Archive for January, 2010

Why I Want To VBAC

Posted on January 24, 2010. Filed under: VBAC after inverted t incision | Tags: , , , , , |

My friend Desiree inspired me to do this one. I have talked about how I am going to VBAC and all the logistics and preparation and details involved but I haven’t talked about why I want to. I think for a lot of women it is easier to schedule an elective repeat cesarean section (ERCS).  Many OB’s do not support VBAC or hospitals have VBAC bans or people have misinformation that does not make VBAC seem like a safe and healthy option.

I know I am certainly one of those women that it would be easier for. It would probably be easier to go ahead and schedule my ERCS now. I was told after Graham was born that due to the inverted t incision scar on my uterus that there was an up to 15% chance of uterine rupture and that it would be best to schedule an ERCS at 36 weeks to avoid any labor. At first, even though I was devastated, it didn’t sound too bad. I didn’t have Graham until 41 weeks 1 day. Having my next baby at 36 weeks kind of sounded great compared to going past 41 weeks. Plus, we had a really hard long labor, 52 hours total, so the thought of skipping all that and just having the baby sounded pretty tempting. That’s how I rationalized it all in my head, to make myself feel better about having had the first c section and about having to have the inverted t incision. I thought, ‘well, at least I don’t have to be pregnant forever and I don’t have to labor just to end up with another c section and I can plan everything.’ But it never really set in and it never really felt right to me. So I started researching.

I already knew that VBAC was a safe and healthy option for moms with bikini cut scars so I didn’t really start out researching VBAC safety as a whole. I started with the inverted t incision because that put me in a whole different category of risk according to the doctors. I looked for the studies that backed up the 15% claim of rate of uterine rupture in a subsequent trial of labor (TOL) and couldn’t find anything. I did find the most commonly quoted rates of 4-9%. So I started thinking that at least that meant there was a 91-96% chance that no rupture would occur. That was motivating. The I found my friend Jessica, another inverted t incision mom. She had started a Yahoo group, Life After Inv T, on her own webiste, Jessica’s Haven, she shared her birth story of a VBAC after inverted t incision. It was the first I had ever heard of this and I was so excited. I didn’t even know it was possible then I realized, she had two other moms stories on her site too. This gave me confidence to start really looking at VBAC as a viable option for me.

One reference that Jessica made as far as determining the safety of VBAC after an inverted t incision was the Landon Study 2004. The Landon Study found a rupture rate of 1.9% for inverted t incision type scars. I was floored. This was the largest VBAC study ever done and the rate was more than half to almost four times less than the smallest rate quotes I had found previously. At this point I got angry. I got angry at all the information I was given after my first c section. I was angry at the suggestion that I purposely deliver a preterm baby when I have always known that it is better for babies to initiate labor, letting us know they are ready to be born. I was angry at the thought of having to endure another c section, not just for my own sake but my baby’s sake.  I realized that ERCS tend to be easier on both mom and baby but what if I want a third child? A fourth? Each c section a woman has increases risks of complications. And what about the issues that area associated with babies that are born by c section? They weren’t risk free either were they? My brain was racing and I was again on a quest to learn more.

I have read the Landon Study many many times. I gave my Korean OB a copy of it the first time I met him, in case he had never heard of it. I highlighted all the parts that pertained to me and any other information I thought should be discussed. He was very welcoming of that information and asked me to be sure to bring him anything else I come across that my help me have a better birth or for him to be a better doctor. I really appreciated that support.  I found a post on a message board the other day that kind of breaks the Landon Study down a little bit. I am including that information here because there are several points that I want to touch on that really define why I want to VBAC. I am going to bold these points and I am going to italicize any of my own commentary.

The 2004 Landon study in the NEJM (12/2004) is a very good source for UR information. It included nearly 18,000 that had a TOL (trial of labor which may or may not lead to a successful VBAC). The overall rate of UR was 0.7% which translates into 124 uterine ruptures in that group of nearly 18,000. Only 2 of the babies died following a uterine rupture. Keep in mind, the group included women having a TOL after 1, 2, 3 and 4 c-sections. It also included women who classical, invert T and J incision as well as the low tranverse incision (which is most common and considered the safest for a TOL). About 25% of the women in the TOL group had their labors induced (with prostoglandins or pitocin) and/or augmented with pitocin which also increases risk of uterine rupture. About 25% of the women in the TOL group were less than 2 years from their previous c-section. Clearly, there were many other potential risk factors that could come into play here with the risk of UR.

According to this study :

The absolute risk of neontal death is 0.08% with a TOL vs 0.05% in an ERCS; stated otherwise, the risk of neonatal death is 1 in 1250 babies with a TOL vs 1 in 2000 with an ERCS . Babies can die in both a TOL and an ERCS. The difference between the two is very very small as you can see. TOL and ERCS both have risks. There are risks associated with vaginal birth in an unscarred uterus. There are risks associated with getting in a car and driving to work and leaving your house with the oven on and with pretty much everything else we choose to do in life. At least these are calculated risks with firm data to give us an idea of what we are dealing with.

