Necesareans

Note: if you are planning a natural birth, especially with hypnosis, don't read this without your "Bubble of Peace" on Mega-Force-Field-Strength.  If you are planning a peaceful, wonderful, pleasant and awesome birth and you want to visualize only wonderful happy things, click here for my favorite water birth video.

If you'd like to learn about real medical reasons for c-sections so you can potentially help avoid an unnecessary one, please proceed.

You've been warned.  Bubble up?

Necesareans

The current US c-section rate is somewhere between 33 and 38% of all deliveries.  The World Health Organization states that no region in the world should have a rate greater than 10-15%.  If the WHO is correct, that means that 54%-73% of all American cesarean deliveries are unnecessary.  Average the numbers out, and that means that 2 out of every 3 c-sections performed in the USA may be unnecessary.    Let’s play with some pretend, averaged and hypothetical numbers.

The 2010 rate is estimated at 33.9%.

100 laboring women.  33 have c-sections.  22 women had surgery they may have been able to avoid.

Now here’s the twist.  11 of them did need c-sections.  There are valid medical reasons for c-sections.  Women used to die in labor, far more often than they do today.  Babies used to die in horrific numbers during childbirth, and the c-section is an amazing medical advance, a relatively “safe-ish” surgery that can and does save lives.  Before the advent of the c-section, labor and delivery were leading causes of death for young women and babies. Since 1980 (and not on this chart), the number of maternal deaths is rising again, and many say it is because of the overuse of the cesarean section.

Maternal deaths per 100,000, 1880-1980

How do you know which one you are?  Is your birth a real emergency, one of the 11, or one of the 22 that might have been avoided and could be putting you and your baby at needless risk?  Your doctor will always tell you that you’re one of the 11, unless you have an elective surgery (very rare – despite the hype, less than 0.5% of c-sections are truly elective, with zero “medical” reasoning provided).  Your doctor will always say that you had a c-section because it was necessary.

So, you’re in labor, or close to it.  Things aren’t going according to plan.  Your doctor wants to do a c-section, and they’ve been to medical school.  You haven’t.   How do you keep from being part of the 22?  How do you know if you’re one of the 11?  Ultimately, you have to trust your care provider, which is why selecting one is so very important.  You also have to do everything you can to reduce your risk of running into a real medical reason (avoiding interventions unless they are medically necessary).

Below is a list of medical indications for cesarean section, with details. Knowledge is power, right?

As always, please note: I am not a doctor.  I have not gone to medical school.  I have never performed a c-section.  I am not an expert.  I am a mommy who likes to write stuff and post it on the internet.  Please do not take anything I write as medical advice, but as information and opinion.  Inform yourself, do your own research, and talk to your medical experts before you make a serious decision that could seriously impact you and your baby.

Necessary C-Sections

Placenta Previa

Placenta Previa means that your placenta is located above your cervix.  Both partial and complete placenta previa (placenta blocks the cervix completely at the time of delivery) is absolutely an indication for c-section.  If your placenta blocks your baby’s exit, you are at risk for extreme bleeding, and there is no way for the baby to get out.

What you should know: Placentas can move.  Suspected placenta previa can be often be confirmed via ultrasound or even via vaginal exam.   Just because you have a low-lying placenta early in your pregnancy does not mean it won’t shift out of the way by the time of delivery. “Marginal” placenta previa, where the placenta is just very close to the cervix, is not generally an indication for c-section.  You should know which one you have before you consent; information is power.

Cord Prolapse

If your water breaks, and the cord comes out before the baby, this is Umbilical Cord Prolapse.  Cord prolapse is an immediate emergency – either you must immediately deliver vaginally, or proceed directly to the OR.  Time is of the essence to save the baby’s life – whichever method gets the baby out fastest should be used.

What you should know:  Cord prolapse is much more likely to happen if your baby is premature, and especially if your waters are broken artificially.  So, if your care provider offers to "get things moving" by breaking your water with a hook, remember that this is a (small) possibility.

“True” Knot in Umbilical Cord

These are very difficult to diagnose prenatally, but it has happened with 3D ultrasound (which carries risk).  A true knot is exactly what it sounds like - it can prevent oxygen from getting to the baby.  If one is seen on ultrasound (again, rare – usually they are discovered after delivery), you will likely be sent to the OR.

Placental Abruption

If your placenta detaches from the wall of your uterus while the baby is still inside you, this is a placental abruption.  Symptoms are severe abdominal pain, heavy bleeding and back pain.  Partial abruption prior to labor is usually treated by bed rest and transfusions, but a complete abruption at any point or any kind of abruption during labor is an emergency situation.  Like a cord prolapse, immediate steps need to be taken to get the baby out – immediate vaginal delivery or emergency cesarean.

Click here to read a very sad story about a baby lost due to an abruption - recognizing the symptoms of an abruption and seeking immediate, emergency help is vital to avoiding this tragic result.

Uterine Rupture

If the uterus tears, an immediate, emergency c-section must be performed to save the life of the mother and baby.  This is rare (1/1500 births).

What you should know: Risk of uterine rupture is often given as a reason not to allow VBACs (vaginal birth after cesarean).  New research shows that the risk of c-sections may be higher than the risk of rupture, which is very rare.

Toxemia, Severe Pre-Eclampsia, HELLP syndrome, pregnancy-induced hypertension

Pregnancy-induced hypertension is high blood pressure that just keeps rising.  Eclampsia, toxemia and HELLP are all potential complications of uncontrolled high blood pressure in a pregnant woman.   If PiH isn’t controlled, high blood pressure can cause strokes, cerebral hemorrhage, respiratory distress and even death for the mother, as well as endanger the baby.  Toxemia, HELLP and Eclampsia are all potentially deadly complications of uncontrolled PiH.

During pregnancy, there are a number of treatments that can slow disease progression.  The only “cure” is delivery.  If your blood pressure rises severely enough and quickly enough, it is imperative to get the baby out ASAP.   BP over 160/110 is considered severe.  Because prolonged labor can be stressful on your body (not that c-sections aren’t!) many doctors prefer to perform a c-section to avoid the possibility of your blood pressure rising further.  If the situation becomes unmanageable, immediate action to deliver the baby is required.

You should know: You can reduce the risk of pre-eclampsia with diet and exercise, among other things.  Click here for more information about pre-e (to start).

Transverse Lie (baby is lying sideways)

While it is possible to deliver a breech baby vaginally, it is not possible to deliver a baby who is sideways in the womb.  That being said, babies move.  Just because your baby is sideways NOW doesn’t mean they’ll be sideways when you actually go into labor.  80% of babies who are transverse at 37 weeks have moved when you go into labor!  So, don’t just schedule the c-section.  Wait to see if baby flips.  Check out http://www.spinningbabies.com/ if you want to get your baby on the move.

You should know:  While transverse lie is an indication for surgery, breech often isn't.  See below.

Acute Fetal Distress

Fetal distress is often used as a reason for c-section delivery, but the definition is nebulous.  “We’re worried about the baby” is a sure-fire way to get a laboring woman into the OR without argument.  There is a difference between “fetal distress” and “acute fetal distress.”  There is a clear definition of acute fetal distress. 

