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    WPPW (Week 2): Birth





    Throughout April, I'm taking part in Lauren Wayne's Weekly Parenting Poetry Workshop. This week's theme is "Emerge", and within this theme, the first prompt: "Labor: Each minute in labor is suspended animation. Describe your labor in a poem." Last week's poem's theme was "Prepare".

    Please do join me in writing! (Obviously) you don't need to be a poet to participate; you need only have a bit of courage to put words to paper (and then hit publish.) :)


    Weekly Parenting Poetry Workshop

    Birth

     

    The stream hit my back and time stopped. Suddenly the pain - deep, endless, unforgiving - abated. No longer knocked sideways off my feet with each backstabbing impact, I rocked on the stool, riding the waves. Alone with the water, despite a periodic invading scope, I was alone --- with your heartbeat. My hope.

    I was unafraid.

    Hours? Blissful.

    Then, too soon, I was torn out of my own watery womb and back into the bright lights. Pain like an abyss. And the accursed beeping.

    And hands and eyes and words: asking, prodding, suggestions thrown; but I'm mute.

    Fear crept in nauseating swells up my neck and belly. Fast friends with hurt.

    Hours pass. Fretful.

    Fear: a stealthy, strong enemy. And doubt.

    "You can't do this," doubt whispers with malice, climbing wretchedly up my arm to rest - cold - on my shoulder.

    I agree, I succumb, and I go under screaming.

    And still the beeping - terrifying, reassuring; my connection to you, my baby. Arresting sleep, yet keeping me from panic. I drift.

    The tears, my pain, and I lie legless, helpless.

    Numb.

    Oh blessed curse, painkiller. Physical agony gone briefly, I'm weakened by sickening gratitude.

    Pain usurped by guilt.

    This wasn't in the plan.

    And yet still you came to me, from me, through me. Oh perfect baby, wrenched from my pelvis where you'd wedged yourself.

    Birthed through a clean slice, vibrantly belting out your disapproval, voice urgent: I AM HERE!

    Your immense strength nourished my own.

    My daughter, my heart; you made me a mother.

     

    Why Should You Breastfeed Your Baby?





    If you are pregnant, you may be considering breastfeeding your baby once she arrives. Breastfeeding is natural, normal, and healthy – for your baby and for you! You may not know yet if it’s the choice you want to make, but, please consider these reasons why breastfeeding – even if you aren’t sure it’s the right choice for you – is likely the right choice for your baby:

     

    Breastmilk helps fight infection!
    When you breastfeed, your antibodies are passed from your body to your baby. What this means is that your baby will get sick less often [50% reduced risk of ear infections, 64% reduced risk of GI infections, 72% reduced risk of hospitalization from pneumonia | Source: http://www.breastfeedingtaskforla.org/resources/ABMRisks.htm
    ] and when she does get sick, it will likely be less severe, and the duration will be shorter. The antibacterial properties of breastmilk don’t stop IN your baby. You can use breastmilk topically too – to clear & moisturize tiny noses, treat pink eye, and soothe rashes, small scrapes, and other infections.


    [Source: WomensHealth.org]

    Breastfeeding your baby reduces the risk of SIDS!
    SIDS risk is diminished by about 50% in breastfed babies according to a study done in Germany
    . But WHY does breastfeeding help keep your little one safer? There are several reasons! [Eight of which are discussed in detail on Dr. Sears’ website]. The infection-reducing properties of human milk keep baby healthier while sleeping – reducing the risk of RSV which can lead to SIDS. Breastmilk contains vital nutrients and fats to help baby’s brain and nervous system develop more completely. Breast milk is natural – so if aspirated, is less likely than formula to cause irritation or lead to apnea. Breastmilk reduces the severity of GER in infants. Breastfeeding calms and organizes baby so she does not fall into unnaturally deep and potentially dangerous sleep. Breastfeeding helps mom connect more deeply with her baby – and become more sensitive to baby, even while asleep (I have felt this distinctly myself). Finally, breastfeeding is more of a challenge for baby than bottle feeding, so baby develops better sucking, breathing, and swallowing coordination and facial muscle tone – all of which help baby breathe better while sleeping.

     

    Breastfeeding is natural and normal; formula is not!

    Human milk is perfect for human babies! What comes from your body is designed specifically for your baby. If you can’t breastfeed, another human’s breastmilk is still far closer to what your baby needs than formula made from another species' breastmilk or from a plant. Breastmilk is living: it changes with your baby, according to her needs, and is always just the right temperature. Formula is made in a factory, and is mixed with water and served in a bottle. As such, it can be subject to contamination. The ingredients (water and bottle included) can be tainted with pesticides, fertilizers, hormones, antibiotics, cleaning chemicals, dangerous bacteria like salmonella, foreign material, high levels of metals like aluminum (particularly in soy-based formulas), and the list of potentially toxic or dangerous possibilities goes on. While breastmilk isn’t always contaminant-free, you can control most of what is in your breastmilk through your diet. And, even if what you eat or drink isn’t perfect, breastfeeding is still the healthiest choice for your baby. If you’re concerned that what you eat might not be compatible with breastfeeding, check this page out first – you might be surprised! There is very little that a mother can't ingest that would negatively affect baby. 

