pain and comfort

Little hand, big hand

Recently we had our second experience with the dreaded Nursemaid's Elbow, our third trip to Children's Hospital of Philadelphia, my first time taking her by myself. We are so lucky to live by such an amazing Hospital. While obviously I'd rather never need it, if the situation arises, I'm so glad we have CHOP. Its wonderful to feel you are in loving, capable hands, since otherwise, situations like this can leave you feeling so helpless. I'm not a panicky person in general, and when push comes to shove I can always get done what needs to get done for my family... but boy does my mama heart break when my girl is in pain and I can't fix it.

This recent experience took me back, first to January and a dark, late night trip to the ER for her weird symptoms and pain (turned out to be a new presentation of Hand Foot and Mouth); then to this time last year, her first experience with Nursemaid's Elbow, my girl holding her arm, whimpering. She's forward facing now, and I was driving, so a different feel, but those times she was rearfacing and I sat in the back with her as she fell asleep in her seat on the way home. She reached out with her little hand and grasped mine, soothed by my physical presence.

Oh did she seem so small to me then, and that fact, well that took me all the way back, to that very first ride home. My brand new baby, the weighty new responsibility. I sat in the back with her that first time, just staring, and her little hand, it found mine then too.

So much changes with Gwen every single day. She's bigger, doing more and saying more, always learning. One hurt elbow though, and we're right back to day one. As parent's we aren't charged with making sure that our children never experience pain, but we are burdened with the wish that we could! Life, really living life, entails that at some point there will be physical and emotional pain. That doesn't make watching it any easier. So I hold out my hand and sooth her as I can.

Victoria's Birth

As promised, here is the birth story of my third child, born in April of this year. 

I was 22 weeks pregnant with my third child when my midwife told me that she would be retiring effective a few weeks before my due date. “Just give me another month,” she said. “I know I can get coverage in time to be able to deliver your baby.”

I live in New York, where certified nurse midwives (CNMs) can’t attend births in hospitals without a written agreement for backup with a licensed OB/Gyn. My due date was in mid-April, and my midwife was retiring at the end of March. She was hopeful that she could get someone to agree to cover her just for my birth, even though technically she would be retired. But there was no way I was going to wait a month to see if she could get coverage, and then making it even more difficult for me to find an alternative if she couldn’t. At the time, I adored my midwife and I was so upset that I would have to switch care, especially in the middle of my pregnancy.

As it turns out, my former midwife did me a favor. Never one to sit on things, I started calling midwifery practices as soon as I left her office, going in and out of a corner Starbucks to protect myself from the drizzling rain that chilly evening. I was incredibly fortunate to get a slot with a group of midwives I had considered with my previous pregnancy, and after the orientation, I knew I had made the right decision.

Being with this group of midwives meant that I would have a chance to deliver at the ever popular, and notoriously difficult to get into, Birthing Center within St. Luke’s Roosevelt Hospital. It was an amazing opportunity to finally have the birth I was hoping for, and one I would not have had with my former midwife (she was attending births at another hospital).

I tend to think that location is not as important as your support system. I think if you trust your birth attendant, for the most part the location comes second, though it also matters, of course (there are always exceptions). I knew a fair amount about this group of midwives from researching their practice and as I got to know each of them, I felt a great sense of relief and trust that they would be my advocates no matter where I ended up giving birth. Now that the Birthing Center had been dangled in my face, however, I wanted in.

This is a birth story, not a midwife recommendation, but I cannot write about this experience without discussing the fantastic care I received from this group. They advocate for, and trust, women. I commented to my husband after each visit what incredible listeners each of the midwives were and how comforting their advice always was. I was never rushed, never felt disrespected or stupid for asking any question, and my concerns were always addressed. Not a hand was placed on me without asking my permission—I was treated like an intelligent adult and my opinions and instincts concerning my pregnancy mattered.

It occurs to me that all of the above should be the standard—the fact that it was a new experience for me speaks to how much in need of improvement our medical system is, in particular our maternity care.  After years of “hand on the door” treatment, after the birth of my son, which left me emotionally and physically broken, after feeling essentially dumped by my former midwife—the type of care I received this time around was honestly something I had never expected.

Getting ready for this birth had meant I had to reconcile my feelings about my last birth. Though wonderful and life changing in its own right, it was also extremely stressful. Having your water break in the car somewhere in Manhattan while your husband is cursing at pedestrians is not exactly peaceful. This time my hope was to have a natural birth, but also a peaceful one, where I could appreciate the sensations and emotions. I knew I wanted to sit on a birthing ball and labor in water for as long as possible. I had bought a birthing gown, had a relaxation CD loaded into my iPod, had plenty of snacks, a picture of my kids to use as a focal point, good smelling lotion for massages—I was ready.

