Pregnancy Number Two! And Other Ramblings

     Those of you who know me well, have already heard the news that Nic and I are expecting again. We found out when Vera was only eight months old, that next spring well will be the proud parents of two. They will be sixteen months apart. Part of me is terrified and the other part is thrilled. I am only eighteen months apart from my sister, and she is my best friend, so I can only hope the same is true for these two.

The pregnancy itself has been a bit of a roller coaster. It started out pretty typical; first the fear and excitement of having two under the age of two. Then the smell sensitivity and nausea set in. I could barely get out of bed, being more exhausted than ever in my life. Also, note at this time, not only am I pregnant, but I am full time nursing an eight month old who still wakes several times a night to eat.  Strangely though, around eight weeks, everything stopped. In a matter of 3 days, my nose went back to normal, I could eat again, and I was no longer exhausted. I did not feel pregnant anymore. I was also having some signs of miscarriage. I was totally convinced that I was no longer pregnant. I was waiting to loose this baby. I morned the loss of a child who I already welcomed into my family, and never got to meet. Then depression set in for about 2 weeks, I just moped around and accomplished nothing, barely keeping up with the normal everyday stuff. Crazily enough around 10 weeks, I started acting/feeling pregnant again. So, I just resigned myself to not know.... I did not know if I was pregnant or not. Nic knew though... the whole time he kept saying “you are so pregnant”.

Some of you might be thinking, well, why the heck didn’t you just get an ultrasound to know for sure?! I try to avoid unnecessary medical interventions as much as possible, so I just decided to wait. Eventually I would start getting fat, if I was pregnant, right? Also, I only had to wait a few more weeks until I could hear the baby’s heartbeat at home with a doppler.

This whole time, of about 2 months, Vera was progressively getting fussier. She started waking more and more at night. She got to the point of nursing (I am not exaggerating) every hour at night. And during the days she was usually cranky. This on top of me being physically and emotional exhausted from pregnancy, was beginning to make me loose my mind. I used to put her to bed and she would nurse to sleep in 10-15 minutes, now every night it was an hour and half long struggle of nursing and screaming, until she finally wore herself out. Because of her change in attitude we decided to put her on the scale and discovered that she had lost a pound. Poor little thing! She was crying because she was hungry! Boy, I felt like a real shame of a parent, when I figured that out.

Since I became pregnant, my milk has progressively slowed down. I tried many things to boost my milk supply, (herbs, pumping, eating special foods, hydrating) but nothing worked. So after about 8 weeks of beating myself up and stressing out about not making enough food to feed Vera, I gave up. We are now supplementing her diet with formula and donated breast milk. Since I made that choice, life is better, she is a different baby. She is happy most of the time. She goes to sleep without a struggle and sleeps better, and I sleep better. Even though much of the natural parenting world, has so much against formula and I personally do not like it; I know it is not the best food for my child, but now I have a new appreciation for it. Formula is not the devil, like so many out there think! I am actually quite fond of it at this moment, because when you have a hungry child, food, any food, is better than nothing.

     I felt sad about this choice for a little while, but she needs to eat. She is 10 months now, and starting to experiment with solids and I continue nursing her. At least she is getting some breast milk. I quit beating myself up over it, because this next little one must need the energy that was going into making that milk.

Now I am almost 13 weeks and feeling mostly great! I still hope to get more than 4 hours of sleep before the next kiddo arrives, but I am not sure that will happen. If any parents out there have tips on helping their kids to sleep for long periods of time, I’ll take them! However, If it involves the “cry it out” method, you can just keep it to yourself, something about that just goes against my soul, and I will not do it. I guess I’m not that desperate yet. 

Oh yeah, I forgot to mention, with Vera I was so sick I could not eat at all for the first 3 months. I survived on rootbeer and crackers. I lost about 7-8 lbs with her, in the beginning and I feel like that had a lot to do with why she was so small. So when I found out I was pregnant again, I made it my goal not to loose any weight, and so far I have only lost a pound. I seem to be showing much earlier too, so that’s cool.

