Mama Musings: The Home Birth of Auden

It’s boggling to realize that it’s been over nine weeks since the birth of my second child, Auden. I marvel at this stunning little person, so easily distracted by her hair, her cat-like stretches, the downy fuzz on her ears and the way she purses her lips in a way that instantly recalls memories of her brother at this age.  In the span of her little life, parenting has become a strange experience of contradictions. Life is both easier and harder; clearer, yet more disorderly; more expansive, yet also very limiting. My days are measured in moments of undiluted joy and blinding exasperation. Now that I think of it, these are all ways in which I would also describe her birth.

The evening before Audie’s birth, my husband took our toddler son to our local children’s museum for the evening. I decided to use the time alone to indulge in some needed solitude. I poured some tea and a bath and read a little in the tub. I got lost in the quiet, watching my belly thump and stretch to the rhythm of the one-girl dance party inside.  I took my time shaving my legs. A friend had given me lovely handmade lotion bar, and I used it generously afterwards. I blow-dried my hair and dabbed on a little perfume. It occurred to me that I was behaving as if I were getting ready for a date. Maybe I kind of knew on some level she was coming, I remarked to my husband later the following day as we lay next to each other for a nap in our bed, a freshly born daughter dozing serenely between us.

I had woken up around 3am on my due date with contractions. This was not a new experience; I’d been awoken numerous times by similar sensations over the course of the previous weeks. I laid in the bed watching my husband and son sleep for a few moments, realizing that these contractions were coming pretty regularly. I got up to use the bathroom, thinking, If I could just go to the bathroom I’d feel better. But I didn’t feel better. For about an hour, I used an app on my phone to time the contractions while I stayed in bed, unconvinced that these were the ticket to the big show.

With my son’s birth, I lost my mucous plug early one morning, had bloody show that evening, and about 5 minutes after that my water broke. Contractions started within the hour. That was my only frame of reference for how my body managed birth, so this is what I expected to unfold again. But I hadn’t lost my mucous plug; I’d had no bloody show; my water had not broken. The contractions were lasting anywhere from 50 seconds to a minute, coming every 4 – 5 minutes. When I was no longer comfortable laying in the bed, I crawled out of the covers and creeped over to my husband’s side of the bed. I told him in a whisper that I was having regular contractions and was going downstairs to take care of a few things. I encouraged him to stay in bed and told him I’d let him know if I needed anything.

Just after 4am, I went to the kitchen and brewed some coffee, but no sooner than the pot had filled, coffee suddenly seemed like a terrible idea. Feeling a little hungry, I pulled out a sauce pan and started gathering ingredients to make oatmeal, but no sooner were the ingredients all collected, oatmeal suddenly seemed similarly disgusting. The contractions still continued to come, and I braced myself on my cold granite countertop until each one receded. There was a fresh pineapple in our fruit bowl on the counter in front of me, and it was all I could smell. I took deep breaths of pineapple and swayed through a few more contractions. I swept the kitchen floor and wiped down my stove top in between contractions that made me feel increasingly unsteady. You know, because insignificant chores are what all ladies who are in slight denial that they are about to have a baby do. In hindsight, I think I was desperately trying to distract myself from from the intensity of it all.

I texted my midwife, Linsey: 4:16AM, Feb 9: Having regular contractions this a.m. since about 3am. About 50sec-1min long every 5min or so. Feeling ok, trying to rest. Will check in again soon. 

A minute later, she responded: 4:17am, Feb 9: Ok. Thx.

I pulled some bagels out of the freezer and gathered some apples and bananas. I grabbed the pineapple, thinking I might slice it, too, but just the thought of that suddenly seemed like way too much effort.  I plucked a sampling of tea bags from the cabinet and arranged them next to a jar of honey, some lemons and a few mugs. You know, just in case we’d be having guests–the kind who birth babies for a living–for breakfast.

I texted my in-laws, who were on-call for birthing day toddler duty: 4:40am, Feb 9: We might be having a baby today. Will keep you posted. Reg contractions since 3am. Everyone here still asleep. XO

My husband came downstairs briefly to check on me a few moments later. I told him that I was managing, that I might try to sit in the bath for a little bit. He asked if he should get the birthing pool ready. Fearful that a poorly rested toddler might present some challenges for us as the morning wore on, I told him that we should probably let our still-snoozing son sleep as long as possible. The plan had been to inflate the pool in our bedroom, but I worried the pump for the pool would likely wake him. If that didn’t, our scurrying in and out of the room surely would.

I went back upstairs and poured a bath. I couldn’t get comfortable in the bathtub. I weathered just a couple of contractions there, got out, dried off, and put my pajamas back on. Apparently the idea that a baby was on her way was beginning to sink in because I didn’t bother putting my underwear on under my yoga pants.

My head started to feel a little fuzzy. I’d been listening to Hypnobabies scripts for the last half of my pregnancy, but suddenly couldn’t remember which script I needed to listen to at this point.  I went to our tv/playroom and rifled through my Hypnobabies home study book trying to find the answer, but I couldn’t focus on the words and quickly gave up and laid down on the couch. (I had a great Hypnobabies birth with my son, and I knew these scripts by heart–I think my gridlocked brain had everything to do with the tsunami of intensity of this fastly unfolding birthing.) I tried to breathe through a few more contractions, but my breaths involuntarily came out as groans. I was toppled by a wave of nausea. I grabbed a bowl from my my birth supply basket, convinced I was about to vomit. I felt like I was on fire and started profusely sweating. I opened the door from our tv room that leads out to our front balcony and stood in the doorway taking in the winter morning breeze. When another contraction came, I braced myself on a nearby rocking chair. The contractions were so powerful, almost paralyzingly so.

I started to feel my composure slip away; I started to vocalize a lot. It came reflexively, the loudness. The I-don’t-care-who-hears-me-ness. My husband came into the tv room and closed the balcony door. I thought he’d done it so that neighbors wouldn’t hear me. Later he told me that he’d actually closed the door because the room was freezing in the 30 degree breeze. The chill never registered to me. I was somewhere else.

I texted my midwife: 5:39AM, Feb 9: I think I forgot how intense this can be. Got in my bathtub for a bit but could not get comfortable. frequency is slowing some but each wave feels harder. 

She messaged back: 5:41AM, Feb 9: It is intense but its manageable. 🙂 Let us know when you’re ready for us. We can come any time. Sounds like you must be having some nice alone time right now. 

With one of the following contractions, I sank to my knees. I was kneeling in front of my couch, prayer-like. My husband kneeled down beside me, and I started to openly sob. This hurts. I am struggling. I don’t remember it being this hard.  It wasn’t like this with Arlo. Oh god, this is awful. He would whisper, You’re doing great. And I would breathlessly say, But you don’t understand. 

Oh, transition, you wicked, wicked thing. 

I could feel everything shifting between my legs. There was this uncontrollable force of downward motion in my body. My body was moving the baby. I tugged down my pants, but couldn’t get them all the way off. I was frozen in that kneeling position and could not pull the waist of my pants beyond my knees.

My husband scuttled between the bedroom, checking on a sleeping Arlo, and the tv room, checking on me. I was still kneeling on the floor in front of my couch, burying my head into the cushion and reflexively vocalizing with each contraction. I tried to be quieter, but my body was in control, not my mind. In my head I kept repeating, This is only temporary. Listen to your body. This is only temporary. Listen to your body. 

At some point my husband had returned to my side, and I heard him say, Hey, buddy. Our two year old was standing in the doorway. He’d woken up, padded down the hall to the tv room and was surveying the scene. As my husband scooped our toddler up, I said, Call Linsey. Call her now. It was just a few minutes before 6am.

My back was to the door, so I didn’t realize that Linsey, my midwife,  had arrived until she was suddenly kneeling next to me. She listened to the baby quickly with the doppler and then began gently placing big waterproof pads under me. She was quietly empathetic and encouraging.

I felt my body pushing again, and I joined with it, pushing a little too. I had one of my hands between my legs, and with that little push I felt a trickle of water on my hands. My bag of waters. Good, Linsey encouragingly said to me.

My husband was out of the room with Arlo, who was protesting his ban from the room. He began to cry.  I was so worried about scaring my toddler. I don’t want him to see me like this, I said to my midwife. She said, He’s okay. He just wants to be with you. I needed my husband, and I was worried he’d miss something. I asked for him to come back into the room, and with him came my happy, unfazed toddler, who hopped up on the couch next to where I was resting my head between contractions. He gave me a bubbly greeting, Hi, Mommy!

I buried my face into my folded forearms with the next contraction, and Arlo said, I hide too! and he buried his face similarly. He handed me a book, Mommy, read? We all laughed. 

