Monday, July 28, 2008

Signing In: My pregnancy at 27 weeks...

So I realize that in my last two posts I kind of got long-winded. I would like to pardon myself with the excuse that I (we) just feel so passionate about having our preferences honored when it comes to this birth. In any event, if all that medical blather got kind of tiresome, my apologies.

It IS nice to have the record of what we are going through though. Tonight for the first time since I started this blog, I went back and read a lot of the earlier entries. What amazes me most is how quickly everything has gone by - and especially how fast this baby has been growing inside of me. I canNOT believe, for instance, that the baby was ever "just" an inch. (At 27 weeks now, he is apparently about 14.5 inches long and 2 pounds in weight!) It is also nice that all the queasiness and morning sickness is long behind me. That was something I thought I would never get past.

This week actually marks my entry into the third trimester, so sadly, my "honeymoon trimester" is apparently behind me now. In contrast to the second trimester, which is supposed to be the easiest, the third trimester is said to be difficult again, because the baby will be growing very quickly, and this is naturally associated with lots of new pains and discomforts.

We calculated that with only three more months to go, VJ should probably gain roughly 2 pounds per month until October! That means this month he will double in size. (Assuming that he will be around 8 pounds at birth)

And, of course, given all the growth, I too am getting bigger faster! Today I am wearing a preggers blouse that I only bought, it seems, a few weeks ago, but it is already almost too tight and uncomfortable. I barely got to wear the dang thing! Same goes for a couple of pairs of slacks I bought, originally thinking I was NEVER going to fit into those things. How I was really wrong on that one! Now, in only a few weeks, they have gotten unbelievably too too tight - which makes me kind of sad (ahhh, sigh).

Along with getting bigger, I have also slowed down ALOT. Last Friday, I tried hiking a trail that I used to hit at the beginning of this pregnancy in an effort to stay in shape. It is unbelievable how the trail seems so much steeper and daunting now. It really was a challenge to climb the hills - I had to take it very slowly and psyche myself out with all kinds of mind games in order to get over them this time around.

So, that is about all that is new for now. In less than two weeks we will have another OB visit - this time with a mid-wife. Our hope is that she will be a little more open to our wishes for less intervention than our OB has been. Since she is affiliated with the hospital though, we have been warned that she might be a "MED-wife" as opposed to the type of MID-wife that we are really hoping for...

Tuesday, July 22, 2008

Advantages and Disadvantages of Pitocin in 3rd Stage Labor

In my last blog entry I wrote about things that disappointed us about the policies of our hospital. We were surprised to learn that our OB insists that her patients use a hep-lock in case of medical emergencies (4% of births). Scott and I feel determined that we don't need one. If our birth does result in a "medical emergency" (aka. the need for a C-section), we learned that I should be "knocked out" through the administration of anesthesia with inhalational agents anyway. The hep-lock will still be unnecessary.

The other big thing that disappointed us (that I promised to follow up on in the last blog) is our hospital's use of pitocin, a synthetic hormone, in third stage labor. This has different effects from the use of pitocin in second stage labor, which I will discuss briefly, first.

Many mothers are administered pitocin during first stage labor if the delivery is "failing to progress." (This drug is also often used to induce labor if the baby is overdue.) Studies show that this drug is used most often after a woman has been given an epidural, which can retard her labor considerably. If the labor slows too much, the doctors recommend the pitocin to stimulate stronger contractions of the uterus to push the baby out more quickly. Sometimes the use of pitocin is quite painful (as it is meant to stimulate stronger and more frequent contractions) that can override the numbing effects of the epidural. Unfortunately, if the pain is too much, a mother will be administered another stronger epidural, which, in turn, might cause her to need even more pitocin. Putting the harm that this MIGHT cause the baby aside, this "downward spiral" or "snowball effect" of epidural -> pitocin -> epidural -> pitocin can easily put the fetus in distress. If overused, the unborn baby can start to develop a fever, altered heart rate, and other symptoms, which lead more and more doctors to diagnose the need for emergency c-section deliveries. (A description of the snowball effect as highlighted in the recent movie, The Business of Being Born, is discussed in this review.)

