Finding out the sex

With Littles
We chose to find out Littles' sex prenatally, during her 20-week anatomy scan. Both my husband and I felt going in that it was a girl, and obviously, we were right!

At the time, the Internet wasn't full of all sorts of cute ideas to find out the sex like it is today. So the ultrasound tech just told us. It was... not all that exciting :) If we were going to find out the sex again, I think we'd have the ultrasound tech write down the sex and put it in an envelope, rather than telling us, and do an idea along these lines. Or even just open the envelope when it's just the two of us (and the older kids, maybe) -- just so that it's more of a family moment, rather than a medical moment.

A lot of people like to know the sex in advance to be able to buy gender-specific stuff or do a gender-specific nursery. But really, knowing Littles' sex didn't change a whole lot about how we prepared. One nice thing was that we knew the sex during spring garage/consignment sale season, so we were able to stock up on clothes for cheap. But we bought most of our big items gender-neutral so we could reuse them for future babies, and we didn't decorate the nursery at all. (We were living in a rental apartment, and ended up moving when she was 3 months old.)

With Noob
I hadn't really wanted to find out the sex with Littles; it was my husband who really wanted to know in advance. Since we did it "his way" with Littles, he agreed to do it "my way" with Noob.

So, we found out that Noob was a boy when he came out. And it was truly one of the most amazing moments of my life. To be honest, I felt through most of my pregnancy that Noob was a boy; I even told some friends a few weeks before the birth that I would be shocked if it was a girl. But "knowing" didn't make that moment any less intense. My husband yelled out, "It's a boy!" and you could hear the emotion in his voice. I cannot put it into words. Just incredible, and totally worth the wait. One of the highlights of my life.

Speaking of my husband's announcement, I always tell expecting parents who are "Team Green" (as opposed to Team Blue or Team Pink :) to talk through the announcement with their care provider. My husband definitely wanted to have the honor of announcing the baby's sex, and that is C's "default" anyway. Some providers "default" to calling out the sex as soon as they see it, which definitely would have taken away from our vision of that moment! And on the flip side, some parents want to have the doctor be the one to call out "It's a girl!" or "It's a boy!" right away. This is one area where a quick conversation with your provider can make all the difference in that moment living up to how you envision it.

As far as preparations, being Team Green was not a big deal. Most of our big items (car seat, stroller, baby carrier, swing, bouncy seat, etc.) were hand-me-downs from Littles and gender-neutral already. We did a gender-neutral nursery. We knew we'd need to buy a new wardrobe regardless of gender, since Littles was a summer baby and Noob was a winter baby, but it was easy enough to buy some gender-neutral basics to wear around the house for the first few days. Then my husband had a ball hitting up the thrift shops for clothes after the birth. Within a week or two, Noob had a full gender-specific wardrobe, for cheap.

With Q
Not surprisingly, I didn't want to find out the sex again. I hadn't with either of the other two kids, and the amazing moment of finding out Noob's sex at birth certainly hadn't swayed me in the opposite direction!

I fully anticipated that my husband would want to find out the sex, since he had with both of the other two kids. To my complete and utter surprise, when I asked him if we were going to find out the sex ahead of time, he looked at me like I was crazy and said, "No way!" I guess him calling out "It's a boy" with Noob was one of the highlights of his life, too :)

Keeping the sex under wraps was more of a challenge with Q, because she was diagnosed at her anatomy scan with a kidney issue. This meant I had to have a couple of follow-up ultrasounds in the second half of my pregnancy to monitor that. (With Noob, the anatomy scan was the last ultrasound, which made it easy to "stay strong" on not finding out the sex: If we decided to change our minds, we would have had to make a special appointment just to get an ultrasound.) The perinatologist who did the follow-ups always checked the sex, for some reason, but always made sure I looked away in time, and was careful not to slip about it.

As with Noob, not knowing the sex was not a problem in terms of preparations. We moved houses early in my pregnancy, so we ended up doing another gender-neutral nursery. Q was another summer baby, so we were all set for girl clothes. (Had she been a boy, we would have done another round of thrift store shopping.) And the older kids didn't mind not knowing, either. Honestly, I don't think they were even aware that we could find out the sex ahead of time. Littles expressed a bit of a preference for having a sister, Noob for having a brother, but we made it very clear to them that it could go either way. If Noob was at all disappointed by the end result, he didn't express it.

And that end result -- hearing my husband call out, "It's a girl!" -- was well worth the wait. Again.

Induction, part 3: Luck

I am a great believer in luck, and I find the harder I work, the more I have of it.
     -- Thomas Jefferson

I started to write this post about two months ago. I had collated a ton of information on questions to ask when you're headed into an induction. Then my computer crashed, and I lost all of it, and I haven't had the motivation to write it again.

Until a few weeks ago, when I got a text from my good friend "N." After months of preparing for a med-free childbirth, she was facing a medically-necessary induction, and was wondering if I had any tips? Gee, it would've been nice to be able to point her to that blog post...

As it turns out, N didn't need it: She made it through her induction epidural-free and birthed her baby girl vaginally. But with induction rates soaring, there are still a lot of women out there who do need this information.

I see a lot of commonalities between N's labor/birth and mine with Littles. We both got lucky, for sure. One of the things that really struck me about Littles' birth was how little control I had over the process. It was up to my body to do its thing, or not do its thing. Thankfully -- luckily -- it did.

But I don't think my successful induction, or N's, was due to pure luck. We both worked hard to be that lucky. There is nothing a woman can do to guarantee a successful induction, but there are certainly some things she can do to up her chances of it.

Namely, ensuring that she has answers to a couple of key questions.

Do I have the support that I'll need?
A successful induction starts long before the induction. In retrospect, three keys to my induction were in place many weeks before I found out I would be induced:

1. I educated myself -- and perhaps more importantly, my husband -- on birth and birth options via childbirth preparation classes.
2. I talked over my birth plan with my OB, and ensured that she was on the same page.
3. I hired a doula.

Many people say that these things aren't important, and for some labors, that's true: I probably could have gotten through my two-hour labor with Q without any of that in place. But inductions can be challenging -- Littles' certainly was! And so having that support in place can make a huge difference in the outcome.

In fact, if you have that kind of support lined up already, you could probably skip the rest of this post. You won't have to ask a whole lot of questions before/during your induction, because the people around you will automatically shepherd you in the right direction. Indeed, my friend N had great support as well: She birthed at the awesome hospital where I originally planned to have Noob, she took Bradley classes with her fabulous husband, she hired M (who attended my last two births) as her doula. So when she texted me to ask for advice heading into her induction, I gave her a few quick pointers, but trusted that I didn't need to say a whole lot. She already knew most of what I'm about to write, and I was confident that her husband or OB or doula or L&D nurse would help with the rest.

What are the risks of an induction?
Even the most necessary of inductions carries some risk. This goes back to my key #1 above: If you've taken a good childbirth prep class, you're probably well aware of these risks. If you haven't, ask your OB. If your OB tells you that there are no risks... do some research on your own. M (my doula) has a great blog post that will get you started.

Why am I being induced?
Hopefully, you don't even need to ask this question, because you and your provider are communicating well and you fully understand the reasons behind his/her recommending induction. But if you're unsure, well, you'll want to clarify whether you're being induced for urgent medical reasons or just because your provider is going on vacation.

Can we wait to induce for another day? Two days? Three days? Longer?
Every day your baby stays inside is another day for him/her to develop, and another day for your body to prepare for labor. (Or even go into labor on its own!) Even so, sometimes, babies reach the point where they are safer out than in and really need to be induced ASAP. But it's worth clarifying whether this is the case with your baby or if you could wait another couple of days (or weeks?) to induce.

What is my Bishop score?
Your Bishop score takes into account the dilation, effacement, consistency, and position of your cervix, along with your fetal station.

The higher your Bishop score, the higher your chance of a successful induction. Bishop scores of 9 or higher are associated with the greatest chance of induction succeeding.

Your Bishop score should be weighed against the answers to the previous two questions. If you have a low Bishop score but you're being induced for solid and urgent medical reasons, you should start with cervical ripening and hope for the best. But if you have a low Bishop score and you're considering an elective induction... well, you might want to give some serious thought as to whether that is the right course of action.

If I need cervical ripening, will you use Cytotec?
If you need to be induced despite a low Bishop score (5 or lower), your provider should recommend cervical ripening first, before starting Pitocin. There are a variety of methods for achieving cervical ripening, including a foley catheter, Cervidil (prostaglandin E2 gel), and Cytotec (misoprostol).

Cytotec is a favorite villain of the natural birth community, primarily for these three reasons:

1. Cytotec is not FDA-approved for labor induction. Induction is an "off-label" usage.
2. There have been reports of uterine rupture after using Cytotec to induce labor.
3. As a result of #1 and #2, Searle (the former manufacturer of Cytotec) sent a letter to doctors warning them not to use Cytotec to induce labor.

