Saturday, July 5, 2014

Guilty Pleasures

I talk a lot about how hard motherhood can be and what a spiritual discipline it is for me. But lately I've been feeling guilty. Actually, I've been feeling really happy and... um... enjoying myself. I care for my 2 boys and work a part-time job from home. Still, last week I managed to sunbathe at noon, work out almost every day, lunch with a friend, and stroll the aisles at Target. I'm in an insanely good mood from the amount of sunlight and warmth I've snuck into my days through eating popsicles on the back porch with my toddler and turning him lose on his orange bike at the elementary school track while baby Leo and I walk laps.

Lately I've been thinking, this gig has to be up soon. This is too easy. This is too fun.

This is how life is right now. This is how I thrive--with manageable doses of meaningful work, simple pleasures, and plenty of  margin to welcome the unexpected. How, then, have I come to view this pace as not enough, self-indulgent, and even lazy?

What kind of respectable person has time for on-the-fly play dates and the freedom to sunbathe at noon on a Tuesday?

Is it possible that this pace of life has some sort of merit? When I think about the difficulties that the rest of the world is struggling with--hunger, war, basic survival--I think I have no right to live the way I live. But at the same time, I feel presence and empathy more readily. When I'm not consumed with my own basic survival, I'm a better mom and more conscious traveler upon this earth.

I've also been watching my kids and how innocent and free they are when they're consumed with play and exploration. Isn't that the goal we're all trying to achieve? To get back to that pure innocence and enjoyment of life?

I don't know the answer right now, but I feel like I'm stumbling onto something with my current pace of life. Yes, I feel guilty, but I also feel hopeful that this life might give way to something more meaningful and impactful than I could ever have imagined.

Sunday, May 11, 2014

A Mother's Day Act of Courage

This is for the moms. You know who you are.

You ate half a bag of chocolate chips last night after the kids went to bed.

You worked out so hard last Monday that you couldn't stand up and walk to the childcare center to pick up your 5 month old.

You haven't had a solid night's sleep in 2 years. You haven't had sweets in 2 weeks.

You lost your mind when you lost your mom, but you go on, determined to find your beautiful, messy way.

You pushed a baby out with nothing to numb the pain but water and breath.

You're a physician. You can fit 2 fingers between the gap in your abdomen muscles, and it kills you.

Your second baby is due Saturday, and today you wore your bikini to let your belly soak up the sun and play in the splash pool with your toddler. You hate your thighs.

This is for the 50-year-old mom who looks back at pictures of her 30-something year old postpartum body and says "Damn, I looked good, and I didn't even know it."

This is for my husband, my neighbors, and even Facebook. Judge me, envy me, approve of me, ridicule me, turn your head...whatever.

This is for the moms, and this is for me.

And I have this vision. What if all the moms dared to bare their bellies? What if instead of going to websites with pictures of strangers baring their postpartum bodies, we could see each other happy and comfortable in our own skin at whatever stage of motherhood in which we find ourselves.
I know, there's modesty. There's cultural norms. But today there was the sun, and a cookout on my back porch, and an invitation to don my bikini. And so, I got inspired. I got comfortable. I got bold. Care to join me?

Wednesday, January 29, 2014

Hard Day

Today is a hard day. There's nothing in particular that's extra difficult. I think I'm just in a funk from sleep deprivation and the piggyback illnesses that finally left our house. What's hard, and what scares me, is that I want to be anywhere but here.

After fighting so hard to fandangle a way to stay at home with my kids, here I am wallowing around in an icky gooey puddle of malaise, boredom, and exhaustion.

These are the days I said I don't want to miss.

Lately, I'm missing the days. My unmet needs for adult socialization, intellectual stimulation, and me time are clouding my time with my kids. Instead of doing something about those unmet needs, I'm overly relying on the television to fill the void between my kids' desire for attention and my capacity to give it.

I don't think that I need a big change to regain my presence and balance. The days are unusually mundane and isolating when it's 19 degrees outside and your newborn has bronchiolitis, which he caught from your toddler, who now has a stomach virus.

But I do need a serious time out.

It's time to refocus. It's time to remember how lucky I am to make faces with my newborn for an entire hour in the middle of the work day. It's time to savor the privilege of bearing witness to my toddler's unbridled enthusiasm for trains, fascination with counting, and innate concern for his baby brother.

It's also time to cut myself some slack for that missed workout, that extra hour of television, and that extra glass of red wine. The best advice I received leading up to the birth of my second child is to be kind to yourself. Being a full-time mother, however much I genuinely want to do it, is not easy.

