Low platelets and postpartum hemorrhage

Time for some crowdsourcing!  A reader just emailed me with a request for information about low platelets and the risk of PPH. Here's her situation:

Hi Rixa,

I'm a long time blog follower and have loved following all of your births. I had a homebirth two years ago - I switched to a homebirth at 40 weeks after I was risked out of a birthing center for the baby being 'too high, too big, and too much fluid.' I ended up with a wonderful positive homebirth experience (although I did push for 4 hours!!) Your blog was especially comforting while I was anxiously awaiting my son (he arrived at 42w3d).

I'm 38 weeks with #2 and everything has been great. But I just found out my platelets are low - they were 109 at 28 weeks, 90 at 37 weeks, and 83 yesterday. My CNM's have referred me to an OB, who is recommending I do a hospital birth. She has also referred me to a hematologist - who I just met with in the spirit of gathering as much info as possible. The OB was actually quite pleasant to speak with - she understands my desire for homebirth and seems very supportive of natural hospital birth. I'm just not sure at what point I should actually be thinking about a hospital birth. I have read many conflicting articles, blog posts, etc. on the subject in the past few days.

PPH is the worry - but the frustrating part is that nobody (OB or hematologist) can tell me what the actual percentages are for PPH with a low platelet vaginal unmedicated birth. The hematologist said there is no risk to the baby at birth, so the main concern is me. He wanted to prescribe steroids to increase my platelets which he says also has no risks to the baby (I disagree). The CNM's did say they felt the treatment for PPH would be the same at home as in hospital - but they are not comfortable going against the OB and hematologist recommendation for steroids/hospital birth. I have another midwife I can use (CPM), but I just want to make sure I'm being smart about the decisions.

If you wouldn't mind posting some of the questions, that would be wonderful. I would love to find out if anyone has had personal experience, and what the outcomes were.

Thank you!

I'm super busy with the start of the semester. If anyone can provide information, or has dealt with low platelets personally or professionally, please help her out!

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Bourgeois Baby bib & burpcloth giveaway!

Jamie Bourgeois of Bourgeois Baby contacted me last month wondering if I'd test out a handmade bib and burp cloth. I have the world's messiest toddler--how does that girl get food everywhere, every time?--so I said "yes, please, send them my way!"

About Jamie

Jamie worked for 11 years as a Registered Nurse in maternal-child health, then 3 years as a Certified Nurse Midwife. She's also been following my blog since Zari was born. She wrote to me:

My life completely changed when I had my daughter Vera. She was born at 31 weeks. Very unexpectedly. It sent my whole world upside down. Her birth and subsequent NICU stay had me seriously questioning so much of my previous career that I knew I needed to change paths.

At the same time, as my daughter was growing and flourishing as a (fortunately!) healthy infant, I decided to put my crafting skills to work and opened Bourgeois Baby. It really all started with a bib, taking modern cloth diapers as the design inspiration. My bibs are the staple of Bourgeois Baby, but I also do burp cloths thick enough for serious reflux babies, swaddles, sensory toys, bodysuits, and more.

Jamie sent me an Original Bourgeois Baby Bib and a matching burp cloth in Multi Color Dots. The bib offers serious protection and covers your baby from neck to waist to well beyond the shoulders.

The bib has has an inner layer of absorbent flannel, and the bottom layer comes in your choice of terry cloth or waterproof PUL. If your child likes to dump entire bowls of cereal on herself...cough cough Inga...you'd probably want to go with the PUL so liquids will never soak through.

There are two snaps at the back, letting you adjust the neck as your baby grows. (And no velcro! I hate unsnagging that stuff when I take it out of the wash!)

All Bourgeois Baby products are handcrafted by Jamie. What a wonderful way to bring (clean) fun into your child's life!

Inga approves. 

No Inga, the burp cloth is not edible. But it does a great job catching Ivy's spit up. Which happens a lot.

