Wednesday, March 31, 2010

Wordless Wednesday: Windy Day

Dropping the Ball

I don't feel like I've been the regular blogger I used to be. I'm working on one post in particular, but it's really not coming together well at all. Maybe I need to up my omega-3 intake. Pregnancy brain.

I also feel like I really don't have anything to add to the discussions in the blogosphere right now. Everyone is saying it so well! Maybe I'll join a couple of blog carnivals just to give me ideas.

Meanwhile, we have somewhere between 4 and 5 weeks left in Provo. We think. Our landlord has already found someone to replace us and emailed us yesterday wanting to know if we might be moving before the end of the month. I guess the new tenants are anxious to move in. We've actually been considering it since McKay's final is on the 16th and we weren't planning on moving until the 30th. Of course, that means a week or more of no income and rescheduling the moving truck (can you do that?). And we'd have to find a place to live out in California. Quickly.

Last weekend we decluttered the desk and it is BEAUTIFUL. We got rid of so much! Old paperwork, random office supplies, even my wedding bouquet. The next few days in Provo should be rainy, so maybe I'll get through the rest of the house. Once we're decluttered, it's deep cleaning time. Yay?

And the pregnancy... it's still happening. Baby keeps moving and growing and I look very pregnant. I need a new belly picture, but when I remember I'm not dressed so it doesn't get done. Margaret is still nursing strong and is working on getting 4 molars right now.

I keep having strange dreams. Last night I wore a fancy ball gown made of garbage bags. Two nights ago I dreamed that we went to church and our new ward hated us. And the night before that I dreamed about spending $19,000 on groceries. Weirdness all around. Yay pregnancy.

And then there are the usuals: knitting, pretending to sew, grocery shopping, laundry. Good times. Remember, if there's anything you'd like to hear about, ask! I like doing Inquisition Mondays. :)

Monday, March 29, 2010

2 Years

We've had 2 happy years with this young person and we're looking forward to many many more.

FHE earlier this month

Happy Birthday, Margaret!

Earth Hour last Saturday

Saturday, March 27, 2010

Our Visions, Our Voices

Yesterday, I went to Our Visions, Our Voices: A Mormon Women's Literary Tour at UVU. It was part of a tour of Mormon women writers that started in California and ends tonight in Salt Lake City. "Mormon" was not restricted to members of the Church of Jesus Christ of Latter-day Saints, but included the Community of Christ and Fundamentalist LDS groups, too. Speakers were chosen for the tour to read their poetry and prose to the group, and those who came to listen were welcome to give copies of their manuscripts to the project where they will be preserved in a collection of writings of Mormon women in the 21st century.

I arrived a few minutes late because of snow and my inability to walk quickly because of my pregnancy. Fortunately, it seems that they run on "Mormon Standard Time" too and I was there before they started. As Reese Dixon described on her blog about going to the California presentation, we started with the group poem, "My grandmother's name is..." Each member in the audience shared their grandmother's name as a way for us all to connect. It was very nice.

I forgot a notebook and pen, so I didn't take notes (I remembered my knitting though!). And I only stayed for an hour because I needed to get home to nurse Margaret down for her nap. But the hour that I was there was very nice. I'm very partial to personal narratives and memoir writings, so those were the ones that held my attention most. The experience reminded me to work on my own writings, but being surrounded by poets and writers with writing degrees was a little intimidating as a lowly math major.

While sitting there, I could imagine a similar set up for small Relief Society groups where women could get together and share their writings with each other. It is definitely a medium for inviting the Spirit and lifting each other up as sisters.

I also forgot a camera, but on the blog, By Common Consent, you can see a picture of the writers/speakers at yesterday's forum. If you're in Salt Lake, there is still time to go to the one tonight at 7!

Friday, March 26, 2010

Friday Fill-ins

1. The right word is "yes".
2. "Shhh" and shut the door quietly, please.
3. Up and away we go!
4. In a library is where you'll find me.
5. Ooh! What is that shiny thing?
6. Knitting during naptime is a good idea.
7. And as for the weekend, tonight I'm looking forward to baking a cake, tomorrow my plans include Margaret's birthday party and Sunday, I want to have pork chops for dinner!

