Wednesday, December 30, 2009

Strepococcus Agalactiae - Group B Strep - GBS

In the world of information and modern medicine you would think that women and men everywhere would know about Group B Strep and its effect on pregnant women - more importantly its effect on delivery. But alas, this symptomless bacteria goes unmentioned in women's health education until you become pregnant. Then you start picking up on clues - mentions of what to expect in doctors visits, pregnancy books, childbirth education classes.

Today I know that 43% of women carry GBS in their vagina and/or anus. The bacteria is different than Strep Throat. It is not an STD or otherwise a transmittable bacteria - it is just something you pick up along the way that is consistently becoming more prevalent, or at least awareness has increased, in our society. For example, books published 10 years ago state that 1 in 4 women have it whereas yesterday I learned that the most current statistic is 43% of women carry it. And yes, I also learned that I have Group B Strep growing in my vagina.

It sounds terrible and gross, right? Actually not really gross? It is symptomless unless you have certain autoimmune diseases or are getting chemo - then it might become a problem in the everyday life of a woman.

But when you are having a baby it becomes a big damn deal, and so it should. The knowledge of GBS has identified the cause of many health problems with newborns, such as fever, breathing problems, seizures, limpness/stiffness, heart rate and blood pressure abnormalities, poor feeding, sepsis, pneumonia, meningitis and sometimes death.

So what does this mean?

Between 35 and 37 weeks you get tested for group B strep. They don't do it earlier because it is so easy to catch that they need to check at the very end. If you have it then you have to get an IV of antibiotics every 4 hours for approx 20 minutes throughout your labor. The bacteria grows so fast that they have to keep giving you antibiotics - but at least they no longer make you be on an IV the whole time. As a result, I now have to have a needle in my arm, something that we had hoped to avoid. This also means we have to go to the hospital a little earlier (we were going to wait until contractions were 3 minutes apart but now we have to do 5 minutes apart) and we have to stay in the hospital for approx 2 days so that the baby can be monitored to be sure they don't develop any complications from the bacteria. We had hoped to leave the hospital much earlier, but alas we will be there for a couple of days now to make sure Thriller is okay.

In Bradley they continuously tell you that Healthy Moms Have More Options - which is true - and now my options are limited by a bacteria that I did nothing to contract and didn't even know existed prior to being pregnant. In reality we are blessed to know what GBS is, know that I have it, and be in a place in the world where we can take preventative measures to protect Thriller from it. But I feel dirty and like I am already doing something that puts my child at risk so I feel terribly guilty too! I can only come to the conclusion that these feelings are the result of a lack of information about GBS. I think we should talk about it more and be more educated about the bacteria as a society rather than slipping it in like a dirty little secret that puts your unborn child at risk when you are pregnant.

I have to get over my disappointment in the diagnosis and move on - and likely this is a good exercise for me to go through prior to delivery as I am sure there will be other bumps in the road that deviate from our ideal birth plan. Needles, early admission, later discharge. Not that big of a deal, I can still move around, get in the tub, and generally do everything just as we have planned. And we have information to protect Thriller. That is what is most important.

Friday, December 18, 2009

Parent's Right to Choose?

(Preface: As I start to frame this blog entry in my mind, I KNOW that as compared to other countries around the world Morgan and I are extremely blessed in the technology and wide range of birthing options available to us in the United States. I just want to put that out there before I express my frustrations.)

I thought I was keenly aware of regulation of my body. I grew up in a pro-choice home, have an undergraduate concentration in Women's Studies and am very well versed on the history of regulation of women's bodies and sexuality by laws and social norms around the world. All of this background did not, however, prepare me for the laws, hospital regulations and variations of standards of care surrounding the birth process and having a child.

Over the course of my pregnancy I have lived in California, Virginia and North Carolina (where we are settled). We have been planning a natural childbirth from the start, but finding the location for our birth has presented complications along the way.

If we were still in California, I would be having a water birth at home with a midwife. There it is legal and our insurance would have covered the entire cost (which would have been much less for them, like a total of $3,000). As the home birth midwifes in California are legally admissible to the hospital, if there were complications my midwife would go with me and continue to be my primary care provider. Additionally, as midwifes are legally licensed in California they bring oxygen tanks, pitocin for the afterbirth, general anesthesia for repair and other necessary items into your home to provide the same medical care you would get in the hospital.

In Virginia I was introduced to the reality that in some states there are two kinds of midwifes, those who do home births, who are not admissible to the hospital, and those who do hospital births. In the hospital birth scenario the midwife does not give you the individualized care of a traditional midwife-patient relationship, but rather operates with multiple patients at a time, providing quick and unpersonalized care (I am sure there are some exceptions here, but generally this is the case).