My only suggestion for improvement: add a pocket at the bottom of the bib that sticks out. Half of Inga's meals land on her lap, and a pocket to catch these spills would be amazing.

And now, a giveaway!

Do you want to win a Bourgeois Baby bib and matching burp cloth? Jamie has generously offered to give a winner their selection of one of three designs:

Scallywag

Pink Paisley

Sock Monkeys

Entry Rules

• Visit Bourgeois Baby and leave a comment here about your favorite Bourgeois Baby product
• For an additional entry, like Bourgeois Baby's Facebook page (new comment, please)
• Open to US and Canada residents
• Contest ends on Sunday, Sep. 1st at 5pm EST

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Ivy is 5 months old!

On top of almost crawling, Ivy has started grabbing her feet. And everything else within range. We have to really watch out when we're eating dinner, otherwise our plates (and food) end up on the floor!

I just put up her new baby hammock today. She slept SO well in it!! As soon as I put her in the hammock and start her bouncing, she conks out. Amazing. (Tutorial coming soon).

I've been a bit nervous using a different sleeping arrangement. I've only seen a baby hammock once before; I think they're more common in Australia than in North America.

I studied lots of tutorials and read up on safety issues, then designed my hammock so it's super slip-proof. The fabric ties on to the wooden support bar on each side. It also ties onto the carabiner on the top, so it can't slip from side to side. For added stability, I also added a D-clamp where the fabric goes through the carabiner. This probably won't make sense now, but it will once I make the tutorial.

Her belly button makes a perfect spiral.

Fun on the swing.

She pees on the potty really well, and I occasionally get some poops too. Unlike my other kids, Ivy only poops once every several days. So we don't get lots of opportunities to practice :)

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What I'm making right now

...a baby hammock!

Ivy isn't sleeping well, and several readers suggested a spring-mounted baby hammock.

From Dwell

My first thought: "I can totally make that!"

I have lots of fabric and wood on hand. I have power tools as well as a sewing machine. So I took a trip to the hardware store yesterday and bought a large carabiner, a large eye hook, a spring, a D-fastener, three spring links, and a few feet of chain.

The fabric part is finished, and the wood support bar is cut and sanded. I'm waiting for some wood filler to dry (had an "oops--cut too far!" moment with the table saw). 

I've pinned several DIY tutorials here.

I'm also putting away edamame and picking tomatoes today. I made sauerkraut last week, but it's not quite fermented enough. Yum...

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My kids have some awesome skills

Ivy

Ivy can do a perfect downward-facing dog.

Kind of hard to see with a dress on...let's take it off.

See? Not bad for less than 5 months old!

She can also rock back and forth on her hands & knees.

A quick movie of her today:



Inga

We're working on potty-training Inga. She goes naked bum all day long and has never had a pee accident when she's been naked. She has a harder time pooping, though. She's so good at holding it --because she's naked and doesn't want to have an accident--that she's started pooping only while she's sleeping. But we finally got her to poop on the potty today. She was super excited. "My faire poop on the potty! My did poop four times!" And so on.

Dio

Really good at being cranky, refusing to do things, then finally doing them. Also good at giving hugs and snuggles. Likes to make rocket ships and boats out of scraps from the recycling bin.

Zari

Made her own laptop the other day. The keys even go up and down. It locks shut with leftover pieces of 3M Command Strips.

Started 1st grade (or "grade 1" in Canada) on Wednesday.

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Currently reading (and a giveaway!)

Non-fiction:

Breasts: A Natural and Unnatural History by Florence Williams. 
This book was a Silent Spring for breasts. Funny at times, gravely disturbing at others, it covers the history of the breast from just about every angle. You'll learn about the history of bras, breast sizes and shapes, and breast implants. You'll discover disturbing facts about how closely our breasts are tied to our environment and the many contaminants in our air and water. I love the front and back cover art!

