Category Archives: Pregnancy

Baby / Pregnancy

On Natural Birth

February 27, 2017

I am by no means an expert on giving birth, but since I have now had medicated and un-medicated deliveries, I thought I would share my thoughts on what helped me through the labor and delivery process with each. And if you’re planning a natural birth, here’s what worked for me.

I went into both births with the intention of delivering without drugs, but gave myself permission to go with what I felt was best in the moment.

First, with both of my deliveries, I tried to give myself over to the process. Being induced and on Pitocin was certainly not part of my birth plan with Prim, but with my preeclampsia diagnosis there was really no way around it. Ultimately, I had the mindset of “whatever is going to be best for my baby” and tried to go with the flow to the extent possible. My induction was started with a Foley catheter and Pitocin around 11am on Friday, and by the time I hit 6.5cm at 6:30am on Saturday, the following morning, I was done. I was exhausted, hadn’t eaten or slept in almost 24 hours, and had been dealing with Pitocin-induced contractions for well over 20 hours. Having gone through labor with and without Pitocin, let me tell you this — Pitocin-induced contractions are a whole different ball game. There was no break between my contractions for hours on end and it got to the point where I couldn’t breathe at all while they were happening and could barely speak in between because I was in so much pain. Ultimately, I felt like getting the epidural during Prim’s birth was the right decision. I was able to rest before pushing, which made the pushing process short and very easy. Having the epidural also made me feel very present for the pushing process and able to really soak up the moments with Prim immediately following her birth.

Lark’s natural birth was amazing. If I could plan a birth, this would be it. Recovery was significantly easier after Lark’s birth, which I attribute to the lack of medical intervention. My body was able to progress and deliver naturally, which I think makes a big difference in the aftermath of giving birth. That being said, I should note that my labor with Lark was significantly shorter and easier than with Prim. I went into labor naturally and the whole thing lasted just barely over five hours from my first contraction to when I delivered. (Just for reference, 5 hours of labor vs. 24+ hours is VERY different.) Labor with second babies tends to be shorter and easier than with first babies, and the fact that this was my second delivery in under two years also means my body was somewhat primed to give birth already.

Because I had planned a natural birth with Prim, KC and I had attended a birthing class which covered breathing techniques and coping mechanisms for labor. Ultimately, I didn’t really use any of this information, but if you’re someone who thrives in the classroom setting, taking a birth class certainly can’t hurt you in preparation for birth.

The things that helped me most through labor were:

  1. Walking/moving during active labor. After timing the first hour of contractions while laying in bed at 4am, I got up at 5am and never really sat down again until I got into the bath around 7:45am when transition was starting. Walking felt more comfortable than sitting or lying down and I think also helped speed up my labor.
  2. The HypnoBirthing breathing techniques. To be honest I didn’t even read the whole book — I really just covered the breathing and read through some of the visualizations.
  3. Dimming the lights. I like a calm atmosphere for labor, so I dimmed the lights and kept things super-mellow for both of my births.
  4. Listening to music. I listened to the Hozier Pandora station while in labor with Prim. For Lark’s birth I listened to a mellow playlist I created on Spotify.
  5. WATER. Honestly there was nothing that compared to being in the tub for transition during labor with Lark. I had used the shower while in labor with Prim, which was really helpful, but a tub is even better, in my opinion.

During contractions I focused on taking deep breaths and tried to relax my whole body starting with my jaw and shoulders and working my way down. For both labors I tried to just focus on my body as labor was happening. I lost track of time and focused only on staying relaxed and breathing. This worked up to a point during labor with Prim, but being in the bath for transition with Lark was especially helpful because I could just float and let my body relax through contractions while I focused on breathing. KC also helped a lot by talking to me through transition. In between contractions he would tell me I was doing a great job and I think may have been reading me Yahoo headlines (ha! I really don’t remember what he talked about), but having the distraction of conversation really helped take my mind off the intense contractions at the end of labor.

Pushing without drugs is a whole other ballgame. Your body sort of takes over and it’s terrifying and painful (I mean, let’s be honest here), so really the only advice I can give you is to get yourself a good doctor, midwife or labor coach who can support you through the pushing process. It definitely requires someone who can pull your focus away from the pain and get you to breathe and focus in between contractions. My midwife was right in my face for pushing, telling me how to breathe and what to do during the next contraction, but other than that, the only real advice I can give you is try not to freak out too much and just do your best to get through it.

