Friday, April 26, 2013

What Happens When Your Water Breaks and You Don't Deliver in 24 Hours:Part 1

First and foremost, I'll be honest; I am not a doctor or a midwife. I'm not giving you medical advice just sharing my experience and some of the resources I used in making my medical decisions with the support of my midwives. Only you can make your medical decisions based on your body and your unique pregnancy, but this general information is not that well known so I want to share it.

Most women (about 85-90%) will have their water break during the course of labor usually close to delivery. For about 10% of women, however, their labor begins with their water breaking. Be it a warm trickle, a series of squirts, or a big gush, the sensation of having your water break outside of active labor beckons the more familiar feeling of accidentally wetting yourself (in fact there are occasions when babies drop hard on their mother's bladder and cause the bladder to release making the mother wonder if her water has broken when it hasn't). A good rule of thumb is that if you can squeeze your kegels and the flow stops, it is probably urine, if it doesn't, it's probably amniotic fluid. You can also usually tell by the smell. Urine is pretty unmistakable in its smell. Healthy amniotic fluid is clear and either has no smell or only a light smell that is not gross at all. (If the fluid is yellow or greenish and does not smell like urine but does smell bad, call your practitioner because those are signs of meconium in the fluid and that is a sign the baby is in distress. Another time to call immediately is in the case of your water breaking prematurely before you are term (before 36 or 37 weeks) this is called PPROM and there are different risks associated with it.) If your water does break pre-labor, you may be tempted to rush in to your birth place immediately, but you don't have to medically. For mothers whose water breaks when they are term before contractions start, it is not a real emergency and studies have repeatedly shown that you do not have to go in right away. Women who deliver up to 72 hours after their water breaks show almost the same infection rate as those who deliver within 24 hours if they do not go in and get their cervix checked immediately. The studies that did show that it is a great risk of infection to not deliever within 24 hours were actually timed AFTER the first cervical check (an action that introduces outside bacteria into the area and it is that cervical check that actually makes the risk of infection jump). If you don't go in and get a cervical check right away, the clock is not really "ticking" on infection, yet. In fact my midwives confirmed, you are safer staying at home with bacteria you are accustomed to while you wait for labor begins. Although I already knew this when my water broke with my first labor four years ago, what I didn't know then was that even if you do not deliver your baby within 24 hours it STILL is not an emergency. And am I ever glad I did my homework because this time my water broke really early and all my research after my last baby was absolutely critical in the success I would eventually have with my VBAC. Most women (somewhere between 80% and 90%) who have their waters break before labor begins will go into labor and deliver their babies before 48 hours have passed, so chances are that you will be having your baby soon and quickly without augmentation if you do choose to wait for labor to begin naturally. Another 6%-9% will go into labor and deliver between 48 and 72 hours. Then another 1%-4% will go beyond the 72 hour mark. I was part of that small percentage with my recent VBAC.

I want to say that having the right kind of support team in place before your water breaks is an absolutely necessary piece of the puzzle. If your provider has a hard and fast rule about "having" to deliver within a certain time period, and will not respect you if you decide to make a researched medical decision and a calculated risk to give yourself more time, than you are left with two choices (A) not letting them know when your water broke/that your water broke before labor began or (B) go in when they tell you to (often as soon as your water breaks) and hope that your body complies to whatever time constraints are placed on you. However, if you are in the enviable position (as I was) of having a provider who not only believes in the body and its intrinsic ability, but also believes in women and their ability to make decisions than there is a third option, you can wait until labor begins with the knowledge and support of your provider. Even though I ultimately chose to go in to get my labor augmented with pit (after not going into active labor for almost 63 hours after my water broke), because the choice and the timing were clearly mine, I felt stronger in facing the augmentation and the (very slight) increased risk of repeat c-section and uterine rupture it represented for me and that is what made me capable of getting through the fifteen hours of pit labor including over four hours of pushing it took for me to have my successful VBAC. Yes, you read those numbers right. My provider believed in me enough to support me coming in over 60 hours after my water broke, supported me in an additional 11 hours of dilation, and then over four hours of pushing and did not take me in for an "emergency" c-section as many providers would have and considered it a true emergency. I was even "allowed" to get into the tub to ease my discomfort during labor and was not placed on "preventative" anti-biotics because I and my baby showed no sign of infection and never did come down with any kind of infection.

