An Rh Sensitized Pregnancy: Aftermath (Part 5)

At the end of it all, after all my worries about induction and further transfusions, my baby was born normally. Naturally. Spontaneously. (Well, mostly. I did have a membrane sweep.)

And four days prematurely.

After my son's birth, he spent some time with me, then was ultimately taken to the NICU. He was more or less fine at birth--clearly not anemic, no signs of shock, dealing great with the transition to being in the outside world. But because of my Rh sensitization, he would need monitoring for awhile.

Much of the next few days was a blur. I was recovering from birth, but despite my exhaustion, I barely slept that first night. Even without my baby in my arms, I was feeling the birth high! I eventually slept, but roused myself to use the breast pump every three hours or so. (I was determined to breastfeed! And determined that my baby would not drink a single drop of formula.) I visited the NICU frequently to see my little guy, and tried to nurse every time I was there.I slept as I could, and while I was sore, I never really needed pain medication of any kind.

I stayed in the hospital for two days, eating mediocre hospital food (although they get bonus points for having vegan options beyond side dishes!) and pumping and shuffling back and forth from the NICU to my lonely little room.

Coconut Baby, meanwhile, was in the NICU. Initial tests had shown his red blood cell count to be within the normal range, so he was definitely not anemic. His blood sugar was fine, although that'd be monitored for awhile due to my gestational diabetes diagnosis. Baby did, however, have an unknown quantity of my antibodies floating around in his system, and they were breaking down his cells at a faster than normal rate. The result? Jaundice. Baby's bilirubin count was very elevated, and still going up. At some point when I arrived for a visit in the NICU, he had been put on phototherapy, with two big sets of bili lights shining on him from above and a lighted blanket down underneath.

He had blood tests twice a day, to monitor his bilirubin level and RBC, as well as his blood sugar. He had to wear a little mask to protect his eyes from the phototherapy lights. He had an umbilical IV and a feeding tube, although for the first few days they switched him to IV nutrients (as opposed to my milk; instead, I steadily built up a stash of pumped liquid gold in the NICU fridge). He was so tiny, and there were so many wires attached to him, although I recognize that many NICU babies fared far worse. He was very sleepy, from the combination of being newborn, slightly premature, and jaundiced, but aside from that, he was doing well. Breathing fine, no temperature problems, no heart issues. I was barely allowed to hold him; he needed to stay under the lights.

I only got to spend two nights in the hospital, and after that I was forced to spend the better part of every day away from my new little squish. Although I tried to take the opportunity to enjoy being with my older boy, my heart felt torn in half. I continued pumping every three hours, and every day when I visited the NICU I brought all the milk I had made. Baby kept getting blood tests, kept receiving phototherapy. I tried to nurse when I was there, and he received my milk in bottles when I was at home. His bilirubin remained high, and the doctors warned us were were edging toward baby needing a transfusion after all. But instead of just giving him blood--he wasn't anemic, after all--they'd be doing an exchange transfusion. Essentially, the idea would be to swap out most or all of his blood for fresh blood, blood that didn't contain my antibodies.

It was a terrifying prospect.

Instead, we authorized the doctors to give him a dose of IVIg (intravenous immunoglobulin), which would help protect Coconut's red blood cells from my antibodies; this, in essence, would slow the breakdown of the excess cells, hopefully either lowering his bilirubin count or at least leveling it out for awhile so his body could have time to catch up with the load.We were told that IVIg is normally not particularly effective in cases of Rh disease, but that it was certainly worth a try. Anything to try to avoid an exchange transfusion.

Thankfully, it worked. Coconut's bilirubin dropped dramatically after he received the course of IVIg. He still had to stay on phototherapy, but they were able to remove one of the banks of lights. A few days later, we authorized a second dose of IVIg, which further helped his body get on top of things.

Finally, after eleven days in the NICU, Coconut was allowed to come home with us. The monitoring wasn't over just yet, though. He needed a blood test three days later, and then another four days after that. We continued doing weekly blood tests for weeks, monitoring his bilirubin (to ensure it kept dropping), his red blood cell count (to ensure it didn't drop), and his reticulocyte level (which was an indication of how quickly his body was producing new red blood cells). Those days were the worst part of Coconut's week; he hated the heel pricks (who could blame him?), not to mention getting his blood pressure checked and all of his other vitals taken.

Finally, though, when he was approximately six weeks old, the doctors released him. Officially. Bilirubin was nice and low, indicating that his body was able to handle it on its own. Red blood cell count was up, indicating that my antibodies were leaving his system. Reticulocyte count was way up, indicating that his body was finally making plenty of new red blood cells.

Six weeks after birth, my baby was finally free of the effects of my Rh sensitization.

In the end, I feel like I was really quite prepared for the issues I encountered during the pregnancy itself, although the reality of the blood transfusions was far more intense than I had thought they would be. Where I felt unprepared was when it came to the aftermath. No one had really warned me of the issues we'd be dealing with after birth; I had naively believed that once baby was born, he might need a transfusion if he was anemic but that would be that. I hadn't realized that jaundice was a major concern. No one told me my antibodies could linger in his system for up to three or four months. I was unprepared for the frequent, heartwrenching blood tests, or the reality of having a NICU baby.

We got through it, though. It was so much harder than I expected, but it was quite worth it in the end. Of course! Being Rh sensitized made for, quite frankly, a pretty awful pregnancy and birth experience. Thank goodness for the modern medical procedures that enabled this baby to come into the world and into my arms.

***

See more:

• An Rh Sensitized Pregnancy (Part 1)
• Mid-Pregnancy-ish Update
• An Rh Sensitized Pregnancy (Part 2)
• An Rh Sensitized Pregnancy (Part 3) 
• An Rh Sensitized Pregnancy (Part 4)
• The Birth of Coconut Baby

The Birth of Coconut Baby

When I was just past the 36 week mark, I saw my doctor for my final prenatal appointment.

Of course, I didn't know at the time that it was going to be the last one!

As has been par for the course in this pregnancy, I had an ultrasound first. Well, technically I had a biophysical profile, since it was followed up with a nonstress test. I wasn't expecting that, but as with so many things this pregnancy, I didn't question the necessity. I was high risk and in my final month, after all; if my doctor thought a nonstress test was needed, then I was just going to go with it. Besides, I'd already spent so many hours on the fetal monitors that twenty more minutes didn't even faze me.

Unfortunately, this particular ultrasound was not reassuring. Despite the fact that it'd been only about two weeks since my baby's last blood transfusion--a big one, and which we were hoping would indeed be the last intrauterine transfusion--baby's MCA reading (the measurement of how fast the blood was flowing in one of the arteries in the brain, which can be an marker for fetal anemia) was showing high. Not dangerously high, but much higher than my doctor wanted to see, especially so soon after a transfusion.

We did the rest of my appointment, and my doctor asked me to come back again on Friday for a follow-up ultrasound. We had already scheduled an induction for a few weeks away, aiming to get baby out around the 38/39 week mark (which is when they estimated another transfusion would be necessary), but my doctor warned me that the high MCA reading meant we'd be moving the induction forward by at least a week. Depending on how the ultrasound looked on Friday, we might need to induce that very day.

This obviously was not what any of us wanted, but I know how bad anemia can be for a baby, so I readily agreed. We'd hope for the best on Friday, and plan for induction the following week. I told my husband and he told his job, and we all planned as best we could.

I then asked my doctor if we could sweep my membranes at my next regular appointment. In case you've never heard the term before, a membrane sweep involves a doctor (or midwife) doing a cervical exam, and then if conditions look favorable (meaning, a certain amount of dilation has already occurred and the cervix is already somewhat effaced), gently lifting the amniotic sac away from the cervix. If the body is close to being ready to go into labor, this can sometimes kick things into gear. At the very least, we were hoping to encourage my body to keep making the hormones that would continue to thin my cervix out so that induction would be more likely to be successful.

