Friday, June 27, 2014

Baby 4 Week 15: Possibly Offended

Week 15

I feel like the birthy decisions have settled down. No prenatals this week, no picking up medical records, and I'm even down to checking my blood sugar only every other day (as per Dr. C's recommendation)... so everything felt very normal this week. My blood sugar is great, fastings were mostly in the 80's which is awesome, after meals continue to be in the 80-90 range.

I wonder if kicking up my workouts is helping my fastings. Muscles use glucose for energy and instead of running so much (sometimes 7 days a week) I'm down to running 3 days a week and doing strength/cardio or just strength classes 3-4 days a week. I can definitely see the difference. I'm still trying out gyms, I have a pass at the YMCA and I've done RIPPED (Resistance, Intervals, Power, Plyometrics, Endurance, and Diet) a few times, a long time favorite, Boot Camp, and Step & Sculpt. One day I decided to go to "BYOB" (Bring Your Own Body I think?) which is usually a weight lifting class taught by a guy who plays rock from the 80's I think... I don't know... I grew up in the 90's. Anyhow I got there and there were strike pads out... which I'm down with... but then I realized we would be doing partners and I'd have to hold a pad while someone kicked me. Probably not recommended in pregnancy, but I did it. I've also been trying out a small gym on south Main called 2 Steps Ahead, which I really like, but I'm pretty certain we can't afford. I went to Piyo on Wednesday which was killer... super impressive. I felt huge next to all the skinny tan moms in there, but I more than kept up which made me feel good. So yeah, just really working on building muscle at this point to turn my body into a glucose burning machine.

It was a very birthy week, even if it wasn't about my birth. On Saturday I went to a fantastic workshop in Sacramento on VBAC (vaginal birth after cesarean) which is something I'm passionate about. It was mind blowing, so much amazing information... and I got to meet Jen Kamel of Celebrities do nothing for me... birth celebrities... super exciting.

With a few ICAN (International Cesarean Awareness Network) ladies and Jen Kamel
On Sunday I started a private class with a new couple. On Monday I taught my Salinas class. On Wednesday I taught my Carmel class and on Thursday I did a webinar for ICAN on how to avoid a cesarean. It was pretty awesome. I was SO nervous! I way rather be on a stage than talk into the internet... but I got comfortable and I think it went well. I hope they got me... here are a couples of slides... so you know what I mean.

I just love that shirt!

Who doesn't think Gandalf when unnecessary cervical checks come up?
And tonight I'm going to a pregnant mamas potluck. And then Saturday I teach again... and Sunday I'm having coffee with an expecting mama. I love it... nothing else I rather fill my week with. And how awesome is Eric for watching the babies while I do all that? Pretty awesome.

So I think I had my first stranger recognize that I was pregnant today, but I'm not sure. I was at the grocery store picking up ingredients for bruschetta for the potluck tonight. I just had a couple things and there was an old lade in front of me. I stood behind her for a bit then she told the checker, super kindly, "let this young lady through." I thanked her, and she said, "you need to get home and eat honey." Again... super nicely. And I was totally nice back, but deeply confused. I didn't look all that pregnant in what I was wearing, but it was tight so maybe? I was in workout clothes, maybe because she could tell I finished a workout? It was so weird. 

Well that was this week! Talk to you next week!

What this week was like with my other pregnancies:
               Milo, Week 15: Great Expectations
               Indy, Week 15: Put a Potato Where?

- Cori

Thursday, June 19, 2014

Baby 4 Week 14: Compromises I'm Unwilling to Make

Week 14

I am officially in my second trimester! I still don't really feel like I'm pregnant. I was a little more tired this week, I really felt the toll of the late night Orange is the New Black marathons... and by late night, I mean 11pm, and by marathon... I mean either one whole episode or MAYBE two episodes. Yesterday I woke Eric up at 9am and told him to make sure the kids don't die, I need a nap... and passed out for 2 hours. I went to bed at 11:30pm the night before, but 7 hours just isn't cutting it. I have a theory that pregnant women kinda slowly turn into babies over the course of their pregnancy... spitting up, frequent naps, unpredictable digestion, middle of the night feedings, rolling over becomes a big accomplishment, bursting into tears without warning. It all makes sense now.

