Sunday, July 31, 2011

Day Six: The Troops Roll In, and The End of Exercise?

I debated using my elliptical today, briefly, but the chiro said it can hyperextend my pelvis. Given that our focus is on the pelvis right now, this seems like a bad idea. Also, I am feeling pretty tired these days... but sometimes, not exercising makes me tired... while also giving me insomnia. So I wasn't sure.

But the exhaustion I felt after a short trip to the farmer's market, 99 Cent Store (to buy a beach umbrella, just in case I had the energy to go to the beach this afternoon with a friend... hah!), and health food store (all within a block of each other) pretty much sealed the deal. To be fair, my back was also aching by the time I got home, plus it was so damn hot, but still, I was about ready to cry (again). I haven't actually cried, I've just wanted to.

But in any case, I think my elliptical days are over until after this baby arrives, unless the insomnia really becomes an issue. I talked to S about it, and he officially "gave me permission" to stop working out, and that helped too.

So I'm guess I'm done with formal exercise for the duration! Wow.

I don't know what to think about my back. It felt so much better after the chiro, but carrying groceries, even not that many of them, really made things hurt. And I'm not even tempting fate with the exercise ball -- that would certainly make things worse. I put it behind the elliptical.

My sister arrives tonight. I'm excited to have her here... and am VERY much hoping that she gets to help with more than just assembling a crib, cleaning my tub, and vacuuming my rugs.... praying like crazy that this baby comes soon! My friend just asked about my plans for next week... and my heart sank because I realized, for the first time, that I should be making plans for next week... there is a VERY good possibility that I won't have delivered by then! It's not so much that my due date is next Saturday, it's the thought of how long I've felt ready for her to come. It's sort of surprising that next Saturday is only my due date. I'm still early at this point. Wow.

It will be interesting to see what, if anything, the biophysical profile and non-stress test reveal tomorrow. I'm not sure what to hope for. OF COURSE I want my girl to be healthy and thriving. But there's a part of me that wouldn't be sad to hear that my fluid levels were just low enough to consider inducing, without being a threat to the baby.

And now, if you excuse me, I am off to pump my (empty) breasts while I write letters to my ten and twelve year old family members who are off at sleepaway camp.

Saturday, July 30, 2011

Day Seven: The Chiropractor, and Possible Progress

Today was my first visit to the chiropractor.

I didn't know what to expect. I've always been kind of scared of chiropractors, after hearing a couple of horror stories about people having their necks cracked, that sort of thing. I don't even like having my toes pulled or fingers cracked, so neck cracking scares me. Still, I'm willing to try pretty anything at this point, so with my midwife's urging, off I went. Luckily for me, I had mentioned this to the acupuncturist at my last visit and found out there's a chiropractor right in her office. She brought him in to meet me, and he seemed nice, so I was game to give it a try.

The left side of my back's been aching a bit anyway from all the sitting on the ball (to try and get the baby to turn); the same place where I had problems years and years ago, back in San Francisco, where I "put my back out." I learned then, through physical therapy, how to stretch it out, so when the soreness flares up now and then through the years, I know what to do. Still, I was eager to see if he could do anything, as the stretching has only been working partially the last couple of days.

Plus, I was eager to see if he could get the baby to turn anterior (facing my spine instead of my belly button) as well as to see if he could get my pelvis to "open up" so the baby would descend.

The experience was interesting, and pretty pleasant. He told me that pregnant women are usually quite easy to manipulate, because of all that relaxin hormone coursing through us... but I ended up being very tight indeed, and not so easy. First, he pressed on some acupressure points in my lower back, hips, and shoulders. He had told me that it would be unpleasant... so after enjoying the sensation for a while, I asked when it would start being unpleasant. Apparently, the thing I was enjoying is painful for many folks... he told me I have a high pain threshold! Cool. Maybe that will come in handy, say, in the next few days or weeks.

After that, he rolled me into various positions and then sort of squished me down into the table with all his weight. That didn't hurt, but it was sort of uncomfortable, mostly because of having all the air squished out of me. This was the part he calls "being manipulated."

He decided that that didn't open up my pelvis sufficiently, so then he used this sort of gun thing that pushed pressure into my back. That felt sort of nice. After a few more pushes on my lower back, he pronounced me done for the day, and told me to come back in two days.

I had searing pain in my forehead for a couple of minutes after I stood up, but apart from that, I felt great! My back wasn't 100% improved, but it felt like there was somehow a lot more space in there -- like my hip was less jammed up, somehow. And he didn't seem to expect that I would feel different after only one treatment, so I consider myself lucky. A special bonus: I felt more energetic afterwards!

Unfortunately, my back/hip area got tight again later, what with trying to sit correctly in a cafe with my friend, you know, sticking my butt out and accentuating the curve of my back. It's weird that sitting correctly makes my back sore! Finally we came back to her apartment and I could slump -- ahh -- in the armchair and on the floor.

While we were eating dinner, I felt like I really needed to pee, and finally hauled myself off to the loo. Where I discovered that I didn't need to pee in the slightest. This feeling has persisted the last hour or so...  and so I think that maybe, we have experienced some progress in Lentil inching (or "millimetering") her way down into my pelvis! It's not dramatic from the outside, though I think perhaps my bra is not digging into my belly quite as much as usual. So I am interpreting this, in the absence of conflicting evidence, as some small progress towards her someday making her exit!

Friday, July 29, 2011

Eight Days

Again, not really. God only knows how many days I will still be pregnant. Eight days until my "guess date," anyway.