The baby will be here very soon, Linsey said. My in-laws still hadn’t received our texts and calls. Arlo, it appeared, would be there to see his sister born.

She checked the baby with the doppler again. I pushed when my body pushed, and a gush of water came with it. With the next push, the baby was crowning.  I could feel that she had hair on her squishy head. Keep your hand down there, Linsey encouraged. I think it’s helpful.

I pushed carefully with the next couple of contractions, fearful of repeating the third degree tear I’d had with Arlo. It was so hard to be patient–it burned to hold her there like that. Her head was nearly out.

And with the next push, her head was out. From behind me, I heard Arlo chirp, Hi, Baby! I later learned that Arlo had been very interested in one of Linsey’s flashlights, so she had given it to him to play with. The kid I was so worried about scaring was actually standing behind me with a midwife’s flashlight taking the scene in like it was zero amounts of a big deal. So incredible.

We were so blitzed by this labor that we’d completely forgotten to call our birth photographer. Our midwife snapped a few pictures with her phone for us, and there is one particular shot that absolutely steals my breath. It’s grainy and dim, which adds to its magic. Audie’s head had just emerged, and there is her face, so perfect, peaceful, and recognizable. Beneath her head is my hand, cradling her head, and under my hands are my husband’s two hands, open and ready to catch her.  Oh, how I love it: that perfect face, those three eager hands. 

I held her there again, waiting for my body to guide me through the next push. And then she was out, into my husband’s hands, with a big gurgly cry. My husband was positioned behind me and passed her to me back through my legs, and there she was, the baby I never expected, but wanted so much: slick, pink, whole and perfect. Lots of hair. Long fingers. I sat back on my heels, admired my daughter, and clutched her to my chest in relief. And joy. But lots of relief.

And there was our birth photographer, quietly on the scene after finally being summoned by our mindful midwife, snapping pictures of these first few minutes of our daughter’s life.

I nursed Audie briefly and marveled again at her features. She reminded me so much of Arlo. I handed her to my husband, and with my midwife’s assistance I stood and delivered my placenta with ease.

I walked back to my bedroom so that I could get cleaned up and changed, and there at the foot of our bed was the half-inflated birthing pool. The limp sight conjured up a little sad trombone for a moment, but I could really only smirk at it–yet another thing that I’d ardently planned out, but went in a completely different direction. We’d planned a water birth, but instead my baby was born about two feet from a pile-up of Arlo’s matchbox cars. Hah! I never mourned the whole not-in-water thing; once I was down in that kneeling position, I knew that’s where my baby would be born. There really was no moving at that point, and it was a very easy thing to accept. I had no choice, really. I did what my body told me to do.

I changed, nursed and cuddled my gooey baby some more, and then turned her over to my midwife for her exam. Audie checked out beautifully. She measured two inches longer than Arlo and was nearly a pound heavier. My midwife checked me out. I had a tiny labial split (not significant enough for a stitch), and no tearing of my perineum this time. Huzzah.

My midwife and her assistant cleaned up where we’d birthed, took down the birthing pool, and completed paperwork. Linsey spent some time peeking at Audie’s latch, and she went over all my postpartum aftercare information.

It was a blessing that my son was present for the birth. I’d thought I was pretty certain I didn’t want Arlo there, and I am now so thankful and excited that he is a part of his sister’s birth story. I love that  he was the very first person to greet this little girl and that he took the whole birth in with curiosity and ease. He may not remember being present for her birth when he grows up, but he’s a charming part of the story of the beginning of their siblingship, a story that we will tell them both over and again. May it be just the beginning of the all the times they are there for each other. 

Rhianna, a former social worker and current stay-home parent/human napkin, blogs from her adopted hometown of St. Louis. She has a masters degree in social work and credits this education and experience for priming her to be a gentle, attached parent. You can read previous posts about her home birth experience here, here and here. 

Mama Musings: How I Secured Health Insurance for Our Home Birth

Here’s the short story: I developed an instant respect and fondness for my midwife before I began seriously exploring the extent of my health insurance coverage for midwifery care. Afterwards I learned that I had no coverage, and I spent more than two months running through an infuriating gauntlet of insurance red tape in pursuit of some measure of coverage for my home birth. I’ll walk you through my journey to help those of you who may be navigating the same maze.

Here’s the longer version. After discussing with my midwife the fee for her care, some quick mental math told me that I’d likely be paying close to what I paid for my previous hospital birth. My midwife charges a sliding scale fee of $2500 – $2900 (you determine where you wish to pay in that range).  With my first pregnancy, my OB charged $900 for the term of my prenatal care, and the hospital bill from my first son’s birth was $1600. (The sum of these two costs doesn’t include the various co-pays and bills for labs and such that are a part of general prenatal care.) The expense for a home birth, I quickly concluded, was pretty much on par with my out-of-pocket responsibility for a hospital birth. I figured we’d just roll with the expense as we did the first time.

But there are many differences between my current pregnancy and my previous one, and the critical one is our family’s income level.  It was notably easier to absorb the expense of my first pregnancy when we were both working outside of the home. But now, as a single-income family, we have to be considerably more mindful of how we spend our money. There really is little room for unnecessary spending.

After many conversations with other home birth mamas, I learned that some of them were able to get partial reimbursement for their births, and a seed was planted. Any amount of money that we might be able to save ourselves would be worth the effort, I figured, no matter the hassle. Further, we pay for our health insurance, and we should do our best to make it work for us, rather than against us. Midwifery care is as valuable, substantial, and worthy of insurance coverage as obstetrical care is, and not trying to secure some coverage seemed like I was, I don’t know, conceding that this type of care is inferior to obstetrical/hospital-based maternity care.

My midwife contracts with a billing service specifically trained and experienced in billing for midwifery care and interfacing with insurance companies to suss out coverage. I swallowed a lump in my throat as I read the notes on my Verification of Benefits document from the billing service: Midwives are not covered. In-network exception is not possible; home birth and midwives are not covered. 

BLERGH.

At this point, I reached out to the human resources department for my husband’s job  and started a dialogue with her about this lack of coverage. I wasn’t sure where this effort would take me, but I figured that she likely had worked with other families who may have experienced network gaps. I wish I could say that this exercise was helpful. It was not.

The HR staff person was receptive and eager to assist; she contacted her counterpart at the insurance company to see if this individual could also help suss out the details. That insurance person (who was responsible for structuring policy) repeatedly provided incorrect guidance over the course of several weeks. (No, this was what we needed to do next. No, wait, it’s actually this. I’m sorry, I was mistaken. Your next step should be this.)  Perhaps this repeatedly wrong guidance isn’t the insurance person’s fault; perhaps this just serves to illustrate how insanely cumbersome and confusing it is to navigate insurance policy.

With each new piece of instruction, I would contact the care coordination department of my insurance’s member benefits office. I would tell the care coordination person what I had been advised by their very own personnel–their personnel implicit in formulating our current policy–and the care coordination staff would contradict the information I’d been provided. Lather, rinse, repeat.

Because there were no midwives covered within a 30 mile radius of St. Louis (how is that even possible????), I was eligible to request an exception that my midwife be considered in-network for our policy.  At first I was told that my midwife’s billing service could do this on my behalf. They tried, but were told they could not. I was then advised that I could personally make the request, and when I tried, I was told that I could not. It took weeks–not an exaggeration–to simply identify the correct process for pursuing this network gap exception request. We’d make these requests, they’d languish somewhere in the insurance company’s cosmos, and when I’d follow up that’s when I’d be informed that the request hadn’t followed the specific procedure for my policy. MADDENING.

For anyone, however, who is able to make their own request, here is a sample letter to accompany your request. This template was given to me by my midwife’s billing agency:

Date

Insurance Company
P.O. Box 12345
City, State, Zip

Member ID # [123456789]

Request for In-Network Exception

To Whom It May Concern:

I write to request an in-network exception for maternity care to be provided by my midwife, XX. I am requesting that the midwife services from dates of service [May 04, 2012] through [April 20, 2013] be authorized to pay at the in-network level for based on the following reasons:

1. XX is educated, trained and licensed as a midwife. Maternity and newborn care is within her scope of practice per state code.

2. The services provided by a midwife are very cost effective. Midwife services on average, will cost an uninsured individual $4,000 – $6,000. A typical hospital birth will range from $10,000 to $60,000. This reflects a savings for both you as an insurance company and me as a member.

3. There aren’t any contracted midwives within a 30 mile radius who will perform a home birth (use this sentence if you know this to be true).