As for the rest of my life: we're moving in 5 weeks! Woohoo! And now that we're past the equinox, we officially have between 3 and 6 months before the baby arrives since the baby is due between the solstice and fall equinox. :) Last I checked it was lying transverse and I was measuring small- but it's normal for transverse babies to cause your fundus to be small. There's lots of time for the baby to turn. A lot of the time the baby IS head-down, but 2 nights ago it was transverse. I don't know why. Maybe it's fun. But at this point in the pregnancy it's nothing to worrry about.

Wednesday, March 24, 2010

Monday, March 22, 2010

Inquisition Monday: Dilation

Melodie emailed me and asked,

How do you/will you check your cervical dilation? (I'm sure you must know how to do this. It's one thing I never figured out and since I have had midwife attended births I never felt the need to know). Or will you even check it? Will you instead just wait for the instinctual need to push and not bother with checking dilation? Have you read "The Rule of 10 Versus Women's Primal Wisdom?" This article really spoke to me and I wondered if it resonated with you too.

I will probably not check my dilation. I actually have no idea why I keep dreaming about dilation because it was never a factor in Margaret's birth.

I didn't check my dilation during Margaret's birth for two reasons:
  1. I didn't want to find out that 12 hours of back labor had done nothing for my cervix. I'm pretty sure that the reason my labor was so long was because Margaret was not putting pressure on my cervix evenly because of a slight malposition issue, despite the fact that she was anterior and head down. The fact that 2 dawns happened with no baby in my arms was discouraging enough. I didn't want to find out I was only at a 4. But most importantly,
  2. I don't believe in 10 centimeters.
I once tried to find out where "10 centimeters" came from. I expected to find some study that took X amount of women in labor and stopped them during their pushing stage so that the researcher could stick a measuring tape up there and find out how dilated they were. Then I expected the study to analyze that data, giving us a mean and median near 10 centimeters.

But I didn't find that study. I don't think it's out there, although if it is, I would definitely be interested in it- send it my way!

What I did find, I mentioned in this blog post: namely a page suggesting that it's possible for women to get to 13 centimeters (!) and another page saying that "10 centimeters" comes from the measurement of the diameter of a newborn's head.

Now, I'm just a lowly mommy blogger with a degree in mathematics, but basing cervical dilation on the diameter of the head after it passes through it doesn't make sense to me at all. In general, women are one-size-fits-all. Women have vaginally birthed babies with large heads, babies with broad shoulders, babies whose birth weights are above 10 pounds. And then there's the baby, whose skull plates mold and even overlap to fit through the birth canal. And how soon are they measuring these heads? Margaret's was very very molded- moreso than any baby I've ever seen, but within hours it was going back to round- and within a day you could never tell it was once elongated.

I have seen the "Rule of Ten..." article you linked to, and I agree: some women are probably ready to push at 8 or even 6 centimeters. I would also say that 10 is no upper bound for cervices. Instructing or coaching a woman to push once she gets to 10 centimeters could mean hours of ineffective "purple pushing" if she's an 11 or 12 centimeter women. And my guess? It's probably different for each birth. Maybe a woman needs to get to 10 centimeters for one birth, but only 9 for another.

I do think it's important to know how to check your dilation, though. I never felt compelled to check mine during Margaret's labor, but I can't say I won't ever feel the need to in the future. It's also important to know the dimensions of your fingers. Ten centimeters is 4 inches- be familiar with the width of your hand and fingers because "2 fingers" for one person is "3 fingers" for another. Also, being able to recognize and reach your cervix is important. It's a useful skill for fertility awareness and I think it's important for women to be familiar with their bodies. Also, if you practice feeling your cervix throughout your pregnancy, you'll maintain flexibility. If you can reach your cervix, you can bend over and catch your own baby whether or not you originally planned to. Sometimes midwives don't make it on time and sometimes hospitals are just 5 minutes too far away. Knowing that you have the flexibility to catch your own baby can help you stay calm in a situation you didn't originally plan for.

I check my cervix when I shower because I know my fingers are clean at that time. Right now, my cervix is too high up for me to actually feel it, but I also have short fingers. Most descriptions of the cervix say that it's "hard" like the tip of your nose. As you near your due date, it softens to be like lips. This happens earlier if you've had more than one pregnancy. The "hardness" of your cervix also changes throughout your monthly cycle. The beautiful cervix project features images of the cervix throughout the month and even during pregnancy. Those might be helpful to you or even your partner if you'd like for them to know how to check your dilation, too.

