Why You Might Want a Natural Birth.

It's been so long since I've blogged.  I miss it.  And I haven't.  I've been quite present online, whether on diaperswappers or Facebook's newsfeed or various forums or discussion boards, or Instagram or craigslist... to the point of having to seriously limit myself.  But blogging, not so much.  I've been seldom opening the computer between one thing & another (smart phone, hello!), and when I do it's usually for a specific task, like DOULA CERTIFICATION COURSEWORK!!!!  (might be slightly looming over my head)  All that to say, I do have a few posts rolling around in my head-- mostly ones that will be helpful to my expectant mama clients.  It's on the brain, what can I say?  If you choose to read this, please know that I am NOT in any way suggesting that those who go a different route-- whether by choice, happenstance or emergency-- are failing, stupid or "wrong."  I'm simply trying to explore the rationale behind the choice, since you know we get asked it! :)

Childbirth-- it's a big deal for most women.  It's something they either look forward to, fear, find inspiring, find intriguing, or find disgusting.  Or, more likely, all of the above in varying degrees.  Movies portray it as a scream-fest involving a scared husband watching his wife being wheeled away as the doors slam in his face, her threatening divorce until she gets an epidural, then sneezing and popping out a pink clean chubby baby (and all the moms say "no way is that a newborn").  Why would anyone want to endure THAT unmedicated??  Isn't it so dangerous, so painful?  I mean, didn't women DIE all the time from childbirth a hundred years ago?  Well... not exactly.

There actually are several reasons why mothers might chose a natural birth, despite having access to medication & technology.  Here are a few I thought of, in no particular order:

1.  God is smart.  He designed birth, and it's a complex, intricate, miraculous process that even the best doctors don't fully understand.  From what begins it to the hormones that regulate it to the way various organs in both baby & mom change radically throughout the process, it's just really really cool.  For thousands of years, women have given birth.  What about the Curse, you ask?  Didn't it mess up childbirth?  Well, yes, women's main role-- as relational care-givers-- is now hard.  But the pain in child-bearing extends far beyond conception, labor & delivery.  It's just as seen in rebellious toddlers, in horrific accidents taking teenagers, and in sending your dearly beloveds off to take their place in their own families.  We mothers will always suffer in so many ways.  But pain & death doesn't summarize motherhood any more than sweat & frustration summarizes work (the arena where men were cursed)-- and neither does it summarize childbirth.  Yes, things can go wrong there, and yes, there is much that we humans can do with the intelligence God has given us to intervene skillfully when those things do go wrong (placenta previa, shoulder dystocia, maternal hemorrhage, etc), but, just as in the rest of life, stuff usually goes the way it's supposed to go.  Great sermon from John Piper on the suffering of motherhood.

2.  Women's bodies were made to birth.  Not only do we have all the right organs, we have all the right hormones & instincts.  This is the fundamental difference between [most] OB/GYN perspectives and a midwife's:  the former views pregnancy/labor/birth as one of many pathologies of the female reproductive system that must be "treated."  Midwifery views it as a natural process, and trains practitioners to watch for warning signs of problems & otherwise just empower women to labor on their own.*  I'll briefly touch on a few aspects of the intricacies of birth:
- the hormone cascade, in which oxytocin (mood-altering bonding hormone & pain killer), prolactin (milk-making hormone), adrenaline (strengthening hormone) and beta-endorphin (opiate & analgesic) all are precisely released.  There is no way to artificially mimic these-- synthetic versions can't cross the blood-brain barrier so can't act as pain-killers, and once the cascade is interrupted  it's difficult to get the train back on the rails, so to speak.
- the beginning of labor itself, which I've blogged about before.  Pregnancy generally lasts longer than the 40 weeks we've come to expect (especially in Caucasian first-time mamas).
- position & its effect on pushing, which is far more instinctive than we Westerners tend to think it can be.  Laying flat on your back is probably the absolute worst way to push, yet if you are medicated & monitored, catheterized and hooked to an IV, it's about the only way you can push.  Women who are unmedicated and thus in tune with their body's instinctive positioning will usually choose to push in a crouched, standing, hands-and-knees or squatting position.
- baby's rotation as it descends, which can be affected by Mom's position while in labor.  Again, an unmedicated mom will be in tune with what she needs.  Here again laying still on a bed is not helpful.  The "wrong" position will be agony, the most helpful will provide relief.
Recommended reading: Ina May's Guide to Childbirth, by Ina May Gaskin