My doctor agreed that it sounded like a good idea. "I can sweep them today if you want," she offered. And so she did.

Neither of us expected it to actually work, though!

The sweep itself didn't hurt at all, which I was a bit worried about. It was uncomfortable, sure; cervical exams always are. But it didn't hurt. Before I left her office, my doctor warned me that I might experience some spotting, and that some crampy feelings were normal after a sweep. So I didn't think anything of it when I did indeed find a bit of bloody discharge, or when I noticed cramps during my middle-of-the-night bathroom runs. It felt like menstrual cramps, exactly what I was expecting based on what I'd read.

The cramps did get a little worse as the night progressed, but they were nowhere close to bad. Certainly not anything I couldn't sleep through. They didn't feel like labor contractions. It was just the sweep, that's all.

Sometime the next morning, they did start feeling a bit more like contractions. Similar to my first birth, I at first assumed that I was finally feeling the Braxton Hicks contractions. After all, I had been having them for weeks. Regularly. They had caused problems leading up to the last cordocentesis and transfusion, after all; they'd been so regular that the doctors had put me on magnesium sulfate to try to slow them down (but to no avail). So surely that's all these contractions were. I was finally starting to feel them.

...Or maybe it was early labor?

A few hours later, I lost part of my mucous plug. It was at that point that I started to take things seriously.

My contractions started to get a little more uncomfortable. Still nothing I couldn't function through. I took my older child to swim class, where I found myself swaying my hips through the contractions. I was still able to drive, but sitting still was getting a bit uncomfortable.

I downloaded a contraction timer app to my phone. Bug and I went home to have lunch, and the contractions were getting worse. When I finally started timing them, I found they were coming every 4-6 minutes, and were about 30 seconds long.

The husband and I scrapped our plans for doing some baby gear shopping at Target. We went out for an early dinner of Thai food (spicy!), but my appetite was already starting to fade, and I ate barely any. I debated calling labor & delivery for advice, but my contractions were getting longer and stronger. I opted instead to just head straight to the hospital.

The drive to the hospital sucked. There was traffic, and instead of 20 minutes we were in the car for at least 45. I couldn't lean back in my seat. But sitting up straight and leaning forward (as much as one can lean forward with a big belly, anyway) were uncomfortable, too. I kept timing the contractions, and they continued at about the same pace, although they were 45-60 seconds long at this point. Every time one hit, I did my best to wiggle as I could, trying to work through them, but that's hard when you're strapped into a car! I found myself thinking fondly of my son's birth, which took place at home. Why would anyone choose to drive to the hospital while already in labor?!? I knew the nature of my pregnancy meant that a hospital was the best place for me and baby--whom we had been calling Coconut--but I couldn't help but be a little wistful for the idea of another home birth.

When we got to the hospital, I was checked in and shown to a room. I changed from my pants into a loose sarong; no hospital gown for me! They put me on the monitors and I waited for someone to come check my progress. I had put into my birth plan that I wanted to minimize cervical checks, but I was okay with a few of them (emphasizing that consent was required!). When the doctor finally came in, I was a bit disappointed to find I was only at a 5. I had already been at 3 the day before, when the membrane sweep occurred. And I'd been having contractions for hours already! The rational, birth-obsessed part of my brain tried to counsel me about the dangers of putting too much stock in exams--your cervix is not a crystal ball, after all, and just because the progress seemed slow didn't necessarily mean that I'd be in labor for days. Those contractions were working, and they were likely helping baby get into a good position and doing other things not readily apparent by the surface numbers. I was definitely in active labor; no doubt about that! Never mind the numbers!

And then further bad news: Coconut was technically coming prematurely (by four whole days), and so the doctors wanted me on the monitors continuously. My room had a nice, deep tub for laboring in, but clearly I wouldn't be using it. I was stuck with bouncing on the yoga ball, moving my hips, and being massaged by the soothing hands of my husband and doula for pain relief.

The nurse put in a heplock, and it was a sign of how far I'd already drifted into the haze of labor that I barely even cried. It took two tries, and I cried a bit for the first attempt and barely even flinched for the second. (For the record, getting an IV always makes me cry.) I just kept doing my thing.

Time passed. I bounced on the ball, tried a few different positions for labor. I couldn't move far because they didn't have wireless monitors, but I ended up ultimately finding my place on the bed, kneeling and leaning against the raised backrest. Husband and doula massaged my lower back as I moaned and swayed through contractions. Husband also fed me ice chips and offered coconut water. I had actually brought snacks to the hospital, intending to eat despite their silly, outdated nil per os rule, but I wasn't hungry at all by that point. I could barely drink and suck on the ice.

As time passed, I started to get exhausted. It was evening, past dinner. I hadn't eaten since lunchtime, and I had no interest in eating. My husband tried in vain to get our son to fall asleep. (Did I mention that he was there? Bug was super interested in being present at the birth, so we ultimately decided to bring him with us!) I continued working through contractions. Time became rather hazy.

The contractions were hard, and I was feeling discouraged. I was starting to feel flushed, but then I was also feeling cold at times, too. (Transition, anyone? The rational part of my brain recognized it, but I didn't say anything aloud because I didn't want to get anyone's hopes up, least of all my own.) I was in pain, and I was so very tired. I started to doubt myself. The contractions seemed nonstop. I couldn't get any real rest in between them, and my limited range of motion made it feel like I wasn't coping well.

I asked for pain meds.

Not an epidural, but something short-acting, just something to take the edge off so I could rest a bit. I wasn't sure I'd have enough energy for pushing if I didn't get some rest.

...And the nurses told me no.

When the nurse came in, it was apparently pretty clear to her that I was past the point of medication. She offered instead to check me, so we could see how far I was.

No one was more surprised than me to hear that I was at a 10!! I was given "permission" to push whenever I wanted. I realized I was feeling a little pushy, but not much, nothing like I remembered with my son's labor/birth. I tried bearing down a bit, but I was just so tired, and it's even harder to push when your body isn't helping you out.

So instead, I opted for an intervention: I gave the nurse the okay to break my water. I had been hoping to let that happen on its own. With my Bug, my water didn't break until literally a split second before I pushed him out. I was secretly hoping that this baby might be born in the caul, since Bug had been so close. But it was not to be. I wanted this baby out, and I wanted him/her out now! Under the circumstances, breaking my waters seemed a small price to pay.

According to my husband, the nurse soon returned with a rather scary-looking tool. I have since described a standard amnio hook to him, and apparently the tool they used at my hospital was not that. Regardless, they broke my water, and I soon felt a gush all over the backs of my legs and feet (I was still kneeling on the bed).

The difference was immediate.

With one of the next contractions, I felt an intense urge to push. And by urge, I mean my body started pushing, and there was absolutely nothing I could do to stop it at that point. My husband says that you could see the difference in the contractions, in how my belly looked once that urge to push set in. I sat up as straight as I could on my knees and pushed! I groaned as I pushed, trying to keep my noises deep and my jaw open and loose.

I pushed for another contraction or two. Apparently, I was making rapid progress, because the nurse asked me if I could try to slow it down a little. I don't remember my exact words, but my response was a resounding no! I guess no one expected baby to come quite so quickly after my waters were broken, and most of my birth "team" (on-call OB, more nurses, NICU pediatricians, etc.) was not yet in the room.

Since there's obviously no way to stop a baby once it's coming, the nurse apparently yanked the "call the nurse" remote out of the wall, which sets off alarms in various parts of the hospital. I was lost in my labor haze, so I didn't notice as the room flooded with people. Another push, and baby's head was out. I immediately felt a sense of relief, but I wasn't done yet. One more strong push, and baby was earthside!

