Baby # 2

We're having another baby due in January 2012. 

We were slow to tell people again (14-15 weeks), this time we haven't even sent a mass email, just word of mouth. We're excited & happy, but tired usually, so don't think about it.  Once again the gender is unknown as we like the surprise. We're working with same midwifery center affiliated with Vanderbilt Hospital; actually our primary midwife is Soheyl again which is super cool as she was the person on duty when we went into labor with Julia. We're planning on attempting a VBAC with high hopes for a successful delivery & not a repeat C-section.

All is well with the pregnancy, I'm just so tired, more than I remember last time, but that's because I have a little person to hang out with when I come home from work. Little time to rest as I did often while pregnant with Julia. : ) We're not doing any of the interventions/tests - only did the ultrasound at 20 weeks which was cool, made everything seem more real.  Even though I'm 41 I'm a healthy person & don't feel like it's necessary to spend time & money on tests. Once again I got an interesting response from the midwife when I went for my last appointment & we discussed my next visit at 28 weeks (Oct. 26) for the glucose test. I said I wasn't going to do it. I know I wrote a post in 2008 about a similar conversation with them about refusing the test. Most people must do it even those women who have a midwife as their medical provider.

Anyway, this baby is definitely different in utero, much more active & busy, especially when I'm trying to rest or sleep. Julia was way more mellow inside, compared to outside now! : ) I am really curious to meet this individual, male or female; I know they will be different babies & children. Hopefully I won't compare them too much which I know is difficult. I also am trying to be more excited, but it is second time & I'm not really into being pregnant. I hate the constant bathroom visits & heartburn discomfort, both of which started WAY earlier this time! : ( I'm sure this baby will have lots of hair too which I don't need heartburn to tell me! However, I'm excited & curious about breastfeeding despite that constant work of feeding a baby & of course sleep deprivation. I'm hopeful that this time we'll have more success earlier with breastfeeding, with fewer complications & issues. At least one of us will have some experience & lots of support from La Leche League & other friends. : )

Congratulations as Julia likes to say when she uses the toilet. So funny!

Julia's Birth Story: Part 1 (at home)

Apparently I was in labor all day Monday, December 8 ... didn't realize it for sure until quite late that evening. I had been having Braxton-Hicks contractions for weeks and on Monday, the contractions seemed a little different, stronger, slightly more intense, but not anything I associated with labor "pains." They were uncomfortable, but not frequent, not lasting long, not what I expected. I'm at work, going about my daily routine, I think I might have seen a few students which I hope I didn't because would you want to talk with your school counselor while she's in labor? : ) Actually I joked with Niki that I wondered what if they were real labor contractions and I was in the bathroom and had the baby. You know like in a cheesy after school special or those random stories you hear about 'teenager has baby at prom.' I call out "hello, anyone there? " while I hold a slimy, newly born baby in the middle school's girl's bathroom. How possibly true this story could be you will learn as I tell the rest of this story.

So after work I decide to go to Target, I don't know why, just wanted to get a few items, nothing that crucial. However, I had a To Do list and wanted to cross these items off of it. So I'm walking to the check-out and I have the most intense back ache thing and thought I would pass out. Still I pay for my stuff, walk to my car, get in, drive home, still having the same kind of contractions (not like the one in Target) and I'm keeping track of the frequency (it hadn't been more than 3 in an hour and they were 15-20 minutes apart). However, now I'm wondering if these might be something real. I get home, decide not to go to water aerobics even though it's Monday which is my routine, head to the couch for my TV fix and knit (I have a hat I'm trying to finish before Dec. 20), still keeping track of frequency. Jai gets home around 6pm and I say "hey, don't want to worry you, not sure what's going on, but I'm having these contractions that seem different." Jai handled this info quite well, said something like "OK, so what do we do?" I said I don't know, just see what happens. He goes and gets one of our many pregnancy books : ) and reads some details and we decide to keep a true record, not just in my head, so I start noting the time and length of the contractions.

Again they were still 12-20 minutes apart and less than 40 seconds ... so we ate dinner, watched TV, I kept knitting. Around 9pm I couldn't take the stress anymore and went to take my evening shower. When I got into bed close to 10pm, I'm hoping to rest. I don't get a chance because an intense contraction happens and they continue to every 6-7 minutes. Now I'm thinking this is real, oh, my goodness, this is real. I tell Jai "hey, I need you to do some laundry, there's some stuff in the basement to wash, also clean my bathroom (he hadn't had a chance to do it on Sunday), make sure the dishes are done in the kitchen. You know all of those nesting activities people talk about, but I'm not able to do though I'm constantly getting up to go to the bathroom since I cannot relax. I also tell Jai he might want to come to bed so one of gets some sleep because this is REAL.

