Monday, March 28, 2011

Money makes the babies come out

Our local hospital closed its maternity department in March, leaving a gap in OB coverage in our region. This came as a surprise to our community, since the hospital had recently renovated the maternity department and created new LDRP suites.

Newspaper articles cited financial issues as the main reason for the closure. I was talking with someone a few weeks back whose friend a hospital administrator. Here's the inside scoop:

55% of our hospital's maternity patients were on Medicaid. Medicaid reimbursements were so low that the hospitals' maternity department lost $500,000 last year. The administrators feared that the entire hospital would have to close if this trend continued. So they decided to close the maternity department, rather than risk shutting down the hospital.

Now, I'm not sad that this particular hospital closed. It had one of the higher c-section rates in the state (33.4% as of 2008). It also banned VBACs, another thumbs-down in my book. In contrast, a small community hospital 30 minutes away had a cesarean rate of 23.7% the same year. Both hospitals served nearly identical patient populations--only low-risk pregnancies and near/full-term babies--and did the same number of births per year.

But I am disappointed that I no longer have a hospital 5 minutes away. Granted, I'd only go there in an extreme situation where it would be impossible to travel to the other hospital (which does VBACs and is working on its Baby-Friendly certification).

Low Medicaid reimbursement doesn't just affect hospitals. Currently 60% of my midwife's clients are on Medicaid, 20% have private insurance, and 20% pay out-of-pocket. Although her global fee is $3,600, Medicaid only pays 15% of that amount per birth (a bit under $700). She cannot require her Medicaid patients to cover the rest of her global fee, which means that she actually has to pay to take Medicaid clients. Her birth supplies and birth assistant cost her more than she gets paid. She is currently deliberating whether to stop accepting Medicaid, since it is causing her practice to lose money.

A flip side of low Medicaid reimbursement is exorbitantly high billing for those with private insurance. A friend had her baby at our hospital a few months ago, before it closed. She had a spontaneous vaginal birth with no maternal or infant complications and no nursery stay. The total fees for her prenatal care and birth came to $25,000. The bill was negotiated down a few thousand dollars, coming to a total of around $22,000. Between her deductibles and co-pays, she had to pay close to $5,000 out-of-pocket to have her baby. 

Other reading on the topic:
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Sunday, March 27, 2011

Last day to donate & win!

Don't forget to donate to the Giveaway of Gratitude. Today is the last day to be entered to win one of the prizes: a $55 gift certificate to CSN stores, a sampler package from Daisy Ribbons, and a silk sling from Second Womb Slings. I'll select the winners first thing tomorrow morning, so you can do it as late as you wish today.

Some organizations my readers have donated to:
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Saturday, March 26, 2011

Blessingway flag

I've been sewing like crazy the past week or two. On top of about a dozen sling orders, I made myself two new slings--you can never have too many, right? One of my fun projects was creating this Blessingway flag for Gina, aka The Feminist Breeder. (I hope it arrived on time Gina!) I made it out of scraps from Inga's birth quilt.
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Friday, March 25, 2011

Currently reading

In addition to these short mentions, I've probably read another 2 dozen books, mostly fiction, from my postpartum reading list.

What Mothers Do Especially When It Looks Like Nothing by Naomi Stadlen. Hands-down the best book a woman could read to prepare for motherhood. It's not at all an advice book; instead, it describes in women's own words the work of being a mother. If you're pregnant or a first-time mother, you NEED to read this book. And if you're a mother of two or more, you're sure to love it.

The Politics of Breastfeeding: When Breasts Are Bad For Business by Gabrielle Palmer, 3rd ed. Gripping read, couldn't put it down, will make you want to save the world one breastfeeding mother at a time.

The Year My Son and I Were Born: A Story of Down Syndrome, Motherhood, and Self-Discovery by Kathryn Lynard Soper. Okay writing, very powerful story, made me cry.

Free-Range Kids: How to Raise Safe, Self-Reliant Children (Without Going Nuts with Worry) by Lenore Skenazy. Loved it. It will make you tell your kids, "go outside to play and don't come back until dark!"

Unbroken: A World War II Story of Survival, Resilience, and Redemption by Laura Hillenbrand. Fantastic story of an Olympic runner whose plane crashed over the Pacific, who survived for 47 days on a rubber inflatable raft, and then who spent a few years in a Japanese POW camp in absolutely horrendous conditions.

Ship of Gold in the Deep Blue Sea: The History and Discovery of the World's Richest Shipwreck by Gary Kinder. The fascinating story of the man who developed the technology to locate and recover deep sea shipwrecks. More gripping than many novels I've read.

Stunned: The New Generation of Women Having Babies, Getting Angry, and Creating a Mothers' Movement by Karen Bridson. Interesting, had me nodding along in many places. The writing isn't fantastic. Loved the section about "the where game." Read page 6 to see what she's talking about.

Mother's Milk: Breastfeeding Controversies in American Culture by Bernice L. Hausman. A decent read if you can wade through the heavy academic prose.

A History of the Wife by Marilyn Yalom. Fascinating history of Western ideals of wifehood from the ancient Hebrews to the modern day.

