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Friday, December 31, 2010

Photo illustration: delayed cord clamping vs. immediate cord clamping

 World Health Organization supports delayed cord clamping. Here's what research shows:
  • 25-50% of baby's blood volume is in the placenta and cord immediately after birth. 
  • In the minutes following birth, baby's circulatory system retrieves exactly the amount of richly oxygenated blood he or she needs. 
  • Premature cord clamping cuts off baby's oxygen supply from the placenta before the lungs begin to function, which is essential for brain function.
  • Babies whose cords are clamped and cut prematurely are more likely to have respiratory problems, need resuscitation, need a blood transfusion, and/or be anemic. 
  • Cord blood provides baby with his or her own essential stem cells when the cord is allowed to continue pulsating until it is physiologically finished. 
Nevertheless, many OBs (and even some midwives) continue to routinely clamp and cut the cord within 30 seconds after the birth. Why? Tradition and convenience.

Research also shows that pushing in upright positions on the mother's cues and instincts is more beneficial for both mother's and baby's health in the majority of instances. Here's an excellent 2 minute video clip on pushing positions. Although many OBs and midwives routinely practice active 3rd stage management (including immediate cord clamping and cutting, cord traction and fundal pressure to assist delivery of the placenta, and routine Pitocin shots), much has been written that suggests that these practices can cause many of the same problems they purport to prevent, such as hemorrhage.

Below are photos which two mothers have graciously given me permission to publish. They illustrate the difference in appearance of placentas after pushing on instinct in an upright position, physiologic 3rd stage management, and delayed cord clamping,  versus placenta after directed pushing in lithotomy position (on her back),  active 3rd stage management, and immediate cord clamping. These educational photos are graphic, therefore I'm giving fair warning to anyone who does NOT want to view photos of placentas.

*please continue to scroll down to see photos of placentas

*please continue to scroll down

*please continue to scroll down

* You can't say I didn't warn you if you haven't closed this page by now.

The first is a placenta after delayed cord clamping and cutting (30 or so minutes after the birth). The mother pushed on her body's cues in an upright position. She had a waterbirth and delivered the placenta into the birth pool on her body's cues about 30 minutes after the birth, then the placenta was transferred into this bowl right away. The amount of blood that was delivered with the placenta was so minimal that it did not even change the color of the water.

The next photo is of a placenta delivered after active third-stage management. The mother pushed in the lithotomy position (on her back) with directed pushing. The cord was clamped and cut within seconds after the birth. While the mother was still on her back, the midwife directed when and how to push the placenta out, while she gave cord traction. (This was not nearly all of the blood that was delivered with the placenta. It came out with a gush of blood, much of which went directly into a biohazard bag at the end of the bed.) I realize that much of this blood was mother's blood, not baby's blood (placental blood), but it still shows an interesting difference between examples of pushing on instinctive cues and directed pushing; between watchful waiting and active third-stage management. 

It is an interesting pictorial of the variations of third stage management, placentas, and cords.

I have a collection of links (including NIH, Cochrane Review, and PubMed research) on delayed cord clamping and the consequences of routine cord clamping here. I continually add to this bookmark site.

Here is Midwife Thinking's blog post on the role of the placenta and cord in the newborn transition.

Edited to add: Even in the case of C-section, moms can request delayed cord clamping (barring unexpected complications). It's being done safely in some major hospitals by OBs who are meeting consumer demands for delayed cord clamping and other options for a family-centered cesarean. You can read more about family-centered cesareans on ICAN's White Papers and here at Preparing For Birth's sample birth plan for family-centered cesarean. Preparing for Birth is owned by Desirre Andrews, who is ICAN's president as well as a childbirth educator and doula. Family-centered cesareans are another post for another day.

Wednesday, December 8, 2010

Wordless Wednesday: A Father's Labor Support

I took this photo of an amazing couple during labor. The father and mother's love for each other shined so beautifully. His caring presence and touch was a great comfort to her.

Tuesday, December 7, 2010

Remembering our angel babies at the holidays

I've been asked to write a blog on grief/loss/remembering lost babies over the holidays. It's such a tough topic to handle for so many reasons. There are so many different ways to grieve, different ways to honor memories of our lost babies, and even so many different ways of celebrating that time encompassing Thanksgiving,  Christmas, Chanukah, New Year's, Kwanzaa, Winter Solstice, and Festivus (did I leave anything out?).

I feel the need to give a disclaimer that whatever works for you, is the right answer for you. As I've said before, fear of criticism for saying the wrong thing has held me back from writing about grief and loss.

The holidays are often a grief trigger following a loss, even if things have seemed to be "fine" or at least "better" for a while. Why is that? Sometimes it has to do with expectations we had of that holiday: showing off an ultrasound, baby bump, or our new baby in our arms. Sometimes it means being around a mixture of relatives, some of whom don't know about the loss and it feels overwhelming to tell the whole story allllllll over again. Sometimes it feels like too much to answer questions about what happened. And all too often, it's awkward because there are no questions; everyone acts as though nothing happened. "Please pass the turkey." It's the elephant in the room nobody talks about.

Or maybe it's because nobody knows that the loss occurred because we hadn't announced the pregnancy, and we preferred to keep the loss and grieving process private. It can still be difficult to face a crowd when you are mourning and no one knows why you are not quite acting like "yourself."

Sometimes we *want* to talk about it but we don't know how to bring it up or who will be a sympathetic listener. Or we don't want to be the one to ruin the family get-together. Or we don't want to be accused of being self-centered or making the event "all about me." Or maybe that was just what I heard from certain family members. Or maybe we don't want to ruin our makeup when we tried so hard to put on a brave face and attend this thing after all.

Sometimes it's hard to be around family or friends who were pregnant at the same time as us or whose child(ren) is/are the same age as our baby would have been by then. It's hard to hold their baby, even though we want to hold them and love them.

Sometimes it's simply hard to be around festivity when deep down, we don't feel terribly festive.

Think about what brings you comfort: privacy and curling up on the couch with your honey, or being surrounded by friends and family at a gathering that is bustling and takes your mind off things for a while? Talk it over with your significant other and see if you can find a compromise that works for you both. Would you feel most comfortable attending a family gathering but setting a time limit on it? Would it help to have a code word that means "I can't do this, we have to leave now!"? Maybe this could play out: "Where's the mistletoe, honey?" "I'll get our coats."

If you just don't want to attend, and if you would rather send the gifts by mail or give them to a family member to take for you, or even if you want to send your significant other (and/or kids) as your ambassador and explain that you weren't feeling well and you regret that you couldn't be there, that would be 100% true.

Some families opt to do something different altogether to ease the pain of the absence of the loved one. This could be a temporary solution for one year, or a new tradition to keep each year. It's a bit of a different situation, but several years ago, my friend's mother died on Thanksgiving day after dinner after a long illness, and her father died of cancer a few months later. For the following Thanksgiving, she and her sister took a cruise over Thanksgiving instead of attending dinner at extended family's houses. I thought it was a great idea. Since that time, they have celebrated Thanksgiving with various other family members, but it really helped them make that transition for that first rough Thanksgiving without their mother. Getting away for a while could be a nice way to reconnect and recharge the batteries, physically and emotionally. Alternately, a new tradition closer to home could give a new way to honor baby's memory at the holidays, such as helping others (donating time, money, or needed items to a local family or charity in need) or even some fun activity such as going bowling or ice skating as a family.

Some moms find comfort in making or buying a memento, whether it's a piece of jewelry etched with baby's name, due date, or loss date; a Christmas ornament; a suncatcher; naming a star in his or her memory; donating to a charity in his or her name; a piece of art (custom or one you find) that represents your memory; a doll, stuffed animal, or blankie; a birdbath, fountain, or garden stepping stone (perhaps with a phrase or scripture that comforts you). Some parents write a poem (and even frame it) or journal to help in the grieving process. There are endless options for finding a way to honor your baby's memory in a way that represents you, your family, and your traditions.

If you receive money as a gift or want to buy a treat for yourself, My Forever Child is a great company owned by a jewelry artist who has lost a baby as well. Here are photos of my pendant I received as a gift from friends shortly after my loss. If you have actual handprints or footprints of your baby, you can scan and email them to her and she will custom-etch the images onto a pendant or keychain.


