Tuesday, February 23, 2010

Still Waiting & Nesting

At 37 weeks, everything is going good. Because I had some things I needed to get done, and was wondering if the baby had "dropped" or not, I had my midwife go ahead and do a cervical check when she did the group B strep test. Everything's still high and tight, so it looks like baby's going to hang out and bake a little longer [ie, cervix is still closed and posterior, no dilation or effacement, and he hasn't dropped]. I'm still measuring a little ahead on fundal height, and he's probably going to be a big boy, but we already knew that, and my midwfie, unlike the OB, is not freaking out about it or seeing it as a reason to plan an early induction or section.

I was involved in a minor car accident this weekend [was rear-ended at a stoplight], but both the baby and I are fine, although I was told to take it easy for a few days just to be on the safe side. With that, I am officially taking a break from work, because it's to the point where it's really a little too much stress and activity to plan on showing houses right now [some days I'm fine, others I'm totally wiped out and it's hard to work with people and do walking and stair climbing with low energy and soreness]. I do plan to go back to work some as soon as I'm recovered from the birth, but hopefully I'll be doing more working with home sellers than buyers, which is easier to schedule and will involve less driving and time away from the baby during the day [I have a full home office, and can work from there as easily as from the main office, with fewer distractions].

I am still nesting like crazy too, and wanting to finish all these home projects, and I think that is spreading to my husband as well. It was driving me nuts this weekend, because I wasn't supposed to be up on my feet doing things, so I didn't get a whole lot done. He did finish installing the tub though, and I spackled and patched the walls where they got dinged, and where he had to cut to get the tub in, this morning. He's going to sand things down when he gets home, so I won't be breathing the dust, and then I'll paint the wallboard behind the surround tomorrow, to cover the bad spots and give the adhesive a good clean surface to stick to. Once that's dry, he'll put up the surround, and I can do a good deep clean and put all the stuff back where it goes, and the bathroom will be finished. He's going to replace part of the washroom floor this weekend too, but all I'll need to do there is clean behind the washer/dryer while he has them out, and clean the dryer vents [we have a kit to do this, with brushes and the vacuum to pull all the lint out]. I'm also trying to sort through clothes, so I might do more of that, and we can make another Goodwill run this weekend. I gave away a lot on Freecycle this weekend, and it's nice to have the extra room & know that stuff is going to somebody who will actually use it instead of just sitting around.

Thursday, February 18, 2010

Momotics is Giving Away a Copy of Birthing from Within!

As part of her blogaversary giveaway, Danielle @ Momotics is giving away a copy of Birthing From Within by Pam England (donated by ICAN).

 Y'all should already know about this because her blog is awesome, and ditto for her Twitter posts from @BirthBabiesBlog, but if you haven't visited Momotics yet, don't subscribe, or lost the feed somehow, now's your chance to "re-connect" and possibly win a great book on childbirth in the process.

Tuesday, February 16, 2010

Still Pregnant, but Nesting More than Blogging

Whoops, I definitely meant to post more than that last week, but things have been sort of crazy. We had more random snow and ice, and had a tree down because the ground was so wet, which knocked our power out for two day. We also had a dog die, and don't know why - she was only 3 years old, hadn't been sick, and and her kennel-mate was checked by the vet and was fine but is all mopey and sad and mourning now which is breaking my heart. With this plus a sinus infection and general case of the blahs, most of my computer time was spent vegetating rather than trying to be coherent enough to type out a post.

In other news, not much happening on the pregnancy front, but that's a good thing. We went to the pregnancy class at the hospital, and it was OK, but a little boring, Most of it covered interventions in depth, which was good, but not when you've already researched them on your own. Still, I'm sure it was good for those who didn't know much about them already. We also go to watch some birth videos. One was a woman who had lots of interventions, and the second was a woman who had a natural, unmedicated, birth. Both were in the hospital, but I liked the contrast between the two, and the way that the natural birth chosen was mostly positive and didn't include a lot of screaming or vocalizations that would freak most people out - the only thing that really bugged me was that the doctors still had her get on her back in lithomy position in the bed once she hit transition, instead of continuing with the movement she had going on. They also showed a cartoon type video of a c-section, but not the real thing.

