4.27.17

 

Testing, testing.  Our last functioning laptop bit the dust the other day, so I took a giant leap(for me) and bought a mobile blogging app.  With 11 days to go until my stitches come out, I'm feeling a little manic energy around tying up all the loose ends before my hands are full of baby.  I've cleaned every closet in the house, washed the car seat, detailed the inside of my van(with help from my more-flexible-than-a-pregnant-body 12 year-old), ordered all the things from Amazon, and now I'm just trying to be patient. 

While I have no idea what it's like to watch a due date come and go, I imagine that waiting to go into labor is different for women who make it to term.  When my water broke with Lochlan at only 33 weeks, my first response was dread.  Now that I'm approaching 35 weeks I feel markedly less anxious, and while I feel super uncomfortable I'm content to wait and feel grateful for every day that this baby stays inside.  I'm excited to be done being pregnant and have room to breathe again, and I actively fantasize about guzzling ALL THE WATER right before bed with reckless abandon because I won't wake up to pee every hour, but having a history of preterm birth takes a lot of the pressure off of waiting.  I'll get to meet this baby soon enough, but hopefully not too soon. 

Lady in Waiting

So I'm pretty much the worst blogger in the world.  My favorite blogs to read are the ones that are frequently updated, and yet my own blog sits fallow, gathering dust. 

First and foremost, I'm sitting here seven months pregnant.  So much for using my blog to document important life events, but things are busy.  We are still homeschooling, the big boys are both in Scouts plus Matteas is doing baseball, and Lochlan is a total wild man.  Wilder than the other two boys were, and he and baby #4 are closer together than Jack and Matteas were.  Also, pregnant at 33 is not as easy as pregnant at 21 was.  Shocking, but true.

I debated about whether or not I was going to share this detail of my pregnancy, but I was talking to my sister Briana and she was all "You have to, for posterity!" I try to write the blog I'd like to read,  so in the event that my experience could possibly benefit someone else and/or in the name of writing at the level of sharing I like to read, let me tell you a little bit about my cervix.  In case you want to know.

Mine is over-eager, which is why I all my babies come early.  Technically, what I have is called an "incompetent cervix," or "cervical insufficiency."  We found out about it halfway through my pregnancy with Lochlan, but at that point the risks posed by surgical intervention are about the same as non-surgical options, so I chose the non-surgical route and ended up having a baby at 33 weeks.  Obviously he turned out fine, but we're really hoping to avoid the NICU and maybe even have a homebirth this time around.  At 14 weeks pregnant, I had a minor surgical procedure called a cerclage, during which my OB(same fabulous doctor who delivered Lochlan) stitched my cervix closed.  This does two things: 1) ideally, keeps my cervix from dilating prematurely and 2) will immediately alert me to any attempt at dilation because word on the street is that when your cervix had been trussed shut with surgical zip-ties, dilating is a painful and gory affair.  Something to look forward to!  Hopefully not.  The stitches come out on one of two occasions, the first being emergency removal if my body finds a way to go into labor early.  That's the sub-optimal option.  The second option, the one we're hoping for, is scheduled removal at 36 weeks, at which point my cervix is free to dilate away and I can deliver wherever I want.  We're getting close, but I'm also getting really nervous. 

I'm 32 weeks and four days today, and my water broke with Lochlan at exactly 33 weeks.  Premature labor tends to occur earlier and earlier, so the fact that I haven't gone into labor by now is really encouraging.  However, my Braxton Hicks decided to really step up their game today, and while I'm not having any bleeding or pain I'd identify as coming from my cervix, I'd just as soon prefer that my uterus calm down.  I've been taking it easy today and drinking lots of water, and ignoring the deteriorating condition of the house.  I've done most of my nesting already, so it's not too hard to just sit as much as I can.  Aaron came home and took Lochlan to Matteas' baseball game and is picking up takeout for dinner, and my plan is to lie in bed, read all the beautiful books I've been amassing, and order stuff for Easter on Amazon. 

Laryngo-whatnow?

After his fourth and final clipping, Dr. O'Hara referred us to an infant feeding specialist at Children's.  Although Lochlan's latch has improved dramatically, he still chokes every time he nurses and gets a belly full of air.

"Does he always breathe that fast?" asked the pretty, thoughtful therapist.

