Tuesday, March 29, 2011

Let's Talk About Breastfeeding - Part I

Whew, now that the stories are told, we can get down to business. I think the major theme that ran through those first six posts was "breastfeeding." First, how badly I wish I had, and second, how obsessed with that goal I became, and third, how thrilled I am at how well it went for me the second time. So let's talk about breastfeeding. In Part I, we'll look at the clinical side. What's so great about breastmilk? What are the benefits of breastfeeding for mother and baby? What's "wrong" with formula? And so on. I'll keep it to summary length, as there's plenty of this information out there. In Part II, I intend to make it more personal. Why did I want so badly to breastfeed? What do I feel I got out of it? What do I feel my son got out of it?

I've adopted the philosophy of many breastfeeding-advocacy sites and groups who now like to say that "breastfeeding is normal and formula is an inferior substitute." I put this right up front because what we're most used to hearing is the catchy phrase "breast is best." This implies that any alternatives to breastfeeding are perfectly fine, but breastfeeding is "better." Along with this come the studies that say "babies who are breastfed have fewer ear infections," "babies who are breastfed have a lower mortality rate," and so on. Why not flip it around? "Babies who are not breastfed have an increased risk of ear infections," "babies who are not breastfed have a higher mortality rate." It changes the way you think.

I don't want to put myself out there as a "boob nazi" or "lactivist." Frankly, as I said in my first post, I don't have any real say in what choice you make. I just want you to make an informed choice. I'll admit it does make me a little sad when I see or hear that someone is feeding their baby formula, but I don't always know the whole story, and there are many reasons why you might need to feed formula, from adoption to fostering to a medical issue with mother or baby. I'm sure all of this will come up in future posts. Anyway, I'm hardly one to talk, considering.

Okay, disclaimers out of the way. Let's get to the meaty stuff. Or the milky stuff, as the case may be.

Formula versus Breastmilk
Let's start with the most common alternative to feeding breastmilk: Infant formula. What is it? Infant formula is a complex combination of various proteins, vitamins, minerals, fats, and sugars, and sometimes beneficial bacteria and/or amino acids such as DHA and RHA, derived from natural and artificial sources, usually using cow's milk or soy milk as a base. In the early days of formula, it was simply cow's milk mixed with some sugar and other additives, which you mixed yourself based on a "formula" (or recipe) created by scientists and doctors, but the formulas that are manufactured today are far more complex and, to be honest, much better than those olden-day home-made milks. They are heavily processed to break down and change the protein and fat content of the base milk, then fats, vitamins, minerals, and sugars are added so that the baby is receiving the right balance of all of these ingredients, vital for the development of the brain, eyes, muscles, bones, and everything else.

Babycenter (http://www.babycenter.com/0_choosing-formula-a-primer_1334669.bc?page=2#articlesection4) has a good overview of the main ingredients in a typical baby formula.

Sounds pretty good, right?

Infant formula is a valid, if inferior, alternative to feeding breastmilk if there is an indicated reason to do so. Many, many babies have been raised on exclusively formula and are perfectly healthy, intelligent, successful people. Formula will not kill your child, and you are not a terrible person for using it. I would never presume to say that.


Let's look at breastmilk for a minute, shall we?

I'm only going to cover the bare basics here, because human milk is a fabulously complex, ever-changing, and still mysterious compound containing hundreds of "ingredients," not all of which have been identified! We know that breastmilk contains all of the water, fats, proteins, sugars, vitamins, minerals, and other nutrients that a baby needs for at least the first six months of life, meaning that a baby requires nothing but breastmilk to be totally healthy and to thrive. These nutrients are present in exactly the right balance, and are primed for easy digestion by a baby's immature digestive tract. Also in breastmilk are antibodies provided by the mother's immune system that coat the baby's intestines and help prevent absorption of harmful bacteria and viruses that may cause infections, diarrhea, and other serious illness. Breastmilk also contains stem cells and amino acids. In addition, the nutrients in breastmilk are more bioavailable than the artificially-introduced nutrients in formula, meaning the baby can make better use of them and absorb them better, just as adults can better utilize the vitamins and minerals in natural foods than those in a multivitamin supplement.

The most amazing thing about breastmilk, I think, is that it changes in composition over time. In fact, the breastmilk a mother's body manufactures for a preemie is different from that for a full-term newborn, which is different from that a 10-month-old baby drinks. Different antibodies are present depending on what diseases the mother has been exposed to. Scientists are still discovering all of the compounds present in breastmilk and figuring out what they do. Far be it for me to try to write a treatise on it! A simple Google search will bring up plenty of pages of information about what's in breastmilk and what those things do.

Dr. Sears' website has an interesting chart comparing the ingredients of breastmilk and formula. (http://www.askdrsears.com/html/2/T021600.asp)

Other Benefits of Breastfeeding
There is more to breastfeeding than just the milk the baby receives. While the milk alone is incredibly important, as you may have gathered, there's a lot more to it. The act of breastfeeding, itself, has many positive effects on both baby and mother. Thus, even if a woman is truly unable to produce enough breastmilk to fully support her baby (we'll talk about this in a separate post down the line), continuing to feed from the breast as much as possible while supplementing with formula has additional benefits.

In the early days and weeks of a newborn baby's life, skin-to-skin contact with a parent helps the baby to regulate his body temperature, respiration, and heart rate. (This is also why placing the newborn on the mother's chest directly after birth is so beneficial.) Babies who are touching another human are calmer, less fussy, and show less stress reaction than babies who are separated from their parents or denied skin-to-skin contact. Breastfeeding automatically creates this contact between mother and baby, and the skin-to-skin contact also helps to stimulate milk production in the mother. Here is more about the benefits of skin-to-skin contact (http://www.naturalchild.org/guest/jack_newman2.html).

Then there's the whole "breastfed babies are healthier" thing. It's true. Scientists are still not entirely sure of all of the "whys" of this, but we can probably think of a few obvious reasons. Breastmilk contains all of those antibodies that can help the baby fight infection. Also, the bioavailability of the fats, proteins, and nutrients in breastmilk mean that the baby efficiently absorbs all of those building blocks of a healthy body that are necessary for the body to function normally.

Breastfed babies are less likely to develop ear infections, asthma,  diabetes, obesity, certain cancers, diarrhea, and other digestive issues. There may be many reasons for this, but the statistics are clear. In fact, the journal Pediatrics published an article in April of 2010 that stated that if 90% of American women breastfed their babies for the first six months of life, approximately 900 babies' lives per year would be saved, along with about $13 billion in healthcare costs (per year). (http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-1616v1)

Breastfeeding also provides health benefits to the mother. Women who have breastfed show lower instances of breast and ovarian cancers as well as diabetes and other health concerns. There appears to be a cumulative effect, in that the more years a woman breastfeeds, the lower her risks of these cancers.

The hormones secreted during breastfeeding also have a beneficial effect on the mother. Oxytocin, the "bonding" or "love" hormone, is necessary for the "let-down" or milk-ejection reflex that causes milk to start flowing. Oxytocin also produces feelings of love and closeness between mother and baby. (Oxytocin is also produced during orgasm, incidentally, probably facilitating the feelings of love between a woman and her partner.) Prolactin, the hormone that regulates milk production, is also known as the "mothering" hormone and stimulates the mother to care for her baby.

