Wednesday, May 21, 2014

3rd Unplanned Cesarean: The Best One.

I must admit I still had some preconceived notions of what a 'good birth' is this third time around. We all know the end result that is desired is a healthy baby and mom. But what is a 'good birth'? I did not get my VBA2C. This birthing experience ended in another unplanned cesarean. However I would still deem it a 'good birth'. I will always grieve the fact that I never got to experience a vaginal birth but I feel that this experience was healing for me. As my doula points out this was likely the result of all the emotional work that I put into healing from my previous 2 cesareans. I now know in my heart and in my mind that all 3 of my surgical births were medically necessary. I do not feel like my body failed me. I feel grateful that modern medicine was able to safely get my darling babies outside. Each had their own valid reason for needing to come into the world this way.



J’s Birth Story:

I woke up bright and early on Good Friday morning at 515am with contractions that were painful and about 15-30min apart. I was staring at Chris’s face when he woke up. He got a little freaked but I was excited. I had actually gone into labour or at least it felt like it was going to be. I went about getting ready for the day and was getting my makeup on when I felt something gooey slide out. I quickly wiped and saw that it was my mucous plug. I texted my mw to let her know and she said to just keep ignoring it until I couldn’t anymore. We got everything left ready to go to the hospital just in case things went fast. I texted Jen to say I might need her for the kids that day. I went to the grocery store to get some last minute supplies and stuff for Emmett’s party the next day because this might peter out. I got together the kids Easter stuff into a garbage bag and we packed overnight bags for the kids. I attempted to eat all day since I knew I was going to need the energy. By the evening I was having to breathe through contractions I texted the doula to let her know where things were at. She was encouraging. I called Jen and she said she would come and get the kids. I had to tell Emmett at some point during the day that his party might not happen if the baby was coming. He kept saying what if she doesn’t?  This was hard I didn’t want him to resent his sister for arriving on this day. I told him she was in the heat of a contraction. The kids kept staring at me when I was breathing through the contractions. I tried to reassure them but they still looked so scared. They cried and cried when Jen came to get them. I felt terrible like I hadn’t prepared them for this. My heart broke sending them away but it felt like I needed all of Chris’s attention, which couldn’t happen with the kids there.
We went for a walk after they left and the contractions sped up to 3-4min apart. I decided to have a bath and try to sleep a little. The bath felt good but hard to move with the contractions. The contractions seemed to be coming in a pattern of one long one and then some smaller ones. I rested on and off get up to the bathroom several times and after pee or bowel movement I had a contraction on the toilet with so much pressure on my tailbone. The contractions never stopped but they spaced out a bit by morning. I called the mw to come and check she wanted me to go to the hospital in case I needed pain medication or gravol. I had already taken Gravol and didn’t want anything for pain. She came and checked me. I was effaced but not dilated yet. This was disappointing because the contractions felt real but didn’t seem like they were doing real work. I also had ketones in my urine and needed to eat and drink more. She asked about the pattern and I told her. She said it was likely the baby’s position and suggested doing the miles circuit. I called the doula after this and cried about the disappointment she helped me to breathe through some contractions and relax in the bath. I tried to drink a smoothie and juice and some emergen C packets in juice and water. At some point I vomited up the smoothie. I think it was after the first round of the miles circuit. That was hard. The contractions while in the inversion position were excruciating shakey contractions. I rested for a while and then when the contraction pattern didn’t change I did another round of the miles circuit. By evening I was feeling like I wanted to see the mw again. The contractions were very painful in my back and hips. It felt like they were simultaneously being burned and ripped apart. I ate a couple bites of soup but that was all I could stomach. Tried to distract with tv but it didn’t really work. We met at the hospital that night and she monitored the baby and checked my urine, which was full of ketones still. I got a couple bags of fluid. Baby wasn’t totally happy at first until I got the fluid. We were there for quite a while until the monitoring looked better. Then we headed home again about 9pm to try and sleep again. The contractions picked up when we got home. I had another bath but couldn’t stay in. I tried to sleep but the contractions were 4-6min apart and they got harder I was having to vocalize through them and waking Chris up. Needless to say I got no sleep that night. I had the heating pad on my hips and was buried under the warm blanket but had to throw everything off during a contraction. Still some were worse than others some I felt like I couldn’t get to the peak. Chris was a trooper pushing on my back and hips to counter the pressure. I think he only slept through one or two. I could tell he felt helpless but was doing what he could.
