Milk Machine, Again

Checking in from somewhere deep in the Land of Sleep Deprivation…

And the real question is: How is breastfeeding going with child #2?

The answer: Better, worse, the same.

I will say this: we got off to a much, much better start with Sophie.  This, in large part, is due to my doula, Gracie.

I had been in recovery only a couple minutes when she said, “I think we should try breastfeeding now.”  This was after the forty hours of labor and a rather hellish c-section.  I was relieved to finally be lying down in peace, as close to resting as I had been in two days.  The idea of breastfeeding at that moment, honestly, did not thrill me. 

My husband expressed doubts, too.  “But she’s still hooked up to so many things (me, not Sophie), and there are all these tubes.  I don’t know if she’s in any shape…”

Gracie would not be deterred and pressed in her oh-so-gentle way.  “Sophie’s about an hour old and now is the perfect time.  We’ll help place her and get her comfortable.” 

With some rearranging and maneuvering of tubes and gown, Sophie was placed on my chest, where she quickly latched on and began to eat.  I could barely move to hold her, but Gracie helped to keep her in place.  I was amazed and thrilled, moved to tears that this was happening and so very grateful that I had someone there helping to make it happen.

Compared to our early days with Eli this was a fairy tale beginning.

Sophie continued to and has been exclusively breastfed so far.  This makes me very, very happy.

This is not to say all has gone without a hitch. 

I am, again, a constant food trough.  My nipples have taken a beating.  There have been blisters, there has been cracking, there has been blood. 

Our last day at the hospital Sophie spit up blood.  I was in an immediate panic: why was blood coming out of our baby?  To see it spattered on her shirt made my blood pressure spike and I felt lightheaded.  Vinny was off doing release paperwork and I could barely make the flustered phone call to get him back to the room.  

After much hoopla by the nurses and attending pediatricians, not to mention a half-day delay in our release, it was decided, “Oh, your nipple was bleeding when she ate and she spit it up.  Totally normal.” 

Good times, friends.

All the old ailments and challenges returned: engorgement, spontaneous leaking (and no, not just when my milk lets down, just whenever … it soaks through my nursing pads and my shirt), her pulling back while latched on, clicking, total agony when water and/or a towel brushed anywhere in the vicinity of my nipple.

It’s hard in these early weeks, as we are adjusting to each other, to truly enjoy the process.  I am thankful to know this time around that we will arrive at the day where we are both comfortable, where things will proceed without a hitch, where the process will feel natural. 

We’re not there, yet.  And it gets frustrating.  One feeding goes well.  The next does not.  One feeding she eats calmly, the next is a frantic feeding frenzy that ends in me near tears and her with a gassy belly, screaming in pain. 

We are still in the “learning” period. 

You’d think there would be more patience this time around.  But the combination of sleep deprivation and knowing things should and will be better in the future sometimes sends me into a tailspin of frustration.  Did I mention we are also moving across the country in just over three weeks?

Add to that our 18-month old who is also adjusting to all this change, vying for my attention, wanting to be picked up by me (this breaks my heart, and was one of the reasons I so adamantly did not want a c-section), etc., and I often feel myself being pulled in too many different directions.

Thankfully, my husband has been home with me since the day we brought Sophie home.  He keeps me centered when everything feels overwhelming, keeps Eli happy when I cannot give him attention, and is my true partner in keeping our household functioning.

And so the days unfold, often in a haze, often spent entirely in my pajamas.  I know one of these days soon I will realize with a start that breastfeeding is going smoothly… that the haze is lifting and there is once again some semblance of a “normal” life.

Until then, it’s one feeding at a time.

 Sophie and I with my doula, Gracie, at our post-partum visit, 

where we talked at length about breastfeeding.

And She's Here...

I wish I could say otherwise, but I had another c-section. 

It was a possibility, of course.  One I had hoped wouldn’t come to fruition.  However, at the end of the ordeal we met our daughter, Sophie.  And she’s beautiful and healthy, and I’m doing pretty well, too.

So what happened?

On Monday, April 4^th, I had contractions off and on all day.  Nothing steady, but I knew we were getting close.  Then on Tuesday I was woken at 4am by a contraction.  I fell back to sleep and eight minutes later was woken up by another contraction.  This continued until 7am.  I had hoped for more sleep, but part of me was already giddy with excitement.  I was sure this was the day we were going to meet our daughter.

We attacked the day, rushing around the apartment doing last minute tasks, all the while my contractions were getting closer and closer together.  At 10am I spoke with our doula, Gracie Davis, and it was decided the time had come for her to join us.  We made the arrangements to have Eli picked up, and I was happy for the distraction of the contractions; it kept me from thinking about the fact that Eli would be leaving soon, the first time I would be separated from him overnight.

Gracie joined us, Eli left, and the day rolled on.  Gracie did a lot with acupressure to ease me through contractions as I was having a lot of back pain.  We also took a couple walks around the neighborhood, probably frightening our neighbors with my contractions on the sidewalk.  Regardless, it felt nice to be at home, relaxed, not panicked about whether or not we should be leaving for the hospital yet.  Gracie kept careful track of the contractions and would let us know when we should leave.

Around 3:30 that afternoon we decided to head to the hospital.  My contractions were 3-4 minutes apart, lasting 60-80 seconds, and the intensity had been building all afternoon.  L.A. traffic any afternoon is not my idea of a good time and I started to worry that we’d be stuck somewhere, hence the decision to make the move.