It's Natural
I want to conclude with a simple thought. All mammals feed their young their own milk. Humans are mammals. Why should it be different for us? The milk produced by each mammal is uniquely suited to the needs of their young. Why should it be different for us? Indeed, if we consider how much we know about the detrimental effects of processed and artifical foods on the adult body, and how much more benefit we derive from eating foods closer to their natural state, then it makes sense that the same should hold true for babies. How could an artifically-created substance be better for a baby than that which was created (either through evolution or by G-d, depending on what you believe) in nature to uniquely suit the needs of that baby?

I don't claim that this is anywhere close to a comprehensive overview. I also don't claim to be any kind of authority on the matter. I've simply tried to compile a basic summary of the wealth of information out there about breastfeeding and breastmilk into a digestible form. There's more to know, and more to learn, and plenty more information where all of this came from.

Thursday, March 24, 2011

My Second Son's Birth

Even though you essentially know the end, I hope that you'll consent to enjoy the ride on this one nonetheless. Maybe it's kind of like watching "Apollo 13," where you know they get home safely, but you're still on edge watching it, wondering how in the world they manage it. Well, I love hearing birth stories, and I love telling my birth stories, and I love "Apollo 13," so let's see what happens.

As you'll recall, I was due December 31 but was having problems with high blood pressure throughout the month of December. On December 16, a Tuesday (also my grandmother's birthday, though that is fairly irrelevant), not only was my blood pressure once again stubbornly high, but there was +1 protein in my urine. Figurative alarm bells went off. I was once again sent to have labs drawn and go down to the hospital to be monitored. Sigh.

Having done this a week and a half prior, I figured surely everything would be fine again. I called my neighbor to see if she could watch my son while I made my way down to the hospital to be checked out, assuming that I'd be back in a few hours. I called my husband and told him not to bother coming with me this time, since there wasn't any point in his missing more work to watch me lie in the L&D triage room for 90 minutes again.

I went home and packed a few things to take with me in case I was there a little longer than anticipated, then made my way to the hospital. Once there, the four L&D triage rooms were all in use, so I got to wait in an office with a couple of nurses while we waited for a triage room to open up. There was no sense of urgency in my case, really, and I kind of enjoyed the behind-the-scenes peek at what the nurses were doing when they weren't in the patient rooms. This was a little after 3:00 P.M. on Tuesday.

When one of the other women was sent home (as I hoped to be in a few hours), I was put into a triage room and hooked up to a blood pressure cuff and fetal monitors again. I was having regular contractions, though I couldn't feel them, really, and my blood pressure Would Not Come Down. A nurse-midwife came in and did an internal check to see if my cervix was dilated at all. Upon finding that I was about 4cm dilated already, she declared "this baby is coming tonight! Let's get him out."

Er... What?!

First of all, my husband was 45 minutes away, my son had only very temporary childcare, we were not expecting to have a baby just yet, and, wait, I was only 38 weeks! I still had two weeks to prepare! My mom would be there in a week. She was supposed to stay with my son. What were we to do?!

Well, I called my husband, of course, and told him of the change of plans. They intended to induce with Pitocin and were still quite willing to allow me my trial of labor and VBAC attempt. But, as mentioned in the previous post, I knew that a Pitocin induction would increase my risk of c-section. I decided to delay any other interventions as long as I possibly could, hoping that would help me avoid the dreaded repeat c-section.

We decided the only possible course of action was for my husband to bring our son with him to the hospital. As difficult as it would be for me to have him there with me while I labored, and as problematic it would be that my husband would have to mind our son instead of being totally there with me in the labor and delivery, we couldn't think of anyone else we could call upon who would be able to take our son overnight. My mom was supposed to be there!

They got me set up in an L&D room while my husband picked up our son from daycare and drove down to the hospital. I was hooked up to an IV for fluids and Pitocin, and they also said I'd need to be on magnesium to help prevent seizures due to my blood pressure. The problem with magnesium is that is is a muscle relaxant, also used to stop preterm labor! So they would have to balance the magnesium and the Pitocin carefully to make sure labor didn't stop while still ensuring I had adequate protection from the risks of preeclampsia.

Another problem with magnesium is that it can cause you to retain fluids dangerously, so they would have to very carefully monitor my fluid intake and output while I was on it. This sounded inconvenient.

The biggest problem with magnesium, though, is that, as a relaxant, I would be unsteady on my feet, and weak, and possibly unable to control my muscles, and unable to properly care for a baby as long as I was on it. This meant I would not be allowed to be alone in the room with the new baby until I was able to come off the mag, which was the absolute biggest concern I had. Come hell or highwater, whether I needed a c-section in the end or not, I was going to breastfeed! And if I couldn't room-in with the baby, how was I to start a successful breastfeeding relationship? I was quite upset by this news, but still determined to make it work somehow.

My husband arrived with our son. He had the foresight to bring PJs, books, blankie, pacifier, and snacks for the little guy, who was very well-behaved and charmed everyone with his sweet nature, general cuteness, and amazing red curls. The nurses started taking bets on whether the new baby would have such gorgeous hair, too.

My son's being there meant that I was a little distracted from this whole labor business. I tried to remember to change positions, did not request pain relief, and got up to pee when I had to. I was quite surprised to find, however, that I was feeling almost no pain at all, despite the use of Pitocin. I was contracting nicely, and my cervix was opening, and everything that was supposed to happen was happening, but where was the pain? It was nice, but surprising.

I was very concerned about frightening my son if I were to need to yell, so I tried only to hum quietly when the contractions became stronger. My husband took him out of the room when the doctor came in to break my waters. She had trouble getting slack in the amniotic sac because the baby's head was pressed right up against the cervix. He was excited to come, unlike his reluctant brother! She eventually popped the bag, and my waters came gushing out.

Then the pain started. I felt those contractions like a vise clamping down on my abdomen. It was crazy. When I had to yell, we had my son and husband yell along with me. He thought it was a great game (ah, two-year-olds).

I had made some calls to friends and relatives to give them the news before things got really intense. One of these calls was to my rabbi and his wife. My rabbi's wife called back wondering where my son was during all of this. I told her he was with us. She said she'd arrange for someone to come and get him and bring him to her house for the night. I was so relieved. I couldn't imagine what we were going to do with him when things got really heated. I wasn't sure I wanted him to witness the birth, but I also wanted my husband to be there with me!

A friend came to the hospital, and my husband met him outside, switched the car seat to the friend's car, and sent our wonderful child off to a bewildering night's stay with the rabbi. We learned later that he cried a good bit of the way back north, but that our friend was able to sing to him and calm him (G-d bless him!). We also learned later that our son wouldn't sleep alone, so he ended up sleeping in the rabbi's bed the whole night! (It should be noted here that, at the time, the rabbi and his wife had three small children, the youngest of whom was exactly the same age as our son, and they were expecting their fourth child within the next few weeks!)

My husband came back, and the relief of not having to worry about our son meant that I was experiencing fully the insanity of Pitocin-induced contractions. I remember one of the nurses saying that they needed to increase my Pitocin, and the other one saying she didn't want to do it because she had been at a uterine rupture. I was so happy that she had said that in my hearing! How reassuring! But they did increase the Pitocin, and I couldn't bear it anymore. I was 6cm dilated, which I thought was a pretty good accomplishment right there. I asked for the epidural, and they sent for the nurse anesthetist.

