Monday, March 30, 2009

The Right Words at the Right Time

My grandfather doesn't talk very much, but when he does, he always has something interesting to say. We (me, mom and grandma) were talking about a friend of my grandmother's whose grandchild was having discipline problems. My grandfather chimes in (unusual) and said,"You never know about kids. Why, about 25 years ago, I was working in the shop with this gal and her husband was a welder. Every time we had a welding problem, we'd call Ronnie and he'd come over and fix it. He got sick and was gone about 6 weeks later, leaving Donna with three boys that were 12, 14 and 16. Well, the boys started staying out all night getting into trouble and Donna didn't know what to do. She said to me,'Will you go have a talk with the boys?' I didn't know what I was going to say, but I went. I sat them down and said,' Now there's things that need to be done in the house and you boys need to divide up the tasks and rotate them to keep the house running."

He gave them some lists and then went on his way.

As he 's telling the story, he starts to tear up and says,"The other day, I was in Value Home Center (one of his favorite hang outs) and this man comes up to me and says,'Mr. S., you are the one who talked to my brothers and I and I just wanted to thank you and let you know it all worked out!"

Very cool. A man of few words, said the right thing at the right time and three boys got through the death of their father and adolescence a lot easier.

Friday, March 27, 2009

How to Plan Your VBAC (Vaginal Birth After Cesarean)

I just had a great VBAC a few weeks ago and learned a lot in the process. The climate for VBAC in the US is pretty hostile most places, even if your doctor seems positive in the beginning, by the end, many change their tune. There are some things you can do to give yourself an edge for success.

First of all, if you know you are going to have to have a cesarean due to baby position (try an External Version first if all natural methods fail), placental condition or other health issue, make sure you ask for a low, transverse incision with double stitching. Some doctors will say that double stitching makes no difference, but it is a criteria for VBAC consideration for many practitioners, so insist on it.

That, said, if you had another type of incision or only single stitching, you can still have a VBAC, but will have to work harder to find a practitioner.

The other thing you can do if you know you are going to have to have a c-section, is wait to go into labor before you have the c-section. That way, the baby gets the dose of hormones from labor that stimulate lungs and you know the baby is ready to come. You will have an urgent c-section, but not critical emergency.

Whether you had a scheduled, planned or unexpected c-section, you should do your research on VBAC. Find an ICAN chapter, read books like Henci Goer's The Thinking Woman's Guide to a Better Birth, and find support from like-minded people, either in real life or online in places like the Mothering discussion boards.

Before you get pregnant again, you need to research the VBAC policies of the providers in your area. Many providers like to see 18-24 months between births. That is very common. Don't try to get pregnant before that. The uterus needs to be well-healed from your c-section before it starts to stretch again. This is something that you can control so why not meet this criteria?

Get your medical records from your first c-section to find out the type of incision and suturing you had. Your new provider will want to see your records and sometimes there is information in your records that can help you figure out contributing factors to your c-section or other issues about the pregnancy.

Then, research natural childbirth. The fewer interventions you have (like epidural) the better your chances of VBAC because one intervention often leads to another. Also, pitocin and cervical ripeners cause more stress on the uterus than natural contractions and are linked to higher instances of uterine rupture. Pitocin can be used on a VBAC, but I think it should be avoided for your best chances. Both pitocin and epidural can cause fetal distress which would lead doctors to call for a c-section.

Reduce your health risks before you get pregnant. If you are overweight, before you get pregnant again, exercise and improve your eating. It is better for you, better for the baby and will reduce your risk of gestational diabetes, high blood pressure, etc. which can lead to providers pushing a repeat c-section. That doesn't mean you need to get down to a size 0, but if you incorporate some regular exercise, cut out junk food and add in healthy foods, you will be in better shape and reduce your risks.

Find a truly supportive provider. This is key. If you don't have a supportive provider, your chances of VBAC are very low. How do you know if a provider is truly supportive? Ask for their VBAC policies:

*How far past your due date can you go?

*Will they induce if you go past your due date or schedule a repeat c-section?

