Adventures in Breastfeeding

The reason that I am writing this is that I feel like I was ill prepared to start breastfeeding.  For some reason, it is a taboo subject to many people and so there isn't an open dialogue about challenges that new moms face.  I have faced many challenges and have learned many tricks, and I feel that it is important that I be open and share these lessons.

I am a major proponent of breastfeeding.  Any of my classmates will tell you that.  In dietetics, it is hard to find motivated patients.  In fact, I shadowed dietitians who did nutrition counseling at a bariatric surgery center (you have to give weight loss the good ol' college try through diet and counseling with a dietitian before they will let you get the surgery) and the no show rate for patients was 50%.  Going in to have someone tell you that you are eating too much of the wrong things isn't a pleasant appointment, and most of the patients are not dedicated to making dietary change.  That is what attracted me to the field of lactation consulting.  People usually choose breastfeeding because they are highly motivated and they want to succeed.  They will seek help rather than avoiding it.  This was my ideal patient population.

The more I studied breastfeeding, the more passionate I became about it.  I wrote a paper about donor milk banking.  It can be used for adopted babies who otherwise wouldn't get breast milk, or for premature babies before their mothers own milk can come in.  I volunteered at WIC.  They had done a breastfeeding class and wanted to tabulate the results of a survey that they gave after the class.  I made a powerpoint presentation that could be played automatically in the waiting rooms of doctors' offices that told the benefits of breastfeeding for mom and baby.  I worked in the NICU during my internship and promoted the use of donor breast milk.

So it is understandable that when I had my baby that I would want to breastfeed.  And, as you will read, I have been quite determined to succeed.

Within just a few minutes of giving birth, I was breastfeeding for the first time.  It hurt some, but I figured that it was just the normal soreness that people had been telling me about.  I had shadowed a lactation consultant during my dietetics internship, so I knew several of the "tricks" to get your baby to eat better.  The first time that Gwen ate, she ate for 20 minutes...with a little prodding.  She would stop eating periodically, and I told Keith to "chicken wing her."  If you have met with a lactation consultant before, you likely know what chicken winging is.  If you have not, however, you likely think that this sounds crazy.  Keith, who had never met with or shadowed a lactation consultant, responded with, "You want me to eat her arms?"  Chicken winging is taking the baby's folded arm and moving it up and down, resembling a chicken wing.  It is gentle stimulation that can wake up a sleeping baby and encourage them to eat longer.

Thankfully I asked immediately for an appointment with the lactation consultant because by the end of the first day my nipples were bruised and slightly bleeding.  I had no idea why.  I was making sure that she had a deep latch (the baby should not only have the nipple in her mouth, but a large portion of the areola, or it will cause damage), so it didn't make sense that she was causing so much damage.  Furthermore, when you remove your nipple from the baby's mouth, it should look round, not flattened. If it looks flattened then it is likely that the baby is not latched on correctly.  Mine looked flattened every time.  Keith was extremely helpful to me, but he had no breastfeeding experience, so he could only do so much.  I enlisted the help of several nurses because I was in so much pain.  More than one nurse stuck their fingers into her mouth to check her suck and said, "Oh, you have a biter."  While she was latched on correctly, she would bite me each and every time she sucked.  The baby's tongue is supposed to act as a little cushion between your nipple and the baby's lower gums, but she would pull her tongue back with each suck.  She also had a tight jaw and her tongue got bunched up in the back of her mouth (when she would pull it back off of her gums), which was what was causing the flattened nipples.  The nurses suggested that we start something called "suck training."  For suck training, you dip your finger in glucose water and put it in the baby's mouth.  You then massage their tongue down with your finger so they learn to hold it correctly.  By doing suck training for a few minutes before each feeding it also relaxes their jaw so they are less likely to bite down.  I know that she was biting really hard because Keith said "Ouch" a couple of times when she bit his finger.  If it hurt my husband's finger, it made sense that it hurt my nipple.

The hospital that I gave birth at offers a breastfeeding class daily for new parents.  We missed the class the first day because it started just an hour after she was born.  We made sure to attend the second day, however, because we wanted to make sure that we were doing everything correctly as she was making things pretty difficult by being a biter.  The class was super helpful, and I learned about correct breastfeeding positions (cross cradle, football), indications that the baby is eating enough, ways to keep baby awake during feedings, etc.  We implemented several of the tips during the next feeding, but were still struggling.  Thankfully, the lactation consultant was scheduled to come in that afternoon.  She also said that it looked like our sweet teeny tiny baby was a biter.  She helped me with my hold on the baby, and gave Keith a list of ways that he could help me to feed her.  She told us that we should feed the baby from one side and then take all the baby's clothes off and change her before feeding her from the second breast in order to wake her up.  Everything felt so awkward.  I knew breastfeeding would be challenging, but it felt so unnatural.