In the past few days I've found some solace in this post I saw floating around on Facebook. Specifically, this part:
How was my day? Today has been a lifetime. It was the best of times and the worst of times. There were moments when my heart was so full I thought I might explode, and there were other moments when my senses were under such intense assault that I was CERTAIN I’d explode. I was both lonely and absolutely desperate to be alone. I was saturated — just BOMBARDED with touch and then the second I put down this baby I yearned to smell her sweet skin again. I was simultaneously bored out of my skull and completely overwhelmed with so much to do. Today was too much and not enough. It was loud and silent. It was brutal and beautiful. I was at my very best today and then, just a moment later, at my very worst. At 3:30 today I decided that we should adopt four more children, and then at 3:35 I decided that we should give up the kids we already have for adoption. Husband — when your day is completely and totally dependent upon the moods and needs and schedules of tiny, messy, beautiful rug rats your day is ALL OF THE THINGS and NONE OF THE THINGS, sometimes within the same three minute period. But I’m not complaining. This is not a complaint, so don’t try to FIX IT. I wouldn’t have my day Any.Other.Way. I’m just saying — it’s a hell of a hard thing to explain — an entire day with lots of babies.
How do you find your way back to the still waters beneath the waves of parenthood and daily life?

Friday, January 17, 2014

Adjusting Attachment Parenting for 2

Both boys are home sick today. It's the first day since Leo was born that I've been the primary caretaker for both boys all day long. So far, so good. I've actually enjoyed the morning, and now both boys are taking an afternoon nap--at the same time! Just call me super mom.

One of the hardest adjustments for me as a mother of 2 has been watching my relationship with Cameron evolve. I tend toward attachment parenting, and it's not so easy with 2 attachees. In the good old days as an only child, Cameron enjoyed nursing, bed sharing, baby wearing, and copious amounts of one-on-one time with me. Now he sleeps in his own bed (can I get a hallelujah?!), holds hands and walks like a big boy, and goes to preschool plus lunch and nap for 6 hours every week day. I deem all of these things necessary in order to maintain my career on a part-time basis and establish a quality bond with my new nursling.

Let's talk about that new nursling. Leo has enjoyed at least a good 2 hours in his Ergo carrier today already, and I lost track of how many times he's nursed. But he also cried by himself this morning. He shows an obvious need for a nap around 8:30 or 9 in the morning, and when Cameron is home it's too noisy for Leo to fall asleep. So I do my best to settle him, and then put him down in his co-sleeper with the door shut to allow him to fall all the way asleep. He doesn't get the luxury of falling asleep for every nap on my lap like his big brother did. If we did that, either he would never fall all the way asleep or Cameron would self destruct downstairs while I tend to Leo upstairs behind closed doors. Cameron is a 2-year-old boy. He doesn't sit quietly.

Mommy guilt is alive and well in my psyche. I miss my one-on-one time with Cameron. I cringe when baby Leo cries alone. Despite my misgivings, our setup is getting easier and more sane with time. I'm so proud of Cameron for his growing independence and his ability to entertain himself when I'm unavailable to play. When Leo stops crying upstairs, and especially when he doesn't cry at all, I pat myself on the back for recognizing his need for sleep, and then I proceed to enjoy a few precious moments alone with Cameron.

What I can't wait for is the day when Leo and Cameron develop an attachment to each other. Already my heart melts when Cameron holds Leo, when both boys lie down in one bed together, and when Cameron imitates my soothing skills in an attempt to stop baby Leo's crying. There are a lot of needs flying around this house lately. My hope is that my boys grow up confident in themselves and their needs, and rooted in unconditional love.

Do you have more than one child? How did you adjust your parenting style to best meet everyone's needs?

Friday, January 10, 2014

My Second Chance Birth

Today is my last day of maternity leave, so it's time to kick this story out into the blogosphere. I'd like to start by celebrating that I got my home birth.

Leo Scott, born November 25, 2013

Home birth doesn’t just fall in your lap. I drove an hour each way for my prenatal appointments, paid out-of-pocket for a birth assistant and medical supplies, and had to find a new pediatric care provider when my toddler’s provider said he wouldn’t see my baby if he was born at home. When I was 38 weeks pregnant, an insurance representative incorrectly told me that they do not cover home birth. A week after birth, I got stuck in another insurance snafu that made getting my baby’s newborn metabolic screening nearly impossible.

So why bother with the road less traveled when things could have been so much easier?

I had a vision of how birth could be. I’ve seen it in documentaries and read about it in Ina May Gaskin’s books. I sampled just a taste of it during my first birth, which rapidly turned into a freight train of runaway contractions, vomiting, dehydration, and Stadol. Everyone told me I did a great job with my first labor and that anxiety just got the better of me, but I wasn’t satisfied. I didn’t know if I had the capability of navigating birth and introducing my baby to life with the ease and grace with which I heard was possible—and I needed to find out. So, without further ado, here’s how my second shot at labor went down.