While all of these criticisms are true, they do not give the full story:

• Regarding Cytotec's "off-label" usage, doctors prescribe drugs off-label all the time. It is not necessarily dangerous or sinister. Case in point: I've mentioned previously that I took progesterone supplements (specifically Prometrium) during the first trimester with both Noob and Q. Prometrium is FDA-approved for hormone replacement therapy in menopausal women; pregnancy is listed as a contraindication. Yet it's commonly prescribed "off-label" for pregnant women with low progesterone, and I credit it with saving both Noob's and Q's lives.
• Regarding the reports of uterine rupture, they occurred primarily in women attempting VBAC (vaginal birth after cesarean). Certainly, Cytotec should never be used in women with a history of uterine surgery. But for women without such a history, the risk of uterine rupture with Cytotec is similar to what it is during a spontaneous labor.
• Regarding Searle's letter, it was primarily a "cover your ass" move, to absolve the company of any responsibility for adverse outcomes resulting from off-label use of the drug. Again, it does not mean that this off-label use is dangerous or sinister.
• Cytotec has been shown to be more effective than other methods of cervical ripening. Women induced with Cytotec are less likely to need other interventions, such as Pitocin or a c-section. See, for example, this study and this study.

All that said, when I was facing induction, I specifically talked to Dr. S and Dr. K about avoiding Cytotec. There are two things that I don't like about Cytotec:

1. It is a pill that you take either orally or vaginally. If it does cause uterine hyperstimulation, which is a known risk, you cannot remove it (like you can with Cervidil) or turn it off (like you can with Pitocin). You just have to wait for the dose to dissipate and hope your uterus doesn't rupture in the meantime.
2. A Cytotec pill contains 100 micrograms of misoprostol. The recommended dose is 25 micrograms. This means that the pill must be cut into quarters before administration to the patient. Since the medication may not be dispersed evenly across the pill, a quarter of a pill could contain 25 micrograms of misoprostol... or 0 micrograms... or 100 micrograms. You just don't know.

Bottom line, there are benefits and risks to Cytotec. Informed consent is key. Ask your provider if s/he plans to use Cytotec, and if s/he does, have a conversation about those benefits and risks so you can decide if Cytotec is right for you.

How do you see my induction unfolding, as far as which induction mechanisms at what time?
Most providers will have women who need cervical ripening (Cervidil, Cytotec, foley catheter, etc.) come in the night before the actual induction to get started with that. For example, my Monday induction started with Cervidil on Sunday night.

If your cervix is already ripe, your provider will likely have you come in on the morning of your induction to get started with Pitocin, amniotomy (breaking your bag of waters), etc.

You should talk over the "schedule" with your provider, as well as discuss which induction mechanisms s/he plans to use and why. For example, if your provider plans to induce you via amniotomy, you might want to talk about whether that will put you "on the clock" (many providers want women to deliver within a certain time frame after their bag of waters is broken, usually about 24 hours), when and why s/he might decide that you need Pitocin to move things along, the risk of infection, etc.

Will I be able to eat/drink freely during my induction?
I already wrote a whole post on eating and drinking during labor, but it is even more relevant to an induced labor because inductions can take a long time. And unlike a spontaneous labor, where you can labor at home (and therefore eat and drink freely) for much of your labor, an induced labor typically takes place entirely in the hospital. I've had friends who have had 2- and 3-day inductions where they were allowed nothing but ice chips. That seems borderline cruel to me!

As I pointed out in the other post, there is really no good reason for hospitals to restrict food during any labor, induced labors included. With Littles, my hospital brought me breakfast on the morning of my induction, after the Cervidil was removed but before starting Pitocin. If your hospital isn't as progressive, consider sneaking some snacks to keep your energy levels up.

What sort of fetal monitoring will I need?
Most hospitals require continuous electronic fetal monitoring (EFM) for women being induced. This is for good reason: One of the big risks of induction is that it can be too effective, causing uterine hyperstimulation, potentially leading to fetal distress, uterine rupture, etc. EFM can help detect this situation before it becomes an emergency.

Normally, EFM requires two large belts to be strapped to your abdomen (one to monitor the baby's heart rate, another to monitor your contractions) and hooked up to a machine:

Obviously, this greatly limits your freedom of movement... but you can still move around while on EFM. I certainly wasn't walking the hospital halls during my induction, but I was able to sit on the edge of the bed, sit on a birthing ball, sit in a chair, stand up, squat, etc. Good thing, because lying in bed was absolutely excruciating for me. If I hadn't been allowed to move into other positions, I don't think I would have lasted more than an hour or two without an epidural. And if I had gotten an epidural, then I wouldn't have been able to move into other positions. My body was already at a disadvantage, trying to birth a nine and a half pound baby who was not necessarily ready to come out, without the benefit of all the spontaneous-labor hormones that would have prepared my body to help her come out. Being stuck in bed would have put my body at even more of a disadvantage.

Despite all this, many doctors require women to stay in bed while on EFM. As far as I can tell, there is no good reason for this. The only problem that moving around caused me was that the belts would slip and lose Littles' heartbeat. This meant that a nurse had to come in every few minutes to readjust the belt and pick up her heartbeat again -- inconvenient for her, I'm sure, but, well, it was her job. My job was to get my baby out. We both did our jobs, and I absolutely believe that contributed to the positive end result.

So, if you'll be on EFM during your induction, don't let them stick you in bed! Talk to your OB about moving around within the limits of the EFM machine. Also, ask if your hospital has wireless telemetry units. These allow for fetal monitoring while giving you complete freedom of movement. You can even go in the tub with one on! But not all hospitals have them, and those that do sometimes don't have enough for every laboring woman -- so it's good to know ahead of time whether it's an option for you, and to express your interest in using one if possible.

I wanted to birth without pain medication. Now that I'm being induced, is this still possible?
This isn't a question for your provider, but for yourself. And the answer is an unequivocal YES. You have to believe that you can do it... because you can.

Back when I was pregnant with Littles, I heard very few stories of pain-med-free inductions. Even my doula admitted (after the fact) that I was her first client to make it through an induction without an epidural. Now I hear those types of stories all the time. Women are doing it. You can do it.

I've done everything "right." Does that mean I'm going to have a wonderful, easy vaginal birth?
Unfortunately, no :( It might not be any of those things. That's labor for ya. Jefferson said that the harder he worked, the luckier he was -- not that he was lucky all the time.

But for me, this goes back to my birth mindset. I had a sense of peace when I showed up at the hospital for my induction. Induction wasn't what I had hoped for, but I knew that it was the safest, most informed decision under the circumstances. I knew that I had asked all the right questions. I knew I had a great support team surrounding me. And so that sense of peace came from knowing that I was headed for the best possible outcome. Again, not necessarily the outcome I had hoped for (that is pure luck)... but the best possible outcome regardless.

It's my hope that every woman headed into an induction -- or into spontaneous labor, or into a scheduled c-section, for that matter -- has that sense of peace, and achieves her best possible outcome as well.

Induction, part 2: A change in mindset

I headed in to my 41-week appointment with Littles prepared to set an induction date. I wasn't prepared for how upset that would make me.

The appointment was with Dr. S. He and I had never really "clicked," and our relationship certainly didn't improve as my pregnancy progressed. By this point, I had the on-call schedule memorized and was actively hoping not to go into labor on the days he was on-call.

He did all the usual appointment stuff, as well as a cervix check to assess my "progress," and a non-stress test (NST) and biophysical profile (BPP) -- two common forms of monitoring for overdue women. Then, at the end, he announced that the baby needed to be born by 42 weeks, so I needed to get an induction date set. He also said that I had an "unfavorable cervix," so I would need to come in the night before (i.e. no later than 41 weeks 6 days) for cervical ripening prior to Pitocin.

I left the appointment in tears. Dr. S had not seemed real open to questions. For example, when I asked him whether I'd get Cervidil or Cytotec for cervical ripening, he stared at me in surprise for a moment before answering -- like he wasn't used to answering questions like that.

But I had lots more questions running through my head: Would I need continuous fetal monitoring? Would that mean I'd be stuck in bed? Since I had to come in the night before, would I get breakfast in the morning, or would I be expected to labor the entire time with no food at all? And perhaps the most important questions: Could I do this without an epidural, as I had planned all along? Did I have a decent chance of delivering vaginally, or would I likely end up with a c-section?

I pretty much cried for three days straight. My husband was upset at seeing me so upset. He encouraged me to call and schedule another appointment, with Dr. K, who would be the OB on call during my induction. (That was one benefit to being induced: I was able to choose to deliver with Dr. K, rather than Dr. S, or one of the other four doctors in the practice, none of whom I'd met before.)

They squeezed me into Dr. K's schedule on Friday morning, 41 weeks 3 days. Dr. K ran me through the same tests that Dr. S had done earlier in the week, but she seemed much more relaxed, and it made me more relaxed. Rather than rushing through the ultrasound for the BPP, as Dr. S had done, Dr. K took her time to explain what she was looking at and why it was important. Later, I asked her the Cervidil vs. Cytotec question again, and she took it completely in stride, spending a few minutes explaining what she planned to do and why. I was able to open up and get all my other questions answered to my satisfaction.

My induction date didn't change as a result of that appointment. My mindset, however, changed drastically: I felt 100% comfortable with what was happening. I still wasn't thrilled about it, but I had come to terms with it, and became determined to make the best of it.

I hope every woman facing induction can have a similarly productive conversation with her provider -- especially if she wants a pain med free birth. If you're one of those women, and you're wondering how to kick off that conversation, stay tuned for my next post...

Induction

Littles was born via induction, due to being two weeks late.

Labor induction is the subject of much debate, for a variety of reasons. For one, it's on the rise: Approximately 1 in 4 labors in the USA now start via induction, and it appears that much of the increase is due to elective (rather than medically-indicated) inductions. "Early term" elective inductions (at 37 or 38 weeks gestation) are associated with a significantly higher rate of NICU stays and other complications, compared to inductions at 39 weeks or later. Pitocin, a drug used in many of those inductions, has the reputation of stimulating contractions that are far stronger than contractions experienced during a spontaneous labor, dramatically increasing the likelihood that the mother will need an epidural. And since by definition, induction is designed to make a body give birth before it's ready, it has the reputation of greatly increasing the risk of ending up with a c-section.

