Monday, June 21, 2021

Pregnancy After Loss

The theme of my pregnancy after a 16 week miscarriage seemed to be "I knew that pregnancy after loss would be hard, but I didn't know it would be THIS hard." The hardest part was knowing there was no guarantee of a living baby. And having to wait 9+ months to be able to see if she would make it. Even after your baby is born, you're not really "safe," because with life comes the possibility of death. But after they're born you can at least just look at them and know that they're still alive. Even though I believe in the inherent safety of birth (as opposed to believing it’s a medical emergency with a high risk of death), getting past the birth seemed like a big milestone.
   Pregnancy after loss is often very difficult and that is why it's called a "rainbow pregnancy" and the baby is called a "rainbow baby." The "rainbow" part refers to the joy a baby brings after the storm of loss and also reflects the difficult journey of a pregnancy after a loss.
   My other pregnancies I had virtually no fear of loss. I knew it was possible but it just didn't seem likely, similar to how most people view their healthy older children dying. Of course you know that anyone can die at any moment but the thought doesn't consume you. This pregnancy I worried a lot. Sometimes it was obsessive. The first 2/3 of pregnancy I was consumed by anxiety and depression at times, to the point where I had trouble sleeping and doing everyday tasks. The anxiety was always worse at night, which is also when I had the most cramping (I had a lot of cramping throughout pregnancy that no one could explain). Many nights Ryan and I would be watching tv and I would feel the cramping getting more intense and I would tell him “I’m going to start bleeding any minute!” as my anxiety ramped up into a panic attack.
   I also had a lot of insomnia, nightmares, and night waking. I tried several things: homeopathy, relaxation scripts, prayer, EMDR therapy, and some of it took the edge off but nothing worked completely. The anxiety and sleep disturbances were directly related to the amount of cramping I was having. I would try to alleviate the cramping with things like epsom salt baths, calcium magnesium supplements, hydrating, resting, believeing it was possibly due to dehydration and overdoing it physically. That worked some of the time. As my pregnancy progressed I went from worrying about a miscarriage to worrying about a premature birth.
   One night when I was 27 weeks nothing I was doing would help the cramping so we went to St John's L&D. They didn’t see any discernible contractions on the monitor and did an ultrasound to measure my cervical length. The doctor, whom I had seen previously for a consultation after my miscarriage and whom I trusted, reassured me that since I had gone to term in my first two pregnancies, since I wasn’t having actual contractions, and since my cervix looked great, it was very unlikely that I would go into labor early. After that the cramping slowed down considerably while I continued to have normal braxton hicks (which always felt different and I knew it was common to have a lot of strong braxton hicks in a 4th pregnancy). In hindsight I think the cramping was partly caused by my mental state.
    After hitting each “milestone” in my pregnancy I would feel better: 7 weeks (my first ultrasound), 12 weeks (miscarrige rate drops considerably after this point and we heard the heartbeat on doppler), 16 weeks (when I lost the twins), 20 weeks (second ultrasound), 22 weeks (earliest viability), 24 weeks (most hospitals will intervene to save a premature baby at this point), 27 weeks (third ultrasound and hospital visit), 34 weeks (very good chance of survivability for premature baby), and 37 weeks (safe to have a homebirth).
    As I reached each milestone my fear shifted from miscarriage to preterm birth to stillbirth. As I went into the third trimester it did help a lot that I was able to find her heartbeat with my fetoscope and feel her moving several times a day. Earlier than that I would spend days and even weeks coping with anxiety and depression, wondering if my baby was still alive. The anxiety improved by reaching the milestones, reassuring prenatal appointments, and getting farther into pregnancy, but it didn’t completely go away until after she was born. Now at 5 weeks postpartum I feel like my regular self once again.