You should also know that there is a slightly increased chance of some serious infections if you do decide to wait after the 24 hour mark even if you don't go in for a cervical check, but the risk is way lower than going in for an immediate cervical check and then going over that same mark. If you do make the decision to wait it out (as I did), you should follow these guidelines to limit your chances of infection and keep both you and your baby healthy.

1. Stay hydrated, you will be making a lot of fluid to replenish the fluid that is leaking. (Note: You will more than likely never run out of fluid. Your body will constantly replensih your amniotic fluid as long as you stay hydrated. It will also continue to leak throughout your pre-labor and labor until you have the baby. If it is a really long time before you go into labor, you might form a "pocket" where the flow slows down or even seems to stop (as happened in my first labor where my water also broke before labor began) or it can even seem to stop altogether for days if it is a high leak and the baby moves into a position that blocks the leak as happened in my VBAC labor) .
2. Do not go swimming in a public pool or bathe in a hotel bathroom. You do not want to introduce any bacteria that your body isn't used to because that is the kind of bacteria introduction that is most likely to cause infection.
3. Do not allow anything to enter your vagina after the water breaks. No tampons, limit or avoid cervical checks, and no intercourse as an induction method.
4. Monitor your temperature. Any fever is a sign of possible infection and you should go in immediately.
5. Monitor your baby's movements. Any significant decrease in movement should be taken seriously, particularly if you are not yet in active labor and under the direct supervision of your care provider. Alert your care provider to any changes.

Most of all, try to stay calm and rest. You are going to meet your baby very, very soon although the time between your water breaking and active labor beginning may seem to drag on forever. I know because I've been there. Twice. The second time for days. My personal story that led me to this resource will make up part two!

Thank you for reading!

Monday, April 22, 2013

Babywearing: a carrier comparison

MT wrap conversion
A friend of mine, pregnant with her third little one, recently asked for some recommendations for carriers. Since everyone has slightly different needs, I broke it down to some pros and cons vs. just giving a recommendation for one type of carrier. What the best one is for you can depend on a number of factors. I'm sure she won't mind that I share this here. 

I probably used my Mei Tai the most, and the longest. It is easy to use, can be used from newborn through toddler (with no additional inserts), and is quick. It might not be quite as supportive once they get bigger (depending on how big your toddlers are), but I still carry Gwen in one and find it comfortable (she's just under 30lbs at 3 years). I never owned my own soft structured carrier (Beco, Boba, Ergo) but they work similar to the Mei Tai, 
Beco - right before doing
a 5.5 mile walk for MS
only with buckles instead of ties. They are super padded and supportive, but I think the MT gives a little more freedom of how you want to carry (high back or low back, front, hip, tied tibetian or more like a back pack). You also typically need an infant insert (or a rolled up blanket or something) when they are smaller, so there is that additional item to futz with. I have to say, after borrowing a Beco from a friend to use for the MS Walk this past week, the added support is wonderful. I was able to carry Gwen for the full 5.5 miles with no problem. My one complaint, was that it was a little annoying getting Gwen up and down from the back carry for her potty breaks. If I could have taken the whole thing off, or had a chair or table to lean on, it probably would have been easier.

wrap - Ellevill Zara Deli LE
I used my wraps a lot when Gwen was smaller, since they are endlessly adaptable (my favorite carry was the double hammock), offer good support, and are pretty.  :-)  I can't say enough about the adaptability and support of wraps, but they do have a bigger learning curve, and take some time at first. Once you've practiced a while, it gets easy to pop them up, but at the beginning tying is slower. There are tons of videos online to show different carries, so if you are interested, check them out. One con, they are not as great as a MT or a sling for taking them in and out a lot (aka if you are planning to put them up and keep them up while you do some chores or take a walk, great... but it would have been a bit of a pain for me this past weekend to untie and retie Gwen each time she had to pee!).

