Tuesday, June 29, 2010

Can't we ask the "right" questions?

Humpf. I'll just say it. I'm frustrated. Can I get my PhD and several huge research grants, like, tomorrow? Humpf. Or better yet, yesterday.

The source of my angst? I'm just very, very tired of seeing actual scientists/researchers continuing to ask the wrong questions as it relates to the care of preterm infants, newborns and mothers. Why are we doing research that asks if doing A or B is better based on the flawed paradigms within which the ENTIRE medical community works?

Can't we find ways to look at how basic paradigms are sustained despite effective research to the contrary? Shouldn't there be some lithmus test for research proposals that sounds the "uh-huh" alarm when the scientific question is based on the failed paradigm? Yes says me. Et tu?

Sunday, June 27, 2010

I'm not just singing to the choir OR our best ain't good enough

I met 28-week Jasmine first, observed her powerful efforts to keep her tiny, one and a half pound body tucked, arms and legs folded in close for security as if trying to recreate her experience in the womb where she’d been just hours earlier. The sounds of the bright and busy intensive care nursery, the breathing apparatus, the lines and unwieldy diaper she wore, all weighed on her attempts to find a comfortable moment for rest. Her nurse that day generously responded to my suggestion to encourage Jasmine to quiet her movements by adjusting her blankets, rearranging her equipment, and quieting the room so that Jasmine could rest while being softly supported in a tucked posture. Jasmine grasped my finger tightly as her nurse gently adjusted her blankets, and then fell into a quiet, relaxed sleep. I headed down the hall to the post-partum unit to meet her parents. Tina and Jason greeted me hesitantly; their anxiety that I might bring unwelcome news of their newly born baby girl somewhat relieved as I introduced myself and congratulated them on the arrival of their amazingly strong and engaging baby. Tina, recovering from emergency surgery due to placental abruption, pre-eclampsia, and having not yet seen her baby, smiled weakly to my account of Jasmine’s behavior. As the days turned into weeks, Jasmine and her parents spent many hours together, somehow managing a bright attitude despite the lasting effects of pre-eclampsia damage to Tina’s body, the unexpected infection that put Jasmine on a breathing machine for a short time, and the difficulty of spending hours with little privacy or comfort. Along the way, I spent time with Jasmine and her family, guiding and encouraging them in their developing roles. I experienced satisfaction that Tina and Jason felt safe to share their worries, frustrations and hope during our times together. I managed effectively to advocate for a quieter room and a number of nurses invested in this family regularly cared for them. Despite these good efforts, I am left with the challenge of “was it good enough”? far too often. As typically occurs in so many instances, the earlier appreciation of the baby’s need for a supportive environment in which her abilities emerge, gives way to the hope that pushing the baby to “take a bottle” will result in an earlier transition to home. Despite what I felt had been a particularly successful process in providing this family the foundation to navigate past the typical obstacles, the forces of habit and NICU culture prevailed. Ultimately, Tina and Jason took Jasmine home healthy yet, breast-feeding abandoned. Furthermore, I know they experienced undo pain and plenty of conflicting messages as to their competency as parents along the way. The story of one family continues on long past "discharge"; the chapter of time when I get the privilege to walk along with them carries a great deal of joy yet also, the burden of always wanting and needing to do more with the little time that is given. Families who must endure the NICU deserve better. Evidence and logic demand it. While there are many who sing the same song, there is much work to be done.

*names and details have been changed to protect privacy*

Sunday, June 20, 2010

To those little lost souls

As Father's day winds down and as I sit here cruising the Internet after an ill-conceived cup of coffee at 7pm, my mind keeps turning to the memory of two little ones who spent only a few short months in my womb. Part of me hopes that by finally writing these last two birth stories that I can finally heal the sadness that shadows me every day. Maybe by writing about them I can give them new life and free myself too.

Larry was an angel - He came and left without any stressful obstetric/maternal care interventions or choices. He gave me the gift of a natural miscarriage, one I knew was coming and for which I waited, confident after my vba2c in my body's ability to manage it. It wasn't exciting or pleasant, but in a way, I birthed him and was able to bury him. The completeness of this I found out later was really important.

About 10 months later, I was again pregnant. I felt fearful that I would lose this baby, Lucy, too. I went to see some midwives that I'd hoped would help me with a home birth for the next baby. Although I'd had a successful hospital vba2c, I really wanted to have a home birth but still, apparently this isn't a real option for women where I live.

