Tuesday, November 07, 2006

The tip of the iceberg

A nurse asked me the other day, “Do you just meet your clients at the hospital? Do you meet with them at all during the pregnancy?”

Kat’s pregnancy and birth sprang to mind instantly. A nurse herself, she knew the superstition about nurses’ labours - “you get everything that you don’t want.” So, she knew she’d have to work hard to set up the best environment for birthing her baby without much “fuss.” So, referred by a friend, she hired me one October when she was three months pregnant. She had a lovely family doctor who specialized in maternity care, and trusted Kat’s ability to give birth. Then she signed up for prenatal classes, prenatal yoga and fitness programs. Everything was in place.

After our initial interview over tea, we phoned regularly, and I made two long visits to her home, talking with her and her husband about their personal philosophy, their challenges over the years, and their hopes for the birth. I answered all their questions from, “How will he be able to finish his thesis with a baby in the house?” to “Why does everyone say I must have an epidural?”

Throughout the pregnancy there were challenges to discuss...not big enough to call her doctor, but enough that Kat needed my support. For example, early in her pregnancy, she went to an independent lab for an ultrasound. She had been shuffled in and out within 5 minutes. “Next!” She was back in the car before she knew it...in tears. We talked on the phone after that, for at least an hour. After our talk, she decided she would only go for testing at her own hospital, where there was a greater chance of continuity and consistency of care. She was glad that she could use me as her sounding board.

In our many phone calls, we talked about her fears... “What if it’s so fast that you don’t make it to our house?” and her thoughts on her own ability to deal with pain...”I’m a bit of a wuss.” We talked about her hopes and dreams, her expectations of motherhood, and her concerns about her husband making it through the labour if it was long ("He'll need to sleep!") She called whenever she had a cold, when her friends gave birth ("Why isn't it me?"), when the baby was moving too much or too little, when she needed help sleeping, whenever anything needed to be discussed.

I worked to help her see the big picture, to help her to let go of expectations, to help her listen to her body. As an oncology nurse, she found it was a struggle to let go of fears, but, with encouragement and her own strength and wisdom, she met the challenge.

In late March, another phone call: “Did I tell you that I want to avoid the baby being suctioned, to have everyone quiet at the birth, to avoid medications, to get lots of encouragement??? The last minute worries had surfaced, the fear of not having her wishes honoured was voiced. We had talked for 12 hours by this point, over the course of the pregnancy...and it was really starting to spill out now.

Then came the due date. Another phone call. Then came another two weeks. Daily phone calls to me. More doctor visits. Testing at the hospital. Our contact increased as the days passed. When she finally went into labour, she was comfortable with her “team,” and we had discussed almost every possible scenario in advance. Kat had decided that, in order to labour with minimal intervention, she would have to stay home as long as possible.

Two days later (all the time in labour)...

...we had baked, walked, made soup, taken photos, and watched two nights of playoff hockey. Her husband was finally asleep in the bedroom, and I was at my limit and ready to fall onto the futon beside me.

Kat was still pacing the living room. To say she was frustrated was an understatement. Her contractions had never quite “kicked into gear.” We had been in touch with the doctor and hospital at regular intervals, and had been told to stay home until things escalated. What was it going to take?

Finally, I said that we would have to go to the hospital for further support if nothing had changed within the hour. I suggested that she try one last bath, (and a firm talk with the baby!) while swishing her hips from side to side to loosen her body. I closed my eyes...

“Quick! Jacquie! My water broke!” The words tumbled into my dream. It was an hour later. Kat was standing beside me, dripping... I tried to wake up. The next contraction came, and it was STRONG! Finally! I worked hard to wake up her husband, and we drove Kat to the hospital.

The baby was born!

Someone at the hospital said, “Well, that was easy for you guys! You just popped into the hospital and the baby was born!” We all yawned, then laughed.

So, to answer the nurse’s question, “No, I don’t just meet the couple at the hospital. We usually work together for many months during the pregnancy, and many hours in labour before you see us. It might look easy...but...”

It’s just the tip of the iceberg.

George, Entropy (and the Second Law of Thermodynamics)

I always say that we can only hope for the best on the day of labour - that the baby is the wonderful and unpredictable 'wildcard.' So, we must trust our body and our baby to give us strong clues about what needs to happen, then make the best choices on that particular day, with the support of those around us...

Here’s George, introduced by his mother:
“George was born Feb 16th - I had the induced labour that didn’t progress well and a cesarean - and he turned out to be 11 pounds! Remember us? These women who labour in the park, cooking turkey dinners...well, humbug. Not at all how mine went, although it was totally great in its own way.”

