Update on Life

Yes I know, the blog has been quite quiet. And I’m sorry about that.

And I’m not sure it’ll get better any time soon.

Today I go for my second nursing orientation, and I start classes August 22. The program is a 2-year RN, so needless to say, I’ll be very busy with school for awhile. Each semester has three nursing classes, five weeks a piece, one right after another. Each semester except the last I’ll have a couple of additional classes: Anatomy, Physiology, etc. that will keep me busy. I’ll also be tutoring this year and am considering a nursing externship for later seniority in the local system. Last spring I took Nutrition, Math Reasoning, and Life Span Development. Over the summer I crammed and took Microbiology and Chemistry. I’m thankful I did so, as it’ll certainly help me coming workload.

So, where does this leave Healthy Mama Childbirth?

I’m still here, but I will probably not be taking any doula clients for the time being. I’ve found that as I look at EDD and on-call times, I don’t feel that I’d be able to provide the support necessary to be a good doula. I’m saddened as I turn down clients, but I know that it is best so they can get the support needed in this area.

I am still taking childbirth education clients and will be offering another Prepared Childbirth Series in the fall. I also still take private clients for flexible scheduling and course offerings.

I plan this year to begin lactation-related education online in preparation for the Pathway 1 IBCLC exam requirements. I had considered IBCLC previously, but thought it out of my reach since I wasn’t in the healthcare field. However, now as I find myself in nursing school, it’s back on the table for consideration. I’m also hoping in the near future to go through doula certification, though it’s certainly on hold until I can take clients. I’ll still be available to local doulas as a backup and hope to continue to be active in the local birth community.

I’m also honored to be the chapter leader of our local ICAN – ICAN of Greater Charleston WV. Please visit http://ICANGreaterCharlestonWV.weebly.com for more information about meetings.

As for the blog, I’m leaving it open, but please understand that I have little time at the moment to really devote to entries. I’ll do entries as the mood takes me (I hope), but regular updates – which were not often as it was – cannot be expected.

:-D Much love and happy birthing!

Co-sleeping, a failed account? Part Two

Our night-time sleeping was very different from our naps. While he would refuse to nap longer than twenty minutes in a place other than mommy’s arms, he refused to sleep there at night.

Well, let me back up…

Like I said before, at about a month old he started having trouble sleeping at night. Cutting dairy really helped, but the biggest fix at that point was to co-sleep. We have a king-size bed (best investment ever), so instead of him sleeping in the Arm’s Reach, I just had him snuggle. Most of the time, I slept on my right side, with little man snuggling there between me and the co-sleeper. Sometimes, he slept between my husband and me, but with my husband’s sleep apnea, I was more comfortable with the other set-up.

While little man co-slept with us, I was amazed at how our sleeping patterns worked together. Even just having him in the room accomplished this. Babies have shorter sleep/wake cycles than adults, allowing them to wake, eat, and keep getting the calories necessary for growth. Short sleep/wake cycles may also have a protective effect in regards to oxygen levels and adjusting to life outside the womb.

The difference in sleep/wake cycles is what makes parents so tired with new babies, but here mothers have an advantage. Having baby in the room allows these sleep cycles to be synced: beneficial for both mama and baby. Some research suggests this may be protective against SIDS. And for the mother, the added benefit is waking more easily rather than from a deep sleep.

For us, here’s how it worked. Little man would feed and drift off to sleep snuggled in my arms. I’d drift off around the same time. A couple hours later, I would wake. My deep sleep cycle was shorter in response to his, so most of the time I felt pretty good. I would look down at little man, who was still asleep but begging to root around and stir. This gave me time to get ready for feeding. He would then feed and re-settle, much of the time never fully awakening. I would then drift back off as well. This synchronization may be part of the reason breastfeeding mothers get more sleep than formula feeding mothers.We had this great set-up until little man was about three and a half months old. He started by feeding. Then he would arch his back and squirm. He would touch and explore my face. He’d coo and squeal, discovering his own voice. As cute as it was, he was starting to go from tired at the beginning of the night feed to wound up by the end. Eventually he would drift off, but he was fussing more during the drift off period. Sometimes we would have to give up for a bit and try again later, as late as 11pm.

