Sunday, June 14, 2009

Postpartum recovery






The first few days after birth were rough. I realized a couple of hours after my labor how much adrenaline was involved. I expected to be fatigued. Surprisingly, my upper arms & shoulders were sore (I remember having similar soreness after riding a scary, adrenaline-fueled carnival ride), probably from holding on to the squatting bar too tightly. My perineum was sore & swollen. My stitches were burning, especially with urination. I applied ice to perineum constantly. That along with round-the-clock Ibuprofen & Percocet relieved my pain enough to move around. According to Sally, I had more than usual perineal bruising & swelling. It was almost impossible to sit for the first couple of days. I even ate while kneeling on the floor. Eating while standing was another option but I was too dizzy to stand for long. My estimated blood loss was about 400 cc, but I was surprised how dizzy I felt. I could not urinate right after delivery (probably to due to massive swelling in my perineum), so the nurse had to use an in-and-out catheter to drain my bladder. That was the last resort since none of the less invasive methods to induce urination worked: smelling peppermint essential oil, running water, taking a sitz bath, & sitting on the toilet while relaxing perineum as much as possible. The nurse drained only 400 cc of urine from my bladder even though I drank so much fluid & received 1 liter of Lactated Ringers during labor. I didn't think I was that dehydrated. This was probably due to pbysiological fluid shifting. Thankfully, I was able to urinate on my own a few hours later. The Tucks pads & peri-bottle became my best friends for the next 4 weeks. A friend recommended I apply the Earth Mama Bottom Balm to my stitches, & I found this product to be a lifesaver. I was also very thirsty & hungry for the first couple of days after birth.
I've attempted to breastfeed Sophia but latching was difficult due to my flat nipples. So I began to pump the colostrum using an electric breast pump. Sophia was fed using a combination of a nipple shield & SNS (supplemental nursing system - a tube connected to a syringe filled with formula/colostrum). I spent most of my initial postpartum time snuggling in bed with her, however, made myself walk around the room & in hallways that same evening. Sophia slept most of the time, & we got good sleep that night. Sally saw me the next morning & wrote orders for discharge home. However, we did not leave until around 4 pm due to Sophia needing a metabolic blood screen as well as a hearing test & me needing post-partum teaching & a lactation consultation.
We arrived home in the evening of May 15th. I rushed to find & hold Gerritt. Poor thing, he looked so confused & sad. He was overwhelmed with our sudden attention after not seeing us for more than a day. He pointed to Sophia & proclaimed, "Baby!" Later that evening he lost it when he saw me giving Sophia a bottle. He looked at me feeding her & threw himself on the floor crying. He must have thought that bottle-feeding is a special thing I do exclusively with him. My husband had to take over Sophia's feeding while I held & kissed Gerritt. My husband's Mom watched Sophia that night while we got some sleep. After that night we were on our own.
The next month was about survival. The hardest part was not taking care of a newborn, but carving out time to give Gerritt enough attention. I read somewhere that he loses the most with the arrival of a new sibling, so we were determined to make this transition easier for him. We've kept Gerritt in his daycare for 3 days a week just to give him some sense of a routine & normalcy. On days Gerritt was home with us, my husband took him outside to one of the parks. Gerritt & I still had our special time every morning with bottle-feeding while watching cartoons, & I continued to put him to bed every night with lullaby-singing & holding. I was also giving him his bath once every couple of days.
