Pregnancy

Pregnancy Update — January

January 20, 2017

I’m in the home stretch now, and I have a feeling that this will likely be my last pregnancy update for this little one. Because my belly is still measuring behind (though not by much — measuring 33.5 at 35 weeks) I was sent for an additional ultrasound to check on baby’s growth. Much like Prim, this little one is measuring a little below average but completely within normal limits, and to no one’s surprise (or at least those of us who know Prim), baby’s biggest measurements came from leg length followed by belly size. Prim, long-lean kiddo that she is, is pretty much all legs and belly — and has been since day one. And frankly, with the size of Dutch babies, I have to admit that I’m a little relieved that this baby isn’t measuring above-average (because, guys, the kids here are enormous.)

weeks: 35 1/2

baby’s size: honeydew

i’m feeling: tired and achey. I’m getting into that “real pregnant” phase where my body is just exhausted at the end of the day. Everyday tasks require a lot more effort and are getting increasingly more uncomfortable as my belly grows, and the baby is super low and engaged in my pelvis which means she hits all kinds of fun nerves which give me lightening pain in my back, belly, and legs pretty much all day long.

food love: fruit and baked goods. I’ve been on a baking kick lately and, among other things, have made homemade peanut butter brownies, raspberry scones, and chocolate chip walnut blondies. Sugar is so, so delicious during pregnancy.

food hate: I don’t have any major food aversions at the moment, though certain things are still sounding pretty unappealing most days (like a giant cheeseburger — mmm, no thanks).

3 pros for january: 1. KC and I have a sitter coming weekly until the baby comes so we get to escape once a week for date night. It’s only for a few hours, but it’s so nice to get out of the house together. 2. It’s been snowing on and off here in Amsterdam, which is so pretty and magical. I’m sure I would grow tired of it if I lived here permanently, but since it’s new for me (being a California native) I’m still thrilled by the little flurries.  3. We have everything we need for the new baby now, and I’ve done all the laundry and organized the whole house. The nesting phase was definitely less intense this time around than it was when I was pregnant with Prim, but man did it make me productive when it finally hit!

3 cons for january: 1. The cold weather means that the streets here are getting increasingly more icy. Since I’m worried about falling, I’ve officially stopped riding my bike around until post-baby (and likely for quite awhile beyond that). 2. My blood pressure has risen a little bit recently, which is worrisome with my history of pre-eclampsia. There’s no reason to be worried just yet, but I was really hoping to avoid the whole hypertension/pre-eclampsia/induction conversation completely this time around. 3. I’m trying to get into the “birth mindset” as my due date is rapidly approaching. I don’t really remember exactly how I felt at this point when I was pregnant with Prim, but I feel mentally unprepared for birth at this moment. I’m hoping that instinct kicks in and takes over when the big day actually arrives.

currently living in: pajamas and KC’s enormous sweatshirts, because I basically want nothing tight on my body at this point. When I do manage to get dressed (which, between Prim’s constant colds and the frigid weather, is rare at this point), I’m still wearing my maternity jeans and tops (though I’ve noticed that a few pairs of shoes have recently become too tight!)

looking forward to: meeting this little lady, though I’d really prefer that she cook for a few more weeks! (Ahem, please take note, little one!)

dreaming about: drinking champagne. Lots of it.

Life Abroad / Pregnancy

My Birth Plan

January 11, 2017

Obviously the grammar could be cleaned up a little…

In case you’re curious, here’s what I laid out in my birth plan*, based on the format provided by my midwife (with the specifics being basically identical to what I asked for when laboring with Prim):

  • My expectations regarding my pregnancy and delivery:
    • Give a short description of how you see the course of your pregnancy and delivery
      1. Calm, normal and quick (ha!)
      2. I would like the delivery to be calm, peaceful and supported. I would like to be able to dim the lights and play music in the delivery room.
  • Who will be present during delivery:
    1. Husband, midwife, any necessary medical personnel.
  • Contractions: relaxation and pain relief
    • If applicable, which positions would you prefer to soften your contractions whilst giving birth? (eg: walking, on the birthing stool, showering bathing, etc.)
    • How would you prefer to counter the pain associated with the contractions? (eg: breathing techniques, etc.)
      1. Would like to try all available positions to soften contractions (walking, birthing stool, shower, bath, etc.)
      2. I would like medication/epidural pain relief available, but hope/prefer not to use.
  • Where would you like to deliver:
    1. At the hospital (OLVG Oost).
  • Special treatments/interventions during deliver?
    • Do you have any other wishes or ideas about your delivery not mentioned above?
      1. I had a delayed, massive postpartum hemorrhage following the delivery of my last child due to a large blood clot.
      2. I have had back surgery on L5/S1 and have a bulging disk at L4/L5 — if given an epidural, it needs to be above L4/L5.
      3. Prefer delayed cord clamping, especially if baby is born before 37 weeks.
  • Postpartum period
    • Do you want to breastfeed or bottle-feed (with formula) your child?
    • Do you have any other wishes or ideas about your postpartum period?
      1. Skin to skin immediately following delivery, for as long as possible.
      2. Husband to cut umbilical cord.
      3. Breastfeeding exclusively as soon as possible after delivery.