3.  Birth is empowering.  Just like people voluntarily climb mountains, bike across the US, and run marathons, so there is joy in physically, mentally & emotionally "pushing yourself" and seeing just how far you can go.  The bear went over the mountain, why?  To see what he could see!  And probably, to see what he could do.  When women are properly supported in labor, they are admired, affirmed, and encouraged, perhaps like never before in their lives.  They are doing something unique that no one else can ever do:  bring forth that child into this air. The incredible endorphin rush after birth had me saying, seconds after my daughter emerged after 45 hours of labor "let's do that again!"  I have never forgotten the incredible sense of accomplishment and thrill I got from birthing each of my children!  Anything worth doing is hard, and we know that deep in our bones.  After my first natural birth, I felt inducted into the kinship of all the mothers before me, including my own mother, grandmother, and even that teenaged girl laboring in a barn in 1st century Palestine, bringing forth my Savior.

4.  Human imitation is always, at best, just a mimicry-- with plenty of [often unforeseen] pitfalls & side effects not present in the Original.  Think margarine instead of butter, aspartame instead of honey, 'ostomy bags instead of colons... The more we know about birth, the more we realize we don't know about it... and the more amazing it is that so many babies/mamas emerge relatively unscathed in all the impositions various centuries have tried to force on it (Victorian diets of crackers & water & indoor confinements, restrained "twilight sleep," among others).  There are pitfalls & risks at every stage of intervention, from induction (lots of aspects of risk here, from autism to use of pitocin to accidental prematurity), to restriction of food/water intake due to IV use, to use of artificial hormones (pitocin, cervadil), to use of drug-analgesics (such as epidurals), to guided pushing, to use of forceps, to use of surgery.  We simply don't know the long-term effect medications have on infants who receive them (many studies suggest that it's not good), and it's well-documented that epidurals are hard on babies during delivery, and that's just the tip of the iceberg.  Recovery & long-term health for mom, future pregnancies, health of baby, mom & baby's early relationship, all can be affected by interventions. Recommended reading:  Henci Goer's Thinking Woman's Guide to Better Birth. Recommended watching: The Business of Being Born

5. The skills found in natural labor are very beneficial in other areas of life.  Learning to manage pain, to work through physical exertion, to relax & focus despite circumstance, to keep outcome in mind despite process-- these are all very useful!  Labor can be a tremendously powerful unifying agent to husband & wife, sister & sister, mother & daughter, too.  There is something sacred about any birth, and natural birth is particularly beautiful to be a part of.  Spiritually, I learned to trust God for strength in the moment in a way I'd never had to do before.

6.   Pain is not the problem; suffering is.  There are other ways of managing pain besides drugs-- to either minimize, remove, manage, or remove it from the foreground of experience.  This is a crucial point to make.  While I accept that pain may be a part of most women's labor, just as it is in pretty much any other intense physical feat (distance running, team sports tournaments, weight lifting...), suffering can be avoided.  Those of us who birth without pain meds don't like pain.  We just know that some pain can be managed, gotten through, used-- and true suffering can be avoided.  Some methods include:  hydrotherapy (laboring in a deep tub of warm water is called "the midwife's epidural" for good reason!), aromatherapy, massage, position, use of a rebozo (shawl/sling), emotional support, internal focus, self-hypnosis, sterile water injections, movement (slow dancing, belly dancing, walking, swaying, rocking), and controlled vocalizations.

Mamas who've done this, what would you add?

*Note:  notice how OBs usually talk about "delivering a baby," or even "delivering her of a baby" while midwives usually speak of mothers "delivering their babies."

