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Gentle Cesarean: How-To

6/4/2017

Recently, I shared about my own gentle cesarean experience. A gentle cesarean, also called a family centered or natural cesarean, is a set of practices that bring positive aspects of vaginal birth into the operating room. These practices may include:

Delayed cord clamping
Immediate skin-to-skin after cord clamping, with or without breastfeeding
Delayed newborn exam to allow plenty of skin-to-skin time
Music chosen by the person giving birth
Clear drape at the moment of birth

Below you'll find the birth plan for my most recent c-section and my c-section playlist.

Dear Caregivers at __________________ Hospital,
Thank you for your care during the birth of our third child. This is a special day for us, and we appreciate your care in helping us achieve our goal of a happy, healthy birth. I am attempting a VBA2C and these are our birth preferences. We know that birth is unpredictable and in the case of emergency, we will cooperate fully with medical staff after informed discussion.
I have breastfeed my two previous children and plan on breastfeeding this baby. We will not be circumcising the baby if it’s a boy. We do not know the sex of our baby, and we would like Charles to be the one to announce the sex to Stephanie and to our families. I will be taking the placenta home and would like it to stay in the room with us. Thank you for honoring our preferences as much as circumstances allow. We know we are in good hands with your team.
My primary obstetrician is Dr. John Gonzalez of Capital Women’s Care. My doula is Amy Bookwalter.
[I have eliminated the parts of the birth plan pertaining to the VBA2C attempt, as it became a scheduled CS]

If a cesarean is necessary, I would prefer a gentle cesarean including:

Walking into the OR with [husband] and [doula], who will be present for prep and surgery.
Choice of music during surgery
Being asked asked ‘Are you ready to have your baby now?’ before delivery.
Hands free during the surgery, narration of the procedure and a clear drape for delivery
[Husband] announcing the sex of the baby
Delayed cord clamping of at least two minutes if mother and baby are stable. During this time, I would like to hold the baby’s hand through the drape if possible.
Immediate, uninterrupted skin to skin care with delayed routine care (medications/vaccines, measurements, footprints). Charles would like to take pictures during this time.
[Husband] accompanying the baby if separation is necessary, while Amy will stay with me.

So, how did it turn out? You can read the entry I linked to at the beginning for the whole story, but here's the short version:

My doula reminded me to ask for the IV in my forearm and all the leads to be attached on my back so that my hands and chest would be free for immediate skin to skin. When I met the anesthesiologist in the triage room, he told me I could have both my doula and husband present in the OR for the surgery, but I had to choose one of them to walk in with me for prep. In the OR, the anesthesiologist is in charge, and they are the person who gets to decide who gets to come in. I was completely satisfied to even have one support person (I chose the doula for emotional support).

In addition to the points of my birth plan (which at least a few members of the team actually read!), the staff made a huge difference. They were warm, celebratory, and stayed focused. My OB spoke to me throughout the surgery so I never felt absent from the experience.

When compared to vaginal births, those who have c-sections are more likely to report dissatisfaction with the birth experience, have trouble bonding, struggle to breastfeed, and experience postpartum depression. A gentle cesarean experience can help with the transition from pregnancy to motherhood and ease many of these issues. Speaking anecdotally, I am absolutely satisfied with this birth experience. It was worlds better than my other two c-sections. In fact, I can't stop talking about it to anyone who shows the slightest interest. It helped me make peace with not having the vaginal birth I'd hoped for.

I should add that I did a lot of mental work leading up to this birth, which I believe was as important as what actually happened in the OR. I found these affirmations very helpful. I read them throughout the end of my pregnancy, and some of them have carried over into the postpartum stage. I listened to my playlist regularly, especially when I was experiencing prodromal labor or feeling anxiety about another c-section. I walked myself through the routine stages of a c-section (experience helped there, but there is a lot of information on-line) while listening to the music. I also designed it to carry over after the birth as a playlist to listen to with the baby.

The Playlist
1. Offering--The Avett Brothers. (This is our song, and I felt like it was important to connect with him in the moments before our child was born).
2. Let It Be--The Beatles. (For acceptance)
3. Blackbird--The Beatles (For healing)
4. Somewhere Over the Rainbow/What a Wonderful World--Israel Kamakawiwo'ole (I designed the playlist so that this would play approximately when baby was ready to come out, and then the playlist switches to love songs for baby and lullabies
5. Rainbow Connection--Weezer & Hayley Williams
6. You Are my Sunshine--United Guitar Players
7. You Were Born--Cloud Cult
8. Reasons to Love You--Meiko
9. When You Dream--Barenaked Ladies
10. Falling Slowly--Once
11. Twinkle Twinkle Little Star--Lisa Loeb
12. Gracie--Ben Folds
13. Baby Mine--Alison Krauss
14. Bye-Lo--The Innocence Mission
15. Lullabye (Goodnight, My Angel)--Billy Joel
16. Forever Young--Rhiannon Giddens and Iron & Wine)
17. Better Together--Jack Johnson
18. Lullaby--Jack Johnson
19. Godspeed (Sweet Dreams)--Dixie Chicks
20. When You Wish Upon a Star--Billy Joel
21. Songbird--Fleetwood Mac
22. Beautiful Boy--John Lennon
23. Sunrise--Norah Jones
24. Over the Rainbow--Innocence Mission
25. Three Little Birds--Bob Marley
26. You Are my Sunshine--Ray Charles
27. I Won't Give Up--Jason Mraz
28. Ho Hey--The Lumineers

Somehow, after #4, my phone got put to shuffle, so the rest of the playlist didn't go as planned, but to be honest, I didn't really listen after she was placed on my chest until we were out in recovery. To listen, they just put the phone next to my head on the operating table and then in bed with me to be wheeled to recovery. It was awesome because everyone was singing along to Let it Be. My OB joked with me that next time, he'd rather listen to Hamilton, and I told him it was a deal.

Important Note: I was able to have everything on my wish list because of a cooperative hospital/team, and both baby and I were stable. We lucked out with our anesthesiologist (the other one on duty would not have allowed two support people or anyone to accompany me for prep). If it had been an emergency situation, some or all of the elements might have gone out the window.

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The Fourth Trimester: Not Just for Babies

5/19/2017

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More and more people are talking about the "Fourth Trimester," the first three months of an infant's life. It's come to be seen as an extero-gestation. These tiny people still use their mothers' bodies to regulate their respiration, heart rate, and temperature. They benefit immensely from skin to skin care and closeness to caregivers. It's a time when they are adjusting to their world on the outside. You might also hear the term "Nine in, Nine out," extending that time period for a full nine months. There are endless articles about the benefits of keeping babies close during this three to nine month period. But today, I'm going to address that from a different angle.

During the time between the birth of my second child and third child, I read a book called A Good Birth: Finding the Positive and Profound in Your Childbirth Experience by Dr. Anne Drapkin Lyerly. Lyerly is an obstetrician who surveyed more than a hundred women about what made their births a positive experience, whether it was a home birth, scheduled cesarean, or even a cesarean under general anesthesia. One of the most profound thoughts in the book is this:

Birth is a separation as well as a meeting.

For months, the gestational parent has gotten to know this tiny life inside. It has been a constant presence. In the early weeks, the presence might be ignored or temporarily forgotten, but by the end, it's impossible to ignore. People nickname their babies in utero (especially if they opt not to find out the sex) and the belly seems to have a personality of its own.

Here's a favorite quotation of mine from my favorite book series:

"'I've thought that perhaps that's why women are so often sad, once the child's born,' she said meditatively, as though thinking aloud. 'Ye think of them while ye talk, and you have a knowledge of them as they are inside ye, the way you think they are. And then they're born, and htey're different--not the way ye thought of them inside, at all. And ye love them, o' course, and get to know them the way they are...but still, there's the thought of the child ye once talked to in your heart, and that child is gone. So I think it's the grievin' for the child unborn that ye feel, even as ye hold the born one in your arms.'"

-Dragonfly in Amber

As I hold my own newborn daughter, just as the speaker in the lines above, I think about who she was before I knew her and who she is now. I didn't know the sex of any of my babies, which makes the line of before and after even greater. The first time I was in a different room, the first time I was on a different floor of the house, it felt strange and alien after having her next to my heart for so long. Babywearing feels more familiar to me, as well as providing comfort to her. It will take me time to fully adapt to the separation between us: we are now two instead of one.