     

    “…research tells us that the quality of a mother’s diet has little influence on her milk. Nature is very forgiving – mother’s milk is designed to provide for and protect baby even in times of hardship and famine. A poor diet is more likely to affect the mother than her breastfed baby…” [Source: How does a mother’s diet affect her milk?]

     

    The truth is, our bodies do an excellent job of filtering out what isn’t good for baby, and giving baby exactly what she needs, even if we don’t do the best job of eating ourselves. Trust your body to do right by your baby!


    [Source: WomensHealth.gov] 

    Breastfeeding is free!

    This may seem like a simple concept, and as such, it is often overlooked – particularly if you’ve been given tons of free samples in the hospital (and from friends, or in the mail). But the fact is, when the free samples run out, you have to buy formula – and it is expensive; particularly if your baby needs a special formulation due to formula intolerance, or you choose premixed liquid, instead of powder. And as baby gets older, he’ll need MORE formula, as it is always the same and doesn’t change in composition like breastmilk. Going rates are anywhere from $100 - $300/mo. or more just in formula costs – and that doesn’t include bottles, bottle brush, drying rack, etc! Now, if you add in to the equation that breastfed babies are typically sick less often (thus reducing doctor and presccription bills), breastfeeding really is the most economical choice. For an interesting comparison of the cost of formula with the typical costs of breastfeeding, check out this calculator.

      

    With all these benefits in mind, why not give breastfeeding a try? Even if you only nurse your baby for a few days you will have given your baby the natural gift of your milk. I really believe the choice to breastfeed your baby is a choice you won’t regret. I know I never have; it's one of my most amazing parenting experiences so far!

    Nine Parenting Truths





    In my going-on-seven years of parenting, I’ve discovered some things – seemingly universally experienced by parents – from all “sides” of the parenting spectrum: stay at home parents, working out of the home parents, homeschooling parents, attachment parents,  etc. – that no one bothered to tell me, prior to having children. Of course, when you want children, you don’t listen to anyone else anyhow because your pregnancy will be super-awesome, your birth will be a breeze, and your baby will be all sweetness and light, right? Right. So, without further ado, nine things:


    (Me... A mere ten days before my world completely changed)

    1) There is no off switch on children. Volume? Always on, and usually set to high. Movement? Always on the go unless sleeping (& oftimes not even then). Needs/requests? Always present; never ending. Certainly many needs ease a bit as children age, and all but the most urgent can usually be delayed a bit. But, especially when they're young, the urgent needs (see #2) of children really don't let up. The fact of the matter is, in spite of what you might see in pictures or hear from great-grandma’s memories, children aren’t typically quiet, they aren’t usually calm; they aren’t mini adults.  They are always on, and expect you will be as well.  The good part about this is that you learn how patient you can be. Patience, as they say, is a virtue.

    2) Taking care of sick kids is really quite challenging. It pushes the limits of your empathy and innate care-taking qualities (for details, see #3). Most especially when you also are sick (& when you're not sleeping because you're up with sick kids, and being exposed to all manner of germs picked up from every possible play surface in the universe even some that you don’t consider play surfaces but your children certainly do, like grocery store aisle floors – you likely will be), and would rather be in bed, having someone care for YOU.  But, there must be a light at the end of the tunnel.  I think there are two: First, I keep in mind that through illness, children are building their immune systems one cold at a time – getting stronger and healthier. And two, I remember my childhood illnesses with an odd fondness – being home with my mom all day while being allowed to draw and watch as much television as I wanted – I don’t much recall the illness as much as the special attention.

    3) Cleaning throw up out of the car stinks. Literally. As does cleaning throw up out of the bed in the middle of the night, or off of yourself, at any time of day. There's just no good time for puking, really, but it's particularly unappealing when it isn't yours and it's on your stuff, your person, and/or you've had about 2 hours of sleep when said cleaning is required. Trying to think of an upside to this… if there is one, please feel free to chime in.

    4) Appreciation for all you do as a parent is not readily forthcoming. Whether you work another job in addition to parenting or raising your kids is your sole vocation, no one really says thank you – not specifically, anyway. And why not? Because parenting is not really considered a job, and, big sigh, its commonplace: nearly anyone can become a parent; nearly everyone is.  Thanking someone for being a parent is like thanking someone for clipping their own toenails: Great job, keep on being human, you. And children don’t know to thank you because… well, because they’re children and, you’re just doing what you’re supposed to be doing – taking care of them. Thanks, Mom, pass the granola, and can you take me to the playground, please?
    And though it’s arguably one of the most important jobs on the planet – the maintaining of new, and hopefully functional, kind, and creative humans – it’s just a particularly thankless, underappreciated job.
    Yet, there are some periodic bonuses: sweet chubby cheeked kisses, toddler snuggles, lovely drawings with MOM scrawled across the top, spousal recognitions of job well done, strangers’ comments on how "well behaved" your children are, watching your kids achieve their own independence or success – it's enough to keep going at it each day.