My midwife reviewed my plan thoroughly and informed me that this is all “very standard” in the Netherlands — including delayed cord clamping (it’s the standard to delay clamping in all births here). Also, you get to eat during labor here (hallelujah!) As I’ve mentioned before, I wasn’t allowed to eat anything for over 24 hours while in labor with Prim and was STARVING, so I’m glad that I’ll at least have the option to re-fuel as needed here, without having to sneak it behind the nurses back (because, yeah, I would this time).

Now, obviously, a “birth plan” is kind of a misnomer in itself because birth plays out how it’s going to play out, no matter how hard you try to control it. The above is more a “birth wish list” of sorts; and just like I did when I was pregnant with Prim, I’m going in with the intention of letting my body do its thing naturally and will re-assess my needs as they come up in the moment.

An interesting note on the hospital and postpartum period here — the standard hospital stay is a mere 4 hours after delivery. That’s right, 4 hours after you deliver you’re sent home with your brand-new baby. Again, if this were my first child, I would probably be freaking out a little bit about this, but since this is my second, I’m ok with it (in principle). Obviously if you have any sort of complication or reason for extended monitoring you stay in the hospital longer, but part of the reason for the short postpartum stay is because you are provided a home health nurse for the first 8 days following birth.

Standard insurance covers a kraamzorg (basically a home postpartum nurse) for about a week after delivery, for anywhere from 3-8 hours a day. The nurse comes and checks your healing, assesses how the baby is doing, assists with breastfeeding, and will also watch older children, run errands, and do light housework.

Amazing, right?

Also, the first health appointments you have following birth (for you and baby) are conducted at home. The midwife comes to you for your postpartum check and the consultatiebureau (which handles pediatric care in the Netherlands) also comes to your house to check the baby. This is partially for your own comfort and also so the consultatiebureau can assess the baby’s living and sleeping situation (so smart!)

Further, when you actually go into labor in the Netherlands, the process is a bit different than the US. Much like the US, you call your midwife (or doctor) when you believe labor has started, but rather than managing it all on your own, here in the Netherlands your midwife will come to your house to monitor and support your labor. She tells you when it’s time to go to the hospital and accompanies you, and while at the hospital she can stay with you during labor if you would like the support. Once you’re ready to deliver, assuming you don’t have any complications, the midwife will deliver your child with assistance from a nurse. This means that if you have a normal, low-risk pregnancy, labor, and delivery, then you won’t actually see an OB or other doctor EVER during your birth or pregnancy. Nuts!

*I also went through a longer-form birth plan here, which is awesome any very comprehensive — but it is in Dutch and the google translate is only about 90% helpful. That said, if you’re looking for a birth plan template, this really covers all your bases!

Life Abroad / Pregnancy

Planning a Dutch Birth

January 10, 2017

One of the things I’ve noticed being pregnant in the Netherlands is how attentive my midwives have been to my birth preferences. The conversation about my “birth plan” literally started at my very first appointment. Home births are very common here, with somewhere around 30% of women delivering at home, as many insurance plans will only cover a hospital birth with medical necessity. When I signed up for insurance here I knew we wanted to have another baby, so I opted into a higher-priced plan which covered hospital birth without medical necessity (though I’m pretty sure that my history qualifies me for a hospital birth either way).

I’m not against home birth in principle, but I personally prefer to deliver at the hospital, so I informed my midwife that I would be planning on a hospital birth. She had consulted an OB-GYN about my medical history (as I had brought my medical records from my previous pregnancy and ER stay) and felt that my decision to deliver there was a good one.

Once I reached 20-something weeks I was given a form to fill out with my birth preferences. I filled it in and brought it to my next appointment where my midwife reviewed it thoroughly and we discussed my wishes.

This whole process was such a departure from my experience in the US, where any discussion of my “birth plan” was completely lead by me — not my doctor. I prepared a birth plan all on my own in the US and brought it to an appointment with my OB where she stuck it in my folder without even glancing at it. And since I ended up going to the hospital to be induced without any warning, I didn’t have my birth plan with me to give to the nurses so I just told them what I wanted verbally.

Luckily, I had some great nurses and doctors who were very supportive of my wish to labor naturally, and I was well taken care of during Prim’s birth. I have spoken to many friends who have not had such positive experiences trying to labor and birth without drugs or additional medical intervention in the US.