The absolute risk of the mother’s death was 0.04% with an ERCS cs 0.02% with a TOL; stated otherwise, 1 in 2500 mothers will die due to an ERCS vs 1 in 5000 mothers will die with a TOL)   Again, very small increase in risks here. Even though the risk of maternal death doubles for an ERCS, it is still under a half of a percent. Compared to the risk of fetal death, the mother’s risk is lower so one could say that VBAC is safer for the mom than it is for the baby but I am not sure that is very accurate since again, all of these numbers are under 1% total. And even if I sound cold or strange, I think for me I have to consider Graham, the child that I already have living here now. While the baby growing in my belly is very important to me, I could not imagine dying and leaving Graham to grow up without a mother. If I were basing my decision on the risk of fetal death vs maternal death, I would choose to lower the risk of maternal death. I have not based my decision to VBAC on comparing these two risks, however, and again, since all the risks are so very low, it’s not really important that I compare them that way. Some people may, but I’m not.

This study also separated out the number of women and the number of UR based on incision type:
– Low transverse incision (n=14,483): 105 ruptures (0.7%)
– Low vertical incision (n=102): 2 ruptures (2.0%)
– Unknown type of incision (n=3206): 15 ruptures (0.5%)
Classical, inverted T or J incision (n=105): 2 ruptures (1.9%) I can’t really say anything. It’s right there to see. It’s not 15% or 4-9%, it’s 1.9% and I believe this.
– Unclassified (n=2)

It also separated out the number of women based on rates/types of induction:
– Spontaneous labor (n=6682): 24 ruptures (0.4%)
– Augmented labor (n=6009): 52 ruptures (0.9%)
– Induced labor (n=4708): 48 ruptures (1.0%)
– With any prostaglandins, with or without oxytocin (n=926): 13 ruptures (1.4%)
– With prostaglandins alone (n=227): 0 ruptures
– With no prostaglandins (n=1691): 15 ruptures (0.9%)
– With oxytocin alone (n=1864): 20 ruptures (1.1%)
– Not classified (n=496): 0 ruptures

Augmenting and inducing does raise UR (uterine rupture) rates. The numbers are still very small but in the absence of a valid medical reason to augment or induce, I would not do it. I feel that way about unscarred uteri though. Elective induction causes problems whether it’s for a first timer, a VBACer or anyone else.

A Breakdown of the number of previous cesareans (obtained from a subsequent study by Landon in Obstetrics and Gynecology 7/2006) (the women who had more than 1 c-section were grouped together and had a UR risk of 0.9% while the women who had 1 VBAC had a risk of 0.7%):
• 16,915 (94.5%) had 1 prior cesarean
• 871 (4.9%) had 2 cesareans
• 84 (0.5) had 3 cesareans
• 20 (0.1%) with 4 cesareans
8 women had an unknown prior # of c-sections

Risks of choosing a a TOL (trial of labor) vs an ERCS (elective repeat c-section):
•More likely to suffer a uterine rupture – the rupture rate in the TOL group was 0.7%; there were no ruptures in the ERCS group, however, women who presented in early labor and did not have a documented intention to labor were excluded so it is possible that women went into labor before their scheduled c-section and ruptured but were excluded from this study’s data
•1.4 times more like to have a uterine dehisence (typically a benign, thin area in the uterus)
•1.7 times more likely to need a tranfusion
•1.6 times more likely to develop endometriosis
•1.3 times more like to have another adverse event such as (broad ligament hematoma, cystotomy, bowel injury, ureteral injury)
•1.6 times more likely for the baby to die (doesn’t sound like that big of a difference right? Remember that babies only die in about 2-10% of uterine ruptures according to many studies AND babies do die after c-sections.

Risks of choosing an ERCS over a TOL:
•1.5 times more likely to need a hysterectomy I could have lost my uterus the first time, it was T’d secondary to difficult delivery of the head and once removed for cleaning and stitching it was found to be extremely large. So large in fact that they couldn’t get it back in. And it wouldn’t contract. I remember the slight panic in the room in those minutes. Luckily with a few shots of pitocin straight into my shoulder, it contracted and they got it back in. I’d kinda like to avoid that drama this time around. I’d like to have another baby, maybe two after this one.
•2.5 times more likely to have a thromboembolic disease (deep venous thrombosis or pulmonary embolism) I have a blood clotting disorder, prothrombin gene mutation. I am already higher risk for developing a DVT or PE. I do not know the stats but factored in with the risks of developing these issues just by having an ERCS, it is very motivating for me to stay off the operating table. PE  is the number one cause of death in pregnant women. So while the data shows a higher rate of death for the ERCS group at 0.04%, mine risk is going to be higher than that, even though I don’t know what the numbers are. It would be pretty hard to find information on risk of death by PE during an ERCS for a woman with PGM. That’s a mouthful.

•2 times more likely for mother to die
Risks of a successful VBAC delivery (remember that TOL can end in repeat c-sections) vs an ERCS:
1.2 times more likely to need a transfusion My doc said I could be a little higher risk on this one as my placenta is anterior and if I have any detachment issues after the birth. I am A+ which is an extremely common blood type in Korea and I am delivering at a University hospital in Seoul with plenty of blood in the bank. I feel ok with this.