One night, probably a week or so after this change, I cleared out the Arm’s Reach. After he fed, I scooted him over into it. At first he fussed, but after a few nights, it was getting better. If the fussing seemed to be “sleepy-time fuss,” I let him be. If it was “I need mommy, I’m scared!” fusses, I’d pull him back over and snuggle. For awhile our sleep routine came to be starting out in bed, then the Arm’s Reach for part of the night, back in bed for the rest. I tried my best to read his cues and let him sleep where he seemed to settle the easiest. After a few weeks I noticed he was spending less and less time snuggling with me in bed and more and more time sleeping contentedly by himself in the Arm’s Reach. Along the way he had realized he was definitely falling asleep snuggled with a warm mommy, but he could coo and be cute and “fight it” a little longer by himself.

Knowing the independent part of his personality, this all doesn’t surprise me too much now how easily he self-weaned from co-sleeping. At the time I was surprised and even a little embarrassed. Co-sleeping was an important part of my nurturing parenting philosophy, and I felt I must not have done it right for him to have weaned so early.

But for us, this was exactly right. He was ready and let me know in his own way. Around six months he settled into sleeping in the crib at night since he was able to crawl out of the co-sleeper. I attribute his good sleeping habits now to the security he had sleeping then. Falling asleep at a young wasn’t scary; he wasn’t hungry, cold, or wet; and he knew mommy would be right there if needed.

Recently, we got to co-sleep again. We went to the Columbus Zoo, and little man was having trouble sleeping in the hotel room. My husband suggested we have him in bed with us, so we decided to try. He took his sippy, coo’d, explored my face, and drifted off with me sleeping on my right side again. It was uncomfortable, as a sleeping toddler is much more mobile than a sleeping two month old. But it was beautiful and I loved it. I miss our nightly snuggles, but I’m glad I listened to what he was ready for.

Co-sleeping, a failed account?

 I was so fortunate that prior to pregnancy I had learned about many safe sleeping practices, one of which was co-sleeping. In the end, we just decided we would “go with the flow,” and that crying out wasn’t an option.

I highly recommend that approach.

However, I really expected our co-sleeping story to be different than how it actually played out. I’ll go through our story and talk a little about why I think it worked for us.

Around the time my son was born, we were staying with our pastor and his wife (fun stuff like our new home not being ready on time necessitated that). At the same time, my husband’s mother and grandmother were in from Mexico.

It was a hard way to start out with a new baby. I was in an unfamiliar environment, with a slight pressure to perform. (Side note: I love my husband’s family, and the pressure didn’t come from them but from my own self-consciousness). My husband and I were sleeping is separate twin beds so I could recover from surgery and little man slept in a Pack N Play at my feet.

Not my ideal set-up to be sure, but necessary at the time.

Little man was swaddled for the first week, but after that we simply had light blankets covering him. We stopped swaddling because he started to hate it, probably as his startle reflex was calming down. He slept at naps and at night, which was unexpected.

By the end of his birth month, we had moved home. My husband’s family was still to be with us a few more days as we settled in. We put up our Arm’s Reach Co-sleeper with our King-sized bed.

Elias was still doing fine with our set-up of alone naps and nights until right before my husband’s family. He was starting to be more restless at night a bit irritable during the day. Where he had previously been a greater napper, sleeping three hours at a time, he was now cat-napping twenty minute sessions.

Finally, one night he literally refused to sleep. At 2am we had him in the car, trying to lull him done. He gave in but was up as soon as we were in the house. That night we pulled the swing into our room and let the rocking work its magic.

The next day I starting cutting dairy from my diet. I also held him for naps. He would nap without me holding him, but he napped much longer in my arms. At night, I started cuddling with him in our king size, using the Arm’s Reach as a table.

Later, I discovered Elizabeth Pantley’s No Cry Sleep Solution. I had heard of it, but at this point I finally bought it. I was desperate for something to help him sleep without me, but refused to try “crying it out.” We had seen a crying fit from him on the six hour drive from Washington D.C., and the pain and terror he was in was not going to “work.”

Pantley simply confirmed to me that all was actually ok with our sleeping situation. When he cat-napped, he wasn’t getting adequate sleep, making night times more difficult. I charted his sleeping habits and made my decision.

We’d keep going with the flow.