Here in the Netherlands, birthing without drugs is the norm. Only about of 10% of women receive an epidural here. This is partially because fewer women deliver in hospitals here than in other modernized countries, but also because anesthesiologists do not work the way they do in the states. Here, anesthesiologists often aren’t available after-hours, and if you request an epidural and the anesthesiologist is busy, it’s highly likely you won’t receive one. (I’ve also heard that if your nurse thinks you don’t need an epidural that you won’t get one.)

Since the Dutch treat pregnancy and birth like such a normal process that the body is designed to handle, this approach isn’t all that surprising. I have spoken to women who have received an epidural here — one of my midwives had almost exactly the same experience I had during her birth, where she labored as long as she could on pitocin after having to be induced and finally gave in and was given medication when she became too exhausted — so the epidural-assisted birth does indeed exist here, it’s just much rarer than in the US. C-section rates are also considerably lower here.

Here’s a comparison by the numbers between the US and the Netherlands:

  • Births via C-Section:
    • US: 32.7%
    • Netherlands: 7.7%
  • Epidural use during labor/delivery:
    • US: 60%
    • Netherlands: 10%

Coming up tomorrow: my birth plan and the Dutch postpartum approach. Stay tuned!

Pregnancy

The Dutch Maternity System, Part 2

January 6, 2017

Happy New Year, friends! We are currently fighting colds and jet lag here in Amsterdam, which has made blog posting seem impossible. I have literally had a cold for 2.5 weeks straight now (thanks, pregnancy immunity!) and it’s showing no signs of letting up anytime soon. Prim also decided to take this opportunity to revel in the jet lag stemming from our return home from California. It took her a whopping 6 nights to get back on track — by far the longest transition period we’ve had since we started taking these trips. Aaaand I’m currently writing this post at 3:30am because my pregnancy insomnia is REAL these days.

So, all of this is basically a really long-winded way of saying — I’m tired. We’re 6 days into 2017 and the whole year feels tiring. Ugh January. You’re always the worst.

Anyway, I’ve been wanting to update you all on how navigating my pregnancy in the Netherlands has been going, since I’m rapidly approaching the end here. Having been through one pregnancy in the US already, I have to say that I’m still sort of continually surprised by how hands-off (and dare I say common sense) the approach to pregnancy in the Netherlands is.

Once you get through the first trimester in the US, the intensity of the testing tends to slow down a little. There aren’t quite as many milestones to get through before the end of pregnancy, but there are certainly a few things that you still have to take care of. That being said, here’s the rundown of what you generally deal with in a normal, low-risk pregnancy in the US after week 14:

  • 20 week ultrasound to detect any fetal abnormalities
  • 20 week blood test to detect any chromosomal abnormalities
  • Gestational diabetes test (standard is the non-fasting 1-hour test with a fasting 3-hour test to follow if you fail the 1-hour)
  • Flu shot
  • TDap shot
  • Strep B test
  • Late-stage ultrasound to check baby’s size and positioning

Here’s what’s standard in the Dutch system after 14 weeks of pregnancy (again, for a normal low-risk pregnancy)

  • 20 week ultrasound to detect any fetal abnormalities

Yep, that’s it. I ended up doing the gestational diabetes test here due to a family history, but even that is only one test — a single 2-hour fasting test, rather than the potentially 4-hours you might spend over two days in the US. (Please note that in the US I had to do the 1-hour test TWICE due to family history and the 3-hour test — and all three came out negative for GD.)

I did opt into getting Prim and I flu shots here since I knew we would be traveling back to the states over the holidays, but I had to pay out of pocket for the vaccine.

The TDaP is a standard vaccine for babies here (I believe they get their first round at 4 weeks) but not for pregnant mothers.

The strep B test was sort of fascinating, as I tested strep B positive in my pregnancy with Prim, which meant that I had to have a whole mess of IV antibiotics while I was in labor. I asked my midwife about the test here at my last appointment and she informed me that they only test if you have a risk factor for it (much like pretty much all of the other tests). She explained that strep B rarely results in a sick baby and so many people test positive for it, meaning that they have to be pumped full of antibiotics for something that will likely not cause harm. The Dutch believe that unless there’s reason to believe that it’s something that will negatively affect the baby, the best course of action is to leave it alone (thereby avoiding the baby being exposed to all sorts of antibiotics in the meantime).

Now, as I think I’ve said before, I can definitely see how the Dutch approach to pregnancy would not be for everyone. It’s much less hand-holding than the US model, and if you’re someone who has a lot of anxiety in pregnancy, the more medicalized model that the US follows might offer you some valuable peace of mind. I, personally, have really enjoyed the Dutch approach so far. Given that I’ve been through one normal pregnancy already, I generally know what to expect and where my risk factors lie. I appreciate the fact that the Dutch treat pregnancy like a very normal process which your body was built to handle. A lot of autonomy is given to the pregnant woman here (my midwife didn’t even bat an eyelash when I told her of my plan to fly to and from California at almost 30 and 33 weeks, respectively). They assume that you know your body and that you have a vested interest in the fetus, so you’re the least likely person to put yourself or the baby in unnecessary danger.

