Resovled.

The time has come. There are other resolutions, of course, involving things like finances, flossing, playing more with Lily, and making a dent in my exponentially-growing reading list, but the cliche simply must be a priority this year. Annie over at PhD in Parenting inspired me to share this on the blog itself, so mixed in amongst the birthing & nursing & doula content, you'll occasionally get an update on this.

I figure this is common enough as a mothering-related experience (and indeed, a common female experience, period, parity aside, but that's another topic, what with all the social context such a topic requires) that it might be useful or interesting to readers on some level, especially those who are in a similar place themselves, or who have been there, or soon will be. There's even a breastfeeding-specific point I want to make, so read on!

In PhD in Parenting's original post, she said, "I want to lose weight. I want to do it for all of the right reasons and some of the wrong ones. But mostly I’m doing it because I want to feel like myself again." I think this was simply and honestly and beautifully put. Much of what follows is an elaboration upon the comment I wrote.

Count me in. You phrased it exactly as I have: I want to feel like MYSELF again.

Lily is 20 months now and I STILL haven’t lost all the baby weight! Now, I gained a whopping 65-70 pounds during my pregnancy – I was forbidden exercise due to my placenta previa. This is a story I'll have to tell here one day; I have a lot to say about my experience of parallel care with a mainstream medical practice as compared to the care I got from my home birth CPMs. Anyway, from week 18 all the way up to my last ultrasound at week 34, I was on strict pelvic rest (nothing in the vagina at all, and no sexual activity of any kind) and was warned against anything but the gentlest prenatal yoga. As most of you know, I went on to have a wonderful home birth, but as a formerly extremely active person, this had a huge impact on my weight.

Then, after Lily's birth, we had unforeseen challenges with nursing, which took up a tremendous amount of time and energy (totally worth it in every way, I'm certainly not saying otherwise), and I was living alone about 75% of the time, as Aaron was only able to commute to stay with us for a week or so every month. So, yeah, solo baby care, compete with pumping every 3 hours around the clock no matter what, including the wee hours? Exercise just did not make it to the priority list at all, much less the top of it, aside from an occasional walk. What can I say? What's done is done.

Enough explanation/excusing myself. The situation today: I’ve lost about 50, net total (including a brief period of gaining some back during a complicated period of what might, in retrospect, have been some minor postpartum depression - yet another thing to post about in the future), but still have 25 left to go, since I was already 5-10 pounds above my healthiest weight when I got pregnant. But even with all those factors, you'd think by now I'd be back to normal or at least close to it, already.

I’m still nursing, but with less overall output – you know how it goes with a toddler. It’s funny, I’ve been kind of reluctant to talk about it publicly because one of the many great benefits of breastfeeding absolutely is weight loss – so if I’m still at it, why are these particular pounds so stubborn? Well, I recently developed a theory, based solely on myself and what I’ve observed in friends and many online anecdotes: I think perhaps breastfeeding helps you lose the weight you were SUPPOSED to gain in pregnancy, i.e. 25-35 pounds-ish, or whatever it was for your particular frame and body type – I actually did drop 25 pounds extremely quickly. But then, any additional, excess weight you packed on? You’re on your own. And if you gain weight back?! God help you.

Totally just my theory. It makes me feel better, anyway.

SO. I’m restarting the 30 Day Shred, and hitting Zumba at the Y at least 3 days a week, and hopefully power yoga 2-3 times as well. I would attend yoga classes daily if I could afford it and work out the child care - I know many people cultivate amazing home practices, and I admire that deeply, but I thrive on the classroom and the relationship with the teacher. I'm sure my former life as a dancer has much to do with that. Routine is also always key for me - I need to keep a regular schedule of classes or otherwise scheduled workouts. As far as the food end of it goes, after a lifetime of experimentation (see above re: former life as dancer), I know myself well enough to know that carbs are my nemesis, and thus a modified South Beach-ish approach (absolutely NOT Atkins), with lots and lots of vegetables, is the most effective way for me to go. An aside: Kalyn's Kitchen is a great resource for low-carb dieters and for foodies in general - amazing low glycemic & South Beach -friendly recipes for food lovers of all kinds.

