Thursday, April 28, 2011

Winner of the "Arms Wide Open" giveaway . . .

. . . is Jennifer, commenter number 5! Jennifer, email me at annetegtmeier [at] gmail [dot] com with your snail mail address and we'll send it off to you posthaste. (If I don't hear from you within a week, we'll draw another number, to be fair.)

It seems especially meaningful to share a midwife's memoir as we memorialize another.

Thanks to all my readers for taking in our sharing of Briana over the past week. It's something that has affected us quite a bit, so I appreciate having an especially relevant place to share it. I'm hoping to get the grand finale to my previa story up next, but sometimes life and all it encompasses - including death - takes precedence.

Briana Blackwelder (at my son's birth) from David Perry on Vimeo.

Thank you for bearing witness.

Wednesday, April 27, 2011

Briana's Words, Briana's Wisdom

Created by my sister Kate and her husband, Neil. This uses footage from her adoption documentary project (more of which, including the conversation all 4 of us featured subjects got to have together, will be included in the final project).

Briana's Words, Briana's Wisdom from Kate and Neil on Vimeo.

If you watch, definitely make sure you catch the very ending.

A scholarship fund has been created in her honor at the Midwives College of Utah. Please consider donating to her legacy.

Monday, April 25, 2011

In memory of a young midwife

This is Briana Blackwelder, a 28 year old midwife and good friend of my sister, who was killed in a car accident this weekend.

I was lucky enough to get to meet her just a few months ago, en route to Portland, when we stopped in Provo and stayed the night with family. My sister is working on a documentary film project about adoption, which I mentioned in this post a ways back. Kate is in DC, but since I was stopping through, this meant that 4 out of 4 interview subjects would be in the same city for the blink of an eye, so she arranged for us to meet and Skyped herself into what was a wonderful conversation between us all - my mom, a birth mother; myself, a relinquished child; Kate's friend Ashley, a birthmother-to-be; and Briana, Ashley's midwife. This was all caught on film, and editing is underway.

After the conversation, I got to chat with Briana for a bit longer, talking about my hopes of attending Birthingway and about some of her own experiences, and I truly looked forward to getting to know her more in the future. Hindsight often magnifies these fleeting things, especially when tragedy and grief are involved, but I don't think it is any exaggeration to say that this was a truly extraordinary person whose genuine vocation as a midwife emanated from her very being. In addition to the inexpressible loss her family is suffering, the world of midwifery has experienced a huge loss as well.

I'm reposting the Vimeo video from my previous post about the film; it focuses on Ashley, but in the process, you get to see Briana in action for an all-too-brief moment, starting at about 4:30. An all-too-brief moment in an all-too-brief life.

Women's Bodies, Women's Wisdom from Neil Ransom on Vimeo.

When Kate's film is finished, we'll be able to see her interview footage, and I very much look forward to hearing everything she has to say. I'll share this with you as soon as it's available.

Please take a moment to hold her in your thoughts or your prayers or in whatever way you honor the departed.

Memorial services will be held on Wednesday in Salt Lake City
, if you're a local.

Thursday, April 21, 2011

Big Birthday Giveaway! "Arms Wide Open"

At long last, my first giveaway! I've been looking forward to doing this for some time, but was awaiting a ripe opportunity. Hence, my birthday.

I love a good midwife memoir, and just started this the other night, at long last: "Arms Wide Open: A Midwife's Journey". I'll be giving my thoughts on the book soon enough, but wanted to get the giveaway going first!

SO! Standard blog giveaway rules. One point each for: Following me on Google Friend Connect (over thar in the sidebar), liking my page on Facebook, following me on Twitter, or subscribing via RSS. Post a separate comment for each! I'll give it a full week, then choose a winner via Winner gets a free copy of the book, of course!

Enter away!

Monday, April 18, 2011

The Parallel Paradox Part 3 - Dealing with Placenta Previa

Continued from parts one and two.

After getting off the phone, and calming down, I drove directly to my local natural parenting store, where I'd been going for cloth diapers, slings, and a home birth support group. Surely their abundant bookshelves would offer up some helpful and reassuring information, somewhere in all the books I'd been devouring for their information on natural/home birth and holistic pregnancy.

On the contrary. I looked in index after index after index. And each book in turn referred me to a page that mentioned the several universally-agreed-upon contraindications for a vaginal birth. I might as well be walking around with a pre-prolapsed cord. Some mentioned that placentas can migrate late in pregnancy, but offered no further information. All the crunchalicious books I had found so empowering were now shutting a door in my face, or so it felt.

