Thursday, July 26, 2012

Beauty and/or Beast

me: Do you want to get down?
her: flap flap flap flap.
I haven't posted a proper photo update in awhile. Lily is now 10 months old and HUGE! She is so active it's hard to keep up with her. She pulls herself up to stand on just about everything and her favorite toy is the treadmill. She climbs up there and plays for awhile then sits on the side and waits until one of us gets her down. She is standing, furniture walking, eating everything in sight, playing with toys (instead of eating them) well maybe a little eating of the toys too, and babbles all the time. She communicates well through her own signs and actions. Her yes is now a flailing of both arms, like a flightless bird. She shares wonderfully and is getting so independent. She is getting three more teeth, all at once (that makes a total of four!) She wants to do everything herself, without a diaper. Yes. She hates diapers. She hasn't figured out yet how to take snaps off *WHEW*.

Without further ado... my daughter. (P.S. Sorry for the blurry pictures, she is SO active now)

LILY MONSTER!! (Her new favorite game)
Playing peek a boo!

Who knew she loved the cob so much!

She went crazy with it!!

This one was just her size :)

The aftermath (that's asparagus and mushroom in her mouth)

Please let me in mama, I promise I wont drink the vinegar!

Dumping/Eating her cheerios.

Here is my little beast child who BROKE into our bedroom. Yes, she opened the door and tore it apart! That is my pump (and all the pieces), toilet paper ripped to shreds, pajamas, my contact stuff and some papers all over the floor. (There are those flailing arms after we asked her if she did it.)
My little lady with her purse. (Excuse the mess, a little lady tore her treasure box apart.)

In closing here is a video of Lily eating cor and asserting her independence. Crazy Beast.

There you have it. Our tenth month old beauty and/or beast. :)
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Monday, July 23, 2012

A Guide For Parents-To-Be: Part 3 (Pain Management and Pain Medication)

Pain Management and Pain Medication in Labor

One of the things pregnant women fear most is whether they can handle the pain of labor. It can be scary when no one can explain to you what a contraction feels like and everyone just wants to tell you horror stories about long hard labors! I'm here to tell you, you can. It is a mental game and with someone to support you (whether that be a doula, a good nurse, or a prepared partner) you can do this!!!! But what if you don't want to handle it. What if it is worth it to you to just get pain medicine instead? That's ok too!! This is your birth and you have choices, including  whether you want to take pain medication or not. So lets talk about some of the options out there and the pros/cons for each.

First, lets talk about some non-invasive pain management techniques. These techniques are what most doulas will use to help relax mom and minimize pain.