These reputations are so pervasive that I've heard women say things like, "I knew the Pitocin-induced contractions would be awful, so I refused to let them start Pitocin until I had my epidural." Or, "My OB is talking induction, but I'm thinking it would be better to just accept the inevitable, and have a scheduled c-section. Better than an emergency one after a failed induction."

Simply put, this wasn't my experience. I labored on Pitocin for nearly 12 hours with no epidural or other pain medications. I ended up delivering vaginally with no complications. Even now, having experienced two spontaneous labors, I still consider Littles' birth to be a wonderful experience -- very different from my other two births, to be sure, but amazing in its own way. I also didn't find Pitocin-induced contractions to be any different from the spontaneous contractions of Noob's and Q's births. The main challenge in Littles' birth was just that it took much longer -- roughly 11 hours of truly "active" labor, compared to about 4 hours with Noob and maybe 2 hours with Q. The individual contractions weren't any harder to deal with; there were just a lot more of them to deal with :)

Numerous studies back up my experience. For example, this study, this study, and this systemic review all found that inducing labor does not raise the risk of a c-section, and may actually result in lower c-section rates in certain populations, e.g. women at or beyond 41 weeks gestation. And in the seminal Dublin study on active management of labor, 25% of labors were induced (via amniotomy followed by oxytocin [Pitocin] if contractions didn't start on their own) and 55% of labors were augmented with oxytocin at some point, yet the c-section rate was only 5.2% and nearly half the women in the study did not receive any pain medication.

(As for the issues associated with "early term" elective inductions? Those are definitely real, and are the reason for a March of Dimes campaign against such inductions.)

Okay. Studies are great and all, but it really seems like most of the moms I know who went in for an induction walked out with a c-section. Especially the first-time moms. And when I hear their birth stories, I often find myself shaking my head at some of the unnecessary hoops they were forced to jump through. Like the women who were forced to stay in bed for the duration of their induction. Or who were only allowed ice chips for sustenance.

The natural-birth community loves to vilify Pitocin, but this gap between the studies and my reality makes me wonder whether the problem is not Pitocin per se, but how it's used, or abused, as the case may be. For example, in the aforementioned Dublin study, each laboring woman was assigned a personal nurse for support -- essentially a doula. The mere presence of a doula has been shown to lower epidural rates and c-section rates. Perhaps that helps account for some of the study's results despite the relatively high reliance on Pitocin.

If that's the case, it is good news, because it means that women can do something to improve their chances of a successful induction. In my next few posts, I'll talk about some of the things that I believe helped with making my own induction successful.

Eating and drinking during labor

As I've mentioned previously, I'm a former Ironman triathlete, and I draw a lot of parallels between my Ironman experience and my labor experiences.

Ironman is lengthy (I completed mine in just over 13 hours; participants have up to 17 hours to finish) and physically intense. This can lead to the dreaded "bonk," which is sudden and extreme fatigue that occurs after exercise depletes the body's glycogen stores. Obviously, fatigue is not a good thing in the middle of a long race, so Ironman participants and other endurance athletes eat/drink throughout the race to replenish those glycogen stores. Not a five-course meal or anything crazy like that, just light snacks (fruit, pretzels, energy gels, etc.) and plenty of liquids (water, electrolyte drinks e.g. Gatorade, etc.)

Labor also tends to be lengthy and physically intense, so it makes sense to me that laboring women should be fed and hydrated much like Ironman participants, with light snacks and plenty of liquids.

So why do many hospitals restrict laboring women to only clear liquids or, in some cases, only ice chips?

The roots of this restriction lie in a landmark 1946 paper by an OB named Curtis Lester Mendelson, entitled "The aspiration of stomach contents into the lungs during obstetric anesthesia." I can't find the full text online, but this recent paper has what appears to be a pretty decent summary:

Nitrous oxide and ether anaesthesia administered by face mask for operative delivery was complicated by aspiration in 66 women from 44 016 maternities (0.15%) between 1932 and 1945. The only two deaths were from airway obstruction by solid, undigested food in two of five women who aspirated [vomited and then inhaled] solid material. In those who aspirated liquid, a syndrome of dyspnoea, cyanosis and tachycardia was observed. Recovery after 24–36 h was universal—in an era that predated respiratory intensive therapy by decades.

Prevention of "Mendelson's syndrome" via NPO (from the Latin nil per os, or nothing by mouth) after midnight of the day of a planned surgery became a key component of anesthesiology. After all, if you have nothing in your stomach when you're anesthetized, you have nothing to aspirate, right?

Well, not exactly: Turns out that the emptying of solids and liquids from the stomach is not as straightforward as you might think. For example, multiple studies have shown that your stomach contents are smaller if you drink clear liquids 2-4 hours prior to a procedure, versus fasting for 4 hours. As a result, the American Society of Anesthesiologists no longer recommends NPO after midnight prior to surgical procedures. Instead, they recommend fasting from solids for 6 hours prior to the procedure, but continuing intake of clear liquids up to 2 hours prior.

Even if you didn't follow those fasting guidelines, read the quote above again: In Mendelson's original study, only 0.15% of women aspirated at all, and only two out of over forty four thousand women (0.004%) died as a result of aspiration. And this was 70-odd years ago, when (as noted in the quote) respiratory intensive therapy didn't exist, not to mention numerous advances in anesthesiology that we enjoy today. Today's risk is almost certainly lower.

Finally, this should be obvious, but laboring women are not surgery patients. (With the obvious exception of scheduled c-sections, which are rightly subjected to the same restrictions as any other planned surgical procedure.) Despite all the consternation about the USA's high c-section rate, the fact remains that 2 out of 3 pregnant women will deliver their babies vaginally. And approximately 95% of those who do deliver via c-section will do so under regional anesthesia (spinal or epidural), which carries a much lower risk of aspiration than general anesthesia, like that used in Mendelson's study.

In other words, the risk of a woman going into labor planning a vaginal delivery and ending up with a c-section under general anesthesia leading to death via aspiration are miniscule. (One study theorized that it might happen in approximately 7 in 10 million births.) The risk of that same woman having a fairly lengthy delivery and needing something besides ice chips to avoid the labor version of "bonking?" Much, much, much, much higher.

So why the continued insistence on restricting food and drink? Well, old habits die hard: Even for planned surgical procedures, many hospitals still do not adhere to the updated ASA guidelines. See, for example, this study, this study, this study...

Also, women in labor (regardless of pain medications used, or not used) often vomit, which can obviously be unpleasant with a full stomach. Still, this is purely a comfort issue, not a safety issue, so it hardly seems right to tell a woman who wants to eat that she can't. Some providers recommend not eating anything that you wouldn't want to vomit back up, which is excellent advice. But that determination should ultimately be left to the patient, not the hospital. It's also worth pointing out that studies (such as this one and this one) have shown that women who eat during labor are no more likely to vomit than women who don't.

Finally, to be fair, I should also point out that those studies don't show any significant benefit to eating/drinking during labor. In fact, the first one found that women who eat tend to have longer labors -- although presumably, they're more comfortable because they're not starving! There is no significant difference in intervention rates or adverse birth outcomes. Again, I think this backs up the idea that the laboring woman is best positioned to decide whether or not she wants to eat. Blanket hospital policies should be reserved for safety issues. This isn't one.

OK, I'll step off my soapbox now. Here are my own experiences with eating/drinking during labor.

With Littles
When I went over my birth plan with Dr. K, I specifically brought up eating/drinking during labor. She said she had no problem with it, but warned me that the nurses might not be as accommodating.

The topic came up again when I got scheduled for my induction. Inductions can take a long time and I wanted to make sure that I wouldn't starve during the process. Dr. K encouraged me to eat a good dinner before coming in to start Cervidil at night. She also told me that the hospital would bring me breakfast in the morning. I chose to skip the bacon and eggs, and just eat cereal.

Once active labor got underway, my nurse informed me that I couldn't eat or drink anymore. I knew I could either sneak some snacks (I had brought some from home) or get Dr. K to tell the nurse it was OK for me to eat, but I wasn't hungry by that point anyway, so I chose not to push it. Since I was allowed clear liquids, I drank a lot of cranberry juice to keep my energy levels up. It worked out fine.

With Noob
When I asked F about eating/drinking during labor, I got a similar response to what Dr. K had said: She had no issue with it, but the nurses might. I talked it over with M at one of our prenatal visits, and she confirmed that I'd have no problems sneaking in some light snacks, but: "You probably won't be able to eat Chick-fil-A while in transition." :) This became a running joke between us, but in all seriousness, it was one of the things that made me start leaning towards homebirth. Even a great hospital is still a hospital. You simply don't have the same freedoms that you do at home. And while I was pretty certain that I wouldn't want Chick-fil-A while in transition, it made me wonder what things I might actually want that wouldn't be possible in a hospital.

In contrast, C, like most homebirth midwives, actively encourages eating during labor. I had some fruit for breakfast on the morning of Noob's birth, and then when C arrived, she had me eat a light snack (apples and peanut butter). I also drank water freely throughout. As it turns out, my labor wasn't long enough to need anything else. And anyway, it was a Sunday, so Chick-fil-A was closed :)

With Q
I ate a normal dinner the night that I went into labor. Since active labor ended up spanning a time (roughly 10 PM to 1 AM) when I don't usually eat anyway, and since it went so quickly, I didn't end up eating anything while laboring, or even immediately afterwards. I ate a normal breakfast the next morning -- my husband's homemade breakfast tacos, yum! Much better than hospital food, or Chick-fil-A!