It was 10:28 P.M. No wonder I was so tired!

I fell against the bed in relief, so glad to be done. I don't know who caught him, but my husband got to see him before me, and he quietly announced to me that we had another son! My firstborn, apparently, was standing by, completely enthralled with the process. Someone milked the cord, getting my potentially anemic baby as much of his blood as they could in a short period of time. The cord was cut, and the NICU pediatricians gave him a quick once-over before giving the okay for me to hold him. (Because of my high risk pregnancy, my Rh sensitization, they wanted to make sure he was not visibly anemic or in shock.) Someone helped me to sit down normally, to lean back, and I got to hold my precious new boy in my arms.

Everything was still very hazy at that point. I know I held him for about thirty minutes before someone told me I needed to try to birth the placenta. I think the pediatricians took my Coconut again for a few minutes while the nurses helped me into a squat. A few pushes brought the placenta out, and then I reclined again and greedily reached for my boy.

I gave the okay for someone to give me a small infusion of Pitocin at that point, to ward off any potential excess bleeding. I nursed my littlest boy while my husband and bigger (but still little) boy crowded around.

Other immediate postpartum stuff happened, but I can't remember what all that was or in what order it occurred.. Placenta was examined, and I received the okay to take it home with me (or, rather, to send it home with my husband). My bottom area was examined; I had one small tear, but it was very much a surface tear, not even bleeding. I opted not to suture it. I switched my baby to my other breast and nursed some more. I ultimately allowed the vitamin K shot, even though I had been planning to decline in favor of drops. Coconut Baby got his Apgar score: 9/9. Bug started showing random things to the baby and trying to explain what they were; he was taking his role as big brother seriously right from the start! My doula took a few pictures, and eventually, quietly, bowed out. D bagged up the placenta and put it on ice. I kept nursing, cuddling, absolutely amazed at this new little person I had brought into the world.

Coconut Baby was 6 lbs., 6 oz. He had a full head of hair and the tiniest hands and feet.

After an hour or so, the NICU pediatricians unfortunately had to take my baby away. He wasn't in immediate danger from my anti-Rh antibodies, but he did need to have some lab work done, along with frequent monitoring, and his temperature was a little low despite being skin-to-skin with mommy.

The room slowly cleared out. D took Bug home (it was after midnight by this point), Coconut was in the NICU, and the nurses cleaned me up a bit and arranged to move me to a recovery room. My arms were painfully empty, and the birth haze had lifted enough to remind me just how exhausted I was. Still, I was wired, and I sent out some text messages and called the moms to announce the good news.

It had been a hard birth, much harder than I remember Bug's birth being. But I did it, and despite the circumstances--being stuck in a hospital, tethered to the fetal monitors, high risk pregnancy turned late preterm birth--the birth was pretty much everything I could have hoped for. Very few interventions, and those that did occur were with my full consent. Natural, medication-free vaginal birth. Almost immediate skin-to-skin, and nursing in the delivery room.

Beautiful, perfect baby. My rainbow after two losses and a high-risk pregnancy. Bliss.

Review: Birth Work As Care Work

These days, more and more pregnant people are starting to spend time researching birth before actually giving birth. They’re researching where they’ll give birth, who their care providers will be, who their support team will consist of.

And yet, as a society we still have a long way to go. A long, long way.

It’s easy for those of us who benefit from societal privileges to be completely blind to the advantages we have. It’s easy to forget that some birth givers don’t have access to the “good” hospitals because of location, insurance, or financial means. For some pregnant people, a higher risk of unwanted interventions or unnecessary surgery is unavoidable. For some, home birth is not an option. For some, hiring a doula is either impractical or impossible. For some, prejudice is faced at every turn due to skin color or gender identity.

For some, it’s a blessing simply to be able to give birth without being chained to the bed.

There are many issues that those who perform birth work need to be concerned with. Midwives, doulas, and childbirth educators are always learning, always reading. A new book to add to the “to read” pile is Alana Apfel‘s Birth Work as Care Work: Stories from Activist Birth Communities.
This anthology delves into a lot of sensitive ideas that are not often discussed in more mainstream birth communities, although there are certainly individuals and groups out there that are working in these areas.

“Ultimately the anthology is conceived as a platform through which to honor birth–in all its forms–as itself a profoundly radical act that holds the potential for deep transformative change.”

For example, many sections discuss the idea of white privilege with regards to birth, although those aren’t the exact words used. But there are discussions about how birth is experienced by racial minorities, and how marginalized groups have less options and less choice, and often face a certain amount of judgment simply for who they are. In addition, these people must sometimes deal with more affluent birth workers–because birth work often tends to draw in white, wealthier women–and the stigma of being “saved.”

“One such problematic narrative relates to the language of ‘choice’ within modern maternity care. The danger of celebrating the rise of choice within transactional birthing environments lies in masking ongoing forms of coercion that result in a denial of choice for marginalized communities and those with less access to the kinds of choice-making power enjoyed by more privileged counterparts.”

Also discussed is how birth is shaped by a person’s gender identity. Sure, plenty of white, hetero, cisgendered women give birth every day, but that doesn’t mean that birth is restricted only to straight women or even to those who identify as women. This book is sure to get readers thinking about ideas that some may have never encountered before.

And of course, Birth Work as Care Work talks about some of the issues that are widely known about among birth workers of all stripes, such as how the institutionalized medical model of care affects birth outcomes, the value of midwives, our society’s implicit (but not always well-deserved) trust in medical professionals.

“People see their doctors as authorities with complete control over their bodies and their babies–to the extent that they expect to be raped. The word rape might sound extreme, but I am quick to point out that when someone does something to your genitals without your consent, that is rape.”

Readers will get an overview of some basic herbal medicine–just a discussion of herbs, but no recipes–because of the importance of reclaiming medicine for ourselves. There is also a wonderful, straightforward glossary: the “Political Dictionary.” This gives readers an easy understanding of some terms they may be less familiar with, which makes this book even more accessible to everyone.

There are discussions of how doulas can serve different kinds of pregnant people, and readers will learn about groups they may not have heard about before: volunteer doulas, prison doulas, doula training programs, doulas that work in areas of reproductive health not normally associated with doulas at all (like abortion or adoption).

There are also a number of birth stories, which readers will love. Birth is beautiful, and these stories celebrate it in all of its messy, myriad forms. This is the kind of birth the author and others are fighting for, and readers will enjoy getting to experience it up close.

Overall, Birth Work as Care Work is a book that will leave readers thinking and questioning, and perhaps wanting to get involved (if they’re not already). This is a fascinating and thoughtful collection of stories, questions, and essays, and a book that any birth worker would benefit from picking up.

“Transformation happens when we come together and meet each other where we actually are, not where others perceive us to be.”

*****

I received this book from the publisher, PM Press, in exchange for an honest review. The opinions expressed within are completely my own.

An Rh Sensitized Pregnancy (Part 3)

Somewhere between 30 & 31 weeks

 About 28 weeks into my pregnancy, my baby started to show potential signs of anemia.

At that point, we'd been doing weekly ultrasounds for quite some time (I've honestly lost track of how long exactly). Half of those ultrasounds were at my normal doctor's office, while the other half were in the hospital where I've been seeing a different specialist, one who has a lot more experience with my particular medical condition (Rh sensitization).

As I explained in my last post on this topic, they've been monitoring four things in particular:

• the MCA, or how fast the blood is flowing through a particular artery in the brain (faster blood flow = thinner blood, which could indicate anemia)
• the presence of hydrops, or excess fluid around certain organs or under the skin
• swelling of liver or spleen, both organs that deal with old red blood cells (larger organs = baby's body is working harder to deal with the red blood cells that my immune system is attacking)
• level of amniotic fluid

Any of these is considered a soft marker for anemia in a baby or fetus; the presence of two or more of these signs is much more indicative of a problem.

