Birth and Babies

Mid August is coming up quick!  And considering I am considered “term” at 37 weeks, this baby could be here before we know it! 

I ordered my birth kit from In His Hands birth supply, my midwives have their kit contents listed with the owner so I just had to order the kit my midwives had already set up.  My next prenatal appointment is next week, and then I’m nearly positive the next one after that is the home appointment… Everyone who will be at the birth needs to be at this appointment, I have my prenatal appt. in my home, and my cupboards are raided to make sure I’m eating healthy (I am!) and plans for the birth are laid out.

It’s time I start getting my own birth supplies ready!  The towels, wash cloths and bedsheets need to be santized.  I have to gather up a few onesies and sleepers for the baby, and get some cloth diapers and covers ready.  I need to gather my “after birth” clothing, and misc. supplies for labor and birth.  I want to make sure I have ingredients on hand for laboraide and make a list of the items I’d like to snack on and drink during labor.  I’d love to have a big meal frozen and ready to heat up to feed everyone who is here during the birth.  My husband always treats me to whatever I want to eat after I give birth (last time I wanted roast beef sandwiches, so my husband made an Arby’s run while my dad stopped out to meet his newest grandchild and watched my daughter so I could relax), but last time I didn’t have a meal for my poor midwives, mother or friend and they had been there since 9pm the night before!  What was I thinking!!

I am thankful that this pregnancy has gone by so slowly.  It really has.  I’ve had time to enjoy this pregnancy.  The last two seemed to go by so quick!

When your baby is born in a hospital, it seems nearly immediatly the cord is cut and the baby is whisked off to a bassinet sitting under a warmer.  The reason for this is quite simple: your baby is born wet and they are unable to heat themselves when they’re born.  So, a warmer makes sense to keep the baby warm while it’s getting examined, cleaned up, footprinted and swaddled.

A baby will benefit more from skin-to-skin contact with mom though, instead of sitting under a warmer for any length of time.  Moms body, combined with a blanket, will keep the baby wonderfully warm and also comforted because your baby will recognize your smell, enjoy the feeling of your skin, and be soothed by the sound of your voice and heartbeat.

When we had my son born at home I held him close, skin to skin, until his cord stopped pulsing.  We cleaned him up the best we could with a towel and made sure all was well as soon as he was born of course, however the exam didn’t come until later.  Once the cord was cut, I got up to shower and was settled into bed.  My midwives then did the newborn exam, I got the honor of putting his first diaper on (cloth, of course!) and my daughter chose that moment to wake up - as soon as my son was cleaned, examined, swaddled and back in mommy’s arms ready to nurse for the second time (first time we nursed right after birth as I was waiting for the cord to stop pulsing).  My daughters timing was perfect! My son was born at 5:53AM - and I loved being up in labor all night while my daughter was asleep….  But this time, I hope to labor during the day so my daughter can watch the birth. She is so excited!

Many babies - about 60% of full term and about 80% premature - develop jaundice.  This is the end result of too much bilirubin in the baby’s system and the liver is not able to break it down effectively when they’re born.  The yellowing of the skin is due to the bilirubin being absorbed and the circulatory system carries the excess to all the body tissues.

No on really knows why some babies develop jaundice and others don’t.  It seems to be a pretty common occurance!  Babies tend to have a higher chance of jaundice when there are medicines used during labor such as pitocin and epidurals, infection, hemorrhage, too much acid in the body and Rh incompatibilities.

For most babies, regular feedings and exposure to sunlight is all the treatment a baby will need.  If you are breastfeeding, your pediatrician will likely suggest you feed your baby formula in the early days to help “flush out” the bilirubin.  Avoid formula if at all possible especially during the early days and weeks.  Jaundice babies need to eat often to assist removal of the bilirubin - and breastmilk will digest faster than formula, leaving baby ready for more.  Breastmilk is also the gentlest on your baby’s digestive system, and of course superior nutiriton compaired to formula.  Your baby needs those antibodies and the other live properties of breastmilk that formula lacks.