And in case you're curious: I've had some mild nausea with all of my labors (much more with Littles than with the other two), but no vomiting.

Q's birth story

A couple of notes about the birth stories:

1. Grab a cup of coffee and settle in. They are long.
2. They contain stuff that some people may consider TMI. Mucus plugs, bloody show, tearing "down there," etc. You have been warned.
3. They were all written within days of the respective births. That means that they are a good indication of my perspective and mindset at the time of the birth. In some cases (especially regarding Littles' birth), my perspective/mindset has changed with time.
4. Hypnobabies users: You may want to use your BOP. All birth stories contain standard terminology (no "birthing time" or "pressure waves" here...) Littles' mentions p**n a few times; Noob's and Q's do not.

Still want to read? OK. Here goes...

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On Sunday, July 1st, I was two days away from my due date. I was hoping for a few more days of pregnancy to wrap up some stuff at work, but I was happy to have made it into July (Littles and I both have late June birthdays, so it's a crowded birthday month in our house) and was on high baby alert, since Noob was born two days before his due date as well.

I had light contractions throughout the day. This wasn't too unusual on its own, but they were accompanied by a lot of pressure in my bottom, like I had to poop, but I didn't. I knew that was the baby moving down.

I started trying to time contractions at about 3 pm, but they were still too light and far apart to even be timeable. Soon after, Noob called for me from his room, where he was supposedly napping. "Lay down!" he told me. I did, and fell asleep, waking up every so often to another light contraction (and to Noob playing and not napping at all).

I got up with Noob at about 4:30. I finally let my husband know that I was feeling some contractions, but nothing major yet. Noob wanted to go swimming, so we went out to the pool. The water felt good and my contractions died down. Baby got the hiccups, and I realized, "This could be the last time I feel this baby hiccupping in my belly. This could be the last time I feel hiccups in my belly, ever." Noob was exhausted from not getting a nap and actually ended up falling asleep on my shoulder in the water -- very rare for him at his current age. I just sat there for a while in the pool, savoring that moment with my current "baby" in my arms, even as my body worked to push a new one into them.

We got out of the pool for dinner. Contractions continued sporadically.

7:13 pm - My husband pleaded with me to contact our midwife, C, so I texted her to let her know what was going on. She said exactly what I expected her to say, let her know if things progressed, or otherwise she'd see me at our scheduled appointment the next morning. I also texted our doula, M, as a heads-up.

Meanwhile, it was my turn to do bathtime for the older kids, so off we went. Normally, whichever parent does bathtime reads Littles her bedtime stories, while the other parent reads to Noob. But my mother-in-law happened to be there (she was staying with us for a few nights because the air conditioning was out at her house), and she offered to read to Littles instead. This night, I didn't mind relinquishing that responsibility. I headed into my home office to finish up the kids' sibling shirts and some last-minute things at work. Contractions were intensifying to the point where I sometimes stopped what I was doing to focus through them.

About 9 pm - Littles came in asking for another story. I figured I'd take the opportunity to clue her in on what was going on. I told her that Q might be coming soon, maybe even that night. A contraction came, and I went into self-hypnosis (Hypnobabies) to get through it. I can't talk while in self-hypnosis, so I think Littles thought I had fallen asleep :) She was poking me and saying, "Mommmmmm! Mommmmmmm! Come ONNNNNNNN!" Once the contraction subsided, I told her that my body was giving Q big hugs, and sometimes, I really had to concentrate while it was doing that, and I couldn't talk. Satisfied with that explanation, she picked out Angel in the Waters to read. We've read it quite a bit this pregnancy, although not for a few months now. It was good timing, to remind her of what Q was going through at that very moment.

After I finished reading, I went back into my office and kept working.

10:10 pm - M texted me to see how things were going and to say that I should probably try to get some sleep. I knew she was right. My husband came into my office shortly after, and I relayed that to him. He agreed. By now, contractions were lasting about 1 minute every 5-8 minutes, and I was often stopping what I was doing to lean over the yoga ball I've been using as an office chair for the past few weeks. But I was able to talk through the contractions when my husband was in the room, so I figured they weren't too serious yet.

10:40 pm - At my husband's urging, I texted an update to C. I also texted our birth photographer, E, so that she was aware. My husband said he was going to go read for about 20 minutes and then come get me for bed.

10:42 pm - I finished updating my maternity leave backup documents and emailed them to my manager.

11 pm - My husband came up to get me. I was in the midst of a contraction leaning over the yoga ball. Like the awesome labor coach that he is, he waited quietly for it to finish. Then he told me that he wanted to call M. She lives just a few minutes away from us, so it wouldn't be a big deal to call her over even if contractions ended up petering out.

I wanted to take a shower, to get clean just in case, so I went downstairs and got in. It was hard because standing up made the contractions more frequent. My husband came in and saw me sitting down in the shower and said, "OK, I'm calling M." I didn't argue.

11:23 pm - My husband called M. I eventually finished in the shower and managed to get out, but had to keep taking breaks to lie down through contractions. The tile floor in the bathroom wasn't real comfortable, so I was lying down in the carpeted walk-in closet that's adjacent to the bathroom. I told my husband to keep M out if she arrived, so that she wouldn't see me completely naked, while I worked on getting dressed between contractions. "I'm still in the modest phase," I noted to myself. "Can't be serious yet."

I also told my husband to make up the futon in the baby's room, so M would have someplace to sleep if it turned out to be a long night. I was still pretty convinced that if I could just lie down for a bit, the contractions would let up and we could all get some sleep while waiting for things to intensify.

11:45-midnight - I think M arrived somewhere in here. By that time, I had gotten dressed, and had brushed my teeth... still lying on the closet floor. She came in and I got up to spit out the toothpaste and she said, "Oh, don't get up on my account!" I said, "No, I just have to spit." :) Then I grabbed my hairbrush to brush my hair, and went to lay down in bed while doing it. M was laughing at the fact that I was concerned about my hair at that moment, and I said, "Hey, I forgot to brush my hair after I got out of the shower during labor with Littles, and it was a huge mess!" (There is a lovely picture in this post.)

Over the baby monitor in our bedroom, we heard Noob wake up. He does this sometimes and usually settles right back to sleep, but this night, he was having none of it. It's like he knew something big was going on. Eventually, my husband woke up his mom to lay with Noob, so that he could come back down to be with me.

12:07 am - I was lying in bed when I felt my water break. Of course it would break in bed: We just bought a brand new mattress a few weeks ago :) Luckily, I had made up the bed as recommended a few days earlier, with a waterproof mattress cover over the mattress, then a set of sheets on top, then another waterproof cover and another set of sheets. So I knew the mattress was protected, and cleanup would be easy, since all the midwives would have to do is strip off the top set of sheets and cover, leaving the clean sheets underneath.

M checked my water to make sure it was clear. She helped me get my wet shorts and underwear off. I asked my husband to bring me some clean pants and underwear, but nice underwear, not my old ones that have elastic hanging off and stuff. He brought me about 5 pairs of underwear, because he wasn't sure what "nice" meant. Since I was leaking more water with every contraction, and putting on pants/underwear just seemed like too much effort, I ended up staying bottomless for the rest of labor. And I kept finding underwear in the bed!

12:08 am - Prior to the underwear discussion, I had called C to let her know about my water breaking. She asked if I wanted her to come over. I said yes. I knew there was no turning back now -- with my water broken, baby's arrival was imminent, one way or another -- so it would probably be good to get her there. But I still felt I had a ways to go.

I also asked C to call E. They live close and sometimes ride to births together. E had to nurse her own baby first, so she told C to go ahead without her and she'd follow a few minutes behind.

Back at our house, my husband told M that the futon was ready for her if she wanted to get some sleep. M was like, "Ummmm, I'm not going anywhere!" My husband said, "OK, well, I might try to lie down and nap for an hour or two." I wasn't the only one in denial :)

To that point, I should explain how I was feeling through contractions. They started with a very sharp tightening in my upper belly. When that happened, I usually shifted to my hands and knees (if I wasn't there already) and breathed deeply all the way through my abdomen. My lower abdomen, in particular, always felt tight to start and as soon as I breathed it out, the contraction felt like it pretty much subsided. I could detect some lingering tightness in my belly and back, and the tightness eventually went away, but that was it. Sometimes, that tightness persisted for what seemed like a long time, which made me wonder whether that was a very short contraction, i.e. just the initial sharp tightening, with the lingering tightness being just how I felt between contractions... or a very long one, i.e. the entire length of time that I felt tightening. Given all that, I couldn't tell if the contractions were intense and frequent enough to make my cervix change like it needed to. And if I wasn't sure, I'm sure the people watching me were even more confused.

I kept working through those I-think-these-are-contractions while we waited on C's arrival. My hair was in my face and annoying me and I was worried about a repeat of my birds-nest hairdo after Littles' birth, but I was too focused on what my body was doing to say anything. Somehow, M read my mind and asked me if there was a hair band handy that she could grab for me. She found one, and I managed to get my hair up. What a relief. M is amazing in that way -- she had moments like that during Noob's birth, too, where she just seemed to know exactly what I needed, big or small.