As for me, I wanted a Christmas stocking in memory of Evan, my baby who I lost in 2007. It is basically a place-holder, in my eyes. I didn't want to pretend he was never here. My mother-in-law made stockings for my husband and me when we got married, then gave a stocking of the same shape/pattern to each of our children for their first Christmas. I asked her in June 2007 if she would make a stocking in memory of Evan, but she said that she would not have time to do that. I asked my dear sister-in-law Candi if she would make a stocking for Evan, since she has my mother-in-law's pattern and this stocking would match all the others. Even though it was a sacrifice of time and effort, Candi took time every evening for several days straight to put together this stocking for me, allowing me to choose which fabrics I wanted and where. Her gift of love meant--and means--so much to me.

To mark the significance of the stocking, I added a Precious Feet pin, which is an accurate replica of a baby's feet at 10 weeks gestation. I lost Evan at nearly 15 weeks gestation, but he stopped growing at nearly 9 weeks gestation, so the pin is pretty close to the size of Evan's feet at the time we lost him.

Evan's stocking is the one with the snowman, in the middle.

All our stockings: the 5 children's, then mine and Rick's.

Having Evan's stocking as a physical way to honor his memory made the approaching Christmas season feel much more bearable. My children know whose stocking that is, and sometimes they tell visitors about it. It is a tangible witness to their baby brother's existence. They know that he was a real baby, that he is still their brother, and that he is in Heaven now.

I've put up Evan's stocking along with all the other stockings, each year. However, I also bought a Christmas ornament in Evan's memory in 2007, but this is the first year that I have felt strong enough to bring it out of its place in my memory box and hang it on the tree. I bought it October 2007 from a WV artisan at an arts and crafts festival, and the artisan inscribed it with his name and the year.

The underside of the blankie reads "Evan Michael DeGroff, 2007"

Maybe on a tree this size, no one else will even notice Evan's ornament, but I know it's there.

What are some of the ways that you or someone you know has handled the holidays after a loss?

Sunday, December 5, 2010

Commercial baby carriers: what's available other than crotch-danglers

Maybe you're looking for an ergonomic, safe baby carrier or sling, but you don't have a high-end baby boutique that would stock brands like Ergo, Boba, Beco, or Sakura Bloom. [Update: Toys 'R Us now stocks Ergos, both online and in some retail stores!] Maybe you are in a hurry and have to buy a baby gift for a shower this afternoon, and you don't have time to email Tre'Slings and custom-order a gorgeous, designer fabric ring sling (she ships anywhere in the US & Canada). Maybe you read my previous post "Babywearing FAQ" and you want a readily available baby carrier from Target or Toys 'R Us, but you want to avoid the pitfalls of crotch-dangler carriers. Here are a few great options.

One of my favorite carriers for newborns, among widely available commercial baby carriers, is the Moby Wrap. You can find them at most Target or Toys 'R Us/ Babies 'R Us stores for around $40.

I was so excited when I was at Marshall's the other day and I saw this new Infantino  Wrap & Tie, otherwise known as a Mei Tai style sling, for only $24.99!

"Buy this..."

The package was sealed so I didn't get to look at it closely or try it out, so I can't vouch for the quality, but this style carrier is so much more ergonomic for mom and baby both! As with many carriers, the packaging did show a photo of wearing a baby forward-facing using this Wrap & Tie, and I would advise against forward-facing babywearing for all the usual reasons, but this carrier looks like a great compromise for an affordable, safe, easily available baby carrier.

Unfortunately, right next to that Wrap & Tie, Marshall's had these crotch-dangler carriers, also $24.99 each:

"...not that."
I can't for the life of me figure out why these Infantino Front 2 Back Riders, Infantino Comfort Riders, Baby Bjorns and the like are even still on the market when there are such nicer alternatives for the same price. Maybe they're like pleated pants: they're not good for anyone, but so long as there are people willing to buy them, manufacturers will continue to produce them. They do not provide adequate support for baby's legs or spine in this position where baby's legs dangle straight down, whether baby is forward-facing or facing the wearer. Baby's weight and center of gravity are also pulled down and away from the wearer, instead of being wrapped around the wearer's body.

Although I haven't seen one in person yet, I've heard good reviews of Infantino's new Ergo knockoff, the Infantino Balance which sells for around $60 at Toys 'R Us. I'm encouraged that possibly market demand is forcing commercial baby product companies to offer better alternatives than the past. I'd love to see this trend continue, and who knows, maybe some day we will see BabyHawk, Ergo, BobaBeco, Sakura Bloom, or even Tre'Slings offered at Target and Toys 'R Us.

For more information about the difference between good, supportive baby carriers and crotch-danglers, see this helpful blog post by Becoming Mamas.

What about you? Have you seen any good, ergonomic, affordable baby carriers in chain stores? Which carriers? Which stores?

Wednesday, December 1, 2010

Myth-conceptions about Episiotomy,The Unkindest Cut.

This MyOBsaidWHAT.com entry particularly hit a nerve with me.

“I’m almost done, just putting in an extra stitch. It will make your husband really happy.” -OB during tear repair.

Where to even begin with how wrong this is. *sigh* You can read the comments at the bottom of the post to read the thoughts of childbirth educators, doulas, midwives, and other birth advocates. A great read on the facts and mythology regarding episiotomies is Chapter 14 from Henci Goer's Obstetric Myths Versus Research Realities, which can be read in its entirety here.

The assault on the woman's genital integrity and bodily autonomy by this OB's use of the "husband stitch" is so bad that it would require a whole other post. The mother whose original post that was did NOT consent to that procedure, and there's no way that an "extra" stitch would help her heal better in any way. If anything, her recovery would be prolonged, possibly by many months. That's a rant for another day.

At any rate, I hear this one a lot. It makes me really sad.

Often, my clients in my childbirth classes (or private in-home classes) will bring to class their mother, sister, or best friend who they want to be present at the birth. With this example, we will call the mom-to-be Ashlee and her mother (the grandmother-to-be) Jane (not their real names). As part of what I regularly cover in my classes, I explained to mom-to-be Ashlee that episiotomies are only medically necessary about 5% (or less) of the time and that most of the time, they amount to nothing more than genital mutilation. We discussed how a tear will often be far WORSE and deeper with an episiotomy, and how recovery from an episiotomy has been found in studies to be more painful and difficult to heal than after a natural tear. I also shared with them the most common (totally preventable) causes of tearing and how to prevent/avoid a tear. Grandma-to-be Jane nearly teared up after hearing this, sharing a bit of her birth story. She was glad that chose to have unmedicated births with her (now-grown) children and encouraged her daughters to have an unmedicated birth, if possible. She said that she treasured her memories of her own births--until she found out that what happened to her didn't have to be that way.

She said that everything went great up until the time that her OB cut a deep episiotomy on her, then as he stitched her up, he told her he was putting in "one more stitch for her husband." Jane said, "At the time, I thought that was normal, but now I think I should have popped him one!" I told her that I was sorry that she had that experience. She replied that she was glad she found out the truth so that hopefully her daughter wouldn't have to go through an unnecessary episiotomy and subsequent painful recovery.

Tuesday, November 23, 2010

Informed consent: Moms, do YOU want to be vaccinated after giving birth?

I wanted to give a heads up to moms who will be giving birth anytime soon in a hospital and possibly in freestanding birth centers. Several different moms have told me recently that after they gave birth in a hospital (two different hospitals), staff offered vaccinations to the mother. I'm not talking about the Hepatitis B vaccine typically offered to newborns. I'm talking about vaccines for mom.

One mom, in her post-birth blur, said that she was pretty sure that one of the vaccines may have been pertussis and she wasn't sure what the second one was (possibly flu?). She consented because the healthcare worker (I'm not sure whether it was a nurse, doctor, or other) rolled up her gown sleeve for her and told her that she *had* to have these vaccines. She did receive both vaccines, but she didn't feel that it was informed consent.

The other hospital did not present it falsely as a mandate, and the mother at that hospital declined the vaccines without any further struggle.

I'm not telling you to accept or decline any vaccine. I'm just here to give moms a heads up that they may need to make such a decision shortly after giving birth in an institution, so it's best to research your options and make your choices on available information instead of in a rushed manner, without having time to read product inserts or ingredient lists, and when they know that you're distracted with a newborn on your chest. Whether to accept or decline vaccines for mom is not something that most women think to include in their birth plans.

Links to CDC list of vaccine ingredients, PDF (US licensed vaccines)

Links to package inserts for US licensed vaccines

CDC page listing possible side effects of US vaccines

CDC list of vaccine contraindications (US vaccines)

VAERS (Vaccine Adverse Event Reporting System), co-sponsored by CDC, FDA, and US Dept. of Health and Human Services

National Institutes of Health/ Cochrane Review to "assess all studies evaluating the effects of vaccines against influenza in healthy adults." Conclusion: "Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission.WARNING: This review includes 15 out of 36 trials funded by industry (four had no funding declaration). An earlier systematic review of 274 influenza vaccine studies published up to 2007 found industry funded studies were published in more prestigious journals and cited more than other studies independently from methodological quality and size. Studies funded from public sources were significantly less likely to report conclusions favorable to the vaccines. The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies. The content and conclusions of this review should be interpreted in light of this finding."

