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Sunday
Feb172013

Hernia

So, I have a hernia, an incisional hernia that burst through my former Open Roux en Y Gastric Bypass (which was in 2001) scar. The outer scar goes from just above my belly button to about 3 inches below my sternum. The hernia, an opening in the layers of my abdomen, is small, about 2 inches in diameter, but when I saw the surgeon, she said she’d rather see humongous ones than small ones because small ones can constrict more than large ones. Great, of course I get a small one. 

I sat up in bed and the hernia burst through the tissues and I was in enormous pain. It took all day to get the intestine back into my abdominal wall, but I finally did. If they stay out and constrict, it’s emergency surgery time. I didn’t/don’t want that! 

I spent the time waiting to see the surgeon sitting still. Thank goodness I had no babies due. The hernia only popped out one more time, but I was able to get it back inside my belly without a problem.

I saw the surgeon last week and she was awesome. She explained the whole hernia experience to me, what happened, what’s coming down the pike (surgery) and recovery after surgery.

Regarding surgery, before I saw the doc, I’d gone online and checked out surgeons’ sites and saw that almost all of them required their hernia patients to have a BMI of 30 or less. Oh, criminy. That would be about 130 pounds from now! While I am on the Eat to Live Diet Plan, I just don’t think I can wait to lose 130 pounds before I have surgery. They do that so they can do the surgery with a laparoscope instead of an open procedure (with a long incision). The more incisions you have in your belly, they more complicated your insides become… adhesions and more possibilities for incisional hernias. This doc was great and told me that even if I didn’t lose any more weight than the 20 I’ve already lost, she would still be able to do the surgery laparoscopically. There would always be the risk of having to revert to an open surgery, but she felt comfortable with the laparoscope. Even so, it’s best if I lose some weight, so we put the surgery off ‘til June, so I can try to lose about 40-50 more pounds. (Wouldn’t that be awesome? Sounds great to me!) I want the surgery to be as safe as possible.

So, what about working? I have one client due now and will attend her birth, but I am having to pass off the rest of my spring and summer clients. Bummer all around. I have a binder to hold in the hernia as I do the upcoming birth, but the surgeon told me that binders don’t always work, so no lifting anything above ten pounds until surgery. Afterwards, no lifting anything more than twenty pounds for six weeks. That’s a long time! I’ll have to be creative at the upcoming birth. I can do it, though.

I did really well not getting a hernia after the gastric bypass. About 50%-70% of patients get one within the first couple of years post-open gastric bypass. I went 12 years! Pretty good.

Now, the goal is to keep the hernia inside as much as possible so I don’t have to have an emergency surgery between now and June.

During the surgery, the doc will put a large mesh over the hole in my abdominal wall and she’ll staple it there. I might feel the staples until they disappear (3 months or so post-op). It’s outpatient surgery, too, so that’s great. She said I’d feel like crap for a few days, but then will feel fine unless the staples hurt on the inside, which is rare. We talked about the risk of a seroma and she told me if I get one to NOT let anyone try and reduce it with a needle, to just let it disappear on its own. She said the needle, no matter how sterile, introduces bacteria into the mesh and the mesh gets infected most of the time and that’s a huge mess if that happens. No aspiration of seroma; check. 

Otherwise, everything sounds surgery-straightforward. I just need to keep myself as safe as possible during the surgery. 

Isn’t this fun?

Wednesday
Feb132013

OT: What's Hard About E2L

While I am glad I am doing Eat to Live and it is the easiest plan I’ve ever done, there are definitely hard parts.

The first two days, I cried almost inconsolably. I really wanted to eat my old food choices. I couldn’t attribute it to anything but detoxing, if there is such a thing. It was more likely mourning. Who knew how addicted to the SAD (Standard American Diet) diet one could be?

Is there an addiction to food? We have to eat to live, so how could someone have an addiction to something we are required to do at least three times a day? I’m learning that I have serious feelings about food. Well (laughing), it isn’t like this is new information. I have been in therapy much of the last 30 years and food has always been a popular topic of discussion.

I don’t know what other word to use with regards to my compulsions to eat and my mourning about not eating the SAD diet except addicted. And in dieting circles, it’s a common word used. Even the term abstinence is used, as if one can abstain from eating? No, it’s abstaining from the foods that cause the distress… distress with Morning Glory muffins, peanut butter toast and luscious casseroles dripping with cheese. It almost makes me cry just seeing the foods on paper! Is that addiction? I think so.

In the book Eat to Live, it tells about the 6-Week Plan. I am almost to Week 5 (on Thursday). The 6-Week Plan is the most restrictive, limiting lots of yummy natural foods like potatoes, cooked carrots and eggs. The whole program gets looser with time, but always limits SAD foods, fats and animal products. I’ll be doing the 6-Week Plan for a lot longer than six weeks because I have so much weight to lose.

Supposedly, one eventually gets to a place where SAD foods become repulsive and the cravings are for lettuce and green beans. I can’t imagine, in my wildest imagination, getting to that place. If I was 20, maybe, but after 50 years of eating out and having regular food, it just seems far-fetched. I’ll be sure to let you know if I start craving lettuce, though.

I used to be a food writer. I participated in the writing of Vegetarian Walt Disney World and Greater Orlando in 1998 (nom de plume, gardenia) and I love fine dining. It’s going to be interesting seeing what chefs can come up with without oils. Not that I’m eating fine dining right now. In fact, eating out would be a dangerous proposition. I ate breakfast with a friend and didn’t make a wise choice, eating a wonderful quesadilla with pesto and artichoke hearts. I felt sick the rest of the day, but much of that was regret at my choice. I am trying not to beat myself up when I go off program, but it’s hard. 

So these are some of the difficulties I’m experiencing as I eat differently. I know that while some challenges resolve themselves, there will probably be new ones on the horizon. I’m glad I’m writing so I can talk about them. Thanks for listening!

Tuesday
Feb122013

OT: Eat to Live

This is my blog and it is midwifery oriented, but there's something going on in my life that I want to blog about and it's just going to have to be here. At least it will make the site more active again!

And it is relevant to midwifery.

I am fat. Very, very fat. As I've gotten bigger, it's gotten harder to doula more than once a month because it is really hard on my body. While I am at the birth, I am totally mobile and active, but afterwards, it takes days to recover. This is so hard to admit, but so important to talk about, especially for fat doulas who continue gaining weight. I am the fattest doula I know, in real life or otherwise.

I am damn tired of being fat. It can't be good for me, not just physically, but also emotionally. It has caused me to limit my interactions outside of the house, so much so that I get anxious even leaving the house. I am so sick of that!

So, Zack and I were channel-surfing in December and I stopped on PBS with Dr. Joel Fuhrman talking about Eat to Live, a diet/program that focuses on vegetables and fruits as its base for health. It isn't vegetarian/vegan, but certainly could be depending on how one does the program.

I've been doing Eat to Live (E2L) for a month now and am already down 19 pounds. In a month! Before those 19 pounds gone, when I walked down stairs, I had to go one step at a time, sideways. Now, I can walk down stairs normally and that small change alone has been really cool. Otherwise, I haven't felt much different. My skirts are getting longer, showing that my belly or butt is getting smaller. I think it's stomach, which is great; less chance of recurring diabetes.

I have no health problems at the moment. Hemoglobin A1c is a normal 5.9 (although I will find out the most recent one in a couple of weeks), Blood Pressure is normal. Kidney & Liver labs are all normal (my kidneys are doing so well I've gone from Stage 3 Kidney Disease to Stage 2!). Lipid panel is all normal, but my HDL could be higher. So many of those who start E2L are really sick and have that motivation. Mine is fat and a desire to continue with my healthy labs.

I've been on diets my whole life. I was on Phen-Fen in 1996 and lost 111 pounds. I had a gastric bypass in 2001 and lost 190 pounds. Blessedly, I never got up to my fattest, but I sure did damage to my GB weight loss. The idea of another diet is depressing, which is why E2L is something more for me.

I have not had a second of hunger. It takes almost zero discipline to do this except for choosing the foods to eat. I never did well with structured plans... failed miserably with Weight Watchers, Overeaters Anonymous, the Lean Cuisine Diet... anything that made me measure or eat smaller portions failed. This gal wants to eat and the E2L allows me to do that, even though the choices are not the typical Standard American Diet (SAD).

Don't get me wrong. I miss my peanut butter toast, cheese and casseroles, but I am enjoying walking down the stairs better. I know I will never be able to go back to eating the old way and that has created mourning in my heart (food addiction, anyone?), but I cannot be this fat anymore.

The main focus for me is Gabriella. My 17-month old granddaughter. I want to play with her, run around with her and enjoy her life as a toddler and growing kid. I want to be alive to see her find a loving partner one day. I want to see my other grandbabies that aren't even here yet.

I can do this. I have to do this.

So, I'm going to write about my journey on E2L here. I will continue to put OT in the title so those who couldn't care less can pass it by. I do, however, know I will intertwine the weight loss with doula/monitrice work. I eventually want to take 2-3 clients a month... and look forward to do that.

Those who continue reading, welcome!

Friday
Dec212012

A New Accusation Against Dr. Biter

Take a look at this one. This is horrid... involves a fetal death in a home birth. Disgusting.

What's so revolting is in his Facebook page, he continues denying his guilt, saying the "truth" will come out and "karma" will show the real story. What he doesn't seem to understand is the Medical Board is unfolding the real story right in front of every one of us. That he doesn't even acknowledge his responsibility in the pain and suffering of the women and children he's hurt demonstrates the level of mental illness he harbors. I sincerely hope he gets help.

While I am so sorry this poor baby had to lose his life at the hands of Dr. Biter, the family can rest easier knowing their speaking out against this man has removed him from hurting anyone else (we hope).

Friday
Dec142012

The Feminist Breeder as Doula

On Dec. 5, 2012, Gina Crosley-Corcoran of The Feminist Breeder wrote a post entitled “20 Births Later: My Thoughts on Being a Doula.” Just as it sounds like, she reflects on her beliefs about births now that she’s attended them and they aren’t just in theory as they were before. She learned that doctors aren’t all evil and midwives aren’t all wonderful, that UCs are not such a great idea after all and that inductions sometimes have their place. In her mere twenty births, she has seen more than one Postpartum Hemorrhage (she doesn’t say how many, but it is plural) that, she says, “that blood poured out of their birth canal like spicket (sic).” She makes a comment that the medications used to stop the PPH would have been used at home, but it bears noting that not in all home births, even with midwives; it depends on the laws. And while the hemorrhage she witnessed can be scary as hell, if it can be stopped with just three medications, it isn’t that big of a deal. Let’s get going with six medications, a trip to the Operating Room, blood products pouring through two IVs wide open in the woman’s arms. These are the PPHs that terrify and traumatize the doula and show her that UC is the stupidest idea on the face of the earth. But, that’s in the next 100 births she attends.

I read through Gina’s piece smiling, thinking, “And this is with only twenty under her belt. Does she realize how few this is and how profound her opinions have changed already?”

I’ve written extensively on the turning points in my own birth life, one of the main ones being witnessing the mother dying from amniotic fluid embolism. At that time, I had already had a UC and my pendulum was swinging towards the middle from the farrrrr left, so the death solidified my more center-of-the-road beliefs –and that’s where they’ve stayed (pretty much) these 25 years. I’d had been in the Trust Birth camp (decades before there was such a thing), thinking the body always knew what to do when left alone. I’d believed everything my Bradley classes told me, that the Brewer Diet was perfect for avoiding preeclampsia (never mind the classmate who had eclampsia despite her meticulous following of the diet) and that relaxing completely would allow the baby to come as pain-free as possible. Meghann’s birth was one experience that demonstrated that just because I was told something doesn’t mean it was so.