Here’s my memory:
Okay, what I remember was a mum, close to 2 weeks overdue, whose contractions were like a jackhammer in concrete. They never let up! When I arrived at her home, she was leaning over the bathroom sink, dealing with one contraction after another. Though she was coping, these contractions were a strong message from her body, saying, “There’s something really big in here that I’m working hard to get out!” She needed help fast. When we arrived at the hospital, the nurse measured her tummy, and looked up at me with one eyebrow raised. This was one big baby! The contractions weren’t slowing down, and there’d been hardly any progress. It seemed to take forever, but the staff grabbed an epidural out of the toolbox (finally!), after which mum said, “I haven’t felt this comfortable in months!” When the option of a cesarean was presented after many hours of labour with no progress, and the baby’s head up high in the pelvis (another sign from the body), everyone came to the conclusion that a cesarean was the pragmatic option of the day. Rather than seeing this as a negative option, I saw this as a way to honour the body, and the baby’s personality - powerful, strong, spirited...

Back to George’s mum:
“Spirited is one word for it, original source of entropy in the universe is another. It is a great way to be, in life, I could use more of it myself...
So, George is 8 months old now. I think it has been fairly smooth sailing. He nursed well from the beginning. He never did get colicky, and has been very good natured all along, but it took us 6 months to get a daily routine with naps and feedings, and more than 2 hours between nursing, so I was feeling a little stir crazy for a couple of months there.

Anyway here we are. He’s still good natured most of the time, but not placid, really active. He's been crawling since 7.5 months, now pulling up to stand on anything taller than his knees. He is never, ever still - won't sit in your lap.

He used to enjoy diaper changes, because he used to love lying on his back and kicking and waving, and at 3 months he'd kick and wave for up to 20 minutes at a time! Now, though, he's the boy who's never still. He practically flies through the air. I often have to actually pin him to the floor with my feet on his shoulders to change a diaper, and it's really frustrating.

He's removed two doorstops (I had to remove the rest), the cap from the toilet bolts, and the cap from a childproof bottle of vitamins. He's working really hard on climbing the stairs and opening the closets. No trips to Emergency yet, but I think it is in our future.

We don't want to totally childproof the living area (there is a totally childproof area upstairs) - we'd rather have him learn that some things are out of bounds. But I get tired of redirecting him away from the lamp cords over and over again. He doesn't get that he shouldn't be chewing them, and I don't think he's developmentally capable of restraining his impulses. Any ideas?

Today he finally figured out how to use a straw, slurping up big mouthfuls of my club soda and letting most of it pour right out his mouth again. He generally finds that a fun trick. He'll take a cup, slosh in a big mouthful and spit most of it out through a big grin. I don't give him juice or we'd be really sticky.

He and the cat never quite worked out their relationship. George loved Lily, but Lily didn't love George. I had always assumed that a cat would just avoid the baby. Well, not Lily. If anything she would taunt him, coming up to the other side of the baby gate, just within reach, then swatting him if he reached out to her. Once he started crawling, she would stand her ground and swat at him when he grabbed for her, so I was having to supervise them both, keeping two mobile organisms away from each other. Finally, she went to live in a cabin in the woods somewhere in Squamish. Apparently Lily is having a fabulous time with no babies, and a big wild world.

So, in some ways it's easier than I ever thought, because I had quite an easy baby, especially for a newborn. In other ways, it's harder; I thought there would be some pattern to the days that would emerge, or that I could try to impose, much earlier than it turned out. I thought naps would be longer, and I'd be able to get more done. Next time, if I should be so lucky, I will be better prepared! I will have a postpartum doula, and a big stash of Clif bars, and I'll be good to go.

Now, I'd better get some sleep!”

Thanks to George's mum for being so wonderful and open and honest about the realities of labour and motherhood. If we laugh at any of the descriptions, it is only because we see a little bit of ourselves or our children in the images. The details are unique, but the struggles are universal!

Wednesday, November 01, 2006

Old and New Collide

Screeching into the 21st century, I've started listening to podcasts. My favourites so far (apart from the CBC, and BBC Comedies/Quiz Shows) are the downloads from the health segments on BBC Woman's Hour. Just the name reminds me of being a little girl, rolling out playdough, my mum listening to the radio. It's rather soothing. But the information is current, and the discussions are compelling. I always feel the need to dash home to my computer, tear off my iPod, and google away to discover more on each topic.

It's just the stimulus needed when you have a new baby in the house. Something to make you feel all "adult" again. I hope you enjoy these podcasts!

p.s. Please remember that the British Medical system is quite different from ours, with different protocols, recommendations, etc. Please listen these podcasts from a social and cultural perspective.