4. Basic CPT and diagnosis codes that will need to be approved are as follows:

Mother’s Dx: V22.0

CPT Codes for professional services to be billed on a CMS1500 form:
59400-Global OB care
99232-Hospital Visit/Care
59410-Delivery & PP Care
99356-Prolonged Care
59425/59426 Global AP Care
99357-Prolonged care
99203/99204/99205 Office visit
A4550-Supply Kit
99123/99214/99215-Office visit
99348-Home Visit
99354-Prolonged Care
99349-Home Visit
99355-Prolonged care
99350-Home Visit

Baby’s Dx: V30.2
CPT Codes:
99461-Newborn exam
99464-Birth assistant
S3620-Metabolic screen
99212/99213-Office Visit
99348-Home Visit

5. Please put your personal reasons for wanting a home birth with a midwife here.

I trust this information will help you in your decision to authorize these services at the in-network level. If you have any questions, please feel free to call me at phone number.

Sincerely,

The final bit of instruction was this: I needed an in-network provider to make this gap exception request. I was first told that my former OB–the one whose practice I’d left over birth philosophy differences–needed to make this request. I attempted to explain that my OB was no longer my prenatal care provider. Why would a provider no longer providing care to a patient make such a time-involved request on their behalf? My records at that point had already been transferred to my new provider. Nevertheless, I called my OB’s office and respectfully and directly explained my issue; they respectfully and directly told me that they would not make the request, as I was no longer receiving care there. Made sense.

I was then told that ANY in-network provider could make the request on my behalf. Problem? I was connected with no other in-network provider. I didn’t have a primary care doctor or a family doctor. I haven’t needed one since I moved to STL less than a year ago. It seemed completely ridiculous that I’d have to set up an appointment with a PCP or family MD  for the sole purpose of having them interface with my insurance company to request that my midwife’s care be covered.

I obtained a few recommendations for area doctors who have a reputation for supporting home birth and made an appointment. I felt so ridiculous explaining to the nurse at the beginning of my appointment that I was perfectly healthy and was essentially using them in an effort to make a gap request. The nurse was good spirited about it. The doctor was even kinder. She boggled at the bureaucracy of it all, said that she was a big advocate of home birth and that she felt I deserved to have the birth I wanted, and instructed her nurse to initiate the whole process for me. RELIEF.

An additional hiccup later (the nurse supposedly made the wrong kind of request–surprise) and the network gap exception request was finally and legitimately sitting in someone’s inbox for review. It only took 10 weeks.

A week later I had a letter in my mailbox explaining that my request had been approved and that my midwife would now be considered an in-network provider. I nearly shit myself. If there had been any alcohol in the house, I would have consumed it in teary-eyed celebration. Finally, it appears that my home birth will be covered. I will hold onto this letter for dear life. (Well, it should be covered beyond the satisfaction of my in-network deductible, which has been nearly met.)

So, tips for pursuing coverage for your home birth?

• Enter this process with an expectation that it will be time-involved and cumbersome. If your process flows more smoothly, awesome! But, um, don’t count on it.
• You are, basically, the foreman of this whole process. Do not take for granted that someone on the other end of the phone has done their job. Do not wait for them to call you back. You call them–follow up every day if you have to. Be persistent, annoyingly so if you must.(For example, my new family doctor’s office called to tell me that they’d put the gap request in. The following morning I called the insurance company to ensure that this had been correctly done. It supposedly hadn’t. I made sure that the request was then submitted again, this time correctly. If I’d have waited, more time would have been lost.)
• Seek coverage for your provider. I posed the entire inquiry as provider-based–here is this caregiver whose services I wish to have covered. I never once explained that I was planning a home birth. No one ever asked where I planned to birth my baby, and I did not volunteer this information at any juncture. Would that knowledge of an intended home birth have colored the insurance company’s decision? I wasn’t about to risk the chance.

Here are some additional resources regarding pursuing insurance reimbursement for home birth:

• Bring Birth Back Home’s How We Got Reimbursement from our Insurance Company for Our Out of Network Home Birth

• GentleBirth.Org’s Negotiating for Health Insurance

• Paa-La’s Homebirth Insurance Reimbursement Tips

What was your experience securing coverage for a home birth?

Rhianna, a former social worker and current stay-home mama of two, composed this post in the very room in her St. Louis home where she birthed her daughter nearly 8 weeks ago. She now feels like a seasoned home birth ninja in the battle for insurance coverage. 

Mama Musings: Preparing the Older Sibling for a New Baby

This is the third installment in Rhianna’s series of posts about her home birth preparation.

You can read the first here and the second here.

photo credit: danhuse, flickr creative commons

My husband and I had gently closed the door on actively trying to grow our family when I unexpectedly discovered that I was pregnant. When the idea of parenting two children finally took root for me, I, um, kinda melted down a little. Just how deep are my wells of flexibility, patience, creativity, energy, and kindness? How much space is there in these wells for the successful, gentle parenting of more than one child?  And then this beautiful post showed up in my reader, as if it were written just for me at just that time to reassure me that it will be okay. And much of the time it even will be better than okay. I will be fine. My son will be fine. The new baby, too, will be just fine.

Once I regained confidence in my ability to navigate the challenges of expanding our family, preparing my son for his impending big brotherhood and this milestone of big family change secured an ongoing presence on my to-do list. He’s two years old, and developmentally it’s all still quite abstract for him.  Perhaps much of my prep approach has as much to do with readying me for this new sibling dynamic, too.

But, wait–this post is part of a series that is supposed to be about home birth preparation, right? My son was one of the big factors playing into my decision to pursue a home birth, so it’s difficult to tease the sibling stuff out of the home birth experience for me.  I want my son to be included in the process of welcoming this new baby at any appropriate opportunity we identify; I do not want there to be any limitation in our ability to incorporate him into this birth experience. And I want to preserve as much of his routine as possible, because I know much of it is about to be upended.

These may all be unrealistic aspirations–perhaps these things will have little helpful impact, perhaps this is all beyond his current developmental grip–but at least I will know that I gave my level best effort to acclimate him to the idea/event of home birth and a new sibling. Over the last many months, this is what we’ve had up our sleeves in this effort: 

We found out our baby’s sex. We pointedly chose not learn our baby’s sex when I was pregnant with Arlo. Holding out to discover if our baby was a boy or a girl made us feel like we were holding on to the only Hallmark moment available to us after a meticulously orchestrated effort to get pregnant.  This time, though, we wondered if knowing our second baby’s sex might help make the idea of a new baby more concrete for our son. Perhaps being able to pepper our conversations with references to his sister could travel some distance towards making the baby seem “real” to him. 

My son has attended every appointment with our midwife, both at her office and in our home.  My in-laws had been watching Arlo for my appointments when I was seeing the OB in the early weeks of my pregnancy. From the appointment wait time (sometimes as long as an hour) to the actual office environs, my OB’s office was not at all toddler-friendly. I’d  wager that most aren’t. When I first interviewed my midwife, she inquired about my thoughts for Arlo during birthing, and when I explained my hope to have him present on some level, she immediately and warmly advised that it’d be smart to bring him to  our appointments. She encouraged that this would make him comfortable around her and would normalize the experience of having her in our house. Makes perfect sense. She is so animated and sweet with him and always prompts him to be involved in the the appointment, such as inviting him to help measure my fundal height (he holds one end of the tape, while she holds the other) or listening to the baby with the fetoscope (she gives him a second one to play with while she’s listening. I so wish I could get a picture of this!).  He greets her by name now (adorable), which tells me she has become just another normal part of our landscape.

We’ve coordinated with my in-laws to have them care for our son in our home during our birthing time. We’ll call them when it’s Go Time, and they’ll be here in the house or close by in the neighborhood  with Arlo. This way we’ve got the comfort of knowing our toddler is in capable hands and that he can be with us at any time we want him to be. This will hopefully disrupt his daily routine as minimally as possible, and it gives him the opportunity to meet his sister sooner and visit without an interruption imposed by someone other than us.

We gave him a baby doll. Our son was given a baby doll over the holidays, and he instantly loved her. It was all spontaneous kisses and tender cuddles and loads of the sweetest stuff you’ve never seen your child give to an inanimate object before. She was the ideal specimen for practicing gentle touches, swaddles, and diaper changes. She became the perfect reference point for our soon-to-come little sister.

We find ways of incorporating mentions of the baby in our daily haps. For example, “When the new baby comes, we’ll take her to school with us like Alexandra brings baby Luke to school.” Or, when we’re eating dinner, “What do you think the baby will eat when she comes?” And then we talk about the baby nursing, how he nursed a lot when he was a little baby, and how he both nurses and eats food like Mommy and Daddy now. We try to connect the idea of the baby to whatever we might be doing at that given time.