    (Appreciation from my 6yo - note that it says love-together-peace-life. Man, she's awesome!)


    5) Parenting can be boring. Like glassy-eyed staring at the ceiling (or the clock counting the hours ‘til bedtime) oh my goodness when will the repetition end kind of boring. Babies are incredibly adorable, and… they don’t do anything (but they sure need a lot) – thankfully they have the big eyes and chubby thighs going for them. Toddlers are sweet as pie, and… they want to read the same book. Over. And over. It’s kind of like that knock knock joke your preschooler memorized that was really funny the first time, but not so funny the eleventy-billionth time she told it.  Boredom is just part of the deal. On the upside, this has made me more creative – both in my kid-and-adult-centered-activity-planning (i.e. finding things that can be interesting to both me AND my kids) and in my clandestine escapism (i.e. learning to tweet whilst doing the dishes), AND more able to slow down & appreciate the boring... because my children's childhood goes far too quickly.

    6) Parenting makes you tired. Bone tired. To the core. No matter that your kids are sleeping through the night or not – by that time your ability to sleep normally yourself has been so altered that you can’t sleep anyhow. No matter if your kids are older – then you’re staying up to make sure they come back home safely at night. Parenting is synonymous with exhaustion. When you go to bed at night you fall into bed. It’s a tired more deep than a day’s hike with a heavy backpack or International travel. Of course, you learn to live with it, you adjust, your kids start sleeping better, you start sleeping better… but the sleep of the parent is never the same as the sleep of the non-parent. Perhaps the good from this is how amazing a morning to myself is – sleeping in while Adam makes breakfast and plays with the children – those two extra hours of sleep never felt so good.

    7) Parenting is huge. Even when you don’t want it to be; it is everything. You are in charge – whether you want to be or not and whether your children “fail” or “succeed” – you are to blame. You make the choices, you carry the burdens. You select your children’s method of birth (or sometimes it selects you, no matter how much you prepared), your children’s method of feeding, schooling, discipline, experiences, etc. etc., and however it works out – or doesn’t – falls on you. The responsibility (as unfair as it may be since we all know nurture – or is it nature? – isn’t everything in how a child turns out. ) can be overwhelming.  It can also be liberating – realizing, as much as we want our children to be a certain way – as much as we try and succeed, or fail – our children are going to be who they are; they are resilient and amazing, in spite of us.

    Of course, the unspoken rules of parenting aren’t all negatives. There are some positives that I wasn’t told, either. Like:

    8) Watching your child figure something out is awe-inspiring. Whether it be learning to speak, crawl, walk, stack blocks, multiply, write in cursive, ride a bike… Just observing your child learn, and develop skills – particularly ones that you weren’t even directly involved in teaching – is absolutely and endlessly fascinating.  
     
    9) You will feel more love than you've ever felt or ever know what to do with. If you thought you loved your spouse, or your dog, or your mother... you didn't really know how deep love could be until you held a tiny baby, drifting off to sleep, who’s clutching tight to your finger in the silence of the middle of the night in the rocking chair. The smell of your baby's head is the most delicious aroma you've ever experienced and stirs a fondness so strong and lasting and bonding… the love of a parent for a child is infinite.

    So, did I leave anything out? What’s the most amazing – or challenging – thing you’ve discovered about parenting?

    Posted: Jan 10 2011, 15:04 by kelly | Comments (13) RSS comment feed |
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    Filed under: Children | Parenting

    Techniques for Turning a Breech Baby





    During pregnancy, babies spend their time in various positions.  However, they “should” be heads-down (cephalic or vertex) – and most are (around 95%) – by the time they are ready to be born.  However, some babies are persistently heads-up (breech), even until late in pregnancy.  There are three types of breech – frank (where babies bottom is down & feet are up near their ears), complete (where baby’s knees are flexed & feet are by their bottom – like a crosslegged position), and footling/incomplete (one or both feet are down, lower than the bottom). The most common breech position is frank breech.

     

     

    The determination that baby is heads-up typically isn’t welcome news because it often means, for many women (in this current climate of medicalized childbirth), that a vaginal birth is no longer easily available or an encouraged option for delivery, and a scheduled cesarean section is instead recommended for delivery.