(Oh, and if you want to be a “good pusher” my recommendation is to do Bar Method and to tuck your hips during the pushing process. I don’t think I could have identified where my abs were without having done Bar Method, and as my American OB said — “We love Bar Method students. They’re good pushers.” Both of my babies were out in less than 4 pushes, so I think she might just be right!)

Baby / Life Abroad / Pregnancy

Reflections on Giving Birth Abroad

February 26, 2017

If you’ve been following along for awhile now, you already know that there are a lot of differences between how the Dutch and American systems handle pregnancy and birth (if you’d like to get caught up, see parts 1, 2, and 3 here). I’ve also written about Prim’s very “American-style” birth (read: induction, Pitocin, epidural, being forced to wait to push) and Lark’s decidedly Dutch entrance into the world (no drugs whatsoever, born in the water, home less than 3 hours after delivery).

So given the choice, which model would I opt for next time?

The Dutch approach, hands-down. As I’ve mentioned before, I do think the Dutch approach has its drawbacks. I think it’s a tougher model for first-time moms in some ways. If you are struggling with breastfeeding (like I did with Prim), being sent home from the hospital mere hours after delivering could add additional stress to an already stressful and emotional situation. Also, if you’re someone who has a lot of anxiety with pregnancy, the American approach will likely give you more peace of mind than the the sort of “free-range” Dutch model. And if you’re someone who is dead-set on having an epidural for delivery, the American model is going to be your best bet. (Remember that 60% of American births are accompanied by an epidural, whereas only 10% of Dutch births use one.)

The Dutch model is very much based on the natural progression of pregnancy and childbirth; so if you’re into the natural pregnancy/birth thing (which I am), the Dutch model is amazing, in my opinion. I love that there’s not a lot of unnecessary medical intervention in the Dutch model, and that they really focus a lot on your wishes for labor and delivery ahead of time. Not to mention that the model of having your midwife present for the majority of your labor I think helps support the natural birth model, as they can provide valuable support and insight during the labor process.

I loved that my midwives were deeply invested in my birth plan long before I went into labor. I felt very supported in my wish to have a natural birth and labor in the water. Additionally, one of the things that really struck me after giving birth was how much my midwives wanted to discuss my labor and delivery after it was over. I have seen or talked to four of the five midwives in my practice since delivering, and all four have brought up Lark’s birth, saying that they had heard about my delivery (“Delivered in the water — how wonderful!”) and asked me how I felt it went.

In the US, no one asked me about my birth. Even after my postpartum hemorrhage, where I literally almost bled to death, no one — not even my regular OB — asked me about my delivery or its aftermath and how I felt about it.

If you’ve given birth, you know that it’s a huge, life-changing moment. It’s something that you want and need to discuss afterwards. The Dutch seem to recognize this, but the American system does not. Overall, the Dutch seem to recognize that in order to have a “successful” pregnancy and birth, you support the mother personally first and medically second. The American model seems much more based on risk-aversion and doing what the doctor feels is best, even if it’s not what the mother wants.

I love that the Dutch seem to still regard pregnancy and birth as a miracle created by a woman’s body. There is a lot of respect for the woman throughout pregnancy and birthing process, and a lot of weight given to her own wishes and feelings throughout the nine months. A good example of this was after my delivery my midwife and kraamzorg were talking to me about Lark’s birth and I mentioned that the timing was especially fortuitous because my mom happened to be visiting Amsterdam for a mere three days and I had managed to deliver during those three days. Without missing a beat, the kraamzorg said, “Your body knew,” and my midwife immediately said, “Yes. Women’s bodies — they know.”

Isn’t that wonderful? I know it’s a little crunchy-granola sounding, but I think a lot of the respect for the female body has been lost in the American system. So much of the US system is focused on the fetus, rather than the mother. While I agree that the fetus is precious, you don’t get the baby without the mother. Creating and birthing a life is a huge, wonderful thing that should be celebrated. If you’ve been or are pregnant, you know the awesome sacrifice of carrying a life, and I’m here to tell you that what you’re doing — it’s not easy, but it’s amazing.

If you’re considering a birth abroad, or moving to the Netherlands and considering expanding your family, I can’t recommend the Dutch approach enough. As I told my midwife after delivery, I don’t know how I’m going to go back to the American system after this, as I feel like Lark’s birth was about as ideal as it gets.

Baby / Life Abroad / Pregnancy

The Dutch Maternity System, Part 3 (The Birth!)

February 24, 2017

Now that I’ve completed a full pregnancy and birth in the Netherlands, I wanted to recap how the Dutch handle the end of pregnancy and the delivery and postpartum period, compared to the American system.