Saturday, March 20, 2010

Aran Sweater

Oops! The post that was here was supposed to be published on my knitting blog. Check it out here.

Thursday, March 18, 2010

How to UC: Birth Supplies

A couple of weeks ago I blogged about what equipment we had on hand for my prenatal care. This week continues on with birth equipment.

When I was reflecting on Margaret's birth, I was amazed at how little we really needed. Most of our "equipment" were extraneous wants. For example, I didn't really need a tub; I could have had a land birth and Margaret would have still been born.

But here's what we had or are planning to have this next time.

Labor Management
We used some cheap washcloths for warm compresses during my back labor. As far as food and drink- we had some leftovers in the fridge that were always ready to be heated up and also juice and electrolyte drinks for hydration. And my friend brought donuts on Saturday morning. Need those carbs for fuel!

Water Birth Equipment
We borrowed a tub from someone who had recently had a homebirth. The model happens to be the one seen here. While I'm sure the fancier tubs are very luxurious and nice, this one was large and deep enough that I didn't feel hindered nor did I think, "Gosh, it would be nice to have a deeper pool." If we go with a water birth this time, we'll probably buy that same model for the sake of cost and that it can be used as a kiddie pool in the future.

We borrowed an air pump for blowing up the pool. It was very handy and needed to prevent McKay from dying while getting the tub ready. We own one now for future use.

We used our large stock pot to fill the tub with water and to boil water on the stove to keep the tub warm.

Water Control
We gathered up a few different waterproof items to lay under the tub and to line the path from the tub to the bathroom so I could get up and not get our carpet all wet. We bought an ugly, on clearance, flannel-backed, waterproof table cloth to put under one side of the pool. We also bought a bunch of clearance bath towels for water spills. They were handy during the pushing stage when I wasn't being careful about leaning on the edge of the pool. The walkway to the bathroom was lined with chux pads, which are just rectangular incontinence pads.

Disinfecting and Stains
We used peroxide to clean the tub both before and after the birth. Also, peroxide will get blood stains out of the carpet if needed. For Margaret's birth it was all contained in the tub and the only blood on the outside of the tub were just a few drops when I moved from the tub to the couch after she was born. McKay cleaned those up with peroxide and you'd never know a baby was born there. In fact, the next day, the only evidence of a birth was the wet spot on the carpet from my pushing stage when I wasn't being careful about keeping water in the tub- and that was blood-free water.

When the placenta was released, we caught it in a large mixing bowl. From there we transferred it to our 9x13 pan. The placenta was surprisingly large- the size of a dinner plate- so the 9x13 pan was good for inspecting it. I may also get some herbs for hemorrhage.

Clamping and Cutting the Cord
We used cotton yarn to clamp Margaret's cord and some never-before-used meat scissors (boiled) for cutting it. Those scissors have only been used that one time, but will probably prove useful this summer.

For Margaret's birth, I didn't have much on hand for this aspect, but this time I'll be a little more prepared. We have already acquired a large handheld mirror from the dollar store for the purpose of assessing any tears. As for repairing tears, we will buy some liquid bandaid stuff and have some seaweed (like the kind for making sushi) for healing. If it's a particularly bad tear that requires stitches, I'll get help for that. If I were to give birth in Utah, I know a midwife I can call for stitches, but unfortunately, we'll be in California. I'm not sure if I'll be able to set up a similar arrangement since some midwives aren't fans of being used for a la carte care. We'll see how that pans out in the future. Ideally, I won't tear at all. I'm still debating whether or not I want to do any perineal massage during the pregnancy. We might have some olive oil on hand during the birth for that purpose if I do decide to go that route.

How it all worked out
McKay did all the cleaning. I think on some level, the manual labor required was therapeutic for him in processing the birth. Any chux pads and towels with blood on them were wrapped up in the table cloth and put out in the dumpster. The towels that were simply wet with water were kept and we still use them today. It's always useful to have extra towels on hand with babies and kids. For over a year, I slept on one of those towels because I had such overactive letdown at night. McKay emptied the tub manually with bowls of water and scrubbed it out with the peroxide.