Reading Birth and Death: A History of Obstetric Thinking by Jo Murphy-Lawless.
Brilliant, acute, spot-on, a must-read for anyone involved in maternity care. I only read through page 50 before I had to return it to the library. I'm going to check it out again and finish reading.







Fiction:

Someone Knows My Name by Lawrence Hill
A narrative of a young African girl captured by slave traders and sent to the American Colonies. She gains her freedom and becomes involved in the British abolitionist movement.

The Language of Flowers by Vanessa Diffenbaugh
Fantastic novel about an emotionally disturbed young woman whose childhood was spent shuttled around in the foster care system. She finds solace by communicating through the language of flowers. Some pretty intense parts but so, so worth it.

Sideways To the Sun by Linda Sillitoe
Written maybe 2-3 decades ago, a short novel about a Mormon woman and mother whose husband abruptly abandons her and leaves her to reassemble her life. She gains newfound strength as she is forced to support her family and figure out who she is outside of her Mormon roles of mother and especially wife.






Books on my to-read list:

• Born At Home: Cultural and Political Dimensions of Maternity Care In the United States by Melissa Cheyney
• The Blood Sugar Solution by Mark Hyman
• Complementary Feeding: Nutrition, Culture and Politics by Gabrielle Palmer
• A Cultural History of Pregnancy Pregnancy, Medicine, and Culture, 1750-2000 by Clare Hanson
• What's Mine Is Yours: The Rise of Collaborative Consumption by Rachel Botsman
• The World's Strongest Librarian: A Memoir of Tourette's, Faith, Strength, and the Power of Family by Josh Hanagarne
• Thea Gallas Always Gets Her Man by Kristen Panzer (just bought it for my Kindle!)

And finally, a giveaway!

I've been reading Everybody Has Everything, a novel by Katrina Onstad. It's about a couple who have been trying for years to have children. They finally accept their infertility, then they suddenly become parents to a 2-year-old whose father died in a car crash and whose mother was in a coma. The sudden leap into parenthood--maybe permanent, maybe not--destablizes their relationship and leaves them wondering: are we really able or prepared to take care of another human being?

The novel was a fun, fast, gripping read. It reminds me a lot of Dan Chaon's writing: depressing yet uplifting with its sharp observations of human relationships and the small details that make the story feel, well, less like a story and more like real life.

The publisher was kind enough to give me a review copy AND offer to sponsor a giveaway for five lucky winners!

To enter the giveaway:

• Write about a memorable parenting moment (funny, embarrassing, scary, crazy, whatever). If you're not a parent, write about something from your own childhood.
• Giveaway open to US residents
• Be sure to leave an email address, website, blog, or other way to contact you
• Contest closes on Friday, August 16 at 5 pm EST

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Payback time

I love having newborns. They're cute and cuddly, and best of all they sleep a lot. People always talk about how exhausting it is to be a new parent. But for me, nursing a newborn every 2-3 hours at night is a piece of cake. I feel well-rested and enjoy many good nights of sleep after my late-pregnancy insomnia.

With all of my kids, this "honeymoon" period comes to a screeching halt around right around 3 or 4 months and doesn't get much better for a long, long time.

Yep, it's happened again.

Ivy sleeping in a boat

Ivy is really restless at night and will sometimes wake up every.single.sleep.cycle. That's every 45-60 minutes, all night long. Last night I had one 2-hour stretch of sleep. The rest were 1 hour long or less. 6 weeks ago, she was waking up once or twice to nurse over a 12-hour stretch.

The more kids I have, the less I know about helping them sleep. When people ask me, "When will this get better?" or "What do I do when my baby does X?" I laugh and say: "I have NO idea. I muddle through and survive until it gets better."

I've tried keeping Ivy up extra long before bedtime. She used to have about 2 hours, so I tried 3 hours. Then I tried 4, even 4 1/2 hours. No matter how exhausted she is, she still wakes up shrieking after 20-30-40 minutes after I put her down in the evening.

