Do You See What I C?

**Warning. Frank talk about c-sections, innards, and other woman-stuff details pertaining to pregnancy and delivery. And I use the word 'vagina.' Might be TMI for some people.**

My first pregnancy and birth were what my husband and I jokingly referred to as a "Mary Poppins pregnancy." No morning sickness, no stretch marks, no grody varicose veins. All my previous ailments went away - seasonal allergies, lactose intolerance, citrus allergy, migraines, clinical depression, carpal tunnel, acid reflux, etc. You name it, it either went away, or was severely reduced in effect (I got the acid reflux back the 3rd trimester, but it wasn't ever as bad as it had been before I started taking medication when I wasn't pregnant.) And apparently I was rockin' a mighty fine preggo body, judging by the dagger-stares and muttered cuss-words from my sisters when they saw me prancing around in my undies one time. And while I started dilating early, at about 7.5 months, everything went well and she went to term with no complications or bedrest and was only born 3 days early. And as an added bonus, I got a bunch of extra ultrasounds and non-stress-tests where I got to see and hear her, just to make sure she was still doing okay the whole time (which she was.) Scoooore!
One of my Grandmas had super-easy, quick, pain-free labor, and it appears I inherited something similar.
That combined with my wide 'birthing hips' and my cervix pointing the right way made delivery fairly easy. The only tough part was the back labor, but overall it was only 11 hours from when I started timing contractions (while finishing a dungeon in Warcraft!) until she was born.

So other than my inability to actually GET pregnant, my body is apparently designed to BE pregnant!

Which totally paid off with this one. We had so many freaky little complications going on in my uterus, I'm amazed nothing 'bad' happened. Truly. First up was the 12-week ultrasound (part of a new test called a Combi-screen, with a very painful finger maiming blood draw combined with a high-detail ultrasound at a specialty high-risk clinic. This guy does all my ultrasounds. He's a doctor, so I get the information right away, as he's seeing it, rather than the technician doing it then having the doctor come and consult me about it later. And this guy is GOOD. He can check for Downs Syndrome, Spina Bifida, Cleft Palate, even Club Foot!) He found a twin remnant, which was kind of sad and freaky, since I hadn't known that the other embryo had attached at all. He also thought he saw a velamentous cord insertion and maybe a little bit of placenta previa. He said we'd check again at the 20-week ultrasound. Now, I'm still not sure what exactly a velamentous cord insertion is, and I was advised by my sister not to look into it too much. My husband looked it up a little. Something about where the cord attaches to the placenta, which makes it more likely to have an issue, thus leading to lower birth weight, and a slightly increased chance of miscarriage. And during labor, if the cord happens to be between baby and the cervix, then a vaginal delivery is unsafe, as the baby could suffocate herself by pressing against the cord. Placenta previa I knew some about. It's where the placenta covers some or all of the cervical opening, which is a risk when you start dilating, as it could burst a blood vessel, causing baby and possibly Mom to bleed out. Bad news.

At the 20-week ultrasound, he confirmed both the velamentous cord as well as the placenta previa, which was now a 'full' previa (which I think means covers most or all of the cervix.) Plus, as an added bonus, my placenta was a freaky shape, resulting in a bi-lobal placenta. Basically, instead of one big grody lump, I had 2 smaller grody lumps, connected by a thin bridge of placenta. One of these lobes was on my cervix. Yay. The major complication with this condition is low birth weight. Luckily, she was holding firm at just a little under 50th percentile in size. Now, we still had another 20 weeks to go, and with the uterus growing, it was still possible for the placenta to move off of the cervix, thus negating the need for a planned c-section. One could always hope! Plus this meant I got an extra ultrasound at 30 weeks! Another chance to see my beautiful baby girl!

