Trick or Treat?

This Halloween a friend of a friend invited us to her house for a Halloween-themed party. Everyone (kids & adults) were encouraged to wear costumes. Being 3 weeks away from delivery, all I could fit was an extra-large Halloween t-shirt I found in my Halloween storage box. Gerritt wore his bumblebee outfit while Sophia was a pink butterfly again (despite my strong encouragement for her to be Dorothy from the Wizzard of Oz).


At the craft table (Gerritt is making a necklace)

The evening was full of activities for the kids. They made bead necklaces, got prizes for their costumes & went trick-or-treating. It was Gerritt & Sophia's first time trick-or-treating & they absolutely loved it! By the end of the night, Gerritt was competing with his friend Anna to be the 1st one to ring the doorbells.


Sophia & a new turtle friend


Gerritt got a prize for the most "buzzy" costume :-)


Sophia got a prize for the most "bouncy" costume. Right at the beginning of the party she discovered a large leather couch & spent most of the evening climbing it & jumping on top of the soft pillows.




Getting ready to trick or treat


Heading out


Sophia admiring a pumpkin

Amazingly, Sophia kept up with the older kids (she was the 2nd youngest child in the group). I had to pick her up & run with her a few times not to be behind, but she insisted on doing most of the walking herself. I could hear her excited voice yelling, "Trick or treat!!!" and, of course, she was her usual polite self & said, "Thank you!" every time. People thought she was adorable & gave her lots of candy.




Trick or treat!

Thankfully, Sophia only liked to collect candy (like shiny interesting toys), but not to eat it. Gerritt was a complete opposite & a major sugar bug (one of my favorite names for him), so I had to set the rule of him eating only one piece of candy in the morning & one in the evening.


Sophia is last, but not the least (she got more candy than Gerritt because of her size & cuteness)



Gerritt - the first one at the door

Gerritt loved trick-or-treating so much, he requested to go again upon waking up the next morning. He was slightly disappointed when I told him he had to wait until next year's Halloween. I must admit, I enjoyed trick-or-treating a bit too much myself & would be more than happy to do it again next October. :-)

The Pumpkin Patch

Today I worked my last nursing shift at the hospital. I had a difficult patient assignment, but luckily my coworkers felt sorry for me & helped out quite a bit. Everyone kept complimenting me on how great I looked being just 3 weeks away from my due date. My last day at the clinic is November 17th (just 5 days away from my due date). Maybe I've overcommitted myself? Oh, well, baby may always decide to come early.


This week I've attended a continuing education conference for nurse practitioners in downtown Seattle. It was so much fun to run into my former classmates, preceptors & instructors. Two long days of sitting & note taking ensured that I would not have to take any continuing education courses (which are required to maintain my nurse practitioner license) for a while!
By the time Saturday came, all I wanted to do was to stay at home & rest. But then the projected rainy day didn't happen. Instead, Saturday turned out to be sunny & warm. It was a shame to waste such a gorgeous day, so we packed the kids & headed to the Pumpkin Patch at the Dr. Maze's Farm.


I am 36 weeks 5 days pregnant

We last visited this farm when Sophia was just 5 months old, & it was fun to take her back there all grown up. I waddled my way through the farm & even enjoyed gorgeous fall colors & my kids' contageous excitement of running outdoors.


Gerritt & I have really enjoyed the following books for the past few weeks (any book by Mo Willems turned out to be a big hit!):

Bulldog's Big Day by Kate McMullan
Oscar and the Very Hungry Dragon by Ute Krause
I Will Surprise My Friend by Mo Willems
I Am Going! by Mo Willems
My Friend Is Sad by Mo Willems
Don't Let the Pigeon Stay Up Late! by Mo Willems
Don't Let the Pigeon Drive the Bus! by Mo Willems
The Pigeon Finds a Hot Dog! by Mo Willems
Time To Say "Please"! by Mo Willems
Leonardo the Terrible Monster by Mo Willems

Next October we will have another pumpkin patch outing, only with 3 kids!

