Archive for July, 2010

Meconium Happens…but sometimes it needs some encouragement

Posted on July 31, 2010. Filed under: Uncategorized |

My side:

Stella latched on soon after birth while we were still in the pool. She wasn’t really interested in nursing but she did make contact. After we got out of the pool, we realized I was bleeding a little too much, Danica the midwife, held Stella and my breast and latched her on and helped her feed while Dr. Chung and Rosa worked on me. The contractions and fundal massage where incredibly painful and my placenta had not passed so i was really not able to hold her and nurse her myself, especially while lying flat on my back. I was glad to have an extra set of arms so that Stella didn’t miss out on that very important after birth skin to skin contact.

Over the next two days, nursing continued to go well. I knew I had colostrum and on day two after birth Stella began peeing in her diaper. She had not, however, passed meconium. Generally newborns pass meconium before they pee but pee is also a sign that baby is getting plenty of colostrum to stay hydrated. I wasn’t worried about her getting enough to eat but I was concerned about the lack of poop. Most healthy newborns will pass meconium by 48 hours. Stella didn’t have any symptoms of an intestinal blockage like a painful or distended belly or spitting up bile or bilirubin but I did worry that if she didn’t pass the mec soon that she would become jaundiced.

I talked to Karen about it and we called the pediatrician who said to insert a q-tip just a bit to see if it would stimulate a poop. We tried it and it didn’t work and really it just seemed mean even though we were really gentle about it. I knew that if we took her in that they would do it again but more aggressively and that they’d poke and prod the rest of her. I figured that a little extra fluid would be enough to push the poop right out but my milk hadn’t come in yet. I didn’t get milk until six days postpartum with Graham so I was a little worried about waiting because I didn’t know how long it would take this time. Karen and I had already discussed her nursing Stella if i had a repeat c/s or surgery for the retained placenta so I knew she was ok nursing Stella if I wanted her to. I really wanted to avoid formula and bottles at all costs and Karen had no hangups about nursing someone elses baby. We decided once we hit the 48 hour mark after birth without a poop that we’d give it a shot.

Karen nursed Stella for about a half hour and the baby was quite content. I didn’t feel the least bit weird about it, I was really grateful to not only have a friend close enough to do this but also to have a much more gentle approach to stimulating a poop. This just seemed like the natural course of action and even Karen’s kids didn’t seem phased by it. Of course, her 16 month old wanted in on the action but that’s to be expected. Once Stella was finished, Karen brought her back to me in a milk coma. She did stir and want to nurse from me some more which was great because she knew she was back to mama. While I was nursing her she began to pass some rather loud and very smelly gas. I pumped her legs, pushing her knees up to her belly and held them with a little pressure, then released and repeated. After a couple of minutes Stella emptied out for a good five minutes. I gave her time to finish before I began to change her but she was still pooping when I opened the diaper so I just swapped it out for a clean one and let her lay on it while she finished. It was thick black tarry meconium and a lot of it. She pretty much cleaned herself out with that one poop. The next one she made, a few hours later, had only a little black mec and the rest was the yellow seedy breast milk fed baby poop. That was the last of the meconium.

I was so excited. It was nice to have an instinct and be right and take care of her in a gentle peaceful way. And what better friend could a new mom ask for than one who will nurse your baby without a moments hesitation or thought about it? The funny thing is that almost immediately after all of this took place, i felt the tingling in my breast that signaled the beginning of engorgement. I knew my milk was on the way. By the next morning, I had a nice big full supply.

Karen’s side

Stella was latching well and nursing frequently, but with the exception of the meconium she passed on the inside, she hadn’t had a good meconium poop on the outside by the second day. Since she was peeing and nursing well, the plan was to go see the pediatrician in the morning if she still hadn’t pooped. Amy called the pediatrician who suggested a butt-probe. I put some petroleum jelly on a q-tip and gently twisted it around. There was a bit of mec on it when we took it out, so we knew something was in there, but hours later at the 48 hours mark, it still hadn’t passed.

Since I have full-on milk because I am still nursing, Amy asked me to nurse Stella. We had already planned to have me nurse and pump for Stella if Amy had to have a c-section or surgery for retained placenta. We felt that nursing would be a much more pleasant remedy than a more aggressive butt probe by the pediatrician or messing with finger feeding formula.

Stella is the first baby that I have nursed other than my own children. It was very natural. It seemed just the right thing to do. In fact, after she was born and I held her in the Moby as we were getting ready to go to the hospital, I had an instinct to nurse her. I didn’t do it at that point because she had already been nursing from her mom and I was able to get her to sleep in the Moby.