Well, it was all confirmed at 30-weeks, so I switched from my midwives to an OB I had seen in the past for a surgery to remove polyps from my uterus a few years ago. (Yeah. Fun.) Plus she delivered my youngest sister's first child, and my mom and other sister had seen her as a patient in the past as well. I joked that she's seen 2 generations of vaginas in my family! One of the great things about my new OB is that she's very much an advocate for women's health and her patients. She listens to her patients, and she would rather do some extra unnecessary tests rather than not do enough tests. Plus she really knows her stuff! She was asking about things I hadn't ever even thought of (plus some I had wondered why the midwives weren't doing too.) And because of all the fun placental and cord anomalies, she talked about possibly doing an MRI to look for placenta accreta (where blood vessels in the placenta are attached to the uteran wall and require surgery and cauterization to remove!) which no one else had thus far even thought about mentioning. Joy.
The down side is that because she's so awesome and truly cares about her patients (if one of her OB patients goes into labor while she's working, even if she's not on call, she does their delivery!) her schedule is packed, and she is usually running behind, which results in a loooooong wait under that little paper sheet!

At the tail-end of 36 weeks, we did an amniocentesis to see if Little E's lungs were mature enough to do an early delivery. Nowadays, any planned delivery earlier than 39 weeks pretty much requires an amnio. My OB had wanted to do my c-section earlier in the 37th week (12/19,) but the OR was totally booked that day, so I was put on a waitlist. The earliest opening that fit into her schedule wasn't until 37w5d, on 12/22. The amnio is usually done the day before the planned c-section, except I was waitlisted for a Monday delivery, and they don't do amnios on the weekend. So I went in the Friday before (12/16.) And as it turns out, despite the amniotic fluid looking cloudy and mature, she was considered 'transitional.' Which meant her numbers were higher than a definite 'not mature,' but not yet at a number that meant definitely mature. The amnio doc called me after hours (!!!) to discuss the results, and said that a delivery on our scheduled date of the 22nd should be fine. And then my OB called me after hours and said the same thing. So since I wasn't having any complications or reason for an emergency c-section earlier, I got off the waitlist for the 19th and we stuck with my scheduled time on the 22nd.

But despite these potential problems (and my previous history of early dilation,) my cervix stayed closed, there was no bleeding, and she continued to grow and thrive in there, as healthy as can be. My OB told me that with all the hot mess going on up in there, she was quite frankly amazed we got to wait until our scheduled c-section at 37 weeks 5 days.

Once I found out I pretty much had to get a c-section, everyone who'd had one tried talking them up. But no amount of someone else loving them was going to change my mind about not wanting one. I was WILLING to get one, for the safety of my baby, but I certainly would have preferred the messier, more painful, longer recovery, and less needle-y vaginal version! In fact, I almost managed to go needle-free with my first one! I caved after about 10 hours of back labor and not dilating (I had started at 4.5-5cm going in, from the extra month and a half of dilating on my own) and asked for an epidural, just so I could rest a little. During the 20-minutes on a lactose ringer IV to rehydrate me first, I banged out to 9.5cm and powered through without the epidural. Yay!

Anyhoo, no amount of 'Oh my recovery was SO easy!" or "It was so nice being pain-free" could convince me that I wanted a c-section. I have a needle phobia. Now, most people say that they are scared of needles. But for me, it's an irrational fear. Inside, I'm screaming. My fight-or-flight instinct kicks in. I have a physiological reaction which causes increased heart rate, cold sweats, dizziness, nausea, etc (called a vaso-vagal reaction, apparently.) With all the rigamarole involved in getting IVF (loads of blood work, shots, etc,) I've pretty much managed to man-up for routine stuff. But I really hate needles that stay in my body, like with an IV. And needles that go in freaky weird places, like my mouth at the dentist, or in my frickin' SPINE! And I especially hate having to be cool and cooperative. I prefer my surgeries to be the kind I get to sleep through. Then I only have to think about needles in my flesh for a short time before it's all over and someone's feeding me ice chips and juice.