  • Position Changes- 
    • Every woman is different. Different positions will be comfortable for different mama's. But there is one universal position that DOES NOT HELP with pain management. This is lying flat on your back in bed. When a laboring mom gets stuck on her back, she often feels the contractions way worse than they actually are. 
    • Many hospitals want to continuously monitor or even intermittently monitor your baby's heart rate and contractions while you lye in bed. There are other ways though!! Often you can sit in bed, lye on your left side, sit on a birth ball next to the bed, etc. Do not be afraid to mention these alternatives! They will help you minimize pain. 
    • Out of bed there are many other positions you can try. You can kneel, rock, sit on a birth ball, lay over a birth ball, walk, squat, lunge, dangle, lap squat, etc. All of these position changes will help move things along and minimize pain. There aren't really any cons to position changes. It may take a few to find one you like, but it is worth it.
  • Accupressure-
    • Accupressure can ease anxiety, mitigate pain and help speed things along if labor is stalled. 
    • It can help dad, help mom. It can help mom, help mom. Accupressure is a very simple technique that can take the edge off of those agonizing contractions. 
    • 4 points that will help most during labor: GB-21, Hand Point, KID1, SP-6
    • Check with your doctor before using these points. Some women react differently to accupressure.
  • Breathing Techniques-
    • This is the easiest and most basic technique. EVERY woman should know at least one breathing technique to help her relax and get through a contraction. 
    • The simplest and most effective is take slow deep breaths. It's as simple as that!! Slow breath in 2, 3, 4. Slow breath out 2, 3, 4. 
    • Breathing greatly help in pain management. If you are not breathing, you wont be able to handle  it. If you breathe too fast, you may hyper ventilate! Get your partner or a nurse to help you remain calm and breathe with you when you start to feel anxious! 
    • Vocalization also helps. Whether singing, humming or moaning. (I took to moaning.) 
  • Relaxation/Focusing Techniques- 
    • Once again different things work for different mama's. So try a few! You can try visualizations, massage, music, counting, or focal points. 
    • Your doula may help you relax with Roving Body Check. 
  • Heat/Cold-
    • I have mentioned hot and cold packs in a previous post with tips to handle labor pain. Hot packs feel amazing, especially if you have back labor. I carry around two rice packs with me in my doula bag just for this reason!! Cold packs keep you from overheating, I mean you are running a marathon here!!!
    • The warmth of a shower can relieve pain too. During the birth of my daughter I spent countless hours with the shower head on my back. The heat gave me major relief.  Some hospitals/birth centers even offer labor tubs! If one is available to you, I would consider trying it out!!
  • Counter Pressure-
    • A different kind of labor is back labor. It is when you feel the contractions in your back, instead of your tummy. In the case of back labor counter pressure is vital. You may like constant pressure against the pain or light massaging or heavy massaging! Be prepared (partner) to try different styles that work for the mama.
Now onto pain medication. After all, that's what most of you want to know about!!
  • Systemic Painkillers-
    • Often narcotics or tranquilizer's. 
    • Narcotics are used to take the edge off of the pain. You can still feel it, it just isn't so bad. They are usually given through IV or less often injected into muscle. Often, you cannot receive narcotics after 7 or 8 cm because it will effect the baby. These can make you a bit sleepy and nauseous. They take effect within minutes.
    • Narcotics are often given with a tranquilizer. The tranquilizer is used to calm anxiety or nausea. 
    • Pros- Narcotics often lessen the perception of pain for 2-6 hours and promote rest. 
    • Cons- Don't eliminate pain. Often come with sleepiness, nausea and may temporally depress breathing for you or baby.
  • Epidural-
    • An epidural numbs the lower half of your body. It is continuous pain relief that is delivered through a catheter (small flexible tube) inserted into the space just outside the membrane that surrounds the spine. It can be turned down or up if the dose needs to be adjusted. This is the most common pain medication used in labor. 
    • Pros- Alleviates most pain. You are awake and alert (if you want to be hehe). Usually has little effect on baby.
    • Cons- May decrease your blood pressure and lower baby's heart rate. It can cause temporary difficulty in breathing. You may need a catheter since you often cannot empty your own bladder. Fever, soreness and itchiness at the injection site are common. May make pushing more difficult and additional interventions such as pitocin, vacuum extractor, forceps or cesarean may become more likely. You must remain in bed which could stall labor. You usually must remain in bed after birth (per hospital policy). A headache in the days following delivery is possible. May cause some trouble latching on to breastfeed.
  • Spinal Block- 
    • A spinal is very similar to an epidural. It has the same effect on your body however it differs in two ways. 1. It is delivered directly into the spinal fluid. 2. It is a one time injection instead of a continuous feed. This results in an immediate reaction but doesn't last quite as long. 
    • Usually used late in labor when there is no time to wait for an epidural or more recently in combination with the epidural. 
    • Pros- Complete pain relief in lower body for 1-2 hours. Medication is only given once and you will remain alert and awake. Usually has little effect on the baby.
    • Cons- May decrease your blood pressure and lower baby's heart rate. It can cause temporary difficulty in breathing. You may need a catheter since you often cannot empty your own bladder. Soreness at injection site is common.  May make pushing more difficult and additional interventions such as pitocin, vacuum extractor, forceps or cesarean may become more likely.  You must remain in bed during labor. A headache in the days following delivery is possible.  May cause some trouble latching on to breastfeed.
  • Local Anesthetic-
    • A local anesthetic is often used during labor to numb the tissue in the vaginal opening if an episiotomy is needed. More often, it is used if your care provider has to repair a tear. It is injected into the vaginal tissue or perineum and takes effect very quickly.
    • Pros- Temporarily numb a specific area. Negative effects are rare.
    • Cons- An allergic reaction is possible. Not for labor contractions.
  • Pudendal Block-  
    • A pudendal block is usually given in the second stage of labor just before delivery of the baby. It relieves pain around the vagina and rectum as the baby comes down the birth canal. It is also helpful just before an episiotomy.
    • Pros- Relieves pain in lower vagina and perineum for up to an hour. 
    • Cons- May work on only one side of perineum. Cross placenta and can effect breast feeding relationship immediately after birth. Risk of hematoma and infection (although rare)

