The Birth of Emerald Nanette: part two

So here we are...the birth of my baby is imminent and all I want to do is escape. I am waiting for someone to tell me what to do. We go back and forth for a while. My indecisive nature is showing up at the worst possible time.

I have this image and memory on repeat in my brain, just like one of those old film reels: my second baby, Moses, was plopped onto my chest, fresh and slippery with a little scrunched up face. This was everything I wanted in a birth, and yet I feel completely empty and emotionless. I feel the aftermath of an unmedicated vaginal delivery- the stinging reminder that I just pushed a tiny human being out of my body. But I look at my son, my child- and I feel nothing. No connection. It's like the oxytocin just refused to flow. Is this even my baby? I think. He seems so unfamiliar. This child and I have been physically connected for nine months now, but he feels like a total stranger. And now, I am about to give birth to my third baby, and I am so scared that the past will repeat itself and I'll be stuck in that same situation. What if I don't love my baby? What if my kids lose their mom? What if my husband isn't up to dealing with a psychotic wife and my marriage really does end this time around? 

I am surrounded by some of the most understanding women that walk the earth, but the nature of birth work is that it isn't your story. You can't tell a mom how or where to give birth, and that's exactly what I'm asking them to do. Jennifer, who is typically a very pragmatic, yet supportive, midwife, has now stepped into such a beautiful (and much needed) nurturing role. Sandee, who has had six babies with a variety of births and outcomes, has been there. She has no judgment and wants the best for me- such fitting traits for a doula. Carissa is just wholly on my team, ready to step into action wherever my impending decision takes us. But I- I am struggling between the disappointment of a "failed" homebirth and the inability to cope with the pain of labor. I obsess over the financial aspect of transferring to the hospital. It wasn't easy for us to pay for a homebirth, but I worked childcare for next to nothing to make it happen. If we went to the hospital now, we would have to pay out of pocket for our birth up to our deductible, which wasn't something we could afford. Still, my husband said not to worry about that. He was so torn between wanting to push me to have the birth I wanted and just wanting my suffering to end. And suffering is the only word to describe the place I was in at that point. 

The rest of the story goes like this: I stayed home. 

I pushed my baby out quickly and effectively for about fifteen minutes until I felt her head crowning. I continued to push, but nothing was happening. Up to this point, I had been guiding myself through the pushing process, manually feeling her progress as her head moved in and out, and it was such a lovely process. I was in a squatting position on my knees. After three minutes of crowning and pushing and pushing and pushing, Jennifer asked if I could feel my baby moving. I misunderstood this as fetal movement in utero and said yes (I could still feel her kicks during pushing), but she was really asking if she was moving through the birth canal- basically, if my pushing was working. And it wasn't.

It's kind of a blur from here because panic mode ensued. They lifted me up to a runner's position- standing with one foot on the edge of the birth tub- pushing, pushing, still nothing. Without a word, Jennifer jumped into the birth tub (sorry about your pants, Jennifer) and manually dislodged baby's shoulders one at a time (this is called shoulder dystocia and occurs when the baby is partially birthed but one or both of shoulders get lodged in the birth canal, which occasionally can be dangerous or even fatal for the infant). To give you a mental image you probably don't want, she was basically elbow deep uprooting my wedged baby, which literally felt like someone was ripping apart my uterus. And then I just laid back and her 9.5 pound body slid right out. I pulled her up out of the water and held her blue, virtually lifeless body, but I was so thankful it was over that I was totally oblivious to her condition. Everyone else was running around and I was in my own world with my baby, admiring her. Carissa grabbed the oxygen mask but so quickly she inflated those little lungs and her blood started flowing to her brain once again, so assistance wasn't even needed. We stared at each other, feeling the connection of thankfulness from our mutually traumatic experience. I grabbed Jennifer's arm and just poured out my gratefulness, knowing full well she had saved my baby, and in process saved me.

Really, this team of people- Jennifer, Carissa, Sandee, and most importantly, my husband Blake- saved my life. They helped formulate a plan to combat my inability to process my emotions and helped me sort through resources to find the right fit for me. My husband insisted on the right care for me and gave me time and space to work through it. My primary care provider at Cole Family Practice (who I just cannot say enough good things about- thanks, Annie!) came right on board with my plan to start medication immediately following birth, so they worked me in and I began taking Zoloft just 6 days postpartum. A few weeks later, I began seeing a counselor at the Hope Clinic and later started seeing a psychiatrist there who now manages both my medication and therapy. I have learned so much about myself, but the healing has only just begun. The on-boarding time for SSRI medication is 4-6 weeks, so those first couple of months were really difficult. My father-in-law also passed away when Emerald was six days old, so that added to the difficulty of this season for our family, and especially for my husband. We have grown exponentially in our marriage, but it's still difficult to juggle our support for one another and the everyday craziness of raising three small children. 