I've tried swaddling, swaddling with one arm out, and no swaddling. I've tried propping her up on her side. I've tried fans and no fans. I've tried various kinds of white noise. I've tried keeping her in bed and putting her in a crib. I've tried nursing her and letting her fuss back to sleep.

Nothing really makes a difference, except nursing her--obviously--helps her calm down quickly. She wakes up all the time even when we're not in the room, so it's not just a matter of us disturbing her.


~~~~~~


Dear Ivy,

Please sleep at least a few hours at a time. I am very tired. 

Love, 

Your clueless mother

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Exercise is the joy of life

My 90-year-old German grandmother has been leading a free exercise group three times a week for 40 years. She was born in Danzig (now part of Poland) and grew up in Berlin and Vienna. She attended a dance conservatory and has always been very physically active. She also raised 8 children!

Her local newspaper just wrote a story on her exercise class. I've gone to her class, and believe me it makes you work and stretch and move!

I've been thinking about the presentation I gave to a camp for teenage girls and how I encouraged them to think about their bodies in terms of what they can accomplish and experience, not in terms of what they look like. My grandma is a great example of finding joy in what her body can still do.

Here's a teaser from the article:

Monday, Wednesday and Friday mornings, a group of women ranging in age from young adult to 95 meet at an LDS church house in Logan to exercise.

The group, led by 90-year-old Brigitta Clyde, completes a 40- to 45-minute program that works the body from head to toe.

“Every joint is involved,” Clyde said.

More than 40 years ago, the Logan [Utah] resident was asked by the Relief Society president in her LDS ward to organize an exercise class. Clyde accepted the assignment, planned a routine and decades later, the class is still going.

“It was funny, you know, when we started out together we were saying, ‘how can we do that when we are 50?’ ... and then we were saying, ‘think we can do it 10 more years when we’re 60?’ Then we said, ‘Seventy? Eighty? Ninety?’ You know, we kept saying that to ourselves as a group — will we be able to? And we are still able to,” Clyde said.

Read the rest here. 

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Garden thoughts

We're starting to harvest food from our garden! Most dinners consist of whatever we can pick plus the occasional supplemental protein in the form of farm eggs or local meats. Yesterday, for example, we ate:

• cucumbers, hardboiled eggs, and tomatoes in balsamic vinaigrette
• sauteed green beans (Masai haricot vert and scarlet runner beans)
• thinly sliced purple carrots and beets (braised and then sauteed for a few minutes in olive oil and sea salt)

Today we ate:

• cucumbers and tomatoes with vinaigrette
• green beans again
• brats from a local pork farmer (I've found a person in the area who raises pastured pork with no additives/hormones/antibiotics in the feed...and the prices are just as good or better than the supermarket)

I have a really big garden, and I'm still surprised at how little it yields, relatively speaking, to feed our family. We still have to buy a fair amount of other staples for lunch and breakfast...and we rarely have anything left over to can, dry, or freeze. How did people ever grow enough to last them through a whole year? It boggles my mind.

I'm also reminded of both how easy it is to eat garden food...and how much work it is at the same time. You can walk around, pick some cucumbers and tomatoes, and eat them straight off the vine. But you can also spend 10 minutes shelling peas and only come out with a small bowl. I admit that I'm still way too used to opening up a bag of frozen vegetables.

I'm going to try my best to do a second planting this month whenever I take something out. I'm thinking lots of kale, salad greens, brussels sprouts, and carrots. What else grows well as a late summer planting?

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Interview with photographer Meg Gregory

I'm excited to share this interview with Meg Gregory of m.e.g. photography! She is a talented photographer and mother to two girls ages 3 1/2 and 13 months. Besides photography, she has a passion for marine animals.

Meg with her two girls and her favorite dolphin

1. Tell me more about how you got into photography.

Honestly, I sort of fell into the business. I used to work for the zoo as a marine mammal trainer. When the Colts went to the Super Bowl, myself and some of my staff members worked together to make a video to help promote the zoo. It's not a fancy video in the least, but we started doing a series of videos to help promote the zoo and different aspects of our job:

