Sunday, July 24, 2011

The Reverse Time Out

This one works pretty well for my tantrum girl :P
Try it!

Monday, July 11, 2011

The Birth Story of Ryder Aaron Brown

Reyna and Rance took Bradley classes with me a few years ago when pregnant with baby boy Riley. They are an awesome couple, and Reyna especially just radiates positivity and energy. I want to be Reyna! When Reyna was 41 weeks and 2 days she needed a cesarean with Riley and you can read her birth story here. [Search Reyna].

When pregnant with her second child she knew that she wanted to try for a vbac and she did the right things by having supportive care providers and taking good care of herself in pregnancy. Here is her vbac story! [Note: One thing I think that is important about this story is that people need to know that vbac moms still have options to use medical pain relief if that becomes needed.]

The Birth Story of Ryder Aaron Brown
Ever since my first son, Riley, was born by c-section I knew I wanted to attempt a vaginal delivery the second time around. The doctor (Dr. Sandra Crowder, M.D.) who was on call that day and delivered Riley fully supported my plans for the future. She double stitched my uterus following the c-section as well as said she would take me as a patient when the time came around again. The only potential problem would be that when I went into labor I would be at the mercy of the on-call doctor which may or may not be her. She reassured me that "most of" her colleagues felt the way she did about VBAC’S and I shouldn’t have any problems as long as I go into labor on my own. It was hospital protocol that no induction methods can be used on a previous c-section mothers. If they don’t go into spontaneous labor on their own by 41 ½ weeks, another c-section would then be scheduled.

My pregnancy was a great one. I was able to remain active and healthy the entire time and I loved every moment of it. It all seemed to pass by in the blink of an eye. As the end grew closer and closer I was filled with doubt. I was haunted by the memory of the birth of my first son and how my body never went into spontaneous labor. A million questions ran through my mind. Would it happen again? Could my body birth my second son all on it’s own? Was a VBAC really possible and realistic? Then, finally at 39 weeks and 3 days pregnant, it happened.