The separation began at birth, and I think our birth experience (hers and mine together) helped ease that transition. First, by letting her cord pulse as she absorbed the blood that had flowed between us for months. Second, by placing her immediately on my chest. I was not immediately alone. There she stayed for most of the first few days of her life. Only gradually did she spend more time out of my arms. It's only been two weeks, but she has started to spend some time sleeping on her own. It still feels strange. I can't imagine leaving her entirely at this point.

That brings me to my next point. I recently saw a meme about how in many places it's illegal to separate puppies from their mother before eight weeks, but we expect women to return to work at six weeks postpartum or even sooner. Twelve weeks should absolutely be the minimum time for families to adjust to the new family member. (I would argue that paternity leave and adoption leave should be held to the same standard, but that's a post for another time). It takes time to transition, and everyone benefits. If women were given time, space, and practices with which to make this transition gentle and gradual, I'd be willing to bet that there would be an improvement in maternal mental health. It starts at the moment of birth and continues through this fourth trimester. It won't solve all problems, but it would be a major step in the right direction.

To expectant parents and new parents: I'm not going to tell you to savor every moment. That would be exhausting and unrealistic. But when you have a moment of peace and quiet with your new baby, be conscious of it. Acknowledge the transition. Give yourself space to process how life has changed. It is one of the most dramatic and sudden changes in the parenting journey. You don't need to feel a certain way about it, or assign value to your feelings. Just be mindful of them.

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A Healing Cesarean Birth Story

5/10/2017

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While this is a blog about parenting, rather than birth, birth can have a fundamental impact on family relationships. Today, I'm going to share a little bit about my own birth experiences in the hopes that I can be part of the movement to improve birth practices. It's a long story, so I'm posting in a slightly different format. On the left, you can read about my previous births, which provide back story about what made this birth different (and so much better!). In the middle, you can read about how I prepared for both a VBAC attempt and possible scheduled CS, both physically and mentally. On the right, you will find the story of my gentle cesarean. Below, you'll find photographs from the gentle cesarean (which the hospital calls a family centered cesarean and is also sometimes called a natural cesarean).

The Birth Backstory

Birth #1: Planned Unmedicated Vaginal Birth turned Emergency C-Section
With my first child, I took Bradley childbirth classes and planned on an unmedicated vaginal birth. I found the knowledge empowering, and actually switched OB practices at 36 weeks after feeling pressure to induce early without medical cause. At 42 weeks, my water broke the night before my induction appointment. I had some prodromal labor, but did not move towards active labor. At noon the next day, I had 0cm dilation and only 50% effacement. I was induced, and after 12 hours of nonstop contractions and a swollen cervix actually decreasing dilation, the OB suggested an epidural. He gave me time to think and talk it over with my care team, and I decided it was the right decision. 30 hours after my water broke, I was 6cm, and he ordered pitocin. At 32 hours, my daughter had enough and she went into distress. An excellent team of nurses worked hard to help me change position to keep her safe and keep me from the OR, but it just wasn't working. I was 8cm dilated but she wasn't tolerating labor anymore. I had to head straight to the OR for a c-section. When she was finally out, I was so relieved that she was safe, and so happy to meet her that I wept with joy. I felt blissful, and that feeling lasted for weeks. Not a hint of baby blues. I felt acceptance of my birth, because I trusted my doctor. He was a top recommended OB for natural birth in the area, and if he said I needed to deliver, I believed him. With my third, I took another childbirth class series as a refresher, which took my knowledge even deeper. These two classes, taught by Amy Bookwalter of Rosebud Doula, helped me learn exactly what happened during that birth. It felt like cascading interventions, but I couldn't decide what I would have done differently with my knowledge of pros and cons. When she described conditions leading to posterior (sunny side up) presentation and how things go during labor, it described my daughter's birth perfectly. My daughter's chin had gotten stuck, keeping her from descending. I didn't know enough about what could be done during labor to change her position and help her. I was very excited about what I learned in Amy's classes. But I'm jumping ahead a little bit.

You can just barely tell that my left arm is strapped down. They unstrapped my right arm so I could touch her, after she'd been cleaned, examined, measured, and swaddled.

Birth #2: Planned VBAC turned Scheduled C-Section
With my son, I planned on attempting a vaginal birth after cesarean, or VBAC. The pregnancy went smoothly, with no indication that it wouldn't happen. But when I hit 42 weeks and showed no signs of impending labor, the same doctor said that it was time to deliver. My last prenatal visit was a Friday, and he told me we would schedule a CS for Tuesday. Sunday night, I broke down and cried. Time was running out to go into labor. After a good cry, I felt a little bit better although I was still sad, and a little scared, about another c-section. Monday morning I woke up, and we decided to make a nice breakfast and spend the day enjoying ourselves as a family of three for the last time. We were just pulling into the parking lot of Potbelly to have lunch when my husband’s phone rang. It was the OB's office. The receptionist informed me that my “procedure” was scheduled for 3pm that afternoon. It was now 11:30am.
“I’m supposed to come in tomorrow for an exam, and then go to the hospital for either an induction or a c-section based on the exam,” I told her.
“There’s no room at the hospital tomorrow or Wednesday, so you have to come today.” Her attitude was curt.
“Well, am I being scheduled for an induction or a cesarean?” I was almost shaking at this point. I was supposed to have one more day to go into labor. One more day to come to terms with a second surgery.
“I don’t know. I’ll call you back in ten minutes. Don’t eat or drink anything. When was the last time you had something to eat or drink?” I answered the question, suddenly very glad I’d had a big breakfast and realizing that I was currently very hungry and thirsty. We parked in front of the Potbelly, waiting for the phone to ring, AC running. Finally, at noon, the phone rang again. It was my OB. He told me the hospital couldn’t book me any other day before July 6. He was not comfortable letting me wait that long, and neither was I. He told me to come to his office at 1:30 for an exam, and then I would go straight to the hospital. Basically, sticking to the plan, but a day early. When we arrived at the doctor’s office, they were already closed for the day. When I knocked, they told me that the OB had been called to the hospital for another c-section and would meet me and examine me at the hospital. When we finally arrived, they seemed a bit unsure what to do with me. I had apparently already been scheduled for a c-section, but they sent me to the waiting room to wait until the OB was out of surgery and could examine me. Finally, they took me back to a little triage room to change into a hospital gown and wait. He came in, and I could tell by his face while he examined me what the outcome was going to be. Even though I thought I was ready to hear the news, as soon as he left the room, I cried. For some reason that I can't remember, I was alone in the triage room. I walked to the OR and got onto the operating table under my own power. I’m glad. It gave me back a little bit of feeling of control. I was so nervous when the spinal was placed, and hated being in the OR without a support person there. The spinal block went in, and I felt the warmth and then numbness flow down my legs. They helped me lay back. It felt strange to be so exposed as everyone went about their business, with my arms strapped down. Finally, they hung up the curtain and sent in my husband. By now, I was shaking from all the hormones rushing through me. It had happened with my daughter too, so I was more prepared for it. I started panicking, thinking that I could feel my legs. The anesthetist ran a cloth over part of my belly and I freaked out because I could feel it. Then she said, "do you feel this?" I said, "No," and she said, "Good, because they've started." When he was born, we had some back and forth conversation about his name, but all I really wanted to do was roll over and go to sleep. Finally, we were in recovery, and I could hold him and nurse him. The nurse in recovery let us know that I was the last patient of the day, and when I was released from recovery, she could go home. I was completely and utterly exhausted, despite not having gone through labor. (Of course I was tired! I'd just gone through major surgery!) I felt numb. I didn't feel that immediate elation or love. It took me a month to feel truly bonded to him, and I struggled with postpartum depression and anxiety for more than a year.
I also missed out on the excitement of sharing the news with family and friends. Only one person was allowed in recovery at a time, so it was up to my husband to go out and announce the birth. A friend video recorded the announcement, which I didn't see until much later. There was so much joy out in the hallway that I missed out on witnessing.

