Eggs

Roger made himself lunch today. I was mean and would not let him have cold cereal because he'd already wasted nearly a whole bowl when he didn't finish it at breakfast, so he decided to make himself some scrambled eggs. Four, to be precise. I warned him, "You'd better eat everything you fix."

When he got up from the table to go play I asked him, "Did you eat all the eggs?" "No!!" he exclaimed. "Why not?" I ask. "There were a whole lot of them and I was full!!" I looked at his plate and saw that it was empty. "What did you do with them, did you throw them away?" "No!!" "Then what happened to them?" "I was full, I couldn't eat them!"

Finally, I figure out that he thinks I meant all the eggs in the fridge when I asked him if he'd eaten all the eggs. The whole time I was thinking, "What the heck happened to those eggs, then?" and he was likely thinking, "Is mom nuts??"

Two and a half weeks left

until my due date. Things are now going swimmingly with the pregnancy. All of the various issues I'd been concerned about have cleared up and things are going along normally now. Hopefully it will stay that way through the delivery!

Are we ready? Not in the slightest. I haven't gotten the infant seat from out of storage at my parents' house, haven't washed and organized the baby's clothes, and in fact don't even have drawers or a box or anything to put the cleaned and organized clothes into, and don't have a place for such drawers even if we had one. We haven't gotten the cradle out and put it back together (and I'm not sure where the cradle's sheets are!), or packed a hospital bag, or collected phone numbers together so we can call people after the birth (my address book has met a sad an untimely end). The house is still a pig sty, no meals in the freezer, I'm sure I could list more things that are undone. The child has no socks at all, but does have a fedora waiting for him. Don't you love our priorities?

In other news, the boxes containing all our homeschooling materials for next year are now in the state, and will be delivered tomorrow! Ten to one those things will be gone through, organized, and carefully put away before I even think about the baby things.

Should we trust birth?

"Trust birth" is a phrase that I've commonly heard among those in the natural or home birth advocacy movement. There are even Trust Birth groups springing up advocating this. Such groups may state that trusting birth is natural, and fearing or distrusting birth is unnatural and has simply been taught through our culture. Is this correct? Fear of childbirth has in fact been common throughout history, in all times and cultures. Why? Because while birth is a natural process, it is also naturally a dangerous process. Childbirth in humans is an evolutionary bottle neck, where the advantageous feature of large, well developed brains conflicts with the advantageous feature of narrow pelvises, to aid bipedalism. It is also a complex process, to which no other natural process can be an adequate comparison. Pregnancy itself precariously balances the needs and health of the fetus against the needs and health of the mother. The result is historically high rates of both perinatal (around the time of birth) mortality for the babies involved and maternal mortality. This has the evolutionary purpose of keeping head and pelvis size in check, yet as a human event each loss represents a tragedy. We are not willing to accept the death of a human being as simply "evolution in action."

Improved sanitation and nutrition and modern medicine -- including antibiotics, safer cesarean sections, improved ability to monitor the health of mom and baby during pregnancy and childbirth, and developments in neonatal resuscitation and life support, among many others -- have dramatically decreased the perinatal and maternal mortality rates, although attempts to further reduce it are constantly being made. We now take these improvements in mortality rates for granted. We assume that mother and child will come through birth and be fine. Ironically, it is these very improvements that allow us to assume that birth is low risk and worthy of trust.

If we cannot trust birth, should we then fear birth? Are all interventions good and necessary, with no harmful side effects? Is the best response to make birth a completely medicalized event, attempting to remove all uncertainty? This position forgets that birth, as a natural physiological process, is not fully understood by science. We know of what can go wrong, but still often do not know why it goes wrong. We don't fully understand the purposes of the natural physiology of birth -- we can't know for certain what elements in the process of birth serve a purpose in the health of the mother and child, and we don't always know the long term effects of medical interventions.

I propose the best attitude of a birth attendant is not "trust birth," nor is it "fear birth," but rather is "respect birth." That is, respect birth both as a natural physiological process which goes well much of the time, AND respect birth as a complex event with inherent and natural risks. Birth attendants need both to allow labor and birth to unfold, and to exercise vigilance and intervene when deviations from normal begin to put mother and child at risk. This balance isn't easy, it likely takes significant training both in normal births and potential complications. It means accepting and responding to the scientific evidence on birth practices and interventions without prejudiced ideology. It means abandoning simple catch phrases or black and white positions and truly grappling with what we know, and what we don't know.

30 1/2 week update

Less than 10 weeks until my due date! Only 10 more weeks of stabbing pain when I walk, joy!

