On seeing baby's ultrasound and uncertainty after loss

Trigger warning: This post is about coping with the emotions and issues of pregnancy following loss.





I've been getting really antsy lately to find out whether my baby is still alive. Judge me all you want, but unless you have lost a baby, you have no idea what it's like to wonder if your baby is dead or alive. I've had people judge my faith in God over this, telling me that I just need to have faith. How do they know how much faith I have or don't have? How much faith I have is irrelevant to whether my baby will make it.  I had faith in God when my Evan didn't make it. I had faith in God when my others did. I've even heard some say that by worrying about it, it's more likely to happen due to the Law of Attraction. Sorry, but I don't believe in that. Nobody deserves a miscarriage, attracts it, "asks" for it, etc.

Since my 2007 miscarriage was a "missed miscarriage," everything felt fine and normal. I had no symptoms of miscarriage (other than a dead baby). I had no cramping, no spotting or bleeding, no pain. I still had morning sickness. My uterus continued to expand and I was measuring on target because my womb was filling up with blood and amniotic fluid after my baby's death. I carried him around 6 weeks after he passed on, without having any knowledge of it until the next checkup when my midwife couldn't find the heartbeat.

For this reason, it has been no consolation to me that everything has felt fine and normal. It's not reassuring that I'm definitely showing. These "signs" didn't mean anything when Evan died.

I had my 10 week prenatal checkup this morning. I wasn't sure how long I would wait until asking to hear baby's heartbeat with the Doppler due to the small risk of possibly doing damage or causing miscarriage. I hoped to wait until I was at least in the 2nd trimester to reduce the risk since baby would be less fragile at that point, but I really wanted reassurance. I realize that listening in is only one moment in time and can say that baby is alive at that instant, but can't guarantee what will happen next week or next month. Nevertheless, I need to buy maternity clothes and I have been too scared to buy any for fear of taking the tags off then the baby might die and I would be stuck with the reminders.

The other midwife had taken the regular prenatal equipment bag on rounds today, so my midwife had the backup Doppler that only works half the time. It didn't work today. She hauled out an old monitor to try to listen in. Yes, a monitor, like a hospital monitor to listen to baby's heartbeat in labor. One monitor paddle is a Doppler, just in a different shape, but its flat shape made it impossible to angle downward into my pelvis to be able to hear baby's heartbeat. As a courtesy, my midwife offered to take a peek with her ultrasound machine. By this time, I already had my mind made up that I wanted to see/hear that baby is alive, so I accepted.

We saw ONE baby (not twins, despite how big people think I look for first trimester), right size for 10 1/2 weeks, with a heartbeat. That was reassuring, but not to the degree that I expected. I hoped to feel much better, perhaps even "back to normal." Maybe there is no such thing any more. Maybe it's just because we have no assurance of tomorrow. Knowing that my baby is "fine" today doesn't mean much since we're still in that first trimester when there's the highest risk of miscarriage.

I'm thankful for a good prenatal checkup today (all other measurements and markers were perfect as well), but I'll feel much better when I feel baby's movements. I pray that I'm blessed with a squirmy, active baby who makes his or her presence continually felt sometime in the next month or month and a half.

Belly shot: 8 weeks along

This photo was taken at 7 weeks 6 days along with New Baby, right after the James Taylor concert hubby and I went to. (We bought the tickets with my Well Rounded Birth Prep teaching money from Jan. & Feb.! Thanks to you, my clients!)

Pregnancy #6, live baby #5.

Before I got the positive pregnancy test at 4 weeks 4 days along, I already had to unbutton my jeans when sitting down. I've lost 3 pounds from nausea, but still have to unbutton my jeans when sitting. I've already worn my Bella Band over unbuttoned jeans a few times.

My body gets one whiff of hCG and says, "We totally know what to do with this! Let's GOOOOOO!"

...and my best friend is pregnant, too!

Trebor on left, me on right, w/ our 4th babies. Nov 2010.

You might remember my best friend Trebor's Sutler's birth story from her previous baby. She had a peaceful home waterbirth with midwives, on Christmas day a few years ago, which was her second VBA2C (vaginal birth after 2 cesareans). Here is her birth story and what led up to it. Her story was featured in several local newspapers.

Trebor and her husband Rob have a lot in common with me and my husband, Rick. We each have four children close to the same ages, lost one to miscarriage, homeschool our kids, similar lifestyle choices (try to eat healthy, teach our kids manners, etc.), homebirth, baby-led weaning, and more. Trebor and Rob decided a few months ago to try for Baby #5. Rick and I cheered them on but did not plan on joining that club.

Then I found out I was pregnant. That was supposed to be Trebor, not me! At that point, Rick doubled up his efforts to root for Trebor to get pregnant ASAP so that he and I wouldn't be the only ones in this boat. About two weeks after I got my positive pregnancy test, Trebor got hers. Wow. Our due dates are only two weeks apart!

We share the same homebirth midwives and now we're in a race to the finish. Who will get our primary midwife (maybe we both can)? What will the weather be (due late December or early January and we both live up a steep hill)? Surely we won't go into labor at the same time. I was counting on having her as my doula and birth photographer. If all goes as planned, we'll still be able to doula each others' births, but one of us will have to attend the other's birth with a newborn in a Moby Wrap and hope that he or she sleeps a lot.

My husband had a different idea. He thought that it actually *would* be a good idea for me and Trebor to go into labor at the same time so that we can get it over all at once, share a birth tub, moo together, then catch each others' babies. Then the men could go watch TV while we women do all that birth stuff. Haha Rick. Um, no thanks.