If your baby develops jaundice within 24 hrs. of birth, it may be pathologic in nature, requiring treatment.  If your baby develops jaundice during the first few weeks of birth, it may be breastmilk jaundice from a substance in mothers milk that interfers with bilirubin metabolism.  It is still safe to breastfeed in most cases!  This will usually dissapear in a week or two.

Physiologic jaundice (as mentioned above from an immature liver) and breastmilk jaundice usually require no actual treatment other than frequent feedings and exposure to sunlight.

Babies may have daily blood draws to measure the bilirubin level to make sure it doesn’t get too high.  If your baby does require treatment, typically babies undergo phototherapy, which is exposure to flourescent lights.  Some hospitals have fiberoptic phototherapy blankets which enable the baby to be held and fed while still undergoing treatment. These blankets can even be taken home so your baby doesn’t have to stay at the hospital (under certain circumstances).  In severe cases, newborns may need a blood transfusion.

http://milkshare.birthingforlife.com/ is a wonderful site providing information about breastmilk donation.

If you are a mom who cannot produce enough and would like to consider accepting donor milk, or a mom who would like to donate to the cause, check this site out.  If you ask around, you might be able to find a local, trusthworthy donor so you don’t have to worry about shipping costs.  I have expressed breastmilk for a local baby and plan to express milk when my next baby is born.  If there is a local baby who needs it, wonderful, otherwise I will donate it!

Sometimes a mom is encouraged to pump her breastmilk to see how much she is producing.  Some formula companies encourage mothers to do this, to make sure their baby is getting enough (and then suggest they supplement with formula if they can’t pump a large enough amount).

First of all, pumping breastmilk is ineffective as a way to measure your total production, simply because a breastpump does not work the breast the same way your baby does while nursing (and different grades of pumps will work better than others, for instance a mom who needs to pump large amounts on a regular basis and keep her supply would have better luck using a hospital grade pump rather than a storebought manual or electric) .  Your baby, provided the latch and positioning are correct, will be able to express MORE milk than a pump.

Many moms try to pump because they are worried their baby is not getting enough, only to pump maybe an ounce.  This leads them to jump to supplement with formula because they are afraid their baby is only getting an ounce of milk at each feeding.

There are more effective ways of determining if your baby is getting enough nourishment and it has nothing to do with measuring your breastmilk.  Instead - is your baby happy and content?  Gaining weight?  Having enough wet/dirty diapers? 

If you are concerned, consult a board certified lactation consultant - not anyone else.  No one else has the training that a lactation consultant has when it comes to issues like weight gain.  In most cases, a pediatrician will suggest you start supplementing with formula if your baby is not gaining enough, when there are other options that can keep your breastfeeding relationship intact.

For locals in Monroe, Mercy Memorial Hospital has a wonderful IBCLC, Julie Lee.  Contact her with your questions if you feel there is a problem. 

Breastfeeding naturally reduces the chances of most women getting pregnant again soon after delivery, so long as three rules are followed:

• The baby being breastfed is 6 months old or less
• The baby is still nursing both day and night, without extended periods of time between feedings and without any regular supplementation.
• Your menstrual cycle has not yet returned.

Multiple studies done on this method of birth “control” found it is 98-99.5% effective at preventing pregnancy providing the above rules are followed.  There are other methods of birth control that can be used in conjuction with breastfeeding also. 

But you may have thought so!

I just released my latest book and have been swamped filling orders, marketing and promoting and general business stuff.  I still have a lot to do, but needed a break! 

I was recently reminded of the miscarriage we had just over a year ago (ok, it’s always been on my mind but when I woke up the morning of June 8th, I felt out of place!)  It’s amazing to think we’re pregnant again, and due in August!

I thought maybe I’d blog a little about miscarriage.  And a gentle reminder to all - no matter how “far along” a woman was when she miscarried… It’s still a depressing event.  A miscarriage happening early in pregnancy isn’t much different emotionally than one happening later in the pregnancy.

On average, one out of every 4 pregnancies ends in a miscarriage.  There are some thoughts now estimating miscarriages occur in a high number of pregnancies - maybe as high as half!  Many women miscarry so early they never even knew they were pregnant.