     

    There are studies which indicate that vaginal breech births are safer then breech cesarean deliveries – particularly for the mother.  However, vaginal breech births can present risks for the baby – particularly when the baby is not in the frank breech position – such as cord prolapse, cord compression, and head entrapment. Consideration of these fetal risks, combined with the fact that as c-sections have been more and more routinely recommended for breech delivery – thus resulting in far fewer practitioners who are familiar with the procedure for safely delivering a breech baby vaginally – unfortunately has resulted in vaginal breech delivery being considered the more dangerous mode of breech delivery across the board and not recommended – particularly on an “untested” pelvis (first birth).

     

    "Before a vaginal breech delivery is planned, women should be informed that the risk of peri-natal or neonatal mortality or short-term serious neonatal morbidity may be higher than if a cesarean delivery is planned, and the patient's informed con-sent should be documented."

    See ACOG’s statement on term singleton breech delivery: http://www.ncbi.nlm.nih.gov/pubmed/16816088 At this time, in the United States, over 90% of breech births are delivered by cesarean section; an astounding number. Most women just are not given a choice of vaginal delivery any longer.

     

    There is a recent documentary film called, A Breech In The System about giving women back the choice to birth their breech babies vaginally, instead of via cesarean section. You can view the trailer here: http://www.youtube.com/watch?v=vRjSmR9QmYg&sns=tw

     

    The comparative risk of cesarean section versus vaginal breech delivery is a complex one, and many factors need to be considered, studied, and discussed with your care provider before making a decision. There are several places you can visit to learn about these risks & comparisons of modes of delivery:

    http://emedicine.medscape.com/article/262159-overview

    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)02840-3/fulltext?_eventId=login

    http://www.ncbi.nlm.nih.gov/pubmed/3452635

    http://jeremyscorner-grifter.blogspot.com/2009/03/breech-vaginal-birth-is-not-emergency.html

     
    Regardless of what you decide once baby is about to be born; before baby is at term, there are many things you can do (and that I did as a pregnant mother carrying breech babies – twice) to help your baby to turn, and increase your chances for a safe vaginal delivery. I’ve included every idea that I tried through my two pregnancies, the theory behind the idea, the process & outcome, and my thoughts on each idea.

     

    I recommend talking to your doula, midwife, doctor, or other care provider before trying any of these… just to be safe. :)

     

    Ideas for Encouraging a Breech Baby to Turn

     

    Idea:

    Cold aversion – Take a bag of cold peas, and place on the top of your tummy, near where you believe baby’s head to be.

     

    Theory:

    Baby will move away from the unpleasant coldness, and towards the warmth of your lower abdomen. 

     

    Process & Outcome:

    I tried this only with my first, and only once. Baby didn’t turn.

     

    Thoughts:

    I didn’t like this method – it felt intrusive and not entirely friendly to me.  I “warned” her ahead of time & told her she might not like what was coming up. In all honesty, the coldness probably isn’t that shocking with all the “padding” between me & baby.  But I have a thing about cold, and so I didn’t repeat the experiment.

     

    *****

     

    Idea:

    Music/Sound – Play music or have a deep voice (preferably your partner so that baby will have a better chance at recognizing the voice) at your pelvis. 

     

    Theory:

    Baby will turn to better hear the voice or music.

     

    Process & Outcome:

    My reading had suggested playing classical music, but instead I chose music with a heavier beat & deeper bass – to increase the chance baby would hear it.  Adam also spent many nights talking to my lower abdomen.  Baby didn’t turn.

     

    Thoughts:

    This idea was one of the easiest and least invasive.  It felt very natural to me to talk to baby & play music as an enticement to move.

     

    *****

     

    Idea:

    Light – Shine a flashlight at your lower abdomen.

     

    Theory:

    Baby will notice the light & try to move towards it.

     

    Process & Outcome:

    We tried this several times without luck.

     

    Thoughts:

    I had no problem with trying this one multiple times, but was dubious about the effectiveness due to how dulled the flashlight would actually be shone through so many layers of flesh, muscle, skin, blood, etc.  I would recommend trying this when baby is awake – so drink a glass of OJ first!

     

    *****

     

    Idea:

    Visualization – Picture baby moving downwards into your pelvis; settling into a comfortable heads-down position.

     

    Theory:

    Mind over matter.

     

    Process & Outcome:

    Upon learning of each of my babies’ breech positions, I immediately started thinking of them in a vertex position; birthing vaginally – particularly with my son, after having experienced a long, difficult labor with my first. I knew that positive thinking was so important. I knew my daughter would turn on her own, and she did.  I also felt certain my son would turn as well, but due to circumstances beyond either of our controls, his in-utero environment was simply not conducive to turning.

     

    It is difficult to know for certain if/how visualization helped with turning; but I would like to believe at the very least it improved my outlook.

     

    Thoughts:

    I believe this idea is one of the strongest and least invasive methods, particularly when used consistently and in conjunction with some of the physical suggestions. If nothing else, putting your mind in a positive place when it comes to birth, can only help outcome – even if the outcome is not that which you visualized, I believe knowing you’ve done all you could, will help with coming to terms with the birth you do end up having.

