Thankful for Vivian on Thanksgiving

I have always thought that choosing a name for a baby is a difficult task that carries a lot of parental pressure; it is the one thing you give them that stays with them for their entire life, right?  We had Vivian’s name on our “list” for a while, it kept floating to the top partly because we liked it and partly because it has special meaning for me.  It was my paternal Grandmother’s name and she was a really good person. I have many fond memories of my time with her as a child: walking with her through the woods at my grandparent’s ranch picking wildflowers, sitting in her kitchen watching her cook up delicious things without a recipe in sight, and admiring her seemingly untiring strength as she did chores around the ranch.  I hope my Vivian can embody the kindness, caring and strength that I saw in my grandmother.  Secondly the meaning of Vivian is derived from the Latin word for “alive” which has personal meaning to me because of the 4 consecutive miscarriages I had before I became pregnant with her.  She is the one, who despite the odds, lived.  And now her name has continued meaning for that same reason; she made it through this ordeal, she is strong, and she is alive.

You may also wonder about her middle name, Grace.  Well, honestly, we let Avery choose.  We didn’t even give her a list, she just told us she wanted her name to be Grace and we said, “ok, how about that for her middle name?” and the deal was done.

I know there are at least some of you out there that want the details of how it all happened, so here they are.  This is really the first opportunity I have had to come up for air in what, for the most part, has felt like a week of drowning.  But now that things are going well we just feel so lucky to have her be with us and I “think” I can write this without crying but we’ll see.

On Tuesday 11/15/11 Andy and I arrived at St. Als hospital at 7 am for my scheduled induction, I was one day past my due date and feeling very done with being pregnant.  I was lucky right off the bat because there had been an error at L&D and 2 of the people originally on the induction list had accidentally been crossed off as having delivered when they hadn’t!  So several of us had all shown up pregnant and ready for inductions but there wasn’t room for everyone and so a couple of people had to get sent home (whew! Glad it wasn’t me!).  At 8 am my doctor broke my water (I didn’t ask if I could write about her publicly so I’ll leave her as anonymous, but she is a fellow Family Physician who I trained with and consider a friend as well as a really good doctor) and we decided to wait and see if I went into labor spontaneously.  I sat around for a few hours and not much happened so by 11 I was ready to get things going and so we started pitocin.  As the pitocin was being increased the contractions got predictably more intense.  I was trying the hypnobirthing/relaxation method (see previous blog entry) and at first, when the contractions were 4-5  minutes apart it was really helping.  But as they got closer together and a lot more intense to where they felt like they were almost on top of each other (really they were 2 minutes apart but it felt closer than that!) I got really irritated with the hypnobirthing lady telling me to relax and sort of lost it.  I think Andy wrote on facebook that I was swearing, I might have been, I don’t remember because I was in a lot of pain at that point.  It was midafternoon by that time and I thought I could tough it out for a while, and so I had the nurse recheck where I was at, hoping I was 9 cm, but no, I was still just 5 cm!  That is when I asked for the epidural and was pleased with how rapidly they arrived to place it.  It was really wonderful, I had forgotten how great it is to be in such tremendous pain and have it completely relieved.  The only down side was that Andy almost passed out while I was getting it, and then I got hypotensive afterwards (70/30) and almost passed out too but was brought back with a little ephedrine.  Vivian did fine through all of that and overall appeared well throughout labor.  In retrospect, she did have some times where her heart rate went up a little bit (180’s) but they looked more like big accelerations than a baseline change.  I asked the nurse at one point what she thought about her heart rate and she said, “you just ate popsicle, she probably liked it,” and that also reassured me everything was fine.  I never had a fever or any other signs of chorioamnionitis, I had no risk factors for GBS and my screening test had been negative.  Everything was really going quite smoothly.  At around 6:45 pm we were joking around with my nurse that she was going to miss the delivery since she went off shift at 7 and I was going to be sad about that because I had really liked her when I suddenly felt some pressure (not always easy when you have an epidural) and sure enough I was complete and ready to push!  So my doctor came and we all got ready.  I pushed with a couple of contractions and it was that “I hope I’m doing the right thing because I really can’t feel anything at all” sort of pushing (they said I was doing ok).  Then around the 3^rd push her heart rate dropped to the 60’s and stayed there after the contraction was over and through into the next one.  They did the oxygen thing and I asked my doctor if she was low enough for a vacuum and she said she thought she was and I said that would be fine.  My nurse said that she was calling the NICU team to come and I said that would also be fine.  We were all pretty calm about the whole thing.  So the vacuum was placed and I pushed as much as I possibly could given I was totally numb from the ribcage down and she was born at 7:10 pm!  She had one of those nuchal/body cords where the cord was wrapped around her neck, one arm, and her whole body and once she was untangled from the thing she started crying vigorously and pinking up right away which was great.  As I looked down at her on my chest I almost couldn’t believe it, that she had finally arrived! Andy and I were both crying and from the moment I looked into her eyes I instantly fell in love with her.  We spent the next hour just gazing at her.  She was breathing a little fast and so the nurses wanted me to let her transition a little bit before I nursed her but after an hour she seemed a little better and she nursed really well at that point (which in retrospect is a little odd that she could nurse well at all given what her chest x-ray looked like just a couple of hours later).  Around 10 pm I was finally able to walk enough that they could move me to a postpartum room.  I was holding her while they wheeled me in the wheelchair and I looked down at her and thought, “well that’s funny, her face looks dusky, I wonder if it’s the lighting in this hallway.” We got to my new room and as I was getting in the bed I asked the nurse to unwrap her and assess her because I thought her color wasn’t right.  As soon as they unwrapped her I was like, “that is NOT how she was before” because there was a clear line right at the nipple line and above it she was pale and below it she was almost purple.  I watched her chest and estimated her respiratory rate was around 80.  The nurse confirmed it was.  They started giving her blow by oxygen and called the NICU to bring down a pulse ox.  The NICU charge nurse came down and checked her pulse ox, it was 97%, even on room air, but she agreed, her color was very strange.  At this point there were now 3 nurses in the room: my labor nurse, my postpartum nurse and the NICU charge nurse and no one really seemed to know what to do.  The NICU charge nurse mentioned that the neonatologist happened to be coming in to see another baby and maybe he could come take a look.  I said yes, please call him and have him come, and also call my doctor (since I happened to know she was on call) and if she is in the hospital maybe she can come and look too.  After a little while the NICU nurse came back in and said that on the phone the neonatologist thought it sounded like harlequin effect (http://www.ehow.com/info_8533538_harlequin-effect-newborns.html) but that he wanted to get blood pressures.  After awhile they figured out that they didn’t have a cuff in the postpartum area to take an infant blood pressure and that they would have to take her to the NICU to get the blood pressures.  I was relieved she was going to be assessed in the NICU because, while I hoped it was something benign like a harlequin effect, I was still really worried about her breathing so fast even with a normal O2 saturation.  From experience I know that when babies crump, they crump very quickly and so I was nervous that she had been breathing so fast for 3 hours now and that she could get tired out at any moment.