It's always a good idea to research ingredients and relative safety/risk of each vaccine vs. the relative safety/risk of each illness as well as the effectiveness (or lack thereof) of each vaccine. It seems that many people spend more time reading the ingredient list on the back of their cereal boxes than they do reading what is injected into their (or their children's) bodies.

Tuesday, November 16, 2010

One man's trash is another man's treasure?

A few days ago, I was making small talk with another mom who asked me what I do for a living. I told her that I homeschool my 4 kids and I teach childbirth classes. That's an interesting conversation opener. You'd be surprised how many people automatically start telling me about their births--even men, sharing how their wife had to have 2 Cesareans and why.

Like so many others, she told me how she has had cesareans with all three of her kids. She didn't say why she "needed" her first cesarean, but she did say that she scheduled her cesareans with the next two children. After all, her dad had read on the internet about "those VBACs." (I'm not making this up.) Besides, she elaborated, it made it so much easier to schedule her in-laws' visit around the scheduled C-section, and her husband could plan ahead when he needed to take off work.

I smiled and nodded. She didn't ask me any questions, and I didn't give her any commentary. I didn't even tell her how my own children were born. Someone changed the subject, and that was fine.

Then I received a text message from a friend who is a doula. She had been keeping me updated for days about her VBAC client's progress. She had texted me a few times for advice or encouragement, and I was honored to be a text-witness to something amazing. The text I received while sitting with this mother: "VBAC!!!!!!" Yes, she had finally achieved her VBAC after a 60 hour, unmedicated hospital VBAC. She worked so hard for that birth, not just those 60 hours but for the previous 40-ish weeks, preparing for and working toward this birth, overcoming incredible obstacles from her previous traumatic birth.

It was an interesting juxtaposition to observe, sitting at the table with a mother who knows nothing about what her body is capable of or designed to accomplish with birth, who was content with her three cesareans and said she would schedule cesareans if they have any future children, then receiving that text: "VBAC!!!!!!" Knowing what incredible event had just transpired, and how much that mother had wanted it--what victory.

It's interesting to observe who is content with what and why.

Monday, November 15, 2010

"How do you overcome the fear that your body doesn't work?"

On my Well Rounded Birth Prep Facebook page, Samantha posed this question: "How do you overcome the fear that your body doesn't work?" It's such a huge and important question, one that so many women face, especially after a difficult or traumatic birth.

I don't know Samantha's (or anyone else's) particular situation or medical history, so I'll try to write out a few things that many moms find helpful.

First of all, I'm sorry that you had an experience that left you with doubt and fear. It can be helpful to request a copy of your medical records from your previous birth(s) to see the details of what happened. Maybe a midwife or doula could help you decode what you read and help you identify any preventable interventions or other potentially avoidable factors that occurred before. This can give you a better idea of what you can do next time to help have a different result.

For example, some moms know that they had a bad reaction to narcotics or other medicines in the past. For them, having a game plan to avoid those meds in a future birth can help them feel less fearful and more confident for a future birth. For others, a bad perineal tear may cause intense fear of future birth. If lithotomy pushing (on back, hold breath, count to ten) is to blame, that's another fairly easily avoided situation. If there was a bad outcome following an induction, it can be helpful to avoid an induction the next time around (more on that later) unless it's medically indicated and if the potential benefits outweigh the risks of induction. If the last birth was a cesarean birth, identifying which factors led to that can help you decide what action plan will help give you the best odds of a vaginal birth the next time around.

Reading every GOOD birth book and article possible can be a great first step in processing all this. I keep meaning to write a blog with my book recommendations. Many of them are on the Amazon.com widget to the lower right on each of my blog posts. If you scroll through the pages, there are birth books for many different topics and situations. I can't overemphasize the importance of reading fact-based, evidence-based birth books instead of funny, tongue-in-cheek books, or worse: those which downplay the risks involved with birth interventions and normalize a medical birth. A few suggestions:

to read:

The Thinking Woman's Guide to a Better Birth by Henci Goer

Ina May's Guide to Childbirth by Ina May Gaskin

Pregnancy, Childbirth, and the Newborn by Simkin, Whalley, Durham, Bolding, and Keppler

to watch:

The Business of Being Born, produced by Ricki Lake and directed by Abby Epstein

for VBAC hopefuls:

The VBAC Companion: The Expectant Mother's Guide to Vaginal Birth After Cesarean by Diana Korte

Silent Knife: Cesarean Prevention and Vaginal Birth After Cesarean VBAC by Nancy Wainer Cohen and Lois J. Estner

ICAN (International Cesarean Awareness Network) is a great resource for cesarean research, articles, information, support, and healing. Their White Pages are a wonderful resource for statistics and current cesarean recommendations. ICAN's community and message board have been a source of healing and cesarean/VBAC info for thousands of women.

This is just the beginning for a reading list, but if I keep going, this will morph into that other blog I still need to write.

If you PM me your particular interests for reading or specific situation, I can try to point you toward books, articles, research, and/or websites to help you start your quest for information and empowerment.

Have you read about the fear-tension-pain cycle during labor and birth? Ina May's Guide to Childbirth describes it in detail. A good, independent childbirth class (NOT affiliated with a hospital or other institution) can go a long way toward helping you understand how your body works and how birth works. For anyone in western or southern WV, I can recommend one. ;-) The more you know and understand about the design of birth, the more you can recognize what's normal, and the less there is to fear. This, combined with your reading, can help you have a good grasp on how rare true, non-preventable birth complications are, and how they can be safely handled. This won't guarantee that you won't be one of the rare few, but perspective does help bring confidence and reassurance.

Finding a supportive care provider (midwife or OB) AND place of birth that are compatible with and supportive of your birth philosophy are CRUCIAL to working toward the birth you envision. To quote Desirre Andrews, ICAN President and owner of Preparing For Birth, "It comes down to the fact that you can't get Chinese food at McDonald's." Most hospitals, birth centers, OBs, and even midwives have a pretty firmly set order of operations. They are unlikely to bend their normal procedures to your requests. It's far easier to find a care provider who supports you than to struggle against your OB, nurses, and hospital during the time that you should be able to put all your focus on labor instead of arguing with staff. Here's my blog on "How to Avoid the Ol' Bait-and-Switch with your OB."

It might be worth your time to interview midwives and even consider whether you might be a candidate for a homebirth or freestanding birth center birth. It can be helpful to discuss your concerns openly with your care provider so that she or he can be aware of your grief and/or trauma triggers and be sensitive about them.

On that note, it's crucial to be selective who you invite to attend the birth. A sense of safety (both emotional and physical), security, and privacy is so important in allowing labor to unfold unhindered. It's essential that anyone present is someone who you would feel comfortable with in your most vulnerable moments, and that he or she supports you and your birth plan 100%. "Giving Birth With Confidence" had a great article on this topic. A doula can be a wonderful asset to your birth experience as well.

Journaling or otherwise processing what happened with your previous birth(s) is another step you may find helpful. I have compiled a few links on birth related PTSD and PPD, and I'm continually adding to the lists.

I also encourage my birth class students to recognize what can and what cannot be controlled with a birth. You can (generally) choose your care provider, birth setting, environment (candles, quiet, mood). While birth itself cannot be scripted, many moms find it reassuring to write birth plans for Plan A, Plan B, and Plan C eventualities of birth, with their preferences for example, with Plan A for a non-medicated birth with no interventions, Plan B for preferences if induction becomes medically necessary, and Plan C for a family-centered cesarean should the need arise. This allows you to make thoughtful decisions for your preferences, in advance while you are level-headed and have time to research various options. Some expectant families even write out their preferences in the event of a stillbirth or if the baby dies (photography: Now I Lay Me Down To Sleep, assist in bathing and dressing baby, save a lock of baby's hair, and more). While it's unpleasant to think about anything but Plan A of birth, it can give a sense of relief and free up mom not to have to worry so much about "What if?" when many possibilities have been covered with the birth plan.

Whether you are still in the planning/preparing stage for your next pregnancy or whether you are already pregnant, optimizing your health is another proactive step you can take. The common sense things like taking your prenatal vitamins, exercising to your ability, and best possible nutrition really do make a difference.