Other Options
Some people use those green fish tank nets for removing various bits out of the tub. I was pleasantly surprised that I never did poop during the birth, so that wasn't a problem and we just used a bowl to scoop up my mucous plug. We could have used a hose for draining the water, but we didn't and it was fine. If it had been warmer and we had a yard, we probably would have just dumped the pool out on the grass. And there's always the option of having the baby in the bath tub and just washing all the mess away. How easy! Also, you can buy homebirth kits, but we decided that most of the supplies were unnecessary for us. Why would we need latex gloves to catch and hold our own baby? Instead of using a plastic cord clamp, we used yarn just as effectively. We decided to keep it simple.

Wednesday, March 17, 2010

Not an Issue

I found this the other day and discovered it's been my parenting manta for a long time, but didn't know it.

"Disobedience is not an issue if obedience is not the goal."
Daron Quinlan

Just something to think on today, tomorrow, and every day.

Monday, March 15, 2010

Another Labor Dream

I'm getting to that stage in my pregnancy when labor dreams show up more. Last week I had another.

In my dream, I was in labor- very close to the "ring of fire." There was a midwife there and I decided to ask her to check my dilation. Why? I don't know. I was apparently pretty far along and I knew that, but I asked her anyway. Her response?

"You're somewhere between 4 and 9, give or take a couple of centimeters."

That wasn't... vague...

Anyway, her answer kind of pissed me off, and so I got tense and immediately I felt my cervix close a little and the baby's head went back a couple of centimeters in station.

Noticing this, the midwife gave suggestions on relaxing and other things to encourage dilation, but the more she suggested, the less open my cervix was.

And I woke up before the baby was born, still amazed at the "between 4 and 9, give or take..." statement. I mean, really, who says that?

Oh well, it was just a dream. Maybe it's verifying to me that I'd be more comfortable on my own. Or it was just dream. A crazy weird dream.

Friday, March 12, 2010

Friday Fill-ins

This week has been kind of rough. There are errands I was supposed to do Monday that I still haven't done and the house is still a disaster. Decluttering takes up space: bags and bags of stuff we don't need anymore just waiting to find a new home.

1. I am so looking forward to never having to drive across I-80 again. Once we're in California, I am DONE with Nevada.
2. We can find time for all that later.
3. When you get everything done, there is still more to do.
4. Why breastfeeding pictures? Because breastfeeding is a big part of my life.
5. If you need anything knitted, I can probably do it.
6. Yesterday's excursion to Salt Lake was quite a trip! (It even involved some throwing up in the car.)
7. And as for the weekend, tonight I'm looking forward to homemade pizza night, tomorrow my plans include watching some capoeira and Sunday, I want to take a nap and make up for the loss of an hour!

Thursday, March 11, 2010

How to UP/UC: Birth Plans

At around the middle of your pregnancy, those weekly emails you signed up for eventually start saying, "Your baby is the size of a fruitcake now! Time to write up a birth plan!"

What does a birth plan look like if you are planning a UC? Do you need one?

For Margaret's birth, I didn't have an "official" written birth plan, but we did have an understanding of how things would go. If it makes you feel better to write things down, do it. If you're too lazy (me!) then don't.

Initial Plan
"Ok, McKay. I'm in labor: what do you do?"
"Whatever you tell me to do." Exactly.

We also had some transfer plans in place.

Transfer Plan I- in labor
A birth plan for a transfer is obviously going to differ from a birth plan that starts in a hospital. For one: you are going for the intent of getting medical care that you can't get at home. This means things like "I don't want my waters broken," "I want to be able to eat/move freely," are a bit superfluous. It's likely you'd be transferring for a cesarean because you can try almost any other sort of invention at home. Things you will have to consider include postpartum baby care like many other birth plans. Do you want the baby bathed immediately? If the baby is doing well and the transfer was for maternal distress and not fetal distress, do you want to practice kangaroo care? Delayed cord clamping? What are your decisions about the Hep B vaccine? Eye drops? Vitamin K shot? PKU? Also, you'll need to make decisions about feeding-related issues such as supplementation, artificial nipples, etc.

Transfer Plan II- postpartum
Transferring postpartum is slightly different in that both parties might not need to be to be admitted to the hospital. If you are transferring for the baby, the mom doesn't need to be admitted, and similarly, if you are transferring for the mother, the baby doesn't need to be admitted. Limiting the number of people admitted to the hospital will probably decrease the amount of time you spend there. Again, if the baby is being admitted, baby-related plans need to be discussed as above.

