6 months in!
Wednesday, March 31, 2010
Sunday, March 28, 2010
Friday's Appt. and Questions to ask the OB
Friday's appointment went well. Tray's heartbeat is still strong and everything looks good. Well, everything except that I'm measuring big. For the second visit in a row, the size of my belly is bigger than it should be. Granted, the OB uses a fabric measuring tape so that measurement is quite crude. If I continue to measure big at next month's appointment, I will have to have another ultrasound. (Side note: With a totally normal pregnancy, the last ultrasound is at 20 weeks! Can you believe that? They don't look at the baby again until s/he is born!)
I know Tray and I just went through a growth spurt so that may explain why I'm measuring big. At our February appointment (19 weeks), I'd only gained a total of 7 pounds, which is under where I should have been. At this appointment (24 weeks), I'd gained a total of 12 pounds (up 5 pounds), which is right around where I should be.
One of the big decisions we recently made was to hire a doula for my labor. A doula is a labor support person for the mother. They offer pain coping techniques including massage, counter-pressure, relaxation exercises, birthing pool, etc. for the duration of the labor. Typically, they also offer support postpartum in the form of home visits and 24 hour phone support for up to 2 months after birth. We met with the doula we eventually hired a couple of weeks ago and Matt and I both really like her. She's a mother of three, a distance runner, a writer, a brand new yogi (like us!), and the former director of the Seattle Midwifery School (which means she's also a midwife, although, she will only act in the capacity of a doula for us). It was very helpful to hear her perspective after assisting at over 300 births!
The hope is that we will labor at home for as long as possible with her assistance. She will bring all of her doula toys (birth ball, birthing pool, rebozo, hot/cold packs, scented oils, etc.) to help us try to meet this goal. (This is, of course, assuming a totally healthy pregnancy and no potential issues.) Ideally, we will birth at home until 6-8 cm of dilation. The hospital is a short 10 minute drive from here, so we will be in a good position to get there sooner if necessary. The ultimate goal is a natural birth, without intervention or drugs but in the hospital with our OB (sounds like an oxymoron in this day and age). This is just a goal and we are well aware of all that lies on the other side of the spectrum. We want to be prepared for all possible outcomes.
At Friday's appointment, we got to have a conversation with our OB about our doula. We were also able to ask our OB several questions our doula brought up during out meeting. First off, our OB is very friendly to the idea of a doula and has worked with doulas in the past (she even gave us a sheet of recommended doulas last time we asked). She's also aware that if we were living in a European or an Asian country, there's a 90% chance we'd be giving birth with a midwife, as OBs are only used for high-risk pregnancies in the vast majority of the world. All and all, our OB is about the best doctor we could ask for right now. The only problem is that she works in a hospital and hospitals follow strict protocols. Let me explain.
Like all of medicine, protocols are developed out of research. Medical research is most often based on the bell curve. Medicine looks at the distribution of a given scenario and a protocol is instituted for the mean (the average) of that distribution (the very top of the curve). So, for example, with a woman in labor, the protocol might be to put her on pitocin (a synthetic version of oxytocin which is what your brain is producing to get your body to start contractions) after ____ hours without natural contractions. The protocol is applied to all women at a certain number of hours (whatever the protocol is), with very little variation. The problem is that variation exists in the real world (as the bell curve proves). On a bell curve, the mean is just the very top of the curve. 50% of people fall on one side of that inflection point and 50% of people fall on the other side of that inflection point (i.e. some women will experience natural contractions much sooner than the average and some women will experience natural contractions much later than the average). But everyone gets treated the same because that's how medicine is able to minimize risk and how hospitals are able to keep up with the demand. Our OB, despite her desire to give us the birth experience she knows we want, will ultimately have to follow the protocol at our hospital, more or less.
In the scenario of a woman without natural contractions, say 8 hours after her water breaks, the hospital will put that woman on pitocin to minimize risk for infection and speed up the labor process. A midwife would let that woman continue to labor at home unless there was some reason for alarm. Pitocin exists for a reason, absolutely, but too often it is applied to nearly every woman who walks though the doors of the labor and delivery ward, before seeing what her body is naturally capable of. However, the real problem with all of the interventions that occur at a hospital during the labor process is that one intervention leads to another, which leads to another, and to another. It can be a very slippery slope. Historically, the ultimate goal of obstetrics was a healthy baby, and protocols were developed in response to that goal. From my perspective, the real goal, however, should be a healthy baby and a healthy mother.