At about 28 weeks, the MCA shot up. Before that, it had been staying on a nice curve (it naturally increases speed as baby grows) well within the "acceptable" limits. They've been tracking it on this nice-looking chart (I wish I had a picture of it to share, but I do not) that shows my numbers and what's considered both too slow and too fast. As my doctor once explained, a high MCA doesn't necessarily mean anemia, but he's never before seen a baby with anemia whose MCA wasn't above that acceptable limit. So once my baby's MCA became borderline too high, my doctor immediately ordered cordocentesis. Yes, it was only one of those markers mentioned above, but when dealing with fetal anemia, it's much better to be conservative and to do more tests than it is to watch and wait.

Because one of the potential risks of cordocentesis is early delivery, I was required to have two shots of a corticosteroid ahead of time, which helps speed up the development of baby's lungs. I had the first after that fateful 28 week ultrasound, and the second on the following day at my regular hospital. Both are shots to the butt, so I probably don't need to say anymore about the unpleasantness of it.

Cordocentesis is known by several other names: fetal blood sampling, or percutaneous umbilical cord blood sampling (PUBS). It's a test used to detect certain abnormalities in a baby or fetus; in my case, the goal is to obtain the baby's complete blood count (CBC), a number that can be obtained within minutes, which then indicates, among other things, how many red blood cells baby has (red blood cell count, or RBC). A low number for RBC is a definite marker for anemia. Additional blood tests are also done with the sample collected, but I'm not sure what all else they did.

So here's the basic procedure for cordocentesis. It's an outpatient procedure, so I wasn't checked into the hospital. I got to stay in my regular clothes. They created a sterile area around my stomach with drapes and cleaning solutions, then gave me a shot of local anesthetic to numb the area. Using ultrasound as a guide, a larger needle was inserted through my abdomen and into baby's umbilical cord. Then they took a few small vials of blood, did the red blood cell count with some of it, and kept the rest to be sent to the lab later. The initial CBC did not show that baby was particularly anemic, so that was that.

After the procedure, I had to spend 20 minutes being monitored electronically; they were watching baby's heart rate, to make sure baby had no issues from the procedure, and they were monitoring me to make sure the procedure hadn't set off contractions.

There are definitely risks to cordocentesis, but they're generally pretty small. There's a risk of internal bleeding, hemorrhaging even, since they are sticking a needle inside me and inside baby's umbilical cord. There's a risk of preterm labor. There's a risk of baby reacting badly to the procedure, which might necessitate immediate (cesarean) delivery. There's a small risk of baby dying. But those risks are all small, and (in my mind) they were definitely outweighed by the benefits of knowing for sure if baby was anemic or not.

We spent the better part of the morning in the hospital, then left, ate lunch, and headed home.

The following week, I went back for my normal ultrasound (I'll be getting all of my scans at the higher risk hospital from here on out). Apparently, the MCA had jumped up further above that acceptable limit, so my doctor came in and told me that after cordocentesis the following week (which was already the plan, since we needed to see how baby was holding up over time), it was almost certain that we'd be doing a blood transfusion as well.

Intrauterine blood transfusion. It's exactly what it sounds like: a blood transfusion to a baby (or fetus, depending on how far along the pregnancy is) while it's still in the uterus.

Suddenly, my upcoming appointment was a whole lot more nerve-wracking. My appointment time was moved up and I knew it would be a longer day.

Of course, I now realize I really had no idea what to expect from this new procedure. Sure, I had talked to specialists and read everything credible I could get my hands on, but the theoretical just didn't quite match up to the reality. I assumed they'd do it all at once, cordocentesis followed immediately by intrauterine blood transfusion, and that since they wanted me to arrive sooner it'd all be done fairly early. Instead, we spent pretty much the entire day in the hospital.

The morning started with a blood draw for me (yay?), followed by the usual ultrasound. MCA was still high; still no sign of hydrops, stressed organs, or abnormally high amniotic fluid levels. Then, I was checked into the hospital. Formally. Intrauterine blood transfusion carries much the same risks as the cordocentesis does, but the numbers are higher. This time, the procedure would be inpatient, performed in one of the operating rooms just in case there was an immediate need for a cesarean.

I was brought up to labor and delivery and checked in. We managed to sneak my husband and son up (well, bend the rules a bit might be a better description; the hospital recently instigated a "no visitors under 18" rule, and technically my son wasn't supposed to be there at all. If I had known that, both of them would have just stayed home all day!), and I was put into a labor room. I had to change into a hospital gown (ick) and they gave me an IV (double ick; also: ouch). I was not allowed to eat or drink anything (yay for nil per os? Except not, since it's an outdated and non-evidence based policy) because of the slight risk of immediate delivery under general anesthesia. They wiped my belly down and shaved it (also in case of cesarean). They had me sign lots of consent forms. They even wanted to give me a catheter, but I managed to put that off unless actually necessary, since it literally only takes a few minutes to do. And they put the monitoring belts on me. I was all but prepped for a cesarean.

So there I was, stuck in bed for HOURS, waiting until the blood was ready for the baby (and for me too, just in case). My husband and son got to stay for part of it, but once they left to get lunch, they couldn't come back. Finally, at some point after lunchtime, they were ready. I at least got to walk myself over to the OR, where the setup was much the same as with the cordocentesis. Sterile area on my belly, drapes, me lying there crying (because that's what I do when I'm anxious). Lots of doctors and nurses crowded around. Ultrasound machine on, and a quick scan to make sure everyone knew exactly where they were aiming. The local anesthetic, which my doctor described as a "bee sting," hurt a lot. The needle through my abdomen hurt even more (because I was only numbed on the surface).

Not a lot of pain from the procedure itself; instead, I felt a lot of pressure and tugging. I kept crying off and on, but I tried to focus any tension I had on gripping my kleenix box (since I couldn't hold my husband's hand this time; next time, I'm bringing a stuffed animal!) so that I could keep the muscles in my belly loose. Lots of yoga breathing, and I like to think that the essential oils I applied just before leaving my room helped me stay calm, too.

Turns out baby was more anemic than last time, but not as anemic as the doctor was expecting her/him to be. Consequently, the blood transfusion was rather small; they just gave baby a little boost with some fresh, thick, healthy blood. Everything was all over relatively quickly, thankfully.

I was walked back to my room (yes, at least I got to use my own legs again!) for recovery. After an hour on the monitoring machines, I was allowed to eat lunch (which my wonderful husband brought, although my nurse had to go downstairs and get it from him), and the simple fact of consuming real food made me feel so, so much better. I hadn't been lightheaded or anything before, since I'd been receiving IV fluids, but there's something to be said for a good, hearty salad and a nice chunk of bread.

Apparently, the norm for intrauterine blood transfusions is to continue monitoring mom and baby for at least three or four hours post-procedure. I managed to talk them down to two hours; I wanted to go home and be with my family, and there were absolutely no signs of distress in the baby or pre-term labor in me. And it's a long drive home. So after a few dull hours of sitting in bed--monitoring belts attached, peaceful music on the TV, book in hand... you'd be surprised at how weird and boring this was for me--I was finally able to sign my discharge forms. The dreaded IV was removed, I got to put on my real clothes again, and my little family and I began the long drive home.

And guess what? Before too much longer, I get to do it again. And probably again a few weeks after that. And again every two or three weeks until baby is term enough for induction to be safer than another transfusion. This is the reality of an Rh sensitized pregnancy. It's not pretty. It's far from fun. But it's necessary to keep baby healthy and strong. Ideally, I won't be induced until 38 or 39 weeks, but we'll see how the reality plays out.