"Is he breathing fast?" I asked.

"Yes.  A normal breathing rate for a baby his age is 30-40 breaths per minute; he's doing about 60."

"Oh," I said, "then yes.  This is how he always breathes."

She held her tiny stethoscope to his throat as he nursed, or rather struggled to nurse, and listened to his swallowing.  She asked a lot of other thoughtful questions, each one pertaining to some quirk of his that I hadn't even told her about.  Then she told me that Lochlan has laryngomalacia, which literally means "floppy larynx." The short of it is that his airway collapses a lot, and that while eating he often has to choose between swallowing or breathing. This is good news and bad news.  The good news is: it is non life-threatening; it resolves with time; he will eventually be able to transition from bottles to breastfeeding.  The bad news is: it lasts until four months corrected age at least, possibly longer; it causes frequent choking during eating; it can cause severe reflux; it may take several months to resolve.

In a lot of ways, the diagnosis was a relief.  It explains why it takes him SO LONG to finish a bottle, and why he still struggles with breastfeeding.  Combined with his very sensitive gag reflex(a vestige of his tongue tie), the therapist said it's a miracle that he's not underweight, as most babies with his degree of issues are.  Sometimes when I know he's hungry, he'll gag on his bottle but cry when I remove it.  When that happens, I have to calm him down and then offer the bottle again by just barely tickling his lower lip with the very tip of the bottle nipple; it has to be his idea to pull the nipple into his mouth, or the gagging and crying starts all over again.  He's outgrown his stridor, but he still sometimes looks and sounds like he's drowning while eating, waving his arms and breathing more and more frantically.  It can look like hunger, but now we know he's struggling to breathe.  Previously, we were using Dr. Brown's bottles with a preemie nipple, but the therapist gave me some ultra-preemie nipples which are slower flow and he does better with those, as he can take in less milk per suck and give himself more time to breathe in between.  He also burns a lot of calories just to breathe and especially to eat, which explains why he's not obese despite taking in almost twice as many calories per day as most babies his age.  The therapist told me to imagine I'd just run at a very fast sprint, then had to drink from a garden hose that was on full-blast while tucking my chin into my chest.  That's what breastfeeding feels like to Lochlan.

I'm a little bit upset that this wasn't diagnosed sooner, especially since he's had the stridor since birth and he was looked at by so many doctors, nurses and lactation consultants during our NICU stay.  Stridor is the number one symptom, but he's got almost every single one on the checklist to go with it.  I mentioned his reflux to his doctors and nurses in the NICU, but they all told me that it was likely from his feeding tube.  The only real difference having a diagnosis would have made was that I would have had a better idea of what our long-term trajectory would be from the start, rather than waiting for resolution to be just around the corner.  Lochlan's infancy and all the issues that have come along with it have only strengthened my desire to be a doula in the future, particularly because I know how much energy it takes to advocate for yourself when you're navigating life with a newborn baby and a postpartum brain.  Also, one million points for mother's intuition.  Two different doctors clipped Lochlan's tongue, one in the NICU and one doctor I called on a recommendation, and they both declared he didn't need any further revision.  When his latch was still painful and not improving, I took him to a third doctor and she said his tongue was fine.  She recommended that I breastfeed him 4-5 times a day.  The feeding specialist at Children's told me to breastfeed him no more than twice a day, otherwise he'll burn too many calories.  If something doesn't feel right to you about your baby, seek a second opinion.  And a third and a fourth, if necessary.

So we keep pumping and waiting.  I'm glad to know what's wrong, and to know that he is thriving despite pretty substantial difficulties.  I'm also deeply reassured in terms of gauging my own experience; I still don't feel anywhere near recovered, and it turns out that nobody in my position would be.  His sleeping patterns are still wildly unpredictable, and if he has a choking episode in the night it gets adrenaline going in both of us which makes it hard to go back to sleep in a timely fashion.  It can sometimes take over an hour for me to give him a bottle, settle him back to sleep and then pump a bottle for the next feeding.  Some nights he'll wake up to eat at two a.m. and not go back to sleep until six.  Aaron has started staying home "late" two mornings a week so that he can take the 5-8 a.m. shift and I can get a reliable block of sleep.  The therapist asked me how I was surviving with such a high-needs baby on so little sleep, and I told her that I don't do anything else.  I basically have zero social life right now, and focus on