I have tried breastfeeding Sophia for about a week & found it to be difficult. Initially, I breastfed using a nipple shield. It kept coming off or leaking milk, so on our 3rd day home from the hospital I just decided to get rid of it completely. I put Sophia directly to my breast & she seemed to breastfeed well. It was so satisfying to hear her swallow milk. Sometimes she would even choke because too much milk was released too quickly (I couldn't believe it!). Just like Gerritt she kept falling asleep after about 15-20 minutes of sucking being all snuggled & warm. So I was pumping after feeding her to empty my breasts completely. I was on Vicodin for about 5 days after arrival from the hospital. When my Vicodin ran out, I realized that I had blisters on both of my nipples & a bleeding crack on my left one. Apparently, Vicodin was numbing my nipples enough for me not to realize Sophia's had a poor latch. Breastfeeding became intolerable with me crying in pain every time Sophia latched on, & I've decided to pump for a few days to heal the nipples. Of course, Sophia got nipple confusion & when I tried to breastfeed her several days later, she gagged & spit the nipple out. That is how I came to exclusive pumping, again. I pumped for about another 3 weeks & decided to switch to formula-feeding full-time. I kept getting plugged ducts on both of my breasts, which were so painful, I could not have anyone touching me. Hugging Gerritt & my husband or sleeping on my side were out of the question. The breast pump is definitely less effective in removing milk from the breast compared to a baby. I also had to pump every 2-3 hours, which meant I was pretty much tied to the house. It's amazing how fast those 3 hours would go by & it was time to pump again. The longest I could go without pumping at night was about 5 hours, & I would often wake up with red, swollen, hard & tender breasts. I thought maybe I didn't produce enough milk in the beginning so I took galactorrheic herbs I bought on the Low Milk Supply website (it was highly recommended to me by a lactation consultant at the hospital). I drank tea made of organic chamomile, alfalfa, blessed thistle, fennel seed powder & fenugreek seed powder several times a day. My breasts definitely produced more milk as a result, however, more suffering has followed due to my inefficient breast pump.
It is my one unfulfilled dream - to be able to breastfeed. In hindsight, I should have consulted a lactation consultant right away. I had one come to our house when Gerritt was born, however, it was about $150 for a 2-hour consultation. I wanted to save money, however, I ended up spending way more on formula in the long run. Plus, if you think of difficult-to-calculate hidden costs to your & your child's health, it is so worth it. Another thing I should have arranged is to have my Mom come over & stay with me for at least 6 weeks until breastfeeding was well established. Newborns want to breastfeed often, sometimes every hour, so it was very difficult to solely focus on that while trying to cook meals, clean the house, get reasonable amount of rest & entertain a toddler. My husband was off work by the time Sophia was born, however, he didn't fully understand the importance of breastfeeding, so, unfortunately, wasn't as supportive as he could have been. He was annoyed at how time-consuming breastfeeding was & that I had no energy for anything else. "Gerritt was bottle-fed & he turned out fine!" I was fatigued, in pain, & suffering from post-partum mood swings, & several negative messages were just enough for me to give up breastfeeding all together. It is definitely like a full-time job with overtime hours. The first few weeks of breastfeeding are the hardest. I could have also rented a hospital-grade breat pump to relieve breast engorgement & pain. I've learned from both of my kids' births & next time I will make sure I have good support systems in place. The most important thing I've learned is that I CAN breastfeed (I had so little faith & no confidence in my body's abilities after Gerritt's birth). I am determined to succeed next time, whenever that would be... :-)
I had some "baby blues" for about 3 weeks. My emotions were raw & little things could upset me greatly. I remember my husband & I going out for lunch at the Microsoft Commons. He stepped out for a few minutes to buy some food & I could hardly hold back tears while waiting for him to come back. I started bawling upon his return. Why? I didn't know, just felt like crying my eyes out. I felt overwhelmed, like my whole world was turned upside down, which, of course, it was, silly me. The mood swings are difficult & my least favorite part of the post-partum recovery.