I also have a ring sling. I didn't get it until Gwen was a toddler, but it can be used from newborn on. They are easy to use, easy for on/off/on/off situations, and can be gorgeous. They aren't quite as supportive as other carriers though and the weight isn't as equally distributed. You could probably carry your newborn for quite a while before you notice it, but would notice sooner with a toddler. They can still be quite comfortable though, and I like them for walks when I knew Gwen would want to be down a lot of the time, but what to get up to rest periodically. I can pop her in without even stopping. If you did get one, get a ring sling... not one of the bag slings, which make proper positioning hard and can be dangerous. Ring slings are fine and safe for newborns, as long as you are careful and get good positioning (resource here).

Stay away from "crotch dangler" carriers (ie. Bjorn, Snuggli and Infantino) as they are less comfortable for Mom and Baby (weigh is not distributed as easily), and are not ergonomically good for baby. More about that here.

So, I'm in the Use All The Carriers! camp, but I guess my favorites are wraps and the MT for different situations. If someone were only going to get one carrier, I'd probably recommend a MT, with a soft structured carrier being a close second. I hope this helped, and please let me know if you have any other questions.

Other Resources: 
Becoming Mama's has an amazing Guide to Babywearing

Thursday, April 18, 2013

The Pressure's Off

Yesterday I went out, by myself, to Target and Starbucks. To Target to search for a new skirt and pair of sandals to wear to an upcoming wedding, and to Starbucks for some quiet reading, coffee, and cake pop time. At least once every two to three weeks I like to go out in public somewhere, anywhere, without my usual six-and-under entourage. So, yes, I regularly pay another person good money so I can drink (lattes) solo. And I don't feel pressure to do much else with this time.

Oh, I used to. I would previously stress over What I Could Accomplish During My Two Hours of Alone Time. I would obsess that if I didn't do something Really Important and Significant it was just a waste of time (and money) and I should feel bad about it. 

And it's not just since I've become a mother that I felt this way, I think I've always had this lingering guilt about being productive. Even when much younger and single, if I had a situation come up where I could spend some quality time say, writing, and I blew it, I would feel like I wasted the opportunity and shame on me. Being in airports and traveling come to mind. I flew by myself several times in my single days, and before I left I always had this idea in my head about what I would do while puttering about the airport or during the flight. Usually it involved drafting the first 20,000 words of a novel or something equally unattainable. Then when it didn't happen, I'd feel like a failure.

I feel compelled to add here that if my husband had one of those normal jobs where when someone asks when's he getting home I could say "6:00" or "around dinner" instead of "sometime next month" or "August" I would probably just disappear every other Saturday morning for an hour or two. But this is where we are.

I will also share that in the past I did something similar without paying for a sitter by joining a babysitting co-op. Although that was in my need-to-feel-productive-all-the-time years, so I probably did something super exciting like go to the gynecologist or have a tooth drilled.

Now, I drink coffee. Eat sweets. And blog. Or read a book. Occasionally try on shoes. And I don't stress about it.

I let go of the pressure to do something and just let myself be. I've accepted that it's okay to take time to be alone with my thoughts. I don't have to be executing something of value every waking moment. Wait, maybe being alone with my own thoughts is valuable.

What do you think? Precious alone time: accomplish as much as possible or just breathe?

Thanks for reading and have a blessed day. 

Wednesday, April 17, 2013

What To Do When Someone You Know Has A Late Term Pregnancy Loss

Over the past few months I have been asked this question personally, as well as seen the topic a number of times on online chat groups.  Since my loss at four months just this past December, I have a new perspective on this and thought I'd share, since it seems to be a bewildering topic that is best answered by someone who has been through it.  I'm fully aware that my situation could've been far worse and my loss could've taken place even later, but this was my 6th miscarriage, and getting four months into the pregnancy only to have it very unexpectedly end was, and still is, indescribably painful.