Around 11 she went up to the NICU with Andy and I was still in my room since at that time it was busy on the floor and no one could take me up to the NICU in a wheelchair (and I couldn’t really walk well yet from the epidural still wearing off).  I wasn’t there to see how it all played out but the doctor told me later that he really became concerned when he looked at her and couldn’t feel any peripheral pulses and also noticed she was getting hypothermic.  She also had an episode where her O2 saturation went down into the 80’s and that clinched the deal that she would get an IV and a blood draw.  Finally someone was able to come and get me and take me up to the NICU and it was around midnight when I arrived to see them trying (and failing repeatedly) to get an IV.  The neonatologist was truly concerned at this point because he had done a capillary blood gas and her CO2 was 90 and he felt she needed a fluid bolus right away and so she would need umbilical lines.  So just after I got up there we turned around and went back to our room so they could work on her, feeling very scared not knowing what was going on.  That’s when I started crying, and that didn’t really stop for the next few hours.  After the lines were in we went back up to see her and her color looked slightly better after the fluid she had been given but she still looked really pale (which was better than purple I thought).  The neonatologist showed us her x-ray which looked like pneumonia and he felt very confident this was some combination of pneumonia and sepsis and that it was likely her blood cultures would be positive with some sort of bacteria.  He warned us he might need to intubate her but that for now she was doing ok with nasal CPAP and so he would keep her on that.  We were sent back to our room so he could do the LP and some other things and sat there and cried some more and watched the seconds ticking by on the clock.  After another hour we called up to see if we could come back up and see her and they weren’t quite ready yet so we waited some more.  The neonatologist came down after that and let us know that the LP was negative for signs of infection which was reassuring (because meningitis carries a higher morbidity) and also to gather more history.  He was very kind and nice; I was so appreciative of his good bedside manner at that point because I was barely holding it together.  He also told us that she had an elevated CRP and neutropenia (an ANC of 900), which were both likely related to sepsis.  Also she was DAT positive for anti-D (long explanation required here if you don’t know what that means, but basically it’s a blood type incompatibility thing between her and me).  The risk for that is mostly related to jaundice, which was not our primary concern at that moment so we just shrugged that one off.  And then I asked the “what is the mortality rate in this scenario” question and he said given all the factors 20-30% in the next 24 hours but after that if she was getting better it would drop to much lower.  So after he left the room I fully broke down; the thought of her dying was more than I could take after such an already emotional day.  It was like falling off of an emotional cliff where the pure joy of meeting your baby for the first time quickly plummets while the fear of her precious life being taken away escalates into panic and horror.  I hope no one reading this ever has to experience it.  The next 24 hours after that are a blur, partly because we hadn’t slept and also because there were just so many trips up and down from our postpartum room to the NICU and back again.  We found out that she did have group B streptococcus in her bloodstream, which, while awful, was also reassuring because we knew that it was sepsis and we knew that it was being treated appropriately.  She was a fighter that first 24 hours and thankfully never had to be intubated or require blood pressure support with medication.

On the second day, the morning of the 17^th, we got the unfortunate news that my Grandfather had passed away.  For those that don’t know the story he was 95 years old and in August, when I was visiting my parents in Montana, he had flown up to Montana from Tucson, where he lived with his wife (also 95) for a visit.  He had arrived by himself and my mom and I had been shocked at the airport because he was not in good condition; he could barely walk and seemed severely malnourished and acutely dehydrated.  He had been having some swallowing problems and so hadn’t been eating much over the past couple of months and at over 6 feet tall and weighing approximately 115 pounds he looked like a skeleton.  That first night he had an episode where he almost lost consciousness and my mom and I had to carry him to the bed.  We tried orally rehydrating him at home (per his wishes not to go to the hospital initially) but were not very successful and convinced him to go to the ER.  He was admitted for aspiration pneumonia and because of his swallowing problems got a PEG tube almost immediately so he could be fed.  He developed some strange neurological signs (leg spasms and the sensation of falling) as well as a rather rapidly progressive weakness so that he couldn’t walk without at least 2 people and a walker to help him.  He spent the next 3 months going between the hospital and the skilled rehab facility connected to it for various things (a couple of additional bouts of aspiration pneumonia, anemia requiring transfusion, CHF exacerbation, and just requiring more nursing due to the neurological type symptoms). Three different neurologists consulted on his case and came up with 3 different possible answers for his symptoms, none of which really seemed to explain it fully and none of which were treatable.  He had been offered hospice a couple of times but along the entire hospital course had wanted to fight; mentally he was 100% intact and he made it clear he didn’t want to die.  It took over a month for them to convince him to change his code status to DNR and he did not want to stop the feeding tube.  My mom had been by his bedside every single day over that 3 month period (except 5 days in early October when she had flown down to stay with me while Andy went to a conference out of town).  Then, unfortunately (in terms of timing), the day my mom flew down to Boise (the 12^th) one of the hospitalists met with him and encouraged him to move to comfort care and he decided to do that and stop the tube feedings.  It was the right decision but the timing was just terrible and I still wonder why the hospitalist did that (since my mom had told them repeatedly she was leaving that day).  On the 14^th they moved him to comfort care and stopped his tube feedings.  The last time I talked to him was after Vivian was born on the 15^th, he was able to tell me congratulations, he had been waiting all day to hear that she had arrived safe and sound.  After that he became less aware of what was going on around him, partly because of his condition and partly from the combination of morphine and benzodiazepine that they kept increasing to keep him comfortable.  His passing was hard news to take given everything going on and already feeling emotionally at the end of our rope.  I also just felt so bad for my mom, that she wasn’t able to be there for his last few days, and wasn’t really able to have any closure.