12:45 am - C must've arrived somewhere around this time. She asked me if I wanted my cervix checked and I said no. Then she checked my vitals between contractions: temperature, pulse, blood pressure, baby's heartbeat. All good.

Not long after C's arrival, I started grunting and pushing through contractions. This feeling was familiar to me from Noob's birth. I knew that I was entering second stage labor. I was really surprised because like I said, all the way up to that point, I wasn't convinced that my contractions were all that intense. I guess I wasn't the only one fooled: C was telling E (who was en route) not to get a speeding ticket, she still had some time to make it over, and M was just getting started filling up the bathtub for me to get into. But I did ask my husband to go wake up Littles -- she wanted to be there for the birth itself. She came down, still a bit groggy, and curled up in the glider in the corner of our room to watch, a sleepy smile on her face. I hoped it wouldn't take too long, for her sake.

It didn't. Pretty soon, I could feel the head coming all the way down. C said, "Do you want to get in the tub?" I replied, "I'm not gonna make it!" The tub was only half full anyway. Good thing I didn't have my heart set on waterbirth :)

The pushing phase was the main thing I wanted to change from Littles' and Noob's births. With Littles, I had never felt an overwhelming urge to push, so I had to push very consciously. I did feel the urge to push with Noob, but because of my experience with Littles, I didn't really "trust" it, and so I still put a lot of conscious effort behind each push. In both cases, the pushing phase was short (around 30 minutes), and so I probably didn't need to push as much as I did. Furthermore, I suspect that putting my own force behind what my body was already doing was part of the reason why I ended up tearing with both. So, this time, when I started grunting/pushing with contractions, I trusted my body, and let it push on its own.

And it did a damn good job. It was probably just a minute or two after C asked if I wanted to get in the tub that she said, "You're crowning... Head is out... Reach down and grab your baby!" I was still on my hands and knees, so I couldn't see what was going on, but I heard my husband say, "It's a girl!"

I slid down to find a baby between my legs! I pulled her -- oooooooohhhhh, HER!-- up to my chest. Littles and my husband climbed onto the bed with us, and we all just stared in amazement at our newest family member. She cried a little at first, just to let us know she was OK, but immediately quieted down and stared back in equal amazement at us.

It was 1:11 am. 2 hours 29 minutes since I had emailed my maternity leave plans to my boss.

E ran in a few minutes later. Good thing C didn't wait for her! :) The assisting midwife, K, also showed up shortly afterwards.

(Here is a link to the sneak peek of the pictures that E took: http://earthmamaphotography.com/blog/2012/07/07/samantha-july-2-2012-flower-mound-irving-dallas-birth-photography/)

We heard Noob over the monitor again, so my husband went upstairs to get him, along with my mother-in-law. We weren't planning to wake Noob for the birth, but it worked out perfectly that he was up anyway. It was fun for E, in particular, to see him again, since she hadn't seen him since *his* birth! And he did amazingly well. I mean, it was the middle of the night, he hadn't napped (very unusual for him), and, well, he's a 2-year-old mama's boy who had just gotten displaced as the baby of the family. He could've been a super-clingy overtired mess of a toddler... but he was in a great mood, really sweet with his new baby sister, and even accepting of the fact that she was indeed a girl. (He's just learning the difference between boys and girls, and had been insisting that Q was a boy for the last few weeks.)

We all just hung out in bed until I was ready to deliver the placenta. C asked me if I wanted to clamp/cut the cord first. It was really short, so I opted to do so. Littles wanted to help my husband with the cutting, although it was pretty thick and tough, and the scissors weren't exactly made for 5-year-old fingers, so he ended up doing it mostly himself.

Once the cord was cut and the placenta delivered, I was able to get Q (who did have an actual name by this point :) up to my breast to nurse. She latched on pretty well for a first timer. When she was done, C inspected my bottom. Intact perineum, but three stitches for an internal tear -- apparently, baby girl threw me an elbow on her way out!

C also got my placenta cleaned up and gave Littles, Noob, and me a little tour of it. (My husband opted out.) This was something I was too chicken to do with my previous two births, but I'm so glad I looked this time, because it's pretty neat to see! My side and Q's side looked completely different. Hers was way cooler :) With the amniotic sac still attached (there are actually two sacs that you can see), the umbilical cord and "tree of life" veins spidering through it, etc. Littles even got to touch it ("it feels squishy!") and she says that this was her favorite part of the birth.

Then my husband took the older kids up to bed while M ran an herbal bath for Q and me. Yep, I finally got to get in the tub. Haha! Admittedly, some of the romanticism of a relaxing herbal bath post-birth was taken away by the fact that Q kept pooping :) But it was still nice to just relax in there. E showed me how to hold her out in front of me in the water, and it was amazing how she instantly relaxed and went right to sleep. She's been chillin' in water for the last nine months; I guess it just feels like home.

Eventually, we got out, and C and K did the newborn exam. Q weighed in at 9 lbs 4 oz -- 3 oz smaller than Littles (born at 42 weeks), 9 oz heavier than Noob (also born at 39 weeks). Considering this was after about 3 hours and a *lot* of pooping, she was probably at least as heavy as Littles was when she was actually born, quite possibly even more. (Littles was weighed within minutes of birth.)

Q passed her exam with flying colors and everyone packed up to leave. We finally went to bed about 5 AM.

Recovery has been a breeze. I have to consciously remind myself to slow down, I just had a baby, because I don’t feel that way at all. My husband has been waiting on me hand and foot so that I can relax and rest up. Having an intact perineum, even with the internal tear, has helped so much -- my bottom is a lot less sore when sitting around than I was with the other two. The main thing bugging me is the afterpains (cramping due to my uterus contracting back to its original size), but those are manageable. Q has been really chill thus far and the older kids are both great with her. We are so blessed :)

Noob's birth story

A couple of notes about the birth stories:

1. Grab a cup of coffee and settle in. They are long.
2. They contain stuff that some people may consider TMI. Mucus plugs, bloody show, tearing "down there," etc. You have been warned.
3. They were all written within days of the respective births. That means that they are a good indication of my perspective and mindset at the time of the birth. In some cases (especially regarding Littles' birth), my perspective/mindset has changed with time.
4. Hypnobabies users: You may want to use your BOP. All birth stories contain standard terminology (no "birthing time" or "pressure waves" here...) Littles' mentions p**n a few times; Noob's and Q's do not.

Still want to read? OK. Here goes...

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I was supposed to spend most of Saturday, January 30, 2010, coaching at a lacrosse playday about an hour away from home. But rain on Friday cancelled those plans, so instead, we just practiced at our home field around midday. In retrospect, this was a good thing!

I stopped by Joann's on my way home for a few things. When I was waiting in line, at about 3 PM, I felt my pants get a little wet and thought, "Great, I'm peeing myself. How embarrassing." But then I remembered that I have good bladder control, even when pregnant... and that a slow amniotic fluid leak can feel like you're peeing. When it happened again, I realized it probably wasn't pee. I paid for my items and hustled home, where I quickly confirmed that yes, my underwear was wet and no, it was not pee.

I called C, my midwife, to discuss this. She said that it could definitely be amniotic fluid, but time would tell. She asked me to call again if I started having regular contractions, or at around 6-7 PM regardless. My husband and Littles had just gotten home from visiting some friends, so I filled them in. We put Littles down for a nap while we cleaned up the house, just in case.

We called M, our doula, too, and were a little surprised when she didn't call back immediately. But there was no urgent need to speak to her so we just waited. She finally called back at around 6 PM -- she was at another birth! That mom was nearly two weeks overdue, and we had always expected me to go well into February, so our doula never thought we'd end up overlapping. The power of a full moon! Luckily, the other mom was getting close to pushing, so I wasn't too worried about M being available when we needed her.

Throughout this time, I did keep leaking slightly, and I lost more of my mucus plug. (I had lost some of it in the morning, before lacrosse.) I also had some sporadic contractions, but nothing major. I called C shortly before 7 PM, fully expecting her to say that this was a false alarm. Instead, she said, "If you are still leaking, your water is broken. For most women, that means spontaneous labor will kick in within 24 hours."

I didn't really believe her :) But we started preparing just in case, checking in with M and "E," our birth photographer [not to be confused with our doula from Littles' birth], lining up friends to help with Littles, getting my mom to fly out on the first flight from Atlanta in the morning. Other than that, it was a pretty normal evening. I cooked chili for dinner, and we did Littles' bedtime routine. Knowing that this might be our last night as a family of 3, we spent a little extra time on bedtime stories, finishing up with On the Day You Were Born, which has long been one of my favorites, and was especially poignant that night.

I went to bed around midnight, and woke up to pee at about 1:30 AM. When I did, I lost more of my mucus plug and started bleeding. That's when I realized that C was right. This was it.

My reaction was to panic. I don't really know why, because I had been looking forward to this moment for months, even years. But when faced with it, it was overwhelming and scary. I laid back down and put on a Hypnobabies track, and that helped me relax a little bit.

My husband was sleeping on the couch, leaving the bedroom to me, but at around 2 AM, I heard him get up to use the bathroom and called to him. He was a little freaked out as well. This was our first experience with spontaneous labor, and we had warned both C and M ahead of time that we were pretty nervous about it.

We decided to call M, as we felt like we could really use her presence. She was finishing up at her other birth but agreed to come over as soon as she could. In the meantime, I timed some contractions and they were roughly 7 mins apart, lasting around a minute. I texted a quick update to C and E.