We (Dad and I) are hoping to avoid this kind of scenario by having a natural childbirth. Of course this "downward spiral" is only ONE of the many reasons why we have elected to TRY to avoid the meds at the hospital - especially during the first and second stages of labor, before the baby has been delivered.

In addition to the first two stages, we would like to avoid as many unnecessary interventions as possible during the third stage, which involves the delivery of the placenta. Although many hospitals now use pitocin as a matter of procedure to help the third stage along, we have decided that we would prefer not to have this drug administered. Our doctor, unfortunately, does not see why we wouldn't want this intervention. (Although it is a common request nowadays to forgo the pit during stage 3, as indicated by a birth plan toolkit on the ever-popular web site, babycenter.com, our doctor said that she has "never ever heard of such a thing.") She argues that administering pitocin is hospital policy, and that there is no reason why we should object to something that is so "harmless." She argues that pitocin is "exactly" like the natural hormone, oxytocin, that our body already produces, so how can it be problematic.

I have been doing a lot of reading on this. And I agree that there are certainly medical benefits to using pitocin in 3rd stage labor if the mother fails to deliver the placenta naturally. (Pitocin can help her avoid bleeding out, for example.) But I have also come across compelling arguments that claim that use of this synthetic hormone is only necessary in rare emergency situations. The fact that our hospital insists on delivering it to all women no matter their need only suggests to me that the hospital is just trying to wrap up the deliveries quickly (time is money, and quick turn overs are advantageous to the business-side of hospital policy), without having to look back, waiting for slower, more natural deliveries, and, worse yet, worrying about the potentiality of law suits.

While there are certainly risks during 3rd stage labor (as there are at all stages of childbirth!), I have come to find that there are also risks to using pitocin. I will list the potential disadvantages that I have found (and my sources) so far here: (this list is far from exhaustive, and I would love to hear about additional problems/risks that might be included)
  1. Sometimes the effects of this hormone shot can actually trap the placenta inside the uterus. The mother then has to be put under sedation while the doctor goes in after the placenta and scrapes it out of her. (McCutcheon-Rosegg, 182)

  2. Second-time mothers can have unnecessarily violent post-partum contractions with this hormone that are often reported as more uncomfortable than labor. (182)

  3. In a natural (drug-free) childbirth followed by immediate breastfeeding, stimulation of the nipples and suckling stimulate the body's natural hormone, oxytocin, in turn causing the uterus to contract after the placenta out. Oxytocyin is the body's natural form of pitocin. If everything functions properly (which it does 96% of the time), the new mother does not need the synthetic hormone. Unnecessary shots of this fake hormone can give the woman a painful “double whammy” of artificial contractions on top of natural ones. It is a nuisance that can be avoided. (224-25)

  4. Because pitocin is an anti-diuretic, its use can lead to water intoxication, which in turn brings about an irregular heart beat, hypotension, nausea and vomiting, excessive swelling, and difficulty nursing. (England and Horwitz, 253)


Wednesday, July 9, 2008

A trip to the OB - and a trip to a "Hospital of the future"

On Monday, Dad and I went for our 5-month visit to the doctor. The trip started out a little rocky; when I had to do my usual weigh-in when we first got there, I found out to my horror that I have already passed the 150 lb. mark!!! : ( (To be exact, I was 151.0 lbs) I was so horrified about my blossoming weight that I even shed about 3 tears.

Don't get me wrong. I don't think I would change a thing. And I told Scott that I would rather consume too much than too little, in order to ensure that VJ is getting all of his proper nutrients and vitamins. I have been following a strict nutrition plan and getting my exercise (prenatal yoga), and I feel pretty committed to following the "diet," even if it might be causing me to gain a few extra pounds. (The program, which recommends a hearty intake of milk, lean meats and eggs, is apparently good for decreasing the mother's risk of pregnancy-related problems such as preeclampsia, toxemia, and premature labor.)

The doctor said that VJ's heartbeat is very strong and told me not to worry about the weight too. She mentioned that at this stage of the pregnancy that there is a lot of water retention, and when she looked at my ankles she said they are indeed swollen. So a couple pounds of that weight is water. (I hear from my yoga instructor that pregnant women tend to retain more water during the summer heat as well). My only main concern is whether I will be able to get this extra poundage off, once our little baby gets here.