As I said in my previous birth story, each of my pregnancies and births has taught me something, and this one was no different. My darling Victoria took her time coming, making my pregnancy with her the longest and testing my limits and patience (both of which are very short).  She was in position for a good two weeks, moving down and pressing on my pelvis, making me feel like she was going to drop out any minute.

I had “pre-labor” symptoms from week 35 on. Then, I had almost two weeks of prodromal labor. I woke up every night around 3 a.m. with intense back pain and pressure, and would get a few good contractions that always made me think, “This is it.” No such luck. For an impatient control freak, this was a lesson. I was on an emotional roller coaster, up and down, up and down. Excitement, then disappointment. Incredible anticipation and elation, then restlessness.

Then there was the looming clock, the silent alarm imposed on my pregnancy by the almighty powers that be at the Birthing Center. The rule was, if you go over 40 weeks, 6 days, you automatically move to the regular Labor & Delivery floor. There are obviously many opinions on this matter, and my opinion is that this was the worst rule ever.

Many could chime in and say how ridiculous and wrong it is to have this sort of rule, and I would tend to agree with that. However, I’m sure the hospital has its reasons for instituting it, and whether I agree with it or not, I knew this going in, and I knew there would be no way around it. As a midwife whose blog I follow once said, “You buy the hospital ticket, you go for the hospital ride.” One note, since I’ve named the facility, this had absolutely nothing to do with the Birthing Center itself, nor its staff, nor the environment. It was wonderful.

My hope is that talking about this aspect of my experience will not overshadow my birth or the great facility that the SLR Birthing Center is. Risk out rules and all, they provide something that for many women like me is an opportunity to have the best of both worlds—birth without intervention with medical equipment and personnel close by.

Thankfully, the word “induction” was never even uttered by my midwives, and they had no problem with the pregnancy continuing so long as both baby and I were healthy. This time limit for the Birthing Center did, however, have a profound effect on my mental state (and that is the number one reason I oppose this rule). As the days passed and I got closer and closer to the “deadline,” I started to feel depressed. Once again, not good enough for the medical establishment. What was wrong with me that I couldn’t give birth within their parameters? Why wasn’t this baby coming already?

Then I got angry. There was nothing at all wrong with me. In fact, I decided, even if I did go into labor in time, I would show them and refuse to enter the Birthing Center! Besides, I reasoned that even if I did make it in time, the Birthing Center could be full, or closed. There was no guarantee I would make it in anyway. I would choose L&D and take control of my own destiny. No one was going to tell me where to birth, damn it.

On the morning of April 16^th, at 40 weeks, 5 days, I woke up at 3:30 a.m. with the same backache, the same sporadic contractions. Here we go, I thought. Another sleepless night.

Only this time, after I had a snack and laid down on the couch around an hour later, I felt what I knew was a very real contraction.  About 15 minutes later I felt another, and then another 13 minutes after that. I woke up my husband and we timed a few together. Around 5:30 a.m. we called the midwife, and she called back with good news: the Birthing Center was open and awaiting our arrival. And of course, that’s exactly where we went.

Though I obviously was there for my births, they were all surreal, each for different reasons. With my son I was on various drugs and barely aware of what was happening. With my first daughter I had back labor and felt like I had one 45 minute continuous contraction. This time it seemed that I was actually going to get what I had hoped for, in the place I had wanted to be in for so long. I slowly got dressed, still in disbelief that it was happening. My husband picked up my mom and she stayed with our older kids. I woke my son and told him we were going to the hospital and gave my daughter a kiss as she slept.

In the car, I breathed through each contraction and chatted happily with my husband in between. Contractions were every seven minutes now. The last time we were in the car together and I was in labor, I was screaming at the top of my lungs and my husband was driving on sidewalks and running red lights.

We got to the hospital, parked the car, and up in the elevator we went. I couldn’t help but feel as if this was my first time—and in many ways it was. It was the first time I deliberately walked of my own accord into the place where I was to give birth. It was the first time I felt conscious, sane, and aware of what was happening. It was the first time that I was excited and full of anticipation, and I knew what the general progression of things was going to be.

We got to the labor floor and there was the sign, with an arrow: “Birthing Center.” Just seeing it now in my head brings tears to my eyes. We were here, we were going in, and I was going to have my baby in my arms soon. I don’t think I can adequately describe the sweet feeling of “knowing” that comes only from having this experience more than once.

We got in our room, I changed into my birthing gown (whereupon my midwife told me I looked like a goddess—bless her! I truly felt like one.), and sat for the blood test and fetal monitoring. Twenty minutes flew by, and I got on the birthing ball for a while. While I was on the ball, a woman I can describe only as the Best Nurse in Creation came in and after a pleasant chat suggested I get up and walk (contractions had spaced out just a bit). My husband and I went out to the blissfully quiet and private hall and walked. My midwives changed shifts but both ended up staying around, chatting with me about my birthing gown between contractions.