Risks of an ERCS vs a succcessful VBAC:
•3 times more likely for mother to need a hysterectomy   See above. The above stats were for ERCS vs TOL (VBAC attempt whether successful or not). This stat here is for ERCS vs successful VBAC.
•5 times more likely to have a thromboembolic disease (deep venous thrombosis or pulmonary embolism)
See above. The above stats were for ERCS vs TOL (VBAC attempt whether successful or not). This stat here is for ERCS vs successful VBAC.
•1.5 times more likely to develop endometriosis
•4 times more likely for mother to die

2 things this study does not address regarding newborns is the incidence of respiratory distress in babies born by elective repeat cesarean which can be quite serious. It also does not address the number of babies that have brain damage as a result of a UR. I want to say the chance of brain damage is about 10-15% when you have a UR but I’d have to double check that. Obviously, UR is very rare but it does happen. When it does happen, UR rarely results in fetal death or brain damage though that too can happen. Babies are usually okay after UR. As far as the mother goes, it doesn’t address the decrease in hospitals stay, post partum surgical infection, etc.

Overall, I feel as if the medical data on the safety of VBAC, fetal death, maternal death, and other complications assure me that VBAC really is the best option. Medical reasons aside, there are emotional reasons as to why I want to VBAC. HERE is the linkt to a fantastic video of a woman and her three births. The first two were c sections and the third was an HBA2C (homebirth after 2 cesareans). Bring tissues.

I just feel like i owe it to my baby to birth it in a natural and peaceful way. I owe it to the baby to come into the world, straight my arms and not into the hands of rough strangers. I want the experience but mostly I want the baby to have the experience. Graham and I were separated the first three hours of his life, that is heartbreaking!  Part of giving my baby the peaceful birth is to also birth it without drugs as well. I don’t want the baby to be groggy and disoriented at birth or to have latch or suck issues which is very common with c/s babies, including my first baby. I want immediate skin to skin contact with my baby after it’s born, not for it to go to a warming table where it is suctioned and scrubbed and roughed up so it will cry. None of that is necessary, what’s necessary is the skin to skin contact, with me, with my body heat and my scent and my touch.

I truly believe that how we birth matters. I realize there are women who have c sections and they are happy about them and they had no bad outcomes and their babies were fine after them and emotionally they are happy they had their c sections. I also believe that a lot of women who have an unplanned c section the first time do have some emotional baggage as a result. I think that many women who go on to have ERCS rather than VBAC still think about VBAC and ‘what if’ really aren’t that happy that they had c sections and wonder if they really were necessary or not. I am not a woman who escaped my c section unscathed. II did have a lot of emotional baggage as a result. It’s already been proven that c section moms have a higher rate of postpartum depression and I can attest to that one personally. For me, ultimately, I just believe that I can birth. Even though it didn’t quite work out that way the first time, it doesn’t stop me from believing it or believing that birthing the baby myself is the best option for both me and the baby. I know that I could end up with a repeat c section and I am mentally prepared for that outcomes but it won’t be because I didn’t do the work or set myself up for the best possible scenario. It will be because it truly was necessary and that will be enough for me.

I am really looking forward to my labor. I am looking forward to the contractions and finding my rhythm with them, going off to labor land and having a pretty low intervention peaceful birth. I am looking forward to it because at one point in time I thought I’d never get to do that again but I am getting that chance and I am thankful for it. It seems so far away right now but I bet it will all be in here in no time.

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Supplements and Herbs That I’m Using This Pregnancy

Posted on January 15, 2010. Filed under: Supplements and Herbs | Tags: , , , , , , , , , , |

These are the supplements and herbs I am using in my pregnancy.

Organic Prenatal Vitamins: I am not big on commercially processed anything so of course that includes prenatal vitamins. They are full of synthetic vitamins with limited bioavailability and lots of artificial color and preservatives. My OB doesn’t like them either and actually said that if a woman had to choose between commercially processed and nothing to take nothing (but to eat really well). I love his holistic view. He searched high and low for a quality organic vitamin to recommend to his patients and ended up with Douglas Lab Ultrapreventive II. It is not formulated as a prenatal but it ranks as the 2nd best vitamin produced and scores 95.4% as determined by The Comparative Guide to Nutritional Supplements.  There were 510 vitamins used in this study and each of the criteria used were based on scientific evidence found in the latest literature.  The rankings were based on 14 criteria that include completeness, potency, bioavailability, metabolic support and more. To review the complete list and study go HERE.  The more well known the vitamin, the worse they tended to score. Centrum, for instance had a score of only 4.7% and ranked 442 out of 510. I didn’t see any prenatals on the list as I scanned it but like I said, it had 510 vitamins so it’s a long list. I doubt any of the synthetic prenatals would have faired any better than the rest of the synthetic vitamins. All that said, it is still better to get the vitamins and minerals from the source, it’s better assimilated by the body (and really, even though organic vitamins are better they are still processed and very expensive). I am taking only 1 pill a day. Douglas Labs recommend four and my doc recommends two. I don’t think I need two or four as I am using other herbs and supplements and will get my nutritional needs met there and with my diet.

Fish Oil: I am taking one fish oil capsule. It is also organic courtesy of Dr. Chung. It’s been suggested that fish oil  has very high significance in preventing the pregnancy complications like premature delivery and low birth weight. The consumption of fish oil during pregnancy reduce allergy in the newborns, help in development of brain and reduce risk of post partum depression. There doesn’t seem to be any risks in taking it so bring it on, I say.