My first few contractions started the minute my moms walked in the door after their 12 hour drive from Florida. We were all hoping they would arrive in time for the birth and had no idea how close they would cut it. At first I wasn’t sure if the contractions were real. I braced myself on the kitchen counter for a clear, deep breath, then rested on the sofa feeling my way through those first squeezes. Two hours later, I was on my hands and knees in the middle of my toddler’s bedtime routine.

I called the midwife and birth assistant to talk my way through what was happening. We decided to call it early labor, and my team started their trek toward my house just in case things progressed quickly. Meanwhile, my midwife encouraged me to take a warm bath and then try to get some sleep.

At midnight the midwife was on my front porch, and the birth assistant was close behind. After an initial exam, the two of them decided to camp out on the downstairs sofas until I showed signs of active labor.

Time blurred once everyone in the house was sleeping. It made sense to let everyone get as much rest as possible so that they’d have the stamina to help me when things got intense. But there I was, awake and aching for someone’s touch. I choked down the growing knot in my throat and asked my husband for help. He broke open the essential oils and commenced rubbing my feet. Tears streamed down my face; I wasn’t alone anymore.

Over the next hour I dozed between contractions just as I had while on Stadol during my first birth. It was my most restful hour of the night even though contractions sped up to every 5 minutes. At 4am, my husband woke the birth team, and they came upstairs to start their care.

One of my birth plan requests was to not tell me how dilated I was or what station the baby was unless I specifically asked. Numbers got in my way last time and triggered unnecessary anxiety. But just this once, I asked for a report. I was coasting through labor and wanted confirmation that something was happening.

“Six centimeters, 2+ station,” said the midwife.

It has to get harder than this, I thought. Last time I walked into the birth center at 4 centimeters, -2 station and begging for drugs. My midwife said that because my water hadn’t broken like at the beginning of my first labor, I had a cushion between me and my baby’s head. I was proud of myself for coping so well this time around, but even more so, I felt unforeseen relief in the knowledge that my inability to cope last time was not my fault. I didn’t have a weak character or resolve. I didn’t have an unusual problem with anxiety. I just got dealt a bad hand.
Active labor was in full swing, and because I had tested GBS positive this pregnancy, I received IV antibiotics to minimize the baby’s risk of exposure. The birth assistant hung the IV bag from the ceiling fan, and after 15 minutes, I was free to move around. The contractions again sped up, and I headed for the tub.

“Do you prefer we stay in here with you, or do you want us out of your way?” asked my midwife.

The birth assistant, midwife, and my husband stood looking to me for instructions. The knot in my throat swelled again.

“I don’t know,” I said. Then the tears fell.

“Aw, get her moms,” said the midwife. That’s exactly what I needed—the silent presence of women who know me inside and out and understand exactly how to support me with touch, tears, and well-timed words of encouragement.

In just a couple minutes, my moms came up from the guest bedroom. What followed was one of the most beautiful parts of my labor. I couldn’t have picked better music for my labor playlist. My moms complimented me on how peaceful and relaxed I seemed. I drifted back and forth between deep breaths with eyes closed to eyes wide open and cracking jokes.

At 7:30am, my toddler woke up. The adults took turns watching him and ushering him in and out of the bathroom when he wanted to see what was going on.

Things started getting intense over the next hour. Waves of nausea hit me between contractions and my midwife thought for sure that the last bit of my cervix was dilating. I decided to move to the bed for a rest, but it wasn’t long before my midwife strongly encouraged me to get upright.

“I really think your water needs to break before this baby will come out,” she said. “Let’s get up and do some sideways lunges on the stairs.”

So after being up all night and headed into my 13th hour of labor, I got up. I gave my midwife the evil eye and headed for the stairs.

Every time a contraction hit, I’d stop on the stairs and squat. I kept going. I persevered. But right before 9am, I plopped down at the top of the stairs and despaired.

“I have to get this baby out,” I said.

I meant it, and my midwife could tell. I started seriously entertaining the possibility that I might need to go to the hospital for an epidural so that I could rest and try pushing the baby out later.

“Well, here’s an option,” said the midwife. “We can keep letting things progress naturally and not intervene, or we could break your water and see if that speeds things up.”

“Yes,” I said. "Let's do that."

“Now, you have to realize that things will probably get even more intense once we do this,” she warned.

“Let’s do it,” I said.