Most babies become mildly distressed during labor – so do many moms!  Being born is hard work, and it can be stressful.  Your baby is often working as hard as you are in this team effort.  There’s a BIG difference between being stressed and being in danger.  Below are the textbook definitions of “Acute Fetal Distress”.  #1, 2 and 5 alone are enough to indicate acute distress.  #3 and 4 are used in conjunction with other factors.

1 – Fetal heart rate greater than180 bpm or less than 100 bpm for longer than 4 minutes.  Note – an occasional rise or fall to these numbers does not automatically indicate distress.  An average over one minute is used.   

2- Repeated or variable deceleration.  It is normal for the baby’s heart rate to increase and decrease during and after contractions.  If the dips become too severe, it can indicate fetal distress.  If they don’t happen in time with the contractions (variable), they could be related to something else, such as trouble with the cord or placenta.

3 – Meconium staining of the amniotic fluid.  This alone is not necessarily an indication of distress, but it is a symptom.  Distressed babies release meconium (poop in the womb).  Not all babies who produce meconium in utero are distressed.  (Irish girls have pale skin.  Not all girls with pale skin are Irish.)

 4 – Fetal Movement: frequent decrease and weakening.  Again, this is not an indicator by itself; many babies get “quiet” during labor, often just to sleep.  If decreased movement happens along with another factor, it’s cause for concern.

5 – Acidosis: If you want to be sure if your baby is in distress and there is time, this is a definitive test.  A blood sample is taken from your baby’s head (a tiny scratch).    They can immediately test the blood’s PH, oxygen and carbon dioxide levels to see if your baby isn’t getting enough oxygen.  This is only possible if the baby’s head is engaged and your water had broken.

                pH below 7.20 (Additional information about acidocis here)

                pO2 (oxygen level) below 10mmHg

                CO2 (carbon dioxide) above 60mmHg

If the baby is in acute distress, it’s time to get the baby out, by the swiftest method possible.  Please, if your doctor says the baby is in danger, don't spend time printing out this post and checking the lab work...

More information about fetal distress here

You should know: If the baby is in mild distress, the first course of action should be to attempt to remove whatever is causing distress.  Sometimes, your position can be compressing the cord – occasionally, if you change position (lie on your side, your stomach, or even get in a tub), this can alleviate pressure and allow the cord blood to flow properly.  If you’re on pitocin, they should turn it off.  Overly strong contractions can stress the baby.

Previous Abdominal Surgery

This is not absolute, but depends on the type of incision and the type of scarring.  Certain abdominal surgeries can cause complications during vaginal childbirth.  One example is a iliostomy/j-pouch surgery, removal of intestines, vertical previous c-section, or c-section that is not yet healed (less than 1 year).  Necessity is dependent on the location of scarring and weaker tissue.

Active Herpes Lesions

If you have genital herpes and have active lesions, you can pass the disease on to your baby at birth.  Herpes can be deadly to a newborn, and there is no cure, so they’ve got it for life.  Between 10 and 14% of women with genital herpes have a lesion at delivery.  The chance of passing the virus to your baby decreases based on the amount of time Mom has had the disease.  If you have had herpes for years, the theory goes that you have developed antibodies and will pass these to your baby – even if you have a current lesion.  If you acquire herpes during your pregnancy, especially during the 2nd and 3rd trimester, your risk is highest, and you may consider a c-section even if no lesions are present.      See this site.

Multiples greater than twins

Triplet and higher deliveries are almost always delivered by c-section.  First, these deliveries are rarely full-term, and premature babies may not handle the stress of labor as well as full-term babies.  Second, 3+ cords and 3+ placentas can be complicated.

You should know: Twins are regularly delivered vaginally without complication.  Even triplets can and have been delivered vaginally (see here for a recent study), but this is rare because triplets and greater so often arrive ahead of schedule.

Known Health Emergency for Baby

If your baby has certain known health issues or birth defects (I hate that phrase, no baby is “defective”) that need to be addressed immediately, a cesarean section may be your best choice. Work with your neonatologist.

Health of the Mother

If a mother is physically incapable of labor because of her own health conditions, c-section is the alternative.    Some examples include physical abnormality (certain kinds of dwarfism or pelvic abnormalities), some kinds of paralyzation, out-of-control diabetes, and a few other extreme conditions.

Generally speaking, most women are capable of at least attempting a vaginal birth (there is stress involved in a c-section as well; delivering a baby isn't a walk in the park no matter what your health).  You and your doctor need to weigh the benefits and risks.

DEBATED REASONS

These are reasons often given for cesarean sections.  There is debate about them.  Some people say they’re necessary to mitigate risk, others say that vaginal birth should first be attempted.  Do your research, work with your care providers and reach your own conclusions.

If you do decide to have a c-section, armed with the facts, more power to you.  My goal is informed consent.  If you personally decide that the risks of a c-section are less than the risks of vaginal birth, awesome.  I just hate to see women pressured into something they "had" to do when they didn't want it.

Abnormal Fetal Position (breech): 

Most midwives and doctors will not deliver a breech baby vaginally – but some will.   Many babies are born happily and peacefully in the “frank breech” position, that is, butt first, feet by head.  This position is most favorable to vaginal birth, if you can find an experienced provider who is willing to assist.  Breech babies have all been delivered successfully vaginally.  Breech births do carry higher risks of cord prolapse, increasing with the type of breech delivery.  Not included here is Footling breech, which carries the highest risk.  In this presentation, baby comes out feet first. 

If you attempt vaginal delivery of a breech baby, it is of vital importance that your midwife/OB be well-versed in the intricacies of breech birth.  If you can’t find one (providers are much more rare than breech presentations), you may have a c-section.  It is important to note that vaginal breech birth should not be attempted without an experienced medical professional who is on board with delivering breech.  There are risks to delivering breech vaginally; neonatal death has happened as a result of breach deliveries being handled improperly.  Work with your provider to assess your individual situation.

HIV Infection

Some research has shown that HIV transmission from mother to baby can be reduced by surgical delivery.  Other research has contradicted this, and found that there is no increased risk with vaginal delivery.  For more information, start here and keep on going: http://www.wdxcyber.com/npreg13.htm

Failure to Progress

I would personally argue with this reason.  If failure to progress exists but is not accompanied by any health issues for mom or baby (see Acute Fetal Distress above), what most mothers need is patience, not surgery.   Mom may need more support.  She may need help feeling safe.  She may need (eek, omg, yes I’m saying it), help with pain so she can sleep, or other medical assistance.  Surgery should be the last option, not the first.  Get in a tub.  Close the doors and kick the world outside.  Listen to soft music, turn down the lights.  Magic can happen!

Long ago in caveman days, you wouldn't want to deliver a baby in "unsafe" conditions.  Say, there's a warring tribe attacking your cave, or a tiger on the loose - real, physical danger.  You wouldn't want to deliver a helpless baby.  We're programmed so that labor slows down in periods of stress and fear.  Many women who aren't progressing need to feel extra safe and protected before their bodies will allow them to birth their children.  Threatening most women with unwanted surgery is not a way to make them feel safe!   