One of the employees that I had become friendly with came over to offer some help, and I told her what was up. "I guess I'm just feeling pretty powerless right now," I said, fighting tears but still self-conscious that maybe I was blowing the whole thing out of proportion. She reiterated what the perinatologist had said about the likelihood of migration, and though she didn't know anyone who'd dealt with this personally, she had known of some women on a message board who had. I decided to check in on the message boards when I got home.

Before I logged on, though, I decided to browse through my own shelves and see if I found anything new. All of my own books produced the same result as the books at the store - "Previa, placenta, 176, contraindication to vaginal delivery"; "Placental abnormalities, 242, previa"; "Placenta previa, 52, reasons for cesarean"; "Previa, placenta, 67, abandon all hope" - except for one. One very unexpected resource.

When she got the news of her impending grandmahood, my birthmom ran right out and picked up what seemed to be THE book, the bible, even, for pregnant women, and was recommended as such by the bookstore employees: "What to Expect When You're Expecting". Now, as you'll gather from that snarky link of mine there, this is a book that, generally speaking, is not held in the highest regard by many naturally-minded people. Those on the spectrum of crunch tend to see it as very conventional, quite pro-intervention, and unnecessarily anxiety-provoking. Yet this book was the one place that went beyond listing placenta previa as a flashing red light, offered me some more information, and even managed to be reassuring.

It explained that previas are present at only 1 in every 200 births, that "A low-lying placenta is fairly common but as pregnancy progresses, the placenta usually moves upward and away from the cervix." It went on to say that nothing (nothing!) needed to be done about it - no mention of pelvic rest or limiting activity. "You don't even have to give your low-lying placenta a second thought." I wondered if I should have the authors call [insert Connecticut OB/CNM collaborative practice name here].

The book then mentioned a few risk factors for placenta previa, including smoking and previous uterine surgery. Though I had already quit, I did smoke for 15 years, and 'uterine surgery' does include D&C, which, as the perinatologist had so sensitively clarified in categorizing its non-spontaneous nature, was also true in my case. Enter guilt: because of mistakes and poor choices past, my baby was now at risk. Add that to my custom blend of fear and helplessness.

Yet despite feeling this guilt, I felt a little better about my odds, and a little more armed with information. I had a longer talk with Nancy, my midwife, about things I might be able to do for myself under the circumstances. "The worst part is that there's nothing that I can do about it!" I cried. "Oh, but there is," she said. No, she didn't know of any acupuncture or homeopathic treatments, as I had been wondering, but talked about visualization as a powerful tool, and explained how placentas tend to be attached to parts of the uterus with good, iron-rich blood supplies. I devised a regiment where I would take Floradix*, a natural and non-constipating liquid iron supplement, every day, and every night I would utilize my massage skills and use upward strokes on my belly to help me visualize my placenta migrating upwards. (This is not a medical treatment or even an official massage technique, simply a tactile aid to my own visualization and positive-thinking process.)

As the week wore on, I talked with others who offered comfort and support, and also valued the use of visualization. One of my wise massage therapy co-workers and mentors was especially adept at 'manifestation', and helped me fine-tune what I was going for. One important point was to work on visualizing and verbalizing things in the positive - in her view, the Universe doesn't respond to our negations of things in our statements, but to the things themselves. I know, I know, can I vague that up a little more? For example: in a birth plan, rather than asking for "no episiotomy", you would ask for and envision "an intact perineum." So, in my case, rather than asking for and focusing on "no placenta previa", I worked on manifesting "a clear and open cervix".

Does this all sound awfully "woo" to you? I know. It kind of is. I'm actually really not much of a woo person in general, but this was all I had. It helped me to think I was doing something for myself, being active in the process, and taking back some power in some small way, rather than sitting around feeling passive, powerless, and sorry for myself, victimized by a cruel combination of questionable past choices and lousy luck.

All this was prior to my next cervical check with the CNM practice. I had one more to go before they would give me the no-cerclage-necessary all-clear, and the perinatologist had sent them his recommendation to do all subsequent internal exams via transvaginal ultrasound. So I returned to the CNMs about a week after the Level II ultrasound that diagnosed the previa, a week that had started out as an emotional Space Mountain, but during which I had gradually found my way to feeling more stable and optimistic, however hesitantly. Assuming my cervix was still closed, I was planning on discontinuing the parallel care, but was a little uncertain now that my placenta had thrown a wild card into the mix.