   This past year I have been consumed by fear and by and trying everything I can to overcome that fear and to trust that God has the best plan for me. Having covid restrictions and other disturbing things happening politically and socially at this time contributed to my anxiety. It has been weird that covid restrictions started right when my miscarriage happened, lasted through my entire rainbow pregnancy, and mostly ended (for now) right when my pregnancy ended! My anxiety and depression also started and ended around the same times. I know the two things are separate but because of the timing they have felt very interconnected for me.
    I have also definitely felt the contagious fear of death and that definitely contributed to my anxiety. It is interesting that before covid, it seems like society wasn't concerned with death and now people are obsessed with fear of the knowledge that they will one day die. Unlike a lot of people, I don't fear death for myself. I would rather die when I'm old and not now when I have a young family, but I do know that if it's my time, it's my time. And when I die I will go to Heaven. What I feared during pregnancy is having to live through the death of another child, especially because I really didn't think I could physically or mentally go through yet another pregnancy with no guarantee of a live baby. I had mourned the twins and accepted their deaths but I didn't know how I could do it again with no hope of ever having a living baby at that point.
    In early second trimester I also heard about several women I knew all having miscarriages at the same time. It really freaked me out and made me wonder if something terrible had been released into the environment (the elitists, such as Bill Gates, are all about depopulation after all!). It's interesting how when you are pregnant you are SO influenced by your environment and the people surrounding you .
   Physically this was my hardest term pregnancy by far, perhaps partly because I am now much older. Not only with the cramping but I was also so much more tired, achy, and I had trouble sleeping. I didn’t exercise as much as I should have and I gained a lot more weight than I did in my first two pregnancies. I did do cranial sacral therapy and that helped some (chiropractic has never really done much for me). The physical and mental difficulties combined had me super convinced that this was our last baby!
   This pregnancy I also chose a lot of medical interventions that I normally wouldn't. Some I consider to be necessary with little to no risk, such as taking bioidentical progesterone supplements and folate instead of folic acid. But others I have really struggled with and feel guilty about choosing, such as multiple ultrasounds (which do have risks for the baby). At the time I absolutely needed the ultrasounds for my mental health, as I needed to know that my baby was alive and healthy and that my cervix was not dilating. But that doesn't negate the harm that may have been caused to my baby. I wish I had been able to trust God and His design for pregnancy and birth, but it was hard when I felt like my body had already failed me once in keeping my babies safe.
   Interestingly, I had little concern about how breastfeeding would go, even though I technically had trouble with my supply when Audrey was an older baby (long story I wrote about in previous blogs but the abbreviated version is that she had severe kidney reflux that we didn’t know about until she felt so sick that she drastically reduced her intake during nursing and lost a lot of weight. After a hospital stay and many medical interventions, including surgery, her kidneys are working well and she has been on track for growth since about 18 months old. But she initially she declined so drastcially in such a short amount of time I do believe that she was in danger of dying if we hadn't insisted on hospitalizing her.) I believed that once my baby was here everything would be fine, including nursing and weight gain.
   And that, thankfully, has been what’s happened! I’ve had the normal ups and downs (and going through the death of my last grandparent) but overall my postpartum has been so wonderful and joyous! It has actually been so good that Ryan and I both wish we could have another baby! The newborn phase has been my favorite phase by far with each of the girls and it’s a shame it goes by so fast. I have tried hard to savor and enjoy each moment even when I’m sleep deprived or I can’t get Lily to settle down. I suppose that is part of our biology - we quickly forget how hard the pregnancy and birth was so we will get pregnant with another baby. As my friend once said, “when it’s good, it’s SO good!” I am so grateful to finally have my baby and to have postpartum be SO good.
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Saturday, May 22, 2021