I was starting to think maybe the baby had dropped, because he's feeling heavier and I'm feeling it in my hips and bones a lot more now, but he doesn't really seem low so maybe it's just a general change in positions. I saw the midwife last week and everything is good. My blood pressure was a little higher than normal, but not into the "high" range yet, so we just chalked it up to a rough week. I also met with my doula, just to go over final plans and the birth plan and all, and to check in. Everything's still good there too, although I'm finding it amusing, considering the stereotypes and impressions surrounding the two jobs, that my midwife [CNM, practicing with an OB] is more "crunchy" than my doula [DONA-certified, former L&D nurse]. This will be my doula's first birth at the hospital I'm changing to, and her first time working with this particular midwife, but she was very glad to hear that there was someone with more waterbirth experience and a more natural birth friendly hospital nearby, so maybe that will help some of her future clients who are looking for these things.

I've also had this crazy nesting instinct going on, which has kept me away from the blog. On the days I've had a good amount of energy, I've gotten a lot done. I am on FlyLady, and she's started her "Declutter Olympics" this week, so I've been participating in that on top of the whole last minute getting the house & nursery ready things. I totally stripped out the nursery, shampooed the carpets, and scrubbed the walls & floors to get rid of any smoke or other residue, and then decided to do the same to our guest bathroom, where we are installing a new tub. I am also decluttering & rearranging the living rooms and closets, so I can move some furniture around and make better use of the space and rooms we have. In between, I'm working on my wardrobe -  I have lots of clothes, but most are old & not very flattering, so I'm getting rid of most of them and building my post-pregnancy wardrobe from the ground up, keeping it basic, but shopping for things that will make me feel good. Too much of my clothes were bought because they were "on sale" or "would fit" and that was all they had going for them - I feel like taking the time to look nice in whatever size I wear will help me to be more accepting of my own body, and show that even us fat women can look good.

Wednesday, February 10, 2010

The Fat Girl - A Response Turned Post


Sorry for the lack of blogs this week. I'll try to get up some normal posts by the weekend, it's just been crazy here with the weather and lack of energy, and one of our dogs died, which I'm taking harder than I expected. 

This is in response to a blog post on another site, in which the author goes on a tangent against fat acceptance because she saw an "obese" teenager eating an  ice cream cone:

Not that long ago, I could’ve been the fat girl you talked about. I still see a lot of myself in that image. It’s not just the weight or the ice cream, but your description of feverish activity and that drugged look. I remember it a lot from the years I was bulimic. Ice cream was great, because it was so easy to throw back up, made easier by the judgmental stares from total strangers if you dared to eat in in public. I could eat with one hand while tracking the calories on my favorite mobile diet website on the other, figuring if I ate x calories, throwing up would get rid of about 1/2, and I could have ice cream or normal food again 3 days later, after a 2 day fast and exercise session to burn off the rest of the calories.

Then, I found the “truth” all of these anti-fat people want to drill into our heads – it wasn’t just the weight that was bad, it was the fat itself, and I’d have to stop eating and exercise more to make it go away. So I did, and lost my job, my college career, and almost my life. It’s ironic, I was clinically underweight and admitted to a hospital eating disorder unit, but never looked thin because I still had excess skin from my previous fat. If only I had learned how unacceptable eating and being overweight were earlier in life, before the age of 19. Maybe I could’ve skipped the weight gain and bulimia and went straight to restricting in 5th grade, rather then binging or purging. I could’ve been a skinny role model or another dead teenager, but at least I wouldn’t have been another fatass around to pollute society with my appearance.

Seriously, what do people want? Are they that offended by unperfect bodies that they’d rather encourage starvation or see us all drop dead or locked away than put up with a few extra pounds? Without some form of fat acceptance or positivity, that’s what it will take, because it’s pretty damn hard to take care of yourself and get healthy, at any size, when you are hating yourself and shamed by others. People get healthy by loving themselves and seeing themselves as worthy of taking care of, and that takes acceptance, not judgment.

Saturday, February 6, 2010

Congenital Heart Defect Awareness Week

Congenital Heart Defect Awareness Week 
(Original Post from Danielle @ Momotics)

Sunday will mark the beginning of Congenital Heart Defect Awareness Week which will run from February 7th, to Valentines Day.

Congenital Heart Defect (CHD), is the #1 birth defect in the United States, affecting 1 out of every 115-150 births, or around 411 babies each day.

Many people who have never heard about CHD have learned about it on Twitter or birth/parenting blogs through Cora’s Story. Cora was born with an undetected CHD and passed away on December 6th 2009 while breastfeeding in her mother's arms. Since her loss, Cora's mother,  Kristine Bright has become an activist for CHD and for mandatory pulse oximetry ("pulse ox") testing on newborns to test for CHD and hopefully prevent it from going undetected or undiagnosed in any more babies.