She latched perfectly and nursed for about 30 minutes. Ian and Eva (my children) were very interested. I was surprised that Ian (who is almost 4) didn’t find it strange at all that I was nursing another baby. Eva (16 months) is fascinated by Stella and just kept saying,”Baby! Baby!” She eventually did get jealous, though. I attempted tandem nursing, but couldn’t get into a good position for both of them. Eva patted Stella as they nursed together.

When Stella finished nursing on one side, she let go, flashed a peace sign and relaxed into the milk-drunk happy state that babies get to when they have full bellies. I offered the second side, but she just played, so I took her back to Amy.

When Amy held her, she recognized mom and wanted to nurse again. Shortly after that she had a MASSIVE butt-plosion. Amy waited through several blasts before attempting to change her and even then, more was coming out. I felt strangely proud of myself for being able to clear her out like that. In fact, it worked so well that her next poop had only a little meconium and actual poop!

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The Birth of Stella Rose: Home Water Birth After Inverted T Cesarean

Posted on July 25, 2010. Filed under: Anterior placenta, AROM, home birth, inverted t incision, vbac, VBAC inverted t incision, water birth | Tags: , , , , , , , , |

My baby girl Stella was born just over 24 hours ago and I have to get the story down now. I’m high on it and the details are running through my head and it needs to come out now! Stella’s birth story begins with her big brother Graham’s birth story. This is Stella’s story though so HERE is the link to Graham’s story.

After having a c/s with an inverted t cut, I was nervous to get pregnant again. I knew that I didn’t want another c/s but finding a doctor to attend me would be really hard. I did find the perfect team right here in Korea, which saved me from having to split up my family and going back to the States. My birth team was so much more than convenience though, each person was there for a specific reason and each person was there in their own perfect capacity. I truly did have the best birth team possible in Korea and most likely Stateside as well. I am very sure of this.

Graham and I were already in Seoul at my friend/doula’s apartment, where I planned to birth. We live two hours from Seoul and the nearest hospital is about 45 minutes away and my OB and I agreed that was too far away in the event of transfer since I was planning to have a(n) HBAC (home birth after cesarean). We came into the city on the 15th, my estimated due date to await baby Fuller’s arrival. My husband was out in the field for an exercise and waiting to get the call to join us. He was 2.5 hours away minimum which made me nervous. In hindsight that is really really funny.

On Thursday, July 22nd I began having prodromal labor: start and go labor, regular then irregular contractions, no contractions, ‘false’ labor, etc. I also began losing my mucous plug. I called Josh to let him know and he decided to go ahead and make the trip to Seoul. Even though we weren’t sure when labor would really kick in, we knew it would be soon, especially since I was 41+ weeks at that point. He got in that evening and Josh, Graham and I checked into the hotel on post to get some private time as our last few days of a family of three. The next two days were spent hanging out, playing with Graham and doing lots of walking. I continued to have the prodromal labor until Friday night.

Friday night at 1am, I was woken up by a contraction that was not like the prodromal ones. It was ‘real.’ I layed there thinking I should ignore it and go back to sleep. Three and a half minutes later, I had another one. Then another one the same interval. I went to the bathroom and realized they weren’t stopping. Graham and Josh were both sleeping so I got on Facebook and started what would end up being a live feed of the birth until the end. I never planned on doing that but it helped me cope for many hours of the labor and once I couldn’t do it anymore, my husband and Karen (friend/doula) took over.

For the next 2.5 hours, I had contractions 3.5 minutes apart. I started to get the shakes and decided to text Karen and let her know I was thinking about coming back to her apartment. I also woke Josh up. It took about an hour and a half to get ourselves back to Karen’s and thankfully, Graham went back to sleep for a few more hours. I continued to labor all morning. I also had bloody show and knew it was the real deal.

Around lunch time or so my labor seems to space out. The contractions went down to 7-8 minutes apart and I was mildly annoyed. I knew it was because the baby was trying to get into a better position and just went with it. I made sure to eat and drink and I took a nap between the contractions. After that, Karen did a maneuver on me called a hip lift that we learned from the Pink Kit and I had immediate results. When she did it, I felt my pelvis open and there was an obvious shift in the baby’s position. Karen felt the movement too and she was only touching bony pelvis. As soon as I stood up, my contractions kicked back in stronger than ever. They were very intense compared to my labor with Graham. I had no back or hip pain but had intense cervical and lower uterine pressure, so much so that it caught me off guard and I found it overwhelming at times. I listened to my Hypnobabies tracks the entire time and it really helped me focus if I began to struggle at all. A few hours later I was able to nap between contractions some more and it really helped since I had only had four hours of sleep the night before.