I'd like to sum it up by saying, you are the expert on your own body and on your baby. Read, prepare, surround yourself with great support people, then listen to your gut. Nobody knows what *your* normal feels like and what's right for *you*-- but you.

I hope this list is helpful. Feel free to add a comment with your own experiences.

What has worked for you to help you overcome fear that your body doesn't work or any other birth fears?

Thursday, October 21, 2010

My grief & healing from miscarriage, 3 years later

This will be my last Debbie Downer post for a while. I promise. Bear with me. This is fresh on my mind because of October 15th Pregnancy and Infant Loss Awareness Day last week, followed quickly by my due date with Evan today, October 21. Even though we all know that due dates are worthless, October 21 is all I have to hold onto for remembering Evan's "birthday." Evan would/could/should have been 3 years old today. I always feel better starting on October 22.

For the past three years, I've managed to move along with daily activities with my four remaining children for most months of the year "just fine." I still think of Evan often, but the sting isn't as new, fresh, or intense. It varies from person to person and from year to year, but in comparing notes with other moms who have lost little ones, here are just a few common "grief triggers."

I feel like I have to defend, define, explain, and give disclaimers for everything I say about loss. I wish it weren't that way. For me, I'd loosely define "grief triggers" for me to be something that brings back a wave of sadness or remembrance when it hadn't been on my mind much for some length of time. Even still, I occasionally have to work to fight back tears when I'm in public or among people who I cannot trust with my heart, after a grief trigger.

Baby's anniversaries and/or "angelversaries" are almost always trigger times. "Angelversary" usually means the anniversary of baby's death. In the case of miscarriage or infant loss, a parent may recognize the date of the ultrasound when no heartbeat was found, the day that bleeding began, the day that the baby was actually (physically) miscarried, the date of D&C, or baby's burial date as an angelversary. Other tough anniversaries include the time of conception (if known), the date of the positive pregnancy test, and baby's birthday or EDD (Estimated Due Date) which represents the would-have-been birthday.

Spending time with friends who were pregnant at the same time with close due dates or birthdays to the baby we lost can be hard. It can be difficult to see their beautiful, glowing, round bellies next to my empty one; later, it is hard to watch them cuddle their adorable newborn or toddler run around and think to myself, "That's how big Evan should have been by now."

Along those lines, walking through the baby aisle at stores and attending baby showers can be difficult for a while. It's tough to weigh whether to attend a baby shower and fight back tears the whole time, hoping that no one notices, to honor a mother-to-be for her special day vs. having an emotional breakdown and sneaking off to the bathroom to cry and trying to clean myself up, blow my nose, and put wet, cold paper towels on my face to reduce the obvious redness before anyone notices I'm missing and heaven forbid might ask me "What's wrong?" and set off the crying all over again. I can attend baby showers now quite happily, but I really struggled to attend them in 2007. By 2008, I had an easier time attending baby-centered events because I was pregnant again and had that joy and hope.

Mother's Day and Father's Day are obvious grief trigger dates. Well, you would *think* they would be obvious grief trigger dates, but for some families, it's a day to honor the grandparents, but not the parents. Some families have family traditions that are rather set in stone, and they get offended if the parents who recently lost a baby don't want to join in and celebrate. Others take that time as an opportunity to judge the parents for "not being thankful" for the living children they have. If the parents who have lost one or more babies have no living children, these days can hurt especially deeply because many friends and family do not even acknowledge that they are parents at all.

Any festive holiday normally celebrated can be a grief trigger, thinking how far along we would/could/should have been at that point, how big our belly should have been, what we might have worn, or how big the baby should have been. Holidays are the time that we daydreamed about getting to show off our baby to distant relatives or friends that we don't see often. These are also the times we think of "firsts": what the first Valentine's Day, Easter, Fourth of July, Thanksgiving, Christmas, Festivus or New Year may have looked like. Empty Christmas stockings or Easter baskets. Baby's holiday-themed outfits and matching bibs, socks, or hair bows. Possibly baby's first solids tried at the family table.

For the months immediately following my loss, I found celebratory events of any kind to be very difficult to attend, including children's birthday parties, weddings, and family reunions. It just seemed so wrong somehow to be in the depths of mourning and surrounded by festivity and smiles. The juxtaposition of extremes made those days far more difficult than the mundane, routine days. Big events also glaringly highlighted the missing person, in my eyes. The missing baby in the family portrait. The missing baby at the celebration dinner table.

I can attend all these celebrations normally now, but I don't know how I did it in 2007 when my grief was so raw and overwhelming. I wish I had not forced myself to attend events to please other people and in fear of criticism if I did not attend. I should have opted out.

Answering the everyday question, "How many children do you have?" was extremely difficult for me for the first two years after the loss. Even though I knew that the politically correct answer was to give the number of live children I had, I felt that this was a betrayal of Evan. This was compounded by the fact that I was pregnant one year after my loss, and how do you answer the question "How many children do you have?" during pregnancy? If people didn't believe that my Evan was a real child because he wasn't viable or a certain arbitrary number of weeks along or born yet (or insert other excuse here), why would they believe or count the baby in my belly? A family member wouldn't even include my baby (who was born a year after Evan died--this person never did include my Evan in any tally of "how many children") in the tally when a friend asked how many children I had. I was 8 months along at the time.

After the birth of that fourth (fifth) child, I found it easier to answer the question more simply. I understand that most of the time when people ask how many children you have, they're just making polite conversation and they don't even really care about your answer. Nevertheless, it took those two years for me to answer it the way America wanted me to. Sometimes I try to avoid answering the question. If all my children are present with me when someone asks that, I introduce my children instead of giving a number. I also find myself answering, "E is 8, G is 6, J is 4, and K is almost 2," or "I have 3 girls and a boy at home," which avoids pinning myself down to choosing between 4 and 5.

The two best pieces of advice I received about healing from child loss both came from friends who had, themselves, suffered miscarriages.

The first was the analogy of healing from loss and grieving the way the body heals from a painful physical wound. At first, the wound is so raw and vulnerable. It can be accidentally reopened so easily, such as accidentally and unintentionally crying all over an acquaintance in a grocery store or dentist's office who happened to ask how the pregnancy was going or how old the baby was by now. This kind of reopening of the raw, intense wound on my heart embarrassed me and made me hate myself for revealing such vulnerability to someone who I normally would not unload upon. As with physical wounds, emotional wounds too eventually heal with time and gentle care, and become scars. At first the scars are bright pink and still tender to the touch. Eventually they are silver and shiny war scars, showing where you have been and how far you have come. These tough, silver scars can withstand a lot more pressure or injury than could have been tolerated when the wound was fresh. I really relate to analogies, and her explanation made so much sense to me. I still think of her story often.

Another friend reminded me that when we lose a loved one, we re-grieve every loss we have ever mourned. This friend (who suffered a miscarriage before I did) shared this bit of truth with me earlier this year when one of my dearest friends, Sandi, died suddenly and unexpectedly (leaving behind her two sons, ages 6 and 8, who were close friends of my children). Naturally I was crushed by the intensity of the grief I felt for her sudden passing, but when my friend shared that, I realized she was right. I felt myself mourning all over again the losses of my baby in 2007 and of my dear grandmother (who raised me) who died in 2003 and of my grandfather who passed on in 1998. I felt all of those losses compounded all over again when my father succumbed to cancer this past June. Her words were true, and they brought me reassurance of my sanity and normalcy (don't argue with me here! just roll with it!). I knew that this was yet another season of life and that this, too, would pass and bring days that felt like the new "normal." Another friend (who has lost two dear babies to miscarriage) reminded me how helpful a re-reading of the book of Ecclesiastes can be at times like these.

I'm so thankful to have the friends who have supported me on this journey. For those of you who are just beginning on your journey, I'm sorry for your loss and pain. I pray that you find some way of strength and coping as your hurts become more toughened scars. It won't always feel feel like this. <3

Wednesday, October 20, 2010

Guest post: Candi's home waterbirth story (finally!)

A few months ago, I shared with my readers Doula'ing my nephew's gorgeous home waterbirth! with photos from her birth. My sister-in-law Candi finally typed up her birth story and asked if I would share it with all of you. Isn't she thoughtful?

“For this child I prayed; and the LORD hath given me my petition which I asked of him..." 1 Samuel 1:27

I’ve thought a lot the last 10 days (there was a little break in there, now it’s been 12 weeks) about how I am going to put his birth into words. Whenever anyone asks me how it went, I smile and say, “Perfect”. It was. For some reason, it seemed like a “textbook” birth to me…

If you are close to me, you know that the birth of our first child, Matthew, was somewhat a traumatic experience. I hope to also do a story comparing and contrasting the two, but before I do, I want to get into words the thoughts and feelings that I have of only Patrick’s birth.