Friday, February 5, 2010

Why I Switched to a Midwife

For those of you who've been following my blog, you'll know I've been having doubts over the last couple months about my choice of hospitals and healthcare providers, and have been looking at other options. After asking around my community and online, I decided to look at my options in the next county over, which means a change in hospitals, pediatricians, and care providers.

After a few interviews and facility tours, I decided that I would be much more comfortable with both the hospital and the pediatrician there, which left the biggie - the midwife or doctor that will be delivering my baby. I met with a midwife who came highly recommended both by local women I talked to in person and online, and by reviews on mothering.com by women who'd seen here at a previous practice in a much larger city. Long story short, I will be transferring my care.

I'm sure some people would like to know why I'd "change everything" this close to my due date, so I'll go through a few of the reasons. The main thing though, was just following my heart - I was becoming increasingly uncomfortable with the way my care was going and just had a gut feeling that something wasn't quite right with the path I was on. The last straw was when my OB mentioned starting cervical checks at my next appointment [35 weeks], and said something about "loosening the membranes" while he was doing that. I asked if he meant sweeping/stripping, and reminded him I wouldn't even be full term, and he said something along the lines of  "well, sometimes things take time to work, and big women have big babies, so you'll want him out as soon as possible". I'm not sure if I was more pissed about the fact that he'd strip without explaining what it was and getting my consent first, or that he was all about an early induction just because I'm a fat chick [which I could just see leading into another one of those "necessary c-sections" for obese mothers], but I know it was time to get the heck out of there before that appointment came.

He also basically told me 2/3 of my birth plan was too difficult and unrealistic, and I should just listen to the nurses and "plan on having a healthy baby". He said I could ask for whatever I wanted, but he would not sign anything, and they would probably just follow hospital policy to "be on the safe side". Even though another doctor in his practice had verbally OK'd several things in my birth plan, he pretty much said it would depend on which doctor out of the 4 was on call as to what they'd "allow", and he didn't want to make any waves. He even told me with the waterbirth, which was one of the first things I'd asked about, that one provider allowed labor in water but was not "going to get down on the floor", so I'd have to get out during transition and get on the bed, and one of the others would want me in the bed and in stirrups as soon as he showed up because he didn't deliver in "non-standard" positions. So much for all the things we'd discussed, and that I had been assured were OK over the past few months. Of course, he was in such a hurry, I practically had to block the door just to get straight answers to these few questions before he left the room.

When I met the midwife, it was such a huge difference. For one, our first conversation took place in a private office with chairs, not while I was half naked in a paper gown. Also, she didn't seem rushed, and took time to ask about me, why I wanted that type of birth, and what my expectations and experiences were. I feel like if my OB had done that, we'd have known straight off that it wasn't going to work out. When I mentioned the birth plan issue, she asked if I had a copy, and said everything looked fine to her, and would be OK at the local hospital, which she said was much more laid back about birth and following the mother's wishes. She has done a lot of waterbirths and natural/unmedicated births, and the the backup OB at the practice is also very hands-off and is fine with both. She encouraged me to meet him just in case he is on-call and she's gone when I deliver, but also said to have the hospital call her cell phone if she's not there when I do go into labor, because she does try to make an effort to be there at least in time for the birth. She also said the the cervical checks are up to me, as long as they find the position of the baby [if he stays the way he's been, you can tell from the outside], and that there is no real reason to do them before labor, and only during labor if there's a decision to be made [ie, if I decide I want an epidural or augmentation - if I'm at 8+cm, there's no point], and that she will try to explain everything she's doing and to ask questions if I have any. Again though, the main reason I'm switching is just instinct and the overall vibe I got from her, like birth is just natural and something we're working together on, not some big procedure where I'm expected to be scared and give up all control.

Thursday, February 4, 2010

Birth Plan

One of the things that helped me in preparing for my birth was looking at birth plans online, and then researching the different options out there to see why people asked for and made the choices that they did. I finally reviewed mine with my new midwife today [yes I'm switching, but that will be a later post], and everything looks OK, so I'm posting it here for reference. This is as approved - the irony is it was totally rejected by an OB at another hospital as "too unrealistic and demanding", so that's where choosing a provider who's on the same wavelength as you can make a big difference. Erythomycin is required in my state, and vitamin K is usually grouped with it and required by the hospital so I am not able to opt out of those, but it was the only change we had to make.