Okay, I feel renewed and fortified in my ambitions. By Lily's second birthday on April 14th, I WILL feel like myself again. Realistically, I'll still have 5-10 pounds to go, but I'll be almost there. And then by June? Dare I commit to posting a bathing suit shot here? Yes I do.

I've thrown up a ticker on my side bar - I used my original starting weight, to remind myself of how far I've come already. The little scale marks where I'm at today, beginning anew. Annie is much braver than I, sharing bathing suit shots, but I'll still pony up a humbling picture or two. Here's a real "before" shot, visiting LA when I was, unbeknownst to me, exactly one week pregnant. And hey, it's at the beach, if not suited up:

And good grief, here I am about 36 weeks later:

I KNOW. Gah. (Cute kiddo, though, eh? Daughter of one of my best friends.)

Here I am today, basically, as of a few weeks ago:

I know you can't see much of the body - I purposely don't pose for many shots were you can. I cal always tell where I'm at by my face, though. Here's one where, even if it's not a great pic in general, you can see more bod, sling-draping and weird position aside:

Stay tuned for the "After" shot.

(Uh, it might be awhile.)

Wordless Wednesday: My Future IBCLC

I'm now tandem nursing, apparently, as per Lily's demands.


Future lactation consultant? "Positioning looks good, now let's work on that latch."


Examining tongue for possible tight frenulum.


Changing the diaper (hey, it even came with cloth).


The really funny thing? I have to back up a little here. Despite my referring to it as "nursie" or just "nurse" from day one, Lily insisted on inventing her own word for breastfeeding, which is not in any known language but basically sounds like "Boh-tee" or "Buh-tea". So random, right?

Well, one day, Aaron (her daddy) forwarded me this, which he had just come across and which completely weirded him out. Normally I don't pass these kinds of tired old "isn't extended breastfeeding freaksome" sketches along, for obvious reasons (tired, old), but here's the thing: listen to what he calls it.


Whoa, right?

And the name of her first doll, the baby version of the American Girl line, pictured here, that she got for Christmas? Bitty Baby.

*boggle*

Fathers and partners and doulas, oh my!

The blogger known as Baby Making Machine is prolifically sharing her pregnancy experience, and much to her credit, she is asking a lot of questions about everything, including birth. One of the topics that has come up for her is to doula or not to doula, and she blogged about one specific, lovable, handsome "doula dilemma": namely, her husband.

He had a few arguments I tried to take into consideration: 1. Doulas are for rich people. 2. I want to help, I want to be your doula (or my "dulla oblongata," as he jokes).

The first argument, while I can see his point isn't necessarily true. To him, if we can make it through labor like many of our family and friends have without one, why spend the money? "Having someone you pay there to help is something rich people do." Well... Many doula's I've found in my area don't have rates on their sites because they work with people to set the right price on an individual basis. Most I've found prices for seem to range from the $200-$1500s but I hear some are in the $2000s, depending on location, experience, services, etc. Most of my friends seem to either have a friend and get one for free, or paid about $300-$600. Everyone has said it's worth every penny.

Now, looking at those numbers my husband says no way. He's rather use that money on things for the baby, or classes, books and material we can take together to be prepared for labor. But I heard you can get doula's who are getting certified and need live births to help you for free! I wrote to my local DONA lady to get the list of women in my area who will be certifying over the next year so I can contact them about helping me out. I told my husband this and he was a little hurt that I was so insistent on this. Which brings me to the next point... Him wanting to help.

I've read great articles and posts here and there about doula's helping husbands know how to help their wives, but he really wants to be the primary support. He really hasn't had a strong opinion about too many things in this pregnancy process unless I pry, so having him out and tell me how he really feels about it made me think again. He told me he wants to take classes with me and learn how to help me through it, but he doesn't want someone with us 24/7 and "taking his place." I can even picture him shying away because there's an extra woman there, and not wanting to help as much... If I had other help.