We found out we were pregnant again in October. We had just had a miscarriage on September 12. We were not very surprised to find out we were pregnant again, because it was what we intended, but it was still somewhat surprising to find that my body processes were already back to “functioning normally”. We were very excited, but had decided to keep it to ourselves for a while because the hardest part about losing our baby was having to tell everyone who knew we were pregnant that we weren’t any more. I didn’t want to take that chance again. I feel like it’s revisiting the death of my child whenever I tell someone that we lost our baby before he even arrived. In case that happened again, I wanted it to be more of a private matter. After our loss, it was about six weeks before I got back to functioning “normally”, (if there ever is a “normal”) again. I still went on to work and church, and I kept it up for Matthew, but my heart was still extremely tender and I did little outside of doing what I absolutely HAD to do. I remember finally finding peace at a Jeremy Camp concert. He sang, “I still believe in Your faithfulness / I still believe in Your truth / I still believe in Your Holy Word / Even when I don't see, I still believe”. It began to become clear to me that although I didn’t understand why God would take a baby that I already loved so much and would always love, that He does have a purpose for our loss. My heart still has what feels like and empty space. I still hurt and ache for that baby, but somehow, I’ve found a way to continue on. God promises that I will see that baby someday…

As strange as it may be, being pregnant again helped me to heal more quickly as well. Of course, I was very thankful that we were able to conceive again and was able to turn the focus of my hurt away for awhile. However, I was still always very aware that something could still go wrong and we might lose this baby, too. Given that, I was determined to be thankful for all the ups and downs, emotional and physical, that come with pregnancy (and I believe that, possibly, God was testing me, because I had sixteen very difficult weeks of morning (er, allday) sickness, exhaustion, and just a general feeling of ICK—ALL THE TIME!). I was convinced that we would not ever try and get pregnant again because I didn’t think I could do it again. But, I did find some hope at around 14 weeks when I started feeling those glorious flutters of reassurance that were my baby moving to let me know that he was there! After that and knowing that I would have a chance to hear that wonderful reassuring sound of baby heartbeats over the Doppler were signs of hope to me! I looked forward to our prenatal checks and counted down the days to our due date.

We chose to have a birth center birth with Matthew. When we moved to this area and I found out there was a birth center, I was immediately excited! My mother had un-medicated, natural births with me and my two brothers 25, 20, and 18 years ago and I was determined to do the same, but I knew from all the stories that I was hearing from other mothers that the chances of having a hospital birth and NOT having an epidural, medication, or c-section were going to be slim. Maybe if it were more accessible, I would want to give in to an epidural? I don’t know. Even before I knew of birth centers and midwives, I knew that if I could help it, I did not want to have a baby in a hospital. Not to mention, I have NEVER been in a hospital other than to visit a patient or for routine care, so the thought of being in a hospital for something that is supposed to be a natural process just seemed weird to me. I had not done any research on hospital births at this time, and had even thought about having a homebirth, but that seemed a bit “scary” to me. The Birth Center was right across the road from a hospital and I felt comfortable and felt that it was going to BE a homebirth, just in a more “medicinal” setting and I let that be my comfort for those nagging what-ifs that most people have when going into pregnancy and birth. I just knew that I wanted to have our baby at the Birth Center. Before I say the following, I want to preface by saying that I know things could have been much worse, but I went in hoping for the best and hoping that my wishes would be respected. We walked in with a birth plan that was thrown out the window. I look at it now and get angry because I had in writing what I wanted, and nothing was followed. By my standards, it was a disastrous experience. It was the complete opposite of what I expected. While I didn’t end up with medication, epidural, or c-section, I ended up with tears inside and out, too many stitches to count, some hemorrhaging, and my baby was transferred separate from me where he was given vaccinations, x-rays (which I didn’t even know about until I received a bill two months later), and formula from a bottle and nipple, all without my or my husband’s consent or even consultation. This was an experience from which I needed to recover.

When we got pregnant in September 2009, we were still going to go through the Birth Center again because we felt that we were now more informed and would be more firm and able to proceed with having the Birth Plan we wanted rather than to have it thrown out the window as soon as we went into labor. I had made my first appointment there and when I started bleeding, I knew something was wrong and called immediately. It was a Saturday morning and I got the answering service. I left a message that I believed I was having a miscarriage (I had taken another pregnancy test and it was negative) and wondered if I was OK to wait it out at home, if I should just go about my day, or if I needed to head to the ER. No one has EVER called me back. When I hadn’t heard from them by the following Tuesday, I needed someone who I knew would listen. I knew of a CNM [Angy Nixon] because of a business contact of my husband and also through my sister-in-law who had three very positive birth experiences with her. I consulted with her until we were sure that all had passed normally, well, as normal as something like that can be, and that everything was back to “normal”. Not that there’s anything that feels normal about losing a baby.

So, Jon and I considered the benefits of having this baby at home. It just seemed like the next best choice. And, as it turns out, was THE BEST choice we ever made! We made it through the pregnancy with no health problems or concerns. I did test positive for GBS this time, but decided not to treat unless we were met with any risk factors (prolonged ruptured membranes, fever while in labor, etc.). Easy, easy, easy (after those first few rough weeks, anyway). Although, many of the people with which I came into contact in the last few weeks said I looked “tired” and “miserable”, I really felt good. I did have some pelvic/pubic pain, but treated with my chiropractor and was able to cope through that fairly well. I’m pretty sure I whined A LOT, though. It was hard to move or get comfortable. I would just feel searing pain in my pubic bone every time I walked, tried to turn over in bed, got up from sitting…Ugh. Not comfortable. But, I never had to take pain meds. I made it through that!

It was a little difficult for me to get to the gym (we were doing Crossfit at the time) for the first half of my pregnancy, but for the second half, I stepped it up a bit and made it more of a habit to go. I worked out with another mama expecting only a week later than me! She had her baby four days before me. We did lots of squats, lunges, walking, wall balls, pushups, rowing, etc. to keep us physically ready. I also had a lot to get over and so spent my little bit of spare time just trying to reframe and focus my thoughts on having a more positive birth experience and so read good birth and pregnancy books and watching birthing videos. In particular, I still remember one birth story that I read in “Gentle Birth Choices” about a lady who had struggled to yield to the birthing process and then while in labor, she suddenly relaxed, leaned back, and the baby just “slid out”. I got that picture into my head and that was my visualization aid when it came time to start thinking about the actual birthing process. I just started to think that when this baby came, I would just let it go and it would just slide out.

Jon and I also attended birth classes, “Well Rounded Birth Prep” given by my sister-in-law, Sarah DeGroff. Even though we’d already gone through birth once, it was three and a half years ago, and I had forgotten a lot of what to expect and what would happen. Not to mention, after our first experience, I really just wanted to start from scratch. I wanted this birth experience to be the exact opposite of what we had already been through. These classes helped us to remember that birth is a completely natural process for which a woman’s body is intended. I felt like I needed a lot of support and I found it here. Angy Nixon and Dorothy Kaeck (our other midwife) also helped to remind me that I DO need to spend time getting in my head that this was going to be a different experience. They told me that they had positive feelings about my birth, and faith in me that I could do this. We were positive this experience was going to be much better. About three weeks before my due date, I remember writing in my prayer journal, and asking God to just go ahead and prepare me for getting through this birth in case I forgot to ask Him while I was going through it! I’m pretty sure he did! He’s good like that! ;)

The night before my “due date”, July 18th, we had just finished putting up the co-sleeper at 10:30pm. It was the last thing on my “ready list”. We had decided that we were going to try a waterbirth and had rented a pool to set up in our dining room. I had this mental list of everything I wanted done to be “ready” for this baby to come and it was the last thing on it. As it turns out, looks like “change faucet” and “get birth pool ready” should have been on it as well, but I had no idea that everything would go as quickly as it did (or that it would take so long to change the faucet and fill the pool)! Ah! Anyway, we got up early on Sunday and went to church. I told our choir director that I would sing a few solos that morning in hopes that if I made plans to sing, that I wouldn’t be there and would have had the baby by then. But, nevertheless, I prepared and practiced two songs to sing (which I threw out at the last minute—ha) and sang anyway. After church, we went to eat together as a family, and went to Lowe’s to get a new faucet (the one that was currently on our sink would not allow us to hook up a hose and was about the bite the dust anyway) and a new hose to fill up the pool. We went home. Jon mentioned that he wanted to go up to the gym and do a solo workout and I had decided that I was just going to lay around (I’d already taken a week off work, but spent it doing way too much and didn’t rest). I curled up in bed to watch a movie around 2. At 3:10, I felt my first “real” contraction. I’d had toning contractions starting at 22 or 23 weeks. Exactly 20 minutes later, I had another that went clear across my belly and into the tops of my legs—exactly how labor with Matthew started. I told Jon that he’d better go get his workout in and the faucet changed because we may have some action this evening. He left and I had three more contractions, exactly 20 minutes apart, while he was gone. I was able to move around as normal between them and really only just stopped to breathe slowly through these light contractions. I also wanted to spend some last minute one-on-one time with Matthew and was already getting hungry and was going to cook dinner. TACOS! Jon got home from the gym and started on the faucet while I cooked dinner. We downloaded an app to his iPhone to time contractions. We played a few games on the Wii and spent a last few minutes together, just the three of us. I sent Angy a text message just to give her a heads up that things may pick up, but honestly, I really was skeptical that I was going into actual labor. I scarfed down THREE tacos. I never do that and looking back, I guess that maybe my body knew something my head didn’t and was preparing to store up a little energy to get me through the next few hours.