We continued the suck training and woke our baby up every 3 hours, as instructed by the lactation consultants.  We also started pumping since Gwen was not eating well.  This created a very busy night. Since baby wasn't eating well, very little of the feeding time was spent with her actively eating.  In order to get her to eat for 15 minutes, she would be at the breast for over an hour.  Then I would have to pump for 15 minutes and wash all of the pumping equipment.  By the time that I would wind down after feeding her, I would have about an hour to sleep before it was time to wake her up again.  We did this routine for 2 nights, and we were completely exhausted.  Thankfully, we met with the pediatrician the next day (due to Gwen's jaundice), and she told us to just let the baby wake up when she got hungry.  This worked much better because when we woke her up every 3 hours she wasn't hungry and would just fall asleep.  When we let her wake herself up she began eating well at each of her feedings.  It also gave us a 6 hour stretch of sleep.

Unfortunately, the same day that we went to the pediatrician, Gwen started having 30 minute screaming sessions at the beginning of each feeding.  She would latch on, break off almost immediately, and then scream over and over again.  I would have my nipple in her open, screaming mouth and she would shake her head back and forth refusing to latch on.  I would plead with her to just close her mouth because what she wanted was already in her mouth, she just had no idea.  I called the breastfeeding hotline at our hospital and they said that the problem was likely that my milk had come in and that my nipples had a different firmness and Gwen was having to learn to latch on all over again.  They suggested that I pump for a couple of minutes before each feeding to help soften my breasts so she would have an easier time latching on.  I did this for a couple of days, and she started eating better, but still not well.  Each feeding would start with screaming for several minutes.  We still had glucose water from the hospital, so I would rub some on my nipples each time she would latch on and break off because it encouraged her to stay on longer.  After a while, however, I believe that she was figuring out that if she broke off she got more glucose water (yum!  sugar!), so we tried to switch things up the next day.  I finally figured out that it was not that my breasts were too full of milk, but rather that we had a hungry hungry hippo who was not one for delayed gratification.  If she didn't get milk immediately she would break off.  Pumping helped because it would cause let down to occur so she would get milk faster.  Glucose water helped because she was getting a little something until the milk came out.  But I wanted to stop pumping if possible, and I didn't want to use glucose water any longer.  Then we came up with the next plan.  The lactation consultants had told us about breast compression to help get the milk to come out and that babies who are fed by moms who used breast compression got more milk at each feeding.  So the second we got her to latch on, we would both squeeze with all of our might.  And this worked.  She got milk immediately, stayed on longer, and was a much happier eater.

Since we solved this problem, feeding her has become much easier.  She latches on and stays on much better.  I no longer have to stack pillows and blankets to get her into the proper position, and no longer have to apply a firm hand to her shoulder blades to keep her at my breast.  I can feed her by just holding her in my arms, she actively feeds longer, is much more efficient, and I am no longer in pain.  It is a joy to feed her now.

However, I got a plugged duct about 1.5 weeks ago.  A plugged duct is caused by the fat in the milk collecting and solidifying in the milk duct, causing milk to back up in the gland.  A plugged duct, with the proper treatment, should clear up in 48-72 hours.  The therapy is to use warm compresses for 15-20 minutes before each feeding, to massage the gland and duct at each feeding, to feed often from the side with the plugged duct, and to face the baby's chin towards the plugged duct.  Facing the baby's chin towards the duct is the most effective treatment and it is often easy since the duct tends to be on the side or bottom of the breast.  I have an abnormally positioned plugged duct, however, that is on the top, medial aspect of my breast.  In order to fact her chin towards the duct I would have to feed her upside down.  I called the breastfeeding hotline after I had the plugged duct for 2 days because I knew there was a risk for a plugged duct to turn into mastitis.  The lactation consultants told me that I was doing everything right, so to just keep on trying for a couple of days.  However, a couple of days passed and the duct had not unplugged.  Furthermore, it was Christmas weekend, so there was no way to contact the lactation consultants or my OB.  I either had to continue with what I was already doing and hope that it didn't turn into mastitis, or go into urgent care if my condition deteriorated.  After 1 week of having the plugged duct, I called the breastfeeding hotline again.