1. Feeding Lochlan
2. Not going crazy

That's not meant to be a complaint, as I mostly lack the capacity for a social life.  It feels stressful to have anyone over during the day, as I don't feel free to go back to bed with Lochlan when he goes down for his big nap and I often need all the sleep I can get.  Going over to a friend's house is stressful because I have to pack up my pump and all my supplies, and if I forget any vital pieces(like I did when we went to my in-laws for dinner) we have to go home.  Going anywhere at night is out of the question because I'm usually so tired I can't drive safely, plus Lochlan still has his moderate-to-deep unhappiness periods from 6-9 each evening.  And then the constant pumping.  I have to pump every three hours to produce enough food for Lochlan and keep my supply from diminishing, which poses obvious logistical difficulties.  If I'm out in public, the options are to go back to my car or stand in a bathroom stall and pump manually.  Lochlan also likes(demands) to be held every second that he's not sleeping, so if we're not home I have to either enlist someone else to hold my cranky baby or let him cry until I'm done, both of which feel stressful.  He's also happy about 10% of the time, and when he's not sleeping or eating he requires constant pacing and back-patting.  He prefers that I not sit down pretty much ever, so I'm being very, very gentle with myself and cocooning at home.  We are nowhere near back to normal and won't be for a long time, so I'm giving myself permission not to do anything that isn't absolutely essential.  Laryngomalacia, in addition to its other charming characteristics, puts Lochlan at an increased risk for complications like croup if he gets a cold, so I'm even less inclined to venture out in public or hang out with anyone else who has petri dishes germ factories kids.

Despite all that, I am madly in love with this baby.  His difficulties and challenges have made me even more present to his peaceful moments, which are few and far between but getting more frequent with age.  He has started to coo and sing me love songs which reduce my heart to total mush, and I know from experience that he will outgrow everything that's hard right now.  It's just a season.

Waiting for Normal

Lochlan is ten weeks old today!  I realized the other day that, as the third child, he is getting totally shortchanged on the blog.  I know I won't remember things as well as I think I will because postpartum sleep deprivation seems to color all my memories in a haze of fog, so I'm resolved to power through even though I've only had one cup of coffee today.

Nursing is still a work in progress.  He had his fourth tongue clipping on Monday and had it stretched on Thursday, so he has been extra-clingy but no one can blame him.  On his best day, he is not exactly what I would describe as "content," and no one has used the term "easy-going" about him.  Still, we are all pretty in love with him, especially Jack.  Lately we've discovered that Lochlan has special place in his heart for Jack, and he can usually calm him even when he's especially fussy.  He also has an uncanny knack for getting Lochlan to burp, which is difficult even for us veteran baby burpers.  We call it the "Jackie magic," and Jack is quite pleased with his new-found indispensability.
Lochlan loves the shower, but hates baths.  Not a fan of his car seat AT ALL, strongly objects to lying on his tummy after eating, and has a complicated relationship with his binky.  He weighs almost 11 pounds, and pees and poops constantly, especially when not wearing a diaper.  He loves to look at lights of any kind, though he clearly prefers white twinkle lights to colored(he's his mama's son).  He's on the verge of being able to "talk;" I can tell from the intensity of the faces he makes while he's staring intently at me, and his breathing gets really fast and he purses his lips and sticks out his tongue.  His eyes are very, very blue.

He is a pretty decent sleeper, considering.  He generally goes down for the night between 10 and 11, and wakes up every three hours until 6 or 7, when he gets fidgety and doesn't want to go back to sleep after eating.  That's when he gets to go hang out with Jack for an hour or two while I get a little more sleep, a discovery which has been fairly life-changing.  Mornings used to be pretty crazy since Aaron leaves for work around 5:30.  Lochlan is usually ready to get up for the day around 7:30, so I give him his bottle and then would put him on the bed next to me while I pumped, with varying degrees of success/crabiness.  Now, I feed him and then take him to Jack(who has been awake for some time already) and he watches cartoons while pacing around with Lochlan.  I make my coffee and take it back to bed with me, where I pump and cruise facebook in relative comfort and peace.  It is a luxury, and I bask in it because luxuries of any kind are few and far between these days.  The other night I was praying with the boys before bed, and I thanked God for each of my boys.  When I said "Thank you God for Lochlan," Jack added "even when he's cranky."  Indeed.