I got up around 6 and called the doula to talk through it with her. I felt like I couldn’t do it anymore like I just needed a rest and maybe if I got some meds I could do that. She agreed and I called the mw not thinking it was Easter morning and she likely had plans with her family. She met us at the hospital at 730. She put me on the monitor and checked my urine, which was not too bad. The monitoring was still showing a not very happy baby, no variability. I drank some juice to try and pick it up. I tried lying down, nope that was way to painful I was writhing on the bed. I told the mw I was probably getting dehydrated again so she gave me some more fluid and went to get herself food and call the ob to find out what I could take for pain since I am allergic to morphine. We still hadn’t gotten a good monitoring strip on the baby by the time the fluid was in and the mw was back. She checked me and I was 1 cm dilated and station was still very high. She went to show the ob the strip and consult. The ob came in to talk to us. She said at this point they could not send me home with pain meds because that would depress the baby’s responses even more. She gave me the option of breaking my water and starting Pitocin and an epidural. She said she the chance of it working was small and that it was a stress test for the baby. She said the other option was to go for the c-section sometime that day. She gave Chris and I time to talk about it. She was the NICEST OB I have ever met. She sat on my bed and talked to me like a person. I immediately trusted her. I asked about delayed cord clamping and she agreed. I decided I couldn’t go through with the induction. I knew in my heart it wouldn’t lead to a vaginal birth it would only be so I could say I tried everything. I knew that I was at the end of my rope. I decided I couldn’t take the chance of the baby ending up in distress and going through all of those interventions just to end in another c-section and then to possibly have the baby go to the NICU or for me to have complications with the epidural. We told the mw and she told the ob who said 1-2hrs. I called the doula to come. I felt like a failure but knew I was making the right choice.
The mw got me prepped for the surgery, the ob came in and got my consent, bloodwork was taken, all the while between fast and furious contractions. Chris ran home to get the bags although he was afraid to leave. Every time he has left I have had to be whisked to the OR with a baby in extreme distress. The monitor kept falling off. I wanted to ditch it but the mw said no since the baby is not happy we can’t. At this point things got fuzzy. I remember Chris and the doula arriving and having to stand between contractions and then excruciating agony of the catheter that took 2 attempts. Then it was in and during a contraction I was peeing down my legs. I’m a nurse. I know that the pee is not supposed to go past the catheter. So back on the bed for more agony, lying down during a contraction was so intense. The mw got it fixed and although I felt the awful burning sensation no urine was running down my legs. A nurse came to get me with the OB for the OR. I remember the doula not getting dressed for the OR and wondering why but not asking. I found out later the nurse didn’t believe in doula’s in the OR and had made a fuss before. The mw and the doula decided I needed a calm, drama free birth so she didn’t come in. The mw stayed with me in the OR while I was getting the spinal. She held my hands while I held the table. I had about 4 contractions in the 15 minutes it took to get that spinal in and I had to hold still for all of them. I remember the anesthetist land marking with my hips and just about jumping out of my skin because they were so sore from the contractions. The relief after the spinal took effect made me feel euphoric. It was bliss. I made a conscious decision to feel happiness in these next moments and not disappointed. It was my last baby’s birthday and I was going to celebrate. The stars had lined up with the OB being great, the paediatrician on call was fabulous, the OR was available right away, and the other nurses in the room were jovial and joked with me. No talking over top of me, no time alone in the OR, my wishes were being heard and respected. I made the decision to be present and to not let anxiety, fear or disappointment cloud this moment. I could only do this because I had mentally prepared for this possibility and I had been through this twice before. The mw lined up the baby warmer with my head so I could see everything. They brought the camera in the OR. This was huge I have no photos of either of my older children’s birth. My husband took a photo of her coming out. The OB exclaimed"Oh there's her face" she told us she was face up with her forehead pressed to the front of my pelvis. This presentation was why she wasn't descending and I wasn't dilating. t didn’t get skin to skin or nursing in the OR but Chris did skin to skin as soon as they got back to the room. I had to stay in the OR for a bit after they closed me to get a special anesthetic block of my abdomen because of my allergy. That was fabulous. I didn’t feel a thing. I had such poor pain control last time it really traumatized me so I was very grateful for this.
              My mw recovered me because the L&D department was short nurses. I knew from previous conversations that she didn’t do this I was supposed to go off to the surgical recovery ward where I couldn’t have my baby or nurse. I was incredibly grateful to her for this. It made a world of difference in my experience. The doula snapped pictures, we called the kids and I blubbered on the phone scaring my 8 year old. They arrived an hour later and I blubbered all over again pulling them into bed with me. That was the hardest part being separated from them, sending them off again afterwards, my son’s cancelled party, their tears and sadness. At this point I had been up over 58hrs and I didn’t sleep until that night. I was woken every 3hrs by the nurse to make sure I wasn’t bleeding out or suffering a post op complication. I was a bit cranky with her and she was old school but in hindsight she was great because she brought me my meds and made me take them on time and had everything prepped in the bathroom for me to get up to. The OB let me out a day early because of the construction outside my room starting up. The staff knew I was eager to leave and got all the paperwork done. My mw told me that the cord blood gases were pretty bad and that J would not have tolerated the induction at all. This and the OB's statement of the presentation helped me to make sense of my body's response and validated my choice. All in all I felt supported which made this my best birth experience and very healing. I will always mourn the fact that I will never experience a vaginal birth but I don’t feel broken or that my birth’s weren’t the ‘right kind’ anymore. 