I also realized that I had not been the first or even the second non-medical professional to hold my daughter. Of course my husband was the first, but because they wouldn't let me hold her until they were done monitoring my blood pressure, other family members got to hold her first. I was also restricted from nursing both of my babies immediately.

My first time holding my son, after he was almost two hours old. I wasn't supposed to be nursing him but I didn't listen.

Interlude
I started seeing a therapist who specialized in birth trauma and postpartum depression, although I hesitated to describe my own experience as traumatic. After all, it was a completely medically routine c-section. We were both healthy. My therapist recommended a book called A Good Birth. It was tremendously helpful in analyzing why I felt fine after one c-section but not after the second. I learned about the importance of agency, mutual trust, and respect in birth.

I initially assumed that a third birth would automatically be another c-section. I knew women who had VBA2C (VBAC after 2 c-sections) and one who had successfully had VBA3C. I also knew that a lot of these women had to fight hard for their options, and I didn't feel that I had the emotional energy. In December 2015, I read a beautiful story about a local family centered cesarean. The doctor had allowed a doula in the OR and used a clear drape at the moment of birth. The doula shared a photo of the mom holding her baby's hand through the drape while the baby's cord pulsed. Then the mom was able to hold her baby skin to skin immediately after the birth. I knew right away that I wanted that experience. The hospital was within a reasonable amount of distance to my home, and I had met the doula before--she was the backup doula for my first birth and we had met professionally as well. I immediately made an appointment with one of the OB's in the practice for my next annual visit. I met him and loved him! He asked me if I wanted to attempt a VBA2C. I was surprised that he suggested it! I told him that I was just starting to try to get pregnant and would hopefully see him soon.

After eight months of trying, I found out I was pregnant! I'd been tracking my fertility, so I knew exactly when I conceived. I have PCOS, and I conceived in a 60 day cycle. I'd had some spotting late in my cycle, so I gave that as the date of my LMP to the doctor. It was pretty close to the predicted due date based on when I ovulated. They predicted a due date of April 21. They did a dating ultrasound as well, which gave me an EDD of April 15. In the end, they went with the April 21 date. The actual due date based on my ovulation was about halfway between those two dates.

The doctors in the practice had no problem with my desire to wait until 42 weeks to deliver. Many doctors push repeat cesareans at 40-41 weeks, but I really felt like my babies need the extra time in utero. Neither of my other two had been big babies. I also decided to try again for a VBAC, if I went into spontaneous labor, since I had a supportive doctor. I hired Amy (Rosebud Doula again) as my doula, and she encouraged me to take her class. Once again, I can't recommend her class enough to anyone in the area. Her Weekend Madness class is incredibly useful for those planning births in or out of the hospital, medicated or unmedicated. We couldn't stop talking about everything we'd learned in her class, despite our previous knowledge and experience.

I saw a chiropractor throughout my pregnancy, for my own comfort and to work on the baby's position. I also worked with a prenatal masseuse. My husband described her as more of a prenatal physical therapist (although that's a different kind of certification) because she worked on specific ligaments to try to encourage a good position for the baby. It was less about a relaxing pampering session and more about aligning my body. However, it did relieve a lot of my late pregnancy aches and pains, especially in my pelvis. Totally worth it.

I continued to see my therapist and work on headspace so that I would accept any kind of outcome. I knew I was getting really excited about the idea of a VBAC, especially when I found out my hospital was getting a birth tub.

I had intense prodromal labor from about 36 weeks onward (I'm drafting a blog post about that experience too). There were so many times that I thought I was going into labor. I spent many nights in my bathtub, listening to music and swaying and moaning through contractions. I scheduled a CS date for 41 weeks and 6 days (by the doctor's count, 42 weeks 5 days by ultrasound). That gave me a date to count down to when the pains got intense. It also gave me time to prepare my mind for not going into labor, rather than playing a last minute wait and see game.

As I headed for 40 weeks pregnant, I was trying almost everything to get my body ready and go into spontaneous labor. I'd been drinking red raspberry leaf tea to tone my uterus (although I took a break to see if it was related to the prodromal labor. It wasn't). I ate a very large number of pineapples. I made the magical marinara sauce and the magical lemon cupcakes. I ate dates. I did Spinning Babies exercises. I used my breast pump and manual nipple stimulation. After 41 weeks, I went for three sessions of acupuncture. Frequently, after trying something, the prodromal labor increased, but it always stopped. At my weekly prenatal visits, my cervix remained as impenetrable as Fort Knox. Only a few things remained off limits: castor oil and evening primrose oil, both of which I'd tried the first time and had since researched and decided weren't worth the associated risks. Really, if you've heard of it as a natural or at home labor induction technique, I either tried it or decided it wasn't right for me. I can almost guarantee I've heard of it.

I was also working on my head space. I made a c-section playlist, carefully adding, deleting, and moving songs around until it was perfect. I listened to it while I was in the tub or trying to nap, and visualized the steps of a CS, trying to imagine what would happen during each song. I listened to the Earth Mama Angel Baby Labor Companion CD to help me through prodromal labor. I purchased a digital download of some beautifully lettered inclusive birth affirmations. I read them over and over again. And I continued to go to therapy throughout my pregnancy.

Finally, it was the last week of my pregnancy, with my c-section scheduled for Thursday. I was still a little nervous about how I would feel after a repeat CS, now that it seemed the most likely outcome. For the last seven days, I stopped trying to go into labor. I only worked on my head space and focused on my family. I'm very very glad I took that time.

At my last prenatal visit that Monday, my OB suggested I come into L&D on Wednesday to see if I could be induced with a foley bulb. If it didn't work out, we'd go ahead with the scheduled CS on Thursday. I agreed to the procedure. I wasn't hopeful that it would be a possibility, given that my cervix was still not favorable for induction, but I wanted to truly feel like I had exhausted all my options before heading to surgery.

Birth #3: Family Centered Cesarean
On Wednesday, we went to L&D as planned but my cervix was still high, closed, and tight, so it wasn’t possible to insert the necessary balloon. I’d been so prepared for that outcome that I hardly told anyone we were going in. While I was there, they monitored baby’s heart. It was within the range of normal, but on the lower end, lower than it had been at all of my prenatal visits. I drank a bunch of apple juice and ice water, while our doula, Amy, poked at my belly to try to get baby to wake up. The baby woke up enough to get some higher numbers, and they let me go home. But for a few minutes, I was sure they were going to admit me to have a baby right then. I also realized that I was completely at peace with that. I was ready for the prodromal labor to be done and to be able to see my baby and know he/she was ok.

That night, we went out to dinner with our families. The big kids went to spend the night at Nana’s house and my husband and I went home. On the way home, my prodromal labor was incredibly intense. It felt every bit like active labor, not just early labor. My back ached and I moaned through every contraction and could hardly wait to get out of the car and change position. Finally, we made it home. My husband ran a bath for me while I laid down. The contractions lessened in intensity once I was out of the car, and the rest of the pain went away once I was in the bath. I listened to my birth playlist and walked myself through the steps that would happen the next day. My husband shaved me in preparation for surgery, rather than having a nurse do it in a sterile and medical environment the next day.

Thursday morning, we woke up naturally around 7am. By this point, I felt nothing except excitement that I was finally going to meet my baby! We took care of our animals (dog, chickens, rabbits) and headed over to the Dunkin Donuts for the husband to get some breakfast. It was a little bit of tradition--we stopped at Dunkin Donuts on the way to the hospital to have our daughter. Then we popped into the Hallmark store to buy a little stuffed Yoda doll for our Star Wars Day baby. Finally, we were on our way to the hospital.

We arrived at the hospital a little before 10am and met Amy in the lobby. The three of us walked back to Labor & Delivery together, where we were greeted warmly at the nurses station. One of the nurses took us back to our triage room. They got an IV started and hooked me up to the monitors. The hospital has an essential oil diffuser, so Amy set that up with some lavender oil to help me relax. After a bit, my sister showed up too. One of the most gratifying parts of that part of the day was to watch my contractions on the monitor. For so long, I had felt crazy or wimpy, but now there was empirical data that I wasn’t just making it up or imagining things. You could see the strength of some of the contractions right there on the print out. And now I knew it was almost done. A nurse came and asked for a copy of my birth plan.