Preventing Occiput Posterior Baby Positioning

Left occiput transverse - our baby's current position

Yesterday my husband & I had another appointment with Charlene, our midwife. She determined that the baby was in left occiput transverse position. The good news is that he is head down, but we really don't want him to rotate any more posterior. Like into occiput posterior position - the reason I had my C-section when birthing Gerritt 4 years ago. I still remember the excruciatingly painful back labor (it was worse than the uterine contractions). Plus the occiput posterior baby most likely will lead to a long & exhausting pushing stage & even a possible hospital transfer (yikes!). So... we have another plan in place to prevent another posterior occiput baby.


Occiput posterior position

A posterior occiput baby has its back facing the mother' back & such baby needs to rotate all the way around in order to be born. Posterior occiput babies can't fully flex their heads to help them descend into the birth canal & the diameter of the head is larger than that of an occiput anterior baby (the most desirable birth position). In an anterior position the baby can easily tuck its chin onto its chest to fit through the pelvis.

How can you tell if your baby is in a posterior position?

- You may feel a lot of the baby's movements (punches & kicks) in the front
- Your abdomen may appear flat below your belly button when you are laying down on your back
- Your midwife can tell when she palpates your abdomen in clinic

What makes babies turn posterior?

- Sitting in cars
- Leaning back in comfortable sofas or recliner chairs
- Limited physical activity
- Poor posture
- Crossing one's legs

How can I prevent my baby from being posterior?

- Avoid all reclining positions. You should always sit with your pelvis tilted forward. This can be accomplished by always having your knees below your pelvis & your back straight. Sitting on a birth ball or sitting backwards on a kitchen chair is great.
- Get into the hands-and-knees-position as often as you can. Do it while you watch TV or read a book. Crawling is helpful too (go ahead & scrub the floors on all fours!).
- Do pelvic rocks 10 times in a row 2-5 times a day. Get on your hands & knees & rock your pelvis up & down (alternatively arch your back by tucking your pelvis under & then straightening, like the mad cat pose in yoga).
- Sleep on your left side with your left leg straight & your right leg at a 90-degree angle supported by a pillow or two. This creates a "hammock" for your baby & will encourage the baby to have their back cradled into your tummy.
- Pregnant in the winter? Babies like to have their backs warm. If you are pregnant in the winter & are not wearing a parka that closes in the front, your baby may decide to correct this by turning his back towards yours to stay warm & cozy.

I truly believe if I had followed the above instructions or at least was aware of the concept of optimal fetal positioning, I would have avoided my C-section. In my first pregnancy I had just graduated from the UW Nurse Practitioner program & spent months preceeding Gerritt's birth hunched over in front of the computer studying for my board exam. I hope this information will help someone else.

Additional Resources:

1) The Midwifery Group (the midwifery practice in Vancouver, Canada)

2) The Spinning Babies (a website dedicated to optimal fetal positioning):

a) Occiput posterior (OP)
b) How can I help my baby stay anterior?
c) Myths of occiput posterior

A Pregnant Pumpkin

Sophia kept saying, "Mommy pumpkin, Daddy pumpkin, baby pumpkin!!! Ha, ha, ha, ha!"


There are only 6 days left until Halloween. Gerritt & I went to Safeway today & picked out 3 gorgeous pumpkins. I originally thought of carving out a spooky witch, a gost or a scary monster, but then remembered this unique carved pumpkin photo by one of my favorite natural/home birth blogging Moms Rixa Freeze from Stand and Deliver. She really inspired me!