Best Nurse in Creation filled the jacuzzi tub, and then began the most awesome part of my labor. If you are reading this and considering laboring in water, consider no longer. It. Is. The. Best. I would do it a thousand times over. I labored in that tub, with my husband at my side, with the jets providing the utmost support and relief, for two hours. I don’t know how the nurse and midwife knew it was what we wanted because we never specified it, but they gave us privacy to labor, only coming in to intermittedly check the baby’s heartbeat and to see how we were doing.

I ate and drank to my heart’s content. I continued to be happy, relaxed, and in a positive state of mind, bowing my head and giving in to the flow of each contraction, making the sounds my body led me to make and visualizing opening and having my baby in my arms (though every time I did the latter I started to cry, interrupting my zen state). Contractions are likened to waves, and rightly so. Each one would start off low, then heighten and reach a crescendo before retreating and leaving me in an almost meditative state.

Once my “birthing sounds,” as they called them, started to get intense, my midwife came in and said we should probably check and see what’s happening, and then I’d either walk around or get back in the tub. Getting up and out of the water was like being pulled from a dream. But I was already nine centimeters dilated, and after two more hard contractions on the bed, I was ready to push my baby out. I remembered the sensations of the baby moving down from the birth of my first daughter, and I knew she would be here soon.

I pushed four times for only eight minutes—but it felt like an eternity! My husband said my face turned purple and broken capillaries would later confirm his observation. The physical sensations were at their most intense at this point and I was reacting to them. My midwife kept telling me to stop clenching my legs because I was holding the baby in and I said, “I can’t!” That’s when Best Nurse in Creation said, “Yes you can! Do it now!” And I did.

And then there was my baby, slimy and gooey like the others, looking exactly like her brother did seven years before. And I cried harder than I ever had at seeing my squirmy little one, another soul to love, another life to cherish. She was so beautiful and small and quite simply a miracle.

I’m still somewhat in disbelief that it happened this way. I’m indescribably grateful and I feel so lucky. Not that my body did what it was designed to do, mind you—I’m thankful to have had a healthy pregnancy that resulted in a healthy baby, and getting the birth I hoped for is the icing on the cake. After my first high-intervention birth, I felt like I had gotten robbed of the most amazing and miraculous human experience. And after having two intervention and drug free births, I wouldn’t have it any other way.

I wish more women would look upon labor and birth as a gift rather than as a cross we have to bear. As difficult as it can get, as intense as the physical sensations can be, for me it has been an immense privilege—to be able to communicate with my baby before she ever made a sound outside my womb.

Will we have another child? People are already asking. As we were getting ready to leave the hospital I was sad because I didn’t want to leave my birth behind. I knew I wanted to write about it as soon as possible, to be able to process it and remember the details. I almost want to have another baby so that I could get to relish just one more birth.

Time will tell. But if we start on this journey again, it will be a blessing and an honor once more. In the meantime, I look at my new little love and I thank her for giving me a sense of completeness that I never knew was possible.

5 Things Moms Want In a Doctor

Most doctors and pediatricians get into the profession because they want to help people. Most pre-med students and doctors I've talked to always say that they got interested in medicine because they want to make people feel better, they had a positive medical experience or a negative one (either themselves or through a relative) and they want either emulate that experience or make it better for others, or they love science and want to make life better for others. I've never heard anyone say that they want to go into medicine because they want to intimidate people, de-humanize people, ignore people, or condemn people for decisions that they've researched more thoroughly than they have. And yet, I've known many moms who have mentioned these three exact reasons for why they are switching doctors either for themselves or their children. I've even read about moms who purposefully lie or refuse to discuss things with their doctors for fear of being disrespected, disregarded, and disparaged. I'm sure that there are no doctors out there who would say that what they want patients to do is lie to them. So, where's the disconnect coming from?

I think that most doctors, even the ones who the moms are complaining about, probably do want to help people, they just aren't aware of what they are doing that isn't helping. So, I talked to some moms through the connected mom facebook page and some of the moms I know in real life, and I decided to compile a list to let doctors and pediatricians know what it is that parents really want in a doctor. These are the keys to getting parents to stay with your practice and developing honest, long term, and open communication with your patients.