Just like what Gina and I were told about birth in general. And as we experienced more and more, we saw that things weren’t always what were led to believe they were.

Over time, Gina will also likely learn that cesareans aren’t evil and many aren’t unnecessary. She’ll discover that those who perform cesareans are almost always respectful during the surgery and speak only about the birth at hand, not talk about the football game or what restaurant they are going to after they get off that night. She’ll find that babies aren’t separated from their mothers after the cesarean, but are brought to them in the Recovery Room, being held by dad or cuddled by mom even if she’s sleepy. There’re other lessons about cesareans she’ll learn, too, but I’ll leave those to her.

It’s amazing the transformation Gina’s already had in this short amount of time, over these few births; I’m impressed. It doesn’t take long to go from Trust Birth to Respect Birth when one begins attending births. It’s clear that those that are in that Trust Birth camp just haven’t been to any or very few births. Once you start going to births, even normal, natural, 100% unhindered births, you begin seeing the complications that Nature throws into the “perfection” that is birth.

I’m proud of Gina. It took a lot of guts for her to speak her new truth. It will be easier to continue talking about the changes over time and I hope she does. I’m mostly glad she spoke up because I know she isn’t alone. I hear from doulas who echo these sentiments all the time, but are afraid to say anything. I now can point to a prominent figure and say, “See! Gina, too!” Thanks, dear doula sister. You’ve done a brave and power-full thing. Keep speaking up. We need you to.

Thursday
Dec062012

Hyperemesis Gravidarum

The Duchess of Cambridge, Kate Middleton, is newly pregnant (hurray!), but sadly has already been hospitalized with a rare illness of pregnancy called Hyperemesis Gravidarum. One can Google the term and get a decent clinical explanation, but I knew there was a better way to learn about HG: Ask the women themselves. So I did. This is what they said:

HH: HG is miserable.HG is almost total incapacitation for 8 months. HG is the reason I haven't had another baby yet.

CAM: I only had HG with my first! I lost 19 pounds in the first 5 months, hospitalized 4 times before having a pick (PICC) put in and a nurse come twice a day to give me IV fluids! I started at 110 lbs ended at 102 lbs had my daughter at 34 weeks because I went into labor at 28 weeks was put on bed rest until 32 weeks, was hospitalized and went into heart failure! HG sux! Oh and I busted most of the blood vessels in my eyes from the vomiting so I looked like a pregnant zombie!

JS-J: I had it with my twins. 18 hospital visits. A mediport (permanent IV implanted in my chest), IV fluids running constantly, 4 anti-nausea meds given every 4-6 hours around the clock, and still vomiting 30-70 times a day. I vomited so hard my cervix bled from the pressure. I ate 1 milkshake per week, not because it would stay down, but because it was the least offensive thing to throw up. I lost 20 pounds and gained back 7. I'm convinced that the lack of nutrition in the first 5 months caused me to deliver at 26 weeks (no nutrition=weak placenta and amniotic sacs). Oh, and I still vomit at the drop of a hat. Especially during PMS times.

JL: HG is hell on earth. At my worst, I was vomiting 15+ times a day- and that was while I was on the strongest anti-emetics that could be prescribed. I was ultimately prescribed a Zofran pump which, though a life saver, required me to give myself two painful injections every day as the sites would quickly become irritated. That, in combination with home IV therapy, and total bed rest just barely kept me from having to have a pic(c) line inserted. All told, I lost over 20% of my body weight with both pregnancies before I was through the first trimesters.

LML: The single worst experience of my life. 4+ years later, I'm still picking up the emotional and physical pieces.

ESG: Losing 20lbs in the first trimester. Needing fluids regularly in the ER. Throwing up in every bathroom in Ann Arbor, Michigan. Never knowing if something I ate will agree with me or not. Misery, misery, misery. I only had it with my twins, thank goodness. Every pregnancy after that had less and less vomiting.

KDK: From the purely objective side... without meds I would vomit 12-20 times a day. If I kept 2 oz of fluid down that was a good day. I've had PICC's and midlines and Zofran pumps. Home nursing care and home IV hydration. It would end around 20 weeks and then I would be fluffy. This is considered mild HG. I was never admitted to the hospital, I never needed a feeding tube. I know women who are NPO for months, my longest stretch was 4 weeks. My cocktail was Zofran, Phenergan and Doxylamine. I have a permanently wonky gag reflex and damaged teeth. This.is.mild.HG.

Psychologically HG is brutal. HG moms are at far higher risk of peri and postpartum depression and anxiety.

I looked like I had the measles from the broken blood vessels in my face. Love hate relationship with Zofran. The side effects of Zofran can be as miserable as the nausea/vomiting.

JA: No personal experience other than supporting a client who had HG... but I did gladly participate in this study and hope that many others who will as well.

For those needing support and information, this seems to be the organization to turn to:

HER Foundation: Hyperemesis Education & Research

AP: Jessica at The Leaky B@@b had it with all six pregnancies. She's got some horror stories, including providers (mw and ob) being AWFUL to her.

PB-G: I vomited 12-20 times a day for 7.5 months (and then a few times a day for the remainder of my pregnancy) despite being on a high dose of prescribed Diclectin and Gravol. I lost 20 pounds in the first two trimesters and was medically required to quit my graduate school internship, thus not finishing my Master’s Degree pre-baby as planned. I also bled for 10 weeks of my pregnancy, and although we never nailed down the cause, it seemed linked to happen primarily during vomiting episodes.

BK: Hyperemesis gravidarum is what had me losing 90 lbs. with my first child. I was unable to keep my job because I was so sick. I wasn't hospitalized for it, but that is ONLY because I loathed hospitals and was too damn stubborn (and probably stupid) to go. It can become an immensely dangerous condition if it gets to the point where mom is dehydrated and anaemic because she can't keep anything down. I don't think I've met anyone who had to be hospitalized for the condition, but I do know that there are women out there who have.

TW: Horrible! Hard to believe your having a baby feels more like dying slowly; just thinking about it makes me want to cry!

EEC: It's the thing that makes me hate pretty much every single minute of being pregnant and probably the biggest obstacle in getting a VBA2C. By the end, I just want it all to END and the instant relief of a C-Section is much more alluring than throwing up through labor. We are currently working up the nerve to try again and every time we get to the point of trying, my PTSD goes through the roof knowing what I am about to put my body (not to mention my family) through. It's pure hell and I am really glad that it's getting a little bit of media attention, I just hope my miserable managers are taking note and having an "Aha" moment and will treat the next employee that has HG with a little more respect and understanding. (That felt good!)

KT: Nausea and sickness so bad that I was signed off work. I had to drive with a sick bowl in the car for almost 7 months. Some days could barely keep down water. At its worst, that horrid feeling overshadowed any excitement I felt about being pregnant. And the hardest part was knowing that I couldn't make it go away. It lasted 27 weeks. After it stopped I felt amazing!

SS: HG robbed me of a positive pregnancy experience. Society, your friends, family, and partner can't even begin to understand what you are going though, how isolating it feels. Everyone tells you to enjoy your pregnancy. That hurts a lot. It's not easy to enjoy something that is killing you.

Your kidneys can stop functioning, you can't think clearly, you don't pee for days, or have a BM for weeks. You encounter healthcare providers that tell you are being over dramatic, and that it's all in your head. So you go home, even more defeated than when you came in for help.

Your body is eating itself you are truly starving to death. You know what it feels like to be starving, truly starving for food/water. You lose five pounds, then fifteen, then thirty. Your friends and family laugh and tell you that you should be happy to lose weight instead of gaining during pregnancy. If they only knew what you would give to be able to gain, even a LITTLE weight.

You vomit the contents of your belly, then you vomit bile, blood, and when there is nothing left, you dry heave. You can't swallow your own saliva. You carry a plastic zip lock bag with you everywhere you go so you have somewhere to puke no matter where you are.

Your esophagus becomes damaged, and every time you vomit, or try to drink/eat, you feel a million pieces of glass cling to the inside of you.

Smells, commercials, visuals, even the words surrounding food/eating make you puke again. Your family can't eat in front of you, or have the smell of food in the house. The smell of a hot meal in your home and you wretch all over.

Shampoo, soaps, cleaners, lotions, hair spray, deodorant all have a scent that is vile. Even though the bottle will tell you it's unscented.

You sleep on the floor next to the toilet (which is now ALWAYS sparking clean) because you are too weak and tired to move from your newly assigned post.

You lose your sense of self, you lose your ability to care for your family/children, you lose the ability to work, you rack up medical bills.

You are so thirsty, and the glass of water mocks you. If you let it touch your lips, and pass down the burning esophagus it comes right back up burning you a second time.

You try sea bands, saltines, ginger, pregnancy pops, herbs, OTC nausea meds, prayer, acupuncture, acupressure, pot, Phenergan, Zofran, Reglan, steroids, NGs feeds, pumps and PICCs. The nausea/vomiting remains.

You worry.

"Is my baby getting enough to survive? What will these meds do long term to me? to the baby Will I still have my teeth left when this is over? What if I vomit so hard that my blood vessels in my eye rupture?”

“What if I vomit so hard that my placenta detaches?"

Your teeth are forever ruined. The acid has eroded them and wore them down.

All for a chance at saving your life, and the life that you are trying so hard to create.

For further reading: The ABC’s of HG.

KDK: Spit cup, how could I forget that but I had a towel. A cup full of rank spit was just another trigger so I would spit into a towel.

IPV: It’s kinda like dying a slow death.

ESG: Oh yes, bursting blood vessels in the face! I'd forgotten about that ::shudder::

KDK: Best place bar none for HG info is hyperemesis.org. Their forums are a lifesaver, literally. I encourage all birth workers and women to familiarize yourself with that site so you can refer clients/ loved ones.

NgM: SS: Tears are streaming down my face at your description, so apt and so true.

All of you, so brave and strong to stay alive with such pain and struggles. I'm so sorry pregnancy is so hard for you. I know people forget having a baby isn't all beautiful and joyful for everyone.

I think the worst is that people think you're faking it. Not many of you mentioned that, but that's what I've heard the most. That "it's all in your head" and if you just embraced your pregnancy (or this or that or the other) your vomiting would disappear. Being told it's your fault is so demeaning and cruel.

Along those lines, my own experience with HG and clients, the thing that's helped quell it somewhat has been mindfulness-based stress reduction (a type of meditation), but even that doesn't work all the time and I would never consider saying someone didn't do it right and that's why they still had HG. It works for some; not for others... and who knows why. Just like some of the meds can help some sometimes, but not others. Hit and miss most of the time, with miss the majority of the time.

Again, you all are so brave and I totally understand the fear of not getting pregnant again. It would terrify me, too.

KDK: Getting pregnant after HG is terrifying. Been there done that a few times. Best remedy ishaving a treatment aggressive OB ready to go; early and aggressive treatment can make a huge difference in severity and duration.

KY-P: I endured three HG pregnancies. My first was the most severe weight loss, and went undiagnosed. I vomited until I was well into the second trimester, had a relapse, and then ended up admitted in pre-term labor at 27 weeks on magnesium sulphate with a severe uti. I went in for fluids many times at the end.

Number two was bad, I did not lose as much weight and was able to take some Diclectin. I had 9 er visits for fluids, sometimes up to 8 pokes for IV and blood work because I was so severely dehydrated. Constant bladder and kidney infections. I would vomit all day without meds, with meds I was barely alive. I even fell at work in the bathroom once, totally passed out... Luckily I was working at the hospital so was able to just take a wheel chair down to emergency. I vomited all through labor and was denied medication, despite having an IV but I was thankful for fluids.