Overall, I found the recovery time from a vaginal birth to be significantly shorter & easier compared to a C-section. I was up doing laundry, cooking, cleaning & playing with Gerritt immediately after returning home from the hospital. I definitely overdid it & my feet became edematous for several days afterwords. The worst side effect of prolonged standing were increased pain & swelling in my perineum. The longer I was up on my feet, the more perineal burning & pain I felt. In hindsight, I should have had my Mom around or hired a post-partum doula to do all of the housework for at least a week after birth. My husband was home, but he was busy tying loose ends at work & entertaining Gerritt. He is not a fan of cleaning & the mess drove me nuts. I wish I had someone designated just to care for me. Doesn't everyone? This is one of the drawbacks of having kids so close together. I remember barely being able to sit because of the pain, however, I had to put Gerritt to sleep starting on my first night back from the hospital because he would not go to sleep with anyone else. Just to review, at bedtime I give Gerritt his bottle of formula, then sit & hold him in my arms while singing him lullabies & stroking his head until he gets sleepy enough to be lowered into his crib. Still, I was grateful I wasn't pregnant anymore because doing this with a big belly in front was even more difficult.
This time my husband & I got out of the house a lot sooner. We took Gerritt to different community parks, went out for lunch (with Gerritt in daycare), shopping & even to a party about a week after Sophia's birth. I was pleasantly surprised how much more I could do after this birth. Of course, I had to sit down frequently & walk slowly, but it was still an accomplishment. I had to stay on Ibuprofen (800 mg 3x/day) for almost 4 weeks. Probably not good for my stomach & kidneys, but I had so much to do. I tried getting more Vicodin from my midwife when I ran out, but received a firm "no." She said if I was still having that much pain after a normal vaginal delivery then I was probably doing too much. She recommended I rest more or return to her office for an exam if I felt something else was wrong. Easy for her to say! It's impossible to get much rest when raising a toddler. Still, caring for Gerritt post-partum was way easier than caring for him being 8 or 9 months pregnant. As much as I enjoy being pregnant, it felt wonderful not to carry so much weight around anymore.
As strange as it sounds, I also went through a short period of mourning that the pregnancy was over. It was so wonderful to carry Sophia with such a feeling of anticipation. The whole time I felt like I was participating in creation of a miracle. The unborn baby gradually became such a big & important part of my life. My husband & I actually talked about having another baby while still in the hospital. My birthing experience was so powerful, euphoric & life-altering, it made me sad to think I might never experience anything like that again.

Friday, June 5, 2009

Sophia's birth story







Well, the sweeping of the membranes worked! Since coming back from my appointment with Sally at around 4 pm on May 13th I was having intermittent mild contractions. They were nothing major though to make us think we would have a baby soon. I had a lot of energy & accomplished much around the house (see my earlier blog entry). The contractions even slowed down around midnight. When my husband briefly woke up from his sleep & asked me how I was feeling & whether I was still having contractions, I snapped at him not to bug me because they have stopped & I was so disappointed. I fell asleep, but remember tossing & turning often. The strength & frequency of the contractions gradually intensified & by 4 am I could not ignore them any longer. I got up & checked to make sure my hospital bag was packed, then I took a long warm shower & made a split-second decision to wash my hair to be as clean as possible prior to going to the hospital. There was no guarantee I would not end up with another C-section & I realized it could be a while before I washed my hair again. By 5 am the contractions became uncomfortable & I woke up my husband. I could not talk through them any more so we've decided it was time to head to the hospital. I called Sally & she approved of the plan. My hubby's Mom was up to check on me frequently. She prayed fervently for most of the early morning prior to us leaving. I was happy Gerritt was still asleep & we didn't have to deal with his crying as he saw us leave.
The drive to the hospital was easy since there was no rush-hour traffic yet. We found the Family Beginnings Birth Center at the Group Health Cooperative Central Hospital easily & were officially admitted at 5:45 am. I changed into a hospital gown & then sat in bed in a semi-reclined position since the nurse was trying to start an IV. The sitting still was really uncomfortable since my body craved movement, but I was determined to be a good patient. 3 different nurses attempted to start my IV & were unsuccessful. A female anesthesiologist eventually placed one near my left antecubital fossa after applying warm blankets to both of my arms.
