Avery's Birth (Finally!)

A run-down of Avery's birth for those who have asked about it, plus a short review of the Contraction Timer App.

Waiting, waiting. The other boys took 41 weeks, so I thought this baby might be likely to follow their pattern. 41 weeks came and went and we were approaching a "deadline" of 42 weeks, after which Kristin would not be legally licensed to attend the birth at home.
We tried stripping membranes, taking evening primrose oil, other herbs, plenty of walking, acupressure points, and hooking up to a breast pump to cause contractions. Got some contractions but it didn't turn into actual labor. So with two days left, I went to bed with plans to try taking castor oil in the morning. Let's just say castor oil produces muscle contractions of all sorts and can be unpleasant.

Imagine how thankful and excited I was on many levels to wake at 11:30 with "real contractions" (meeting baby and no castor oil, yay!). Unfortunately for Nate he had not gone to bed yet; no sleep for you! He was great at getting the necessary things done and being awake when I needed him though.

I texted Kristin at 1:05 saying contractions were 9 minutes apart. I tried to rest between them but I was too excited so I took care of things like making sure a babysitter was available for the boys if they woke up, cleaning up some things, finding various birth supplies, etc.

1:24 I texted her to say "Every 4-5 minutes now at about 50 seconds long". Things seemed to be going more quickly than my other labors.

Kristin arrived around 2:15, at which point Nate had turned up the hot water heater and started filling the birth tub. I was doing OK with the contractions, which were now around 3 minutes apart, by leaning on the counter and trying to relax, and putting cold washcloths on my tummy. But I was mostly wishing that the tub would fill…fast. Kristin checked things like blood pressure, baby's heartbeat and position, and my temperature every once in awhile. The doppler for the baby works underwater so she could keep doing that after I was in the tub too.

Once I got in the tub my contractions slowed to every ~4 minutes (or 2 minutes if I happened to get out to use the bathroom…I tried to be quick but sometimes got caught out of the water during a contraction, ouch!). See the contraction that came after 7 minutes and 43 seconds? I remember that one...I think that is where I made Nate put his hands on my back during contractions and not lay down between anymore.

Kristin's assistant was on her way and I could tell it was definitely time to push this baby out. As his head came out Kristin said that he was still covered in the amniotic sac which had not broken. I couldn't see because of how I was leaning in the tub. Later she told me he looked like a bank robber with nylon pulled over his face, and that she was trying not to sound too excited so I didn't feel bad about not being able to see it. His shoulders and whole body came out and then the amniotic sac broke as I was leaning back to see him and hold him. It is super rare to be born "in the caul" (supposedly 1 in 80,000? but I'm guessing no one has good statistics on it). If you're superstitious it means all sorts of crazy things; Kristin said it's more likely that in a healthy mom with a not-huge baby and gentle birth practices it just happens sometimes. Our neighbor, where the boys went while Nate and I slept the next morning, said that one of her daughters was born this way too.

The placenta came quickly, and likely related to that, I lost enough blood to be considered a hemorrhage. Thankfully it stopped on it's own, I was not even aware of a problem until Kristin told me later how much I lost. Midwives do carry injectable medication (Pitocin) to manage bleeding if it hadn't stopped on it's own. Anyway, steak and spinach are on the menu to build iron back up!

The assistant had arrived somewhere in that time and helped me get settled while Kristin took a look at Avery and examined the placenta as well. She looked at her charts and checklists (something like this one I think) and said Avery looked in every way to be 40 weeks gestation, not nearly 42. I'm glad he came when he was ready.

Avery weighed in at 7 lbs. and 5 oz and 20.75 inches long. Tobias and Malachi slept through the whole thing and came in to meet their brother briefly in the morning. Then Nate walked them over to a neighbor so we could sleep for awhile.

We are enjoying getting to know this new little boy in our family!

          Psalm 100:3

Know that the Lord, he is God! 

 It is he who made us, and we are his; 

 we are his people, and the sheep of his pasture.

Short review:
The Contraction Timer app on my phone was easy to use and to see the minutes. There is one button to start and stop, but if you want you can go back and edit the times of a contraction like if you forgot to press "stop". The only thing that would have made it easier to use was it if would connect to my Pebble watch and I could start it and stop it right from that! I would recommend this app because while you are in labor you want something easy for yourself or a helper to use.