RRLT: Red Raspberry Leaf Tea. Raspberry leaf contains high concentrations of fragarine and flavonoids, which are believed to strengthen, tone and relax the uterine and pelvic muscles. In addition it is high in vitamin C, contains many vitamins, minerals and antioxidants. Overall, drinking it is good for your body. Of course, Kegels will also tone your pelvic muscles too so do them also!  Studies have found two very important things about drinking RRLT. First, there were no side effects noted in women taking moderate amounts of red raspberry leaf in the third trimester. Secondly, women who drank red raspberry leaf were less likely to require a cesarean or forceps during labor. The American Pregnancy Association says:

Red Raspberry Leaf (Likely Safe) – Rich in iron, this herb has helped tone the uterus, increase milk production, decrease nausea, and ease labor pains.  Many of the “Pregnancy Teas” commonly contain red raspberry leaf to help promote uterine health during pregnancy.
There is some controversy about whether this should be used throughout pregnancy or just in the second and third trimester, so many health care providers remain cautious and only recommend using it after the first trimester

Nettle Leaf: Nettle leaves are a storehouse of nutrition, with high iron and calcium contents, as well as an excellent source of folic acid, an essential nutrient during pregnancy. Nettle strengthens the kidneys and adrenals, while it relieves fluid retention. Because nettle also supports the vascular system, it can prevent varicose veins and hemorrhoids. Postpartum, it increases breast milk. Nettle tea has a rich, green taste and can be mixed with other herbs. The APA says:

Nettles (Stinging Nettles) -(Likely Unsafe-see note ) High in vitamins A, C, K, calcium, potassium and iron. Used in many “Pregnancy Teas” because it is a great all-around pregnancy tonic. (*Note on the safety of nettles: Natural Medicines Database gives nettles a rating of Likely Unsafe, even though it is used in countless pregnancy teas and recommended by most midwives and herbalists. This may be in relation to which part of the nettles plant is used, the root or the leaves, and how much is used. According to other sources, the use of nettles is encouraged during pregnancy because of all its health benefits.2)

Even with a “Likely Unsafe” rating given by the FDA, I am very ok with this one. It is widely used and I am using the leaves not the roots. I am also using it in moderation.

Alfalfa: with its deep root system, contains many essential nutrients including trace minerals, chlorophyll and vitamin K, a nutrient necessary for blood clotting. Many midwives advise drinking mild tasting alfalfa tea or taking alfalfa tablets during the last trimester of pregnancy to decrease postpartum bleeding or chance of hemorrhaging. Alfalfa also increases breast milk, as alfalfa hay is fed daily to milking goats and other dairy animals. The APA lists it as possibly unsafe because those with heart conditions should not use it. I have read that chlorophyll is very good for strengthening scars so great for VBACs.

Rosehips: Very good source of Vitamin C and helps boost the immune system. Especially important for VBACing as Vit C will help build tissues and strengthen scars.

I will use the alfalfa, rosehips, nettles and RRLT to make an infusion. I will probably drink it on ice with honey since my 3rd trimester will be in the late spring and (VERY HOT KOREAN) summer.

I am also eating a very high protein diet, 80 to 100 g per day to strengthen my uterus.

My doc recommends an organic iron supplement starting at 25 weeks but with my prenatal, nettles tea, RRLT and balanced diet, I do not anticipate needing it.

Good nutrition is important for every pregnant woman. It is essential for the VBACing woman. There are women who have gone in for repeat cesarean after a failed VBAC attempt after proper nutrition and the docs were barely able to make out their first scar. I want to do everything I can to give my body the best shot possible and nutrition is something I have direct control over. Luckily, I have a holistic minded OB who supports my ideas and I am appreciative.

There are herbs that should not be used when pregnant. Please be sure to do your homework before using anything.

So this is what I’m doing, what are YOU doing?

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Adventures in Potty Training

Posted on January 14, 2010. Filed under: Potty training | Tags: , , |

Graham is 21 months old and we are potty training full time. We began a little back when he was 13 months old. he would pee in a solo cup. He was fascinated with watching himself pee and every time I would take his diaper off to take a bath, he would pee in the floor so I started putting a solo cup under him to catch it. He thought it was fun so I kept doing it. Every time I’d change his diaper I would do it.

In October I finally bought a potty chair and he loved using it the first few weeks. He did very well and would even poop in it and occasionally tell me when he had to go. I just thought I had it made. But after a few weeks the newness and fun of it wore off and he started hating it. I use pre-fold cloth diapers and would have him wear one without a cover to make it easier to get on and off but still I think he hated that whole process. He has always hated diaper changes so I thought maybe if I got training pants it would be easier since we would only have to pull them up and down.

I did my homework and settled on the Imse Vimse training pants. They are super soft organic cotton and they are very absorbent. I know that training pants aren’t supposed to do the work of a diaper and I didn’t expect them to, but I did want something that would hold up to nap time without leaking. I thought it was counterproductive to put him in a diaper for nap time. Boy do they hold up! He can have a full bladder release and not the first sign of a leak. He has had poop accidents as well that didn’t come out at all. Combined with how soft they are, for the price they are completely worth it. They are $14 a pair but I justify the cost in that a pack of disposable pull ups would be at least that much and would only last a few days. These training pants will work for us until Graham can get through the night without wetting the bed, however long that may be. The fit is great but he will be able to wear them for another year or more even.

So armed with training pants, I was ready to retackle potty training. It’s been working but since he doesn’t tell me when he has to go, if I don’t stay on him, he does wet his pants and he doesn’t care if he is wet so he just sits in it. I decided to start letting him run around naked and that has helped also. He hates getting wet so midstream he stops peeing and I tell him to get on his potty and he runs for it.