M arrived around 3:30 AM. We talked with her for a bit and she encouraged both of us to get some sleep. We got her set up in our guest bedroom so she could do the same, since she needed it just as much as we did! I did fall asleep, occasionally waking up to contractions. It reminded me a lot of the wee morning hours of labor with Littles, when I was contracting on Cervidil and things were starting to pick up. I had a few contractions that I wasn't sure I could get through on my own, but I didn't want to disturb my husband, so I did.

At about 8 AM, my husband and I both got up, as did M. We checked in again with C and E. I ate a little fruit, but was starting to reach the not-hungry stage. The contractions were starting to pick up, so I walked around when they hit.

I still felt fine in between them, so I puttered around a bit. My husband and I had just bought some broccoli to cut up, cook, and freeze, so I cut that up in between contractions for a while. Then M and I started to work on making the bed -- a set of sheets on the bottom, a waterproof pad in the middle, and then another set of sheets on top. That way, if anything got on the sheets, it would only be on the top set, and the midwives could easily strip those off to leave us with a clean set of sheets. Unfortunately for M, leaning over to put the bottom fitted sheet on triggered a strong contraction, and I walked off. After that, I was pretty much done puttering, and just focusing on the contractions. Bless her, she finished making the bed on her own.

Littles slept in until about 9:30 -- rare for her, but she was fighting a cold and needed the rest. It worked out well anyway, to have that extra time without having to worry about her. When she did wake up, we had two of our friends come over to help with her. They live just a short walk away, and are planning a natural birth for their first baby (due in July), so they were a perfect choice. I went into the bedroom, relaxed, and listened to some Hypnobabies scripts while my husband cooked breakfast for everyone.

I quickly figured out that rocking on my hands and knees was the best way to get through contractions. At one point, after getting through a contraction that way on the floor of our room, I flipped over and looked up at M, who was watching me from the bed. I said, "I thought I had a lot of freedom to move with Littles, but I had no idea what I was missing. This is so much better." I'm not sure how I would have dealt with that position in the hospital -- on the hospital floor? Ick. In the hospital bed? Not a ton of room there, compared to our king bed at home. Not to mention what the drive TO the hospital would have been like!

Hypnobabies helped a lot, too. I reminded myself that I was only feeling pressure and tension, and used my "peace" cue word a lot. One of the Hypnobabies birthing day scripts had an affirmation that went something like: "I am safe, and my baby is safe, no matter how much power flows through my body," and I loved envisioning all that power moving through me during contractions.

Somewhere in there, someone called C and E to get them to head over. I think they arrived around 10:30 AM, but I had lost track of time by that point. C quickly checked my vitals -- good blood pressure, no fever, baby still head down and sounding great.

We mostly stayed in the master bedroom. I was still on my hands and knees most of the time, on our bed. That is the domain of our cat, so she often wandered under my belly and between my arms during contractions, and it was comforting to have her there. My husband or M or both applied counterpressure on my back during contractions, and M had brought a rice sock that she heated up to put on my back too. It all felt great. I usually looked up after a contraction and saw C -- she was just hanging back, quietly encouraging me, and checking in on the baby with the doppler every so often. E just disappeared; I was occasionally aware of the flash of her camera, but barely noticed her presence.

Littles, our two friends, and my mom (who arrived shortly before C and E) were out in the living room, but Littles came in every so often to say hello. As with the cat, her presence was always a welcome distraction. At one point, C wanted me to eat something, so M made me a plate of apples and peanut butter, and Littles jumped right up on the bed to share them with me and drink out of my water bottle.

Then she showed E her "monkeys jumping on the bed" routine. She was totally unfazed by the entire experience. On the contrary, she seemed excited by all these people in her house and enjoyed showing off for them!

At some point, probably around 12:30, I started noticing that the contractions were getting really long, and more on top of one another. There was one in particular where I had been walking around in the hallway and went back in to the bedroom. It ended up being just my husband and me in there. He was behind me, and I leaned back into him and we swayed. The contraction seemed to subside, but then it picked right back up and I noted the time. It was two minutes from that point until it went away for good, so the entire contraction must have been at least three to four minutes long. I knew I was probably in transition. It wasn't bad or awful in any way. Just different.

A few contractions later, I was back on my hands and knees on the bed. Midway through the contraction, I stopped the low vocalization that I had been doing and started to grunt. I felt my body pushing and it felt good. When it was over, M asked, "Did that feel different?" and I said, "I think so. I couldn't tell if I needed to push or if I just wasn't doing a good job of relaxing through that contraction." M said, "Well, let's see what the next one feels like."

The next one felt much the same. This was a really different experience for me, as I never really had the urge to push with Littles. G, the assisting midwife, had arrived a little while earlier, and she got to work on filling up the tub. C came in to see what was going on, and it was clear that it was time to push. This picture was taken right around that time:

A funny aside: I never once had my cervix checked. Not prenatally, not during labor. Apparently, out in the living room, my mom made a comment to C along the lines of, "When I was in labor, they were able to tell me how far along I was by giving me a number." Of course, that's the norm with most births today, too! But C just told her, "I can tell how far along she is by watching her. It's obvious." And I guess it was!

With another contraction, I pushed, and suddenly felt a pop and a huge gush of fluid -- my water had finally broken completely. I got scared because it was stained yellow, and I knew that meant meconium. When the contraction was over, I rolled to my side and asked C, "It's meconium, right?" and she said, "It's very light. Nothing to worry about."

Soon, it was time to get in the tub. It felt wonderful! My contractions disappeared for a bit and I wondered if maybe the tub was a little TOO effective at relaxing me, but soon enough, I started contracting again.

I remember pushing feeling really good with Littles, but this time, it didn't really feel good at all. I wanted it over with, so I held my husband's hand and pushed hard with each contraction. C applied counterpressure to my perineum (to help with tearing and hemorrhoids, two big concerns of mine), and G checked in on the baby with the doppler every so often. C asked my husband and me a few times if we wanted Littles to come in, but not knowing how much longer it would take, we decided to let her stay out in the living room until the baby came out.

After a few contractions in the tub, C told me that the head was right there and that my tissues were stretching. I could feel it all, and felt the head slide back up when the contraction ended. With the next contraction, I pushed the head all the way out, and was instantly more comfortable. It was wild to look down and see my baby's head there, under the water, and I asked C if it was OK for it to hang out like that! She said, "Yes, the umbilical cord is still providing oxygen right now." Then she told me that the body would come out on the next push.

And it did! I opened my eyes to see C pulling my baby up. And then came the moment I had anticipated for nine long months: My husband yelled out, "It's a boy!" I cannot even put it into words, the excitement and pride in his voice. It was amazing, hearing my husband say those words rather than an ultrasound tech, coming with all the emotion of seeing our baby -- OUR BABY! -- for the very first time. Hands down, one of the highlights of my life.

C put him right on my chest and we just started to laugh and cry. He picked his head right up and looked at us, like he was saying, "Hello, Mom! Hello, Dad!"

He was very quiet initially, just looking around with his deep blue eyes, taking it all in. After a few minutes with no noise, C got concerned about his breathing, so she did a lot of suctioning and finally he started crying. She asked if I wanted to move to the bed to deliver the placenta, but I was pretty comfortable in the tub, so we stayed in there for a bit.

They covered me up with towels, and we had our two friends and my mom bring Littles in to meet her new baby brother! Someone asked her what she thought and she said, "I have a big nose!" Everyone started laughing, but since she was standing right next to me, I heard her follow up quietly with, "He has a little nose." Very true, Littles. Very true.

My husband was on the phone calling people to tell them the news. He kept saying, "Just one more person!" And he'd call that person and then say, "Oh wait, I have just more person to call!" Proud daddy! Everyone kept asking what his weight was, but we didn't know yet, because he hadn't had his newborn exam.

C was getting a little concerned that my placenta wasn't coming out, and she suggested that I try nursing to cause my uterus to contract. I had some trouble because the cord was a little short, so C checked to see that it had stopped pulsating, and then she got my husband to cut it.

I tried nursing, but Noob had some trouble latching on. After a few more minutes, C asked my husband to take Noob so that I could try squatting to get the placenta out.

That didn't work either, even when I did some pushes, so we drained the tub and moved to the bed.

C felt my stomach and said she could feel some bleeding behind the placenta. She asked a couple of times if I was feeling faint, which I wasn't, thankfully. But I was starting to get a little nervous. E asked, "When was the last time she emptied her bladder?" and C said, "That's a good question!" I knew it had been a while. So C and G helped me to the toilet, where I tried soooooooooooo hard to pee... and I just couldn't! They were just outside the toilet room, writing some stuff down, and C told me to try pushing a bit again. I felt it come sliding right out. Whew. C and G didn't notice, so C asked, "Any luck?" And I said, "Well, something just came out, it was the placenta, another baby, or the biggest poop of my life" :) Then she asked if I had been able to pee, and as if on cue... "ssssssssssss." LOL! I got up and she confirmed it was the placenta. Whew!

While all that was going on, Noob took a HUGE poop. I missed it all, but my husband said he was covered from practically the shoulders down. Luckily, the new towels that we bought are dark brown :)

I got back in bed just as E was showing M the best way to put a prefold on a newborn :) I had specifically put some easier diapers into the box of diapers, figuring no one else would want to mess with prefolds. But E's tips made it really easy. My husband has been doing most diaper changes while I recover, and he loves the prefolds!

Once Noob's first diaper was on, I tried nursing again. E suggested trying the football hold, and that worked out really well. He latched on for quite a while, and made up for his lack of noise when he first came out by murmuring contentedly throughout the entire nursing session.

