Baby notes and fifth childbirth class.

[rivka]

I never got around to writing up the fifth childbirth class, and tonight is the sixth and last. So this is a catch-up post.

It was also supposed to include an account of my 32-week midwife visit, but we got to the office this morning to discover that four of their clients were in labor and one of the midwives was out with strep throat. Unsurprisingly, office visits were canceled for the day. (Apparently, they tried to call and tell us so while we were in the shower.) So, alas, no midwife update.

Just in the last week, the third trimester has hit me like the proverbial ton of bricks. After three days in a row of thinking, "wow, I'm having a rough day today - I must have overdone it somehow," I realized that the unnaturally charmed portion of my pregnancy is probably over. I felt fantastic right up through the end of the seventh month, so I don't have anything to complain about - but now it's different. I'm tired. By the end of the day, I'm exhausted. My pubic bone hurts when I get up from sitting or lying down. It's gotten harder and less comfortable to move around. And did I mention that I'm tired?

But I'm trying not to whine too much. curiousangel is being a saint, but I don't want to tax his patience.

Yesterday afternoon, the Li'l Critter managed to wedge herself into a transverse (crossways) position, with her hard little skull digging into my ribs. She stayed that way all afternoon and evening, despite the obvious fact that there's not room for her to lie in that position. Honestly, it can't have been any more comfortable for her than it was for me. I woke up at 5am to feel kicks on the normal vertical axis, and I was so. Pathetically. Grateful.

Okay, and one final digression: how did I not know about Luna bars until now? They're so tasty, and they have so much calcium, and they do such a good job of stopping the pre-lunch shakes.

But anyway, back to the fifth childbirth class. It focused on what the instructor euphemistically referred to as "unexpected events," but despite that, I came out feeling reassured.

We started with a brief recap on episiotomies, and how to avoid them. Apparently we have all already done the main thing that needs to be done to avoid an episiotomy: hiring a practitioner who isn't epi-happy. We did some pelvic floor exercises. Michele told us she'd distributed perineal massage instructions in our binders, and that it was worth trying but might or might not make a difference.

Then we moved on to a discussion of birth plans - not in all their minutia, but in terms of "what is the most important thing to me about this birth?" She used that framework to structure her presentation of things that can go wrong during birth, and how to keep your focus on the most-important aspects. (For our group, those things were: healthy baby, healthy mother, no separation from the baby, being alert during delivery, and feeling empowered. A pretty sensible list. Actually, Michele had to elicit "healthy mother" after "healthy baby" was mentioned - she pointed out that mothers tend to think exclusively about the baby's health, whereas fathers are more concerned about both. The men in the room all nodded; the women all got "Oh! Yeah, I guess I should think about that" expressions.

We talked briefly about forceps deliveries ("it's like a big set of salad tongs") and vacuum extractions. She had a vacuum extractor on hand - it's almost comically cheesy-looking. The up side to vacuum extraction is that, compared to forceps, it's less likely to tear up the mother. The down side is that the baby is likely to have a big blister/bruise on the top of the head, for weeks. Our midwives don't do forceps or vacuum deliveries, so if we need them done an OB will be called in.

Caesarian sections. This was the section of the presentation I found the most reassuring, mostly because I had been imagining it as worse than it apparently is. (I'm not afraid of surgery, because I've been through it a lot. I'm not afraid of post-surgical pain. I'm afraid of (a) missing the birth because I'm under general anesthesia, (b) being separated from my baby for a long time, and (c) having trouble nursing because of the effects of separated and medication.)

She described the experience of C-section, step by step: how you're prepped, who is present, what the room looks and feels like, etc. Reassuring fact #1: most C-sections are not true emergencies - they're done because of failure to progress or positioning or cephalo-pelvic disproportion (translation: the baby's head is too big to fit), and so there's plenty of time to see it coming. That's especially reassuring to me because more time to plan probably means a greater chance that the anesthesiologist will be willing to try spinal anesthesia despite my history of spine surgery. Before I got pregnant, I never would've imagined wanting to be conscious for a surgical procedure, but now I really really want to be awake and aware for my baby's birth.