Postpartum depression is the ugly beast I have kept hidden in the closet for the past three+ years, using my well-formulated excuses to shut myself in that dark space just stroking the identity of that monster time and time again. And I returned to those tendencies during the initial weeks of Emerald's life. I sat in my dark room, unable to move and having little or no desire to live. I drove away from my family late at night, just to drive right back because I didn't know where to go. I obsessed over the most ridiculous things with no realization of how minute they were. I couldn't give my baby a bath because I had recurring thoughts of drowning her. I couldn't cook because I had images of cutting myself with knives or burning myself on the stove. I had so much anxiety about driving and would picture the most horrific wrecks imaginable or driving my minivan off a bridge. I have since learned that these are intrusive thoughts and are irrational, but rarely dangerous. Still, they are absolutely terrifying, and will make you feel like you are unfit as a mother. But just in case nobody else will say this to you: you aren't. 

Look, birth doesn't have to look this way. The postpartum period does not have to look this way! There are so many resources for new moms and for seasoned moms too! This is a biochemical response, not a choice. The idea that mental health is anything other than a physical condition is just absurd. People of faith, hear this: no matter how much you believe in the power of Christ, not everyone can just believe themselves out of depression. And although some things can help, there are situations in which no amount of worship music, yoga, meditation, service to others, etc. can undo the complicated chemistry of your brain and teach the neurons to fire the right way or the hormones to produce at the right rate. I am the last person on earth to want to take medication, trust me. I try to out-will a headache like the best of them. But every week that I put my compilation of pills and supplements in their little bright green daily organizer, I am making a choice to put my mental health- and my family- first. I have been in a place where I was so close to choosing not to live, and that's no longer my reality. For my kids, for my husband, and for all the other moms who are fighting, I am choosing to live. 

My message to fresh mamas is this: you may have heard of the baby blues...you know, a little weepiness and some irritability after birth. No big deal, right? But if your baby is six weeks old, it's time to stop masquerading it and call it what it is; there is no shame in that. I'm so sorry for the stigma you have to face, but I can absolutely assure you that there are good people who actually want to help you, and you will not regret seeking that out. If you feel like this may be you, let somebody know! I am in no way a mental health expert, but if you feel like you have no where to turn, I am more than happy to meet you for coffee and just talk through it. You are not alone in this.

And hey, hiring a postpartum doula can help too! :) 

The Birth of Emerald Nanette: part one

My first daughter was born about a week "late," so when my due date came and went, I wasn't exactly shocked or surprised (even though my second was a day early). Each day that passed afterwards felt like a year, though, and my frustration just kept growing. I had looked forward to being pregnant during fall, but Tennessee had other plans and the 80 degree temps in December were making me a crazy person. I was not interested in seeing anyone or talking to anyone and felt like some sort of hybrid between a dump truck and a blubbery whale. After months of remodeling and adding on to our house, just hoping the baby didn't come in the middle of laying grout or hanging doors, the time had come...but baby wasn't budging.

And seriously, I was completely over chasing after two toddlers like the Michelin Man. 

On Monday, I cleaned my house for the thousandth time that week. I had been having plenty of cramps and irregular contractions for days, but I knew baby wasn't low enough yet. A couple of weeks earlier my midwife confirmed that baby was low and engaged, but then I felt like baby had moved. Sure enough, at my 40 wk. appointment, baby was no longer engaged (did you know babies could disengage? I did not). So that afternoon I put the kids down for a nap and started the Miles Circuit to try to move baby into position for labor. I started watching the show "This is Us" to keep me entertained. When I finished the circuit on the birth ball,  I definitely noticed baby was much lower. When my husband Blake got home from work I mentioned I had been having increasing cramps and even threw out a nonchalant "I think we may have a baby soon." 

We did dinner and bedtime routines with the kids as per usual. I settled on the couch, but was pretty uncomfortable and ended up going to bed early. I told Blake the cramps were just really intense so I wanted to rest. 

(at this point, using the term "cramps" was my way of not actually admitting that I was having contractions...)

We had set up the Christmas tree in our bedroom this year (because, toddlers) so I kept the tree lights on and laid in bed all night, getting little spurts of sleep....8 minutes....5 minutes....3 minutes. I had to pee at least seven thousand times that night and every time I got up the pressure would intensify. I knew I had a choice to either rest for few hours or go ahead and get up and walk around to really get things going. I chose to rest, as I was no stranger to the exhausting process that was to come. 