Standard therapy wasn't working, so it was time to see if I needed to go into the doctor.  The lactation consultants gave me a couple of more ideas: taking 1200 mg of lecithin 4 times each day, and massaging in the opposite direction (from the nipple towards the gland), and they told me that I should call my doctor if the problem didn't resolve itself in a couple of days.  I tried their ideas for a day, and then called my doctor because I was worried if I waited any later in the week that I wouldn't get an appointment before the holiday weekend.  I got the last free appointment for the day.  My OB said he was concerned that I was developing mastitis.  He put me on antibiotics and told me that I needed to face Gwen's chin towards the plug.  I asked him if I was supposed to hold her upside down while she ate.  He told me that his wife had the exact same problem with one of their children and that, while it sounds ridiculous, that I would have to lay her on her back with her feet towards my head and then I would have to position myself over her body on my elbows and knees to feed her.  This would face her chin towards the plugged duct.  This has been working pretty well, but I feel pretty silly each time I feed her.  The first time Keith saw me feeding her like that he laughed at me (I laughed at myself too...you have to keep a good sense of humor about it).  Unfortunately, I still have the plugged duct, feeding her in that position puts my nose right by her diaper (not pleasant if I haven't changed her yet, and I usually wait to change her until I have finished feeding from one breast in order to wake her up again), and it puts my head right by her legs (she has kicked me in the face several times).

Breastfeeding has been very difficult, but I am so happy that I am doing it.  I find it very rewarding, and it is getting to the point that it is an enjoyable experience.  I can, however, understand why so many people either don't even try to breastfeed or stop breastfeeding right away.  I feel that this is an important thing to do for my child, and I am proud of myself for sticking with it.

17 Days

My little baby girl is 17 days old today.  And the past 17 days have been nothing of what I would expect.

Things started out much harder in some ways and much easier in other ways than from what I had expected.  I really expected labor to be much different from what I experienced.  It started out harder than I thought, thanks in part to Gwen being positioned posterior, but then pushing was much easier and more rewarding than I had anticipated.

The next thing that was harder than I thought was recovery from labor.  I guess I should have expected that it would be difficult for your parts to recover from pushing out a 6 pound baby (thank goodness she wasn't any bigger), but for some reason when I was planning how things would go, I didn't think past the birth.  I had envisioned giving birth to my baby, and even the potential stitches that I would have to get immediately after birth.  But for some reason, it didn't occur to me that I would have to recover from giving birth.  While I was pretty sore when I left the hospital, I was kind of surprised that I was given discharge instructions including items like "Don't lift anything over 10 pounds" and "Don't drive for 1-2 weeks.  I guess pushing out my little watermelon was pretty traumatic to my body, but I never thought that there would be restrictions to my activity.  Which is why, within 1 hour of getting home from the hospital, I left Keith and Gwen at home by themselves while I went to the grocery store (this was a necessary trip as we had no diapers at home, and a desired trip as, while I love my daughter, I wanted 1 hour away from her as a little break).  I drove 55 hours after giving birth and lifted grocery bags that weighed more than 10 pounds (the bagger decided to put all of the cans and bottles in one bag).  It is no wonder than I was sore and bleeding more the next day.  The pain continued for several days, and I got mad at myself each time I forgot that I had stitches in a sensitive zone and flopped down onto the couch.  The bleeding and stitches, unfortunately, still continue.  Bleeding was supposed to last for about 2 weeks, but has persisted longer most likely because I ignored my discharge instructions.  The stitches should hopefully dissolve by the end of the week.

The next thing that was easier than I thought was my beautiful baby slept through the night the second night we had her home (she likely would have the first night, but we faithfully woke her up every 3 hours to feed her as instructed by the hospital lactation consultants).  The second day that Gwen was home, we had to take her to the pediatrician.  I was so happy that we went to the pediatrician on Gwen's 3rd day of life rather than her 7th day of life because the pediatrician told us to just let the baby wake up when she was hungry and to not worry about trying to wake her up every 2-3 hours.  We joyfully applied this advice and got in a 5 hour stretch of sleep (Gwen slept for over 6 hours, which technically applies as "sleeping through the night" as a trick to mothers who realize that actually sleeping through the night would require a full 8 hour stretch of uninterrupted sleep).  Since then, however, he sleep habits have deteriorated.  I have tried following the pediatricians advice for good sleep habits: keep her awake before bed.  Do her last feeding.  Wake her up slightly so she learns to go to sleep in her own bed rather than being held until she falls asleep.  This would be great advice if it worked.  But each time I put my baby down she screams.  She might make it for about 20 minutes before she realizes that no one is holding her, but once she wakes up and realizes that she is in that bassinet all by herself she has a colossal meltdown.  I learned last night that as long as I sleep in a chair with her on my chest, she will sleep for more than 20 minutes at a time.  I think she may have been a bit exhausted from the past several nights of very little sleep because she slept from 9 pm to 3 am.  She may have slept for 6 hours, but I woke up about once an hour since I was worried since I hadn't heard her cry yet.

