Wednesday, November 26, 2014

The One Year Anniversary

It's the one year "anniversary" of Audrey's hospitalization. I have a lot of conflicting emotions about this: I'm so happy and relieved at where she is now yet I still feel the sadness and trauma of what she went through. The other night in the car I turned to a radio station that's already playing Christmas music (which I love, by the way! I drive Ryan nuts by playing it the entire month of December every year) and I unexpectedly starting crying when I heard the prerecorded announcement "We wish you a very merry Christmas, from all of us at Kool 108."

In a lot of ways I think this will be a difficult Christmas simply because the memories of last year are everywhere. I suppose you can't go through an experience like that unscathed. But at least Audrey won't have bad memories or flashbacks like that as we really didn't do many holiday traditions or celebrating last year. (On Christmas Day last year both Audrey and Ryan got the awful stomach virus that was going around and she vomited so hard her feeding tube came out. So we spent part of Christmas in the emergency room getting it replaced while poor Ryan sat in the corner drinking small cans of Sprite and eating crackers. And then I got sick the next day.)

I wasn't the only one remembering last year during her birthday party though. I've started a tradition of making a slideshow of pictures of Audrey during the last year to play on her birthday, and also as a keepsake for her. So this year's slideshow started with pictures of her first birthday party and hospital stay. Part of the reason I included them is because it's really amazing to see her progress throughout the year. I also didn't want it to seem like I was hiding those pictures, as they are part of her history and I think it's important to acknowledge it, especially as she's older and watching it. We are all about transparency and honesty in this family!

She fell asleep on her Great Aunt during the slideshow

Besides the emotional aspects of the slideshow her party was so much fun! I'm sure it felt extra special to us, to see her enjoying it and running around excitedly, because during her first birthday party she was very clingy, lethargic, and hardly smiled. This time she ran around babbling excitedly to everyone, eagerly opened her presents, and ate almost a whole cupcake!



On Monday she had her 2 year check up, which I've been nervous about even though I can tell she's doing great and growing. Our doctor was taking longer than normal to come in the room as she usually is right on time, so that made me feel uneasy too. When she finally came in she asked a few weird questions like "Do you think she has another UTI?" and "How is her energy level and have you noticed dry skin lately?" Then she wanted us to double check her weight. It turns out the nurse had written it down wrong as 22 lbs! No wonder she was concerned! (Audrey weighed in at 23 lbs 8 oz a month ago at the urology appointment). This time her weight was 24 lbs 9 oz, but she was wearing clothes and holding a toy so it may actually be a little lower. The doctor had been making a plan for us before coming into the room as she thought Audrey was losing weight again!

Upon realizing her weight and height are great and right on track (33 inches in height, so about 25th percentile for both. Not even the bottom of the charts anymore!) we were able to talk about the regular things for her check up. She did write an official referral for speech therapy and said it was completely up to us since Audrey has made substantial progress since she last saw her. She is now "babbling" a lot, saying many different sounds, and occasionally real words and short sentences! One of the cutest things she's doing lately is "reading" a book to herself aloud. The doctor said that she should be fine either way but she may progress faster if we do therapy. I plan to schedule an evaluation with a therapist my friend recommended sometime in January and we'll go from there.

She also recommended looking into physical therapy or even gymnastics class, as Audrey is a little behind in some gross motor skills (she can but won't walk up and down stairs, she prefers to crawl, and she hasn't kicked a ball before). Funnily enough, my mom got Audrey a parent/child gymnastics class as her birthday present!

Audrey had a slightly elevated temperature, which we thought was due to her having a mild cold. I mentioned to the doctor that, as far as I know, Audrey has NEVER had a real fever, not even when she had that first UTI for who knows how long. I had mentioned this is several doctors in the past but they all disregarded it, even her pediatrician. Our current doctor, however, said that this was very odd and could indicate that she is possibly immune-compromised, so we may address this in the future with another specialist. I have to admit that I've never taken her temperature more than a few times, however, because I assume that if she has a true fever she would feel very hot to to touch, which she never has. She has felt warmer than usual at times, but never hot enough that I would think "fever." Part of the reason I've never bothered with taking her temperature is because I wouldn't be concerned about most fevers as I believe it can actually be harmful to try to reduce them. See here for more information on this philosophy.

Audrey will be going in for another check up in 6 months, just to make sure she's still doing well. And although this time may be difficult for us in some ways, overall we're looking forward to a very happy (and normal!) holiday season!

Friday, November 7, 2014

20 Reasons I Will Always Choose Homebirth


I recently came across this amusing list of 45 Reasons NOT to Have a Home Birth and it inspired me to make my own list of why I will always choose homebirth (obviously I'm assuming my future pregnancies will be healthy and low risk. Of course I would have a hopital birth and/or c-section if it was medically necessary!)

