Friday, March 30, 2012

Oh the nosebleeds!

As I sit here with a tissue hanging out my nostril for what feels like the millionth time, I figured I'd write about the always untimely experiences of pregnancy nosebleeds.

First I should mention that nosebleeds during pregnancy are quite common, and as long as they are minor are usually considered "normal".  Why?  Basically the blood vessels throughout your body expand due to increased blood volume in pregnancy.  This increase in blood supply mixed with all of those fun pregnancy hormones causes those delicate little capillaries in your nose to rupture more easily.  {Read more here} No biggie right?

Except when you're me, and you already have a history of nosebleeds, and you're at a birth about to bleed all over a laboring mama!!!

You see it all began about 10 years ago, in my early twenties, as I stood on my parents' back porch one fine spring day.  I had just gotten over a cold (or maybe I still had it...hard to recall) and I wanted a bit of fresh air. I tried to take in a nice whiff (apparently with all my might), sniffing heartily, and boom went the dynamite.  My first nosebleed ever.  I was shocked as I ran in the house trying to get to the nearest tissue.  Little did I know this one lone broken capillary in my right nostril would become my nemesis for many years to come.

After that day I seemed to get repeated nosebleeds.  Always the same nostril, always the same little capillary.  I was still performing professionally at the time (for those that don't know, I have a background in music, dance, and theatre...)  and I remember often feeling the bubble of panic arise on stage as I wondered if I was about to have to incorporate a bloody nose into the story of such refined characters as Guenevere in Camelot!  Needless to say I developed a slight sense of paranoia around the whole bloody-nose-at-inopportune-times-thing.

I finally went to an ENT and had the little booger (no pun int) cauterized.  This helped for a few years but even the ENT said it may require repeat cauterizations.  Once the bloody noses returned they were truly few and far between, so I didn't worry with a second procedure.

But now here I am... pregnant and the flood gates just keep opening!  A few weeks ago I was at a birth and I had 3, count them T-H-R-E-E, nosebleeds at the most inopportune times!  The first time I was leaning over the mom applying pressure to her aching back and suddenly I felt the fast drip in the all too familiar nostril.  I quickly cupped my hand under my nose, unsure of a real nosebleed or just paranoia, and was able to catch 'er in time confirming my suspicions as blood started to fill my hand.  "Ugh", I thought... "seriously?!  Right NOW??"... I ran to the restroom and plopped in the floor stuffing tissue up my nose, thankful for a relatively quick mend.

A few hours later, the mom was laboring in a huge bathtub and I was leaning way in to reach her.  (Starting to realize my pattern of leaning over, aka more pressure to my head, aka you get the idea...)  Next thing I knew that familiar fast drip appeared again, and thankfully I was able to cup my hand and catch the stream JUST before my blood dripped into her water!  (I don't even want to think about having to get her out, drain the tub, and refill it had that blood made contact!)  Again, I was grateful to be aware enough of that all too familiar feeling so that I could quickly get out of harms way.

And finally, on the drive to the hospital later that day, I felt it yet AGAIN.  "ARE YOU KIDDING ME???," I'm pretty sure I hollered aloud.  While driving a stick-shift in busy northern VA traffic, I quickly scrounged for a tissue, or a sock, or...shoot I'd take anything absorbent!  I was able to find 3 Starbucks napkins in my glove compartment... so crusty and painful, I stuffed one into my nose pressing as hard as I could, but unfortunately this one wasn't stopping!  We arrived at the hospital and I had to send the parents ahead of me... I sat for 20 minutes, soaking every bit of all 3 napkins with my loveliness.

Once I joined the couple inside the hospital, their midwife immediately stuck out her hand to introduce herself... I felt so rude as I explained I needed to wash my hands first... that I'd just had a nosebleed in the car... and wanting to make sure she didn't think I'm some sort of coke addict or something I added, "because I'm pregnant".  She quickly gave me 'that look' of understanding saying, "oh yes... those nosebleeds during pregnancy are the worst, huh?"  Feeling the slightest bit validated I continued on with my work, thankfully blood free for the rest of the evening, though tasting a throat-full of bloody metallic yumminess.  As annoying as it was, to say the least, I'm happy to say I was able to walk away that night without truly interfering with the birth!

I'm not so excited to admit that I've had a nosebleed at every single birth since then except for one!  Somehow my nose just knows! Though thankfully, thus far, I'm always able to feel that crazy fast drip just in the nick of time so that I can sink back, fix the problem, and go on relatively unnoticed.  Last night at a birth dad came in the room to see tissues hanging out of my nose (a look that's starting to feel like part of my regular attire) and he asked if mama had punched me in the face!

While I sit here now... nose stuffed with tissue and that bloody-throaty-taste yet again... I think to myself that I'll be calling an ENT asap to get this sucker cauterized!  All joking aside, I actually think to myself that I'll gladly endure another, and another, and well... as many as necessary as it reminds me each and every time of the beautiful miracle of life that I get to be a part of and all the sacrifices mothers make for their children every day.  For that, words can not express how strangely honored and proud I actually feel... dangling tissue and all!

Friday, March 23, 2012

What do we really know?

It's been almost a week now and I am finally able to sit and share a recent experience that brought new meaning to the word faith.  I choose to write about this because it's not only therapeutic for me, but also because in my own agony I was unable to find ANY answers to help me.  Hopefully this will help someone else find hope in their despair.