Another area that has been more difficult than we had anticipated is with Gwen's health.  She has had a difficult couple of weeks.  Since she has been born she has had jaundice, diaper rash, a cold, and a plugged tear duct.  First was the jaundice.  The jaundice appeared shortly after birth due to an incompatibility between her and my blood types.  It lasted for about 10 days.  While I felt a little concerned, I knew it would subside on its own as her liver took care of clearing away the hemolyzed blood cells, and the jaundice came with the blessing of making Gwen a little bit sleepier than a typical newborn allowing us extra sleep at night.

At about 10 days, Gwen went from "pumpkin" to a more normal skin tone and developed ailment number 2: diaper rash.  It was understandable that she had diaper rash.  She pretty much constantly poops herself and gives us no indication that she has a dirty diaper.  We check periodically, but usually we only know if she has a dirty diaper if we hear it becoming dirty or smell it after the fact.  So we pulled out all stops trying to get rid of her diaper rash: we stopped using baby wipes, started using diaper rash cream, and did our best to keep her clean and dry.  We even tried to let her air dry a couple of times each day, but this ended up being much more dramatic than just leaving her in a diaper full time.  You see, she does not like being naked.  The first time we tried to let her air dry, we placed her on her belly on top of a towel.  Immediately, she started screaming.  The bad part wasn't the screaming - we can handle that.  The bad part was that each time she screamed (about once a second), poop shot out of her bottom, past the towel by about 1 food, and onto the carpet.  She became a poop sprinkler.  We didn't know if we should be horrified or laugh since it was funny and disgusting all at the same time.  Thanks to our quick work, we wrapped her up in the towel and obtained carpet cleaning spray from our cleaning supplies.  We haven't tried air drying her since then, as she not only made a mess, but never got dry since she spent the whole time crying and launching poop cannon balls.  Thankfully, I remembered that my mother-in-law had off-handedly mentioned that he kids couldn't wear certain brands of diapers because they would cause irritation.  Keith and I had noticed that the Pampers, while fitting Gwen better than Huggies (newborn diapers are too big on her and I couldn't find premie diapers at the store), had a mesh layer that stuck to her skin whenever her diaper was dirty.  I decided it wouldn't hurt to switch back to Huggies, and within 48 hours of being back in Huggies the diaper rash was gone.

To add to the difficulty of having diaper rash, and to make my first night alone with her memorable (Keith had to work night shift at the hospital), Gwen got a cold when she was 12 days old.  I had no idea what was going on at first.  I just knew that she wasn't sleeping at all and that there was no one else in the house to help me calm her down.  But as the night dragged on I noticed that she sounded more and more snuffly.  I also realized that when I held her on my lap with her head propped up higher than the rest of her body that the sniffles would subside somewhat.  When I would lay her flat in the bassinet, the sniffles would come back and she would wake up crying.  By the time I put together all of the pieces of the puzzle and figured out that it was a cold, Keith was on his way home from the hospital.  He set up the humidifier, we put her in her baby seat, and she was finally able to sleep.  She didn't sleep well for the next couple of days, but she slept much better in her seat than she had lying down.

The diaper rash is gone, and her sniffles are minor now.  But I woke up yesterday morning to notice that her right eye was completely crusted shut with yellow crusties.  I immediately called the pediatrician since I was worried that she had pink eye.  They reassured me that as long as the sclera of her eye was not red that it was likely a plugged tear duct.  I had no idea if her eye was red or not when I was on the phone with them because I couldn't get her eye to open because of all of the crusties.  After learning that it was likely a benign problem, I ran a washcloth under warm water and wiped away all of the crusties.  The good news: her eye was white.  The bad news: plugged tear ducts can take months to get rid of, and during those months you have to wash the eye several times a day and massage the tear duct, both of which seem to be the end of the world to baby Gwen.