The anesthesiologist told me that if I started freaking out too much he'd knock me out. Normally, I'd be a big fan of that. But it takes longer for the grogginess to wear off, and I wanted to be there for Little E as soon as humanly possible. So while I was totally freaking out inside (seriously. I almost lost it a few times,) I focused on breathing. And trying to eavesdrop on my OB and her assistant MD. Who were doing their level best to talk too quietly to be heard. Meanwhile the anesthesiologist and one of the nurses couldn't stop jabbering on about their kids or something, which was totally annoying. My husband and doula did their best to keep me distracted and breathing (my doula reminded me right at the start to breathe, thus earning her paycheck all on its own. I totally would have freaked out without her there reading my body language and knowing when to help calm me down and when to distract me.) I originally had lofty plans to hold baby skin-to-skin in the OR, while they were closing me up, but really it was all I could do to not start screaming and flailing around in a panic. I didn't have the energy to focus on anyone but me. So it was nice to have Hubby in there to hold her and make sure no one swapped her out or anything. And it was nice having my doula there to make sure my husband didn't bumble around ineptly, and to check on the happenings on the other side of the drape. And to make sure I didn't go stark raving bonkers and get put under.

Cons of Having a C-Section:

• Pretty much everything. 
• No food, antacids, or WATER for 8 hours before. So basically I had to lay there sitting up; hungry, parched, and acid-refluxy, all night. Well, okay. Until 5am, when I had to get up and get ready to go to the hospital. Between that and trying to share my childhood twin bed with my daughter at my mom's house (so we wouldn't have to get her up and out the door early to take her there that morning,) I got, like, 5 minutes of sleep total.
• The Shakes. I had the shakes pretty bad for a while after. My doula had disposable hot packs she was using to help warm me up, but it took forever for the shivers and shakes to go away after I was back in my room.
• Catheter. Oh yes. Did I mention that these involve catheters? Apparently they do. And actually it wasn't so bad... until they took it away and made me get up and go potty on my own after spending a day blissfully staying hydrated. Heartless monsters.
• She took my uterus out to make sure she got everything. Which apparently can cause extra cramping and gas. And, boy howdy, did it!
• Needles. 
• Needles in my spine. 
• An IV that apparently required three attempts to put in. And then she ended up having to put it on the side of my wrist, where it was very uncomfortable whenever I bent my wrist. Like when trying to hold my child, for example. And then I had to keep it in for an extra day, just in case. Two weeks later I still have a scab on my wrist from where the needle got ground around in my flesh for 3 days. *shudder*
• Slasher-flick on my abdomen. 
• Having to be awake and not totally freaking out throughout. Gaaaaah.
• Plus for the first two weeks, it felt like everything was put back in the wrong spots. Freaky.
• Did I mention that she took my uterus out of my body?!

Pros of Having a (Scheduled) C-Section: 

• Being able to make childcare plans for the older kiddo.
• Extra day at the hospital.
• Being able to sit without the aid of an inflatable donut for the first few weeks.
• It stopped looking like there was a crime scene in my pants by Day 5.
• She was already all up in that when they discovered that I had placenta accreta after all, and she had to do some emergency cauterization and other fun stuff to get the placenta out and stop the bleeding.

Would I do it again by choice? Hells no. But, as luck would have it, due to the placenta accreta, I now have scar tissue or something on my uterus. Apparently on the cervical area. So if I get pregnant again, and the placenta happens to attach at that scar tissue (which is likely, apparently,) then it's pretty much guaranteed that I'd lose my uterus. And since it would be on my cervix again, I'd need another c-section. And even if somehow magically the placenta grew somewhere else, if I started dilating or tried for a vaginal birth, there's a chance that the blood vessels near my cervix could rupture anyway or something. So I'd be safer going for a c-section again and not risking it. Gah.

But I would trade my monthly visitor and the probability of not getting to have more kids in a heartbeat in exchange for another little one! And if I have to be disemboweled one more time for the safe delivery of my little miracle, then it's a price I will, once again, pay gladly.

The $15k price tag to get pregnant again, however, might be a deterrent!

What Child is This? (Or: Oops, I Did it Again...)

