I Suck at Structured Play

That’s the short of it. 

Sophie had her two-year well visit back in April.  She has been what is considered slow to talk and/or acquire language.  I haven’t felt alarmed about it, though as a parent, I would love to hear her little voice putting more words together.  Thankfully, we have a very laid back pediatrician.  She suggested that if Sophie wasn’t progressing or making a significant effort within the next two months then we might contact Early On, just to have her evaluated. 

This seemed reasonable, and is exactly what we did.  In late June, two women came to our house to evaluate Sophie.  When it comes to her receptive language skills, she tested out of the book (the book stops at a five-year level… at that point it is assumed the child is ready to begin school).  I know Sophie is intelligent and observant, but watching her follow through with complex tasks and questions blew my mind.  Her young brain has been very busy taking it all in. 

When it comes to her expressive language skills, however, she tested “just under” what is considered normal (although later it was talked about how she is nearly a year behind on her language development, so who knows exactly where she falls, although it is most certainly not in the “normal” range).

As a parent, I have struggled with labels and how they are so quickly thrown onto children at every turn.  I realize these labels are meant to have a constructive element: they allow children to qualify for certain services, give parents some relief in knowing what their child may be struggling with, etc.  With a label like speech delayed, however, it’s hard not to feel like I’ve somehow not done things the right way, or played with her enough, or, or, or…

Beating myself up is useless and counterproductive, I know.

Then there’s the part of me that wants to justify how awesome she is.  “Look!  Look at the puzzles she can do!  Look at her hand-eye coordination working with tools, screws, latches, etc.!”  Eli can’t do most of the puzzles that Sophie sits down and does easily.  He struggles with fine motor tasks that she breezes through.  Clearly, they’ve developed particular motor skills at vastly different rates.  But because Eli never stops talking it’s as if he gets a pass on the other motor skills.  And because Sophie’s “delay” is something that is quickly noticed as being absent, well, she doesn’t fly through.

On the day of the evaluation, a plan of action was laid out for us.  The women that came to visit us were so kind, and clearly understood how hard it can be to hear that your child is delayed.  They didn’t pressure us to accept their help or services and assured us we could take all the time we needed to decide how we wanted to proceed.

We didn’t need time to think about it.  Of course we are accepting their offer of help.  Why?  Well, why not?  What made me agreeable to this intervention and offer is that it is all based in fun.  We will not be drilling Sophie, or otherwise overloading her with language in the hopes that she’ll just get it one day. 

Instead, we have a speech pathologist that comes to our home and plays with Sophie, modeling techniques that we can then use with her.  It’s only been two weeks, and I can already see improvement in Sophie’s attempts to say words. 

This doesn’t mean it’s easy.  There are very specific ways to play with her, techniques to use, music to listen to (more on that in a moment).  I’ve had flashbacks to the days of physical therapy with Eli for his torticollis.  He was three months old when he began PT, and there was a rigorous schedule of stretches I had to do with him each day.  It was miserable.  I spent most of his waking time stretching him, and making him do tummy time.  When I didn’t do the stretches as prescribed, the therapist would berate me and make me feel like a terrible mom.  Needless to say, I switched to a different PT office, where things improved.  Still, it was hard to spend my free time with Eli doing things he so very clearly hated.  I just wanted to hang out with and enjoy my baby.  Instead, I had to reverse the months of muscle tightness that had built up in his neck because he was jammed in my belly with his head cocked sideways (asynclitic is the technical term).

When I look back, the PT seems easier.  I didn’t have to fake anything, I just had to do it.  With Sophie, the play is very specific, and there are certain techniques we need to implement (silence, listening, waiting for a response, trying to get her to use eye contact with us a lot more).  Then there’s the music.  On our first home visit, the pathologist handed over a CD of kid songs that are meant to encourage participation, repetition, and speech development.  She handed the disc over with a warning: “These songs are going to drive you crazy.”  I knew this before she opened her mouth.

I’m just not that mom.  The one that plays kid-centric music, cheerful sing-alongs, etc.  We love music in our house and listen to it all the time.  Just not necessarily “kid music.”  We’re just over one week of listening to this devil music on a daily basis.  The kids have slowly gotten into it and I, of course, have the most annoying song on the disc stuck in my head every night at bedtime.  I want to choke the guy that sings the Puppy Song (I refuse to look at the playlist and learn the actual title of the song).  It is, naturally, Sophie’s favorite song. 

So it’s slow progress.  My initial resistance to playing “a certain way” has begun to wear off (though it is hard for me when things are less spontaneous, when I feel like there is a purpose to play other than play itself), I’m dealing with the music (okay, and even like two of the thirteen songs on the disc now), and most importantly, feeling less caught up in the labels and tests and feelings of inadequacy and more focused on what matters: Sophie.