I saw Dr. Chandler on Monday for what I hoped would end with "go, have your home birth." and it pretty much did! My blood sugar looks awesome. I definitely have gestational diabetes, there's no doubt about that, but over all my numbers are very well controlled. The fact that I already had a good diet helps a lot. Dr. C was worried I was starving myself to control my numbers but I assured him that this is just how much food I eat normally... unless I'm breastfeeding... then it's on. My fasting numbers are still mostly in the 90's. I questioned him on why a pregnant woman needed to keep her numbers under 90, or 92, or 95 (I literally heard all three this pregnancy) and a nonpregnant woman could be under a 100 (what my new midwife is going by). He said it just depends on the provider, adding, "We could make everyone diabetic if we wanted, just move the limit down." The number seems to be pretty arbitrary, I feel very comfortable for shooting for under 100 now.

We checked my blood pressure again because it was high last time, and it was high again. However, I noticed that both times the cuff was painfully tight... like my hand started tingling... and it had to tighten and release several times. It really hurt. The reading was 149/80something. High. Dr. C said to check again with my midwife and if everything is fine to not worry about it. I checked when I got home and it was 125/79... with similar readings a few times since then. So I think I'm good!

So basically I just have to stay healthy at this point. I'm not going to lie, it is taking a lot of commitment. I workout every day for an hour. I went to boot camp for the first time in two years to mix up my routine. I was worried I wouldn't be able to keep up, but I had no problem at all. Anything where I had to get up and down a lot was a little rough because I can get light headed at times and sometimes straightening my abs quickly hurts... but it was still a fun class. The music has gotten better since I went last, and that's really what is important right?

I'm drinking a lot of smoothies... ice, greek yogurt, strawberries, spinach and flax. They don't raise my blood sugar too much and they are great for when I just want popsicles and ice cream... which is all the time. I'm warming up to salads again. Quinoa remains a staple. My diet is so much better than this point with my other pregnancies. I've actually lost 10 pounds, but I really think this has more to do with less and less breastfeeding  (maybe a few times a week now) and nausea than my diet. Also, in the months right before the pregnancy I gained almost 10 pounds (because I went off Metformin I think) so I feel ok with the loss, I'm now where I was for most of the last year.

Last week I talked about the planning our home birth and finding our midwife, I haven't really talked about why we are planning a home birth. I have thought about this a lot. I didn't have horrible hospital births, I'm really proud of my last birth even though it was medicated, I don't feel the least bit driven to home birth by negative hospital experiences. I had some basic things I wanted to avoid, like a long postpartum stay (24 hours way too long for me) or not having access to a tub in labor... and I had both an OB and a midwife share how I can get around those things... and they are right... I could fight for them... but... I just don't want to. I shouldn't have to!

I decided I'm not willing to compromise on many aspects of my birth because I know there is no reason that I should have to. Compromises that have nothing to do with my safety, my baby's safety, and everything to do with a system that is very proud and very slow to change. I've done this too many times and I know all too well how unnecessary many policies are. Could I go in and refuse an IV, absolutely, I've done it twice... but I don't want to. Can I insist on intermittent monitoring? Of course, I've done that too... but I don't want to. Could I birth my baby in whatever position I want? Probably... but there is always a risk that there will be a debate... and I don't want to do that either. I just want to birth my baby the way that I know all women have the right to, and I will fight to change the system... but not during my birth. I just want to labor and birth my baby. Should any intervention become necessary, I will of course consent, and I would be ok with it just as I was ok with it in the past. But I'm not going to discuss routine interventions. I'm beyond that. I don't want to have to think one time "Do you know how informed I am? Do you know what I do?" I just want to be a mom having a baby... undisturbed... and I know that that is almost impossible in our hospitals, so we are staying home... and I'm way fucking stoked.

These posts have been awful long. Thanks for hanging in with me!

What this week was like with my other pregnancies:

- Cori

Thursday, June 12, 2014

Baby 4 Week 13: Confidence Pie Chart

Week 13

Since I wrote last I've had a prenatal appointment with Dr. Chandler and interviewed 2 more (so 3 total) midwives for our home birth that I had just about given up on. Before we dig into all that...