Karen and I had discussed when to call Dr. C and I just felt like that even though I was definitely in active labor, it wasn’t very progressive and I didn’t want to have the pressure of a bunch of people there just yet. Little did I know that my med team (Dr. C and MW1 and MW2) would be the least pressure I’d encounter! We did call them around 7pm to let them know we were ready for them but that they didn’t have to be in a hurry. They arrived around 9pm. They checked the baby with a portable contraction/fetal heart tone monitor for about a half and hour and she was doing perfectly. My vitals were great as well. Everyone retreated to the kitchen and living room and gave me my space to continue to labor. Karen and Josh alternated helping me and keeping me company. At some point before the med team arrived, Karen and Rachel (another doula friend of ours that came by to help out evening #1) got the pool filled and I got in. I love it.

Around midnight I decided that I wanted a vaginal exam. I am not a fan of routine exams and my team knew that if I wanted one that I’d ask so no one ever offered. Rosa (MW1) checked me and said I was complete, 10cm and 100% effaced. I was floored that I was complete and excited too because I just knew that I’d be pushing soon and would be done! Then Rosa said that the baby was still a -2 station which is high in the pelvis still.

Because of the work I did with the Pink Kit and and the time I had spent discussing my birth history and pelvic shape issues with Gail Tully, the midwife that runs www.spinningbabies.com , I knew that I had some things to contend with and work through. I knew the entire labor that these things were why the labor had been somewhat funky with the spacings and with the baby being high. I also knew that if I could get the baby to descend into my pelvis that there was a very strong possibility that I’d push her out. The trick to this would definitely be getting the baby to descend.

Rosa began working me in different positions to aid descension. The first was walking while doing abdominal lifting in between contractions. I did this for 30 minutes. The she had me swaying my hips between contractions for 30 minutes. Then she had my so a side lying position in the bed for an hour. This was nearly torture. The rest of the birth team slept except Karen and Josh. My contractions were at the strongest intensity that they had been the entire labor at this point and laying down in bed on my side but while also squishing the left side of my belly into the bed (to force the baby out of a left occiput transverse position) was torture. Karen and Josh had to talk me through every moment of it and the last 20 minutes made me want to scream at both of them. And I did along with many choice cuss words that would embarrass some people but I managed to do the hour because of those two and it did help the baby move so it was worth it in the long run.

That said, that hour was so incredibly difficult that I lost my control and focus. Josh went to take a nap while Karen stayed with me. I got back into the birth pool and tried to refocus and get my control but I struggled. I told Karen I was done and I ready to go to the hospital and I didn’t care about a VBAC any more. I wanted an epidural and some sleep and if that didn’t work, fine. She looked at me as if to say ‘everyone else is asleep’ and I glared back ‘then go wake them up!’ But what I said out loud was “I’m so tired and I need to sleep” and she responded with “so sleep then.” She didn’t pity me or baby me which is what I wanted. She was blunt and she wouldn’t let me jump of the ledge I was so desperately trying to escape from. It pissed me off but I do mad way better than I do upset or pity so it worked and I went to sleep. For two and a half hours I slept in the pool. My contractions had spaced a bit, maybe 6-7 minutes apart and I did wake up to work through them and then I went back to sleep. Karen slept on the bed next to the pool.

When we woke up the sun was coming up and I puked and ate, in that order. Rosa did another exam and said that the baby was still at -2 but that her head had moved to an OA (occiput anterior, optimal for birth) position so we were all encouraged that things would start moving. My water had not broken either and the bag was bulging out in front of the baby’s head. I wondered then if they would want to break it and analyzed how I felt about it. I didn’t like the idea but felt like something needed to happen. No one said anything about it.

Because of the nap and the food, I felt much better. I was still worried that I didn’t have the stamina to continue when my labor kicked back into high gear but I was beginning to believe that maybe I could do it. I had more energy, now I just had to find a rhythm. Karen and Josh rewarmed the pool and I got back to work. I labored in positions that made my pelvis feel open. Mostly I stayed on my knees while holding onto the side of the pool. Around lunch time, Dr. C told me they were going to go eat in shifts and that when they were all back that we’d discuss rupturing my bag of water. I had been at 10cm for about 12 hours that we knew of at that point and since the baby still was’t descending it seemed like something worth exploring.