I started with a trip to the ultrasound technician's room, where she confirmed the same placenta location, and also noted that my cervix was still long and closed - no sign of 'incompetency'. I then went into an exam room to wait for whoever the rotation assigned to me that day, feeling a little wary but fairly resolved, based on everything I had learned.

The CNM that entered the room was the one I had come to think of as Ms. Worst Case Scenario, the youngest one in the practice and also, in my experience, the most conservative. It had been she who raised the alarm about my cervix to begin with, and had exerted a substantial amount of pressure regarding prenatal testing. Now, she looked over my revised chart with its fresh new scarlet P, and reviewed all the precautions I needed to take, including pelvic rest and no strenuous exercise. I agreed to all of the precautions, and then started to explain what I was doing on my end, with visualization and positive thinking.

She cut me off with a shrug, saying, and I swear I quote this word for word, even after all this time, "Well, either it's going to move or it's not, and no amount of thinking you do is going to change that."

Long pause.

You know, you don't have to believe in what I was talking about. I had my own doubts. But my GOD, it was obvious that the whole placenta situation was really , really upsetting to me, and even more obvious that this was something that was helping me to feel better about it. Would it have &@#$!ing killed her to at least pretend to be - well, not supportive, because that was clearly beyond her, but to simply remain neutral? Sure, YOU might not think it would help, but there's also no way it would hurt, so what the hell was the problem? Even a noncommittal nod, a "Mmm-hmm . . ." and a change of subject would have been preferable to just dismissing me outright.

I shouldn't have let it affect me, but I was already on shaky ground. I tried to remind myself that, AGAIN, this was just the world that she came from, and she wished me no ill will; on the contrary, she was giving me the care that she believed in, and was trying to do what was best according to her belief system. A placenta previa WAS something to take seriously (none of my posts are intended to suggest that it isn't.). And again, in contrast with other major pregnancy complications, fetal OR maternal, things certainly could have been worse. I knew better. Already, I knew better, yet her words took the wind right out of my fragile fledgling sails.

Slowly, I was realizing how I had been swept along in a cascade of interventions, prenatally. Hospital tickets aren't only issued for the grand finale-ride of labor.

We went on to have a bit of an argument about whether or not it was okay for me to fly home for Christmas. I had mentioned my plans to visit family in Colorado, and she grimaced as though I was suggesting I take up jousting. Asking her to explain her concerns, as every book and website I visited stated that travel was fine at this point (it might be unpleasant when feeling nauseous in the 1st trimester, and that in the third, the concern was that IF one should happen to go into premature labor, one would be away from appropriate care - not that it caused premature labor), that 2nd trimester was the safest time of all. Did my previa make some kind of difference?

She said her concern was the possibility that an abrupt change in pressure, should there be an incident, could cause my water to break. I was learning to speak up, however hesitantly, and have fewer l'esprit d'escalier moments five minutes after leaving the office where I thought of all the things I wished I could have said in the moment, and I pointed out that this unlikely scenario could happen to ANY pregnant woman. So was she really suggesting that no pregnant woman should ever board a plane, period? She waffled a little, but essentially said yes. There was a risk, and if that risk came true, how would you live with yourself?

This is pretty much where I realized that East was East, West was West, and never the 'twain shall meet. I was trying to reconcile two very, very different worlds, and had fallen into a strange kind of mostly self-created trap as a result. The fact that I had been needing to decompress after every CNM visit had already demonstrated that there was a fundamental dissonance in mindsets. However unintentionally, I had bought the hospital ticket. I went into the situation thinking that parallel care would be "the best of both worlds", but it became ever clearer that it was not nearly as simple as that. The kind of care given (and sought) in pregnancy IS, in part, a manifestation of various sets of beliefs. I don't think it's remotely as black & white - or as polarizing - as "Trust Birth" vs. "Fear Birth", but there IS a spectrum between those two poles, and these particular CNMs** and I were clearly many, many miles apart.

I left that visit with a stamp of approval regarding my cervical competency, informed them that as a result of said competency, I was not planning to continue parallel care in general, but did need to return for a follow-up ultrasound at 28 weeks. The odds were totally with me. One more spin on the hospital ride, I hoped and prayed and visualized - to see if it had migrated.

Here I break with what would make the most sense in serial narrative form, and post a spoiler:

It hadn't.