The poops on the other hand, OH crap. Literally. He just doesn’t want to go on the potty. But he hates pooping on himself naked so he starts to poops and runs to me to tell me “poo poo!!!” at which point I tell  him to sit on the potty (while I clean up what he left behind, gross!). And he sits and sits and sits but no poop. Then he gets up and guess what, he starts to poop again a few minutes later and the whole process starts again. It’s tempting to just put a diaper on him to let him get it all out and be done with it but that’s not sending the message I want him to get so for the last two days, I have been cleaning lots of little poops off the floor. I feel like I am training a puppy. We are getting somewhere though because he actually did get a little in the potty today. I am sure he still has some more to get out so I am watching him closely for poop cues so I can get him on the potty before it ends up on the floor. I just wish I knew how to get him to relax enough on the potty to just let it all go at once.

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My Lending Library

Posted on January 10, 2010. Filed under: Lending Library | Tags: , , , |

I thought I’d share my lending library list with everyone. I frequently loan out books to clients. Sometimes they request certain book and other times I recommend certain books based on what I have learned about a client. Sometimes I recommend certain books based on what is most important to the client or on what she is most worried about. I frequently give two or three books to a client and mark certain chapter that may be most pertinent to her and then if she wants to look over the rest of it she can. I also always leave a breastfeeding book, usually La Leche League’s Breastfeeding Book of Answers, at our last prenatal meeting.I have found this to be a very effective way of getting information out and I think (hope) my clients appreciate it. I always collect up the books at the postpartum visit.

Recently I have been loaning out books to aspiring doulas as well.

Here is the list. And yes, I have read them all.

Pregnancy and Childbirth Preparation

Gentle Birth Choices, Barbara Harper 2005

The Mother of All Pregnancy Books, Ann Douglas, 2002

An Easier Childbirth: A Mother’s Guide for Birthing Normally, Gayle Peterson, 1993

Ina May’s Guide to Childbirth, Ina May Gaskin, 2003

Spiritual Midwifery by Ina May Gaskin (Paperback – Mar 2002)

The Simple Guide to Having a Baby, Whalley, Simkin, Keppler, 2005

The Thinking Woman’s Guide to a Better Birth, Heci Goer, 1999

The Complete Book of Pregnancy and Childbirth, Sheila Kitzinger, 2003

Pregnancy, Childbirth, and the Newborn, Simkin, Whalley, Keppler, Durham and Bolding, 2008

Natural Childbirth the Bradley Way, Susan McCutcheon, 1996

Hypnobirthing: The Mongan Method

Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation by Pam England and Rob Horowitz (Paperback – Jul 1, 1998)

Back Labor No More: What Every Woman Should Know Before Labor by Janie McCoy King 1994

VBAC

Open Season A Survival Guide for Natural Childbirth and VBAC in the 90’s, Nancy Wainer Cohen, 1991

Natural Childbirth After Cesarean A Practicle Guide, Crawford and Walters, 1996

Silent Knife: Cesarean Prevention and Vaginal Birth after Cesarean (VBAC) by Nancy Wainer Cohen and Lois J. Estner(Paperback – Mar 30, 1983)

Breastfeeding

New Mother’s Guide to Breastfeeding, Joan Yonger Meek, AAP 2002

The Nursing Mother’s Companion, Kathleen Huggins, 2005

Breastfeeding Made Simple Seven Natural Laws for Nursing Mothers, Mohrbacker and Kendall-Tackett, 2005

The Ultimate Breastfeeding Book of Answers Newman and Pitman, 2006

The Breastfeeding Answer Book, La Leche League International, 2003

The Womanly Art of Breastfeeding, La Leche League International

Mother Food: A Breastfeeding Diet Guide with Lactogenic Foods and Herbs – Build Milk Supply, Boost Immunity, Lift Depression, Detox, Lose Weight, Optimize a Baby’s IQ, and Reduce Colic and Allergies by Hilary Jacobson 2007

Baby and Beyond

Baby’s First Year,   Sandy Jones and Marcie Jones 2007

Your Baby’s First Year,  AAP, Stevfen Shelov 2005

The No Cry Sleep Solution, Elizabeth Pantley 2002

The Happiest Baby on the Block, Harvey Karp, 2002

Baby Hearts, Linda Acredolo and Susan Goodwyn, 2005

Caring For Your Baby and Young Child Birth to Age 5, AAP Stephen Shelov 2005

The No-Cry Discipline Solution: Gentle Ways to Encourage Good Behavior Without Whining, Tantrums, and Tears: Foreword by Tim Seldin (Pantley) by Elizabeth Pantley (Paperback – May 15, 2007)

History

The Surprising History of How We Are Born, Tina Cassidy, 2006

Doula

The Birth Partner, Third Edition: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions (Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, &) by Penny Simkin (Paperback – Jan 15, 2007)

The Doula Book: How a Trained Labor Companion Can Help You Have a Shorter, Easier, and Healthier Birth by Marshall H. Klaus, John H. Kennell, and Phyllis H. Klaus (Paperback – Nov 5, 2002)

There are a few more that I would like to add and there may be a couple that I have left off the list. If I come across any or buy any new ones I will come back and edit this post. If you have any suggestions for ones that I should add, please let me know. And if you have any questions about any of the ones on my list, ask away!