*If they induce, what type? Will they do balloon cathetar inductions?

*What are the reasons for suggestion induction/repeat c-section? (If you hear "big baby" that is not a good sign.

*What kind of monitoring? If continuous, external fetal monitoring, does that mean you'll be confined to the bed? Do they have telemetry units?

*Can you labor and push in any position that you choose or do they require you to be on your back?

*What is the c-section rate? VBAC rate?

Ask for provider recommendation from the local ICAN chapter, from people who have had VBACs, from natural childbirth advocates in the community. They usually know who is supportive of VBAC.

Don't be afraid to keep changing providers until you find the right one. I went through 4 providers, 4th times the charm!

I started out at a Korean doctor in Seoul, but the c-section rate is higher than the US (who would have thought?) and they don't allow VBACs in most hospitals. There was one provider in one hospital who would let foreigners try, but I decided to go back to the US instead (I have since learned of other options in Korea for VBAC such as midwives and OBs in Women & Children's hospitals, but I was originally told my choices by a Korean OB).

I did the rest of my prenatal care in Korea at the US military hospital because they would bill insurance and then headed back to the US. I planned a homebirth, but my baby was breech and so I needed to find another plan. I had to look outside of Erie, to Pittsburgh. I had already traveled half way around the world, what's another 2 hour drive? I got the baby turned and had a great birth with the right birth team.

Next, prepare your mind. I highly recommend Hypnobabies for labor management. It also programs you with positive messages about pregnancy and teaches you to resist all the negative messages which will be coming at you. Watch VBAC and natural childbirth You Tube videos. Talk to people who have had successful VBACs. Read positive VBAC birth stories and positive natural childbirth stories.

Also, start chiropractic work before, or soon after you become pregnant. Chiropractic work can help prevent or correct poor fetal positioning. Many scheduled c-sections are for poor positioning: breech or transverse. Many c-sections after "failed labor" are because of posterior position. Chiropractic can help prevent or correct these positions. Find someone trained to work with pregnant women, certified in Webster technique.

Spinning Babies is a great site for exercises to prevent or correct poor positioning. You can also find out things to do in labor if you have back labor due to posterior baby. Interestingly, the worst thing you can do is lay on your back--exactly what most doctors want you to do.

Now even if you do Spinning Babies and chiropractic, you may have a fetal positioning problem like I did. In that case, try External Cephalic Version. Many doctors do not like to do this, but you just need to find another doctor. You may need to go to a bigger city to a teaching hospital to have it done, like I did, but it is totally worth it. A confident provider is more likely to be successful and less likely to have a problem like placental abruption during it. They use ultrasound so they can see where everything is and see if there are any obvious reasons for the breech/transverse position. If your baby is meant to be breech, the baby will turn back. The procedure was not painful at all (unlike stories I had heard), just a little discomfort, mostly feeling faint from lying on my back. I think the Hypnobabies really helped with it, but the other thing is that the procedure takes only a minute. You'll be in the hospital for a few hours for monitoring before and after, but most of the time, they are only pushing on your belly for a minute or two. It can take longer, but if the practitioner knows what they are doing and you relax, it is usually very quick. Even if it is takes longer, it is much shorter than a c-section recovery.

Finally, hire a doula. It is worth every penny to have an objective person who is experienced in natural childbirth. She can help your partner help you, She can help you stay focused and relaxed and remember your wishes and remind you of them when you do not. Even if you have a midwife, a doula is necessary. Midwives are not always with you the whole time. Even if they are with you the whole time, like mine was, the presence of a doula allows the midwife to take care of medical things so there is no break in the emotional physical support of you. I really needed a doula because there was a chance my husband wouldn't make it ( turns out he didn't make it) so she supported me through my labor. My mom was with me, but she had never had a vaginal birth and though she was willing to do whatever needed to be done, she was grateful for the doula's presence. She was able to see her grandchild being born which was very special for her, but it was all she could do to keep herself calm. My mom is very good and pretending to be calm and pushing through to get something done--like making the 2 hour drive to Pittsburgh when I was in active labor--but the doula really helped.