Healthy labors can last for days, especially the first time around.  This is not necessarily pathogenic.  It is annoying to hospital administrations who may want the room for the next woman.... So, personally, unless fetal or maternal health shows signs of deterioration, I'd argue against the knife.

True “failure to progress” is defined as 4 or more hours with no dilation progress, when mom is dilated at least 5cm.  Early labor (less than 5cm dilated) can last for a really long time under totally normal circumstances.  

Twins (or sometimes even triplets)

Twins are, like breech, a variation on normal.  Like breech delivery, you will need to find an experienced caregiver to work with you, but it's absolutely possible.  Baby position is also key here - ideal presentation is below, but babies have been successfully delivered in all sorts of presentations. 

This is a great site to see videos of twins born vaginally: http://www.givingbirthnaturally.com/natural-childbirth-video.html

This is also a great discussion of mothers who've done it.

An additional complication to the births of multiples is prematurity or babies who are small for their gestational age.  Please work closely with a trusted professional to determine your best 

Twins, both head down, an ideal position for vaginal birth.

  What you should know: Delivering one twin vaginally and then the next by c-section is not unheard of.  Some providers (but not all) prefer that you have an OR on "standby" or at least nearby when delivering twins or triplets the old-fashioned way. 

Previous Cesarean Delivery

VBACs are not permitted in many hospitals.  Why?  Well, there have been some studies done that showed an increased risk of uterine rupture in mothers who had previously had a c-section.  It scared hospital administrations, and nowadays a lot of hospitals won't let you try vaginally.

The evidence does not support this fear.  The risks of a second c-section are usually higher than the risks of attempting vaginal birth.  You may have to fight hard for a VBAC, but the evidence is with you.

I am oversimplifying the situations surrounding VBAC - but if you'd like to consider it, please do some research.  Not all cesareans are alike, and not everyone is a good candidate for VBAC.  If you are a candidate, you may want to consider it.  See the bottom of this page for additional information.

Macrosomia (baby's too big)

This one's tossed around a lot as a reason for surgery.  Again, most evidence does not support it.

I don't remember where I found this picture.

1 - It is very difficult to truly assess the size of a baby before he's born.  Ultrasounds and belly measurements are notorious for being way off.

2 - Most mothers' bodies won't make a baby too big to come out.

3 - Big babies are delivered vaginally all the time.  11-12 pounders!

4 - Baby fat squishes.

If a baby is truly too big to come out the old-fashioned way, that will prove out in labor.

Cephalopelvic disproportion  (CPD)

A variation on the "baby's too big" theme, true CPD is also rare, and virtually impossible to diagnose prenatally.  CPD means the baby is too large to fit.  Sometimes smaller-statured mothers are given this as a reason for c-section. 

Tiny mommies have big babies naturally all the time. CPD is real, but it varies widely.  Mothers who have had c-sections for CPD have gone on to have successful VBACs. 

You should know:  If a baby does get "stuck" (shoulder dystocia), changing positions can enlarge the pelvic opening.  The Gaskin Manuver is a potentially life-saving technique that can be used in the event of shoulder distocia.  The lithotomy position (on your back with your legs up in stirrups) is the one of the *smallest* positions for a woman's pelvis.  Flip to all fours or squat, and you can get up to another 3cm in diameter!  Shoulder dystocia is a true emergency for the baby, and a competent provider is absolutely essential to saving the baby's life.

Plus-Sized Mama

I am a plus sized mama.  I gave birth (vaginally) to a 7 pound baby, who ultrasound "estimated" at 9 pounds 3 days before his birth.  Whoops.  So much for that "big baby" worry.  Some doctors offices will label you "high risk" by the size of clothes you're wearing, and automatically steer your chubby self to the operating table.  I call bullsh!t on this one, with some exception.

Generally speaking, if you are healthy enough to vigorously engage in the activity that got you pregnant in the first place, there's no reason that you shouldn't at least attempt a vaginal birth.  If, however, you have a hard time getting around, you might have a tough time managing labor.  You never know though - you may be surprised with the amazing things your body can do.

In fact, the risks of c-sections are often higher in obese women then the risks of vaginal delivery.  Check this out if you're a plus-sized mama-to-be.  Personally, I don't see harm in attempting a vaginal birth, no matter what your size - but, again, not a doctor.

You should know: Taking care of yourself during pregnancy and having a supportive care provider are the best ways to ensure a healthy labor and delivery, regardless of your size.  If you are plus sized and suspect that your provider is not "size-friendly", switch.

There are undoubtedly many reasons I missed that are either real or dubious reasons for c-section.  If you know of any, please comment with them and I will happily edit this article.  I will also happily correct any (verifiable) mistakes; I'm not a doctor and I don't play one on the internet.

Ultimately, many c-sections are necessary, but not all of them.  Women who have c-sections are no less strong and awesome than those who deliver vaginally, with or without medical assistance.  C-sections are not a failure, often they are a massive and amazing miracle that could have resulted in the death of mother or baby not long ago in our history.

What's important through the whole process is informed consent; if you have a c-section, that you understand why it is necessary and agree with your doctors about the choice.  Choice, and understanding.   C-sections are a blessing and a curse; if used when necessary, c-sections save lives.  If unnecessary, they put the health of the mother and baby at increased risk for infection, bleeding, and even death.

Women are people worthy of respect throughout all of labor and delivery.  Contrary to media portrayals, we are capable, intelligent and rational people, even after our water breaks.  :)  We want what is best for our babies, and we want to be treated as adults and active participants in our own healthcare.


Additional Resources:

For more information about the unnecessary c-section epidemic and how it's affecting maternal and neonatal health, check out: http://www.theunnecesarean.com/ and http://www.ican-online.org/

For information about VBACs, click here: http://www.vbac.com/ and http://vbacfacts.com/

For support dealing with birth trauma, including PTSD, visit these sites: http://www.solaceformothers.org/ and http://www.birthtraumaassociation.org.uk/

To learn more about recovering from a c-section, see here: http://www.csectionrecovery.com/ and http://www.csectionguide.com/

Birth Plans and Birth Realities

I'm was going to get my whole "birth story" up on here some day (my son's now 9 months old, hmmmm).  Meanwhile, however, I was digging through some old files and I found my Birth Plan, and thought this might be a good way to tell it!

I gave birth to David #9 at the birth center of a small community hospital, about an hour from my home.  I picked the hospital very much on purpose - they are the only one in the state that allows water births, they don't have a nursery, they're "baby-friendly", and I absolutely loved my midwife.  I wrote up a plan, and not everything went according to plan.

Overall, I would give my birth experience an 8/10 (the baby gets 11 out of 10, I'm talking about the experience).  I've heard the question asked often - "Does anyone have a birth plan for people who want to birth naturally in the hospital?"  I do....but it's only a plan.  If you want to be guaranteed the best shot at a natural birth, stay home. If, however, you do choose to have a hospital birth, I found this plan to be a pretty good one.

Anyway, without further ado, here's the plan, and how it actually turned out.