*Note: I'm a fan of Floradix, but word to the wise, plan to have something in hand to 'chase' it with immediately. Great product, revolting taste. I always followed with orange juice.

**It bears reiterating that I am not at all trying to slam CNMs in general - this is, again, just my own experience.

Friday, April 15, 2011

Goin' to Boob School.

On the board in one of our classrooms. Like it says: Boob.

In the midst of all the birthday craziness, and crossing the line from *sniff* toddler to preschooler, I also started Boob School this week! Officially, I'm part of the first degree program for lactation at Birthingway College of Midwifery, in case you missed the memo, which qualifies us to sit for the IBCLC exam. Our first day was great, a 4 hour orientation and then 4 hours of Anatomy & Physiology (which I could have transferred, but I really want the information anew). Today, sleep-deprived and homework in hand, I'm off to Breastfeeding I.

Things I theoretically want to focus on over the course of the next two years:
  • Tongue tie (obviously), based on the intensity of my own experience.
  • Low supply, both perception and reality. The fear/belief that she isn't making enough milk is one of the biggest reasons moms give up nursing, and it largely isn't true - often a growth spurt combined with a care provider not well-versed in advising moms on breastfeeding is the killer combination. And the flip side of that is that there ARE true supply issues, and I want to know everything there is to know about them.
  • Herbal galactagogues in depth. Over and over, I see the question "How do I increase my supply?" And a chorus of totally well-meaning people say, "Fenugreek!" It's just so much more complex than that, and I'm looking forward to learning all about exactly how it all functions.
  • The role of maternal nutrition, particularly with regard to food sensitivities and intolerances, something I haven't written about here yet. Or have I? No, if I have it's only been in passing. I think.
  • Women with long term challenges (again, obviously), especially in terms of using breastfeeding tools like the Lact-Aid, and with special attention to how to transition OFF the tools.
I also have an idea for a study, perhaps an independent one, that I would loooooove to do in tandem with someone, potentially a medical student or someone going for a masters, say, in public health. Possibly more people than that. If that sounds like you, buzz me! Anyway, it could possibly be a thesis, and something valuable for the field as a whole.

Whew! Is that an agenda or what? I realize things may and probably will change over the course of time - just like I thought I was going to do practically nothing but sports massage while I was in school for massage therapy, yet the work I was drawn to once I was in practice was quite different. But still, it's helpful to have some direction at first.

Thursday, April 14, 2011

Three Years of Lilybean

Beloved firstborn girlchild, I offer you a prayer on this, your third birthday, courtesy of Tina Fey.

First, Lord: No tattoos. May neither Chinese symbol for truth nor Winnie-the-Pooh holding the FSU logo stain her tender haunches.

May she be Beautiful but not Damaged, for it’s the Damage that draws the creepy soccer coach’s eye, not the Beauty.

When the Crystal Meth is offered, May she remember the parents who cut her grapes in half And stick with Beer.

Guide her, protect her when crossing the street, stepping onto boats, swimming in the ocean, swimming in pools, walking near pools, standing on the subway platform, crossing 86th Street, stepping off of boats, using mall restrooms, getting on and off escalators, driving on country roads while arguing, leaning on large windows, walking in parking lots, riding Ferris wheels, roller-coasters, log flumes, or anything called “Hell Drop,” “Tower of Torture,” or “The Death Spiral Rock ‘N Zero G Roll featuring Aerosmith,” and standing on any kind of balcony ever, anywhere, at any age.

Lead her away from Acting but not all the way to Finance. Something where she can make her own hours but still feel intellectually fulfilled and get outside sometimes And not have to wear high heels.

What would that be, Lord? Architecture? Midwifery? Golf course design? I’m asking You, because if I knew, I’d be doing it, Youdammit.

May she play the Drums to the fiery rhythm of her Own Heart with the sinewy strength of her Own Arms, so she need Not Lie With Drummers.

Grant her a Rough Patch from twelve to seventeen. Let her draw horses and be interested in Barbies for much too long, For childhood is short - a Tiger Flower blooming Magenta for one day - And adulthood is long and dry-humping in cars will wait.

O Lord, break the Internet forever, That she may be spared the misspelled invective of her peers And the online marketing campaign for Rape Hostel V: Girls Just Wanna Get Stabbed.

And when she one day turns on me and calls me a Bitch in front of Hollister, Give me the strength, Lord, to yank her directly into a cab in front of her friends, For I will not have that Shit. I will not have it.