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I Think My Nursling Is Weaning

Posted on January 8, 2010. Filed under: Breastfeeding | Tags: , , , , , |

And I am happier about it than I thought I would be although I am a little sad too. Graham has been down to two nursings a day for months now. He did it on his own. Sometimes he would nurse three times but mostly just twice. He would always nurse in the mornings, he HAD to, it was his coffee and then once in the afternoon. For the last week he has only nursed in the morning. He never asked at any point during the day. Then today, he didn’t ask this morning and never asked at any point. I can’t believe it really because that morning nursing has always been such a big deal to him. I am almost 14 weeks pregnant so maybe it tastes different, he never acted like it did though. Maybe there isn’t enough, I haven’t been very good about taking pre-natals and I don’t eat much. Maybe it’s just time. He just turned 21 months on the 5th (REALLY????!!!).

I had intended on nursing through the winter and weaning him at two, which will be in April, but I suppose if he is done then great. There are so many benefits to breastfeeding through the second year and I was hoping to continue those benefits. I believe child led weaning is the best method but I was going to gently encourage him in the hopes that by the time the new baby is born he would be done. Of course, I was mentally preparing to nurse both for a while because I didn’t want to upset Graham by weaning him then nursing a new born in front of him, that’s kind of mean.

Now if only potty training was that simple….

***UPDATE

A week after this was written it seems that my son is weaned. Over the next week, he only asked to nurse after waking up in the morning one time. A couple of mornings he was fussy and whiny like something was off (like not nursing) but he didn’t ask and I didn’t offer. He didn’t ask at any point throughout the day either. The last few days he’s woken up in the morning without so much as a thought of nursing. I guess it’s official, we are done! I am a little sad it’s ending but glad to finish this pregnancy without breastfeeding. I am also glad that I won’t have to worry about breastfeeding jealousy because by then he would have been weaned nearly six months. I was prepared to tandem nurse if necessary but I am kind of glad he weaned himself on his on when he was ready. I  feel accomplished!

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Triplet VBAC in GA with Dr. Tate!!!

Posted on January 8, 2010. Filed under: Triplet VBAC, vbac | Tags: , , , |

Dr. Tate is the doc I would have used if I were going back to the States to VBAC. Instead I found Dr. Chung here in Korea who is, in my opinion, even better than Dr. Tate but both men are amazing docs with a calling to really provide care and options to birthing women in all scenarios.

The details are just coming out about this VBAC but apparently the woman had her triplets in a hospital attended by Dr. Tate. I am assuming she went natural, as in unmedicated, as that’s generally the way with a VBAC with Dr. Tate.  From what I am reading so far, the first two babies were head down and the third was footling breech. Here are the babies stats according to the ICAN of Atlanta chapter posting.
3 girls, all vaginal, all Apgar 8/9.

A= 4# 6oz, 18.25in @ 10:24pm, vertex.
B= 6# 4oz, 18.25in @ 10:37pm, vertex.
c= 3# 11oz, 16.5in @ 10:39pm, double footling breech extraction.

All three babies are successfully breastfeeding as well.

What an amazing day for this mother, her family, Dr. Tate and the VBAC world as a whole!

Congratulations everyone!

***EDIT: I was first informed by a commenter that the mother had an epidural and delivered in the OR. I have since been informed by Dr. Tate that the mother did have an epidural in the event that baby C got into some trouble and he had to reach up and get it out quickly, which is in fact what happened.

I found this study done on the safety of triplet vaginal delivery. One woman in the study was also a successful VBAC of triplets.

[6] Preliminary experience with a prospective protocol for planned vaginal delivery of triplet gestations.

AUTHORS: Alamia V Jr; Royek AB; Jaekle RK; Meyer BA

AUTHOR AFFILIATION: Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, State University of New York at Stony Brook, New York, USA.
SOURCE: Am J Obstet Gynecol 1998 Nov;179(5):1133-5

CITATION IDS: PMID: 9822488 UI: 99039941

ABSTRACT: OBJECTIVE: The objective of the study was to evaluate a protocol for vaginal delivery of triplet gestations.
STUDY DESIGN: All women with triplet gestations managed between January 1, 1995, and December 31, 1997, by University Medical Center’s perinatal practice were offered enrollment in our vaginal delivery protocol. Our protocol offered attempt of vaginal delivery if triplet A was in vertex presentation, fetal monitoring was possible, and there were no other obstetric contraindications. Twenty-three triplet gestations were identified; 8 achieved vaginal delivery. Outcome parameters investigated included neonatal mortality, Apgar scores, neonatal intracranial hemorrhage, arterial cord pH, neonatal weight, and length of postpartum hospital stays of mother and neonates. All parameters were analyzed with analysis of variance and the Student t test as appropriate with the JMP 3.1 statistics program (Cary, NC).