The anesthesiologist came in right at noon to talk me through the anesthesia. I asked if I could have one or both of my support people (Amy and Husband) come back with me during prep and insertion of the spinal. He told me both could be there during the surgery, but I had to pick one during prep because it’s such a busy time and he needed space to work. A little while later, my OB arrived. His excitement was contagious even though I was starting to feel nervous. Amy and Husband put on their surgery cover ups and walked to the OR with me. I said goodbye to Husband, who was going to wait back in the triage room until they were ready for him. Amy walked into the OR with me, and people started introducing themselves. By now, my heart was pounding and I was feeling really anxious. The nurse anesthetist was wonderful at explaining everything she was doing--I’d been through it all before but it’s practically impossible not to get nervous when you are about to undergo major surgery and remain fully conscious. I leaned on Amy while the anesthetist placed the spinal. Amy reminded me to release tension and kept me calm. She also pressed on pressure points on my palms while the needle went in. Then they laid me back on the table. When I was nervous, they calmly and respectfully talked me through. They checked and double checked to make sure I was numb. Amy stayed right by my head, talking to me and narrating.
The neonatologist came over and told me that she’d read my birth plan and saw that I wanted skin to skin. They unsnapped my gown and pulled it down so I was ready, then put a blanket over me to keep me warm during the surgery. All the leads had been placed on my back, out of the way. The IV was placed in the top of my forearm to be out of the way for the same reason.

Finally, they brought Husband in and he started my birth playlist. That morning, we’d jokingly added the Star Wars Throne Room music to the beginning of the playlist, and when he hit play, we all giggled a little bit. After about 30 seconds, I was ready for the relaxing music I’d picked out so we skipped to the first official track: Offering, by the Avett Brothers, which is our song. I started crying happy tears. By then they were beginning the surgery. Dr. G. was laughing and joking with me. He said “there’s a huge cyst in here! Oh wait, it’s your uterus.” The second song was “Let it Be,” and a few people started softly singing along. It gave me such a moment of connection with the people who were in the room. The third song was Blackbird, which we skipped when finally, Dr. G. very excitedly announced that it was time to lower the drape. I saw him pull out the baby’s head, and they quickly lifted the baby out and placed it on my abdomen. It was so fast that Husband didn’t see whether it was a boy or a girl, so they held up the baby and he shouted “it’s a girl!” We were both shocked! Then they put her back down, right up next to the clear drape, and I touched her through the plastic, holding her hand as best as I could. She was crying and I wanted to hold her, but we were waiting for the cord to stop pulsing. It stopped pulsing right at the two minute mark and they clamped it and brought her around to my side of the curtain. They placed her on my chest, and finally, I was holding her in my arms. She immediately started rooting around and trying to latch on, even though I hadn’t planned on nursing in the OR. Amy wiped her mouth a few times because she was draining amniotic fluid. All this happened during song #4, Israel K’s Somewhere Over the Rainbow/What a Wonderful World. I was crying happy tears and felt so much love and warmth. While Dr. G. was stitching me up, he kept looking down at me through the clear drape and smiling. Little Girl and I just stared at each other. Everyone was so joyful and centered on birth during the surgery. It never felt like just a routine day at work. Husband and Amy took pictures while I stared at my newborn daughter and tried to process that she was really here..and a girl! Dr. G. joked that he couldn’t take her back, all deliveries were final.

When they were done stitching me back up and almost ready to move me to recovery, they took her for her measurements and newborn procedures. Husband went to the other side of the room with her, while Amy stayed with me. They wheeled us all to recovery where I saw my sister and got to see her reaction when she saw the baby and found out she was a girl. It was an incredible moment. More crying on all sides. The recovery nurse, who had also been my prep nurse, seemed really excited too. As soon as my bed was in place, they gave her to me again and I nursed her a little more easily now that I wasn’t completely flat on my back. Then they wheeled us down the hall to the mother baby unit. She spent most of her first hours on my chest, snuggled up skin to skin, where she belonged.

So tired but oh so happy

Why does having a "Good Birth" matter?

I'm six days postpartum now, and I haven't stopped smiling. I love holding and snuggling my little girl, and I feel only happiness when I think about her birth. It's a story I'm excited to share to help others, but it's also a story I'm excited to share because I feel like I'm getting the baby moon that I missed out on the last time. Both births were scheduled c-sections, but one felt like a surgery and one felt like a birth. In this most recent birth, there was acknowledgement that birth is both a separation and a meeting. There was joy in the room, rather than it feeling like the last task of a shift before going home. I was equally as exhausted afterwards, because it's still major surgery, but felt proud and happy rather than numb. Because I had a good birth, I've had more resiliency in the days afterwards. There were some concerns about her getting enough breastmilk in the hospital, and I had to pump and use a combination of a supplemental nursing system and syringe feeding for a couple of feedings (she's doing great now!). I had the emotional energy to take on that challenge and feel flexible about whatever needed to happen to get my baby fed. When I came home and saw myself in the full length mirror in the bathroom, I felt pride and happiness in the sagging skin and fresh scar. Last time, my body image hit an all time low because I felt like my body had failed me and my son. My daughter will have a better mother during the first year of her life because I felt respected and in control of my birth experience, even though she came through my belly instead of my vagina.

Important Note
I was able to have every single thing I asked for in my c-section birth plan for four reasons:
1. Supportive OB. You have control over this part. Interview OBs, even before you are pregnant. Ask them about your options from the beginning. Even if you are planning a vaginal birth, have a c-section birth plan and discuss it with your OB ahead of time.
2. Supportive hospital. This hospital has made it a priority to offer these types of cesareans. It happened because of a lot of advocacy before I even got there.
3. Supportive anesthesiologist. In the OR, the anesthesiologist is actually the top boss. They get to decide who is allowed. They may limit support people because of space or worries that a support person will get in the way or even faint. There were two anesthesiologists at the hospital that day. The other one said he would not have allowed more than one person into the OR, and no one at all during prep. You probably don't have control over who you will have as an anesthesiologist.
4. Everything went smoothly. This is the area of least control. I had a scheduled c-section, but complications can always happen. Because it wasn't an emergency, we were able to take time.

That being said, I feel strongly that every birth should involve respect, informed consent, and an acknowledgment that birth is a big deal for the family. Delayed cord clamping or immediate skin to skin can't happen if mom or baby is in distress, but the medical team can still keep the attention in the room on the people who are central to the experience.

If you have a positive experience at a hospital, especially if they are breaking norms, write thank you notes. Write positive reviews. Write letters. Share your experience widely. Our anesthesiologist let our doula into the room because a previous anesthesiologist had allowed her in the OR. Precedent matters.

And now, for photos.

1. This is Little Girl on my belly while her cord pulses.
2. See the hand on my head? That's Amy's hand. She kept a hand on my head almost the entire time, which was incredibly reassuring. You can see it in the top three pictures.
3. That look on my face is absolute pure joy.
4. The only gap between her on my belly and her on my chest was the time it took them to walk around the table and get her safely situated on my chest. My hands are free because they were never strapped down.
5. That skin to skin time was amazing. Traditionally, c-section moms are deprived of the "golden hour" of skin to skin time that's recommended. I got a good portion of that hour.
6. You can see husband on the other side of the room, where he's standing with the baby (camera strap across his chest). By the time they took her, they were ready to take down the drape. Amy stood right by me so that I wasn't alone, telling me what was happening. She only stepped back from me to take this picture for me. Those moments without partner or baby are the loneliest part of a CS and I can't express enough what it meant to have someone by my head, telling me what a good job I did.

I also have photos of her emerging, which is amazing to me. I realize not everyone wants to see themselves being operated on, but I thought it was cool. (I couldn't see any part of my own body through the clear drape, by the way).