Most miscarriages can not be prevented.  They are not usually caused by something a pregnant woman did or did not do.  Miscarriages don’t usually have an effect on future pregnancies.  The reason behind why miscarriages occur will never be known, but researchers have found that in some cases, the embryo was genetically abnormal and not viable (or capable of life).  This can be hard to hear for women who have heard their baby’s heartbeat, or who miscarried enough into their pregnancy that a heartbeat was likely.  Though miscarriages can happen early and not get cleaned out for a while… The body has it’s own way of taking care of its self, and sometimes the signs of a miscarriage happen well after the actual even took place.  In most cases the bosy will take care of it’s self, but for some women a D&C is needed.  For us, I just spent my afternoon on the couch drinking liquids, letting nature take it’s course.  My husband already had taken time off of work to visit with his mother who flew up here (she was dying of cancer).  He left the hospital to come home and take care of me (but I told him to stay with his mom… she didn’t have long).  I didn’t really need much help. I wanted to take care of myself and take it easy, monitor blood flow and grieve.

In the case of genetic abnormalities where the embryo wasn’t “viable”, these generally do not repeat themselves.

In the instance of repeated miscarriages, there are a few factors that may contribute:

• Physical conditions: malformation of the uterus (or within, including conditions of scarring and fibriod tumors) or cervix. 
• Ectopic pregnancy: when tissues are attached to the fallopian tube instead of the uterine wall (there is a slight chance this could happen again after the first)
• Infections
• Hormonal abnormalities
• Environmental factors: exposure to harmful chemicals, toxic fumes, excessive irradiation, video displays or cigarette smoke.  These factors have been suspected but there is no conclusive link.

When we became pregnant again after the miscarrage, of course our first thought was to “protect” ourselves by not really giving the pregnancy too much thought.  We held back telling a lot of people, because having to tell everyone I miscarried was very painful.  I tried not to let myself get too excited, and kept wondering “what if it happens again?” My first reaction to the positive pregnancy test was incredible excitement that fell short remembering what happened just a few months prior.  Until I made it into my second trimester, I really didn’t feel comfortable with the pregnancy.  Of course, miscarriages can and still do occur after the 1st trimester, but they are less likely.  Most miscarraiges occur during the first 13 weeks.

I notice a lot of women I talk to who have miscarried, experienced the same thing.  Every woman will grieve in her own way.  It’s the emotional response to a loss.  The surprising thing is that it takes a lot longer to recover, and “get over it” than society tends to think - even as long as a few months to a few years.  Even a year after my miscarriage, I still feel grief over what could have been.  I understand God has a reason for everything, and my faith in Him is strong.  It’s hard to not grieve though - I never thought about miscarriage too much… Until it happened!

Here is another finding: Researchers have learned that men grieve over miscarriages also, and their greif is often overlooked.  The truth is that he may also grieve intensely, but deal with it differently. Is your partner silent about a miscarriage you had?  It’s likely not because he doesn’t care.  Men bond with their unborn babies very differently than women do.  They will also grieve differently, too.

Pushing your baby out can be satisfying, scary, painful, or any other variety of emotions and feelings.

I’ve had a hunch about something, and I wanted your thoughts.  After doing some research, this is what I came up with (which did agree with my hunch):

The actual ACT of pushing can be painful (think ring of fire as your baby crowns).  But when you are actually pushing - at your own pace - do you still experience pain?  Contraction pain?  Pushing pain?  We’re talking about unmedicated births here, or at least medicated births where the meds have worn off so there is some feeling

If a woman is pushing hard and long because it is what is EXPECTED of her (and not because of uterine contractions demanded it, or because she senses an atmosphere or urgency, or if she is pushing against her will), pushing will be painful.  Tension in the mother will result in tension of the area she needs to have relaxed and open most during birth.  Tension will lead to more pain!  The connection between loose/open mouth and loose/open vagina does exist, though tension in any part of your body, even emotionally, can lead to more pain during the birthing process (and during labor, too).

However, if a woman is comfortable and allowed to push at will - when her contractions demand it, for as long as she feels comfortable, with as much effort as she feels comfortable giving - pushing will not be a painful event she would wish to forget afterwards.