We’ve checked out a stack of “new baby” children’s books from the library. I started with this list, including those recommended in the comments. I re-read the blogger’s take on each of the books after reading through (or attempting to read through) these books with Arlo. I nodded my head ardently to her assessments. Some are too wordy and geared toward older children, so I omit entire paragraphs or simply just describe what I see in the pictures. I found some on the list gratingly and disappointingly negative, so back to the library they went. The three big winners for us have been:

• Lizzy Rockwell’s Hello, Baby!–this is a hospital birth story, so I edit some details as I read (for example, changing in the word “midwife” for “doctor” and totally excluding the fact that the parents leave to go to the hospital). This is my son’s favorite of the batch. The big brother is very much included in the preparation for the new baby and in his newborn sister’s care. Fun.

• Jenny Overend’s Welcome with Love–a home birth story. It is a little too wordy for a 2 year old’s attention span, so I edit out much of the story or simply describe what I see in the pictures. The illustrations are soft and pretty, but more birth-graphic than you might expect from children’s literature. I was a little surprised at first blush, but I think these are valuable, gentle illustrations about the truth of birth. There are pictures of the mother laboring, leaning on the father; a picture of the baby’s head emerging as mom births in a supported standing position; and a picture that includes the subtle detail of the placenta hanging out in a bowl. And there is nursing and bedsharing depicted, too.

• Mary Batten’s Who Has a Belly Button? is from the juvenile non-fiction section and is clearly intended for older children, but it uses anatomical language (“uterus” instead of “belly,” for example) and the pictures are great. It spends a great amount of time identifying mammals and discussing their belly buttons, so for my animal-lovin’ toddler the pictures alone are fun. Lots of mom and baby animal illustrations. 

We  have a small gift from the baby for Arlo to be given to him sometime shortly after he meets her. Arlo adores his Schliech animal figurines. We got him the pair of lion cubs from this set, and we’ll tell him that they are brother and sister, just like he and the new baby. We found these at our local zoo’s gift shop; we have a zoo membership, which includes a discount of gift shop items, so it was totally a budget-kind and wildlife conservation-supporting purchase, too.

Will these approaches go some distance towards easing Arlo’s transition into big brotherhood? They certainly can’t impede it, that’s for sure. It’s going to rock everyone’s world, this adjustment to a squishy-faced fourth member of our family, and we have a realistic understanding that these approaches we’ve implemented aren’t magic bullets and that there will still be challenges aplenty.

These are a few other links I found interesting and insightful about big sibling preparation:

• Code Name: Mama’s Preparing Your Child for a New Sibling Informational Outline and Resource List (super thorough list of links!)

• PhD in Parenting’s series on preparing for a second baby: Part One (What Were We Thinking), Part Two (To Tandem or Not to Tandem), Part Three (Making Room for One More in the Bed), and Part Four (Soon They are Best Friends)

• PhD in Parenting’s Guest Post from Hobo Mama on Preparing an Older Sibling for a New Birth

• Perpetually Nesting’s Preparing Sibling for New Baby: Some Thoughts

• Perpetually Nesting’s What Nobody Says about Bringing Second Baby Home

 Rhianna lives in St. Louis and edited this post with her newborn daughter snoozing serenely on her chest. She’s happy to share that big brother repeatedly interrupted said editing effort by peppering his new sister with sloppy kisses and unrequited high-fives.

Mama Musings: Preparing for Our Home Birth

This is the second post in a series about Rhianna’s planned home birth. You can read the first post here.

photo credit: 3BL Media, Flickr Creative Commons

During my first pregnancy, I got lost in preparing for my baby’s arrival. I  researched  and researched baby goods, carrying that Baby Bargains book around like it was my bible. I spent hours upon hours composing the perfect eco-conscious baby registry filled with green sundries like organic receiving blankets,  organic baby carriers, cloth diapers and plant-based, chemical-free baby toiletries.  I spent even more time creating my baby’s nursery–picking out and coordinating fabrics, researching and arranging furniture, and sewing all kinds of projects from a crib skirt to an ottoman cover. You know, like it was my job. Everything was a Seriously Big Deal.

I’ve done close to zero amounts of obsessing in this manner this go ’round. My calmer, milder approach has everything to do with experience. I have some grounding in what to expect from birthing, breastfeeding, and general newborn care. Experience has shown me how little babies typically need in this first year, and I already have most of the needed baby gear.  Taking notes from my fellow TOBB blogger Kate, and based on how we ultimately rolled with our son (nursing beyond infancy, bedsharing), we opted not to assemble a nursery this time. It was simply a matter of pragmatism, and I don’t feel the slightest bit of longing over forgoing a nursery. It works for us.

But, you know, there is something to be said for madly researching baby products and lovingly assembling a cozy, stylish baby room. These acts are bonding rituals. In immersing yourself in these tasks, you’re also immersing yourself in the idea that there is a real, live little creature on its way to rock your world.  I think this can be powerful, meaningful stuff.

I’ve missed this sort of baby-prep ritual, just a little, this time around. But, no worries, because there is a good measure of other things to sink yourself into when you’re planning a home birth. My bonding ritual has come in the form of getting ready for birthin’ mah behbeh at home.

At 35 weeks, my midwife instructed me to order my birth kit. My understanding is that many midwives assemble a custom birth kit that can be ordered with ease through specific birth supply providers. At its base, the kit it cost $49. These are the items included in that kit:

• 10 Basic Underpads, 23×36”
• 10 Large Deluxe Underpads, 30×36”
• 2 Alcohol Prep Pad
• 1 Plastic Back Sheet
• 10 Gloves, Sterile Synthetic Singles, Medium
• 2 Mesh Panty, choose size
• 2 Peri bottles
• 10 Gauze, Sterile 12-ply, 2 per pkg.
• 3 Straw, Flexible and Individually Wrapped
• 1 Newborn Paper Tape Measure, 36″
• 1 Newborn 100% Cotton Hat, choose from pink, blue or white
• 1 Povidone Iodine Scrub Brush
• 1 Povidone iodine Solution, 4oz
• 8 Lubricating Jelly, 3g
• 1 Umbilical Cord Clamp
• 1 Cord Ring
• 1 Infant Heel Warmer
• 1 Tenderfoot Lancet
• 1 Sani-Cloth Germicidal Towelette
• 1 Non-sterile OB Pads, pkg of 12
• 1 Economy Bulb Syringe, 2oz
• 1 Homebirth Certificate, choose style
• 2 Protection Plus Classic Underwear
• 1 Muslin Bag, 4×6”

Because I am planning a water birth, I also added a birthing pool liner to this kit for an additional $22. I am renting a La Bassine pool from my midwife. (She also offers an Aquadoula pool rental option.) The La Bassine is an inflatable pool (you can see in the link), and it’s tucked safely in my bedroom closet with a speedy electric pump (provided by my midwife as well), ready to be inflated, lined and filled.

Besides my midwife’s professional equipment and the supplies included in the birth kit, there are other necessary supplies as well, and these are the ones I’ve been slowly accumulating over the last few weeks. Many are items I already had around the house and simply needed to collect together and keep in a central place.

• 2 large mixing bowls, preferably not glass (for holding the midwife’s tools, for placenta)
• 1 large stock pot (in case the hot water heater runs out and we need more hot H2O)
• bottle hydrogen peroxide
• 4 large dark garbage bags
• package 1 gallon Ziploc bags
• 1 plastic shower curtain or flannel backed tablecloth (for protecting your bed linens)
• 1 roll of toilet paper
• Thermometer (inexpensive standard size digital is best)
• 1 set of sheets for your bed you don’t mind staining (You make your bed with your usual sheet set; cover this with your shower curtain(s)/tablecloth; and then cover the waterproof layer with these sheets. You can then just pull off the messy sheets post birthing, and your clean stuff is there and ready for your post-birth nap.)
• 8+ large bath towels
• 4-8 receiving blankets.
•  4-8 wash cloths
• 1 box of super maxi-pads
• Diapers (cloth or paper diapers are fine)
• Soft cotton clothes for baby
• postpartum clothes for mom
• 1 small bottle olive oil (for perineal massage or even for smoothing on baby’s bum to make meconium clean-up easier)
• Flashlight with fresh batteries
• Unscented candles only please
• Birth pool (If you are planning to use water for birthing support)
• 1 Pool liner
• 1 water-resistant floor covering for under the pool. (You can use flannel backed table cloths, a tarp, drop cloth or shower curtain)
• 1 new or cleaned hose
• Adapter for faucet
• Rehydration drinks (I am a coconut water girl, so I have a few cartons tucked in the fridge)
• Ice
• Easy to make and serve healthy labor snacks. Cheese, nut-butters, toast, granola bars, fruit, nuts, etc.
• Meals and snacks for all. Frozen meals, casseroles, fruits and veggies, nuts, eggs, etc. are all great.
• postpartum meal. Have available yummy, hearty food or us to prepare for you after the birth – you will probably be very hungry!!