At any rate, a true best friend will walk with you through any journey in life, and I'm looking forward to sharing this crazy ride with Trebor. It will make for some awesome maternity photos!

I'm pregnant (yes, AGAIN!).

Wednesday, April 20, 2011, I was on day 32 waiting for my cycle. This wasn't unusual for me, since my cycles vary from 26 to 34 days. Rick and I were going on a 3-day-2-night mini-trip without the kids; Rick had a work conference he had to attend and I was tagging along, figuring that I could shop and relax while he was in meetings. (This was a first, literally. We rarely have a babysitter even for one evening. We had never taken a trip without the kids.) We were leaving that evening, so I took the test early that morning, just so I could get a negative result and have it off my mind. I really did NOT anticipate seeing two lines. Just to be sure, I took the second test, which was a different brand, and figured that the odds of two false-positives were nearly nil.

So, I'm pregnant again. This is my 6th pregnancy (5th live baby); my oldest child is 8 (but will be 9 by the time baby comes). I'm due late December 2011 or early January 2012. This should be interesting.

I've put off posting it publicly for a number of reasons. I've had several time-sensitive, time-intensive, stressful issues that I've had to deal with. I'm homeschooling my four kids. I have been teaching private birth classes. My hubby usually works late. And I was just recovering from 2 bouts of strep within a month.

But mostly, I'm not prepared (still) to deal with any criticism. It's nobody's business how many children we have. We're not on public assistance, so nobody can complain that my kids are a tax drain (they're not). I wasn't particularly worried about what my blog readers would say, since many/most of you are birth advocates, birth junkies, and/or birth professionals, and you will probably be happy and excited for me. Maybe you'll follow me on this journey. It's mostly acquaintances or complete strangers who make snide comments.

We believe that every child is a blessing and a gift from God. Even so, this was a bit of a surprise and I'm left feeling a bit unprepared to start alllll over again when things were just starting to get a little bit easier. My (former) youngest is 2 years old and can entertain herself somewhat. My kids can play independently and even make themselves a sandwich (and put all the ingredients away). All 4 of my kids can dress themselves (the oldest two help dress the 2-year-old) and even get themselves buckled into all their car seats in the van. I realize that these things will make life easier when the new baby comes. My children have always been big helpers for whoever the new baby was at a time, and they'll be even more helpful this time around. I'll figure it out, because people do.

Here's a list of stuff not to say to me, at the risk of me snapping at you. Don't push me or you might be on the receiving end of a pregnancy-hormone-laced response.

• "Don't you know what causes that yet?" 

What I might reply: "Why yes, yes I do. In fact, I teach classes on it; would you like for me to draw you a helpful diagram?" 

What I'm thinking: "Do I look THAT dumb to you? Seriously??? No, I really DON'T know what causes that, because I'm an IDIOT. What do YOU think??? Do you really think you're the first smart-aleck to come up with that one, anyway?"

• "You know there's a way to stop that, right?" 

What I might reply: "To each their own. I'm glad that your decision worked for you." 

What I'm thinking: "How rude! I don't tell others what to do with their bodies or whether they should or should not be using contraception or have surgery. What right do they think they have to tell me what to do!"

• "Oh you poor thing. I don't know how you're going to do all that with 5 small children. You sure are going to have your hands full!" 

What I might reply: "I'd rather have my hands full than empty. We're really blessed. We love our kids."

What I'm thinking: "Some days I'm discouraged and intimidated and I don't know how I'll manage this, although I'm trusting God to give me grace to handle it the way He would have me to. However, I don't need any Eeyores hanging around telling me how awful it's going to be. The baby is coming whether you like it or not, so how about offering me encouragement or help or SHUTTING UP?"

• "Are you trying to have enough to have your own baseball team?"

What I might reply: "Haha. Maybe. I hadn't really thought of that."

What I'm thinking: "Another genius who thinks he's original."

• "How are you going to pay for college for that many children?"

What I might reply: "I'm an only child, yet somehow nobody managed to set aside money for my college. I was told from a very young age that I would earn an academic scholarship. I knew that I needed to work toward that goal, and I did it. Scholarships are a great possibility."

What I'm thinking: "College degrees have been devalued to the point that they might or might not be the best option for my children when the time comes. They may want to work in a trade or apprentice. Who knows?  Besides, what business is it of yours? How are YOU going to pay for college for YOUR children?"

• "Are you sure there's only one baby in there???"

What I might reply: "I'm measuring on target for one baby. I'll see baby at the 20 week ultrasound. This is my 6th pregnancy in 9 years, so my body responds to pregnancy hormones and I 'show' very early."

What I'm thinking: "I'm sorry that you think I look like a COW. As if I weren't insecure enough about my belly without your help bringing me down. Try a little sensitivity."

• "Are they all yours?"

What I might reply: "Yes, they are. We have good kids."
What I'm thinking: "No, they're *not* all mine, I just thought it would be a good idea to babysit a bunch of kids and drag them all over town instead of staying home for the few hours I'd be babysitting."

• "Wow, better you than me!"

What I might reply: "I agree!"
What I'm thinking: "She set herself up for that one."

That's just the list for starters. I'm sure I'll think of others later. I've heard them ever since my 4th pregnancy (with Evan, the baby we lost in 2007) so this will make the third pregnancy where I have felt that I have to defend myself. Also, I know I'll feel better once I round into the second trimester and the risk of miscarriage drops substantially. Wondering whether this baby will make it has made defending myself doubly hard.

In spite of all that, I don't want anyone or anything to steal my joy. There's a baby inside of me!

The Day My World Came Crashing Down--4 year anniversary

***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.

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?

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.