On Thursday Feb. 2nd, Andy and I went in for our 8 week ultrasound.  Mainly ecstatic about getting to hear/see the little click of our baby's heartbeat and slightly nervous about the unknowns of what could be found, we headed to the hospital during Andy's lunch break.  In good spirits we went into the sonogram room, I laid on the table, scooted my bottom to the very edge, and placed my feet in the stirrups (I hate that part!).  The doctor proceeded to insert what I like to call the "white-Bob Barker microphone looking thing" or more appropriately termed, the "electronic array transvaginal transducer" inside me (check the links.. they really do look similar!)  It didn't take long for the good spirits and joking to subside.  The doctor stayed positive, saying that everything looked great, but that our baby was definitely not 8 weeks... but rather measuring only 5-6 weeks.  My heart sank.  He quickly said that our dates must be off, but I knew this could NOT be the case.  Not only did we chart with temperatures and use ovulation predictor kits, but we also travelled just after our last time together and I was away from Andy until just days before we got our positive pregnancy test!!  I explained that this couldn't be accurate... by his measurements my baby was basically conceived AFTER our positive test?!  Ummmmm.... this wasn't good.  Knowing me already through my work as a birth doula, the Dr. was prepared to chat with me about what on earth could be going on.  He knew that the questions would immediately start flowing and indeed they did.  He told me that he knew that  I "know too much" about how this stuff works (yet not nearly enough in my opinion) and so he was willing to tell me more than he would normally share with most patients. (Not that he wouldn't normally give full disclosure to a patient with questions, but he said that he would normally just decide the dates were off and move on.. no worries.  He knows that I was diligent with our fertility especially having had regular periods, and knows that it's unlikely for me to be WEEKS wrong.. so we chatted long and hard over this). He agreed that being so fixed on those dates made things quite questionable and decided that we should return in a week to see if the pregnancy was looking viable.  I asked him if this was like ultrasounds later in pregnancy, often substantially off when calculating weight and even due dates... he replied that 'no, in early pregnancy these things are incredibly accurate... even to the day'.  "OH!"  I asked, "are you measuring age from conception?? Then this would be completely accurate", and he said "no, unfortunately I'm dating the entire gestational age from your last menstrual period." I went on to ask many questions about miscarriage, his own potential margin of error, and also asked if he'd ever seen an embryo measure 5-6 weeks one week but to then find an accurate up-to-date measurement one week later?  He quickly said, "no... never that far off." After about 500 other technical questions, my heart began to break as I was grasping for answers.  You may ask why was my heart breaking?  Hello Juli, he said everything looked fine, it's just younger! Stop worrying!!  Because I knew what the alternative could be and so did he.  Our baby could have stopped growing at only 5-6 weeks (it was too small at this point to make out a heartbeat) and unfortunately only time would reveal whether or not this pregnancy was going to be viable.  We made the appointment to return in a week to see if there would be any change.  We left the hospital parting ways as Andy had to return to work.... though Andy's spirits never fell.  He was incredibly positive about it, and that never wavered, but when I repeatedly did the math it just didn't add up. At all.

I called my mother on the drive home.  Excitedly awaiting my call with my father, (and both expecting good news) she answered the phone squealing, "CAN I PUT YOU ON SPEAKER?!!!"....... With a wobbly voice I could barely choke out the word, "no" before I lost it.  Immediately I was bombarded with her questions, "WHAT IS IT?  WHAT'S WRONG JULI...... {my sobs}.....{waiting}..... WELL TELL ME!".  I couldn't speak... hearing my mother's voice only reminded me of how badly I wanted a turn at being a mother myself.... and so all I could do was cry.  I did my best to pull it together and told her of what had just happened.

My mother decided to come visit that coming Sunday... she would stay the week to help distract me and hopefully cheer me up.  The next few days leading up to her arrival were horrible.  I searched the internet constantly (always a terrible idea) desperately seeking some small nugget of hope...hoping to find someone else who had been through what I was going through, ideally with a happy outcome.  I did find MANY stories just like mine when googling "8 weeks pregnant but sonogram measuring only 5-6 weeks".   Unfortunately, however, the responses were never quite the same  situation and most weren't even good outcomes.  The ones that did turn out ok after their one week wait all said "but my periods are incredibly irregular so I guess we had our dates wrong."  Nope.. I couldn't have my dates wrong.  On to the next option.  Then I read, "either your dates are wrong or there is something wrong with your baby".  Plain and simple.  My heart seriously sank into my uterus.  Why couldn't I find ANYTHING saying that the darned sonogram COULD be wrong???  Maybe the measurements were off???  I did read somewhere that sonograms were "incredibly accurate, especially in the first trimester, within a 1-2 week range."  Um, last time I checked 1-2 WEEKS is NOT accurate!!! So that helped a smidge.  I also wondered how many people actually challenged their doctor when these findings were present?  I mean, how many women TRULY know when they ovulated or last did the deed to even prove that these measurements can be off? Most women just went on with their new dates and end up delivering 2 weeks early!  Some definitely did know their dates... and in many of the stories that I found, these women were going along with their doctor's seemingly off measurements but their main concern was in trying to convince their spouses that the baby was theirs!! They knew they hadn't been intimate (with each other anyway) during the newly proposed conception time and so husbands were looking at their wives with a skeptical eye!  Ok, that honestly does stink... especially if these people have been faithful to one another, but infidelity is SO not even close to on our minds right now!  The other women that felt strongly that their newly calculated dates were impossible ended up going back a week later to find that their baby had indeed stopped growing, that they had a missed miscarriage... then to go on to have a D&C or to finally pass the baby on their own.  The thought of these options just devastated me... to the point of feeling sick to my stomach.

Speaking of being sick to your stomach... I had been having regular nausea since just before 6 weeks up to our appointment.  Thankfully I wasn't vomiting, but I felt pretty crummy every day and the doctor was happy about this.  He was also happy that the yolk sac looked nice and healthy as did the embryonic sac.  "Normally," he said the yolk sac would start to collapse if the pregnancy was beginning to take an unfavorable turn.  But of course the second I left his office my nausea completely subsided.  Was it mental?  I assumed it had to be because there was no way it would just turn off like a light switch... especially if my baby had stopped growing WEEKS before.  That gave me hope, but I was paranoid and desperately wishing for my nausea to return.  I mashed my breasts non-stop to see if they were still tender.  They weren't.  I woke the next day crying because I just didn't "feel" pregnant at all anymore.  I felt heartbroken and empty.  As each morning came I awoke with that sinking feeling of heartbreak... the "oh yeah, this is really happening" feeling as I felt so sad and depressed.  After I obsessively computed the numbers over and over again in my head I just didn't feel good about the outcome.  Waiting a week was excruciating.  Hearing everyone say, "stop worrying, it's not healthy for the baby" was incredibly frustrating. "Yes, I KNOW that worrying isn't good for myself or the baby," I thought, "but I'm worried sick and everyone flippantly telling me NOT to worry is adding a TON of pressure... it's making me worry about the fact that I'm worried!" Needless to say, this was exhausting.