All things considered, I think we're all doing remarkably well.  Aaron and I are way better at having babies together than we used to be, and are enjoying Lochlan as much as we can for two people who can barely see straight by 8 p.m.  My physical recovery from this birth was fairly rapid(pre-pregnancy jeans, baby!), and postpartum hormones have been a little gentler with the aid of progesterone.  Incidentally, I think taking progesterone immediately after birth is also protecting my milk supply.  By the time Jack was this age, pumping wasn't enough to keep my hormones at bay and my cycle came back.  My supply tanked, and actually completely disappeared for one awful night.  I pumped and pumped and Jack cried and cried, but I didn't produce so much as a drop of milk.  I sent Aaron to the store for formula, but Jack refused to drink it.  He eventually passed out, and was too tired to wake up all night.  Early the next morning, I pumped and got 9 glorious ounces.  I was able to keep my supply going for another three months, but had to start supplementing with formula after that.

Lochlan is almost three months old, with no sign yet of returning fertility.  I'm sure I would have gotten my cycle back by now if it wasn't for progesterone, and even though protecting my milk supply wasn't the intended purpose of it I'm super grateful for that side benefit.  If nursing doesn't work out for Lochlan, I'm not sure how long I'll keep pumping.  I love that he's getting all the immune and digestive benefits of my breastmilk, but my goodness it's rough at night.  It takes so much more time and effort than just lying in bed and nursing.  Since he's my third baby, I'm less of a purist about how much formula he gets and when.  I can tell you from experience that knowing your baby isn't getting enough to eat is way worse than knowing your baby has a belly full of formula.  Still, we're going to try as long as we can.  He does actually nurse, but still gets so much air that he has a tummy ache for hours afterwards.  His latch improved dramatically after his last clipping, and I'm hoping that as he matures he will learn how to nurse more effectively.  Even if he never nurses, he likely would have had other difficulties as a result of his tongue such as speech issues, teeth crowding and excess cavities.  I'm ready to be done though.  We've been home for seven weeks, and Lochlan has had at least one doctor appointment a week and most weeks two.  I just want to stay home and snuggle my baby.  I feel like we never really got a "babymoon," because we were in the hospital for the first three weeks and after that Aaron had to go back to work mostly full-time.  I know bringing a new baby into the world is always a little difficult, but we've had more than the usual set of challenges and adjustments with Lochlan.  I'm so looking forward to "normal," like being able to go somewhere without having to be back in three hours to pump, or lugging all my pumping equipment with me.  We'll get there, eventually.

When Breast isn't Best

...or, "Why we're never leaving the house again."  Lochlan will be seven weeks old tomorrow, but technically he should've been born yesterday.  All the nurses in the hospital said that eating is usually the last hurdle for preemies, and while it was Lochlan's only hurdle we are still in the thick of navigating challenges.  Within a few hours of his birth, one of the nurses noticed that Lochlan was tongue-tied.  When he was about a week old, one of the neonatal doctors clipped his tie and we tried breastfeeding again.  He was able to take a whole ounce(which, at his current size, was a full feeding), but it was excruciatingly painful for me.  We'd given Lochlan a few bottles of my expressed milk, but he seemed to be actively offended by bottles so we mostly stuck to tube feeding and nursing.

Evergreen is a very pro-breastfeeding hospital, which I love.  To a point.  One of his nurses was so adamant about protecting Lochlan's breastfeeding instincts that he went so far as to hide Lochlan's bottle so the other nurses wouldn't offer it.  After another week went by and Lochlan still wasn't taking significant amounts at the breast, I had to tell that nurse politely but firmly that I was going to get my baby home any way I could, nipple confusion be damned.  I think he underestimated my stamina, fearing that if I started giving Lochlan bottles I'd never break the habit.  Had I insisted on waiting until Lochlan could successfully breastfeed before taking him home, we'd still be in the NICU.  Eventually they'd probably have kicked us out, because even after getting his tongue clipped three times Lochlan still isn't breastfeeding.