I'm feeling good. Last week was super busy. I taught birth classes Monday and Wednesday, On Tuesday I went to a professional round table discussion on gestational diabetes and on Thursday I went to a talk on pelvic floor health... all after working 10 hour days and somehow trying to squeeze runs in between work and whatever birthy thing was happening that night. This week I focused on resting and working out, fit in some longer runs and tried to get to bed earlier. I was pretty successful! I'm not sure what the association is but I notice that when I work out really consistently, I don't get heartburn, which is reason enough to lace up my running shoes. Other pregnancy feels... pretty awful congestion, sometimes when I sneeze I somehow blow snot into my throat, it's disgusting. I've been a little more nauseated the last few days after not feeling much of any nausea at all for a while. That's it! Really, very little to complain about.

My prenatal with Dr. Chandler was interesting. Thirty minutes before my appointment, about when I should be walking out the door, Eric called to tell me that he couldn't leave work. All three kids were dead asleep, mostly naked, taking their naps. So I had to wake, dress, and load them all in the car in less than 15 minutes. I somehow managed but they were bouncing off the walls in the office. Dr. C just looked at me and said "I feel like I'm really getting to see inside your life." Ha... thanks.

We couldn't get baby's heart beat on the doppler, which I was anxious to hear since my pregnancy symptoms were so mild, so we went over to ultrasound. There was a little active baby in there... it was hard to get good pictures, but baby did face me, kinda waved... we weren't planning on any ultrasounds until 20 weeks but I can't say I don't love sneak peeks at baby.

little hand by face
profile, measuring baby

We mostly talked about medication and my blood sugar. So this is one of the many ways in which medicine is a - not an exact science, b - fucking confusing. The first midwife I interviewed with said my fastings should be 90 or lower and if I have any high readings I'll need to transfer care... well considering that my normals have been 89-95, and occasionally 97... I'm risked out before I'm even in. Then Dr. C said his cut off is 92 and below. Any higher and he wants to put me on a medication called Glyburide. I have also been under the care of a provider who said 95 was her max. Well... what is ACTUALLY safe? By the way, for a nonpregnant person a normal fasting is 100 and below. So what if my normal IS around 95? By getting pregnant I have to somehow get my body is lower its normal? And we are taking about a few points difference here.

I didn't really dig into any of this because in the moment I'm just taking in everything as gospel which is so incredibly easy to slip into when you are sitting in an exam room... I was also trying to keep kids from climbing in the biohazard can. I asked if I could take Metformin instead of Glyburide which I have a long history with and has been very effective for me. I researched adverse affects and currently there aren't really any for mom or baby, it actually has been really effective in helping moms gain less weight (important for me at least because increased weight exasperates the diabetes), and control their numbers. The concern is that it passes freely through the placenta to baby, but there haven't been any negative effects to baby. Glyburide has been shown to increase weight gain and works like insulin which has been totally ineffective for me in the past, but less of it passes through the placenta. Ultimately I want to avoid medication in the first place, but during that conversation it felt unavoidable.

My blood pressure reading was really high, 148/90something. I was physically struggling with a 15 month old at the moment and had just ordered Ash to not lick anything. So I'm going back in on Monday to discuss my blood sugar again and check my blood pressure... without kids. However, I am less concerned with what Dr. C is going to say about my blood sugar, because he is no longer going to be my primary provider and I'm not going to take medications for such a small variation in my fasting numbers unless he has a fantastic argument for it on Monday.

After interviewing three midwives, two that I count as friends and one I had never met before... I believe we will be signing a contract next week. In all we talked to Jamie Meyerhoff, CNM, Caroline Cusenza, LM, and Jacqueline Little, LM, CPM. Jamie and Caroline I have known for a long time, we have relationships, I didn't think it was really necessary to interview someone that I didn't know. However, neither Jamie or Caroline were completely comfortable taking me on, though both were willing. Our local midwives, and the midwives in most areas, only take on very low risk moms... so even though they might be (and in this case, totally ARE) fantastic midwives, they just might not work with a lot of women at my level of risk. I really didn't want to find someone who would take me on because they were irresponsible and opposed to the medical community... and they exist! Just not locally... thank God! But I wanted a provider who was completely within THEIR comfort zone, then I could really relax too.