After a few days of my autonomic nervous system operating in hyperdrive, I realized that I had to make a change.  I had to pull it together... I had to have some faith in this little one, in my husband who seemed to be so sure of his gut, and most importantly in that oh so powerful higher power. Maybe we aren't meant to understand.  Maybe we think we have our science down to a "T" but in reality these little babies are miracles being created each and every day... why does mine have to fit into a specific scientific mold?  We are all human, the doctor is human... we all make mistakes, maybe the doctor made a mistake?  Machines make mistakes... maybe it was the technology?  I had to finally just give up and trust in miracles or I was going to go crazy.  I definitely grieved... I tried my very best to prepare myself for the worst outcome and then decided to put that away on a shelf.  I decided that I wanted to be positive for my baby.  While the advice was annoying I also knew it was true.  My baby needed a healthy environment to grow and I don't want it born into a little nervous wreck because it's mommy was such a hot mess! Every single time I went to the bathroom (and still do) I checked for blood... turning on lights in the middle of the night to quickly glance at the toilet paper, thankfully able to breathe out a sigh of "still ok" every time.  So needless to say the thoughts NEVER left my mind, but what I did with the thoughts had to change.

First I banned myself from the internet.  I wasn't allowed to look up threads on the topic or read for hours upon hours the sad stories that I was so dreading for myself.  No more.  I then sent out emails and phone calls to those that I knew would pray for us (telling details to the few who knew I was pregnant, and to the others just asking for prayer and positive thoughts in general).  I knew that I needed all the prayer I could get... one way or the other... and it was time to really turn to faith in God.  To trust that I would be given the strength, patience, and peace to get through this no matter what the outcome. I started connecting with my baby again.. the way I had before this dreadful scare... talking to my baby, laughing with my baby, singing to my baby, telling my baby stories, and praying and meditating with my baby.  I told my little one that I wasn't going to give up on her/him... that I'm here to fight for her/him and that I wanted "herm" (my combination of her/him) to grow at it's own pace, no rush, to be 'hermself' and that I will always love 'herm' for being an individual.  This made me feel better. It didn't give me answers but it did give me hope.

Then my mother came to town cooking us yummy dinners, talking me through my worries, laughing with me, and praying every day with me when my emotions began to creep back in.  Being mothered was what I needed and I will always treasure the time that I had with her that week..... mothering the mother like I do with my own clients.  And Andy... he was a rock.  At first I was frustrated... WHY wasn't he worried with me?  Did he not care???  When I expressed this he said, "OF COURSE I care more than anything Juli, and come Friday if things don't look good THEN I'll be devastated and I'll be worried... but right now I feel great about it, and one of us has to be strong for our baby!"  I told him that I hoped to God that he was right and that I would GLADLY say it over and over again if we were to learn of good news.  But my heart still sank when I thought of that upcoming Dr's visit.

I dreaded Friday with everything in me and yet Friday couldn't come soon enough.  I wanted answers but I didn't want it to be over.  I didn't want someone to say that this was the end for us.  Friday morning arrived as I knew it eventually would, and at around 10am I received a call from the receptionist saying that the Dr. was out of surgery early and wondered if I could come in sooner.  My heart skipped a beat... I quickly called Andy and we planned to meet there at 11am.  I jumped in the shower, shaved as fast as I could (didn't want anyone down there with it looking so frightful!) and jumped in the car.  On the way over my heart was pounding in my chest... literally.  Thankfully my mother was in the car with me and was able to talk me down.  This was it.  The suspense was poisonous.

Upon arrival they asked me to leave a urine sample.  I went to the restroom and am pretty sure that I stopped breathing for a few moments as I found a small amount of blood in my underwear :(  I panicked.  "Seriously??? NO blood thus far and now it's here???" I looked closer and noticed it was along the side of my underwear instead of where any fluids or discharge would be.  It hit me... "aha! my quick shaving job!  I must have cut myself!?" I was literally bent over in the bathroom craning forward to see if I could find the root of this menacing blood!  I wiped again and again but nothing was on the toilet paper.  I took a deep breath and thought... "you've got to calm down, you'll know either way in a minute."

The nurse took me back to get my weight and blood pressure.  I told her the blood pressure was pointless as I knew it would be through the roof.  The Dr. stopped in to see how I was doing... I told him that I was about to have a heart attack most likely!  He felt my pulse as the nurse took my blood pressure and he quickly commented, "you're going to blow a vessel if you keep at it like this!" 136/72... very high for me (it was 100/60 only a few weeks before). He knew I was beyond scared.  He said that he understood... and for us to hope for the best but be prepared for the worst... that we had a 50/50 chance..  'Reeeeallyy??? Only 50/50?'  Gulp... (I was hoping for more like 80/20).  As the doctor walked me back to the room and the nurse went to grab Andy and my mother, he asked if there had been any blood.  I inhaled my embarrassment, not expecting that question, and sheepishly told him that I just found some in the restroom but "um... I think I cut myself shaving..."  (Apparently I really am all about full disclosure!) ... he chuckled and quickly said "ouch!"

Next thing I knew that same room we'd been in the week prior became dark and I was scooting my bottom toward the very edge of the table and sending my feet to those darned stirrups all over again.  The crunchy-paper-cover-thingy was over me and I swear I could see it lifting as my heart began to POUND harder than ever.  I put my hand over my chest... sent a quick prayer upstairs, and asked my heart (aloud) to please calm down.  Andy stood by my side holding my hand while my mother waited in the corner.  The doctor explained that he would go in with the "Bob Barker Mic" (my words not his), take a look around, and then tell me what he'd found.  He had the screen pointed towards him.  "UGH..." I thought, "he'll be in there forever before he says what's happening..." I just wanted to cry.