There was an article in the NY Times earlier this week about the c-section rate in the United States. The World Health Organization recommends that the average c-section rate in any country should be no higher than 15%. The c-section rate in the US is now at 32%. One in every 3 women gets a c-section!! Some states are as high as nearly 40%! It used to be that a c-section was only performed as a life saving measure. Now, if I wanted to, I could elect to have a c-section (elective c-sections are probably only a very small percentage of the 32%). I totally see the benefits of a c-section and I can understand why they are performed. But, again, I don't want to be forced to have a c-section because of protocol alone.
The hospital where we will deliver had a c-section rate of 34% in 2008. The flaw in that statistic is that our hospital has one of the best neonatal departments in the state. They see more high risk pregnancies than other hospitals which drive up their total. We asked our OB what her c-section rate is. The last time they measured, as a group (there are 8 female OBs total), they were around 13-15%. We asked our OB how often she delivers her own patients. She's on call one night a week, which means that if I deliver in the middle of the night, I have a 1 in 7 chance that my OB will be the one who delivers our baby (good thing her partners share a similar philosophy!). For daytime deliveries, she's on call 5 days a week (meaning she runs from the office to the hospital (next door) to deliver her patients throughout the day). Overall, she says there's a 60% chance she will deliver our baby. I asked our OB about birthing positions. When a woman gives birth on her back (how most hospitals require a woman to give birth), her pelvis is 33% smaller than if she was squatting or bending over (the baby passes through the pelvis). Our OB says she has delivered babies in all kinds of positions but, typically, once a woman has an epidural, she's required to lay flat so most women give birth lying down. If I'm able to make it through labor to the pushing phase without an epidural, I hope to get into whatever position feels best at that time. Obviously, that position is TBD, but it's nice to know that I may be able to do something other than lay in bed.
The more research we do (books, documentaries, etc.), the more we are glad that we're getting the big picture. We will give birth with an OB in a hospital and that is reassuring in many ways. But we will also have our doula with us and she will know what type of birth we want and she will advocate for us, which becomes especially important when you end up with labor nurses you've never met before and an OB you've never seen because yours is off duty. Also, studies have shown that doulas decrease the likelihood that you will end up with an epidural, a c-section, etc. Ultimately, we don't know what the labor experience holds for us and, more than anything else, we're trying to prepare for that unknown equipped with as much knowledge as possible.
I know Tray and I just went through a growth spurt so that may explain why I'm measuring big. At our February appointment (19 weeks), I'd only gained a total of 7 pounds, which is under where I should have been. At this appointment (24 weeks), I'd gained a total of 12 pounds (up 5 pounds), which is right around where I should be.
One of the big decisions we recently made was to hire a doula for my labor. A doula is a labor support person for the mother. They offer pain coping techniques including massage, counter-pressure, relaxation exercises, birthing pool, etc. for the duration of the labor. Typically, they also offer support postpartum in the form of home visits and 24 hour phone support for up to 2 months after birth. We met with the doula we eventually hired a couple of weeks ago and Matt and I both really like her. She's a mother of three, a distance runner, a writer, a brand new yogi (like us!), and the former director of the Seattle Midwifery School (which means she's also a midwife, although, she will only act in the capacity of a doula for us). It was very helpful to hear her perspective after assisting at over 300 births!
The hope is that we will labor at home for as long as possible with her assistance. She will bring all of her doula toys (birth ball, birthing pool, rebozo, hot/cold packs, scented oils, etc.) to help us try to meet this goal. (This is, of course, assuming a totally healthy pregnancy and no potential issues.) Ideally, we will birth at home until 6-8 cm of dilation. The hospital is a short 10 minute drive from here, so we will be in a good position to get there sooner if necessary. The ultimate goal is a natural birth, without intervention or drugs but in the hospital with our OB (sounds like an oxymoron in this day and age). This is just a goal and we are well aware of all that lies on the other side of the spectrum. We want to be prepared for all possible outcomes.
At Friday's appointment, we got to have a conversation with our OB about our doula. We were also able to ask our OB several questions our doula brought up during out meeting. First off, our OB is very friendly to the idea of a doula and has worked with doulas in the past (she even gave us a sheet of recommended doulas last time we asked). She's also aware that if we were living in a European or an Asian country, there's a 90% chance we'd be giving birth with a midwife, as OBs are only used for high-risk pregnancies in the vast majority of the world. All and all, our OB is about the best doctor we could ask for right now. The only problem is that she works in a hospital and hospitals follow strict protocols. Let me explain.