At about midnight Jai comes to bed and rubs my back which felt like heaven. Around 12:30am (Dec. 9) I feel this gush of fluid and I roll out of bed SO QUICK and fast walk to the bathroom where I discover that indeed that is my water breaking. I tell Jai and jump in the shower to wash off this slime while enduring another contraction. Jai calls our midwifery center and discovers that Soheyl is the midwife on call. YEAH!

I get out of shower, go to the bathroom again and discover more nastiness - green/brown version - which Jai reports to Soheyl who says that is meconium and she asks how far are we from the hospital (no more than 20 minutes) and instructs us to head there now. That's what I thought we were planning to do anyway, but I couldn't remember what the deal is with meconium (possibly some kind of distress for the baby). Luckily my hospital bag is packed (you know me, packed for weeks) so we get dressed, Jai puts Johnders in back yard (who knows what he's thinking, he never goes to the yard at 1am!), starts the car and puts our bags in the back while I make my way as fast as possible out the door.

We drive to the hospital which is strange because there are hardly any cars on the streets. Every bump in the road is annoying and the contractions are happening, but I have no idea of the frequency anymore. I forgot to track them. Jai says I barely grimaced or moaned, but they sucked!

TO BE CONTINUED ... "Julia's Birth Story: Part 1 (at the hospital)"

Childbirth Education

Recently I had a fascinating conversation with Bonnie about our lack of childbirth education/preparation. Bonnie realized that neither I nor Jai had mentioned taking a class and wondered why. When I said we didn't take one, Bonnie was really concerned which surprised both of us. She kept asking how will we know what to do, how to breathe, be prepared for each stage of labor, on & on ... very unlike Bonnie's usually laid-back persona. I was not fazed; slightly perplexed by Bonnie's reaction but not questioning our decision. However, Bonnie wanted me to ask the midwife about the situation. : )

Therefore the next day, I (who usually has a list of questions, but that week didn't have any) discussed this particular question with the midwife. Basically it is not required or necessary, depends on the needs of the couple. Do we need information about Labor & Delivery process, newborn care, breastfeeding? It seems like the potential for information over-load, a large time commitment (class is 2 hours once a week for 6-8 weeks) as well as a financial cost.

Information can ease/alleviate anxieties and provide coping skills, but it is not necessary to get them via an organized class. There are lots of other ways to access information now (books, DVD, internet) and the midwife speculated that it could be a generational issue that developed out of a need for women to feel more empowered 30-40 years ago. It also depends on the personality of the couple. Some people are private and don't enjoy group experiences or being with strangers and others like sharing experiences about pregnancy and parenting.

The midwife shared that many midwifery clients do not attend childbirth classes. One reason is the different kind of prenatal care/interaction than with a traditional OB/GYN. I definitely agree that I converse often with the midwife about all kinds of questions which have occurred throughout the pregnancy.

Both of us read alot of books - that is one of our favorite ways to get information. We also saw the DVD "Business of Being Born" and saw lots of babies being born in a variety of settings and situations. Jai reads more stuff on the internet, but I do read some web-based resources. This weekend we spent some time talking about the stages of labor and possible issues and concerns, as well as ways, Jai can support me. It was helpful, but an organized childbirth education program isn't for us. We'll see how it goes very soon!

LJ - the nephew (so far the only male grandchild)

There is so much that we could write about LJ, the 14 year old son of Tara's brother, the first, and only male, grandchild. He is a character and he has been true to form during the pregnancy! Overall he is so sweet and earnest and curious about the baby.

From the moment we told him Tara was pregnant, it has been a hoot. Tara called her dad in NC on Father's Day and told him next year Jai would be celebrating the holiday ... cute, right?!? Then LJ got on the phone (he spent the summer with Harold, his grandfather, and extended family in NC) and Tara tried the same tactic: "guess who will be celebrating Father's Day next year?" ... long pause ... "Jai will be" ... another long pause. Finally it clicked and LJ said "you're having a baby ... how many months?!" Tara replied "yes, 3 months." LJ said "how could you not tell me all these months?"

