Monday, July 28, 2014

Pre-Term Labor

Ever since my first pregnancy, I have pined for an early delivery. Like, maybe even earlier than 37 weeks? Just a smudge? This is for several reasons, some of which are good and some of which are considerably less-than-good. Actually, most of which are not good. Here's something like how it went in my mind:

In the first place, the end of pregnancy is extremely uncomfortable. Avoidance of pain is not necessarily a good reason to deliver a baby, though, especially if he's not quite ready. Besides, bearing the pain of pregnancy placidly is good practice in bearing all the other pains (physical and psychological) of parenthood in a similar way. Easier said than done, but a worthy goal...!

In the second place, I kept thinking that if I could just stay skinny during one of these pregnancies, I would deliver my baby between 37 and 39 weeks like all my other skinny friends. Then, my doctor would love me because I'm skinny AND because I delivered my baby right when he wanted me to! But alas, I gained less weight with the last two pregnancies than with the first two (30-35 pounds each), and I still went nearly the full 40 weeks with both. I don't know how it would be possible for me to eat less or gain less weight without lying around the house moaning with hunger. (And if you've been keeping track, please don't worry about the baby: both of my skinny-pregnancies resulted in healthy eight pound babies at birth!).

In the third place, I kept thinking that little babies would be easier to deliver. A baby delivered at 36 weeks is bound to be smaller than a baby delivered at 40. But my 9.5 pound second son took all of 20 minutes to push out, so I no longer think that's necessarily the case. At least, not for my pelvic dimensions. Apparently there's plenty of room!

Even in spite of having some of these myths busted, I still kept thinking there would be some benefit to having a baby slightly before term. At least I could avoid the haggling over induction date with my doctor, right?

Well finally, two things happened at the end of this pregnancy that firmly convinced me it's better to still be pregnant at 39 weeks than have a baby that's not ready to be born on the outside of the womb at 35 or 36.

One day, I was walking around our neighborhood, hugely pregnant, with my three boys in tow. A NICU nurse who lives nearby was walking her dog. We casually struck up a conversation about when I would deliver (I was 35 weeks at the time), and she said, "Oh no, you want to wait a few more weeks. Even babies born at 35 weeks have it rough. They especially have a hard time nursing." I love nursing my babies, and the thought of a baby really struggling to latch and be nourished by the milk that was made just for him made me very, very sad. I decided that I would wait as long as I had to, if it only meant he was ready to be nourished on the outside!

Secondly, I did almost give birth at 36 weeks this time around. I was completely unprepared! I suppose there might be a few things I could do to get ready before 36 weeks next time, just in case. But it was shocking to me that even though I had already done this three times before, I somehow wouldn't be even mentally prepared to have a baby when I was only a month away from my due date.

Thirdly, a woman with whom I am very close had a medically-indicated c-section at 34.5 weeks. Thirty-four-and-a-half-weeks! Wouldn't that be great! Skip those last 6, painful weeks of pregnancy! I've heard that 34-week-old babies almost always do well outside the womb, because they are usually able to breathe well enough on their own by then...

Well, this family I know had a terrible time of it. Their little boy was not, in fact, ready to breathe on his own at birth. He was in the NICU for 17 days. Almost as soon as he came home, he became sick and was back in the hospital for 48 hours with a spinal tap. I looked at myself, 39 weeks pregnant, on the day that this little boy came home from the hospital for the second time, and decided that I would rather be 39 weeks pregnant than go through all that!

So I know that there's a difference between 34 or 35 weeks pregnant and 40, and that a lot changes in those last few weeks. It is, of course, right about 37 weeks that it becomes less clear whether it would really be so terrible to have baby on the outside, even at the cost of an induction. I'll have more thoughts on that in another post. But suffice it to say, I am now resolved never to wish to go into labor earlier than 37 weeks, even if I might have been tempted to wish it so before!

Monday, July 21, 2014

The "Kangaroo Care" and "Back to Sleep" Campaigns Don't Play Nice in the Sandbox

Public Service Announcement: "The Back to Sleep" Campaign and Kangaroo Care do NOT play nice in the sandbox. And by that, I mean, a mother cannot really be expected to do both when she is taking care of her baby postpartum in the hospital.