Labor is a personal time and experience. Opinions, needs and wants differ greatly. If decide against or decide to use pain medication, do not let other people's opinions effect you. This is your decision! As always, I invite you to educate yourself further on these options. Decide what is right for you by making an educated decision. 

Sending Easy Birth Dust Your Way!!

                              (Vaccinations, feeding baby, circumcision, discipline, and routine procedures)
To be covered in part 4: Making Decisions on Raising Baby
                             (Babywearing, Day Care, Montessori Method, Co-Sleeping, Introducing Solids)

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Thursday, July 19, 2012

Lily's First Convention

Every year we attend a three day bible based convention. This year was Lily's first!! She spent some time with Grandma and Popop, Uncle Nathan and Aunt Olivia and her cousins James and Lindsey.
Reuniting with Popop

With her grandparents

The Original Clan, plus one.

Our Family :)

Love her little double chin!

Demanding Dinner

And getting some....

These people are crazy!

Aunt Olivia

Uncle Nathan


Pretty Eyes!

Showing Love to the camera!

Every time everyone would clap, or music would come on she would scramble to the edge and get SO excited!

She enjoyed meeting so many new friends and seeing some old ones, but in the end she was exhausted.

Overall. I think Lily had an amazing weekend (and so did we hehe)

When we got home it started storming and Lily found her favorite place in the house!

It was a good weekend with lots of fun! Pin It Now!

Sunday, July 15, 2012

A Guide For Parents-To-Be: Part 2 (Interventions)


Interventions in Labor

When you go into labor you will be so excited, THIS IS IT!!! Many women time every single contraction and anticipate the moment they get to go to the hospital. Lets talk about some things that may happen once you get there. What can you anticipate? 

Many interventions are used in Hospitals today. For example, About 81% of women who birth in a hospital receive Pitocin. Pitocin can double your chance of a cesarean birth. That's where education comes in. The more you know, the more control you can have during your labor. Below are common interventions used. I encourage you to do further research on your own in order to help make educated decisions
Always remember, you have choices.

1. Induction
2. Electronic Fetal Monitoring
3. Other Interventions

Here is a sample document to help you share how you feel about each intervention.

1. INDUCTION- Labor should only be induced if it is more risky for baby to remain inside the uterus than to be born. (American College of Obstetricians and Gynecologists)