Even after exposure to Virginia, I mistakenly assumed that North Carolina would be one of the liberal states and that I would have the same options as I did in California for birthing location. (Note that the states have an approx 50/50 split regarding home birth and midwife legality.) Our first choice was the Women's Birth and Wellness Center in Chapel Hill. This birthing center provided the safety of being in a "facility" which we felt was an important concession to make to our parents, and also provided a place where I could have a water birth which was my top choice for birthing method. My mother in law said early on that I should consider the fact that the success rate at the Birth Center is contingent on the fact that they only accept a very specific group of patients with low risks. I didn't want to listen, and assumed that I would be low risk - no problems, low blood pressure, no reasons for concern - but alas, when I finally got around to submitting my records they did not accept me as a patient because my BMI was too high for their guidelines. Please note that they never even examined me! I cannot even tell you how it felt to be told that I was too fat to have Thriller there. I was devastated.

At this point I was hitting 6 1/2 months pregnant, moving to a new town, no contacts, and no clue what to do. I cried a lot - and Morgan got online and started researching options. Home birth had been our initial choice, and in the absence of the birthing center, seemed like our best option. Additionally, we really wanted a water birth and hospitals in North Carolina will not let you have a water birth! You can labor in the tub but not have the baby in it.

Little did we know that we are now living in one of the most conservative states regulating home birth! It is not illegal for us to have a baby at home, but it is illegal for any medical provider to attend the home birth. There is an underground group of providers that will help you, but their names are not disclosed and if you go to the hospital not only will they not be admitted, but you can also not disclose who was there without exposing them to loosing their license or arrest! We have the SAME INSURANCE as we had in California, but given the laws in North Carolina we would have to pay out of pocket for the home birth. Not to mention that any provider who would attend the birth would not have insurance. Additionally, I am just not comfortable with an underground midwife bringing pharmaceutical supplies and drugs into my home. I don't think it should be illegal for her to have them or administer them - but when it comes to the birth of my child, I want to make sure that the best legal alternatives are around.

Assuming risk by employing civil disobedience, despite my liberalism, is not appropriate when it comes to having a baby.

Luckily my Bradley instructor made a great recommendation for Triangle OBGYN (doctor/midwife practice, very natural birth friendly) and Wake Med Cary (10 minutes away from our house, also very natural birth friendly) - and generally I am happy. The parents are happy and I do not feel like I need to go into the birth with my defenses up.

Despite the fact that I have found a good doctor/midwife practice and am having Thriller in a very progressive hospital I still find my mind wandering back to extreme frustration! It is my body and Morgan and I's child growing inside of it! Shouldn't we be in charge of how it comes into the world? It is SO MUCH safer to bring home birth above ground where it can be legal than have it occur behind closed doors with a hush hush attitude.

Here are some other ways my body and Thriller have been regulated thus far, I'm sure there are more to come:

Testing:

Simply being pregnant and receiving medical care opens me up to having legally required testing for transmittable diseases at the beginning and at the end of my pregnancy. Is there good reason for this, of course! If I have HIV they must know. If I contract HIV they must know prior to delivery as a c-section is required to protect the child. Moms may sleep around, fathers do cheat, etc - But nonetheless I am subject to body regulation without any choice.

But here is the kicker - they test me for every STD in the book prior to delivery but still the law requires that Thriller get an eye ointment to prevent blindness in case I have gonorrhea after birth. Doesn't it make MORE since to not do an unnecessary procedure and preserve the resource if they already know I don't have it? Really?

Alcohol & Drugs:

If I disclosed to my doctor that I was still drinking, or simply said I had ever smoked pot or used illegal street drugs, I would be subjected to routine drug testing, the law there applies to the doctor's responsibility, but it is still my body! In some cases women are even forced to meet with a probation officer and counselor like someone on parole! All this does is make it so women cannot trust their doctors and will not disclose their history to them, which is a real shame. This is not to say that an active drug user should not be subject to testing and counseling - but to be routinely tested after simply saying something like "I smoked pot in college" is a gross over extension of concern.

Vaccinations:

Vaccinations bring up a whole other debate. I have never felt so pressured or truly controlled and violated as I did the day I received my H1N1 vaccine. Was it the safe thing for me to do? Probably. But the CDC issued a statement that said ALL DOCTORS had to advise me to do it, binding their liability, and I honestly do not know that I will ever feel that I had a chance at getting the complete picture. Not to mention that both my mother and mother in law were extremely clear in their belief that I should get the vaccine which added genuine, loving pressure.