They had me get up to go pee one last time before the epidural. I have my timeline a bit mixed up here (oddly enough), but I think my husband had taken our son outside right about the time I asked for the epidural, so that our son wouldn't be able to watch them do that. I'm not exactly sure when he got picked up and taken back to the rabbi's house, but it was not long after.

While in the bathroom, the contractions starting coming one after another. It felt like one didn't even end before the next one began. I couldn't believe the torture. I could barely walk back to the bed, and when I got there, I started throwing up. The nurse said not to worry, that I was just in transition and it would pass.


In the five minutes I had taken to pee, I had gone from 6cm to transition! Wow!

The nurse anesthetist was there, and he was able to do the epidural despite my shaking, nausea, and general incoherence. The epidural was perfect. It took away the pain but not all of the sensation. I could still move my legs, and I could still feel that I was having contractions, but it didn't hurt anymore. It was amazing.

Though I was fully dilated, they said I didn't have to start pushing right away. The baby was fine, and he could labor down on his own for a while so I didn't exhaust myself pushing when I didn't need to. This was new to me, since the minute I had reached 10cm with our first son's birth, they immediately had me start pushing. I liked this new way better! I was able to rest a bit, kind of drowsy and groggy. It was a little after midnight by then, I think, on Wednesday the 17th. I had been in labor for a little over 6 hours. Right there, I was already amazed by the contrast with my first labor, which took over a day to get to this point!

Finally, they said I really did have to start pushing. He had come down to +2 all on his own (what a guy!), but he needed help to come the rest of the way. (This also is in contrast to my first labor, where the little boy wouldn't even come out of the cervix - he was stuck at -1 station the entire time I pushed!) I protested, enjoying my relaxation, but they set up the table for delivery and called for the doctor. He wasn't going to come out if I didn't do a little work!

The epidural was such that I was able to feel the need to push on my own. So I pushed, and he came down a little. I pushed, and he came down a little more. I pushed and pushed, and he kept coming almost out, then sliding back in. After about half an hour of this (during which there was a fair amount of "I can't do this!" and "I don't want to push anymore!" whining out of me, as is apparently how I react to hard labor (haha!)), the doctor said he really was just about there, but my perineum wasn't stretching quite enough, and he kept springing back. She said probably just a little cut would let him slide right out. Now, an episiotomy was my second worst fear in childbirth, but if it meant all of this would be over, and I would have my baby in my arms, I was willing to do it. It was far less traumatic than a c-section!

A little cut, a few more pushes, and out he slid, a gorgeous, little, bald baby boy, at 1:19 A.M., after only about 7 hours of labor and 39 minutes of pushing. I had done it! He was here! I could not believe it. I couldn't! The placenta slid out a few minutes later, to my surprise. In fact, I distinctly remember saying, "What was that?!" and my husband reporting that it had been the placenta. For some reason, I had thought I'd have to work harder to get that out. They took the baby to be cleaned, diapered, Apgar-ed, weighed and measured - he was only 7lbs., 6oz., almost two pounds lighter than his older brother had been! - then brought him to me quite quickly and put him on my chest for his first breastfeeding. I had no idea how to hold him, and the doctor was still down below doing... something. I put him to the breast. He latched on and sucked. I held him and held him and held him and he nursed and nursed and nursed, and I knew this was how it was supposed to be.

First of all, tending to him took my mind off my other end, where the doctor was working busily stitching me up. Apparently, I was bleeding quite heavily (so what else is new?), and she was trying to get the bleeding stopped along with sewing up the episiotomy and so on. It was not particularly pleasant, but I had a very pleasant distraction!

I ended up staying in the L&D room for about four hours, and the new baby lay on my chest, nursing, the whole time. They were looking for a room on the maternity floor for me, and they were also still monitoring my blood pressure. It started to come down, and stayed down, and they decided they could take me off the magnesium and instead give me oral phenobarbitol, an anti-hypertensive, instead. Hooray!! No fluids monitoring! No fall hazard! I could keep baby with me.

All my dreams had come true.

This time, the hospital stay isn't that important. I will complain only a little, that since this was my second baby, they apparently assumed I knew how to breastfeed and didn't bother to send me anyone for help. At one point during the first day, while I was nursing him for the umpteenth time, a nurse came in to check my IV, saw me trying to figure out how to hold him, and gave me the one tip that solved almost all of my problems. "Turn him toward you," she said, "and make sure his ear, shoulder, and hip are all in a line." Voila!

He nursed almost nonstop, pretty much every hour for up to 45 minutes at a time. I didn't care. I wasn't going to let him go. I was going to nurse this baby. It was going to work!

I recovered quickly and was able to go home Thursday afternoon, not even 48 hours after giving birth. What a difference! I was on iron supplements, because, as it turned out, I again lost quite a bit of blood, although I had tolerated it well and didn't require a transfusion this time. No one told me, this time, that I couldn't make milk because I was busy making blood. No one told me to pump eight times a day. No one told me any of that nonsense that had so discouraged me the first time. (No one gave me any good advice at first, either, except that one nurse, but I had done lots of reading by then and had a pretty good idea of what was going on.)

I am thrilled to report that I breastfed him exclusively for the first six months of his life, then added solids but continued to nurse rather frequently well past his first birthday, then continued to nurse a few times a day until about a month after he turned two. At that point, I was ready to wean, because I was pregnant again! (And I was also ready to start sleeping through the night, but that's a post for another day!)

I was also able to express and donate a fair amount of breastmilk to a couple of other mothers in need of some extra milk. I also occasionally gave a few ounces to my older son to drink, when he was sick or had sores in his mouth, because I firmly believed (and still do) that it helped him recover faster. I felt like I was finally able to give him a little bit of what I had always wished I could have given him.

I don't think I can describe how good it felt to not only be able to nurse my own son, but to have enough excess milk to help out other babies, too. It was this that convinced me that I most likely would have had plenty of milk for my first son, as well, had I just started nursing and continued to nurse right from the beginning. As you read, the circumstances were such that it was not all that simple, but I was reassured that I would have no trouble nursing future babies. And I am so looking forward to nursing this new little one whenever he or she is ready to appear, and however he or she comes into the world. Of course, I'm dedicated to another vaginal birth!

And that brings us to the present, and why I'm writing this blog, and how I know as much as I do, and why I want to share it with everyone!

Tuesday, March 22, 2011

Setting the Stage for Baby Number 2

Having (hopefully) read the first four entries here, you now know all about my rather unfortunate birth experience with my first son. That whole sequence of events at first made me swear off baby-having at all, but it also made the whole idea of having another baby simply terrifying. I was sure my uterus was completely messed up, between the scar tissue from the c-section and whatever had caused the bleeding and clot. My OB at the time had said during labor that I should be able to have a vaginal birth in the future if I wanted, but after the bleeding, decided it would be safer if I stuck to scheduled c-sections, "because labor might put too much stress on your uterus."