I also came across this opinions piece on a local mommy blog that irked me because it urged families to reconsider homebirth, VBAC, and natural birth based on her personal opinion and experiences. So I decided that my list would be full of personal opinion too, just from the opposite side. (Although I do link to research on some points)

I  know there's tons of "Reasons To Have A Homebirth" blog posts around the internets, so feel free to move on if this is old news to you.

Disclaimer: Unlike the NICU nurse blog post linked above, I DO NOT think I know the best birth place for everyone. Two people can look at the same data and decide very different things, or have other factors to consider. This list is not a judgement of anyone's choices, it is not meant to fuel the so-called "mommy wars," and is not meant to convince anyone to birth anywhere. It is just a list of personal reasons why I choose homebirth. Similar to choosing to go to a Lutheran Church on Sundays or eating a dairy and gluten filled pizza on a Friday night may be the best choice for me, that does not mean I judge anyone for being an Atheist or avoiding animal products. Nor does it mean I'm trying to convert anyone to Christianity or junk food.

Without further ado, my list:

1) I don't want strangers at my birth. Even if you get your care provider of choice, which may not happen if you give birth during their "off" hours, you will definitely get one or more nurses you don't know. I spend 6 months getting to know my midwife during hour long prenatal visits which means we know each other pretty well and I am comfortable with her and her practices.

No strangers here, just my husband, mom, and midwife.

2) I don't want to be bombarded by a million stupid questions during admittance to the hospital and annoying typing sounds as they enter the information into the computer. "Did you take your prenatal vitamin today?" clickity clack clack "When was the last time you ate something and what was it?" clackety click click "Are you allergic to any medications? Oh now I see on your chart that you're not" clickity click clack "Ok, now it's time for me to shove my fingers into your vagina to assess your 'progress.'"

3) I don't want to leave the privacy and familiarity of my home during labor and go into the bright lights and cold, clinical atmosphere of the hospital. Car travel while dealing with contractions sounds like a nightmare. And privacy and familiarity are often important in order for your cervix to dilate. Giving birth is like pooping. No one wants to be constantly monitored by strangers in an unfamiliar place while they are pooping.

Laboring in the comfort of my own home. Ryan is doing the rebozo technique to encourage baby to change positions (she was posterior) and for my comfort during contractions.

4) It's WAY cheaper! I know this isn't the case for most people with good insurance, but I'm on the bare minimum insurance with super high deductibles. It would actually cost us MORE for a natural birth in the hospital than it does for a homebirth midwife. Especially considering all the prenatals and postpartum visits homebirth midwives provide.

5) I want evidence based fetal monitoring. Intermittent auscultation (listening occasionally with a fetoscope) is shown to be better than even intermittent doptone or efm (electronic fetal monitoring). And there's no ultrasound used with a fetoscope. See here for information on evidence based fetal monitoring.
Palpating for baby's position, after which my midwife used a fetoscope to listen to baby's heart tones.

6) My child(ren) deserve to be present during the birth of their sibling(s). I suppose a sibling attended birth may be possible in a hospital but in homebirth it is often expected and even encouraged.

7) I want a waterbirth. Waterbirth has many documented benefits for baby and mom and is safe. See here. It's possible to plan a hospital waterbirth but it's much more likely to actually occur at home as you aren't competing with other women for use of the tub or getting 'risked out' for reasons that may not be evidence based.
Shortly before Audrey was born in the water

8)  I want to push when my body tells me to, not when someone else tells me to. Hospital staff often tell women to push HARD as they count to 10 and to do so 2 to 3 times during a contraction. They may also want you to start pushing as soon as you reach 10 cm dilation even if you don't feel the urge yet. Partly because they see mostly medicated births, where the woman often can't feel the urge to push, and also because they want you to hurry up and have this baby now. My body is perfectly capable of knowing how and when to push and I don't want to be put on someone else's timeline.

9)  I want to be free to instinctively choose the position for pushing my baby out which may be squatting, kneeling, standing, lying on my side, or something else. The most common position for a woman to give birth in the hospital is lying on her back, which is actually the worst position physiologically. It's what we're used to seeing in media and it is convenient for the staff. The woman is often too tired and away in "labor land" to be able to assert her desires to move and then actually do so. Plus she is often on her back already for the EFM and vaginal exams that are frequently performed.

10) Speaking of vaginal exams, I prefer none. I know it sounds crazy to not want another person's hand up in your who-ha. But there is no good reason to do them during pregnancy (see here) and I trust my body to know when to push my baby out. I may decide to have one done before I start pushing if there's concern that there is still cervix left, or in the case of variations like a long labor, but that will be one exam likely done at my request. Not several exams every few hours by various nurses and doctors. Labor is MUCH MORE than mere cervical dilation!