The Birth of Lily Cynthia

This pregnancy was very difficult emotionally. I will be writing about that in another post. I haven't been able to really talk about it much yet besides with close family and friends.

Labor started with my water breaking on Thursday at 2:30 am (just like how my miscarriage started). It was clear, I had no signs of infection, and baby was doing well so I decided on watchful waiting for the time being. Usually contractions start on their own within 24 hours of membranes rupturing. Ryan and I went back to bed after notifying the midwife. I had occasional strong cramping but not any real contractions. It took me awhile to fall back asleep because I was excited and knew that sometimes labor goes fast after the water breaks (especially for a 3rd full term pregnancy).

Thursday during the day I kept waiting and hoping contractions would start but nothing did. My midwife came to check on me and baby and we were both doing great. I was worried that my body wouldn't go into labor on its own even though I knew logically that would be pretty unlikely. I wasn't sure how comfortable I was waiting many days for labor to start on it own. The risk of infection does increase with time, but it is a very small increase. The real risk increases when you have vaginal exams, of which I was not having any. But the fear of losing another baby was still pretty strong at times and I definitely made medical decisions this pregnancy that I never would have if I hadn't lost the twins.

Another big fear I had was having to transfer to the hospital. A hospital birth is nothing at all like the homebirths I have, and especially with covid paranoia still rampant it would be even worse. Although of course I would do anything medically necessary for the health of me and baby, a hospital birth, especially if it could have been avoided, would have been very traumatic. I would likely not have been "allowed" to do things like catch my own baby, have uninterrupted time with baby after birth, have my older daughters present at the birth, etc. 

So with all of this I was considering "natural" induction techniques to help ensure that birth would happen while she and I were still doing well versus waiting too long and then running out of options. I discussed all of this with Ryan and he was all for inducing labor! (He was super excited and impatient to hold his baby!)

The first things I tried on Thursday night were taking a long walk and pumping for 2 hours while we watched a funny movie. The walking was to help her head engage in my pelvis (she was still pretty far up, which is not uncommon for a 3rd full term pregnancy). The pumping and funny movie were to encourage a good flow of oxytocin in my system, which is the hormone that makes the uterus contract.

I went to bed on Thursday hoping that I would wake up in the middle of night in labor. I did have some stronger contractions but they were 1-2 hours apart. So while my body was progressing some it wasn't enough to start real labor. 

Friday I decided I needed to do an herbal induction, which is the same thing I did for my miscarriage. I do wonder if emotionally I needed to have a "redo" of that experience with a positive outcome. Although I would not have chosen this path and was upset at the time, ultimately it was very healing to have labor start the same way. Kind of like rewriting my miscarriage. Early in my pregnancy I did EMDR therapy and some of the exercises involved "rewriting" your traumatic experience with what you wish had happened. In hindsight that's kind of what ended up happening - all the negative parts of my miscarriage were positive in my birth.

My friend, Jody, and I took a long walk that morning and discussed my situation. I felt like I was, once again this pregnancy, betraying my principles of trusting my body and trusting birth. It helped a lot to talk this over with someone who understands (Jody used to be a childbirth educator and doula and has 4 children she birthed naturally). I cried and prayed about this when I got home and ultimately felt like I was making the right decision.

My midwife came over in the afternoon to help me with the induction. There is some risk with even "natural " induction techniques so she monitored my vitals and baby's heart rate after each round of the herbal tinctures. Everything went well and after dinner I started early labor. I was worried things would just stop so Ryan took the kids downstairs and I listened to Christian music in my bedroom with the curtains pulled shut trying to get out of my head. I switched between standing at my dresser swaying my hips and sitting on the birth ball doing figure eights (both of which can help the baby's head descend through the pelvis).

In order for the hormones of natural birth to work optimally, a woman needs to be in the more instinctive, primitive part of her brain versus her neocortex, the thinking part of her brain. This usually happens without effort but sometimes overanalyzing the situation and emotional issues can be strong enough to interfere with the natural flow of hormones and can even stop active labor. So by being alone in my bedroom with music on I was trying to get out of my "thinking" brain and into my "birthing" brain! The darkness and privacy of my bedroom also helped, because the hormones flow best when a woman feels private, safe, and unobserved.

I also thought about my twins and cried and prayed more. I did the same things (be alone in my dark bedroom, listen to music, cry, and pray) after inducing labor with them and it felt right to be in a similar situation at this point.

At about 9pm I was getting tired so I layed in bed but she was moving so much between contractions and they were getting pretty strong that it was hard to rest. I decided to give up resting and went into the dining room to labor alone while Ryan tried to sleep. (I hate feeling watched during labor unless I'm close to the end!) During this whole time I kept timing contractions and analyzing what was going on. I was still worried that labor wouldn't keep progressing. Even though I knew that I needed to it was hard to get out of my head as an experienced homebirth mama and birth worker.

Around midnight contractions were getting stronger although still spaced out. I woke Ryan to do counter pressure on my back and I checked in with my midwife about the baby moving so strongly. She had me use my fetoscope to check her heart tones. All was good and my midwife started to make her way here since she lives an hour away. 