Number three was the most severe nausea of them all. I learned to take things into my own hands, because my midwife would not agree to a picc line or fluids, but a local natural doctor agreed to run bolus fluids for me preventatively with vitamin support and some B vitamins. I stayed at my desk job and did not move 8 hours a day (that saved my life, being out of the hospital). My husband took care of the cooking and physical work.

My son is now 18 months old, and I still have flash backs. My body has violent reactions when I am nauseous or sick with gastro bugs. My teeth survived, but my dentist said the enamel is worn. I have a hernia as well, and reflux. On a five year wait list to see a gastric specialist... Canada is wonderful for some things and awful for others.

All in all I had mild to moderate hyperemesis and was lucky that I did not gain weight (lose weight?), but I vomited daily despite treatment for over 40 weeks. I am still physically recovering - my muscles were so wasted that a back injury I had between baby one and two was definitely exacerbated by lack of tone in my supporting core. I live with severe daily back pain as well. Anyway, just my experience. I love my babies, but I hate HG and what it did to my family.

AO: Vomiting up blood, bile, and anything you dare attempt to eat. ourbananafamily.blogspot.com

PLB: I had mild HG, but also am severely emetophobic (phobia of vomit/vomiting).

I had a lot of suicidal thoughts. I'd sit for hours staring, trying to will my body not to heave, fighting back tears because crying would make me lose control and heave again. My husband couldn't eat anything in the house for my entire pregnancy. He experienced caregiver burnout that almost destroyed our marriage.

Zofran and Phenergan around the clock. Lost weight until 8 months and finally gained a few because I was finally able to eat 2-3 light meals per week-- thank you, frozen blueberries for staying down.

I rarely left the house for fear that I'd come in contact with something that would trigger me to be sick and I'd be trapped out somewhere. On the handful of occasions I did leave, I brought a whole sick kit with me in case I did get sick.

I, too, have nausea and heaving still, 2 years PP, especially during hormonal fluctuations.

JP: Ugh. I HATE HG. Had it with both of my pregnancies. The helplessness, realizing how much longer you have to deal with it. I'm lucky in that I was able to take Phenergan, Zofran, and Reglan around the clock and keep the vomiting down to a handful of times a day (never mind the severe nausea). Off meds I couldn't move from bed and vomited every 20 mins or so. Even on meds I spent 3-4 months on the couch. I didn't see daylight for over a month. I missed a part of my daughter's third year while preggo with my son. I can never get that time back in her life.

It hurts when people say it's in your head, or if you just release your fears you'll be fine, or you should just buck up and deal with it. You look at food so differently. There aren't cravings, just fear. I want so badly to enjoy my pregnancies!

I had a cousin who had HG, she only had 1 kid. No one else has it that I know of. I also get Gestational Diabetes. I'm unsure if they're somehow related. My water broke both times at start of labor/right before contractions (lack of nutrition?). Thankfully both kids were term and had no issues (both small, born at 6 1/2 lbs).

I'm just thankful I have a 'mild' case that meds helped and didn't need hospitalization/home health as we don't have insurance. I did require an IV with fluids once with my first. I'm sure I needed it with the second, but I was too sick to get in the car or care to leave the apt for it. I also still get nauseated easily, and get hit hard by gastro bugs.

MH: Not able to keep anything down. Throwing up water and the color of bubble gum. Throwing up everyday til the baby is born.

SH-W: Nurse told me that my hg was "natures way to get me to lose some weight". Lost 30 lbs first tri gained back 9. Vomiting blood. Spinning room. For months! My hubby gave me daily shots in the butt of an anti emetic. Only way I made it. Had to wean 26 month old over night because I was hospitalized with borderline organ failure. And my mom says that I was "just like her with my morning sickness" and wouldn't come see me in hospital. Awesome . Very misunderstood condition. Much love to all with hg. Every time I think of having another baby hubby looks at me like I'm nuts. I had nausea everyday of every preg but only hg in 3rd.

TC: I had a psychiatrist tell me that HG was me trying to "throw up my baby" because I was depressed (was depressed before pregnancy, too, btw) and she was an unplanned pregnancy. It was really hard to get a diagnosis or someone to take me seriously. I was miserable and got used to throwing up everything. Worst was when I tried to eat rice pudding after drinking lemonade (almost the only thing I could drink). Worst thing ever to throw up. I subsisted almost entirely on goldfish crackers, lemonade, and eventually found I could eat plain noodles with soy sauce (apparently my sodium might have been low, hence the craving).

Smells, car rides, putting food in mouth, even someone just touching me meant terrible nausea. I was unable to work and was actually on a sub-cutaneous pump of anti-emetics for several months, with occasional at-home nursing care for IV fluids because I didn't have reliable transportation to the ER. It finally let up around 31 weeks, when I then had premature labor that had to be stopped, and then an emergency c-section at nearly 36 weeks. I was not a glowing beautiful example of a pregnant woman, heh.

And like others I want to stress that my experience was a MILD one. I was not hospitalized and did end up with a net gain in weight of a few pounds. No PIC(C) line or catheter, "just" IVs and antiemetic pump. Many of the moms on the HelpHER forums had it much worse than me and made sure I kept my suffering "in perspective".

KHM: Misery. Pure misery. Zofran took the edge off. I was in fmla for a month at the beginning of my pregnancy with Lorelei. With Coralynne it was bearable because I had a desk job with a bathroom right across the hall. I was very worries that my lapband was going to slip, but it stayed intact.

JL: Clinically I had HG as lost 10% bodyweight in first pregnancy but compared to what some of you ladies have been through... I don't think I'll ever moan about it again!

KWM: I've had it three times and they were the worst experiences of my life, and, four years after my last pregnancy, I still have a PTSD response (shaking, anxiety, dizziness, nausea) if I think or talk about it too much.

I thought I was dying (and sometimes wanted to) from what I can only describe as "blinding" nausea and constant, violent vomiting. Nothing stayed down, I literally starved. Lots of aversions to food, smells, sights. I lost my first pregnancy because of it, which was devastating, and a heartache I still feel 15 years later. My second & third pregnancies, I lost weight, lost my job, lost my tooth enamel, lost muscle mass I've never gotten back, and often had periods of losing my joy of pregnancy, and, eventually, lost the dream of a bigger family. And I had relatively MILD HG!!! Other people have it much worse!

My heart goes out to Kate Middleton, and I sincerely hope she ends up championing HG, and helping raise much-needed research money for this devastating, mystifying condition.

Saturday
Dec012012

Doulas at Unassisted Births

A recent post on Facebook provoked a slew of comments that brought out the polar thoughts on the topic of doulas at Unassisted Births. I started the argument with: “Doulas attending UCs make me CRAZY!” That got ‘em going. Here, I share the most cogent of the discussion, with a few of my added interjections.

JT: So women who choose to UC don't deserve the support of a doula?

NgM: No

JT: Wow. That's messed up. Unassisted does not mean no outside support. It means no birth professional such as an OB or midwife. At least in the birth world I belong to.

NgM: What happens is doulas become the professional at UCs. They get asked questions about safety. They get asked if something is normal. They get asked if a transport should occur. Doulas are NOT just there as doulas; they become the professional. THAT is why a doula has no business at a UC.

DJ (who said it better than I did): A doula attending an unassisted birth may be considered "the most experienced and educated person in the room" and therefore the most liable. Philosophy and ideology aside, it just doesn't seem wise.

CU: I'm conflicted about this. Years ago, when I was a doula, one of my clients decided not to go to the birth center or hospital after 72 hours of PROM. After she said she would just do it at home if she had to, I consulted with colleagues and told her I would not be the only professional at the birth. The mother was PISSED and fired me. Do I think she deserved support? Of course. But it's not fair to be the only paid, trained person there--it's not fair to the doula. Better to ask a friend or a family member, rather than to hire a doula, IMO. By the way, I was flamed all over the (anonymous) internet for what I did--everyone responded saying that I abandoned her and was acting selfishly. Sigh.

DJ: Why can't I decide when to move my child to a booster seat? I know my child better than anyone.

NgM: I think any doula who goes into a UC situation is asking for trouble. She could end up in jail if anything untoward occurred, her being the most professional at hand an important legal point.

KJP: That may be correct NGM, but it's still of the utmost importance to protect the choices mothers/families have in regard to who they want at the birth and what kind of assistance, if any, they desire.

WB: But believe so strongly in the services they provide I women so they risk it!

DJ: Women who choose unassisted birth can choose nonprofessionals to be present with them. Since when does the need for emotional support trump the need for medical guidance? If you feel you need any professional in attendance, and not simply a family member, then what are you really thinking?

LS: I don't feel that it matters if it’s a friend or family member or random client. If they are planning a UC, you become liable. If something goes wrong, the doula present becomes the face of doulas everywhere, just as a midwife at a mw-attended home birth becomes the face for all of those tragedies when that goes awry. The situation could bring you under legal proceedings by local authorities seeing you as an unlicensed practitioner or the parents could decide you had a hand in the child's fate. Simply a bad place to be, IMHO. You stake the well being of your own family and finances on being the only birth professional present by contract.

AO: Doulas are not birth professionals and you seem to not really understand what a UC really is and the work, and the emotions that go into planning and having one, birth is not a medical event so why do I need medical assistance?

NgM: Doulas sign contracts. They are, indeed, birth professionals. I/We do understand what UCs are and the work that goes into them. YOU might not consider birth a medical event, but legally, it is.

GB: That may be true, but that is not up to you or anyone else to decide FOR anyone else.

AO: Doulas are support, not care providers.

NgM: That’s true, but doulas offer an enormous amount of information to women including options in birth and when things might need to be changed if stuff is going wrong. Doulas carry a lot of weight with responsibility and women put them in that position.

DJ: But being the only professional present gives the appearance of having some responsibility. At least that's the way the law sees it. Hence, you are at risk of "practicing medicine without a license." It doesn't matter what your intentions are. You can argue whether it should be that way, but that's just how it is.

TB: A doula decides for herself what is in her scope or not (or her certifying org decides for her if she is certified). If a doula is comfortable attending UC, clearly states in her contract AND to her client exactly what she does and does not do, then its really between her and her client. Just BC you don't want a doula at your UC doesn't mean it wrong, stupid, risky, etc for everyone else. As a doula I like to support my clients however and wherever they need it. I also don't just take anyone, and would be especially picky with UCs. I do not become a "medical professional" even if there is not one at the birth. My role is still the same, I still don't provide medical support.

NgM: A doula can have every intention of staying “non-medical,” but when the shit hits the fan and the mom starts asking questions, what’s the doula going to do? Say, “I don’t know,” when she does? Or is she going to help the woman save the baby’s life. We know that answer.

AT: Wow. Selfish to want to have support without medical assistance. Nice to see why we can't get things changed in the birthing community. We're too busy worrying about whether everyone is doing everything just right by everyone else's rules.

ED: But a doula is NOT a medical professional. That's like saying the photographer would somehow be the "default authority" in court or something.

NgM: A photographer does not have training in birth. That is a ridiculous comparison.

AT: Frankly, a woman will ask a doula if something is wrong no matter what. Women look to doulas for many things when they're scared in labor. In which case, the mom probably shouldn't be UCing. Having no medical professionals there doesn't change the situation. If something happened while waiting for the midwife to arrive or on the way to the hospital, the doula would be at risk. Being at a home birth period is risky for the professionals, no?