What a concept, huh? Trusting a woman to know and manager her own body. Fascinating. (Please note the heavy sarcasm UNITED STATES.)

And a final note, because I thought this was such an apt illustration of the difference between the two systems:

During my last midwife appointment before my trip back to the states, my midwife laid me out on the examination table and felt my belly to determine the baby’s position (no need for an ultrasound here!) For the first time this pregnancy, she pulled out a measuring tape and measured my fundal height, rather than just feeling it. I was a little over 29 weeks at the time, but was only measuring 27. Now, in the US, if you measure +/- 2 weeks or more in either direction (meaning that you’re carrying small or large), you’re required to go in for an additional ultrasound to check growth size. My midwife felt around my belly some more and said, “I’m just trying to see if the baby is big enough. She’s very low — she’s so low I can’t feel her head, so I have to just go off the size of her body.” She ended up pulling out a model of an average-sized 28 week fetus and said, “Oh yes, no you’re baby is much bigger than this,” and sending me on my way. No need for an ultrasound, no reason to worry.

For those of you who haven’t been pregnant before, here’s why this was so great — because the baby was already engaged in my pelvis during that appointment, I’d already effectively “dropped,” which can make fundal measurement inaccurate. (As an example, in my pregnancy with Prim I always measured exactly on track, then at my very last appointment at 38 weeks I was only measuring 36 — most likely because Prim was already engaged and super low in my pelvis at the time, something my OB told me was “completely normal” at the end of pregnancy). Baby #2 has since come up a bit (thank goodness for the sake of my ability to walk) and I am now measuring perfectly on track again. But what a nice experience to have a medical professional use common sense to trouble-shoot a very common problem and use her experience to not only reassure her patient, but have her avoid a whole lot of additional worry and headache.

Pregnancy

Pregnancy Update — December

December 20, 2016

It’s crazy that that there will most likely only be one more pregnancy update after this one posts. I’m getting more and more excited to meet this little one, even though I know it means exhaustion and hormonal insanity for quite awhile (lucky KC!) Prim has been getting increasingly more interested in my growing belly, and now points and says “baby” or “sister” even before we ask her “what’s in mama’s belly?” She also loves pulling my shirt up and giving my belly kisses, which is so, so sweet, and seeing her interact with my sister’s 4.5 month old has just gotten me all the more ready to give Prim a little sibling of her very own.

weeks: 31

baby’s size: coconut

i’m feeling: surprisingly good, considering how far along I am. I think chasing after a 19 month old helps me forget about my big belly a lot of the time so I don’t really have time to dwell on my current physical restrictions. I will say though that my big souvenir from our recent trip to Paris was a maternity support back brace, since all the walking we did was getting to be really hard on me and my growing belly. Soo… anyway. Just living that glamorous pregnancy life over here.

food love: oranges and my mom’s homemade toffee. (I’m fairly certain that the bulk of my weight gain is going to happen during these three weeks that we’re back in California. The food in Amsterdam just doesn’t compare.)

food hate: meat is still weird. The other night we ordered greek food and I got a greek salad with chicken souvlaki — normally something I would totally be into — but when I went to eat it I was like, mmmm nope.

3 pros for december: 1. We’re back in California for the holidays now and it’s been so nice to spend time with friends and family. 2. My flight from Amsterdam to California with Prim was pretty uneventful, which, when flying with a toddler is a huge win.  3. We are officially through the jet lag over here (hallelujah) and Prim has been soaking up every second of time spent with her little friends and cousins.

3 cons for december: 1. As soon as Prim got over her jet lag, she got a cold (of course), which now seems to have made its way to me. Pregnancy with a cold isn’t all that pleasant. 2. I’m definitely getting full-on late pregnancy sleep now — meaning that I wake up multiple times a night because I’m uncomfortable, have to roll over (which is like trying to turn a ship around at this point), or have to pee. I suspect that I won’t get a full night’s sleep until looooong after the baby has arrived. 3. Baby girl is head down and in position now, which is great, but she, like Prim, has decided that hanging out suuuuper low in my belly is her preferred position, which means I can’t walk normally. In fact, at my last midwife appointment my midwife informed me, “She’s head down and really low. She’s so low I can’t feel her head.” I informed her, “Don’t worry, can feel her head.”

currently living in: H&M maternity jeans still and comfortable flat shoes. Luckily a swing dress I bought awhile back at Old Navy still fits over my bump, so I’m ready for a fancy night out for our anniversary later this week!

looking forward to: Christmas!

dreaming about: premature labor, which is stressing me out to no end.