I had said to several people that whatever is supposed to happen will feel right, it'll feel perfect. Jacqueline moved here last week from Los Angeles. I think it was when I posted a interview on youtube with one my favorite birth advocates and obstetricians, Dr. Fischbein, that a friend, Candice Garrett (prenatal yoga instructor and pelvic floor health... expert... I don't know her title... she's just my friend!) posted "hey my friend who is a midwife is moving here works with him." and I said something cool like "OMG OMG OMG INTRODUCE ME!!!!" And then I think Candice tagged her... and I friended her... this was in like... February. I don't know why I didn't set up an interview, I guess I was just really preoccupied with all the other appointments.

Candice took care of that, she group messaged Jacqueline and I last week and we set something up. Everything just clicked. She had dealt with women of moderate risk a lot more because she trained and worked alongside an OB... this OB by the way, exclusively does home births and he is the only OB who works in a free standing birth center. So... she was totally comfortable with me, very experienced, and didn't have any hesitation in saying that I should be able to have a home birth. Everything that was important to me was there, along with additional personal things that might not go on a resume, but really resonated with me. This, my friends, is what it's like when you find "the one" whether it's your provider, or your doula, or educator...

Eric was able to attend the interview and totally agreed. Here's her page from Sanctuary Birth Center, so you can meet her to :)

click to enlarge image

We meet again next week to go over my medical history and hopefully sign a contract and make this happen! There is still a good part of my confidence pie chart... I'm going to go with a... 16th... that is like... there's no fucking way this is going to happen. That must be my skeptical slice. We'll see how I feel as this sinks in.

Next week I will be writing to you from my second trimester... that's insane.

What this week was like with my other pregnancies:

- Cori

Friday, June 6, 2014

Baby 4 Week 12: Pregnancy Hamster Ball of Peace

Week 12

Heavy week. Not me... I've lost 7 pounds... but just... everything else... personally (not Eric, he's great), professionally, and pregnancy wise.

I haven't talked a lot about where I'm going to birth or with whom on here... or at all.. I'm not sure. The options I'm considering are a home water birth (ideal), or if I risk out of that option (possible, more on that), then I'm going to pursue a water birth at Natividad (which has not happened before, it's something I'd fight for), and if that is not possible, then I will go to Sutter and take advantage of their lovely jacuzzi tubs and birth my baby on land. I am comfortable with all the options. I am very comfortable with laboring in a hospital, I have been pretty much left alone during my last few births. However, I don't want to fight for any aspect of my birth on my baby's birth day. I don't want to be told where I can and cannot be, I don't want to be hooked to a monitor for even 20 minutes of every hour, I don't want to be told how I'm going to birth my baby or watch nurses panic as I don't birth the way they are used to... on my back with feet in the air. All that also might not happen... but if I can avoid the possibility, that would be great. I also want at least the choice to birth my baby in the water if I want to at that moment. I might not want to... but I might. I could just get in the water and refuse to get out... but is that the environment I want to birth in? Panicked medical professionals who think they are witnessing a disaster only because they don't have information? Yeah... not really.

So why might I not be able to have a home birth. I know some people go into their birth refusing to anticipate any variations in their plan... this is especially prevalent in home birthers... if we don't think about bad things, bad things wont happen... and I get it kinda. When I teach couples planning a VBAC, if they are dwelling on another cesarean, I wonder how committed they are to their choice to birth vaginally. My multiple back up plans might look like a lack of commitment to my hope to birth at home. This is something I've pondered at length on my long weekend runs. Should I have a plan B or should I just pile my eggs into my ideal basket? I don't think I've answered myself yet, but these are my thoughts.

I've been testing my blood sugar for a week. My after meals have been great, all under 100mg/dl (should be under 120mg/dl), except for one day when I had pasta, veggies, and fruit and no protein (other than what was in the pasta) and my reading was 136mg/dl. So there is no doubt, I am already gestational diabetic. My fasting numbers had also almost all been high. First thing in the morning they should be under 90mg/dl, and 4 out of 5 days they have been between 90-97mg/dl, and the other day it was 89mg/dl. Having high fasting numbers already is a serious concern and the one midwife I have interviewed has already said she would not feel comfortable taking me on if they were high... which is understandable. It blows... for sure... My diet is awesome, but there isn't a lot I can do about fastings. Chromium helped last time, and I plan to start taking it again once I've been testing for a while to determine what is really going on.