DC: I have had a UC with a doula there. She was only there for emotional and physical support, not medical advice. I was not scared and I didn't ask her for medical advice, like someone here said all women do. It was wonderful and 100% complication free.

NgM: But, what if there had been complications? What if you had asked for advice? What if you were scared?

ASM: It's her uterus and her choice. And I stand as a (soon to be) fellow that supports her choice to birth as she feels right (TBA student). Until then, I take my risk at jail time for serving UC's as a doula. Because I serve women. And I accept risks for what is right for her. But that is my choice and mine alone. And I don't give a flip what anyways else says. Women deserve a choice.

CM: Hey, doulas shouldn't do something because they might be held liable or arrested...

Law = justice = truth = the right thing always, right?

We all have the obligation to do right by each other, support each other, love each other.

Fear driven care, whether midwifery, doula-ing, ObGYN practice is dangerous for women.

O: I really love your blog but this time have to respectfully disagree. Doula isn't a medical professional and doesn't 'attend' birth in that capacity. She is not intended to replace a medical professional but support the mum. Freebirth is a legal right and a woman's choice and contrary to popular belief - far from reckless. Some UC mums might want a doula and if they need one - they should be able to have one. There's nothing wrong with a doula at a freebirth.

NgM: Again, she might have every intention of attending in a non-medical capacity, but if complications arise during the birth, she will be thrust into a whole different scenario.

ES: Someone who puts "doula" in her name is the same as a mother or grandmother who has helped other mothers through their births in the past and brings support, wisdom, etc. they both have every right to attend a UC if the mother desires and if they cross the line into medical advisers then that is their own risk, but they should not be banned from all UCs simply because that risk exists.

NgM: Now that’s a clever comment.

AY: I've not taken on clients in my doula role if they want to UC. You can be prosecuted for acting as a midwife and if you are there even in your doula capacity and something goes wrong it's a huge risk to take that the CPS would understand the difference between doula and midwife etc. and not prosecute. For my own safety I wouldn't attend.

JL: I can put sparklemummy in my name and treat you like a sister but because I am a trained person if you we're choking I'd bang you on the back and do abdominal thrusts because I am also a nurse. If a traditional untrained midwife is there acting as doula and something goes wrong she will use her skills! And thus she will be in the shit. And so will you because she has no Ob backup no O2 and can't intubate.

NgM: Lastly, I think this poster speaks for many of us in this field, those who want to help, but are constrained by the fear or the law… or fear of the law. She says this eloquently.

SM: I have such mixed feelings about the matter and really don't think there is any good answer in place yet. On one hand, a doula is putting herself out on a limb legally by attending a UC, whether or not the mother has any intention of holding her responsible for problems. The state doesn't require the mother's consent to do that. If that was not the case, if there was some way to protect the doula, I would be completely in favor of a doula's choice to attend medically unassisted births.

On the other hand, when I had my third child and wanted to give birth in NY near family, having the baby with only a doula seemed like the best option at the time. All I expected from her was counterpressure to help with my back injury. My husband was NOT capable of that and nobody else lived close enough by to commit to it. As it turned out, my sister completely missed the birth.

If I was to have a fifth child, I don't know what I would do. And if I was to start working as a doula again, I still don't know. It's just complicated.

Thursday
Nov222012

Cesarean Scar: Graziela

While researching on the internet about post pregnancy body I ended up finding this webpage. It called a lot my attention and I was touched by some of the stories. Why not to share mine as well? 

My daughter was a premature baby (7 and 1/2 months) and the cesarean was a choice of mine. It was actually planned from the beginning on, but my little girl was not so patient and the water broke on week 35. 

I carried her for months inside of my belly, felt her moving when she was growing and loved her from the moment I got the positive result of the pregnancy test. Being a mother is much more than pregnancy, labor or delivery. Being a mom is pure miracle. It is genuine and unconditional love.  After all, mothers of adopted kids are no different than us. 

My cesarean scar is far from being beautiful, but it does not bother me that much. It is just a scar. What do I think or feel when I look at it in the mirror? That I am a very proud mom of a beautiful and healthy little girl.

Wednesday
Nov142012

Amniotic Fluid Embolism Story

A few weeks ago, my daughter told me a work colleague of hers almost died at her birth and, in Meghann’s words, “if she’d have been at home, she would have died.” My family doesn’t say things like that lightly so I knew what had happened must have been catastrophic. Later, she told me the friend had had an Amniotic Fluid Embolism with Disseminated Intravascular Coagulation (AFE/DIC). The woman was still in ICU, so I let Meghann know the recovery rate was very low and to send good thoughts to her family who must be extremely distressed. The new baby was not in the NICU, so that was a good sign; the AFE/DIC happened after the baby was born, it seemed.

I kept asking after the woman’s health and she was recovering more and more. After time in a step-down unit, she went home and then the next I heard, Meghann was advocating a Blood Drive to replace the blood she’d used during her DIC experience and recovery. I asked how many pints of blood she’d needed and was told 36. Thirty-six pints of blood. That’s completely replacing the blood in the body almost five times.

In the Facebook thread on the Blood Drive, the woman herself, Michelle Moon, responded to me and I felt comfortable reaching out and asking if I could ask her some questions. I told her that I had a special place for AFE/DIC since it was the only maternal death I’d ever witnessed. She was gracious saying she wanted to help bring awareness to AFE/DIC and would be glad to share her story with me and my blog readers.

Amniotic Fluid Embolism is a rare obstetric event, occurring in 1 in 8,000-30,000 pregnancies. (Determining the exact amount is extremely difficult.) Maternal mortality reaches about 80%, but here in the United States, it is 61%. 50% of the women who die, die in the first hour. “Most women who survive have permanent neurologic impairment.” And 79% of the babies live here in the US, so the babies do fair better than their moms.

Disseminated Intravascular Coagulation is not just an obstetric event, but can occur with acute trauma anywhere in the body. A good explanation is:

“Normally when you are injured, certain proteins in the blood become activated and travel to the injury site to help stop bleeding. However, in persons with DIC, these proteins become abnormally active. This often occurs due to inflammation, infection, or cancer.

Small blood clots form in the blood vessels. Some of these clots can clog up the vessels and cut off blood supply to various organs such as the liver, brain, or kidney. These organs will then be damaged and may stop functioning.

Over time, the clotting proteins are consumed or ‘used up.’ When this happens, the person is then at risk for serious bleeding, even from a minor injury or without injury. This process may also break up healthy red blood cells.”

So when the person is in DIC, the body can no longer clot and the blood just flows. Unless it is replaced, not just with blood, but with other blood products (as you will see), the person will die.

In a homebirth, AFE/DIC is one of the risks women take, that there is zero chance of living if it occurs. If it happens before the birth, the baby will also die; it is a given. Homebirth midwives discuss this in in our apprenticeships and in school; it’s one of our worst fears. But, that so few women survive, even in the hospital, was always a comfort. And that those that survived were mentally incapacitated made the impending death even more… acceptable? Not that death is ever acceptable, but that if a woman was doomed to live as a vegetable (a horrid term), perhaps it was best she not live at all. It was what we said to ourselves.

But then along comes Michelle Moon; a mom who has not only lived through her AFE/DIC, but is not remotely mentally affected. (I will share her lingering affects below.)

Michelle was gracious enough to answer my questions and her answers in email were so straightforward, yet so impactful, I decided to share her story in that format. Here, in Michelle’s own words, is her story of her AFE/DIC.

“I am happy to share and help bring awareness to AFE/DIC.  It is one of those things that I never knew could happen.  You always hope and pray for a ‘normal’ pregnancy and birth.  This was my second pregnancy.  We have a healthy 4 year old girl (Bella) who was delivered in a hospital in a vaginal birth with no complications.

“My recent pregnancy was as normal and standard as the first.  I was healthy, ate right, and went to my scheduled appointments.  I went into labor on my own at home on Friday, September 28.  When the contractions were about 2-3 minutes apart we headed to the hospital.  After checking in I received an epidural, my water was broken by the doctor (NgM: a couple of hours before the AFE) and everything seemed to be progressing fine.  I was dilated to 7 cm.  Then all of the sudden I knew something was wrong.  My husband and mom were with me.  I remember jolting up in bed.  I started yelling ‘something is wrong, something is wrong, someone call the nurse.’  I still remember the horrible feeling of darkness that seemed to be creeping up my body. I remember I couldn't breathe.  There was this horrible dryness and warm sensation in my chest as I struggled to gasp for air.  I don't remember anything from this point until the following Monday-Tuesday when I woke up in ICU. 

There are a few parts that have come back to me from time to time.  But for the most part I was out of it.  My husband hit the nurse button right when I told him to.  Within 8 minutes from that point they performed a c-section.  Piper (our daughter) was not breathing when they pulled her out of my body.  They resuscitated her quickly and she is doing well.  We don't think she will suffer from any complications.  After the C-Section (Friday) I went into DIC.  Then Saturday, they opened me up again and did a second surgery to remove the extra blood and clots, then the final third surgery (Sunday) was a Hysterectomy which helped stop the bleeding.  I still have my ovaries, so no hormone therapy right now.

“I want to be sure to answer all of your questions.  Let me know if you need further information. I have pasted your questions and then my answers for each are below:”

Did you have any risk factors?
“Not to my knowledge.  My pregnancy seemed to progress just fine and I was healthy.  No complications.”

(NgM: Risk factors: “Several factors have been associated with amniotic fluid embolism syndrome. They include precipitous or tumultuous labor, advanced maternal age, cesarean and instrumental delivery, placenta previa and abruption, grand multiparity [≥5 live births or stillbirths], cervical lacerations, fetal distress, eclampsia, and medical induction of labor.” Amniotomy would not have been a risk factor.)

Induction?
“I was not induced.  Although, I was induced with our first daughter.”

Augmentation?
“”I was 41 weeks pregnant.  I went into labor on my own and was dilated to 7cm when everything happened.”

How did the AFE present?
See above paragraph”

Do you remember any of it?
“See above paragraph.  For one of the surgeries the doctors were afraid to sedate me with anesthesia because my heart rate was too low already.  They gave me some light sedative but did not completely knock me out.  This is one of the memories from the weekend that I have. I woke up during the surgery and saw the doctors and nurses above me.  I started to shake my head ‘no’ back and forth to alert them that I was awake. Someone held my head and stroked my hair to calm me down.  The other memory from the weekend is when I woke up to find the family Deacon standing over me giving me my last rights.  We are Catholic.  Talk about terrifying.  I remember thinking to myself (since I couldn't talk, not enough energy) ‘Oh,hell no... I'm not going to die.’”

What's the last thing you remember and the next thing you remember... what's the time spread between then?
“See above paragraph - Friday to Monday I was not really coherent.  I woke up in ICU with a tube in my throat to assist me with breathing.  I was pretty drugged up in the ICU so I slept a lot.  I remember having to write messages to communicate and asking if I was going to die.  I was terrified.  I was so swollen after all of the surgeries.  I had gained 40 pounds of water weight.  My eyes were so swollen I could barely see through them when I first woke up.”

Did you think they were lying when they told you how many pints of blood they put in you?

“It really is unbelievable to think about it.  I never in a million years would have thought that I would need that much blood products.  I received 36 units of red blood cells, 22 units of platelets, 12 units of fresh frozen plasma, and 8 units cryo.”