  • Artificial Rupture of the Membranes (AROM)- AROM is when the care provider breaks your bag of waters.  The care provider will insert a tool called an amnihook and 'catch' the edge of the amniotic sac. This method is often used to induce labor, allow the care provider to see if there is meconium (baby's first poo) present, and for use of an internal fetal monitor. 
    • Pro's- Labor may be shortened by an hour, allows amniotic fluid to be examined for presence of meconium which could cause fetal distress. 
    • Con's- Baby could turn into breech position making birth more difficult and cesarean birth more likely (if head isn't engaged), umbilical cord could slip out first (prolapsed cord), possibility of infection increases, more intense contractions.
  • Prostaglandin Gel- Medication applied to the cervix prior to induction. Used to thin and shorten (efface/ripen) the cervix which prepares it for birth. There are three types, a gel, oral dose and a tampon-like dose . Prepidil is a gel while Cervidil is applied like a tampon. If over stimulation occurs cervidil can be easily removed, Prepidil can be wiped away but the oral form cannot be removed.
    • Pro's-  Minimally invasive, No IV required, Can be an overnight administration (administered, then sent home).
    • Con's- Ripens cervix but does not induce. Possible symptoms, oral form cannot be removed in case of over stimulation
  • Cytotec- Cytotec or Misoprostol is intended to soften, efface, and assist in dilation as a means of induction. The dose is given in pill form. The pill is placed vaginally against the cervix and cannot be removed once given. It is NOT approved by the FDA for use in labor but still used today. Below are two links, an FDA warning and the Cytotec label.
    • FDA Warning
    • Cytotec Label
    • Pro's- Fast acting, considered reliable
    • Con's- Not FDA approved for use in labor, Has highest reported incidence in all of induction methods, Used with continuous fetal monitoring, cannot be removed once administered
    • Side Effects-  fetal cranial nerve palsies, fetal death, maternal death, severe postpartum hemmorhage, uterine tetany, decreased uteroplacental blood flow, uterine rupture, necessitating hysterectomy, amniotic fluid embolism, placental retention, maternal and fetal shock, fetal bradycardia, uterine tachysystole, higher incidence of infection vs Pitocin and higher incidence of c-section
  • Pitocin/Oxytocin- Pitocin is a synthetic form of the natural hormone Oxytocin. It is used to induce labor and is considered the safest method of induction as it can be regulated. Pitocin is administered through an IV to initiate and regulate contractions. It can be accelerated, reduced or stopped at any time. Many care providers will start an induction using Pitocin then turn it off when things get moving. Many others administer Pitocin after baby is born to stop/prevent hemorrhage.
    • Pro's- Considered safest form of induction, can be mobile, low risk of infection, can stop post-natal  hemorrhage
    • Con's- Aggressive and invasive, Continually administered (use of IV pole and bag), Usually used with continuous fetal monitoring or intermittent monitoring, Labor can progress quickly resulting in need of pain medications, Side effects
2. ELECTRONIC FETAL MONITORING- When admitted into a hospital you will typically go into triage and have monitors strapped to your belly to monitor babys heart beat (typically for about 20 minutes or so). If all looks well some will allow intermittent monitoring. If fetal distress is evident or if mom is high risk, continuous monitoring will be used. 