Friday, April 4, 2014

Motherhood vs. Career: An Epic Battle

I got some news yesterday that really upset me. It shook me to the core. The news was about a possibility of a job. No one died. No one has cancer. Why was I so upset? The job opportunity is a clinical informatics role in chronic disease management. It's the role that I have been told I would be perfect for, for the last 2 years. It merges both my loves the clinical and the technical world. Sounds perfect right? Sure… Except, it is being posted next month. What else is happening in a month? Oh right! We're having a baby. So this means applications would be due right around when I am giving birth. Interviews due when I am about 2 weeks postpartum and still bleeding, raw, emotional and leaking milk. Nothing makes a women more confident in front of an interview panel like wearing crotch and breast pads, am I right? Then, there's the logistics. It's a union excluded job with no job security and no guarantee it will continue to be funded AND it starts right away. Family and friends say apply if it is what I want and they will support me. If it was as simple as that I would. However the logistics while part of the problem are not the real issue at hand. It comes down to question of whether or not I can have both: career and kids.

In reality if I am being honest with myself the reason I am so upset is the realization that I do have to choose between my family and a demanding career. If I was to get the job choosing either way inevitably means sacrifice. This wouldn't be a regular staff nurse job where I can go home at the end of the day and be done. Work would come home. I know this because I know the work environment and the demands of the job. I also know that the first 2 years of a child's life while magical are truly exhausting for all involved. I guess what I was experiencing was grief over the career I thought I would have at this stage in the game when I embarked on this journey of a double master's. I was a sobbing bawling mess yesterday with the news. I was railing at the Universe and It's shitty timing last night.

You know what snapped me out of it? My child screaming in fear and pain. She got knocked over by the dog and smashed her ear on the concrete step. I didn't see it but I could hear the pain and terror in her shriek and the panic in my husband's voice. In that instant I was over it. Even after she was fixed up and in bed I was over the grief stricken sobbing. I've already made my choice. My career will come... later. I need to learn to be content in the now. This last pregnancy, this last baby will not happen again. Jobs will come and go. This is not to say that I won't work out of the home. I need to do that to feel settled. I just can't take on an all consuming position that may or may not exist in a year and give up the time with this baby. I still feel a little tug of shame like somehow I am not good enough if I don't apply. I still feel a slight internal war between desire for the satisfaction I get from my job and my little ones. I think this will ease. The nerves are still raw from grief.