Today was better, at first. I woke up after ten hours of sleep (plus two bathroom breaks) feeling a lot more energetic and rested, ready to tackle some projects! I opted against a quick workout on the elliptical... given how badly I felt yesterday, I felt another day of rest would be prudent.

I got the mailing list created for birth announcements, pre-formatted for the labels I bought. I tried out my WonderWash, finally... the results were underwhelming. The blueberry stain didn't come out of my white camisole, and water drained onto the counter as well as onto the sink. A work in progress, hopefully. Then I did a regular load of laundry, including the seat for the swing and a couple of stuffed animals that somehow got missed on previous loads.

And then... I crashed. I suddenly felt like I was burning up, and even took my temperature (97.9) but it was normal, and completely exhausted, and needing to cry. I am just tired of being tired. I want some energy back. It's ridiculous that I'm exhausted and I haven't even left the building. And how could I ever contemplate being pregnant again, with a small child already in the house, if I can't get [practically] anything done. And wow, I'm tired of cat/cow poses, always sleeping on my back (to get her to turn) and sitting on the exercise ball for hours... It's doing nothing for her position, but is making my back sore.

I want to be done. I want to have this baby. And I know it's early still. I'm not even "late" (post "due" date)  yet!

I tore off all my clothes and lay down on the bed with the AC turned all the way up. And cancelled a trip to the health food store with Emily. So much for my one outing of the day. After a few minutes, it occurred to me that this needing-to-cry feeling  happened yesterday too, and got much better with eating. So I hauled my corpulent self off the bed and set off, naked, for the kitchen, where I blended up a smoothie.

I felt gradually better, and strapped on the breast pump for a few minutes afterwards, to try (hah!) to see if I could get labor going. (What a weird feeling it is. Is it supposed to make one, but not both, of your nipples sort of burn a little?) I'm still really wanting to go into labor (PRODUCTIVE labor, please!) but at least I don't need to cry anymore. Still, the days are d.r.a.g.g.i.n.g.

Hopefully my first session with the chiropractor tomorrow will help with her position... but I found out today that it often takes 6-8 sessions to get a baby to turn, not just one session, as I had assumed in my ignorance. So I'm not so optimistic. This worries me because with her head not well applied to my cervix, my cervix won't ripen. Well, hopefully at least getting my pelvis loosened up will help. After all, women do go into labor even with the baby in posterior position. At this point, I don't even care anymore about back labor, epidurals, anything. I just want a healthy baby on the outside, with a healthy mama to boot... one who will soon have both more energy (I hope!) and a better attitude.

To all those who wish they were pregnant... I'm really sorry to complain. I know it sucks to read this. I am very lucky and I have not forgotten it. I'm just eager to move to the next phase. Sorry. Truly, I am.

Thursday, July 28, 2011

Still Day Nine, and Discouraged

I'm discouraged by how lethargic and ambition-less I am.

I was supposed to go get some free diapers tonight from a local parent, entailing a less-than-one-mile walk each way. And I realized... I just couldn't do it. I don't have it in me.

To be fair, I slept horribly last night. I had the worst heartburn ever, developing about three hours after I ate (does this happen to anyone else? I thought it was supposed to happen when you eat! not THREE HOURS LATER! but this is usually how it happens for me.)

Anyway, I couldn't fall asleep, presumably from the heartburn plus general ?antsiness, perhaps being worried about S, worried about my phone...

Oh, yes, the phone!

Last night while I was out for pizza with my SMC friend Emily and her three year old, I realized my cell phone wasn't working. I was surprised to see that it seemed the battery was dead, because I had charged it earlier in the day, but figured somehow a button got pressed for an "app" that used up a lot of energy. After pizza, I came home and plugged in the phone, and... Nothing.

So there I am, a 38w4d single pregnant woman, home alone, without a working phone. Awesome! (And it was already late enough, about 10 pm, that there wasn't anything to do about it. Except for feeling nervous, which I was all over.)

I emailed my two labor coaches to let them know, but then hunkered down and daydreamed about what I would do if I did, indeed, go into labor. Part of me thought that of course I would go into labor, because it would make such a great story, having to go out in the middle of the night to the local bodega (that's NYC-ese for "mini mart") and explain that I was in labor to the nice... ?Bangladeshi storekeeper that I was in labor and could he please either let me use his phone, or make a couple calls for me? (That's assuming he's even open in the middle of the night... I've never seen the store closed, but I am not usually out all that late.)

Obviously, I experienced No Such Luck.

Anyway, I couldn't sleep with all this going on, and then I had to get up early to go to S's appointment, feeling approximately like hammered shit, to use one of his colorful expressions. Then the wait for the subway took forever (like 30 minutes instead of the more typical 5 minutes I expect during rush hour), and I got more and more panicked that I would be late. I sprinted across a street in front of six lanes of traffic to make a light... I can't even imagine what that looked like, but I was glad to know I still had it in me!... and went to the wrong address. When I finally got to the correct address, of course S was no longer waiting outside, since I was so late. And I couldn't text or call him to explain that I was on the way, on account of my phone not working. I explained to the doorman what I was looking for (I didn't know the doctor's name). Thank god there is only one doctor's office on the second floor!

And what a relief, S was happy to see me, and not annoyed or frustrated that I was late. I think I would've burst into tears if he had been mad. And as he pointed out, we couldn't both cry, and he had already called today. As it turned out, of course, there wasn't any crying, but he was just reserving the right.