Saturday, July 2nd, started like any other Saturday. We were getting ready to meet my parents and head up to the lake for the day to celebrate the 4th of July weekend. Had I known what was ahead of me later that day I would have stayed home and slept the day away. I didn’t know though so off we went. The temperatures reached triple digits early that day but the lake water was refreshing and spending time soaking up the sun with my family made for a great day. After lunch, the menstrual cramps started. I didn’t think much of it because I’d had them from time to time throughout my pregnancy. Still though, I was tired from the sun so we decided to head home early. The cramps began to worsen but I figured that I was dehydrated and had overdone it at the lake so I started downing water. Then, around 1pm I got my first contraction. I still denied it and proceeded to lay Riley down for his nap and took a nice relaxing shower. I started watching TV in the recliner when I realized that the contractions were coming about every 15 minutes. I still shrugged them off as nothing at this point. We wanted to head to bed early that night so we decided to have an early dinner around 3pm. Immediately following dinner is when the stomach upset started. I knew then that something was definitely going on but I was afraid to get too excited and I wanted it to get significantly worse before jumping to conclusions. My wish surely did come true. At 6pm the contractions started coming closer together, about 7-10 minutes apart and were becoming more uncomfortable. Rance began to officially time them using an app on my Android called, Daddy511. I text my parents letting them know what was going on and to be ready to potentially come over and stay with Riley if everything continued. 8pm is the time that I consider my "labor" starting. Really it probably started at 1pm but it was 8pm when the contractions were so painful I couldn’t talk through them and I had to concentrate and just breath. According to Daddy511 and of course Rance, it was time to go to the hospital. The contractions had been 5-7 minutes apart, lasting 45-60 seconds since 7pm. We kissed Riley goodnight and laid him down for bed. My parents came over and my dad stayed at my house with Riley while my mom accompanied Rance and I to the hospital. The drive from Hesperia to Fontana Kaiser Permanente felt like an eternity but I was still in good spirits between contractions and very excited. By the time I was checked into triage at Labor and Delivery, the contractions were coming every 3-5 minutes and were extremely painful. I was relieved to hear that upon arrival I was dilated to 6cm, fully effaced and wasn’t going anywhere but to a labor room. Once we were admitted to a labor room my mom joined us. We had the nurse dim the lights. I turned on an app with relaxation music on my phone and plugged in the headphones so I could zone out. Rance massaged my arms with lavender scented lotion to aid me in my relaxation. I continued to breath the best I could through the contractions but I was quickly running out of steam. At midnight we decided to get a shot of Nubain in efforts to relax me enough to rest for what was still to come. I say "we" decided because Rance and I discussed every intervention as a couple. This was "our" baby and we are in this together. Unfortunately, I continued to labor through the night without any rest. At 7am a familiar face came to see us. It was the on-call doctor, who just so happened to be the OB who followed my first pregnancy (Dr. Karl Urban, M.D.). I had seen him a few times in the weeks prior because my primary OB was unavailable. He was the one who ordered the iron infusions for my severe anemia. We were so happy to see him but sad that the end of his shift was at 8am. He checked me and I was now completely dilated and effaced! So let’s start pushing right? Wrong. The problem was that Ryder was not engaged at all and my water was still intact. He then suggested one of two things to us. 1.) Rupturing the bag of waters in efforts to bring Ryder down. He told us that since the water was bulging the cervix outward, my dilation probably wasn’t accurate. The cervix dilation would be less after the rupturing but I should reach a true 10cm in not too much longer of a time frame. It’s the engaging of Ryder that would potentially be the long part. To our surprise, the second thing he recommended was the epidural. He could see how uncomfortable and tired I was. At this point I hadn’t eaten or drank for 16 hours and hadn’t slept for 24 hours. He said that I still had a way to go before pushing, I needed to conserve my energy and it would be giving me and the baby the best possible chance for a successful VBAC if I got one. We had two main concerns with the epidural. Our first concern was it stalling my labor. We didn’t want it to slow things down or stop my progression completely. We knew that the next on-call doctor would determine whether a little Pitocin (which could jumpstart things again if I stalled but is a form of induction which is not something all doctors are in favor of doing. Most will give it if a mom is already laboring on her own and just needs help but not all) was something favorable or not. Our second concern was the sensation to push. We didn’t want the epidural to numb all the feelings away so I could still feel to push. Dr. Urban reassured us that my body would continue to progress and I would definitely feel enough to push Ryder out. The epidural would be nothing like the spinal I had received with my c-section, which is what I had pictured in my mind. Needless to say, we agreed to both of his suggestions. Shortly thereafter, the nurse anesthetist came in to do the epidural. She commented on how calm I seemed for being 10 cm and how she had never done one on someone who was already complete. "Congratulations for coming so far!" she said. I told her, "Thank you. All I want is to have this baby naturally." I was very pleased by just how much feeling I still had in my extremities after it kicked it. Once the epidural was placed Dr. Urban returned to break my water. He has been practicing for 30+ years in the field of OB/GYN and he said that in all his years he had never seen a mother with so much amniotic fluid before! Upon breaking my water, the amniotic fluid flowed down the bed, soaking my socks and poured off the bed onto the floor. It continued to do this for a few moments as the nurse ran to get more towels. I immediately felt and saw my belly get smaller. Ryder looked great on the monitoring strip and had tolerated everything well. Once he re-checked me I was now at a true 6cm. At this point, the night shift was off making way for the day shift. I knew that the day shift staff would be with us for the delivery so we were praying for good staff. Next thing we know the day nurse walks in to our room and to our delight it was the same nurse we had when Riley was born! Torria. She would be the one to see us through to the end, again. The hours went by and my contractions slowed down a bit. Torria informed us that the on-call doctor (Dr. Inocencio-Diaz) wasn’t one of the doctors who favored giving Pitocin to a previous c-section mother. My heart sank and panic set in. What if I needed it and couldn’t get it? Would it all had been for nothing? The supportive words of my mother and husband kept me focused and renewed my faith in what my body was doing. It was doing exactly what it was made to do, on its terms, at it’s own pace. Torria commented on what a happy baby we had. His heart rate and activity were picture perfect on the monitoring strip which brought us all great comfort. By 11:30am I was completely dilated and thankfully still contracting on my own, about every 4 minutes. Ryder however was still at 0 station so we had some more waiting to do before we would be able to push. With every contraction I would close my eyes and visualize Ryder descending down to where he needed to be. I prayed that I would continue to progress and be able to give birth to him naturally. By 1:30pm I was starting to feel a lot more of the contractions as the epidural wore off. I was grateful for this. They checked me, Ryder had fully descended and we were finally able to start pushing! At 2pm, with my mom on my left side and Rance on my right we started to push. Pushing was much harder then I had anticipated because I was literally running on empty. 20 hours of labor, 31 hours without sleep and 23 hours without food, embarking on the hardest thing a woman will ever have to put her body through. With every push I could hear the gasps of my mom and Rance as they could see his head coming further and further out. "He’s got black hair, baby!" exclaimed my husband. It motivated me to keep giving it all I had. More medical people joined us in the room and I knew I was really getting close. One nurse commented to Torria, "Oh, she’s a VBAC! Good for her!". Torria responded, "And she got here all on her own! No Pitocin needed!" Finally, I heard someone say, "One more good push, Reyna and we’ll have a baby". So I pushed with everything I had left in my body! I felt Ryder’s head come through, out from under my pelvic bone and out into the world. After one hour and nineteen minutes of pushing, Ryder was finally born! Unlike Riley who had been entangled in his umbilical cord, Ryder was free to cry and did so immediately. Which then caused a chain reaction between all of us. "We did it! He‘s here!" I cried. It was an amazing moment. To quote my husband, "Seeing it on TV is nothing like being here and experiencing it in real life with the one you love. It was unbelievable to see someone I love so much give life to someone ELSE I love so much!" I spent the next hour skin to skin with our 7 pound 2 oz 19" son, Ryder and Rance was at our side. Ryder nursed right away and was fully alert and looking into our eyes the entire time. Another layer of my heart was revealed the moment Ryder was born. I fell in love with him instantly. An unexplainable love. Its incredible! I was and continue to be in awe of what my body did. I should have never doubted the process. The body isn’t going to start something it can’t finish and the design of giving birth is one of greatness. We are so proud of what we accomplished. We want to show others what’s possible. Just because you have a c-section once doesn’t mean you have to have one again. Every pregnancy and every baby is different. Hopefully other couples who want the same thing will be inspired by our story and persevere to get the outcome they desire and deserve. We had wonderful medical staff who supported us from beginning to end and it made all the difference in the world. This time around, we couldn’t be happier about our birth experience and the beautiful outcome.