: )

Once LJ returned home to Nashville, we've seen him sporadically which is normal; his interest in the pregnancy and baby has not disminished. He loves to check the belly (size), talk to the belly ("hi, baby"), touch the belly (see how hard it is), even kiss the belly (very affectionate). He also is VERY determined to know the gender. He really wants the baby to be a boy. He has 3 female siblings on each side of his mother and father's families so he is one male surrounded by 6 girls! He also refers to the baby as his nephew though we explain that the baby is his cousin. : )

This week LJ stayed with us a couple of days which worked out nicely in particular for 2 appointments we had. One was with Smile Mommy! diaper service (the only one in the state of Tennessee). They brought our initial weekly supply of cloth diapers (80), wipes (80) and covers (20 in yellow and green) as well as the diaper pail and liner bags. LJ heard the explanation of the process and learned how to change a cloth diaper. (It seems simple, but a doll is not the same as a squirming infant, potentially projectiling bodily fluids; we'll see how we do. )

Then the next day he went with Tara to her midwife appointment. He asked the nurse if she knew what gender the baby is. Actually almost every time we talk with him or see him he asks if we know the gender - like we didn't know before, but we know now and can tell him. (Actually the only person who should know the gender is the ultrasound tech when we went at Week 21; it's not a secret and we're not telling anyone. We don't know and we won't know until delivery.)

LJ got to hear the heartbeat which is always strong and loud. The midwife was really complimentary of LJ; he asked some good questions about the impending labor & delivery. What to do when the water bag breaks (call) and how long before we head to the hospital (depends on how far apart the contractions are)? LJ doesn't want to be present for the birth which is fine with us, but he's excited to get the call from Bonnie and come to the hospital. We think he's going to be a great older cousin, even willing to change a few diapers! : )

Business of Being Born

Last night we watched Rikki Lake's Business of Being Born. I saw this as sort of a Super Size Me for baby birthing. It is told from the perspective of home birth advocates and it shows the glory of that side while it shows traditional obstetricians as closed minded doctors who think you can only do birth with all the gadgets.

What I found most interesting is that the featured home birth advocates and midwives look at what they do as empowering. I see some of that - the field of obstetrics having turned the most natural of processes into something scary and clinical - but what I didn't understand was the pain of pregnancy being liberating. I guess you have to be a woman for that to make sense.

Tara had mentioned the possibility of home birth but it weirds me out. I'm a little more conventional and I am also a worrier so I think about what if there are problems and whatnot besides, insurance doesn't cover home birth which, they talk about in the movie. If you like these exposé type documentaries I would recommend it. Some of it was enlightening. Some of it I assumed and Tara knew. 

Warning: naked pregnant woman, surgery and childbirth are all explicitly shown.

Midwife visit # 5

Susie came with me this time since she was in town. All is going well. I gained 4 pounds since last visit 5 weeks ago. Overall I've gained 24 pounds so I'm happy and the nurse guesstimated I might gain about 10-12 more pounds in the remaining 10 weeks. As I say to Jai, "as long as I don't weigh more than you!" :)

It was fun for Susie to hear the baby's heartbeat; the midwife (Emma, another full-timer, I think I have 2 more to meet) said it is good and strong. They are all wicked nice and enthusiastic and they love that we're not finding out the gender. She had me sign the release about declining the gestational diabetes test. Actually Soheyl called me a few weeks ago to check in with me and discuss the pros and cons of doing the test and encourage me to keep eating healthy and watch carbs; Emma talked with me about that also.

Ironically Susie and I then got something to eat, quite a few carbs, not too many veggies. To top it off we went to Gigi's Cupcakes - yummalicious! If you haven't gone there and you live in Nashville, you must. I love cake, especially the frosting. These cupcakes are creative and artistic and also made daily so they are moist and the frosting is AWESOME!

Back to the midwife, I had a few questions for her ... of course. : )

• The baby makes these strange (to me) flutter movements - probably hiccups.
  
• Leg cramps - probably related to potassium and magnesium intake so banana-a-day.
  
• Heartburn - she commiserated & supported the natural remedies, but also mentioned OTC options like Tums & Pepto-Bismal; I'll see what happens.
  
• Discharge - UGH! You don't want to know. Though it's normal and common.
  

I mentioned to Emma that Jai & I went on the L&D tour at Vanderbilt and how reassuring it was to see the facilities. The people were really friendly and about 1/4 of the women in our tour are using a midwife so I didn't feel so alone. Even though I'd like for Soheyl to deliver our baby, if that's not possible, I feel certain that we will be comfortable with one of the other providers.

Why Midwifery?