That morning that he died Vivian really turned the corner, she seemed to be truly improving and we were so incredibly thankful to have the feeling that hopefully the worst was over.  Of course Andy and I both understand that complications can happen and so we were still holding our breath, but overall we were pleased with how rapidly she was getting better.  That night we actually got to hold her which was so wonderful.  You may be able to see in the picture I was still pretty emotional about the whole thing.  I had played out the scenario in my mind of her not making it through and the potential of not ever holding her again and then to actually hold her in my arms that night, even with all of her cords and lines, was the most amazing miraculous thing.

That same day I was discharged from the hospital and I went home and again completely lost it and cried for a long time.  Coming home with an empty car seat to an empty crib in an empty nursery is a horrible feeling, even though I knew she would come home eventually, it still just made me feel so forlorn and lost.  That day was also the beginning of the most exhausting part of the NICU stay.  All of the veteran NICU moms that I know warned me it would be like this (they were right).  It is very tiring, even more tiring than the normal postpartum period because you’re never really able to lay down anywhere or take care of yourself very well.  Additionally, it starts with sleep deprivation from the beginning (since we hadn’t slept in almost 48 hours).  But I think one of the hardest parts is all the pumping.  From the beginning I was pumping every 3 hours around the clock, which means setting an alarm at night to get up and pump (which is definitely not the equivalent of a crying baby) which doesn’t sound bad, but pumping is already not as satisfying as feeding your own baby, and to have to wake yourself up to do it is even more painful.  Then, early in the morning getting up and getting ready and going into the NICU like you’re going to work.  And the daytime is a lot of work, feeding and caring and worrying about your infant, watching vigilantly for any signs of improvement or worsening, pumping even more during the day, and scrubbing in and out all day long.  Like I said, it’s exhausting.  But, obviously, totally worth it!  So it’s strange to have that mix of emotions too, the “I’m so happy she is alive and they saved her!” combined with the “this is a miserable first week of her life for me and it’s so not fair that I can’t be at home with her!”  Thankfully there is now an end in sight as we plan to take her home tomorrow night!

So that’s the story.  It really has put a lot in perspective for us.  I also appreciate the irony of the entire scenario given my previous post from a couple of months ago about the hard process of trying to let go of the feeling that something bad was going to happen and waiting for the other shoe to drop.  When she was laying there on my chest right after she was born I had a moment where I finally felt relief and let go of that worry, because finally she was here!  And she was fine!  And then 3 hours later she wasn’t.  Just another good lesson in letting go of things you can’t control and having gratitude for every moment of every day.  We are so incredibly thankful that Vivian is alive today and hope she will live up to her name for a long time to come!

I hope everyone is having a Happy Thanksgiving and giving their loved ones an extra squeeze today because each life is so precious!

Dreaming of a Gift Free Holiday Season

I’m currently having an emotional wrestling match with myself about the upcoming Holidays.  After a year+ that involved two big moves and getting rid of a lot of stuff, I am feeling uncomfortable with the impending gift giving season and adding more stuff to our household that we don’t need (particularly when we could still use to get rid of more!).  But there are children involved, and therein lies the rub.  Whereas I would really love to go completely “gift free” I know I can’t with the kids (who both believe in Santa), it would be devastating for them.  Even last year, when we went to Disneyland for Christmas (a wonderful gift in itself) Avery was like, “Santa didn’t bring us much this year, he must think I’ve been a bad girl.”  I had to explain to her about the global economy and recession to try to convince her Santa cut back for everyone, not just her.  And it also made me angry with our society for impressing upon young children that they receive Holiday gifts based on their level of “goodness” which, if it was true, might be a fair system, but as we all know, it is not.

I was trying to explain this internal debate to my husband the other night, and unfortunately he misinterpreted my vehemence about the topic as being directed at him and so it almost turned into an argument.  I admit, I was whining about how it is a little harder because we have two holidays in our family that involve gift giving (Hanukah and Christmas) and how I was happy that this year they actually overlap so we can avoid celebrating a full 8 days of one and then all the days surrounding Christmas too.  Hey, I was being honest, I have nothing against Hanukah, except that it is so long and drawn out.  But, in the process I may have destroyed my best ally in this holiday gift giving battle.  So now I must reach out to the internet.

I continue to struggle with what to do, how to limit the gifts, how to talk to the kids about it without ruining the magic of the holidays, etc. etc.  Of course we try to focus on the role of giving of ourselves and the importance of spending time with family as a gift and they get that, sort of, but they still wish for toys and “things” and that is the harder part to wean out.  For example, this year Avery has said she wants one of those mechanical dogs that follows your commands.  Two years ago Santa brought her one of those dogs and she never played with it!  We got rid of it because it was so obtrusive and ridiculous.  Even when I remind her that she had one before she still says she wants it, that this time it will be different!  What? How?  I have repeatedly told her I think it’s really unlikely Santa will bring her a toy he’s brought before and that she didn’t play with, hopefully that will sink in at some point.