***

See more:

• An Rh Sensitized Pregnancy (Part 1)
• Mid-Pregnancy-Ish Update
• An Rh Sensitized Pregnancy (Part 2)
• An Rh Sensitized Pregnancy (Part 4) 
• The Birth of Coconut Baby
• An Rh Sensitized Pregnancy: Aftermath (Part 5) 

Review: Touching Bellies, Touching Lives

Ever since I got pregnant with my Little Bug, I have been somewhat obsessed with the entire process of pregnancy, labor, and birth. True story. As any birth junkie can attest to, once you get bitten by the birth bug, you never lose that fascination.

And despite my own rocky history with pregnancy, I too remain fascinated. I read every pregnancy birth I can get my hands on, sometimes reviewing newly-released ones for SF Book Review. I love talking pregnancy with my friends. I celebrate their pregnancies and revel in their birth stories. I read articles and blog posts and never, never stop learning.

I know I'm not alone in my obsession. And for people who love birth as much as I do, getting to read a book like Touching Bellies, Touching Lives by Judy Gabriel is a real treat.

Gabriel fell in love with Mexico at a fairly young age. Later, as an adult, she spent weeks and months at a time traveling through the southern parts of Mexico, meeting with traditional midwives and hearing their stories. Her book gives voice to a group of people that is in danger of disappearing completely, as Mexico adopts the worst of Western practices regarding how labor and birth should be "managed."

Many of us are already well aware of the problems that pregnant women face in America; the over-medicalization of normal, healthy, low-risk pregnancies has been getting plenty of media attention in recent years, including on some rather prominent news sites. We know that interventions are over-used, that the cesarean rate is too high, and that birth trauma is a very real issue.

But what we hear less about is how some of these problems are sneaking into other countries and cultures. Touching Bellies, Touching Lives has opened my eyes in a lot of ways. I hadn't realized that midwifery in Mexico is currently facing the same challenges that midwifery in the United States faced decades ago, that mistrust and lies are driving women away from traditional care and into hospitals. I hadn't realized that the use of pitocin (artificial oxytocin, which is the primary hormone that drives contractions during labor) had become so standardized, that even many midwives used pitocin routinely now and that pregnant women asked for it. I hadn't realized that in the hospitals in Mexico, the cesarean rate not only rivals that of the U.S., but in some places surpasses it (the book quotes 45% overall in Mexico, with some private hospitals having rates as high as 90%).

However, the heart of Touching Bellies, Touching Lives lies in Gabriel's interviews with dozens and dozens of traditional midwives throughout the region. There are so many stories scattered throughout the pages of this relatively small book, stories where women tell of how they became midwives in the first place, where they learned the skills they use to care for pregnant women, and some of the more memorable births they attended. These midwives tell of learning their practice from established midwives and local healers, of attending cursos (government-sponsored courses in midwifery), and of the way their practices have evolved over time.

Many of the midwives feel deeply drawn to midwifery by God; many described it as a calling of sorts, and many said they became midwives because there was no one else in the area to help laboring women give birth. They talk about using the rebozo (a long, wide scarf) to help reposition babies and ease labor pains, about traditional remedies for pregnancy and labor, and the value of regular belly massage throughout pregnancy. In fact, one of Gabriel's primary methods of locating midwives was to ask about women who massage the bellies of pregnant women!

Touching Bellies, Touching Lives is a fantastic and informative read. While it will appeal most strongly to those already interested in pregnancy, labor, and birth, readers of all kinds will be able to see interesting parallels between the over-medicalization of childbirth in the U.S. and similar trends in Mexico. Gabriel's passion for midwifery is clear in every page of this delightful book, which is a true pleasure to read.

***

I received a free copy of this book from the author in exchange for an honest review. All opinions expressed are my own!

I Believe in Empowered Birth

 Once upon a time, I did not think I was ever going to have a baby.

Hard to believe, right? I spend so much time nowadays talking about pregnancy and birth and babies that most people probably assume I was that little girl who always played house, pretending to care for her baby dolls and imaging names I'd give to my future children.

Not so much. I honestly never thought much about it as a child. Or I don't remember thinking about it, anyway. And as a teenager, I was adamantly against the idea of having a baby. The weirdness of growing a living creature inside my own body, the pain of labor, the actual process of birth... no, thank you! If I ever had a a baby, it would certainly be adopted!

As a young adult and through the first few years of my marriage, I maintained that point of view. No babies, not for us. We'll just be the "cool" aunt and uncle, who visit our nieces and nephews bringing toys and cupcakes, but then we still get to go home by ourselves at the end of the day. That thought suited me just fine.

I'm not sure entirely when that changed. The seeds may have been planted when I read my first natural birth book (Birthing a Better Way by Kalena Cook and Margaret Christensen, which I was inspired to pick up as a review book for San Francisco Book Review during my sister's first pregnancy). Maybe it had something to do with both of my siblings having babies of their own. Maybe it was having pregnant coworkers, or making new friends who were already parents. Whatever the case, D and I started discussing actually having a baby of our own.

I still had my own fears to get over, of course. I was still very freaked out by the idea of pregnancy. And as for birth... well, I just couldn't wrap my mind around the idea of a baby's head coming out of my vagina. And the pain of contractions! Every movie and TV show I'd ever seen depicting birth showed screaming women who felt like they were being torn apart from the inside, dramatically intense labors beginning with an explosion of amniotic fluid, mantras that consisted of "I can't do this I hate you I'm going to kill you for doing this to me I just want this to be over." Birth looked downright scary. But what was scarier, the pain itself, or the big epidural needle that could take it away?

But we did it anyway. And apparently that one natural childbirth book had made a deeper impression on me than I realized at the time, because as I started reading about birth, I immediately found myself gravitating toward less interventions. I did not know quite what I did want from birth, but I certainly had some ideas of what I didn't want, and the hospitals in my area did not seem to be able to deliver. Routine electronic fetal monitoring, mandatory IVs, high c-section and epidural rates, the regular use of drugs to speed things up.... these were not what I wanted.

I like to say that I accidentally stumbled into the natural birth community. By knowing what I didn't want, I eventually figured out what I did want. Through rejecting some mindsets and the books that promoted them, I instead found books advocated for natural birth. I discovered birth centers and home birth. I learned that for many low-risk women, ultrasounds aren't actually necessary. I found out that I didn't have to take a test or do a procedure just because my care provider included it in their standard of care (and I was fired by my OB for doing just that!). I learned about natural, non-medicated ways to cope with labor pain (and the more I read about the side effects of epidurals, the more determined I became to avoid one). I read about the many benefits of not cutting the umbilical cord right away. I learned about skin-to-skin, about why the vernix shouldn't be washed away, and why that ointment they put in a baby's eyes was completely unnecessary for us.

Between books (I was lucky enough to have someone refer me to Ina May, and I followed my instincts and returned What to Expect to the library just a few days after checking it out in the first place) and the Internet (where I discovered many wonderful blogs and the beauty of positive birth stories), not to mention the guidance of my midwife (who introduced me to The Business of Being Born, among other things), I was able to figure out what kind of birth I wanted.

And you know what? The birth of my son was perfect. It was the most amazing and empowering thing I've ever done. And I attribute that to the amount of time I spent researching my options, learning everything I could about the normal process of birth.

To me, that is what empowered birth is really about. Empowered birth does not necessarily mean a natural birth, nor does it mean a pain-free hospital birth. It means taking every step you can to ensure having the kind of birth YOU want. It means being treated with respect and dignity throughout labor, so that even when things don't go they way you wanted them to you still feel like you had a great birth. It means knowing your options. It means knowing potential side effects, knowing the benefits and the risks of everything. It means informed consent - AND refusal.