The end of my pregnancy was (luckily) fairly uneventful. My blood pressure went up a little, but never hit a level of real concern (140/90 or higher). Even though I wasn’t in “dangerous” territory, my midwives took the rise in my blood pressure seriously and made sure I was coming in weekly for appointments where they would check my blood pressure and run a test to ensure there was no protein in my urine. The week I got my first high blood pressure reading the practice arranged for a midwife to come to my house two days later to measure my blood pressure and test my urine again to make sure everything was ok. Once my blood pressure (thankfully) leveled off, I continued to have weekly appointments, much like they have in the states at the end of pregnancy.

As I mentioned in Lark’s birth story, I did call my midwife once before I was in “real” labor, because I’d been having regular contractions that had lasted all day and were getting closer together. The protocol in the Netherlands is to call your midwife at the first signs of labor, they then come to your house to assess you and determine if or when you should head to the hospital. In the US, you generally call your OB or the hospital at the first sign of labor, and they tell you whether you should go to the hospital just based on hearing your symptoms over the phone.

Having the midwife come to you first ensures that you don’t head to the hospital too early or before it’s really time. So many women end up at the hospital in the US, hooked up to monitors that measure contractions, only to be sent home hours later because they’re not really in labor yet or they’re not far enough along to warrant being admitted to Labor and Delivery. (And what a glorious waste of time and money all of that is.)

Once my labor started and I contacted the midwife, she took the reigns and determined when we would head to the hospital and took care of the logistics of calling the hospital to ensure that there was room for me to be admitted. At the hospital there was no paperwork, no wrist bands, no IV, no continuous fetal monitoring. My midwife stayed with us the entire time I was in labor and would listen to the baby’s heartbeat intermittently with the doppler.

We saw a hospital nurse once during our five hours at the hospital — she came in early on just to say that we should press the red call button if we needed anything and she would contact my midwife if she wasn’t in the room with us. (In the Netherlands, if a hospital is short-staffed in labor and delivery, your midwife will call your kraamzorg company to send over a kraamzorg to assist in your birth and postpartum period at the hospital. It’s customary for your kraamzorg to be present if you deliver at home as well. A kraamzorg from the company I had signed up with came to the hospital and was present for Lark’s birth and took care of me after I delivered.)

At the hospital I was free to walk around, dim the lights, play music, and was generally un-interfered with. My midwife set up the birthing tub for me and monitored the baby’s heartbeat occasionally between contractions, but she basically just let me labor as I wanted until it was time to start pushing. I think if my labor had been longer/harder, the midwife would have stepped in and given more support as needed. As it was though, my labor was very short and, in my opinion, very easy. Once I started pushing my midwife really stepped in and supported me. Pushing during a natural birth is super scary and your body basically just takes over (it’s true what people say about being inside their bodies for pushing — that’s exactly how it felt). In between contractions my midwife was right next to me, literally inches from my face telling me to breathe and what to do during the next contraction. It was so helpful to have her pull my focus between those intense moments because I was able to re-center myself and prepare for the next wave of pushes.

After Lark was born I was able to hold her immediately after (I mean, I pulled her out of the water myself!) and had an hour of skin-to-skin where no one bothered me, other than to ask what I might want to eat. After Prim’s birth in the US, there was a small delay between when she was born and placed on my chest, where the doctor held her and had KC cut the umbilical cord. She was also removed during the first hour to be weighed, wiped down, and given her first set of shots. Having uninterrupted time with Lark right after she was born was so amazing and made me feel so much calmer. She was able to breastfeed successfully and adjust to her new life outside my belly.

After the hour was up, Lark was weighed, given her eye treatment and vitamin K shot, then dressed and returned to us. She never left our room or even our sight while we were at the hospital.

In the US, all postpartum care takes place in the hospital, whereas in the Netherlands it takes place at home. The newborn hearing screen, heel prick and first set of vaccinations takes place at your home during the first few weeks — the local authorities who handle these logistics come to your house and assess the baby’s living situation in addition to taking care of whatever baby-care they are tasked with completing. Your midwife also comes to your home for your first postpartum appointments.

And then of course the most Dutch aspect of the birthing process — the kraamzorg.

A kraamzorg is a postpartum nurse who comes to your home for the first eight days following the birth of your child. You sign up with a company of your choice, and you can opt for anywhere from three to eight hours a day with your kraamzorg for that period. The kraamzorg assesses your healing, helps with breastfeeding, monitors the baby’s temperature, and how she’s eating and generally progressing during the first eight days. The kraamzorg also helps out around the house, by preparing food, entertaining older children, doing laundry and light cleaning.