Joy in Our Hearts-- Lots of It

I listened to music while laboring with both my babies. With Eowyn, the song I most remember (the one playing as she was born, actually) is Sandra McCracken's "Close of the Day"-- fittingly a song about all the simple blessings of life -- "close of the day/ fireworks and rain, feels like a holiday/ unburdens my frame"-- as well as the deep blessings of the Gospel-- " the marks of my name/ torn into Your Hands" --with the refrain "and this is not what I deserve." Really perfect to remember as I contemplated the joy of bringing forth a child contrasted with the Hell I'd have earned myself with all my sin, as well as the far greater pain He went through for me!

Anyway... the song that will always remind me of Liam's birth is Sara Groves' "Joy is in Our Hearts." It's got a great tempo, great contemplative, calm, intense vibe that is perfect for the work of labor. And the words... wow, the words are great for the discomfort, pain and trial of waiting that is the last stage of pregnancy and all of labor. It's also been perfect for me as a new mom full of fears: once you've been given such a precious gift, it's easy to fall prey to the temptation that it will be taken from you. This song helps me remember that even if I lost my little son or worse, I would have Christ, and Him for all eternity!- and that would be reason enough to sing for joy. This song was written, I think, with the persecuted church in mind.

 I pray this little montage encourages you! I get teary just watching it. :) Pregnancy and labor are good for my spiritual condition. Which means we'll probably be having more kids.

"Joy Is in Our Hearts"

"We were pressed on every side,
Full of fear and troubled thoughts;
For good reason we carried heavy hearts

"It is good to come together
In our friendship to remember
All the reasons hope is in our hearts:

Hallelujah! Hallelujah!
Christ our joy and strength!

"Now with patience in our suffering,

Perseverance in our prayers,

With good reason this hope is in our hearts:
Hallelujah! Hallelujah!

Christ our joy and strength!

"Oh, we saw the face of angels--

Many good things well-secured

For good reason this joy is in our hearts:

Hallelujah! Hallelujah!

Christ our joy and strength!

For good reason joy is in our hearts."

Favorites for Infant Days

Eowyn knows how to stuff a bag!

My second time around with infancy and my first time as a mom of multiple children I've either discovered or affirmed my appreciation for certain baby items.  Of course, all you REALLY need is diapers, clothes, a car seat and some place to lay the baby (eventually)... but there are plenty of things that can make my life easier.  I'll list a few of them, and please add your own recommendations in the comments!  It's fun with the second baby because most of the big needs are already out of the way, especially if you cloth diaper, so you can splurge on a few cool items.

-- tote-style diaper bag that can accommodate your toddler's needs as well as yours.  Who needs to try and juggle multiple bags?  We're teaching Eowyn to carry her own things (though her idea of doing that was putting it all in Liam's car seat next to him when we weren't looking yesterday, hah), but there's always a snack, a bib, a spare shirt, etc.  I got my sturdy canvas "Large Utility Tote" from 31, and it has plenty of pockets for easy access!  My only improvement will be making some big zippered bags to separate out my stuff and Eowyn's.  Graco makes a pretty cool similar one, with an internal bag that snaps out.  I like giving it as a gift.

-- swaddle blankets-- especially since reading The Happiest Baby on the Block, I'm a fan of swaddling in the early days, and blankets come undone so easily.  William really likes it-- possibly because he must have been VERY tightly swaddled in the womb those last weeks.... still not sure how he fit all 10 lb-22" of himself in my uterus...  The BEST brand for us has been the Kiddopotamus/Summer Infant Swaddleme, in fleece because all the AC around here means it's cold inside even in the summer!  The velcro's more logically placed than it is in some other brands. I also like this Carter's sweater-knit 100% cotton blanket I received as a gift, because the weave and size are perfect for a tight swaddle.  You can easily find these at consignment sales or new at discount stores like TJ Maxx or Ross.