In summary, you can do it and it is worth it! In fact, it was so much work to get to the point of being allowed to labor and deliver, that the actual labor and delivery was very easy in comparison. I credit the chiropractor, Spinning Babies, staying healthy, being confident in my birth team and Hypnobabies for a short and easy labor and delivery.

Reasons for repeat c-section: your age, your weight, big baby, gestational diabetes, high blood pressure, pre-eclampsia, placenta previa, danger of uterine rupture, not enough time between pregnancies.

Some of these, like placenta previa, you have absolutely no control over. The placenta implants where it implants and it usually moves up in relation to the cervix, but not always. If they tell you that you have placenta previa or marginal previa (like they told me), just put it aside and stay positive because the odds are in your favor. If you get to the end and you still have previa and have to have ac-section, just make sure you get the right type: low, transverse incision with double stitching.

Other things are bogus like:

* big baby: (often wrong because ultrasound can be off by 1-2 lbs either way and even if it is not wrong, many women have VBAC babies bigger than their c-section babies for CPD)

*your age: risks go up with age for many things during pregnancy, but not necessarily, many OBs treat women who will be 35 or over when they deliver like geriatric patients.

*danger of uterine rupture: it is less than 1%, especially if you avoid cervical ripeners or pitocin.

Some, like I wrote before, you have control over like you weight, time between pregnancies and your health. There are some people who have gestational diabetes or high blood pressure despite a good diet and exercise, but you can reduce your chances so it is worth doing. Again, the better your health before pregnancy, the better your health during pregnancy, but it is never too late for changes to have a positive effect.

Saturday, March 21, 2009

Two Weeks with Two Kids

It has been a great two weeks. Eva sleeps and eats and poops a lot. Like Ian, she will stay asleep or at least in bed with me as long as I nurse her. I can't advocate breastfeeding and co-sleeping enough for sanity preservation. I know it doesn't work for everyone, but give it a try!

Eva is a lot more patient than Ia. If I get her in the nursing position, she calms down and waits for me. She smiles in her sleep and actually laughed in her sleep today. Ian didn't smile or laugh for a long time. She sleeps a lot more than Ian. Ian liked to look around. If she is awake, she wants to eat. Ian insisted on being upright. She prefers to be held lying down, which is great because my husband's friend, Ruth, just sent me a Mamma's Milk Pouch. The pattern om mine is light blue dragon. It is very pretty. It is also adjustable. I love the Beco and Ergo baby carriers, but I you need an insert to use them with an infant. (The new Beco Butterfly has a built-in insert, but I have the 4th Generaton). I bought the carriers when Ian was 4 months old so I didn't need the insert because he had great head control. I do not like the carriers with the insert as well as I like them without. Since she will tolerate being carried on lying down, I tried the pouch that I made, but it just doesn't work. I think it is too small. I tried my ringslng and I just don't like ring slings. I think they are a pain to adjust. I am really looking forward to the Mamma's Milk Pouch. I think it will work really well for Eva's first few months.

As for Ian, he loves to hold Eva. He has had more meltdowns than usual, but they aren't directly about her.

We packed a lot into the first two weeks: doctor visit, zoo trip, dining out, roadtrip to Ohio, first photoshoot and baptism.

Friday, March 20, 2009

Buying Underwear

Today, I took another small step towards potty training Ian: I bought underwear. Just a 3-pack of dinosaur briefs to check the size, but they are purchased. I am not going to push until we get back to Korea, but I was inspired by Tuesday's playdate. Only one of the (4) kids is actively potty training and doing well. She decided she had to go and after she did, all the moms clapped for her. The other three kids stormed the bathroom and two of the three (including Ian) peed on the potty, Well, Ian peed on the floor because he was on a little girls potty seat without a splash guard, but let's not quibble: pee was released on the potty and not in the diaper!

