***trigger warning*** This blog is about miscarriage.
I realized that I have never written about That Day, the day I found out that my baby was dead, at 14 weeks 3 days along. I've written about the day after, researching my options and trying to decide whether to be induced or whether to wait it out to allow my body to go into labor naturally or whether to choose a D&C. I've written about the path to healing. But not about what happened That Day.
Four years ago today, I thought everything was fine. I was pregnant with my fourth baby, and my oldest child was four and a half years old. I had a regular prenatal appointment at my house with my midwife That Day. My last prenatal appointment had been at 8 weeks 3 days along. I had asked my midwife if we could stretch the next prenatal appointment a bit farther than the usual 4 weeks between visits because I had a busy schedule around that time, and she accommodated me.
The first part of my checkup went normally: blood pressure, pulse, weight, urinalysis, my midwife asking me how morning sickness was going and whether I had started to feel better yet. (My morning sickness had been normal, with queasiness starting around 6 weeks along and lessening around 13 weeks. My pregnancy hormone levels were high and healthy.)
Everything was fine until my midwife got out her Doppler to listen to baby's heartbeat. She couldn't find it right away, but I wasn't alarmed. She tried to reposition it to see if she could hear it from a different angle, but still couldn't locate it. I still wasn't worried. I figured that it could be possibly still be difficult to find the heartbeat on Doppler this early. My midwife wanted to get me an appointment for an ultrasound right away. Like, 3 hours later. I was a bit taken aback at the seeming urgency for this, but went along with it, knowing that I would feel much reassured after seeing that baby was fine when I had an ultrasound.
At first, my husband Rick said that he wasn't sure if he would be able to take the afternoon off. Neither he nor I understood the seriousness of the situation. My midwife said that if he couldn't come, she would go with me, because I should not go to that appointment alone. Uh oh. That doesn't sound good. Rick managed to hurry home and we got the kids into the car and rushed them off to my friend's house so we could go to the ultrasound alone.
I remember that it was chilly and drizzling that day--same as today. I remember being on the interstate nearing the hospital, thinking it was so surreal, still thinking that everything was fine. I remember thinking that we would look back on this afterward and think, "Wow, that sure was a close call. Pretty scary. I'm glad everything was OK." I just didn't get it.
We didn't have to wait in the lobby for long. They took me and Rick back to the private ultrasound room. The ultrasound tech started the scan--and my heart sank right away. She moved the transducer around, but my baby didn't move. There was no heartbeat. And I've seen enough ultrasounds to have a general idea what babies look like at different gestational ages on ultrasounds; this definitely wasn't right. My baby not only didn't move, but was way too small. The ultrasound tech said she was sorry, but there was no heartbeat, and the "fetus" measured 8 weeks 5 days. She left to get the doctor to confirm. I was shocked. My world was crushed in an instant.
The doctor was very matter-of-fact and sort of cold. I don't remember his exact words; they cut too deep for me to record them at the time. He was quite casual about it, saying that 25-50% of all pregnancies end in miscarriage, often before the mother even knows she's pregnant. That may be true, but it didn't change the fact that my baby just died. MY BABY DIED. Whatever else he said involved the words "product of conception," the first of many times I would hear that phrase from medical professionals over the next few days, unfortunately.
I cried. Rick held my hand. Then we did the Walk of Shame as they ushered us quietly out the rear exit. I was embarrassed because I realized that it was more for the sake of the other pregnant mothers in the waiting room, to spare them from having to see me shaking with sobs, rather than to spare me from having to see other pregnant women.
We made our way back to our van. I had no idea what to do next. We called my friend who was watching our kids to let her know what had happened, and she said to take as much time as we needed. Rick and I took a drive for a few hours, talking it over and calling our family and a few close friends to tell them the news. Ironically, the sky cleared and the sun came out. The rest of the day was beautiful.
This happened on a Thursday, so I knew that I was pressured for time to decide what to do. If I decided to wait it out for my body to miscarry naturally, I would be in no hurry, but who knows how long until my body got the memo. I had not had any cramping, bleeding, or any other miscarriage symptoms yet. But I wanted this over with. My baby was gone already, so it didn't matter to try to have the "best birth possible to keep baby safe." I could not begin to seek closure while my baby's body was still in my womb, and waiting could potentially take weeks. I was also frightened of what a natural miscarriage could be like. I wish I had known more people who had been diagnosed with a "missed miscarriage" like mine, who did choose to wait it out, because I might have chosen differently had I not been so afraid. I felt rushed because if I didn't make my decision that night, I'd be forced to wait out the weekend and would not be able to have a D&C or induction until Monday. I didn't want to be cornered into a decision because I was pressed for time.
