Tuesday, February 26, 2013

Birth Plan

If you have zero interest in birth stories, please feel free to skip this entry. Birth is a topic I am extremely passionate about and that will probably be reflected in this entry. I hope to one day be active in an organization that supports women throughout their pregnancy,  labor, and postpartum... be it either as a doula, ICAN leader, or La Leche League leader etc. More on that later. I am also writing this entry while things are still fresh in my mind. If being a parent has taught me anything it is that the details get hazy. So here we go, rewind a couple of years....

I found out I was pregnant with my first child in the fall of 2010. I was over-the-moon excited as being a parent was one of my life goals. I had a very healthy and normal pregnancy with the exception that my baby was breech (Frank breech)...which means he looked something like this:

Pretty uncomfortable huh? He was this way at my 37 week appointment so my incredible OBGYN scheduled me an appointment with a specialist to attempt the External Cephalic Version Procedure. read more here. I had watched videos of this procedure and felt ready for the discomfort that was supposed to come along with it. However, when I went in for my appointment at 37w/3d, my amniotic fluid was too low to even attempt the procedure. Actually, it was at such a level that my OBGYN was concerned it would require an emergency C-Section. To say I was devastated would be putting it mildly. I know I sobbed. You see, I had gone through Lamaze class, written my birth plan, educated myself ad nauseum and firmly believed that my body could do exactly what it was intended to do- give birth. I was ready (As much as you can be) and was actually excited about the prospect of laboring. I do not believe in birth interventions used in the name of convenience. I also believe that oftentimes they are shrouded as "medically necessary" but are nothing more than convenience measures. On the flipside, I trusted my doctor. She approached medicine with an evidence-based mentality which is rare in older practitioners. She did not want to take my baby via c-section at this point because she said it was too early and the baby was not ready. (again, in line with current research that says a baby is not ready until week 39 at the earliest). However, the low fluid was a concern. She sent me home on bed rest with instructions to drink 1 gallon of water over the next 24 hours and return the following day for a fluid re-check. We went home a mixture of emotions. I cried. alot. This was not the birth I wanted or dreamed of. I felt like my body had failed me. I drank the water and then some. I returned the next day and my fluid had increased to acceptable levels. I was to return every day for fluid checks until I made it to 39 weeks where I would undergo a scheduled c-section. Because Mark was breech, I did not question that I needed a c-section. Now, I know I could have tried to labor and birth Mark as the Frank Breech presentation is considered the safest breech to deliver vaginally. I have also since learned that Touro Hospital has physicians willing to let you attempt to do so. At Ochsner, it was not an option for me. There is the complicating factor that although my fluid increased, it still remained low which might have resulted in a c-section at another facility.  Regardless, at this point, I do not characterize my c-section as unnecessary; although, it was definitely not what I wanted.

The days following my c-section are a blur. For me, it was a horrible experience that I do not want to repeat. From the bright lights, to being alone while they TOOK FOREVER to place my epidural (not their fault, my vertebrae are apparently super close together), to the entire surgical environment, it was bad. After my epidural was placed, they laid me down on the table in placed the curtain so I could not see the surgery (thank God). Did I mention I was still alone. George was not allowed in the room until the first incision was made. I understand, sort of, the rationale behind this, but it left me feeling incredibly scared and alone. George is my rock and in this uncertain time, I need him to hold my hand. I was shaking so badly I thought my teeth would shatter. I felt sick to my stomach with every tug that I assure you I felt. When George came into the room, I wept and he looked a little terrified. He sees patients on a daily basis but he later explained that nothing can prepare you for seeing your wife on an OR table. He held it together though and told me as soon as he laid eyes on our son. He told me he was perfect and the look on his face was indescribable. I guess I should clarify my above statement that the entire experience was horrible...there was one shining moment. When I heard Mark cry and they brought him over to me so I could kiss him. If I close my eyes, I can go back to that moment. However, I could not hold my son for over an hour after his birth. I could not do skin-to-skin for over an hour either. Although I got to kiss him shortly after he was pulled from my abdomen,  he was whisked away to the nursery and George followed him. So there I was, alone in an OR, behind a curtain, shivering and feeling nauseous. The tears came and they didn't stop. I wanted to hold my baby. I had waited my whole life to meet him, and after a brief moment together, he was gone and I was alone. With every tug of the sutures, I felt sick. Thank God for anti-nausea meds. They wheeled me into recovery and I had to wait some more. I mentioned before that I have a wonderful OBGYN... case in point- she saw Mark in the nursery sucking on anything and everything he could get near his mouth and when she came to the recovery area to check on me and saw he wasn't there yet, she called down and instructed they bring him to me asap. I am forever grateful for that phone call. I also am so grateful for the amazing lactation consultants and for my son for being such a hearty nurser because without those two, I don't know how our breastfeeding journey would have looked. Over the next 24-hours I had a PCP of dilaudid. I had a fear of what the pain would feel like (I had watched a c-section video on You-tube) so I kept pushing that button every time I could, fearful of any pain. I wouldn't do that again. I don't handle pain meds well and all they made me want to do is sleep. I continued to take pain meds when I went home which left me exhausted (more so than normal), and nauseous. It was a rough adjustment. The recovery from a c-section is not something I would like to repeat. I hated the before, during and after. No part of it was tolerable in my opinion. Thank God for George, my mom, and mother in law who allowed me to do what I needed to let my incision heal properly- physically rest.