• The Colts' newest player
• Dolphin Dome Session
• Dolphin Husbandry
• Walrus Enrichment

I did all of the editing of the videos, which led me to a volunteer who worked for a medical company in need of some simple video work for a new product they were launching. They hired me, and the work I received through them gave me enough income to cover the costs of new camera equipment.

In theory, I could have continued on with videography. But photography was much more suited to my interests, so thus began the spark. I'd always loved photography, always taken tons of pictures as a hobby, but never had any formal training. When I first began, the plan was to be primarily a wedding photographer so that I could just work one day per week and would still be able to stay at the zoo. (Because who would want to leave a job swimming with dolphins and petting walrus every day?!)

I went out and purchased my first DSLR camera and all of the gear I needed to get started in late 2007. In February of 2008 I began interning with a local photographer in the area, Stuart Meyer, who literally taught me everything I needed to know. How to shoot in manual, what equipment I needed, how to do formals, album design, lighting, EVERYTHING. He got me in touch with a larger company, Bello Romance Photography, so after I was finished interning with him I started working with Bello as a lead photographer.

After a year working with Bello, I began branching out on my own and soon had my business running full time. I continued working at the zoo and running my business until May 2010, when I left the zoo after the birth of my first daughter. I continued the photography business while being able to stay home with my daughter; it was the perfect solution.

2. Your nursing photos are beautiful! You've nursed both of your own two children. Please share more about your breastfeeding experiences.

I remember when I became pregnant with my oldest how scared I was to breastfeed. I came from a very breast-feeding friendly family; my mom breastfed all three of us (me and my siblings), my sister breastfeeds all of her children, my aunts breastfed, my grandmother breastfed. . . . I honestly felt a lot of pressure and worried I wouldn't succeed.

But with the pressure came a ton of support, which I soon realized how important that would be in my journey. Having my family, especially my mom and sister, there to support me, offer advice, answer questions, and assure me that "You DO have enough milk!" or "It is totally normal for them to eat for 3 straight hours every night!!" really is what made my breastfeeding story a successful one. I went from just wanting to make it past the first 6 months, to planning on going to 1 year, to nursing a toddler and researching tandem nursing when I become pregnant with my second.

Now, it is such a huge part of my life. I love it, I think it's such an amazing gift we can give our children AND ourselves, and can't imagine doing anything else!

3. How do you combine your work with mothering two young children?

Hahaha. Sometimes I do feel like I'm teetering on the edge!! As every mother knows, life is a balancing act. Over the past 3 1/2 years, I've learned through trials and failures (and some successes) what works and what doesn't.

I quickly learned more than 15 weddings a year is too much. Scheduling sessions both days of our weekend is now a "no-no". I work when the girls are asleep, which leaves me very little time to myself but that's what I do to get things done! I force myself to NOT work one day/week, otherwise I would go crazy!! Luckily, I am my own boss, so I get to pick my schedules, I set the hours, and tweak it to suit our family. It's still not a perfectly running machine, but it's getting there :)

4. What are your favorite events/people/things to photograph?

Newborns! Lifestyle photography newborns, whenever possible. I do love the newborn posed photos, but what I REALLY love are the pictures in between the pictures. When mom stops to nurse. When dad and big brother are playing in the corner. When grandma is snuggling with her new grand baby while everyone else is getting ready. Weddings are a big, important, and magical day. But seeing the dynamics of a family with a fresh new family member is beyond words.

5. Tell us about the most unusual or exotic location you've done photoshoots in.

I had a wedding this summer in Turks and Caicos -- it was beautiful!! Such a tough job, huh?? I also did an engagement shoot at the Motor Speedway and we had a special guide who took us to all of the coolest locations on the track. Those are probably my two favorite :)

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