Breasts by Genichiro Yagyu. Quirky illustrated children's book all about breasts.

The Dance of the Dissident Daughter: A Woman's Journey from Christian Tradition to the Sacred Feminine by Sue Monk Kidd.

The Price of Privilege: How Parental Pressure and Material Advantage Are Creating a Generation of Disconnected and Unhappy Kids by Madeline Levine. I agreed with her arguments, but I lost interest about halfway through reading the book

Urgent Message From Mother: Gather the Women, Save the World by Jean Shinoda Bolen. Lost interest partway through the book
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Thursday, March 24, 2011

Breech skills workshop in Indianapolis!

I am thrilled to announce a vaginal breech skills workshop coming to Indianapolis this July! Participants will perform and observe simulated vaginal breech deliveries with Canadian obstetrician J. Peter O'Neill and learn upright (hands & knees) breech techniques from Canadian midwife Betty-Anne Daviss. She will also be giving a free public lecture about upright breech birth on Saturday, July 16th.

Click on the images below to download the flyer & registration form (PDF).

Please circulate this to physicians and midwives who might be interested in updating their vaginal breech skills. Don't forget to take advantage of the early registration discount before April 15th.

I hope to see you there!

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Tuesday, March 22, 2011

Blood clots, again

I have worn thigh-high 20-30 mmHg compression hose religiously since the beginning of October. The only day I didn't wear them was when I gave birth to Inga. And even then, I wore them in the morning when I was in labor. I've also worn them every day since her birth.

A few days after she was born, I noticed several blood clots in my varicose veins, in exactly the same place as last pregnancy. How is this possible?!

 I met with the vein specialist today (remember him from A Tale of Two Doctors?) to make sure the clots were not in the deep venous system. Everything looks good--no DVT, just superficial clots. I'm planning on having the varicose veins removed before the end of this year. At my request, the HR person at Eric's university changed our health insurance contract to cover medically indicated VV treatment. (She's pretty awesome, don't you think?)

Although I don't care a whit about "preserving the youthful appearance of my legs," I do look forward to ditching my compression hose and to having legs that don't ache all the time.


In case you're looking for compression hose, I have tried the following brands & styles:

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Saturday, March 19, 2011

Don't forget to donate!

Don't forget to donate to the Giveaway of Gratitude. I've found more organizations you might be interested in:
I know it's easy to put things off, so I am offering double giveaway entries to anyone who donates by midnight tomorrow (Sunday, March 20). I am also extending the deadline for the giveaway until next Sunday, March 27.

If you've turned to my blog for information or support...
If my blog has inspired you to think about pregnancy, birth, breastfeeding, or mothering in new ways...
If you've read a post that made you laugh, or cry, or both...

...then please show your appreciation by donating!

Let's see how much money we can raise to better the lives of women and children all around the world. Make me proud.
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Friday, March 18, 2011

You want to stick that WHERE?!?

Some things you wouldn't believe were true, except they are.

Like the story of my birth. My mom had a straightforward unmedicated delivery of my older sister in Washington state with a supportive nurse who coached her through the process. When she was pregnant with me and living in Rochester, MN (home of the Mayo Clinic), she assumed that the next birth would be much the same.

So she was astonished when she found herself upside down during my birth. Literally. Her doctor had a theory that giving birth upside-down would prevent hemorrhoids. He hung my mother by her ankles from the ceiling, with only her shoulder blades touching the bed. Without her permission. She was screaming to be let down, to no avail. I made my entrance into the world in a rather unconventional fashion.

To top it off, she has never had hemorrhoids with any of her five children, no matter what position she gave birth in.

But that was a generation ago, you're thinking. Surely we're more enlightened now.

Remember the BirthTrack?

Oh yeah. Well, but...

How about the Hem-Avert Perianal Stablizer Device? This FDA-approved medical device, which one commenter on At Your Cervix described as "something that belongs in the S&M section of a sex store, not in L&D," is supposed to prevent hemorrhoids due to childbirth.

Looks really comfortable!

Then there's the Materna medical device that is supposed to prevent tears by stretching the vagina for 1-2 hours before the baby is born.
Yes, that's right: instead of feeling the "ring of fire" for just a few minutes as your baby's head is emerging, you get to enjoy hours of that pleasant sensation!

Please hop on over and complete the survey about the Materna. Here's an excerpt from page 3:

It is has been shown [argh! bad grammar!] that 8 out of 10 women will have some degree of tearing during childbirth. These tears can range from from small vaginal tears, to tears that extend from the vagina all the way through the anus. Additionally, there can be invisible damage to your pelvic muscles which can lead to consequences later in life. Short term consequences include infection, extended pain, and longer recovery times. Long-term consequences may include pelvic organ prolapse, loss of urinary and fecal control, and potential sexual dysfunction.

Materna has developed a device that may be able to decrease some of the pelvic damage and the resulting complications that can arise as a result of childbirth. The device is a semi-automated mechanical vaginal dilator similar in design to a standard obstetrician’s speculum.