Thats about all, I know it was a long rambling post, but it has been a long rambling 3 months, so that’s all I’ve got. 

The Superfood-Superdelish Green Smoothie

Although the color may be shocking, this smoothie tastes like pure tropical delight and is full of greens!

Ingredients:
1/3 Cucumber, peeled
1/2 Avocado, peeled
1 1/2 cups loosely packed spinach
1/4 cup wheatgrass
1/4 lime, peeled
6 frozen pineapple juice ice cubes
 A splash of pineapple or whatever type of juice you have, just enough to get the smoothie to blend.

 Toss it all in your blender, and wha-la, a delicious treat to drink.

My latest obsession...

     Lately I have been compiling a lot of research regarding the maternal/child health crisis in the United States.  The disparities in the current model of care versus evidenced based practice are alarming. I am appalled that we have access to amazing studies that support the midwifery model of care and yet, current obstetric protocols are based off of long standing opinions. 
  The first report that I would like to highlight is the Milbank Report. The Milbank Memorial Fund puts together reports to improve health by supporting evidence-based practice in all fields of health care. "The Fund has engaged in nonpartisan analysis, study, research, and communication on significant issues in health policy since its inception in 1905."

   The specific Milbank report I have been blown away by is Evidence-Based Maternity Care: What it is and What it Can Achieve. It discusses the paradoxical system we have set up in the US. We (the current medical system.... not midwives!) do more interventions that are known to cause harm and do less of the interventions that we know are beneficial. If we know theses things then why do we continue to do them????? 
     Money is why. "The present system of payment for maternity care provides strong incentives for inappropriate care of healthy childbearing women." This includes overusing technology to achieve provider goals.... get the women in and out with the least amount of time(money). Also, since providers are often paid for all OB care in a total package fee, those who take the time to allow a woman's body to do it's thing naturally (which we all know can take a long time), are not reimbursed for their time or effort.
     So if you want to talk about health reform, this is where it should start. Pregnancy/childbirth/newborn care is the number one reason for hospitalization in the US. Six of the top 15 hospital procedures are related to childbirth. “Mother’s pregnancy and delivery” is the most costly hospital condition for both Medicaid and private insurers, followed by “newborn infants.” These conditions are associated with 27 percent of hospital charges to Medicaid and 15 percent of hospital charges to private insurers." If you do not have children and think this this does not apply to you, you are wrong, as long as you pay taxes in this country it involves your money paying for these poor outcomes. 


    Not only do we spend twice as much on maternal child health, than any other country in the world, we have terrible outcomes. "World Health Statistics 2010 identified 33 countries with lower maternity mortality ratios than the United States, while 37 countries had lower neonatal mortality rates, 40 had lower infant mortality rates, 65 had lower low birthweight rates, and 32 had higher rates of exclusive breastfeeding to at least six months". See this Maternity Care Fact Sheet produced by the Childbirth Connection for many more shocking statistics.
     If you are not a research junkie, like me, and do not plan on reading the entire report I would like to highlight the interventions that are overused and have associated risks: induction, epidural analgesia, cesarean section, continuous elelectronic fetal monitoring, rupturing membranes, and episiotomy. I would like to make note that these interventions are needed in specific situations, however not to a majority of women. The over-use of these interventions exposes women and babies to risks with little to no benefit.  


Please note the differences in intervention rates: 

   
     The things that we know have benefits with little or no risks are: USING MIDWIVES or Family Physicians. "A systematic review comparing provision of prenatal care led by midwives and/or general practitioners and by obstetricians found that the differences in outcome favored midwives and general practitioners, who were associated with reduced likelihood of pregnancy-induced hypertension and preeclampsia, greater satisfaction, and lower costs (Khan-Neelofur, Gülmezoglu, and Villar 1998)." Other under-used interventions that midwives often promote are: prenatal vitamins, smoking cessation,  ginger for nausea or vomiting,  preventing pre-term birth, external version for breech babies, practices to increase women's satisfaction with care, continuous labor support, measures to relieve pain, bring comfort, and/or promote progress during labor, delayed and spontaneous pushing, non-supine positions for giving birth (not on their back),  delayed cord clamping, early skin-to-skin contact, breastfeeding initiation support, interventions to reduce newborn pain, and interventions to reduce post-partum depression.  
    