I was also devastated that I hadn't been able to successfully breastfeed. At first, I was defensive about our use of formula. "The baby is perfectly healthy. Look how big he is!" (Constantly over the 90th percentile for weight and height - still is at 4.5 years old!) "Formula is working out just fine." "I did try to breastfeed, but I didn't really like it." And so on.

But after a while, and not that long of a while, I really started to regret it. I felt I had deprived my son, and myself, of something very important. I mentioned in my last post that I had tried to relactate. It didn't work, but I also didn't try very hard.

I also starting thinking forward to a future baby. I had some very definite ideas about what I didn't want a second time around, and began to feel like if we had a second baby, maybe I could get it "right" this time. I had twinges of guilt, like I shouldn't think that I had done something "wrong" the first time, because that really wasn't fair to my son, but there was something missing inside me. I felt like I had been deprived of an experience that you only get a few chances to have.

So I started reading. I read forums on LiveJournal. I read articles about VBAC (vaginal birth after cesarean). I discussed it with women who'd been through it, women who were practicing doulas, women who knew more than I did in general about pregnancy, childbirth, and breastfeeding. I watched other women breastfeed. I listened to their birth stories. And I became a huge breastfeeding advocate, despite feeling slightly hypocritical. I also learned that in almost EVERY case, VBAC is safer than a repeat c-section. I learned that the risk of uterine rupture with VBAC is lower than any of the other risks associated with having a c-section. I learned all about the benefits to mother and baby of a vaginal birth. I learned all about the benefits to mother and baby of breastfeeding. I learned how amazing breastfeeding is, and how amazing breastmilk is, and I couldn't believe I didn't know any of this before my son was born. How could I not have listened when people tried to tell me? How could I not have wanted to know?

These are the topics I expect to cover in future posts, so I'm not going into a whole lot of detail now. Each heading deserves one or more articles of its own! So don't worry. I'll get to all of this!

Anyway, I decided that when it was time to have a second baby, I would go in with eyes open and armed with information. This time, I knew what I wanted.

When our son was about 18 months old, we decided, heck, let's go for it. Let's have another. Now, it had taken us almost a year to conceive our first son, so we thought we had some time before I got pregnant a second time. My body had other ideas. By the second cycle off birth control, I was pregnant! Our kids would be about 26 months apart, which we actually felt was a good age difference. I was due December 31, which I thought was pretty darn cool.

We had since moved from Philadelphia to San Diego, so I had a new set of doctors and new insurance - Kaiser Permanente. I had heard good and bad things about Kaiser, and I wasn't sure what my experience would be, but I didn't have much choice.

My pregnancy was quite ordinary, which was good. I read La Leche League's publication "The Womanly Art of Breastfeeding" cover to cover while I was pregnant. I read and re-read information about VBAC and breastfeeding. My new set of prenatal caregivers - a nurse-midwife and an OB at Kaiser - were both on board with the idea of a VBAC, even though they knew my history and what my previous OB had said. Neither was overly concerned. The OB was willing to let me have a "trial of labor," but she wasn't terribly confident of "success." She felt that the conditions that "required" the first c-section - a large baby with a large head - could easily be repeated, since the babies had the same parents as before, and that significantly lowered the statistical chances of a successful VBAC. As the pregnancy went on, she started making not-so-subtle hints that I should just schedule a c-section. ("If it were me, I would just schedule a c-section" was one comment she made. I was annoyed.) I was SO hesitant to agree. I asked, "Couldn't I wait until I go into labor, then have the c-section at that point?" That way, I would know for sure that the baby was ready to come. I was concerned about having a baby early and the problems that could cause. She didn't understand why in the world I'd want to do it that way. She assured me that 99% of the time, babies born by c-section at 39 weeks don't have respiratory issues. I asked if I could schedule it for 39 weeks, 5 days, very, very close to the due date. She said sure. I think I was subconsciously hoping that I would spontaneously go into labor before the scheduled time so that I wouldn't have to worry about it. I never did actually commit to a schedule because, while I was annoyed at the lack of support from my primary OB, I saw a different OB for one appointment. And his advice was totally different.

He explained that repeat c-sections carry great risk, because every repeat c-section increases the chances of placental accretion (I think), which is when the placenta is absorbed into the uterine wall. This is a very bad thing. Also, each new scar makes the uterus weaker, which increases the risk of rupture or other complications. Plus, c-sections always carry risks, including blood loss, infection, and whatever else might go wrong while they rearrange your internal organs. Not to mention the risks to the baby of not having a vaginal birth, which are still somewhat unclear but are becoming clearer by the year. He was all for a VBAC. He agreed that my statistical chance of "success" might be low because of the circumstances, but that was no reason not to have a trial of labor.

I was convinced. I ignored any further plea from my primary OB to schedule a c-section and told her I intended to have a trial of labor. She said that was fine. Not that she had a choice.

Everything was perfectly fine, up until the end. By the last month, I was having problems with high blood pressure. High blood pressure can mean preeclampsia, which can lead to seizure or stroke in the mother, and if not treated, eventual maternal death. It's a Big Deal. The only real "cure" for preeclampsia is to deliver the baby. So they monitored my blood pressure very closely and took urine and blood samples regularly. If any protein showed up in my urine, there would be cause for greater concern, because it meant there was kidney involvement.

On December 5, my blood pressure at my usual checkup was quite high - 150/105 - and didn't come down after resting for a while. The doctor said I needed to get myself down to the Kaiser hospital in San Diego, which is 45 minutes away without traffic, and this was at rush hour on a Friday. My husband and I scrambled to find care for our son, then went on down to the hospital. When we got there, they hooked me up to a blood pressure cuff and fetal monitors. The baby was fine, I was having very mild but frequent contractions (not labor), and my blood pressure, thankfully, came down nicely and everything went back to normal very quickly, in about 90 minutes, and I was sent right back home. Whew! But that scared me, because they said if the numbers didn't come down, or if the baby showed any distress, they would induce right away. I was so not ready for that! So it was a relief that everything was fine.

An induction was just about the last thing I wanted. It made me feel like the universe was conspiring against my plan to have a VBAC. You see, if you go into natural labor, avoid an epidural, and allow yourself to move around, and keep medical interventions to a minimum, your chances of success are quite good. An induction, however, is less likely to end up in a vaginal birth regardless of whether it's your first baby or a VBAC. This doesn't mean you will have a c-section if you're induced, just that it's more likely than if you aren't.

Here's why.

Scenario 1) They try an induction and it fails. If this happens, the only other option is a c-section. If your body isn't quite ready to give birth, an induction may just simply not work - you won't go into active labor. So if it's necessary for the baby to come out, say, in the case of preeclampsia, then they'll have to do a c-section.

Scenario 2) The induction results in active labor. Okay, this is a good thing. You're in labor. You're having regular contractions. Your cervix is opening up like it should. Here's the problem: An induction using Pitocin results in contractions that are MUCH stronger than those your body would produce in natural labor. This means they are MUCH more painful than a typical labor contraction should be, which means that most women simply cannot handle them without external pain relief. This means epidural. With an epidural, you are pretty much stuck on your back in bed. In addition, sometimes the epidural can slow labor, which means they'll need to up the Pitocin to keep labor going. Which means the contractions will become even stronger. You can end up in a pretty vicious cycle. Now, if you're going for a VBAC, the stronger your contractions are, the greater your risk of uterine rupture, so they can't push the Pitocin as much as they might do otherwise. If your contractions aren't strong enough, or regular enough, your cervix might fail to open fully, and you will be labled "failure to progress" and be advised to opt for the c-section. Or, even if labor does continue successfully, the Pitocin contractions are so strong that they can cause more stress on the baby than natural labor contractions would. This can cause the baby to go into distress, represented usually by a sharp drop in fetal heart rate. If this happens, you will probably need an emergency c-section to save the baby.