She did it, and she was right. She didn’t tell me until after the birth, but when she went to break my water, she discovered that I was still only 6 centimeters dilated—the same as the first time she had checked me 5 hours earlier. Breaking my water immediately opened me to 7 centimeters and ushered me into transition.

Just as my labor got every bit as intense as my first had been, my midwife made me get up. Again. I squatted beside my bed with every contraction and in less than 10 minutes I headed back to the tub.

The warm water helped me get a grip. When the temperature dropped, my mom would turn on the hot water and swirl it with her hand like warm ribbons wrapping around my torso. I felt the urge to push, but with every push it felt like there was no way out for my baby. I’d go with the urge and then stop cold against what seemed like a closed door pushing all the pressure back inside me with its unyielding tension.

I switched from deep breaths to low moans--the embarrassing ones that I never thought would come out of me until I experienced my first labor. My midwife coached my breath, position, and sounds. She asked me questions about what I was feeling. Finally, she asked me to reach down and tell her if I could feel my baby’s head. I could, but I still felt no relief or progression.

“I see hair!” she said. Still no solace.

Then out of nowhere, out came my baby’s head.

“Okay, Melissa, I need you to stand up,” said my midwife. She had warned me about this possibility earlier in the night. Babies can be born in the water, but if the head starts bobbing in and out of the water, it’s no longer safe.

I hiked my leg up on the side of the tub and squatted one more time. My mom says the midwife literally caught my baby, but it felt like she pulled him out as he broke the rest of his way into the world.

“Thank god!” I half sighed and half roared. I peeked down and saw my baby’s bluish skin. “Is he okay?”

“He’s fine,” said the midwife. But I heard no cry.

“Is he okay?” I asked, this time with more urgency. My baby answered this time with his beautiful cry.

My midwife handed me my baby and I walked back to bed with my prize. My husband and toddler joined me on the bed, both with equally wide eyes. My toddler wasn’t in the bathroom for the birth, but I had prepped him with my Mamamor birth and breastfeeding doll, so he wasn’t fazed by the cord or the placenta that followed.

“Baby brother!” he yelled with a huge smile stuck on his face.

The third stage of labor, breastfeeding, newborn exam, and standard postpartum care followed. Everyone told me I could sit up or do whatever I felt I needed to do. But all I wanted to do was lie horizontal, admire my baby, and revel in how pain-free and at rest I felt.

I did it. I birthed my baby.

If I could go back and do it over again, I wouldn’t change a thing. Nature dealt me a good hand this time around, and I knew how to handle it—one contraction, one breath, and one minute at a time. I got lucky, yes, but I didn’t just win the labor lottery. Birthing at home helped me avoid unnecessary tension by nixing the car ride to my birth site. It also allowed me to visualize the birth ahead of time in the very room it was likely to take place in. I practiced deep breathing in the tub and guided meditation in my bed. My nightstand housed a copy of CNM Nancy Bardacke’s Mindful Birthing.

And it wasn’t just about my experience. I believe what I did was best for my baby, too. I had gestational diabetes that was well controlled through diet and exercise. Despite our best efforts, nobody knew how big my baby would be. A 36 week ultrasound estimated 6 pounds, 11 ounces. At 38 weeks the midwife guessed 7 ½ pounds. On his birthday at 39 ½ weeks, it took me an hour to push out all 9 pounds, 12 ounces of him. If I had run into trouble getting him out, we had an emergency hospital transfer plan ready to go. It wouldn’t have been fun, but we all knew what to do just in case. If I had started in a hospital, my care team probably would have freaked out about me staying at 6 centimeters for 5 hours. If we got past that, I probably would have asked for an epidural, which probably would have further extended the pushing phase, which would have raised our risk for a cesarean section. Instead, we had a peaceful birth followed by plenty of time to establish breastfeeding before proceeding to eye drops, vitamin K, and blood sugar testing on the bed right by my side.

Another mother-baby combo could have faced the same situation and decided on a completely different route. In the end, I think birth setting is an extremely personal decision with no black and white answers. There are risks and benefits to every birth setting, and every woman deserves the freedom and authority to weigh them for herself and her baby.

I’m so thankful for my birth team, my family, and all the friends and health care providers I consulted along the way who lent me their best advice and knowledge. I ended up with a deeply satisfying birth experience that taught me how to voice my needs, fight for what I want, and confidently face each moment one breath at a time.
“So birth like a lion. Roar your baby out. Thrash and burn and yell and squeeze tighter….let the train barrel through you, hold on tightly, jump out of your body and right back in again. Deep down sounds—low in your belly. Growl. Yes. Birth is like this.”