    Another report to check out is Deadly Delivery released in 2011 by Amnesty International. It puts more of a human rights spin to the heath care crisis.

     All I can say is if you are pregnant or planning to become pregnant, you should not go into the health care system blindly expecting to receive the highest quality care.  Educate yourself and take responsibility for choosing a health care provider that has your interests in mind, and of course, I would say that is a midwife!

Somehow, I have done it again.... Filled my life so full of craziness, that I cannot seem to find time to blog. The original idea behind starting this blog was that it would force me to sit down and reflect on life. Oh well, maybe I will begin to find the time. Until then, here's some tomatoes:) Yes, homegrown.

My almost green thumb.....

I started some seeds a few months ago, and they did pretty well as seedlings, but they have been needing transplanted for a long time.  Since Nic has been so busy at work, we couldn't find the time to get them in the ground. But his parents have been here for the past week, and Elston built me an awesome planter. I have tomatoes in the top row (and 7-8 little green tomatoes), cucumber and zucchini in the middle row, and lettuce, spinach, and herbs in the bottom box planters. I gave up on my cucumbers a few weeks ago and pretty much left them to die. Just as I was about to through them out, I found this! Yes, those sickly looking plants in the middle of my planter, are growing little baby cucs. I don't know how they are still alive, but I'm going to be feasting on those beauties.

Colic Remedies (part one)

  Of course as soon as I posted "living with a colicky baby" hoping that we were past it, Vera had another one of those nights where we questioned if we should take her to the Emergency Room. It has now been a few weeks since we last had that thought. I will start by saying that all of these worked a little, but none of them worked very well and most of the relief was very short lived. Hopefully in my desperation and research I came across some valuable information that can help another crying baby.

swaddling, shushing, and different swinging movements: This is based off of the theory by Dr.Karp the author of The Happiest Baby on The Block.  He claims that human babies are born "early" and immature.  For the first 3 months or so of life, babies crave an environment that mimics the womb. He has written about out the 5 basic calming actions for newborns. "The 5 S’s: Five simple steps that trigger the calming reflex (swaddling, side/stomach position, shushing, swinging and sucking). " For more information you can check out his website.  There are plenty of videos of him online "magically" calming fussing babies, however these techniques did not work for Nic or I. We did find some solace in swinging Vera though the air while simultaneously shaking her butt.... there's no way to explain it other that seeing it in person. Really only Nic had this motion down and it worked for about 20 seconds:)

Different nursing positions and breast rotations:  At one point, pretty early on,  I had an "oversupply" issue; I was making so much milk that it was like she was trying to sip out of a fire hydrant. I would wake up in puddles of milk, shower her (and anything else in a 2 foot radius) with milk during feedings, and leak milk continually.

 I found this awesome article on  La Leche League's website, that cued me into looking at oversupply as a reason for Vera's crying. She met almost all of the common symptoms associated with this: (from LLL)

• Baby cries a lot, and is often very irritable and/or restless
• Baby may sometimes gulp, choke, sputter, or cough during feedings at breast
• Baby may seem to bite or clamp down on the nipple while feeding
• Milk sprays when baby comes off, especially at the beginning of a feeding
• Mother may have sore nipples
• Baby may arch and hold himself very stiffly, sometimes screaming
• Feedings often seem like battles, with baby nursing fitfully on and off
• Feedings may be short, lasting only 5 or 10 minutes total
• Baby may seem to have a "love-hate" relationship with the breast
• Baby may burp or pass gas frequently between feedings, tending to spit up a lot
• Baby may have green, watery or foamy, explosive stools
• Mother's breasts feel very full most of the time
• Mother may have frequent plugged ducts, which can sometimes lead to mastitis (breast infection)

     When a woman has too much milk, the baby drinks proportionately more foremilk which is high in sugar/low in fat. The breakdown  of the sugar produces more gas for the baby and the low fat content of the milk results in green stools. One remedy is to change nursing positions to slow the flow of milk. A few positions I found helpful were, nursing while reclining or having her lay on top of me, essentially forcing her to nurse against gravity. I found these to work somewhat, but it was impractical to lay down every time she wanted to eat. Another option, is to let her latch on until my milk lets down, then let an ounce or two of milk spray out until the flow is much slower. With these techniques she would nurse longer and get more of the high fat hind milk. 