Reassuring fact #2: "Your midwives are the most patient people on the planet." They don't rush into C-sections. If you have a fighting chance of a vaginal birth, they'll wait as long as it takes to make it happen.

Reassuring fact #3: After the baby is out, the pediatricians take over for about five minutes to check her over, suction her little lungs, etc. If nothing is dramatically wrong, she then gets handed to her father, who keeps her for the entire rest of the time. In other words, they don't routinely whisk C-section babies off to the nursery. curiousangel would be able to bring her over right next to me, where I could see and touch her while I was still being stitched up. If I were conscious.

I feel much, much better about the possibility of a C-section knowing that the baby won't be separated from both of her parents. Research has proven that, at birth, she'll already recognize curiousangel's voice as well as mine. So she'll have a comforting, familiar presence even if I can't hold her right away.

Reassuring fact #4: "How long after a C-section before you can attempt to breastfeed?" "About an hour." (Attempting to nurse in the first hour is associated with better breastfeeding outcomes.)

The last unexpected event we talked about was induced labor. Michele said, "one of the things I like about having everyone in the class be clients of your midwife practice is that I don't even have to get into a discussion of how to refuse induction." That's because our midwives don't suggest inducing labor a few days past the due date, or because the cervix isn't dilating at the rate of a centimeter per hour, or for any of the other stupid reasons why one in five American labors are now induced. Reassuring fact #5: "Reasons why your midwives might induce labor… well, for example, if you were to develop pregnancy-induced hypertension." (That's a life-threatening complication for which the only cure is birth. I'm okay with that as a reason for induction.)

We finished up the class with an incredibly positive and affirming birth video which left both curiousangel and me teary, and a guided imagery exercise focused on relaxation and letting go of fears. I got a lovely mental image of standing on the shores of a lake holding the Li'l Critter in my arms, watching a sailboat full of my birth fears disappear into the distance. It's definitely time for me to start practicing imagery at home, in preparation for birth.

Comments

[therealjae.livejournal.com]

Eeeeeeek vacuum extraction! Eeek eeek eek. *shudder*

-J

[saoba.livejournal.com]

I was, evidently, a forceps baby (military hospital during the Baby Boom, big surprise). There are almost no pictures of me prior to two weeks of age, as my mother found my great big black eye disturbing and only wanted 'pretty baby pictures'.

Your midwives sound fantastic, I cannot wait to meet them.

Third trimester exhaustion, Lordy yes. And I got that blast of sudden energy and nesting urge about three days prior to delivery as well. Being a bit dim sometimes I didn't ever recognize it for what it was, of course. I just knew that I had a whole day or three of being Not Tired and the baby's room needed things done to it. Heh. See the vastly pregnant woman decide to make curtains. At seven am.

But I was never so manic as K was with her nesting fit. Repeat after me "No, I don't think it would be loads of fun to wallpaper the nursery, so stop asking. You are too pregnant to climb a ladder. If you must do something go repack your hospital bag."

[pecunium.livejournal.com]

At the risk of being pointlessly fulsome, Thank you for the commentary on the classes.

As Maia and I are considering, no planning, just not right away, kids, and she has the mid-wife already chosen, the details (knowledge is power) have been a great reassurance to me (and I have experience in the delivery room).

Forceps scare the be-jeesus out of me, because I have friends who found out (25 years after the fact) that a heavy-handed OB had caused the brain-damage to their eldest daughter (they had thought it was congenital, and so tried to avoid another, but teracycline kills the pill).

I ought to link to all of these for reference.

TK

[eeyorerin]

I have these clear memories of my mother at 9 months pregnant with my last brother, up on a high ladder stencilling the living room.

...I think my father had learned not to argue with the Nesting Pregnant Lady at that point.

[mittelbar.livejournal.com]

Thank you for the update. Most of this sounds very reassuring and lovely. Except for the hurty part, which I guess just means it's almost time.