After IV placement & drawing my blood for a platelet count, the nurse checked my cervix & announced I was 8 cm dilated. This hasn't surpised me at all since I was 9 cm dilated when I arrived to the hospital while laboring with Gerritt. Apparently, I am blessed to have a high pain tolerance since by the time I think the contractions are uncomfortable, I am almost fully dilated. However, I remember asking about an epidural while the nurse was trying to start my IV. I was told I could have one at any time since an anesthesiologist was available on site 24 hours/day. I just wanted to make sure good pain relief was available should I change my mind while attempting a natural vaginal birth after Cesarean (VBAC).
As my labor progressed, I remember being really thirsty & asking for juice often. I sat on a birthing ball briefly but spent most of my time kneeling on the floor while leaning over the bed. The nurse encouraged me to get off the floor so I was soon kneeling in bed while leaning over the bed's headboard. While resting between contractions I noticed Sally & a midwife student arriving. I was fully dilated at 6:54 am & started pushing while squatting on the bed & leaning over the bar in front of me. Initially, every time the contraction came I would tense my shoulders & extend my body over the bar, so Sally encouraged me to guide my energy downward instead. My bearing down efforts were spontaneous & I was making deep grunting sounds I didn't know I was capable of making. It felt like my body was in an autopilot mode & I was along for the ride since my urges to push & my need to grunt while holding my breath were completely involuntary. My legs started to go numb from the prolonged squatting, so I leaned back slightly & put my feet in stirrups. Every time the contraction came, my legs were flexed & drawn up by the nurse on one side & my husband on the other (to open my pelvis wider). After a while my contractions started to slow down (the resting or latent phase of labor) so I had a worrisome thought about possibly needing a Pitocin drip. I was really dreading it since I knew going "natural" while on Pitocin is not so easy, however, Sally reassured me that even though my contractions were further apart now, they were also more intense & lasted longer. My bag of waters never broke on its own, so I was pushing out what looked like a white balloon thanks to a large mirror in front of me. My Russian labor & delivery nurse (interestingly enough also named Yelena) was joking that Sophia would be very fortunate in life since she was being born "wearing a shirt" (Russian saying "родилась в рубашке"). Finally Sally decided to rupture the amnionic sac so that I could see Sophia's head as she descended down the birth canal. As I pushed with every contraction I saw a small part of Sophia's head. I never thought I would make it that far so I stared in the mirror in front of me in amazement. The lights in the room were dimmed & the only light that was on was aimed at my perineum. The head slid back as each contraction went away, which was disappointing. Two steps back, one step forward... However, after a while Sophia's head did not slide back but stayed down & I was able to touch her hair for the first time. I realized I would be holding her in my arms soon.
The head's crowning was one of the most intense experiences (the transition or crowning phase of labor). I haven't complained of pain up until that moment. As my tissues were stretching to accomodate Sophia's head, I felt intense burning & stinging in my perineum (the "rim of fire"). I remember complaining how much it hurt & that I couldn't go on. When I saw my perineum in the mirror I could not imagine it stretching any wider. I felt a tearing sensations on top near my urethra (at 12 o'clock) as well as at the bottom (at 6 o'clock). Warm wet washcloths applied to my perineum helped tremendously. It was difficult to push against the pain, however, I knew getting the baby out was the only way to relieve it. Sally offered to relieve my pain using a pudendal block & I agreed (pudendal block consists of injections into both sides of vagina to block pudendal nerves). However, by the time Sally opened sterile packages & drew up a local anesthetic into a syringe, Sophia's head was right at the vaginal opening & there was no room at all for Sally to insert a single finger into my vagina, let alone a needle. Sally was massaging the stretching tissues & applying a lubricant. She said that the baby would be born with one or two more pushes, & that's exactly what had happened. I remember having a really strong urge to push & then Sophia's head was out. It happened quickly & I was so shocked