I would never be the same person after That Day.
Well Rounded Birth Prep
WellRoundedBirthPrep.com
Wednesday, April 27, 2011
Sunday, April 17, 2011
Good labor snacks--and why moms need them
There's an old wives' tale that you shouldn't have anything to eat other than ice chips during labor (with the possible exception of clear liquids such as popsicles). The good news: research has shown for years that there are clear risks to withholding food and drink from laboring moms, and that they need calories and hydration to complete the hard work of labor and birth, with literally no benefits at all to withholding food or drink. This means you should be able to eat and drink anything you want! The bad news: most OBs believe the old wives' tale and aren't even aware of research contradicting it.
Chapter 4 of The Thinking Woman's Guide to a Better Birth, by Henci Goer, is called "IVs: 'Water, Water, Everywhere, Nor Any Drop to Drink." She details the history behind current obstetrical traditions and superstitions regarding eating and drinking during labor, as well as the risks of withholding food and drink from a laboring woman, and risk/benefit comparisons. There are several pages of explanation of why routine IVs have serious risks of their own with no potential benefits; routine IVs do not replace eating and drinking in labor.
Synopsis of Ms. Goer's Bottom Line on Forbidding Food and Drink in Labor:
Pros: None
Cons: Hunger, thirst, discomfort, dehydration sometimes resulting in fever, exhaustion leading to fewer or less effective contractions (which is viewed "Failure to Progress" and is seen as a necessity to augment labor by means of Pitocin or other drugs and interventions), imbalance of electrolytes, drop-off in blood sugar levels producing ketones which can cross into fetal circulation causing fetal blood to become more acidic (acidosis) which is a symptom of fetal distress. Increased perception of pain when hungry and/or thirsty. Seizures can result if mom's electrolytes are out of whack and blood sugar is bottomed out.
What kinds of foods make good snacks during labor? Here's Ms. Goer's suggestion: "Fat delays digestion. Solids must be broken down into tiny bits to pass into the intestines. High concentrations of sugar and acid and either low or high concentrations of salt also slow digestion. Heavily sweetened drinks can also cause nausea and acid in the stomach, which, as we have seen, should be avoided. Icy liquids empty more slowly as well. Given these criteria, choose food and drink that you know you tolerate well, the kind you would consume if you were recovering from the stomach flu."
Eating and drinking small quantities more often is easier on the digestion than larger quantities less frequently.
That being said, it's your labor, and if you're craving something that's on the forbidden list (for example, greasy or rich foods) and don't care if it comes back up, have at it. While not all moms vomit during labor, vomiting can help with dilation.
Many mommas can manage to eat lightly in early labor but don't want to eat as labor progresses. Some moms aren't hungry in labor or are nauseated and food doesn't appeal to them. For a short labor, that's fine; listen to your body. For a long labor, momma will need sustenance from somewhere (if not from food and drink, then from IVs. See chapter 4 of The Thinking Woman's Guide to a Better Birth for full list of pros and cons to that option). Sometimes it's easier to drink little sips in between contractions even in active labor, transition, and pushing, than it is to eat.
I've compiled a list of popular labor snacks and drinks. Feel free to take what works for you and leave the rest behind, keeping in mind your particular dietary needs and preferences.
Labor drinks:
water (will meet your hydration needs but not needs for calories, blood sugar, electrolytes, and more). Bring plenty of bottled water for your birth partner and doula, as well as for yourself for dumping in electrolyte powdered drink mixes.
100% fruit juice (non-acidic). If packing for hospital or birth center, 100% fruit juice boxes are convenient.
electrolyte drinks. You can make your own safe electrolyte drinks if you don't want to ingest the artificial ingredients in Gatorade. Some moms have enjoyed Emergen-C powdered instant drinks for a labor pick-me-up, but as the previous linked article explains, there's a question whether Vitamin C overload (or possibly the imbalance of calcium and other minerals/vitamins in the presence of large volumes of Vit C) can contribute to hemorrhage. A sort-of-natural alternative to Gatorade is Crystal Lite's Pure Fitness powdered electrolyte drink, which contains no artificial colors, flavors, or preservatives, and is sweetened by Stevia. While traditional artificial sweeteners such as aspartame, saccharin, acesulfame K, etc., are clearly not safe for pregnancy, Stevia may be a safe alternative. I'm not turning this blog into a discussion about Stevia; you can Google it if you're concerned. I've also heard good reviews about Vitalyte electrolyte drink, but I do not have personal experience with it.