So now it's evening, and I'm just completely wiped out. I slept through much of my Hypnobabies "Visualize Your Birth" recording, nearly an hour, but for some reason leapt straight up off my bed when it was counting down to waking up, pulling a muscle in my back, and leaving me feeling startled and distinctly cranky. Luckily the muscle pain wore off.

I've been getting up earlier, trying to shift my schedule back towards early mornings... but without going to bed any earlier. So I'm hoping that some of this fatigue is just from that.

But right now, I just feel a little miserable. I don't like feeling like such a slug. My friend called and invited me to go to a Mark Morris dance performance in the park, and I just couldn't find the energy to go, as awesome as I know it will be.

I don't like being like this. Fingers crossed it's not much longer... even though I know I have nothing, really, to complain about. (Thanks for "listening" nonetheless.)

Nine Days, and Great News

The great news is that S's prostate cancer is Stage 1. This is the least aggressive cancer stage. And it hasn's spread outside his prostate! Phew!

We reviewed treatment options with the urologist. (Wouldn't it have been totally awesome if my water had broken in his office? I mean, I feel like that's the one situation he's just not prepared to deal with. Alas, Lentil is firmly entrenched and showing no signs of moving out of her comfortable digs.)

He's a surgeon, and specializes in robotic surgery, so not surprisingly, that's what he recommends. However, it sounds like there's a bit higher risk of side effects (impotence and incontinence), and the results are the same as with radiation until 12-15 years out... after which there's a 1-2% higher chance per year of recurrence with radiation. I think that S and I both agree that 12-15 years from now can take care of itself... who knows what the medical knowledge will be at that point? Versus better odds of peeing and screwing now... definitely!

The next step will be to meet with the radiation oncologist to hear more about that option, since the urologist preferred to skim over that and let a specialist present that information.

The only thing I'm less than thrilled about is that although he didn't particularly recommend "active surveillance"  (the watch and wait approach), and indeed said he would prefer to start treatment within 6-8 weeks... he also made it clear that the cure rates wouldn't vary by waiting a while. So S is thinking that he wants to put this off for a while. He's thinking months, but I know him all too well, and I'm afraid that months could become years. If he does choose the active surveillance option, he's supposed to have a biopsy and a prostate exam every six months... but I'm afraid that since S thinks he's not really choosing that, just putting off the decision, that he can avoid the biopsy (which he hated) and exam. I'm scared of that outcome.

But I think for today he wants to just celebrate that the cancer hasn't spread, and is not aggressive, and I don't want to interfere with that. Poor guy hasn't slept or eaten much in the past week. But I also don't want him to put off making a decision, or at least, doing more research, for very long. Yet neither do I want to become the nagging mother figure, harassing him about making a decision. That was a huge reason for our breakup in the first place -- I refuse to do that (except I guess I might have to for my own child.)

Wednesday, July 27, 2011

Update from T Minus Ten Days (Not Really... If Only!)

I'm ten days out from my "guess date" but there's no telling when Lentil will actually arrive... the outside window is forty-two weeks, I reckon, which is August 20th. Praying it doesn't go that long. Please Lord!

Anyway, I'm finally having weekly visits with Catherine, my midwife, now!

All looks good. I gained another pound, my blood pressure is holding steady at 100/60, and my fundal height is 39 cm. Oh, my hemoglobin and hematocrit rose nicely from the iron supplementation, and I am Group B Strep negative. So I don't have to get antibiotics during labor. Excellent.

Unfortunately, as I had suspected, Catherine confirmed that Lentil is in a posterior position. Despite time spent on my hands and knees (without having any fun at all), and diligently sleeping on my side. I'm tired of the damn cat-cow poses.

Also, although the OB chief resident had forgotten to mention it to me (though the covering midwife informed me after I left the hospital on Monday, via phone), my amniotic fluid levels were a little low at 6.6... unknown units. I've been drinking tons, so Catherine wants me to try to rest more. Not the worst sounding idea ever... I get so tired these days, schlepping around in the heat.

Personally, I think the resident just wasn't particularly knowledgeable, and didn't search around all that hard for fluid. The last time I had an ultrasound with an ultrasound tech, she really hunted for fluid. But I don't mind. Because it means I go for a biophysical profile and non-stress test next Monday (basically, an ultrasound checking for amniotic fluid levels and for the baby to be making practice breathing movements, I think, from what I've read from other people's blogs.)

There's a little part of me that thinks, gosh, what if I just happened to not remember to drink enough water (or iced raspberry leaf tea, a uterine tonic, which is actually what I am swilling by the quart these days)???

I think if it weren't for the issue of really wanting my sister to be here for the birth and postpartum period (she arrives Sunday, at 39 weeks, 1 day, unless I go into labor before then... in which case, she is ready to jump in the car and drive post-haste from Massachusetts, about a four and a half hour drive), I wouldn't be so antsy. Though part of me is just excited to move to the next step, even without the issue of my sister. Still, I'm grateful that I'm not nervous or agitated about it anymore. Just eager, really.

Anyway, Catherine is having me start taking a homeopathic medicine, Caulophyllum, to help prepare my cervix. I take five pellets, under my tongue, every thirty minutes for two hours, twice a day. No eating or drinking during this time, either... but then I got a reprieve for water. Two hours (or two and a half?) is a long time to go without drinking in this heat. I got very thirsty trying to do this earlier today... especially since I went for another grass-fed burger and fries after acupuncture today... so good, but now I can barely even eat half the burger and a few fries before getting full.