To Doula or Not To Doula?

If you’re like most people, your first thought is probably: what is a doula?  A doula (pronounced doo-luh) is, in the most basic sense, a labor assistant (read more here).  I had never heard the term until a friend of mine used a doula nearly six years ago for her first labor and delivery.  I thought it a strange word at a time, and the concept itself seemed rather foreign as well.

When I was pregnant with Eli it didn’t occur to me to hire a doula.  A couple friends recommended it, but I figured, “well, my body is going to do this the way it’s going to do this, how would having someone I barely know there with me be of any help?”  Again, a naïve sentiment, but only in hindsight.  And only because my labor and delivery with Eli didn’t go well.  Had it gone well I probably wouldn’t have considered the idea this time around, either.

But here we are.

Initially I had an interest in hiring a doula because I knew I was going to be delivering at a hospital that is: 1) not very labor friendly in general, and 2) was not going to be supportive in the least of my attempt at having a VBAC.  I felt like having a doula on my side, helping to coach me along, would help to offset some of the anxiety I was feeling about my less-than-ideal birth location.

Why didn’t I just switch care providers/hospitals?  Long story short my husband, son and I had temporarily re-located to Michigan for seven months as my husband had work there.  I knew we’d be returning late in my pregnancy (34 weeks) and I love my OB in L.A., who had said from the get-go he would be supportive of my VBAC attempt.

Well, we’d barely been back in L.A. two weeks when our well-laid plans began to crumble.  My OB started telling me that I couldn’t say VBAC at the hospital and that we were at least going to have to schedule my c-section to make it look like we were “playing by the rules” (the hospital, for reasons I do not understand, had deemed me a mandatory repeat c-section). 

Then the avalanche of negative feedback kicked in.  How reviled is this hospital?  The first doula we interviewed refuses to attend births there because they are so labor unfriendly, but was willing to make an exception as a favor to a good friend of mine.  Then, three days later, at my first chiropractic appointment here in L.A., the chiropractor asked me why I decided to deliver at that hospital. 

“I really like my OB, and it’s where our insurance covers us,” was my reply.

“Well, your insurance also covers you delivering at X, Y, and Z hospitals,” he responded.  “How badly do you want a VBAC?”

I didn’t have to think long.  “Very badly.”

“I hate to tell you this, but you’re at the worst hospital in L.A. for what you’re trying to do.”

I couldn’t ignore the growing pit of anxiety in my stomach.  It felt so late in the game to make a switch this major.

Two days later I switched OBs and hospitals.  The following day I learned that my original OB threw out his hip and was going to require surgery and would be out for 6-8 weeks, minimum.  In other words, I would have had to switch OBs anyways.

The decision felt right.

The hospital I am now delivering at has midwives on staff 24-hours a day.  I decided this would suffice as support, that I would simply call a midwife in if I was struggling, or if this baby happened to be asynclitic as well. 

The reassurance that the hospital was now behind my decision to attempt a VBAC meant my anxiety levels came down, a lot.

I decided I didn’t need a doula anymore.

Well, for about a week.  Then I began to realize that while yes, my anxiety levels had dropped and I felt better about the environment I would be delivering in, I still was having some serious self-doubt about my ability to deliver this baby without medication (not an absolute requirement, but strongly recommended when attempting a VBAC). 

I wanted someone there with me that had been through this before, that could suggest techniques, reassure me in my moments of waning confidence, and generally offer guidance.

Doulas are a varied bunch.  There is a wide range of experience.  Some doulas specialize in massage or hypnobirthing or acupressure or… 

After speaking with a couple doulas, I found one close to my age, Gracie Davis.  She isn’t the most experienced doula I spoke with, but she had a c-section with her first and a VBAC with her second.  She immediately understood where my self-doubts were coming from, and having someone that “got it” suddenly became the most crucial form of “experience” in my book.  Her demeanor is so calming.  She has already worked hard to familiarize herself with my previous birth experience, my concerns, and my hopes for this upcoming birth.  We’ve talked about how she’ll communicate with me, what she’ll suggest, and how she should interpret my responses to her. 

I never imagined I would “need” so much extra assistance to get through this process.  Sometimes I feel like I should be able to buck up and just do the damn thing.  But knowing that had I been better educated AND had a doula last time that my labor and delivery experience may have gone differently … well, I want to know I did everything this time around, for the baby and for myself.

To VBAC Or Not To VBAC

Sometimes it can't be avoided: serious topics. And I'm struggling to find much humor in this one.

At my last OB visit, my OB-of-the-day (there are four in the practice) wanted to talk about my upcoming labor and delivery.