Meanwhile, C and G were cleaning up the placenta. C asked if I wanted to see it? Nooooooooooo. E asked if I wanted a picture? Noooooooooooo. Thanks for asking though, ladies. And thanks to M for taking it and throwing it away for us!

Once Noob finished nursing, my husband took him again while C and G inspected my bottom. They initially thought I hadn't torn at all, but it turned out I did need a few stitches. I figure it was probably my fault for pushing so hard, rather than letting my tissues stretch slowly, but oh well! It still wasn't as bad as last time, and both midwives said the tear was pretty clean and should heal up fine.

Then it was time for William's exam. Everyone guessed on his weight. My husband thought he was under 8 lbs, but all the ladies guessed in the 8 lb 9 oz to 8 lb 13 oz range -- and they were right on! He was 8 lbs 11 oz. He measured 21" long, nearly 1" longer than Littles, despite being over half a pound lighter. C and G ran through the rest of his exam on the edge of our bed, checking everything from his palette to his ear placement to his hip movement.

Once that was all done, around 4:30 PM, everyone packed up to leave. Pretty soon, it was just our new little family, along with my mom. Noob and I spent the rest of the evening cuddling in bed, relaxing, and nursing (which he got the hang of pretty quickly). Littles came in many times to visit with her baby brother -- still insisting, as she did for most of the final weeks of my pregnancy, that he is a girl :)

My husband and I went to bed with Noob at around 11 PM. We soon discovered that he wasn't a real fan of the pack-n-play, so he spent that first night sleeping in between us -- something that would not have been an option in the hospital at all, where the bed was definitely not big enough for two adults and co-sleeping was strongly discouraged anyway.

We woke William to nurse every few hours. After his 3 AM feed, I spent about an hour just laying in bed, cat on one side, my two boys on the other side, reviewing all the incredible events of the day in my head, completely blissed out.

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When C, G, M, and E left, they all came over one by one to give me a hug. When it was C's turn, she asked, "Are you glad you sent that email?" Because when I initially emailed her to set up an interview, I told her that I'd been thinking about sending that very email for months, and had finally decided to just do it. That email, of course, is what put us on this path towards homebirth.

I told her "yes," but really, that little word doesn't to justice to how glad I am. I had been very wary about seeking the "perfect" birth, because one thing that Littles' birth taught me is that there is so much that is outside your control when it comes to giving birth. But the experience ended up being about as close to perfect as I could have ever imagined.

One of my favorite parts of the movie "The Business of Being Born" has always been a line that goes something like this: "A woman will always remember the way she felt -- the way she was made to feel while giving birth." With Littles' birth, I felt strong, powerful, in control, in awe of my incredible body and all it could do. But I also felt like the people around me had "their" way of doing things that they followed, regardless of my desires. From the saline IV that the nurse just assumed I needed, to my OB tugging on the cord to get the placenta out without asking me, to even my doula asking for cervical exams when I wasn't sure I felt like lying on my back to hear semi-useless news of "progress."

Noob's birth was my way, all the way. I felt just as strong and powerful as I had with Littles. But I was also made to feel completely comfortable, and completely supported. Nothing happened to me, like it had in the hospital; I was asked at every step of the way what I wanted.

With Littles' birth, I was in awe of my body. With Noob's birth, I was in tune with my body. After Littles' birth, I felt like I had conquered a mountain -- because my body had taken everything the hospital had thrown at it, and overcome it. After Noob's birth, I just felt normal -- because my body had been allowed to do exactly what it wanted.

I still feel that Littles' birth was the way that SHE needed to be born, and I still consider it to be a really positive experience. But Noob's birth... well, as Littles loves to say, "Oh wow."

Littles' birth story

A couple of notes about the birth stories:

1. Grab a cup of coffee and settle in. They are long.
2. They contain stuff that some people may consider TMI. Mucus plugs, bloody show, tearing "down there," etc. You have been warned.
3. They were all written within days of the respective births. That means that they are a good indication of my perspective and mindset at the time of the birth. In some cases (especially regarding Littles' birth), my perspective/mindset has changed with time.
4. Hypnobabies users: You may want to use your BOP. All birth stories contain standard terminology (no "birthing time" or "pressure waves" here...) Littles' mentions p**n a few times; Noob's and Q's do not.

Still want to read? OK. Here goes...

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Background: I had an easy, healthy, normal pregnancy, aside from testing positive for Group B strep at 36 weeks. We planned a natural birth and took Bradley method classes. Unfortunately, the baby wouldn't cooperate, and at 41 weeks, I got scheduled for an induction starting at 41 weeks 5 days (June 17). I was rather upset, as this put a major kink in my natural birth plans and there didn't seem to be any reason to rush the baby out, but I decided to make the best of it and try to make it through with as few interventions as possible.

Afternoon of 6/17/2007 - I stood up and noticed a tiny gush of fluid. I thought it was probably my imagination, or if not, most likely urine -- but that itself was odd, as I had no problems with urine leakage at all during pregnancy.

6/17 7:30 pm - We were getting ready to leave for the hospital when I noticed a more noticeable gush of fluid. Still nothing huge. I had a gut feeling that it was amniotic fluid.

8:15 pm - We arrived at the hospital and got checked in. I mentioned the fluid leakage to the nurse. She said if my water really did break, it would keep on leaking, and to let her know if that was the case. I got hooked up to the external fetal monitor, which showed I was contracting about every 5 mins, but I couldn't feel them at all.

10:30 pm - The on-call OB examined me. I was 1cm dilated, very soft cervix -- basically no change from my appointment the previous Friday 6/15, so my contractions weren't really doing anything. I had had no more fluid leakage, so she went ahead and inserted the Cervidil and kept me on the fetal monitor. Pretty soon, I started feeling more contractions. They either felt like a painless tightening of my stomach or like mild menstrual cramps. I turned down an Ambien (I didn't want the baby or me to be sedated, in case things got moving before the drug wore off) and tried to get some sleep.

6/18 12:00 am - I had just drifted off to sleep when I felt something leaking. We called the nurse, who confirmed that my water had broken. She consulted with the on-call OB and decided to leave the Cervidil in, but put in a hep lock and start IV penicillin due to my GBS status.

(In retrospect, I'm pretty sure that my water would've broken on its own on Monday or Tuesday had I not been induced. Getting induced when I did was something of a blessing, as it allowed me to labor some on Cervidil rather than going straight to Pitocin.)

6 am - The contractions had gotten strong enough that I could no longer sleep through them, so I was waking up about every 5 minutes. I tried to relax through them and hoped they were doing something.

6:30 am - Round 2 of penicillin.

7:30 am - My OB, Dr. K, came in to examine me. Good news, I had dilated to 4cm and 90% effaced on the Cervidil alone! She decided to let me labor for a bit on my own to see if we could avoid Pitocin. We called our doula E, and I took a shower and ate breakfast. I did some walking to try and get things moving -- it just felt good to be off the monitors and the IV. (I still had a hep lock for antibiotics and for Pitocin if needed.)

10 am - Yep, I needed the Pitocin :( Back on the fetal monitors and the IV. No more walking.

11 am - I posted a labor update to my blog. By this point, the contractions were strong enough that I could not type during them, but I still had a good break in between them. They quickly got so intense that I couldn't do anything but focus on them.

1:30 pm - I'd been laboring hard for 2.5 hours. My bloody show had turned from pink to bright red, and I was feeling some pressure in my bottom. So the nurse came in to check on me. I had moved to 100% effaced, but I was still 4cm dilated, just as I had been six hours earlier :( Thank goodness for Bradley classes, where we talked about the NAP (natural alignment plateau) -- my husband, E, and I all knew I could be minutes away from transition even at 4cm. Transition turned out to be a little longer in coming :), but I didn't get too discouraged. I told E, "I don't care that I'm still 4cm. I know I'm making progress. This hurts too much to NOT be making progress."

Around 2:30 pm - Dr. K came back (she'd been at the office) and asked if I'd had a shower. Of course I hadn't; I was still hooked up to the IV and fetal monitors. Bless her, she told the nurses to take me off all that and let me get in the shower. I don't know if it was the shower that helped or just being off the Pitocin, but my pain got better. It was a very welcome break for maybe 20-30 mins, giving me a bit of a second wind.

4:30 pm - Dr. K checked me again. "Floppy" 6cm dilated. OK, better than 4cm. At least I was making progress. I was still nervous that my progress might just stall at some point.
By this time, the contractions were incredibly intense. I was chanting "Open" through them and trying to visualize my cervix opening up. I was switching positions as much as I could, from sitting on the edge of the bed to sitting in a chair to sitting on E's birth ball. I was also able to stand up, but I felt very tense in that position, so I figured it was counter-productive. Lying on my back or side (which I had to do momentarily when they checked me) was absolutely miserable.

The wonderful thing about having E there through all this, besides the obvious support that she gave me, was that she was able to give my husband a break. He actually took a hard 20 minute nap during this period, and he was also able to get lunch and dinner throughout the day. Without E there, I think he would have been too exhausted by the end of the day to really support me when I needed it desperately. Doulas are worth their weight in gold!

6:00 pm - Another check. 8cm, stretch to 9cm. Still making progress. Referring to my Ironman experience, I made a crack about how I'd finished the swim and the bike, and now just had a marathon to run :)

6:30 pm - Round 3 of antibiotics.