     

    *****

     

    Idea:

    Inversion – putting yourself in various upside-down positions

     

    Theory:

    If baby’s tendency is to be heads-up, moving your own body in the opposite direction (i.e. your pelvis higher than your head) may encourage baby to turn. 

     

    Process & Outcome:

    There are several ways to do inversions with the key point being raising your knees & hips 12 – 20” above your head & shoulders. I was able to achieve this in several ways:

    -          kneeling on the couch, and lowering my torso down onto my folded arms on the floor. 

    -          “elephant walking” – i.e. a downward dog position, but with elbows on the ground, and “walk/crawl” around.

    -          doing a headstand against the wall (note: at the time, I had been actively doing yoga, and was in good physical shape, and familiar with this position – I would not recommend headstands if you’re not already familiar with and comfortable with doing them pre-pregnancy)

    -          lying inverted on an ironing board which was leaned up against the couch – I’d lean the closed board against the couch, straddle the board with feet on the couch for stability, then lay myself out, head-down. I watched a lot of TV upside down. 

    Whichever inversion you choose, hold the position for 5 – 10 minutes.  Make sure that you are supported, comfortable, and won’t fall.

     

    Several of these positions are documented in video/pictures at SpinningBabies.com (a wonderful site for optimal fetal positioning - well worth checking out!): http://spinningbabies.com/techniques/the-inversion

     

    As for outcome, its hard to tell whether my inversions helped or not. I did them every day from about week 34 on with my daughter, and she did turn on her own, so I’d like to believe so.

     

    Thoughts:

    Another good idea, non-invasive, and overall will help stretch your ligaments, and has a good chance of encouraging baby to turn by using gravity. The only issue I had with these positions is that late in pregnancy, they can be uncomfortable to get into, remain in, and get out of, particularly when your center of gravity is off, as well as your sense of balance. I made sure that Adam was close at hand whenever I did any inversions.

     

    *****

     

    Idea:

    Swimming

     

    Theory:

    Submerging yourself in water tends to push your fluids inward, perhaps giving baby a bit more room in which to turn. This theory works with the idea of inversions (above), with the benefit of buoyancy – inversions are much more easily done.

     

    Process & Outcome:

    Swim, flip, and do headstands; anything to help relieve the constant downward-pressure of gravity. Inversions are much simpler to accomplish in the water.

     

    Note: if your bag of waters has ruptured, or you have a slow leak, please consult your care provider before swimming.

     

    Thoughts:

    I went swimming several times per week in late pregnancy – and it was the only time I felt really light, fluid, and graceful in my pregnancy.  Whether or not swimming aided in my daughter’s position change, the benefits of swimming in pregnancy were well worth the effort. I highly recommend this method as it is non-bothersome to baby & mom… and just fun!

     

    *****

     

    Idea:

    Moxibustion

     

    Theory:

    Burning herbs at the acupuncture point (BL67) on the little toe to encourage baby to turn.

     

    Process & Outcome:

    The suggested time is 10 minutes per side, twice a day. I purchased a moxa stick, and used an online guide to locate the correct point, and performed the moxibustion on myself.  Here’s a video guide:

    http://sarah-stewart.blogspot.com/2008/02/using-moxibustion-to-turn-breech-baby.html

     

    I have also read that simply massaging this pressure point may help baby correct her position.

     

    Even after repeated tries at moxibustion, baby did not turn.

     

    Thoughts:

    I was not able to find a practitioner with whom I was comfortable to do this procedure with my first pregnancy, so I attempted it myself. Performing moxibustion on myself was uncomfortable – it isn’t easy to get into the correct position when you have a huge belly – think about tying your shoes for 10 minutes at a time.  I set up a block to hold the moxa stick, which did help, but I still found the heat and the smell rather non-relaxing and off-putting.  Perhaps had I found an experienced practitioner, this method would have had a more positive experience. Overall though, it’s non-invasive to baby, so I’d recommend giving it a try; particularly with a willing partner.

     

    *****

     

    Idea:

    Webster Technique (chiropractic)

     

    Theory:

    By loosening the ligaments holding baby though a chiropractic technique called the Webster Technique, the uterus will have more flexibility and openness, and baby will have more room to move.

     

    Process & Outcome:

    Prior to discovering my first baby was breech, I’d never been to a chiropractor.  I found one certified in Webster Technique (which, I believe is SO important – I used a chiropractor not certified in the technique while pregnant with my son – though she was a prenatal & pediatric chiropractor – and her technique was completely different than the chiropractor who treated me with my daughter).

     

    You can use this search took at the ICPA to find a Webster certified near you: http://icpa4kids.org/Find-a-Chiropractor/

     

    The visit(s) will consist of back, leg, and lower abdomen/pelvic massage and pressure.  The chiropractor will not (and should not) ever attempt to move or even touch baby – the technique is simply about loosening ligaments which may be holding the bottom of the uterus tightly. 