The soft, blue portion is inserted into the vagina after you arrive at the hospital or birthing center in labor, and will require 1-2 hours of dilation time before delivery. A medical provider will control the expansion of the device, which will gradually stretch the vaginal tissue during labor. The device can be easily removed at any time, and will pose no harm to the baby.

By dilating the vagina over 1-2 hours instead of the rapid dilation which normally occurs during childbirth, perhaps some of the pelvic damage can be prevented. The idea is similar to an athlete stretching muscles before a workout to increase flexibility and prevent injury. The device will be removed before you deliver, and should never come in contact with your baby.
Both Navelgazing Midwife and Dou-la-la have comment on the Materna. Go read their posts for a good laugh.

Then finally, there's the Cervo-Check. It's a prototype device that goes inside the vagina to detect early signs of pre-term labor.

L&D nurse & student nurse-midwife blogger At Your Cervix commented:
1. Painful and huge
2. You want to stick that where???
3. Will in fact irritate the cervix more. Hello - manual stimulation to the cervix/a device touching the cervix is going to trigger more prostaglandin release --& contractions!
Seriously, my bottom hurts just thinking about all these devices. Clips on my cervix, inflatable dildo in my vagina, plastic V pushing against my rectum...SIGN ME UP!

Read more ...

Thursday, March 17, 2011

Postpartum belly: 2 weeks after

Postpartum belly 2 weeks after giving birth
And some Inga cuteness...
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Wednesday, March 16, 2011

Sad family

Yesterday I found this drawing on our kitchen counter.

I asked Zari to tell me about it. She pointed to each person and said that they were sad. Mama was sad because she had to ask Zari to get dressed too many times and she was frustrated. Zari was sad because she didn't listen to Mama. etc...

She definitely needs more positive interaction. Poor girl...
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Tuesday, March 15, 2011

The babymoon is over

Eric's mom left on Sunday, and Eric's classes resumed yesterday. The babymoon is definitely over. Inga doesn't like being put down, so yesterday morning I had to hold her and get the two other children fed, dressed, teeth brushed, coats on, and out the door to the indoor track. Not my idea of fun. I was going to leave the kids at the track with my friends and have some quiet time at home the rest of the morning. But once I got there, I decided I might as well stay and talk. This morning Eric took the kids to the track. I managed to get Inga to nap on the bed while I sewed four slings.

Getting the kids dressed--Zari especially--is a huge stress for me. I've asked Eric to take over that task before he leaves for work. Zari has been acting up a lot since Inga was born. I'd expected that Dio would be the one with adjustment issues this time around, but he's taken everything in stride. He does ask to nurse more often--I don't blame him, now that there's milk in abundance!--but otherwise he's his same goofy self. Zari, on the other hand, has been really obstinate, disobedient, contrary, and temperamental. As a result, she's been getting way too much negative attention from us. I can tell this has been affecting her. It would bother me, too, if I were always being reprimanded or scolded or told that I was doing something wrong. So I'm trying to figure out how to meet her needs for emotional connection, affection, and positive interaction, when I'm already feeling emotionally overstretched taking care of an infant. 

Inga has been really fussy the past few days. I suspect it's due to pain from a plugged duct under her left nipple. (Did you know that infant girls will sometimes produce small amounts of breastmilk due to maternal hormones?) It's red and hard as a rock, and she screams when I touch it. Poor girl. I hope it goes away soon.

On the up side, I've been sleeping wonderfully. I don't have to sit up or even work to latch Inga on at night, other than turning her onto her side and opening my shirt. We both sleep really well with her in the crook of my arm. She will even sleep on her back as long as she's making body contact with me, and my sleep feels very restful between nursing sessions. By the way, someone asked about sleeping with babies in this position. I don't ever put her on top of my arm. Instead, she lies on the bed and her head is basically in my armpit. I wrap the blankets around my other arm, which keeps them well away from her head.

I have a few disposable diapers left over that I've been using at night. I have to admit that I like using disposables at night! I'm a bit tempted to buy more just for nights; after all, it's just one diaper per day. Or I could sew some newborn-sized pocket diapers. I'd have to change those probably once during the night. Not as bad as my cloth AIOs that need changing every 2-3 hours tops, but the lure of disposables for nights is pretty hard to resist...

I'm looking forward to my second babymoon at the end of this month when my mom comes out to visit.
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Sunday, March 13, 2011

A Giveaway of Gratitude

I am full of gratitude for the blessing of Inga's pregnancy and birth. Thankful that she made it here safely. Thankful that she was born healthy and strong. Grateful for access to skilled midwives and to hospital services if needed. Grateful for the simple but essential things that keep us healthy: clean drinking water, sanitation, and fresh, plentiful food.

I would like to invite you to share in my thanksgiving by making a donation to a nonprofit maternal/child health organization of your choice. To entice you to participate, I am thrilled to offer three fantastic giveaway prizes!

Prize #1: $55 online gift certificate to CSN Stores
With over 2 million products, from swing sets for kids to baby gear to kitchen appliances, CSN Stores is sure to have something you want!