 The view from the birthing center at Newport Hospital.  

Not taken by me, but I remember vividly being in labor and watching the sun rise like this over the bridge during a contraction.

Arrival Plan

•    Can I have the room with the tub?  Pretty please?

•    Please assign a nurse who doesn’t think I’m insane for wanting a med-free birth

•    No IV, hep lock if necessary

•    Let Me Eat and Drink (and puke…yeah, I expect it)

•    I’d like to wear my own clothes

•    Intermittent monitoring (via Doppler if possible, please don’t strap me in bed)

What actually happened:
My first sign of labor was my water breaking all over the bed at home at 37 weeks on the dot.  We drove to the hospital, and I got the room with the tub, but never ended up using it.  I was assigned a nurse who didn't think I was nuts.  A saline lock was started 3 hours after I arrived - this was not a big deal.  IV wasn't started until later.  I was allowed to eat and drink whatever I wanted.  I wore my own clothes for 14 hours, until the plan went off track.  Intermittent monitoring was also permitted until pitocin was administered; after that it was continuous. 

Labor Plan:
I would prefer to avoid interventions, but we trust your medical opinion of what may be necessary.  Please discuss any interventions you believe may be necessary with me and my husband.

•    I’m using hypnosis; please don’t try to talk to me during contractions (pressure waves).  Dave or Mom can talk for me if it’s an emergency.

•    In hypnosis I am very susceptible to suggestion.  Please be careful with what you say – avoid words like “pain” and use “pressure”.

•    Ahhh! Bright Light!  I’d like to keep the lights low, if possible.

•    Play that funky music…. I’m bringing my iPod and speakers.

•    I know what my pain relief options are.  I’ll ask for drugs if I want them.  Promise. 

•    Limit the number of internals, and don’t tell me how far I am dilated unless I ask.

•    I would like to birth my baby in the water.

•    If I can’t be in the tub, please let me choose the position that is most comfortable for me.

•    I would like to try “mother-directed pushing” rather than counting to 10.

•    Please let me know how I may reduce tearing.

•    I would prefer to tear rather than have an episiotomy.


 What Actually Happened:
For the first 14 hours, I got everything I asked for.  We had a lovely playlist (5 hours long) going on the iPod, the lights were dim, nobody asked me if  I wanted drugs, I was given a ball to bounce on, a bar to hold, and given free range of the hospital to walk.  My progress wasn't checked (although they did ask).


After 14 hours, I consented to be checked, thinking I would be 7-8cm....but I was 3cm dilated.  My midwife was concerned about infection, given the extended length of time since my water had broken.  She recommended that I be given pitocin - which meant that I was stuck in bed with a monitor on, and that water birth was no longer an option.  After an hour with pitocin, I gave in to the epidural.  The contractions had quickly gone from something I could handle to absolutely miserable, especially since I no longer had the ability to move around.  My "unmedicated" birth was gone, I couldn't use the tub, and in many ways my will was broken.  I know there are moms who can do pitocin without an epidural...I am not one of them.

I will probably always wonder if Pitocin was truly necessary.  In retrospect, I should have asked to use the tub to see if that would help me progress....but when your contractions are 2 minutes apart and you haven't slept in 24 hours, you don't see clearly.  Ultimately, I trusted Kathy - she was the expert, and I trusted her professional opinion and her 20+ years of midwifery, including her own 5 natural births....but still, I question.

When, eventually, I got to 8cm, my midwife turned the pitocin and the epidural off.  I love her for that!  She told me - and the nursing staff - not to push unless I had absolutely no choice, until my body told me "push or die!"  The epidural wore off just as that feeling hit me.  Well,  first I threw up all over my husband, then I had to push like it was the end of the world.

Just as the last of the epidural wore off, I had full feeling in my body and I was able to first sit up during contractions, then squat on the floor, holding the bed.  For the first 40 minutes, all pushing was "mother-directed."  I started to give up a little (it had been 28 hours), and Kathy did have me do 3 massive "count to ten" pushes until she saw David begin to crown.


Then, she had me stop pushing.  Hardest thing I've ever done!  She had me stop pushing and hold, to let my body stretch.  She instructed me to give tiny pushes even though I wanted to give it everything - and David gently wiggled out of me.  I actually had an orgasm.  Seriously.  I laughed out loud, and it was the best feeling ever.  Ten minutes after I gave birth, I asked my husband when we could do it again.

The music was still playing, the lights were still low, and Kathy was wearing cowboy boots and jeans.  No scary medical equipment, no shouting - peaceful and lovely, just how I had envisioned it.    "I Just Haven't Met You Yet" played when David was born, and Rascal Flats "God Bless the Broken Road" was playing when I first held him.  I'll never forget that!

I didn't tear or need an episiotomy.  YAY for stretchy lady-bits!  Oh, and because I know I was concerned, especially with the Ulcerative Colitis....I didn't poop on my midwife.  Heh.

David James IX, 7lbs even.

When the Baby is Born
If mom and baby are healthy….
•    I would prefer that the baby be placed on my stomach immediately for skin-to-skin contact for at least 1 hour after birth.

•    I would like cord clamping to be delayed at least 5 minutes or until the cord stops pulsing.

•    I would like to deliver the placenta without pitocin or traction.

•    If I need stitches, please provide anesthetic (local or otherwise).

•    I would like to delay all newborn procedures – including weight and length checks-  until after we have had the opportunity to breastfeed.

•    I would like to allow the “breast crawl” if possible.

•    Please don’t allow any visitors in until we say we’re ready for them.

•    We plan to exclusively breastfeed.  Please do not offer pacifiers or formula.

•    Our pediatrician will handle the HepB vaccine; please do not administer.

•    Can we use liquid vitamin K instead of the injection?

•    Eye goop (antibiotics) should be delayed until after the first breastfeeding session.

•    Do not circumcise, and do not retract. (Click here for the 50 reasons we didn't)

•    The baby should be with Mom or Dad at all times for any procedure (including first bath).


What actually happened

David came out a little blue, so Kathy delayed clamping and held him below me until he pinked up - no suctioning or toweling.  I'm convinced that delayed cord clamping saved him a trip to the NICU.  He was placed on my stomach, and did the Breast Crawl and self-latched.  It was the most amazing thing I have ever seen.  We were allowed 30 minutes of uninterrupted bonding/breastfeeding time, before any weighing or cleaning was done.


It would have been longer than 30 minutes...but my placenta wasn't moving.  At 30 minutes, the nurses started to massage my stomach (OW), no dice.  At 40 minutes, they started pitocin again....I disliked it as much the second time around!  At 55 minutes, I started to bleed heavily and they called to prep the OR.  At the very last minute, Kathy's partner and ex-husband Doug-the-OB asked me if I wanted him to try a manual removal, rather than a D and C.

I didn't want to be separated from my baby and I didn't want to go under ansethesia, so I said yes.   They cleared the room, my mom and husband were actually escorted out of the maternity ward.  Kathy held my shoulders, and Doug reached up inside me and manually removed my placenta.  My poor husband said he could hear me screaming from across the hospital.  Hurt like hell....but given the choice, I would probably do it again to avoid the operating room.