It took a lot of work, but the end result was worth it


A pumpkin in honor of my unborn son this Halloween

35 Weeks

36 weeks pregnant

This baby is continuing to train me for the upcoming sleep deprivation by waking me up around 5 am on most days of the week. Usually I get up to use the restroom, then have a snack (I am usually starving early in the mornings), then have a hard time going back to sleep. So I just get up & find something to do.
Luckily, I've had plenty to do lately. With only 5 weeks to go before my due date, it seems the time has accelerated. For example, yesterday (my only day off this week), I started the morning with a meeting with my manager at the hospital to sign my maternity leave paperwork & finish some of the required annual continuing nursing education competencies (chest tube care & epidural pump programming, just to name a few).
Then I rushed to downtown Seattle for a meeting with a lactation consultant at the Birth & Beyond store. With 2 failed attempts at breastfeeding, I have a major anxiety about being unsuccessful again, so I've been in touch with a lactation consultant to prepare as much as it was possible in advance. She looked at my inverted nipples & recommended I rent a hospital-grade pump about a week before my due date. I bought the BPA-free personal use electric pump kit & filled out paperwork for a pump rental. The rental for the Medela Symphony will run about $70/month (still cheaper than the cost of formula). We also talked about me using the Medela SoftShells to draw out the inverted nipples, but not until 1-2 weeks before my due date (they can stimulate breasts enough to cause premature labor).
I started my afternoon with a visit to my chiropractor for another spinal adjustment, followed by a pregnancy massage. I've been having more back pain since the start of my 3rd trimester. After finding out that my Aetna health insurance covers chiropractics & massage I decided to give them a try. The only paperwork I had to do was obtaining a massage prescription from my midwife. What a relief! I should have done it sooner. Every pregnant woman deserves to be pumpered with some kind of body work.
It was 3 pm by the time I finished my morning & early afternoon errands. I was starving! After having some lunch at home, I've decided to make the most of a few hours my kids had left with their nanny. I headed to my favorite Value Village (a thrift store) for much needed home birth supply shopping (it's advised to have everything ready by the 36th week of pregnancy). I was very productive & bought many large & medium-sized towels, 2 bed sheets, 2 large pieces of plastic - one for the bed & one to be placed under the birth tub (actually, they were U-Hall plastic mattress protectors), 2 large metal bowls, 2 large cookie sheets with raised edges, a flash light & a gooseneck lamp. I also found a beautiful white sheer bed canopy - got to have the right setting for those postpartum family photos! Of course, I couldn't pass up some other good finds & bought a shoe rack for my closet, almost new pair of Umi shoes for Sophia, 2 large soup bowls, a springform baking pan, a new linen shower curtain liner, & beautiful red Christmas table cloth. I didn't have any trouble falling asleep that night!


Gerritt has discovered another favorite activity - listening to books on CDs


Gerritt pretending to go on a trip (on the evening Shon got back from his business trip)


Sophia learning to eat all by herself


Gerritt dressed himself as a race car driver (including wearing my boots!)

Gerritt has been more irritable lately. The fact that he still sleeps with me is probably to blame. I wake & toss & turn often while trying to find a comfortable position, so his quality of sleep suffers as well. Gerritt has been making great strides in learning Russian. His favorite activity to do after turning off the lights at night is to "practice Russian." I usually name various Russian words (objects in the living room, fruits, vegetables, body parts, colors, etc.) & he translates.
My husband took a recent business trip to San Francisco recently. He was gone for 4 (!) nights. The kids, 2 dogs & I all slept in one king-size bed. It was challenging, but we managed. We were very happy to pick up Daddy at the airport on Friday night. I am grateful my husband doesn't have any more trips planned after the baby's birth.
My Mom's criminal background check is ready, however, I am still waiting for her photos to come in the mail. It looks like she won't make it in time for the baby's birth, but it may not be such a bad thing. The idea of home birth frightens her, so her presence may hinder rather than help my delivery.
I had a OB/GYN VBAC consult at the UW Women's Health Center about a week ago. The doctor told me she thought home birth was dangerous, but at least was nice going about it. We discussed all the VBAC risks involved, & she told me it was my choice at the end. I was dreading the appointment not knowing how I would be received by the provider. I am glad it's behind me.
Good news! My latest platelet count went up from 113K to 146K! My ITP treatment plan must be working. I am that much closer to my dream birth!

My Birth Plan

Only 31 days to go... I can't postpone writing my birth plan any longer.

I had the first meeting with my doula, Patti Ramos, today. We've discussed my birth plan. Not in great detail since I am not sure how different this labor will be, but enough to cover the most important points. Having already delivered 2 babies, I know exactly what I DON'T want. I had to prepare the home & hospital birth (in case of an emergency transfer) versions. I wanted to get right to the point since there is a running joke among conventional OB providers that "the longer the birth plan, the faster it's to a C-section." I've been postponing this part of the birth preparation long enough...