Breastfeeding has been easier and harder in several ways, but I will save that for another post as that has been an adventure in itself.

Proud Papa

Gwen already has Keith wrapped around her little finger.  They are currently sitting in the living room chair next to me.  He is moving her hands around and talking about how she needs to practice her surgeon's knots.  He is also pulling up on her arms periodically, making her flex her teeny tiny biceps (today, at her 1 week pediatrician appointment, she measured in at the 8th percentile for weight) and saying that she is going to get ripped.  All the while he is throwing in some random Spanish words to try to make her bilingual...I'd better try to learn Spanish or they will start talking about me and I will have no idea.

He has several pet names for her already.  The one that I have heard most often is hobbit.  And yes, hobbit like the creatures of the Shire in Middle Earth.  In all fairness, I told Keith we could watch whatever movies he wanted while he is on paternity leave and he chose the Lord of the Rings trilogy, so hobbits have been on his mind.  He also calls her Gweny, Pumpkin (her jaundice made her look like a pumpkin until the last couple of days), and normal pet names like sweety, and honey.

He also has been doing major digital data accumulation in the form of photos and video.  After the first day of Gwen's life Keith's parents said, "I think you have already taken more pictures of her than we took of you during your entire childhood."  This is the beauty of having a digital camera.  The first pictures that we have of Gwen are beautiful, whereas Keith's first baby picture makes it look like he was hit by a bus.  While she doesn't really do anything yet, Keith loves shooting video of her "looking cute."  When she is wide awake, right before eating, she looks like she has a smile on her face and talks constantly.  We will likely end up with several hours of video of her cooing.  As for pictures, we already have a few hundred.  And not only is Keith taking pictures, but he is posting them to facebook.  I think that in the entire time that Keith and I have been together he has only put a couple of albums on facebook.  One album he added right after we began dating because I bothered him about not having the pictures.  The second album he put up was from the night he proposed.  Since he proposed I don't think he put up any albums until the night that Gwen was born.  She had been alive less than 12 hours and he posted a 58 photo album.

Keith has never been a fan of newborns because he thinks that they are boring.  We were baby sitting a couple of nights before Gwen was born and Keith said, "So what are we going to do with the baby?"  I said that we would probably hold her and feed her for about an hour and then put her to bed (she is only a few months old).  He then realized that at that point they don't really do anything.  But things are different with daddy's little girl.  He will just sit with her, look at her, and talk to her.  I think he may now be a fan of newborns...at least our newborn.

A Baby Story

Gwen was born on Monday.  I was right when I last posted that I thought that I was in labor.  It was quite an experience for which there is no way to truly be ready.

In the day leading up to going into labor, Keith and I were quite busy.  Keith is the head of the A/V team at church (audio visual team) and had scheduled us to work during the first church service on Sunday morning.  I had told him back in November that I would be willing to do A/V for that Sunday, but had warned him that he would probably have to find someone else as we would probably already have a baby given my early dilation.  I hadn't, however, gone into labor as of Sunday morning, so we didn't have to worry about finding a replacement.  After church we decided to head to the mall since we hadn't been to the mall during this holiday season.  We shopped for a few hours and picked up our last 3 Christmas gifts.  After leaving the mall we made our way back to church.  There was a wedding on Sunday and they required A/V people to work in the booth in order to run the lights, sound and video.  Keith had not found another person to do A/V for the wedding, so he had been asking me for the past week if I could possibly hold off until Sunday at 5:00 pm to be the earliest for me to go into labor because we were scheduled to work the wedding.  I showed up at church, Pastor Kevin made a joke asking if I was still pregnant (he had made the same joke before church that morning), and we worked in the A/V booth at the wedding.  On the way home I told Keith that I had kept my promise and not gone into labor, but now that the wedding was over I was ready to have the baby.  We went home and were asleep by 9:00 pm.