Within seconds of Bob Barker's mic entry, I heard these words:  "Juli... looks like you've got a big baby in there!"  "WAIT... WHAT??  I DO????", I cried while grabbing his screen and pulling it my way without even asking.    "Yep!  Look!"  Right there before my eyes was my very own sweet little blessing.  My answered prayers.  I cry as I write this remembering my precious little miracle dancing right there for us.  Last week's barely-there fetal pole (aka a small line that faded in and out) turned into a small baby... a head, body, hands, feet, and I could swear I could see indentions of eyes, ears and a tiny little nose!!  The Dr. prodded at my uterus with The Bob Barker and the little one danced in response!  It was almost like he/she was saying "Hi mommy and daddy... see here I am!  I'll even do a dance for you, just pwease don't be sad!!!" The best part... there was a beautiful clicking heart beat that I so longingly dreamed of seeing!!  The doctor then chuckled saying, "Andy... I would go ahead and check that calendar if I were you!" but before we could dispute any dates he measured a 9 week baby!  This was exactly spot on with my original calculations (so being right about one thing might have been the second best thing about it)!  As I teasingly slapped the Dr's arm, I told him not to ever do that to me again, that he scared the.... (well let's be honest) he scared the sh*t outta me!  I asked "what the HECK happened???"  He looked at me and said, "honestly Juli I have no idea, but a LOT can happen in a week!".  I cried my eyes out, laughed a hearty laugh, and quickly (and gladly) told Andy that he was right :)

The mood immediately lifted.  We were able to bring home our first photo of our little one and Andy video'd the moment we learned that our little blessing was ok!  I'm not blaming anyone, but I want people to know that these things CAN BE OFF!  If you find yourself in our shoes, it does NOT necessarily mean that 1) your dates are wrong or 2) you're baby stopped growing.  I always say you're never out of the woods until you have a baby in your arms, but on THIS particular issue, I am happy to say that our baby defied the odds... whether by miracle or by human/mechanical error.  And when the Dr. said that he had "never" seen a baby measure 5-6 weeks and then "catch up" to 9... I do believe he can now say he has!

{Our little 9 week bean!}
"Welcome to parenthood!", another doula friend of mine said to me (she has 9 kids of her own!).  The immense worry and love and fear that comes along with babies is blinding and it's only just beginning!  I now realize that for me to get through life joyously, and to be the best mother I can be, I have to stay committed to counting my blessings each and every day and having faith that this whole procreation thing is OH SO very outside of our realm of understanding.... despite what we may think.  After this experience, I can be ok with that.

Monday, March 19, 2012

Saved by the husband!

So I'd like to start by disclaiming that the following is really embarrassing.  For me.  But I figure I didn't get to hear (much) about this symptom so I may as well share it so that somebody else won't feel so bad!  I'd also like to disclaim that this, while coming across as a 'complaint', is a welcome part of pregnancy, as I realize there are many out there (including myself) who would do anything to feel symptoms of pregnancy if it meant that a baby was at the end of the tunnel!

So with all of that said... I have gas.  And I'm not talking about a toot here and there.  I'm saying, BOY do I REALLY have gas.  You hear about nausea, yeah I've had that too but it's to be expected and thus far has been pretty manageable.  I have to pee all the time too... but again I expected this.  My breasts are sore and crazy itchy.  Expected that.  I'm also quite bloated to the point where sadly at only 6 weeks I looked about 5 months pregnant, and yes, I'm even a bit constipated.  (I told you this would be embarrassing for me... but what on earth is interesting about pretending or even lying that pregnancy is always pleasant and predictable?). But what I did NOT expect, or at least never to this end, was this gas!

It began in very early pregnancy... I mean even before I had taken a test.  Suddenly I had this bloated, full, gassy feeling that once unleashed would easily clear a room... or perhaps even an entire store.  Mortified by what my body was suddenly able to create, I initially giggled and knew that this must be a good sign!  However I will say that weeks upon weeks (ok months now) have passed... (ha. no pun intended) and so continues my gas!  The odd thing is that every morning I'm just fine again... I have a relatively normal day, (aside from that first trimester nausea) and then BOOM:  4pm hits and I have this sudden, uncontrollable urge, every 2-5 minutes to pass the worst smell in the entire world that lasts well into the middle of the night!  My poor husband is about to take up an 8 month lease in a hotel or something.  The dogs love it, which helps me to feel that their love is truly unwavering, but that's just gross :)

So why am I sharing this?  Well for a few reasons.  As I said, I didn't expect this to be such a debilitating symptom, and of course my friends, my sister, and my mother (you know, the close people you would dare ask) all said "nope.. didn't have that one"... so I figure if I can share it then it's out there for others to know:  It is VERY MUCH a HUGE symptom!  I'm also sharing it because it's quite funny if you think about it and I enjoy laughing at life's bloopers.  I'm scheduling my days and appointments around when I am least likely to seep one out without being able to control myself... literally thinking as I check my calendar if I take that appointment will I have THE gas at that time??  And I think about how I'll excuse myself during births every 2 minutes while a mother is laboring away... only to drag the horrific odor back into the room with me upon my return!  Talk about nausea!  (I'm thankful to report that somehow I've yet to need to pass gas at a birth!)

And if you're actually still reading this, I'll end with a funny little story.  You know your husband loves you when he takes the heat (lol again no pun intended but I'm laughing pretty hard over here) for your misfortune.  A few weekends ago we were going out to dinner with some friends of ours.  While Andy and I were driving over to meet at  their house, I accidentally slipped one in the car.  Of course the entire car immediately smelled of a rotten-egged-stink-bomb, and I began apologizing profusely to my husband.  We rolled down the windows, my husband gagging by my side, and went on about our night.  We visited with our friends at their place for about 45 minutes before we all headed out to the restaurant.  Since I can't drink, we decided I would be the driver (aka driving in our car...).  As we walked up to the car I had a sudden thought/fear... oh gosh, what if? what if it's NOT GONE???  I quickly opened my door trying to discreetly sneak a sniff before anyone else could get in the car.  Yep.  As feared, there was an old lingering eggy hot smell hanging out in the car.  Trying to think quickly and trying to pick the lesser of embarrassments, I said, "OH NO honey!  Your little problem sort of stayed in the car!" (Now mind you, this buddy we were with was Andy's old roommate when we met.. aka boys are gross around each other... so I figured I was somewhat safe with this little white lie!) With a glimmer in his eye and a slight smile, Andy said, "oh sorry guys"!  Phhhewww!!! I was completely saved by the husband!  We got in the car and our male friend laughed saying, "yep.. that's an eggy one dude!  I'll make a contribution if you'd like!"  His girlfriend said, "ugh, men...aren't they so gross?!"  I quickly agreed.  Andy winked at me and squeezed my hand, and until now it's been our little secret. So I doubt those friends will stumble upon this blog, but if they do... I guess I've just outed myself :)

To those of you out there who have gas in pregnancy and feel kind of embarrassed and alone... you're not!  To those of you who think I'm completely disgusting and have no intention of ever reading my blog or thinking of me the same way again... well so be it! I'm human and I think honesty in our human existence makes for a much more interesting (even when really embarrassing) life!