I do plan to interview another home birth midwife. What I'm wondering is if I could take Metformin, which I was taking before the pregnancy for milk supply and it helps with insulin resistance. The midwife I already talked to said no, but the Medical Board of California states that only insulin-dependent women should be risked out of midwifery care. I'm going to meet with an OB today and ask if Metformin would count, and I will ask the other midwife I hope to interview the same thing, That might help me control my fasting numbers. It's a lot to consider, and I'm trying to take it all in stride.

This week I also decided to activate my pregnancy hamster ball of peace. This will probably be one of those "you probably think this song is about you..." moments... but it seemed like almost every day since I posted last I somehow offended, angered, hurt... something... someone. I do spend a lot of time in my head,  I play and replay conversations, go over my relationships and wonder what is me, what is someone else's issue that they haven't dealt with that I've just happened to stir up. I check in with Eric a lot. And then check back with myself.

I was in the midst of one of these mental struggles on a car ride up to the bay area to pic up our table. Eric was driving and we had Marc Maron's podcast WTF on and I was mostly not listening because I was navigating a tense situation in my head... but I decided to take a break and listen to Maron's interview with RuPaul. It was awesome, and then he said what I needed to hear, even though it wasn't about my life specifically... it resonated with me:

"No, it is not the transsexual community. These are fringe people who are looking for story lines to strengthen their identity as victims. That is what we’re dealing with. It’s not the trans community, because most people who are trans have been through hell and high water and they know -- they've looked behind the curtain at Oz and went, 'Oh, this is all a fucking joke. But, some people haven't... You know, if your idea of happiness has to do with someone else changing what they say, what they do, you are in for a fucking hard-ass road. 
My 32-year career speaks for itself. I dance to the beat of a different drummer. I believe that everybody, you can be whatever the hell you wanna be. I ain’t stopping you. But don’t you dare tell me what I can do or say. It’s just words. Yeah, words do hurt… You know what? … You need to get stronger. You really do, because you know what, if you think, if you’re upset by something I said, you have bigger problems than you think."

You can listen to a 6 minute clip of this part of the conversation here. I have said almost this exact thing to people and have been made to feel like I was a uncaring person for it. I care, but I also need to be truthful, and believe it or not, I only speak my mind a fraction the time. I'm quiet a lot too, and I listen, and I let people be who they are choosing to be. But if being liked by everyone means I need to constantly censor what I believe, or try to figure out what this person wants to hear and what I can say so they think I'm great, or change who I am or what I believe depending on where I am... well then I don't want to play. I'm not going to be an activist among activists, conservative among conservatives, and offer to believe in anything just so people like me. Not for anything. Not for friendships, not to grow my business, there is no excuse that is worth my integrity. It's something that makes me so angry when I watch people do it. When that's the way you live, you will eventually be found out anyway... maybe not by everyone, but by someone, and you'll be seen for what you are. I can't adopt a quality that is literally against everything that is me. And if I don't use my talents and energy and passion to work to bring more truth and hopefully initiate change... even though change inevitably pisses most people off... then what is the point of me? It's hard... and I'm getting tears all over my hamster ball now. But the little twisty door is shut tight and this is where I'm going to hang out for a while.

I'm looking forward to my appointment with Dr. Chandler in a few hours. I'll get to hear baby's heartbeat which will be the only sign of baby's existence in the last month or so. I really am not feeling sick or all that tired. The tummy is growing. I was getting what felt like tightness in my chest, not quite a palpitation, but something... and was getting concerned and then I read that happened with Indy too. Weird. I'll ask about it today.

Same place same time next week? Cool.

What this week was like with my other pregnancies:
                       Milo, Week 12: Puking in Public with Style
                       Ash, Week 12: Zen Baby
                       Indy, Week 12: Pressure Cooker

- Cori