I was excited when I first perused these lists; I was stoked to have a project to focus on. But I am going to admit something: as the weeks passed, I began to feel a bit overwhelmed by it all. As soon as I crossed one of these items off of my to-do list, I would replace it with about three other things. There were so many things I wanted to do this time around that I didn’t do or didn’t anticipate needing to do last time: things I missed having with my son’s birth (seek out recommendations for and hire a birth photographer!); things experience taught me I would  definitely need during the immediate postpartum time (search out recipes and prepare freezer meals); things I could sew while I thought about my new daughter, just like I did when I made those items for my son’s nursery (get fabric and supplies and find the time to make baby booties, burp cloths, nursing pads); things that would get my nursing relationship off to a good start (make and freeze lactation cookies, touch base with insurance company to inquire about coverage for lactation consultant visits, check out now-mandated-by-Affordable-Care-Act breast pump rental);  things to consider about my placenta more seriously this time (encapsulate it myself or research and hire someone else to do it?); and things to help soothe my post-birth vag (like these awesome DIY postpartum care pads).

The overwhelm was temporary and, I now realize, was an understandable part of readying for a big family change. I more fully involved my husband in the to-doing, and I asked for help from family members, who were eager and excited to oblige, much to my fortune and gratitude. Take freezer meals, for example. My mother-in-law was talking about a possible baby shower-type event one day, and I said, “You know what I think I’d really like instead? A cooking party. Where everyone comes and makes meals for us to take home and put in our freezer.” And, just like that, she was on it. One recent past weekend, my in-laws’ kitchen was filled with people making food for my family for after the birth. We’ve now got a couple of weeks’ worth of dinners tucked in our freezer.

Here I am now, nearing 40 weeks, and the to-do lists are pretty quiet. We’re ready. There are still some sweet little booties to be made, and hopefully they will be made during this last stretch of waiting without distraction and with my heart fully on this soon-to-arrive little girl.

 

Rhianna lives in, blogs from, and will birth her new baby in her new home city of St. Louis, where she has been happily surprised to discover a growing community of folks advocating for gentle, informed, and evidenced-based birth practices. 

Mama Musings: My Journey To Choosing Home Birth and a Provider

This post is the first in a series I hope to complete before the arrival of my second child, who I plan to birth in our home under the care of a midwife in the coming weeks.  I’m always a bit reticent and feel somewhat tender when discussing birth preferences and experiences (my own and those of others) because I full-heartedly feel that birth preferences and experiences are sacred things, things to be respected and honored, no matter what your birth looks like. It’s in that spirit that I compose these posts–in a spirit that respects and honors this milestone in my family’s life and in a spirit that perhaps respects and honors your curiosity and concerns about the processes involved in home birth.  These posts are not intended to be prescriptive, but rather as a peek into what has informed my decisions so far. Please tread gently.

A bit ago I wrote a post sharing my question about where to birth my daughter–in the hospital or in my home.   Several of you shared your insight and support on that matter, and I’m genuinely grateful for the time you took to lend some perspective. A couple of weeks after that post my husband and I came to our  decision: we chose to plan a home birth, and I transferred my records from my obstetrician to a midwife.

photo credit: eyeliam, Flickr Creative Commons

Briefly, these are the factors that bolstered my interest in and my ultimate decision to pursue a home birth: I want to  have a birth experience that is inclusive and supportive of the whole family; I wanted a provider who felt more like an invested partner in my maternity care, rather than the commander-in-chief of my care; I had an unmedicated vaginal birth with my son, and I feel confident in my ability to do this again; my previous pregnancy was and my current pregnancy is healthy and low-risk; and my previous birth experience (in a hospital) was supportive and generally pretty positive, illustrating clearly to me how invaluable this amplitude of support can be during birthing. My decision to pursue home birth was never made from an anti-maternity establishment frame of mind, as some have assumed; it was my positive hospital birth experience with my first pregnancy, in fact, that underscored how invaluable and necessary respect, support, comfort, and confidence are in any birth experience.

There is an overwhelming amount of fear-mongering about birth out in the vast interwebz. Trust me, I stepped in a lot of steaming, fear-stoking crap as I forged my path to my birth choice both times.  You owe it to yourself and your baby to be thoroughly educated about your options and the procedures and processes involved in birthing, no matter where/how you plan to have your baby. You are not merely a passenger in your birth experience. And if you are reading this as someone, like me, who struggled to get and/or stay pregnant, you especially deserve to reclaim some power on your path to motherhood; there is much about the infertility and loss experience that erodes our sense of self-determination and our confidence in our body’s capacity to get things right.

There is a good amount of insightful, balanced reading out there for those seeking to shore up a decent perspective on birth options. My favorite book (I read it during my first  pregnancy and then revisited it for my current one) is The Thinking Woman’s Guide to a Better Birth by Henci Goer. I also enjoyed Active Birth: The New Approach to Giving Birth Naturally by Janet Balaskas. I read many others, but these were the standouts for me. Other very popular and instantly recommended books in the”natural” childbirth community are those written by renowned midwife Ina May Gaskin. (You can also find some additional birth education recommendations from TOBB here.)

Finding My Provider

My initial debate surrounding the venue of this birth had much to do with being in a brand new city with limited insight into community resources surrounding birth and a limited understanding of the  birth culture in this new locale. I’ve always been attracted to the midwifery model of care. It pretty much sounds like a dream come true, no? (I think this brochure is a perfect frame of reference for selecting any prenatal care provider, even if you feel more comfortable with or have a medical indication requiring obstetrical care.)

I had an OB for my first pregnancy because there were only two certified nurse midwives practicing in my small former home city, and both of them practiced in large OB practices. My professional experience as a hospital social worker on a women’s & children’s unit (L&D, mother-baby, NICU, pediatrics) gave me priceless perspective on the limitations of large OB practices, and  I knew I would not be pursing prenatal care with either of those big practices. Instead, I sought out an  OB who practiced independently, as I felt this would give me a better shot at individualized care. Sure, either of those midwives at the other practices would have been able to give me this kind of care…but only on their rotation. I knew that a merry-go-round of OBs (with several of whom I’d repeatedly had dissatisfied professional experiences) was not for me. I didn’t want to run the risk that one of these disliked OBs would be on call the day my birthing began, because that would have been my luck.

So, now here in St. Louis and apparently pregnant, I immediately began asking other moms for recommendations for prenatal care providers, hoping to find a certified nurse midwife this go ’round. I was advised that there is only ONE certified nurse midwife in all of St. Louis who delivers in the hospital. (How is that even possible in a city this size with not one, but TWO schools of medicine?) I belong to an attachment parenting group here, so I lobbed my prenatal care quandary at those moms, knowing that we likely shared some of the same gentle birth ideas and that these women have had broad birth experiences–hospital/birth center/home/high-risk/low-risk/vaginal/with pain support and without/emergency cesarean/planned cesarean. They were a wellspring of knowledge. And this is where I learned that the majority of the other midwives practicing in the STL area are certified professional midwives who deliver babies at home.

There is a difference between certified nurse midwives and certified professional midwives (and lay midwives and direct entry midwives, etc.). Did you know there were so many types? I didn’t. This explains the differences in experience, education and credentialing.

Many of the moms I talked to had birthed their babies at home, and while home birth wasn’t something I’d been considering at the time, I listened to their experiences with an open mind. And I jotted down their providers’ names, just in case.

As I mentioned, I began my prenatal care for this second pregnancy at a small “natural birth-friendly” OB office (with two OBs) in my insurance’s network while I continued to suss out additional resources. At this point in time I was planning to attempt to repeat my previous birth experience: an unmedicated, Hypnobabies-bolstered, doula-assisted hospital birth surrounded by caregivers who value individualized care and who are experienced in supporting mothers through this kind of birth. As my appointments ticked away from 8 weeks to 20 weeks, it became evident to me that my hopes were a little too high for this particular office. I was constantly being shuffled to the nurse practitioner instead of my OB for appointments, even when I had specifically requested to see the OB and had been told I would see the OB; the nurse practitioner told me she was unable to answer many of my birth-related questions because she was not the provider who would be attending my birth, and instead she gave me vague and contradicting answers. In the appointments I was able to have with my OB, she was non-committal and dodgy in her answers:

“I would really like to try a water birth; how do you help manage water births at your hospital?”