[writingortyping.livejournal.com]

I was a forceps baby too. No brain damage, but my newborn pictures look like a prizefighter who went 10 rounds, no decision. And I still have faint scarring.

I don't think they had much choice though - apparently, I was trying to come out sideways somehow.

[tammylc.livejournal.com]

All things considered, my c-section was a remarkably positive experience, so I know it's possible. Here's hoping you don't need one, though.

The biggest issue I had was that the OR was extremely cold. To counteract that, they put a bear hugger blanket on me, which was a paper thing with hot air flowing through it that covered my entire chest and my arms, essentially pinning me down. I was extremely glad to have it, as I would have been really distracted and uncomfortable if I were that cold. But on the other hand, it meant that my hands weren't available to touch Liam until I was in recovery, which I was a little sad about.

The one thing I regret most is that, while we were able to convince them not to bathe Liam for a couple/few hours after he was born (the smell of amniotic fluid is thought to help with getting nursing started), I forgot to smell him! Even without any mind-altering drugs, I was still pretty spacey for my first few hours of recovery. I totally can't remember what my first words were after seeing him - my guess is that it was either "Hello baby" or "He's so beautiful." Goodness knows I said that second one over and over that first day.

Well, writing that brought back some nice memories. Thanks. Have I shared my c-section birth plan with you? If I haven't and you'd like to see it, let me know.

[elisem.livejournal.com]

Milestone after milestone: the sixth class, the third trimester tiredness, the "unexpected events" discussion, and all. Yay, all three of you!

That's good about the patience of midwives regarding induction. A number of obstetricians are also pretty patient about it these days, which is very good, in my opinion. (signed, a labor coach who helped with a rather long labor in which the doc let the mom go ahead, checking in with her respectfully to see if she was up for it. she was. it turned out good.)

I should say that at the end of that labor I just mentioned, after all the exciting bits were taken care of, the doc (who had been wonderful, especially for a substitute doc who came in at the last moment and wound up dealing with a not-completely-routine situation) said to the new mom, who had showed amazing energy during the pushing part, "I thought you said you were tired."

She said, "I'm exhausted."

He said, "Woman, I would hate to see you when you're rested," and she and he both laughed. It was pretty cool.

[minnehaha.livejournal.com]

I had a forceps delivery for my first one. No marks on the baby, no problems at all.

K.

[nex0s.livejournal.com]

it's all so exciting!

and i have something to mail to you, it's washable (cotton & acryllic) that's all knitted up.

email me at my LJ addy?

it's wrapped and waiting...

n.

[rivka.livejournal.com]

I think it's great that you guys are planning kids, and that you're learning as much as you can.

Forceps scare the be-jeesus out of me, because I have friends who found out (25 years after the fact) that a heavy-handed OB had caused the brain-damage to their eldest daughter.

Our instructor told us that they don't use forceps very often these days - they prefer to use the vacuum extractor - and that high-forceps deliveries (starting from when the baby is still up in the pelvis) aren't done anymore at all. Probably today your friends would've had a C-section instead. Whew.

I ought to link to all of these for reference.

You should be able to see all the pregnancy posts together in my memories, under the category "maybe baby." (Because I made the category when I was about 6 weeks pregnant and feeling very superstitious.)

[rivka.livejournal.com]

*blink* Of all the things I mentioned, including major abdominal surgery, the vacuum extraction is what makes you run and hide? Okay...

Seeble

[tendyl.livejournal.com]

I ought to say thank you as well. The Beloved and I have started talking about kids for the last 6 months or so. Reading your information has helped me feel more empowered about having my future babies.

[windsea.livejournal.com]

Your midwives' practice sounds *great*, and very very sane. Just a couple of, I hope, reassuring notes (all in the context of our maternity hospital here in Halifax, which one wouldn't think to be the centre of the progressive birthing movement :-) :-):

* My kids were born in 92 and 94, in hospital (I think I already gave you the link to Kate's births story). Already, back then, babies born by C-section weren't being separated from their parents. Doulas were welcome in all stages of labour. Birthing rooms and tubs were encouraged, and staff, if they felt fetal monitoring belts were essential, were told to put them on, get a reading, take them off so that the labouring mother could move around, and then put them on again 10 minutes' later.