They (med team) were all back by 2pm. They discussed what they though amongst themselves then Dr. C came to talk to me about it. Since the head was in a better position he thought that if he broke my water that the more intense contractions that would create would push the baby down farther into my pelvis. He was blunt and honest and said that he didn’t know if it would work but if it did hopefully I’d have the baby soon (music to my ears since I was 36 hours into it at that point) or it wouldn’t work and we would go to the hospital to explore other options. I agreed with him and gave him the go ahead.

They wanted to do a half our of monitoring first so we did and baby looked great. It was about 4pm when we were all ready to rupture the membranes. He wanted to break the water during a contraction so that the force of the contraction would bring the baby’s head down and prevent cord prolapse since the baby was still high in my pelvis. Rosa did the job and wow did i ever have some water! It just poured out. The baby’s heart rate jumped up to 180-190 for a bit so they gave me oxygen and had me lay on my left side. I had a contraction and more water poured out and then I had another contraction and my body pushed with all it’s might in the most uncontrollable way that I have no words to describe it. I looked at Dr. C and said, “I pushed!” and he said “I see that!”. They had me side lie for about 20 minutes longer and continued monitoring and the baby looked great so I was given the go ahead to get back into the pool.

The pool made everything better. I was ready to do it. I pushed when my body said push. I was loud and I roared and grunted and made noises that I never imagined. I remember Karen saying to be a lion and thought it was funny even though I ignored her. I pushed spontaneously for about two hours before I asked Rosa to check the baby’s station. The baby was at zero which was improvement but I knew I still had a ways to go. Rosa made sure I was swaying my hips and changing pushing positions at interval. I also got very serious about pushing and began bearing down as hard as I could on top of what my body was doing. It just seemed like I should. I was exhausted and had been pushing forever and was so ready to be done with birthing! After a bit, I could feel the baby’s head just inside and that gave me a lot of strength. I was oblivious to the world around me. I knew Graham was in the room and he seemed ok with my roaring. Josh said that he said ‘ow mama’ a few times and ‘oh shit’ more than a few times as that was my cuss phrase of choice. After the three hour mark of pushing I knew the baby was really on it’s way out. I felt fierce and determined. Everyone was focused on me and I didn’t care, I was happy and loved every single person present and so grateful that each of them were there for that moment. I soon realized that the baby’s head was crowning and I yelled “OH ring of fire, that’s sucks!” and I thought about how many times I told a client that ‘you can do anything for a minute!” and it made me want to slap myself and hug myself at the same time! In the next push, Dr. Chung reach down to help slow down the baby’s head and I really felt the stretching then. The next push I bent over on hands and knees and Josh got prepared to catch the baby from behind from outside the pool (I didn’t want him to get in). Dr. C and Rosa moved to the backside with Josh and I pushed what felt like a huge rock. Dr. C told me when to push and when to breath through it and not push. He has a 70% no tear rate so I told him I would listen and do exactly as he said. In fact, when I realized the baby was crowning, I asked him if it was time to listen to him which got some laughs. The next push brought the head all the way out and that was the hardest thing I think I have ever done. I waited until the next contraction for push again and Josh said that she opened her eyes and mouth and moved her head under the water. The next push brought her shoulders out one at a time which I felt every bit of then her body just squished out which kind of felt like a reverse vomit or something equally strange. I looked over my should in that moment and saw Dr. C and Josh both with outstretched arms and the next thing I knew they were trying to pass the baby back under my legs to me. I sat back in the pool and was somewhere between “OH MY GOD I JUST HAD A VBAC” and “OH MY GOD, I’M DONE!”. The very first thing I did when they handed me the baby was lift her leg and then say “I knew you were a girl!” It was an amazing moment. Karen was crying and saying “you did it! you did it!” and Josh was tending to Graham because as soon as the baby popped out he lost it. I sat back in the pool and stared at my baby girl and just couldn’t believe what had just happened! I had a perineal tear that wasn’t bleeding so we decided not to bother with stitching and opted for resting with my legs closed for a week or so instead.

The amazing thing about my birth is that Dr. C was so incredibly comfortable and confident. He was confident but not cocky. He listened to Rosa, who is more experienced than he is but he still made the call when it came down to what he felt was best. He discussed everything with both me and my husband and Karen and I ultimately had the final say in every aspect. There were no time limits, no unwanted interventions, lots of privacy. They did monitor regularly but were not over bearing and were unintrusive. Rosa is probably one of the most experienced home birth midwives in Korea. She is a CNM who worked in a hospital for 10 years before doing home birth. She also runs a birthing center. Dr. C respects her and listened to her and she did exactly what I wanted her to do when I asked her to join the birth team which was help me deal with positioning issues. I knew going into my birth that I have pelvic shape issues that would made birth more difficult and that lended a hand in what was Graham’s c/s birth. I wanted the best and she brought it. Dr C told me later that adding her to the team was the perfect choice.