Friday, March 28, 2014

Ignoring My Children

I recently read this article on the Benefits of Ignoring Children (Sometimes) over at MDC. I agree with the majority of what this mama writes. My husband's new boss has commented to him that we are raising independent children that can problem solve on their own. She thinks this is rare in this day and age because of all the things we give our kids and the safety nets we have set up. I had to reflect on this a bit. Do I want independent children? After all, I loosely follow an attachment parenting philosophy does this go against what I believe? Am I doing this intentionally or is this just because I am a selfish person? I've written on the topic of independence and AP before here in response to another article. So you all know that I don't think it's an either/or. I guess I agree more with this mama than the other because she does not feel that meeting an infants needs is akin to making an older child dependent on you for every little thing. 

The article talks about the guilt mother's feel when they take time for themselves. I thought I had written a post on losing the mommy guilt but it must have been an intention I never fulfilled because I cannot find it. I have felt this guilt when I have decided to go to the gym or take an extra shift. I have felt it when I happily go off to work and send them off to daycare. I've often wondered why H never feels this guilt? I guess he does, just in a different way. He probably wouldn't label it as guilt. But he often needs permission to go off and do something not family related on the weekend because he feels obligated to spend time with us. Not that he doesn't enjoy being home but he, just like me, needs time to pursue hobbies and self interests. I'm thankful he is so dedicated to his family so that we can work together to balance meeting our own needs outside of the family. I do feel more guilt meeting my needs and ignoring the children when he is home. This often feels like I am abandoning him. I'm not. I always keep an ear out for chaos and true needs. But it may look this way if I go take a bath or read a book in another room while he is in the room with the children. I feel the guilt most keenly when I have company or family over and they are doing their own thing because the children are not their responsibility. I feel like I can't ignore the kids because then that causes them to gravitate to the next adult who likely feels obligated to respond. I guess I need a sign that says 'Feel free to ignore my kids. They like it.'

I think boredom and free play are important for adults and children. I believe that it is integrally important for my kids to see me pursuing activities and satisfying needs that don't involve them. Which means that I cannot satisfy their every need or I would be perpetually drained. That is why the first year of a child's life is so exhausting for me. I do need to meet their every need. I get that and I'm good with it. But I must admit that when they gain some independence I enjoy parenting more. I love my babies. I do not love the baby stage. 

So yes, I ignore my children purposefully on a regular basis. I ignore their requests, pleas, whines, or cries. Even if they are being completely polite and well behaved I will still usually ignore them. Don't get me wrong, I really like that they are polite but I still would like them to try and figure it out by themselves first before coming to me. This is not to say that we don't help each in this house, we do. However, I realize that one of my top values and wishes for my children is self-sufficiency. So my parenting approach as they get older is 'Yes I love you. Go figure it out.' followed by 'Try it again a different way' and finally 'Ok now I can give you some help'. It's all age appropriate of course. I do not let the 5 year old manage the stove or the sharp knives by herself. This is what works for me as a parent and my sanity. I think it's working for my kids. They don't seem too messed up ;)

Thursday, March 27, 2014

VBA2C Internal Conflict As the End is Near.

I am 36 weeks tomorrow. In my my mind thus begins the 'waiting game'. I already have all the prodromal signs of labour. I have had them for weeks. So I'm not expecting anything to alert me that my body is gearing up for labour. Actually I've never gone into labour on my own. With my first I had the cocktail and labour tea which brought on early labour. I never got into the active labour part according to dilation (3cm was all I 'achieved'). With my second I had an NST and an emergency c-section so no actual labour. I have no idea if my cervix remembers anything. It seems as if my body likes to stay pregnant. Or maybe it's just that the baby has control over labour and neither one felt safe triggering it due to their cord issues. If this is the case I'm scared to induce even when overdue. To me overdue means something is wrong. But..... then I will worry that my fears will prevent labour. It's a vicious cycle. I feel a desire to start things in motion such as EPO, acupuncture, sex etc to see if I can prep my body. Yet I feel like I shouldn't try to force or push anything into motion. I'm so conflicted.