She also wants me to see a chiropractor, to help turn the baby anterior (facing my spine, instead of facing my belly button... to avoid a long and painful back labor) as well as soften up my pelvic. Apparently Lentil's head still isn't engaged in my pelvis -- she could barely feel the head on pelvic exam. (Yes, I asked her to do another pelvic, just to make sure the resident didn't miss anything. And she promised to pass along feedback about how terrible that pelvic exam had been.) Unfortunately, she agreed that I wasn't at all dilated or effaced. I need that baby's head to press on my cervix to make progress on that front.

So between the acupuncture, chiropractor (which will be a totally new experience for me), and BPP/NST, I will be pleasantly busy for the next few days! Especially since I may do the three-days-in-a-row-to-stimulate-labor acupuncture treatment next week.

Pregnancy is becoming a full time occupation.

It's very lucky I don't have much else going on. I can't for the life of me imagine how folks handle the exhaustion, never mind the appointments, while taking care of another child as a single parent. My hat is completely off to you ladies! (Thinking of you, Claire, at the moment, with a two year old and a newborn... and not allowed to lift the toddler due to your C-section! WOW! And congratulations!)

Laid Back Breastfeeding

An online/phone SMC friend of mine who is a La Leche League leader just tipped me off to this.

Apparently it's way more comfortable for the baby and for the mama. An all around win!

In a nutshell, instead of having to sit up and pull the baby to you, mama is encouraged to lean back and drape the baby's body over hers, maintaining that tummy-to-tummy contact. All that contact makes baby feel more secure,  and thus more able to focus on the task at hand with less fussing, and mama gets to lean back and relax.

Here's some more information for anyone who is interested. (This isn't necessarily the best link out there, it's just one I tried that seemed to do a good job of summarizing the topic.)

Laid Back Breastfeeding

(Not my baby. She hasn't been born yet. Hopefully very soon!)

Monday, July 25, 2011

Worst. Pelvic. Exam. Ever.

I woke up this morning, 38 weeks and 2 days gestation (you know, approximately), with Lentil's rump causing a massive protrusion off the left side of my abdomen. I had never felt it quite so dramatically, and once again, excitedly, I began poking and prodding my stomach, trying to see if she had switched back to an anterior position (face towards my spine, instead of spine towards my spine).

No such luck.

But then I noticed that despite my poking and prodding, Girlie wasn't kicking and flailing in protest.

Out of character. Definitely weird.

I got nervous.

I got up from bed and poured myself a [refreshing] glass of iced decaf coffee, laced with a healthy slug of cream, and unwrapped a Mojo Cliff bar. No time to slice strawberries and stir them into yogurt... I wanted a more rapid infusion of sugar into my bloodstream.

No response.

Of course, since I don't drink juice, there was no juice in the house. I started to drink my emergency container of Coconut Water... but then realized it expired in April, 2011. Ooops. No sense in poisoning my poor girl on top of everything else.

So then I retrieved my bag of Jolly Rancher hard candies, leftover from first trimester nausea days, and started sucking on them frantically, while noting the time to do an official hour-long kick count. While simultaneously sitting down to do ever-more online lactation consultant coursework (access possibly expiring today, so no time to lose). A few minutes later, I threw on some clothes and went to the closest bodega and bought a bottle of Gatorade, harkening back to my Ovarian Hyperstimulation Days, when I was forced to mainline the stuff.

An hour went by, with only three feeble kicks. My heart was beating faster and faster.

I called my midwife, knowing she was off camping for the weekend with her daughter, but needing to get the phone number for the back-up midwife off her voicemail. To my surprise, she answered... it was nice to hear her voice. I think I kept the panic mostly out of my voice, and she gave me the number for the back-up midwife.

The back-up was lovely, and told me to head over to Labor and Delivery to get checked out. She also asked "where do you guys live?" and then, "how will you guys get there?" At first, I wasn't sure if by you guys she meant me and Lentil, or me and my partner (I'm sure that in Brooklyn, she would never assume I was in a straight couple, God forbid, but ahh, now us SMCs have taken the need to be PC to the next level.)

The hospital was uneventful, except that I started feeling dizzy and nauseous when I got there. My sort-of- friend, the hospital-based midwife, is on vacation, so that meant I had to go through official channels, and fill out paperwork... telling them I felt like I might faint didn't seem to particularly move things along any faster. Good to know. There was another woman in triage who seemed far more uncomfortable than me, with her face in her hands, breathing heavily (and likewise, very pregnant). They seemed, if anything, even less interested in her. Poor girl.  This makes me even less excited about going to the hospital in actual labor. (I still have fantasies about somehow "ending up" with a home birth... like if the baby came so fast that there was nothing to be done but deliver her in the bathtub in my very own bathroom. Seems unlikely, but it's my fantasy. Apart from the cleaning of the tub afterwards.)

Once in my own little triage room, The nurse did, however, reprimand me for taking Metformin without a particularly good reason, as did the OB Chief Resident, who scolded  me, "Well, now I'm going to have to go look up the [Pregnancy] Category of Metformin."

Umm, since you just acknowledged a moment ago that Metformin was approved for first trimester use in women with PCOS, to prevent miscarriage... how do you not know that it's [relatively] safe to use in pregnancy? (I say "relatively" just because you never know with any medication that it's definitely safe.) Isn't that a thing that an obstetrician who has made it to her chief resident year should know?

Just wondering.

Anyway, the dizziness subsided rather quickly, once they started tending to me. My blood pressure was 98/60, which is fine... perhaps it had been lower before that, leading to the dizziness? Blood sugar (which the nurse insisted on checking, since I am on Metformin, when I remember to take it, anyway, which I did not today) was normal at 107, baby's heartbeat was perfect, there were no uterine contractions, and the ultrasound/BioPhysical Profile/Non-Stress Test all looked normal.