I pretty much knew all of this. So the idea of an induction was very frightening. I thought that if it came to an induction, a c-section was almost certainly in my future after all. I desperately hoped I would go into labor naturally instead and that my blood pressure would stay under control.

When my blood pressure was worryingly high again on December 16, I assumed that it would be another "go down to the hospital, go on the monitors for an hour and a half, and be sent home." So I went down there by myself, rather than shlepping my husband along on another useless trip. That, apparently, was the wrong decision.

How's that for a cliff-hanger? Stay tuned for the story of my second son's birth! (You already know the end - I got my VBAC!)

Wednesday, March 16, 2011

My First Birth - Part IV - The Scariest Event In My Whole Life

So, after a reasonably traumatic c-section, serious blood loss, difficult recovery, and breastfeeding issues, we come to me at three weeks and one day postpartum. I was starting to come back to life, considering breastfeeding as a more viable option, up on my feet, able to care for baby alone. I was even getting a little work done from home. I was still in a lot of pain, but I hadn't needed the Percocet for a while, just ibuprofen. My blood count was coming back up. Things were looking good.

That Monday, I missed my afternoon pumping session, and when the baby got hungry, I decided to try just feeding him directly from the breast to see what would happen. According to my journal entry at the time, "It went OK." I was still unsure, but the decision was soon to be tabled. About three hours later, around 8:00pm, my husband went down the street to get us hoagies for dinner. The baby was asleep, and I was futzing around doing who-knows-what. The previous evening, I had had some uterine cramping that was a much more severe than it had been since the delivery, but it had gone away, and Monday had been fine.

Suddenly, the cramping started up again. I went to the bathroom to see if anything was going on, and I was bleeding more than I had been, which was surprising given that I was already three weeks postpartum. I decided to take some ibuprofen. On my way to the kitchen (we're talking a 1000sq.ft. apartment, so not a long walk or anything) to get water, I felt a gush of blood and instead ran back to the bathroom. When I sat down on the toilet, blood started to pour out of me. Sorry for the graphic detail, but I want you to get a sense of my terror: The usual course of uterine bleeding, whether a regular menstrual period or postpartum bleeding, is a start-and-stop sort of thing. Like, there's a spurt of blood, and then it stops, and then there's more at some point later on. My fellow female readers know what I mean. This bleeding I experienced was not like that. Rather, it was as if someone had turned on a tap or opened a vein. Blood just kept coming.

Remember, my husband was not home. I did not have a phone near me. The baby was in the bedroom, and I could hear him stirring. I didn't know what to do. My only thought was that I should get off the toilet, but I couldn't because my maxipads were too far away and I didn't want to bleed all over the bathroom trying to get to them. I don't think I realized just how serious things were.

After a few minutes, by which time I was trembling with fear and almost in tears, my husband came home with the hoagies. I called him to the bathroom, told him what was happening, and asked him for the phone to call the OB's office emergency line. This was not normal, I was sure. I also asked him to hand me a pad so I could get off the toilet. This was a smart move, it turned out.

I left a message with the OB office's answering service that I was experiencing severe postpartum bleeding. I then got up from the toilet and promptly collapsed to the bathroom floor and lay on my back on the bathmat. I was so dizzy I couldn't stand up. When we saw how much blood was in the toilet, there was no mystery as to why I had collapsed. My husband decided to skip waiting for the OB to call back and called 911 instead. He then called my mom to come over so she could watch the baby when the ambulance came. I remember feeling like my limbs were full of sand, and I kept yawning. My husband thinks I may have passed out briefly a few times.

A police officer came, followed by the paramedics. The paramedics told me I was hyperventilating, and their calm helped me to calm down. They told me to breathe deeply, and the sand-filled feeling subsided. They asked me a few questions, joked with me about how they were missing the hockey game, and loaded me on a stretcher and carried me to the ambulance, where I was whisked away to the same hospital where I had given birth (also the closest hospital). My husband followed in the car.

I was coherent enough in the ambulance to be impressed by how easily the paramedic got an IV started in a moving vehicle, considering the trouble many a nurse had had trying to do it while I was lying still on a hospital bed.

Once in the ER, I was examined first by an ER doctor wearing black scrubs and tended by some excellent nurses. They drew blood and determined my hemoglobin was back down to 8.8, low enough for concern. My OB had called back to my home after we had left for the hospital, and my mom told him we were already in the ER, so he came down to see me, an OB resident in tow. They each performed a pelvic as well and couldn't figure out where the bleeding had come from. Since lying down on my bathroom floor, the flow of blood had stopped - that was probably the smartest thing I could have done, though I didn't know it at the time - because I imagine it put the weight of my other internal organs on the source of the blood and caused it to clot. That's my guess, anyway.

My OB decided to order a CT scan and a unit of blood. They wanted to see what was going on, and they also felt I might need a(nother) transfusion.

The CT scan was a new experience for me and was fairly unrevealing. They saw I had a large clot (about the size of a Cutie orange, or clementine) in my uterus that hadn't been there before, but they couldn't tell where it had come from. They admitted me to the hospital and eventually found me a room.

They had me stay in bed all the next day. They did an ultrasound, which was marginally more helpful than the CT in its image of the clot. Another of my OB's came to examine me and also didn't know what might have happened. Her (and her colleagues') best guess was that my stitches had dissolved before I was completely healed, and a weak spot in the tissues had opened up. She said they hadn't had to readmit a patient to the hospital for postpartum bleeding in years.

My breasts started to feel a bit engorged, and the nurse offered to bring me down a breast pump. I pumped once but spilled the milk on my sheets, then figured it didn't really matter. I had created an association between nursing and this emergency, my mind figuring that since nursing causes uterine contractions, perhaps my breastfeeding attempt earlier on Monday had caused a contraction that led to the bleeding. Who knows.

I stayed in the hospital until Thursday afternoon. They did another ultrasound Thursday morning, and there had been no change in the clot. Since the bleeding didn't restart, they felt it was safe to send me home, as long as I restricted my activity. They also sent a home health nurse to check on my Friday. Everything was fine.

I stopped pumping, stopped breastfeeding, went exclusively to formula. Only about four weeks later, I started feeling very depressed about that decision and tried to relactate, with advice from the La Leche League leader whose help I had previously rejected. My attempt was unsuccessful, although I do have a few cherished photos of me with the baby latched to my breast as I sat on the couch. At least I know I tried, although I also knew that I couldn't pump and nurse 'round the clock, as I would have needed to in order to bring in any kind of useful milk supply after never having established a full supply to begin with and having stopped completely for a month.