Things are different with this baby. I have a different birth team. A different midwife (I loved my previous one), a very experienced doula, and a more supportive husband (same guy just better relationship). I am a stronger person. I know I am capable of overcoming obstacles. I completed 2 years of my masters education while working 3/4 time with two small children. No small feat I tell you. I learned to run. I trained and finished a major fitness event (Tough Mudder). I am proud of myself and who I am both as a mother and as a woman. I just want this one thing, this vaginal birth, to feel healed and complete. Yet, I am scared to hope it will happen only to be disappointed, yet again. Two failed homebirths will do that to a girl I suppose. I hate that term 'failed homebirth'. I didn't even get to try with my second. I am hoping that the differences with my support team, with me, with my birth location, with my body will help me get a different outcome, but scared to hope. Again conflicted.

I am letting myself feel this fear trying to process. Yet I am taking steps to overcome/accept it. I am going to do a fear release hypnosis session with my doula. I am also going to go to the L&D ward to sit and process. My first reaction when my doula suggested this trip was an immediate "No! I don't need that!" Yet after some reflection I think I do. I think my reaction is just my conscious mind saying that it really doesn't want to go back there. I need to deal with whatever is going to crop up going there. It feels a little silly since I work in the same hospital, have gone there to meet babies of friends and family. However this was all in a different capacity. I was safe in those instances, not wearing the labouring or pregnant mother hat. This time I will be vulnerable. I despise feeling vulnerable. That's why I wanted the homebirths before. I wanted the control over my environment and people involved in my birth. That's not an option this time so I am preparing and trying to eliminate as many possible conflicts as I can with this hospital birth.

Part of that process is packing for the hospital. I am going to pack my bags this weekend. This will require me to imagine what will happen and what I will need. The crib is going up today. The carseat is in the car. Once I put the bags in the car we have the essentials ready. One more week of work and then I need to find a new distraction from the waiting game. Any suggestions?

Thursday, February 27, 2014

School, Allergies and Emotions

School is hard. Not the academic stuff, although that may be hard for some, but the social intricacies of being a kid and finding your niche. Add to the mix food allergies and you've got a recipe for some very difficult emotional situations for a child. Adults with celiac disease, anaphylaxis, diabetes or other dietary restrictions have trouble dealing with feelings of exclusion when not partaking in the food at a celebration or gathering. Yet we ask kids to deal with this at school on a regular basis.

I can tell you that my oldest who has been dealing with it for 3 years of elementary still has trouble processing it. There's an event tomorrow and when he heard that it was based around food that he can't have he choked back the tears until after school. He let the river flow when he got home. I know in the long run he will be resilient and empathetic because of these challenges. It still hurts my heart to watch him. His feelings are real, I'm not going to tell him to suck it up and deal with it. He does when he's at school. He lets them out when he gets home. My middle child is celiac and we will be dealing with this again starting in September when she goes to Kindie.

Every year I talk to his teacher and let them know the extent of his allergy. I ask for warning before events with food so I can prepare him and send some suitable substitute. I ask that when the notifications about allergies go out that his be included so that parents are aware. He still feels 'different'. It's not about the treat it's about the feelings of participation and inclusion. I understand that if it's not on your radar it is difficult to be aware of this at all times when choosing treats. I don't expect parents to always have my kids or others with allergies on their mind. So I have another suggestion.

Here's my wild notion: Let's take the food out of the celebration at school. Let's think outside the box and use non food ways to celebrate like games and activities.

Wednesday, February 19, 2014

Chronic Injury: Reflections from a Pregnant Wife

I guess I can call it a chronic injury now. It has been 14 months since the car accident in which my husband sustained a back/neck shoulder injury. The first few months were the worst with him having to lie down or sleep most of the time. Dealing with the injury was one thing but dealing with the torrent of emotions was much worse. I felt resentful doing it all. Then I felt guilty for feeling resentful. I felt irritated with him for being so angry and snappish. I felt sad that my needs weren't being met physically or emotionally. I felt scared. What if he never recovered? I feel proud of him for moving through it and making an effort to get better. However, when he has a flareup I feel a rush of unpleasant emotions… like PTSD I suppose. I guess it doesn't help that I'm 31 weeks pregnant and in constant pain of my own.

I think some of the anxiety and fear I am feeling links back to the early months after D's birth. Husband had a mother of a kidney stone. It was his first of many. We made a trip to the ER thinking he had an obstructed bowel or something. He came home on meds which his body didn't tolerate very well and it took over a week  to pass it. He laid around and took meds and worked from the bedroom. I remember trying to get him to watch D while I went out for something and he said he couldn't because what if the pain hit him. I remember being so incredibly angry. Why does he get to retire to the bedroom when he's not well and I do not?