When he was about two weeks old and there was still no end in sight to our NICU stay, I decided to try bottles again.  Lo and behold, he took almost a whole feeding by bottle!  By his third day of bottle feeding, he was taking 100% of his food by mouth and his nurse had removed his feeding tube.  I still tried breastfeeding him sometimes, but now that he was bigger and stronger he could suck a lot harder and nursing felt like I was being stabbed with 1,000 white-hot needles.  That's not what nursing is supposed to feel like.  We tried a nipple shield, we tried different positions, we tried different cushions, but everything was painful.  I made a lot of phone calls and eventually found a doctor around the corner from Evergreen who could see us a week after we were discharged for an assessment, and the following week she clipped Lochlan's tongue for the second time.  He immediately began sticking it out further than he ever had, and we went home with a list of stretches for his tongue and a follow-up appointment for next week.

Meanwhile, I scheduled a lactation consultant for a home visit.  I highly recommend this.  A lovely woman named Joy spent about an hour and a half with us, gave us some additional tongue stretches(which are really more like games) and remarked that to her, Lochlan's tongue still seemed restricted.  I chose this particular lactation consultant because on her website she mentions that her own son was tongue-tied, so she had personal experience with what I was going through.  She asked me to let her know how Lochlan's follow-up appointment went, and to call her if breastfeeding remained painful.

At the follow-up appointment, the doctor declared that his tongue looked good and said to keep doing the stretches and come back in a week.  I said that breastfeeding was still as painful as ever, but she said it would take time and not to worry.  I've done a lot of reading on tongue-ties, and although Lochlan is my first tongue-tied baby I felt like his tongue was still doing a lot of the things that tongue-tied babies to.  I called Joy and described what I was seeing, and she said she would text Dr. O'Hara for me and tell her I needed to be seen.  Dr. O'Hara is the premier tongue-tie doctor in this area, and she is very, very difficult to get an appointment with.  She's so busy, she doesn't do initial consultations.  Your baby has to be diagnosed by another doctor or lactation consultant, and her entire practice is comprised of "complex" cases.  Lochlan is a complex case.  I scheduled an appointment with Dr. O'Hara, as well as another doctor who is also a lactation consultant.  I kept both appointments, and after a thorough exam and observing Lochlan breastfeeding the doctor/lactation consultant said she didn't think Lochlan needed further clipping, just cranio-sacral therapy.

A few days later, we saw Dr. O'Hara.  Thirty seconds into the appointment, she confirmed Joy's diagnosis and said Lochlan's tongue was still restricted and she would clip him that day.  That was Monday.  We went back for a follow-up today and she re-stretched the incision site(awful, awful, awful), but numbed it with some lidocaine first.  She said that the way it's healing is a little "fibrous," so she gave me some steroid ointment to keep the inflammation down and we go back again next week.  She said she would likely clip Lochlan a fourth time then.  I asked her how often she has to do multiple clippings, and at what point should I accept that maybe Lochlan will never breastfeed.  She said his tie is definitely on the more difficult side, but it's not uncommon for many of her patients to need multiple clippings.  She is such an amazing doctor to watch, and if I didn't trust her so much I'd give up and go buy formula right now.  She is the only doctor I've ever met who sings to babies while she examines them, and Lochlan seems almost as comfortable in her arms as in mine.

So we'll try one more time, but after that I think we're done.  I'll continue pumping breastmilk for Lochlan as long as I can, but eventually I know I'm going to need to sleep.  I'd also like to have a social life again someday, but in the event that I eventually have to start giving Lochlan formula I want to ensure that I left no stone unturned before deciding that he's never going to breastfeed.  I pumped for eight months when Jack was a baby, but I don't think I have it in me to do that again now that I have three kids instead of one.  Aaron said he's afraid that all our friends are going to think we don't like them anymore, so just to be clear, it's not you, it's me.  I just don't have the energy to go anywhere or have anyone over.  Pumping takes a lot of time, and when I'm not pumping I'm washing bottles and pump parts and trying to sleep.  My parents haven't held Lochlan, and my dad hasn't even met him.  In fact, my mom and two sisters are the only people in my family who've actually seen him.  I'm a pretty tough cookie, but right now all I can do is take care of my baby and try to keep my head above water.  Good thing he is such a delicious baby and I am so madly in love with him, because for now he's really the only person I hang out with :)

Loch one, Loch two, Loch Lomond

Surprise!  We're having a baby today(ish).

