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Week 14
~ A Great Midwife Appointment
It's been a long hard week. I've been in a bit of a funk and I'm not sure why. Lack of sleep is probably some of the cause and I've also been a hermit since I found out I was pregnant which I sure is part of it too! I have seasonal affective disorder (SAD) and a history of depression so I know better than to be a recluse like I've been, but I can't always recognize what I'm doing when I'm doing it. Hmm, did that make sense! With no true commitments I have reverted back to my night owl habits and we've been going to sleep later and later every night and waking up later and later every afternoon (yes, some days it is afternoon when we wake)! By we I mean Tommy and I. Tom goes to bed at the same time as us, but he gets up for work and leaves us sleeping most days.
This past week I've been tired and have wanted to go to sleep earlier and Tommy just isn't cooperating because we've let his clock get messed up too! He sleeps cuddled up with us, well me usually, and since he only sleeps 9 hours a night I would rather have that 9 hours be 11pm or midnight to 8 or 9am than have it be 8pm to 5am! But recently he hasn't been going to sleep until around 2 or even 3 am or later! He also no longer nurses to sleep and that has been tough. It used to be so easy. We'd decide to go to bed, do the diapering and pj routine, I'd brush my teeth and he'd brush his along side me then I would take out my contacts as he climbed into bed next to daddy for a cuddle, finally I hopped in bed too and he nursed off to dreamland. Now he will nurse . . . and nurse . . . and . . . nurse. He just won't go to sleep!
Last night for instance he nursed for an hour and a half! By that time I was really stiff and needed to move so I unlatched him and told him that the "milkies" went to sleep. He did not like that! He started to cry and fight me and tear at my clothes to get back to his milkies! I would normally keep nursing him, but it is also very painful still and it becomes more painful as my breasts empty. Now a nursing mother's breast never truly empties, but after the stored milk is gone and my body starts to make more on the spot the sensation changes. It didn't used to bother me, but now that I'm pregnant it isn't comfortable and after an hour or so I've just have enough. Tom steps in at this point - not voluntarily! It takes some poking and pleading on my part to get him to wake up and then he will walk Tommy and attempt to get him to sleep that way. Some nights it works, but lately it hasn't been working. Last night he went into a deeper cry and started fighting Tom. At that point Tom will put him back in bed and Tommy resumes the clothes pulling and kicking and punching. He isn't trying to hurt me, but he's tired and cranky and he just really wants his milkies! Finally he will settle down and wrap both arms around my neck and lie his head down next to mine on the pillow or on top of mine. He tends to suffocate me in his little chest or tickle my face with his soft curly hair, but that wouldn't be a problem if he would just stay in one place. But no, my little energizer bunny can't sit in one place - it's unnatural! He changes positions every 10 seconds until he finally goes to sleep and I'm completely spent! Last night he was very sweet though. After wrapping his arms around me and winding the hair at the back of my neck into a huge knot (he's a big hair twirler like his daddy used to be, usually his own, but lately he's gone after mine too), he then took over my entire pillow and pulled my head onto his chest so that I was resting in his arm the way I typically cuddle him. Then he stroked my hair and sang a song to me about daddy. It went "Da da da! Dee! Da de de da" and so on. I actually fell asleep before him and eventually rolled off his chest. I never did get my pillow back though, and the little guy took over my entire side of the bed! I ended up scrunched up against Tom, but I can say that I haven't slept that well in weeks! And Tommy slept a full NINE hours in a row! He never does that. Recently he's been sleeping about five to six hours, and then nursing and going back down and just a few months ago he was still regularly waking every two to three. It's never been an issue because with him in our bed I can nurse him half asleep, or sometimes I'll be fully asleep, and he always goes right back down to sleep so I wake fully rested in the morning. Of course last night I needed to get up to pee about three times so his sleeping through really doesn't matter anymore!