I still, over four years later, regret that my older son didn't get as much benefit from breastfeeding as he was entitled to. I no longer blame myself, however, which I did for a long time. For a long time (years), I berated myself for my lack of dedication, my resistance to help offered, and for not educating myself better before the birth. Now, instead, I don't really blame anyone. But I am angry that the "system" failed me, that I was told from numerous sources that formula was just fine and not to feel bad if I didn't breastfeed, and that the lactation consultants and the pediatrician, on whose advice I relied heavily, led me down the wrong path.

I also still have anger that my older son's birth didn't go the way I feel it should have, which led to the scariest moments of my life, lying there on my bathroom floor. But, now I am channeling that anger into something productive - educating other women and offering support so that they can have a better chance at getting the birth and breastfeeding experience that they want. Hence this blog.

It's not all bad news, though. I look forward to my next post, in which I will tell the story of my second son's birth. I think you'll be as amazed at the contrast as I still am.

Tuesday, March 8, 2011

My First Birth - Part III - The First Weeks Home

I won't go into excruciating detail about the next three weeks of my son's life. Rather, I'll give some highlights. Basically, we came home with this newborn who was still jaundiced and needed to continue to be on the bililight. We were given a Wallaby, which is a portable bililight that you wrap around the baby. This makes it hard to hold him, hard to swaddle him, and hard for him to get comfortable. Thankfully, it was only needed for one very long day before his bilirubin levels came down into an acceptable range. He slept in the Pack 'n' Play bassinet in the living room. I slept in the bedroom. My husband slept on the floor beside the bassinet and got up to give him his night feedings.

To be honest, I barely remember those first few days home. I was in pain, pale, weak, and confused. I tried to pump, but the baby was getting mostly formula. I couldn't even really take care of him by myself, although over the next couple of weeks, I started to do things like laundry, wash bottles, make bottles, hold him, feed him, change his diapers... all the things you do when you're caring for a baby. I began to heal, and life got a little easier. My husband still took care of most of the night wakings. I remember one night when he was changing a diaper and the baby decided to continue to poo during the diaper change. I heard a "Ugh! Oh my God!" and went into the bathroom to find baby-poo had squirted clear across the room. Welcome to newborn baby care!

The first major event after coming home was the baby's bris (circumcision ceremony) when he was eight days old. I don't remember much about the day itself, but one conversation in particular comes to mind. A friend of mine, who was in the natural-birth and breastfeeding camp and had two kids of her own, actually offered to nurse the baby for me while I watched so I could see how it should look. I found this strange, somewhat creepy, and a little bit intrusive at the time, although now I appreciate what she was trying to do. She was trying to help. She wanted to see me succeed at breastfeeding, and she didn't know exactly what was going wrong, but she wanted to do what she could. And she could nurse. I declined, said that I knew his latch was good but that I didn't have much milk. She offered to put me in touch with a local La Leche League leader who had helped her out. I declined this offer as well. Frankly, I don't know why I was so resistant to offers of help. I think my attitude was, "They told me what to do in the hospital, and now I'm just trying to follow directions. I've got this." Which, obviously, I didn't. And, as it turns out, what "they" told me in the hospital was not the be-all and end-all of breastfeeding advice, and I still sometimes beat myself up over not letting go of my own ego and asking for help.

I did ask his pediatrician for advice. She said that sometimes women who don't have enough milk will breastfeed and then "top off" with a couple of ounces of formula. She suggested that maybe I could do the opposite - give him most of a feeding from a bottle, then "top him off" with a breastfeeding. That way, he wouldn't be frantically hungry while breastfeeding, so he might be more willing to latch and suck. I don't have to say that this is really not very good advice, do I?

Finally, when the baby was three weeks old, I made an impassioned post to my LiveJournal called "Thoughts on Feeding My Son," in which I lamented that the baby was only getting about three ounces a day of breastmilk, and did that little amount even matter? I asked, plaintively, if I should just try putting him to the breast next time he was hungry and see how he did. I asked for advice, finally, but I didn't want "biased" advice. I wanted "objective" advice, whatever I meant by that. I think I was very disillusioned by the "help" I had gotten in the hospital from the lactation consultants there, and I was hoping someone would just go ahead and tell me what to do. In fact, I think I'll copy here some noteworthy quotes from that post, so you can get a sense of what was going through my mind.
"I didn't have the dedication in those first couple of weeks to pump and nurse often enough and for long enough to boost my milk supply once I recovered from the blood transfusion, so now when I do pump and I only get 2 or 3 ounces from both breasts combined, it's very discouraging. Not to mention that I'm only pumping 3 times a day on a good day, and not actually nursing at all. It's no wonder I have such a low supply." 
This quote is interesting. I was convinced I had a "low supply" because I "only g[o]t 2 or 3 ounces" at each pumping session. I didn't know two very important things, and I only wish someone had told me. The first is that pumping is not an indicator of supply. In other words, I might have only been pumping three ounces, but he might have gotten a lot more if he actually nursed. Secondly, some women just don't respond well to the pump, and though they may have plenty of milk, they only pump an ounce in 15 minutes.

I was convinced I had a "low supply," by the way, because the lactation consultants in the hospital told me I would. I'm pretty convinced now, 4+ years later, that I actually had plenty of milk. Especially after nursing my very healthy second son and pumping extra besides, but only when I felt like it. (When I felt like pumping that is, not nursing. I nursed, um, a lot. But we'll get to that story in another post.)

Another quote:
"When he gets hungry again in a few minutes, should I simply put him to my breast and see what happens?"
As a matter of fact, I did decide to do this, he did latch and suck, and I felt like it actually went pretty well. In the next post, I'll get into why that was the last time we breastfed.
"I want a totally practically-minded opinion, and I feel like an LC would push me to try breastfeeding, when I find it so discouraging. It's the lactation consultants who first told me to pump 8 times a day, and I didn't manage to do that and it just made me feel bad."
I'm not sure if I wanted someone to tell me it was "okay" to formula feed, or if I wanted someone to tell me that breastfeeding would get better and easier if I just did it, or what. I'm not sure what I meant by a "totally practically-minded opinion." But the second sentence says it all. I somehow thought that all LCs would be as unhelpful as those in the hospital. I somehow thought that I didn't want someone to "push me" to try breastfeeding. Maybe I didn't at the time.

And, finally:
"Breastfeeding is the one thing only I can do for my son, and I'm not even sure I want to do it. I know I'm not alone. I know there are other mothers out there who tried to breastfeed and just didn't want to. But I never thought I'd be one of them. I never thought I'd find it so difficult or, frankly, unpleasant."
I want to go back to Jessica of November 2006 and pat her on the back and tell her it will be okay. I want to go back to her and say, "Yes! You're the only one who can breastfeed your son. So go for it! You'll do it! And you'll grow to love it." But, unfortunately, that isn't possible. So instead, I hope that other new mothers and mothers-to-be will see these words here and see a reflection of how she's feeling and know that "Yes! It will get easier!" and "Yes! You can do this!" and "Yes! It's so worth it."

The most important message I want to send, though, to those new mothers and mothers-to-be is ask for help. Don't be afraid of the advice you'll get. Ask for help. (But ask the right people!)

I put a teaser up there for the next post, in which I will describe what happened not three hours after my last breastfeeding attempt, and the definitive reason I ended up not breastfeeding. The drama continues...