     

    More information on the Webster Technique:

     

    YouTube Video: http://www.youtube.com/watch?v=Et7JuuMrr-Y

    From International Chiropractic Pediatric Association: http://icpa4kids.com/about/webster_technique.htm

     

    As far as outcome goes: I had ONE visit to the chiropractor while pregnant with my daughter – and she turned THAT NIGHT; I felt her move more in the car on the way home, and that evening than I had at any other time in my pregnancy. With my second pregnancy, I had repeated visits to the chiropractor, and my son never budged.  Again though, he was in a previously sectioned uterus, and had very low fluid levels, and my chiropractor was not certified in Webster Technique.

     

    Thoughts:

    My visits to the chiropractor – both with my daughter & my son – were relaxing, rejuvenating, and I always left with a positive outlook. While I wouldn’t go so far as to say its completely non-invasive to mom, because there is a lot of manipulation, it is for the vast majority of the time relaxing non-painful manipulation, so as long as you can tolerate hands-on and lying on your stomach (the appropriate pregnancy pillows are provided), I have nothing but good things to say about the chiropractor.  I highly recommend this method to all women – breech or not – to help optimally position baby.

     

    *****

     

    Idea:

    External Cephalic Version (ECV)

     

    Theory:

    To physically turn the baby through external manipulation of mother’s abdomen. 

     

    Process & Outcome:

    I was checked into the hospital, given a heplock, signed consent forms and warned about the inherent risks to doing an ECV. Once baby’s position had been confirmed again via ultrasound, I was given the option of having pain relief and/or a muscle relaxant, both of which I declined. I was wired with an external fetal heart monitor, and a nurse held a constant ultrasound, and my OB and midwife began the ECV process.  I found the actual process to be very painful, stressful, and unpleasant. The manipulation was extremely forceful – though not blunt – just extreme pressure (my midwife and her OB backup were putting ALL of their muscle into attempting to turn my baby through my contracting uterus) on my sensitive pregnant belly. The first attempt my daughter made it about 3/4s of the way around but would just not move any further, and as soon as they released pressure, she moved herself right back up to breech.  A second attempt was started soon after, which I requested to stop midway through because the pain was too much for me, and I was still not willing to consent to medication. Had I made a different choice in that matter, perhaps the outcome would have been different – that I cannot say for certain.  The outcome was that my daughter did not turn from her breech position, my abdomen was bruised, and I left with a very negative feeling from my midwife (who felt the procedure failed due to my unwillingness to consent to muscle relaxant).

     

    For information on the procedure: 

    http://www.aafp.org/afp/980901ap/coco.html

     

    Thoughts:

    I am torn about this very complex process.  On one hand, having a baby optimally positioned for vaginal labor – heads down, anterior, is what you want. A baby in the “right” position is more likely to move more quickly “down & out”, labor is less trying, painful, and safer for mom.  Less interventions are likely to be requested or necessary, and a baby in the optimal position is less likely to be cesarean sectioned.  On the other hand, the ECV is a highly invasive procedure – and in some hospitals requires an IV, pain medication (even via epidural – which presents its own risks and increased chance of cesarean section), muscle relaxants, and continual fetal monitoring via ultrasound and heart monitor. You are essentially overriding baby’s preferred (for whatever reason) position by force.  It runs counter to how I feel about pregnancy, childbirth, and child-rearing. And yet, if the procedure is successful, certainly it is less invasive than a cesarean section. I will say that had the ECV process been made available to me during my second pregnancy, I would have had to think long & hard before consenting to the procedure again. It was frightening for me, and concerned both Adam and I how it felt to our baby. 

     

    *****

     

    I truly hope that by trying some or all of the techniques, are able to help your baby into a more optimal position for a safe, vaginal birth. 

     

    However, if your baby does not turn, and you & your care provider decide that a cesarean section is the best way to deliver your baby, I would encourage you to read about ways to make your cesarean delivery as comfortable, safe, and satisfying as possible for you, your baby, and your partner. It is my experience that even a c-section delivery can be a wonderful, and even empowering birth experience.  Here are a few links to help you:

     

    Plan a family centered cesarean:

    http://www.ican-online.org/pregnancy/family-centered-cesarean

     

     

    The Natural Caesarean: A woman-centered technique:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613254/

    Posted: Oct 25 2010, 18:17 by kelly | Comments (12) RSS comment feed |
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    Filed under: Pregnancy & Birth

    Birth: Things I Did Differently





    I've given birth twice.  There are moments of both of my births that feel somewhat unsettled and disempowered, moments that feel triumphant and strong, and moments that are simply amazing.  While I feel mostly at peace with my birth stories, something in me wants to share what I did differently from one birth to the next, or what I could do differently, if I could do it again (note: two children is just the perfect amount for Adam & I!) Maybe it’s the birth activist in me.  Or, the natural-minded mama.  Or maybe it’s simply that hindsight is 20/20. I just wish that every woman could feel successful and glorious and proud no matter how she gives birth.  I’m hoping that by sharing some of the things I’ve learned, I might help another woman reach that place of peace with her birth.