That's why, even today, more than three years after my son's birth (and with no certainty of whether or not I'll ever be able to experience birth again), I remain so passionate about birth. I don't even want to think about what my son's birth could have been like if I hadn't started reading. I know so many people who had birth experiences that were disappointing or downright traumatic... and in most cases, they probably didn't have to be. (And that's a failing of the system, of the way birth happens in our country. It is not a failing of birthing women!) Birth is absolutely unpredictable, and things don't always go according to plan, but it's amazing how simply being educated about the process can make the entire process more satisfying overall.

I believe every woman deserves the opportunity to have an amazing birth. That is why I briefly sought certification as a natural childbirth educator (and why I may eventually return to that vocation someday), why I dream of being a doula in the future, why I share a million pregnancy- and birth-related articles with my friends through social media.

I got lucky. I read one good book, and then I stumbled upon others and some amazing websites. I found I had questions, and I discovered the answers that were right for me. But it shouldn't have been merely determined by luck. The information necessary for an empowered birth is out there, but it shouldn't be so hard to find. 

And that's why we must all keep working to make sure pregnant women have access to real information about birth.

Practical Gifts for Expecting Parents

When my Bug was born three years ago, I was one of the first among my close friends to have a baby. Most of my friends from high school aren't even married (or in a committed relationship) yet, but that's slowly starting to change.

Now that I'm almost (gasp!) thirty years old, I imagine a lot more friends from my age group are going to start entering baby land. That biological clock is ticking, after all (forgive me for saying that, but it's actually pretty true).

Aside from that, most of the new friends I've made in San Diego are also moms, married with a baby or two, or are planning to start trying for one soon. And thus, I expect I may start hearing more happy announcements in the next few years about incoming newborns. Let the creative Facebook declarations commence!

Whether baby showers happen or not, everyone loves sending gifts to expecting mothers, especially first-timers. I know I loved (and deeply appreciated) the flow of clothes and books and toys, much of it from people who had already been in my position long before me. People who understood to offer clothes in sizes other than just newborn, so that I'd actually have enough onesies and sleepers and such to get me by for at least the first year. People who thought to offer things I'd never think of getting on my own. People who knew me well enough to not offer obnoxious battery-operated toys or boxes upon boxes of disposable diapers.

Since having my own baby, I've learned a lot about some of the more practical gifts one can give an expectant parent. Looking for gift ideas for the next baby shower you get invited to? Here are some you may not have thought of.

     Classes.
There are so many things to learn about pregnancy and birth and parenting. In my opinion, every pregnant woman needs a good childbirth class; why not help pay for a series? Or perhaps a breastfeeding class? Or a baby massage class? (Or maybe a prenatal massage for mama?) Perhaps some prenatal yoga classes to help her relax during pregnancy? Or think ahead and find a good baby sign language class. If an entire set of classes is out of your price range, consider teaming up with another friend to pay for the classes, or get a gift certificate to contribute to the overall cost.

     Services.
Being a new mama is hard, what with the lack of sleep and lack of time for doing anything other than holding baby (or so it seems!). And it's even worse for a first-time mama, who might be struggling with breastfeeding, or who might need help just staying on top of laundry, or who would love to have some kind of meal that didn't come from a box. Consider paying for (or helping to pay for) some kind of service like a postpartum doula (who can help with baby care, assist with breastfeeding, and answer any and all questions a new parent might have) or a maid.

     Clothes.
Well, you've probably thought of this one. I did mention it above, after all. But try thinking outside the box if you just can't resist getting clothes (and who can?). Don't just shop for newborn or 0-3 month clothes, as most babies grow out of those ridiculously fast. Look for 6 month, 9 month, or even 12-18 month articles of clothing, to ensure that baby will be fashionably clad for some time to come. Look in unusual places to find clothes too. Try online stores like Etsy for one-of-a-kind onesies, check out websites like ThinkGeek for your nerdy AWESOME friends, and look in local gift stores for outfits that you can't find at stores like Babies R Us. I've even seen some pretty awesome onesies and toddler t-shirts at my local farmers' market!

     Blankets.
Yes, everybody gives baby blankets. But yes, new parents will probably use all of those baby blankets. As a matter of fact, there will be times when every single one of those blankets are in the laundry hamper, because they have been spit up on or peed on or otherwise been dirtied. In my opinion, new parents can never have too many baby blankets. Look for unusual designs and consider getting gender-neutral colors so that blankets can be reused for subsequent babies or passed on more easily to family/friends. Bonus points for handmade blankets or quilts!

Handmade quilts also make for great photo ops.

     Diapers.
Enough said, right? Make sure you find out preferences first, though! If cloth diapers are the thing, are there any particular styles or brands that would be preferred? Consider gift certificates to websites like Cotton Babies, so mama can pick out her own. Consider cloth diaper accessories, like wet bags or cloth diaper wipes, or even cloth diaper detergent. If she's going with disposables, also check for preferences: bleach-free, eco-friendly, biodegradable? Something special for ultra-sensitive newborn skin, but something different when baby gets older? Going with a name brand, either due to a rewards program or easy availability or some other reason? It's important to have plenty in the smaller sizes, but also consider getting some in larger sizes that will last beyond the first few months.

     Baby Care and First Aid Kit.
If you want to get something that will really be appreciated, consider putting together a collection of essential baby care items. First, think of the essentials: shampoo, body wash, baby lotion, diaper rash ointment (pick your favorite; I absolutely love Angel Baby Bottom Balm). Add in some other useful tools: nasal aspirator (those bulb thingies that are used to remove boogers from baby's nose) (or consider a Nosefrida if you're edgy like that), baby nail clippers. To make your collection complete, add in items like a quick-read thermometer, saline spray or drops (to help break up congestion), baby-friendly acetaminophen (Tylenol, in case of fevers), and baby chest rub (preferably a variety that is free of menthol and petroleum products). Earth Mama Angel Baby offers a fantastic Baby Essentials Bundle if you're looking for an easier option along these lines.

     Mama Postpartum Kit.
Chances are good that someone will think of getting a new parent some of the baby supplies listed above, but what about supplies to care for the newly postpartum mama? Recovering from labor and birth is tough, but some thoughtfulness from a friend can go a long way to helping a new mama stay sane. Items to consider: pads (for postpartum bleeding, or lochia) (bonus points for also including soothing freezable postpartum pads to help with healing), Epsom salt, an herbal sitz bath blend, a peri bottle, something soothing for the perineum (such as Mama Bottom Balm). Earth Mama Angel Baby also offers a Postpartum Recovery Essentials Bundle, which might be an easier route.

     Mama Breastfeeding Essentials Kit.
For the mama who plans to breastfeed, a few supplies will always be appreciated! Consider a container of your favorite nipple butter/cream (Lanolin was the only thing that worked for me, but other friends have other favorites), reusable breast pads, a nursing necklace (something pretty for baby to focus on while nursing; I love the ones by Wild Mother Arts), lactation tea. One of my good friends got me a package of breast shells, which I can say with complete honesty were a lifesaver for me. For mamas who want one, consider a nursing cover, or thin blankets for covering with while out and about. For even more bonus points, include a package (or a subscription!!) of lactation cookies.