Resources

If you are in Northern Virginia, here are some local resources that I found helpful.
Childbirth Classes/Doula: Amy Bookwalter, Rosebud Doula
Prenatal Massage: Marilyn Alger
Chiropractic Care: Dr. Erica Statman, Maimonides Chiropractic

The OB practice for this birth was Capital Women's Care, with Dr. Gonzalez as the delivering OB. The hospital was Prince William Hospital. Not only did I have an excellent birth experience, the postpartum care was above and beyond. They promote skin to skin bonding and were very supportive of breastfeeding, although formula was available if I needed it. Every part of our stay was positive.

And finally, please reach out to me if you have any questions.

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Piedmont Parenting Confession #1: Postpartum Depression

6/2/2016

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(Trigger Warning: Discussion of Postpartum Mental Health Disorders).

Postpartum Depression.

Baby Blues.

Andrea Yates.

Suicide.

I'd heard all about postpartum depression (PPD) or so I thought. I knew about the tragic history of Andrea Yates. I knew that some level of "baby blues" was normal, and even to be expected. I'd gone through several periods of depression in my high school and college years, and knew that someone in my family tree had committed suicide possibly because of postpartum depression. When I was pregnant with my first, I watched a friend struggle with PPD.

I was prepared to struggle. Especially when my planned unmedicated vaginal birth turned into an emergency c-section. But when they held up my daughter, I thought she was the most beautiful thing in the world, and I felt a glow for months.

When I became pregnant with my second child, it did not occur to me to worry about my postpartum mental health. I was fine the first time, it had been years since I'd felt depressed. If I hadn't fallen into depression after 14 months of infertility or after the deaths of my father and grandmother 13 months apart, it wasn't going to happen.

But it did. Whether it was because a planned VBAC (vaginal birth after cesarean) turned into a repeat c-section, and I didn't have the hormone rush associated with birth, or because of the treatment I received from health professionals on my son's birth day, or simply because I was still at risk of depression, I don't know. But when my son was born, I was strapped down to the operating table. I was tired. Numb. If I could have rolled over, away from my newborn son, I would have. I just wanted to go to sleep. He didn't look beautiful to me. (Reality: both of my children looked exactly like all newborn babies). Then, we struggled. He had colic. He struggled to breastfeed. My daughter struggled to adapt to sharing her mommy. For a whole month, I took care of him out of obligation. Each morning, I got dressed and brushed me teeth and hair. Then I put on the ring sling and put him in it. In the ring sling, he was as content as he could be. He was close to me, feeling warm and safe and loved. I didn't feel love, but I made myself sniff the top of his head to stimulate oxytocin production in my own body.

One day, I looked down at him in the carrier, and love washed over me. It was absolutely incredible. I could hardly hold it in, and I kissed him and smiled, and got choked up, and felt everything that I had felt when I looked at my daughter for the first time. He was a month old.

The story doesn't end there.

Although I now felt deep love and attachment for both my children, I still struggled. I struggled with rage. I yelled. I slammed doors. I threw things on the floor. And my heart broke when I looked at my sweet toddler daughter and saw her confusion and fear. I was not the mommy she knew. And I struggled to be the parent I wanted to be. I wondered why I couldn't keep my cool with one child when I used to manage far more difficult children in greater numbers.

On top of that, I developed postpartum anxiety, phobias, and intrusive thoughts. I developed arachnophobia, which is a big problem because I live in the country and we have spiders in great quantities and magnitudes. I could not walk in the grass in my yard (I live on three acres). I became convinced that I would lose control of the car when I was driving, and crash.

I got help. I started seeing a therapist every week. In fact, I still do. My mental health right now is great. Certainly, I still have a level of stress and anxiety, but when you are running a business and raising children, a certain amount comes with the territory. It's not ruling my life, and I am able to handle the meltdowns that come with having two children under the age of four.

Why do I share this? It's because postpartum depression wasn't what I expected. It didn't feel like the depression of my younger years. The anger, the anxiety, the phobia. I would not have known those were typical of postpartum mental health disorders if I had not been connected to a broad community of mothers.

For now, take heart. If you haven't already, download my quick self-care guide here. You are not alone. Reach out. Get help. Professional if necessary. Visit Postpartum Support International for resources. I can also help link you to professionals in your area.

Possible Signs and Symptoms of Postpartum Depression

The following is not a complete list. For more information, or for a description of postpartum anxiety and obsessive compulsive disorder, click here.

The following emotions may be indicative of postpartum depression. You do not need to feel all of them to be suffering PPD.

Overwhelmed
Guilty
Confused
Scared
Irritated
Angry
Nothing/Empty/Numb
Sad
Hopeless
Disconnected

You may also feel like you are struggling to bond with your baby. You may have thoughts of running away or hurting yourself or child, even if you know you would never act on them. You may have trouble eating or sleeping, either too much or too little (when you have the opportunity to sleep). You find a new inability to concentrate. If you feel like you are struggling, reach out.

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Green Mama Parenting is now Piedmont Parenting Resource

5/4/2016

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Seven Simple Self-Care Tips for New Moms

4/20/2016

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I've seen so many analogies about the importance of self-care for moms. Put on your own oxygen mask first. Fill your cup before you pour into others' cups. Why is it so important for moms to take care of themselves?

Mirror neurons.

Babies lack the ability to regulate themselves in many ways. They look to their caregivers, especially their biological mothers, to regulate their temperature, their breathing, their heartbeats, and yes, their moods. When you are feeling calm and relaxed, it helps your baby to feel calm and relaxed. So, it's not selfish to take care of yourself. It's very important.

Whether or not you struggle with a postpartum mood disorder, motherhood is tough. We all have hard days. Take care of yourself, and be easy on yourself. Here are a few things you can do in less than fifteen minutes to take care of yourself.

Get dressed. Put on makeup. Do whatever you need to do to feel like you look like yourself.
I wasn't a huge makeup person before I had kids, but I found that putting on a pair of jeans instead of pajamas or sweat pants made a huge difference in my mood. If you love wearing pajamas, think about what else you do that's part of your signature style. Maybe it's even just clean pajamas!
Take a five minute walk outside.
Even if the weather is nasty, grab an umbrella or a coat, put baby in a baby carrier, and head outside for five minutes. The fresh air can work wonders on both you and baby.
Message or call a supportive friend or family member.
Sometimes, we don't have a support team nearby. Your best friend might live across country or your family might be in a different state. Text. Facetime. Call. Connect to another adult somehow. Catch up on each other's lives.
Dance around with your baby. Use ear plugs or headphones if necessary.
If you are holding your crying baby, they won't know that you have headphones or earplugs to block the sound. Moving your body helps your mood, and may soothe baby at the same time.
Take a silly selfie with your baby.
Smiling when you are stressed or sad actually improves your mood, whether or not you feel like smiling. On top of that, acting goofy with your baby can help cheer you up. Post a favorite on Instagram or Facebook.
Do a few stretches.
I like the exercises on this page. Make sure you clear any exercise with your care provider, and take it slowly.
Drink a glass of water, cup of tea or coffee. 
Most breastfeeding mothers can drink caffeine in moderation. If drinking a cup of tea or coffee helps you relax, go for it. Otherwise, drink a glass of water. Squeeze some lemon in it. I like to make a ritual of drinking tea in my favorite mug in the afternoon to recharge.

Printable Self Care Guide

Final Note: Self-care is important for ALL caregivers, not just biological mothers, and not just first-time mothers. Anyone who expends a great deal of time and energy caring for another human being needs to make sure to take care of themselves. Adapt these tips as needed to fit the life you are living.

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Green Mama Parenting: Baby Registry Guide

4/14/2016

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I'm a little bit of a baby gear nerd. I love following the Baby Guy on Facebook and reading about new products. At the same time, I've learned about what's truly necessary, what is nice to have, and what's less than useful. When it comes down to it, babies don't need that much. They need a place to sleep, something to catch waste, clothes, and a way to eat. However, there are a few things that can make life a little bit easier. Adjust this list as needed to fit your own plans and lifestyle. (This post contains Amazon affiliate links)

Don't forget to download your printable registry checklist at the end of the post!