I was 10cm dilated with an intact water bag for 20 hours or so before any intervention. Dr. C told me today that he didn’t feel intuitively about doing anything earlier than what we did. There was a chance it could have cause more harm than good and by waiting we were able to increase the chance for best case scenario. I agree wholeheartedly and adore him for his patience and do not know of another care provider that would have been comfortable doing that. He said that the baby was fine and I was ok so waiting was what was needed. When we did break the water, it worked exactly as it should have. I am in awe.

After the birth, I had some heavy bleeding. It wasn’t to the point of hemorrhage but it was concerning. The placenta did not detach either. Afte two hours and still bleeding and still no placenta birth, Dr. C told me he wanted to take me to the hospital. He felt like everything was ok but he wanted me monitored over night and wanted blood work done. Josh and Karen got us together and Karen took the baby. I was weak and needed a lot of assistance getting out so Dr. C and Danica (MW2 who was also great but more of a Dr. C/Rosa support person than so much for me). We got checked in to the hospital and I ate some food that Karen packed up for me and Josh took care of baby Stella. Once settled in, i was able to sleep for about 5 hours until Stella was ready to nurse. She nursed like a champ and slept all morning on my chest. Josh go to sleep for 5-6 hours in the morning.

Once morning came, Dr. C dropped by and checked me out. The bleeding was at a normal level and my labs were fine and other than being weak I was ok. The placenta was still attached but in the absense of any indication to do so (such as infection or bleeding), Dr. C is comfortable with waiting to see if it will come out on it’s own. He doesn’t want to have to do a manual or surgical extraction. So orders are bed rest and daily check ups and blood work and infection monitoring and we will reevaluate the situation daily until either it comes out or he takes it out.

None of the after birth stuff has affected my birth though. It was exactly the birth I was supposed to have and I would do it again five times over if it meant not having to recover from another c/s. I am still in shock and awe and amazement and I can’t believe I did it! It was the hardest thing I have ever done and I’m so grateful to my team, they were perfect. I know I’ve left out important details and that this hasn’t been proofread but I had to get it out. Enjoy! I’ll edit later.

EDIT: The placenta came out a few hours after I posted this birth story. I went to the bathroom and couldn’t pee much but could tell my bladder was full. I stood up and felt a very heavy weight on my bottom and I looked in the mirror and saw the placenta bulging out. I didn’t push but when I spread my legs it plopped out onto the floor all at once. My bladder immediately released and for a second I couldn’t tell what was going on and was afraid that I was bleeding. I realized what happened and calmed myself before yelling for Josh. I told him what happened and he was super excited then I told him how bad it smelled. It was TERRIBLE and like meat that had been left out for a few days. He peaked in to look at it on the floor. I had him go wake up Karen (who of course, took a picture) and she called Dr. C. Since I wasn’t bleeding he decided to wait until our planned check up for the next morning. My bleeding has been a bit heavy but still normal, so I’m not concerned and I’m sure he won’t be either.

I feel SO much better physically. I immediately felt different when it came out. I did get weak and woozy and had hot flashed but the pain I was having in my bottom was gone. I’m still sore but i can actually move around with little assistance now. My body knew that the placenta didn’t belong in there any more but I guess it just needed time to release it. I’m so glad Dr. C was patient and didn’t force manual extraction. Again, everything about this birth was exactly as it should be and I’m so happy there was not a surgical ending to my beautiful VBAC. The placenta was born 29.5 hours after my baby was. Dr. C told Karen “Time. She needs more time. With Amy, everything takes more time.” He knows me so well!

Our baby girl’s name is Stella Rose. I didn’t know Stella meant “Star” when we chose it but it’s so appropriate because for our VBAC the stars had to align on so many levels. We chose Rose as her middle name to honor our Korean birth team. MW1’s Korean name is Kim Oak Jin (Oak Jin is her first name) and there is no English translation for that name so she chose Rosa as her English name. We thought that by choosing Rose for Stella’s middle name that we were acknowledging our medical attendants and their dedication, hard work, patience and confidence in our birth. Plus, Hwan Wook (Dr. C’s first name) didn’t flow very well with Stella!

Stella Rose
9lbs 2 oz
21.5 inches
15 inch head

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