1. Be honest yourself.
Be honest not just about what you know, but also about the scope of your knowlege and what you don't know. Don't be afraid to say when you don't know something or you haven't done much research about something. This sounds like one that would be easy, but when you are in a position of authority, you might have the urge to pretend you know more than you do. Don't. That was one of the biggest red flags moms complained about with doctors. Parents care about your credentials and that you are knowledgeable, but they care more about your honesty. My son had to go in for cranial surgery when he was ten months old because of a dermoid cyst located between his growth plates in his skull. The first two doctors I saw in our family practice were very honest with me that they thought it was probably a harmless cyst, but they honestly didn't know what kind of cyst could be so rigid and if that cyst was dangerous. They then gave me the option of pursuing more tests and seeing specialists. Their honesty helped me to get an accurate diagnosis for my son and he ended up with a surgery. It turns out that had the doctors bluffed me into false security, my son likely would have ended up with brain damage because we were (literally) micrometers away from neural damage. I did not choose new family doctors and I did not lose confidence in them because of their honesty. Instead, their lack of knowledge became an integral part of my decision making and likely saved my son from permanent consequences.

2. Treat every patient (no matter how small) as important
One of the most beautiful responses to my question of "What do you look for in a pediatrican or a doctor?" came from a mom on the facebook page. She wrote: "At my son's first pediatrician appointment, she took him in her arms,looked directly in his eyes and said "Welcome to the world, I am so very glad to meet you!" Another mom wrote, "I also look for a pediatrician (or family doctor) that actually talks to us, especially our daughter, rather than asking question after question. You get a lot more by talking to a child about their lives than asking pointed questions at their parents." Moms were clear that they didn't care how long they had to wait for an appointment as long as they felt they and their child were well cared for during their own appointments. Little differences, like making eye contact, asking before you touch them or their child, talking about the child's health rather than just running down the checklist of questions, made all the difference in whether or a parent would continue taking their child to you. As yet another mom put it, "If a doctor acts like they're too busy for me, it's always my last appointment with them."

3. Be respectful.
Parents look to you to provide accurate, educated health information and recommendations to parents so that they can make good decisions for themselves and their children. Because they are in the position to make the ultimate decisions, remember to respect their questions and their opinions, even if they are different from your own. One mom wrote about her annoyance with her doctor's fixation on her child's place on the low end of the growth chart. She and her husband are both small themselves and were also small as children. While it is her doctor's job to point out that her child falls outside the norm on the growth chart, the mom knows that her child eats well and is healthy. She gets frustrated that the doctor seems to "judge" her for not wanting to take action.

Likewise, there may be times when you disagree with a parent's choice such as when a parent chooses not to vaccinate, but you must respect that even though they have made a choice that you may not approve of even after you have given them all the information you feel is important. The decision is ultimately their's and not yours. Most moms seem to be fine with you giving an opinion contrary to their own as long as you show them respect for theirs. As another mom put it, "The most important thing for me is getting a sense of mutual respect. I don't feel like I need a pediatrician who agrees with all my parenting choices, but I do need someone who respects them and whose opinion I can respect. I want someone who will work with me and who is alright with me being informed and engaged, not someone who will do whatever because he says so."

4.Don't overstep your bounds.
Be clear between your research and your opinion. If a parent asks your opinion, of course you should give it, but make a clear delineation between what you know from personal experience and research and what you just think. Offer it as a piece of advice not "doctor's orders." For example, if a tired parent comes in and asks about sleep pattern normalcy, tell them what you have researched as in the normal range for that age because that is the medical, physical answer, but don't offer opinions on what that parent should or shouldn't be doing. You are offering medical information, but parenting decisions are up to each parent. You may never choose to bedshare, breastfeed, or cloth diaper, and you may believe that tantrums should be ignored or that infants shouldn't be held too often, but these are all highly personal parenting decisions that should be made by the person with the most experience with each individual child. While you may have seen that child every month for about twenty minutes to an hour since he or she was born, that parent has been with them all that time plus the other 23 hours a day. As one mom put it, "I really don't like it when doctors give you parenting advice, such as what to do about a temper tantrum, how to get your child to not throw things on the floor, sleep training, etc. I feel they are not trained in it and don't have any authority in that area[.]"

5. Don't forget how important everything you do can be.
What may be a routine diagnosis or procedure for you, may be intensely scary or life changing for a parent or a child. Make sure to show your compassion for people alongside your passion for medicine. Make sure that you soothe nerves and worries as well as you heal wounds. I remember that the second my son went limp from the anesthesia for his operation, my child was taken from me and I was told to "quickly give him a kiss and walk away." When it took me more than three seconds to respond and disappear, I was given the order more sternly. I understand that they were in a hurry to intubate him and that they were focused on my son's surgical needs and the task at hand, but they clearly didn't realize that my whole life was on that table and that I needed a few seconds to process that. I needed someone to actually look me in the eye and say, "We'll take care of your baby."

Thanks for reading and I hope this has reached a well meaning doctor somewhere!

Shawna