The easiest, most general advice I can give to anyone who may know somebody who has had the great misfortune to lose their baby late in the pregnancy is to treat that loss like you would any death in the family.  Miscarriages are still so taboo in our society, and people just don't respond the same way.  People don't generally flood your doorstep with food and flowers, the way they may do so if you lost a child they had a chance to know.  While I will admit that there is most certainly a difference, as I cannot even fathom the devastation I would experience if something happened to my 2 year old daughter now, and I realize it would be far greater than anything I recently experienced, I still believe that right out of the gate, I think the feelings are pretty comparable.  I felt equally incapacitated with grief and unable to function. 

Furthermore, women who lose a child that far along (or at any stage, really) are not just dealing with mourning a loss, they must confront the physical aftermath as well.  I had gone in for a routine appointment, expecting to be in and out with no suspicion that anything at all was wrong, and minutes later my entire world was turned upside down when there was no heartbeat.  I was presented with the option to either induce labor within the next day or two and birth my baby, being warned that I'd be on a maternity ward and that it may take days, or I could schedule a D&E.  I did not think I had it in me emotionally to handle the labor, so I went with option B.  Unfortunately, since I was so far along nobody would touch me, including my OB GYN.  I had to juggle phone calls between my doctor, my insurance company and several specialists, trying to get in for the procedure as soon as possible.  In the end, I had to walk around with my dead baby rattling around inside of me for an entire week.

One week to cling to the already large belly that I had.  One week to try to explain to my two year old that there was no longer a reason to kiss and hug my belly and tell it she loved it everyday.  One week to hang on to the last physical evidence I'd ever have that this child existed.  One week to begin the grieving process, and then have to start all over again once the baby and my belly were finally gone.  I felt movement very early, and could still feel it for that week, except unlike before, it was only when I made sudden movements to make it move.  I spent that week going back and forth from thinking maybe everyone was mistaken and it was still alive since I could feel it, to running to the bathroom because I felt like I was starting to bleed. 

Throughout it all, I still had a child to feed and a home to manage, but people just don't reach out in the same way as they do when other family members pass.  It was the few that did that made me realize how important it was, and prompted me to write this post.  Several sent beautiful flowers and gifts, and women I've never personally met from an online forum I belong to even got together and made a magnificent gesture of sending angel wings ornaments (this was Christmas time) and cards.  One kind friend took our daughter off our hands for the afternoon, just so my husband and I could be together and mourn.  And my mother brought us groceries, which was just huge.  Grocery trips are rather difficult (they still can be months later), because the stores are often filled with babies and newborns.  There is no way I would've gotten through a grocery trip that first week, and my husband was too busy back at work so he could afford to take off when I physically needed him after the D&E, plus he was taking care of my daughter and trying to keep up with all of the things I was too devastated to do - all while dealing with his own grief.  Then of course the D&E led to some issues afterwards, and it was quite some time before I could physically put everything behind me. 

So that is why my advice is to treat it like any death in the family.  Cook for them, clean for them, whatever they are comfortable with allowing you to do, but whatever can be done to make their lives easier, especially if they already have other children, is in my opinion, the best way to help.  I know the devastation would be far more insurmountable if my child had made it to this world and I got to know it first, but that didn't make it any easier at first.  I find myself never saying the word "miscarriage."  Since my other 5 losses were very early, before we even heard the heartbeat, to me they will always be miscarriages.  What I find myself saying instead is "when my baby died."  Because that's what happened - I had a baby and it died.  If I had a 10 year old child die there would be no euphemism to say in its place, I'd simply refer to that time as when my son/daughter died.  I don't do it consciously, but realized it recently.  So if you ever have the great sadness of knowing someone who has experienced this, treat it like their BABY died.  Not just an unspoken "miscarriage."  There was a baby, and they never got to know it.  I will forever wonder what my child would've looked like.  Whether or not they would've looked just like my daughter, very different, or somewhere in between.  I will never be able to know that child, but I will never forget. 