Saturday, March 17, 2012

This is our month!

Dec. 22nd was an incredibly special day for us.  Two years ago on that day, Andy had asked me to marry him.  This year, already in the Christmas spirit as I was loving the magic and joy in the air, I had a sense of calm over me... This is our month.  I just "knew it" for some strange reason that is truly difficult to explain, but it helped me in trusting that Santa was going to be especially good to us this year.

Oh, I should mention that I've wanted children my whole life.  I've dabbled in a handful of different careers (ok, 2), but the one career I always knew I wanted to have was that of a mother.  So naturally I had fears going in (and still do!) as to whether or not this process would be an easy one for us or a difficult one.  Working in the childbirth community and seeing so many beautiful births unfold, I often heard that fearful voice inside saying, "what if you don't ever get to do this?  What if you can't even get pregnant because you WANT to so badly?"  For years I've wondered this... "would MY body know what to do?"  I always worried that it may take me a long time to get pregnant (for no other reason than fear), so I did a lot of studying and research on fertility well before it was time for us to get crackin'.

You see then, that it comes with great joy and gratitude to say that we didn't have to try for long.  We actually decided we would start trying in November but the idea of "trying" quickly became stressful.  As any good little student of FAM (fertility awareness method) I had been charting my temperatures for months in preparation for November.  Like clockwork every month I would ovulate as I suspected, but then in November... just when I was relying on that very clockwork for our perfectly timed 'baby dance', suddenly I wasn't ovulating at all!  Everyone knows that stress can effect ovulation, and our work became such a chore that I quickly felt like my body just couldn't do it.  All of this coupled with my eventual ovulation date landing on Thanksgiving, while traveling no less, made for a month that we quickly wanted behind us so that we could start fresh!

But then something happened in December.  One day Andy and I were sitting watching TV and we just turned to each other smiling and said, I feel it... this is our month.  In agreement  we were now able to enjoy this process, somehow knowing this was it.  I continued to temp but only periodically.  I enjoyed some wine here and there with dinner and decided to have fun with this rather than stress (cause hey, baby-making should be fun, no?!).  Sure enough, as my fertile week approached, I took an ovulation predictor test and got a positive result the day before Dec. 22nd. (These tests usually 'predict' your ovulation 24-48 hours in advance).  "How exciting", we thought, "two years to the date that we were engaged we might just conceive!"  Like good little students we continued to do our homework* in those next 24 hours and hoped that it would pay off!  The next day (dec. 23rd) my temperature rose indicating that I had indeed ovulated!

*Our "homework" was actually still quite detailed in a somehow relaxed environment. (haha!).  From FAM,  to doing the baby dance every other day, to using Preseed, to ovulation predictor kits, ligament releases, fertility massage, red raspberry leaf tea, keeping my pelvis propped/tilted for approx. 30 minutes, and lots of prayer, positive thinking, and laughter etc. etc. ETC., we were by no means expecting a one hit wonder!

Naturally the next two weeks of waiting before we could test dragged on, though we were lucky to have Christmas and New Years filled with traveling, family, and friends to keep us more distracted than usual.  After charting for as many months as I had, I knew the usual pattern of my luteal phase (the period after ovulation leading up to menstruation) and what it usually did and didn't look like.  So sure enough, on Jan. 2 (only 12 days past ovulation and expected menstruation still 2 more days away) I took my temperature at my usual time of 5:30am.  As I gasped sitting up in the bed,  Andy asked, "what did your temperature do?"... I quickly responded, "it stayed up!".  Now this little tip-off was no sure sign for pregnancy by any stretch of the means, but usually my temp started to take it's little nose dive by this day before my expected period would arrive.  I shot up out of bed and said "I can't take it.. I have to test!".  So I quickly ran to the bathroom, grabbed a test, and wee'd away.  Both of us stood in the bathroom staring at the darned thing with hearts (ok my heart) pounding.  Within about 20-30 LONG seconds I could see the start of a very faint line BESIDE the control line!  "THERE'S A LINE!" I squealed... "um, I can't see one" replied Andy.  "BELIEVE ME, I KNOW WHAT THESE THINGS LOOK LIKE WHEN THERE IS NO LINE... THERE IS TOTALLY A LINE FORMING I TELL YOU!"  After another few minutes there was no question... a definite second line (though still lighter than the control line).  Andy turned to me saying "so wait.. this is it? Is this REALLY it??", as we giggled and jumped up and down hugging in the bathroom.  I quickly suggested (of course) that we take another test.  Andy said we should wait a day for my hormones to increase.  I agreed but I was BUZZING with energy and my mind was racing a million times a minute.  "Great"... I thought, "it's 5:30am and I have NOTHING to do for hours and NO ONE to tell!"... this was gonna be a long but inarguably amazing day!

{I can barely see that second line in this fuzzy picture, but I promise it was there!}

After about 2 hours of laying in bed, heart pounding and eyes wide open,  I finally fell asleep for a little while.  I woke with that all too cliche feeling of pinching myself to see if this was really happening.  I had a full bladder again and I couldn't take the suspense, so I quickly scrambled to the bathroom and decided to use one of those fancy digital tests.  Sure enough, before the allotted time was over, the word Pregnant was staring me in the face.  I immediately took a picture and texted it to Andy saying, "I couldn't wait.  Believe it now?" :)


So at the end of the day who knows if it was all the hard work that we put in that did the trick, or if we would have conceived just as easily with a one hit wonder... but knowing all that I did know about fertility, I couldn't just sit back and not try just about everything!  I can say that we did have a lot of fun this time around (even if the laundry list of to-do's sounds daunting!) but perhaps that was because we just knew, somehow, that we wouldn't be working on that to-do list for very long!