I think what we will do is put underwear on and stay home for a week to work on it. At Montessori, that is how they suggest potty training. if the child wets or dirties, the child has to help clean themselves up. We are going to wait to try it until we get back to Korea because it will be hard to keep it up with international travel.

Recycllng Baby Clothes

I have been the lucky recipient of two boxes of baby clothes from friends. They are finished having children and ready to start clearing out and I am happy to take the stuff off their hands. One if the boxes was mostly newborn clothing. I will be able to dress her in lots of variety without spending a lot of money for the short time that she'll be in newborn size. It is definitely more fun to invest in bigger clothes (at least 12 months) because they last a lot longer than these early sizes, but you still want them to look cute!

Saturday, March 14, 2009

Big Brother

Ian, though he has had increased meltdowns, is doing a great job with Eva. He loves to hold her and helps me by telling me when she is hungry. I make sure to point out to him that Eva can't have chocolate or meat or cheddar bunnies or even cow's milk, only mama's milk. He has been very sympathetic as a result (chocolate deprivation is a terrible thing in his mind) and tries to make sure she gets enough milk.

Today we went to my mother-in-law's house to introduce Eva to my husband's relatives. Ian did not like the relatives (except my mother-in-law) holding Eva. He got very upset and said, "Give her to mama!"

As we were getting ready to go, my mother-in-law was holding her and Ian went to take her and said,"We're gonna take her now."

Nice to know he likes her and feels she belongs to us!

Back on the Sauce!

Ian stopped drinking while nursing back in mid-August, but continued to "nurse" a bit through January. He asked to nurse a few times since Eva has been home, but didn't really drink or stay on very long. I thought he had totally weaned. Well, he has started drinking again. Eva is a great nurser and I am not having any problems, so I am fine with Ian picking it back up. I will limit him to mostly bed time and nap time, though.

Sunday, March 8, 2009

Review: Hypnobabies for Childbirth

I decided to use Hypnobabies for labor preparation. It is supposed to keep you relaxed and focused and some people even have pain-free births. The Hypnobabies Home Study course has 12 scripts. The program requires you to listen to two (approx. 30 minute) scripts per day: Joyful Pregnancy Affirmations which can be listened to in the car and another self-hypnosis script which must be listened to at home by yourself. At 38 weeks or so you can switch to from Joyful Pregnancy to Birthing Day Affirmations. I left my cd in Korea so I never made the switch. I did contact Hypnobabies customer service and after contacting the moderator on the Hypnobabies yahoo Group, I got them to send me the mp3 of Birthing Day Affirmations, but I never got to use it because I had my baby. You also practice your "finger drop technique" 5 times a day.

I bought several supplemental scripts as well: Birth Partner Be Calm and Confident (for Curt), VBAC Success and Turn Your Breech Baby.

From the reviews I read, the closer people followed the program, the better it worked for them. I did really well in my second trimester. The holidays, my persistent breech baby and trying to find a new provider at the last minute, definitely hurt my Hypnobabies practice. I did not practice the finger drop technique much and didn't always listen to both scripts a day because I was listening to the Turn Your Breech Baby script a lot. After the version worked, I was much better about listening to both scripts.

I used the "Peace" and "Relax" cues during the version. I also listened to some scripts on my ipod before the procedure. I definitely think it helped during the version. I did not find it painful like many other people have.

For labor, by the time I realized I was actually in labor, my contractions were 3 minutes apart. I had to lay on the floor of the van for 2 hours to get to the hospital. I listened to the Easy First Stage of Labor Hypnobabies script on my ipod. It made the ride seem a lot shorter than I thought it was going to be. I had my ipod in a sports armband which really helped. I kept it going almost the whole time. There was a point where things got very intense and the script had ended and I did not restart it and I definitely felt a difference. When it came to pushing, I put the Push Your Baby Out script on. I remembered the "Choose to Use Your Hypnosis" principle that they talk about in the program and turned the Push Your Baby Out script on. I did not feel a ring of fire, though I did have a tear. The pushing phase was fairly short and manageable. I was not pain-free for the whole labor, but it was manageable. I just felt discomfort for most of my labor because I didn't even realize I was in labor.