Sometime around 4am I just couldn't lay down anymore and decided to get up. I let Blake know things were pretty real and I got in the shower for about half an hour, which felt nice. At around 5:30am, I let my midwife, Jennifer, know I was ready for some extra support. At this point I was pacing and walking circles around our house because I was still in denial that I was in labor. Blake started to get the house prepped and asked his mom to come get the kids to take them to their mother's day out program. We had several friends on-call for help with childcare because Blake's dad was in the ICU and we didn't expect his mom to be available to help, but it just happened to work out that she could, which was really helpful. Lucy, our 3 year old, woke up pretty early because I guess she realized something was going on. She was so interested in everything and helped Blake get the birth pool set up.

My birth team arrived at about 6:30am and my mother-in-law came to get the kids at about 7am. I love my babies dearly, but they were such a distraction and getting them out the door was crazy, so I was glad to be able to focus again. (Jennifer was laughing at me as I was gathering backpacks and finding little shoes in between contractions) When I did regain my focus, things had intensified quite a bit. I had a protein drink that I was sipping on to stay hydrated and to keep my blood sugar up. I do not like eating during labor but get really weak and trembly, so I knew I needed to stay on top of hydration. 

The pressure was getting really, really strong and the contractions harder to work through. It seemed like it was taking for-e-ver to fill up that dang tub and I desperately wanted the relief of the water. I was having some urges to squat when the contractions came, which in the past has been a sign I was pretty far along. Jennifer asked several times if I'd like her to check my dilation, but I was so very anxious about not being where I wanted to be (which of course was like....at a ten, please??). I finally decided to relent and had her check my progress. I was dilated to 7cm at that point, but Jennifer stressed that she thought once baby slid down just a little bit more it wouldn't be long at all. I was a little discouraged, but the tub was ready and the water was such a relief.

I continued working through the waves and relaxed into the warm water in between pains. Sandee, my doula, encouraged me to get up and move around a little and to empty my bladder (Sandee's signature move, for which I have a love/hate relationship). I labored on the toilet for a little bit, which is my very least favorite, but one of the most effective places as far as gravity and pelvic positioning are concerned. 

I got back in the tub. From this point, things get a little fuzzy to remember. And honestly, the rest of this story isn't pretty. It really just isn't. This is the part that has kept me from putting this experience into words, but it is so very necessary for me. It is here where I place my trigger warning for anyone who has experienced emotional birth trauma. 

First, a little back story: after my first daughter was born, I wanted so badly to be a good mom and thought it would come naturally, as I had always been told I had a maternal sense about me. It turns out it was anything but that. I felt so awkward and out of place and struggled with intense guilt, confusion, and paranoia. I was finishing college at the time & had to leave my baby at 4 weeks to go teach 9th graders every day. I wept every single day. I pumped constantly, obsessed over her schedule, berated my husband for giving her a pacifier, tried "sleep training" which was truly a terrible experience, and never slept. I would lay her down in her crib in our tiny little apartment and go downstairs to the furthest corner from her room and just scream on the floor as she screamed in her crib. I was a total mess and had no idea that this was not normal. Fast forward to the birth of our second child, my son. I call this postpartum depression: take two + toddler. This time it presented itself as intense rage. Tiny daughter doesn't clean up her blocks? All hell breaks lose. Husband home two minutes late? Time for a divorce. Baby needs to feed at 1.5 hours instead of every 2 hours? I wanted to die. Seriously...I was absolutely out of my mind. I tried to get help, but for the sake of time and space and protecting the character of others, it was a failed attempt, several times over. 

So now, here I am in my living room. Everything is set up exactly the same as it was for Moses' birth...down to the same set of ratty purple towels for cleaning up all the messes a homebirth brings, the same people talking amongst themselves, and the same dreary winter weather. At some point, I just lost it. The physical pain triggered all the emotional pain and helplessness and guilt I had felt as a wife, mom, and human being over the past three years. I needed out...now. I started to beg to go to the hospital, saying over and over again "Take me to the hospital. PLEASE, somebody take me to the hospital." Looking at Blake with desperation and physically shaking and tensing and pounding on my belly telling my baby to stop. I got out of the water and continued to insist I couldn't do this...we needed to go to the hospital and I needed them to put me under and cut this baby out of me. Jennifer asked if that was what I really wanted and I felt paralyzed; I didn't know how to answer. I could see the worry and fear in their eyes and I knew something was going wrong. What I really wanted was to have the baby at home. It's what I planned for and paid for and prepared for, and yet here I was begging to be dismissed from it all. But each wave of pain that hit me pulled me further from reality and the pain-tension-pain-tension cycle persisted. I was so, so very afraid. I didn't worry about postpartum depression, I was already dealing with it. The anxiety ran through my veins in the same capacity as the blue tinted A-positive. I was in full panic mode. I threw on clothes and flip flops and began to talk through the hospital transfer process with the birth team. Jennifer started explaining it, and it hit me that I wouldn't make it through all of that. Because it wasn't a truly emergent situation, we would have to go through L+D, wait in triage, be moved to a room, wait on an anesthesiologist, etc. etc. etc.