Friday, March 16, 2012

So I'M actually taking the Journey of the Bump too???!

Well the time has finally come!  Many of my clients, past and present, have often said that they can't wait to hear all about when I take this little ol' Journey of the Bump myself... so here we are!  A sweet little bean has finally decided to set up shop inside of me!! {And by finally, I should say that I mean that I've waited my whole life for this... but when the time came we were blessed to conceive after only our 2nd try!}. I've decided to share this journey through my blog since I think that I have a unique perspective. I am a childbirth professional who knows {and by knows I mean intellectually, intuitively, and through "experience" having studied and worked as a supporter and observer} her fair share not only about the major physical changes this journey brings to a woman's body, but also the hugely transformative experience of the mind, the heart, and the spirit through pregnancy and childbirth.  And yet, with all of this "knowledge" I have never been blessed with the chance, until now, to walk the walk myself (and we all know that talking the talk and walking the walk are two very different things!).  Those of you who know me, even just a tad, know that I am beyond thrilled to be taking a turn at this amazing experience!

So while this won't be published until my husband, Andy, and I decide to "go public" with our news (which means if you're reading this then I've finally made it to my second trimester!!), I've decided to start my blog from...well naturally, the beginning!  While I've decided to pull back on my work load during my pregnancy, I will still be attending births and providing bodywork, so of course I will enjoy sharing these beautiful experiences as one who is taking this journey alongside my clients.   I hope those of you who choose to read along will enjoy this journey with me as my professional perspective shifts, my own motherly fears arise and (hopefully!) subside, and if all goes my own precious little blessing enters this world in his or her very own special way.  Now here we go!

Thursday, March 1, 2012

A guide to choosing a care provider and place of birth

{Before I begin I would like to disclaim that I am in NO WAY against one side or another (regarding both care providers and places of birth).  In sharing information it is always a sticky task and quite easy to misconstrue factual information as having some sort of negative agenda.  This is in no way what I aim to do, as I am simply trying to bring greater awareness to society's knowledge on the subject through both research and observation.}

Choosing your care provider and place of birth during pregnancy is an incredibly important task and can feel quite overwhelming at times.  Often moms choose their care provider because it's someone their insurance covers and recommended in the area, he/she has been their gynecologist for years, they chose them from a quick internet search, or even from misguided information.  Some choose their place of birth simply because it is nearest in proximity to their home without knowing what the facility has to offer.  Without knowing what to look for, or that something better even exists, many moms end up frustrated throughout their pregnancy, labor, and delivery.  Whatever your preferences, do your homework so that you know your options!

OB vs. Midwife?  
Ah the start of this whole process.  Do you want an Obstetrician or do you prefer a Midwife as your care provider?  First it's important to know the difference between the two.  An obstetrician is an MD (a medical doctor) with a specialty in childbirth. Therefore many people say, "ok yeah, then that's the one I definitely want... because they know more, right?".  Not necessarily.  Don't get me wrong... OB's unarguably know their stuff, but it's important to note that just like any other professional, not all OB's are the same. {I'll come back to that point in a moment.}  In general, Obstetricians are considered specialists in pregnancy and childbirth, and are experts at identifying pregnancy and birth related problems and being able to counteract these complications with medicine or surgery.  They are surgeons.  This is often where they thrive.  In other countries you see a specialist ONLY when you have a problem.  OB's in other countries are only seen IF you have a complication or are at a higher risk of developing one.  So one might think, "ok well I'd rather have the specialist so that they can better find any unforeseen problems or handle them better if they arise... right?".  Not always.  Midwives are specialists too... but they are specialists in normal birth.  In other countries everyone sees a midwife first and then are referred to an OB only in cases where problems arise.  Midwives are also fully capable of identifying complications (proactively) and referring patients to an OB when a complication extends past their scope of practice (before, during, and even after labor and delivery).  So in other countries, if you mention having an OB, you might hear, "oh... I'm so sorry" as it indicates things aren't normal in your pregnancy.  And just to add a not-so-fun fact in case you're thinking "well other countries aren't as developed as ours, so they're just behind"... our country is actually ranked 41st for maternal mortality.  That means 40 other countries (some "less developed" than ours) have better birth outcomes than we do.  In other words in case you still don't understand: 40 other countries have fewer women die in childbirth than we do!  Quoted from an article from the LA Times by Shari Roan and Lisa Girion back in 2010, "Though the U.S. spends more per birth than any other nation, maternal mortality is higher here than in 40 other industrialized countries, including Croatia, Hungary and Macedonia, and is double that of Canada and much of Western Europe."  Why????  Well, there are many areas where we can point the finger, from maternal age being higher than it used to be, poor health, overweight mothers, heredity, poor prenatal care, to underserved communities.  But one of the major preventable causes that raises eyebrows is that of intervention. Roan and Girion also write, "Some experts implicate the rise in rates of cesarean sections, which account for one-third of all births — up from one-fifth in 1997. Although many are done to save the life of a mother and her baby, perhaps half are elective, meaning the surgery is medically unnecessary. After one C-section, cesareans are typically recommended for subsequent pregnancies. Yet these are major operations and "should not be taken lightly," said Dr. Michael Lu, a UCLA associate professor of obstetrics and gynecology. Each additional cesarean increases the risk of placental complications that threaten the lives of mother and baby." -- "The induction or prompting of labor by medication, which is sometimes medically advisable but more often performed for the doctor's or patient's convenience, has climbed so steeply — it now occurs in 22% of births — that the American College of Obstetricians and Gynecologists felt compelled to advise its members last year to avoid inductions before 39 weeks' gestation.  When labor is induced a week or so before the due date, the uterus may not be ready, leading to prolonged labor. After delivery, the exhausted muscle may not contract properly to stop bleeding. Blood can no longer clot and becomes the consistency of water."  {Click here if you'd like to read the full LA Times article on the rise of maternal mortality rates}  So while we can't be certain of one direct cause, we can start with "if it ain't broke, don't fix it!".  If a pregnancy is normal, then I believe (as do good doctors and midwives) that you shouldn't mess with it or try to make it abnormal just in an attempt to find something to do!  There is no need to try and better a very natural process by speeding things up with drugs or conveniently scheduling when your little one "should' arrive. With this said, and going back to my point about not all OB's being the same... there are most certainly excellent OB's out there who fully support and honor the natural processes of pregnancy and childbirth and only step in when a true need arrises.  So if you think you definitely want an OB, then that's great... just do your homework in finding the right fit (or if you're local, ask me!) :).  Again, I'll come back to this point on how to find the right one for you in a moment.  First let's talk about the "other side".  So we already know that a midwife is a specialist in normal birth.  But it's also important to know which kind of midwife you are seeking.  In some states there are both CNM's which stands for Certified Nurse Midwives and there are CPM's which stands for Certified Professional Midwives.  Basically a CNM is a registered nurse who has gone on to become a midwife. They are legal in all 50 sates.  She has privileges in hospitals, but is always overseen by a physician.  She is able to administer drugs and some insurance companies may cover CNM care. So again, some would say "then I definitely want a CNM because they can work at the hospital where we're safest, right?!".  That is certainly fine if you feel strongly about delivering in a hospital...  but do remember that not only are they overseen by a physician but some would say (and I'm making a general statement which does not in any way reflect my personal opinion of all nurse midwives) that they are really "medwives"  as they seem to push the same interventions on moms that OB's sometimes do.  Hm... why?  Perhaps a product of their medically minded environment, or perhaps some are wannabe OB's?... who knows, but I too have witnessed this in SOME cases.  I have equally witnessed wonderful nurse midwives who are just as natural and less pushy as the home birthing kind, so again, just do your homework when finding the right CNM for you!  Now on to CPM's.  CPM's are not legal in all 50 states, though they have been in VA since 2005.  CPM's cover home births and free standing birth center births in the area and do not have privileges in the hospital.  Some believe that they have more autonomy in their practice as they are not overseen by a physician (though it's important to have good relationships with physicians in cases of transfer). They do not administer medications but instead use natural methods in their practice and are fully trained and prepared for neonatal resuscitation if the need arrises (though less than 1% of baby's born at home or birth center need resuscitation).  