What effects have been lingering?
“My body was pretty weak after everything happened.  I was in ICU for 7 days and in Post-Partum Recovery for 6.  I am now 5 weeks removed and not in much pain. I stopped taking the pain meds last Friday.  It was 5 days after the last surgery before they allowed me to work with PT and I sat up in the bed for the first time.  It was day 9 before they let me stand up and try to walk a few steps.  My muscles are completely gone in my legs.  I walked with the assistance of a walker for a few weeks.  Now, at 5 weeks I can walk unassisted; however, my feet and calves bother me. My feet cramp and my calves feel heavy and tighten up.  I am Anemic and take iron supplements 3 times a day.”

Are they from anemia?
“Yes, very tired. I was resting a lot at first.  Now I am able to get around the house pretty well and just get exhausted at night.”

Or from other organ failure issues?
“Yes, the hardest hit organ were my kidneys.  At one point my kidneys only had 10% function.  I received dialysis when I was in ICU.  They were able to remove 2.5 liters of fluid.  My Creatinine was 6.9 at the highest and slowly has been lowering.  At week 3 my creatinine was 1.32 and they gave my kidneys an estimated function of 47-50%.  We will re-draw blood in two months to see where my kidney function plateaus.  My Nephrologist is hopeful that the kidneys could fully recover given my health and age (31).”

Are there lifelong residual issues you will have to watch for?
“At this point they say I will just need to be careful and monitor my Kidneys.  Even if they do make a somewhat full recovery, one dose of over the counter Aleve, Advil, etc. could poison them and send me back into renal failure.”

Are you nursing?
“Unfortunatley no.  I had planned to and did successfully with our first daughter.  They started to pump my breasts the first few days in ICU but it was becoming stressful for me.  So we decided since I was still not out of the woods to allow my body to heal and recover without the added stress or task of the breast feeding.  I was so full of meds that they had to dump everything they pumped.  We didn't know when the milk would finally be safe enough to give to Piper.”

Is there anything about your recovery that you want others to know about that you don't get to share too often because no one asks about it? Like sex has been impossible because of headaches or you can't lift anything more than the baby still (just random thoughts).
“The doctor's used the same incision for all three surgeries.  A few days after being released from the hospital the incision opened up.  I received a KCI Wound V.A.C. to help the wound heal.  It's been on for 2.5 weeks.  They say it should close within the next two weeks.  I can't even imagine having sex right now.  I'm still in recovery.  I'm also nervous about it.  So we will just wait on that one.  I am not supposed to lift anything heavier than Piper for another week or two.  I'm pretty weak still.  It wasn't until this past weekend that I could dress myself from the waist down or put my socks and shoes on.  I am scheduling an appointment with an Internist to look into my feet and calf cramps.  I really don't get too many headaches.  I did at first, especially when I was in ICU.  But maybe just once a week.  I attribute them more to eye strain.  They happen when I watch too much tv.  I have had a twitch in my right eyelid since this all happened.  I noticed it goes away when I wear my glasses.  The doctors think the eye muscles might have suffered some neuropathy. I remember I had a few strained blood vessels in my eyes when I was in ICU.”

I happened to travel to San Antonio this last week and was able to meet Michelle and her daughters in person Monday. It was such a privilege to take a few minutes out of her day to take a picture of her and the baby.

She certainly didn’t look like a woman who was so near death a few weeks ago. Talking with her, I learned she had help at home for several hours in the morning and then in the afternoon as well for several weeks. She’s weaned off the help gradually and this week is her first week without help at all during the day; her husband is there at night. She has a meticulously beautiful home and it was clear her four-year old daughter has been an enormous help to her through this.

AFE/DIC still is a risk in any birth and while there are risk factors, they are more risk guesses than anything. It’s true. If Michelle had had a home birth, neither she nor the baby would be here today. It is a risk one takes in choosing a home birth. A miniscule, but real risk. Those  who choose home birth weigh the risks and benefits of other more common experiences such as  lowering their chances of having a cesarean, being permitted a VBAC or having a provider who respects their wishes in birth. To them, the benefits outweigh the risks of possible death from something as obscure as AFE/DIC.

Even so, I felt it was crucial to bring a face and a name to a catastrophic obstetric condition midwives and obstetricians alike dread. I can’t thank Michelle enough for allowing me to tell her story, in her own words, which were more powerful than anything I could have written. Her story finally erases the horror of the birth/death I saw back in 1987.

Thank the Universe for modern medicine.

Monday
Nov052012

Going for a Non-Stress Test/Bio-Physical Profile:

How to Level the Playing Field

When going for an NST/BPP, a little preparation can help you make sure you are hydrated and the baby will be as active as possible before being hooked up to the monitors. This is not to fool the doctor, but to set yourself up for success. If, after following this regimen, the baby or amniotic fluid still shows there is something amiss, you will know you did your part to make sure both were as normal as possible. 

  1. Two hours before your appointment, soak in a tub full of water. Soak for 45 minutes to an hour and while you soak, drink as much of a half a gallon of water as you can. You will definitely have to go to the bathroom more afterwards, but hydrating through soaking and drinking water are two great ways to make sure the amniotic fluid index is as normal as possible. Many women are induced because of low fluid levels when they are really dehydrated. We don’t want that to happen to you.
  2. After your bath, eat a full meal with plenty of carbs. Protein is always important, of course, but you are doing your best to put some glucose into your system so the baby will be as reactive as possible. Reactivity is one of the major aspects of the NST/BPP.
  3. Before you walk into the doctor’s office, drink a full-sugar soda, a small bottle of juice or a cup of coffee – whichever you have abstained from during the pregnancy but wished you could drink. This is sure to perk a baby up!
  4. As you’re getting hooked up to the monitors, talk to the baby and let him or her know what will be happening and that you want to see a perky baby. Also tell the baby if there are problems you can’t see or feel, to “tell” you and you’ll listen and honor the message; babies are very receptive to your wishes and thoughts. 

Hopefully, these strategies can help your upcoming NST/BPP be successful. Of course, if you have any concerns, don’t hesitate to talk to your care provider.

Monday
Nov052012

The Irrelevance of Time:

a loving plea for late pregnancy and middle of the night nursing worries

Imagine you are a woman living in the jungle. You have no clocks; only seasons. You know the stars and the tides, but they are a part of your being more than a conscious thought.

Your baby grows within without conscious thought. The baby has zero concept of time. Is it time to grow a toenail? Time for that 30th hair on her head? Without any schedule or concept of time, it just happens.

Our jungle (or desert or forest or Amish) woman lives her life. She pays passing notice to the increased weight on her joints, the frequency to urinate; she lives her life. She harvests the food, or makes the bowls, or cleans the hut, or builds the house, or skins the animals or cleans the clothes in the river with her other sisters, pregnant and not. She does not have the luxury of sitting still and wondering about her body.

Contractions touch her, but things need to be done. She knows from experience that when her labor is enough to slow her down, it will be time to seclude herself. No one in the tribe even has a word for "Braxton-Hicks Contractions" or "prodromal labor" because the women have too much to do to stop and think about twinges (strong or not). The elders steal quick glances as she leans over again and again as she hangs the clothes to dry, yet no one mentions anything; the woman has enough... enough inside herself to do this work. And they all believe.

Once labor begins, depending on the culture, she might labor alone or with another woman or several women in attendance. Labor knows no time. There is no watch. No clock ticking on the wall. No one says, "You've been four centimeters for two hours now, time for pitocin." Labor is allowed to unfold in its own way. The women around her merely witness, remind her of her strength, press cold cloths to her face and hot ones to her lower back. And still, they all believe.

Pushing, the same thing... no clocks timing how long to push... that counting to ten three times for each push would seem absurd to our jungle woman! She pushes when she feels it. No one touches her cervix to feel if she is "complete." She is complete. Without anyone checking anything. Her completeness is simply a part of her existence.

The same can be said with nursing our babies. When there are no clocks, breastfeeding goes much smoother. When I was nursing my first child during the night, it would drive me wild because of how often he wanted (needed) to nurse. I would grind my teeth as I saw that he had just nursed 45 minutes earlier... that I had now been awake for longer than I had been asleep. That bred anger and resentment.

I did things differently with my second child. I learned to cover the clock - or better yet - remove it from the room. When she wanted to nurse, I was there, present, nursing my baby who, in the wilds of the world, would have clung to me for survival. It is the instinct with which she was born.

That same survival place that caused her to grow to health and wholeness inside... that didn't trigger labor until her lungs were fully ready to be born... that didn't know that I was tired when she was ready to be born (and didn't care)... that same survival place existed to remind me I was there to serve her - my body, in pregnancy and in nursing... and eventual continuous mothering. I was her complete servant. She didn't give one whit about time.

I encourage all women, especially pregnant or nursing, to let go of time. Grow your babies. Feel those tightenings. Embrace the beauty of your heartburn, your frequent peeing, your insomnia, your separated pubic bones, your weight gain... and your baby's movements under your flesh, your child's inner hiccups, your 100% safe-from-the-difficulties-of-this-world child. When exhaustion overwhelms you, feel your childs breath on your nipple, look at those silky eyelashes, touch his skin that will never be softer than this very moment, and know there will be a time when your child never nurses again. Pull this moment as tightly to your heart as you possibly can.

Time, as trite as it sounds, is so fleeting. My own heart cries for those aches and pains. My youngest is now almost three decades old and I am sorry for ever wishing any of those moments of difficulty away.

I speak here so others might take a deep and grounding breath, say a prayer or incantation if that is your way, and stay in the moment with your child. It is the only time ever you two will be alone together.
As your baby grows without guidance and conscious thought, so too, begins labor and birth. Your body producing nourishing milk continues the miracle of your perfection.

And we all believe.

Sunday
Nov042012

Let's Get Started Breastfeeding

This is the handout I give clients who are going to breastfeed.

While breastfeeding is natural, it doesn’t always feel natural learning how to do it. Here, I offer some basic information that might help you get off on the right foot. 

-          It can’t be said enough… early and often. Having your baby on your body from the beginning is the best way to learn the patterns and rhythms of your newborn. Even though most babies do not nurse for about a half hour or so, occasionally, so nurse sooner. When the baby is on location, initiating nursing is on his schedule, not the hospital’s.

-          It is routine for hospitals to wrap babies in blankets, making them look like a burrito. I encourage women to unwrap their babies, put them skin to skin and cover both of you. Research does show that when a baby is skin to skin with mother, she retains her heat better than when she is in blankets alone.

-          When you have your baby in your arms and are ready to bring him to your breast, there are two main positions to try… and I do recommend trying different positions because each one has its benefits.

Cradle Hold – Put the baby’s head into the crook of your elbow and your same hand on the baby’s bottom or holding a thigh. Babies all have a way of making this more difficult than you think it should be, so don’t be discouraged; just keep trying. At first it can be a three-person job! Pull the baby’s bottom arm around your waist and hope the top hand doesn’t go right into her mouth, blocking the nipple action you are trying to do. Some women find it easier to swaddle the baby tightly before nursing. That can keep little hands hidden, but if he isn’t swaddled tightly enough; the hands find their way out of the blanket and the whole tangle begins again. It’s really okay. You will find your own style with your baby. Having the baby’s belly against yours helps align his mouth with your nipple. We say, “Belly to Belly” – if you remember that, it can make this hold a lot easier.

Football Hold – The baby’s legs are going to wrap around your waist, her head will be in your same-sided hand. Having the head in your hand gives a different type of control over the nursing experience. Many women find this easier because they can see the baby’s mouth and can pull the baby closer than in the Cradle Hold. No matter which hold you are doing, do not lean into the baby; bring the baby to you. Now, the baby has receptors from the  chin, across the cheeks and up around the temples and they need to be left alone because, as you touch them, the baby will think there’s a nipple there and turn his head in that direction. So, when you are holding the baby’s head in this position, your thumb and pinkie finger shouldn’t go closer than the hairline. This is not an exact science, so please don’t worry if your hand is further or closer than that; you and your baby will find your own way. With your opposite hand, compress your areola slightly to make it look like a “V” and then, when the baby opens her mouth wide, pull the baby into and onto your nipple.