This is something that comes up for other women, too, so I thought it was worth addressing at some length. I started out just responding to her blog, soon realizing it was definitely a reply-turned-post, and then I couldn't get my comment to appear on her page at all due to some bogus HTML issue, so I just threw it all up here, period. Hope this is helpful to FutureMama (as she goes on Twitter) and to any other mom out there with a reluctant partner.

Again, kudos for taking such a thoughtful approach. I can already sense that this might be a reply-turned-post . . .

I want to briefly echo what Mommy Bee said about epidurals: I completely respect your right to make an informed choice, but do be aware that just because you've decided you want one does not guarantee that you will get one, or that when you do get it it will work, so the need to be prepared and to have support is just as valid even if you feel an epidural will likely be part of your birth experience. There are all kinds of benefits to laboring for quite a good ling time without one, reasons having less to do with the effects of the drugs on the baby and more to do with the effective progress of dilation and with optimal positioning of the baby for birth. As you'll learn when you go through childbirth ed classes and/or read further on your own, the baby's position in your pelvis is key, and the more movement and versatility of position you can bring to your labor the better. Doulas are experts here.

And let's say you labored a good long time without an epidural, and then decide to go ahead and get one. It's not like it's just Game Over at that point: there are still so many decisions to be made, and you have a say in every. single. one of them. Are you going to receive Pitocin as well? If so, how much and how quickly? What about AROM? What about episiotomies? There are so many choices to be informed about. (Do read "Your Best Birth" if you haven't already! It breaks the whole cascade of interventions down masterfully and easily. Immensely readable.) Due to her experience and education, a doula can be vital in keeping abreast of your goals and preferences, and help you ask all the right questions. She helps you advocate for yourself.

As for whether a doula is desirable if you aren't necessarily going for a 100% natural birth, my honest opinion is absolutely. Even if you have a c-section, a doula can be a godsend in dealing with hospital personnel and procedures and protocols. Marfmom's experience is a good example of this. I actually have an upcoming post planned for my own blog on exactly this topic, as inspired by a Twitter conversation the other day: how doulas benefit cesarean birth experiences.

Anyway, I can understand why your husband feels so strongly that he wants to be the primary support - and he ultimately will be, either way! But others here have given good examples of situations where, for all their good intentions, their partners were unprepared for the reality of the hospital setting. No matter how much they read (and if he does do a lot of reading, that is AWESOME and all the better, I don't mean to discount that; some husbands can't even manage that) and how attentive they are in a childbirth ed class, many of them become deer in headlights when faced with the White Coat of Authority suggesting something you both know you don't really want. At those moments, mothers sometimes lose their former allies to fear, and suddenly the man who had been their rock and their solace is now saying "Well, honey, maybe we should just do _____ after all; he IS the doctor . . ."

I'm not saying this WILL be the case with your husband - he really does sound like a peach. But some of the other husbands caught off-guard were wonderful guys, too - it's just a completely foreign experience for them, navigating the thorny maze of hospital protocol.

And this is where doulas are trained and experienced and prepared. It's not just about knowing back massage techniques, offering sips of Recharge, repeating affirmations with you, helping you walk around, bounce on the birth ball or relax in the tub, though those are all useful too. It's about helping both of you make your way through this sterile, high-tech, foreign land.

That brings me to the other point I wanted to mention. You are becoming a mother that day, and that, along with bringing this new being into existence, is the main attraction, of course. But your husband will also undergo a transformation that day. He is becoming a father. As much as he intends to be there for you, he is, by definition, also having his own experience of birth. This is a good thing! And he can still support you, and can still make attending to your needs at the top of his priority list. But the fact remains that a doula is the only person who is 100% there only for you and your support. This takes some of the pressure off your husband. Space has now been created for him to both share this experience with you AND have his own experience of transformation. He will still be your rock and your solace - and he can now breathe a little easier, knowing that someone is there to help you both advocate for your needs.

I hope that came across with compassion - it was meant to. It's truly hard for men to admit that they need help sometimes, especially when it's help in an area that they feel they SHOULD be responsible for. Often they insist on being the sole supporter simply because they think they should be, when in reality they might not feel comfortable once they're actually in the situation. When this is questioned, they can feel their authority threatened, even when they know, rationally, that this isn't really the case. I say let's give the guys a break!