Like all of medicine, protocols are developed out of research. Medical research is most often based on the bell curve. Medicine looks at the distribution of a given scenario and a protocol is instituted for the mean (the average) of that distribution (the very top of the curve). So, for example, with a woman in labor, the protocol might be to put her on pitocin (a synthetic version of oxytocin which is what your brain is producing to get your body to start contractions) after ____ hours without natural contractions. The protocol is applied to all women at a certain number of hours (whatever the protocol is), with very little variation. The problem is that variation exists in the real world (as the bell curve proves). On a bell curve, the mean is just the very top of the curve. 50% of people fall on one side of that inflection point and 50% of people fall on the other side of that inflection point (i.e. some women will experience natural contractions much sooner than the average and some women will experience natural contractions much later than the average). But everyone gets treated the same because that's how medicine is able to minimize risk and how hospitals are able to keep up with the demand. Our OB, despite her desire to give us the birth experience she knows we want, will ultimately have to follow the protocol at our hospital, more or less.
In the scenario of a woman without natural contractions, say 8 hours after her water breaks, the hospital will put that woman on pitocin to minimize risk for infection and speed up the labor process. A midwife would let that woman continue to labor at home unless there was some reason for alarm. Pitocin exists for a reason, absolutely, but too often it is applied to nearly every woman who walks though the doors of the labor and delivery ward, before seeing what her body is naturally capable of. However, the real problem with all of the interventions that occur at a hospital during the labor process is that one intervention leads to another, which leads to another, and to another. It can be a very slippery slope. Historically, the ultimate goal of obstetrics was a healthy baby, and protocols were developed in response to that goal. From my perspective, the real goal, however, should be a healthy baby and a healthy mother.
There was an article in the NY Times earlier this week about the c-section rate in the United States. The World Health Organization recommends that the average c-section rate in any country should be no higher than 15%. The c-section rate in the US is now at 32%. One in every 3 women gets a c-section!! Some states are as high as nearly 40%! It used to be that a c-section was only performed as a life saving measure. Now, if I wanted to, I could elect to have a c-section (elective c-sections are probably only a very small percentage of the 32%). I totally see the benefits of a c-section and I can understand why they are performed. But, again, I don't want to be forced to have a c-section because of protocol alone.
The hospital where we will deliver had a c-section rate of 34% in 2008. The flaw in that statistic is that our hospital has one of the best neonatal departments in the state. They see more high risk pregnancies than other hospitals which drive up their total. We asked our OB what her c-section rate is. The last time they measured, as a group (there are 8 female OBs total), they were around 13-15%. We asked our OB how often she delivers her own patients. She's on call one night a week, which means that if I deliver in the middle of the night, I have a 1 in 7 chance that my OB will be the one who delivers our baby (good thing her partners share a similar philosophy!). For daytime deliveries, she's on call 5 days a week (meaning she runs from the office to the hospital (next door) to deliver her patients throughout the day). Overall, she says there's a 60% chance she will deliver our baby. I asked our OB about birthing positions. When a woman gives birth on her back (how most hospitals require a woman to give birth), her pelvis is 33% smaller than if she was squatting or bending over (the baby passes through the pelvis). Our OB says she has delivered babies in all kinds of positions but, typically, once a woman has an epidural, she's required to lay flat so most women give birth lying down. If I'm able to make it through labor to the pushing phase without an epidural, I hope to get into whatever position feels best at that time. Obviously, that position is TBD, but it's nice to know that I may be able to do something other than lay in bed.
The more research we do (books, documentaries, etc.), the more we are glad that we're getting the big picture. We will give birth with an OB in a hospital and that is reassuring in many ways. But we will also have our doula with us and she will know what type of birth we want and she will advocate for us, which becomes especially important when you end up with labor nurses you've never met before and an OB you've never seen because yours is off duty. Also, studies have shown that doulas decrease the likelihood that you will end up with an epidural, a c-section, etc. Ultimately, we don't know what the labor experience holds for us and, more than anything else, we're trying to prepare for that unknown equipped with as much knowledge as possible.
Wednesday, March 24, 2010
23 weeks!
I know I've been slacking on updating this blog. I'll try to be better in the future! Here's a picture of me from this morning at 23 weeks. We go in for our 6 month check-up on Friday and we're looking forward to hearing Tray's fast little heartbeat again. I haven't been sleeping well lately and when I wake up in the middle of the night, it's been harder to fall back asleep because of all of the activity in my belly! This kid *really* likes to punch and kick his/her mama!
I can't believe I'm nearly done with the second trimester!!
Wednesday, March 17, 2010
22 weeks
My belly seems to have grown a lot in the last week! If you compare my 19 week photo to my 21 week photo, strangely enough I look much bigger in my 19 week photo. And so, perhaps, that is why I look even larger this week!