I woke up Monday morning at 1:00.  I woke up because I had to pee, and got back into bed a few minutes later.  I felt a little off, so I figured that I would hop onto my computer and cruise around the internet until I got sleepy again.  I had gotten an email about our Bible Study Christmas party and was looking at the menu for the restaurant that we were supposed to go to in a couple of days in order to make my menu selection.  I was having some cramping pain, so I decided to watch some tv on Hulu until I felt better (I watched One Born Every Minute, a reality birth TV show on Lifetime that takes place at the hospital at which Keith works and at which I was scheduled to deliver - it was kind of cool learning what to expect by watching that show).  But I didn't start feeling better.  I started feeling worse.  Much, much worse.  Between 1:15 when I felt my first contraction and 1:45, my contractions sped up from once every 15 minutes to once every 4 minutes (contraction 1: 1:15; contraction 2: 1:30; contraction 3: 1:40; contraction 4: 1:44), and they did not let up after that.  Not only did they speed up, but they got much more intense.  At 1:45 I decided it was time to take action.  I woke Keith up (he was due to wake up at 5:00 to get ready for work, so I had been trying to let him sleep in case it wasn't labor) and told him that I was having really intense cramps and back pain.  So of course, instead of suggesting that we go to the hospital, I said, "Could you go downstairs and clean the living room and the kitchen in case I'm in labor since we'll probably end up with people in the house?"  He spent 30 minutes cleaning, during which time my contractions sped up to being once every 3 minutes.

I was getting a little bit irritable, but was trying to be patient.  I had only been in labor for an hour, so I decided to update my blog and make a couple of phone calls.  I called my mom and dad to tell them that I was going to leave for the hospital soon, while Keith showered and took the dog for a walk.  By the time that we climbed into the car it was about 2:25.  I was much more uncomfortable than I had been and was stomping my foot each and every contraction because the only way that I could think of to relieve the pain was to move, which was difficult being strapped in with a seat belt.  My contractions sped up on the way to the hospital to coming once every 2-3 minutes.  We got to the hospital at about 2:45, but it took about 10 minutes to get from the car to the labor and delivery floor since every time I had a contraction I had to stop walking and lean against something.  I had 4 contractions between leaving the car and checking in.

Once arriving in labor and delivery triage, they hooked me up to a monitor (in order to determine if I was really in labor or not).  They told me that I had to lay down because the monitors weren't working when I was standing.  Each and every contraction my legs would shake uncontrollably, my back would arch, and I would hyperventilate.  The nurse worked with me to stop hyperventilating because it was making me incredibly nauseated.

The next part of my labor was a surprise to me.  During pregnancy I had read several books about natural childbirth and was convinced that I wanted to do it.  I had grand ideas of giving birth in a birthing center and using a birthing tub for my second birth, but was already locked into a hospital birth this delivery.  Plus, I became a high risk patient this pregnancy, so anything but a hospital birth was out of the question.  However, I was willing to keep my mind open.  I wanted to do whatever was best for the baby, and if that was receiving medication of some sort I was willing to do so.  But writhing in pain (writhing is the word that Keith used to describe me) in triage, I asked the nurse how soon I would be able to get an epidural.  She said that there was one person in line ahead of me, but that the anesthesiologist could come in after her.

They moved me from triage to my new room, hooked me up the monitor, and I immediately threw up half way through a contraction.  All decency went out the window as I would double over with an open backed hospital gown for the duration of each contraction.  The nurses questioned my ability to even get an epidural because they said that it would take a few minutes to place the epidural and that they doubted my ability to hold still.  The danger of not holding still is that if they accidentally puncture the dural sac, cerebrospinal fluid will leak and you will end up with the worst headache of your life, all while trying to keep up with a newborn.  I knew the danger of moving, so I told them that if there was a large needle in my back by my spinal cord that I would certainly hold still through anything.  Within 2 contractions of getting the epidural placed I already started to feel relief.  I couldn't figure out why I was such a wimp though.  1/3 of births are done without an epidural, and I couldn't even make it from 1:15 to 5:00 without getting one.  The nurses made me feel better, however, by letting me know that I was 7-8 cm dilated, was going through the transitional stage of labor (which occurs at the end of active labor, just before you push, and is the most painful stage of labor).  Then I felt even better when the doctor came in and checked and let me know that the baby was posterior.  The easiest way for a baby to come through the birth canal is if their face is turned towards your back.  If the baby is posterior then their back is pointed towards your back.  This creates the most painful kind of labor, back labor, because the baby is in a suboptimal position to be born and is pushing against your tailbone.  So, apparently, I wasn't being that big of a wimp.  I was having about the worst labor pain possible every 2 or so minutes, so that made me feel better.

Once I got the epidural my labor slowed down.  It took about 2 hours to progress the next 2 cm.  I decided to take the pain free opportunity to do my make-up (hey, these pictures are going to be around for a long long time and I wanted to look good).  I also straightened my hair.  Everyone told me that it was a lost cause because once I started pushing my make-up would run and my hair would get sweaty. I decided to do it anyway - I felt comfortable, was being very chipper, and needed a way to pass the time.  In fact, when my nurse saw that I was doing my make-up (when she had originally been worried about my ability to sit still for an epidural) she paged my triage nurse to come down to see how pleasant a person I was when not in pain.  They could not believe the shift in my demeanor.