This bedtime difficulty is something new and it is directly related to the pregnancy. My milk supply has always been lowest at night and I do believe it is getting even lower now. Unlike many pregnant moms who are nursing I haven't lost my milk yet, but the supply is decreasing. Occasionally Tommy will unlatch and dribble a little milk out of the corner of his mouth, but he is doing it less often now. He used to have that milky grin just about every time he nursed, but now it's every few days. He's definitely working harder to get milk, but he doesn't really seem to care. I suspect that I am no longer letting down well if at all. Breast milk has an almost narcotic effect on babies, and mommies too! The natural relaxing hormones in mother's milk are often referred to as a mothering hormone, and the high you get is often called a "nursing high". It relaxes moms and gives them nurturing feelings and also relaxes babies. When Tommy was younger, it was better than any of the post-surgery pain meds I was given (I had gall bladder surgery when he was six and a half weeks old)! It has also helped me tremendously with my post-partum depression (PPD). If you can't tell I'm a huge nursing advocate! Tommy still nurses to sleep for his naps, and in the early AM when he wakes he will nurse right back down, but at bedtime my breasts no longer seem to have the power to knock him out and I believe that is directly related to my decreasing supply which is even slimmer in the evenings. He just isn't getting the volume and fast flow of milk that he is accustomed to and he isn't lulled off into dreamland.
I was talking with some other mothers in my La Leche League group yesterday. One is pregnant and has no milk left. Her milk disappeared at the start of her fifth month. Her daughter is very verbal and she asked her if there was any milk in the ne-ne's (or whatever her word for nursing is) and her little girl answered a definitive "NO!" She still wants to nurse though. Another mother who now tandem nurses said her milk also went away about midway and her son slowly went from nursing frequently to just occasionally nursing. After the baby was born he nursed steadily again for a month or two then gradually went back to once every other day or so. He also had never slept through the night until her milk dried up. Then he just decided it wasn't worth it to wake up if there was no milk there so he just slept. After the milk came back he continued to not wake since he was now used to sleeping through. I am thinking perhaps that is what is happening with Tommy. I don't really want my milk to go because he very obviously still needs to nurse, and I see him still nursing even if the tank is dry, but I really won't mind him sleeping through the night! It will give us more room in bed for the new baby too! As soon as he stops night nursing consistently I plan on moving him out of our bed into a toddler bed next to us, and if he does well with that we might try him in his own room. If he doesn't do well we're ok with him staying with us as well. I'm sure that something will work out by the time the new baby arrives! And we have a king size bed so there is room!
I'm not really sure how I feel about the possibility of our nursing relationship ending. It is difficult in some ways because it has been hard enough seeing Tommy growing up. I look at him and realize he really is a toddler now, and no longer my little baby! Now I will have a new baby, but she or he will not be Tommy. The days of little baby Tommy are gone and they aren't coming back. With all these pregnancy hormones surging through me I'm probably being more emotional about this than I would be if I weren't pregnant, but then my supply wouldn't be lessening if I weren't pregnant either and his possible weaning would probably be a ways off. I have always wanted him to be the one to decide when to wean, and I know you can't force a child to nurse if he doesn't want to. I'm letting him take the lead on this. If he wants to keep nursing, great; if he wants to stop he will, and if he wants to tandem nurse I'm sure it will be a different challenge, but we'll do that too! I will just look at it as an opportunity to lose even more weight post-partum! Or as more free calories for me as I will burn even more making milk for two!
After all this talk about how he doesn't nurse to sleep at night anymore guess what he did tonight! He has been nursing as I was typing at the computer this evening and dozed off at 11pm. Now it is almost 1am and he is snuggled up close to daddy fast asleep. Their snores are harmonizing as well. Daddy's loud snore (which is worse now because he is congested) and Tommy's sweet little snore! And I'm now kicking myself for not joining them earlier myself!
I promised to write all about my midwife appointment. It went great! It was our first official appointment and second time meeting. The first time was an interview, but I really wasn't up to asking a lot of questions about the delivery because I couldn't think past all the bleeding I was having! We have talked over the phone now and then about how things were going and I gave her updates on the tests the OB ran, but this was my first chance to ask the nitty gritty about the big labor and delivery time! First she went over all my family history, my personal history and discussion of my last pregnancy and birth and of course the labor and delivery. She wanted to not only know the facts, but also my feelings about everything. Tommy sat like an angel in my lap through this part playing with his Little Tykes power drill. He was also giving the midwife a good looking over to see if he approved of this person or not! She kept telling me how beautiful he was so of course that made me like her more!