Around this time, things got really bad. I had been able to relax through my contractions for most of the day, but now it was all I could do to hang on and stay on top of them. I couldn't even chant "Open" or hum anymore; I just tried to breath. I was incredibly tired and just wanted to get off the Pitocin, fall asleep, and continue laboring later. I actually did sleep in between quite a few contractions.

In addition to the three positions we'd been using all day, E also had me try all-fours and squatting. All-fours felt pretty good. Squatting was REALLY intense. I tried it two or three times and I just couldn't handle it.

My memories of the next few hours are a little fuzzy as far as time goes...

Contractions started to get all over the place. Some were so intense and painful that I couldn't do anything but cry out "Ow! Ow! Ow!," and I even kicked my husband once. Others were quite manageable and gave me a nice break. I also started feeling more contractions in my back. I must've hit transition somewhere in here, but it wasn't very different from what I'd been feeling all along. I did get some shakes, maybe around 7:30 or 8 pm?

Everyone kept asking me if I was feeling pressure, as this would indicate whether it was time to push. Well, I'd been feeling pressure all day, so how was I supposed to know when it was "real?"

The L&D nurse (Melissa) and Dr. K checked me a couple of times. I was fully dilated but still had an anterior lip of cervix that neither of them could push back. I was incredibly discouraged and convinced that the lip would never go away.

Finally, Dr. K said to go ahead and push as she held the lip back. This worked out fine -- the lip moved, and I was finally able to push freely!

Pushing was hard work, but an incredible relief. I was on top of the contractions again. I was DOING something! And it was fun 'cause everyone was cheering me on. I have no idea how long I pushed. My husband says 20 minutes. I think it was closer to 30-45 minutes. I pushed mostly on all fours, then switched to my left side for the last few contractions.

And then, at 9:26 pm, out came Littles! 13 days past her due date, 23 hours after labor got started, 11.5 hours after the evil Pitocin went in -- and totally worth the wait.

She came right on my belly, and not knowing any better, I thought she looked like any other newborn. It was Dr. K, Melissa, and E (who have been around a lot more newborns) who immediately said, "Wow, that is a BIG baby!" Sure enough, she weighed in at 9 lbs 7 oz. We had NO idea she was that big, as my OBs don't typically do late ultrasounds for weight estimates. I am glad they don't, because if I had suspected she was big, I might have doubted my ability to push her out. Ignorance is bliss :)

I am really glad we let her have those extra days in the womb. She has been doing so well -- very active right from the start, picked up breastfeeding right away, no jaundice issues, fantastic hearing (the hearing test lady was very excited, as she scored over a 300, which is apparently fairly uncommon) -- and I think part of the reason why is that she got those extra days for her brain to build some extra connections to help her out.

Anyway, whatever the reason, she is just wonderful and we love her so much already :)

"Q" is here! It's a girl!

Q was born on July 2nd, 2012, at 1:11 AM Central time. It's a girl!

I'm going to post Littles' and Noob's birth stories, followed (eventually) by Q's. I do have more blogging to do on some specific birth-related topics, but that will have to wait!

Group B Strep

Group B strep (GBS) is a bacteria that is carried in the vagina and/or rectum of about 25% of pregnant women at any given time. It normally doesn't cause any problems or symptoms in the mother, but when she gives birth, she has a higher chance of passing the bacteria along to her newborn than an non-colonized mother. This can cause GBS infection in the newborn, which can be very serious or even fatal.

Here is more information about GBS infection, screening, and treatment from the CDC. Here is an article that presents an alternative view regarding treatment, from Mothering magazine.

With Littles
I was screened for GBS at my 36-week checkup, via a swab of my vagina and rectum.

I tested positive.

I was devastated. This was the first real curveball thrown at my med-free birth plans. (It wouldn't be the last.) It meant that I needed to get IV antibiotics during labor -- ideally, at least two doses, at least four hours apart, prior to the birth. I didn't like the idea of having to get to the hospital early to ensure I got the first dose of antibiotics in time. I didn't like being required to get an IV. I didn't like that Littles would get antibiotics before she even took her first breath.

I talked it over with Dr. K at my next appointment. She made me feel a little better by saying that I could get a saline lock (also called a hep lock), rather than a constant IV. This would allow me to be hooked up to the antibiotics when needed -- that is, for roughly 10-15 minutes every 4 hours -- and then disconnected, to give me freedom of movement until it was time for my next dose.

She also wasn't overly concerned about changing when I left for the hospital. Since I was a first-time mom, she was pretty confident that as long as I followed the standard 5-1-1 rule for leaving for the hospital (contractions every 5 minutes, lasting for at least one minute, for at least one hour), I'd end up getting there in time for my two doses regardless.

I asked her about alternative treatments, such as a chlorhexidine wash or even declining antibiotics completely. (Even with no antibiotics at all, fewer than 1% of babies born to GBS+ mothers actually develop GBS disease.) She had never heard of a chlorhexidine wash. She said that I could decline antibiotics, but added that if Littles developed any symptoms of possible GBS disease, she would be treated very aggressively. "Spinal taps on a newborn are no fun," she cautioned. I decided that it made sense to do the antibiotics, rather than risk any unnecessary discomfort for Littles.

As it turns out, I had to be induced, and so the GBS thing was not a big deal at all compared to everything that came along with the induction. Induction eliminated any concerns about getting to the hospital in time, and since I had a constant IV for Pitocin, I barely even noticed when they added the bag of antibiotics to the mix.

And, of course, Littles was fine. Hardly surprising. The antibiotics cut her risk of developing GBS infection from about 1 in 100 to about 1 in 4000.

In retrospect, even if I had gone into labor on my own, the whole GBS thing really wouldn't have affected it much at all. I really had no reason to be as upset as I was when I first found out.

With Noob
Some doctors treat a mother who has tested positive for GBS in past pregnancies as being GBS+ for any subsequent pregnancies as well. Early in my pregnancy with Noob, I asked my midwives if they did this, and they answered no. So my history with Littles made no difference: I'd be screened at 36 weeks again, and as long as I tested negative, there would be no need for antibiotics.

When I relayed this to my doula, she told me about a regimen of vitamins and herbs that her own homebirth midwife suggested to fight GBS prior to the screening. It consisted of probiotics, echinacea, vitamin C, and garlic, starting around 32 weeks. All of these things are naturally antibacterial, so they can potentially kill off GBS bacteria in a colonized mother. They also carry no known risks. I figured it was worth a try.

Some people consider this to be "cheating the test." I disagree. If this stuff does in fact kill off the GBS bacteria in advance of the test, presumably it will keep killing off any new GBS bacteria for as long as you continue taking it. For this reason, I opted not to take garlic: It's a blood thinner, so you need to discontinue use of it at 37 weeks, to avoid any bleeding issues during birth. I started on everything else, fully intending to continue taking until I gave birth.

At the time, I didn't know that I'd be switching to homebirth. I made the switch at 36 weeks, so I never did the GBS screening with my hospital-based midwives. Instead, I did the screening with C at 37 weeks. She handled it differently from the OBs I had with Littles:

• C left it entirely up to me as to whether I even wanted to do the screening. She gave me a paper with all sorts of information about GBS screening and treatment to ensure I could give truly informed consent. I opted to do it. In my eyes, there was no downside to screening: Even if I tested positive, as long as I birthed with C, I was free to choose my preferred course of treatment, including no treatment at all. And there was a potential downside to not screening: If I ended up having to transfer to the hospital for any reason and my GBS status was unknown, I'd be treated as positive regardless.
  
• C had me swab myself. It's really easy to do, no need for years of medical school to learn how, honest. And as far as I'm concerned, it's good to minimize how often I take off my clothes unnecessarily :)
  
• C instructed me to only swab my vagina, not my vagina and rectum. Rectums have more bacteria in general, so it's hardly a surprise that women who have both swabbed will be more likely to test positive than women who have only their vaginas swabbed. In case there was any doubt, this is backed up by studies, such as this one and this one. But those studies only looked at the number of women who tested positive from a vaginal swab vs. vaginal + rectal swab, not the actual incidence of GBS infection in their babies. And, well, last I checked, the baby doesn't come out your rectum. The reason generally given for doing the rectal swab is that a woman with GBS colonization in her rectum is more likely to develop GBS colonization in her vagina as well, but if that's the case, wouldn't a vaginal swab pick that up, at least the vast majority of the time?
  
• If I tested positive, C was not able to give IV antibiotics during labor. For better or worse. She offered a couple of alternative options, such as a chlorhexidine wash (which has been shown to be effective, e.g. in this study and this study), various herbal treatments, or no treatment at all, simply observation of the newborn in the early postpartum period. If I really wanted IV antibiotics, I would've had to go to the hospital myself.

C knew I was anxious about the results, so she called me as soon as they came in, even though it was just a day before my next appointment and she could've easily waited till then to let me know.

I was negative.

Of course, I have no way of knowing whether it was the vitamins/herbs that made the difference, or if it was skipping the rectal swab, or if I just wasn't carrying the bacteria this time around. (It does come and go.) Whatever the reason, it was a huge relief for me.

I continued taking everything until I gave birth.

With Q
Since I was with C from the start, I asked her for her preferred GBS-fighting regimen. Hers was similar to what my doula had suggested with Noob:

• Vitamin C (at least 500 mg/day)
• Echinacea (without goldenseal, following the dosage on the container)
• Optionally, garlic oil capsules (following the dosage on the container, stopping at 37 weeks).

Again, I opted out of the garlic, but took the other two, starting at 35 weeks. Again, I tested negative at 37 weeks.