Congratulations to the Brown Family!

Saturday, July 9, 2011

Food for Toddlers

It can be a tricky thing feeding the little ones who aren't breastfeeding as much and frankly don't seem to like to eat! This post is as much a reminder for me as it is for those of you who now have an older baby.

1. Scrambled eggs- Eggs are a good weaning food because they have many of the same vitamins and minerals that are present in breastmilk. Dr. Brewer always liked to say that an egg was like a prenatal vitamin. When babies have a picky diet, eggs are a good way to fill in nutritional gaps.

2. Beans- good protein source and easy for little fingers to pick up. My toddlers have liked black beans a lot even spooned out straight from the can without heating. When drained and rinsed they travel well too.

3. Frozen peas- I completely forgot about this one until I saw Erica F at the park with her little boy Justin and ALL of the kids were vying for his peas!

4. String cheese- It's easy and convenient. They can tear it off themselves or you can cut into little disks.

5. Rice balls!- My toddlers (and even when they get older) have always liked to eat rice balls. Just make plain white rice and scoop out with a small melon baller.  It makes it easy for them to pick up and put a nice gob into their mouths.

6. Pretzels, saltine crackers, Fritos, Lays potato chips, tortilla chips- All of these fall into the "crunchy salty carbs" category and I don't know any toddler who doesn't chomp on these items pretty frequently. Some may be surprised at my inclusion of Fritos and Lays, but when comparing nutritional content, they actually have less sodium per serving than a serving of graham crackers, with very similar nutritional content otherwise. Plus Fritos are made with "whole corn, corn oil, salt. No preservatives". That's a pretty natural food if you ask me!

7. Smoothies- a great way to get lots of good food into a yummy drink! If you make your smoothie with mixed berries you can add some frozen chopped spinach to the mixture without affecting color or flavor.

8. Waffles- I enjoy making Bisquick waffles and substituting some of the mix with oatmeal and flax seed. I add some chopped walnuts as well. These are good to make in bunches and freeze.

9. Crock pot meats- My kids are picky but they always love any meat out of the crock pot.

10. Bananas- I used to joke that my house came to a standstill without milk, juice, bread, eggs, and bananas. I'm actually not serving bananas as much these days, but it seems that the banana is a staple toddler food so I have to include it. When they start to get too soft, peel and put in the freezer to use for your smoothies.

Do you have any staple toddler foods in your home?

Thursday, July 7, 2011

Low Amniotic Fluid

This is a story about low amniotic fluid and how a normal check up can potentially turn major intervention in a matter of hours.