Sleep
The American Association of Pediatrics recommends room-sharing with baby for the first six months to reduce the risk of SIDs. Some families decide to bed-share from the beginning, while others are more comfortable with baby on a separate sleep surface. If you've been following me for any length of time, you might have caught on that our sleeping arrangements are flexible. Here's what's worked for us:

Cosleeper or Bassinet
Portable crib
Crib
Crib mattress
2-4 fitted crib sheets
2 waterproof mattress covers
4 muslin swaddle blankets

Favorite products: We loved the Arm's Reach Cosleeper, although we ended up part-time bed-sharing. For the portable crib, we went with a Graco Pack 'n' Play, sans accessories. We chose the SUNDVIK crib from IKEA for the price and its compact size. Skip the fancy bedding sets: the padded crib bumpers are a suffocation risk, as are thick blankets. Instead, register for a couple of fitted crib sheets and waterproof mattress covers. Instead of cotton flannel receiving blankets, register for muslin swaddle blankets like those from Aden & Anais. These large swaddle blankets do double and triple duty as burp cloths, nursing covers, carseat shades, and changing pads. The bamboo blankets are extra soft but the cotton ones served us well. If you are looking for items to round out your registry, I love the Dream blankets, loveys, and sleep sacks made by Aden & Anais too.

Eat
Your registry might look different depending on your feeding plans. You might be planning on nursing at the breast exclusively, returning to work after your maternity leave, or bottle feeding from the beginning. If you plan on staying home and don't see yourself pumping, register for a manual pump in case of emergency. If you plan on returning to work or building an emergency stash, or if you plan on pumping much at all, go for the electric pump. No matter your feeding plans, plan on having at least a few bottles on hand just in case. Feeding pillows are useful no matter how you feed baby.

Nursing pads, disposable or reusable/cloth
Breast pump (manual if only for emergencies, electric if you plan on pumping at all)
Breastmilk storage bags
5-10 4 ounce bottles with a couple of extra nipples
5-10 8 or 9 ounce bottles
Dishwasher basket for bottle or pump parts
Bottle and nipple brush
Bottle-drying rack
Feeding pillow

Favorite products: I went through a lot of nursing pads trying to find ones that kept me dry, didn't irritate my skin, and managed heavy leaking. Milk Daze pads were the only ones that met all of the above criteria. If you opt for disposable pads, the Lansinoh pads worked well for me. For breast pumps, check to see what your health insurance covers. If you are planning on pumping, check out the Kiinde system. Breastmilk storage bags screw directly to your pump using brand-specific adaptors, and then snap into a bottle with nipples that work with a breastfed baby's latch. If you plan on formula feeding, the Dr. Brown bottles worked great for us. There are also fabulous glass and stainless steel bottle options now. We've used Boon's Grass drying rack for 3.5 years now, and found it useful long beyond the bottle days. Finally, for a feeding pillow, the My Brest friend is great as a breastfeeding pillow, while the Boppy works great for either breastfeeding or bottlefeeding.

Diaper
Before registering, think about whether you plan on using disposable diapers, cloth diapers, or both. If you aren't sure where to start with cloth diapers, schedule a one-hour consultation with me!

Packs of disposable diapers OR 24 cloth diapers
Disposable wipes OR 48 cloth wipes/baby washcloths
1-2 small wet bags
Diaper pail
Pail liners for cloth diapers
Diaper sprayer
Changing pad
Diaper bag(s)
Diaper cream

Favorite products: I don't have a lot of knowledge about disposable diapers (we used what we got from the hospital and baby showers) but I have a long list of recommendations for cloth diapers, depending on a lot of different factors. Way too many to list here! For wipes, I like the BumGenius wipes, but baby washcloths do just as well. I could write a dozen posts about cloth diapers (and probably will), so I'll keep this one short! I will say that I recommend wet bags whether or not you plan on cloth diapering because they are great for swimsuits, soiled clothing, and gross burp cloths. You can, of course, just use plastic bags, but cloth wet bags won't develop holes at inconvenient times. If you use cloth diapers, make sure you register for cloth-safe diaper creams.

Wear
Although I'm including clothing on this registry checklist, don't expect people to give you the exact clothing you register for. Most people buy the clothes that they think are cute. That being said, most places offer a completion discount for items that remain on your registry.

2-4 sleep sacks
2 swaddle sleep sacks
6-8 bodysuits
5-6 pants
5-6 nightgowns
10 pairs of socks
Small bibs for droolers/spitters

Favorite products: I love the Halo Sleep Sacks for swaddle escapees. I also like the sleep sacks from Aden & Anais because they are nice and lightweight over pajamas in the winter and a onesie in the summer. Whether you have a boy or a girl, nightgowns are way easier for nighttime diaper changes. During the day, opt for bodysuits (onesies) and pants or baby legwarmers, or footed pajamas in cooler weather. You'll need socks but not shoes. And finally, even before babies are ready for solid food, they often drool or spit up and bibs can help save outfits.

Wash
Babies don't need a whole lot of bathing in the beginning, and sponge-bathing will often do the trick. Many bathe baby in the sink, while others love a baby bathtub.

2 hooded baby towels
Baby soap/shampoo
Baby washcloths

Favorite products: To be honest, I didn't have a lot of brand preferences in this category. I was really all about keeping it simple.

Other Essentials
Your essentials list might be different than mine, but you will definitely need a carseat.

Carseat
Baby carrier(s)
Stroller
Nosefrida
Baby thermometer
Car mirror
Dresser

Favorite products: For carseats, I'll direct you to a far more qualified source: The Car Seat Lady. Bucket seats are useful if you want to be able to use the carrier to transport baby in and out of the car or snap it into a stroller frame, especially for colder weather. A convertible seat will work from infancy and well into toddlerhood and beyond depending on the size of your child, and works great if you know you plan on using baby carriers when you are on the go. We got into babywearing pretty early, and found that bulky travel systems didn't work for us. We preferred using the stroller frame that worked with our bucket seat, and then using a lightweight stroller after the bucket stage ended. For the most part, though, we stuck to baby carriers, and that's all about finding the right carrier for you. I can help you with that!

With my first, the Nosefrida grossed me out and I passed---but then I realized bulb syringes were much grosser. The Nosefrida is the way to go. Along with that in the health category, you need a baby thermometer.

A carseat mirror isn't an essential, necessarily, but it's been helpful for me to know when my babies were asleep or awake. And finally, you need a dresser or something for baby's clothes. We put a changing pad on top of the dresser and skipped the changing table entirely.

For Mom

Nursing friendly pajamas
Nursing bras (daytime and nighttime)
Kangaroo care shirt (optional)

My mother-in-law gave me a beautiful pajama set when I was pregnant with my first, and it was wonderful to slip into them in the hospital after a shower. I wore them a lot at home, especially for those early days with visitors. In fact, I wore them so much I wore them right out.

For nursing bras, I actually had great luck at Target. Register or purchase nursing bras after getting fitted between 34 and 40 weeks pregnant. You may increase in size even more after birth, and may experience other fluctuations as your supply regulates. Why nursing bras at night? You need something to hold nursing pads in place.

Even if you are not planning on breastfeeding, or are a non-gestational parent, your baby will benefit from kangaroo care. You can register for a kangaroo care shirt, like the Nuroo, to facilitate skin-to-skin cuddles, or use a Baby K'Tan.

Bonus Items

Glider
Baby bathtub
Baby monitor
Baby swing
Bouncy chair
Play mat
2-3 pacifiers
Sound/white noise machine

I loved having all of these things, but could have lived without most of them. My glider remains my favorite chair, and I will be holding onto it for a long time. The bathtub is useful but not required. The need for a baby monitor depends on your house size and how sound carries in your house. We actually have enjoyed using the Cloud Baby Monitor app, with our iPad or an old iPhone as the camera, and my current iPhone as the monitor. For the swing, chair, and play mat, some babies love them, and some hate them. It's better if you can borrow rather than buy. For pacifiers, don't invest in too many but get a couple. You might swear you will never use them (I didn't plan on it) or you might want to, but your baby won't take it (I couldn't get mine to take it when I wanted him to). We used what we called "Rain Lamb," the Sleep Sheep extensively to create sleep associations. We now use a more robust machine.
What did I miss? What would you recommend? What's on your registry?

Baby #1 wrapped in an Aden & Anais swaddle, in our Arm's Reach Cosleeper

Enjoying a Dr. Brown's bottle

Boppy Pillow in action

Baby #2 loved the play mat. Baby #1, not so much.