RESULTS: Twenty-three sets of triplets were enrolled. Eight sets were delivered vaginally. Eight of 9 patients (88.9%) who attempted trial of labor were delivered vaginally, 1 of which was a vaginal birth after cesarean section. The remaining triplet gestation failed to progress at 4-cm dilation. Twelve sets of triplets had a nonvertex-presenting triplet and were delivered by the cesarean route. The remaining 2 triplet gestations were delivered by the cesarean route because of inadequate fetal monitoring. Neonatal survivals were 100% for both groups. No significant differences in neonatal mortality, Apgar scores, intracranial hemorrhage, arterial cord blood pH, hospital or neonatal intensive care unit stay of neonate, neonatal weight, and change in maternal or neonatal blood cell count were noted. There were no cases of grade III or IV intraventricular hemorrhage in either group. A significant reduction in postpartum hospital stay of mother was noted in the vaginal delivery group (2.8 vs 4.5 days, P <.001). The mean gestational age at delivery was significantly lower for the vaginal delivery group (31.3 vs 34.0 weeks, P <.02). The mean neonatal weight for the vaginal delivery group was significantly lower (1758 +/- 473 vs 2022 +/- 407 g, P <.02). There were no significant differences in outcome parameters for the first, second, and third triplets within each group when compared with each other or with the other study group. One patient who underwent vaginal delivery had retained products of conception and required curettage. A single fetal death occurred at 22 weeks’ gestation from twin-twin transfusion, with the remaining triplets being delivered vaginally at 35 weeks’ gestation. Cesarean hysterectomy was required in 1 case for uncontrollable bleeding at the time of cesarean delivery. Perinatal complications occurred in a large number of patients, with the incidence of premature labor 47. 8% (n = 11), that of preterm premature rupture of membranes 26.1% (n = 6), and that of preeclampsia 34.8% (n = 8).

CONCLUSION: In selected cases vaginal delivery of triplet gestations can be accomplished without increased maternal or neonatal morbidity and mortality and may significantly decrease maternal hospital stay and postoperative morbidity.

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How To Hire A Doula

Posted on January 5, 2010. Filed under: doula, How to Hire a Doula | Tags: , , |

*If you have previously hired a doula, please be sure to share how you did it in the comments section!

When you are bringing in another person to your birth and you are paying them to attend it, you need to make sure that it’s the right person. You should interview a doula just like you would interview someone to babysit your child, build your house, deliver your baby (YES, you should interview your OB or MW!). I think before you ever interview a doula, you need to interview yourself a little though.

Before meeting with a doula you should sit down and answer the following questions…

  • What kind of birth experience am I looking for?
  • Why do I want a doula?
  • Why do I need a doula?
  • What do I expect from a doula?
  • Do I want a doula to advocate for me to the staff?
  • Do I want a doula to help me stick to my birthplan?
  • Do I want a doula to help my partner be more involved in the birth?
  • Do I want a doula to be the main support person during my labor or in the background?
  • What do I need from my doula before the labor begins?
  • Do I need a postpartum doula or postpartum help?

The answers to these questions are the base for what your philosophy of birth is. Do you feel as if birth is a means for getting a baby out and it doesn’t matter how that happens? Do you feel like birth is something that should be experienced and you want to experience it in full? Are you attempting a VBAC and feel as if you need extra support to ensure success? Do you want a natural birth or a medicated birth? Do you want an intervention free birth? Doulas can be valuable in all of these situations but in finding the right doula for your job, you should have an idea of where you stand on these things. Knowing your own philosophy of birth will help you find a doula who has a similar philosophy.

Once you actually meet a doula, here are a few questions to get you started:

  • How do you feel about natural birth?
  • How do you feel about medicated birth?
  • How do you envision your role in my birth?
  • Would you be willing to be in the background letting my partner be my main support person?
  • Will you be my main support person if my partner gets nervous about everything?
  • Can you help my partner better support my by showing him/her ways to help me?
  • What are some of the comfort measure techniques that you use (i.e. massage, guided imagery, hypnosis, breathing, Rebozo, etc)?
  • What kind of training have you had?
  • How many births have you attended?
  • Do you have a back up doula and may I meet her?
  • Why did you become a doula?

If you are a second (third, fourth, etc) time mom, you may have very specific questions based on how your last birth experiences went. Some may include…

  • What is your comfort level with VBAC and how many have you attended?
  • I prefer a very low intervention birth and require advocacy to the staff, can you do that?
  • I prefer to labor at home as long as possible before going to the hospital, can you help me do this?
  • I prefer my labor room to be as peaceful and quiet as possible with no unnecessary staff interruptions, can you help me achieve this?
  • My first labor was ___________ and I know that in my next labor I will need ______________, will you help me do this?       (for me i would say, my first labor was very long and I know that I will need a lot of encouragement if this one is very long also. I will need someone to stay strong and positive and upbeat and to encourage me to change positions frequently and remind me to eat and drink. I will also need for someone to be on the look out for signs of fetal malpositioning and to help me find ways to correct it).

The main thing to remember when selecting a doula is that you want to hire someone who will support whatever it is you want at all times rather than someone who has their own idea of how (your) birth should go. You want someone strong that can help you stay with your birth plan and communicate to the staff but that can also step back at the right time too. Hire someone that can help create a peaceful labor environment and provide the right words and comfort measures as needed. I always say trust your instinct. If in doubt don’t but at the same time if you find the ‘perfect’ person, go for it!

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Gotta New Look. You Like?

Posted on January 4, 2010. Filed under: Uncategorized |

Thought this might be easier to read and navigate. What do you think?

And HEY, leave comments! Comments make the blog go round!