As for the notion that doulas are for rich people, I wholeheartedly disagree that good care and support should only be reserved for the wealthy. This is why doulas have been fighting to be covered by insurance, and are finally starting to succeed, and why many doulas will work on a sliding scale, and why there are organizations providing doula support to low-income mothers in some areas (this is not available everywhere YET, obviously, but you'd better believe we're working on it). And even when none of the above apply, doulas in the certification process will work for free or close to it.

One final question: Labor can last a long time. Ask him how long can he go without using the bathroom. If for NO OTHER REASON than filling in for him so you won't be left abandoned when he needs to pee, you deserve to have this.

:^)

To wrap up: I second (or third, or whatever) the notion of interviewing a few to see who you mesh with, and I agree that it's a good idea to let them know of your husband's ambivalence in advance. If they're experienced doulas, they've addressed this before, I assure you.

And one last idea on cost: if you don't find someone who is in the process of certifying (which I am SURE you can, if you decide to go that route), you could also consider putting it on your registry, so to speak. I can think of no better shower gift, myself (unless it's a postpartum doula). There just might be someone in your life who would be happy to provide such a boon to you. Why not put it out there?

Cesarean recovery, with note on medication and breastfeeding

I just came across this extremely helpful blog post by Birth Activist - and mother who's been through it herself - and I had to share it here. I really like how she breaks it down for both in the hospital and after, and also acknowledges emotional recovery.

The entire post is a definite must-read and must-bookmark-for-future-reference, but here's an excerpt from the section on recuperating while in the hospital:

• Get as much help as you can from family members, your partner, nurses, and other hospital staff. That is what they are there for and during the hours, and days immediately after your surgery, you will need it even if you do not want it.
• Stay hydrated and eat. You may not want to eat, but working on eating a well balanced and healthy diet, as well as staying hydrated (stay away from sugary drinks such as fruit juice and soda) will help to make you start to feel semi human again.
• If private rooms are available opt for one so someone (family member or friend) can stay with you to help you during this time.
• Use a pillow between your legs, and/or on your side to help sleep to be more comfortable. In the days, and even weeks following your cesarean it will not be easy to get comfortable. This is completely normal. It took me almost a full 2 months to even get comfortable in my own bed at home after my second c-section.
• Take pain medication that is being offered if you are in pain. With my first child, I was breastfeeding and was overly concerned about any of the medications being transfused though my milk so I opted for over the counter pain medication such as motrin instead. But it certainly made my recovery longer, and made taking care of my son harder. (As ICAN recommends, ask your provider about a stool softener, as narcotic pain medication can cause constipation.) [See Dou-la-la's note below.]
  
• Get up and walk around. It may hurt like hell, but it will help to get you back on your feet sooner rather than later. The longer you wait, the more painful it will get up, and the harder it will be.
• The use of a pillow to protect your stomach while coughing, standing up, nursing or moving around in bed is a smart idea.
• Do not hesitate to ask for a lactation consultant in the hospital. Breastfeeding after a cesarean section is more difficult not just for mom because of her incision, but also for baby. Check out the ICAN white paper on Breastfeeding After a Cesarean.

I have something to add on the breastfeeding and medication issue: this is one area where MANY doctors, nurses and other practitioners are simply ignorant on the safety of many medications. This is especially true for cesarean recovery and for postpartum depression: women are given the choice between being in pain (physical for the former, emotional for the latter) and breastfeeding. This is patently unfair to both mom and baby. There's a fantastic post from Raising My Boychick on this - it's specifically about mental health, but the general principle is very much the same:

Perhaps you've been lucky enough to have missed this scenario, but I, at the intersection of those with lactating breasts and those with mental illness, have seen it far too often: a woman goes to her psychiatrist, generalist, family doctor, nurse practitioner, or psych nurse, for help with, oh, depression (postpartum or otherwise), or anxiety, or mood disorder, or sleep problem. Being a careful parent and a conscientious patient, she discloses that she is breastfeeding her child, so that she and her health care practitioner can find the healthiest, most appropriate medications for her (should they mutually decide medications are necessary).