Prize #2: Daisy Ribbons Package ($34 value)
Inspired by garden plants and animals, Daisy Ribbons creates beautiful hair accessories. From calla lilies to zinnias, butterflies to bumblebees, Daisy Ribbons bows are sure to please. The Small Package includes four of the most popular bows.

Prize #3: Silk Sling from Second Womb Slings ($60 value)
Turn heads with this iridescent pintucked silk dupioni sling from Second Womb Slings. Woven with scarlet and midnight blue cross threads, the silk appears to change color from plum to burgundy. The fabric features delicate pintucking and decorative top stitching.

Contest Rules:
Please spread the word and donate today. I will donate an additional silk sling for every $1,000 raised!*

Until the silk runs out...
    Read more ...

    Saturday, March 12, 2011

    Got cloth?

    9 days old
    Inga is a stomach sleeper...she will not go more than 5-10 minutes on her back or side, but will sleep forever on her stomach.
    Last night I swaddled her and laid her down on her back. When I woke up more than 5 hours later, she had rolled herself onto her stomach--still completely swaddled! I finally woke her up to nurse because I was bursting. So my quandary is--do I let her sleep on her stomach? I'm reluctant to do so because of the increased risk of SIDS.
    At least Zari is more than happy to be a napping surface.
    Read more ...

    Thursday, March 10, 2011

    Postpartum belly: 6 days after

    I stopped taking belly pictures after day 6, since Eric is out of town. He ended up going on the last half of his immersion trip to the US Virgin Islands. It felt like a good compromise; we've settled into a routine and Eric's mom has figured out how to get the kids to bed, where everything is in town, etc. He phoned me this evening to say the weather is lovely and the snorkeling fantastic. Lucky him!
    6 days after giving birth

    I've gone through an obscenely large pile of books over the past few weeks. Basically all I do during the day is take pictures, blog, eat dark chocolate, nurse, and read with Inga lying on my chest. And sometimes take long baths in the evenings. I wish there were a way to slow time down. I know from having had two other children that this newborn stage passes so quickly. As much as you try to capture these moments in your memory, you forget so much.

    Inga is a calm, snuggly, content baby. As long as she is on my chest or in the sling, she is the happiest thing ever. It's made nights a bit tricky because she does not like lying on her back or being swaddled. She's been sleeping on my chest or in the crook of my arm most of the time. She's so strong that she wiggled herself out of her swaddling blankets when she was just a day old! But being strong and coordinated also has its advantages. She can latch herself on in the dark with pretty much no help from me--something my other kids couldn't do until they were at least a month or two old.

    I switched over to cloth diapers yesterday, but it's been so overcast and gloomy outside that I haven't taken the obligatory picture with her Canadian diapers. Maybe tomorrow. I feel like I'm coming down with something, so it's off to bed for me.
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    Final reflections

    To close the chapter on neonatal resuscitation, I wanted to share some final thoughts. I am still surprised that Inga's birth story took the turn it did. I never expected so much focus would fall on the mouth-to-mouth and so little on the rest of the birth! But that's the nature of writing and sharing our stories on the internet. We can choose the words and images but not the meaning that they take on once they are released "into the wild," so to speak.

    To me, the two minutes where I assisted Inga in taking her first breaths were just that--two minutes, over and done with, and I moved on. They didn't dominate the birth experience (as they have the comments on this blog!).

    I feel no need to create a tidy take-away lesson from my experience. I did not post Inga's birth story to advance an agenda or to teach about neonatal resuscitation. I simply wanted to share my experience of labor and birth with people I care about, and with those who care about me and my family, even if we don't know each other personally.

    With those thoughts, I wanted to share these words from Tatiana of the Becoming Midwives blog (reposted with her permission).


    I don't have a punchline

    There is just this: an unplanned unassisted (but planned home birth) to a mother who, when her baby grew limp and breathless moments after her birth had the resuscitation training to calmly position her, breathe into her mouth, and repeat until her little arms curled up, she sputtered, and she cried. When I first watched the baby's arms grow limp, even though I anticipated it, having read the word "resuscitation" in Rixa's post, I panicked. My own baby was nursing to sleep as I watched this and I startled harshly enough that he pulled back, opened his eyes and looked at me, surprised. As I watched the baby grow dangly, I said to the screen, "No, no."

    That was the first pit of the last 20 minutes, that full-body rejection of the sight of an unbreathing baby. (Qualifier: I am a mom with a still-young baby and some unresolved junk around his birth - I know I have no business bringing all of that to anyone's birth, and I am not attending births. But I'm allowed to watch youtube.)

    And then, as I watched the aftermath, mama settling into the tub, baby squirming in the normal fashion, the bustling attendant arriving and then being asked to leave, and the new baby girl seeming fine, I filled with joyful exuberance. That this one precious, tender, incredibly sensitive new little person could be born needing help and receiving that help from her mother in the warm safety of a tub is a transcendently beautiful departure of what neonatal resuscitation normally looks like. Nothing jarring, nothing painful or invasive, nothing panicked, nothing even as upset as my own response watching on a screen so many miles away. No, just family, breath appropriately applied, and the rolling of time into life here among us other breathing people. I felt buoyant and celebratory.