Since this post is already super-long, I’ll save my own thoughts and opinions on the Dutch birth and postpartum process for another post.

Baby / Lark / Pregnancy

Welcome, Little One!

February 19, 2017

Meet our newest love: Lark Adelaide Deatsch! 

Our sweet little Lark arrived on February 16th at 8:56am in Amsterdam — four days ahead of schedule.

In case you’re curious, here’s how it all happened… (Like all good birth stories, it’s long — even though my labor was short!)Since I was induced with Prim at 38 weeks due to late-onset preeclampsia, I was hoping to avoid induction (and preeclampsia, obviously) this time, and was really keeping my fingers crossed to make it until at least 39 weeks.

On Saturday morning, two days before I hit 39 weeks, I started having regular contractions in the morning. They were annoying but mild and continued throughout the day. That night they got a bit more intense and closer together, and even though I didn’t think it was the “real thing,” I decided to call my midwife just to be safe. I explained that I’d been having contractions that were about a minute long, five minutes apart, for the past hour and a half, but wasn’t sure that it was real labor because they were so mild. Since I didn’t go into labor naturally with Prim, I had no frame of reference for how “real” labor felt — only pitocin-induced contractions.

The midwife said I was right to call and came over to check me out. She said I was only 1cm dilated and 50% effaced, so these contractions were most likely just pre-labor or prodromal contractions. She said that they might progress into the real thing overnight, but that there was no way to really predict.

I continued to have these contractions everyday from Saturday until my next midwife appointment on Wednesday. I explained to the midwife how I’d been feeling and how I was worried about my blood pressure (as it occasionally would rise, and I had noticed that it was higher in the mornings with these continuous contractions). I was determined to avoid induction if at all possible, and asked the midwife if she could check me again to see if I’d made any progress over the past four days. The midwife thought a membrane sweep might help move things along, given that I seemed to be stalled in pre-labor, which I agreed to.

I should also note that my mom had arrived the day before my appointment, on Tuesday, but was only staying until Friday morning, so there was a big part of me that was hoping to go into labor during her stay. This would ensure that Prim would be covered while we were at the hospital and my mom would get to meet her newest granddaughter before heading back to the states — win/win.

The midwife checked me and determined that I hadn’t made any progress since Saturday night, which was a little disheartening. She performed the sweep and said that I had progressed to 2cm and my cervix seemed favorable afterwards, so we would just have to wait and see. I went home and continued to have mild contractions and cramping throughout the day, but nothing that seemed like the real thing.

After going to bed that night, I woke up at 3:45am with what I knew was a real contraction. I tried to go back to sleep, but the contractions were too uncomfortable, so I decided to time them even though they seemed pretty far apart. I timed them for an hour and determined that they were coming regularly at 9 minutes apart. I knew they were too far apart to bother the midwife, but couldn’t sleep through them, so I got up and headed downstairs at 5am. My contractions immediately started coming at 3 1/2 minutes apart, so I decided to ring the midwife after half an hour to see what she said. I was surprised when she told me she would be over in 20 minutes and that I should get my things ready to head to the hospital, but figured she just wanted us to be prepared, so I went back upstairs and woke up KC and let my mom know that the midwife was headed over.

The midwife arrived around 6am and checked me, saying I was 3cm. I had another contraction and she stopped and said, “Well, you’re at 4 – 4 1/2 actually. I think it’s time to head to the hospital.”

One of the weird things about Amsterdam is that if you want to have a hospital birth, you have to call the hospital before heading in to make sure they have room for you. I had planned to deliver at the hospital that was less than half a mile from our apartment — OLVG Oost, not only because it was close, but because it had tubs you could use during labor. (The hospital I delivered Prim at did not have baths, but the shower was so helpful during labor that I was determined to deliver at a hospital with tubs this time, if at all possible.) Unfortunately, OLVG said it didn’t have room when the midwife called to see if they could admit me. I was really bummed, but tried to just let it go — the best laid plans for childbirth often go out the window at the last second. The next two hospitals the midwife called also said they had no space, so she said that she was going to call OLVG again to force them to accommodate us. She spoke in Dutch to the person on the phone, but I was able to make out snippets of the conversation where she threw in “second baby,” “5 centimeters,” and explained my prior postpartum hemorrhage (since that qualified me for a hospital birth based on necessity). She apparently got the answer she was looking for, as she hung up the phone and announced that we could head over there.