I downloaded an app for helping my fuzzled brain keep track of nursing (minutes, sides) for the first few days that I ended up deleting in frustration at 2 a.m. because it required pressing too many buttons rather than a simple "start" and "stop". The one I found to replace it works more simply but kept crashing so I do not have any recommendations in that area.

A Midwife Helped Me Out: Birth, Done Right at Home

Previously I wrote about a few of the ways prenatal care with my midwives has been pleasant, personalized, and has contributed to keeping my pregnancy healthy and low-risk. While aiming not to be too graphic, I would like to highlight a few things about giving birth with midwives at home that were healthier, more evidence-based, or more pleasant than my experience giving birth with a doctor in a hospital. Some of these things could be done in a hospital, but were not, and some are specific advantages to giving birth at home.

• No pressure to induce labor. I was "measuring small" again this pregnancy, but it seemed to be that Malachi was up far enough in my ribs that we just couldn't get an accurate measurement, a much more reasonable diagnosis than IUGR (which is what Tobias's records stated, although I didn't know that until I saw Tobias's records during this pregnancy).
• Less exposure to germs such as MRSA or various flu bugs and illnesses during birth and postpartum visits
• Water birth: provides significant pain relief, also lessens tearing and swelling. Laboring in water was encouraged at the Sunnyside Hospital, to their credit, and was beneficial to me, but I had to get out for delivery. And for the curious, babies don't breathe until they feel air on their face. It's pretty cool!

• In the hospital, delivering while laying in a reclined semi-laying position was the default, and I was in no condition to argue. This position contributes to tearing, and also oxygen shortage to the baby, both of which we experienced to some degree with Tobias. Malachi ended up coming out while I was kneeling in the water. I did most of the work, but it doesn't hurt to have gravity on your side too.
• Spontaneous pushing (pushing when/how you feel you need to) instead of directed pushing: again, less risk of tearing and oxygen shortage for the baby. Also, it felt a lot more comfortable and I think was a big factor in how great I felt afterwards (very minimal tearing and no swelling or soreness at all).
• Umbilical cord was allowed to finish pumping important blood and stem cells into the baby. Evidence supports this as the healthiest (reduces risk of anemia and respiratory distress among other things), but my doctor would not allow it even though I asked.
• Comfort/Personalization: we could have Tobias come home and meet Malachi when we were ready (no visiting hours), I got to enjoy hot cider, pumpkin oatmeal muffins, and chicken soup while in labor as opposed to little cans of juice and the food that we snuck into the hospital with us, no riding in the car while in labor, having all the baby clothes and equipment close by instead of having to decide what to pack.
• Home court advantage: being in familiar, safe surroundings and having less distractions (no filling out paperwork or drawing blood during labor) lowers the stress hormones that would otherwise slow labor and make it more painful. Overall, the day was very laid-back (and exciting at the same time!).
• Kristin was very "hands-off" during labor. She did check my blood pressure and listen to Malachi's heartbeat with the doppler, as well as ask me questions about what I was feeling and occasionally listen/watch how I was dealing with the contractions. She stayed in the dining room most of the time. No cervical checks either...it was obvious without them that labor was progressing.
• Choosing which procedures we wanted. For example, we declined the newborn eye ointment because we don't have STDs.
• Thousands of dollars cheaper

As far as disadvantages, some things were more "work": having various supplies, including food on hand for during and after the birth, preparing the birth tub, etc. And those table trays in the hospital that allow you to easily eat in bed...those are kind of nice. Other than that, I can't think of any big disadvantages.

Safety-wise, many large studies show that for low-risk women, home birth is equally safe as hospital birth when you compare the rates of death for mom and baby (one recent Canadian study even reported it to be safer). It is much safer in terms of the incidences of c-sections, infections, etc. that happen in hospitals. Most cases of needing to transfer from home to the hospital are not time-sensitive emergencies. Midwives are thoroughly trained and licensed and carry a lot of equipment/medication with them for more common needs as well as bigger emergencies. Hopefully you all know me well enough that you know I wouldn't do something that is unsafe!

Unfortunately, there are many entire states (including my home state of Iowa) where giving birth at home with a midwife is not even a legal option; CPMs are not allowed to be licensed and there are very few or no CNMs that offer home birth services. Currently about 1% of babies are born at home, but as the number of people choosing and supporting home birth grows, I hope that more states will make this choice available to families.