    But now I'm sad again. Because this exemplifies what Adrienne Rich said. I believe every baby is that tender, soft, new, sensitive and deserving of such gentleness. Especially when it needs extra help. But in our world, such gentleness is not a universal right but a privilege that becomes available based on the constraints of social, cultural and demographic factors, including educational privilege and a willingness to make a choice that our culture largely regards as reckless. That is an awful lot to ask of people, who are social, dynamic beings in constant relationship and flux with the people around us, carrying with us the vestiges of that sense that certainly we can't know everything about this world, so mightn't it be wise to defer to authority?

    I love Rixa's bold and unapologetic grasp on her responsibility for the choices she makes for her family. I'm so glad for her, and for that sweet baby girl who may have had the world's most tender resuscitation. I'm so glad for my own children's relatively peaceful births, and for the so many that are held in that remarkably rare spirit of reverence and respect in this slowly growing trend of gentle birthing.

    But it is a bittersweet gladness, indeed, when I let myself broaden the lens to the larger world.

    I wish I could summarize it all with... "And here is our clear answer."

    But where? Where is our clear answer? I don't live in a world that has any of those. Not really, anyway. We like to assume the stance of certainty and conviction, but not one answer seems to stand firm against the onslaught of every possible experience, every possible shred of information, and every possible circumstance. And as much as I don't like to leave a bit of writing dangling with this feeling of conflicted joy-sad-ambiguity, it's what I have. There is no punchline.
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    Wednesday, March 09, 2011

    How did she fit in there?

    This is how Inga used to fit inside of me, more or less. Both she and Dio loved to hang out ROT.
    And lots of Inga photos because she's just too cute.
    My favorite newborn shirt. It says "la tĂȘte dans les nuages" (head in the clouds).
    On Dio's birth quilt.
    Sucking her thumb for the first time
    Nursing yesterday...and this was AFTER the engorgement was on its way down!
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    Tuesday, March 08, 2011

    Neonatal resuscitation

    Several people have asked questions about how and where they can obtain training in neonatal resuscitation. If you're in the States, visit the AAP's NRP page. In Canada, visit the CPS' NRP page. You can find links to current NRP guidelines and search for instructors or courses.

    I took my NRP course from Karen Strange, who travels all over the country teaching NRP workshops. She teaches everything required for the NRP certification and addresses how to adapt these to the realities of an out-of-hospital setting (cord usually left intact, resuscitating baby in place with a portable heated surface rather than removing baby to a warmer, etc). She's hilarious, quirky, and has a last name that totally fits her personality.

    Nothing replaces actual hands-on experience gained at NRP workshops. But if there are no NRP courses near you, you can of course study on your own. Do what you can with the resources available to you. Buy or interlibrary loan the latest NRP manual. Watch videos. Read textbooks. Learn more about the fetus-to-newborn transition.

    Who would benefit from taking a NRP class? Besides the obvious (midwives, physicians, nurses), I feel that doulas should also be certified in NRP. Sooner or later, most doulas will attend a precipitous birth where the mother has the baby before she can make it to the hospital, or where the midwife doesn't arrive in time at a planned home birth. In addition, I'd strongly recommend NRP for women planning a home birth or with a history of fast labors.

    What about Inga's birth?
    There is disagreement, even among NRP instructors and NICU/L&D nurses, about whether or not I should have done more aggressive stimulation (drying with towels, rubbing the back, etc) before proceeding to mouth-to-mouth. I am aware of the NRP flow chart (pictured below). During Inga's birth, it was clear to me that she needed mouth-to-mouth at that point, rather taking more time to get out of the tub and dry her off first. Inga was born with color and tone and then started losing it, which indicates secondary rather than primary apnea. In that case, stimulation is less likely to be effective than positive pressure ventilation (either by mouth-to-mouth or bag-and-mask).