E rocking the Ergo on the Paris Metro at 5 mos. old

-- Ergo Baby Carrier-- oh the beauty and simplicity.  I still use my moby-like wrap too, but I LOVE the ease and simplicity of just doing two buckles and ocassionaly tightening a strap here or there.  I don't even have to bother with rolling up blankets under him because he came out so big. :)  He loves being held and this keeps my hands free, and is super-helpful in keeping his acid reflux from bothering him after a feeding. It also works for toddlers up to 30 lbs.  GREAT in airplanes or airports!  Don't even bother with a Bjorn or a Snugli, especially past 3 months-- they're way harder on your back and not good for baby's spine.

-- infant probiotics-- we started off with Biogaia Protectis drops, which in one study essentially eliminated colic.  Apparently this strain of probiotic is especially potent against an overgrowth of yeast, which causes lots of gas and digestive pain.  I think this has been key in helping Liam's reflux be waaaaay less severe than Eowyn's.  At the first sign I bought these and saw a difference within the week.  My one complaint is the serving mechanism-- it drops out very s-l-o-w-l-y, and when you're trying to dispense 5 drops into a newborn's mouth that is no bueno.  A dropper would be FAR better!  So either drip it into a bottle of milk or use a syringe or dropper of your own.  This is a must-have for moms who have used any antibiotics in pregnancy & delivery, who have a history of yeast infections or who had yeast infections during pregnancy.  We've now begun trying a powdered form (Udo's Choice Infant's Blend), and the jury's still out on it-- but by all means try SOME form!  (using bottles of pumped milk to give him the powder has convinced me that I am FAR TOO LAZY to ever bottle-feed by choice!)

 -- nursing cover-- super helpful in descreetly nursing in public.  Get one with boning in it (to better see baby), and if you find one, weighted corners (in case you have a flailer). My friend made mine, and lots of WAHMs do, so go support one of them!

-- Snuggin Go Infant Positioner-- if you have a baby with acid reflux, prematurity, torticollis or colic, buy this.  Now.  I have been SO impressed at how much more comfortable Liam is in his carseat now.  Car seats are perfectly HORRIBLE for kids with GERD (acid reflux):  the slump it forces on them puts pressure on their stomachs, with the result being screams every time we so much as placed both our babies in their car seats.  This insert (invented by a NICU nurse and crash-tested for safety) has made a big difference for Liam.  I wish I'd had it for poor Eowyn.

-- Milkies Milk-Saver-- this ingenius little gizmo catches the milk that lets down on one side as you nurse on the other side.  For me, that's a lot of milk.  The design makes it easy to attach storage bags that can go straight into the freezer!  Waste not, want not.  :)

Liam at 3 days old, swaddled and happy

-- Sticky Bellies Monthly Milestone Stickers -- this is just fun, totally non-essential:  a set of 12 stickers, one for each month of your baby's first year.  Stick it on a plain onesie or t-shirt and voila!  You have a perfect new "outfit" for taking your baby's picture.  If you like chronicling and/or photography, this is super!  Available in Boy, Girl & Neutral patterns.  You can get them at Hobby Lobby too (use those "40% off one item" coupons for a great deal!).

--Serendipity Mattress Cover-- the package info reads:  "Our product was developed based on a 15-yr study in New Zealand that found that covering mattresses with a Toxic Gas Barrier is 100% effective in preventing SIDS. Of the 210,000 covered mattresses with this specially designed barrier film, not a single SIDS/SUID death was reported."  As the risk of SIDS increases with each child that sleeps on a mattress, I viewed this as a must-have for our second baby (even though we were super-careful with our mattress first time around-- no fluid of any kind has ever touched it).

-- bouncy seat-- one of the few baby paraphernalia the stores tell you you "need" that you actually should buy.  It's especially useful at the dinner table, one of the few places I really can't hold a baby (either I don't eat or he becomes a dropped-food mat).  I have a very no-frills version that quite suffices. Vibration options are nice, but really, I usually just use my foot to keep up a steady bounce.