The adults in my family have actually been really good about minimizing the last few years; we give very few gifts to each other at Christmas (sometimes none at all) and we stopped doing stockings for adults a few years ago which has helped tremendously with holiday stress.  I think this year I’m going to try to focus on giving consumable items if I have to give a gift at all, something that can be used and then disappears (a flowering bulb or some coffee or something like that).  I’m going to try to translate that to the kids as well (maybe some art activities or science project activities that will get used up), but the pull to buy them things that they want, things that look like junk to me, is actually really hard to avoid.  Another stumbling block I have is that I do think there is some value in learning to be someone who gives a thoughtful gift, and that picking out something for your sibling is kind of fun so I’m not sure if I’ll be shooting myself in the foot if I have them not give gifts to each other.  I will certainly encourage them to be creative in their gift giving (and maybe make a gift) but I don’t know if, with a newborn, I’ll have time and energy to facilitate that (but will try!).  Anyway, I’m open to ideas that people have about how to teach our kids to want less “stuff” for the holidays and what strategies other parents may be using towards this goal.

In my search for useful information about how to talk to my kids about this, I ran across several Christmas minimalism sites (that are more adult focused) and thought I would share:

http://www.becomingminimalist.com/2010/11/26/35-gifts-your-children-will-never-forget/

http://www.missminimalist.com/2010/11/miss-minimalists-gift-avoidance-guide/

http://zenhabits.net/bah/

Book Review - Hypnobirthing: The Mongan Method (the BEFORE blog)

Since this is the “before” blog you can expect there will be an “after” one as well.  I will be curious to see what that one is like!  I borrowed this book from my friend, who also happens to be my doctor, who used the method successfully for her two births.  She also took the class (which I imagine, after reading the book, is helpful).  But I thought I would review the book now, before labor and then again afterwards to see what I think of it.

Before I start I should throw in the caveat that it may not be completely fair to judge this method on a third labor.  Hopefully (fingers crossed) this is relatively quick compared to the others (although my labor with Asher was only 4 hours, I can’t really complain about that).  But still, I think it’s worth trying.

The reason I’m interested in this method is because I think there is definitely something to it.  I’m not saying it is “the answer” to a pain free birth (as advertised) but having attended hundreds of births I have seen with my own eyes the difference between someone who seems to be relaxed and “in the zone” versus someone who is completely out of control and screaming.  I think “hypnobirthing” or “deep relaxation techniques” or “meditation” or whatever you want to call it is one way of getting in touch with your body and maintaining that control. 

So, the book, I would say it was so-so.  It’s hard for me, as someone who believes in evidence based medicine, to go along with some of the things they say which feel completely fabricated and made up and don’t have any science behind them.  As someone who delivers babies I tried not to feel offended about some of the implications that I might not have the best interest of the patient in mind; I know they aren’t talking about “me” but it’s hard not to feel a little adversarial about that.  But for the sake of participating I pushed aside my scoffing remarks in my head and kept reading.  And like I said, even though there is not a ton of science behind this method, I think there is “something” to it and I’ll go into that a little bit later.

The main premise behind this method is that the reason we feel pain during delivering our babies is that we have “fear” and the fear causes tension which then translates to pain.  The author believes we have all been imprinted upon to believe it is painful and therefore it is.  So a big part of the book is about “releasing fear.”  As someone who has been through labor before (and had an epidural both times) it’s a little hard for me to believe that fear alone made me feel like my body was being ripped in half, like actually torn in two by sharp clawed hands, but, I’ll give them the benefit of the doubt for the moment, because I do agree that pain has a lot to do with how it is being perceived, and we have some science to support that.  There are a lot of analogies and anecdotes in the book about how animals deliver naturally without discomfort, which I don’t think is 100% true (cows bawl when they have calves).  We, as humans, also have the whole “giant head” issue which I would argue is proportionately more painful than it is for other animals.  She also tries to site historical evidence that birth didn’t used to be painful for women back in the day, or else Hippocrates surely would have told us it was.  This is not my favorite type of argument the, “well, they didn’t write down it was painful so it must have been not very painful!”  That just isn’t logical.  The author also clearly experienced her own birth traumas with her own deliveries with the old fashioned ether-forceps method and I really felt bad reading that.  It is embarrassing to me that the medical field did that to women and it makes me angry too, but it is truly not that way any more and so getting people riled up about that now doesn’t seem to be too helpful to me.  Although, I might add, that I “think” the whole thing was well intentioned.  I think doctors thought they were really helping women by putting them to sleep for something that seemed to be really painful, but in retrospect it seems sort of cruel.

After the theoretical and historical discussion, the bulk of the book touches briefly on different types of relaxation/self hypnosis exercises as well as some positioning and labor preparation.  The thing that strikes me as the most funny about the method is that they have renamed pretty much all the aspects of pregnancy and labor with their own terminology.  The author feels that medical terminology puts a negative slant on things and that negative imprinting again can lead to increased fear which leads to increased tension which leads to more pain during labor.  So there are no “contractions” they are called “surges” and your water doesn’t “break” it “releases.”  They actually have a full list of substitute words.  I would argue that it is our perception that makes those words “negative” not the words themselves, but, whatever, call them whatever you want to call them, I don’t care, I’ll stick to my own lingo.  There are some other parts I don’t completely agree with, one being that the birth process can imprint the baby for life and that a hypnobirthing baby is a “better baby” after you take them home.  I’ve seen a lot of different styles of birth and I have trouble believing that a traumatic birth is going to screw up a baby for the rest of their life.  Of course I don’t think anyone has ever studied if temperament is linked to birthing method, but that is what they are suggesting.  What about all of those poor NICU babies, should we just write them off as being future criminals since they were so traumatized as newborns?  I don’t think so!  They often are little fighters and do wonderful as children.  So that part is far fetched to me and setting people up to be potentially disappointed if the method doesn’t work well for them.  The final part that I am wrestling with regarding the book is their description of what we (in medicine) would call “pushing” and they call “breathing down.”  The author emphatically states a woman should “not push” the baby out, that it is counter productive and bad for the baby and that relaxation techniques and breathing techniques be used at this phase.  I’m intrigued by this idea and open to the possibility that maybe pushing can be counter productive at certain times right after transition (which is why we let people “labor down” occasionally).  But personally, even with an epidural, I still felt what I would absolutely describe as “an urge to push” that felt like the natural thing to do.  I also have a lot of patients who describe the pushing phase as a “relief” because it gave them something to do with the pain of the contraction.  I read that section carefully, on how exactly you “breathe down” the baby to delivery, and it sounds an awful lot like panting or quick grunty pushing.  I would be interested to actually see this correctly done and see if it does or doesn’t involve involuntary pushing because I couldn’t completely tell from the book.  Lastly, my final disagreement is that they recommend perineal massage on a daily basis.  This is something we actually have scientific evidence to show that it makes no difference in tearing so I’m completely discounting that advice.  I do have some bigger issues with management of labor stuff they suggest; avoiding intervention, arguing with your doctor and things like that, but I don’t really want to get into that here.  I fully support a natural labor, but I also have the experience and medical knowledge to spot dysfunctional labor and I know what the outcomes are for those labors if we don’t intervene.  My interventions are always an attempt to keep the wheels on the bus to get a good outcome (health mom, healthy baby is the goal!) and sometimes that means things don’t go “as planned.”  Anyway, like I said, discussion for another time.  There are a few other little tidbits here and there that I could argue with but none that seemed like they would actually make any real difference if you did them or not and are probably not harmful, so again, who cares, don’t sweat the small stuff.