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Born in the Caul

Posted on January 2, 2010. Filed under: Born in the Caul | Tags: , , , , |

I attended a birth last night and the baby was born in the caul. I had heard of it and seen videos of it but never witnessed it in person. The mom pushed spontaneously and without instruction in the hospital (WOW) for about an hour. She squatted through most of her active labor and also through the pushing stage. We had the bed broken down and the squat bar set up and she used it with very little assistance. During the pushing phase she was very internally focused ad quiet. She was rhythmic and surprisingly quiet as she had been vocal through most of her labor. She just found her place and went with it, it was pretty awesome to watch. The nurse and the dad were busy entering admissions data into the computer, I was sitting next to mom’s bed on a stool and her best friend was standing in front of her. After a while, the mom reached down and felt and said “I feel something.” She had had a vaginal exam about 30 minutes prior and was 9cm so the nurse looked over very surprised. I asked her if she just touched the outside or if she reached in at all and the mom said she only touched the outside. The nurse pulled the big light out of the ceiling and the mom began another push. When the nurse shined the light down we all saw the bag bulging out of her vagina and could clearly see the baby’s head behind it. The dad was amazed. He just couldn’t believe what he was seeing. I put a mirror down so the mom could see too. The nurse said “yep, your crowning” and ran for the doctor. The doctor came in and mom was starting another push. The mom looked at me and said “It’s burning!” so I told her to stop bearing down on it. Then doc said, give me some little grunty pushes and when she did the whole baby, sac and all, came out all at once. The sac burst when the baby landed on the bed. She kind of just slid out straight onto the bed, the doc didn’t ‘catch’ her. The baby immediately started gurgling and crying so the doc put her straight to mom’s chest. It was a pretty amazing experience for everyone in the room.

The L&D nurse we had said that this was only the 2nd baby she had seen born in the caul. It is rare thought the numbers are conflicting. One article said 1 in 1000 births and another said 1 in 80,000. Being born in the caul is considered to be very special and has a lot of superstitions and myth behind it. Babies born in the caul are known as the caulbearer and THIS website dedicated to being born in the caul says this…

The birth Caul or Veil is a full face mask which may be sometimes found covering the face of a child at birth. Such births are rare and hold special significance for the child born in such a manner. There are many stories and myths about the Caul, many of them erroneous. This site is provided to give some insight to those who are born with a Caul and further promote public knowledge of the phenomenon.

The correct name for those who are born with a Caul is a Caulbearer. Such people are often referred to as being born behind The Veil, as the Caul is also referred to as The Veil in many cultures due to it being a face covering.

It should be noted that Caulbearers may be male or female and may come from any social class, racial or religious group. There are no geographical boundaries to the phenomenon. However it has been observed that Caul births do have tendencies to run in family bloodlines. Sometimes, but quite rarely, more than one member of a family–usually a parent and child–may be born with a Caul.

It has been calculated that Caulbearer births may be as few as one in eighty thousand births. However this does not necessarily mean that there may be one such birth in every eighty thousand births in a particular area or that there may not be more than one in any grouping of eighty thousand births.

The main reason why those born with a Caul were and are held in high regard is principally due to the fact that such births can be calculated in advance and the time and place of such births predicted. This marked the birth of a Caulbearer as being of particular significance, along with the fact that such people often had peculiar abilities in many diverse ways which were not commonly found in the general populace.

Caulbearers are often found to have ability in matters of finding underground water supplies, knowing when weather patterns will change, predicting when fish and other food supplies will become plentiful.

Many are great natural healers, which trait may be manifested by the laying on of their hands, or remotely from a distance. Many are considered to have great ability in matters of judgment and ruling nations and often possess insights which are difficult to appreciate by other people.

In many cultures the Caulbearers were considered to be “Kings by right,” due to the predictive nature of their births and their leadership abilities. This is one of the reasons why certain Buddhist groups, to this very day seek out Caulbearers to be brought up to become Dalai Lamas.

Throughout history the powers that be have repeatedly attempted to destroy the Caulbearers because they were seen to be messengers sent by a higher force to guide mankind in matters both physical and of a higher spiritual nature. In ancient times they were held in high regard for their knowledge in a wide range of disciplines, and therefore became known as ‘priests’ which originally simply meant ‘teacher.’ This was long before the notion of the religious priest was ever conceived.

The Caul or Veil is sometimes also referred to as “The Veil of Tears” due to the tendency of baser types of people to attack or even kill Caulbearers, often for no apparent reason — such as in the Middle Ages, when they were burned as witches and heretics, mainly by the Church of Rome.

Persons of negative character may often react to Caulbearers at a very subconscious level as they sense that there is something different about these people. There are many folk tales about “the curse of the Caul” which appears to come from the fallout of negative actions against a bearer of the Caul.

In many cultures around the world the Caul is more commonly referred to as ” The Veil,” and the word “Caulbearer” is the usual word in English speaking countries. However it should be pointed out that the word Caulbearer will generally not be found in standard dictionaries due to repeated suppression of the reality of such people as they have often been persecuted by those who wished to become kings by might rather than by birthright

Some famous people born in the caul include (I have not verified these, just found them doing a google search):

Liberace - American musician and entertainer
James Couzens - Industrialist, banker, politician
Queen Christina of Sweden
Frank Albert Jones - Black artist
Sigmund Freud
Napoleon Bonaparte
Here is a video of a homebirth in the caul. This video is pretty amazing and it is MUCH slower than the birth I witnessed last night so you really get to see what is happening.
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