It might seem like a lot to remember, so if you need to write things down, do. Emergencies aren't usually a time when you are thinking 100% clearly. It's also important to realize that as a mom, you might be transferring because you've lost consciousness and you aren't going to be awake to ensure your desires are carried out. Having a written plan can help your partner remember all the details.

Our current birth plan
The "Initial Plan" that I discussed above was our birth plan last time. This time I've added more to "Do whatever I ask for." For example, while I did eat and drink during Margaret's labor, I don't think I did it enough, so we've discussed and agreed on "If I haven't had a bite to eat or anything to drink in 3 hours, gently remind me to do so." I say "gently" because I was a bit annoyed at suggestions while I was in labor last time.

Our transfer birth plans are as non-interventional as possible, taking into account that transferring means we are getting some interventions. Special considerations include kangaroo care. We have discussed that if we transfer in labor and the baby is doing well (say, Apgar of 7+), then McKay is supposed to say, "Since the baby is doing well, we're now going to put the baby on mom's chest," and then take the baby and do it. Everything else: bathing, weighing, etc., can wait. Even if I'm unconscious, baby could be given a chance to self latch through breast crawl (see below) which, on average, takes about 45 minutes.

Cool, no?

Wednesday, March 10, 2010

Quick links

Thursdays are my usual days for "How To..." and I will definitely do one tomorrow.

But in the meantime I thought I'd share a couple of links.

My friend Alisa did a mini-series about prenatal testing. Part 1 is here. Part 2 is here. Good stuff all around.

A month ago I was asked on Facebook about checking cervical dilation on your own. Then I recently ran into this blog post. It mentions the labor smell- I definitely remember that. At the time, I figured it was the smell of a house that was boiling water for a day straight- but it was a little different. I also don't remember 2 bloody shows, but I remember the first- it was exciting! I was probably in la la labor land for the second.

Also, there have been a few news articles about sling recalls. This post here sums it up well: any carrier can be dangerous if you don't pay attention. When I first wore Margaret, I was constantly checking on her. As she gained head and back control, I worried less about her suffocating. Be up to date on your recalls, learn how to use products safely, enjoy wearing your babies.

So there you are: a few posts to read today in your free time.

Tuesday, March 09, 2010

16 months later...

November 6, 2008

You uploaded a photo that violates our Terms of Use, and this photo has been removed. Among other things, photos containing nudity, drug use, or other obscene content are not allowed, nor are photos that attack an individual or group. Continued misuse of Facebook's features could result in your account being disabled.

March 9, 2010
You uploaded a photo that violates our Terms of Use, and this photo has been removed. Facebook does not allow photos that attack an individual or group, or that contain nudity, drug use, violence, or other violations of the Terms of Use. These policies are designed to ensure Facebook remains a safe, secure and trusted environment for all users, including the many children who use the site.

Notice the difference? My picture must constitute violence. ;) Personally, I'm not sure how breastfeeding makes Facebook not safe for children. Breastfeeding has definitely proven safe for Margaret- and the other three children I have nursed in the past 2 years. In fact you might say that my breasts are a "safe, secure and trusted environment for... the many children who use [them]."

This is the third picture I've had removed. The two pictured above were profile pictures. Because the second wasn't a profile picture I can't be sure which one it was, but I have a feeling it was this one (below), which I posted to a homebirth group that had lots of baby-coming-out-of-vagina pics so I thought it would be "safe." It's no longer on that group's photo album, though many of the others are still there. It's like someone is out to get me.

Either I'm on Facebook's "list" or I have a really crappy Facebook friend who doesn't have the courage to just talk to me in person or the ability to not look. Dear mysterious "friend": I've definitely "hidden" people in my news feed because their updates got annoying or bothersome. You could try that. Or unfriend me. I'm cool with that. I really am.

Why does this (still) matter? Annie at PhDinParenting did a wonderful job of outlining this right after the FB nurse-in. April at Eclectic Effervescence posted yesterday about her experience with a picture that was removed and demonstrates that Facebook photos aren't removed immediately after being reported. After being reported, they have to be physically looked at by a FB employee who then removes them and send out the form letter. Double standard?

Could it just be that I'm on Facebook's "list" and they have people "checking up" on me? I wouldn't put it past Big Brother. Interestingly, I was commenting on another public blog the other day when someone recognized me, "Hey! We talked about you at work the other day!" After checking out their personal blog, I learned that they are a new Facebook employee. This someone did assure me in email correspondence that I've made a difference within Facebook and that during a Terms of Use lecture FB was giving to new employees, they were told that nudity is not allowed, but nipples were ok if there was a breastfeeding baby on them. Facebook is apparently sending mixed signals to not only the public, but their employees, too. Triple standard? Facebook has some policy sorting to do.