The visit was interesting on a lot of other fronts as well. Since Scott and I have been taking the Bradley class, we have really become quite informed on the different procedures and interventions that hospitals take, and we wanted to ask about our own hospital's policies. We are aiming for as natural a childbirth as possible.

On the whole, we have been very pleased to find out that our hospital (which is apparently ranked #3 in the country AND has just opened the most advanced medical facilities in the country) is quite cutting-edge and supportive of progressive (women-centered) birthing scenarios. For example, the hospital allows women to get up and move around during labor, which is suppose to encourage a speedier birth. (Rather than making her lie on her back, and hooking her up to monitors and IVs) The hospital also supports laboring, delivery, and recovery in the same room, and, as long as the baby is fine, he gets to stay with us immediately after the birth. This is important, because, if possible, the baby should really be breastfeeding during the first hour after he is born. The breastfeeding stimulates the body's production of oxytocin, a natural hormone which stimulates the uterus to push out the placenta and stop bleeding. Without the hormone, a pregnant woman is at higher risk of hemorrhaging or bleeding out.

Another thing we really like is that the hospital assures that it will not feed the baby any formula or give the babies bottles or pacifiers UNLESS we ask them too. This is reassuring, because we had heard that in some hospitals, it is the opposite; even if you ask the hospital NOT to give these things to the baby, some nurses will try to do so anyway. We don't want the hospital to do this, because it confuses the baby about how to nurse. If exposed to the bottle/fake nipple, the baby learns a different, easier method of feeding. The baby has a harder time adapting to breastfeeding AND breast milk especially if it has been exposed to the other man-made alternatives.

Scott and I definitely want VJ to be breastfed, although we heard that it can be challenging at times. Besides all of the health benefits (and there are many), we learned that it is a couple thousand dollars cheaper per year to breast feed. That alone sold me immediately!!

One thing that we are hoping to avoid at the hospital though is the "Hep-lock" (the heparin-lock flush injection) which hospitals like to put on birthing mothers so that, in the event of a medical emergency, they can deliver necessary drugs and fluids to them. Such cases arise in about 4% of childbirths though, and administering the hep-lock in advance assumes that the nurses aren't going to be able to administer an IV quickly enough. (Scott and I think that if an emergency arises, they will be able to put in an IV just fine, with plenty of time. Maybe the hospital is just afraid of getting sued, so it takes this better-be-safe-but-annoying approach).

WE wanted to avoid the hep-lock because the risks don't seem to outweigh the discomfort and pain, that ultimately obstruct the laboring process. When we talked about this with the OB though, we were disappointed to hear that the hospital was very much against our not wearing one. She even suggested that if we choose not to wear one, we might as well go ahead and have a home birth. (As if the hep-lock is the deciding difference between hospital care and mid-wife assisted home births!)

There was one other thing that we weren't too pleased about with our hospital's apparent policies. I'm getting tired of writing for now though, so I'll talk about it in my next blog posting.

Incidentally, I have avoided naming our hospital here, but to find out more about it, have a look at some of these pages: Utube video (that won't embed in my blog), local ABC televised news report, and the general fact page at the new hospital's web site.) The story behind our hospital, which was just transferred to a new, state-of-the-art facility, is quite impressive. I am just hoping that all of this technology (which I'm sure is extremely helpful in certain high-tech medical situations) is conducive to the type of natural birth that Dad and I are hoping for. We feel strongly that too much medical technology in the majority of healthy birthing situations is UNhelpful, and can even lead to unnecessary, and even dangerous, interventions).

Sunday, July 6, 2008

Baby Birthing Music - Relaxation and Sonic Stimulation

VJ is 24 weeks old this week in gestation. Apparently that means his hearing is fully developed and he can recognize his mom and dad's voices, in addition to being able to "enjoy" music. We are looking forward to playing some tunes for the little guy in utero so that he might have some familiar music to relax to when he makes it to the real world! (I know it sounds crazy, but we are just too excited about VJ being a part of our lives now. Also, some studies have *tried* to indicate that "prenatal sonic stimulation" may yield some of the same benefits that have been more scientifically-established by the prenatal consumption of Omega-3 fatty acids. According to early-pregnancy-tests.com, "such purported benefits include enhanced attention spans, improved sleep patterns, increased cognitive development, and sharper language skills...")