Now that she's over a week old, I've decided that she's okay and maybe we'll keep her... Just kidding. After expensive scientific procedures (and loads of needle jabs!) to create her, and weathering through some potentially scary complications to keep her in there long enough, it would be a shame to trade her in now... although I would like a new car...

Behold, my daughter, Little E! Born 12/22/11, 7 pounds 5 ounces (one ounce above the estimated birth weight made by the very-expert ultrasound doctor on the 16th when we did an amniocentesis to see if her lungs would be mature enough for a 37-week C-section.) Which is good news, trust me! All the fun complications I had going on in there usually lead to lack of growth and lower birth weights, so we were very pleased with our Little Trooper's sudden last-minute growth spurt!

**Warning** The rest of this post involves pregnancy and newborn words and concepts, such as 'breastfeeding' and 'uterus.' Nothing really gross, just maybe TMI for some people. Proceed at your own risk.

Despite the complications in her uteran environment and my having to get an early C-section, the worst was not yet over! She was born with something they call 'tongue-tie' which is where the frenulum (the membrane that attaches the tongue to the floor of the mouth) is shorter than usual. This results in baby having difficulty in breastfeeding, and can result in speech issues later. Plus, since it restricts the tongue from stretching out, she wouldn't be able to lick her lips or lick an ice cream cone! There's an easy fix, where the pediatrician clips the frenulum, and baby is over it and ready to eat within minutes! Sadly, Little E has a tongue-tie that's 'posterior' or something, so the hospital pediatricians weren't comfortable trying to clip hers. We have to see a specialist... who is on vacation until the New Year. Yay.
That combined with my slow-to-arrive milk and low-milk supply have resulted in a painful and frustrating nursing experience. But we power on!

Next up, she also got jaundice! Thankfully, it wasn't as bad as Little Z had. She and I had a blood-type incompatibility, where my blood cells had transferred into her body via the umbilical cord and were attacking her blood cells. We spent weeks getting almost-daily blood tests, spending time under the blue lights at the NICU and at home, and finally stuffing her so full of formula that we finally got all the bilirubins out!
For E, her levels never got panic-high, like they did with Z, and we were proactive about having them test for jaundice and the blood-type incompatibility from the start. Her levels kept going up, but always stayed just under the worry-limit. But the hospital pediatrician offered to let us stay overnight Christmas Eve in Pediatrics with the blue lights, or we could take her home and get the less-effective home-light bilibed on Christmas Day. We opted to stay and try and fight it off aggressively NOW, rather than wait and potentially have it get worse at a time where most doctor's offices and labs would be closed! Plus I could stay at the hospital with her, while my husband could take Z to family Christmas activities, and I'd have nurses who could help me feed E and make sure she was doing okay. At home, I'd have been on my own!

The lights worked great, and we got discharged in time to have Christmas with my family at my mom's house. She still has a little bit of jaundice, and we've been having to feed her supplemental formula through a tube, on top of breastfeeding, but the docs are no longer concerned. They aren't even bothering with blood tests. Yay!

Now our only problem is that she wasn't 'thriving.' She'd lost 11% of her body weight by Day 3 (5-10% is considered normal, but they expect growth by Day 5.) By Day 5, she still hadn't gained any weight. And we'd been supplementing her feedings with formula to fight off the jaundice, so the doctor was a little concerned. Little Z had either been not thriving or barely thriving when she was a newborn, but I had been breastfeeding exclusively the first few weeks, and not making enough milk. But with the additional formula, we had expected some growth from E. But due to the jaundice, she was fairly lethargic and would go 4 hours between feedings if given a choice, and would fall asleep almost instantly upon being held in my arms. So we had to start being mean and waking her up and keeping her awake and forcing her to eat more and more supplemental formula.  Ugh.

We were just okay'd to switch from the tube to a bottle, which makes life a little easier, since I don't need my husband there at every feeding (he's in charge of the tube, which is inserted into her mouth while breastfeeding. It's hard to get it in there right, and we'd have to re-do it several times each time she needed a burp or let go with her mouth. Argh.) So now he can be gone during a feeding; spending time with Z, going to the store, etc. But then that means each feeding takes longer again, since before we had it perfected to around 30-minutes (15-minutes on each breast, plus one-ounce of formula via tube on each side during that 15-minutes.) Then use my electric pump to stimulate milk production. Now I nurse for 30-minutes, then feed the bottle. Then pump. (Unless hubby is available. Then he gives her the bottle while I pump.)