At 10 weeks I asked for an ultrasound. I knew that something was wrong. As the technician did the ultrasound I could see a darling little fetus but I knew that she had already passed. The technician sent the doctor in to tell me, but I knew. I really wished I'd brought my husband with me...I was awash with grief.

I decided to once again wait for a natural miscarriage and told the midwives that I'd seek obstetric care if necessary. I went up to visit my family in Minnesota and cried for a week and begged my mom to keep my children another week. The night my husband and I drove back home, I began to bleed and the bleeding turned into hemorrhaging pretty quickly. I felt like I was in labor.

I ended up going to the emergency room at a local woman's hospital. I was treated very poorly for choosing to wait for a miscarriage. "You should have had a d&c, this is what happens if you don't, who LET you wait"? Yeah, I make decisions about my care - no one LETS me do anything! When I asked about taking the fetal remains so that I could bury the baby the OB acted as if I were completely insane. "No one has ever asked to take it home with them! It is a surgical by-product." Thanks for completely dehumanizing me and my baby! I tried to, calmly at first, explain that I didn't need to take it home with me in a jar, but that I wanted to make arrangements for the proper disposal of her remains that would be religiously significant TO ME. I am still very upset about how I was treated. Luckily a social worker came and confirmed that, yes, people arrange for the disposal of their miscarried babies all the time. A local funeral home even donated cremation services for just such a situation.

So here I am, 2 years after losing Lucy, and I am still feeling very sad. This isn't how I wanted my reproductive years to end - with the bad taste of insensitive maternal care in my mouth and psyche. Not to mention that these two losses brought out the worst in my marriage....and we are still trying to work through that. No inspirational message there. Just life - it can be raw sometimes.

Monday, June 7, 2010

Sunshine all the Time! at OneTrueMedia.com

Feeling a bit nostalgic now.....

My VBA2C and yes, I claim it!

For some reason, it has taken me 4 years and 4 months to write this and my previous birth stories. I understand why I am doing it now. I am on the cusp of a new chapter and old chapters need closure before new ones can begin with full attention.....

Even after the debacle that was the cbac birth of my daughter and despite our previous experiences with infertility, I was hopeful that I would somehow find a way to birth another baby. One day I was walking through Costco and saw one of those mega packs of pregnancy tests. I looked at the package and thought "I'm pregnant". I went from there to see my hair "guy" but peed on the stick in the salon's bathroom. Yep, I was pregnant and I wasn't even late yet. Yeah! Even though I was of "advanced maternal age" at 39 at that time, I was quite certain of the outcome. I would carry the baby to term and deliver him/her vaginally and naturally. I knew this with every fiber of my being.

I began prenatal care with my OB/RE and didn't mention anything about wanting a vba2c. I knew he wouldn't go for it and it wasn't worth stressing either of us out over it. In the meantime I began to call OB offices in Chicago, found the national ICAN yahoo group (my lifesaver), and attended homebirth meetups to learn more about natural birth. None of the OBs I contacted would even consider a vba2c, neither would any of the home birth midwives or the one home birth OB in town. So many times I posted pathetic messages on the ICAN group like "All hope is gone" and "why am I being so stubborn". Thankfully my ICAN friends always brought me back to reality and reminded me that there are ALWAYs options, even when we don't think so. They helped me see that my hard labors might have been due to malposition. #1 had a compound presentation and I think #2 was anterior. I started to see a chiropractor to give myself an edge on positioning (plus I was still in pain from the dislocated sacrum from #2 labor). I exercised and was the healthiest I really had ever been. I spent hours reading birth stories, studying the research and understanding my fear of birth/pain. I ordered a hypnobirthing home study CD set and listened to it every night. I found a wonderful doula who was a vbac and hbac mom herself. I was increasingly strong, determined and unwilling to compromise. Family and friends "worried" about me but I was very clear that I was following my instinct and honoring my inner wisdom. Plus, I knew that I was growing within myself a stronger woman, a woman who "finishes what she starts". No more did I say things to myself like "I want a natural birth, but I won't be a martyr if I need an epidural or c/s". Now I told myself "no one knows YOUR body better than YOU, interventions are NOT an option. Period."