Then the OB chief resident did a pelvic exam.

Now, I'm kind of a veteran of pelvic exams at this point, especially what with my seven months of fertility treatments, all in (each with many cozy encounters with Wanda, the ultrasound probe, plus the rare exam by the Reproductive Endocrinologist). So I wasn't nervous or worried about this particular exam.

But then she jammed what seemed to be her entire hand up my yoni, sans lubrication. She forcibly shoved against me while urging me to move closer down the table to her... which was an absolute impossibility, given the force she was exerting on me.

Then she said, "sorry I have to push so hard, it's just your cervix is irregularly placed," as she shoved ever harder. Ahh, so it's not really your fault you are hurting me, it's my damn cervix's fault?

I gasped, "yeah, um, it's usually on the left side."

"No, no, " she answered defensively, "I've already got it."

Then a moment later, more quietly, "Oh, you're right. It is on the left side."

A moment later, she withdrew her hand and I gratefully snapped my shaking legs back together.

And as she snapped off her gloves, she pronounced, "no changes in your cervix. Well, it's shortened, as you'd expect it to be, but it's closed."

Oh well.

Although I am everlastingly grateful that Lentil is okay, I was definitely hoping to find out that I had made some progress. Either that, or else being told, "sorry, everything is fine, but you have to have a C-section. You know, right now. For a really complicated reason that you'd never before considered."

Which wouldn't have made any sense, but would've gotten me out of wondering and worrying how this whole labor thing is going to play out. I've been feeling the last couple days a bit like I am peering down the barrel of a gun, realizing that there is no way around this giving birth situation, except, you know, going through it.

One of the big downsides I am suddenly realizing about late-stage pregnancy.

(It only just occurred to me now, pushing "publish post," that a blog post advertising itself as entirely about pelvic exams might not really that much of an enticing advertisement to most of the world. This little SMC/infertility/pregnancy/childbirth/parenting blogging world we live in is a strange one, isn't it?)

Sunday, July 24, 2011

Thirty-Eight Weeks Pregnant... Officially Full Term!

(Because I don't hold with the older definitions that say that thirty-seven weeks is full term.)

(Check out the puffy feet!)

I feel pretty good.

Yesterday I was kind of sleepy and out of it, so I didn't work out, even though yesterday was the last day I needed to achieve my goal of working out five days in seven (actually, I think I can still achieve it today). I felt icky and weird when I went out, but I figured that that was due to the heat -- it was 104 degrees in Central Park on Friday, and due to be as hot on Saturday. (And OF COURSE it's hotter on city streets than it is in the park... why wouldn't they measure it where we are actually out and walking around?)

This morning, I was woken up by my upstairs neighbor, rolling something (a TV cart?) around, and sighed and rolled over to look at the clock.

Oh. I had slept ten and a half hours.

I think this may be a pregnancy record? And I wonder when is the next time I will sleep this long? Will it ever happen again?

I was dreaming that I adopted a precocious seven month old baby, and was saddened to realize that I wouldn't get to use a lot of the baby paraphanelia intended for young infants (bouncy seat, swing, etc.) when I realized... with a thrill... that I was still pregnant!

Of course, the night before, I dreamed that my college boyfriend and I got back together, and so I decided to terminate the pregnancy.... and then the relationship didn't work out, and I was devastated to realize that it couldn't have worked out, given my sadness in ending the pregnancy. My relief when I woke up and realized I was still pregnant, and moreover, that it is far too late for me to terminate, even if I had wanted to, was immense.

In other news, my feet are looking pretty darn puffy. I have creases where my ankles used to be.

About a week ago, I realized that I could no longer feel the baby's spine against my stomach, where she had been resting comfortably for quite a while. I'm pretty sure this means she is in a posterior position, ensuring an uncomfortable back labor if she doesn't move back again.

My doula suggested I do cat-cow yoga poses, and another she calls "dog peeing on a hydrant," also performed on one's hands and knees. Well, the latter led to hip pain during the nights, so I had to stop doing it. And the cat-cow poses led to rug burn on my knees. Ahh, I remember when rug burn meant I had done something fun! Alas. So now I'm doing cat-cow poses on the bed. Without success, so far.

I feel guilty because I know that I haven't been sitting correctly. But who, in their last weeks of pregnancy, sits backwards on chairs and avoids slumping heavily on couches? Will I really be punished for this?

A few days ago I was coming out of my skin with nervousness, just not tolerating the ambiguity of not knowing when this baby will come. Thankfully acupuncture settled my nerves. I didn't see the midwife this past week, but go again on Wednesday.

I'm wishing that this girl of mine might show up a few days early, say, anytime starting next weekend, when I achieve thirty-nine weeks, but I'm not terribly optimistic at this point. I have tons of Braxton-Hicks contractions, and indeed, am having one right now... but they aren't painful. And I don't think that the baby's head is any lower down than it was a week or two ago. Alas.

The acupuncturist said she is willing to start needling me to activate labor once I hit thirty-nine weeks, as long as I get my midwife's blessing, because of my sister having to leave when I am at 40 weeks, 6 days. But I'm not sure that anything will help if the baby's head isn't engaged and my cervix hasn't started to ripen. The doula said that evening primrose oil, taken orally as well as vaginally, can help the cervix ripen... but my midwife said (at 36 weeks) that vaginally-administered evening primrose oil can cause premature rupture of membranes, so she said I could only take it orally at that point (500 mg three times a day). At my next appointment I will ask when I can start taking it vaginally. But even that... if the baby's head isn't pressing on my cervix, could it (or anything else) really help? I'm pessimistic.