Based on our excitement - and the idea that it certainly can NOT hurt (if not played too loudly) - I've been playing the song "Over the rainbow" by the Hawaiian singer Israel Kamakawiwo'ole (aka "Iz") to VJ every morning after breakfast! I wrap the head phones around my ever-increasingly-rotund belly and turn on the ITunes player...

Speaking of music, Dad and I are now trying to put together a playlist to upload onto our mp3 players for the big day, when VJ is born. We have read repeatedly that labor goes more quickly if the mother is relaxed, and one way to accomplish this is for her and her birth coach (i.e. Dad) to practice relaxing every day to "feel good" music that they can enjoy during the birth. In support of this idea, one of the hospitals that we recently visited for a birth tour provides boom boxes in every room where couples can play CDs and/or hook up their mp3 players.

It is actually really difficult to find "newborn appropriate" music that seems to fit the occasion of a baby coming into this world!!! I have gone through a lot of my favorite and mellow tunes in my ITunes library, and have found surprisingly that many of the songs I enjoy - even if they are ultra mellow - have some kind of dark or sad edge to them. Many of Jack Johnson's songs for instance, are about depressing events and death! Other songs I like that are kind of folksy are also "blues-ey" which normally is very enjoyable. But somehow they seem to sad - or "blue" - for a new born baby.



The very best music I have come up with so far is the Hawaiian music by IZ. (Here is a video on Youtube that plays one version of his awesome song "Somewhere over the Rainbow")

So we have asked friends and are now trying to make up a list of potential singers whom we might enjoy. I haven't gathered (ie. bought, borrowed, or downloaded) a lot of the songs yet, so I am trying to keep track of good suggestions here so I won't forget them in the meantime. So far we have:

Bob Marley (and general reggae)
Enya
Eva Cassidy
Iron and Wine
Jack Johnson
Neil Simon
Nora Jones
Paul Simon
"Talk to Her" Soundtrack

Any more suggestions? If so, please let us know. I hope to add to this list as we get more ideas.

Tuesday, July 1, 2008

The Kicker of the Week!

During the last two weeks, VJ has started to let his Mom and Dad know that he is definitely alive ... and Kicking. His kicks have become very noticeable now - and even Dad has had the opportunity to feel one, rather rare, emphatic thud from the boy while we were relaxing and watching TV the other night. (Note: The picture here is not my belly! I lifted it from this photo contest. Gotta at least give the props)

The kicking is rather irregular now, but for the past week, I have definitely felt the little tyke pound around in my stomach at least once a day. Sometimes the kicks (and/or arm movements?) feel more like bubbles of gas in my tummy, or like nervous butterflies. Other times though, his movements are very discernible and strong. I feel a soft pounding on the inside of my tummy in very even-paced, rhythmic patterns. Apparently the movement won't be regular yet for another couple of weeks. For now, I tend to feel them right when I wake up, before I eat, and right before bed. Also about a couple of other times during the day, he does squirm around in there to let me know he's awake.

When I told my girlfriend recently that he never kicks when I am ready for him to, she said that is because the little guy has showmanship. Sometimes when I am reading or otherwise preoccupied, I'll feel him squirming around, so I'll stop to enjoy the moment. But when I stop everything to feel him move, he stops everything TOO! Then when I move on and become distracted once again, he decides it is now an appropriate time for him to "move on" and start kicking me again. What a tease he is!!

This is definitely one of the upsides of being pregnant. Whenever he kicks or pounds on me, I just feel this giant, immense wave of affection toward the little creature. Scott has mentioned that he feels a little bit envious of the new bond that VJ and I share, because he doesn't get to be a direct part of. He said he wonders if VJ is going to be a "Mama's boy" because we are getting to share more and more these days - exchanging body movements, stomach poundings, and, well, eating and sleeping schedules... (I don't think Scott has anything to worry about that though - I can already tell that he is going to be one big, doting, loving and protective Papa)