 On the morning of Wednesday, June 17th, I was standing in the kitchen minding my own business when my water broke.  I was 33 weeks pregnant, so this wasn't great.  All my babies have come early, but this was the earliest yet.  I'd been seeing a high-risk OB, but I'd just had an appointment on Monday and he declared that I was not showing signs of going into labor imminently, and I should go ahead and start planning my home birth for approximately four weeks hence.  With my last labor, exactly 90 minutes elapsed between my water breaking and holding a baby in my arms, so it appeared there wasn't a lot of time.  Aaron was working in Ballard and the boys were with me, so I called my brother-in-law who happened to be working nearby and asked if he could drive me to the hospital.  I hadn't had a single contraction yet, but I didn't want to risk delivering on the side of 405 while driving.  I hastily stuffed some clothes and a toothbrush into a bag, grabbed a snack and a stack of towels to sit on and got in the car.

At the hospital, an ultrasound confirmed that my water had broken and the baby was very much head-down.  Aaron and my cousin Shannon arrived soon afterward with snacks, and we settled in for whatever was in store.  I was still in the triage area at this point, and soon I had a few contractions.  When I told the nurse my labor history, she quickly got me into a room and got an IV going.  I was given a large dose of magnesium to stop the contractions, and a shot of steroids to help mature the baby's lungs.  I'd never had a magnesium drip before, and although the nurse tried to prepare me for how it would feel, words can't really do it justice.  Magnesium has a relaxing effect on smooth muscle tissue, including blood vessels.  In high doses, it causes rapid and intense flushing.  What it actually feels like is something I can only imagine is similar to being set on fire from the inside.  The nurse had filled a basin with icy water and washcloths prior to administering the magnesium, and I tried to lie very still and not panic while I directed Aaron to place cold washcloths on the parts of my body that felt most incendiary: "My feet, my feet!  Okay, now drape a couple across my calves.  Now my Adam's apple, wtf?!" It was a fun game for everyone.  Luckily, the most unpleasant sensations only lasted 25 minutes or so, then the dose tapered down to one third of the initial bolus.  My contractions stopped, I sent Shannon home until further notice, and gave Aaron a list of things to go buy(diapers, a car seat...).

I proceeded to have contractions slowly and sporadically, sometimes three hours apart, never closer together than 20 minutes.  They were mild, like bad period cramps, but came just often enough to keep me from sleeping at all that night.  I was also hooked up to a fetal heart rate monitor which kept slipping out of place every time I moved, so the alarm would start beeping and then my nurse would have to come in and try to re-position the monitor until it could read the baby again.  Magnesium slows the baby's heart rate and I was high-risk anyway, so taking off the super uncomfortable monitor wasn't an option.

The next morning, my OB's partner came in and checked me.  I'd had some bloody show, so it appeared that labor was still progressing albeit slower than my usual pace.  I was 4 cm dilated, so the doctor decided to keep the magnesium drip going in an effort to get a second dose of steroids into me(given twice, 24 hours apart).  Meanwhile, a neonatologist came down from the NICU to prep us for what we might expect once our as-yet-unnamed baby was born.  He told us that babies born at 33 weeks have very good survival rates with generally few complications, but they usually need to be in the hospital until they reach 38 weeks.  He went over the various forms of oxygen supplementation our son might need, and explained that some premies find touching too stimulating, so there was  chance we might not be able to hold him.  Upon his birth, there would be an immediate assessment and if he seemed stable enough, I could hold him for 20 minutes or so before he'd go upstairs to the NICU.  I told Aaron that if there was the slightest sign of trouble, I wanted him to baptize our son and made sure the doctors knew about this plan.  Then we waited.

And waited.

I made a labor playlist, and we discussed names.  I tried unsuccessfully to sleep, so instead I talked to the baby.  "Baby, mama needs a favor.  I know you're little, but I need you to be a fighter.  Daddy and I want you to be strong and healthy, and we want to take you home as soon as possible.  So I know you're not even supposed to be born yet and it's a lot to ask, but please, be our little warrior."