–Well, I can’t say right now that you can have a water birth. There are lots of things that could happen that might prohibit that. You just never know. 

Ummm-hmmm. While this is clearly true–you simply can’t guarantee how a birth will unfold–an ongoing pattern of this kind of answer and attitude made my care feel like a bait-and-switch deal. There are better/kinder/gentler ways to convey the message that birthing is not predictable and that perhaps we might discover that I am not a good candidate for this means of birthing support. All of my questions were met with these evasive and glass-half-empty answers. It made me uncomfortable, to say the least. Especially coming from a provider who described herself as “natural birth-friendly.” If *this* was friendly…

Maybe this sounds nit-pitcky. Perhaps to some it is. But what I deeply felt is that I did not want to approach my birth with apprehension about a lack of support or with a foreboding expectation that I’d have to arm wrestle my OB and nurses for consideration of my birth preferences…while laboring.

I began interviewing recommended area midwives, one of which is heading up the opening of a birth center about an hour outside of the city. She was warm, encouraging, and insightful. The birth center’s opening had been pushed back again–this has been an ongoing three-year effort, apparently–and this midwife (a certified nurse midwife) was still delivering babies at home in the meantime. She (and the birth center) are located about an hour from where I live. Not exactly ideal. She casually said, “You do know that you have a couple of exceptional midwives in your very own neighborhood, don’t you?” And she specifically recommended one of these midwives to me. (This particular midwife had also been recommended repeatedly by other mamas in that AP group.)

I interviewed her next. I was instantly comfortable with her–her style, her personality, her frank and articulate answers to my questions, even her office environment. And I especially liked that she was trained/experienced in two skills that were non-negotiable for me: neonatal resuscitation and  stitching. I had a third degree tear with my son, who was both posterior and compound. I recognize it’s likely that I will tear again. And I am not a “let it heal naturally” kind of girl if the tear is significant.

I combed the interwebz for interview questions for my midwife interviews, and culled a list of questions from here and here. Our interview (because, yes, she was also interviewing me–was *I* a good candidate for homebirth?) was more of a comfortable conversation, and halfway through, this midwife asked for my list of questions and just went down the list, answering completely each and every question I’d brought. This was such a contrast to my OB experience, where the answers to my questions were foggy, and where questions, in general, felt like an intrusion on her time.

A few weeks passed before I made the switch from my OB to my midwife. I am an over-processor by nature, constantly turning something over in my hands to an anxious, nauseating fault. For me, historically, it’s the process of making the decision that overwhelms me.  And then, one morning, I woke up and realized, This is what I want and need to do. Once I filtered out all the static, the picture was clear. And when I walked into my OB’s office to fill out paperwork to transfer my records to my new provider, I did it confidently and comfortably and with a great measure of relief. Listening to your gut–honoring your instincts–is a feeling that can’t be overstated.

In the term of my care under my midwife, I’ve done the same kinds of tests that I would have received under my OB’s care, such as a glucose tolerance  and GBS tests. She takes my blood pressure and pulse, checks my urine and weighs me, and listens to the baby with either a fetoscope or doppler. She measures my fundal height and palpates to determine the baby’s position. The difference in the care, wholly, is the quality of the interaction. This kind of maternity care has been a good fit for me.

And that’s ultimately what it comes down to–what feels like a good fit for you? What kind/venue of care makes you feel more supported about birth? Because if giving birth in your home feels scary or uncertain, it’s not for you. You need to feel confident, and sometimes that confidence comes from knowing you can deliver in home-like environment (a birth center) or within the structure of the medical model (hospital). Wherever makes you feel emboldened and safe about birthing is where you need to be.   If home birth is something that appeals to you here are a couple of  posts written by other home birth mamas about their experiences: here and here and here.

Tell us about your birth experience: Where did you birth/where are you planning to birth? What informed your decision? How did you find your provider? Do you have any suggestions for handy resources for informing yourself about birthing? 

Rhianna is currently 39 weeks pregnant and feeling every bit of it. There’s an inflatable birth pool in her closet and a length of hose coiled next to her bathroom sink, and she is ready to put them to use. Stay tuned for her next post on home birth supplies and her home birth to-do list. She lives in St. Louis with her husband and two-year old.

Mama Musings: Operation No More Night Boob, Part One (Or, Why We Night Weaned)

Some time around the beginning of my second trimester, once the disbelief about this second pregnancy had begun to settle, I came to the conclusion that it might be time to seriously reconsider the possibility night weaning my then 19 month old. I am open to and hopeful about tandem nursing, but the thought of tandem nursing at night? It made me want to weep big, hot tears.

You see, at 19 months, my kiddo had never slept through the night. He was still waking every two to four hours to nurse. There were times when this night-nursing frequency felt unbearable, but also times when it was decently manageable. We bedshare, and while I solidly credit this practice with strengthening our nursing relationship, I also quietly worried that our family bed set-up could be a giant stick in the spoke on our journey to ever sleeping through the night.

Sleep, oh, infinitely precious sleep! Like any new bleary-eyed parent, I’d done a fair share of reading about infant sleep, some of it instructive and insightful, and some of it…? Well, not so much. I remember one time taking a sleep book with me to a salon to read during some much-needed mama pampering , and it wasn’t until my stylist asked me, “Can you, um, relax your shoulders a bit?” that I realized how tensely I reacting to the dispiriting book I was reading. (Who does that? Reads about infant sleep while they’re supposed to be relaxing? A desperate and exhausted parent, that’s who.)

I don’t mean for this post to be about sleep, per se; you and I could probably sit down together over a pot of tea and talk all night about all of the sleep literature that’s out there and how it jives (or doesn’t) with our respective families’ needs.  After reading the good stuff and the garbage, these three tenets undergirded my personal philosophy about sleep: 1)Nighttime parenting is just as important as daytime parenting; 2)We share sleep  safely; and 3)Sleep is a developmental milestone like any other for my son, and he’ll get there at his own pace.

I’d tried to night wean my son in the past, and it was a pretty gnarly experience. I’d long held on to Dr. Jay Gordon’s approach for night weaning for bedsharing families, like a hopeful how-to manual  for balancing what felt like, to me, the competing goals of sleep and gentle nighttime parenting. This approach relies heavily on the non-nursing partner’s involvement, and the non-nursing partner in this house is much slower to rouse than me. By the time he awoke to parent our son back to sleep, our son was wider awake and more difficult to soothe than he would have been had I just simply popped a boob in his eager mouth. After a few nights of these shenanigans, I figured it was easier on everyone if I just kept on keepin’ on with the boob-poppin’. The kiddo relaxed back into sleep faster, the husband hardly stirred and was better rested for his work day, and I was better able to relax next to a toddler who wasn’t steadily ramping up to a full awakening.

I had hope for the No-Cry Sleep Solution, but it, too, was a stunning exercise in defeat for us. The Pantley Pull Off (the gentle removal method) was simply too confusing for my son: Wait, I get the boob, but then you take it away? And then I get it again, and you take it away again? WAAAHHHH!  And, similar to my experience with Dr. Gordon’s plan, I found that it was decidedly easier to just nurse him back down all the way. I came to slowly understand that it wasn’t that these approaches were unhelpful (I know peeps who’ve had good experiences), but rather it was that my son simply was not ready to be night weaned. I decided to table our night weaning efforts indefinitely.

Enter the unexpected, yet someday-hoped-for second pregnancy. Suddenly, sleep seemed like it would never recover from its endangered status anytime in the foreseeable future. More than six months after our last attempt at night weaning, I heaved a big, weary sigh and decided it was time to test the waters again. Thus commenced Operation No More Night Boob.

In the next week I’ll be sharing more detail about how we night weaned, but here’s a sneak preview: my approach wasn’t anything I’d read in book or on a website. My approach had everything to do with listening to my mothering gut and to my child. Stay tuned!

Rhianna composed the bulk of this post from her family bed in St. Louis, snuggled next to the cutest and snoring-est two dudes she knows. She is currently scratching her head over the best way to introduce a future night-nursing sibling to their shared sleep set-up.

Photo credit.

Mama Musings: Pregnancy Skin Care and the Oil Cleansing Method

In keeping with the running theme of Everything About This Second Pregnancy is Entirely Different from My First One, I have been beset with the facial complexion of a pubescent teenager this go ’round. Friends, this is no pregnancy glow.  It has been…unpleasant.