* My doctor fought to avoid induction with Colin, my elder. I was only 35 weeks along when my water broke out of the blue, and I went into labour some hours later. The official hospital policy was that 12 hours after water breaking, induction would start if labour were not progressing. She managed to spin that out to over 24, and then only because my temperature was climbing, a sign of potential infection.

* My doctor had trained herself in perineal massage, and I had no episiotomies. Crowning still hurt like hell (no wonder some call it the "ring of fire"!), which was something no doula nor childbirth educator had actually mentioned. They talked about contractions and transition, but didn' t mention what it feels like when that head actually starts coming out ... it's short, but DAMN does it hurt, and I think I swore off sex at one point ;-)

Lake, hell, what about the whole Atlantic? :-)

[micheinnz.livejournal.com]

I had a Caesarean section under spinal anaesthetic, and it happened just as your midwife described.

Weegirl was checked over by a paediatrician, then wrapped up and given to d_h to hold while they finished up.

I remember being surprised at how wide-awake and mellow she was -- she just sat in her Dad's arms checking out the room.

It was really cool.

[mactavish.livejournal.com]

I'll keep your sailboat in my thoughts, too.

[hobbitbabe.livejournal.com]

When my brother first described the birth of their first (they now have four, all healthy and wonderful, and he teaches a Parenting course for high school students), the line that I recall was something like "They didn't show us those salad servers on the tour, and when they brought those out the one nurse asked if I was okay and I said I needed to get out of there for a minute. But apparently it only takes a minute, and there she was!"

[therealjae.livejournal.com]

My shudder was on behalf of the baby, mind, not the mother. I think it sounded a little too much like an abortion technique. Bleagh.

-J

[iamjw.livejournal.com]

A friend of mine used to get the urge to pickle things. Giant containers of vinegar would come into the house (never mind that there already were giant containers from the *last* pregnancy) and she'd start pickling away.

I've never entered a home with that much vinegar before or since :-)

[wiredferret.livejournal.com]

If you saw the tools involved, the difference would be clearer. Vacuum extraction uses what now looks to me like the horn part of a breastpump bottle.

[wiredferret.livejournal.com]

I doubt that's a C-section thing. I have no idea what I said first for Baz, and anecdotal evidence indicates that I may have said "A girl? Good." for Kay.

[tammylc.livejournal.com]

Fair enough. I expect delivery - surgical or non - tends to make most women a little loopy!

I remember being really surprised when the doctor said "I see a scrotum" but since Liam was breech, that happened before he was actually delivered...

[rivka.livejournal.com]

Oh jeez, that connection hadn't even occurred to me. As wiredferret says, the tool itself looks awfully innocuous - it's just a little plastic cup attached to a tube. Nothing vacuum-cleaner-esque about it.

[rivka.livejournal.com]

I have been thinking a lot about your C-section experience, including your initial disappointment and emotional reactions. I'm glad to know that, on balance, you feel so positively about it now.

I know how cold ORs are! Although usually I'm just there for a few minutes before being knocked out. They keep them cold on purpose to discourage bacteria growth, and yet research has shown that patients who are chilled have slower recovery times. Maybe someday they will change.

SOP at our hospital is for women who are conscious during C-sections to have their hands restrained. So active touching on my part wouldn't be possible either, although I can envision curiousangel holding the baby close enough to my restrained hands to allow touch, or brushing her against my cheek.

[tammylc.livejournal.com]

I'm still sad and disappointed that I had to have a c-section. Especially as I start to ponder if I want to have another baby, and what it might mean to me to never experience labor or delivery.

But since I had to have a c/s, I'm glad that the surgery itself went well, and that by the scheduled time and date I was able to engage with it and do my part to make it as positive an experience as possible.

[dragon3.livejournal.com]

I pity the skipper sailing away with a boat load of birth fears. I'm sure they make lousy crew!

Hang in there.