My Birth Plan for Home

I would like to:

- Walk around freely, stand or squat during contractions
- Eat & drink as desired
- Be disturbed as little as possible & labor in a quiet, dimly-lit environment. I tend to be silent & close my eyes while resting between contractions - it doesn't mean something is wrong.
- Bear down & push spontaneously in an upright position (most likely while kneeling & preferrably in a birthing tub)
- Use counter pressure & controlled pushing to help maintain intact perineum (Please use local anesthesia for any stitches after birth)
- Help "catch" the baby
- Have the baby on my chest immediately after birth & keep it there for observation/Apgar scoring
- Breastfeed the baby as soon as possible
- Leave the umbilical cord unclamped/uncut until placenta is delivered (If the cord is too short, wait until it stops pulsating before cutting it)
- Refrigerate the placenta right away to preserve it for encapsulation
- Decline the newborn antibiotic eye ointment/vitamin K shot
- Skip the newborn bath all together
- Take lots of photos/video during & after birth

My Birth Plan for Hospital

- My delivery is a planned VBAC
- Please treat me with respect & obtain my informed consent before touching me or performing any procedures
- Don't ask me to rate my pain & don't offer any pain medications unless I ask for it first
- When monitoring fetal heart tones, please use intermittent Doppler or a telemetry electronic fetal monitoring to allow for my greater mobility

I would like to:

- Have my husband, doula & midwife present with me during labor & delivery
- Have the hospital staff to be limited to my own doctor & nurses (no residents)
- Walk around freely, stand or squat during contractions
- Eat & drink as desired
- Be disturbed as little as possible & labor in a quiet, dimly-lit environment. I tend to be silent & close my eyes while resting between contractions - it doesn't mean something is wrong. If you need to ask something, please ask my husband, doula or midwife 1st.
- Bear down & push spontaneously in an upright position (most likely while kneeling). Please don't count & stay calm while I am pushing.
- Use counter pressure & controlled pushing to help maintain intact perineum. I prefer having a tear to episiotomy (Please use local anesthesia for any stitches).
- Have the baby on my chest immediately after birth & keep it there for observation/Apgar scoring
- Leave the umbilical cord unclamped/uncut until placenta is delivered (If the cord is too short, wait until it stops pulsating before cutting it)
- Deliver the placenta spontaneously (no pulling on the cord) & refrigerate it right away. I will be taking it home with me for placenta encapsulation (Please see my signed Release of Placenta & Waiver of Liability form).
- Breastfeed the baby as soon as possible

For baby:

- No circumcision
- No newborn antibiotic eye ointment or hepatitis B vaccine
- No vitamin K injection (I will be administering oral vitamin K instead)
- No pacifiers or artificial supplementation of any kind (formula, sugar water) as I plan to breastfeed
- All medical tests/exams to be done in my presence
- Delay baby's first bath until at least 1 hour after birth

My hospital birth plan turned out to be a bit longer than I preferred. I chose my midwife & doula carefully so many of the points outlined in the hospital birth plan didn't have to be spelled out for them. Many parts of the hospital birth plan will not apply in an emergency home birth transfer (I doubt anyone will have the time to read my plan in a true emergency), but it was important for me to cover "all the bases" just in case. One less thing to do on my birth preparation check-off list!

Home Birth Supply List

We had another appointment with our midwife yesterday where we received a home birth supply list. It's recommended to have these supplies collected & prepared prior to 36 weeks of pregnancy. Although it seems a bit overwhelming at first, for the birth to go smoothly I will likely need most of the items. Also, there is nothing worse than having my husband run to the store for missing supplies in the middle of labor or post-partum when I need him the most.

1) Birth kit
You can probably buy one from your midwife or one of the home birth supply stores on the web (see Your Water Birth or Cascade Healthcare). We bought ours along with the birth tub via the Micronews ad (Microsoft's version of the Craig's List).

Our birth kit contains the following items:

10 - 23x24 underpads (chucks pads)
10 - 23x36 underpads (chucks pads)
2 - 40x72 plastic backed sheets
24 adhesive maternity pads
1 perineal bottle
12 sterile 4x4 gauze packages
15 alcohol prep pads
4 flexible drinking straws
1 paper tape measure
Sterile lubricating jelly
1 cotton baby hat
1 bulb syringe
12 sterile glove singles
1 iodine scrub brush or iodine solution
2 plastic cord clamps
2 stretch briefs
8 oz. herbal sitz bath (made of uva ursi, comfrey leaf, lavender flowers, yarrow flowers & shepherd's purse)
Hand held mirror
25" water hose
Faucet adaptor & "Y"
Water thermometer with a cute plastic rubber duck on top
Debris removal net
Intex Quick-Fill high output electric air pump
Wayne submersible multi-purpose pump
Instructions

The ink-free foot printer & birth certificate were missing, but it's no big deal considering we didn't pay full price for the kit.