Birth Preferences            Patient Name: name  
Midwife/OB: name (practice/office name phone #)             Due Date: date

I realize that a birth plan is a sharing of preferences and ideas for birth, and not a contract or binding agreement. I understand that labor and birth are unpredictable and ultimately want the health and safety of both the baby and I to take precedence, and that unexpected situations may result in my plan for labor having to change to support activities needed to prevent or decrease complications or risk to myself or my baby. When possible, I request that procedures be explained thoroughly (benefits and risks) and also, when possible, I would like to be included in the decision-making process. I appreciate my physician’s, and the hospital staff’s, commitment to my health. All of these requests are for a normal labor, birth and postpartum period.

During Labor I prefer:
•    Freedom of movement & positioning, to possibly include walking during early labor, use of alternative [non-lithotomy] labor positions, & use of the shower or birth pool [self-supplied] during labor.
•    Intermittent fetal monitoring, & would prefer Doppler/ auscultation, if available, while in birth pool.
•    No IV, but if IV access is required I strongly prefer a saline lock [“hep lock”] only.
•    Not to have my membranes “swept” or artificially ruptured, or to be artificially induced.
•    Minimal vaginal/cervical exams, especially after rupture of membranes
•    To sip clear liquids &  eat light snacks as desired.
•    To have the lights dim &  the television off, unless I request otherwise.

•    I prefer to request medication, rather than to be offered it, including epidural anesthesia.
•    If there is time limit to get an epidural, I would like to be reminded once while it is still possible to request it.
•    I do not wish to be given any medications, including Pitocin or Cervadil, without my specific consent.
•    I do not consent to Cytotec (misoprostol or prostaglandin E1) in any circumstance.
•    I would prefer waiting as long as possible before using any sort of artificial augmentation of labor.

During Birth I prefer:
•    To have the following support people:  [husband],  [doula], & [mother]. I want at least one of the above with me at all times, including in case of surgery.
•    I strongly prefer a tear to an episiotomy, and wish to use positioning, compress, etc to avoid one.
•    To use spontaneous pushing, not to be directed when to push, & to try a variety of positions.
•    To deliver the placenta spontaneously, with no Pitocin or cord traction unless there are complications.
•    To have immediate skin-to-skin contact with the baby, and attempt to breastfeed immediately.
•    To delay the bath & newborn assessment until after the first breastfeeding.
•    For my husband to give the baby his first bath, and to cut the cord if possible & if he wishes to.
•    To delay cutting the cord for at least 5-10 minutes or until it stops pulsing [whichever comes first].
•    If a C-Section should be medically necessary:
     o    I would like at least one support person, preferably my husband, with me at all times.
     o    I would like to remain conscious.
     o    Please use a low-transverse [horizontal] incision, and double layer sutures to repair my uterus.
     o    I would like to keep my baby with me & to breastfeed as soon as possible during recovery.

For my Baby, I prefer:
•    No vaccinations at this time, including Hepatitis B.
•    Please delay Erythomicin, vitamin K, & weight as long as possible, to allow for bonding time.
•    Pulse Oximetry screening to detect congenital heart disease, along with the standard newborn assessment.
•    To nurse, if possible, while the PKU [“heel stick”] test is done, to lesson discomfort to my baby.
•    No circumcision at this time.
•    To breastfeed exclusively, with no pacifier or bottles given.
•    To have my baby in the room with me at all times, or accompanied by my husband if out of the room, including for medical tests or procedures.

Reviewed by: signed by midwife or OB            Date: date signed

Wednesday, February 3, 2010

Childcare Class & Pediatrician Interview

Well, this is shaping up to be a busy week.

The hubby & I went to the childcare part of the class at the hospital last night. I'm still liking the tone of the classes and the instructors for the most part, but skittish of delivering there because of their pediatric team and the high epidural & c-section rates. Still, we will be finishing the childbirth education series at this hospital, even if I deliver elsewhere [we already paid for it, and I don't have time for the Bradley class I just found out existed nearby a week ago, and am too poor and cramped for time for Hypnobabies as well]. One thing I liked was that she went into detail on all of the typical newborn procedures, how & why they're done, and how to opt out or ask to delay certain things like the HepB vaccine . With feeding, she explained why breastfeeding was best, even short term, and about some of the things that pressured women into giving it up early [not surprisingly, returning to work, lack of support, & discomfort with nursing in public are big problems].  She also explained that circumcision was an elective procedure with no medical benefit, and even noted that most of the reasons supporting it had been debunked and disproved. Most of the class, of course, was basic newborn care, with pictures of some birth defects and other things and discussion of what is and isn't normal, and when to call the doctor - pretty basic stuff, but good information.