     

    So, with no further ado… the things I’d do (or in the case of my 2nd birth, did) differently:

    #1 – Study up on & practice birth positioning. 

    I think one of the most important factors in an easier labor is having optimal fetal positioning.  That is, having a baby who is heads-down, facing mom’s back, with his back lying along one side of the front of mom’s tummy – in other words, Left Occiput Anterior.  Why is fetal positioning so important? A baby who is occiput anterior will have his chin tucked to his chest, and be able to present the smallest part of his head to the cervix.  What this means is that a baby in the right position will likely be born more quickly and more easily – less pain for mom, and less stress for baby.  A baby not in the correct position (malpositioned) won’t put as much pressure on the cervix, so labor may not start naturally.  Malpositioning may cause labor to be more painful, and baby may have a difficult time exiting, because their head isn’t presenting in a fully flexed position.

    Case in point:  My first baby was Occiput Posterior after being frank breech for the vast majority of my pregnancy.  She turned in the week before she was born.  My labor was long, extremely painful, and ended in a c-section for failure of decent – due to malposition (posterior brow presentation). I understand now this is a very rare position.  Online I found an interesting case study in which the baby was previously breech, turned via ECV (external cephalic version – which was attempted with my daughter, unsuccessfully), the mom went into spontaneous labor, the baby descended in a forehead presentation, and was delivered using a vacuum & repositioning. I found this study interesting because it was done in Australia in 1998, and even then the author mentioned that the decision to rotate baby & deliver via suction (as opposed to c-section) was a tricky one, not easily reached.  In my case, I’d gotten to 10cm (or nearly so – my midwife indicated that I had an anterior lip) pushed for hours in many different positions, and my midwife had attempted to reposition my daughter, but she was “stuck”. A c-section was decided on after much deliberation – part of which included my doctor not being comfortable with suctioning due to my daughter’s forehead presentation, and the other part being that my water had broken 31 hours previously, and I had developed a fever.   

    I want to clarify that I do believe, after much research, in spite of the best efforts given by myself, my midwife, the nurses, my husband, and my doctor, the c-section was warranted.  Unfortunately, I still feel a lingering sense of disappointment and “what-if-itis”:  what if I’d been able to hang on just a bit longer and try a few more positions again (we’d tried hands & knees, standing, birthing stool, lying back with stirrups, half-sitting with a birthing bar, kneeling & leaning forward on my elbows on the drop-end bed… you know, everything), what if I’d waited a little bit longer before getting an epidural (I got one somewhere around 20hrs after my water had broken – my detail memory is spotty throughout my birth story with my first – because it was so long, because I was in so much pain, because my midwife didn’t do many internal checks, and because I don’t have my medical records in front of me), what if I’d stayed home a bit longer (I headed in when my contractions were about 5 minutes apart for an hour – the hospital was 45 minutes away), what if we’d hired a doula who could have helped me understand that staying home a bit longer was okay, or who could have helped me hold out a bit more before getting an epidural, what if baby had been correctly positioned in the first place… the latter the cause for my listing optimal fetal positioning as my #1 do-over.

    There are many ways to affect fetal positioning before labor starts – walking regularly, practicing prenatal yoga (which I did the 2nd time around), chiropractic visits, doing inversions, sitting on an exercise ball, sitting forward instead of lying back in the couch with feet up,  doing regular pelvic tilts.

    Some awesome resources, which I found during my second pregnancy, after learning about the importance of baby’s position in-utero:

    http://www.homebirth.org.uk/ofp.htm

    http://www.spinningbabies.com/

    Take your baby’s position seriously.  It really can mean the difference between an easier or a more difficult labor and birth.

     

    (on my birthing ball during my labor with my daughter – still smiling)

     

    #2 – Hire a doula. 

    With my second pregnancy, nearly the first thing I did after realizing I was pregnant was hire a doula. The first time around, I didn’t really understand what a doula did, why they were so important – so CRITICAL – to birth – particularly when you have no previous birth experience yourself, and you’ve chosen a hospital birth.   I remember wondering why a doula was necessary if you had a supportive partner.  Wouldn’t your partner feel left out?  What exactly would a doula DO if you already had a husband there?