In the meantime... I found out that I may only have a couple more days (until the 25th, today is the 24th, though I found this out on the 22nd) with access to my online coursework to become a lactation consultant. The company is located in Australia, so by the time I emailed them on Friday to ask, they were already closed for the weekend. So I've been frantically rushing through the courses and taking my online tests. Unfortunately, I'm only done with five courses, and have five left. Including the hardest one or two, on the anatomy and physiology of the lactating breast -- it's very detail oriented. I completed part of it months ago, but didn't take the test, so I will be back at the beginning again, trying to remember all the different cells and pathways involved in breastfeeding.

The rest of my to do list is looking pretty good. Plenty left on it, the urgency of items is steadily diminishing: will/health care proxy/living will -- check, new rug ordered/received/placed on floor -- check, diaper pail: ordered and received -- check (I got a small covered trash can and plan to empty it daily, since the trash chute is just down the hall from my apartment, and large trash bags don't fit in it, anyway). Even my Ipod is finally updated with all the music from my old hard drive that somehow didn't make the transition... ahh, the hours I spent fiddling with that before I finally called Apple and amazingly, got phone help, for free.

Once my sister arrives, I'll have her help me put the non-skid pad under the bedroom rug, assemble the crib (she already assembled the bassinet when she was here for my shower, so it's not urgent), assemble the jogging stroller and install the infant seat attachment onto it, and put the Etsy-ordered decal up on the wall above the crib. Once that's done, I'll post the before and after pictures!

So here's to another day, thankfully cooler, spent indoors and at the computer. Wish me luck and endurance with this coursework!

(In case you're interested in the minute differences in my belly size... I just went back and added in the 37 week belly shot. The professional maternity photos were taken at 36 weeks.)

Saturday, July 23, 2011

Pumping & Preparing to Return to Work

I'm copying this from my online lactation coursework, because I will only have access for a few more days... possibly... and I hadn't seen anything this succinct, and thought it would be helpful for others.

Two or three weeks before returning to work, begin pumping an hour or so after a breastfeed.
  • Provides familiarity with the pump setup, feel, and clean-up required
  • Gives the mother practice using the pump at a time and place that is not stressful
  • The milk pumped can be stored for emergencies
  • A person, other than the mother, could offer some of the milk to the baby, getting baby used to receiving his breastmilk in an alternative manner when he is in a familiar place
Your goal is to replicate what normally happens as much as possible... 
      • Start by assuming her baby drinks the average volume per 24 hours, which is about 800ml (27 ounces). (note from Abby: isn't it cool/strange that the amount doesn't vary depending on the age or size of the baby??? but apparently it's remarkably consistent.)
      • How many breastfeeds does baby normally have in a day? Divide 800ml by that number. For how many feeds will they be apart? HOWEVER... daytime feeds are usually larger than evening feeds. Leave a little more for daytime separations, or a little less for evening separations.
      • Refine this after she has started working. Does the baby leave more than 60ml (2 ounces) consistently? Does the baby drink all available and remain unsettled? (may not be hunger though!) Vary the amount left until the baby drinks most of what is provided every time.

How long should she pump?
The simple answer is... until she gets the volume of milk required. Milk ejection should occur within about 2 minutes and milk removal after that will be rapid.
A double-pumping kit will halve the length of time required.
Most women will pump all the milk they need within 5 to 10 minutes. There is no reason to continue to pump longer than it takes to get the required volume.
  • How often should the mother pump and for how long?
    • This is another opportunity for you to apply your professional knowledge of lactation physiology and what is normal.
    • Breastmilk storage capacity varies widely between women. Some women may have a large storage capacity, some may have a small storage capacity.
      For example: A woman who has a small storage capacity will probably need to pump as often as baby usually breastfeeds.
      Another example: A woman who has a large storage capacity may be able to breastfeed her baby in the morning, then pump sufficient breastmilk to leave for her baby until her return that evening, with no need to pump while at work.
      Individualize your care for each mother.
Breast Milk Storage
  • At room temperatureIn an insulated container with freezer blocksIn the refrigeratorIn the freezer
    4 - 8 hours24 hours3 days3 months

  • And more helpful info... this is for increasing supply

  • Fact: The more frequently milk is removed from the breast the more rapidly the breast will synthesize breastmilk. The fuller the breast, the slower the breast will synthesize breastmilk.

  • Additional milk removal, between breastfeeds, will increase total breastmilk produced in that period. Use this milk as a supplement later.
    • When is the BEST time to pump?

      Assume a mother has an insufficient milk supply. Her baby latches effectively and drains both breasts well each breastfeed. When will you tell her to pump?
      Immediately after breastfeeding?? This is what is frequently advised. Mother breastfeeds, then pumps and gets only a few mls, or maybe nothing. That's understandable, the baby had just breastfed effectively. Mother feels disheartened - it proves her inability to provide for her baby. Breastmilk synthesis will not be enhanced because the breast was already as empty as possible.
      However, if she waits for an hour then pumps, breastmilk synthesis would have been at maximum for the majority of that time, beginning to slow now as more milk accumulates in the breast. Pumping may produce 30ml (1 ounce) from each breast (depends on individual rate of milk synthesis). The breast will be emptied again, milk synthesis will be back to maximum rate once again enhancing overall volume produced, and the mother will feel positive about her ability to produce breastmilk.
      This is an example of applying our knowledge of physiology to a problem.
    • Pump immediately after breastfeeding IF the baby does not remove all breastmilk from the breast each breastfeed, as may happen in the mornings when volume contained in the breast is greater, or the baby has an ineffectual suck. (And pump again in another hour)

Friday, July 22, 2011

Names.. and Some Scary, Bad News (Not Mine... Not Really)

WARNING: SD, my BFF, if you read my blog (and I don't think you do), DO NOT READ THIS.