Mostly I am doing the same, feeling gigantic, getting plenty of "Is it twins?" comments, and being exhausted. I had another ultrasound yesterday, to verify that my previously low-lying placenta had moved up (it had) and to check on baby's growth, since I've been measuring big and have been getting increasingly bigger -- I'm now measuring 5 cm ahead. I have never measured big this early, and it is definitely making me more uncomfortable. I'm already experiencing shortness of breath and I can't see how I'll have room to grow for 10 more weeks. The ultrasound showed a baby on the bigger side, but not gigantic. It also showed what my doctor called "a generous amount of amniotic fluid." In my understanding, this can be problematic but at this point we will just need to continue to monitor it, so I'll likely have another ultrasound in a few weeks. Baby is already head down and hopefully will stay that way. Here's some pics:

28 Week Update

Well, I'm gigantic. Or at least I feel like I am. I am measuring 5 weeks ahead, but doctor seems to feel that this is likely due to stretched out muscles from my four previous large babies. I do have an ultrasound scheduled for 30 weeks, to check baby's growth, check my amniotic fluid levels and verify that my placenta, which was low-lying at my 20 week ultrasound, has moved up.

My ligaments and muscles aren't very happy about the size of the baby, and they'll probably only get less happy. I'm feeling pretty feeble but resting and using maternity support have helped. I'm considering making an appointment with the physical therapist at my OB's office, but I'd need to get a referral from my primary care provider and am not sure it would be worth the hassle and the time for the appointments. I am going to try following a stretching and exercise regimen I found online.

Had the gestational diabetes screening today, I'll find out the results in a day or two.

Here's a pic of my hugeness:

Breastfeeding, Mental health and Medication

I was perusing science-based parenting blogs this morning, and came across a blog focused on postpartum depression. As someone who has suffered PPD after each of my pregnancies, this was very interesting to me, and I was even more interested to see a couple of recent posts on balancing breastfeeding with the treatment of PPD. The initial one is here, and there is also a follow-up post here.

My psychologist finally figured out this last summer what was at the root of my struggles with depression and anger -- untreated ADD. Taking stimulant medication significantly improved my quality of life and my ability to function as a mom. It was very difficult to adjust to being off the medication during pregnancy, and I have been looking forward to getting a chance to take it again. However, the medication I was taking, an amphetamine derivative, is contraindicated during breastfeeding. It tends to concentrate in breast milk and would result in a nursling, especially a young one, getting far too much of the medication. It might be possible for me to take an alternative methylphenidate based medication, such as Ritalin, since the amount secreted in breast milk is far lower than with the amphetamines, but there is not good information on whether or not this would actually affect a young nursling or not. I do plan to discuss this option with my ARNP, but I am not sure that I am comfortable exposing a nursling to even low doses of stimulants. Finding accurate information to aid in the decision is difficult, as so much of the affects of medication while breastfeeding are unknown. Even experts disagree. Some who are strong advocates of breastfeeding view the benefits as outweighing the risks of nearly any medication, with only a few rare exceptions, while others view the possible risks of many medications as being potentially more significant than the risk of not receiving breastmilk. For many medications, there is little to no good research on milk transfer rates or possible affects on baby.

I could avoid the whole issue by remaining off the medication for a year or so to enable breastfeeding, but that would affect my ability to mother not only the baby but all my children, as well as affecting my adequacy as a homeschooling teacher. Would we all survive? Yes, we've done it before and we're doing it now, but now I know how much different things were when I was on a medication that got to the root of the problems I was having. Providing external structure through meal plans and a pre-planned easy to use curriculum will likely help, but it will likely all be much more of a struggle than I would have it I were taking a medication that I know works.

At this point, I don't even know which way I'm leaning. Still thinking through all my options, and trying to figure out what will be best for the whole family.

Soccer

Soccer has taken over our lives.

With two boys in soccer (and only two!) we have practices on three evenings a week and games on one weekday evening and Saturday morning. It has meant that all the kids are getting to bed later on a regular basis, especially the girls who beforehand and usually been in bed and asleep by 7:30 or so, and it means that I am constantly thinking about what we have each evening, whether there are clean soccer socks and shorts, etc. I will admit that Roger wore the same pair of socks two evenings in a row this week when I just didn't get the laundry washed. I think we may need to invest in a few more pairs.

I'm naturally a homebody and like to stick to a routine, so this is definitely a stressful time. On the other hand, the boys, especially Pauly, really need to be out moving around. Pauly would be happy spending all his time sitting on his bum reading or playing video games. He will be active if we go to a playground, but it is a struggle to get him outside and moving around at home. It has been very nice to see him at soccer practice and games. He is obviously out of shape and needs to work on endurance, but he has been giving it his best and doesn't stop trying. Roger has been enjoying himself as well. Still, I'm glad that this will only last a few more weeks before the end of the season. I'll enjoy just having evenings at home again!

No pics to share because I am too forgetful to take any. Maybe I'll get some done before the end of the season.