Then it came time to push.  And it didn't hurt at all!  I had heard that even with the epidural that the baby coming out would feel like a burning ring of fire (in fact, for most of the time that I was pushing I had the Johnny Cash Ring Of Fire song stuck in my head), but I didn't even feel uncomfortable until the last two pushes.  I told my OB that I felt really uncomfortable at that point from all of the pressure and he told me that our baby was about as close to being born as you can be without being all the way out.  One more push, her head came out.  One more push, her body came out at 8:58 am, just less than 8 hours after going into labor.  I asked, "So is she a girl?"  She was.  He held her up so I could see her and I thought, "Wow!  She is so pretty!  I'm so glad that I had such a cute baby!"  They put her on my chest, and Keith counted her fingers and her toes (why do parents do this?  Having an extra finger is a pretty benign problem.  I guess since you can't check for heart defects that counting fingers and toes puts your mind at ease).  I breastfed her for the first time.  They weighed her and measured her length: 6 pounds 1 ounce and 17.5 inches.  Keith and I cuddled with her and took pictures while the OB sewed me up.  They kept me in my labor and delivery room for 2 hours after she was born so that the epidural would wear off and I could walk again.  Gram (Keith's mom), Pap (Keith's dad) and Grandma (my mom) came in to meet her and took pictures of our new happy family.  And I will say that I was right about doing my make-up and hair because I never broke a sweat and none of my make-up ran (the most important thing about childbirth...kidding of course; I may have been a bit vain with my labor beauty regimen, but the most important thing is that we have a healthy and happy little girl).

It was undeniably one of the best experiences of my life.  I had preconceived notions about how my labor would go, and I was wrong on every count.  But, like William and Martha Sears say in their book The Birth Book, it doesn't really matter what you decide regarding your labor and birth story as long as you have a healthy baby and are happy with your experience.  I may have had full medical intervention rather than a natural birthing center birth, but I am very proud of my accomplishment and of my teeny tiny Christmas gift.

Labor?

Is this what labor/contractions feel like?  If it's not, I don't even want to know what is to come, because this hurts!!!

Anecdotal data and baby

Anecdotal data is that data that you collect from simply observing things in day to day life.  In the medical field, this can lead to some interesting and useless practices.  For example, how do you remove a clog from a feeding tube?  Many nurses will tell you that you pour soda down it, and this was standard practice for years.  Why?  It seemed to make sense.  If you have a clog, use something acidic (like soda) to break it up.  However, when research was later done to see if this practice worked, we discovered that pouring soda down feeding tubes actually led to more clogs, not less.  This is why the scientific method is important, and why without the scientific method we often end up with old wives' tales.

The reason why I have been thinking of anecdotal data is because I have been experiencing weird changes in my pregnancy symptoms.  The doctor told me on Monday that I no longer had to take my tocolytic (which was supposed to keep me from contracting/cramping), and by the next morning my cramping, which had been occurring about 8-10 hours each day, disappeared.  That is the opposite of what was supposed to happen.  I assumed that since I was cramping 8-10 hours a day on the medication that I would go into labor quickly once I stopped taking the medicine.  This made no sense!  So I started to investigate all of the possible causes of my labor symptoms, mostly to try to figure out how to encourage labor.

This brought me to notice something over the last several days, which would fall under anecdotal data.  The closest correlation that I can come up with to my cramping or not is if I have blogged about cramping or not.  That is to say, if I blog that I am cramping, I inevitably feel much better the next morning.  If I blog that I am not cramping, I seem to get the worst cramps of my pregnancy shortly thereafter.  As a joke, I shared this with Keith this morning.  As he put it, while these events seem to be correlated, he highly doubts that my blogging is causal.  Since I do not believe that my blogging has magical powers, I agreed with him.  It was humorous, however, to discuss (this is the type of conversations that two scientists sometimes have at home...at least when those scientists are Keith and me).