"I cannot do that." I said, trembling from the cold and my fear.
Jennifer said "You're right. I think you'll have the baby in the car."

What to do about morning sickness...

During my first pregnancy, my very closest friend was the toilet. I suffered from hyperemesis gravidarum, a condition which can so easily steal away the joy of pregnancy and replace it with severe nausea, vomiting, dehydration, and undesired weight loss. I was in school at the time, and frequently had to dart out of classes or pull over on the side of the road because of sickness. I was seeing an OB who prescribed an anti-nausea medication. The meds did help, but unfortunately I didn't properly research the intended use or side effects of this medication (which actually isn't intended for pregnancy at all and the FDA has since warned against its use while pregnant). When I became pregnant with my second child, I knew I wanted to do things differently. My sickness wasn't as severe this time around, but still much worse than the nausea the average pregnant woman faces. It took a great deal of trial & error with many failed attempts along the way, and of course it was partly just a waiting game, but eventually I actually began to enjoy being pregnant! It changed my outlook on pregnancy and I was in a much better place. 

Though morning sickness is rather common during pregnant, you don't have to suffer through your pregnancy. There are many things on the market that claim to help ease nausea, but remember to check with your health care provider before using any medication or remedy during your pregnancy. 

 


Nitrous Oxide in Labor

 If you were one of millions of fans of the hit British television series Call the Midwife, you may remember the dramatic episodes detailing the introduction of a new “magic potion” for use during labor: nitrous oxide. Commonly referred to as “gas and air” on the show, this medical phenomena made its way into hospital delivery rooms in the early to mid-19th century with the introduction of a British tank known as Entonox that is still widely used in Western countries today (1). Nitrous oxide was first introduced in its very basic form is a gaseous mixture of 80% nitrous oxide and 20% oxygen which, when inhaled, provides analgesia to its recipient. For the laboring woman, nitrous oxide is often considered a safe analgesia inhalant to relieve labor pains without adverse reactions in infants.


I am forced to the conclusion that modern medicine does not know it all.
— Jennifer Worth, Call the Midwife

Though typically used in dentists’ office across the U.S. (commonly referred to as “laughing gas”), nitrous oxide is rarely offered as a pain relief option for women giving birth (though it is widely used as such in other parts of the world). Its more common counterpart, epidural analgesia, is used in about 60% of hospital births in the United States (2). Nitrous oxide is a weaker analgesic as compared to an epidural administration but has less adverse effects on the progress of labor for the mother, such as non-interference with natural oxytocin occurrence and no hindrance of infant awareness after delivery (3). According to the American Pregnancy Association (APA), nitrous oxide does not affect the breastfeeding relationship between mother and baby, as it does not interfere with the vital bonding that takes place immediately after birth (4).

The side effects of nitrous oxide are lesser than those of many other interventions used for labor pains, such as epidural analgesia. According to the APA, the side effects of nitrous oxide include dizziness, nausea, and vomiting (3), which are also side effects of epidural analgesia (5). Epidural analgesia, however, includes other, more severe side effects, including spinal hematoma, severe headaches, and infection (5). With epidural use on the rise in the United States- from 17-50% in 1997 (5) to over 60% in 2008 (2)- and the severity of many of its side effects, the question remains: why don’t women in the U.S. have access to nitrous oxide during labor? Currently, only 5 U.S. hospitals offer nitrous oxide as an option, including Nashville’s own Vanderbilt University Medical Center and just recently opened, Baby+Co. Birth Center.

In her 2007 editorial CNM Judith Rooks notes that nitrous oxide is far less expensive than administering pain relief via an epidural and does not require an anesthesiologist (6). Additionally, the laboring mother maintains control over administering the relief as she feels necessary. Nitrous oxide is a quick and safe alternative to many of the culturally advertised options women are provided with in the United States, and will hopefully soon re-enter into the medical realm as an option for pain management and relief for laboring women in this country.


(1) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3594866/
(2) 
http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_05.pdf
(3) http://americanpregnancy.org/labor-and-birth/nitrous-oxide-labor/
(4) http://www.porterinstrument.com/~porterin/dentalcontent/app/webroot/files/datasheets/Safety-and-Risks-of-Nitrous-Oxide-Labor-Analgesia-JMWH-%5B2011%5D.pdf
(5) http://www.ncbi.nlm.nih.gov/books/NBK100791/
(6) http://onlinelibrary.wiley.com/doi/10.1111/j.1523-536X.2006.00150.x/full

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