Then she looked for a heartbeat and had a hard time finding it. Eventually she did and just in time because Tommy was starting to get upset. He did not like this stranger running this thing over mommy's tummy! He was doing very well and was calmly sitting in the chair. Normally he fidgets and explores the room (especially outlets), but he was sitting nicely so I didn't have to strap him in to the stroller that I had brought just in case. He really hates that! When she finally found the heartbeat she immediately addressed Tommy to include him. I thought that was great! I was doing the same thing. He seemed confused, and while at 19 months of age he is old enough to understand the concept of a baby brother or sister in mommy's belly I don't think that he quite gets it yet. He hasn't seen too many little babies! When Tom or I tell him to give the baby a kiss he does kiss my belly, but I think it's more because Tom taught him to do that. He will also bless my belly with a St. John Neumann relic we have. That is just the sweetest! He also blesses mommy and daddy and then kisses the relic and holds it up for each of use to kiss and then he puts it back where it belongs! This was a nightly ritual while I was considered a threatened miscarriage, and we still do it quite often.
Getting back to the appointment, we heard and I felt a few kicks on the doppler. That confirmed what I suspected, that I had been feeling movement for a while and it wasn't just intestinal rumblings! At the beginning it is really hard to tell. To add to the difficulty I have IBS (irritable bowel syndrome) so I get a lot more pains and rumblings in my gut than the average person. The movement this time around is more bumpy and achy and less fluttery than it was with Tommy. I wonder if any of that could be due to my c-section scar. Or perhaps it's just the positioning of the placenta or just this baby! They say all pregnancies are different! Tommy felt like a butterfly in my bladder, but this baby jerks around more. He or she doesn't move nearly as much as Tommy either. In and out of the womb Tommy has always been in non-stop motion. On every ultrasound he was turning cartwheels and he was constantly bombarding my bladder with hiccups as early as 15 weeks. I know it's still earlier than that now, but this baby posed completely still for my last ultrasound, she didn't move at all (ooh I slipped and said she! Everyone is convinced it's a she. I'm not convinced yet, but maybe that was a Freudian slip).
My midwife is also very gentle. My OB pounds on my belly and really digs in deep to find my fundus. I've always wondered if that much discomfort and often painful pushing is necessary. Now I know it isn't! The midwife hardly touched me and found it right away! My uterus has really popped up in the last three weeks. The baby was hidden behind my pubic bone at the OB's office and the midwife found the heartbeat halfway to my belly button this time! That's quite a jump in that short of a time. You would think I would have some bladder relief now. I have a little, but nothing significant. With Tommy he definitely raised up off my bladder at this time, but unfortunately it didn't last long. I carried him low and he engaged early as well.
After the exam I had the opportunity to ask her all the nitty gritty questions about her policy and the hospital policy. Since she only delivers at this one hospital where she worked as a labor and delivery nurse for years before she became a midwife I assumed that her policy was the same as theirs. I assumed correctly. She also confirmed what the doulas who know her have told me - when you have her as a midwife the staff at the hospital pretty much just leaves you alone! This is exactly what I wanted to hear! I am really worried about excessive and unnecessary interventions. I looked into a homebirth to avoid that, but I wasn't too comfortable with the only homebirth midwife that insurance would cover, and it took a while, but I finally dragged Tom's feelings out of him and he confided that he deep down wasn't comfortable with a homebirth either. That was all I needed to hear. We are in this together and I need his support and if he isn't comfortable I'm not comfortable! I feel really good about this midwife and hospital setup now after this appointment.
Every question I posed she answered perfectly! Here are some examples:
- She strongly believes in the safety of VBAC and brought up studies that showed that the risk of uterine rupture is no greater for a vbac mother than it is for a mother who has never given birth!