Some women desire coaching - someone to tell her what position to assume, count for 10 seconds, and encourage her loudly when she appears to be giving up during a contraction.  Providing the woman is comfortable with this, and listens to her body most importatly (every push does not need to be 10 seconds!), this usually is not a problem.  However once a woman learns to listen to her body, she will determine how, when, and in what position to push. Some positions are more effective than others (lying on your back is the worst!).

I’ve experienced painful pushing and not painful pushing.  My daughter was a hospital birth where I was lying on my back, purple pushing and all.  That birth was painful.  I still remember the pain, and remember wishing I could push the way *I* wanted to.  I could have, if I knew better, but the nurses and midwife made me feel like if I stopped pushing, something would go wrong!  I could not get comfortable, and experienced pain during and between contractions.

My second birth was at home.  I had two wonderful midwives there to help, and I had my husband catching the baby.  The scene was entirely different - I was on hands and knees, I had no coaching other than to trust my body and push when I felt I needed to.  Once the pushing contractions came on telling me it’s time, I knew it was time.  Once I reached the pushing stage, I had NO pain (other than the ring of fire - however, hot compresses took away much of that).  I had quiet encouragement from my midwives, husband, and mom (yep, mom was there taking pictures!  I have some wonderful step-by-step birthing pictures).  Pushing was SATISFYING - almost enjoyable - and because I was able to maintain control of myself during pushing, the breaks between contractions were enjoyable too.  Again, no pain.  When a contraction would start, I did not experience pain.  As it peaked, my body pushed and I pushed along with it.  It was pretty neat. 

Another good reason to get to know your body, become familiar with the birthing process and know how to keep yourself under control during labor and birth!  No matter where you birth, pushing can be satisfying providing you follow your body’s lead. 

This measures fundal height, or how much your uterus is growing.  Your uterus is measured from the top (the fundus), to your pubic bone.  Did you ever hear “I’m measuring large for dates” or something similar?  This comment is referring to how many centimeters your uterus has grown past your pubic bone.  Generally, how many weeks pregnant you are should match closely with how high your fundus is (starting at about the 2nd trimester) - if you are 24 weeks, you should measure around 24cm.

Too large of a measurement could indicate twins, a large baby, or other issues such as too much amniotic fluid.  A bigger than average measurement could also just be due to this being a 2nd or more pregnancy, or even your baby’s position - a breech baby sitting high in the uterus will measure large.  Too small of a measurement could indicate that your baby may not be thriving as he or she should, or it could simply be due to your baby’s position.  If your baby is lying sideways, your measurements are sure to be off!

Fundal height is not an accurate way alone to estimate how far along you are or how much your baby is growing, but used in conjunction with other methods it is a “peice of the pie” to make sure things are going well.  Your pattern of measurements should remain consistent to a point - if your measurements were staying average and then your measurements dropped all of a sudden, or if they fluctuate a lot from visit to visit, an ultrasound may be scheduled to rule out any problems.  But there is nothing to worry about if your measurements are “off” by a couple cm - different factors come into play which may not get you textbook measurements at each visit, however if there is a large jump or drop, or your measurements are jumping or dropping in large increments, it is likely that your care provider will want to schedule additional tests and/or an ultrasound to get a bigger picture of your baby’s growth, development, and wellbeing inside your uterus. 

I also want to note that there is no reason to worry if you’re “off” by a few centimeters at your visits.  And you’ll get a smaller measurement when your baby has “dropped” or has become engaged in your pelvis prior to labor. 

www.cfmidwifery.org/ - Citizens for Midwifery (great resources, also a directory of midwives)

www.michiganmidwives.net/ - Michigan midwife directory

www.michiganmidwives.org/ - Another Michigan midwife directory

Don’t forget about www.birthpartners.com a great site to search for just about any childbirth professional, including childbirth educators, lactation specialists and more.

Also www.birthnetwork.org/ A non-profit, consumer-advocacy group promoting awareness of the benefits and availability of healthy, normal pregnancy and childbirth