I got a call this afternoon from a client saying that she was being sent to Kaiser Riverside to do a non-stress test on her baby because of low amniotic fluid. She had gone to her regular 38 week appointment and the doctor was having trouble locating the baby's heartbeat from the hand-held doppler so she decided to use the ultrasound machine. Her doctor quickly found the baby's heartbeat but then commented that she had low amniotic fluid. A score of 4.7cms. Normal levels range from 5-25 centimeters although it's common to be in those lower ranges at the end of pregnancy. The concern with low amniotic fluid is that it can sometimes indicate that the placenta is not functioning as optimally as it once was (aka it's "getting old") and that could be compromising the baby. Other reasons for lower fluid levels are dehydration or simply that the mom's fluid levels are lower. What may indicate a problem for one mother, may be normal for another. That's why it is so important to check things out and look holistically at mom's and baby's health.

I do agree that non-stress tests in these situations can be helpful to rule out the concern that the baby is compromised. It is also important to note that the fluid must be measured in the deepest pocket to get an accurate reading. In this mom's case, the technician was unable to find other pockets because the umbilical cord was in the way.

After drinking two bottles of Gatorade before going into Kaiser Riverside, her levels were at a 4.9 but her baby looked great. The technician called the supervising OB and stated the fluid level but also mentioned that the baby looked really good. Despite this, my client was told to check into labor and delivery to possibly be induced. It is important to note these two facts: #1 Induction of labor in first time moms leads to a 44% cesarean rate versus an 8% rate for mothers who go into labor spontaneously. And #2 Low levels of amniotic fluid are no risk to normal birth provided that other tests are normal.  

When the induction was recommended, my client asked if she could just continue to be monitored twice a week to make sure the baby was doing well. Her doctor was not comfortable with that and stated that she didn't want her coming back in a few days with a dead baby. 

The dead baby card. For anyone who has wondered about the dead baby card, that's what it looks like. It is incredibly difficult to think not to mention make rational decisions when you've been handed this card. It's terrifying and it speaks to the soul. It's amazing how an average 38 week check up can snowball into  an induction of labor in a matter of hours, even for a healthy mom and baby.

The problem here is risk. What is the risk of low amniotic fluid provided all other health vitals are normal? According to research, not much at all. What is the risk of induction of labor on a 38 week pregnancy? Essentially taking a perfectly happy baby and stressing him out with hours of pitocin and stressing the mother's body out as well, leaving her with a high chance of failure to progress, fetal distress, or any number of induction-related risks?

She and her husband decided to decline the induction (which means they had to sign the Against Medical Advice form) but agreed to come back every two days to have the baby monitored. This seems fair to me. Despite handing out the dead baby card, her doctor did ultimately say it was her choice and supported her in their new plan of action. And incidentally, right before she left her doctor decided to do one more ultrasound and announced that her levels were a 6.

Why I Love Childbirth- from the BostonShumways

A former client of mine sent me this great post that a friend of hers wrote. She knew I would love it and she was right!

why I love childbirth.