11) I want to be snuggled in my own bed after birth and will likely not be moving (except to go to the bathroom and take sitz baths) for a good many days afterwards. I imagine in the hospital you are constantly interrupted by well meaning nurses. We were during Audrey's hospital stay at least. I also don't want to be kicked out of my birth place 4 hours after giving birth, as is done in a birth center.

So comfy in our own bed! And she's looking at us for the first time.

12) Snuggled on top of me in bed will be my newborn. Yes that's right, I sleep with my babies.  I don't think the hospital staff would take kindly to that and I would prefer not to have annoying conversations about bed sharing. On the other hand, my midwife actually encourages bed sharing. Isn't bed sharing super dangerous you ask? Short answer is no, if you do it intentionally and make your bed safe. See here and this book by LLL for more information.


About 24 hours old, enjoying skin to skin and sleep with Mom.

13) I don't have to remind anyone about my birth plan or risk it being ignored. Many times, mom's desires for a natural birth are respected and encouraged. Not so much for the third stage of labor if she doesn't want them yanking out her placenta or doing aggressive uterine massage. After 6 months of hour long prenatal visits my midwife is very familiar with my desires for birth. And her philosophy of birth and subsequent practices are mostly what would be on my birth plan anyways.

14) My family should be able to bond with each other after the baby is born (me and baby especially) and not be interrupted by random people we will never see again. I don't want my baby rubbed dry with towels, a hat shoved on his head, the cord clamped after it's "done pulsing" at 30 seconds, or  strangers chatting around us. "Oh what a lot of hair!" "Now she's crying good!" "You did so great!" Barring an emergency, I want us to be left alone.
 
15) Baby led breastfeeding. My baby knows how to latch immediately after birth and we don't need a nurse to swaddle her hands up, grab my boob, and shove her on. Information on baby led/laid back nursing

Laid back nursing

16) In the case we have a boy, I don't want to be asked about circumcision or risk having his intact penis forcibly retracted. My midwife, as are most homebirth midwives, is a strong supporter of leaving babies intact. Who knows what the hospital staff's position is! To quote author and urologist, Dr. Adrienne Carmack: "No, it's not ok to cut your newborn child's genitals. Period." Curious about circumcision and why people are against it? See here, here, and here.

17) Homebirth means continuity of care. In the hospital the OB or midwife is usually done with baby care the minute the cord is cut and after the woman is discharged from the hospital her next appointment is usually at 6 weeks postpartum. A homebirth midwife views the mom and baby as one unit, even postpartum (often referred to as "motherbaby") and will continue to provide postpartum care throughout 6 weeks postpartum with many in home visits.

Newborn exams and measurements, which were done a few hours after her birth.

18) If my midwife suggests an intervention or even hospital transfer, I trust that she's not wanting to be home for dinner, needing to adhere to hospital policy (which may or may not be evidence based), or unskilled in what may be a normal variation of birth. Since she is an expert in normal, natural birth I can be pretty sure that said intervention or transfer is actually necessary.

19) On the subject of complications and variations, homebirth midwives are very skilled and knowledgeable on how to handle many of these. You don't need to have a picture perfect birth in order to have your baby at home. During Audrey's birth I actually had several 'complications': long labor lasting 3 days (during which I'm sure my cervix wasn't making any "progress"), meconium stained waters, hemorrhage, and a nearly 3rd degree tear. All of these were dealt with by my midwife. And they would have been dealt with differently in the hospital in a way that likely wouldn't have been as holistic, natural, or respectful of me or Audrey.

20) Lastly, and most importantly, I believe that natural birth is a normal bodily function that happens best when not interfered with and is only rarely a medical emergency. Birthing at the hospital does not give you a 100% guarantee that everything will go right. Just like in everyday life there are risks involved. Most people decide the benefits of getting out of bed to go to work is worth the risks of leaving their house (they may be hit by a car! Or catch a deadly disease from a stranger! Or get gunned down by a co-worker!) The same considerations of risks and benefits apply to birth. For me, the benefits of homebirth far outweigh any risks. And the cons of hospital birth far outweigh any potential benefits. See here for research on the safety of homebirth.

Once again, I will make the disclaimer that this is a personal, biased list of reasons why I choose homebirth. Should you decide to have a homebirth now, based on my list? NO! Go out and do your own research! Interview homebirth midwives; a comprehensive list of MN midwives can be found here: http://www.mfmidwifery.org/, and listen to your own intuition. You can have an amazing and safe birth experience at home, hospital, or birth center, especially if you do your research and are prepared. "Homebirth is not for everyone, but informed choice is." Dr. Stuart Fischbein (homebirth OB)