An aside: this is my temporary OB as we have re-located for my husband's job … we are supposed to be back in L.A. before babe #2 makes her appearance. And a little refresher: Eli was born via c-section due to an abruption. There was also an issue of my pelvis "not opening," or so I was told, so I was also labeled as “failure to progress.”

At the visit, my OB told me that since my pelvis didn't "open" last time there isn't much chance of it doing so this go-round, and that I should seriously consider having a scheduled c-section.

I listened to her reasons and came home. My OB back in L.A. has told me I'm not the best candidate for a VBAC (vaginal birth after cesarean), but in previous visits, told me he would at least let me try.

As the hours after my appointment passed I found myself becoming more upset and emotional. I do not want another c-section if it can at all be avoided. I realize if it's scheduled, meaning: if I don't have the 20+ hours of labor, the abruption and THEN the c-section that my recovery will, in fact, be better. But it will still involve a surgical procedure and me being stuck in bed the first day attached to a catheter and those funky inflating leg warmers to ward off blood clots. I won't be able to immediately bond with or breastfeed my baby. I won't be able to hold her. This is devastating to me, again. Then there are the risks of having a c-section in the first place, and those do not diminish for repeat c-sections.

What I kept wondering was: Why are my healthcare providers so convinced my body isn't capable of doing this?

I went online and decided to do some research.

I posted a thread on Mothering.com (home of Mothering magazine). I know this particular crowd is pro-VBAC, homebirth, midwife, natural birth, etc., and I figured if there was an audience that would encourage and support me in my endeavor to have a VBAC this would be the place.

I laid out my birth experience and asked if any women had had a similar pelvis issue and gone on to have a successful VBAC.

It's worth noting that Eli was asynclitic before I went into labor, meaning he was head down, but slanted off to the side a bit. He was like that for several weeks before he was born, didn't flip for the longest time and was actually quite lodged in there. It was for this reason he was born with torticollis and plagiocephally (an issue with neck muscles; he also had a flat spot on his head). Well, come to find out his position was most likely responsible for my unyielding pelvis, as this is a common “side effect” of having an asynclitic baby. It's amazing what you can learn in an afternoon.

I dilated to a nine during my labor. Were it not for the abruption and had I been handling the sciatic pain (due to his asynclitic position) better, basically, if I had had more time (and no epidural), it's tough to say whether or not he could have been born naturally.

What I do know, after my frenzied research period, is that there are things I can do before I go into labor and even after I do, to encourage an optimal birth position for the baby and to prep my pelvic floor. I can visit a chiropractor, continue my yoga, hire a doula to assist me during labor with stretches and positioning to encourage the baby to move into a good position. Most of all, I will do whatever I can to avoid getting an epidural, as that hindered my ability to move around, thus ending any hope of assisting the opening of my pelvis.

These are all things I didn't know during my first labor, but none of them are absolutes. This baby may not be asynclitic. My pelvis may open if she is in the proper position. Will I have another abruption? There is no way to know. It is the one factor I cannot prepare for and the one big risk I will be taking in attempting a VBAC. Because I have already had one, statistically I am at greater risk of having another. That is frightening. Will it keep me from attempting a VBAC? I don't think so.

The point I’m trying to get at here is that if I only listened to my healthcare providers I would continue to believe that my body isn't "right," that it isn't capable of delivering a baby without surgery. In my heart I do not believe this. I was almost there last time. Had I been better educated (and supported) perhaps things could have turned out differently. That's the beauty of hindsight, and it means I will be better prepared this time.

I would like to think I've moved past my c-section. In most ways I have. All I have to do is look at Eli, at what a beautiful, smart, sweet boy he is, and I know the c-section, in that instance, was the right thing to do, it is what needed to be done to insure the safety of both of us. My problem is that without getting into the next labor, seeing how the conditions play out, I can't say with any certainty it would be the way to go next time.

Sure, if we get a few hours in and some of the same hurdles present themselves and we are not getting around them, well, I wouldn't hesitate to get the c-section. But if I can try and birth my daughter naturally, hold her, feed her, walk around with her on the same day she is born, well, that makes me tear up just thinking about it.

All I can say is be your own advocate. If you don't like what you're being told, do your own research and seek out the experiences of other women. Obtain and read your medical records. I guarantee they will tell you things about your medical history you did not know.

Ultimately, as was the case during my first labor, some conditions and issues cannot be prepared for and if that is the case, I will do what is best for the health of the baby. At the end of the day that is all that matters. But it doesn’t mean I don’t deserve a choice or a say in how my next birthing experience unfolds. I will prepare myself and hope for the best. It is all I can do; it is what I have to do.