We arrived at the hospital sometime between 6:30 and 7am and the place was deserted. The check-in process was us literally breezing past a desk clerk in labor and delivery who pointed us to room 1. No forms, no signatures, no nothing.

We put our stuff down in the birthing suite and the midwife started assembling and filling a huge labor tub. I walked around and breathed through the contractions, KC put on music, and I paced around, waiting for the contractions to become unmanageable.

At 7:30am the midwife checked me again and said I was 6cm dilated. Shortly afterwards the contractions got a little stronger so I decided to try out the tub. The tub was amazing. It took the pressure off my back and hips and made the intense contractions still manageable. My water broke on its own while I was in the tub, which felt totally strange. I was still able to relax and breathe through my contractions so I didn’t even realize how far along I was until the midwife came in and told me to push a little during the next contraction if I felt the urge.

(I should note that I didn’t really even fully realize that I was in transition while I was going through it. During Prim’s birth I was on pitocin and had crazy-intense contractions that rolled together with virtually no break in between. They were so intense and so painful that I couldn’t breathe while they were happening, much less even attempt to stay relaxed. Going through transition with Lark was completely different — the contractions were painful and required a lot of focus and deep breaths, but I was able to relax through them, and there were noticeable breaks in between surges which allowed me to relax further and re-center myself.)

Trying to push while in the tub was a little tricky, as there’s no gravity and nothing grounding you (not to mention your ab muscles are just generally hard to find late in pregnancy). I used the first set of pushes as practice to find my leverage (and my ab muscles) in the tub. I figured out how to push and then quickly felt the baby crown during the next set of pushes. I will tell you this — I was terrified. Pushing without drugs is INTENSE and totally scary. I was lucky that my midwife was experienced and was able to get me to focus and breathe between contractions, but still, there was a moment where I was certain that my body was going to break in half. At this point I knew that the only way out of the pain was through it, so with the next contraction I pushed as hard as I could and out she came. I was lucky that pushing was very quick — three pushes and she was out.

I hadn’t actually gone in with the intention to give birth in the tub, but at the point my midwife said to start pushing I think I didn’t really comprehend that I was pushing for real and it all happened so fast that I didn’t have much of a chance to change my mind and move to another location. Ultimately, delivering in the tub was amazing, once I figured out how to push without the help of gravity or anyone holding my legs. Once Lark was out the midwife had me keep her underwater for a moment, as babies born in the bath don’t take their first breath until they’re brought out of the water. That moment of holding her and looking at her under the water was so surreal and is something I will never forget.

I brought her out of the water and onto my chest and promptly started panicking that she wasn’t crying. Luckily the midwife informed me that she looked perfect and pink, and that because she was born into the water she had a gentler entrance into the world, which was why she wasn’t exhibiting the startled newborn crying of a non-water birth; she simply curled up and fell asleep on my chest. I moved out of the bath onto the bed to finish the sort of “after-logistics” of giving birth, which included getting stitched up sans epidural (funnnn).

^^ squeezing KC’s hand and taking some deep breaths through the stitching process ^^

So one of the craziest things about the Dutch system is what happens after you deliver. After having Lark just before 9am, I had an hour of skin-to-skin with her where I was able to breastfeed and bond uninterrupted. Lark’s cord was clamped and cut by KC after quite awhile, as the Dutch have a general practice of delayed cord clamping.

After the hour was up, Lark was weighed, wiped down a bit (no bath here — they believe in waiting at least 24 hours after delivery to give a bath, so baby gets all the benefits of the vernix) and dressed.

^^ Lark’s position in the womb ^^

While Lark was being weighed and dressed, I was given a meal and took a shower. I got dressed (no hospital gowns here!)

…and then we were told that we could leave.

KC and I both said, “…Really?” and the midwife and kraamzorg both sort of looked at us and said, “Do you want to stay?”

So we left the hospital at 11:30am, 2.5 hours after I delivered. The kraamzorg accompanied us to the elevator, but then left us to find our way out. Again — no discharge paperwork, no assisted walk to the car. We were home before noon.  Prim got to meet her new sister in the comfort of her own home less than 3 hours after she was born. It was pretty amazing… and so very Dutch.

Welcome to our family, little Lark. We love you so, so much.

My overall thoughts and some more details of the Dutch maternity system and birth model will be coming up in a later post. But for now, I’ve got two little ladies to attend to. 🙂

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.