And then their are the concerns for the child's vaccines. Again, the CDC presents a schedule and the doctors have a liability issue if they do not follow it. I don't honestly have a problem with vaccines but I do have a problem with the set schedule and doctors who will not modify it based on the patent's (aka MY CHILD'S) needs. And, in some states, I have a serious problem with the addition of vaccines to the schedule.

I know that state and federal regulations governing pregnant women and children were put into place to protect the child. I know that extreme negligence and risky behavior endangers children and we (the collective society) need to protect them from their parents sometimes. But where is the line?

I believe that our society would benefit MORE from having parent education classes and giving parents the right to choose what is best for their birth plan and child. By taking the responsibility away from the parents and letting the state dictate regulation to protect the child from the moment pregnancy is realized we have taken away an integral part of preparing to be a parent.

I had a dear friend say to me last weekend that she had no idea that she had options, she thought you just went and did what the doctor told you to do. This prevalent understanding of your role in medical care in birthing in our society is so damaging to the parents! Have some ownership! Be an active participant! This is YOUR CHILD! Even if you choose to elect a c-section, take all the drugs offered, etc - OWN IT. Educate yourself and your partner to make smart decisions.

Morgan and I are obviously on the educated side, and as it is our nature, we question state regulations. I hope that we make good educated decisions for our child, and believe that we have in choosing health care providers and in constructing our birth plan thus far. I also hope that we can legally have our next child at home and have freedom to choose what is best for us and our family.

Wednesday, December 16, 2009

Bradley Class 7

I have to say that I feel particularly lucky to have a Bradley instructor who is dedicated to presenting a fair, complete picture of the birth process. I know the course has a reputation of having instructors who are very harsh about the expectation of natural childbirth. In this weeks class we went down the list of procedures, drugs, choices, etc so that we can write our birth plan. It was a culmination of lots of the little bits of information we have gathered so far.

Laura suggested that we start off by loosing the idea of a "birth plan" because there is no way to plan your birth. Rather than we entitle the document "birth preferences" and really get it into our head that that is all it is - preferences. What we can do is be educated about our options to ask the right questions should we need intervention, etc and know what our preferences are. Otherwise you are pretty much setting yourself up for a feeling of disappointment or failure if you deviate from your plan - which will almost certainly happen.

I have been waiting to get my B-Strep test next week before writing my "birth plan" as it will make a significant difference in when we go to the hospital, if I need and IV port, and how long we have to stay. But now that I am thinking about it, maybe I'll go ahead and draft my "birth preferences" knowing that it might change.

Morgan and I were also charged with getting packed for the hospital in the next week or so! By the time I hit 36 weeks our instructor suggests that we should be ready to go! We have a checklist and I am SO NOT ready to go based on its recommendations. I'm still trying to think of a way to sneak Cooper into the hospital - probably not the most realistic thing for me to be focusing on :)

Sunday, December 13, 2009

Thriller Shower


Yesterday we had the most wonderful baby shower and housewarming party thanks to the best friends in the world. Our house filled up early with family and friends, homemade chili, sweet delights, cocktails and toasts! It was wonderful and we are very blessed to have had such a day!



















Thursday, December 10, 2009

Ophelia's Adventure with Thriller

I just had the most amazing experience. I know I talk a lot about Cooper and he may have an unfair favorite pet reputation - but that is only because our sweet kitty is so shy, and moments with her are sweet and often still, which is how she likes it.

Ophelia was slightly traumatized by the move but has settled into our new house nicely. She sleeps beside me every night and is clearly aware that I am expecting. However, I has no idea how interested she was until a few minutes ago.

I took a shower, wrapped myself up in a towel and then laid down on the bed for a few moments off of my feet, a slight space existing between by belly and the body pillow. Ophelia crept into the slight space, and ever so gently (without any nails) started slightly feeling around on my belly. She used her paws to apply the slightest pressure until she found a spot where Thriller was moving and then followed the movement around with her paws (still without any nails) all over my belly. After the little adventure was done, she curled up headfirst to have her head right next to where the last movement was a purred at my belly.

WOW. Animals never cease to amaze me. Looks like our little kitty is getting excited too!

Bradley Class 6

Transition > Pushing > Baby in Arms

In this weeks class we discussed transition and the second stage of labor. I must admit that I was surprised to learn about the drastic changes in body temperature and mood that occur in the transition phase. Also, transition is the phase where women most often give into pain medication - which is arguably too bad because you are so close! I haven't been there so I don't know ... but we have some pointers to get me through without caving into the epidural.