We called our parents to let them know we may be in labor, but again, I still didn’t think that this would be it. I called Josie, our babysitter, to let her know I was having contractions, but didn’t think this was it yet, but wanted to put her on notice. I told everyone that I would call them back at 8 to let them know IF things were progressing. I played with Matthew a bit and then went back and got into our tub to try and see if sitting in a warm tub would make the contractions stop. They didn’t. Jon and I decided that rather than me having to say, “Honey! I’m having another contraction! Start the timer!” (he was in the kitchen working on the faucet), we’d just have a code word. We’d just watched “Four Christmases” and decided that our word would be “Misletoe”. So, as funny as it was, I found myself yelling “Mistletoe!” pretty frequently, about every 6-7 minutes. I felt silly, and it gave me something to laugh about while I was getting through contractions. By now, it was 7. It was starting to get pretty intense, so I called Josie to have her come get Matthew. Jon got him ready and I just sat in the tub some more. I had decided to put on a sports bra before I got in the tub since soon there may be people walking around the house (we were expecting both our moms and my best friend to be at our birth, plus Jon, me, and the two midwives). I sat in the tub until about 8 and was getting excited by the fact that labor was NOT going away. Now, I was just waiting to hit that 5-1-1 mark (contractions 5 minutes apart, lasting for 1 minute and this going on for 1 hour). Jon came in and asked if I wanted him to call Sarah to come sit with me since he couldn’t (he was done with the faucet and was setting up the birth pool, and guess what! Our new faucet wouldn’t take the hose either, even with an adapter, and even if it would have, we’d probably still be trying to fill the pool with it!). I initially said, no, just because I knew we were already going to have so many people there and I really just wanted it to be an intimate thing with just me and him. BUT, then I was thinking that I really couldn’t go through this by myself any more, and if there is anyone in this world who knows how to get through childbirth, it’s Sarah! I told him that even if she could just come while he was filling the pool, that would be great. Thinking back on that, though, that seems pretty silly. Telling Sarah to just come for labor and not the birth itself would be like taking a kid to a candy store and a pocket full or money and telling them they couldn’t buy anything! But, it all went so fast after this any way, that the paparazzi could have been there and I wouldn’t have noticed or cared.

We called our parents to let them know that it looked like we were going to have a baby soon. I had also called Angy while I was cooking dinner to let her know that I thought it may be progressing, but I still hadn’t updated her in all this time. I made my way out to the living room and sat on my birth ball with a towel. I had two contractions on the way there (and, if you’ve been to our house, you know that it’s only about 15 feet from one point to the other). I STILL wasn’t convinced this was real labor. When is it going to sink in?! I asked Jon to get me something to cover up with (a nightgown? Something?) right as Sarah was walking through the door. Then, I figured, who cares? I’m sitting on a birth ball and had a bra on. No one could see anything except my stretch marks. Sarah came right over to me and said, “Uh, have you called Angy yet?” I told her that we hadn’t because I still wasn’t at the 5-1-1 mark yet. She said something to the effect of “I think we’re past that point”. I was sitting naked on a birth ball and moaning through contractions, after all. She called Angy for me. After this, it went so fast, some of the details are fuzzy. I remember Sarah sitting beside me using light touch on my lower legs, reminding me to relax my jaw, to use low sounds rather than high-pitched ones when coping through a contraction. I threw up. There was heat on my back, rubbing on my back, quiet whispers, etc. I also remember Jon’s phone ringing in the middle of it all. His ringtone at the time was “The Final Countdown”. Very inspirational! Teehee. All this helped me get through and made it not seem so hectic, not it seems like a blur. I had no idea what was going on around me, I was just trying to stay focused on getting through this rough part. I know it did now because I had five hours of pretty slow and easy labor, but it just seemed like it didn’t build up nice and slow, the hard contractions just kept coming all at once and very fast. I didn’t feel like I was getting any relief between contractions. I just kept bouncing on the ball and trying to get through each contraction, but all I could think about was how much further I had to go! I felt a little panicky. My water hadn’t broken yet. The pool was nowhere close to being full (they finally ended up filling it up with the outside hose and then ferrying hot water from the stove and faucet). I kept thinking that I may just go get back in my own tub and have him there! Angy and Dorothy arrived very shortly after Sarah called and Angy checked the heartbeat with the Doppler. She asked if I wanted her to check my cervix to see how things were progressing. I didn’t see how I was going to get from the birth ball into a position where she could check me, so I declined. It just sounded like too much work right then, and I was going through too much to even think about it. I believe this is where Dorothy took over filling the pool for Jon and he was finally able to come be with me. I remember leaning on him and then I had to pee. It took me several contractions to get back to the bathroom and I dreaded it anyway. Every time I peed, I ended up with a very strong contraction. After this, though, I felt like I was at a point where Angy could check me to see where we were headed, but I told her that I may get discouraged if she did and we weren’t that far along yet. She assured me that she has a good poker face, so I decided that we’d go ahead and see. I got into our bed and she checked and said that we are at 7, almost 8 centimeters! Yay! That sounded like good progress to me (also, this was the only time I was “checked” my entire pregnancy! I love that option—who wants that on purpose anyway?!)! At this point, though, I needed a break. I lay down and Jon was there with me. I didn’t want him to hold me or touch me, but just wanted him there. I was able to sleep in between three or four contractions. I remember the last one in particular. Sarah had given me a comb to put between clenched fists to try and take my mind off the pain in my belly and focus on clenching that comb as hard as I could. I must have dropped it somewhere in the bed, because I remember feeling that last contraction coming on and I could tell it was going to be very tough to get through and I was feeling (maybe flailing is a better word?) around on the bed trying to find it and I think Jon thought I was going to tear apart the bed trying to find it! That contraction brought me up out of the bed. The chux pad that was on the bed where Angy had just checked me fell right between my legs on the floor in just the right place and landed right under my feet. Right then, my water broke. This was something I didn’t get to experience with Matthew. It was…a weird sensation. I wasn’t really sure what just happened. I remember telling Angy that either I just peed or my water just broke. She assured me that my water broke and to be prepared because things may start getting very intense. I started making my way out to the pool. It took me a while. I remember stopping a few times in the hallway to just hold on to anything to help me out. I hung on Jon’s shoulders, I leaned on him, and I squeezed him. He may have taken a little abuse…but not much! I think by then that the pool was FINALLY ready for me to get in (next time around, maybe I’ll be a bit more concerned with getting it filled early…I don’t think we really accounted for how long that would take. Actually, I know we didn’t. Ugh. Eh, well, it all worked out).