I forgot all about the pain. Sally moved the umbilical cord out of the way & turned Sophia's head to the side (she was in occiput anterior position). Sally encouraged me to give another small push & then Sophia's body slipped out at 8:41 am. She was placed on my abdomen & lifted up her head to look at me. A myriad of emotions hit me all at once: surprise, happiness & relief. As my eyes filled with tears, I put my arms around Sophia & kissed her head. I kept saying, "She is here! I can't believe it! I did it!" The nurse was rubbing Sophia to wipe off some of the vernix & to stimulate her breathing. When she started to cry, her color changed from bluish to pink. As blood stopped pulsating through Sophia's umbilical cord, Sally cut it. I delivered the placenta at 8:49 am, & then there was more pain as Sally massaged my uterus to stimulate it to contract thus stopping the bleeding. I didn't like it much & tried to push Sally's hands away unsuccessfully. Thankfully, the bleeding stopped quickly & Sally proceeded to repair my first-degree perineal tear at 6 o'clock. I required a total of 6 stitches. I hardly felt the local anesthetic & stitching as I was so preoccupied studying Sophia's features. She was beautiful & smelled so sweet. I will forever remember that newborn baby smell. The nurse checked her vital signs & measured her. Sophia weighed 8 lbs 3 oz & was 20 inches long. Her head circumference was 14.2 inches. I was on IV fluids with a small amount of Pitocin for about an hour after labor to firm up my uterus, then they were discontinued. Total labor took 3 hours & 4 minutes (counting from the time of hospital admission). Sophia Christine Hong was here at last & we were overjoyed!
Overall, Sophia's birth was relatively fast, easy, & by-the-book, so to speak. It was such a powerful & positive experience. I felt on top of the world & that I could accomplish anything in life. I was happy to have avoided another C-section. I also felt a big sense of accomplishment at being able to have a vaginal birth of my dreams. I had no expectations & did not even write a birth plan this time, so Sophia's birth was a pleasant surpise. Her birth allowed me to heal from the psychological trauma of my last C-section & made me feel complete as a woman. She is truly my miracle baby!
It is difficult to guess why my 1st birth wasn't successful. I ate the same & drank organic raspberry leaf tea several times a day just like I did throughout this pregnancy. The only thing that was different this time was my diligence about my body mechanics. I made sure to never cross my legs & to always widen my pelvis by spreading my legs & lean forward when sitting in a chair starting in the 2nd trimester. I learned about this via the Spinning Babies: a wonderful & educational website designed by a midwife & dedicated to optimal fetal positioning to ease childbirth. One of its principles states that "the baby will always get in the easiest position for birth - whenever the baby finds it possible to do so." A woman's job during pregnancy is to create such an opportunity. I worked on relaxing & stretching my pelvis by doing a prenatal yoga video & pelvic rocking several times a week. I've also learned from the website that the baby's head rotates more easily during birth when the amniotic sac is not broken too soon. Gerritt's labor started with my waters breaking at home. Could it be that his head didn't have a chance for optimal birth position due to an early amniotic sac rupture? Questions, questions...


"I want women to know that if you’ve had a cesarean birth, an induction, or an epidural, that doesn’t mean you’re not going to bond with your baby... or you can’t love this baby, or any of that. Humans are incredibly adaptable. But why adapt if you don’t have to — if you can let your body do what it was designed to do? I believe that the connection between overuse of intervention and postpartum depression is enormous. If women experienced the ecstasy of birth, they would have the high that would get them through the hormonal changes of the next week. Your body and your inner wisdom give you that high." ~ Christiane Northrup, MD, a visionary in the field of women’s health & wellness & a board-certified obstetrician/gynecologist

"Suddenly, through birthing a daughter, a woman finds herself face to face not only with an infant, a little girl, a woman-to-be, but also with her own unresolved conflicts from the past and her hopes and dreams for the future.... As though experiencing an earthquake, mothers of daughters may find their lives shifted, their deep feel...ings unearthed, the balance struck in all relationships once again off kilter."
~ Elizabeth Debold