And should she choose to be a Mother one day, be my eyes, Lord, that I may see her, lying on a blanket on the floor at 4:50 A.M., all-at-once exhausted, bored, and in love with the little creature whose poop is leaking up its back.

“My mother did this for me once,” she will realize as she cleans feces off her baby’s neck. “My mother did this for me.” And the delayed gratitude will wash over her as it does each generation and she will make a Mental Note to call me. And she will forget. But I’ll know, because I peeped it with Your God eyes.


Tina Fey, Bossypants, 2011

But also know this, oh baby my baby, even if you do get bad flash tattoos and take acting and lie with drummers, I'll still love you more than you will ever, ever know.

- Mama

Tuesday, April 12, 2011

Support Global Maternal Health with "Every Mother Counts"

Whether you're a Starbucks fan or not, you might want to stop by sometime soon. Not for a coffee (unless that's your bag), but to pick up a CD. Say what?

Starting today, April 12, Starbucks stores will be selling a compilation called "Every Mother Counts", a companion to the documentary on global maternal health that I cannot WAIT to see, directed by Christy Turlington, titled "No Woman No Cry":

It's enough that proceeds from CD sales go to the CARE and the Every Mother Counts organization, but check out this track listing:

Martha Wainwright - 'Leave Behind'
Carla Bruni - 'Le Loup, La Biche et Le Chevalier (Une Chanson Douce)'
Gwyneth Paltrow - 'This Woman's Work'
Madonna - 'Promise to Try'
Patti Scialfa - 'Children's Song'
Toshi Reagon and Bernice Johnson Reagon - 'There and Back Again, Pt. 2'
Angelique Kidjo - 'Sweet Lullaby'
Ani DiFranco - 'Present/Infant' (remix)
Dixie Chicks - 'Lullaby'
Rosanne Cash - 'Motherless Children' (acoustic version)
Sheryl Crow - 'Lullaby for Wyatt'
Jennifer Lopez - 'One Step at a Time'
Karen Elson - 'The Last Laugh'
Sinead O'Connor - 'Petit Poulet'
Martha Wainwright - 'No Woman, No Cry'

Pretty awesome, right? It's worth it for the Dixie Chicks track "Lullaby" alone, which, if you haven't heard, check out this rendition of an already heartbreakingly beautiful song:

I've also always adored that Madonna song, love pretty much anything by Sinead, and am, well, intrigued, at least, to see what Gwyneth does with "This Woman's Work".

Here's the Facebook page for Every Mother Counts. Please check it out!

By the way, I am not being compensated in any way for promoting this, I just think it's incredibly cool and wanted to pass it along.

Sunday, April 10, 2011

The Parallel Paradox Part 2 - Diagnosis of Placenta Previa

And so the stage was set.

Despite not having any health insurance, and despite my own reservations, I agreed to the CNMs' recommendation, returning to their practice to have my cervix checked every 2 weeks. As frustrating as this was, I only planned to continue this parallel care until week 20, when they had decreed we could stop the cervical checks. Once I got the all-clear, I was done with them, and would continue my care with Nancy and Gengi alone.

So began a pattern where after each visit to the CNMs, I would visit my CPMs to decompress from the experience (or make a lengthy phone call, if we had no appointment that week). Nancy and Gengi, who I thought of as my 'real' midwives - not because CNMs (a.k.a. nurse midwives) are not legitimate, but because I had started out with no intention of getting any care from them; I had just stumbled into it - did an admirable job of talking me down after each CNM experience.

Fortunately, as those who get CPM care know, these visits were always at least an hour long, sometimes more. The old joke is that with an OB you wait for an hour and see them for 5 minutes, and with a CPM you wait 5 minutes and see them for an hour. (In my experience, which is only my experience, with these particular CNMs, you'd get about 15 minutes rather than the OB's 5.) With Nancy and Gengi, sometimes the first half an hour or more would have to be devoted to therapeutically working through the damage from the last CNM visit. It mostly had to do with my potentially-incompetent cervix, but there were plenty of other opportunities to instill other doubts and insecurities, too. You've gained HOW much weight already? Aren't you getting any prenatal testing done? And what about those suspicious dates?

At week 14, I stayed after my cervical check to get a dating ultrasound, in order to clear up the discrepancy between my conception date and the extra centimeter or so my belly was measuring. I had only planned to get one anatomy scan at around week 20, but hey, what's one more compromise? I got my first glimpse of the precious, and determined that the dates were possibly a week off, though it was impossible to tell for sure (but hey, what's an extra cost for no reason at all?). I also was told that my amniotic fluid might be a little bit high (but hey, you PROBABLY don't need to worry about it yet).