  • Continuous Fetal Monitoring- Continuous monitoring for low risk women has a lack of benefits. It has shown to increase use of other interventions such as vacuum extractor, forceps use and cesarean section. For high risk women though, continuous monitoring can be the safest way to labor. It can let the care provider know whether baby is in distress or an emergency may arise.
    • Pro's- Safe way of monitoring baby in high risk women, can be reassuring to parents, lets doctors and nurses measure contraction length and duration.
    • Con's- False positives are very common, confines you mom to bed, may be uncomfortable, sometimes machine gets more attention than laboring mom
    • Alternatives- Intermittent monitoring, hand held doppler
Doppler Monitoring- Source
  • Intermittent Fetal Monitoring- Intermittent monitoring is safer for low risk women. This involves monitoring baby for 15-20 minute intervals every hour. Mom is often confined to bed for the time of monitoring. Occasionally hospitals have mobile units but you must ask for them and the nurse must be compliant. 
    • Pro's- Helps doctors and nurses keep track of contractions and determine whether fetal distress may be present. Can be reassuring to parents. Easier on mom than continuous monitoring.
    • Con's- False positives are common, confines mom to bed for intervals, can be uncomfortable.
    • Alternatives-Hand held doppler
  • Internal Fetal Monitoring- Requires the amniotic sac to be broken and at least 2-3 cm dilated. A scalp electrode is entered through the birth canal and placed on the baby's head. This from of monitoring is the most accurate. Often mom can be mobile with this form of monitoring. 
    • Pro's- Most accurate form of fetal monitoring, can be mobile while in use, can  determine whether baby truly is in distress.
    • Con's- Water must be broken, increases chance of infection, can be uncomfortable
  • IV (Intravenous drip)- An IV is a clear plastic tube inserted into a vein in the hand or arm. They are often given in labor to hydrate women and to keep the vein open for administering medication in case of an emergency(ICE). Some OB's and midwives routinely use an IV on all laboring women. 
    • Alternatives include hydrating with clear liquids, ice chips, Popsicles, etc. (some hospitals have a nothing by mouth policy). Another alternative is using a Heparin Lock, which keeps the vein open in case of emergency but is not accompanied by an IV bag or pole. 
    • Pro's- Keep mom hydrated, Keep vein open ICE, Easy access ICE
    • Con's- Fluid overload resulting in fluid in mom and baby's lungs, diluted blood/anemia/reduced blood oxygen supply to baby, newborn jaundice, hinders moms movement in labor, usually used with continuous monitoring.
  • Heparin Lock- Also known as a Hep or saline lock. Most facilities require having at least a Hep lock when in labor. Usually it is inserted into the vein on the top of your hand. It can be uncomfortable at times but is a nice alternative to an IV. Like an IV, a Hep Lock is used to keep a vein open in case of emergency. It can also be used to administer pain medication, administer antibiotics if the Strep B test was positive, or Pitocin in case of induction or postpartum hemorrhage.  
    • Pro's- No pole/bag unlike IV, Easy access ICE, Keep vein open ICE, Administer antibiotics then close for remaining labor.
    • Con's- Can be uncomfortable
  • Vacuum Extractor- A vacuum extractor is used to assist in birth. This tool uses suction to either turn the baby's head or pull baby through the birth canal. As shown above, it looks like a suction cup attached to a handle. This is often used if the mother has an epidural, is physically exhausted, the baby is in a difficult position or the baby is getting a lack of oxygen.
    • Pro's- Helps baby descend through birth canal in case of an emergency or if mom is not able to push him/her out on her own.
    • Con's- Baby may have a red area or small bruises on face. Scalp may have blood blister or small bruises. There rarely can be trauma to the facial nerves.
  • Forceps- Forceps are also used to assist in birth. This tool looks a bit like salad tongs which are placed around baby's head and baby is gently pulled from the birth canal. These are often used if the mother has an epidural, is physically exhausted, the baby is in a difficult position or the baby is getting a lack of oxygen.
    • Pro's- (See Vacuum extractor)
    • Con's- (See Vacuum extractor)
If you really want to see an episiotomy, google it!
(I'm thinking about those with a weak stomach)
  • Episiotomy- An episiotomy is a surgical incision used to enlarge the vaginal opening to help birth baby. At one time it was common practice to perform a routine episiotomy with first time mothers. Some old-school doctors still follow this procedure! Ask your OB or midwife how they feel about them to determine your chance of receiving one. 
    • Pro's- Quicken delivery in case of emergency. Used in an assisted delivery (forceps/vacuum extractor). Easier to stitch up than a tear.
    • Con's- Infection, bruising, swelling, bleeding, longer healing time, painful scarring, a period of remaining abstinent, incontinence. Raises risk of tearing.
    • Alternatives- Place clearly in your birth plan that you do not want to have one unless absolutely necessary. Perineal tear. 
    • Prevention- Kegals, exercise (including squatting), controlled (by mom) pushing, perineum massage, avoid  lying on back while pushing, warm compresses
If you really want to see a perineal tear, google it! 
(I'm thinking about those with a weak stomach)
  • Perineal Tear- A perineal tear is a tear in the tissue found between your vaginal opening and anus. They range from small nicks to deep lacerations. Often, women would rather tear than have an episiotomy. 
    • To illustrate: Try to tear your shirt in half, it is pretty hard to do right? You have to put forth A LOT of force in order to do so. Now put a little cut in it and try to tear it in half again. It happens so much easier now right? 
    • Pro's- Heals faster than an episiotomy. 
    • Con's- Can take longer to stitch up than an episiotomy. Uncomfortable or painful healing, Swelling, bleeding, bruising.
    • Alternatives- Use prevention Techniques in  preparation of birth, Episiotomy.
    • Prevention- Kegals, exercise (including squatting), controlled (by mom) pushing, perineum massage, avoid  lying on back while pushing, warm compresses

Interventions aren't always needed. However, in case of an emergency it is best to be educated in what is going on. Doctors don't always clue you in so make sure your partner or support person is paying close attention in order to intersect any unwanted interventions. Knowledge is your friend. Don't forget to check out the free download above to help you convey your wishes!

Sending Easy Birth Dust Your Way!!

                              (Vaccinations, feeding baby, circumcision, discipline, and routine procedures)
To be covered in part 4: Making Decisions on Raising Baby
                             (Babywearing, Day Care, Montessori Method, Co-Sleeping, Introducing Solids)
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