The best parts of the book are, in my opinion, the relaxation techniques.  And probably the truly best parts are not the book at all but the relaxation CD that comes with it to listen to and practice relaxing.  While there is some evidence out there about pain perception and meditation there is not a ton of it, but I believe in the mind-body connection (not based on any science at all, just my own experience and belief system) and so I think that there is something to it.  I have had a handful of patients use this method and 2 in particular that I would consider to be very successful with the method and it was amazing to watch them.  It looked like they were sleeping throughout their entire labor and then all of a sudden they woke up and said, “I need to push” and pushed (in what I would describe as the normal way of pushing, not the “breathing down” way) and had completely normal and beautiful deliveries.  After seeing that, who wouldn’t want that for their own labor?  I’ve also seen people use the technique in the beginning but completely lose it during transition.  I’ve also seen people who had no training in relaxation techniques who seemed to find a place, a “zone” where they were definitely not “present” during labor and managed their pain in that way.  My only personal experience with these methods is in athletics (where I had training from a few of my coaches in meditation/relaxation/visualization techniques).  My best races in swimming contained elements of this.  My very fastest race ever was the closest I’ve come to an out of body experience.  It was a mile swim, so it was around 16 minutes of what is usually a pretty painful experience, but in that instance I was swimming faster than I ever had before and I felt no pain, and I also had time distortion where it was like time stood still and skipped forward at the same time.  So I have experienced it before, just not in the instance of labor/birth.  I believe it is possible.

Overall I think this is a good book.  I always have difficulty with these birth advice books because I really feel there is no “right” way to do this and they often suggest there is.  Every woman is unique, every baby is unique, every birth experience is unique.  To try to contain it within any paradigm is a little bit silly in my opinion.  Plus, it is one of the few scenarios in life where no one is actually in control of the outcome or can really predict very well what is going to happen.  So my plan is to try to experience the best of both worlds.  I plan to use the techniques they present to the best of my ability (without buying into the theoretical mumbo-jumbo) and see how it goes.  But being the scientific type I plan to be in a hospital with a doctor where someone can actually help me and intervene if the wheels do start to fall off the bus.  Here’s to hoping for a fast and pain free delivery, but more importantly for a healthy mom and baby in the end!

Product Review: Towels

I don't often endorse a product, but there are some things that I just love and even though they are relatively small moments they have a way of making my day, and these towels are one of those things:

http://www.bedbathandbeyond.com/product.asp?SKU=109354

These are the most amazing towels I have ever owned.  They make me feel like I am in a spa every time they touch my skin.  They seem to be holding up well to washing (I've had them a couple of months) and maintaining their ultra-softness.  These towels actually make me smile and sigh with contentment.  They were sort of a treat to myself for minimizing our towels (because they are expensive) but let me tell you, they are totally worth it!  And for me all of that is part of what minimizing is about, having fewer things but choosing a better quality product that will last longer and bring more enjoyment on a daily basis than something cheaper and larger in quantity. 

Before we moved we had WAY too many towels of a variety of colors and in various states of falling apart.  Most of them had also become sort of "calcified" (I don't know how else to describe it other than stiff and scratchy) from our really hard water in Wisconsin (even with our water softener the water was still very hard!).  So we donated almost all of them to Goodwill (and I'm sure they threw some of them away!).  We did keep a couple to put in the garage for washing the cars and also a couple to use to catch the buckets of sweat my husband produces by spending hours on the spin bike.  I decided to buy 4 of the above bath towels and 3 hand towels and that is it (I skipped washcloths because I don't find they get used at our house).  Just the other day I went back and bought one more bath towel for the baby so that every person in the house would have one towel.  They are plain white and fit into the decor of both bathrooms so I don't have to worry about matching.  I suppose if we are getting technical then the kids each do have an additional "special" bath towel (a butterfly and a dinosaur) that they received as gifts that they use often and we do have 4 "beach" towels for swimming and such (which, if we didn't have room, could definitely be minimized and we could use our bath towels for that purpose, which I might end up doing anyways now that I think about it...).  But even that amount is still much better than the many many towels we used to have stacked in the linen closet.  The only down side I can see to limiting the number of towels in a house to one per person is that if we have more than 2 guests come stay with us I guess Andy and I will have to share a towel, or use one of the swimming towels (which of course would be fine), but otherwise it makes storage much better!

So, if you're looking to replace some old towels with just one amazing towel, try one of these!

Minimalist Nesting

Now that I’m 36 weeks and approaching the time when the milk in the grocery store will have a due date after mine I’m getting that urge to start nesting.  For those that haven’t experienced it before it is difficult to describe other than a little tickle in the back of the brain saying, “prepare! prepare!”  Unfortunately in our society that translates really quickly into “buy! buy!” which is what I’m trying to avoid.  I’m working on channeling that energy in other ways but it is not easy to avoid the marketing directed at parents.