     What made the most of a difference was adjusting breast rotations to actually decrease my supply (I do not recommend this unless you are SURE it's an oversupply issue). One thing that is recommended is to offer only one breast per feeding. Vera was already eating only one breast at a time and she never came close to finishing it. Since I still had an abundance of milk, I only switched breasts after  2-3 feedings. After a few weeks, my milk went down to a much more manageable amount. Making sure she empties the breast completely before switching, ensures that she receives more of the high fat hindmilk . After doing this, I did notice a change in her stools, they had more consistency and were getting back to yellow.

    

Chiropractic care:     

    When I first head of infants being adjusted by a chiropractor, I will be honest, the idea freaked me out. I imagined their little joints cracking and breaking.  But once I saw a baby being adjusted and realized that babies are not adjusted like adults, I became open to the idea. The theory is that during the birth process, the baby's spine/skull can be misaligned and this leads to digestive issues, ear infections, restlessness, and colic. By seeing a chiropractor their spine can be realigned and they are relieved of the issue. 

     The first time I took Vera, she was content being adjusted. The chiropractor held her and gently massaged and realigned her head, stomach, back, and hips. Vera loved it and seemed to have instant relief. She slept for almost the whole day and night after that. However, the next day the crying continued. I took her back to see the chiropractor 3 or 4 times after that and it did not seem to improve the colic, so I quit going.  I have heard of chiropractor care making a world of difference for other babies, but I did not see the same results.

Prone sleeping, positional changes, inclined sleeping (note on mattress): 

    The link below I found extremely helpful. It is AAP's guidelines for the treatment of Gastroesophageal Refulx Disease. It gave me a pretty good idea of what typical western medicine treatments are for reflux, and enabled us to make an informed decision on if we should take Vera in to the doctor. 

American Academy of Pediatrics Guidelines for Evaluation and Treatment of Gastroesophageal Reflux in Infants and Children

Some helpful tips I learned, sifting through this 30 page document:

• The typical treatment is removal of milk products (via formula or the mother's diet) and acid suppression medication.
• The common practice of thickening milk with rice cereal decreases vomiting, but does not improve acid levels in the esophagus.
• Infants have 50-80% less reflux while in a prone (stomach down) position, however this is not recommended for sleeping because of the increased incidence of SIDS associated with prone positioning.  (side note: There is a major campaign in the US for putting infants "back to sleep". However, there is a study that links the prone positioning to SIDS because of off-gassing mattresses. When the infant sleeps face down, they inhale theses low lying gasses, which leads to SIDs. In New Zealand they have almost completely eradicated  SIDS by placing covers on infant mattresses. I hope to write more on this later. Because of this, I feel fine allowing Vera to sleep in the prone position, on my chest or on a non-off-gassing mattress.) In all honestly, the prone positioning after eating and while sleeping is what made the biggest impact decreasing Vera's crying episodes. Lying flat on her back was the worst position, and we completely avoided it for months.
• The semi-supine position (like in a car seat), exacerbates GERD, explaining why Vera hates the car seat.
• Breastfed infants have lower levels of acid in the esophagus compared to formula fed

At 4 months of age, the colic and uncontrollable crying decreased dramatically. Now, Vera is 5 months old, and she had not had one of those crying fits in quite a while. Since it finally seems over, I am finding it difficult to be motivated to write about, however I hope to finish the second half of this post soon.