    If you read the comments on Inga's birth story, part 2, you'll see a conversation going on among L&D/NICU nurses and NRP providers about whether I should have done more stimulation before proceeding to PPV. Some suggested doing a bit more stimulation/clearing the airway, while others felt that moving to mouth-to-mouth at that point was most appropriate. For example, Sarah, a NICU nurse, explained:
    With primary apnea (a baby born without tone and color) rubbing the baby and clearing the airway will often work to stimulate breathing. With secondary apnea, where the baby loses tone and color, stimulation will not work. The baby needs PPV/ rescue breaths. Stimulation is really irrelevant in these cases.
    From cileag:
    I think it's intimidating for people to see a baby "crash" like that. Like Housefairy said, mostly it's the "perfect" homebirths that get shared. As an OB nurse and practitioner of NRP, I know that the good thing about NRP is that it almost always works.
    My nurse-midwife, who herself is a NRP instructor, wrote to me:
    Stimulation [in the form of giving breaths] and a moment for the cord blood to return to baby again...and baby was clearly just fine. She had no additional need for support, not even blow-by oxygen, which is evidence that this was an acute scenario [i.e., temporary and quickly reversible] and she had a good reserve. 
    Okay, now I'm really tired of talking about neonatal resuscitation, since Inga's was such a minor part of her overall birth. There are all sorts of ridiculous things being said on the internet about me and about her birth. Just to give you a few examples:
    • I am a bad, unfeeling mother because I remained unnaturally calm. A good mother would have panicked more and shown signs of distress and remorse. This reminds me of when I was engaged to Eric. People worried that I had made a bad decision "because I wasn't glowing enough." Apparently there's an engagement smile-o-meter that I failed to pass. Just as I failed the precipitous birth panic-o-meter.
    • Because I didn't follow the NRP flowchart to the letter, I was ignorant and uninformed. Never mind that Inga responded almost immediately to the mouth-to-mouth and had an Apgar of 9 or 10 by time she was 2 minutes old. 
    • Everything turned out fine, but YOU OR THE BABY COULD HAVE DIED! Yes, I could have had a hemorrhage, even though I lost only 10 cc of blood. Yes, the baby could have needed more extensive care, but it didn't and skilled help was on the way. Yes, I could have had a heart attack or an amniotic fluid embolism. But I didn't.
    • Inga's birth proves that home birth kills babies. Holy non-sequitur Batman!
    I have an awesome response coming...stay tuned.
    Read more ...

    Monday, March 07, 2011

    Postpartum belly: 4 & 5 days after

    4 days after giving birth
    5 days after giving birth
    Zari wanted a "picture with the belly"
    morning snuggle
    Zari's turn
    Dio thinks Inga is pretty neat
    He loves to give hugs
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    Sunday, March 06, 2011

    Things I love about newborns

    Everyone raves about "that newborn smell." I'm not sure if I've ever noticed it, but I do love...

    wrinkly hands
    wrinkly feet
    forehead creases and rosebud lips

    What do you love about newborns?
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    Saturday, March 05, 2011

    Postpartum belly: 2 & 3 days after

    2 days after giving birth
    3 days after giving birth
    Read more ...

    Inga's birth story, part 2

    Reflections on Inga's birth

    Additional commentary on resuscitating the baby:
    The midwives Penny and Holly watched the birth video while I was resting after the birth. I asked Penny if I reacted appropriately to Inga’s condition—was I too quick to do mouth-to-mouth? Should I have done anything else first? Should I have waited longer? She said I absolutely acted appropriately and that, frankly, Inga looked pretty darn scary for a while. Based on Inga's rapid loss of tone and color, the midwife suspects there was some kind of cord compression/restriction during the birth. Between my giving her mouth-to-mouth and the blood resuming circulation after the birth, Inga recovered quickly.

    The other nurse-midwife Holly (who arrived after I was settled in bed) added that it was probably best that they weren’t there for the birth. I knew what to do and was able act quickly and calmly. She guessed it would have been more stressful for me had they been there and stepped in to intervene.

    Was I scared? Not really--more focused on the situation at hand. I do remember thinking, as Inga was losing color and muscle tone, "I have NOT done all this work for nothing--come on, baby!" I knew it was serious, but I also knew that I had the appropriate knowledge and skills. I feel strongly that every pregnant woman should prepare herself for how to handle situations such as this, no matter where she is planning to give birth. Had I been planning a hospital birth, I seriously doubt I would have made it on time. And obviously, the midwife won't always make it on time either!

    And as scary as the resuscitating part might seem, I'm glad to to be able to share it. It shows how to handle an emergency situation without losing calm.

    I was very glad to be in a home setting in this situation. It's very unlikely that Inga's cord would have remained intact during a hospital resuscitation, which would have further compromised an already struggling baby. As it was, Inga was able to receive her full placental transfusion and make a quick recovery. 

    Regarding the midwife not making it to the birth on time:
    Not surprisingly, this didn't concern me at all. In fact, it hardly even registered that she wasn't going to make it. Now I didn't intentionally call Penny too late. In fact, when I called her the second time, I still wondered if it was way too early! She probably would have made it on time, had she not taken a shower after my second phone call. She told me, "I should have known not to get in the shower! After all, it was Rixa calling me!"

    As you know from reading my blog, I planned an unassisted birth with Zari, so doing it on my own wasn't at all scary. Plus there's nothing that would have happened much differently had Penny been there. She would have checked heart tones, but otherwise everything else would have been the same. I know this, because Dio's birth that she attended was nearly identical to Inga's. With him, I pushed in the same position for about the same amount of time; I supported and caught the baby myself. Penny was just there to keep an eye on things.

    Other thoughts:
    I'd love to dispense with the practice of labeling our births. In my experience the line between a midwife-attended and an unassisted birth was so fluid as to be nearly irrelevant. Now that I've had a planned unassisted birth, a midwife-attended home birth, and an "accidental" or "surprise" unassisted birth, I can say that the labels don't really mean much at all.

    There was an OB who was hoping to observe the birth, but he wasn't able to make it out. I know he had a busy call schedule on top of regular office hours. Too bad, though. Maybe next time?