For me, a good baby carrier is an absolute necessity. With baby #2, we started the day we left the hospital.

Our "dresser" which organizes our cloth diapers, baby clothes and serves as a changing table, as well as our beloved glider

The Beco Gemini is a great newborn carrier

Click here to download your printable registry checklist!

If you like these recommendations, please use the links below to purchase my recommended baby products and you will help support this blog.

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8 Ways to Keep Calm and Feed Your Family

4/4/2016

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When I was pregnant with my first, I diligently prepared a set of freezer meals for after the baby came. Relatives agreed on days to bring dinner.

Then, two or three weeks went by, and the easy dinners disappeared. I was left wondering what to do next. How could I manage to grocery shop, cook, take care of a baby, and do it all on a smaller budget now that we were a single income family? Then I had to adjust again when I went back to work a year later.

I've now been doing all three jobs for three and a half years, and I've figured out a few things. First, let me share a little bit about our family.

We have two adults in the household, a 3.5 year old, and a voraciously hungry 21 month old. We prefer organic food, but prioritize fresh and unprocessed food. We usually buy organic meat, but eat a largely vegetarian diet. On top of that, I recently went on a gluten-free diet for personal health reasons (the rest of the family still loves and eats gluten). Our monthly grocery budget is $300, which includes a $60 milk share at a local farm. So, I spend about $60 a week on groceries.

Full disclosure: we raise some of our own food. We have 10 hens for eggs, and I didn't account for their feed as part of the grocery budget. In the spring, summer, and fall, we spent less than $60 a week on groceries because we have a garden. But, in the winter, we buy most of our food, still within that budget.

Here are a few things I've learned.

1. You have to prioritize.
Healthy food can be fast, easy, or cheap, but is rarely all three. If you have a higher grocery budget, you may be able to afford healthier convenience foods. If you are on a tight budget, you may end up making food from scratch which may be easy but time consuming. We ended up prioritizing organic meat over organic vegetables, when the budget makes us choose. If you have extra demands on your time, like a full time job outside of the home, you may make time a priority. When I was working, we designated one night a week for eating out or ordering in, to ease a little bit of the pressure to do it all. We also bought a rotisserie chicken once a week.

2. Weekly, or even monthly, meal planning is key.
Every Saturday or Sunday (depending on how busy of a weekend), I sit down with my calendar, and meal plan. I make note of any days that need to be fast meals or slow cooker meals (more on that in a minute). I think about common ingredients across meals, so I can use up fresh ingredients, like a bunch of cilantro. Recently, we even added breakfast and lunch planning into the equation. I'm a big foodie and I used to try new recipes all the time, but I've learned that we need to have a few favorites that we use regularly. I try not to do new recipes more than once a week. Flexibility has been a key part of menu planning. I'll schedule a night of either leftovers or stir fry. If we have leftovers, we use them up. If we don't, I make a stir fry with on-hand ingredients, like leftover vegetables, frozen vegetables, rice, and sauces that we keep on hand. Then, if we end up being out of the house for any reason, I didn't buy extra ingredients for a meal. When I worked full time, I sat down once a month and made a gigantic meal plan, with weekly grocery lists. We always planned on eating out/takeout the same night and eating rotisserie chicken on grocery store day. We also ate at my in-laws weekly (sadly we no longer live close enough to do so). Although it took a long time, especially in the beginning, it saved so much stress and time later that I though the effort was totally worth it. I'll throw a sample weekly plan at the end.

3. Learn to love your slow cooker and freezer
I mentioned making freezer meals when I was pregnant. Well, you really need freezer meals when you have two children under three with a tendency to get cranky just before dinner. I love to do batch cooking, although I don't do it every month. I'll gather up a list of slow cooker recipes and toss the ingredients into gallon bags in the freezer. Then, on cooking day, I just throw them into the slow cooker in the morning. I also have a rice cooker with a delayed start. Because of meal planning, I know which mornings I need to put something into the slow cooker. (Slow cookers are great time savers, but not if you are scrambling for dinner at the last minute!).

4. Find ways to make grocery shopping easier as a parent.
We've tried a couple different strategies for grocery shopping over the past few years. We've tried going as a family, but that always ends up putting us over budget. I've tried going by myself, especially after bedtime, but I'm often exhausted. We discovered something amazing. Harris Teeter Home Shop. I order my groceries online (really easy with meal planning!), and pick them up at the store. I don't even have to get out of my car. They do a great job selecting produce. It's also saved me money. I've eliminated impulse buys, it's easy to price compare and shop sales, and if a sale item is out of stock, they give you the more expensive option for the sale price. They left something out of my order once, and drove the ten miles to my house to deliver the item...after their regular hours. Many grocery stores have similar options, but I can't speak to the quality of any other store. I do pay a fee, but I choose to pay it annually, and it comes out to less than $2 per week. It's also unlimited, which means that I can do an order for a single item if I need to (I don't usually). Harris Teeter is the most expensive grocery store in town, but I feel like the savings of time and money of shopping online are worth it. I live out in the country, ten miles from the grocery stores, and it's great to be able to pick up groceries on the way home from an outing, even if the kids are asleep in the car.

When I do need to go into the store, I look for the fun carts. They are bulky and unwieldy (my husband calls them embarrassing) but the kids enjoy driving the "racecar" enough that it keeps them entertained and a little bit distracted. When my son was younger, I usually wore him in a baby carrier in the grocery store. (Safety reminder: never put a baby seat on the child seat portion of the cart--they are not meant to click in and it can damage the car seat or the seat can fall off).

5. Babywearing is your friend.
With a tiny infant, babywearing is really helpful for grocery shopping and some food preparation. Just be cautious about using the stove, and definitely avoid cooking foods that might splatter. You can definitely make yourself a smoothie, at the least. It also means you can eat!

With older babies and clingy toddlers, you can put baby on your back. I've cooked many meals with a child on my back, and often put on upbeat music so that we dance around the kitchen. It's super helpful during the evening "witching hour."

6. Use toddlers and older children as helpers
My kids are often underfoot when I'm trying to get dinner on the table. I've learned to let go a little bit, and will ask them (even the 21 month old) to set the table. Or the three year old to wash vegetables or chop them with a crinkle cutter. It does take a little longer but it can soothe frazzled moods and make things go more smoothly.

7. Ask for help.
About a month after returning to work full time as an elementary school teacher, I had a complete and utter meltdown about the adjustment. I posted an emotional outburst on Facebook (very atypical for me), and wonderful advice came pouring in, including some of the above ideas. We were also fortunate at the time, as I mentioned, to be able to have weekly meals with the in-laws. On top of that, when I asked for help, a dear friend did bring me a dinner. Certainly, that wasn't going to be a regular solution to the problem, but it helped me get my head above water. If possible, ask your partner for help. Until recently, my husband had a lengthy commute and wasn't home for dinner three nights a week, and got home just in time to eat the other two. But on weekends, I asked him to entertain the kids or grab things for me. And there are some meals that he likes to cook, like chili and tacos, so he makes those a couple of times per month.

8. Use Pinterest wisely.
This is my last tip. I love my cookbooks, dearly, and have several that I use regularly. But with my new adjustment to eating gluten free, Pinterest has been an amazing resource. It's also a great place to look for freezer meals because often you can find whole collections complete with grocery lists. But, don't get sucked into Pinterest Ambitionitis, where you think you have to do amazing lunch boxes and beautiful dinners every day (unless that brings you joy).