For those of you who are pregnant or will be in the future: wherever you give birth (home isn't for everyone!), find a caregiver that will listen to and respect you, and insist on evidence-based practices that keep you and your baby as safe as possible!

Please feel free to ask me questions about anything if you're curious or facing some of these same decisions yourself!

Little Guy Malachi!

Ooh, I'm behind. Malachi's great-grandma blogged his birthday before I got around to it!

Malachi Reese was born at 5:19 p.m. on Thanksgiving day, November 24. He weighed 7 lbs and 6 ounces and was 21 (and a half? I forget) inches long. We are so excited that he's here and very thankful that he and I are both doing well.

He was born at home and we really appreciated the care that Kristin provided before, during, and after the birth. Unfortunately Lorri could not be there as another family was also having a Thanksgiving baby! There's lots I could say about how it was different (and better for us) than our experience giving birth to Tobias in a hospital with a doctor, but that might be another post. Feel free to ask me about it though! I will say that although I felt fine after giving birth to Tobias, I feel great compared to how I felt 2 or 3 days after having Tobias, even without a single ibuprofen. Midwives really help keep the process as gentle as possible.

Tobias and Malachi were in their carseats next to each other in the car today on the way home from church and Tobias reached out and touched his hand and said "I like him. I like his little hands." So I think it is safe to say that Tobias is adjusting OK!

We know Tobias has already established quite a fan club for his videos, so we'll try to get a video up soon of Malachi so he can share the spotlight.

Thank you everyone for your prayers, congratulations, video chats, and support! Malachi is looking forward to meeting many of you soon!

A Midwife Helped Me Out: Prenatal Care

It will hopefully be another 11 weeks or so until this baby is helped "out" out, but I wanted to write a post to all the things I have appreciated so far about my prenatal care with my midwives, especially compared to my experience last time going to a family doctor.

• Appointments are usually 45+ minutes long and cover a variety of topics including any questions I have. When I say "variety of topics", that includes things like chicken-raising advice, tasty ways to cook with coconut oil (fry your french toast in it!), the logistics of flying with a newborn at Christmas, what's going on in my life, etc. Mostly health or baby related, but not necessarily.
• Appointments start on time and I don't have to sit in a waiting room with annoying cartoons on, and with people who might be sick. Tobias comes along and plays in the toy room or "helps" measure my belly.
• They're directly available by phone or e-mail if needed. When I was pregnant with Tobias I had some unexplained abdominal pain (not during office hours, of course) and my choices were to go in to the ER (the ER or OB department understandably can't give any advice over the phone) or wait it out with some extra-strength Tylenol. I haven't had any medical reason to contact them, but Nate did e-mail Lorri asking for a reminder on which Chinese restaurant in Prosser she had recommended during childbirth class. It's the Golden Horse near exit 80, if you're curious! Nate's there right now meeting someone for lunch.
• Nutrition is really important to them. My blood work showed I was low in Vitamin D and probably iodine, so I'm taking supplements to correct those things as well as some other supplements and vitamins. They also give lots of specific advice on healthy eating and haven't stressed or lectured me about my weight at all. Who knows if these changes are why I haven't experienced any leg cramps, bleeding gums, etc. during this pregnancy!
• Kristin stopped by my house for a prenatal appointment when she was in my area, which was nice. If everything continues to go well they will both be here at my house for the birth too, and postpartum checkups. I'm looking forward to not taking a 1 week old baby in to the doctor's office for a checkup...I remember Tobias screaming with hunger while I tried to fill out a bunch of paperwork. But I'm getting ahead of myself there, this is supposed to be about prenatal!
• With many tests and procedures I am presented with the pros/cons and all the options, and then I can decide. For example, since I am at low risk for gestational diabetes, I chose to test my blood sugar with Holly's meter after a meal rather than spending time and money on an official glucose tolerance screening.
• Thousands of dollars cheaper. I'm guessing the prenatal care and birth will come to $3150. Even if for some reason the baby had to be born in the hospital, I think $3150 is a great deal for such excellent prenatal care.

Doctors' knowledge and experience can be crucial, which is why the Midwives Model of Care includes "identifying and referring women who require obstetrical attention". However, since I am currently very healthy and low risk, I can't imagine going back. Why pay more for less?