This brings me to my final piece of advice, which is to check in on that person.  Months down the road when everyone else's lives have moved on and everyone has forgotten...they will not have forgotten, and for them the pain is still very real.

Thursday, April 11, 2013

Planning the Family Meals

I still remember the first food shopping trip I took when I moved in with my now husband. It was our first time living without our parents, and we spent over $200 and bought everything and anything. I don't remember what we bought, but I remember the feeling of excitement and promise, the awesome fact that we could buy and prepare whatever food we wanted, for the first time ever!

Fast forward a few years. With us working full-time, demanding jobs, our meal times consisted of whatever was quickest. I bought pretty much the same food every week, and I can't tell you how much stuff I ended up throwing out over the course of a couple of years--meat that had been in the freezer for months, rotting fruit and vegetables, and stale bread.

At some point, right before I got pregnant with my first child, I realized that we had to make a change in the way we ate. We started with wholesome, non-processed ingredients. We brought healthy lunches to work instead of going to the local eateries. We were on a good road, but once we threw children into the mix eating mindfully and healthily became more of a challenge.

I needed to make a change, and so I decided to start planning my family's meals--dinner especially. I plan my meals for a week and then I shop accordingly. I've done this now for over five years, and it has made such an immense difference in all of our lives. For one, absolutely nothing goes bad or goes to waste, since I only buy whatever I need for what I'm cooking. Second, I'm not left scrambling to throw something together at 6:30; having a plan ensures that we are getting a good meal every single day.

I don't use a website for help, but I write down each meal and the day I'm going to make it, and put the list on the fridge. Since we run around a lot during the week, I plan my meals around whatever each day's activities are. For example, on the days where we have after school activities, I make a stew, casserole, lasagna, or something in the slow cooker (basically anything that can be made ahead of time), so that when we get home we can get straight to eating.

I make the meal schedule flexible so that if something changes, I can easily swap out meals from one day to the next. Sometimes things come up and I'm unable to cook, or we eat out unexpectedly, so I adjust the schedule and often carry meals from one week to the next. So that things don't go bad, I look at my meals and make the ones that use fresh produce first, so that I'm not stuck with rotting food in the fridge. And if there's a meal that requires advance preparation, like marinating or defrosting, I will make a note for myself on my meal schedule list. I look at my meal schedule every morning, and take out meat to defrost, if any.

To keep things a little simple, I make every Wednesday roast chicken night. I roast a chicken with some variation, with a different side every week. This is the kids' favorite meal--especially the crispy chicken skin. I save the bones and any leftover chicken meat and make a mean chicken soup, either later in the week or the week after. Our favorite is chicken soup with celery, carrots, and egg noodles. We have breakfast for dinner every other Thursday (also another favorite). I make gluten free waffles or pancakes, sometimes with home potatoes or bacon, and sometimes a frittata. Once I find a good gluten free pizza crust recipe, I'm going to incorporate a pizza night into our week, as well.

It takes me around an hour to meal plan and shop for groceries. I shop for my groceries at Costco, where I buy most of our staples like milk, cereal, sugar, snacks, etc., and also on, a grocery delivery service in NYC. The online service really helps in terms of managing my time, because it takes a lot less time than going to a supermarket would. That's not to say I don't shop in grocery stores and supermarkets. And I can't wait for my local farmers market, which starts in June.

Planning meals is about more than just convenience. I'm in the middle of reading "French Kids Eat Everything," and learning about how the French view food and mealtimes has re-inspired me to let my kids help me out in the kitchen, for more than just baking cookies. Two nights ago Sofia helped me make Asian-style shrimp with rice noodles and not only did she want to try every single thing as we were making it, once we sat down to eat, she finished every bite and declared the meal the best she's ever had. I love the stress that planning ahead alleviates for me and I love that I can take the extra time to spend in the kitchen with my children.

Does your family plan their meals ahead of time? If not, are you inspired to start?