It actually makes me a little angry sometimes, to imagine ad executives coming up with plans to try to catch me at one of my most emotional moments to make me buy things that I don’t need.  Somehow though, despite this hostility, I do occasionally get sucked in and have found myself accidentally shopping for high-end strollers or special bassinets, neither of which I need.  So I’ve done my best to keep myself from shopping and decided that the best strategy would be to make a list of what I felt (for me) the minimalist newborn equipment would be and try to stick to it. 

In making this list, I have the advantage this time around (being my 3^rd child) of experience and so that certainly helps.  I didn’t know about minimalism as a lifestyle concept after my first two kids were born (now 7 and 4 years old) but even with them, as I was buying things or receiving gifts I would often pose the question, “do I really need this thing?” and at the time the answer was, “maybe?” and now I know that often the answer is “no” or at least “maybe I should wait and see if I need it.”  When my son outgrew his baby things I got rid of almost everything, gladly, with the happy thoughts that the people borrowing it or buying it could certainly use it and our closet couldn’t since I didn’t know if we would have a 3^rd child.  So this time around I’m starting mostly from scratch and I love that I get a clean slate. 

The other up side to this being a 3^rd child is that I don’t plan to have a baby shower.  Don’t get me wrong, I love baby showers and parties of all types, but I’ve never been to one where there wasn’t a lot of unnecessary gifting. Looking back at my own shower, it makes me a little sad sometimes to think about the clothing that I was given for my first daughter that never got worn, that I gave away to friends (with the tags still on!) because we got a lot of clothing as gifts, and she didn’t grow at the standard rate (a lot of kids don’t) and so she never got to wear them!  Because of that experience I always encourage people wanting to give a baby gift to give the gift of a housecleaning, meals, babysitting, or a pedicure as those are often the things you really don’t want to do for yourself after your baby is born and you need a break!  Other great gifts are baby or children’s books (because we know reading to your child at an early age is good for them) or a gift card to buy necessary items that pop up along the way.

So the list, it is tailored to me personally, I don’t expect anyone else to use this list as a rule, but I’ll try to spell out why I think it is what it is.  I also welcome feedback and comments as I WISH someone would have told me these things before I had my first child and I imagine there are a lot of different opinions out there.

The list:

Car seat – This is only if you have a car of course!  We do, and we unfortunately have to drive places (we live within walking distance of a lot of local favorites but both my husband and I are working professionals and our jobs require driving a distance that is not walkable).  I am hopefully going to be borrowing a car seat, instead of purchasing one, which is not something that is necessarily recommended by safety experts (to get a used car seat) but it is from a friend I know well and trust and so I feel comfortable with this plan.  But in the end, in the United States, you normally are not allowed to leave the hospital with your baby if you don’t have a car seat, so that is why this is at the top of the list as a necessary item.

Clothing -- Technically they don’t “need” clothing if they have blankets, but I think most of us feel better with our baby in some sort of clothing, I know I do.  This particular baby is going to be a winter baby and so the list is different than it would be if it were a summer baby (which would probably include only onesies, I know that is what my son pretty much lived in as a summer baby).  But, even a winter baby doesn’t need much and in our household of soon to be 5 people, who all have minimized our wardrobes, we do either daily or every other day laundry so it’s not necessary to have a week of clothing on hand.  I believe a reasonable minimum is 6 gowns or footed pajamas and 3 “outfits” for the 0-3 month age range to start with and to have about the same (minus the gowns, because they generally fit for a long time) for the 3-6 month age range.  Will I probably end up with more?  Yes, probably, I am a sucker for adorable baby outfits, but I am trying to limit my own purchases as I expect we will get some of those adorable baby outfits as gifts.  I’m basing these numbers on the experience I had before, that even on a bad day we would usually only go through about 4 clothing changes.  Maybe less with my second child because I just got lazy and tolerated some spit up here and there without feeling the need to change clothes.  Also, I found that both my kids spent most of their time in gowns or pajamas or onesies, they are just so much easier (especially the gowns, no snaps!) than an outfit, although when the opportunity arises to dress them up a little bit it is fun to have a few cute outfits on hand.

Diapers – I don’t plan on stocking up on too many diapers ahead of time because of the size issue; you just don’t know when they are going to need “newborn” size or “size 1” or “size 2” because they all have different size butts and different size poops! I’ll probably buy a pack of newborn disposable diapers to start with because my babies have been on the smaller size in the past and they tend to go through anywhere from 6-12 diapers a day in the first couple of weeks and then go from there. I’ve never done cloth before but have contemplated it for this one.  My husband said he doesn’t want to participate if we do cloth so that sort of takes it off the agenda for me (an agreeable partner is necessary in the newborn phase!).  I would be curious to hear from those out there who use cloth how many diapers and diaper covers they feel they truly “need” versus how many they actually have.  

Crib – we happen to already have a crib, so we will be using it at some point, but I don’t feel a crib is an absolute necessity, especially not in the first few months.  It would be possible to get by with a bassinet and pack and play or some other arrangement for quite some time. I don’t want to really get into a co-sleeping or family bed debate, I’m going to leave that up to everyone’s individual choice, but I think it is likely that most people do end up with a crib at some point.  I encourage people to buy a safe but inexpensive crib, because really, they only sleep there (sometimes) and they are such large pieces of furniture that are difficult to store afterwards and it’s nice to not feel you HAVE to keep it once you are done with it.

Other sleeping equipment  (i.e. Bassinet, co-sleeper, pack-n-play) – Again, depending on what you choose, any of these are not absolutely necessary.  I happen to already have a co-sleeper, and really loved having it for my other kids.  I liked that I could have them near me to breastfeed during the night but not feel like I was causing them potential harm by having them in the bed with my husband and me.  In our other house we had a pack-n-play, which was really convenient for naps on the main level of the house as well as diaper changes and traveling and such.  That being said, this time we are going to do without, we don’t have space in our new house and I figure I could use the exercise of going up and down the stairs more anyway, if this ends up being the wrong decision I could probably borrow or rent one for a few months to get us through.