[ailbhe]

After my messy vaginal birth, they took Linnea away for five minutes' tests and things, which Rob followed to watch, because I insisted she not be left alone, and then brought her back to me; I was allowed to touch her as soon as she was born, though, and again after they brought her back.

Her venteuse suction marks - plural, she had two because she was so damn hard to get out - vanished in less than a fortnight. They were almost invisible before I left hospital, 5 days after the birth. They really didn't seem to have done that much damage at all.

It didn't occur to me until a while after she was born - hard to tell how long - that I had rights to health too, not just the baby. It didn't occur to me while I was in labour that I could make any choices based on what was best for me, rather than just for the baby. I am very glad they've made it clear that you can.

What I've heard about planned c-sections and non-emergency c-sections sounds lovely, actually, except in cases where the mother was dead set against one. Next time, I will have c-sections and I fully expect it to be actually pleasant - the ob described it as "rather jolly, really".

I know a bunch of people who breastfed successfully after both planned and emergency c-sections. And I did too, after my Thing, and it was the easiest, most natural thing in the world. Oh dear, now I'm crying, thinking of feeding her that first time, when her little mouth knew exactly what to do, and she just did it. *Sniff*. I fed lying down a lot, and that was easy and lovely too. Some people apparently have trouble with it, but I never did.

*Sniff*

A.

[anisoptera.livejournal.com]

Was the warming thingy this?
http://www.bairpaws.com/arizanthealthcare/bp.shtml

[tammylc.livejournal.com]

No. It was a paper and plastic combination that just covered my chest and arms, and was taped down to the operating table.

[beckyzoole.livejournal.com]

Curiously, the major abdominal surgery thing doesn't bother me as much as "restrained hands". I hate having my hands restrained!

But it makes sense, come to think of it. The last time I was drugged and loopy, when I had an endoscopy, I kept trying to remove the oxygen monitor, take out the IV, etc. I wasn't fighting or anything, just trying to get comfy and too high on valium to realize that those things were supposed to be there.

[beckyzoole.livejournal.com]

About forceps -- when Maia was born in 1986, all was going well until she was crowning, and started passing meconium. The OB saw the meconium squishing out beside her head, and grabbed the forceps in a rush. If she had gotten any of it in her nose, it could have caused a peculiarly nasty form of pneumonia. One quick tug of the forceps and her head was out, getting her nose suctioned immediately before the rest of her body was born! Because of the emergency use of forceps, my perineum tore a little. My doc apologised; he knew I'd hated the episiotomy I'd had with my first baby and wanted to avoid one with this one. But the tear healed quicker and with less pain than the episiotomy had, so it was all good.

I begged my OB to induce Maia when she was a week late. I had had my three or four days of nesting energy already, and become completely and totally exhausted. I could hardly walk, and I wept when I talked even though I was not sad. Finally, at ten days late, after ultrasound to confirm that she was as big as she should be, and after I told the doc once again that I was an exhausted wreck, I was induced. Labor pains were not really any different in strength or speed from my first, non-induced labor. I did have to stay in bed the whole time, which sucked, since the hospital policy was to closely monitor all induced births. But, yay! I finally wasn't pregnant any more! And, yay! I had a baby! Yay!

[journeywoman.livejournal.com]

Luna bars are dirt cheap on . My favorite flavor is chai tea. If you think they're indispensable now, just wait till you start nursing. :) Very handy to have at 3 a.m. when you're ravenous and you've only got one arm available for hunting and gathering sustenance.

[rivka.livejournal.com]

I like chai tea, nutz over chocolate, and dulce de leche. I was disappointed by the chocolate peppermint.

[starstraf.livejournal.com]

Thank you for the detailed info. C-section gives me the heebie geebies and it is good to know some info. For some reason even though I don't have kids people come to me for comfort when they are scared, and often that is pregnancy. Reading your class info gives me more info for those times.

[journeywoman.livejournal.com]

Just went to Amazon to restock my supply of Luna bars, and dulce de leche is even cheaper than usual--$10 for a box of 15.