I love giving birth.  Maybe that’s why I’m so anxious to have this baby, NOW!  (That and the fact that all my help is here and we have nothing to do but wait).
Let me say it again, I. Love. Giving. Birth.
I think it is the greatest adventure I’ve ever experienced.  (And I think I’ve had a lot of great life adventures.)
It is hard.  It is work.   It is real and huge and primal.  And all those things are what I love about it.  Those intense feelings that you never feel in the hum drum of everyday life.  They are what make it a miracle.
My biggest nightmare when I’m approaching my due date is that I’m going to have the baby and somehow not experience the birth, the pain, the challenge, the triumph.  I’ve never felt so much in my life.  And I like to feel.  It’s what I believe we’re here for.
And I’ve never felt so close to heaven.  Giving birth is the closest I’ve been to God.  Creating life with Him.  Depending on the Atonement and the Savior’s grace to get me through what I can not do on my own.   In that moment of transition when I feel terrified and alone and weak and near death….. I am carried.  And then comes the cry from a new life.  An old soul squished into a new body.  Here.  Under my stewardship.  Ready for living, feeling, suffering, experiencing, breaking, healing, enjoying, rejoicing.
I’m hesitant to even write about this on the blog because everyone has such different experiences with childbirth. I know a huge huge part of the reason giving birth is so amazing for me is that my body is set up right for it.   My labors (so far) are intense and hard, but doable and don’t last too long.    I don’t want to sound na├»ve in writing about this…..I know many women who have believed in the power of childbirth, have prepared for it and thought about it and it hasn’t turned out to be magical for them for one reason or another.  But I also know a lot of women who haven’t thought much about what this experience can be  and childbirth hasn’t turned out magical for them either.
I just want to put it out there that Childbirth can be an amazingly transformative, empowering experience with the right help, the right support, the right education and some luck.
I think what is important about childbirth is that we think about it, that we research and learn and be proactive and trust ourselves and our bodies..   When I was pregnant with Hazel my journey started out just following what I thought everyone else did.  Get a doctor and go to the hospital that could help me in the highest risk situation.   I didn’t think much about what birth really is and can be until some dear friends gave me some books to read, suggested I think about a few things and gently opened up the wide world of birth to me.  I researched and read and learned all I could.  I thought about what I wanted, what was important to me in childbirth.  I read about people’s experiences. I started forming my own dreams and creating space in my life for Childbirth to transform me.
I decided that I don’t think it matters as much what kind of birth we choose, but that we really choose and don’t just let this miraculous event be controlled by our culture, our assumptions, our doctor or midwives, our friends.  Where and how we give birth should be a deliberate journey.  And then, once we’ve chosen our path and started down it we are aware and educated and can deal with all the unexpected things along the way.
So, for what it’s worth, here are some of the things I love about childbirth:
  • I love it that childbirth connects me with all birthing mothers throughout all of space and time.  I know that sounds pretty new agey and maybe a little strange, but it is a real connection.  I remember before Hazel was born wanting so much to experience what my grandmothers and great grandmother connect with that great power of motherhood.  Some people believe that as babies go through the birth canal all their nerves are kind of squeezed into functioning……it prepares them for life.  I think in the same way the sacrifices and ‘labor’ of childbirth prepare me to mother powerfully.  They teach me about my power and also my weakness and my reliance on God.  
Birth is not only about making babies.
Birth is about making mothers ~
strong, competent, capable mothers who
trust themselves and know their inner strength.
Barbara Katz Rothman
  • I love the places I go during a contraction.  During some, I connect with my baby.  I envision all the productive things the pain is doing inside of me to help my baby come out, I think of a wave washing over and melting things away to make room for the baby.  During others I put myself on the beach at bear lake on a calm august day.  It is still.  It is calm.  During others I think of all those mothers all over the world that are laboring in different places and in different ways.  I think of the mother in Pearl BucksThe Good Earth who delivered her child on her own, strapped him on her back and went back to work in the fields.  I think of the indigenous woman I read about in my college anthropology class who went far away from the village, birthed her baby, bit through the cord, buried the placenta and walked back to the village triumphant with her child.  And then I look around and count my lucky stars that I’m in a beautiful birth center surrounded by so much support.
  • I love my birth team.  My doula who quietly coaches Jeff through supporting me.  My mom whose empathy and compassion give me strength.  The competent, reassuring care of the birth center midwives and nurses.  Everyone totally zeroed in on me and what I need.  Riding the waves of each contraction with me in the ways that I need them to.
  • I love the Cambridge Birth Center.  Just walking into that place makes me feel powerful and at peace at the same time.  They dim the lights when I want them to.  The medical stuff for emergencies is there, but I don’t see it.  There are big tubs to labor in.  Comfortable homey rooms to recover in.  It’s quiet.  It feels like home (only much better because there are no dust bunnies and I don’t have to worry about cleaning it).
  • I love the work of labor.  It is a challenge.  It pushes me to all of my limits.
  • I hate pushing, but love it too.  Finally I can do something with all that pain rather than just let it wash over me.  I can grunt and breath and push and yell. 
  • And then there’s the rush and the relief of that baby coming out.  Yes, the burning is hell, but the slithering of the rest of the baby’s body, that first cry, that wriggly blue body being placed skin to skin on you.  The start of a new life right there in front of you. 
Sure, this is a pretty glorified view of it…..but I think (if everything goes well) when I write again in a few days after going through it again these feelings might even be stronger.  I just think if everything progresses normally and if you have the right team and place childbirth is the most exhilarating, empowering thing you can experience. 
For some pretty amazing pictures of birth check out this photographers website (warning, some are pretty graphic to our eyes that are so trained to reject primal looking stuff…..but I think it’s that primal stuff that makes it all so amazing.  That, and the amazing expressions on everyone's faces as they greet a new life.