Home vs. Birth Center vs. Hospital
Now, just as some moms believe that they are safest at the hospital "just in case something happens", others believe they are safest at home.  It is always important to remember when comparing the two that often the "emergencies" that arise in hospital settings are created by the interventions that have been introduced there.  I'm not saying that hospitals are unsafe, but when people say "oh had I been home, I would have died... or had I been home my baby would have died" it's important to understand that at home, many of those same complications don't arise because no one is messing with the process with medical interventions.  It's important not to really compare the two as they are two very different avenues. With that said, unfortunate, unforeseen outcomes happen every day in both home, birth center, and hospital, so none of this is to say anyone is immune by choosing one vs. another.

  • Home birth (and I'll reiterate that home birth is for normal, healthy pregnancies and births): Moms are in their own environment where they are able to relax, eat, and drink without time constraints, and are able to move about freely while listening to their body as a guide.  They aren't tethered to IV cords or monitors (though it is important to understand that baby's heart rate will still be monitored periodically with a hand held doppler).  At home moms are able to avoid the sterile feel of hospitals, in a designated gown feeling like a "patient" (which often translates to feeling like one is sick or that something is wrong), and where they are able to avoid the constant poking, prodding and monitoring that has been shown to negatively impact the natural birth process by creating an adrenaline response to anxiety.  In addition, moms have a built-up immunity to the germs and bacteria in their own home (and therefore so does baby since they have mom's immunity) unlike the host of bacteria and viruses in hospitals. 
  • Birth Centers:  Some believe they are "safer" than home birth because it's sort of an in-between: not so extreme as home and not so medical as hospital.  While this isn't exactly true, it's about where you FEEL most at ease. Again, be sure to do your homework.  Is the birth center run by CNM's and physicians using medicine or even attached to a hospital?  This may be just what you are looking for as it can be a really nice alternative to the medicalized setting of a hospital. They are often just like normal hospital rooms that happen to look a little cozier, have a bathtub, and keep the interventions better hidden so they aren't as "in your face".  For some this is a nice "in between". Or is it a free standing birth center that is providing a birth much like a home birth (we'll call it a home-away-from-home birth) with a full staff of CPM's and birth assistants and more "natural" equipment?  This can be a nice alternative to home birth if you live in a setting either with roommates, thin walls, or just want to get away to a nice atmosphere that is already set up for your needs (usually already equipped with massive birth tubs!).  Neither is necessarily better... just know what you're looking for when seeking your birth center!  There are a few great ones in this area if you'd like more information.  
  • Hospital Birth: this is a great option for those who are certain they want to be at the hospital, definitely want an OB as their care provider, are at higher risk for complications, or are nervous about the idea of NOT being in a hospital.  Within the hospital setting, things are going to be much more medicalized, though it is completely possible to have a beautiful natural birth here if you so desire.  You will be monitored every hour (if not more frequently), you will most likely have a saline lock if not a full IV, you will have blood drawn, and will be limited (most likely) in what you are able to eat and drink.  In MOST hospitals (but not all from my experience), as long as you are unmedicated, you will be free to move around the room or walk the halls (when not on the monitors unless your hospital has wireless ones which would allow this throughout), you can usually get in the shower, or you can change positions with your doula on or around the bed.  All interventions are just a phone call away, but do realize that sometimes they are used faster because they are so readily available. 

Ok... so while this entire post could easily be about the comparison between OB's, CNM's, CPM's, where they practice, and the rise of maternal mortality (which let's be honest deserves a post all on it's own), I do still want to cover HOW to pick your care provider.  So how do you find the provider that's right for you? Happily, I can say, that these things to look for are important no matter which type of care provider you choose.  Unfortunately, sometimes the answers lie in the behavior and not in the questions... so do be observant when you're at your visits.