Around 9 p.m., I was still only have 2-3 contractions per hour, and I could still talk through them.  They felt slightly more intense than they had the day before, but didn't yet come all the way up to the top of my uterus.  However, I was beginning to feel surges of adrenaline in my legs, a feeling I recognized as transition.  I hit the call button and asked the nurse to check me.  She said they generally try to avoid stirring things up in women whose labors they are trying to stall.

"I know, and I appreciate that, but I have two concerns: one is that I'm still 4 cm and contracting just often enough to prevent sleep, and I'm coming up on 40 hours without sleep.  If I'm still 4 cm, I want an epidural so I can actually rest before having to birth a baby.  My other concern, the one I suspect is more likely the case, is that my lame contractions are, in fact, accomplishing something and I'm further along than anyone suspects."

She agreed to check me.  I was 7-8 cm.  Sneaky uterus.  The on-call OB came in and said "You don't want an epidural; you're going to deliver this baby within the next four hours, and your recovery will be so much better without one." (spoiler alert: he was right)

 My doctor arrived around 11 p.m., and we talked birth plan.  He wasn't on call that night and had already worked a full day at another hospital, but he'd promised me that he would come to my birth no matter what.  I love him.

Chatting, like you do.

 After a while, I felt the urge to push but my contractions were still so-so.  When I did push, I could feel the baby ramming into my pubic bone.  After a few pushes I declared that I felt like I was being hoisted by my own petard; the harder I worked, the worse it felt.  It was 11:45 p.m., and we all wondered if this baby was coming on the 18th or the 19th.  Then my contractions stopped.  Just disappeared.

"I need a chair," I said.

"For what?" my nurse asked.

"For lunges," I replied.  "I'm going to do lunges and get this baby under my pubic bone."

I actually said the words "Pants-off Dance-off!"

 The comparison was too obvious.  "Got a little captain in you?" I said.  I did, in fact, have a little captain in me, and I wanted him out.  The fact that I had not yet lost my sense of humor was an indication to me that labor was not yet fully underway.  So I did lunges for a while, then tried getting on all fours on the bed, then asked for and was brought a birthing stool(which, inexplicably, was bright purple and had actual glitter in it).  After a while I decided to just lie down again.  My doctor offered Pitocin, which I declined at first but after realizing that the magnesium was hamstringing my uterus I agreed.

 And then s*** got real.  Not as real as my other labors, but real enough to make a little progress.  I told my doctor that my contractions still felt pretty ineffective, so he asked if he could put his hand on my stomach for the next one.  The next day, he told me that he'd seen women have stronger Braxton Hicks than the contractions he felt in me.  I pushed, but I wasn't in a good place mentally.  I actively felt ambivalent about getting this baby out, knowing that my body was the safest place for him and that if I did succeed in getting him out, he was going to be taken from me.  Labor wasn't painful enough for me to want it to be over, and my contractions weren't really helping.  I decided to just get it over with, and started pushing hard.

That was a mistake.

I should've waited for the Pitocin to kick in more, because once I got the baby's head approximately halfway out, I ran out of steam and didn't have contractions to help me.  So the baby just paused there, head halfway out, not moving.

And that's when the screaming started.

With Jack, I remember grunting a lot during the pushing phase.

With Matteas, I was quiet and focused and barely made any noise at all.

With this baby, I felt like I was going to lose my mind if I didn't getsome relief from the terrible burning that felt like my entire body was being ripped open with a dull butter knife.

"Don't push," my doctor said.

"Then cut me open and get him the f*** out!!" I screamed.  "I can't not push, I need him OUT!"

 And then he was.  Pink and screaming, with the cord wrapped once around his neck, he arrived at 1:26 a.m. on June 19th.  He weighed in at 5 lbs. 1 oz., and his apgar scores were 8 and 9.  I don't remember Aaron cutting the cord, I just remember being so happy that he was screaming(functioning lungs!) and out of me.

World's Best Doctor.  Seriously.  He was so calm even when I swore at him, and went above and beyond so I could have continuity of care during a very stressful pregnancy.

Other than needing a few weeks to figure out how to eat, our baby didn't have any issues.  He never needed any oxygen support or meds, maintained his temperature consistently and gained weight well.  Every doctor who looked at him declared him mature for his age.  After 18 days in the NICU, we brought him home.

We named him Lochlan Rafael.  Lochlan means "warrior," and Rafael means "God has healed."