Sunday, March 6, 2011

My First Birth - Part II - Four Days in the Hospital

Picking up where I left off in my previous post, I had just had what at the time seemed to be the relief of a c-section, which ended a 29-hour labor and produced a large, healthy baby boy. I had made clear my intention to breastfeed, and they said my son would be brought to me, and that they would send along a lactation consultant to help, once I was settled into my room on the maternity ward. I was wheeled back to the L&D room for recovery, where I had apparently been given morphine on my husband’s consent, and where we met back up with my mom. I was very groggy and exhausted, very weak, and really had no idea what was going on. I do remember telling my mom our son’s name.

Over an hour after the delivery, I was taken up to the maternity ward and into my room. A nursery nurse came to report that sometimes large babies have problems with maintaining their blood sugars, and if our son did, would it be okay to give him some formula? My husband and I had no idea, so we said, sure, if that’s what he needs, go ahead. Then she asked what kind. We also had no idea. We hadn’t “researched” formula (any more than we had researched breastfeeding, to be honest), so we just asked what they recommended, and they said many mothers liked Enfamil with Lipil. We said okay to that.

The baby had been taken to the nursery, where he was cleaned and given all the initial pokes and prodding. It turned out his blood sugar was fine, so they brought him to me to attempt breastfeeding. He was lethargic (as was I!), and it was difficult to get him to wake up to want to feed. The lactation consultant taught us about stripping him down to his diaper and tickling his feet to try to get him to awaken, and he did latch and begin to suck. He had a very good latch and a very strong suck reflex, and she said he should have no trouble nursing. I was tired and weak and in pain and having trouble so much as holding my 9-pounder, and we didn’t nurse for very long before they took him again.

I, however, was not doing as well as the baby. I was white as a sheet. It turned out I had lost a LOT of blood in the delivery. Not long after my abortive attempt at nursing, I began feeling sweaty and hot and very strange. Alarms started going off, and nurses rushed in, and they told me I was tachycardic (my heart rate had shot up to 160) and was going into shock. I had lost so much blood that my hemoglobin had dropped to 6.8. The normal range is 12 to 15, and I had been slightly anemic while in labor, with a hemoglobin count around 11.

They sent a crisis nurse to sit with me and help me calm down and took some readings with some kind of heart monitor (EKG machine, I guess?), which they only sort of knew how to hook me up to. In spite of the trauma of the whole matter, I was almost amused at how they couldn't get the leads to stick to my sweaty skin, and they weren’t exactly sure where they were supposed to go. It wasn’t exactly encouraging, but I guess they got the readings they needed.

It was determined I needed a blood transfusion to restore my blood count, and I was quickly typed (for the umpteenth time) and cross-checked and two units of blood were brought up from the blood bank and hooked into my IV. My veins were so sunken that they had to call in a special IV team even to get the IV started, and even she had trouble finding a vein! But eventually, I was recovering with someone else’s generously donated blood dripping slowly into my body.

I didn’t see my son much that day. He could really only be in the room if someone else was there with me, as I couldn't even get out of bed to tend to him. I was told that I probably wouldn't be able to start making milk until my blood supply was restored.

They told my husband to go home and sleep at night and kept the baby in the nursery, feeding him formula from a bottle when he needed it. They told us if we wanted, we could provide our Avent bottles for him to use, instead of the disposable rubber nipples they had in the hospital, in the hope of preserving his latch. So my husband brought some. I have no idea if it made a difference.

They had me stay in bed all of Monday as well. My husband stayed with me most of the day. He fed the baby, was taught how to change his diaper and swaddle him, and held him. I watched. I remember just being so tired and having absolutely no connection to this baby I had worked so hard to deliver. I did get to try nursing again, this time with a different lactation consultant who man-handled my breasts and tried to teach me two different ways to hold him. I felt clumsy, weak, and bullied. I was discouraged that he was so big and heavy and I was so weak and drained. Somehow, I thought it would be easier, or make more sense, or that I should instinctively know how to do this. Watching someone else open a bottle of ready-to-use formula and feed it to him was much easier than this craziness.

Monday night, I woke up crying in the middle of the night. The nurse on duty insisted it was because I was in pain, said I should tell them right away if I was in pain so they could give me more Dilaudid. I said that wasn’t it, and that I didn’t know why I was crying. No one had told me about the “baby blues,” the ebb and flow as pregnancy hormones suddenly stop and other hormones take their place. It wasn’t helped by my sheer exhaustion, pain, and trauma of the surgery.

Tuesday, I was finally starting to recover a bit. They let me get out of bed and take a shower, which was both scary and wonderful. They wheeled me to the “mandatory baby bath demonstration,” where a nurse, who was also one of the lactation consultants, bathed one of the other new babies to show us how to do it. (I still wonder that they had this mandatory baby bath demonstration where they went into excruciating detail on how to give your baby a sponge bath, which is hardly the most complicated baby-care task, yet there was almost no instruction whatsoever on breastfeeding!)

The lactation consultant came back up to my room with us and brought along a hospital-grade breast pump so she could show me how to pump. She told me I’d need to pump eight times a day – every two to three hours – to bring up my milk supply. I could save my colostrum and they would give it to the baby at his feedings so he could benefit from whatever I managed to extract. The idea of hooking myself up to this machine eight times a day seemed ridiculous. I had visitors, and nurses in and out, and most of the time had no idea what time it was. I think I pumped maybe three times that day, and nursed the baby once. This made no sense at all, but I took her word for it.

Tuesday night, I woke up in the middle of the night with my left hand extremely swollen. I had been on a saline IV to keep my hydrated, and apparently after 48 hours or so on an IV, the vein can just collapse, so saline was dripping into my hand. It wasn’t a big deal, health-wise, but it was scary and a little painful. They moved the IV site and gave me a warm compress to help bring down the swelling. They said the saline would just drain out. Still, I already looked like I had been hit by a bus, and now my left hand was swollen to twice its usual size.

Wednesday I was able to pump eight times, as instructed. I still didn’t have any milk, and I had no idea that this was perfectly normal after a first baby and c-section. It was discouraging, however, and exhausting, and I didn’t want to do it. Plus, washing all those pump parts so often? What a pain! I did try breastfeeding again, and still felt like a moron who couldn't manage this simple task of holding my baby to my breast and letting him suck. How complicated could this be?

The baby also started to show signs of jaundice, and he had to be on a bililight any time he wasn’t being fed or changed. This was… inconvenient, at best.

Thursday morning, my OB came to check on me and told me that I could go home that day if I felt ready. She said if I was still too weak, she could probably get me another day in the hospital, saying I wasn’t sufficiently ambulatory because of my anemia. But another of my OBs came later that morning and strongly suggested we go home. The nurses concurred. They said we weren’t doing ourselves any favors staying in the hospital longer.

I was told it would probably be a good idea to rent a hospital-grade pump, so I could continue pumping eight times day at home. I had purchased an Avent Isis double breast pump ($300) before the baby was born, assuming I’d need to pump when I went back to work, but they said it wouldn't be able to handle the amount of pumping I’d need to do in the early weeks to bring up my supply. I took their word for it. They had given me the name of a woman I could rent a breast pump from, and she came to bring me the pump, wheeling her sixth child in a stroller. She also sold me a hands-free pumping bra and some milk collection bags.