(Secondary PSA: This post will also have nothing to do with diabetes, except that you may want to pull your blood sugar monitor into bed with the baby when you do it!).

After my first son was born, I felt very strongly that I wanted him in my room with me during recovery, and not in the nursery. This was encouraged by the Bradley Method childbirth classes my husband and I took, and besides, it just seemed to make sense. I just gave birth to a tiny human being and we need to spend a little time getting to know each other, right? Besides, shouldn't the baby be most comfortable closest to me, since he's been inside me for the last nine months?

As I lay in my hospital bed with my husband snoring on the couch next to me, they placed my first son in that little plastic box and prepared to leave the room. The nurse shut the door with a "call if you need anything." As the door clicked shut, I suddenly realized that my baby was all of five feet away, but I literally could not reach him. I wasn't even sure it would be possible for me to lift my body out of them bed to sit up, much less pick him up and position him properly to do anything. Then, he started crying...

I don't know what I did that first night in the hospital, but I have encountered the same problem every time I have been lying in the hospital bed next to that little plastic box. How to lift my body into a sitting position? How to sit up when my body is so weak and exhausted from labor? Is it worth it this time, or should I just let him cry for a few minutes? And then, the frustration of swaddling the baby, and putting the baby in the box, only to have him start crying again just after you lay your head down on the pillow.

So the "Back to Sleep Campaign" would have the baby on his back in the plastic box whenever he's sleeping, which, in theory, is most of the time. In fact, however, the baby is more often crying when he's on his back in the box, and almost always happy when he's nestled close to your skin. "Kangaroo Care," or something like it, is the obvious advice for those who have observed how much babies like to be next to their mothers - lots of skin-to-skin contact, holding baby close to your chest, nursing frequently, etc. It's also apparently very good for them.

But how to achieve the "Kangaroo Care" ideal when you a) are forced to lie down a lot because you're exhausted and b) the baby is sleeping most of the time he's with you, but simply won't sleep in that plastic box? Even my happiest baby (number two) would barely sleep in the box the first two days of life. "Back to Sleep" and "Kangaroo Care" just don't play nicely in the sandbox, and I'm frustrated by that. I want my babies to be safe and healthy and not crying, but these recommendations just don't seem to work well together.

So I am all ears to creative solutions to this problem, but the only solution I can come up with is to just pull that baby into bed with me. And most of the time they are not on their backs, because they are nursing. And very often, I was sleeping...or at least resting with my eyes closed. Believe me, I would not be likely to argue for co-sleeping with toddlers, since I like having a little more space in my own (rather small double) bed. But I am very close to considering it all almost necessary with a newborn!

Monday, July 14, 2014

My OB Snuck Pearls of Wisdom into my Discharge Instructions!

First of all, I would like you to envision the kind of man my OB is: he is definitely in his 50s, probably in his 60s, and might even be close to 70. I don't know, it's sort of hard to tell. As far as I can tell, he is one of the physicians responsible for coordinating the clinical education of medical students and residents at the hospital where I delivery. He is originally from Africa, but I'm not sure where. He speaks with a very thick accent, and his name is French. Sometimes I can barely understand him, but I can always understand when he walks into the room and commands my attention with the following words: "Mama Elizabet." And he always says it with a smile on his face. He can go from jovial to serious in the blink of an eye. I know this well because it happened with my last two labors when he realized how quickly things were progressing during the pushing stage.

Here's some postpartum wisdom from this man who has taken care of me during my last three pregnancies, and who probably just delivered the last of my babies that he ever will. He came into my room on the evening before I was discharged with a very conversational attitude, asking me questions about how I would care for myself and who would be taking care of me when I got home. Almost like a friend might. He knows I've got lots of little ones at home, and his job is to make sure I'm taken care of, too.

"Accept help from everyone, even your enemies."

This strikes me as a very African thing to say. I hope that doesn't sound culturally ignorant or awkward, because I only mean it in the sense that it seems to come from another culture...a culture where people might actually have formal enemies...a culture where people might actually have enemies who somehow offer to bring them food after they deliver a baby...