There are just so many levels of wrongness with this whole issue I can't even begin to start. Maybe I'll write a nice, long post about all the wrongness in the future.

TERA has been kind enough to post pictures, with permission from the owners, that have been removed from Facebook. According to Paul Rapoport, after posting my most recent picture, "There are now 199 photos on the TERA site that were submitted by breastfeeding mothers and a few others. Of those, 183 have been banned by Facebook, some more than once."

Monday, March 08, 2010

Preparing Margaret

In less than 2 months, McKay will be working at Pixar. In the summer, we'll have a baby. Meanwhile, Margaret will turn 2 and continue to learn how to be a person. The next 6 months or more will be filled with a lot of transition for Margaret and we've been giving a lot of thought on how to make this easier for her.

First, what we are NOT doing:

  • We are not going to change our sleeping arrangement. Margaret will eventually get out of our bed, but I'm not going to push it at the moment. My mom said whenever they moved when I was small, I would get night terrors- probably from the new environment and changes in my life. In order to minimize extra stress, we'll keep her in our bed until she's ready to get out. At least 8 hours of the day will be spent in the same environment she's used to: between mom and dad.
  • We are not going to wean her. I thought she might wean on her own in the pregnancy; she was never into comfort nursing as a baby. But despite my drop in supply, she still nurses often. With a move and a new baby, we're not going to cut down on our snuggle time.
  • We aren't going to push potty learning. To be honest, she's pretty much there. We've had only a handful of accidents, and she's gone all through church without using her diaper for a couple of weeks now. We're down to using maybe 1 diaper a week. But we also know that with change, kids can regress, and if she does that during the move or when the baby comes, we'll be patient with it.
What we will do:
  • We will probably have Margaret at the birth. I think it will be better for her to know where the baby came from than to go away with a sitter and then come back after the baby "magically" appears. Yesterday, I was showing her birth videos on youtube and she was getting all excited and clapping when the babies were born- and she also expressed concern for the crying babies. "Sad," she said, while indicating tears going down her cheeks. She got happier after the babies latched on and nursed. "Ummy!"
  • We're considering getting a postpartum doula to help with the baby transition. It would be nice to have someone who can do a few light chores so I don't feel like I have to decide between clean dishes and a happy toddler. A couple of the doulas out in the Bay Area also advertise experience with Waldorf/Montessori with toddlers. Someone who could help with Margaret along with cooking meals or tidying the house sounds like a plus to me! Of course, we'll have to budget for that: doulas are around $25-30/hour out there.
  • I will try to remember that Margaret needs mom time and give that to her.
  • I will give myself a good 6 weeks before making myself show up at places and look like a normal person again. We are looking at apartments that are close to parks so we'll be able to get out of the house without actually having to look "put together". Plus Margaret can get some vitamin D and outdoor time. In fact, the baby and I will probably need the sunlight too. We'll probably also start going to LLL meetings out there. But going anywhere that requires a car ride and a bra? Nope. I don't think so.
  • I think I'll knit her some socks. When I was making booties, she wanted some of her own. Yes, hand knit socks will come in handy.
What have you done to ease major life transitions for your little ones?

Thursday, March 04, 2010

How to UP: Gear

The first thing McKay and I did after officially deciding to go with an unassisted pregnancy the first time around was go online and buy what we felt was needed for it.

Flexible Measuring Tape in Metric
This is for measuring my fundus. Pretty self-explanatory. McKay owned one when we got married, so this was free.

We ordered an inexpensive fetal stethoscope. I think it was this one, but it only cost $9.99 when we bought it. Fetoscopes are just stethoscopes, but modified for hearing quieter heartbeats. If someone besides the mother is listening, there is a forehead bar which is supposed to amplify the sounds. I've heard that you can usually start hearing the heartbeat with a fetoscope at around 18-20 weeks. We actually heard it a few weeks earlier than that and are only just now getting some echoes of the placenta. With Margaret's pregnancy, my placenta was anterior and drowned out her heartbeat even after 20 weeks. The first time I listened to her heartbeat, it took me about 45 minutes to find it. I didn't really know what I was looking for, but I got better at it. The placenta is a whooshing sound and goes at about the mother's heart rate. The baby's heartbeat sounds a little like the ticking of a watch underneath a pillow. It's about twice as fast as the placenta. Give or take. By the end of my pregnancy with Margaret, McKay didn't need the fetoscope to hear her heartbeat; he just put his ear on my belly and found it that way.