I started keeping track of his eating and naps (I kept a note pad on the armrest of the recliner) and continued to hold him for every nap, for the entire nap, until he was five and half months.

People thought I was crazy. I got nothing done during his naps.

Around five and a half months, we started trying the crib for naps only. I would rock him while he ate and then laid him down when he was fully asleep. At that point, being fully asleep was key; generally about ten minutes after he appeared to be “asleep,” he was ready to go down.

It worked. Within a few days, he was comfortable sleeping in the crib for naps. Night time was another story…

Should We Have ONE Certification Organization for Doulas?

There’s been some talk lately (nothing new really) about having one national organization for certifying doulas. While it seems like it could be a nice idea, I have some concerns.

First, the good…

In terms of recognition, one doula organization could do some great things. Marketing and awareness for the consumer could be broadened. Recognition in media outlets may increase. We may gain respect as an industry – think of the recognition achieved by being an IBCLC as opposed to a lactation educator, etc.

Recognition for the consumer would be wonderful. With more women aware of doula care, it’s certainly possible many more women would be interested in exploring this in their own birth. If I fully embrace my idealist side, I’d even go so far as to say birthing practices would change en masse and we may see a turnaround in our cultural birth practices.

However, I think have one organization would certainly have some negatives. These negatives have the potential of out-weighing the positives.

Personally, I’m hoping to begin doula certification within the year. I’ve gone back and forth about doula organizations to certify with throughout my pursuit of this career. There is the possibility of doing a DONA training in our area in the fall; otherwise, I’m generally looking at doing distance learning or traveling three hours or more.

However, I’ve never been totally comfortable with certifying through DONA. I’ve had it recommended to me many times before (I’ve even blogged about deciding to certify with them). But it seems to be such an impersonal organization. I don’t want to join an organization simply because it is “premier,” (which is very true of DONA, and I certainly respect that), but there needs to be something more. Maybe I’m missing something, and more consideration will certainly follow before I make any decisions.

That little tangent discussion of DONA will be relevant later; I’ll come back.

I think for some, the biggest issue with having one certifying organization would be in the possible restrictions placed on its members. Most commonly, the restriction doulas complain about is involving “free birth” or unassisted birth. For me personally, I’m not sure I agree with having a doula (a trained support professional) at an unassisted birth, and I’m not sure I would take a client planning unassisted birth. However, there are doulas who would like to serve women and families in such capacity (I can think of one I know personally who is skilled in this area). And I think they should be allowed to do so (and encouraged! If you have such expertise and feel called to serve in such a way: do it!!)

I’m a little concerned that having one doula certifying organization would in some way “medicalize” the profession. Doulas are non-medical professionals, and I feel they should remain so. Doulas who are student midwives/midwives’ assistants walk a fine balance, and I don’t know how they juggle the two. But for the majority of doulas who are not in that situation, medicalization would harm the profession. I’d be afraid of “protocols” and “standard practice” and other such generalized guidelines that might interfere with the personalized care doulas are “famous” for. Doulas are uniquely available to hands-on at all times, without having to stop and chart or do a particular procedure. While many doulas do chart their notes, they typically wait until the birth is finished and the family is settled before hurriedly scribbling.

I’m not saying that I am afraid a certifying organization would begin to require doulas to do medical tasks. However, I do think that unfortunately some families already feel that doulas are part of the medical team, particularly in assisting the midwife. This assumption may cause them to not look further into the possibility of doula care. So many believe that doulas are only for homebirth, possibly stemming from that assumption of assisting the midwife.

So what should be done?

I honestly don’t know.

Back to my concern about DONA, one of the great benefits of the current situation in having multiple organizations is that there are many different philosophies. A common piece of advice for new doulas trying to pick a certifying organization is to “see which philosophy fits you best.” Losing this could be detrimental to the profession.

It also allows some to study and become experts in doula care and choose not to certify. There are a number who go this route, and they should be allowed to continue to do so. I think that families are able to interview doulas and decide for themselves who best to serve them, whether or not they are certified. I would be concerned that simply one organization would attempt to push out “rouge” and “uncertified” doulas.

Me, I’m choosing to certify. I do think that for me, especially among nursing professionals, having certification will be one step in showing my skills. But for all the other doulas out there, I don’t know that any one person/organization should be making that same call.