We did a follow-up weight check on Friday 12/30, at eight days old. Finally! She'd gained 3 ounces since the previous weight check on Day 5, for an average of an ounce a day weight gain, which is what she should be gaining. So all our hard work paid off! Whew! And her color is sooo much better! Only slightly yellow now, and not a raging orange.

So, no fancy lunches or posts lately! I've been busy with hospital, healing, holidays, and spending 30-60 minutes every three hours crammer-jammering as much formula as humanly possible into my little Jellybean.

Why I Do a Doula - Support in the Delivery Room

For those of you as yet unaware from my numerous hints, blatant comments and gestation counter [up top in right column of blog,] I are pregnant. At this point, I am 26 weeks along. I was super excited to get the same doula that I had last time, and when gloating celebrating about it in a status update on my personal Facebook page, I got some questions as to what exactly a "doula" is.

A Tale of Three Sisters

Sister Three (S3) is having her first child. Sister One (S1) is super excited to get to be there, and is looking forward to getting to see a birth in action. This is especially poignant for S1, since she was ten-years-old when S3 was born, and was going to be allowed to be in the delivery room for S3's birth, until plans were thwarted due to an emergency C-Section.
Anyway, during S3's delivery, S1 was horrified to watch as S3 was only referred to in the third person (as "Mom," rather than her actual name,) and never spoken to directly by the staff or other family members present. "Have mom do this." "Watch the monitor, and during a contraction, push Mom's legs up and have her sit up and breathe." etc. When staff was even in the room! There were long stretches with no medical professionals present!
So S1 made it her mission to focus on S3, rather than the baby. S1 made cold compresses out of cold water and paper towels (until finally haranguing a nurse into getting an actual washcloth. Which was apparently a huge imposition.) S1 kept S3's neck and forehead cool, kept pillows fluffy (S1 had an epidural, so wasn't mobile,) and murmured words of encouragement. S1 didn't get to see baby come out (even though it's totally sci-fi-freaky-looking, one hears,) but stayed at S3's head, being emotionally supportive. When "Mom" asked questions, staff ignored her. S1 told her everything was great, even though S1 really had no friggin' clue.
S1 was totally peeved about the whole experience, how impersonal it was, even though S3 had her actual OB present, rather than a random on-call doc from the office.
S3's second and third babies were delivered via planned C-sections.

Sister 2 (S2) was having her first baby just a few months after S3 had her second. S3 had had several false alarms and fruitless trips to the hospital. So when S2 went into labor, Dad thought it was just false labor like her sister and made her wait a few hours before finally going the 30-minute trip to the birthing center and midwives S2 had chosen. Had S2 called S1, S1 would have taken her earlier. S1 went to all of S3's false alarms with her own overnight bag, snacks and extra pillow packed and ready each time! S1 even went and TOOK S3 to the last 2 false alarms, so dad could stay home with the older one. So S1 would have gone to as many false alarms as needed for S2.
S2's labor was fairly quick, so by the time they got to the birthing center, there wasn't time for the aromatherapy candles, setting up the music, and all the other soothing things S2 had planned for her birthing experience. S2 is still a little bitter, over 4 years later.