Urine Test Strips
I track a few things during my pregnancies, but the most important ones for me are protein and glucose. We bought this brand, though I'm pretty sure it was cheaper than $20 at the time. Darn this inflation! I check for leukocytes because I had chronic UTIs as a child and one of my kidneys may have some damage from my younger days. Excess protein in urine can be a symptom of preeclampsia and would be a signal to also check your blood pressure and note any swelling of the extremities. With Margaret, there was a time when my protein was a little high, but my BP was normal and I was able to wear my wedding band my entire pregnancy. After altering my diet, I checked my protein a few days later and it was back to normal. No problems. High glucose levels can mean your body is having a hard time with sugars and could mean gestational diabetes. I did get one test with higher glucose levels, but again, after adjusting my diet, they were back to normal. My other numbers (weight, fundal height) were on track, so Margaret was obviously not gaining too much- a fear with gestational diabetes.

In general, I change my diet to see if I can get things back to normal. If I were to consistently get worrisome readings and symptoms that I couldn't get under control, I might consider getting an opinion from a care provider.

Those are the things I have on hand all the time. Other equipment you could get include:

Blood Pressure Cuff
I check my blood pressure at one of those "check your blood pressure" corners at a pharmacy. I know it's not 100% accurate, but I use the same machine every time so there is some consistency.

Glucose Meter
I would consider getting a glucose meter if I was having regular gestational diabetes-like symptoms.

Bathroom Scale
We don't own a bathroom scale because I don't believe in them, but I check my pregnancy weight with a friends' scale when I'm at her house. It's definitely "off" but, like the blood pressure machine, it's consistently "off" so I have a good idea of what my weight gain is.

Because I'm not 100% sure ultrasound has no damaging side effects, I'm wary of the doppler so we don't have one.

If you are a Type A person, you might want a notebook to document your prenatal care and keep track of all the details. I'm not like that, so I don't. I know some people like to have the information just in case they want to transfer care in the middle of a pregnancy.

How often do I pee in cups? Listen for the heartbeat? As often as I feel like it. Sometimes it's every couple of days, sometimes I go weeks without checking.

What I like about UP is that I can get answers almost instantly. That time when my protein was a little high? It was a Wednesday. After three days of self-care I checked it again on Saturday and it was fine. You don't get that sort of immediacy with a midwife or OB when your next visit is 1 to 2 weeks later. For me, it brought me a lot of peace of mind that I could get answers quickly and not have to wonder, "Is 5 eggs a day enough for my protein levels?" for 2 weeks.

So that's what I have in my medicine cabinet. :) How exciting!

Monday, March 01, 2010

Inquisition Monday: GBS

Natalie asked, "What would you do if your labour began with a premature rupture of membranes and the labour took longer than the usual advised 24hrs? - after which they say that there is a greater risk of infection of the baby with GBS (if present in the birth canal). These were conditions from my first labour and I am wondering what I could have done differently to have a homebirth. They do not routinely check for GBS in a swab sample prior to labour locally, they treat everyone as if they potentially have a GBS infection - and hence I laboured under pressure of the deadline and was given pit to speed up labour - Not a happy time."

Good question. Group B Strep, or GBS, can be dangerous for babies. It's present, often without symptoms, in 10-30% of pregnant women. It dangerous if 1) it's present in the birth canal/anus at the time of birth, 2) the baby's first few breaths takes the bacteria into its lungs, and 3) the baby isn't monitored closely for signs of the infection for the first few hours after birth. According to ACOG in the link above, "GBS infections cause death in about 5% of infected babies." That means the great majority don't die from it even if they are infected.

But still, enough babies die each year from it that they test everyone at around 36 weeks. As you know, the amounts of the GBS bacteria varies over time. They test around 36 weeks thinking it'll be close enough to birth to get an idea of the birthing conditions. Of course, with babies like Margaret who are born at 43 weeks, that gives almost 2 months for conditions in the vagina and anus to change!