Living With a "Colicky" Baby

    
 I have always questioned the idea of a "colicky" baby. I firmly believe that babies cry for a reason, and since it is their only mode of communication, it should not be disregarded.  Because I hold this view, it has been a day and night struggle to find out why my child is crying. I can only sit down to write this now, because the worst of it seems to be over..... she is peacefully sleeping in the other room. Contrary to the old views common to my grandparents generation, I know that her cries were not simply “to exercise her lungs” or “get out extra energy”.
 
     The first three weeks of Vera's life, I thought parenthood was a breeze. She would eat and sleep, she caught on to EC (elimination communication) habits, made the sweetest little baby sounds, cuddled up to anyone, and rarely cried. I was already thinking of the "next" kiddo and wondering when I could get pregnant again. 

           About the time Vera turned three weeks old, she began to have crying episodes in the evenings. The beginning of the "colickly" stage started with me having to stay up late with Vera until she went to sleep. She would sleep for an hour, wake up clearly uncomfortable, fuss for two hours, and repeat the cycle until morning.  I was always tired, and could barely cope with the days.  Feeling continually exhausted, I would break down in tears. I remember having thoughts that I missed my old life, didn’t like being a mother, couldn’t take it anymore, and worst of all that I didn’t like my daughter.  I almost do not want to admit that I felt that way, but it's the truth; sleep deprivation can play tricks on your mind. Then I would cry from the guilt associated with the thought of not liking my precious newborn baby.   Most of the time though, when she would cry, I would cry. There was something about her being inside me for 9 months, I could not separate her feelings from my feelings.  Poor Nic, not only was he dealing with a crying newborn, but on top of that he had to support his crying wife. He is always the strong one, it was much easier for him to think clearly in those moments. Other feelings I had included: desperation, helplessness, fear, anger, and apathy.  At one point my sympathy just ran out, I had felt so bad for her for so long, I just could not feel anymore.

She would cry, unconsolably, for 1-3 hours and sometimes, after a little break, she’d cry for another 1-2 hours. It seemed like everyday, however, it was probably only 5 days a week. On multiple occasions Nic and I seriously considered taking her to the emergency room, which is a BIG deal, since we try to avoid doctors at all costs, hence having her born at home. 
     
     We self diagnosed Vera with Gastric Reflux. We came about this diagnosis because anytime we would lay her on her back she would gurgle, spit up, and the fit of rage would begin. She would scream at a decibel that was clearly due to pain. While this was occurring, she would cough, hold her breath, and clench her fists near her neck.
     
     When she was about 6 weeks old, her aunt Val and grandma Melody were on their way up to visit. I remember feeling like I didn’t want any visitors because I didn’t want them to see what a bad mother I was. I also didn’t want to take her anywhere, because I feared that if she started crying I wouldn’t be able to soothe her. I was afraid if people knew how upset she was, they would see what a failure of a mother I was.  As a midwife I frequently helped other mothers figure out what was going on with their crying newborns, but everything I tried for my own child was not working. I knew, in theory, I had everything she needed; however because I could not soothe her, I felt like a complete failure. 

In our desperation to help Vera we tried many things: 
(For my next post, I plan on going over these, and results I saw)

• swaddling, shushing, and different swinging movements
• Different nursing positions and breast rotations
• Chiropractic care
• Gripe water
• Colic calm
• Prone sleeping, positional changes, inclined sleeping (note on mattress)
• Tummy time
• Praying over her, repenting for any hurt feelings
• Dietary changes
• Probiotics
• Elimination diets
• Allergy testing
• Mylicon drops

      I now know that I am not a failure of a mother. Now that she seems to be over that part of life, I am so thankful that we did not go to the emergency room. Please note, we are not totally against western medicine, it has it’s place. If Vera had not been gaining weight, or had any other signs of ill health we would have taken her to get checked out. Primarily, we think western medicine over-medicates and does not address the  root of the problem.  I am glad that she is not on medications that could potentially cause long term damage to her little body. Most of all I am glad that I was with her through that hard time. Not once did I abandon her, I never gave up,  and she was never left to “cry it out”. That’s my advise to anyone with a crying baby, if you have done everything you can to help them, and nothing works, then just hold them.  Let them know that no matter what, no matter how terrible they feel or how loud or long they scream, you will still be there.