Anyway, here’s the good stuff. I finally got in the pool. Everyone there worked hard to make sure that pool was filled enough and warm enough. I got in, and it was PERFECT. Let me tell you, they don’t call it a water-dural for nothing. OH, it was niiiice. I felt so much relief just from getting in the pool. I was instantly able to relax, a little. For a minute. While I was starting to feel like I was ready, my mom and my best friend, JoAnna came in. They had driven from Fairmont after we called at 8 to let them know this looked like the real thing. I remember feeling like I should say something to them (I didn’t even say “hi”. I was pretty pre-occupied, though, I’m sure they forgive me). I went through a lot of mental changes in these last few minutes. I know I said a lot of “I can’t do this any more” and “I don’t want to do this any more”, pretty much whining just to hear someone say that I COULD do this. Angy reminded me that I needed to change my mind-set to I CAN. And, I knew I could, but sometimes it helps just to hear someone tell you, you can. Sarah kept reminding me that I would be holding my baby by the time it was bedtime. Jon kept telling me that he loved me and he was proud of me. My mom and JoAnna were cheering for me. These are all the things that kept me going. Then, I felt this weird sensation. Pressure…like maybe there was a baby descending? I kept changing positions in the pool, from squatting, being on my knees, being on all fours. I was on my knees, leaning over the side of the pool when I felt like I needed to push. I pushed a little and then changed positions. I remember being in what would seem like this awkward lunging, leaning position…but, it seemed natural at the time. I don’t even know WHAT you would call the position I was in and starting pushing a little. I really don’t recall it as pushing as just letting the baby take the lead. I just kept changing positions from lunging, to squatting and let him descend. All this time, Angy and Dorothy kept checking his heart tones. They always sounded great and healthy. I remember Angy asking if I could feel the head crowning. I felt down between my legs, but did not feel a head. A few little pushes later and THEN I felt his head coming through! His head was delivered and the cord was wrapped loosely around his neck two times. Angy looped it over his head. I felt IMMENSE pressure and burning, and then I felt his little body coming down. I felt his whole body come out and then I saw him slide out into the water. He floated up a little and I saw his eyes open under the water and Angy and I both reached down to catch him. He was so beautiful. I will never forget how he looked that night. I held him and covered him with a towel (they heated them in the dryer—isn’t that a great idea?!). I tried getting him to nurse, but he just wasn’t interested yet. We wanted to delay cord clamping until it stopped pulsating, which surprisingly did not take very long. His cord was very long. I was able to hold him and let Daddy hold him and could not even feel a tug on the cord. I remember looking in the water for blood…there wasn’t any! I didn’t even tear. I was still having contractions because the placenta hadn’t been delivered yet and that was bugging me. I remember standing up and Dorothy was helping me and it finally just slid out. It was intact and looked healthy (not that I’ve ever really inspected one, but it didn’t look bad!). Then, I got out of the pool, went back and took a shower, put on my nightgown, climbed in my own bed with soft sheets and a warm blanket, and nursed my new baby until he fell asleep. It was amazing. It was so amazing, I find myself wondering what the next time will be like. I feel so much more empowered now and so strong. I’ve done this in the worst of circumstances and in the best. I could do this any time! My labor was a little more than 8 hours (had my first contraction at 3:10 and Sean Patrick DeGroff was born at 11:25pm), only about three hours were hard labor. He weighed 7 lbs 14 oz and was 21 ½ inches long. He was pink and round and gorgeous!

I am so thankful for everyone who made my experience wonderful. Angy and Dorothy reassured me that I could do this. Jon was everything I needed right when I needed him. Sarah helped me to remember to relax and let my body do what it’s made to do. Mom and JoAnna were my cheerleaders. Not only did they arrive so quickly, but they also fetched me stuff and fed me and stayed with me off and on for the first few weeks. I feel like I could write pages and pages, but I think 7 is enough. For now.

Candi (Chandra) DeGroff

Thank you so much, Candi, for sharing your story with us (at last!). It's wonderful to hear it first-hand. <3

Tuesday, October 19, 2010

OB office manager's reply to MyOBsaidWHAT.com submission

My email to the customer service link at my former OB's office:

In 2002, Dr. H was the OB on call when I gave birth to my first child. She said something insensitive and cruel as she stitched up my needless, preventable tear. Recently, I submitted her quote and my story to the website MyOBsaidWHAT.com, and it was published. Don't worry; I didn't name names. I didn't want sued for defamation of character. I did, however, blog about my experience to warn other women, so that they can avoid the suffering I went through. Would you please forward the following links to Dr. H:



The office manager's reply:

Dear Ms. DeGroff,
Per your request, I forwarded your email to Dr. H.

Our goal is to deliver quality care and customer service to every patient that we serve. We only know how we are meeting this goal by hearing from our patients or families. I am sorry that we did not meet your expectations.

Director, Customer Service
X Hospital

Readers, what do you think? Is this just lip service? What are the odds that my comments and links were *actually* sent to Dr. H? One thing is fairly certain: E, Director, Customer Service at X Hospital probably spent a little bit of time reading my blog and MyOBsaidWHAT.com.

Saturday, October 16, 2010

Guest post: Labor & Delivery Nurse shares what she wishes you knew about birth

A few days ago, I posted this article to my Well Rounded Birth Prep Facebook page: "Three Things Nurses Wish You Knew About Childbirth." I'll give you a minute to go check out that link, then come back. It's all right; I'm waiting.

Are you back?

Former labor and delivery nurse Joni Edelman shared the following insights on the article and kindly gave permission to share here.

"Former L&D RN here... And here's what I wish my patients knew:

1. Doulas. Yes. The statistics don't lie and a good doula is an asset to the RN too.
2. REAL childbirth prep. Yes.
3. Birth plans. Yes. But be flexible. Only because in my experience, the more rigid the birth plan, the more likely you'll end up in surgery. I can't explain it but it's true.
4. Pain medication is available and we are happy to give it to you. However, sometimes it's too late for the epidural or that last shot. Labor hurts. Sorry. We can't always make it pain free. Frankly I'm shocked at the number of women who expect this.
5. YOU have the right (and responsibility) to make choices for your baby and yourself. You can refuse intervention and treatment you don't want. (IV, induction, etc) Your RN or OB might be mad or even mean to you but it's your baby and your body.

"But what I REALLY wish people knew is that the statistics are true AND scary. The hospital creates as many problems as it solves. Where else can you walk in healthy and still have a 32% chance of having major surgery? Also pitocin, whether they'll acknowledge it or not, makes for complicated deliveries. OB's like pitocin. They like to exert control when they can because unfortunately they are all terrified of a lawsuit. Most OB's pay more in malpractice insurance than most people make in a year. Don't get me wrong, I LOVE OB's. They have an important role to play when NEEDED. Otherwise they really aren't acquainted with normal, unaltered labor. They rely on quantified information which is great, when necessary, but usually is unnecessary.

"So what I wish people knew is it's safe, and often safer, to have your baby at home with a skilled midwife. I just did and even with a delivery complicated by a severe shoulder dystocia, I'm still glad I had my 10 lb 6 oz baby in my kitchen. It's a long story but because of my experience I know what likely would have happened in the hospital making me that much happier I wasn't there."

You can read Joni's incredible homebirth story in 2 parts:

Ella's story. Part 1: BL (before labor)

Ella's story. Part 2. So it begins...

Friday, October 15, 2010

Links to my blogs about my miscarriage (2007)

OK, in honor of October 15th Pregnancy and Infant Loss Awareness Day, this is my gift to you, but if this goes badly, I promise I will set my old blog back to private again so fast your head would spin.

Here is the link to my 2007 blogs about my miscarriage. Included are links for other online resources on miscarriage, stillbirth, and infant loss.

To make a long story short, blogging about it was very cathartic for me at the time. It was also a convenient way for me to vent about a very difficult situation without having to worry about making my audience uncomfortable. After all, nobody was forced to read it. Most people were supportive for a while, but it didn't take long for a select few "friends" to post very cutting comments on my blogs. I quit blogging when it became more stressful than healing. I couldn't take the criticism any more. In fact, against my better judgment, I deleted a few blogs that had some of the most acidic comments. Now I wish I had not. That just shows the true character of the people who chose to make such comments.

What gave me the courage to leave my blogs up was that every once in a while, I would receive an email from a stranger who told me that reading my blogs helped her heal or validated her situation in her mind. At some point, though, even that wasn't enough to keep me from feeling raw and exposed, so I hid my blogs. One person left comments to inform me that I was not doing some favor for women by blogging about this.

Thus my warning. I've had it with nasty people saying nasty things about my loss or my ways of coping with it. Seriously. I welcome positive or neutral comments (or even diplomatic comments that aren't positive per se), but if like my Grandma said, if you don't have something nice to say, don't say anything at all.

Thursday, October 14, 2010

Why I haven't written about my miscarriage

Tomorrow is October 15th, Pregnancy and Infant Loss Awareness Day. I feel obligated to write something about this, either about pregnancy and infant loss in general, or about healing, or about how things have changed for me over time, or even just in memory as my due date approaches. October 21, 2010, would/could/should have been Evan Michael DeGroff's 3rd birthday. Yes, I realize that due dates are worthless, but it's the only date I have.

I blogged about my miscarriage extensively in the weeks following my loss in 2007. At first, family and friends were supportive, but it didn't take long for a select, vocal few to make me feel like I needed to crawl into a protective shell. They made me sorry that I had made myself vulnerable and had expressed my true feelings.