Entertaining equipment (i.e. Swing, bouncy seat, jumperoo, exersaucer, playmats, etc.) – I don’t think these are truly necessary items in any way.  This time around we may borrow a bouncy seat and then maybe an exersaucer just depending on how things go, because I do think it is nice to have a place where you can set them for 15 minutes while trying to grab a shower or start a meal or things like that where you can see that they are “happy” and safe.  I think it is possible to achieve happy and safe without buying large pieces of plastic equipment, it just takes a little more effort, which, depending on the day, might be more effort than one would want to put forth.  Also, in retrospect, the amount of time they use these items is VERY short.  A couple of months, maybe, before they are beyond them.  So investing a lot of money (and house/storage space) in any of these items is not really a good idea.  We have had all of these in the past and don’t have any of them right now so I’m going to wait to see how it goes before deciding whether or not we need them.

Transporting equipment (i.e. Carriers, packs, wraps, strollers) –With both of my kids I spent a lot of time carrying them in some sort of carrier.  Babies like to be close to warm bodies and mine were the happiest in a sling, wrap, or carrier of some sort.  I don’t have a particular preference as to the type; I did love the Moby wrap with my son and feel it is great even for a newborn and adaptable to older infants as well.  I found I hardly used a stroller for my second child as he was always in his wrap or carrier (our Bjorn wore out and so this time I did buy an Ergo, we’ll see how it goes!).  I did the big stroller/travel system thing with our first child and found it to be a total waste of money and space.  I hardly ever used that bulky stroller and it didn’t even fit in our car very well.  At around 4 months with our first I converted to a lightweight stroller for the purposes of travel and was happy with that decision, we still have that stroller (it’s pretty banged up but it still works!) and will use it if needed, it doesn’t fit an infant seat in it so it will be more useful again after 4-6 months when the kid can sit up.  We do own a double jogging stroller (a Chariot) and we have gotten a lot of use out of it with our two older kids and we love using it for our frequent outdoor activities which are an important part of our lifestyle (running, biking) and we’re contemplating getting the ski attachment to be able to go cross country skiing with it.  That may not be for everyone and it is a big investment based on cost and storage space so think carefully if it will work for you and your current lifestyle before buying any specialty stroller.

Feeding items (bottles, breast pumps, baby food makers) – The breast pump decision is totally dependent on plans for going back to work, etc.  I encourage people to wait to buy one because sometimes (depending on your health insurance) the pump may be partially paid for if you are struggling with milk supply issues.  If you’re going back to work very soon after giving birth then you may want to invest in one.  A lot of people can get through with a hand pump and so don’t discount that as a possibility as it is a cheaper option, but if you have limited time for pumping then a higher grade electric pump is a better choice.  My pump wasn’t working that well after it’s second time through and so I got rid of it, this time I’m going to see how it goes as I won’t be going back to work right away, I may borrow a pump from a friend (not generally recommended to share a pump) but again in this instance it is someone I know well and trust.  I encourage people not to buy too many bottles because I find some infants really have a preference for certain nipple types and you might find yourself going through 3 or 4 different kind of bottles before finding one that works.  Of course, if breastfeeding you may not need a bottle at all so better to just wait until you need one before buying.  Since my kids were mostly breastfed and I tried to feed them myself whenever possible we only ever had a few bottles on hand (approximately 5) since we used them just a couple of times a day and washed them regularly, so I don’t really know how many are “necessary” if you are strictly bottle feeding.  As far as baby food makers, I don’t know a lot about them, we never had one.  The amount of time between starting baby food and converting to “real food” is so short (usually between 6-12 months of age) that again I’m not sure a lot of baby food making accessories are necessary.  I do think it is great to make your own baby food, but if you have a food mill or food processor I’m not sure you need a “babyhood maker” but would be interested to hear someone else’s opinion about this.

Other items – I think all other items are really dependent on your personal preference.  Did we have a special diaper disposal system (like a diaper genie)? No, we didn’t, and we never felt we needed it and we don’t need it now.  We never had a baby wipe warmer and our kids’ butts never seemed to be damaged by a cool baby wipe (in the beginning we used warm wet towels anyway).  We didn’t have a changing table with our kids and we still think it is not a necessary piece of furniture (we had a changing pad which we moved around the house and mostly used on other pieces of furniture or the floor and honestly we felt it was safer that way).  We had a baby bathtub with our first child but after a couple of tries it was clear she hated it and she only enjoyed a bath if we were in the tub holding her so we usually bathed with our kids and got rid of the baby bathtub.  We do have a baby monitor because of the distance between our room and our baby’s room, but if our room was closer I don’t think that would be a necessary accessory and we’re probably not going to need it for the first couple of months anyway.  I had a Boppy pillow with my first child but I found it uncomfortable for me for breastfeeding (personally) and I did better with rolled up blankets and pillows positioned for our mutual comfort.  We do have a glider/rocker chair which is a piece of furniture that I really enjoyed during the first 12 months with both my kids and I am glad we have kept it for this third one.  It is very comfortable for breast feeding and rocking soon after delivery, but I think that is mostly personal preference and again not absolutely necessary.

Toys and books – As a parent I have come to loathe manufactured and advertised toys and this is where I feel the minimalist need the most right now.  This is also where I learned from experience as we overdid it with toys during my daughter’s first couple of years of life.  It became very clear to me rather quickly that they do not need a lot of toys.  Babies are much more interested in interacting with humans (appropriately) and that is what we should be doing with our babies most often!  Putting them in a swing or on a play mat or handing them a toy is not that fun for them (except when they figure out they can create a game by throwing the toy on the floor and observing us pick it up for them repeatedly).  Like most kids our daughter loved playing with tupperware and wooden spoons on the kitchen floor more than she liked any of her plastic toys.  Is it reasonable to have a couple of distracting items (like a rattle or stuffed animal and a couple of toys that they can put in their mouth to chew on) yes, I think that is very reasonable, but most kids end up with an excessive amount of large plastic toys that I think are absolutely unnecessary.  Books, however, are healthy and good for babies and so I think having a small library of baby and children’s books is a good idea.  I think using the local library often is great, and most babies probably don’t care what you are reading to them so even reading a magazine is fine (although expect page ripping to occur).