Monday, April 8, 2013

Unexpected Things about Parenthood

I have a great group of Mama friends, whom I met online. We're friends in "real life" too now, but since we are spread far and wide, our interactions are still mostly online. One day, one of them, a freshly born Mama asked the rest of us a great revealing question. We all know there are plenty of things that aren't exactly like we expected, or that we imagined would be one way but are a bit different, but she wanted to know about the things we didn't expect at all. So here are my top 4 things I didn't expect about parenting:

1. How hard coparenting could be.
I love my husband, he's a good man, but parenting together is so so much harder then I thought it would be. Reassuringly, this was a common one amongst my Mama friends too. Parenthood, especially the first time around, can be such a pressure cooker of emotions and expectations. As much as you try to prepare, you can know what its really going to be like until you are in the thick of it. And when you have two distinct individuals, trying to work as one to raise a third distinct individual, well its just not always easy.

2. How insanely different it is when its your own baby. 
I'm 7 years older then my brother, have been around kids/babies my whole life, I've been babysitting since I was 12, taught vacation bible school to preschoolers for multiple summers, was a mother's helper to quadruplets all through college, and was not the first of my friends to give birth. I was also dying to be a Mom, feeling it through every fiber of my being. Yet, all that experience went out the window when Gwen was born. I had the knowledge, I had tools in my arsenal that others didn't, but it is just different when it is your own. Each baby is different anyway, but add into that the biological response your body has when responding to your own child, well I was just unprepared for it.

3. That we'd still be breastfeeding at 3 years old. 
and 4. That we'd bedshare (full-time for the "fourth trimester", then part-time for a long time). 
I knew I was going to be an AP Mama, its how I was raised, and its what I felt the most pull towards. However before Gwen was born I wasn't completely comfortable with the idea of bedsharing, and it was only when Gwen proved that she had other ideas that my husband and I decided to give it a go. And while I always knew I would breastfeed, I didn't realize how strongly I would feel about fighting past the mastitis, the clogged ducts, the supply dips to make it past a year... and how much Gwen would love it, to the point of deciding to keep pumping until 2 years, and wanting her to self-wean. I guess this boils down to the idea that before I was a Mama, I thought I would be the one with the answers; once Gwen arrived I realized that we would figure this out a lot easier if I let her be my guide on a lot of things.

What things did you not expect at all before you became a parent? 


Thursday, April 4, 2013

Three Things Women Should Stop Saying To Other Women

A little reminder of how we don't really know anyone's story except our own. I personally have heard each of these. Have you?

You're so lucky that you get to stay home with your kids. Maybe she is thrilled to be a stay-at-home mom. Maybe she wishes like anything she could have kept her career. Maybe it was a no-brainer decision for her family. Maybe it was a difficult, perhaps agonizing decision for both partners to make. Maybe finances are ridiculously tight and the family is struggling. Maybe she does consider herself lucky. Or maybe she feels trapped. You have no idea, so don't assume. On a related note, please no I don't know how you leave your children every day to go to work comments either, okay?

I support breastfeeding, but [cover up, don't do it in public, you should wean by this arbitrary date, etc.]. You either support breastfeeding mothers or you don't. Once you start putting qualifiers on it, you're being wishy-washy, and wishy-washy is not support. And it probably goes without saying, but for the love of squirrels no negative comments to a mom who formula feeds, either. You have no idea why another mother has chosen to feed her baby the way she has, and frankly, it's none of your business.

I don't understand why people say they need a break from their kids. I will speculate that mothers who say this have a supportive partner, probably one who works a job with regular hours and is home in time for dinner most nights and every weekend. Maybe they have parents or in-laws or close friends nearby. They are likely not in a situation where they are going it alone, either permanently (single parent, divorced, widowed) or temporarily (spouse is military or in a career with significant travel). Their "breaks" may just not be as obvious as a night out or a regular babysitter, but having someone around to share the daily mental energy matters.

What would you add here?

Thanks for reading and have a blessed day.