Finally, when literally all my options were exhausted, I decided to ask one of the midwives at the hospital where I work if they ever had cared for women who wanted vba2c. You can not believe how much courage this took! I work in the NICU as a developmental specialist and I'm always trying to balance what babies and families need for support against the realities of the medical team's emotional availability to be open to new concepts and paradigms so that I can gradually mold that availabilty for the benefit of babies/families. One of the most enlightening aspects of this journey for me was how relevant my road to vba2c was to my professional passions. Anyway, the midwife told me, as if this was not even a big deal, "yes, we support vba2c, in fact our chief is actively working to keep our primary and repeat c/s rates low." Wow. I was so surprised! Could I imagine giving birth just a few steps away from my office? I felt horribly vulnerable but that wasn't going to stop me. I'd found a supportive caregiver!!!

A few miscommunications later and a few VERY satisfying episodes of telling-off stupid residents by citing actual evidence, I officially switched providers at 32 weeks.

The night before my due date, I went to bed around 10pm with some early contractions. I slept for a little while but then woke up around 2 am and practiced breathing and using the relaxation techniques from the hypnobirthing CD. That worked for about an hour then I went downstairs and got out my birth ball and just rocked on it for awhile. Around 6 am I woke up my husband and told him that things were progressing. I fully expected this time that I might have the same quick, intense labor as I did before so I didn't panic when the contractions became difficult to manage. I had also arranged to have a TENS unit as an option for pain control so I stuck that on and continued to rock over the ball while my husband called our doula, Tama, and got the kids ready for school. Tama got to the house around 7:30 am and my husband took the kids to school. Tama encouraged me to squat but that made the contractions really intense. I remember thinking "you are resisting the process! just let go and let it happen!" When hubby got back we decided to try some time in the bathtub. Oh heavenly bathtub!!!! The contractions were still intense but I felt like I could stay "on top" of them while in the water. It was a sunny but bitterly cold January day and the hot water ran out early on. Hubby literally was boiling water and pouring it in the tub. I was so angry that he couldn't get the water warm enough! lol.
Tama was perfect. She simply sat next to the tub and calming interjected a few times to breathe. She somehow knew that what I really needed was her physical presence, without any undo distraction. I loved the tub and didn't ever want to get out. Oh why didn't I plan a UBA2C! I really wanted to stay at home at that point but I thought that probably wasn't fair to Tama to ask it of her. She finally coaxed me out of the tub. I remember being so afraid that my water would break if I walked across the living room to go out to the car. They finally got me in the car around 11am wearing only a sports bra and a towel wrapped around my waist. :-) Incredibly the contractions slowed and mellowed on the way to the hospital. I actually felt good, sensual and so in-control! I was totally into it, moaning and breathing, it was great. I got to the hospital and of course the ER wanted to ask me a whole bunch of stupid questions to which I gave them NOTHING. I didn't owe them anything. This birth was on my terms. In the elevator I was "vocalizing" and I heard someone say, "is that Jennifer"? Ugh, yes, giving birth at work is a bit, well, public. And there I was basically naked on an elevator full of colleagues.

One of my big fears from before was Triage. I had my husband call the unit to tell them we were coming and to make sure an actual room was available. My midwife friend (who wasn't allowed to deliver with me due to me being high-risk, puke) had everything smoothed over for me and we went right into a room. Of course right away an IV went in and they slapped a monitor on me. I was squirming around so much that it was hard to get a read on the monitor. They suggested an internal monitor to which I replied "NO"!!! Geez, the baby was going to be there any minute anyway. I did agree to let them rupture my membranes and that was a huge relief. I went from 8 cm to complete instantly. My only regret is the purple pushing position thing. But it wasn't horrible and I couldn't believe I was actually pushing! It was wonderful. I felt no pain at that time. I was doing this thing that I always knew I could do and had let so many things get in the way of. As soon as my baby was born I said, "I want to do that again"! I was on such a high. My son was placed on my chest and we started nursing. This is how a nursing relationship is supposed to start! What a difference.

I had a few stitches placed, I teared a little, at the time I thought the pinching sensation was the damn residents hands in the way. Maybe it was, I was really annoyed that she was doing anything down there.

Then I got up, went to the bathroom and walked around, holding my baby. When there was a mix up with the cord bili labs, I walked down to the nicu and greeted my coworkers so that I could support my baby during a blood draw. "you don't even look like you just gave birth" and "why are you walking around"? were typical comments. But I felt great!!! I begged the doctors to let me go home early. I was out of there 20 hours after walking through the door.

My little boy was born on his due date at 12:12 pm and so was I after a very, very long gestation.

Written with love on the 9th and 7th anniversaries of 2 c/s.