But then I realize that I have people that bother me, too. I probably wouldn't label them as "enemies," but I might avoid them on most other occasions. Perhaps the tension between us is unnamed, unknown, uneven. The point is that you should not be so proud as to turn down help from someone who offers it to you in your time of need. Thank them, and lay your irritations aside for a while!

"It's OK to eat off a paper plate."

This, on the other hand, is clearly an American thing to say. And true. Paper plates, or napkins, or right out of the serving bowl, or on the same plate for dinner as you used for lunch...it's all fair game when you've just had a baby.

"No one knows half of what a woman does. And she does it all with a smile!"

By "woman," he of course meant a mother. But there is something sweet about being referred to as a woman at the time when I am most likely to consider myself "mother" before anything else. I am, first of all, a woman, and only a mother second. I like being reminded of that. It's dignifying.

Now, I don't always have a smile on my face when I'm washing dishes, faces, and clothes around our house. In fact, I'm probably frowning most of the time. But his comment reminded me that when I do smile while I'm engaged in these mundane, tiring activities, it's amazing. At least, he thinks it is. I'm glad someone can appreciate that.

"And she is so forgiving. A vengeful woman...this is worse than war."

Again, I'm not always so forgiving. See the above comment regarding frowning. I'm trying, but it's hard, and I fail often. And you know what I've noticed? He's right. When I'm bitter and snapping at children and my husband and finding fault with everyone, we are ALL more miserable. And when I'm able to lay those critical thoughts aside, find reasons to be pleased with them, see the best in their actions, give everyone the benefit of the doubt, and at the very least just stay quiet when someone annoys me, the children actually do scream less. It's kind of amazing.

In any case, his comment was a good reminder that my attitude affects my whole family, and I have the ability to foster either a peaceful environment or a very unpleasant, hostile, bitter one. That's a weighty responsibility, but in some ways, empowering to know that I do have the ability to create a climate of love and mercy in my home.


I'm not sure where my OB learned these things, but I would suspect he loves his mother and his wife very much. It seems that in order to have such a profound wisdom about the state of motherhood, one would have to observe a woman and mother very carefully and with great reverence. It makes me wonder what his mother was like, what his wife is like, what their relationships were like. So my OB and I, we don't always see eye-to-eye on everything. But I have to hand it to the man: his respect for women and mothers goes deep. Way deep.

Monday, July 7, 2014

Group B Strep

In addition to that crazy bit about having a baby lying posterior, I was also GBS positive this time around. I apologize for making this disclaimer so often these days, but I'm pretty sure this post will have nothing to do with diabetes.

I know several people who have had a variety of experiences being GBS positive. I know one woman who was GBS positive with her first two vaginal births, received the antibiotics during labor and experienced no complication. I know another woman whose baby became sick because she was GBS positive and didn't go to the hospital soon enough to receive antibiotics after her water broke. I know another woman whose baby was very cranky after she received antibiotics during labor and her baby received them intravenously postpartum. I wasn't GBS positive with my first son, but he did receive antibiotics intravenously for about a week after birth, and he was a very cranky baby, too. I've often wondered if the antibiotics contributed to the problem.

In any case, I was caught off guard by this development at my 36 week visit. It's easy, when you are pregnant the fourth time, to think that everything will be just the same as your previous three. This is especially so when your previous three were so similar to each other (similar baby weights, similar feel during labor, similar gestational delivery dates, similar aches and pains during pregnancy, for example). I've heard of yeast infections being more common in diabetics during pregnancy. I suppose the same could apply to other kinds of bacterial imbalances in the birth canal, I had just never experienced one.

In any case, I took probiotics following the GBS positive diagnosis, and I did receive antibiotics during labor (three doses). IV antibiotics are given 4 hours apart, and the doctors like for you to have at least two doses before baby is born, believing that is sufficient to reduce the risk of infection for the baby. I do suspect, as I almost always suspect when antibiotics are involved with newborns, that it may have made my little man cranky for the first few days after birth. I have no definitive proof of that, only a series of anecdotes, but the suspicion grows over time.

So next time, I think I will take the probiotics before the GBS test. If it's still positive, I will ask them to test again a little closer to my due date (because, let's be honest, I never go into labor before the last week of pregnancy). I hope to avoid antibiotics again in the future, though I will almost certainly take them again if I'm still GBS positive at birth.