NOTE! When learning to nurse, it is a trial and error experience that can last several weeks. Both you and the baby are learning at the same time and neither of you need judge each other. Patience will go far, especially when he’s screaming his head off hungry. Take a few moments, take a deep breath and try again. I promise, it will happen. If you need help, do not hesitate to ask for it! Your midwife, a La Leche League leader and Lactation Consultants are your first lines of defense and can help you overcome most obstacles without bottles. I tell women: If you think about giving your baby a bottle, that is your cue to call me. 

-          For the first day or two, your breasts will probably not change very much. However, if it is painful when you nurse, please call your midwife or your breastfeeding support person. (OBs aren’t versed at all in breastfeeding and Pediatricians are not knowledgeable unless they breastfed their own children successfully.) Nursing should not hurt! It can be uncomfortable or a strange sensation, but pain is your sign that something is wrong, usually with the baby’s mouth… either positioning or a suck issue. Both can be corrected with education.

-          When your milk does begin to come in, you will watch your breasts grow several sizes from their normal shape. It’s important to know that most of the swelling is breast tissue, not milk filling them. Just as when a man has an erection, the tissue swells with blood, not semen; it is similar with the newly lactating breast. Therefore, attending to the tissue swelling is the focus for these next couple of days. Nursing continues as needed, but women can be so uncomfortable with the milk coming in that they give bottles for relief. Here, I’ll give hints for helping without bottles.

Heat before/Cold after is the main rule. Hot, wet washcloths before nursing helps to soften the breast, especially the nipple (which can get so swollen it cannot be grasped). I encourage women to keep at least four washcloths in a crock pot on low, exchanging two washcloths as they cool, back and forth, as the baby begins waking up. Hopefully before he’s screaming his head off, but even if he is, take the time you need to prepare.

After nursing, ice packs on the entire breast feel heavenly. Many women use frozen vegetables because they mold nicely on the breast. The ice helps relieve the tissue swelling, just as we ice a swollen ankle. You can put the ice packs on for 20 minutes and then off for 20 before putting them back on again. As needed between nursings, you can do as much of this routine as you like.

Cabbage leaves are a great home remedy that help the swelling diminish like magic. A chemical in the leaf relieves engorgement within a day or so. I encourage women to take the cabbage leaves off whole and put them in the freezer so when they use the leaf on their breast, it is also cold, taking care of the swelling with two methods at once. Use the cabbage leaves for 20 minutes out of every hour and only use them for two days because they can also diminish milk supply if used for too long.

Ibuprofen, by its nature, helps with swelling and pain at the same time. Many women find they need to augment with medication for pain and Ibuprofen is the best way to do that while nursing. I recommend 600 mg every 6 hours for 2 days. Ask your own care provider what he or she recommends.

Some women find homeopathics or herbs help with the swelling. Be sure to ask your holistic provider to tailor the care to you and your baby.

-          What if your nipple is so engorged the baby cannot grasp the nipple? Many women find that, while using the heat before nursing, you can express some of your milk to soften the nipple. When hand expressing, be sure to put your thumb and forefinger behind the areola and press down and then towards the nipple (which, technically, is the very tip of the areola, the darker part of the breast). It can help if you are able to lean over in a filled-with-hot-water sink, letting gravity help you with expression. You can also do this in a hot shower, letting the water spray on your breasts as you hand express to soften your nipple. Be ready to nurse, though, because very shortly after expressing, the nipple will fill again.

-          All of this can be extremely uncomfortable but really is important in helping you, ultimately, not be so engorged. The major discomfort should last no more than 2-3 days.

-          DO NOT PUMP! Pumping will only make your breasts think you have another baby to nurse and will make even more milk. The small amounts of hand expression will not do this, but pumping should be a last resort, only to soften a bowling ball breast so the baby can grasp the nipple or to relieve a crying-in-pain mother. Pumping hurts, too, when the breast is that engorged, so really is a last resort.

-          If there is ongoing pain or nipple damage, have a Lactation Consultant come and see if there might be a technical issue… the baby sucking on a lip, the baby not sucking properly, the baby having a tongue tie, etc. She will be able to diagnose the problem fairly quickly and get you on the road to recovery sooner than later.

-          Find support through La Leche League meetings. They are awesome. If you don’t like one group, go to another. You’ll find one that fits you perfectly.

-          Hang in there! You can do it. Nursing takes a lot of practice. But the practice pays off in a wonderful relationship with your child.

Saturday
Oct202012

Brewer Diet Be Damned

This could have been written to many people, but just happened to come up with the Hypnobabies course I am auditing. It's an issue with Bradley and any number of midwives and doulas as well. They ALL need to just stop referring to the Brewer Diet. It's crap. It's even dangerous to susceptible women. So while this letter goes to Hypnobabies, fill in the blank with who you know who uses the Brewer Diet; they need to dump it, too.

Dear Hypnobabies Folks, 

I’m sitting in on a Hypnobabies series and we’ve just finished the second chapter on nutrition. As you know, the chapter focuses on the Brewer Diet, Hypnobabies clearly advocating and recommending the Brewer Diet (BD) for those who take the course. As a midwife, I’ve followed the BD through many years, first through the Bradley classes as a student, then with peer pressure and finally, I started learning about the BD on my own because I kept seeing clients getting sick despite being on the BD, getting preeclampsia, including postpartum preeclampsia. I started reading studies about preecplamsia and reading about Pregnancy Induced Hypertension, opened my eyes to the amount of babies there were that were over 9 and a half pounds when their mom adhered to the BD religiously, bigger still, the more protein she took in. I saw shoulder dystocia over shoulder dystocia with these over-nourished babies. When midwives began talking about it honestly, we saw the same things and quit recommending the BD to our clients.

How did this diet come to be so ingrained in the natural birth world when only one doctor claimed it worked? There weren’t even studies that could replicate what Brewer claimed all that protein could do! For groups of people who demand evidence-based care, this is a glaring example of ignoring what we require of others.

For those that believe Brewer could do anything at all to prevent or help PIH or preeclampsia at all, you need to visit Preeclampsia.org and listen to what the women there have to say about The Brewer Diet. Here are the massive amounts of links the women have compiled that discuss the science of PE/HELLP/PIH.

None of this is to say I think a balanced diet isn’t important, but the Brewer Diet isn’t balanced at all. It is protein and calorie overload which taxes the kidneys and the body, especially during pregnancy. Women absolutely need protein during gestation, but not 80-120 grams a day as Brewer recommends.

What I would love Hypnobabies to recommend is a balanced diet of heavy on fruits and vegetables, quality protein, complex carbohydrates, water and minimal processed foods… what we all know to eat anyway!

I love Hypnobabies. I want to put everything I have behind this method. I don’t want to have to say, “Except for <fill in the blank>.” From what I understand, you’re changing the manual; I hope this is one thing you’re completely transforming.

With respect and admiration,

Barbara E. Herrera, LM, CPM

Thursday
Oct182012

Mucus Plug

Here's an awesome picture of a mucus plug pretty much completely intact. This mom was 9 centimeters when this came out. Her membranes were intact.

Photograph by Barbara E. Herrera, LM, CPM

You can imagine that if you "lose your mucus plug" pre-labor, it would be slimy and runny and you might have to wipe a couple three times. It also tends to keep coming out over a period of time, stretching out a little at a time over a couple of days even sometimes.

And just like when we have a cold and the body keeps making mucus in our nose, the body keeps making mucus in our vagina, too, so we technically could have more mucus plug again, though a complete other plug doesn't often happen. Mucus, yes. Plug, rarely.

Thanks to the mom for her permission for letting me use her beautiful plug to share with others. It's taken me years to get a picture of an intact mucus plug. I've held onto this for a couple of years so I could remove any hint of who the mom might be (even though I do have her permission). I came across it with the amniotic sac pic and here you go!

Saturday
Oct132012

Dripping Caul

  photo by Barbara E. Herrera, LM, CPM 

 

 

 

 

 

Friday
Sep282012

Hypnobabies Doula

I just became an official Hypnobabies Doula! To become one, I took an all-day course with a Hypnobabies instructor and then had to fill out an extensive booklet (that took several concentrated days to finish) and send in to Hypnobabies Central for grading. Apparently, I did a good job because I got an email saying I passed! Yay!

I am sitting in on my first Hypnobabies series starting next Friday night and already have my first Hypnobabies doula client. This is a fun adventure for me, learning new information as an experienced doula and midwife. I’ll report from the trenches.

Tuesday
Sep252012

Do You Like Being a Mom?

This is the most recent Facebook question I asked. Knowing how hard this question can be to answer truthfully, I made sure women could feel safe answering however they wanted/needed to, even if it wasn’t in the positive. One thing I didn’t say that I should have was it was a given that women loved their children, even if they didn’t like being a mom. You can see in the answers, the moms who struggle with the question, over and over professions of loving ones kids even in the face of the hardest times. I promise moms, none of us doubts you love your babies, even if you despise being a mom. I don’t think being madly in love with your child/ren and hating being a mom are mutually exclusive at all.

How would you answer this question? 

MCM: I love being a mom! So far I think I would say it's as wonderful, if not more, than I'd imagined.

KS: I can't imagine not being a mom. I love being a mom. There are days I don't like being a mom; it's hard. It doesn't feel rewarding. It brings me to tears sometimes. I have days I know I am not being anything close to the mom I want to be. But I wouldn't trade it for anything. The moments of sweetness and joy far outweigh and outlast any of the hair-pulling, hide in a closet ones.

NWW: No, I do not like it. I don't like it because of external influences. if it were just me and my daughter in a vacuum, it would be bliss. But society, American culture, has ruined it for me.

JT: Overall, yes. There are parts of being a mom I do not like.

SH: At first, no. I suffered from post partum depression/anxiety and it was debilitating for me. After the first year with both boys, I enjoyed it so much more but it was a slow process. I still have my days and I would not want any more children, but overall, yes. It is fulfilling, challenging, frustrating, exhilarating and I never knew I could have so much love toward two little individuals. My boys are 3 and 6.

TC: Yes I do. I like being needed and I like the intimacy of the child-mother bond. I like watching people genetically similar to me grow up. As the youngest child, I never really witnessed this. This also makes it really hard for me. I like that I am able to do it, even though it's really hard. I like the bond it has made between me and my partner. I like it quite a lot.

KO: Overall, I love being a mom. But some days, I hit my limit and I don't like it so much. It is especially difficult when my husband is not here to take some of the weight off my shoulders. However, I try to start every day with a clean slate and I have good days and bad days… but I do love being a mom and I certainly love my kiddos, even if I don't like the things they do all the time.

LSA: Overall, I do love it. I love seeing my little girl grow and learn new things. There are things I don't love about it, but the good parts outweigh the bad most of the time.

AH: There are days I do, other days when I really don't.

CAM: I cannot think of my life without my children! I love them unconditionally and they have gotten me through some very tough times because I knew they depended on me fully. That being said, life would be easier and much more carefree without them. I had children young, first at 20, second at 24 so I never had a chance to "party" but it also didn't appeal to me. At times, I do look at childless friends and think, “Oh, to have the money to travel without kids,” and such but my kids became my life and I chose this life! I look forward to traveling with them and showing them places! Their smiles light up my worst days!