     Books
Most women spend plenty of time during their pregnancy reading pregnancy books and learning all about labor and delivery, but not as many pick up books on actual baby care. And believe me, all new parents will be glad to find a trusted book nearby for all of those unexpected baby things that crop up in the middle of the night! So give a book or three so that mama has a good resource to turn to when questions arise. Also consider a good breastfeeding book for the nursing mother, books about fatherhood, or even a book that focuses solely on postpartum care. Or maybe just get copies of some of your favorite children's books; baby may not really be able to focus on stories or elaborate pictures yet, but reading to babies is always a great idea. Some of my favorite books for new parents:

• The Baby Book by William & Martha Sears
• The Portable Pediatrician by William & Martha Sears
• The Other Baby Book by Megan Massaro & Miriam Katz
• Naturally Healthy Babies and Children by Aviva Jill Romm
• The Happiest Baby on the Block by Harvey Karp
• The Womanly Art of Breastfeeding by Diane Wiessinger & Diana West
• Natural Health After Birth by Aviva Jill Romm

     Other Assorted Baby Gear
Consider getting some other piece of baby gear that may have been overlooked by others. How about a vaporizer, to help baby breathe easier when congested? How about a baby carrier, like a Moby wrap or an Ergo? How about something to make bathing baby easier, like a simple baby tub or a Blooming Bath? How about some simple toys? Don't go too crazy with specialized items that aren't really that useful, but don't be afraid to think outside of the box either.

This is a Blooming Bath, which makes it easy to convert your kitchen sink to a baby bathtub.

     Food
Chances are good that in the days and weeks following the birth, mama will sometimes have a hard time feeding herself. There's simply not enough time to cook when there's a newborn that needs to be held! And this problem is even worse for a woman who is nursing, and therefore most likely ravenously hungry all the time. The solution? Make ahead and freeze meals for her, so that she (or some other member of the family) has only to throw a dish in the oven in order to get delicious, healthy food ready. Consider simple, easily freezable meals like lasagna or enchiladas, soups or chilis. Check ahead of time for dietary preferences/needs (vegetarian/vegan, gluten-free, possible allergies). Consider including healthy snacks like trail mix or dried fruit. Another idea: collaborate with other friends to set up a schedule of bringing by freshly cooked dinners every day for the first few weeks after baby is born. Or bring by a few bags of groceries. One last option: gift certificates for some favorite restaurants that offer take out or delivery.

The Birth of Little Bug

I originally wrote about the birth of Little Bug, my son, on my infrequently-updated blog, Plentiful Thoughts of Miscellany. I haven't gone back and looked it over in ages; it's amazing what the passage of three years can do to one's perception! There are details in that initial telling that I had actually forgotten. There are also some things that I know more about now, after having spent so much time reading and learning about birth.

This version of Bug's birth story is not precisely the same as it appeared on my original blog. Instead, this is an updated version, with some interesting tidbits thrown in as well as just a little bit of clarification on some things that I did not fully understand before.

I present: a birth story!

~*~*~*~

I spent at least half of my labor denying that I was in labor.

My baby decided the time had come when I was a few days shy of 38 weeks. I had spent much of my pregnancy firmly believing that my baby would be born late; after all, as my midwife pointed out, first babies are nine days late, on average. Friends and family had been gleefully telling me how their first babies had come days or weeks late, and I had read many positive birth stories where firstborns came after 41 or 42 weeks gestation. So you might understand why, when people asked me when the EDD was, I would tell them February 19, but then assure them that it would probably be late February, maybe even early March. [After awhile, I stopped even giving out the EDD. I was not looking forward to those daily phone calls and text messages asking if baby had come yet!] In fact, I was secretly hoping for a Leap Day baby, and wasn't shy about telling anyone who asked. [I still think that would have been neat. But my Little Bug chose his own birth date, and I had no say in the matter!]

So when my water broke around 2:30 in the afternoon of February 1, I assumed I had just had an embarrassing bout of urinary incontinence. [I know now that my water did not actually break this early. Instead, I'm pretty sure that I just sprung a leak, high up in the amniotic sac. Fluid leaked out, but my waters did not break completely!] Yep, I thought I had peed myself, and was quite thankful that only the cat was around to witness it. I still had the presence of mind to note the time (halfway through Fresh Air on NPR!) and to sniff it (I know, gross, but my birth class drilled that response into me). [Note that this is one of the few things I actually learned and remembered from that birth class. It was not a very useful class. Part of the reason why I later decided to become a childbirth educator myself!] It didn't smell like anything, which meant it could be amniotic fluid, but it could also just mean that I was really well-hydrated; after all, I had been drinking water like a boss. I should have contacted my midwife then, but I suppose I didn't want to sound a false alarm and be that pesky first-time mom who saw labor around every corner.

Sometime after that, the contractions started. [You would think I would remember when the first one hit, but I totally don't. Seriously. Not at all.] I assumed that I was finally starting to feel the Braxton-Hicks contractions that had apparently started at least a week earlier. At my last prenatal appointment, my midwife pointed out when one was happening; I couldn't feel anything, but she (and my husband) could clearly see that my uterus was contracting. These new contractions felt uncomfortable, but definitely were something I could handle.

In hindsight, I should have taken notice of the fact that these contractions made my back hurt. [Or maybe I should have taken notice of the fact that I noticed them at all?!] Aren't Braxton-Hicks supposed to hurt in front, while real contractions hurt in back? I didn't remember this, or didn't make the connection, and since the contractions were no real inconvenience, I kept going about my merry way.

I next decided that this was a good time to go get a haircut. [I think some part of me realized that I might not get another opportunity to do so anytime soon. Instinct? Belated nesting urge?] But as I was on my way to Great Clips, I got a call from a friend inviting me to come over to play board games. (No, I am certainly not too old for board games, thank you very much.) Clearly, the hair cut could wait until tomorrow.

Famous last words.

As we played a few games, the contractions kept getting progressively worse, but I continued to willfully ignore them. [Progressing contractions - longer, stronger, and closer together - and knowing what I know now, this was a glaringly obviously sign that I was in labor.] Even when they got to the point where I could no longer sit through them, I still refused to recognize that these contractions might be something worth taking note of. Never mind the fact that I was still leaking some kind of fluid; I suppose I thought I had lost my ability to hold in my pee properly. And never mind the other fact that I had lost at least part of my mucous plug a week or so earlier. [It was pretty gross. My midwife told me at the time that it simply meant that my cervix was starting to change, but that it didn't necessarily mean labor was imminent. She probably meant that I was starting to efface. In reality, there's a good chance I had already dilated a few centimeters by the time of that appointment.] I simply refused to entertain the idea that I might actually be in labor. There was no way; it was too soon! [Not true. Labor at not-quite-38 weeks might be on the early end of the spectrum, but it was still perfectly normal. The "average" length of gestation is anywhere from 37 to 42 weeks. Only about 5% of babies come on their EDD. Depending on what source you consult, 70-95% of babies are born within 10 days of their EDD. So, of course, I was part of that minority that was born more than 10 days before it!]

The ten-minute drive home was distinctly uncomfortable. [How I managed to stay sitting in the car during the few contractions that happened is beyond me. I think at least one happened at a stoplight, which I am thankful for. It was late at night by that point, so there weren't many other cars on the road anyway. I think I may have pulled over for one of the contractions, too.] I decided that a hot bath was in order; I think I recalled reading somewhere that a bath could make Braxton-Hicks contractions subside, and I definitely wanted them to subside at this point. [See, if I had acknowledged earlier that I was in labor, I would have tried to rest more and sleep! A good birth class emphasizes the importance of rest during early labor, but I don't think I got to that part in my birth classes. But I hadn't rested. And now it was late, and I desperately needed to sleep if I was going to finish this.] So I filled up the bathtub as much as I could, which unfortunately wasn't much, since the geniuses who designed my apartment complex decided to put in the smallest hot water heaters available. [Seriously. Stupid thing couldn't even fill my tub halfway. The apartment I moved to after that had in-line hot water for every building, which meant unlimited hot water! All apartments should be built that way! For the record, taking sitz baths during the early postpartum days was a pain with such a puny hot water tank, but at least then I had people around to heat additional water on the stove and bring it in to me!] So with bathtub half full (and that's after adding a few pots of water heated on the stove), I climbed in and tried to relax myself. My mama called, and I told her what was going on; I learned later that she suspected it might be real labor but didn't want to shatter my disillusionment, figuring I would come to the right conclusion eventually. [I did!]