  • Ask for an IV of fluid (assuming you are not already on one), take the whole IV and get checked BEFORE asking for the epidural. The IV can speed things along significantly and get you through the scary phase without caving into the drugs.
  • Relaxation techniques: Needs will have totally changed from the first phase of labor, coach will need to remember that he needs to adjust.
  • Remember: More often than not, transition only lasts 30 minutes - Anyone can do 30 minutes!
I was also surprised to learn that I should actually listen to the coaching from the nurses, doctor and/or midwife when pushing to prevent tearing. I don't know why this caught me off guard ... I guess I just assumed that they were looking out for the baby and if you were going to tear you just tore. I have read a lot about the perineum and know that working with (not against) its elasticity will prevent tearing in birth - but it just didn't occur to me that someone from the outside might be able to help me strategize during pushing. It is VERY good to know as I might have just had the screw you I'm doing what my body is telling me to do attitude otherwise.

The inevitable POOP: I was already prepared for the reality of pooping when pushing from reading Ina May's Guide to Childbirth. Luckily Morgan read this too and we had already joked about it. Also, luckily, we do not have a relationship where discussion or the reality of such things is considered taboo. In class this week the reality of the POOP was discussed - and it seems most of my classmates are also going to be able to face this fact. I have had friends who were so mortified by the POOP that they got down to the wire and wouldn't push due to the fear of their husbands knowing or seeing such a terrible thing.

Let me be clear, I'm not excited about this being a part of the birth process, but it is what it is. And it gets taken care of immediately by the staff who are caring for you. And hopefully Morgan will never know - and if he does I know he'll love me anyway and never bring it up. So if you are reading this and POOP is taboo in your life, I recommend facing it now! Besides, POOP will be even more of a reality in our lives after Thriller comes I am sure.

RING OF FIRE: Apparently right before the baby comes you become so hot that you literally will feel like you need to back up off of a heat source at the birth canal. This is often referred to as the "Ring of Fire" and the best way to get through it is to just remember - you're moments away from having your baby in your arms!

I like that part the most. Can't go through the pain, can't go around it - but just go through the ring of fire and meet your child. I think I can handle that!

Tuesday, December 8, 2009

My Big Baby

As I started off pregnancy on the heavy side, then lost 13-18 pounds in the first trimester due to extreme morning sickness coupled with migraines. I have slowly floated along my pregnancy boasting gleefully that my hips are slimmer. Well, the good news is that my hips are still slimmer.

In my last doctor's appointment I finally gained my first pound, and was honestly a bit relieved to know that the baby was getting bigger. At that appointment Dr. V suggested that I was measuring a little big, but did not seem terribly concerned.

However, in the past two weeks I have put on an additional 4 pounds and am measuring 37 cn - which is where I should be measuring at 37 weeks - meaning that our little Thriller isn't so little! I would like to think that he/she has just had a growth spurt and will balance back out to be within the average size range. Morgan, on the other hand, believes I should not put so much faith into what is considered "average." He is probably right as neither of us is anything like average!

I am also sure that in the past two weeks I have gone through major physical changes. It is much harder for me to get up, I am extremely uncomfortable when sitting down, I can't sleep for longer than 3 hours at a time, bending over is no longer really an option and I have an insatiable thirst for water. What is going to happen as I get bigger? Geez!

Due to the increased size, I am going to have ANOTHER ultrasound on 12/22. This will be my 4th one and I am honestly not very excited about having it due to the concerns about over exposure to the process. At UCSF they clearly told us they were researching and publishing why it is important to have as few ultrasounds as possible and suggested you should have 2 at most unless you are considered high risk. I don't think the fact that Morgan and I made a big baby should come as any surprise to anyone, and I don't think that it makes me high risk - especially considering that everything has been totally normal thus far. But alas we are slaves to the medical profession - we should have the ultrasound in case there is XXX which could mean complications YYY. I like Triangle OBGYN and trust them - I don't think they are just trying to make a buck off of me at Thriller's potential expense - so fingers crossed we don't have any Xs or Ys in a couple of weeks.

At least Morgan will get to come to this one so he'll get another visual. There is the silver lining.

Sunday, December 6, 2009

Jane comes to visit!

The nursery is really starting to take shape! I wish I could take any credit, but alas my inexperience with these sorts of things rendered me unable to even consider creative sticker murals as a way to liven up the room given Morgan's moratorium on painting.