How do you feel?

Common Sense Labor Practices - the Walsh argument

It looks like I’ll be finished reading Denis Walsh’s Evidence-based Care in Normal Labour and Birthing soon. I’ve really enjoyed it.

One thing I really like about this book is the underlying theme of using common sense to return to normal labor and birth. The author seems to come back to this idea at least once in each chapter, but I think it is best displayed in the argument surrounding the following topic: Movement in Labor and Birth.

Why is it that we seem to need randomized clinical trials to show us that moving and using gravity in upright positions would be good for birthing?

I was really struck when I was reading about this concept. Well, duh. Of course, even those promoting natural birth do forget about this. We try and try to prove that this works, but why is that we must prove something so common sense? Are we that far away from good birthing practices?

Quite simply: Yes. [insert a number of choice words]

As a culture, we have truly become a nation that absolutely relies on medical intervention. It’s pervasive. We go to the doctor with flu symptoms and find ourselves getting chest x-rays, bloodwork, and antibiotics (Let’s not forget that the flu is a virus. Antibiotics are for bacterial infections, not viruses). Our child gets a bad bump on the soccer field, and he’s in the ER for a CT scan (see this article).

Recently, we took my son to the doctor (not our pediatrician), for a suspected ear infection. Fortunately, he didn’t have one, but the doctor offered us a prescription for something just in case. When I declined, he replied that was fine, and that he offered because some people feel unsatisfied if they come to the doctor and don’t get something, even if nothing is wrong.

Novel idea, I know, but if you’re not sick, you don’t need something.

And this is much of what Walsh is arguing. If not sick, which pregnancy and labor should never be considered pathologies, then why are we doing randomized clinical trials to prove that natural labor needs natural things? (The same argument can then made against IVs, routine AROM, monitoring…)

I’m not making a new argument of course. I’m simply reiterating what many are already saying.

Pregnancy, labor and birth are normal the vast majority of the time. They require normal, common sense things. If they cease being so, then we’ll call for something else. Don’t do anything just to say that you’ve done something.

Preventing ALL Death and Injury?

I’m currently reading Denis Walsh’s Evidence-based Care for Normal Labour and Birth. In my reading this week, I was struck by the chapter called “Fetal Heart Monitoring in Labour.” I understand that fetal heart monitoring is not proven beneficial, though it continues to be in widespread practice. I was familiar with much of the information presented, but the following reference caught me off guard.

Walsh discusses a number of studies and reviews throughout the book, and in this particular case, the review being discussed brings up one (of many) possibly disadvantages for continuous electronic fetal monitoring. Walsh quotes directly, as will I, the following: “[it] shifts staff focus and resources away from the mother and may encourage a belief that all perinatal mortality and neurological injury can be prevented.” (Reference below).

Can I just stop and say “WOW”?

Of course, it makes perfect sense. This attitude is pervasive in western culture. All death should be prevented until natural causes in old age. All other death is negligent and/or preventable by future technologies.

Again, WOW.

I come from this culture of course, and I struggle constantly with the idea. Late last year, my dad was diagnosed with prostate cancer. His prognosis was very good: he was (and is) in excellent health, and it was caught very early. He had surgery and has thus far done well without any other treatment.

My mother, of course, panicked with this diagnosis. Current research suggested to her that even with surgery and complete removal of the tumor, it only extended my dad’s life expectancy ten years. She was distraught.

Let’s put the above in perspective. This year, my dad will be 66. Ten years is 76. My dad (due to good health) probably had a previous life expectancy of 80.

Was surgery helpful? Certainly. Would my dad have died sooner without it? Yes, probably. He has a genetic risk for prostate cancer, so his cancer was likely vigorous. Does he have cancer now? Nope, not as far as we can tell.

Should my mom still be concerned about his life expectancy? Nope, not in my opinion. He will die eventually anyway.

That’s heartless sounding of course, but it’s true. Some of us will die from cancer. If we cure cancer, it’s likely some will die of other causes, beyond the “natural.”

My point is, as a culture, we are terrified of death. We string ourselves out at the end of life, struggling for each breath in some sterile hospital, without being allowed to die in dignity and grace surrounded by family and friends at home.