Why haven't I written about Evan since then, or about loss? It's largely still self-protective and defensive. I'm apprehensive to write anything at all for a fear that people will say something stupid and cruel in response. I still feel betrayed by people who hurt me when this first happened.

The biggest issue I have been avoiding is the "define baby" argument. You are welcome to your own opinion. If you would like to write a few paragraphs about why you think I'm wrong, I suggest that you start your own blog and post it there, instead of littering the comment box with insensitive remarks on how I don't have the right to grieve a baby that "didn't exist." That's what much of this issue boils down to. I lost my BABY in 2007. My real CHILD. Not my "almost-child" or "imaginary child" or "potential to be a child." Not my *shudder* "product of conception," as the ER staff called him. (Even saying the term "product of conception" triggers PTSD in me, or nearly so.) Not just "tissue" or "blob" or "lump of cells." I'll say it very clearly: my baby died.

I know that this isn't the case for everyone, but some people who are "pro-choice" have made it their mission to invalidate my pain and my right to grieve my baby's death, because if they acknowledge my mourning my dead baby as legitimate, with a real source, then what does that say about their stance on stopping that beating heart willingly and purposefully? One pro-choice friend admitted to me that this was the case for her.

I'm also not in the mood to hear any of the following:

"Be thankful. At least you have (insert number here) healthy children."

I am thankful for my healthy children, as well as for God who holds my baby in Heaven and will get me through this, for my loving husband, for the roof over my head, and for the fact that we have enough to eat. One can be thankful for any number of things and still mourn a loss. Grief doesn't diminish or negate thankfulness. Would you say the same thing to me if I were mourning the loss of my grandmother?

"At least you can try again/have more children."

That's really insensitive for a number of reasons, and inaccurate, too. Children are not disposable and replaceable. I cannot go get another one like replacing a 29-cent goldfish. I wanted *that* baby. If any more babies come in the future, I will want them, too. Not only that, but it's not true that just because someone is young and apparently healthy, that they can automatically have more children. You don't know what struggles some people have with trying to conceive, infertility, and the challenges of gestating with joy after a previous loss.

"Your baby isn't 'lost', he's in Heaven now."

Yes, I'm aware of that. I just use the euphemism "lost" to make people feel more comfortable in conversation, but if you prefer that I say "My baby died," I can do that.

"At least it happened early before you got to know him/ got attached."

Um, no. My baby died. I love him. I loved him from the minute I got the positive pregnancy test. I was attached and still am attached. If anything, I envy the time that mothers have with their babies who got more time with them than I did. At least the rest of the world acknowledges the existence of those babies.

"It's better that it happened this way because something would have been wrong with him if he would have lived."

You might feel that way, but I don't. I will love my babies even if they are not "perfect." Maybe you will only accept a perfect baby, and would abort or give a baby up for adoption if they didn't meet your criteria for "perfect," i.e. no Down Syndrome, no birth defects, no cleft lip/palate, no heart defect, boy/girl of your preference, etc. This is America and that's your legal right; I cannot change your mind and will not try to. Keep in mind, however, that nobody is guaranteed a "perfect," "healthy" child, even if they appear so at birth. We are not guaranteed that our children will not get cancer, have heart problems, or be challenged or differently abled in any number of ways.

"It must have been God's will."

Well, to a certain degree, but maybe not the way it's worded here. Without turning my business blog into a religious pulpit, I'd like to at least point out that we live in an imperfect, fallen world. This is not the world that God made; it was perfect when he made it, without sin and without disease or hurt. It was man's sin which brought death and problems into this world. The whole of creation suffers as a result, even the innocent. This is within God's permissive will (meaning He allows it to occur) but I don't believe that God *wants* for babies to die (or be sick or hurt, etc.).

"Just trust God."

Again, yes, but not as it's worded. This is invariably the trite phrase people say when they see that I'm on the verge of tears and they don't know what to say, so they say this. I *do* trust God, thanks. I have from the beginning. And it still hurts. It's called grief, and it's normal to grieve when someone you love dies.

"Don't be angry at God!"

I'm not angry at God. I'm not trying to put down anyone who has this struggle, but personally, it was something I did not experience. So please quit telling me that I did.

"Nobody grieves like this. There must be something wrong with you. You need to seek a therapist and get on medication."

I'd like to throw in a caveat. Some parents do need medical/professional/pharmaceutical help. I'm not arguing that. I would, however, like to say that it's not fair to tell *me* that there's something WRONG with me when there's not, just because the person is uncomfortable with my grief. That's not fair. If you're uncomfortable with seeing or hearing me grieve, that's fine. Walk off.

"You're just trying to make me feel as though I didn't grieve enough/correctly when I had my miscarriage."

No, I'm not.

"Maybe God was trying to teach you a lesson about your life when He allowed this to happen to you."

I heard this from a family member. When I told him that I realized that he didn't mean for it to come across the way that it sounded, but that it was hurtful to me, he clarified that he *did* in fact mean it the way it sounded, and proceeded to give me an hour's worth of earful about his perceptions of my character flaws. I did not feel that it was constructive criticism.

"Maybe the baby you're pregnant with now is really the baby you lost reincarnated!"

This came from someone of a different religion than myself, who *knew* for a fact that I am Christian. Maybe she didn't know much about biblical teachings, but the Bible says that it is appointed to people ONCE to die (not many multiple times) (Heb. 9:27). I'm not trying to belittle anyone who has different beliefs, but if reincarnation were true, then I wasted a HEAP of time crying over my dead baby. All I needed to do was hurry up and get pregnant again as quickly as possible so that I could get my dead baby back. The only inconvenience therein would be an estimated due date about a month or two later. Not only that, but we felt that our dead baby was a boy and named him Evan. Our next baby was a girl.

This is but a small sampling of the unbelieveable (believable) things people say to mothers whose babies have died. Other grieving mothers have told me they have heard the same things. It's not fair that I should feel silenced because it makes other people uncomfortable. Sometimes I feel strong enough to speak out so that I can encourage other mothers that they are not alone, and other times I just want to put up that wall to protect my heart.

Maybe this post is TMI. Maybe this is too personal to share, especially on my business page. But with loss, I feel that you either have to get honest and personal or don't bring it up at all. What good is it to write about loss in terms of platitudes and generalities?

I feel like this had to be said before I could say anything else about loss.

Monday, October 11, 2010

Guest post: Christine's homebirth w/ cord wrapped 4 times

Christine read this post I wrote about nuchal cord (cord wrapped around baby's neck) not being an emergency in births. She wrote me an email and graciously gave me her amazing birth story and photo to share with my readers.

I loved and appreciated reading this today. I gave birth to a baby boy 5 months ago, at home (my 4th baby - 4th home birth). His cord was wrapped around his neck 4 times. He also had heart decels toward the end of my labor - scary heart decels, and my midwife at one point told me "Okay, it's time to get this baby OUT!" She turned up the doppler (I was in water) so that I could hear the heart tones in an attempt to get me to deliver sooner, than later. Both midwives and myself were starting to get slightly alarmed. The decels went away as soon as the contraction ended, so we suspected it was a cord compression issue based on that alone. I wish I could post a photo here as well, because I have a GREAT one, of me standing up in the birth tub to switch positions, as you mentioned, to get the baby in a better position.

I actually caught the baby myself, which brought a whole new level of empowerment into my realm! What a pleasure that was! But back to that cord - how surprised we were to discover a 4 x nuchal cord! And obviously, thinking of the above scenario about the man and his wife's birth story, there was no pitocin, epidural, lithotomy, episiotomy etc going on since ours was a home birth with an (experienced) lay midwife.

Being a 4th time home birthing mother/family, we were never so grateful for the option of home birth and midwives after this experience. Our baby was also born SGA, and I know without a shadow of a doubt, that if we had been under OB care, I would have been heavily and constantly monitored for the small size, and no doubt ultrasounds would have detected that nuchal cord, which I'm quite sure would have robbed me from a mere trial of labor and I would have been sent straight to the OR. Yet, here I can sit now and can say that my baby was born safely at home, in the water, with his cord wrapped 4 times around his neck and he's a live, well, healthy and normal 5 month old baby today!

Thanks for allowing me to share!


Here is the photo I mentioned. This is me in transition, standing up and elevating one leg at a time in an attempt to alleviate cord pressure from my unborn baby who was having heart decels and was born with a 4 x nuchal cord - still, safely at home!


******** graphic birth photo below*******************

***********graphic birth photo below****************

Christine changing positions to help her baby's heart tones.

Above: Christine caught her own baby!

Above: Christine's midwife measuring her son's umbilical cord. It was 3 ft long!