2) Birth supplies
Keep them in an easily-accessible clean box or a Rubbermaid bin once gathered & then lay out prior to birth.

- Plastic mattress cover (It may be waterproof mattress cover, old shower curtain, or other large sheet of plastic. You may need to secure the edges of the plastic with duct tape so it doesn't slide around)
- Plastic sheet for under the birth tub (to keep any water dripping from Mom's body from getting onto the floor/carpet)
- 2 sets of old sheets (ones you don't mind getting bloody)
- 1 flannel sheet (to be put into the dryer in late labor with several towels for warming up Mom after birth)
- 6-8 large and several hand towels (ones you don't mind getting bloody)
- 4 or more cotton receiving blankets
- 1 large heating pad & a pillow case to keep it clean (to heat baby blankets & keep the newborn warm)
- 2 large plastic garbage bags for laundry & garbage
- 2 large cookie sheets with raised edges (to hold instruments)
- Hydrogen peroxide (to take blood stains out of sheets/towels)
- Bleach for clean up (I chose to have Clorox disinfecting wipes instead)
- Portable electric heater (to heat the room quickly when birth is approaching)
- Birth tub supplies
- One large hand mirror (to view birth)
- One good quality flashlight ready with batteries
- A good light source (a portable lamp)
- Baby wipes (unscented)
- Paper towels
- 2 gallon-size ziplock bags
- Oral digital thermometer
- 2-3 medium-sized metal bowls
- Crockpot (for warm compresses if planning a land birth)
- Lots of ice in the freezer

3) Supplements/remedies

- Homeopathic Arnica Montana (for pain relief)
- Bach Flower Rescue Remedy (to relieve stress/anxiety during labor)
- Molasses
- Strainer for loose tea
- Unopened small bottle of olive oil (I bought grape seed oil instead)
- Liquid Floradix Iron & Herbs (for blood-building postpartum)
- Lansinoh lanolin cream (for soothing, protecting & healing sore nipples)

4) Food & drink

These must be high-quality, nutritious foods to be eaten by Mom & the labor support team during & after labor.

- Foods for Mom: easily digestible foods such as fruit, yogurt, whole grain toast with nut butter/honey, nutritious proteins (eggs, turkey sausage, string cheese), & juice popsicles during labor
- Hydration for Mom: water, diluted juice (half water, half juice), healthy energy drinks, popsickles, coconut water & Laboraide

Laboraide Recipe:
1/3 cup fresh squeezed lemon juice
1/3 cup honey
1/4 tsp salt
2 crushed calcium tablets (or 1/4 tsp calcium powder)
4 cups of water
(This mixture can be made ahead of time & frozen)

- Foods/snacks for the labor support team. I am thinking roasted unsalted nuts, sliced fruit/vegetables, string cheese, chips with hummus, dark chocolate, lentil soup (cooked in the crockpot) with rustic bread (?).

5) Postpartum supplies

- Maxi pads (for heavy flow)
- Food for the 1st 3 days prepared & ready to cook
- Ice pack (can be made from crushed ice in a plastic glove, use a small bag of frozen peas or a gel pack)
- Witch hazel pads (to be used for any stitches or hemorrhoids after the birth)

6) Rest area for the labor support team (midwife & doula)

In case they need to rest/sleep during labor or before driving home

7) Optional items

- Abdominal binder (to support abdomen after delivery)
- Ingredients for Comfrey Burn Paste (to heal perineum): 8 oz wheat germ oil, 8 oz liquid (not crystallized) honey, 4 oz comfrey leaf powder

I would also add the following items:

- A pair of warm wool socks
- Birthing ball
- Video camera with a charger & extra film
- Digital camera, fully charged
- CD player (to listen to hypnobirthing) & extra batteries
- Essential oils (to be mixed with grapeseed/almond/olive oil for massage during labor). I included Simpler's Clary Sage (relieves tension & increases contractions), Geranium Rose (believed to decrease inflammation & reduce anxiety & stress) & Rose Absolute (antidepressant, softens ligaments).