We didn't worry about GBS with Margaret because she was born in water, meaning her first breaths were far enough away from my vagina that even if I was GBS positive, the likelihood of her breathing in the bacteria was infinitesimal. Also, there is some evidence that water "washes out" the vagina and reduces GBS infections that way. Plus, she was born in the caul which also meant her first breath wasn't right next to my vagina.

Your situation is obviously different. If you're hoping for a homebirth next time, you might be able to find a midwife who is comfortable with skipping the GBS test all together. If I were seeing an OB or CNM and planning a hospital birth, this is what I would do:
  • About 2 weeks before the GBS test at 36 weeks, I would start a regimen to limit the growth of bacteria in my body. There are herbal rinses/douches specifically for reducing GBS positives. I would increase my intake of garlic and other natural antibiotics. I actually might go to the effort of putting garlic in my vagina to kill off bacteria- but remember to tie the garlic clove to a string like a tampon or else it might get lost. Haha! As an anecdote, a friend of mine said that putting garlic in her vagina made the back of her throat taste like garlic. Our bodies are weird.
  • If I tested positive at 36 weeks, I would continue with an antibacterial regimen. When I was pregnant with Margaret, Rixa posted at link to a regimen that includes lots of stuff I have around the house: garlic, echinacea, grapefruit seed extract, etc. Even if you have to go out to a health food store and pay to get all that stuff, I'm guessing it would cost less than the hospital bill of antibiotics in your IV.
  • If I tested positive, I would ask again for a test at 39 weeks or closer to the birth. Results come in 24-48 hours, so there's a chance to find out you're negative before labor starts. It may mean that particular visit costs more, but again, it would likely be cheaper than receiving antibiotics in labor.
  • For broken water: there are varying degrees of broken water. If it's just a trickle, it could be just a small leak, which can even close on their own. I'd increase the amount of water I drink by a lot- maybe even half gallon to a gallon an hour (make sure you get some electrolytes, too). Your amniotic fluid will replenish itself as long as you are giving it water to use for that purpose.
  • You would probably be offered antibiotics through an IV if you've tested positive for GBS. Natalie, you didn't mention whether or not you were receiving antibiotics through an IV during your labor. If you were, I wonder why the emphasis on a time limit. If you weren't, I wonder why they didn't offer it to you. For your reading pleasure, here's a article on treating GBS with antibiotics.
  • If we feel like we need a hospital birth in the future I would first stay home as long as possible. Second, I would bring a doula who is familiar with my birth plan. Then when the nurse/doctor says, "We need to do X," I will be able to say, "Can you give us 10 minutes to discuss that?" A good doula would be able to say, "Well, I know you wanted to try Y before doing X. How about we try that?" or "I know some women who have done Z before X and it helped," and even, "You know, I think we have exhausted our options and X might be the best thing to do right now." Having that extra opinion is a good idea. In fact, you can always ask for a second opinion from a different OB, especially if the suggestion is major surgery.
  • Remember you can always ask for a new nurse. If you feel like the nurse is giving off a "hurry up and birth that baby" vibe or whatever vibe you're not comfortable with, ask for another. It can make a big difference. Don't worry about offending the nurse- it's likely that s/he can feel the strain in your relationship and would probably welcome a change.
  • I wouldn't wear a hospital gown. You could bring your own or even nothing at all. I've seen lots of custom hospital maternity gowns on etsy. As I've mentioned in my birth nudity post, being naked helps me feel less restrained. For me, a hospital gown would symbolically represent me giving up my body and autonomy and I would feel more powerful and in control without it. That might be something to help you get into a "I'm in charge" mindset: forgo the hospital's gown and bring your own or just go nude. Birth is very involved mentally so if you can feel more powerful, a time limit will have less impact on your birth.
  • Speaking of time, I'm not sure if L&D rooms have lots of clocks in them, but I would hide/cover them and not watch TV. We even hid all the clocks in our house for our homebirth. In the line of feeling powerful- I would probably close the door in the room to give myself an area that is specifically and physically "mine" where nurses and doctors can't just enter my space without warning.
So in all: I would start by trying to prevent a positive GBS test with herbs, but if that's not possible, I would try to make my environment conducive to me feeling like I'm in control of the birth. If you are comfortable in birth, your contractions will be more effective and those time limits won't matter.

I hope that helps. Anyone else have suggestions? Have you been GBS positive in the hospital with a time limit?