I  can often feel a breakout coming on hours before it happens. I will feel an unusually intense wave of fatigue, nausea, and irritability, and voila: a fine hyper-sensitive rash of teeny whiteheads will appear! Everywhere! Like magic! Hormone magic! My face is tender to the touch for days afterwards, almost like a sunburn. My kind-hearted husband gently assures me that it’s “not that bad,” but he has to say things like that, right?

 I’ve enjoyed decent skin most of my adulthood–a few errant blemishes every now and then, but mostly clear and manageable skin. I’ve never been a huge wearer of make-up; I don’t particularly like the feel of it on my face. When I feel the need to wear make-up, a simple tinted moisturizer, a scant swipe of blush, tinted lip balm and a quick curl of the eyelashes are about as much as I do. (I use gentle, plant-derived, fair-trade, mostly sustainably-produced make-up products from both Aveda and The Body Shop.) My skin care regimen has also been similarly simple: a foaming face wash (Avalon Organics and Alba Botanical face washes have been my past faves) followed by a light moisturizer with SPF.

Except, the “gentle” washes I had been using made my pregnant, newly sensitive skin feel further inflamed and achy. I dreaded washing my face. My face would feel unbearably dry and taut after cleansing, and within hours it’d be slicked with oil. I know I am at the mercy of my hormones right now, but I longed for some way to clean and soothe my tender skin–something gentle, simple, and chemical-free.

And that’s when I remembered the Oil Cleansing Method, and I began washing my tender, inflamed skin with a mixture of two oils. I’d first read about the oil cleansing method over at Crunchy Betty and quickly readied my supplies after feeling inspired by her post. I use a 1:3 ratio of castor oil and jojoba oil.  I mix the oils right in the palm of my hand, though most folks mix their oils ahead of time and store them in a bottle for convenient use. I massage the oils into my dry, unwashed skin for a good minute or two, and then steam my face for a few seconds with a hot washcloth. After gently wiping the oil from my face with the hot washcloth, I work just a very tiny amount of silky jojoba back onto my skin for extra moisture.

I know what you’re thinking–Whaaa? Oil? On mah face? Doesn’t that defeat the purpose?  But it works. And amazingly. My skin feels so soft and clean and healthy afterwards. There is no stinging, no uncomfortable tautness. And my achy inflamed skin rebounds much more quickly when I do experience a breakout. It kind of feels like a miracle, like I discovered the coolest secret ever. It’s been such a savior for my pregnancy-related skin troubles.

Both links above explain this facial care in easy-to-digest detail, offering suggestions for ratios and specific oils that might best meet your skin’s specific needs. It’s a cost-effective way to care for your skin, for sure. My bottle of castor oil ($6.87 for 16oz) will probably last a year or more. My jojoba oil was a little more expensive ($9 for 4oz), but it, too, goes a long way.  There are carrier oils that are super spendy (like avocado oil, for example), but most are easily affordable. If you add essential oils to your mixture, the cost can also creep up, but I have been quite satisfied with my two simple oils so far.

Best of all, to me, is that the oil-cleansing method is such a gentle, chemical-free way to tend to my skin. Most of us in the natural parenting community are continually looking for ways to minimize and eliminate harsh chemicals in our households, and this definitely is another way to work towards that goal. I love, love, love that my new skin care routine involves only two very natural ingredients. It doesn’t get any more pure, basic and natural than that.

What’s your skin care approach? Have you ever heard of the oil cleansing method? Ever tried it or wanted to try it?

Rhianna is the mushy-hearted mama of 21 month old Arlo. She wishes her skin was as perfect and stunning as his. Her husband still thinks she’s kooky for washing her face with oil, but she’ll convert him yet. They reside in St. Louis. 

Hospital or Home: How Did You Decide Where to Birth Your Baby?

As I creep towards the halfway mark of my second pregnancy, I’m confronted by questions around which I’ve been tip-toeing: Where, oh where, will my baby be born? Should I go the hospital route again? Should I get my homebirth on this time?

Between my heavy crush on the idea of birthing my baby in the intimacy of my own home and the biting admonitions of a certain blogging skeptical obstetrician, I’m kind of, well, lost. I know what I want, and I know what I absolutely do not want, and I’m feeling a bit uptight and weary about the ability to marry the two.

You see, I got a whole lotta love for my first birthing experience. It was  empowering, awe-stoking, and filled with support and respect. My birth plan was honored nearly to the letter (there was a small hiccup with my request for delayed cord clamping), and even if I could I wouldn’t change a single thing about how my unmedicated, doula-assisted, Hypnobabies-bolstered hospital birth unfolded. (Okay, maybe I could have done without the stubbornly posterior bebe and the third degree tear.)

2012 National Rally for Change in St. Louis, MO, advocating for informed consent and evidence-based maternity care.*

But what I recognize about my hospital birth is this: the circumstances of my hospital birth experience aren’t du jour. In fact, I don’t think it’d be improper to describe those circumstances as exceptional. I worked in the women’s and children’s care center in the hospital where I delivered my son. Day in and day out for years preceeding my pregnancy and my son’s birth, I worked elbow-to-elbow with those professionals–the L&D/postpartum care/NICU nurses, lactation consultants, obstetricians, neonatologists, and pediatricians– in the position to care for me and my baby.

When the time came for me to choose an OB, I already had a pretty sound understanding, based on my professional experience, of which ones I didn’t want anywhere near my vag. When I had questions about how experienced my nurse co-workers were in supporting a patient aiming for an unmedicated birth, or how receptive they would be to the presence of my doula, or if I would be able to take my placenta home with me, I simply walked a few short strides from my office to that of the L&D nurse manager, plopped my pregnant rump down across from her, and asked my questions. When I had questions about breastfeeding resources and support, all I had to do was wave over one of my fantastic lactation consultant colleagues, and they eagerly shared their insight. I had a ton of support and intel at my fingertips long before I was wheeled up to L&D rockin’ 9cm of righteous dilation in my amniotic fluid-soaked yoga pants.

I will openly admit that I enjoyed an uncommon measure of comfort, privilege and preferential treatment birthing my baby and recovering amongst my hospital friends and co-workers. I do not hesitate to credit my unique circumstances for much of the ease I experienced navigating hospital birthing care. The biggest takeaway from my birth experience was this: the relationship you have with your care providers is integral, immeasurable, and irreplaceable.

Happy birthday, my sweet boy

I left that employment for stay-home mamahood, and our family has since relocated out of state to St. Louis. While I understand that each pregnancy and birthing experience is unique, I am acutely aware that the level of care and support I received in the past simply cannot be replicated here. And I have deeply felt reservations about a hospital birth this go ’round.

I’m currently under the care of an OB who as a reputation for supporting patients who desire a less interventive birthing, but I’m full of uncertainty about the hospital where she delivers. Sure, I could switch care providers; I could select an OB who delivers at a hospital with a better rep. Even still, I am nail-biting my way around the implicit fact that a hospital birth here would involve a few things on which I do not wish to compromise. (For example, I want my son to be integrated, when appropriate, into the birth experience of his sibling. And I do not want to be seperated from him for any great length of time, and especially not overnight. We’ve never spent a night apart.)

All signs seem to point to homebirth. Except, you know, those angrily flashing ones on the blog of a certain skeptical obstetrician. I fell down that rabbit hole, reading post after post about the inherent irresponsibility and acute risk of birthing your baby anywhere but a hospital. My cage? Rattled.

I interviewed a highly and repeatedly recommended certified professional midwife here in my neighhborhood, and I left feeling a bit lighter about the prospect of a homebirth. I am considering transferring to her care. In the coming days I will be following up with my insurance company to ascertain the extent of my benefits for an out-of-hospital birth. If nothing was covered at all and I needed to pay the full cost out of pocket, the math shows that I’d be spending just a couple of hundred dollars more than what I paid for my OB and hospital birth with my son. Cost, as I understand it at this point, is not a deterrent.

There is a birthing center scheduled to open this fall about an hour’s drive from where I live in the city. I’ve spoken with the certified nurse midwife heading up that effort, and she, too, was lovely and resourceful. Still, I’m uncertain about the idea of driving an hour away to have my baby. But maybe it’d be worth it?

Help a hormotional pregnant lady out: Did you struggle with the question of where to birth your baby/ies? What helped you confidently forge a decision? What resources/reading did you find particularly helpful?

*Wanna know more about informed consent and evidence-based maternity care? Check it out here.

Rhianna blogs from her adopted hometown of St. Louis, and never before has she missed her former hometown (and its awesome nurses) as much as she does right now. Things keeping her awake at night: crane-kicks to the kidneys courtesy of her bedsharing toddler; in utero dance party courtesy of wiggly fetus; and the anxiety surrounding the place in which the two will meet for the first time.