I would totally recommend Hypnobabies. I will definitely use it again if I have another baby. Here are the things that you will get out of the program, guaranteed:

1. The Affirmations script (you listen to in the car) program you with positive messages about birthing which help combat other people's negativity and build your confidence in your ability to give birth.

2. The daily practice requirement, if you follow it, gives you at least a 30 minute relaxation each day which has positive/restorative effects.

3. The program covers everything you need to know about nutrition, interventions and options with further recommended reading if you want to explore a topic further.

4. If you listen to the Birthing Day Scripts: Birthing Day Affirmations, Easy First Stage and Pushing Baby Out, during your birthing time, they will help keep you focused and relaxed. Even if you don't have a pain-free birth, the focus will help keep it very manageable.

The only negative comment I have is about the supplemental scripts. I was rarely able to listen to the 2 required daily scripts plus the supplemental in the same day. I have a 2 year old son and so we listened to the Affirmations in car on the way to wherever we were going for the day and I listened to one script during his nap, but I didn't often find time to listen to another one. I had to make a choice to replace the daily script with the supplemental script. I think the Birth Partner script that I got for my husband was good, though he didn't get a chance to test whether the techniques worked for him since he missed the birth. I did not need the VBAC script. I didn't listen to it very much and I didn't have a traumatic first labor before my c-section so I don't think I needed it. If you did have a traumatic labor that ended in a c-section and are attempting VBAC, then it might be worth it to get the script to try to work some of that out. However, even then, if you follow the regular program, I don't think you need it.

As for the Turn Your Breech Baby script, since this was my second breech baby, I think I would have been better off sticking to the program and not listening to the Breech script. I think it might have stressed me out more than it helped because as the time went on, it felt like history was repeating itself and I lost focus on the regular program. If it is your first breech baby, then I think it might be helpful. If I have a third breech baby, I will probably listen to it since I bought it, but not as much as I did in this pregnancy, only if I have done the daily requirement for the regular program and have time for the supplemental script.

I really liked the Birthing from Within book, which I read during my first pregnancy, but I do not like the pain coping strategies of holding ice to desensitize yourself, etc. Swapping one pain for another is not my thing. I like the Hypnosis method of not talking about or focusing on pain and focusing on relaxation instead.

Anyway, if you are pregnant and looking for a childbirth class, check out Hypnobabies!

Friday, March 6, 2009

Eva Mahassen

My baby girl was born last night (March 5) in Pittsburgh, Pennsylvania at 11:26pm in a natural, drug-free VBAC!

After dropping Ian off at Montessori on Wednesday, I went walking at the mall with another Montessori mom. Just as we were finishing, I got a got that Ian was sick so I went to pick him up early. He had a gastrointestinal thing happening and slept most of the afternoon. I went to the chiropractor for my final planned adjustment at 3:00pm and then I started feeling badly, like I was getting what Ian had. All through the night, I had a kind of crampy feeling and had to go to the bathroom a lot,--every hour. The next day, Ian was better, but I just wanted to lay around. I still had some crampy gastrointestinal feelings and they got worse over the day. My husband decided to come to Erie, PA from DC that night instead of Friday night as planned since I wasn't feeling well and thought something might be happening. He left DC at 4pm for the 7 hour drive to Erie. But, by about 5:45pm, I told my mom that I thought something was happening. She told me to time the "happenings" and they were three minutes apart. We decided to jump in the car and head to Pittsburgh (2 hours away). Unfortunately, my husband did not have a cell phone with him so we couldn't contact him.

I laid in the back of the van on the floor and listened to my Hypnobabies. I called my doula and midwife, but my midwife didn't call back. I called again and the nurses answered because he had left his phone at the hospital, but they said he was on his way to the hospital to pick up his phone. I told them to tell him I was coming.