Does anyone have any advice on how to choose a middle name?

I think I've got the first name picked, as of a while ago, actually. I told a few people about it, and then I felt weird and stopped discussing it. But I don't know why I lie and tell people that I haven't decided it yet, instead of just saying, "Yes, I know what it is, and I'm not telling you!" So instead I feel weird and awkward... and I lie.

I think there's some fear that my mom will find out the name, and feel compelled to call me up and tell me, "I think that name is a terrible idea." (This would not be entirely out of character for her.) Apparently she did this to my sister. Apparently it runs in the family... my sister just told me that my grandmother referred to my sister as "Amy's flower child" for the first year of my sister's life. Sweet!

But anyway... I don't know if there's some common sense rules about how to align the middle name with the first name? If there is, please fill me in. Like, is there a certain number of syllables to match another set?

The idea I've had for quite a while is to name her (middle name) after my best friend, also my ex-boyfriend.

My ex and I were together for five years, and have been split up for six. From the very beginning, there were niggling doubts... but most of the time, we were so great together. Our minds clicked so beautifully, and yes, the sex was great, too. There was just, you know, that thing that I couldn't put my finger on. Most of the time I could put it out of my head and ignore it.

Four and a half years into our relationship, his eighteen year old son, who has Asperger Syndrome, moved to NYC to be near his dad (from Memphis). Prior to that time, S had called his son on the phone every day for thirty minutes and visited one weekend a month, plus school vacations. Luckily, W didn't move into our apartment... but it felt like he might as well have (he had a series of sublet studio and one bedroom apartments nearby), because he could drop by, unannounced, any time day or night. Into our one bedroom, lacking a bedroom door, apartment... with his booming voice, cackling laugh (I'm not being mean, really, he has full awareness of his habit and enjoys cackling maniacally), his inability to understand the finer points of personal space, his giant belly, and his insatiable need to talk, and talk, and talk... droning on for hours. Frequently after I was in bed for the night. Once, in our upstate house (which likewise lacks proper walls and privacy), I counted -- he talked to (or, more accurately, at) his father for three hours without stopping, mainly sharing his views on Broadway flops (his reigning passion at the time). While I lay upstairs, privvy to every single word, sick as a dog with pneumonia, trying to sleep without success, and ultimately sobbing in frustration. S and I finally had "adult only time" for dinner that night, a gorgeous steak, grilled peppers and portabello mushrooms, and untold other gastronomic delights... and after three bites, I laid my head right on the dinner table. I just had no energy left. (That was just after the first semester of my clinical rotations in pediatrics... i had TEN, count them, TEN colds in a row, basically one per week, then pneumonia, then, after a brief respite, bronchitis and an asthma diagnosis.)

BUT I digress. S and I hung in for a few months, and he even gave me a gorgeous diamond ring (not an engagement ring, mind you, for many reasons... one of them being the pesky fact that he remains married, to this day, to his ex-wife, from whom he has been separated for, hmm, nineteen years now?) that I loved. But ultimately, it was clear to both of us that it just wasn't working... though I guess it became clear to me first. It was an illuminating moment, realizing that both parties can compromise as much as they can possibly bear, even more... and it can still not work out.

But you know what, even while I pulled that plug, feeling guilty and terrible... I felt a sense of relief. I had known, and mostly successfully ignored, that fatal, un-nameable flaw in our relationship. But I knew that his son, as difficult and truly scarring of an experience it had been, was really the lucky excuse, the plausible reason, for me to leave.

Since our peaceful break-up, I've had the best of all possible worlds. We've remained the best of friends, and never went through a period of animosity... though he endured some sadness and I endured some [gnawing] guilt at first. Those feelings are long gone, now, and we have a great time together. I miss our travels and our adventures, but we have the most fabulous dinners and conversations together. We share so many jokes, interests, and passions. He is financially well off, and is incredibly generous with me. Which could be weird, but isn't. Really! Mostly it plays out in him taking me out to dinner, and then giving me cab fare home... in exchange, I'm always the one to bear the brunt of the travel to dinner. Seems fair to me.

But most of all, the thing he gave me... continues to give me... is the unconditional love and support that I didn't know I had been missing.

One of his favorite lines, one that he shares with his family and closest friends, and most especially me, is "of course I'm going to support you no matter what you decide to do."

Growing up in a home with a narcissistic, demanding, angry father plus a mother who was emotional absent anyway, in addition to being tied up with my jealous father... he gave me the experience of being loved no matter what.

He became my family, a family that delighted in my successes and sympathized with my struggles.

Although I've felt some distance from him at times as I've become immersed in the world of pregnancy and preparing for parenting, he's been entirely supportive of my plan to become an SMC from the moment I "conceived" it. I introduced him to running early in our relationship (he's since run, I think, six marathons... three of them with me), and he was quick to tell me that he would be the one to give me a jogging stroller. He also enabled me to get an elliptical just a few weeks into my pregnancy, a purchase otherwise far outside of my financial realm... and one that has already enhanced my life hugely, and no doubt will continue to do so as I juggle my need for exercise with the needs of a child.