And then, literally as I was on my way out, the technician seemed to make a last-minute decision to share one more piece of information with me, something she had been hesitating about.

"Just so you know, right now it looks like your placenta is lying a little low." I must have looked alarmed, because she immediately added, "Most of the time it'll resolve by the end of your pregnancy. It's pretty common for it to be low this early.'

I left the office feeling uneasy, but decided to take her word for it and investigated no further at the time, focusing on the pictures of my sweet wiggly little being, the fetus we came to know as Samily - Sam if it was a boy, Lily if it turned out to be a girl.

More cervical exams with the CNMs, more ranting and railing therapy sessions with my midwives.

Eventually, week 18 arrived, time for the Level II ultrasound I had agreed to as my one concession to prenatal testing. For this, I went to the UCONN Health Center, where the most advanced technology and high-risk specialists were located. Somehow, walking in, I still looked forward to it, being as interested in all things pregnancy and birth as I was. Surely it would be objectively fascinating as well as personally moving to get such an in-depth look at my future baby. First, a friendly technician set me up, spreading the gel and connecting the computer screen to a larger screen where the images were projected on a huge wall in front of me.

There she was (though they complied in keeping the gender a secret), my gorgeous baby. I was captivated, glued to the screen as the technician took measurements and pointed out various parts. There may have been a point where she furrowed her brow and looked worried about something, but I'd be lying if I said I remembered or even noticed at the time - I was too enchanted by the black & white silent movie of my dream come true, shifting and squirming and already looking cuter than any ultrasound I'd ever seen - my motherly bias was already in evidence.

Then the perinatologist entered the room, a bearded and professionally aloof man in a long lab coat. After briefly greeting me, he turned to my chart, reviewing a few things like my age and how many weeks I was. Then he asked about number of pregnancies, seeing that his was not actually my first, and asked, about abortion, "Okay, was this a spontaneous abortion?"

Excuse me while I digress here for a minute. Not only was that completely unnecessarily awkward and uncomfortable, I am fully aware that the medical term for a miscarriage is "spontanous abortion". Is there ANY woman, ANYWHERE who would actually refer to her own miscarriage as a "spontaneous abortion"? For crying out loud. I realize that one's history is important, but there has to be a better way to clarify. Anyway, already off on the wrong foot, I begrudgingly confirmed that no, it was not.

After going over Samily's measurements, which all appeared to be perfectly normal, he moved on to the placenta. Which brings us back to where I opened.

"At this point, we're calling it a complete previa."

After a nanosecond of shock, I burst into tears. I could already see myself on the operating table, right then and there. My hopes of a home birth or even a natural hospital birth, dashed. My body, a betrayal. The doctor, to his credit, tried to reassure me. He explained that, as the technician had mentioned, the odds were in my favor that the placenta would migrate upward as my uterus grew, and that most previas diagnosed this early would 'resolve' by the end of the pregnancy.

There are varying degrees of placenta previas. There are complete previas, which refers to when the entire cervix is completely covered; then partial ones, where only part of the cervix is overlapped; and also marginal ones, where the edge of the placenta just barely borders the cervix but is still close enough to be a concern. My own, to be more specific, though it was complete, was not centered over the os (the 'mouth' of the cervix), as depicted here:

Rather, mine was positioned so the lowermost edge of the placenta lay over the cervix. A bit more like this:

He then used the analogy of drawing a dot close to the opening of a balloon before it's blown up all the way; the dot won't actually relocate, but it will appear to move upward as the balloon grows. This was likely to happen with me - likely, but not guaranteed. I nodded through my tears as he explained that a follow-up ultrasound would be scheduled for about 28 weeks, and this meant that I was on pelvic rest until it was determined that the placenta had cleared out of the way. No sexual activity of any kind at all, especially anything that could cause orgasm, and nothing in the vagina, period. For the next 10 weeks, I was also to avoid any exercise more strenuous than gentle yoga.

Oh, and (double-checking my charts) due to the need to continue checking my cervix for at least one more appointment, the exams would need to be done via transvaginal ultrasound, rather than fingers. Yes, that's right, I was on order to have nothing in my vagina, nothing, not even the gloved fingers of a conventional medical professional . . . unless it was a big expensive medical dildo-like medical instrument. THAT was fine. I agreed, of course, and tried my best to hold it together until I left the office.