Sister 1 (S1) wanted a hospital birth, but not an epidural. S1 was not aware that there were midwives that could practice in the hospital, so went with an OB. S1 had just read in a pregnancy magazine about something called a "doula." S1 liked the thought of having someone there for her, rather than everyone focused on baby. S1 also liked the thought of having someone there she knew, rather than whoever was on-call at the time. And after watching many episodes of A Baby Story on TLC, S1 liked the idea of having someone there who knew what she was doing, who could help Dad not be the incompetent boob all new dads apparently are in the delivery room.
S1's OB/Gyn quit 1 month before her due date, to become just a Gyn, since she was tired of being on-call. S1 was pleased to discover that their office also had midwives (ARNP/CNMs) who were able to squeeze her in only because all the practitioners were trying to squeeze in the quitting OB's patients. Hooray!
S1 had her doula, midwife-in-training (there was another birth at the same time, so the actual midwife was going back and forth,) her mother, mother-in-law, stepmother-in-law, father-in-law, sister (S2,) sister-in-law, brother, and friend all at the birth (although the guys tended to wander into the lobby a lot during the labor part.) Plus the L&D nurse.
While S1 labored in the tub, the doula organized the sisters and whoever else wanted to help into a relay line moving cans of soda from ice box to rub against S1's back during contractions (back labor. Yikes!) and the old ones back into the ice box. Someone else was pouring warm water over the belly. (Ahhhh.) There were many wardrobe changes as S1 was forced to get out periodically to get monitored on the bed, then back in the tub, etc. Someone made sure S1 kept hydrated with water and ginger ale. Someone to hold the kidney-shaped "vomit bowl." Etcetera.
During delivery, the doula helped chose a birthing position, and organized family to help. One person on cold compress duty, someone else rubbing the back, Dad in front helping support S1's squatting position (and getting his arm squeezed too hard, apparently.) Then the doula was free to take photos (nothing X-rated, per S1 and Dad's request.)
And in the end, instead of being peeved that Dad couldn't read her mind, or preferred to hang out in the lobby with his dad, or the classic "I hate you! You did this to me!" as seen in movies and on TV, S1 had channeled all that irrational labor-anger at the doula! S1 had had an advocate in the delivery room to ensure that her wishes and needs were met, or at least taken into account, since they had talked about them prior to delivery (while in a calm, non-labor state!) S1 had someone giving suggestions, reminders of all the stuff promptly forgotten the second birthing classes were over. S1 had someone focused on making her birth experience everything she wanted it to be. And, in the event of a crisis with the baby or mom, S1 had someone to stay with her so Dad could stay with baby. And best of all? Years later, instead of feeling resentment or a sense of detachment or disappointment in the birth experience, S1 walked out of there feeling like her partner had been her partner during the birthing process... even though he really spent most of the time in the lobby with his dad!
Worth. Every. Penny.

Advice for choosing a doula:

1. Do your homework.
Having a doula present can be beneficial for both the mother and baby. Read up on it, to see if this is a right fit for you. I personally cannot recommend it enough. Even facing a potential planned C-section with this one, if they'll let me, I'd have my husband AND my doula in there. There are things he never ever needs to see, and my innards are right up there. But I also need someone who knows what to expect, someone I can trust, keeping an eye on things; telling me what's happening, making sure they do stitches rather than staples, making sure that everything looks right, etc. Then hubby can just be in there to hold my hand and follow the baby.


2.. Talk to your doctor or midwife.
Some won't work with doulas, in which case I'd chose a different practitioner, since I prefer someone who views this as a team effort, rather than views themselves as "The King." The ones who welcome doulas into their delivery rooms might even have some references for you! (My OB had a sheet of Xeroxed business cards, and we picked the one with the most certifications listed on it!) If not, you can look online for a DONA Certified birth or post-partum doula or go to DoulaMatch.net.

3. Interview prospective doulas in person before hiring.
I knew right away that the one we randomly chose was right for me. We're even friends on Facebook now! But you can discuss what you want out of your birthing experience, and see if their values and priorities jive with yours. You can see if this is someone whose face you're willing to stare at for any length of time. If this person's voice is soothing, or just grates on you. All kinds of subtle little things that go beyond "Are you available around my due date and how much do you charge?"

4. Call references.
Although I figured it was a waste of time, since I loved the doula at the interview meeting, and figured she wouldn't give us references from people who had bad things to say. My husband ended up calling, since the doula was insistent that we should check her references. He came away feeling better about my our choice not only in this particular doula, but in hiring a doula in general.