    The timing of this birth worked really well in the end. I was well-rested and fully recovered from the stomach bug. The day before I went into labor was incredibly relaxing, even languorous. As with my other two children, labor began at night and the birth happened during the day. And even the time of day of Inga's birth was perfect. It was a sunny morning and we were in an east-facing bedroom, so the light was beautiful. We got everything in order--barely--before I started pushing: house tidied, kids sent off, birth pool filled, etc. And my mother-in-law arrived the day after Inga was born. Couldn't have been better!

    Someone asked why I chose not to have the kids present for the birth. It would have been way too distracting to have them underfoot, especially Dio. There was no question once labor started about wanting them around. I really liked the quiet time both before and after Inga was born, without the distraction of happy, noisy, energetic siblings. 

    By the next day, the events of the labor and birth were already feeling surreal and dreamlike. Did I really go into labor and have a baby? Obviously yes, since I'm holding her right now! But it seems hard to believe that it really happened and that it's already over.

    And finally, I am SO happy that we filmed this birth!
    Read more ...

    Friday, March 04, 2011

    Inga's birth story, part 1

    I woke up to strong contractions around 1 am. From their length and intensity, I knew this was the real deal. I had to breathe slowly to work through them. Counting breaths became my early labor mantra. By the fifth breath, the peak would begin to subside. By the ninth or tenth breath, the contraction was gone. I got out of bed several times to use the bathroom and turn the water heater to the hottest setting, but otherwise made myself stay under the covers and rest. As much as I wanted to be up and moving with the contractions, I was too warm and cozy and tired.

    I purposely didn't watch the clock, so I don't know how frequent the contractions were. But they were really intense. I listened to the Hypnobabies track "Easy First Stage" once. It was really relaxing and gave me welcome distraction from labor. I also composed a mental list of tasks for Eric to do in the morning: feed & dress the kids, drop them off at a friend's house, fill the birth pool, pick up toys, start a load of laundry, etc. Toward the end of the morning, I drifted in and out of sleep between contractions.

    At 6:48 am, I got up to use the bathroom and decided that I had had enough. Time to get up and work with, rather than try to ignore, the contractions. I noticed the familiar pink-tinged mucous or "bloody show" that has heralded labor with all of my children. Soon we were all awake and getting ready. I called the midwife first thing to give her a heads-up, letting her know I'd call again when I was ready for her to come. I kept hurrying Eric and the kids on. Somehow I just knew that we didn't have the time for a leisurely morning. As soon as I got out of bed, the contractions starting coming much more frequently. I showered and dressed (bikini top & bottom, compression hose, yoga pants, & shirt) and started filling the birth pool as soon as the hot water tank had recharged. My logical brain was wondering if I was jumping the gun, but the instinctual part of me compelled me to act quickly.

    By 8:15 am, Eric had returned from dropping the kids off. The pool was filling. From when I woke up until I got in the birth pool, I did "Rixa's labor hula" during contractions, as my sister-in-law calls it. This was right before I got in the pool and about 10 minutes before my body began pushing. You see me hit the button on the laptop when the contraction ends.

    Eric hurried to finish last-minute tasks, then gave me a blessing. I've asked for one during each of my labors, and they have always been incredibly reassuring. By this point labor was really, really intense. I sensed the dizzy, spinny, buzzing feeling heralding the endorphins of advanced labor. But was I really that far along? I called the midwife a second time and told her to head over. I didn’t want her to arrive too early, but if my instincts were correct, things were really cooking.

    I timed several contractions with Contraction Master. If this labor was anything like Dio's, I was getting close to the end based on how intense and how close together they were. These are the last contractions I had before I got into the birth pool (and in retrospect, about 30 minutes before the baby was born):

    Somehow, I just knew that I would be pushing soon. There was no physical indicator, just an interior knowledge that the baby was on its way.

    About 8:45 am, I got in the pool as it was finishing its final top-off. It was the perfect depth and temperature.

    I was keen to film this birth, so Eric set up the video camera. I had a few contractions in the tub and started feeling a little bit pushy. Already? After another few contractions, in which you hear increasingly grunty vocalizations, there was no question. I knelt and reached inside. Sure enough, there was a hard round head about two knuckles deep. I felt around for a while, trying to figure out what was what. With all of the folded tissues and wrinkly baby’s head, it’s sometimes hard to tell where you end and baby begins!

    Although the birth videos show only the physical side of giving birth to a baby, I was also going through an intense mental struggle. I knew that the sensations of pushing would only become more intense and more uncomfortable. Okay, let’s be honest: I knew it would hurt so much more than it already was. I dreaded it, yet I knew there was no escape. I’m not exactly fond of feeling a baby come out of my vagina, you know? It doesn’t feel good. First your butt feels like it’s going to split in half, then your vagina does. My vocalizations manifested this inner struggle, as well as the physical sensations going on in my body.