EEC: I do like being a mom. I don't like the jobs that come with being a mom though- the endless cleaning and feeding and reinforcing rules. I wish I could source those things out some days and just have the cuddles and sweet moments. But, overall I do like, even love, being a mom.

AC: I found myself when I became a mom. I don't just love it, it is everything I am. Which isn't to say that it's the only thing I am. My favorite part of being a mother is that I will always be one, no matter what else I choose to become in addition to it.

LM: Yes. Now that she's 6 months old, things have gotten easier. The first little while was grim. Some days I miss the freedom of my old life, but I feel like I've finally embraced this new way of living. I love my daughter very much.

ALC: Being a mother is the most wonderful & the most heart-rending thing I've ever done. It's fun, sweet, delightful AND scary, frustrating, disappointing... my kids are a wonder to me- I love them in ways I never realized I could. But mothering itself is hard- pulls against my selfishness, takes time from 'fun' things that would be nice to do, but that aren't practical with kiddos... Being a mother makes me better, less selfish, more compassionate... like the marines (?), it’s the hardest job I've ever loved. Hard, but worthwhile....

SA: Yes. I may get annoyed with my kids and wish for a break, but underneath, I'm so much happier with them than I ever was without.

JK: More than words can express. But I also know it isn't for everyone or every situation. I love it a million times more being divorced and in another city than I did back "home" with my husband. Yes, I know that may sound bad, but it is the truth. Sometimes we are in a situation that makes it hard to focus on enjoying it because we are so miserable, and when we finally remove those unpleasant factors, we are more free to realize how amazing it is.

JEK: No. I really, really love my kids, and I enjoy their company the majority of the time. But I have trouble feeling patient with this stage of my life - there are so many other roles I feel I'm meant to play (midwife, writer, who knows what else), and I really look forward to those days, so sometimes it's hard for me to be content with "mom" being my primary role. I don't identify with being a mom in quite the way I expected I would.

On the other hand, it's a fundamental part of who I am, and I'm skeptical of anyone who says motherhood hasn't changed them in some way. I like myself as a mother, but I don't always like being a mom, if that makes even a bit of sense. So glad you're asking this question, Barb; it's something I've been thinking about a lot lately.

KPB: I love being a mother, but I don't always enjoy the work of parenting. Some days, I just want my kids to clean up after themselves without having to be coached, hop to as soon as I say it is time for bed, and fortheloveofbabyjeebus stop bickering about asinine crap and whacking each other. But they are reminders that they have their own aims and goals, and when I can let go of my agenda and be fully present with them, they are really neato little people with funny stories to tell and charming perspectives on the world. And i am fully aware that one day, they will likely not live at my house, and I will pine for the days when books and crayons littered my floor.

NM: I love being a mom and like a pp (?) I enjoy it even more now that I'm getting divorced. I can focus on my children and myself. But there are definitely times when I would give almost anything for a break, just a weekend off to recharge. But alas, it's just me and my boys and I think we make a great team!

DER: For the first 5 years, I hated it. My son has an "invisible" disability and I needed help. He was getting kicked out of day cares, preschools, play groups, etc. I begged his doctor for help, but she kept telling me how I was parenting wrong. "Friends" kept telling me I wasn't disciplining enough. Family had other obligations and couldn't help. He turned 5 1/2 and people finally started listening to me and finally gave me help. Now I do love being a mom! If those that could help me had listened, I would've loved it much sooner. All that wasted time missed out because even though I begged for help, often in tears, I couldn't get it.

JS-J: A very multi-faceted question. I love my children. I hate the drudge work. Most days, I'm glad I had them--but there are certainly days when I wonder: should we/I have done this? My chronic illness started well before my pregnancy, so I knew going in that my kids, for the foreseeable future, would have a "sick mom". I didn't realize how hard that would be. As I get sicker, it gets harder to parent. That being said, it's getting easier to be a mom.

Short answer: yes.

HJN: I love being a mom, love it. It is, perhaps like the way an endurance athlete loves her sport. The work, hard and the pay off, spectacular.

KM: Yes, but I dislike how it is now my only identity.

SBN: I do like it. I'm not naturally talented at it, and I work full-time as the primary breadwinner, so it is absolutely grueling, but I love being a mom even as it terrifies me.

PR: Mostly. I became a mom at 18, then had two more kids; and was a single mom most of the time (actually even when I was married, I was pretty much a single mom). I was overwhelmed sometimes with fear, fatigue and poverty. And I enjoyed helping the girls become thinking, responsible, effective human beings - although at some points they took a little longer and took a harder road than needful.  

As the girls grew up, other young women, at work mostly, turned to me as a mentor. I mothered these young women as I encouraged the bio-kids to become increasingly independent and strong in themselves. Then I ended up with a series of younger women to nurture - many of whom still call me mom.  

I don't get all ooey-gooey over kids. I do like babies, and I really liked being pregnant and giving birth.  

I look at the girls now, and am sad that they got tangled in the "oh I am a desperate sinner and am rotten" thing, rather than seeing themselves as a cherished creation who is loved. That is my deepest regret.

LA: I love it. I love seeing the world anew through my kids’ eyes. I love sharing in their excitement, their accomplishments, their exploration. I love seeing the amazing people they are growing into... from my 11 month old to my 15 year old, they are just amazingly neat people.  

Sure the daily grind gets annoying. I don't like dishes, laundry, bills, chores the kids can't remember to do, etc.  

Not gonna sweat the small stuff. Their lives with me are precious and fleeting. In no time they'll be gone, grown and I'll have a horribly empty nest.

MH: Sometimes I don't like it, but generally I love it. There are days when I feel like a horrible mother, because my patience is wearing thin. Sometimes it feels like a thankless job and the kids don't seem to care about what I do for them. Other days I receive huge rewards when I see them being kind to each other or people outside our family. I love to see them using the skills and morals I've tried to instill in them.

TD: I love it, but I don't always like it. But motherhood is certainly extreme. It's given me the greatest mushiest happiness I've ever felt and the most frustration, terror and sadness I've ever felt too. But I keep signing up for it again and again!!

APH: I think the quiet desperation of mothers is a dirty little secret that’s rarely spoken, because who wants to be called a bad mother? We feel guilty enough about our discontent as it is. And those feelings are compounded by our isolation. Women the world over share these feelings, not that they'd admit it. (this has many LIKEs)

JMY: It was the hardest thing I ever did. I love my kids but was not always patient and didn't really enjoy parenting when they were younger. Once they were teens it was a lot better. It's still very frustrating occasionally, and they are in their 20s now. But I wouldn't give them up for anything. I've never loved anyone with the intensity I love my 2 sons. I'd do anything for them.

JYP: I do like it, but wow is it hard work and some days it’s all I can do to not completely fall apart. I wish I had more support and help at home, that would help quite a bit. I have 5 kids, the oldest is 9 and the youngest will be 1 month on Sat. It's a big transition time again and that always make me question why I was blessed with so many children when some of my friends struggle to even have 1.

EE: I love the relationship with my children. The jobs associated with motherhood, not so much. I find that if I separate the two I don't get resentful.

RL: I like who I have become because I am a mom. The actual day to day process is very very hard, but I love watching them develop into who they are becoming. Overall, you have to look at the long term with motherhood. That's what it is about anyways. The trick is not to get lost in the difficulties of the day but look at the long term. That's where I find my greatest joy, both for who I have become and who my kids have become. It's about being involved in the process of creating and sharing in another's lives that has effects for generations.

CB: Hells yes I love it, it isn't the distinction of being a mom, I love those little turds. There are things that are hard, but that only shows my limitations (like dealing with individuating toddlers and homework for grade-schoolers, which is bs...). I wish I had more time to myself but that is temporary and at least we have the things we need even if right now I sometimes feel used up.

CM: I love it but man has my patience been tried (this past week especially!). I'm still at the beginning of my motherhood journey (22 months & 6 months) and I know there are amazing and challenging times that lay ahead. As you said, I often times have to remind myself that other "things" don't matter. I find myself frustrated that I can only do kids all day.... None of the other little things I may wish to accomplish for myself.

I've found myself trying lately to search for the balance of C as a woman/wife and C as a mom!!!! Being a lil bit of everything for everyone - including me! Whew! It's exploded my life like I imagined it would and I love all that it is presenting!

RL: I think more moms need to acknowledge and be okay with the fact that there are days we don't like. There are days when all you can do is function. And if you need help, for goodness sake get help. Even if it's just a babysitter. I feel blessed to be a part of a community where I feel like I have the ability to drop my kids off at someone's house for awhile when I need it, no questions asked. It's a fact that in our normal culture moms do not get much support. It's unfortunate because we need it. But like I said the big picture is different. To look back on how I've changed and how my kids have grown is very satisfactory. I wouldn't change it. But that doesn't make it any easier.

PG: I could write a chapter book but to abbreviate things: I had 3 babies in 2 1/2 years so I was either pregnant or nursing for about 6 years. The nursing really helped me to be patient, thanks to the oxytocin! I sure missed that after my last baby weaned. To put it as nice as possible, (seeing how this is a public forum) my husband was rarely available, wasn't very supportive, and we didn't get along so well then so the earlier years of my momhood were especially rough. Now that my kids are all adults we have wonderful relationships and they are my favorite people to be with!

SK: I fought so hard to become a parent (infertility) that people expect me to be over the moon and some kind of all knowing earth mother awash in 2 year old (She has been here 8 weeks) love and bliss. The reality is I have not been transformed into Mother. I am still the person I always was but now with less time, money, energy and sleep. Working to support her while going to school and parenting is proving to be a crappy job and one that frankly I am doing a crap job of. The pressure to transform into a better person and transcend the realities of day to day life bring me down and add another layer of guilt. No I do not love being a parent. This week I do not even like it.

SG: I love my daughter (she's 10) like no one else in the world. I would give my life for her in a nanosecond. I absolutely adore her and do everything I can to make sure she has a good life. That said, I do not like being a mother at all. I'm not good at it, it doesn't come naturally to me, I second-guess everything I do. I'm uncomfortable with it, and really glad that I stopped at one. I'm already worried about whether or not I'm going to screw up the one I have.

AKS: I love my kids. And sometimes I fantasize about running away, or hiring house elves to do the housekeeping, which I suck at. My girls are three years old and five weeks old, and I know that this is a season, and I may miss it when it's over, but it's intense in the trenches, you know? I have a great husband who is gone Mon. a.m. to Friday evening for work. When that changes, and I have help at night, I may feel less overwhelmed.

KWV: I love the relationships I have with my kids. They are rad little people who are endlessly entertaining. Bedtime, having to be the responsible one who makes dinner when I could skip it, remembering to buy the right kind of toothpaste, breaking up constant squabbles, enforcing the rules and henpecking so the chores get done- not so much. I am so much happier since going back to work. Even though I am working 12-13 hour shifts 3 days a week, I have so SO much more patience and energy for the skwids. I love them more than anything and our relationship is the most important one in my life, but the job of being "the mom" is one of the least interesting things about me and I don't think I'll look back on it as my most important life achievement.

JG: I love being a mom. But I am grateful that I can combine it with work and personal goals, in part because I have such an equal partner in parenting.

DG: I love the growth and maturity I’ve gained. I love my son. I love watching him grow. Do I love poopy diapers and and never being able to do anything spontaneous or on my own schedule? No. Some days, I enjoy it less than others and it is hard work, emotionally and physically, every day, but overall, yes, I do enjoy being a mother. I can definitely see how some might not enjoy it and I think we all have days where we just want to run away and forget our responsibilities.