Some people might wonder why we're using a midwife instead of a traditional OB/GYN. One reason is I'm not very traditional. I'm a simple person when it comes to health care. Other than managing my asthma which is fairly mild at this point in my life, I lead a healthy life (eat organic "whole foods" as much as possible, exercise frequently, don't smoke) and usually go to my primary care physician once a year. I rarely use over-the-counter and prescription medications (as needed for my asthma). A drug-free kind of child birth fits my model of health care and midwifery seems like a natural fit. I could go "natural" with an OB/GYN, but the traditional medical model is potentially a lot more intrusive than I want. "You could have complications so let's check on everything rather than seeing me as a normal pregnant person."

Having said all that, it has been fascinating working with the West End Women's Health Center because it seems like a compromise of traditional midwifery and traditional obsterics practices. Throughout June and July I read Ina May Gaskin's Guide to Childbirth which basically tells the story of midwifery. Ina May is famously known from the midwifery practice at The Farm in Summertown, TN. I heard about The Farm often as a child of the 70's & 80's because one of my mom's good friends was a resident and currently is a midwife/instructor in Knoxville, TN. I have always had a positive association with The Farm and its values/tenets of living in community.

However, I didn't know much more about midwifery and this book is very informative and confirms my beliefs about how I want my child birth experience to be. Even at my AMA (advanced maternal age) I am not interested in having many of the diagnostic tests performed and that has been somewhat in conflict with SOP (standard operating procedure) even at WEWHC which surprises me. These tests used to be done for a specific medically driven concern - older age of mother, family history of genetic disorder, or some other genuine reason. With technological and medical developments as well as fear of malpractice, it seems like these tests have become standard and expected for all rather than rare and only truly necessary for a few.

Pregnancy and child birth are a normal part of life; women have been having children for centuries with the assistance of midwives. Actually outside of the United States, midwifery is much more common - something like 90% of women in the world use a midwife, only 5-10% use a different model. In the US, it is the opposite - only about 5-10% of American women use a midwife and most of those are affiliated with a hospital. Ironically that reminds me of the issue of last names when a WOMAN gets married. About 8% of women retain her "maiden" last name or hyphenate - 92% change to her husband's (in a heterosexual model). Once again I'm a non-traditionalist!

There is the convenience of insurance connected with using the WEWHC versus giving birth at The Farm or at home. It is still significantly cheaper to give birth using a midwife, even at the hospital - so I'm told by the WEWHC office manager. However, these lab tests cost money (someone pays for it) as well as being intrusive, possibly painful and potentially harmful to the fetus in addition to any emotional and mental anguish depending on the results.

At the end of my most recent visit to the midwife (not Soheyl again), she mentioned that at my next visit (28 weeks) I would have the test done for gestational diabetes. I said that I wasn't going to do the test and she looked up, seemingly surprised and said "not at all." I didn't understand that comment because I thought you have it or you don't. I said "not at all." Then she said she'd leave a note for my primary midwife who would prepare something for me to sign stating that I was declining the test. Interestingly enough it wasn't presented as a possible test to take and here's some information about why or why not to do it. It was presented as a standard test to have done.

I've read about the test - I don't have any of the symptoms. I haven't had fast weight gain, I don't eat much processed foods, I exercise, I don't have a family history of diabetes, and I eat because I'm hungry. Also I don't want to drink some sugary gunk, wait for an hour for them to take some blood and see if my blood sugar is high. That isn't natural!

I am happy with the WEWHC in general. When I asked the midwife about Labor & Delivery at Vanderbilt - can you move around, what kind of fetal monitoring is used, can you eat & drink, what about bath/showers, limits on labor time before induction, how do they feel about a birth plan, having people at the delivery, etc. - I received pleasing and comforting answers. The number of C-sections performed is low and there isn't pressure to get an epidural; it sounds like a more relaxed attitude about natural child birth which I would expect with midwifery.

First Trimester

During most of April and May, pregnancy exhaustion has been the norm for me. Ironically the week I discovered I was pregnant, the spring tennis league (3.0) started - weekly matches for 7 weeks. I signed up in March, before I was even pregnant! Luckily I felt great once I was playing tennis - wish I could have played tennis all the time. Another positive is that I had another winning season!

Yesterday I went for my first prenatal visit at the West End Women's Health Center affliated with Vanderbilt Hospital which is where I will Labor & Deliver. I researched my OB/GYN options last year and knew that a midwifery practice is a good match for my personality and values about health care. My primary midwife is really cool, a woman named Soheyl who is of Persian descent and has lived in the United States for the past 20+ years. I enjoyed conversing with her about my outlook and questions about the pregnancy/birth process as well as her philsophy. I plan to go natural child birth yet know that the connection to a hospital gives us options in case an alternative is necessary.

I am learning that flexibility is key to this process as well as future parenthood. Also daily naps are a must!