Unfortunately, birth is no different. Birth is a symbolic act of life beginning in another (though I would argue the life began long before, it just needed constant care in a different environment before birth). It is logical that once life begins, it will certainly eventually end. And as much as we would like to, many times we cannot prevent it, not should we.

I do not believe there will ever be a time when NO women and NO babies die in childbirth. That would be like saying there will never be any more SIDS or miscarriages. As tragic as these things are, they happen. They are a part of the life cycle.

Therefore, we need (as much as possible considering the culture we’ve been raised in) to attempt to lose this idea of preventing all perinatal mortality and injury. It will likely never happen. Our focus should be on healthy normal childbirth so we can recognize when it goes astray. When it goes astray from normal, we should focus on doing what we can, WITHOUT CAUSING FURTHER INJURY OR HARM to either the baby or the mother. After that, we should focus on supporting and counseling the family through a difficult life event.

Reference: Alfirevic, Z., Devane, D. and Gyte, G. (2006) Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database of Systematic Reviews, Issue 3.

Baby fever and putting it off...

I have baby fever. It’s unfortunate that right now we can’t have another, so I’m going to lament and have myself a pity party.

As some may know, in January I decided to apply to nursing school with a local two-year R.N. program. Nursing had been in the back of my mind as an eventual pathway to midwifery, but I hadn’t truly considered it for awhile. The decision to apply was very much spur-of-the-moment, and to be honest I can’t remember all the reasons my husband and I considered when we made the decision I should apply. A primary concern of course was financial stability: we’ve struggled our entire married life, and I was not going to reenter full-time public school teaching unless I had to. (We did consider it, and I’m thankful my husband said he’d rather we struggle a way longer than put me through that). My husband is also going for nursing, though he’s not starting the program this fall with me. We felt that since I have a bachelor’s degree, I would get through the nursing program faster than he would. Then I’d be able to do a three day a week/full-time thing while he finished up the program himself. Three days a week would give me enough time home that I would still feel like a full-time mommy, at least as much as I am now working part-time and going to school part-time.

Of course, going to school full-time and then trying to find a job is really difficult pregnant and/or with a new baby. Not impossible, but…

I’ve considered the fact that I could probably take time off from the nursing program. Legally, I’m allowed a semester off (R.N. programs have some special requirements due to accreditation), though I’ve been told by the program director that I’m not allowed any time off. I could fight him on it, but I wonder if it’s worth it. I don’t want any difficulties going through, and I want to be finished and move on with my life. I also get his perspective; they’ve had a lot of concerns about the program’s accreditation with people not passing/dropping out. Rumor has it that of the latest class in the hospital partnership, only about half are making it to next semester. That’s got to be nerve-wracking as a program director to be staring accreditation worries in the face.

Also, I think about what I’m going to be looking at with my next birth. We want a large family, and I’ve already had one cesarean. I don’t want to have another and I’m really considering my options to ensure a VBAC this time. Out-of-hospital birth certainly seems to be the best option, but is it an option for me with my medical history? If I’m risked out of midwifery services, do I “free-birth?” (probably not, but it’s been on the table). How do I manage a hospital VBAC fight while struggling with clinicals? (and a family?)

Apart from the next birth, what about the next postpartum: I want to do everything I can to have a healthy postpartum transition this time around. Fewer stressors would equal reduced risk for me developing postpartum depression again. I was switching from working full-time to mothering full-time at the last birth, so being settled and having less life change is ideal.

Having a great start breastfeeding is also key in my mind: not being able to get out to find the help we needed was a huge factor in our failure to continue breastfeeding. Little man needed specialized care, and that simply did not get met. I would like to not battle with returning to school and pumping; arguing to pump at work seems to be a much easier battle.

So yeah, we’ve decided to avoid for the time being. Neither of us is very happy about it. We both have baby fever to the extreme, and the little man is not very little anymore. He’s talking now, and it’s really obvious that he’s a BOY rather than a little baby. It’s hard also when I consider that by the time I’m done with school, he’ll be almost FOUR. We had hoped to get them close together, so it’s a bit of a blow for us. Of course, we know that conception is not controlled by us, so I guess we’ll see if anything else comes up.

Until then, I’m burying myself in my birth studies, focusing on being the best nursing student, mothering my little man, and being a wife to my fabulous husband. These next two years (or so) better fly by.