In the months following my c-section I intensely mourned for the birth experience I wanted. When others told of their labors and natural birth stories, I was, although happy for them, heartbroken. I had to put away my lamaze bag full of tennis balls, a birthing ball, gatorade, energy snacks, and relaxing music etc. I felt so cheated. Gradually, as time went on, the wound healed. Having a perfect baby boy certainly helped! It also helped that during my c-section, my OBGYN told me that she saw nothing abnormal about my uterus that suggested I would have a problem with a natural delivery the next time. She  assured me that she had been doing VBACs (vaginal birth after cesarean) for her entire career and my incision/closure was such that I could attempt a VBAC if I so wished. The knowledge that I was not doomed for repeat c-section just because I had had one prior helped get me through that depression.

On June 13, 2012 I found out that we were expecting #2, a complete and total surprise! One of my first thoughts was the hope that I would be able to have a natural birth. After I felt baby move, I was convinced he was breech like his brother...convinced that I would have to have another c-section. Boy was I wrong. Baby is head down and has been for months! My pregnancy has proceeded healthily and normally and my doctor gave me the go-ahead at week 36 that I am a good candidate for a VBAC. Words cannot express my excitement! I have been researching the risks associated with a VBAC vs. Repeat C-Section and for me,  the risks of the c-section are greater than those for a VBAC. George has also done the research as he has access to more credible resources and he is supportive of my decision to attempt a VBAC. I have been reading anything and everything I can get my hands on, educating myself completely. I am confident that my body can attempt this. A lot of doctors will tell you that they are VBAC friendly but in reality, they do not practice accordingly. According to the literature my doctor is supportive for the following reasons: She has not scheduled a c-section "just in case"; she told me to labor at home for as long as possible and denied that fetal monitoring needs to begin as soon as I go into labor; and she has not scheduled an induction and says that induction agents administered when the cervix is not ripe nor has labor begun are contraindicated for VBACs. In order to have a successful VBAC, labor support is critical. Epidurals routinely slow-down labor and a drawn-out labor could increase the chances for uterine rupture. Therefore, I want a fast labor, or as fast as possible. Thus, in order to hold off on pain management drugs, labor support is crucial. I have a wonderfully supportive husband who believes my body is capable of giving birth, as millions of women have before me. As a physician, he has invaluable knowledge that will help while I labor at home. I also have my mother on my support team, a labor and delivery nurse who brings priceless knowledge and experience. Finally, I am working with a doula who can add additional support to my team as we need it.

So here I am, 36w6d and my baby boy will be here before I know it. I am confident in the birth plan  I have chosen. I firmly believe that my body was designed for the purpose of giving birth. I also believe, and the research supports, that your body RARELY will allow a baby to grow larger than what you can deliver naturally. I hope to be back in a couple of months with a birth story that is what I wanted it to be.

Wednesday, February 6, 2013

BIG changes.

I am currently 34 weeks pregnant, mommy to a beautiful 18 month old, and wife to my amazing hubby. We have finally settled into quite a routine (and have for quite some time) since welcoming our sweet Mark Perry  18 months ago. The beginning was rocky, but eventually became smooth sailing. Fast forward to present day and we are looking at some HUGE life events from now through August. In that short 6 month period our lives will change as follows: we will purchase our first house, we will move to a city where neither of us have ever lived, I will give birth to our second baby boy, George will graduate residency, George will start a new job, and George will take his Board exams. Phew, it is exhausting to see it written.

It is hard to rank what will rock our world the most. I think the birth of Jack ranks pretty high for life-changing. I have been forewarned that it will certainly speed up the clock and make life seem as if it is going by even faster. Hard to believe that could be possible yet I know it must be true. I find myself, on many occasions, staring at Mark while he is doing what to most would be considered ordinary (yet to me, as mommy, is surely evidence of his genius ;) ) and I whisper to myself "commit this moment to memory.... take a picture with your mind... you're going to want to remember this." I close my eyes and try to hold on to the memory of how his little chubby fingers look like they could pop if they got any chubbier....the way he moves his baby chair outside just so for the perfect climbing device....the way he climbs up the stairs and hysterically laughs when he reaches the top, knowing he just accomplished something....the way he is so determined to climb up to the slide at the playground and on his way down he has a smile that is so big it makes my heart swell. I could go on and on about these experiences that I want to remember forever...the days are filled with these memories I don't ever want to forget. I never really understood what people meant about time flying until I had Mark. Every. single. day. he grows up just a little more than the day before. If I blink, I fear I will miss it. As I stand on the "edge" of being a mommy of one and becoming a mommy of two, this desire to remember it all is stronger than ever. I know our family will constantly create new memories and I am so excited for that, I just wish it could slow down a bit and allow me to savor these moments just a little more. Wishful thinking I guess.

As much as I am slightly wary of all these changes at once, I am more so thrilled about them! I am so ready for George to finish with residency. It has been fun and we have certainly met some amazing people, but I'm ready for him to be compensated for all of his hard work and devotion. :) I am likewise excited about purchasing our first home (although I'm sure it will be stressful at times) and moving to Mandeville. We aren't from there but it seems beautiful and a great place to raise our family the way we want to. Bonus, it's just a hop,skip and jump from the greatest city ever, NOLA. Another change I forgot to mention, that is incredibly dear to me, is my switch from full-time employment to part-time. I will get more time with my family which is more rewarding than any career could ever be. I will still keep my toes in the water, because I feel that I need something that is mine to keep my sanity. But I'd be lying if I didn't admit that I am over-the-moon excited that I will get to spend more time with my babies and husband. I am very much looking forward to this next chapter in our lives!