What a Girl Wants

When people found out I was pregnant with Jack, I received a broad range of responses.  Most of them were polite-if-reserved congratulations, some were wildly optimistic and supportive, and an unfortunate few were judgmental and cruel.  Some people seemed to feel a pressing need to let me know just how disappointed they were in me, and how very much they disapproved of my choices. This may come as a huge shock to those who offered them, but not a single one of those critical moral sermons was helpful. When I look back at the hard parts of that period in my life(and oh, it was hard), there was never one time when I thought "You know what would be a huge help?  If people were more judgmental."  

Why is it that we feel we have permission to offer moral commentary on the lives of people we see as sinners, when we don't do the same to the people we see as morally upright?  Never once in my entire married life has someone come up to me and said "Hey, I think it's really great that you and Aaron have sex.  Just so you know, you've got my approval." I know the circumstances are different, but I can't help but notice how context-dependent some people's responses have been to my first vs. my third pregnancies.  Without exception, everyone I've told has expressed excitement and support of this pregnancy.  Excitement and support were the exception with Jack.  What it highlights is not that people feel differently about this baby, but that they feel differently about me.  It strikes me as singularly anti pro-life to be kind and gracious to a married pregnant woman, but shaming and critical to an unmarried pregnant girl.  Isn't the baby the same?  (Spoiler alert: yes, the baby is the same.)

I think part of the challenge to practicing compassion is that we like a good old-fashioned conversion story, one with a clear Rescuer and a clear Convert.  We're comfortable with the story of the Wayward Girl who sleeps around, gets pregnant, meets a kindly priest or warm-hearted housewife and is rescued from the clutches of Planned Parenthood and her own ignorance.  The main plot point of that story is one of ignorance or misinformation: she didn't know better.  Now that we've set her straight, she can live a life of virtue and holiness.

What tends to make people uncomfortable is when the pregnant girl doesn't need rescuing, informing or converting.  I was, and still am, a practicing Catholic when I got pregnant with Jack.  Conversion wasn't an option, so the only path left that would ensure I knew I'd done wrong was to shame me.  I think what simply didn't occur to most people was that I was not wildly thrilled to be in my position, but no one asked me how I felt about it.  No one asked me much of anything, I was simply told.  I was told, among other things, that I most certainly had to give the baby up for adoption, that I had humiliated my family, that I clearly didn't have the sense to feel ashamed of myself, and, when I asked for discretion, that I didn't have the right to ask anyone to keep my "dirty little secret." By the way, these were all super helpful things to hear and brought me a sense of hope and encouragement in my darker moments.  

This is a great article that brilliantly illustrates the hierarchy of feelings in a trauma situation.  While not ever pregnancy is traumatic, every pregnancy requires hard work and every pregnant woman deserves support, period.

The whole experience has served as an overwhelming affirmation of my desire to become a doula.  I've experienced a wide array of circumstances and feelings surrounding pregnancy throughout my childbearing years, all of them helpful in cultivating the empathy and non-judgment that make a good doula.  Without my own suffering, I wouldn't understand as deeply the need for compassionate, non-judgmental support. I realize now that judgment has nothing to do with what you want for the other person, and everything to do with what you want for yourself.  If you're not the one who's pregnant, your personal feelings on the matter are neither central to the situation nor helpful to the woman actually experiencing the pregnancy.  Your negative feelings or righteous judgment will not serve her.  Your kindness will.  Be really honest with yourself about what your goal is: to let her know how wrong you think she is, or to help her move toward the best possible outcome?  Responding to her, not demanding that she respond to your feelings, is the only productive path. 

Thankfully, there were more people in my life who offered loving support than criticism, and I am forever grateful for them.  The thing that set them apart from the neutral or non-helpful responses was that they each extended their own version of the question my midwives ask me at each appointment: how can I best support you?

I want to issue an unconditional invitation: if you are pregnant and find yourself in need of support for any reason, please come sit on my couch and have tea with me.  I don't care if you're married, divorced, single, religious, or vegan; I want you to know that you deserve good things, that you are beautiful and loved, and that there is support available to you.  If you come sit on my couch with me I will most likely be in my pajamas, there will be a few dirty dishes in my sink, and my kids will have at least three fights while we're talking, but I will welcome you with open arms, whoever you are.