I am going to be busy!

Additional Resources:

1) Preparing for a Home Birth by Mama Birth

2) For Your Birth Bag by Birth Faith

33 weeks/Alternative Treatment of ITP in Pregnancy

With my wonderful midwife, Charlene Campbell, LM, CPM (see BirthJoy)

I have only 7 weeks left to enjoy being pregnant. How time flies! I am so used to being uncomfortable, achy & off balance that it's hard to imagine having my body back again.
My husband & I had our 1st midwife appointment together today. We've decided that he needed to be present for the rest of my appointments so he is on board with our home birth plans & can support me to the best of his ability. My midwife was so happy to see him - she was starting to wonder if this was a desired pregnancy. The combination of my husband working standard 8 am to 6 pm 5-day work week made it difficult for him to attend any of my meetings with Charlene. Thankfully, she opened up her evenings for us, so he would be able to join me for my 6:30 pm appointments on Wednesdays.


Gerritt checking out the pregnancy wheel

I didn't feel like he needed to be there in the beginning. I've carried 2 pregnancies to term & being pregnant again was an "old hat" to me. I tend to be an "easy" patient because I accept pregnancy discomforts as part of the game & don't complain much. I didn't need my husband's presence to discuss & validate my nausea, sore breasts & fatigue. Why would anyone want to sit through this relatively "boring" stuff? Plus we needed to pay extra for our nanny to watch the kids.


But everything changed in my 3rd trimester. Suddenly, I became aware of other expecting couples arriving to the appointments together holding hands & I started to feel that I was missing something. I realized that I couldn't & didn't want to do the rest of my prenatal care on my own & desperately needed my husband there. It doesn't matter if it is your 1st or 3rd pregnancy - each child deserves to be celebrated by BOTH parents. We even had Gerritt join us today. Since he's going to be present at the birth, I wanted him to meet Charlene & also be involved in welcoming his little brother into the world.


My latest craving - kombucha tea (to learn more about Kombucha Wonder Drink go here)

My platelet count dropped from 168K to 113K 2 weeks ago, so Charlene & I discussed our plan to build up my platelets. I developed idiopathic thrombocytopenia a lot sooner in my past pregnancies, so actually it's pretty good for me to drop only in the 31st week of pregnancy this time. My platelet counts in previous pregnancies always stayed above 80K, however, Charlene would be more comfortable doing a home birth with a platelet count > 100K, so I had to committ to the following treatment plan:

1) Drink 1 "green" drink daily.
I use Perfect Food Super Green Formula powder by the Garden of Life. This formula is made with vegetable, sprout & organic cereal grass ingredients & probiotics. One serving is equivalent to 140 grams of fresh grass juice to support digestion & healthy immune function.

2) Decrease amount of physical exertion & get more rest ("Have more energy coming in than out").

3) Take 1 drop of vitamin K twice daily.
Charlene recommended the K-Quinone vitamin K supplement distributed by the Scientific Botanicals, Inc. (Mukilteo, WA). 1 drop equals 2 mg of vitamin K-1 (as Phytonadione). Also, I bought a vitamin K2 supplement from Dr. Mercola's website. 1 capsule equals 150 mcg of vitamin K2 (as Menaquinone-7). Vitamin K2 is called the new miracle nutrient by the natural health community (similar to the relatively recently discovered health benefits of vitamin D). To learn more about benefits of vitamin K2, go here.

4) Increase my protein intake to 100-120 grams/day.
It's a good thing I am hungry all the time & crave mostly red meat. It's not unusual for me to eat meatballs for breakfast, turkey sausage for lunch & steak for dinner.

5) Take digestive enzymes with all my meals.
I use the Raw Enzymes Women by the Garden of Life. This supplement contains a variety of protein-, carbohydrate- & fat-digesting enzymes.