Wow, that's a terrible picture...but a beautiful baby!!

In the 24 hours that followed (we were released early by request, I felt great), there was never a mention of formula or pacifiers.  We were visited by 3 lactation consultants!  There was no question about the Hep B vaccine, and liquid vitamin K was supplied.  No eye goop either, and no pressure to use it. They did ask us 4 times if we wanted to have David circumcised - but when we said no, our decision was met with relief and respect, depending on who asked.


David was only away from my side for 10 minutes, held lovingly by his midwife while I showered and my husband was on his way back to the hospital with the carseat. 

Summary



Overall, I believe my hospital experience was far superior to what many mainstream hospitals will offer a laboring woman.  I was respected, my wishes were respected, and the hospital waited longer than most would to intervene - 14 hours after my waters released, and almost an hour on a retained placenta.  I have since learned that most hospitals will only allow 4-6 hours of "no progress" and a hard rule of 30 minutes for placental expulsion.


Also, even though not everything went according to "plan", we were still able to get back on track.  I had an orgasmic, medicated birth.  I've still never heard of another.  I thought it was all or nothing, and again the world showed me another shade of gray!  Next time around, I'd like to have a home birth, but I'm not unhappy with the experience I had. 


So, if you choose a hospital birth and things don't go as planned, don't give up on the whole thing!  You can have a beautiful, amazing, mind-blowing experience in spite of it all.   And, at the end of it all, I got to bring home the best (early) birthday present ever, blue eyes and all.

Moms with IBD - Part 2!

Here we go - part 2!  Part 1 is about medications, and what's safe or not safe during pregnancy or breastfeeding.  This section is not as specific, I'll try to go after it in a Q and A.

Disclaimer: I'm not a doctor.  I'm a mommy with UC who likes to write stuff and put it on the internet.  Please don't take my advice over the advice of someone who has a medical degree and does this for a living!  Talk to your doctor before you do anything dumb.

I have UC/Crohn's.  Can I have a baby?
Yes.  Lots and lots of women with IBD have kids, and have healthy, happy pregnancies.  You need to take extra-special care of yourself during pregnancy and post-partum.


Does UC/Crohn's affect fertility?
Yes and no.  If the disease is under control, then there should be no change in your ability to get pregnant.  Active disease can affect fertility - mostly due to fever, anemia, inflammation, and general malaise.  If you're flaring, try to get healthy before you try to have a baby.

What should I consider before trying to conceive?
Evaluate your health with your GI doctor.  Does he/she believe you are healthy enough to handle the physical and emotional stress?  Discuss any drugs you may be on right now, and get off any of the nasty meds if you can.

Will I flare during pregnancy?
Maybe, maybe not.  About 25% of IBD mamas will flare during their pregnancy - 75% will stay totally healthy.  If you do flare, it is most likely to happen in the middle to end of your second trimester, when your hormone levels peak.  Keep an eye on your symptoms and address a possible flare early.  Many treatments work for a mild flare but major flares are harder to control.

Do I have to see a high-risk OB?
Not unless you have high-risk symptoms.  Having IBD does not make you high risk.  If your pregnancy is progressing in a healthy way (even if your disease isn't!), you can see whoever you are comfortable seeing.  Despite being in the midst of a rough flare, I was lucky enough to be cared for by a wonderful midwife.

Do I have to have a c-section?
No.  If you have had surgery on your intestines, you may be given the option for a c-section, but remember - it's major surgery.  Many GI and obstetrics professionals recommend vaginal birth, because it is easier on your system.  

If you are flaring severely, there is a slight risk of fissures while pushing.  The solution to this is not a c-section!  The solution is mother-directed pushing; that is, rather than being told when to push and counting to 10, you push when you are comfortable doing so.  Your body will tell you when you push, don't worry - and it will also tell you when not to push, which is very important.  If you decide to have an epidural or other pain medication, ask that it be turned down or off before you start to push.  That way, you can feel your body's reaction and control it.

I know a few moms with IBD who have even had home births.  Don't let your disease rob you of a beautiful birth experience.

I have to have a colonoscopy or endoscopy while pregnant.  Is this safe?
Colonoscopies, sigmoidoscopies and endoscopies should only be performed during pregnancy if medically necessary, and then, they should be performed after the middle of the second trimester.  I had an unmedicated colonoscopy at 21 weeks, and I do not suggest it.  Because my disease was in full swing, it hurt more than unmedicated childbirth!  If you'd like to learn more about sedation options, click here.  I wish I'd researched them before instead of after.

I'm used to the pain that comes with UC/Crohn's.  How is labor different?  Will I know I'm in labor?
I can't answer the first question personally (my first sign of labor was my water breaking!) but other moms say to look for regularity of contractions.  You'll feel your entire belly get hard, and contractions are timeable.  I found that the pain of natural childbirth was really not very bad at all, compared to my worst UC pain.  Pitocin contractions were a different story....

I'm flaring.  Is my baby in danger?
Probably not.  If you are past the halfway point in your pregnancy, your body will usually choose to take care of the baby before it takes care of you.  In your first trimester, a severe flare does carry a higher risk of miscarriage, because of malnutrition.  If you are losing weight in pregnancy, this is a concern and you should talk to your GI doc about getting your flare under control.

I'm scared to take medicine.  I won't even take Advil or have a beer! 
Me too.  BUT, we're in a tough spot.  It's about balancing risk.  Your baby needs a healthy mom - before and after birth.  Putting your own health at risk does not help the baby.  Work with your doctor to find a solution.  Do not hide from this disease.  It will not go away on its own - you have to do something, if it's diet adjustment, supplements, or medicine.

Can I breastfeed my baby?
Yes, unless the medications you need are unsafe for breastfeeding.  Malnutrition can cause supply problems, so do the best you can to stay healthy while you are breastfeeding.  If you end up on the nasty meds post-partum, you can look into milk donation.  There's a great group on Facebook called "Eats on Feets" that can put you in touch with local donors.

Will I pass IBD on to my children?
I don't know.  Nobody does.  There is clearly some genetic component to IBD, but it's not cut and dry.  Breastfeeding cuts down on the risk of your baby getting IBD; so does healthy eating during childhood.  Most people with IBD have a close relative with the disease, but it's not a straight corrolation.  There is currently no genetic testing for IBD.

Any other advice?
Be careful right after you have the baby.  Most of the IBD moms I know flared, not during pregnancy, but right after - in the 6 weeks post-partum.  Your hormones crash, you're not getting enough sleep, you're stressed and anxious, and you eat pizza 4 nights a week.  Not a good combo!

You are most vulnerable after you have your little one in your arms.  Every new mother needs lots of support; you need even more.  The advice to "sleep when the baby sleeps" is especially important to you.  Don't live on take-out; eat healthy and carefully -  make your friends and family cook for you.  Take care of yourself.  On the boards below, you'll hear story after story of IBD moms hospitalized when their babies were weeks old...including me!  Take care of yourself.