The Hoped For, Yet Unexpected Second Baby

We trudged down a long, rugged road to conceive our son, and while future children were always in our hearts and hopes, we had anticipated a similarly turbulent course to further expanding our fam.  That disheartening path of our family-building past has undoubtedly shaped my parenting ethic and has emboldened my aspiration to be an attached, gentle mama. One specific element of my personal parenting ethic–breastfeeding–grew to become a profound and potent combination of attachment and empowerment.  Becoming a mama was such a long-held dream, and breastfeeding had become so meaningful; I made these things–dwelling in my blissfully realized motherhood and nurturing my nursing relationship with my son–my priorities.

When discussions about adding to our brood would crop up between me and my husband, these conversations were always left open-ended. I wondered about child spacing. Worried that we’d get lost on that too-familiar, dark and long path again, I wondered if it’d be prudent to wean my son altogether in order to get a jump-start on trying for another baby. In the end, I found peace in focusing my energy and attention on the relationship with the child I was already so fortunate to have. (Zero judgement towards anyone who has decided differently. That is some seriously heart-wringing stuff, and I have the utmost respect for people who have to contend with making that decision.)

Life, as it tends to do so masterfully sometimes, demonstrated disregard for our difficult decision to table growing our family. My period returned on its own at 14 months postpartum, and after three postpartum cycles, I discovered I was pregnant. It was a surprise that spun my head and world around, one that filled me with a jaw-dropping, Niagra-sized waterfall of disbelief, awe and question.

I was saturated in competing emotions: joy and trepidation; peace and anxiety; gratitude and ambivalence. I suppose these confusing feelings are par for the course when life grants a hope you long ago released. As I now trek into the 17th week of this pregnancy, that deluge of conflicting emotions has evaporated, leaving only faint water marks in its wake–now nearly invisible reminders of how stunned we were by this deeply wanted, yet entirely unexpected bit of fruit in my ute.   

In so many ways–from conception to morning sickness to support system–this  pregnancy has been strikingly different from my last. Though I’ve experienced pregnancy and childbirth before, I feel like I’m learning entirely new lessons this time. It’s exciting. And humbling. 

If you’ll join me, I hope to take you along for this journey. This pregnancy has already thrust us into big changes–my toddler is now fully night-weaned (I will share that story soon). I’m currently navigating the decision about where to birth this bundle of bebe, preparing emotionally and physically for a new bambino, and hoping to learn what attached, natural, gentle parenting looks like when you’ve got two to snuggle and wrangle. I hope that we can trade insights…

How about you? Did a struggle to conceive/sustain a pregnancy influence your parenting ethic? Have you ever debated altering your attachment tools in order to grow your family? Ever had your world rocked by a pregnancy–first, second or otherwise? How did you manage these experiences?

Rhianna blogs from her adopted hometown of St. Louis. She gives thanks to the Goddess of Elastic-banded Pants for her roundly unattractive, but so, so comfortable apparel.  Now if only the Goddess of Morning Sickness would heed her pukey pleas…

My Boobs? Mighty Frickin’ Spectacular, Thank You Very Much

Welcome to the August edition of Authentic Parenting Blog Carnival: Breastfeeding.

This post was written for inclusion in the monthly Authentic Parenting Blog Carnival hosted by The Positive Parenting Connection and Authentic Parenting. As August is Breastfeeding awareness month, our participants are writing about this exact subject! Please read to the end to find a list of links to the other carnival participants.

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I’ve been thinking a lot about my breasts lately.

Several weeks ago I began night-weaning my son, now 20 months old. We had a sputtering, exasperating start to our nursing relationship, and though those struggles felt world-rattling at the time, hindsight now grants me a pretty clear understanding that our struggles were standard issue struggles for the spankin’ new nursing dyad. With that first month of breastfeeding in our rear-view mirror, we kicked our nursing relationship into a smooth 5th gear, pedal to the metal, with the top down (literally). It’s been a pretty fantastic ride so far.

We’ve totally night-weaned at this point, and the transition unfurled much easier and gentler than I could have ever expected. It’s clear to me that we were both ready for this change in nursing routine. Still, night-weaning has got me feeling all kinds of introspective, sentimental, and grateful.

There is much I love about breastfeeding, and I’m certain my personal highlights are also probably standard issue for other mamas who’ve fallen in love with nursing their babes:  those content and sated swallows of mama’s milk; those cheeks so warm and rosy from skin-to-skin snuggles; that one arm sleepily draped across the other breast, gently staking claim on his nosh; that sly upturn of the corner of his mouth when he grins as he nurses; that sweet, sugary scent of milky breath; that instant salve that calms and rights any hurt or overstimulation.

Breastfeeding has deepened my sense of connection with my son, but it has also deepened my connection with my own body. Breastfeeding has gifted me with a whole new respect for this body of mine. Like many women I know, I’ve had mixed feelings about my body over the course of my life. From appearance to functioning, we, as women, have been conditioned to question the adequacy of our bodies.  If you’ve ever had a persistent medical issue, or struggled to conceive or sustain a pregnancy, or, hell, even flipped through an issue of Cosmopolitan, chances are that you, too, have battled a nagging distrust and dislike of your body.

As a teenager, I was self-conscious of my breasts. As an undergrad, I was so ambivalent about them that I seldom wore a bra. As a young woman, I came to see breasts as toxic and dispensable. My grandmother had just been diagnosed with breast cancer, and I had fundraised for the Avon Walk for Breast Cancer in her honor. As I walked a marathon’s length with a small group of friends that first day of the event, I was overwhelmed by all of the stories of sickness and death.  I distinctly recall naively commenting to my friends that I was not attached to my own breasts in any way, and were  I ever diagnosed with breast cancer I would experience zero hesitation or reluctance about undergoing a mastectomy. Boobs, I thought, were just boobs.

Except, you know, they’re not just boobs. They’re not toxic or dispensable. And, nearly ten years later, as a nursing mother, I now get just how profoundly meaningful they are.

I now understand what it feels like to love and respect my breasts, to feel my breasts swell with perfect sustenance, to experience the ability to nourish my son exclusively from them for the first almost seven months of his life, and to watch my son flourish from my milk over these last 20 months. It’s a strikingly empowering feeling.

Last weekend a friend and I went to a vaudeville/burlesque show, and I found myself surrounded by impressively strong ladies with gorgeous, perky, pastied breasts. I looked down at my own breasts–shadows of their former gorgeous, perky selves–and smiled broadly. Oh, they are indeed a droopier state of affairs, but, you know what? They are still mighty frickin’ spectacular.

Rhianna lives in St. Louis with her husband and toddler, both of whom heartily agree with her assessment of her boobs. Everyone’s getting more sleep in her house these days (finally), but she’d be a big ol’ liar if she told you she didn’t miss those quiet nighttime nursing seshes a little.

Photo credit.

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Visit The Positive Parenting Connection and Authentic Parenting to find out how you can participate in the next Authentic Parenting Blog Carnival!

Please take time to read the submissions by the other carnival participants:

• Parenting Myth Busted: They Never Stop Breastfeeding – Laura at Authentic Parenting shares how her 4 year old effectively weans herself.
• 7 Tips for Breastfeeding In Public Stress Free –  From baby wearing to using a scarf, Ariadne of Positive Parenting Connection is sharing many helpful tips on how to breastfeed in public stress free.
• Breastfeeding has been Downhill – Jorje of Momma Jorje compares her nursing experiences and finds… it hasn’t gotten easier with time and experience.
• A Heartfelt Tip for the Nursing Mamas – Margaux from Young Nesters gives her biggest piece of advice for all present and future breastfeeding Mamas.
• Breastfeeding Carnival – Billy at My Pathway To Motherhood writes about the past, present and future of nursing her daughter.
• Amy W. at Me, Mothering and Making it All Work describes why she loves to advocate for and help nurture breastfeeding relationships.
• To My Nursling – Stone Age Parent dedicates a breastfeeding poem to her child.
• My 3 ½ Year Old Breastfeeds As Much As A Newborn – And That Is Fine By Me – Jennifer at Hybrid Rasta Mama
• Authentic Parenting Blog Carnival of Breastfeeding: Our Sorta Sudden Gentle Weaning – Wolfmother Chronicles
• How to breastfeed while babywearing in a men tai – Lauren at Hobo Mama offers a video tutorial for easy, hands-free nursing on the go in a mei tai (Asian-style) baby carrier.
• My Boobs? Mighty Frickin’ Spectacular, Thank You Very Much. – Rhianna from The Other Baby Book shares a post crediting breastfeeding with nurturing a connection not only with her son, but also with her breasts and her body’s empowering ability to do its thing.