6) Drink 2 cups of nettle/red raspberry leaf/alfalfa/oatstraw tea a day (a combination of 1 part nettle leaf, 1 part red raspberry leaf, 1/2 part alfalfa leaf, & 1/2 part oatstraw). I have listed the benefits of individual herbs in my previous post.

I love how holistic midwifery is! This is definitely not an advice you would get from a conventional OB/GYN, although you also have to be careful to avoid choosing a "medwife" as your provider. The standard medical treatment of idiopathic thrombocytopenia purpura (ITP) in pregnancy includes steroids (oral prednisone), but only for platelet counts < 50K. The greatest concern for ITP during pregnancy is the risk of thrombocytopenia in the newborn (although only about 5% of newborns have a platelet count < 50K). Prednisone given for several weeks before delivery does not affect the fetal platelet count, so treatment should be given only if indicated for mother's thrombocytopenia. The platelet counts of infants born to mothers with ITP may decrease sharply during several days after birth, so serial platelet counts are recommended in the newborn period. Even when severe thrombocytopenia occurs, bleeding problems are almost always mild & can be treated effectively. Current recommendations include managing the delivery in a conventional manner & with Cesarean delivery performed only for obstetrical indications. Epidural anesthesia is appropriate for maternal platelet counts above 80-100K (depending on anesthesiologist's preference & comfort level).

Gerritt said a few funny things recently, so I had to write them down:

"I love you 10 times, Mommy!" (Gerritt explaining how much he loves me)
"Can we blow more candles out? That's a favorite part of my birthday."
"I am going to turn into ice & freeze the whole bed!" (while refusing to go to sleep by taking off his bed covers)

Here are a few photos of Gerritt & Sophia. A picture is worth a thousand words, right?


Gerritt, Sophia & their friend Anna are driving the imaginary bus


The rainy season began in Seattle, & Gerritt can never resist jumping into a water puddle


Sophia loves puddles too!


Gerritt & his friend Anna are enjoying a walk in the rain


Gerritt & Sophia pretend to swim like fish when taking a bath


Sophia has officially moved to cosleeping with Daddy (She now uses her crib only for naps in the daytime. Coincidentally, Gerritt started cosleeping with me shortly after turning 2 as well.)


Gerritt & his friend Anna playing dress-up

I still have so much to do! I have an appointment for a chiropractor evaluation & massage for my back pain & my 1st meeting with doula next week. The countdown begins!

Happy 4th birthday, Gerritt!

Four years ago our lives were changed forever when we became parents for the first time. After a difficult labor (natural birth turned into an unexpected C-section) Gerritt was born. My husband & I were both only children & were not exposed to a lot of children as adults. I only remember rolling my eyes while observing a toddler temper tantrum at the grocery store, "I will have better control of my kids!" Gerritt didn't come with a set of instructions & had a challenging task of teaching us how to take care of him. There were many sleepless nights & difficulties along the way, but Gerritt helped us to become a true family. He also paved the way for Sophia & his little brother. Becoming his parents brought us so much joy, we simply couldn't stop at having one child! :-)


Pancake & sausage breakfast with uncle Ananth & family

Gerritt's 4th birthday morning began with a surprise visit from uncle Ananth (our dear friend & Gerritt's godfather).


1st present (Cars-2 movie play set) was opened right after

My husband, Ananth & I shared in the cost of one of Gerritt's birthday presents - the Cars-2 movie play set (a racing track & 4 various cars).


Time to blow out the birthday candles!

Gerritt & I made his favorite chocolate cake the night before. I also bought the sunflowers & the balloons the day prior to make Gerritt's birthday morning more special.


Opening presents from grandma Chris & grandpa Gerry

Gerritt's American grandparents joined us later in the afternoon & more present opening followed. Since Gerritt is in love with all kinds of super heroes, the remote-controlled Captain America on a motorcycle turned out to be a big hit. He also got the Captain America shield from Daddy & Dr. Seuss's Twister game from Chris & Gerry.


Playing the Twister game later in the evening


Running with the balloons is so much fun!


Sophia's turn!

Our neighbor Rinku & her son Yash surprised Gerritt by stopping by in the evening with several more presents including a miniature leggo set & the Cars movie pajamas.


Birthday photo with Mom & Dad (Sophia was taking a nap)

Happy birthday, Gerritt! You are truly a special boy!