As soon as I hit the elevator, I finally let myself sob and sob. The doors opened on a group of young doctors, and I quickly walked by their sympathetic looks, feeling ashamed. Even then, I had perspective. I knew that this medical center had seen more than its share of sobbing pregnant women, and the reason for that sobbing was often much more serious than my own. I knew that this very moment there were women receiving far worse news than I, news of terrible congenital defects or other heartbreaking outcomes. I knew that given the opportunity, plenty of women would trade places with me in a heartbeat. A mere c-section compared with one of the "incompatible with life" triosomy abnormalities, just for one example? No question.

But being aware of this, and trying to count my blessings, didn't quell my sorrow or my fear in that moment. I called the father from my car, followed by my midwife (my 'real' midwife), both of whom did their very best to reassure me. A for effort.

Part 3 coming soon.

Wednesday, April 6, 2011

The Parallel Paradox: My Experience With Placenta Previa, Part 1

"At this point we're calling it a complete previa."

The perinatologist stated this so casually, so technically, so matter-of-factly. A complete placenta previa, detected during the Level II ultrasound I had agreed to do at 18 weeks, as what I thought of as a fair compromise to all the other prenatal testing options offered (and encouraged, frankly) by the CNM practice I had been seeing in tandem with my home birth CPM. The quad screen produced too many false positives, the CVS seemed way too invasive and risky. But hey, I had thought about doing a basic anatomy scan at around 20 weeks anyway, so why not do a sonogram that would be a little more thorough? Including a consultation with a perinatologist to boot? What could be the harm?

Backing up for a moment: Unless you're brand-new to this blog, you already know the happy outcome of my pregnancy: I had an uncomplicated home water birth with a healthy baby girl. What I've never talked about here is the story of the pregnancy itself, including, yes, a placenta previa that cast a shadow over the whole experience, threatening to change my plans for not only a home birth, but any hope of a vaginal birth at all.

Periodically, I see moms posting about their own previa diagnoses, on message boards and Facebook and the like, and my heart goes out to them - I know just how uncertain and anxious and helpless the feeling can be. I always swore that I would someday write out my own story in order to offer up a positive spin on the whole angsty saga. Only 3 years later, I'm finally getting around to it.

The story has more to it than just the painstakingly slow migration of my placenta, however; the experience of getting what's commonly referred to as "parallel care" from a conventional medical practice has lessons - and pitfalls, in my case - of its own. It's hard to separate one aspect of the pregnancy from the other, I've found each time I begin to approach it, so I tell the two tales together.

So before we get back to the perinatologist delivering the bad news to me, a bit on how I, a mom who was planning on homebirth from day one, had even gotten there in the first place.

When I decided on my home birth midwife, Nancy, a wonderful CPM with a very experienced apprentice, I had no intention of getting any extra prenatal care. But in order to get my blood workup done, Nancy recommended I go to a practice in the area that was relatively friendly to the idea of home birth. Emphasis on the relatively; they did not formally offer parallel care, but knew that some of their patients would occasionally be doing this anyway, and so had a waiver on hand releasing them of responsibility. Fair enough - but I didn't go into their practice even expecting to go that far. The plan was just to get the blood work and be done.

But when I made the appointment, the receptionist asked if I wanted the CNM rotation or the OB rotation. I thought it was nice that they offered a choice, and asked for the CNMs, of course. When I arrived, it turned out that I had been scheduled for a full initial prenatal appointment, not just the tests. "Well, why not go ahead and get checked out?" I thought.

"What could be the harm?"


In that first appointment, the CNM I happened to get was the youngest in the practice, and in my experience, the most conservative. She looked over my history, and with great concern, noted that I had needed a cone biopsy on my cervix due to moderate dysplasia, a full 15 years prior (with no abnormal pap smears since). This was something I had discussed with Nancy and Gengi already, who thought there was a small the scar tissue might be an issue when it came time to dilate, but otherwise saw no need for additional concern. They had worked with plenty of other moms with similar procedures in their pasts and had no issues during pregnancy or in labor.

This CNM, however, saw only the worst case scenario, recommending that I have my cervix checked for "incompetency" every two weeks, until I reached 20 weeks, and if it should show signs of prematurely dilating, they would put a cerclage in place, essentially stitching it closed until late pregnancy. The fear was put in me. My body was flawed, my baby at risk. How could I say no, and risk a miscarriage? Never mind that this was at an extreme additional expense: I should also note that this was all going to be out of pocket, since try as we did to get me health insurance, not one company would take me once I was already knocked up, since pregnancy was a pre-existing condition. We were already planning on paying Nancy her fee out of pocket, but hoped to at least get something for any additional care that was needed. To no avail.