After getting settled into my triage room, taking some time to get back into a steady rhythm of contractions, I let the nurse check me.  I was dilated to a one.  Let me say that again:  a one.  After thirteen hours of steady contractions I felt like I had been slapped in the face.  Really, no progress?  I was frustrated and could feel my confidence buckling.

Gracie stepped in and reiterated the positive:  I was 70% effaced.  That was progress.  The work was not for nothing.

I cannot adequately express my gratitude for what Gracie did during my 40 hours of labor.  This scenario was repeated over and over.  I would get checked, things would be progressing slowly or not at all, and Gracie would be at my side, reassuring me, pointing out the good things that were happening, the important work that was being done.

I’m not going to lie: had she not been there I would have caved early on and said “screw this, give me the c-section.”  Of course, had I done that I would be sitting here full of guilt, wondering if I had sold myself short, not having done all I could to bring Sophie into the world without surgery.

After twenty hours I decided I needed an epidural.  This was a critical moment for me.  I was convinced having the epidural would slow down progress and this was something I absolutely did not want.  Yet, I was in so much pain and things were progressing so slowly that I wasn’t sure I had another twenty hours in me without caving to surgery.  I decided the epidural was the way to go, and had much reassurance from my OB and the nursing staff that epidurals do not slow labor when you are in the active stage. 

They were right.  After the epidural things continued to crank along, albeit at my regular slow pace.  I rested a bit here and there and was thankful for the reprieve from pain. 

Now I was trying to grapple with the increasing pressure I felt in my stomach.  I inquired about having my water broken.  The concern was that Sophie was still so high that breaking my water could result in the cord coming down, or her hand flying out, or some other sort of nightmare situation that would necessitate an emergency c-section.  So at this point my OB told us, “it’s not safe to do that.”

Four hours later he came into the room, checked me and said, “Okay, let’s break your water.”  I was nervous but excited.  I was convinced this was the step needed to get things moving along to the pushing stage. 

Well, let me just say all my various healthcare providers had been right about the “large quantity of amniotic fluid.”  It sounded like a waterfall coming out of my body.  The way I was sitting I couldn’t see what was happening, I could only hear and feel it, but to me it was sweet relief.  I immediately felt less pressure and pain in my stomach.  Unfortunately, I soaked my OB and traumatized my husband. 

More importantly, I felt a renewed sense of energy and optimism.  It was time to do this!  Two hours later my OB came back to check me and I was dilated to a ten.  Mind you, at this point we were nearing 35 hours of labor and I was antsy to get this over with.  Although I was dilated to a ten he wanted to wait two more hours before I started pushing to see if the baby would drop further, meaning less pushing for me.  This sounded reasonable, so I agreed.

Two hours later it was time to push.  I was already beyond exhausted, but the thought of meeting our daughter propelled me forward.  If they wanted me to push, then dammit, that’s what I’d do. 

And I did.  I pushed and pushed and pushed.  She would drop down, progress would be made, the contraction would end and then whoosh!  She would get sucked back up the birth canal.  The frustration on my OB’s face couldn’t be hidden and at first I thought he was annoyed with me, that somehow I wasn’t pushing enough or the right way or…  So I asked him and he said, “No, I just really want this to happen for you.”

Part of me knew right then that it wasn’t going to happen.  And so I asked him to be straight with me.  He told me that if there wasn’t progress after three hours we’d need to talk.  So I pushed awhile longer, hoping I could get her out, thinking that after all of this how could I not get her out?  Was I really going to get this close, feel her trying to descend out of my body and then not get the satisfaction of giving birth to her?  I could feel my grip slipping away, knew I was inching closer to having a meltdown.  Gracie kept encouraging me, Vinny tried to crack jokes, get me to smile or laugh in an attempt to distract me.  I appreciated everyone’s efforts, but the look on my OB’s face said it all.

After three hours of pushing he told me we should “go in and get her.”  He didn’t want me to continue straining my body or get to the point where the baby was in distress.  I agreed, it was logical, but my heart broke.  I couldn’t hold it together and didn’t try to.  I was a mess and told him to give me five minutes to be devastated and that then I would pull it together.  And I mostly did.  I knew I had given it my best shot.  I wanted to meet our daughter.  Now.

I won’t go into detail about how awful the c-section surgery was after that much labor.  I’ll say this much:  uncontrollable shaking, radiating pain into my neck/shoulders, and vomiting.  Still, when I felt them pull her out of my stomach I experienced a relief I had been waiting over forty hours for.  When I heard her cry, I cried too.

It’s been a little over a week and I feel okay both mentally and physically.  And let me say, I am more than happy with okay.  I expected the experience to follow me home the way it did with Eli, to feel the depression descend in on me.  But it hasn’t.  It helps immensely that breastfeeding is off to a fairly good start.  And it helps that I knew a c-section was a possibility this time around, despite my best efforts or intentions. 

My constant goal throughout this experience was to know that I had done everything in my ability to get her here without surgery.  And I feel I did that.  So there is no reason to sit here and mentally beat myself up, or wonder what it is about my body that is so inadequate when it comes to birthing my children.  I’m not playing that game this time, and for that I am grateful. 

No, what I’ve been thinking about instead is the fact that I almost did give birth to my daughter.  I could feel her, so close, and yes, I am disappointed things didn’t work out.  But somehow I take joy in the fact that I went through most of the process anyways, that I let my body try to do what it was made to do.  I could sit here and say my body failed me.  But all I have to do is look at Sophie and I couldn’t imagine saying such a thing.  My body made another beautiful baby. 

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.