    Like during Dio’s labor, I needed something to grab onto, so Eric and I “arm wrestled” during contractions. Once the baby’s head began to crown, I put my right hand down to support my tissues. I provided support against the perineum at first. Then, as the baby’s head emerged more and more, the burning and pressure moved towards the front. For the third time, I experienced the impossible-yet-inevitable sensation of a baby’s head emerging out of my body. My palm was cupped over the head. The baby was facing anterior, the smooth back of the head against my palm and my fingertips touching its face. There was a slight pause after the head was born. Then the shoulders emerged. I provided more counter-pressure in the front as the shoulders squeezed out. Another brief pause at the torso, one last little push, and the baby was born. I lifted it out of the water. We discovered we had a girl! We didn’t look at the clock until a few minutes after, so we’re guessing the baby was born at 9:12 am.

    Soon after the birth, Inga lost muscle tone and color. I quickly realized that I needed to perform mouth-to-mouth. Fortunately, I became certified in neonatal resuscitation several years ago, so I knew what to do. It was tricky getting the angle right, since the cord was short. I gave her five breaths. After each breath, she coughed and perked up a bit more.

    Within seconds of Inga being fully recovered, the midwife’s assistant arrived. I guess she hadn’t been debriefed about me wanting to be left undisturbed. She started bustling around and talking and asking questions and I got really annoyed. So I kicked her out of the room, saying, “I just need peace and quiet. I'm okay.” She beat a hasty retreat. This cracks me up.

    One of my other favorite parts is in the middle of pushing when the phone rings and goes to the answering machine. It was an automated appointment reminder for my prenatal visit the next day!

    I sat back in the tub for a few minutes to relax. It felt so good to be done!
    Okay, now that you’ve read about the birth up to this point, go watch the videos. They're about 30 minutes total, from when I got into the tub until about 5 minutes after Inga was born. There’s some nudity since I don’t have a swimming suit bottom on, but it’s quite tame. Between the labor hula video and the birth video, you’ll get a really good idea of how I labor and birth. You’ll see me give birth in an upright kneeling position, provide my own perineal support and counter-pressure, catch my own baby, and narrate what’s going on. And you’ll get an earful of funky pushing noises!

    Pretty intense, eh?

    I rested for a few minutes, enjoying the warm water and weightlessness. The midwife arrived and helped me get settled into bed. Did I mention how good I felt? Ahhhh…I had a silky soft baby on my chest, I could finally lie on my back, and the hard work of labor was over. It felt glorious.

    Inga started rooting around and pushing herself up with her feet. I wanted to let her do the breast crawl and self-attach. She started going through the breast crawl stages. But she got fussy and I was too impatient! So maybe 30 minutes after she was born, I gave her a little help and she latched on perfectly. The midwives and assistant stayed in the kitchen, entering the room only when I asked for something. It was a beautiful, quiet time spent snuggling and talking and resting.

    I started feeling a bit grunty/pushy and figured it was time to get the placenta out. I called the midwife in. She held a bowl, caught the placenta, and then raved about how little blood I had lost—an estimated 10 cc (2 tsp) total! She took pictures of the birth pool and placenta bowl so that her colleagues would believe her.

    About 2 hours after the birth, we did the newborn exam.
    Then I showered and got my bottom half dressed. The midwife checked me for tears--just two periurethral skidmarks, so minor that they didn't even sting! Eric snuggled Inga skin-to-skin for a long time. It was fun to rest in bed together as a couple with our new baby.
    After lunch, Eric brought the kids home to meet their new baby sister.

    You might also want to read:
    Inga's birth story, part 2
    Part 3: Neonatal resuscitation
    Part 4: Final reflections
    Read more ...

    Let's name this baby

    We've decided on a first name for this baby. We wanted something Scandinavian, since many of our ancestors originate from that part of the world. I had a college classmate with a really cool name that we both liked. So our new baby girl is named...

    Inga Freeze

    We're still working on a middle name. I want something short, preferably 1-2 syllables. Any suggestions?

    I'm feeling really good. I've gone up a cup size or two and felt a let-down for the first time this morning. Inga is nursing really well. Now that the milk is flowing more plentifully, I can clearly hear her swallowing when she nurses. She loves sleeping on my chest day and night. A sling is the perfect thing for the daytime; I can hold her and type/eat/read/nap at the same time. Inga has already had 5 poops. The last one was much, much lighter in color, so the meconium is working its way out of her system. Can't wait for that easy-to-clean breastmilk poo!

    I'm uploading the last of the videos for Inga's birth story. Stay tuned--it will be coming later on today!
    Read more ...

    Thursday, March 03, 2011

    Postpartum belly: 1 day after

    I've always wanted pictures of my shrinking postpartum belly. It's like pregnancy in rapid reverse! So here's 1 day after giving birth:
    Read more ...

    Wednesday, March 02, 2011

    It's a girl!

    Announcing the arrival of a baby girl born at home at 9:12 am! It was a surprise unassisted birth; the midwife arrived 5 minutes after she was born. She weighs 7 lbs 9 oz and is 21 1/4" long.

    Birth story, super-short version:
    Contractions started at 1 am. I made myself stay in bed and try to ignore them until 7 am. Two hours after I got up, I had a baby!
    We've been nursing...
    Cuddling skin-to-skin...
    Getting to know each other...
    And just relaxing.
    Welcome earth-side, little one!
    Read more ...
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