After the class, we went upstairs to tour the L&D unit and see a room - it's nice and pretty, but there is a lot of focus and money being spent on c-section related care, and it makes me hesitant because I wonder if a small town hospital really needs not only a separate operating room, but it's own recovery area and 1/4 of available rooms set up for post-op mothers. Also, the nurse didn't really give a lot of information on things, and seemed sort of irritated that we'd ask questions [they didn't seem busy, so it's not like that], and I found out that I couldn't get copies of pre-admission paperwork and consent forms in advance - they only do that for scheduled inductions & cesareans.

This morning, I got up bright and early and braved the lovely icy roads to interview another pediatrician. Long story short, I really, really, like her. The office is about 35 minutes away, but they do have a satellite office for weekend and urgent care much closer to the house. One thing I immediately liked is that they have separate waiting rooms, and separate exam rooms, for sick & well baby care, each with their own bathroom & changing facilities. Of the offices that even bother to separate them, most here have shared bathrooms and several just have chairs on different sides of the same area - this office even has 3 closed in rooms in the "sick" waiting area for patients with flu or highly contagious diseases.

The pediatrician herself gave me the tour, and took lots of time to answer my questions. She seemed very current on her vaccine knowledge, and we even discussed how Merck had stopped making the separate MMR vaccines, but it should be available again sometime in 2011. She said all vaccinations would be my choice, and that she would have no problem giving them one at a time and on a delayed schedule if that's what we decided. She also offered to do titer tests before vaccinating and giving boosters, especially if we delay. When I asked if she was used to caring for intact boys, she said that approximately 1/3 of her male patients were uncircumcised, and that she totally agreed with and supported our decision not to have him circumcised at birth. Again, she seems knowledgeable because she mentioned that if it needed to be done later, she would refer him to a urologist that would do it under anesthesia, but that problems were rare as long as the foreskin wasn't retracted or "messed with" by parents or care providers. She also told me that one of their pediatric nurses is a lactation consultant and that the other doctor in the practice specializes in breastfeeding & feeding problems, and offered for her to come out and check on my after the birth to be sure he was eating well, as well as encouraging me to call the office if there were any breastfeeding issues, rather than giving up or supplementing if that wasn't what I wanted to do. I'm glad I did ask around and didn't just settle for the closest office or the first name of out the phone book, because I feel so much more comfortable now.

On the way home, I toured the L&D floor at the other hospital [the one I'm considering switching to]. The hospital itself is smaller and older, but I like it because it is less institutional feeling. The nurse that showed me around took her time and explained standard procedures, as well as which things were optional or dependent on the physician. She said that the pre-admit and consent forms the had to be filled out within 3 days of admission, but that they had no problem sending home blank forms to review, and I could just fill it out and bring it in when I went into labor. The rooms themselves are not as fancy as the other hospital, but have plenty of room, and are actually set up in a way that gives you more privacy [ie, the tub and bed are blocked from view of the hallway]. She said they have had women labor in the in-room tubs, which or pretty big, or I can bring my birth pool, and they do have an underwater doppler for monitoring, if my midwife OKs that instead of the 20 minute strips with the belts. It just seemed a lot more laid back, and more focused on normal birth rather than strict procedures and expectations of surgery and complications, so I think it will be a more comfortable and less stressful place to give birth. I had a surgery at this same hospital back in April, and the staff there was wonderful then.

I'm going to talk to the midwife tomorrow, and assuming everything is good there, I'll definitely be making the switch. I did a little research online on the woman I'll be seeing in the morning, and everything looks good so far. A few women on the local parenting board see her for well-woman care, and 3 delivered with her, and they all said she was good, and very friendly towards natural birth and "crunchiness" in general. I also found out she previously worked as a midwife in the Atlanta area and was highly recommended there, as well as being one of the few waterbirth providers in that area for a long time. I'm looking at a little more out of pocket expenses with my insurance, but it should totally be worth it to have someone that's on the same page as me regarding birth and parenting.
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