Sample Weekly Meal Plan

Monday
Breakfast: Fried Eggs
Lunch: Frozen Pizza or Mac 'n' Cheese from a box (we have a babysitter on Mondays)
Dinner: Healthy Black Bean Casserole

Tuesday
Breakfast: Oatmeal
Lunch: Egg Salad
Dinner: Slow Cooker Buttered Chickpeas

Wednesday
Breakfast: Cereal and Smoothies
Lunch: Tuna Salad
Dinner: Salmon Teriyaki (homemade teriyaki sauce made with gluten-free soy sauce, frozen salmon from Costco)

Thursday
Breakfast: Yogurt and Frozen Fruit
Lunch: Sandwiches (leftovers for mom)
Dinner: White Bean Salsa Verde

Friday
Breakfast: Eggs
Lunch: Cheese, crackers, and fruit
Dinner: Stir Fry or Leftovers

Saturday
Breakfast: Pancakes (Gluten Free Oatmeal Pancakes for Mom)
Lunch: Leftovers or rice and steamed veggies
Dinner: Beef and Black Bean Tacos in Corn Tortillas

Sunday
Breakfast: Rice Flour Dutch Baby
Lunch: Hard boiled eggs and fruit
Dinner: Roasted chicken with roasted vegetables

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Why I'm an Advocate for Breastfeeding Moms

3/31/2016

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Last week, I wrote about supporting all mothers, regardless of whether they feed their babies breastmilk or formula. This week, I'm going to talk about why I focus so much on breastfeeding in my Facebook posts, blog, and classes.

The American Association of Pediatrics recommends exclusive breastfeeding for at least six months, and continuing breastfeeding for at least one year. The World Health Organization recommends breastfeeding for two years, or as long as both mother and child wish to continue. Eight-five percent of women plan on breastfeeding for at least three months. Nearly 80 percent of women initiate breastfeeding. Of that original eighty-five percent, only 32 percent (one-third) meet their breastfeeding goals. About 40 percent of American women are still breastfeeding at three months, and only eighteen percent are still exclusively breastfeeding at six months.

I'm a breastfeeding advocate because of the discrepancy between the percentage of women who wish to breastfeed and the percentage of women who meet their goal of at least three months. Some of these women may discover after birth that breastfeeding is not the right choice for their family. They don't need a breastfeeding advocate (they may need a formula advocate!).

However, the women mentioned above do not make up the full two-thirds of women who do not meet their breastfeeding goals. Why else might women not succeed?

1. Access to breastfeeding support
Breastfeeding might be natural, but it's not always easy for mother or baby. The dyad may need support for a variety of reasons. This assistance may come from peer-to-peer support, such as La Leche League Meetings, lactation counselors, or Internationally Board Certified Lactation Consultants (IBCLCs). However, there are less than eight support people (in all three categories) per 1,000 live births. In other words, each support professional would need to provide support for up to 125 people for all women to have support. And that's the national average. In some states, there are even fewer support systems in place. Between one and five percent of women have the inability to produce milk. For other women, supportive volunteers and professionals may be able to find the reason for insufficient supply and solve the problem if the mother wishes to do so. I have talked to women who were unable to breastfeed and felt that it was due to insufficient support.

2. Maternity Leave Policies
Half of new mothers say that their employment situation affects their feeding decisions. Women who return to work after less than six weeks of maternity leave are more than three times as likely to stop breastfeeding than women who take longer. And each additional week of maternity boosts breastfeeding duration by an average of half a week. The majority of women who quit breastfeeding after returning to work quit within the first month of returning to work. Despite national laws regarding pumping breaks, many women are unable to pump on the job. In addition, only seven states have laws supportive of on-site breastfeeding in childcare settings. By the end of baby's first year, only ten percent of mothers who work full time outside of the home are still breastfeeding.

3. Hospital Policies
The controversial Baby-Friendly initiative promotes hospital practices that support breastfeeding. However, many hospitals still have work to do to support breastfeeding mothers. Although I fully believe that mothers should have guilt-free access to formula if they want/need it, the practice of routinely giving out formula may effect breastfeeding outcomes. Some women need to be able to send their babies to the nursery, but rooming-in does promote feeding on demand, which is important to establish supply in the first day's of baby's life. I believe that hospital arrangements should be flexible, but they also need to be set up in ways that promote a successful start to breastfeeding for those eighty-five percent of women who wish to initiate.

4. Misinformation
Outdated information has persisted, making women think that they need to breastfeed their newborns on a schedule, introduce rice cereal at four months, and start sleep training early. Nighttime sleep training can be detrimental to the breastfeeding relationship, which is a supply and demand relationship. Although some medications are definitely unsafe for breastfeeding mothers, in some cases alternative medications may be an option. Flat or inverted nipples do not make breastfeeding impossible. Some misinformation can come from health professionals. Growth charts based on formula-fed babies may show a concerning trend for breastfed babies, while an adjusted chart shows that baby is doing just fine. Some women think they need to stop nursing when baby gets teeth (for my babies, that would have meant weaning at four months).

5. Personal Interactions
Although many mothers feel guilt (or have experienced public shaming) for formula feeding, breastfeeding mothers often experience conflict with others. Sometimes it's as benign as well-intentioned family members wanting to give a bottle before the breastfeeding relationship is established. There may be pressure for a mother to go to another room to feed her baby. A pediatrician told me to limit the number of feedings for my breastfed baby. A friend was asked to leave a public location because she was nursing, even with a cover. A stranger told me that breastfeeding in public wasn't safe for my baby (still not sure the logic behind that one). Nursing in a bathroom or in a car, or pumping a bottle and having to keep it cold, are not good options.

My goal:
I want to make sure that women feel empowered to feed their babies in the way that is right for them and their baby. If you have support, and breastfeeding isn't working for you, you can make the decision to move ahead with formula. If you know from the beginning that you don't want to breastfeed, you have the power to make that decision. Returning to work may make continuing your breastfeeding relationship too difficult so you turn to formula. You have my support (but I'd like to see your workplace change!). I want you to have the right information to make your decision (although I won't assume that you don't already have good information). And I want people to understand how they can be supportive of you, no matter how you feed your baby.

Sources:
Returning to Work While Breastfeeding

CDC Breastfeeding Report Card 2014

Breastfeeding Paid Leave

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Formula or Breastmilk? #FedisBest

3/24/2016

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If you've been following my Facebook page, you know that I am a huge advocate for breastfeeding. I regularly post articles about how to be successful at meeting breastfeeding goals. However, I also recently posted a blog post about Why I Don't Love Breastfeeding.

Here is what I really think: Breastfeeding is the biological norm. For women who wish to breastfeed and are able to, it is the best option. I don't really need to go into why when a quick Google search will do the trick.

However, we do lots of things that aren't the biological norm. Vaginal birth is the biological norm. However, it's not an option for all women. Conception through intercourse is the biological norm. But many families are built in other ways. To take it to an extreme, nudity is the biological norm. However, we recognize that in most environments, either because of cultural values or weather (or both!), clothing is pretty awesome. We may choose to pursue biological norms through various lifestyle choices such as diet. However, it's important to recognize that today we do many things outside of the biological norm by choice or by necessity.

I do actually love breastfeeding. I'm fortunate to live in an area where breastfeeding is mostly accepted (at least with a cover), I had access to adequate support, my babies were able to breastfeed without too much difficulty, I was able to stay home during the first 12 months of my daughter's life, and, most of all, my body made it easy for me. I also didn't have any religious restrictions, medical problems, a history of sexual abuse, or any other reason to make me wish to do otherwise.

Not everyone has my history. Some women simply do not wish to breastfeed for whatever reason. Some women are truly unable to, and for others, the obstacles outweigh the positive aspects of breastfeeding. Only the mother gets to decide how many obstacles are too many. Some women choose exclusive pumping or donor milk over formula. For others, formula is the best alternative to feeding at the breast. Suzanne Barston, the blogger behind Fearless Formula Feeder, wrote about her own journey here.

So here is what I promise:

If you have a desire to breastfeed, you have my support. I will connect you with information, resources, and support.

If you reach a day when attempting to breastfeed is no longer working for you and your baby, you have my support. I will help you find information about what to do next, resources, and support if you need it.

If you decide to feed your baby formula on day 1, day 30, or day 365, you have my support. I will help you find information about bottle feeding, resources, and supportive people.

If pumping exclusively or donor milk is the right choice for your family, you have my support.

If you are using an SNS system with donor milk, pumped milk, or formula, you have my support.

If you use any combination of these ways to feed your baby, you have my support.

I won't ask you why you choose to feed your baby that way. I will simply ask you if you feel supported, and if not, how I can help.

The graphic below illustrates two of Our Baby Class's Guiding Principles and sums up my feelings about how mothers feed their babies.