Tuesday, December 31, 2013

Here Now

I'm proud to announce the arrival of Leo Scott, born November 25, 2013.

He weighed 9 pounds, 12 ounces, and was born at home surrounded by family. I've been writing our birth story for the past month, but am still not ready to release it into the blogosphere. So, until then, I'll continue mumbling my way through my journey as a mother of two--count 'em--two!

I haven't done so much as a supta badha konasana since Leo arrived. Instead I'm focusing on the very basic task of breathing through every moment. When I'm nursing the baby and putting my toddler down for a nap, I breathe. When both boys are crying at the same time and I can't soothe either one, I breathe. When I'm awake for the sixth night-time feeding and I'm choking back tears wondering when I'll be able to sleep again, I breathe.

Between the breaths, I rest. I take hot baths, I exercise, I nap, I drink afternoon coffee, and I have red wine with dinner.

The days and nights are long and hard, but I'm determined to soak up every second of my time as a mother of two young boys. More than ever before, I'm convinced that motherhood is fertile ground for spiritual development and brimming with the stuff that tethers you to the here and now.

Wednesday, October 30, 2013

No Hospital, No Service: A Level-Headed Response to Home Birth Discrimination

I've encountered an unexpected opportunity to advocate for home birth. When I called to arrange pediatric care for my new baby at my first son's pediatrician, I was floored to hear that I would need to find a different pediatric care provider because I am planning a home birth. My first reaction was to post the news all over Facebook and seek validation for my anger from family and friends. What follows is my more calculated response, due to be delivered into Cam's pediatrician's hands tomorrow morning at his well-toddler check up.

I feel the need to clarify that I did not include certified midwives in my letter below because they are not yet authorized to practice in Virginia, which is where my pediatrician is located, and I want to avoid any unnecessary confusion over midwifery credentials. Please also consider that this letter arose out of my very personal health care and birth decisions as well as what I think our pediatrician most needs to hear. My opinions are forever evolving, and I respect the validity and fervor of opinions and decisions that differ from my own.
Dear Dr. Wayne Eriksson, 
My son has been coming to your practice for 1 year, and I have thoroughly enjoyed and benefited from our experience. I’ve found your advice in particular to be practical and effective. When I called to arrange care for my second son, due at the end of November, I was quite disappointed to hear that you will not provide him with the pediatric care he needs due to my choice of planned home birth. 
I chose home birth with a certified nurse-midwife because of Virginia’s limited availability of freestanding birth centers staffed by certified nurse-midwives with pre-existing facility arrangements for emergency care. Instead I chose BirthCare and Women’s Health based in Alexandria, VA, which offers the option of birth center or home birth with pre-arranged emergency care and consultation built into their practice system. Given that my first labor and birth happened so quickly and given that the birth center is nearly 40 miles from my home, I believe the safest route is for the midwives to come to me at my home on the big day. 
I am aware that the American Academy of Pediatrics recommends that birth take place in a hospital or birth center. However, their latest Policy Statement on Planned Home Birth also states that pediatricians should respect the right of women to make a medically informed decision about delivery and that: 
  • “Regardless of the circumstances of his or her birth, including location, every newborn infant deserves health care that adheres to the standards highlighted in this statement.” (Of particular note, the statement says that newborns should be evaluated by a health care professional who is knowledgeable and experienced in pediatrics within 24 to 48 hours of birth.) 
  • The goal of providing high-quality care to all newborn infants can best be achieved through continuing efforts by all participating providers and institutions to develop and sustain communication and understanding on the basis of professional interaction and mutual respect throughout the health care system.”
Less than 1% of women in the United States choose planned home birth. However, the rate of home birth has increased by 41% from 2004 to 2010, especially among white, non-Hispanic women. In the coming years, your practice is likely to encounter more mothers seeking pediatric care following a planned home birth. By denying care to their infants, an opportunity is being missed to provide patient education and to advocate for the safety of the baby.  
I am aware of recent studies that found an increased risk of neonatal mortality, low Apgar scores, and seizures among infants born at home in the United States as well as the support and criticism these studies have attracted. I am also aware that choosing a certified nurse-midwife as your care provider at a home birth appears to mitigate these alleged risks. My midwives, collaborating OBGYN, medical assistant, and I have taken great care to ensure a safe environment for my baby and me, including GBS screening, availability of IV antibiotics and oxygen if needed, standard maternal and newborn screening procedures, emergency transfer arrangements, and ready pediatric consultation. 
I am disappointed that our pediatric consultation will not come from Union Mill Pediatrics, but I hope that my letter may have a positive impact on your practice and your future patients. Thank you for your care and advice over the past year, and thank you for considering my concerns. 
Melissa Garvey