I finally stopped timing contractions and I think that helped me to get out of my head and progress faster. I started vocalizing during contractions and that helped a lot with managing the intensity. I switched between standing at the dining room table and leaning over it during contractions with kneeling on the floor leaning over the birth ball. I didn't want counter pressure anymore so Ryan went around doing little things to get ready, like turning on the video camera and the lights by the tub.

The midwives arrived about 2am and Jody came over (she helped with the older girls, Audrey and Deidre, took pictures, and prepped my placenta for smoothies.) Contractions were intense at this point so I got into the tub. I was still playing music from my phone. I made a "birth" playlist and had a variety of Christian and Indie music. I also listened some to a Christian hypnobirthing app. I had planned on using some Hypnobabies tracks too like I did in Deidre's birth but I never felt the urge to switch to that.

The birth tub in the little room off the dining room. Normally this is the girls' playroom.

After a few contractions I checked to see how low her head was. I seem to do this every time right around transition. I love feeling their little heads while they're still inside and seeing if they have hair! It can be really motivating to get through that last, intense part of labor when you feel how close you are to holding them in your arms! 

I was irritated to feel that she was high and I still had cervix left. I was hoping her head would be "right there" as Deidre's was when I checked with her. I complained to my midwife about having "so much cervix left" and she suggested leaning back in the tub to help dilate the anterior lip faster.

Jody and Ryan went to wake up the girls (I have no idea how they slept through all my vocalizing!) And they came to watch labor a bit. I was worried I was scaring them with how loud I was but my husband said later they were fine. We had prepared by watching lots of homebirth videos, most of which showed women vocalizing (I am always loud during birth. I don't know how women can keep that energy inside!)

About a half hour later I felt that I still had cervix left and labor was starting to slow a bit. My midwife suggested I get out of the tub, pee, walk around, maybe try the stairs and that would probably be enough to get rid of the lip. I sat on the toilet for 2 intense contractions, knowing that it would be even more intense on the toilet but that doing so is often a very helpful position in labor. I felt a bit of a pop with the second contraction and had some bloody show, which I think was her head coming over that last bit of cervix. 

Then I walked into the living room. My midwife said "you can hop back into the tub now!" But I thought "Nope! Not gonna make it!" as I started having a really intense contraction. I called Ryan over to lean on him. The two midwives came over with a chux pad to put on the hardwood floor for any blood and to make sure she didn't fall if I was unable to catch her. (I had my main midwife I see for all appointments and a secondary midwife that only came for the birth.) 

My body pushed her out only to her mouth, which I thought was her entire head, so my midwife said I needed to push her head out the rest of the way. Then I stopped and waited for another contraction as I held her head in my hands. She started moving her mouth, which meant she was trying to start breathing. My midwife told me to push her the rest of the way out even though I wasn't having a contraction. I felt her shoulders rotate and pushed super hard because I knew my midwife would not tell me to do anything unless it was absolutely necessary (she is more hands off and knew that I didn't want any "help" unless it was actually needed. Sometimes care providers do a lot of routine things that aren't necessary and I didn't want any of that.) 

I caught my baby and pulled her up to my belly. I thought for sure I tore a bunch as she was so bloody! I ended up only having some small internal tears. This was my first birth that I did not have a bad tear. Recovery has been so easy!



She cried right away and I talked to her as I felt that insane high of oxytocin wash over me. I couldn't believe she was finally here and I was finally holding my baby after that long year of heartache and fear. I saw her beautiful blue cord and verified that the ultrasound was correct for her gender. I told my midwife "I'm done! With this part!" (referring to still having the placenta to birth). She was born about 48 hours post water rupture at 3:35 am. My midwives wiped my legs off and helped me walk the few feet to the couch to sit for third stage.

During this Jody had been reading a book about homebirth to the girls on the couch and said "this is where your mom is in labor" showing a picture of the mom walking around. Then as I started pushing she said "nope, I guess we're on this page where the mom is pushing!" Ironically the woman in the book also births standing up!

Jody told the girls to stay on the couch to watch and rushed over to grab the video camera, which was still in the little room off the dining room. She managed to catch the birth on film.The girls were super excited but did a great job of sitting still and watching quietly! 