- I can go to 42 weeks and then she will encourage natural induction (walking, sex, nipple stimulation) and then she will use prostaglandin gel (softens and effaces the cervix) and other less evasive techniques before pitocin. Pitocin is an absolute last resort in her opinion.
- She has no time limits. My water breaks, no problem. She wants me to take my temperature every hour and only go to the hospital if I feel like I'm ready. If my temp raises it can indicate infection and then I will have to come in, but otherwise she is fine with me laboring at home and for days if that is what my body wants to do provided there is not meconium present.
- There is a tub at the hospital that no one really uses except for her patients. She will allow me in it after my water breaks as well!
- She does not believe in continuous EFM (electric fetal monitoring) even if I am on pitocin, unless there is an indication that the baby or I are having problems. When I arrive at the hospital they will run a strip and then after that she will listen by stethoscope or external monitoring intermittently through a few contractions to make sure the baby is handling them fine. I don't need to have them strapped on which was so uncomfortable during my last labor! She will hold the monitor on me if the straps annoy me.
- She will be at the hospital the entire time I am which might be 30 minutes or 30 hours or more, hopefully not more! She won't continuously be in the room if I don't need her there, but she will be just outside the door catching up on the gossip with the nurses - her words.
- I will have the opportunity to meet her OB backup at least twice. She described her as very laid back, in agreement with her birthing philosophy and as a very skilled surgeon with wonderful hands should I need a c-section.
- She agrees with me about the AFP test - she thinks it's an inherently bad test and does not encourage her patients to get it.
- She has no problems with a full labor and delivery room. She knows that at a bare minimum I will have my doula and husband there and most likely my mother as well. Tommy will be in and out with my father and also at the birth if he wants to be and I am comfortable with this. We're going to go with the flow. I don't know how I'll feel or what noises I might make. If it's going to scare him I don't want him there! He also might be distracting for me so I am fine kicking him out too! Her only requirement is that there be one person dedicated to Tommy's care, and grandpa jumped at the chance of landing that job.
- She doesn't believe in routine IV's or heparin locks unless there is an indication that one is needed. In that case she prefers to do a hep lock.
- She will discharge me immediately after the birth if we are both doing well, or she will let me stay the full 48 hours. It's my choice! I'm not sure what I want, but it's nice to know my options.
- She has had patients with a separated pubic symphysis before. In fact she cringed when I asked this because she knows the extra pain and difficulties it can cause during labor. She personally didn't have this condition, but she understands that extra care is needed in finding comfortable birthing positions. She agrees with what I recently found out, that pushing from a side lying position is often most comfortable for people with this condition. There is a good chance that I won't get this again, but it was nice to know she was experienced with it in case I do!
I asked more questions, but I can't remember them all now. I formulated the questions in such a way that I didn't hint at the answer I wanted. She wasn't formulating her replies just to make me happy. She truly has the same philosophy about birth as I do! I am confident that this birth will be a very different experience than Tommy's! This may sound strange, but I'm actually looking forward to this labor and delivery.
Oh, and speaking of labor and delivery I believe I have found my doula! The day before my midwife appointment (I've been working backwards with this journal, haven't I?) I met with the other doula that I was considering (not the massage therapist). I liked her a lot! I like the first doula as well, but deep down I feel the second is right for me. The second doula just fits in our family. I feel like she could be a sibling or something. The first doula is really nice and sweet, and she blends in personality wise, but it's just not the same! The second doula really hit it off with Tom it seems. He says he liked them equally, but my impression was that he got along better with the second. Tom isn't into this whole birthing thing. It's not that he doesn't try to understand my feelings, it's just that he doesn't get it! I am at peace about this, but I also know that I will need him there. We are hiring a doula because he is not capable of being my primary labor support person, and I need one! He will be in the room because I need him there, but I know that he would prefer to be down the hall in the waiting room pacing the floor like fathers in the old movies! With the first doula I could see him slipping off into a corner and then I would have to fight with him to come back over and join me. Whereas the second doula I know will keep him right in there! She and Tom were already teasing back and forth and he was being quite open about his stereotypes about midwives and natural birth types. She joked that just for him she'll make sure she wears Birkenstocks to the birth. She doesn't own them, but she'll go out and buy a pair just to bug him! She also said that she likes to give people jobs in the labor and delivery room. I can see waving her arms around conducting everyone. Grandpa over there and hold Tommy up so mommy can see he's ok and he can see that mommy is ok and grandma you rub her feet and Tom just hold her tight!