    I now know differently.  Firstly, a doula is familiar with birth – with the stages, the process, the pain and how to cope.  She’s familiar with hospital staff and policy (and which “rules” can be bent or broken). She’s there to help navigate the turbulent and unfamiliar waters of anxious soon-to-be parents, impatient doctors, pushy nurses, and crowding friends & family members.  She can help a mom dedicated to a natural birth plan remember, in the midst of the worst pain of her life, why she wanted to go natural in the first place.  She helps a dad know how best to help.  She’s able to help the laboring mom clarify and state her needs and desires to staff.  She can help a new mom latch her baby on – and this is critical, especially in hospitals who don’t have full-time lactation consultants on staff.  Perhaps best of all, and what I missed the most by not having a doula the first time around, is the certainty with which an experienced doula can tell mom in the midst of a very long labor: “yes, this is normal”, and “yes, you CAN do it”.  Though my second birth ended with a necessary emergent cesarean (olighydramnios + breech + previous C) at 36 weeks, I was still grateful for my doula.  She helped me make clear my needs post-surgery, and helped me with nursing. She set the stage for making me feel empowered in my birth, even while the best laid plans for a natural VBAC were quickly and unexpectedly unraveled. Hire a doula – you won’t regret the money spent.

     

    (me and my doula - before my son's birth)

     

    #3 – Put EVERYTHING in your birth plan. 

    Not just the good stuff, but the not-so-good stuff too.  From early labor right through to the days after baby is born.  While creating my first birth plan, I barely scratched the surface of things I didn’t think would ever happen (i.e. an IV, constant fetal monitoring, pitocin, nubane, epidurals, and a c-section).  Naively, I really didn’t imagine anything would go any way other than as planned. While that type of thinking may have set my mind for success, by doing so, I unfortunately missed out on educating and preparing myself for the “what ifs”.  I didn’t fully research the process of c-sections because I assumed I’d never need one.  I didn’t look into alternatives to pitocin, nor the side effects of it, because I assumed labor would move along just fine.  Yes, I’d read about the “cascade of interventions” and how consenting to meds could lead down a path more likely to culminate in a c-section.  Yet, in my head, I wasn’t going to have a cesarean section, and I wasn’t going to need any interventions, so I needn’t put any further thought into it.  Why plan for a disaster when it’s not even on your horizon, right? Except… when I hadn’t slept for 24 hours, and hadn’t made any progress… in spite of my “birth planned” walking, standing, bouncing on a ball, showering, breathing, visualization, all without continual monitoring… and when the pain in my back from my daughter’s posterior position became unbearable… only then, I realized I really had no game plan.   I hadn’t thought of the what ifs.  Because they weren’t going to happen.  Yet… there they were.

    To put it simply: being informed of the side effects of pain meds when you’re nearly out of your mind with pain and anxiety and tiredness isn’t really being informed. It’s certainly not the optimal time in which to be making decisions. And being completely immobilized on the operating table doesn’t lend itself well to making your desires and needs known for post-surgery care for yourself and your new baby.

    So make your plans – all of them – ideal birth AND less than ideal – beforehand.  Put them in writing, and share them with your support people.

     

    (getting sewn up, with my son on my chest)

     

    #4 – Be ready with lactation support. 

    I was lucky the first time around. The hospital where I gave birth was working on “baby-friendly” designation at the time, so, there was a lactation consultant on staff at all times.  Rooming in was strongly encouraged – they didn’t even have a nursery set up for non-urgent care infants.  There were no free formula samples, no bottles or pacifiers given, and all the neonatal nurses were educated and supportive about breastfeeding. But personally, I had only read a few things online and in books about breastfeeding.  I knew my mother and mother-in-law had breastfed, and I planned to do so myself.  But that was the extent of my preparation for breastfeeding. Again, like with the c-section, I never imagined that things could or would go other than “as planned” – so I didn’t have any alternate plans. Had I not had the amazing support of the staff lactation consultant, I’m not sure I’d have been able to make it through delayed milk coming in, an extremely jaundiced baby (due to ABO incompatibility) in the hospital for a week, and the complexities and frustrations of using an SNS and pump.  At the time, I didn’t know anyone in La Leche League – in fact, I’m not sure I’d even heard of LLL.  I didn’t have any friends in real life who had breastfed.  So, really, in the case of successful breastfeeding, I was just plain lucky.  The second time around, I was prepared with a doula, my LLL contact, a lactation consultant, and friends in my phone.  Not to mention the experience of successfully breastfeeding my first.  Don’t leave your breastfeeding relationship to luck.  Be prepared.  

     

    (my milking machine & SNS - my constant companions in the hospital after my daughter's birth)

    What I’ve learned through two pregnancies and births is that you can’t control everything.  There’s always an element of the unknown; the unknowable.  Yet the more information you have, the stronger you will be.  The more able you’ll be to make real informed choices; to feel empowered; to have a plan and make your plan known.  There’s a sense of calm that comes from preparation, and with that you’ll be better able to craft your birth in a way that is more altogether more comfortable, safe, and satisfying in the end. Here’s to better birthing!

    Posted: May 18 2010, 08:20 by kelly | Comments (9) RSS comment feed |
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