How can I connect with other moms with UC and Crohns?
Healing Well's support group has a lot of great moms and other resources.
UC and Crohn's Mommies on BabyCenter
Facebook - Moms with Crohn's and UC

Good luck!  Post comments!  More than anything, be well and enjoy your baby.  Don't let IBD diminish the beauty of pregnancy and birth for you.  This is a wonderful, precious time.  Love it.

Moms with IBD: All About The Meds

This isn't as universal a post as my other stuff, but hopefully it will be helpful to those who find it relevant.  This is directed at mothers or would-be mothers with Ulcerative Colitis or Crohn's Disease.


When I was pregnant with my son, I didn't realize how much my (then latent) Ulcerative Colitis would affect my pregnancy, delivery, and recovery.  The information online is patchy at best, and every doctor seems to have differing opinions on how to treat UC or Crohn's in pregnant and breastfeeding patients, or in those who are trying to conceive.  It was difficult to put everything together, and there is a lot of bad information out there.  I was going to put this all in one post, but it's too much.  This post is about medication.  See Part 2 about additional concerns during pregnancy and breastfeeding.

I'm not a doctor.  This is the internet.  Don't be stupid.  Talk to your doctor about the best courses of treatment for your disease, and work with your doctor to assess the risks and benefits of any treatment.

Q: "Should I take medicine for my IBD while pregnant/breastfeeding?"


A: Work with your doctor(s).  Flaring while pregnant or lactating isn't good.  If you're pregnant, being malnourished can harm your baby.  If you're lactating, it can severely impact your supply and your ability to be a good mommy.  Don't neglect your own health because you're afraid of the medication.  Try non-medical stuff, but don't end up in the hospital (like I did) because you fear the necessary medications.

ALL ABOUT THE MEDS
I'll start here because it tends to be the thing weighing most on mommy minds.  Let's start with the safest ones, then go up from there.

Safe(r) for Pregnant and Lactating Women

Probiotics 
If you're not already taking these, I highly suggest that you start.  There have been numerous studies that show a strong positive relationship between IBD remission and the use of probiotics.  You can start simple - Kefir (sold at your local grocery store) has high levels of "good" bacteria.  Many folks make their own.

For supplements, the "top dog" is VSL#3, which is available online.  Alternatively, you can try Acidopholus, available at your local pharmacy or health food store.  Get the highest count you can, and keep the pills refrigerated for longest life and potency.  There are no known negative side effects to probiotics; even if they don't work for you, there is no risk in trying.

Vitamin D
I have done a good amount of research, and found that vitamin D deficiency can also contribute to possible flares.  I take 1000-2000IU of additional vitamin D in the summer and 3000-4000IU in the winter.  If you spend a lot of time in the sun, or eat a good amount of foods containing soluble vitamin D, you may need less.

Fish Oil/Omega3
Be careful to look for oils that are mercury-free.  Omega-3 fatty acids can really help your digestive system stay in balance.   If you're not flaring, you can get this from fish and some meats, but if you're flaring or pregnant some of these may be off limits.  Fish Oils also provide DHA and EPA, which reduce inflammation and are also good for the baby's development.

Folic Acid
You may not be able to take a "regular" prenatal vitamin (see below), but folic acid is of vital importance to your baby's health.  Ideally, you should start taking it before you are pregnant.

Vitamin C
Always a good choice.  Again, there have been studies that suggest improvement in IBD with increased vitamin C, and it's also good for the baby (some studies have even shown a link between increased vitamin C and lower SIDS risks).  It supports natural tissue growth and healing - you need healthy tissue and healing, right?

Potassium
If you get cramps (muscle, stomach, whatever), potassium can really help.  Flaring IBD can inhibit your body's natural processing of potassium, so you should pay special attention to this if you have diarrhea or vomiting as a regular symptom.  You can either take a supplement (I did), drink potassium-rich drinks (I kept a bottle of Gatorade in the bathroom; every time I ended up in there, I'd drink it), or eat potassium-rich foods like bananas, avocados, and potatoes.

Prenatal Vitamins - proceed with caution.
Many women with IBD are sensitive to the increased Iron in prenatal vitamins.   You may want to consider an iron-free multivitamin or a combination of other vitamins rather than standard prenatals.  There's a lot of (usually good) stuff packed into a prenatal.  I personally found it better to take everything seperately than in one package.  Less convenient, certainly, but easier on my system.  I find that I am very sensitive to all of the metals (zinc, copper, sometimes magnesium).

Dietary Stuff
This could be really long, but I'll keep it short.  Most doctors say diet doesn't have much to do with IBD.  Pretty much every patient I know wildly disagrees with their doctor on this matter.  Frankly, I think it's ridiculous to ignore diet as a part of treatment!  Personally, I'm very sensitive to sugar and white carbs, popcorn, nuts, and any oil but olive oil or butter.  Other people have other things.  One neat trick - right before you eat something, take your pulse.  20 minutes after eating (and relaxing), take your pulse again.  If it's much higher, you may be sensitive to that food.  Also notice if you feel flushed or anxious; these can also point to sensitivity.  Eliminate or limit the "bad" foods and you'll feel better.

PRESCRIPTION MEDS - LOW(ER) RISK
Many medications for UC and Crohn's are relatively safe during pregnancy (Category B-C).  

Lower risk doesn't mean no risk. But, flaring during pregnancy is certainly something you want to avoid.  You need to work with your doctor to determine what level of risk is acceptable to keep you healthy without causing risk to your baby.  Healthy mommies make healthy babies. 


Mesalamine - Pregnancy Category B
Rowasa, Asacol, Lialda, Pentasa, Apriso, etc.
If you have UC and it affects only your lower colon, the least dangerous (and often most effective) of these are suppositories and enemas.  Ick, yeah, but because they are applied directly to the site of inflammation, very little of the drug enters your bloodstream.   Lialda has the highest dosage of mesalamine per pill, at 1.2g per tablet.

Mesalamine is "bowel-specific", and even taken orally, only a small amount enters your bloodstream.  It does cross the placenta, but studies have not proven any evidence of harm to the baby (note: evidence of harm does NOT mean evidence of NO harm). There have been a few studies that showed a slight risk of cleft palates, but they were not statistically significant.

Mesalamine does pass into breast milk; there is potential that it may cause loose stools in your breastfed infant if they are sensitive to the drug, but most babies do not have a problem with this.   

If you are on Mesalamine as a maintenance drug, your doctor will likely suggest that you stay on it during your pregnancy and while breastfeeding.

Sulfasalazine (Azulfedine)- Pregnancy Category B
Similar to Mesalamine, this is considered another "ASA" med and has similar risks and benefits.  It is often used if you (or your baby) are sensitive to mesalamine.



PRESCRIPTION MEDS - MEDIUM RISK

Prednisone - Pregnancy Category B/C
This is a love it, hate it drug.  The side effects of prednisone are long, very real, and very serious - to you.  Being on prednisone sucks.  Flaring can suck more.  Long-term prednisone use causes adrenal dependency (it's hard to get off of) and even short-term, it causes insomnia, irritability, swelling, weight gain, headaches, and a slew of other annoying, destructive, and frustrating effects.  