coconut water, which contains many nutrients and also contains electrolytes and outperforms electrolyte sports drinks and plain water in research on rehydration.
decaffeinated tea, unsweetened or sweetened with honey
Red Raspberry Leaf tea, which also confers labor benefits (as well as 3rd trimester benefits). You can also blend RRL tea into Pregnancy Punch with apple juice, honey, and frozen red raspberries for a delicious and nutritious labor snack, or freeze it as popsicles.
skim milk
fruit smoothies made with non-acidic fruits (and any other ingredients from this list that sound good, such as honey, yogurt, skim milk, etc.) Here's Birth Faith's Birthing Brew for labor nutrition and possible prevention of hemorrhage (this statement has not been tested by the FDA for effectiveness of use, etc.).
protein shakes/drinks
Light carbs:
honey. Honey sticks, honey packets, honey bears, whatever is most convenient. Honey sticks are easiest for mom to suck on without changing her position.
soft, non-acidic fruits
100% applesauce. If packing for hospital or birth center, individual packs are handy. Here's an innovative form of applesauce packaging: you slurp it through a built-in straw. Handy so that mom doesn't have to change positions.
rice cakes (with jam, honey, applesauce, etc.)
plain bagels (with jam, honey, applesauce, etc.)
toast (with jam, honey, applesauce, etc.)
oatmeal
Cream of Wheat
graham crackers. saltine crackers, any other crackers
cooked pasta, plain or with a bit of salt or cheese
cooked rice. If packing for hospital or birth center, the ready-packs of rice that only need microwaved 90 seconds are a convenient option.
granola bars or trail mix
cereal with skim milk
pancakes or waffles. You can make your own healthy ones ahead of time and freeze them to reheat, or buy pre-made ones. They have healthy alternative ones in the organic frozen section now.
puddings, custards (nonfat or low fat)
Jell-o. Make your own or buy pre-made packs.
sorbet. Individual cups are always a good idea. Do you really want to be looking for an ice cream scoop during labor?
popsicles
lollipops, especially sour ones. They tend to be less nauseating than sweet ones.
Light proteins:
fat-free yogurt or Go-gurt (These taste great frozen, and they have new natural Go-gurts with no HFCS and no artificial colors, flavors or preservatives.)
cheese cubes or string cheese
peanut butter crackers
eggs
chicken noodle soup or broth
protein bars
Don't forget to have more substantial food to sustain your birth partner (husband or significant other), doula, and possibly your midwives (if homebirth). Crackers likely won't tide them over. Also, Mom will likely be ravenous after delivering and will want a hearty meal to reward her for her hard work.
If your hospital has a policy of "nothing but ice chips or clear liquids," it's best to discuss this well in advance with your care provider to see whether this is strictly enforced or whether most moms do in fact eat and drink freely while in labor at that facility. Find out early enough so that if this is going to be a problem, you have time to shop for another care provider or another birth location. If you cannot or choose not to change birth location, you can pack a small lunchbox/cooler of foods and drinks for your birth partner who will certainly be very hungry and thirsty. If any staff asks about the food stash, you can truthfully tell them that your birth partner gets hungry and needs to eat to maintain blood sugar and supportive mood. Do you catch my drift? Good, because I would never tell you to lie to staff or care provider.
Now, go eat, drink, and be merry!
What did you eat and drink during labor? What did you wish you could have but didn't/couldn't? What was satisfying?
Chapter 4 of The Thinking Woman's Guide to a Better Birth, by Henci Goer, is called "IVs: 'Water, Water, Everywhere, Nor Any Drop to Drink." She details the history behind current obstetrical traditions and superstitions regarding eating and drinking during labor, as well as the risks of withholding food and drink from a laboring woman, and risk/benefit comparisons. There are several pages of explanation of why routine IVs have serious risks of their own with no potential benefits; routine IVs do not replace eating and drinking in labor.
Synopsis of Ms. Goer's Bottom Line on Forbidding Food and Drink in Labor:
Pros: None
Cons: Hunger, thirst, discomfort, dehydration sometimes resulting in fever, exhaustion leading to fewer or less effective contractions (which is viewed "Failure to Progress" and is seen as a necessity to augment labor by means of Pitocin or other drugs and interventions), imbalance of electrolytes, drop-off in blood sugar levels producing ketones which can cross into fetal circulation causing fetal blood to become more acidic (acidosis) which is a symptom of fetal distress. Increased perception of pain when hungry and/or thirsty. Seizures can result if mom's electrolytes are out of whack and blood sugar is bottomed out.