Not surprisingly, in retrospect anyway, the bath didn't really help. As I rested on my side in the hot water, the contractions just got worse, more painful even. [Well, the bath didn't help in the sense that it didn't make the contractions subside, like I had been hoping it would. It did feel very soothing, and allowed me to relax somewhat. I think I initially stayed in the tub until the water started to cool, kind of dozing a little bit. Water is amazing for pain relief in labor!] Worse yet, when I got out to use the toilet, I found myself with a little bit of what could only be the bloody show. [One of those things I had completely forgotten about! Yes, I did in fact have bloody show. It really is amazing how the mind blurs out the less-pleasant parts with time.] Resigned to the fact that I might actually be in labor, I decided to call my midwife.

No answer.

I left a message. An hour later, I left a second message. I sent several text messages. No answer. All the while, the contractions were getting stronger and closer together, and I was slowly becoming more convinced that this might be the real deal. [Progressing contractions!] In a moment of frustration, I remembered that the midwife's apprentice had called me a few weeks back; I hadn't saved the number, but I hadn't cleared my recent call data either, so it should still be in my phone somewhere. Eventually, I pinpointed which one I thought was hers and called, hoping I was right since by now it was pretty late at night. Success! While she worked at getting in contact with my midwife (she had other phone numbers to try) [I probably had those other numbers somewhere in my paperwork from her, but I was in no state to remember that], I tried to lie down and sleep some.

Sleeping didn't work. The contractions were pretty close together now, and every time one hit I absolutely had to sit up. [Sleeping during labor did not happen for me. I really started to wish I had rested more earlier!] Eventually I resorted to pacing my house, while my worried cat tried to act as my doula. (He had good intentions, but just didn't know what to do when I was so clearly uncomfortable.) [He did keep me company though! He was quite a trooper through the whole thing.]

Soon enough, my midwife finally called me back. After getting my rough analysis of the situation, she advised me to get my husband home (he's in the Navy and was supposed to be staying on base that night). I had been texting him all afternoon and evening to let him know how uncomfortable I was, so he suspected something was up; he didn't seem entirely surprised when I woke him up around midnight and asked him to come home.

After that, things get kind of hazy, time-wise. I know I filled the bathtub again, and my husband continued to boil water on the stove to keep it warm for me. I know the two of us were in regular contact with my midwife, and it wasn't long before she (and her apprentice) were both on their way to my apartment. I had planned to give birth at their birth center, but an hour-long drive was clearly out of the question for me at this point. [I don't know what ever made me think that it was a viable option in the first place. If I could barely handle a 10 minute drive, how could I manage an hour?! And this was hours after that 10 minute drive, so labor was pretty intense at this point.]

I know I asked my husband to provide counter-pressure on my back during my contractions. I know I pooped a little in the tub during some of the contractions, but my husband showed his worth (not that there was ever any doubt) by putting on rubber gloves and scooping it out. [He's such a rock star!] He also brought me applesauce (the only food I was interested in eating) and kept me drinking water between contractions. [I have learned so much more since then about good comfort measures in labor. I managed just fine with my limited repertoire, but sometimes I wonder if having my hips squeezed might have helped...]

I know that after all of the books I had read, all of the stories and such I had read on the Internet, and the birth class (of which my final class was supposed to be in a week), I remembered only two things. First, I remembered to keep breathing deeply and evenly throughout the contractions; I also remembered to take a really deep breath at the beginning and end of each so that my husband would know a contraction was upon me without me having to tell him each time. [That worked very well for us. The breathing was my ritual to get through the intense contractions, and the deep breaths provided a beginning/end point to help keep me focused. And it helped my husband to be involved, to know exactly when the contractions came on.] I also remembered Ina May's concept that the uterus is a sphincter; as I breathed through the contractions (and squeezed first my husband's hand, then a rolled-up towel after he decided that he didn't want broken fingers), I actively kept my jaw loose, all the better to allow my uterus to open freely.

At some point, my husband became concerned about the water being contaminated [from my having pooped... going to emphasize that because, no lie, it's pretty common to poop during labor; I wasn't bothered by it at all though. I probably barely noticed it at the time.], so we emptied the tub and I decided to try laboring in a few different positions. Hands and knees didn't work for me. Standing with my arms around my husband's neck while he supported my weight didn't work either. I ended up doing most of the rest of my labor sitting on the toilet, of all places. [My own personal birthing stool! I also know now that many women find labor more manageable in an upright, somewhat forward-leaning position like on the toilet, and many women do, in fact, spend time there during labor. After awhile, I was just settled in there. I was focusing on my breathing, keeping my jaw loose, and just letting my body open. I lost any and all interest in trying other positions.]

I started feeling the urge to push. When I think about the pushing stage of my labor, I'm not sure I can understand the concept of coached pushing; when that urge came, I pushed, and there was no way I could stop myself even if I had wanted to. [I did try to hold back a little though, to not push quite as hard. I was hoping to not tear, or to not tear as much. But there was no way I could have stopped pushing entirely!] I assume I was fully dilated by this point, but since I never had any vaginal exams throughout, I can't say for certain.

My water had broken earlier [or, rather, started leaking],  but as I breathed through my contractions, it became apparent to me that the amniotic sac hadn't completely burst. Nope, when I felt down between my legs, there was what I can only describe as a bubble coming out of me. It was a very bizarre sensation. [For reals. I also am fairly confident now that my strong attention to the protein in my diet, and my continuous efforts to get at least the 80 grams per day that my midwife recommended was the main reason why my amniotic sac remained intact for so long!]

The haziness increased. The midwife's apprentice arrived first. [I feel like she was there during some of the position changes, but I can't be certain. It's all a blur in my head, especially this long after the fact.] She came to see how I was doing, then went to prepare supplies for the birth. [My husband says she checked my vitals and monitored the baby through a few contractions, but I honestly don't remember. I was so focused on what my body was doing that I just didn't notice unless she was speaking directly to me. Which she didn't do very often, since she was very aware that I was concentrating inwardly.] Eventually my midwife appeared. And, I was told later, my water broke for real about fifteen minutes later, and the baby came out in the same push.

I gave birth in my bathroom. [I feel like I should mention that the bathroom in our apartment was HUGE. As in, you could easily fit in me, my husband, and two midwives, and have plenty of extra room for equipment and towels and such. And as far as clean-up purposes go, that was definitely a good choice of birthplace!] The placenta followed soon after, and I sat in the re-filled tub for awhile while the midwife checked my son over. I hadn't received any medication of any kind during labor, but I gladly accepted a shot of Pitocin after to help stop the bleeding. [Note that I was not hemorrhaging, or even close, but just losing a bit more blood than my midwife wanted to see. If she had thought it at all necessary, we would have transferred to the hospital in an instant, but she was competent and well-trained and had everything under control.] Eventually I moved to my bed. [The best part about home birth: getting to have your immediate postpartum check in the comfort of your own bedroom! Well, maybe not the best part, but definitely something that I thought was fantastic.] While the midwives checked my bottom area, my wonderful husband held our beautiful baby against his chest; we had decided to wait to cut the cord [delayed cord clamping for the win!], so the placenta sat next to him in one of our mixing bowls. [I dearly wish I had a picture of that... it's one of my fondest memories of the birth, which probably sounds weird, but is totally true.] I had one tiny tear, which took two stitches to close up.

My son was born at 5:43 am on February 2, 2012, fifteen hours after my water broke started leaking initially. No medications, no interventions; a completely un-complicated home birth. I couldn't have asked for a better experience.