Then, Thursday afternoon around 2:30, we packed up, changed the baby into a “going home” outfit, put him in his car seat, and went home.

And if you think that’s the end of this saga, well, wait until Part III!

Thursday, March 3, 2011

Jumping Right In - My First Birth

I don't think I need to start with an introduction. It doesn't matter that much who I am. I will say up front that I don't have any specific credentials - I'm not a lactation consultant, a doula, a midwife, a licensed medical practitioner. I'm not a birthing coach or a childbirth class teacher. I'm not a licensed anything, really. But I am a mom, and I've done this pregnancy and childbirth thing twice, and I'm now pregnant with my third. And I've done a lot of reading, and I've done a lot of self-educating. And what I've found is, I'm passionate. I'm passionate about passing along information about childbirth, about breastfeeding, about what goes on in hospitals that can throw you off track, and about what every woman should know before giving birth, whatever her proclivities, inclincations, or beliefs. I don't so much care what you choose to do. I just care that you make an informed choice.

Okay, that's out of the way. I say right up there in my blog description that I've had a c-section. So let's start there, with the story of my first son's birth, slightly abbreviated, but not leaving out anything important. I’m also going to try to write this as neutrally as possible, even though there are a lot of emotions attached to this story, which I’m sure will come through no matter how hard I try. I think that’s okay. Those strong emotions pretty much changed my life.

When I was pregnant with son #1 (who is now four years old), I was 24 years old, had been married for four years, and was pretty sure I had this pregnancy thing under control. I went to all my prenatal appointments, thought I had taken charge of my body, and thought I had made all the important decisions, like what hospital to go to, how I was going to feed the baby (breast-feeding, because “breast is best”) who would come with me, and whether or not I would want pain relief (I did!). I figured, beyond that, the doctors and nurses in the hospital would know better than I what to do, and I trusted the OBs in the practice I’d chosen, and I trusted the hospital staff.

My son was due October 20, 2006, which was a Friday. That night, just after midnight, I entered the early stages of labor. I lost my mucus plug and started having contractions. We waited about two hours, called the OB on call, and were told to come on in. I spent four hours on the L&D floor, walking around, trying to move things along, only to find, at 6:00 A.M., that I hadn’t dilated at all. They sent us home and told us to come back when the contractions were more painful and closer together. We dutifully followed directions.

As a side note, we had bought a car that evening, not long before I went into labor. We had to pick it up Saturday morning, so we went ahead and did that. I don’t think the salesman had a very good sense of what it meant that I was in labor. He just went on with his spiel, for what felt like hours, giving us a tour of the facility, showing us everything we could possibly want to know about our new Toyota Rav4, and generally doing his salesman thing. I really wanted to go home.

Anyway. We went home. I had no idea what to do with myself. My husband called his parents in Israel. Their neighbor is a midwife, and she got on the phone and told my husband to tell me to take a hot shower. Now that was a great suggestion. The shower felt so good, and it sped up my contractions because I was standing up. Eventually, I got out of the shower, and the contractions slowed down, but it had been another 10 hours or so, and we decided it was time to return to the hospital. This was about 4:00-ish on Saturday afternoon.

I had dilated to a whopping 2cm by then, so they let us stay, since we were now sure I was in active labor. I had had quite enough of this labor thing by then, and couldn't believe the long road I still had ahead of me, with eight centimeters to go! I requested pain relief, but I wasn’t quite ready for the epidural, so I got a narcotic cocktail instead. That lasted about 90 minutes, during which I was high and having the weirdest visions/dreams. I really had no idea what was going on, how much time was passing, or who was in and out of the room.

That wore off, and I labored some more, mostly lying on the bed. My mom was there with me, along with my husband. My mom had given birth to both me and my brother totally naturally, drug-free, and she said I should walk around. But I didn’t feel like it. I was tired, and it was hurting, and lying down was so much easier. Besides, my mom was a crazy natural-birther. I wasn’t crazy like that. Our (my husband’s and my) motto at the time was, “There’s pain. There’s pain relief. This isn’t a test anyone should fail,” which is a quote from one of our favorite shows, “Coupling,” uttered by a father-to-be about whether he thought his girlfriend should have pain relief during labor.

By the time I reached 4cm, I wanted the epidural. It didn’t go very well and actually took two attempts before the anesthetic took hold, but it did its job at that point. I was then stuck in the bed whether I wanted to be or not, but I did enjoy the break from the pain. My water broke at around 5cm, just as the OB was getting ready to break the bag of waters manually.

Much of the next several hours is kind of an epidural haze. They started Pitocin at around 7cm, hoping to move things along. By 5:00 A.M. Sunday morning, I had finally fully dilated, and they started coaching me on pushing. “Here comes a contraction. Take a breath. Hold. Push. 1, 2, 3…10. And breathe. Hold. Push 1, 2, 3…” Etc. They told me my pushing technique was good. But the baby wouldn't budge. It seemed he was occiput posterior (OP), which means the top of his head was toward my back, instead of the more comfortable occiput anterior (OA), where the top of the head is toward the mother’s stomach – the baby comes out more easily if he is face-down during delivery. Many babies will turn in the birth canal as they come out, but mine didn’t want to. It turned out he also had a very big head. I’m making a digression for the point of education. Basically, the head needs to travel through the cervix and under the pelvic bone, which requires the neck to bend. This is accomplished more easily if the baby is OA, although being OP does not automatically make a vaginal delivery impossible.

What I’m getting at here is, after two hours of pushing, he had not moved at all. He was still up in the cervix, with no apparent desire to come out and see the world. My OB told me that I could keep pushing if I wanted, but he wasn’t making any progress, and it might be time to consider a c-section. She was not at all confident that this baby was coming out the more natural way. She stressed that he was not in distress – his heart rate was fine, he was holding up very well, and there was no immediate medical danger to the baby, or really to me, if I wanted to keep trying. However, I was feeling a great deal of pain despite the epidural, I was completely exhausted, and I just wanted this baby out. So my husband and I very quickly decided to go ahead and have the c-section.

They whisked me away to the operating room, where I was suddenly surrounded by a bunch of new people, including an incredibly sweet and caring anesthesiologist who held my hand and looked into my eyes and helped me stay calm during the procedure. My husband took a few minutes to get there, because he had to put on a sterile gown, gloves, hat, mask, etc., and I remember being terribly frightened and looking around wildly for him. I needed him there beside me. A c-section had been my greatest childbirth fear, and now here I was having to face it.

I was aware of some pressure in my abdomen, then a baby’s cry, and my husband holding him. I looked for him and saw my beautiful son. He was 9lbs., 1oz., and 20 inches. He was healthy and strong. And he had a big head, as advertised. And I couldn't even hold him, because I was still strapped down on the table being stitched up.

I’m going to stop here for now. I want to talk in more detail about my hospital stay after his birth, because what happened in the first three weeks after his birth has a lot of bearing on the following 26 months of my life and why I’m sitting here writing this story again. I’ve told it and written it down several times over the years, and the telling changes with every passing year, partly because of fading memory and partly because of my changing attitude toward my experience.

Please stay tuned for the next four days of my son’s life, in which he thrived and I floundered. Don’t worry, though, I’ll spoil the ending. Everyone came out all right.