Because I was not convinced that my blog was somehow acting like a voodoo doll, I thought I would keep on mulling this around in my head to try to come up with a more reasonable explanation.  Thankfully, I did not fall for the first correlation that I discovered, as I came up with a more reasonable explanation this evening.  Bed rest makes my cramping symptoms increase.  I know it sounds counterintuitive, but I spent all day Tuesday and Wednesday on my feet and felt great.  I spent most of today sitting down, trying to finish some craft projects for the baby and started cramping again.  Could it be that our main intervention to preventing pre-term labor was actually increasing my symptoms?  I believe this to be the case.  It would explain why, after nearly 5 weeks of spending most of my time in bed or on the couch I was experiencing the worst pain of my pregnancy.  And it would explain why my symptoms disappeared when I was released to do normal activity.  It would also explain why I didn't believe my symptoms to be too bad between 28 and 32 weeks, when I had mild cramping, but why my pre-term labor seemed to get worse upon entering the hospital.  I plan to test this hypothesis over the next several days (or until Gwen is born, which hopefully is not several days from now) by observing symptoms after activity and rest.  But I think that I am onto something...or at least more of something than when my major hypothesis was that my blog was the culprit.  

An open letter to my baby

Dear Baby,

You have taught me over the last several months that you are the boss.  I was under the impression that I would be in charge until you were born, at which point I would relinquish power to you.  But that simply has not been the case.

First, you created very high hormone levels in my body.  While I am happy that this was good for your growth and development, this did create some eating difficulties for me.  Despite experiencing nausea until 26 weeks, I was still under the misguided impression that I was in control.

Thankfully, at 26 weeks you let the hormone levels decrease enough that I was no longer nauseated.  However, at 27 weeks you decided to introduce a new symptom to my pregnancy: cramping.  I didn't really think anything of this.  Other than laying down for a while every time I felt cramping, this didn't drastically change my life.  That is until I was 32 weeks pregnant and the doctor put me on bed rest for 5 weeks since I was 3-4 cm dilated.

Bed rest was rough, but it made me begin to realize who was the really in charge, and if you wanted to come early we weren't going to stop you.  So I faithfully took my tocolytic and only left the couch or bed to pee to help encourage you to hang out for a little bit longer before being born.  But I knew that, despite the interventions, the timeline was up to you.

At the end of 5 weeks of bed rest, relaxation, and pharmacologic intervention I was cramping about 10 hours a day.  By causing this symptom and increasing its duration and severity the further along we got in this pregnancy you led me to believe that the simple acts of stopping my medication and beginning regular activity would lead to your imminent birth.

You weren't done pulling tricks out of your sleeve though.  As of Tuesday morning, 12 hours after my first missed dose of medication, all of my cramping disappeared.  In order to encourage labor, I decided to spend the entire day on my feet.  While this led to an aching back, it did nothing for labor.

So here we are: 37 weeks, 2 days pregnant.  Now I'm starting to think that you have been messing with me this whole time and that you have no intentions to make an appearance until January.  I get it now: you are in charge and have been since you were about the size of a sesame seed.  Now that I have admitted it, can we stop playing games and get this show on the road because I would really like to meet my new boss.

Love,

Mommy

Full term update...woo hoo!

I went to the doctor yesterday for my 37 week appointment (actually, my 36 week and 6 day appointment, but I don't like driving 45 minutes to get to the office that he works at on Tuesdays, so 4 pm the day before becoming full term had to do).  It was kind of a bittersweet appointment.  While I am super happy that I am now full term, I felt somewhat discouraged that I didn't make much progress.  I am ready to rock and roll today, so I could have handled hearing that I was 5 or 6 cm dilated.  But alas, I was still only a little bit more than 4 cm.  However, he told me that I had gone from being 50-60% effaced to being 70%, so I guess that is progress.  The main reason that I was discouraged it because I have been in escalating pain over the past week.  I cramp about 8-10 hours each and every day.  I figured that this meant that things were moving along, but apparently not.

Thankfully, I was told by the doctor that I could stop taking my tocolytic yesterday, so I am no longer taking medications that are supposed to keep me from going into labor.  I am hoping that I will make some progress over the next week now that I am no longer trying to prevent labor and I am going to try to encourage it (yay for yoga and my eliptical).  I tried to look up natural home "remedies" to go into labor and discovered something disheartening: there is no scientific support for any home remedy to go into labor.  Bummer.  Furthermore, most of the things recommended are either ridiculous (eat 7 whole, fresh, raw pineapples) or dangerous (various natural supplements).  While there is no scientific support, it's not going to hurt anything to try to go ahead and do the things that aren't ridiculous or dangerous, so I will press on.  I realize, however, that everything is on the baby's timetable, so no matter what I do it will likely have no baring.  A girl can dream though.