I also loved her reply to one of my questions. I asked what she would do if they (they meaning the staff, my midwife, whoever) were suggesting something or about to do something that she knew I didn't want. She replied that she couldn't directly tell them no, that has to come from me, not my doula, not my husband, not my mother! But she would give the play by play. Once she had a client who under no circumstances wanted an episiotomy (oops, I forgot to ask the midwife about that!). This woman's doctor reached for the scissors so the doula opened her mouth and loudly and clearly told her client what the doctor was doing which prompted her client to sit dead upright and yell "NO!" That is what I need. I know what I want and what I don't want. I'm not completely rigid about my birth plan, but when I was in labor with Tommy I simply forgot to stick up for myself and no one else reminded me to! For instance during the c-section I knew that it was acceptable to hold my baby immediately after, but I was too out of it to ask so I didn't and they just whisked him away! If I had had a doula she could have said, "Would you like to ask to hold him" and that would have made me ask!
I still haven't called either of their references, which I will do before I make an official decision, but I doubt it will change my mind. Now I have the difficult task of telling the one doula I'm not going to use her. I'm sure it will be fine, but since I really honestly do like her it will be hard. I am still planning on getting massages with her and should I need chiropractic care I will probably go to her husband too! I've also already recommended her to a few pregnant friends who plan on interviewing her as well.
I'm currently reading two birth books, The Birth Book by Dr. William and Martha Sears, and The Thinking Woman's Guide to a Better Birth by Henci Goer. I have really enjoyed both books so far and highly recommend them! I have also read Natural Childbirth After Cesarean, a Practical Guide by Karis Crawford, PhD and Johanne C. Walters, BSN, RN which was ok. I didn't really learn much new, but a friend had this one and lent it to me so it was the first book I read. One thing I did get out of the latter book was the realization that I was fighting contractions during my labor with Tommy. And the book also discussed the use of visualization. I have regularly used visualization in the past while playing competitive sports and I have had a lot of success with it! The doula I want to hire also strongly encourages visualization. I think that a combination of relaxing techniques (I'm planning on taking Bradley classes) and visualization as well as different laboring positions, counter pressure and just plain confidence in my body's ability to birth is what is going to get me through this labor and delivery, the latter being the most important!
I feel like I'm in training right now! I'm paying attention to my posture and sitting up straight and doing a lot of tailor sitting (Indian style is what I grew up calling it) to encourage this baby to not turn posterior like Tommy was. It is still early to be worrying about that, but I figure if I don't get into those habits now I will be more likely to slouch and semi-recline as this pregnancy goes on. I'm drinking my red raspberry leaf (RRL) tea to tone and calm my uterus. I really notice it working as well! I am already getting braxton hicks contractions, not painful ones, but I feel my uterus tightening now and then. It's a different feeling than the baby's movement. With Tommy I didn't feel them this early, but I did get a lot for a first time mom. By the end of the pregnancy they were often painful. I'm a very sensitive person and very much in tune with my body so I feel everything. Tom says I have the princess and the pea syndrome. I agree. If my socks aren't on perfectly my feet hurt! I believe this is why I feel movement very early in my pregnancies, and why I feel every little uterine twinge. RRL not only conditions and prepares your uterus for labor it also will calm an overactive uterus. This is definitely true for me. I was told to drink two strong cups a day during my second trimester and three a day during my third. If I forget one cup I have more braxton hicks contractions. And if I am having contractions and I drink a cup of tea they calm down. I guess the only thing I'm not doing is sleeping. Well at least I'm not doing that tonight. Its now 1:20 and I have to be at a LLL meeting at 10:30 tomorrow morning so I better go to bed now!
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