What kinds of foods make good snacks during labor? Here's Ms. Goer's suggestion: "Fat delays digestion. Solids must be broken down into tiny bits to pass into the intestines. High concentrations of sugar and acid and either low or high concentrations of salt also slow digestion. Heavily sweetened drinks can also cause nausea and acid in the stomach, which, as we have seen, should be avoided. Icy liquids empty more slowly as well. Given these criteria, choose food and drink that you know you tolerate well, the kind you would consume if you were recovering from the stomach flu."
Eating and drinking small quantities more often is easier on the digestion than larger quantities less frequently.
That being said, it's your labor, and if you're craving something that's on the forbidden list (for example, greasy or rich foods) and don't care if it comes back up, have at it. While not all moms vomit during labor, vomiting can help with dilation.
Many mommas can manage to eat lightly in early labor but don't want to eat as labor progresses. Some moms aren't hungry in labor or are nauseated and food doesn't appeal to them. For a short labor, that's fine; listen to your body. For a long labor, momma will need sustenance from somewhere (if not from food and drink, then from IVs. See chapter 4 of The Thinking Woman's Guide to a Better Birth for full list of pros and cons to that option). Sometimes it's easier to drink little sips in between contractions even in active labor, transition, and pushing, than it is to eat.
I've compiled a list of popular labor snacks and drinks. Feel free to take what works for you and leave the rest behind, keeping in mind your particular dietary needs and preferences.
Labor drinks:
water (will meet your hydration needs but not needs for calories, blood sugar, electrolytes, and more). Bring plenty of bottled water for your birth partner and doula, as well as for yourself for dumping in electrolyte powdered drink mixes.
100% fruit juice (non-acidic). If packing for hospital or birth center, 100% fruit juice boxes are convenient.
electrolyte drinks. You can make your own safe electrolyte drinks if you don't want to ingest the artificial ingredients in Gatorade. Some moms have enjoyed Emergen-C powdered instant drinks for a labor pick-me-up, but as the previous linked article explains, there's a question whether Vitamin C overload (or possibly the imbalance of calcium and other minerals/vitamins in the presence of large volumes of Vit C) can contribute to hemorrhage. A sort-of-natural alternative to Gatorade is Crystal Lite's Pure Fitness powdered electrolyte drink, which contains no artificial colors, flavors, or preservatives, and is sweetened by Stevia. While traditional artificial sweeteners such as aspartame, saccharin, acesulfame K, etc., are clearly not safe for pregnancy, Stevia may be a safe alternative. I'm not turning this blog into a discussion about Stevia; you can Google it if you're concerned. I've also heard good reviews about Vitalyte electrolyte drink, but I do not have personal experience with it.
coconut water, which contains many nutrients and also contains electrolytes and outperforms electrolyte sports drinks and plain water in research on rehydration.
decaffeinated tea, unsweetened or sweetened with honey
Red Raspberry Leaf tea, which also confers labor benefits (as well as 3rd trimester benefits). You can also blend RRL tea into Pregnancy Punch with apple juice, honey, and frozen red raspberries for a delicious and nutritious labor snack, or freeze it as popsicles.
skim milk
fruit smoothies made with non-acidic fruits (and any other ingredients from this list that sound good, such as honey, yogurt, skim milk, etc.) Here's Birth Faith's Birthing Brew for labor nutrition and possible prevention of hemorrhage (this statement has not been tested by the FDA for effectiveness of use, etc.).
protein shakes/drinks
Light carbs:
honey. Honey sticks, honey packets, honey bears, whatever is most convenient. Honey sticks are easiest for mom to suck on without changing her position.
soft, non-acidic fruits
100% applesauce. If packing for hospital or birth center, individual packs are handy. Here's an innovative form of applesauce packaging: you slurp it through a built-in straw. Handy so that mom doesn't have to change positions.
rice cakes (with jam, honey, applesauce, etc.)
plain bagels (with jam, honey, applesauce, etc.)
toast (with jam, honey, applesauce, etc.)
oatmeal
Cream of Wheat
graham crackers. saltine crackers, any other crackers
cooked pasta, plain or with a bit of salt or cheese
cooked rice. If packing for hospital or birth center, the ready-packs of rice that only need microwaved 90 seconds are a convenient option.
granola bars or trail mix
cereal with skim milk
pancakes or waffles. You can make your own healthy ones ahead of time and freeze them to reheat, or buy pre-made ones. They have healthy alternative ones in the organic frozen section now.
puddings, custards (nonfat or low fat)
Jell-o. Make your own or buy pre-made packs.
sorbet. Individual cups are always a good idea. Do you really want to be looking for an ice cream scoop during labor?
popsicles
lollipops, especially sour ones. They tend to be less nauseating than sweet ones.