This is when, in a sane society, her physician or nurse would nod, draw on hir vast knowledge of and experience with medications appropriate for breastfeeding, and say "No problem, that only rules out a very few classes of drugs, there are lots of things we can try still." Or, barring that, would reach for the copy of Hale's zie keeps handy in hir office, or would call one of the many breastfeeding-knowledgeable pharmacists zie keeps on file as references. The woman and the health care provider she employs would then work together to pick a medication most appropriate for her particular situation.

That is not what usually happens. Too often (ever would be too often), the physician, upon hearing said disclosure, automatically replies "I don't want to give you anything until you wean/terminate breastfeeding/stop doing that."

There is so much wrong with this situation, I hardly know where to start.

(Read on, it's well worth it.)

Many, MANY more medications are perfectly safe for breastfeeding moms than some physicians and other care providers are aware, and in the cases of some medications that are unsafe for breastfeeding moms, it is usually just a matter of substituting another medication that has equivalent benefits for mom, and no side effects for baby. Some doctors know the difference, but alas, some don't. This is where being your own advocate is vital!

THE bible for medication and lactation is the Thomas Hale guide. Owning the book is a great idea if you're a nut like me (plus it's fun to throw "lactational pharmacology" into casual conversation), but if not, do check out his website and bookmark it for future reference.

Tangent aside - thanks again, Birth Activist!

Do They Know It's Christmas?

Again with the off-topic, but I had to share. Few things can sum up one of the most authentic expressions of the meaning of Christmas AND celebrate fabulous New Wavey Britpop nostalgia in one fell swoop. I can usually hold it together until the line "Well, tonight thank God it's them instead of you," and then it's all over. (Does Bono not look like he's about twelve here?)

This whole song chokes me up and give me a big happy at the same time, and I feel both ancient and instantly right back in junior high. I hope it brings you a smile and a sniffle as well.

Back to birth and babies and boobs tomorrow: for today, Merry Christmas everyone.

Perineal Massage Helpful? Tain't Necessarily So.

[Title edited as per comments.]

I recently received this question from reader Cathy in a comment:

I recently discovered your blog and love it. Can you do a short post on perineum massage if you have the time or direct me to a resource you particularly like? I tried it, but I feel too tight, it hurts, it burns, and I'm afraid I'm going to bust my cervix, haha. I've read over and over "how-to", but I'm a visual learner, and I can't find a video or even illustrations of the technique. I used my thumbs up to the first knuckle, so I don't think I'm doing it completely wrong. I used avocado oil (okay) and Easiotomy Cream (not nice - seemed to burn more.) I guess "For External Use Only" doesn't just mean "Don't put this stuff on toast." Thanks in advance.

FIRST AND FOREMOST: "Easiotomy" cream has to be either the greatest or most horrible product name I have ever heard. HA! When I shared this on Twitter (I mean, how could I resist?), @Crunchynurse had the best response: "Maybe they should call it 'Easy Outta Me' cream." Rimshot!

But seriously, folks. This is a topic well worth addressing, as you're liable to hear different things from different people on the matter. Your timing is excellent, as I recently came across a very interesting post from Peaceful Parenting about it. I did some more poking around on the matter (on the internet, people - get your minds out of the gutter) and found some other resources as well. But before we get to it, I do have a few questions: Is this your first baby? If not, did you have an episiotomy with a previous birth? Was perineal massage recommended by your care provider? If so, what was their reasoning for it? Also, what are your overall plans for birth?

I ask because my initial reaction is summed up well by Gloria LeMay in her "Guide to an Intact Perineum", in which the only thing she has to say about perineal massage is: "Folklore abounds about doing perineal massage prenatally. No other species of mammal does this. Advising a woman to do perineal massage in pregnancy implies a lack of confidence that her tissues have been designed perfectly to give birth to her infant." And I quite agree, from everything I have read so far. A woman who is well-supported in healthy birth practices, i.e. who is able to move freely during her labor, is not numbed and immobilized, and who is able to push in a physiologically sensible position, has already reduced her risk of tearing. Being in a lithotomy position not only closes off the pelvis, making it more difficult for the baby to rotate normally, it also puts all of the pressure right ON the perineum.