Enter Jane Sneed: Oldest friend in the world, mother of two, and regular decorator and re-decorator. Jane is one of those girls who always has images of how to make things look better in the back of her mind - and she worked some serious magic in Thriller's room. We now have trees, owls, squirrels (much to Cooper's dismay), frogs, turtles, bluebirds and bears - creating a warm and perfect little themed (but not over themed!) room.

In addition to Jane's decorating skills, she also re-introduced me to Babys R Us. While I have no intention of making this a regular shopping spot - it was MUCH better to go to the store with an experienced mom who could explain things and help make some since of it all. And that is where they had the super cute wall stickers!

I was treated, treated, and treated again over her stay and learned volumes of practical mom knowledge.

Thank you Jane!








Wednesday, December 2, 2009

Cooper:The Ultimate Protector

I've mentioned throughout the blog that Cooper has been very attentive throughout my pregnancy - I still think he was the first to know that I was expecting. He is especially protective when strangers approach me. Since we have been in Raleigh there has been a lot of rain - causing southern storms unlike those we experienced in California. Today has been one of those stormy, windy rainy days.

Cooper has not only refused to leave my side throughout the storms, but today he has taken it to another level. This morning I woke up to find his paws tucked under my ever increasing belly. As the winds have gotten stronger so has his devotion. Not only does he feel the need to be right next to me but whenever possible he puts himself right next to my belly. He seems totally drawn to touch it and I know that Thriller has been kicking (or punching or elbowing) in areas where Cooper has been resting his head and he has to be able to feel it.

I can't wait to see Cooper greet Thriller! I might have to buy a video camera to document the occasion.

Tuesday, December 1, 2009

Nursery Progress





About 1/4 of the very blue nursery is filled with the few remaining boxes we need to unpack. The rest is full of our recently assembled baby furniture! YAY! Morgan and I spent much of Sunday setting up the crib (which was pretty easy) and the dresser (which was much more challenging!) and today I finished the job by putting together the changing table. Whew. Nesting has taken hold!

We have been all over the place on getting the nursery furniture together - from looking at high end designers to mass producers (Pottery Barn, Land of Nod, etc) to local craftsmen to hand me downs. I was feeling a lot of pressure to get the main parts of the room together and my mom came through and ordered our set right when the immediate nesting need took hold. We decided to go with the DaVinci line, which is constructed of sustainably harvested wood from New Zealand and has a nontoxic finish (higher standards for nontoxic than just what is required by law). However, it did come in a lot of packaging material! So I am not sure that our good intentions totally counteracted our carbon footprint on this one - but we did the best we could. And truly, I couldn't be happier with the look and feel of the room ... and look forward to finishing the room over the next week or so!

Cooper is feeling a little neglected while I am distracted! Tomorrow may have to be Cooper day to make up for all my other activities.

Bradley Class 5

Last night I went to our Bradley class solo, as Morgan is back in California for work. It will be his last work trip for some time, at least until a month after the birth and I am really secretly hoping for April. He is of course following it up with a trip to the Sierras for the weekend, where God willing there will be some snow for him to work out a little of his ski itch.

Back to Bradley. It was the best class yet! At least the most informative as we actually started talking about labor and what we (mom and coach) will need to do up until transition. Not the best class for Morgan to miss - but Laura, our instructor, gave us a DVD for him to watch and I took serious notes - which were of course typed up and emailed to him earlier today - with all the most important parts in bold.

As I am not a scientific person, much of what we learned yesterday that was most interesting to me was about "effacement" - I am now certain that the uterus is the most amazing organ in the body. Muscle literally moves from the front where it is protecting the baby to the back of the uterus to give your more strength to the baby out. Amazing. Wow. Body is amazing. This information, as well as a very visual images of my cervix dilating to 10 cm (about the size of a grocery store bagel) are going to help me tremendously in labor. While I am not a scientific person, I am very visual and I know focusing on images of what is happening inside me will help me get through the contractions.

We also learned about the 3-2-1 rule, which suggests that unless we have an accelerated progression, we wait until the contractions are 3 minutes apart, lasting at least 1 minute for at least 2 hours before going to the hospital. I think this will be key to my stamina - to stay at home as long as possible. While I was initially disappointed with the fact that we are not going to be in a birthing center, the close proximity to the hospital (10 minutes tops) does allow us a lot of freedom in this regard. Fantastic.

My confidence that we are going to be able to birth Thriller is growing by the day - and more importantly by the class. I am certain that by the time its TIME we will be able to be an educated, effective team in the delivery room. And baring any major unforeseen complications - I am certain with can bring this child into the world without drugs.