We arrived at the hospital at 8:45pm or so. I was put in a triage room and checked a little after 9pm and was 8cm dilated! We moved to a Labor and Delivery Room and I labored mostly on my hands and knees. I can't imagine laboring or pushing on my back. My doula applied counterpressure and massage to my back and both she and my midwife offered encouragement through the intense pressure waves. (It is important to note that my back did not hurt, but I needed her touch it was incredibly supportive to be touched). I went to the bathroom and wanted to get in the shower, but my midwife wanted to check me first and then get the baby back on the monitor before I got in the shower. My water broke as he checked me. it was clear and warm and all over the bathroom floor. I was complete.

No time for the shower, we went back to the bed and waited for the pushing urge. I started pushing and don't know how long I pushed for but it wasn't too long and she was born. I did not feel a ring of fire. I did have a second degree tear, but I didn't feel it happen. I did mother-directed pushing and I pushed my placenta out by myself as well, without traction. I cut the baby's cord and then they extracted the cord blood for donation. We do not have anything in our family that would make it likely that we would need it and it is so expensive to store it. Also, it is more likely to get used by being donated. They got a lot so I was happy about that.

Everyone was impressed with how well I handled the pressure waves and that I went drug-free. The Hypnobabies did not make things pain-free, but did help keep me focused, to get through one pressure wave at a time. Everything went perfectly, except that my husband missed the birth, but even that was not necessarily a bad thing because it was so fast. (Maybe next time we'll have a normal birth and he will be there!)

Immediately afterwards I said,"That was it? I could have 10 more babies!"

My mom had three c-sections so this was her first time to see a vaginal birth. I am really glad she was with me and got to see.

Curt got to Erie at 11:00pm and was sent to Pittsburgh by my dad and brother. He arrived at the hospital at 12:50pm, at which point, my mom headed back to Erie to rescue my dad from Ian who bestowed 3 dirty diapers on him in the short time we were gone (finishing up his gastroinestinal issues).

Eva latched well shortly after birth, but slept most of the night. Curt and I just dozed. We ordered breakfast and after I eat, I will wake her and start our breastfeeding journey. She pooped twice over the night and Curt changed both diapers. The hospital is so full that we are still in the labor room and haven't been moved to the recovery floor. It is just as well. Our stuff (almost none of it used) is all over the room. It will be a pain to move!

This was my first labor so I really didn't know what to expect. I thought pressure waves would be a lot more dramatic and a full-belly experience. Everyone says,"you'll know" when you are in labor, but I didn't. It is funny, but Patrick, my midwife, told me on Monday that he always envisioned my labor being quick. I was just hoping to go into labor before March 24 (after the 42 week mark), the day they would induce me if I didn't go in. The other thing that was weird was pushing. I though I'd feel the urge to push in my vagina, but I felt it in my butt. It wasn't even that strong, I've had stronger pushing urges when I am actually pooping.

Anyway, if any of you mamas are far from the hospital and start feeling crampy, gastrointestinal or just weird, might be a good idea to head in and get checked. On the other hand, laboring in a car ensured my drug-free status because I had no other choice.

Eva is pronounced with a long E. This sort of violates my easily pronounceable rule, but most Americans will say it that way and since we are primarily around Americans (except for this wonderful group) it works. Europeans will pronounce it Ava, but that is o.k. Her middle name, Mahassen, is an Arabic name and she is named after a women we met while living in Egypt. She was like a mother to us and was never able to have children of her own. We wanted to give Eva a meaningful middle name and honor our good friend.

Sunday, March 1, 2009

Baby Knitting Projects

I finished two baby dresses. I had to use circular needles for the first time on one of them and a bit of crochet. I still need to block the multi-colored one, but they are done.
Dress #1 was made from this pattern:

I made it with Debbie Bliss Baby Cashmerino Yarn on US Size 3 needles. I didn't crochet around the neckline and the crochet for the button loops is a bit sloppy, but it is still cute. I think I am going to try to make a bigger version in the same yarn (different color), using the bigger size measurements.

This dress was easier. I can't remember where I found the pattern. I'll add it in the post when I find it. I bought the yarn with Sarah at Dongdaemun.