DL: I really do like being a mom. I don't like my failures, my weak moments, the times I don't pay attention to my kids or don't want to play. I wish I still had the energy and gave the kids the time they deserve. I really do believe it's an honor to be a mom. I wish I could just not do the housewife part. By that I mean I want to be a wife, but not have the responsibilities of laundry and cleaning etc. I'd love to just spend family time all the time playing and helping my kids. Could I just get some people to do all the work around here and we could have fun all day?

NgM: These words from KS eloquently describe the intense angst being a new mom can be. While we all love our babies, it’s sometimes hard to describe the times we can’t stand them and wish they would just go away for a little while. Sure, a baby sitter might seem the perfect solution, but that can be cost prohibitive for many families, even when both parents are working. (KS, just like my daughter, is working from home.)

KS: I love my son more than life itself. But lordy, being a mom wears on me. I'm a very social creature and the first lonely desperate months with a newborn nearly sucked the joy out of me. My kid still doesn't sleep very well and I long for one God-damned night of uninterrupted sleep. I love cuddles and giggling together and watching him discovering new things. The tasks and indignities of motherhood--the incalculable amount of time I spend preparing meals that all promptly be tossed on the floor, responding to his fifth request to nurse in the past 20 minutes, the stepping on the sharp edges of baby toys at 3 AM when the teething toddler screams out in raging fury beast cries--these things make me think I was absolutely bonkers to skip willingly into this parenting gig. On those days where it's 2 pm and I'm still in my pajamas and my son has already watched four hours of TV because I have a deadline for work I need to meet and we're both starving and there's no food besides graham crackers and goldfish crackers and he screams at me because I had the temerity to reclaim my smartphone, I think I will completely lose it and end up a headline. Most of the time, it's great, but those bad days make my worst days of work or school look like picnics. And unlike school or work, I can't call in sick to motherhood. The grind can feel unbearable.

LC: I love being a mom. I have given up a lot of things to be a full time mom right now and there isn't a day that goes by that I actively wish I was out in the work force or in school full time or something like that. I actually get a tight feeling in my chest every time a doula client calls, because I know I'm going to have to drop everything, pawn the kids off on a friend, and be absent for who knows how long. I wouldn't trade my mom status for anything. But... I feel quite often that I'm not really very good at it. I'm impatient, I yell, I let my kids play by themselves for hours because I enjoy getting some "me" time. I like baking and cooking but I don't like little helpers in the kitchen, and I feel guilty about that because I know other (better?) moms let their kids help and have fun and learn. I like it when they are creative and turn a box into a boat and all the pieces of the games and puzzles into ocean plankton, but then I start fussing about the mess while the joy of the game they made up is fresh. I hate that I do that. I don't want to be a soul crusher. I love so much that my husband's job allows me to stay home with them because I think I'd be the worst daycare mother on the planet... always forgetting stuff for show and tell and snack time and Halloween day, etc. And I WANT so badly to be their person, the one that listens and hugs and laughs and is a source of joy to them, but I really wonder if to them, I sound like the Charlie Brown teacher in the background, nagging, fussing, uh huh ing... So. Yes, I like/love being a mom, at the most basic "I love my children more than life itself" level. But I feel quite sure most of the time that I'm massively and unknowingly screwing it up, big time. I wish I had the confidence that I was GOOD at it; that would make me like it even more.

NgM: I wrote to LC: “You are the EXACT kind of mom I was... and my kids are AWESOME adults. Do not give it a second thought, worrying your kids will turn out to be anything less than stellar because you don't like them helping in the kitchen. I tried to cook when they were sleeping because I didn't want them in there with me. (Don't I sound like a horrid mom?! Thank goodness we have Exhibits A, B, C & D to show I wasn't.) I was not an artsy mom, either (and have written about that a lot), not an on-the-floor mom, but a reading-on-the-couch mom. It takes all kinds; we're just different.”

MD: I love being a mum, but it isn't my day job.

ESG: Yes, I like being a mom. I love my five children. I, too, struggle with patience and yelling. Of motherhood, mostly hate the drudgery, the mundane-ness -- even as I struggle as a homeschool mom to make their lives NOT mundane -- the constant Sisyphus-like battle with laundry and dishes and cooking. Sometimes I think, "I'd love to outsource some of this." But if I wasn't the one who kissed toes during diaper changes, or rubbed stain-eraser on Tae Kwon Do uniforms, or made sure blankets were on the right beds, would I feel so close to my children?

NgM: Do I like being a mom? You bet. My kids are my best friends, we share the closest secrets and the most hilarious family stories. While I never wished any age or stage away as they grew up, I really do love them as adults; they’re great! For those in the middle of the hard stages, I promise, in a minute, they will be adults. It really does happen so fast. (Some days, I know, not fast enough.)

I loved this question and loved that women answered so honestly. Thanks to all who participated. It was extremely tender and very enlightening. 

Meghann, Darren, Aimee & Tristan

Friday
Sep142012

Trevor & the La Leche League Battle

This is getting out of hand. I cannot believe the hoopla Trevor has created regarding his desire to be a LLL leader in Canada. For those who don’t even know who or what I’m talking about, I’ll start at the beginning, but I’m going to give the short version.

My own prejudice first. I was a LLL leader for ten years. I also happen to be lesbian married to a transman. I had three children I breastfed for years and my partner, then presenting as a woman, had a baby that he also breastfed for 2.5 years. This topic isn’t foreign to us.

Trevor came out as a man and had his breasts removed (Top Surgery… Bilateral Mastectomy). Then a few years later, with his genitals and female insides intact, decided to birth a baby. Once the son was born, he wanted to breastfeed. Trevor says he has milk, but it’s hard to say how much since he uses an enormous amount of donor milk (16 different donors by the time his son was 7 months old, so he says in his blog Milk Junkies) and from what I know of Top Surgery, most, if not all (female) breast tissue is removed and the nipple is (usually) completely removed and replaced (women’s nipples are very different than men’s, even if women are AA sized), making the milk ducts all but inaccessible. If he has any milk at all, it would almost be a miracle of science and possibly a malpractice of his plastic surgeon. To feed his son, he uses a Supplemental Nursing System (SNS) to give the donated breast milk. Trevor started going to LLL meetings and eventually, a LLL leader friend thought it’d be good for him to lead support meetings which led to his wanting to be a LLL leader and his applying. Because he is a man, he was turned down. LLL is a mother to mother organization and Trevor identifies as a man.

Question: If Trevor was born a man and was “breastfeeding”, would he be as welcome at meetings as Trevor? Or is Trevor really being seen as a woman and that is why he is so accepted? I believe it’s the latter.

Trevor’s invading women-only space does an enormous disservice to both transmen and LLL alike. Why is it so important to have every. single. place. be both male and female? Why can’t there be male-only and female-only spaces? Is being politically correct really that important? Still?  

You can read LLL’s requirements for becoming a leader here. It’s clear the roles of mother and father are delineated. Some might find this sexist and that it’s just not keeping up with the times of the science of possibilities, but can’t there be a place where mothers are permitted to just be mothers? Is it gender bias to request that women have a space where men aren’t looking at intimate areas of women’s bodies? While Trevor says he has had no problems at his group, I know there are plenty of women who would never attend meetings if he was a leader (or any other man for that matter). As it is, when guys hear that Zack and I got together at a LLL meeting they are not happy, thinking that they never had to worry about the meetings being pick up spots (not kidding; we’ve been told this on a number of occasions). Men can become Lactation Consultants or Peer Counselors and hired on a one-on-one basis, but can’t LLL just be a place for mothers to come in a group setting?

But, there are other issues that come into play that disqualify Trevor from being a LLL leader. LLL is extremely clear about not mixing causes and it doesn’t take two seconds on Trevor’s blog to see that two of his causes are milk sharing and Lesbian, Gay, Bisexual, Transgender, Queer, Intersex (LGBTQI) issues. LLL has very strict limits on milk sharing and wrote Trevor about it, which he published here. They say:

A Leader shall never initiate the suggestion of an informal milk-donation arrangement or act as an intermediary in such a situation. If a mother wishes to discuss these options – which may include donating expressed milk, wet-nursing or cross-nursing – the Leader’s role is to provide information about the benefits and risks, as mentioned above, including the limitations of home sterilization of expressed breast milk.

Regarding being a specialty leader such as an LGBTQI leader, they say:

I would also like to address your interest in leading an LGBT LLL meeting. I think that it is important for you to know that we do not accredit specialty Leaders. So for example Leaders often say that they need a working mother as a Leader for their Group because she can relate to the mothers in the population the Group serves - I would disagree - what qualifies a Leader to relate to those mothers is her experience of mothering, not her experience of separation. Similarly in this case it is the experience of mothering through breastfeeding which qualifies a Leader to help others. Any Leader can help anyone who is interested in breastfeeding. LLL has accredited a number of lesbian mothers as Leaders. They lead Groups for all mothers.

While LLL initially turned Trevor down (in the letter above, they have since written a statement saying they will look at the issue that has never been presented to them before. This is where I get testy.

A letter of “support” was written that could be cut & pasted or signed and sent to LLL and that letter began:

As the world's most important breastfeeding support organization, it is vital that you include all kinds of breastfeeding families. Regardless of any other issues, LLL should support breastfeeding relationships. I was very disappointed to hear that a transgender dad in Canada was told not to apply for leadership because of his gender identity.

Excuse me? LLL supports ALL families. LLL does not exclude any families from their support, knowledge or information. LLL also did NOT tell Trevor not to apply for leadership. It explained to Trevor why he was not a good fit for leadership, the same way they tell women every single day why they are also not a good fit, either. Some who apply are; most who apply are not. And this is just how the letter began! In this angry tone. What the heck?! This makes it sound like LLL is a vile organization that has unreasonable concerns about trans issues, namely transphobia when, by every bit of correspondence that Trevor shared (without LLL’s permission, I might add), you can see that LLL is extremely respectful and kind. Why Trevor and his spouse decided to write the letter in this tone is beyond me, but it has pissed me off more than any other aspects of the whole topic.

I’ve said in various threads around the Net that if Trevor wants to lead the specialty breastfeeding groups, he will be amazing at it! No, he doesn’t just need to limit himself to LGBTQI groups or milk sharing or SNS groups, but those can definitely be his focus and forte just as each of us midwives also tend to have specialties, too.

Trevor is definitely traversing new ground and it’s awesome that he is. It needs to be tread, but I don’t believe it needs to be tromped on through LLL’s land. I would love to see him start his own organization and I would be one of the greatest supporters. I am all for trans procreation and breast supplementation… fabulous! Zack and I are both on the same page with this issue.

Leave LLL alone, Trevor and others; find another avenue for your energies… something positive and joyful. We have enough fighting in our lives. I don’t believe we always have to shove ourselves into middle of the road organizations, especially ones that are single sex only spaces.  Let’s create something for us… just for us… and show the world how great we are and how strong we can be. There’s more than enough to go around.

Thursday
Sep062012

Dr. Biter in the Union-Tribune

Encinitas Physician Penalized: Repeated negligence occurred, state says.

This, of course, was all before the baby's death July 1, 2012. I pray the Medical Board does something about that as well.

Tuesday
Aug282012

Biter Baby Death on the News

The family that lost the baby with Dr. Biter was on the news last night discussing their being upset about Biter signing the judgement with the Medical Board on May 15, 2012 and it not going into effect until Sept 7, 2012... and their baby died July 1... that something is wrong with that time frame.

You can see the NBC News Report here.