That being said, it is probably the first thing your doctor will prescribe if you're suffering from an acute flare (bleeding a lot, really sick).  It works.  I sincerely hope you don't need this drug.  If you do, try to get off it as quickly, safely, and carefully as you can.  Prednisone should only be used in pregnancy if it is necessary, and if there is no safer alternative.  Flaring is not good for you, or your baby, either.  You need to carefully weigh the risks and benefits with your doctor before deciding if it is right for you.  The more you have to take, and the longer you take it, the greater the risks.  A 5mg dose is not the same as a 60mg dose.  Your doctor should prescribe the lowest dose that will control your flare.

There is an increased risk of cleft palates in babies whose moms took prednisone during the first trimester.  During the second and third trimester, there is an increased risk of low birth weight, and taking it in the third trimester has been linked to increased risk of preterm labor. Flaring IBD in the second and third trimester can also cause low birth weight and preterm labor - studies were not always able to determine if the cause was prednisone or IBD.

Prednisone can increase your risk of developing Gestational Diabetes.  If you are undergoing long-term prednisone treatment, your doctor or midwife will probably have you do the glucose challenge testing several times during your pregnancy.  Prednisone also decreases your ability to fight infection.

It is extraordinarily dangerous to stop prednisone abruptly.  If you are on it and want off, you need to work with your doctor to taper carefully.  Just stopping prednisone can cause adrenal failure and even death.

Prednisone has not actually been assigned a pregnancy category by the FDA.  Some brand names are B, others are C.

Other Corticosteroids (endocort, prednisolone, cortisone etc) all have similar side effects and risks to Prednisone, but they don't always work as well.  Some can be prescribed in enema form, which carries the lowest risk but also the lowest reward.

PRESCRIPTION MEDS: UNKNOWN RISK



Anti TNF Inhibitors: Remicade, Humira, Cimzia, Tysabri (aka Biologics)
These are scary drugs, big guns.  If you are on them, or your doctor suggests going on them, you need to do your research.  I am on Remicade, and it's right for me right now - but I'd be lying if I didn't say that it scares me to be on them.  Nothing else works for me; it's either Remicade or remove my colon.  Some people have chosen surgery over them.  With Crohn's, it may be biologics or the hospital.

Anti-TNF inhibitors (all varieties) suppress your immune system.  They all cross the placenta (when you're on them, so is your baby).  There have been very few studies on how they affect babies.  You will need to discuss this in depth with your doctor, ideally prior to becoming pregnant.  We're delaying our try for the next baby for a few years, until I can get off Remicade, or until better studies are available.

There may be increased risk of birth defects, an increased risk of miscarriage (maybe because IBD affects your body, who knows), but ultimately, not enough studies have been done to determine if they are safe or not.  I know a few people who have been on these during pregnancy and it worked out very well for them.  Here are some things to check out:

Remicade: http://www.otispregnancy.org/files/infliximab.pdf
Humira: http://www.otispregnancy.org/files/adalimumab.pdf

On the plus side, both Humira and Remicade seem to be safe for breastfeeding.  The molecules are huge and do not appear to transfer into breast milk.

EDIT: New research is ongoing, and it appears that Remicade is relatively safe during pregnancy.   I am trying to get copies of these studies, but I am told that the evidence is pretty clear, and that Remicade is being downgraded to category B.  The risks in smaller studies appear to be lower than the risks of corticosteriod treatment (aka prednisone).  It is important to note that no long-term studies have been done;  of Remicade has been linked to higher risks of certain cancers, and it is unknown if these long-term risks also pass to babies.

PRESCRIPTION MEDS: VERY HIGH RISK



Naltrexone - Category C/D (depends on brand).  Known to cause birth defects, smaller risk than the meds below.  May cause PPD and may disturb bonding with your baby.  Does pass into breast milk and may cause developmental delays, however, it may be possible to breastfeed on this drug.  More research needs to be done.  If Naltrexone is on your table of options, get to know Dr. Google.

Mercaptopurine (6MP) - Category D: It says right on the label that 6MP shouldn't be handled by women who might possibly be pregnant.  There may be extreme circumstances that warrant its use, but I would not personally take it while pregnant or breastfeeding in any circumstance.  It causes known fetal harm, including increased risk of miscarriage, birth defects and still birth.  It is also NOT safe for breastfeeding.  You will have to choose between breastfeeding and 6mp - I had to give up breastfeeding to stay healthy.

Azathioprene - Category D: Again, not safe for pregnancy or breastfeeding.  Causes known deformities and increases risk of fetal death.  Do not breastfeed if you are on this drug.

Methotrexate - Category X: REALLY bad.  MTX is used to treat ectopic pregnancy and causes early abortions.  This is the "abortion pill" used in clinics.  Do not take methotrexate while pregnant or breastfeeding under any circumstances.   If your doctor suggests it, find another doctor immediately.

Thalidomide - Category X.  Known to cause extreme birth defects.  Not safe for breastfeeding or pregnancy.  Also should not be used in the weeks prior to pregnancy, since it has a long life inside your body.  If your doc wants you on this while pregnant, seriously question their medical license.


OTHER MEDICATIONS

Metronidazole (Flagyl) - Category B, BUT.... the use of this drug in pregnancy is very controversial.  The FDA has given it category B, which is a "safe-ish"category.  There is evidence of toxicity in animals, but not in people. It definitely causes problems for baby mice, rabbits and rats, including cancer.  It has not been shown to do harm to humans, but there is real cause for concern, and a campaign to change the pregnancy category by some doctors and patients.  Breastfeeding is also not recommended on this drug - "pump and dump" for 24 hours after the last dose.

Ciproflaxin (Cipro) - Category C.  Oddly enough, the research on Cipro shows less evidence of harm than Flagyl, but it's got a higher catogory.  Who knows... anyway, breastfeeding is safe on Cipro.  There is a slightly higher risk of joint problems in babies whose moms took Cipro.

Sedation (for colonoscopies etc): Every doctor seems to use different drugs for sedation during procedures.  All of them have some risk for pregnant women.  Lactating women should pump and dump for 24 hours following sedation.   If you're going to undergo endoscopy or colonoscopy and want to be sedated (I'll write about that tomorrow), this is a good site to check out:
http://www.sedationfacts.org/sedation-complications/sedation-pregnancy

Pain Meds
Technically, the only "safe" pain medication during pregnancy and breastfeeding is tylenol.  Vicodin (hydrocodone) is sometimes prescribed if your pain gets out of control, but there are very real risks, including dependency and difficulty breathing in newborns, if taken close to delivery or for long periods of time. Other pain medications should be avoided.   When my pain got really hard to handle, my doctor suggested that I take Tylenol PM - the PM is Benadryl.  Really, look it up.  Sleeping through pain is better than being awake for it, if you're the sort of person that gets sleepy on Benadryl. 



Phew!  I think I covered most of the meds.  Feel free to comment or add your information!  I will happily edit any misinformation (again, NOT a doctor) and add anything you believe is relevant.
 CLICK HERE FOR PART 2

Advice for New Mommies

I spend time on a couple of Mommy Boards, and I asked for a few pearls of wisdom from the groups for a friend who is expecting in a few weeks.  I figured I'd post their responses here, for the world (or my tiny piece of it anyway) to enjoy.