Yesterday he was diagnosed with prostate cancer at age fifty-nine.

I know that prostate cancer is a "good cancer" to get. If only there was such a thing as a "good cancer."

He's terrified. I don't even know what to feel. My mind is a jumble of emotions. Being nearly thirty-eight weeks pregnant when he got the news probably doesn't help me with digesting it.

The doctor told him, "this isn't the thing that's going to get you." Which is good. Right?

But of course, there are no guarantees, and the ability to pee and fuck when one wants to are abilities we take for granted... until they are casualties of a medical battle we weren't at all ready to engage in.

He doesn't remember what the staging (aggressiveness) of the cancer is... it was all too much to take in at the initial meeting... but he goes for a CT scan next week, and then a meeting to discuss treatment options next Thursday. I'm planning to go to that meeting with him (assuming I'm not in labor). It's a relief to know that there's some little thing that I can do, in this case to be another set of ears, and to ask as many questions as I can think of, and also maybe just a shoulder to cry on. And then I suppose we will just go from there.

I can't really bear to think about worst case scenarios. (Oh, and meanwhile, a close friend emailed me yesterday to say that her boyfriend was just diagnosed with malignant melanoma. I think this is a far worse diagnosis than prostate cancer? But I have no mental energy to process that right now.)

So getting back to middle names... I'm thinking that giving my child a middle name to honor him makes more sense than ever?

PS If you are one of a couple people reading this blog who know S, please don't tell anyone this news. He's not ready for anyone to know yet. I guess I'm taking a risk, blogging about it... but I think the risk is small. Please keep it under wraps.

Another option: Triptych

triptych (play /ˈtrɪptɪk/ trip-tikGreek: τρίπτυχο, from tri- "three" + ptychē "fold") is a work of art (usually a panel painting) which is divided into three sections, or three carved panels which are hinged together and folded. It is therefore a type of polyptych, the term for all multi-panel works. The middle panel is typically the largest and it is flanked by two smaller related works, although there are triptychs of equal-sized panels. (from Wiki.pedia)

Thursday, July 21, 2011

"Birth Preferences"

This is very boring (hey, wow, another boring post! who'd have guessed???) but I thought maybe y'all would have feedback... or if not, maybe it would be helpful to someone else who is thinking about a "Birth Plan."

And for what it's worth, I called it "Birth Preferences" because I have a feeling that calling it a "Birth Plan" makes the nurses get all snarky and say, "yeah, well, we'll see about THAT."

So I hoped that calling it "Birth Preferences" would be a little less irritating to them. Though I am sure it will still inspire eye-rolling a'plenty.

(Names of labor coaches were included on the actual document but omitted on this blog post... but then I added back the names of the midwife and doula on the argument that they are awesome and so, hey, why not give them a little free advertising? I also sent this to my sister and friend with stern warnings NOT to tell my mother that she has been listed as an alternate labor coach. I listed my mother in case my sister has to leave for Florida before Lentil decides to make her appearance... but I see no point in getting Mom's hopes up at this point!)

Birth Preferences

The following are a list of my preferences regarding labor, delivery, and postpartum/newborn care… recognizing that the care I am given will be adapted to the unique circumstances of my birth.

Thank you for doing your best to honor my preferences!

  • Please don’t offer pain medication. I will request it if I need it.
  • Please allow me to labor out of bed… therefore, please allow intermittent fetal monitoring (instead of being tied to a monitor) whenever possible. 
  • I prefer to avoid the use of Pitocin unless absolutely necessary (both during labor and immediately after birth)
  • Please allow me to take fluids by mouth, and to avoid IV fluids. I am an “easy stick” and prefer to avoid having a hep-lock as long as possible.  
  • I would also like to eat, if desired, during labor 
  • Please do not allow any uninvited people into the room without checking with me first. The following people will be present (but won’t all be there at the same time):
o   Catherine Clark – midwife
o   Chloe Campbell – doula
o   name omitted to protect the innocent  – sister, labor coach
o   name omitted – friend, labor coach
o   name omitted – mother (baby’s grandmother), alternate labor coach
  • I prefer my pushing to be self-directed with gentle encouragement from others, and to avoid breath holding/Valsalva  
  • I prefer to push in whatever position is comfortable, but to avoid lying on my back
  •  I strongly prefer to avoid an episiotomy, except in case of medical emergency
  • I would like immediate skin-to-skin contact with the baby, without having her cleaned off first.
  • Please avoid deep suctioning unless she is having breathing difficulties
  • Please delay the erythromycin eye ointment at least one hour.
  • Please wait to cut the cord until it has stopped pulsating (I am not banking cord blood)
  • If a C-section is necessary, please lower the screen as much as possible so I can see her birth. Please allow my friend or family member to hold the baby until I am able to… and let me hold her and breastfeed in the delivery room
  • If there are medical issues requiring the baby to go to the nursery or NICU for more intensive medical care, please allow my doula or labor coach to go with her.


  • I do not want the baby to go to the nursery at any time. She will room-in with me.
  • Please perform any required examinations or procedures in my presence. If there are medical procedures that must be done in the nursery, myself, my doula, or one of my labor coaches will be with her at all times.
  • Please do not bathe the baby. I would like to bathe her myself, preferably after birth. Otherwise I will wait until we get home. 
  • No bottles please. Pacifiers are okay.
  • No Hepatitis B vaccine.
  • I prefer to wait and see how I am feeling before deciding when I would like to be discharged 

(I don't know why the font/formatting looks a little wonky. I think it's a Blogger issue... shouldn't affect the actual document.)