In that same initial visit, the alarm was raised about my dates. Despite knowing exactly when I had conceived, I was "measuring large" for what was supposed to be a 12 week pregnancy, and I was more or less ordered to get a dating ultrasound, even though I had been hoping to get only one anatomy scan at around 20 weeks - again, just to be on the "safe side". I tried to reason my way out of this early ultrasound, hoping that we could just wait until 20 weeks and get a date estimate then, but apparently the sonogram's dating accuracy declines as time goes by, and she insisted that without accurate dates, they couldn't properly continue my care.

I reluctantly agreed to return in 2 weeks for this, along with my next cervical examination, and with some additional strong words encouraging me to decide on a variety of prenatal testing options, we finished the visit. I walked out feeling shaken and manipulated. Not because she meant me any harm - on the contrary, she was just recommending what, according to her training, was the safest course of action. She was only doing her job. But my feelings about my pregnancy were permanently changed, my belief in my body was shaken, and I found myself unable to stand up for what I believed and wanted.

To be continued.

Friday, April 1, 2011

Simianlac: The Closest Yet to Mother's Milk

No, This Time We Mean it: Really Really REALLY Close to Mother's Milk

For some time now, breastfeeding advocates have noted that whenever formula companies release a new product, much of the marketing focuses on insinuating that this new recipe makes their variation closer than ever before to human milk, typically by featuring synthetic versions of various ingredients found naturally in mother's milk (i.e. the essential fatty acids DHA and ARA, vital for brain development, with particularly disastrous results in artificial form).

Other concerns aside from attempts to replicate specific components of human milk include the protein content of the formula, based in cow's milk. These proteins are significantly different than those found in human milk, due to the fact that they are designed for a large ruminant, the offspring of which will be walking almost immediately after birth, in contrast to the needs of the human infant. Dr. Nils Bergman groups mammals into four types with regard to the nutritional needs of their young: Cache mammals, follow mammals, nest mammals, and carry mammals.

That last category is us. In "Breastfeeding Made Simple", Bergman describes it like so:
Carry mammals: This group includes the apes and marsupials, such as the kangaroo. The carry animals are the most immature at birth, need the warmth of the mother's body, and are carried constantly. Their milk has low levels of fat and protein, and they are fed often around the clock. Humans are most definitely carry mammals. Human milk has the lowest fat and protein of all mammalian milks. That, and our immaturity at birth, means human infants need to feed often and are meant to be carried and held.
Breastfeeding advocates and many health professionals have long recognized that cow's milk, and thus cow's milk-based formula, is therefore not biologically appropriate for human infants. This manifests in a number of ways, including the way the proteins are broken down in the baby's stomach, forming tough, rubbery curds that are difficult to digest. Yet aside from turning to soy formula -which introduces a host of other issues - there seemed to be no other real alternative source for the times when breastfeeding is not possible. Chemically enhanced and artificially fortified cow's milk it was . . .

. . . until now.

Abbot Laboratories introduces an exciting new choice in infant formula. Their scientists have been paying attention to these breastfeeding advocates, and conceding their point in at least one argument. "The illogical practice of using milk from a completely different type of mammal with vastly different nutritional needs has been a concern of ours for some time," says Dr. Jane Fossey, a head researcher in Abbot product development. "We have finally found a way to deliver the closest approximation possible to human milk. Rather than using ruminant livestock, simply out of cultural habit and convenience, we decided to try turning instead to another member of the primate order."

Introducing Simianlac.

Simianlac, available in powder and ready-made varieties, is manufactured in the first chimpanzee dairy in North America. Dr. Fossey emphasizes that the chimps are free-range and fed an organic diet, being rounded up only every three hours to be milked. "We're also proud to announce our partnership with Medella, and use only the comfortable, convenient Pumping Style model on our chimps."

At long last, human babies in need of supplementation will have a product that really, truly, seriously, for real now, comes as close as possible to their own developmental needs. Simianlac will hit the market in April. Look for samples in your hospital bag!

Simianlac. Don't monkey around with your baby's milk.

No chimps were harmed in the making of this post. Nor were any real people or companies. There's no such thing as Simianlac. Pure April Fool's silliness.


Yes, it is.