As I sat on the couch we all bonded as a family. Audrey was crying and said "I'm just so happy!" The miscarriage was really hard on them too and she's had a lot of fears about this baby. They liked touching her head while I nursed her and asked about the placenta. Ryan made a joke about birthing the placenta being my favorite part and Deidre said seriously "My favorite part was when the baby was born!"


Lily latched on a few minutes after birth and nursed pretty much the entire first hour. I had minimal bleeding and was able to birth my own placenta about 40 minutes after. I held Lily face down on my right arm while I guided the placenta out with my left.

I haven't been able to get my own placentas out myself, I have needed the midwife to pull it out, so birthing the placenta on my own was important to me. I also hemorrhaged during my miscarriage and needed pitocin as the herbs used to stop bleeding weren't working. I felt very unwell and was actually scared that I was going to die (although I knew logically that I hadn't lost quite that much blood and that we would call 911 and transfer to to the hospital before that point). The two tiny placentas from the twins were also difficult to get out and I required lots of help. So not only having to birth dead babies was traumatic but third stage was traumatic as well. Having both minimal bleeding and birthing my own placenta this time was very empowering and healing, another "rewriting" of my miscarriage.

I was looking forward to seeing my placenta. I used to do placenta encapsulation and in general I find placentas fascinating. They are a brand new organ your body grows during pregnancy that is essential for your baby. Placentas provide the baby with oxygen and nutrients via the umbilical cord veins and the umbilical artery carries away waste. I find it really sad that our society and most care providers regard placentas as "medical waste" and just throw them away after birth.

My placenta was pretty small but healthy. The size of the placenta usually correlates with the size of the baby and Lily was 6.15. Jody prepped my placenta for smoothies and I drank 1 smoothie every day with a chunk of raw placenta in it. Placenta smoothies taste just like smoothie and there are many benefits to eating your placenta. I also did this with Deidre's placenta. (Go here for more info on eating the placenta)

(Birth nerd note: my placenta was a partial circummarginate placenta, which means the chorionic membranes - the fetal side of the placenta - insert inward from the margin of placental edge. It basically looks like a white ring around the edge of the placenta. Sometimes it can cause intrauterine growth restriction. My midwife said she sees this placenta variation a lot, even before covid, and that she doesn't necessarily find it correlated with intrauterine growth restriction.)


Showing the girls and Ryan the fetal side of my placenta. Lily is under the towel, nursing.




Ryan, Audrey, and Deidre with Lily. You can see her cord and that she is still attached to the placenta, which is in a bowl in front of Ryan.

About an hour after birth we went into the bedroom and did cord burning, which was a really nice way to separate the placenta. Cord burning is a slower, more ceremonial way to separate the placenta than cutting. I bought a wooden box made especially for cord burning off Etsy. It had a notch on each side: two for the cord to drape across and two for candle holders. I held Lily in a blanket and she nursed while Ryan and I each held a lit candle to the cord. 

During this we played the song Somewhere Over the Rainbow by Israel Kamakawiwo'ole. That song was played at our wedding and has always been special to me. It was a perfect fit for our rainbow baby! 

It took a little over 10 minutes for the cord to burn through. There wasn't much smell and no smoke, although it did pop a few times blowing the candles out. When finished the cord stump was longer than if it had been cut so I tied it in a knot. It dried very quickly and fell off at 3 days. (We also used goldenseal powder at the base to help it dry faster)

My midwife did the newborn exam, during most of which I held Lily.




This is how babies are weighed at homebirths! My midwife knits and she made this sling.



Lily wants to nurse again!


After the birth team left we all spent most of the day in the bedroom, bonding as a family. There is nothing better than being in your own bed with your newborn right after birth! It was such a magical day and Audrey kept saying "This is the most special day ever!" We were all so happy that Lily was finally here and healthy, and that I was blessed with such an empowering and healing birth.



I wore this necklace during birth. It was made for me during my Blessingway by each friend bringing a bead(s) that symbolized hopes for my birth. I have had Blessingways instead of baby showers for my last 2 term pregnancies and they are such a special way to prepare for birth!

You can read more about Blessingways here.


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