So that is the list!  Again, I’m interested to hear everyone’s opinion about this, I’m sure there are lots of different thoughts out there and I’m pretty sure there isn’t a “right” or “wrong” answer as to how much and what is needed for a truly “minimalist” nesting and first year of life.  Personally I have been trying to use that little “prepare! prepare!” voice in my head to channel the energy that I might otherwise use shopping for “stuff” and invest it in keeping my body healthy during my pregnancy with a good exercise routine and preparing healthy meals for our family (both time consuming activities that require real effort!).  Also I’ve been taking some time for creative things, like painting a wall mural in the baby’s room and doing some journaling, that are both relatively low in terms of cost but make me feel like I’m giving the baby a gift of something that I made just for her that couldn’t be bought.  Sometimes when I’m walking through large stores and seeing aisle after aisle of cheap toys and baby items it makes my stomach turn a little thinking that we, as a society, have placed such importance on such unimportant things during such an important time in our lives.  Our babies need our time, our full attention, and our love, not our stuff.  They come to us naked and with nothing to give but love, which reminds me that in the end, she is the true gift and blessing, she already has all the “stuff” she needs within her and I never ever want to lose focus on that.

Writing it Down for Posterity

After all of our recent struggles with Avery (and things have slowly been getting better, very very slowly), she totally blew me away with something she said tonight and so I have to write it down, because it may be a very very long time before I ever hear anything like it again!  As she was going to bed she said, "Mommy, I love you so so so much!" and I said, "and I love you too!" and she said, "And thank you for taking such good care of me, and making sure I'm always safe and healthy and alive, because I only have one life."  I have no idea where that came from, but it brought tears to my eyes!

Here's to Hope

Oh my goodness, we are actually having a baby!  It has hit me that this might be really happening.  You might think that sounds crazy, to be 33 weeks pregnant and just realize this, but it has been a long couple of years.  The ups and downs of pregnancy and miscarriage were rough and I find myself repeatedly astonished it is actually real.

I feel like I need to talk about the miscarriages a little bit.  I talked about the first one a lot already, because that was emotionally the hardest and required the D&C and all that.   But they are so common (roughly 30% of all pregnancies) and yet hardly anyone ever talks about them openly and I’m still not sure why they are a sort of taboo subject.  Miscarriages are a unique sort of loss.  I knew that before, professionally it is something I deal with so often, but I didn’t really understand it until I experienced it myself and found out how much suffering is involved.  I’m not saying my road was harder than anyone else’s, there are certainly people who have suffered more than I have, but 4 miscarriages in a row did stretch me to the edge of my own ability to cope. 

That sort of pain; deep heart wrenching pain that rips you up on the inside, that feels like the loss of your entire future, is so hard to handle.  Harder, even, when the loss is personal, and private, and lonely.  I wasn’t totally private about it, people around me knew what was going on, but I didn’t stop to grieve either (which in retrospect might not have been the right choice).  I went to work throughout all of it and kept everything around me as normal as possible; it was easier for me to be distracted than to think about it too much.  I also found that when I was working I completely forgot it was happening and I enjoyed taking care of my pregnant patients and delivering their babies and holding their hand through the newborn phase without harboring any resentment.  However, when I was at the grocery store and saw a newborn, or on the street and saw a pregnant woman, or heard of someone I knew having a baby it just seemed so unfair.  The pain was so sharp and searing at those moments and I had the almost constant thought of “why is this happening to me?”  I probably should have worked on letting out some of that pent up emotion but I felt I was struggling to make it day to day as it was.  Each positive pregnancy test was filled with so much hope and each time the bleeding started my hopes were more than just dashed, it felt like they were slaughtered.

Which is why we totally gave up after the 4^th one last February.  I couldn’t go through it again.  It was just too hard.  Of course in the time following that loss I wasn’t thinking all that clearly, as a physician I really should know better: that you don’t have to be “trying” to get pregnant to actually become pregnant and I was truly surprised a month later to see that positive pregnancy test, and also terrified.  My very first thought was, 5!  I can’t go through 5 miscarriages!  But there was a little glimmer of hope.  And seeing that little heartbeat on the first trimester ultrasound was so surprising.  I didn’t cry, I just sat there in awe that momentarily things were actually ok.

Since that moment every positive step forward has been individually reassuring (a normal nuchal screen, a normal first trimester screen, a normal 20 week ultrasound), but none of it has really stopped me from thinking that at some point the other shoe is going to drop.  That feeling never leaves me.  On a daily basis I run through all the bad things that could happen, which is why I think I’ve set up this barrier to believing it is actually happening.  It’s easier to think it’s not happening so that when things go bad I’m prepared.  Even though nothing really prepares you for that sort of loss.  It’s probably a defense mechanism, and probably not the most mature reaction, but I’m working on it.  And as each day goes by things seem to get more real.  Which has led me to actually start working on the nursery.  Which makes me worried I’m jinxing things.  (I haven’t taken the tags off of anything because that feels like I might really be pushing my luck).  It is sad to me, that somehow, in the process of all that loss (and maybe of not dealing with the loss) that I may have dampened my own hope and happiness for this new little one.  Feeling condemned to loss is unfair to her so I'm trying to stop that feeling; with her movements and presence becoming stronger every day I want to work to rediscover what joy that is unfettered by worry feels like.  Easier said than done.  But I want to do it for her sake, so that I will be able to give in completely to the moment I’ve been desperately hoping for; the blissful amazing moment when I watch her take that first breath of life.  Here’s to hoping and believing that miracles, even common every day ones, like a healthy baby being born in a normal way, can happen to anyone, even me.