Scenarios and Questions

  1.  "I want a natural birth and I started asking my care provider questions about it at one of my first visits (8-12 weeks).  They quickly brushed me off by answering, 'we aren't even going to discuss this at this time... we'll touch on that when you're more like 30+ weeks'."  Ok... THIS IS A HUGE RED FLAG!  If your care provider can't take the time to answer your questions FROM THE BEGINNING, then be aware that they are just going to keep putting them off until you feel that it's too late to switch, even if you don't like what you hear.  (Though do be aware that while less convenient, it is NEVER too late to switch care providers!).
  2. "Every time I'm in the office I'm in and out in a matter of minutes and the Dr. never really remembers anything we discussed at our last visit."  Again, not a good sign!  Some large practices are so busy that moms start to feel like they're part of a factory.... just a number in a large line.  You should always feel that you are getting individualized care, from the start, and if you don't then move on!
  3. "I asked my care provider how they feel about having a doula present.  They looked at me kinda funny and then said, 'well yeah... I'm fine with that' but they didn't exactly seem encouraging.  Thoughts?"  Yes... this usually means that they don't love doulas.  They'll "tolerate" one, but do you really want a provider who has to tolerate the presence of someone you've hired?  (I can tell you personally, it's not fun for us!) or do you want to have a care provider that not only encourages it and wants to work as a team, but can even refer you to doulas that they've really enjoyed working with?  If you think you want a doula, it's important to have a provider who is equally happy with this choice.
  4. "My provider told me throughout my pregnancy that they were fine/supportive of natural birth, but now that I'm 39 weeks along, they're getting out the calendar to schedule my induction.  What do I do??"  I see this one more than most of the scenarios.  Some doctors are incredibly quick to induce if you go past your estimated due date, others even suggest it ON or BEFORE your date.  As always, ask the questions as early as possible. It's a very simple question that many moms forget to ask, or don't know how to ask, so here is an example: "how far past my due date are you willing to let me go without induction?  Are you willing to monitor me regularly around my due date with biophysical profiles/non-stress tests to make sure that my baby and I are fine?  If all is well, are you willing to let me go all the way to 42 weeks without medical intervention?" If not, how far ARE you willing to let me go?  If you find that you're running into this at the end of your pregnancy, don't ever be afraid to find someone who will allow you the time and space to go naturally within reason.  They do exist.
  5.  Get a feel for your provider's philosophy.  Do they believe that this is a natural normal process and are they willing to truly let it be just that until proven otherwise?  Or are they anxious types with a fear of lawsuits looming over their actions causing them to be intervention happy or quick to cut?  It's usually not difficult to tell when speaking to them which way they lean, but I have seen those providers that answer everything just as you hoped in pre-natals but when the big day arrives they seem like a different person.  For that reason, it's also a good idea to ask their personal intervention rates.  What is their rate of induction?  What is their rate of cesarean?  If it's a midwife, what is her rate of transfer?
  6. If you're someone who wants to write a birth plan, do so in enough time so that you can go over it with your care provider and gauge their responses.  If you have strong desires on your birth plan, make sure to listen to the answers they give you in regards to these issues.  If they aren't accepting of your wishes, and you know that your wishes are realistic, start shopping for another provider!
  7. I could never have a man as my doctor.  Women are much warmer and more empathetic.  Yes and no.  As I've said repeatedly, not all providers are the same.  I always thought the same for myself when thinking of my future care provider and then I saw some cold, bitter, and well.. just plain rude women doctors who have the, "oh buck up, you're just being a baby" mentality.  With that said, some of the best doctors I've witnessed in this area are male.  Sometimes they're more compassionate, and sympathetic to what their patient is going through BECAUSE they haven't been through it themselves and don't even pretend to know what they are experiencing.   Just a thought before potentially eliminating a whole gender of very suitable providers!
  8. Extend your homework to learn about your place of birth.  If you're delivering at a hospital, especially, look at the hospital's intervention rates. Are almost half the births there cesarean? (If so, that's high!) Are they an emergency hospital? (i.e. Do they treat every patient like their case is an emergency?)  Do remember that the entire team is part of your birth and you don't get to interview your nurses in advance.  A hospital that is used to more naturally minded parents and that sees normal births is going to be more flexible with your birth wishes than a hospital that is used to most of their births being high risk or having some sort of intervention at the very least.  In addition, find out the hospital's baby care protocols.. are they mother baby friendly?  Do they allow the baby to stay with you in your room and will they allow you that first hour (at least) to bond with your baby or do they take the baby away shortly thereafter to the nursery?  Do they leave you alone with your baby or do they feel that it's more important to weigh him/her and start vaccinating baby before you've even had a chance to breastfeed?  Do they allow you to at least DRINK fluids, (the good hospitals are coming around and allowing moms to eat actual meals just FYI) or are they stuck in the dark ages and only allowing ice chips no matter what your circumstances? Do they allow you to move around freely or do they make you have continuous fetal monitoring (rather than intermittent fetal monitoring) which keeps you tethered to the bed and its' surrounding areas?  If they do insist on continuous fetal monitoring (though most don't.. the recommendation is now 20 minutes on the monitor and 40 minutes off) will they allow you to unplug them to at least use the bathroom on your own (which in labor should be approximately every 30 minutes!). Do they allow a saline lock or do they insist on IV fluids at all times? If you are looking at a birth center or home birth, do they have the tools needed or do you need to purchase your own birth kit?  Do they allow water birth?  How far away are they from the nearest hospital and how often do they need to transfer?  Do they have good relationships with the area physicians if a transfer is needed?  All of these details are important to know when deciding on where you want to experience childbirth.

All in all just make sure that your provider is someone that you trust and feel is truly out for your best interest.  Make sure you feel comfortable enough to ask them even the toughest questions.... comfortable is key (remember you're going to have your panties off with them eventually!).  And always observe HOW they answer your questions, not just the answers themselves.   And for your place of birth, make sure that it is a place where you feel most at ease and safe.  If you do your homework, you can have a beautiful birth no matter where or with whom you choose to do it!