Light proteins:
fat-free yogurt or Go-gurt (These taste great frozen, and they have new natural Go-gurts with no HFCS and no artificial colors, flavors or preservatives.)
cheese cubes or string cheese
peanut butter crackers
eggs
chicken noodle soup or broth
protein bars
Don't forget to have more substantial food to sustain your birth partner (husband or significant other), doula, and possibly your midwives (if homebirth). Crackers likely won't tide them over. Also, Mom will likely be ravenous after delivering and will want a hearty meal to reward her for her hard work.
If your hospital has a policy of "nothing but ice chips or clear liquids," it's best to discuss this well in advance with your care provider to see whether this is strictly enforced or whether most moms do in fact eat and drink freely while in labor at that facility. Find out early enough so that if this is going to be a problem, you have time to shop for another care provider or another birth location. If you cannot or choose not to change birth location, you can pack a small lunchbox/cooler of foods and drinks for your birth partner who will certainly be very hungry and thirsty. If any staff asks about the food stash, you can truthfully tell them that your birth partner gets hungry and needs to eat to maintain blood sugar and supportive mood. Do you catch my drift? Good, because I would never tell you to lie to staff or care provider.
Now, go eat, drink, and be merry!
What did you eat and drink during labor? What did you wish you could have but didn't/couldn't? What was satisfying?
Saturday, April 9, 2011
Celebrating my 1 year anniversary as a childbirth educator
Today marks one year from the beginning of my journey as a childbirth educator. April 8-9, 2010, I attended an ICEA workshop taught by Connie Livingston in Dayton, OH. I wasn't even quite sure what my goals were as a future childbirth educator. I had spent countless hours reading books, articles, and research about pregnancy and birth, and it seemed like sort of a waste to have no outlet for that information other than preaching to the choir in message boards for birth junkies, doulas, childbirth educators, and midwives-to-be. I had helped a few friends find the information they needed to make informed decisions about their births, but my scope was limited since I was "just another mom who might have read one too many birth books." I didn't even know what certification might entail. I felt that I needed to take this workshop to become a more effective help, no matter how many or few couples I would teach.
A year ago today, I could never have foreseen how far I would come in a year. I acknowledge that I have so much still to learn, and I'm continually striving to learn more, but I can see progress in a year's time. I've completed the majority of the requirements for completing certification as a childbirth educator with ICEA. Now if only someone would come watch my kids for me so I could get the rest of my reading finished, then I can take the written exam and make it official! (ICEA gives applicants two years from the date of application to complete certification, so I'm ahead of my goal dates.)
* I was required to attend a minimum of two births to satisfy ICEA requirements for my certification. So far, I've attended four births since June 2010.
* In June 2010, I completed (and recorded, and sent to Connie on DVD) a four-week, 12 hour childbirth class series, which she and my clients/students evaluated in depth on ICEA's evaluations. To count for certification requirements, I had to teach a real pregnant momma and her birth partner (not just teach to a camera in an empty room); I was blessed to have 4 pregnant mommas with birth partners for my first teaching series! In the past year I have taught a total of 20 expectant mommas and their families.
I look back fondly at the past year, at the classes I have taught, friends I have made, myths I have busted, and foundations I have built. I'm thankful for these opportunities, and I won't take them for granted or let them go to waste. I look forward to my future.
A year ago today, I could never have foreseen how far I would come in a year. I acknowledge that I have so much still to learn, and I'm continually striving to learn more, but I can see progress in a year's time. I've completed the majority of the requirements for completing certification as a childbirth educator with ICEA. Now if only someone would come watch my kids for me so I could get the rest of my reading finished, then I can take the written exam and make it official! (ICEA gives applicants two years from the date of application to complete certification, so I'm ahead of my goal dates.)
* I was required to attend a minimum of two births to satisfy ICEA requirements for my certification. So far, I've attended four births since June 2010.
* In June 2010, I completed (and recorded, and sent to Connie on DVD) a four-week, 12 hour childbirth class series, which she and my clients/students evaluated in depth on ICEA's evaluations. To count for certification requirements, I had to teach a real pregnant momma and her birth partner (not just teach to a camera in an empty room); I was blessed to have 4 pregnant mommas with birth partners for my first teaching series! In the past year I have taught a total of 20 expectant mommas and their families.
I look back fondly at the past year, at the classes I have taught, friends I have made, myths I have busted, and foundations I have built. I'm thankful for these opportunities, and I won't take them for granted or let them go to waste. I look forward to my future.
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