This photo was taken on our way to yoga class, which we are loving! We only have 2 weeks left in our yoga series. We plan to start looking for a drop-in course to attend once a week starting in April.
This photo was taken on our way to yoga class, which we are loving! We only have 2 weeks left in our yoga series. We plan to start looking for a drop-in course to attend once a week starting in April.
Saturday, March 13, 2010
Pendant lamps for Tray's room
This morning we were up by 8am to head to the gym. While Matt was in his spin class, I took a little 3 mile jog in the early morning sunshine. It was absolutely beautiful but very cold (40 degrees)! I love my morning run with the Olympic mountains and Lake Union as a backdrop, even if I do run a lot slower than I used to!
After our usual Saturday morning after-gym routine (Whole Foods for iced coffee and a breakfast burrito), we spent several hours cleaning and purging. It seems like we make a run to the Goodwill at least once a month these days! Next, I got started on my to-do list while Matt made fresh baguettes!
During our last trip to IKEA, we bought 2 different lamp pendants to try out in the nursery: the knappa and the skimra (don't you love IKEA product names?). Although we have hideous can lighting throughout our house, we recently discovered an adapter that converts a can light into a pendant. We've already hung pendants using this adapter in 6 different places in our house. So, after our neighbor, Ter, generously delivered his ladder up 2 flights of stairs to the nursery last night, we were all set to turn the 2 can lights in Tray's room into pendants too!
Without even trying the skimra shades, we decided on the knappa shades. We weren't sure if 2 knappa shades would be too much for the small room but with vaulted ceilings, we found the room was easily able to handle both. Using the adapter really is the simplest process. It takes all of about 5 or 10 minutes to do the conversion (and the more times you've done it, the easier it is).
Here's the finished product:
And that's the latest update from the nursery! Have a nice weekend!
After our usual Saturday morning after-gym routine (Whole Foods for iced coffee and a breakfast burrito), we spent several hours cleaning and purging. It seems like we make a run to the Goodwill at least once a month these days! Next, I got started on my to-do list while Matt made fresh baguettes!
During our last trip to IKEA, we bought 2 different lamp pendants to try out in the nursery: the knappa and the skimra (don't you love IKEA product names?). Although we have hideous can lighting throughout our house, we recently discovered an adapter that converts a can light into a pendant. We've already hung pendants using this adapter in 6 different places in our house. So, after our neighbor, Ter, generously delivered his ladder up 2 flights of stairs to the nursery last night, we were all set to turn the 2 can lights in Tray's room into pendants too!
Without even trying the skimra shades, we decided on the knappa shades. We weren't sure if 2 knappa shades would be too much for the small room but with vaulted ceilings, we found the room was easily able to handle both. Using the adapter really is the simplest process. It takes all of about 5 or 10 minutes to do the conversion (and the more times you've done it, the easier it is).
Here's the finished product:
We had previously installed a dimmer, which I recommend in every room!
And that's the latest update from the nursery! Have a nice weekend!
Sunday, March 7, 2010
More Nursery photos!
We've continued working on the nursery over the past few weekends. Last weekend we installed the custom Elfa closets where we will soon hang cute little baby clothes!
Currently, Mommy is still hogging Tray's closet! (see clothing on far left)
We're still working on a solution for the big window in Tray's room. We would like to buy an affordable shade (maybe a black-out shade since this room gets full Western exposure in the summer months) as well as some nice curtains. I've tried about 3 different curtains on the window so far and I don't love any of the options. I may end up making the curtains for this window...
Last Thursday, we made an after-work run to Ikea. We came home with the perfect fabric to cover the doorway that leads into the closet.
I love the flag pattern. It's so perfect for a gender-neutral baby's room! The artwork is from an online sample sale. The colors work perfectly with the curtain and the simple lines of the trees in the painting look great against our robin's egg blue walls!
The lamp used to be in my office and was never used so I brought it upstairs and started brainstorming how I could fill the clear glass base. The little stuffed animals were a perfect fit! The lion is actually a mini version of one of the first gifts we gave my niece, Danica, when she was still a baby. The elephant is the lion's perfect companion and matches the dancing elephant fabric I finally got around to framing:
On the wall adjacent to where the elephants currently hang, we will be hanging another piece of artwork. Matt's parents are generously giving us a beautiful elephant print that has been hanging in Matt's childhood room for the past 25+ years. It is going to fit in perfectly and we're looking forward to its arrival!!
Hopefully the next time I post about the nursery, we will have found the perfect pendant lamps to hang from the ugly can lights that are currently in Tray's room. We have a couple options in mind but haven't yet been able to borrow a ladder from our neighbor to test things out. Stay tuned!!
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