Credit for the silly baby instructions goes to "Safe Baby Handling Tricks" by David and Kelly Sopp.  :)  Buy the whole book here.

"Every baby is different and what works for one won't always work for another. Follow your instincts!"

"Laundry/dishes/vacuuming/housework can all wait. Don't feel bad if you don't get off the couch all day if that's what you need to do for you and baby that day, and don't try to stay up late to make up work that "should have" gotten done. Only worry about taking care of yourself and your baby. Get help if you can, from your husband, family, friends, or a postpartum doula."

"I wish someone had told me how amazing BabyWearing was and that I should get a stretchy wrap to start with from the beginning :)  I didn't get one until finding this board and my son was 5 weeks old at that time.  I was so excited to have 2 hands when I was wearing him!"

 

"I wish that someone would have told me that in the beginning breastfeeding is pretty much non-stop and that it is OK to be couch bound or bed bound for the first few weeks...however this is the same reason that I wish I had known about using a wrap- I was able to breastfeed and move about a bit- which felt a bit freeing after 5 weeks of being couch bound :)"

"Trust your instincts; nobody knows your baby better than you do."

"Trust your instincts and enjoy your baby.   So many people offer so much advice and they are only tiny for a short time...enjoy it and don't worry about when your baby is sleeping through the night or if he is spoiled.   Smile and nod at everyone's advice...or better yet...say "Thanks but no thanks"  unless you ask."

"It goes way too quickly - don't wish your child's life away (i.e. I can't wait for him to smile, roll, etc).  Savor every minute that you have - enjoy the now."

"I wish someone had told me to do whatever I needed to to calm a fussy baby....when he was itty bitty and crying all night, I thought it was "cheating" to put him in the swing and I never considered wearing him.  I thought I should be able to comfort him by rocking / singing to / walking / bouncing him.  That seems so incredibly silly to me now, I can't imagine why I thought that."

"Spend the first few days as a family. People will come over and want to visit, but your priority needs to be bonding with that baby!  I see so many new moms exhausted (even more than normal) because all these people come over and watch the baby sleep and then guess who is not sleeping all night because they need to eat?  I encourage them to give people a timeline, and other than that couple of "visiting hours' nobody can come over!"

 "Ignore the clock.  Cover them up if you have to.  Sleep at 4pm, watch a movie at 2am, do whatever works.  Clocks are not your friends right now and they will probably only frustrate you.  Feed the baby when she's hungry, try to sleep when you can, no matter what time it is."

"Do whatever is right for you and your family. If that means sleeping with a baby on your chest or choosing to formula feed vs. breastfeeding. Do whatever you need to do to survive.  "

"If baby is crying, try a hair dryer, it's the only way I can get my son to take a nap. I wish I learned about it earlier. Wear your baby as much as possible if you want to get things done around the house or if baby won't nap. For a while, my son would only nap if I wore him."

 "Family and friends mean well.  But don't let them make you second guess yourself.  And if it becomes too overwhelming having people around ask them to leave for a while.  Even if they're staying with you.  Send them out grocery shopping or to see a movie."

"Sleep when they sleep, don't wake them up to feed them, let them sleep, get out of the house if you want to, ignore advice of others if you want to, listen to the doctor (call even if you think it might be a silly question), ask questions (even if you think they are silly), allow others to help you (watch the baby, make dinner, clean), let your husband be a part of it all, take lots of pictures, and fill out that baby book!"

"Trust your instincts and do what feels right. The first couple weeks (and months for that matter) are a battle to find a routine but it does get better. People mean well, but that doesn't make them right."

"The quicker you get the baby in the night, the quicker they fall back asleep after feeding."

"Nap when the baby naps. Use this time to catch up on sleep, tv, or whatever that relaxes you.  Don't be tempted to do chores!"

"Don't be afraid to tell people NOT to come over. When my daughter was born I was so overwhelmed by people coming over to visit her/us. They all meant well but it was just more trouble than it was worth with everything else going on...I'll change that next time for sure!" 

"Sleep when you can, if you don't get anything done around the house for 2 weeks oh well. You have a new baby and its mommy and baby bonding time. Don't be afraid to ask for help from your husband, in laws or friends. Trust me, my husband knew more about my pump and my boobs then he would have ever wanted to know."

"Try new things with baby to calm them, going outside (weather permitting) will not hurt them, it's good to get fresh air."

"Listen to what others say, but pick and choose the advice you want to use."

"Try not to stress too much over breastfeeding, it's not good for your supply and the baby can feel it. Relax and go slow, and you will eventually get it. I will be the first to say... Its not easy.  That said it's also not for everyone. Don't feel guilty about going to formula of you just can't do it. Whats important is that baby is getting enough to eat."

"If you can, relax and assume that babies know what to do and take your baby's lead on everything.  As long as s/he's eating, peeing/pooping, and growing, s/he's fine.  Try not to compare to the "average" baby or babies you know."

"Make sure you always have a drink for yourself, a source of entertainment, and a burp cloth within arm's reach and that your position is comfy before starting to breastfeed."

"Point the penis down before you secure the diaper.  And always keep in mind that an undiapered boy is a loaded weapon.  Oh, and move from NB to size 1 diapers when your baby starts peeing more volume even if they still fit in NB- I swear my son started sleeping longer after that change just from the added absorbency."

"Try to put the baby down for a nap when s/he is drowsy or showing signs of fatigue not just when s/he is completely out.  Doesn't always work, but saves a ton of time for you when it does."

"Get out of the house early and often for your own mental health.  It's an undertaking the first few times but gets easier and easier.  Take a ton of pictures and enjoy every stage because the time goes SO fast!"

"Don't give a second thought to what you or your baby "should" be doing.  Do whatever works for you and screw what everyone else is saying.  Don't be afraid to stand up for what you are doing.  It's your baby, not your mom's, not your sister's, not your aunt's, not your grandma's, not your best friend's.  So do what you want, not what they want."

"The first 6 weeks (sometimes more) are pure survival.  Allow yourself to let go of the outside responsibilities like cleaning the house and keeping on top of the laundry, and don't feel guilty about it.  For the first month and a half or so, the only time I ever did laundry was when my nursing bras and tanks needed to be washed.  Basically my laundry during that time consisted of the same nursing bras/tanks, yoga pants, and hoodies.  My husband was on his own.  And we ordered in food a majority of the time.  There was no cooking.  I felt horribly guilty about it at the time, but now I wish I would have given myself permission to just let it all go!  I certainly won't be worried about that crap this time around."

"If you have someone over that you trust don't be afraid to let them love on the baby for a bit while you go shower, take a nap, use the bathroom, or just take sometime to yourself.  Some of my favorite visitors were those that I didn't feel like I needed to entertain.  When my best friend came over it was so nice handing her the baby and saying "I'm going to jump in the shower, be back in 20 mins."


"Even though it seems so hard at first, I promise it does get better. :)"