Equally important if not more so is whether the woman is able to follow her OWN urges to push (or to not actively push, as the case may be - the uterus can do the work all on its own for many) and can take her time. In many hospital settings, as soon as the mother is complete (dilated to 10 centimeters), the staff often seems to go into pit crew at NASCAR mode, 'breaking' the bed to put the mom's legs up, insisting that the mother start bearing down immediately, shouting at her to pushpushPUUUUSH (this would have been intolerable for me, just on a personal note), even counting to ten, telling her to hold her breath - all adding up to directed, valsalva or 'purple' pushing, which has been shown to lead to pelvic floor problems for the mother on top of being problematic for the baby to boot.

In case it isn't clear, I feel pretty strongly that the most important factors in avoiding tearing and episiotomy are, first, an environment that supports healthy birth practices, as summarized briefly above, and, second, a care provider whose standards of practice don't include routine or frequent episiotomy. This is really the bottom line. Jill of Unnecesarean fame responded to my aforementioned tweet about the Easiotomy cream, first quoting the product's ad copy: "'A well-prepared mother can greatly reduce the need for an episiotomy'... Cream won't save u from one if your doc does 90% epis."

Ay, there's the rub.

. . . I do apologize. That was totally uncalled for. So without further ado, here's that post by Peaceful Parenting on perineal massage, noting that it is prefaced by many of the same caveats I've shared as well, including LeMay's statement. Some highlights:

It may just be that the best advice for keeping your perineum intact is not to spend hours upon hours massaging prenatally and supporting during birth - but rather to let labor and birth unfold naturally, normally, in its own time, with PATIENCE and a mother's bodily instincts (of how to move and position and when to push) as the guide. Maybe the reason no other mammal tears (or needs to be cut) during birth is not because their perineum is so different - but because birth is treated differently.

However, the "how-to" question of perineal massage is one that I've been presented with frequently. So, for those who feel like this is right for them and something they wish to embark upon, I'd like to highlight some answers here. I don't believe that getting to know our bodies - how they work, how they feel, etc., ever does us any harm. If perineal massage serves no other purpose than to allow you to know what it feels like to have your perineum stretched, gives you an opportunity to feel the tinglings sensations that come with it, so that it is not 'surprising' (and thereby fear-creating) on your birthing day, then it will serve a good purpose.

This last part is echoed in a post by Barefoot Birth on perineal support, saying that "Gentle perineal massage during the last weeks of pregnancy could help a first time mom get acquainted with different sensations in the perineum." Peaceful Parenting then goes on to give what seems like a good protocol for gentle perineal massage, focusing more on exploring rather than stretching. In step 11, I note that they mention hot compresses being applied during labor, along with providing perineal counterpressure/support - to me, this also seems much more important than trying to stretch the tissue artificially in advance.

Readers, especially birth professionals, I'm very interested in your thoughts and experiences on this. On (another) personal note, when I asked my own midwives about this, they felt that massage prior to labor was not only not necessary, but could actually weaken or damage the tissue, especially if done too roughly. I'm interested in studies and experiences that speak to that concern as well. Please share!

I hope this gives you some food for thought, Cathy! I encourage you to read the entire post from Peaceful Parenting - it's wonderfully thorough, even including an excerpt from William and Martha Sears on the same subject. I'm also curious to hear your answers to the questions I posited early on, so I can get a better idea of where you're coming from. I'm hoping you'll keep me posted on your pregnancy in general. And if you have any leftover Easiotomy cream once the babe arrives, I'll gladly take it off your hands, for placement in my future museum of fascinating birth- and baby-related products!

*****

By the way, I like the concept of "doing requests". Though I have enough drafts and outlines on other birth and birth-related topics to last me a good long time, I'm happy to get ideas from readers, too. Would you like to get some info, with my thoughts, on a particular topic? Feel free to send it my way!

Wordless Wednesday: Our Lady of Lactivism