I guess some of the resentment stems from the fact that when he is down for the count I feel abandoned. Also I feel like I do a lot of research and try things to make him better. I cannot say he has done that in any of the difficult pregnancies or c-section recoveries I have had. Don't get me wrong he is an incredible man who cooks, cleans, shops, chauffeurs, parents and loves both me and the kids whole heartedly. I cannot ask for a more hard working or involved partner. Maybe he just doesn't know that I need or rather want that. I am the one with the medical background. I am the one that does the research on anything involving health. It really is my role.

I am likely just feeling overwhelmed as the house is dirty, I am exhausted and we did takeout last night so something must be cooked. All I want is a nap and a hamburger. How do I let go of/process the emotions? I don't want to feel the resentment, fear, guilt, anxiety, irritation etc.

Thursday, January 2, 2014

Getting Over Birth Trauma

I had a coworker unsuspectingly say something that made me cringe. She said "I just don't get women who get all worked up over having a c-section. Isn't the outcome supposed to be a healthy baby and a healthy mom?" Since I have realized that I found my cesarean births very traumatic and have recently given myself permission to feel sad and angry at my loss of a natural and empowered birth I wanted to contradict her. But I didn't…. Perhaps because we were at a table with several others, perhaps because of the stigma around feeling bad about having a healthy baby. I am still not quite sure. Yes I feel traumatized by my births. I was not expecting to be giving birth again so I thought it really did not matter if I got over it. Well here we go again. I'm not going to 'get over it'. I'm going to embrace the trauma and the fear and do it anyway. Isn't that what bravery is?

I completed the Tough Mudder this summer and this was all about overcoming fears. What's the correlation? I figure if I can run 13 miles, jump in ice baths, dive off 15 foot planks, walk through fire, and face electrocution I can embrace another cesarean if that is what the universe hands me or a vaginal birth which may be equally as traumatizing. Another cesarean is terrifying for certain known reasons. A vaginal birth is terrifying and exciting for completely unknown reasons.

Let me tell you if you have never had a c-section the recovery is akin to having major abdominal surgery. It is major abdominal surgery with all the risks and recovery. You have to cough or laugh with a pillow to your belly or feel like your guts are going to explode all over the room. You can't lift anything more than 10lbs. This means your baby + carseat is a no go. If they trap air inside you like they did to me you feel like a hot poker is being stabbed out of your shoulder and NOTHING relieves it. Anything pushing or touching the incision is aggravating and painful this includes underwear and pants. Stairs like the ones to the laundry room or your baby's room are excruciating. One tip is walking up backwards. Someone please let me know how one does that safely? with an infant? Please don't make light of this if you or anyone you know has a cesarean. They've had major abdominal surgery, plus a tiny human to care for, if not many tiny humans.

There's also a huge emotional component to having a surgical birth. Everyone feels and reacts differently and this often depends on the circumstances surrounding the birth. Women can feel like birth has been stolen from them. They can have trouble bonding with their infants because they feel like they did not 'birth' that baby. I myself felt shafted by the universe. My second birth I was tied to the table crying my eyes out because I didn't get to try. I think both times the part that hurt me the most was the nursing/medical staff that were supposed to care for me through this process. I am a nurse. I strive every day to ensure that my patients never leave me feeling like I felt during both births. I was hugely disappointed in the team that I am supposed to work for.

So here we go again. What can I control? Not much... However, I can control my reactions and my outlook on this process. No homebirth preparation this time. I pack a bag fully prepared for both a c-section and a vaginal. I may ask for some things outside of the norm such as breastfeeding in the OR and delayed cord clamping. If I get told no I will not despair I will write action letters to the executive leads of maternity services. I am a STRONG person full of grit and determination. I can overcome fear. I can even enjoy myself while scared. I will prepare mentally, physically and emotionally for the birth of my daughter however it may come about. Everything is different this time. Not necessarily better but different. New midwife, new doula, planned hospital vbac instead of hbac, and me.... I have learned to step up and ask for what I want and need and to surrender to the experience when necessary. This is HUGE!