-- infant car seat cover-- not so useful yet in the SC July heat, but as I mess with blankets and light jackets while inside I remember how much easier this is!  Hint:  get this used at a consignment sale.

-- the books The Happiest Baby on the Block, Secrets of the Baby Whisperer and Real Food for Mother and Baby--  if I were to give a new mom or dad a starter library, this would be it.  Of course, they all need to be taken with grains of salt, but read together they all kind of balance each other out.  Happiest Baby provides great insight into soothing babies and remembering that the first 3 months are special-- you treat infants differently than older babies, and it's ok.  While you can't spoil a newborn, you can train older babies into bad habits, which is where the second book comes in.  Baby Whisperer is all about establishing a flexible routine (EASY- Eat, Activity, Sleep, Yourself) that helps you "read" your baby's needs at any given time.  If you liked aspects of Babywise but found it easy to take too far or misapply, this book finds a great balance, despite my disagreement with her view of formula feeding (that desire to keep one's looks is a valid reason to choose it, or that there might be medical benefit to it).  Real Food is just great when it comes to any question about how to raise a healthy eater, and it's right on as far as explaining why cereal isn't such a great first food, why fats are essential, and how feeding a baby can be very very low-stress.  It also has wonderful charts for eating in pregnancy-- "if you eat anything, eat this" type minimalist stuff.  Get this one before you get pregnant or ASAP thereafter!!

Two things I would love to try (baby #3?) are the folding Puj Tub, and an organic cradle mattress pad.  Anybody know of a foolproof car mirror for rear-facing car seats?  We got an Eddie Bauer one that works fairly well, but it was quite difficult to install in a way that actually let us see Liam's face... not the best design at all.

Two closing tips for new parents:

1. Go gender-neutral whenever possible.  Let your nursery decor, high chair, car seat, even onesies, diaper covers & pants do double duty.  (It's easy to "girlify" green and yellow, and even blue, with bows and eyelet accents.)  Think outside the pink-or-blue nursery boxes.  Pictures of our nautical-themed nursery to follow later (both kids will share it).

2. Invest in quality furniture the first time.  Wooden high chairs, sturdy cribs & cradles and a dresser-changing pad will pay for themselves by weathering multiple children.  Same goes for toys-- better fewer sturdy non-toxic wooden ones than scads of cheaper plastic ones.  (I have my favorite clothing brands for the same reasons.)

Vitamin D and the Breastfeeding (or soon-to-be-breastfeeding) Mom

If you're a breast-feeding mom, you've probably heard-- from either your baby's pediatrician/your family doctor or all the formula companies that send you samples-- that your milk is likely deficient in Vitamin D.  Vitamin D is a fat-soluble vitamin that we need for calcium absorption (i.e. healthy strong bones & teeth).  It's present in raw milk from grass-fed cows, especially in the spring when grass is growing and very green, as well as in milk products made with raw milk (butter, cream, etc.).  It's also naturally found in cod liver oil & fatty fish, some in beef liver & egg yolks, and our bodies are able to make it when our skin comes in contact with the sun's UV rays.  Between drinking only pasteurized milk, staying indoors in the AC throughout most of the summer, and wearing gobs of sunscreen, it's not really surprising that most of us are vitamin D deficient.  The vitamin D that's added artificially back into pasteurized milk and filtered fish oils isn't absorbed nearly so well, because it's a different form of the vitamin and also because Vit D is best absorbed when vitamins A & K are also taken with it
It stands to reason that if a breast-feeding mom is vitamin D deficient, her milk will also be vitamin D deficient, which explains why rickets and Vit D deficiency are so common in the US.  However, if you don't want to supplement your baby with vitamin D (looking at the ingredients on the label made me shudder-- artificial flavoring and sweeteners among them), the best way to make sure he's getting vitamin D (in the form his body can best use, too!) is by making sure YOU have enough Vit D!  Yep-- you elevate your vitamin D levels enough, and your breast milk will become a perfect source of all the vitamin D your baby needs.  (Ideally, you'd be making sure your vit D levels were adequate throughout pregnancy so when baby comes you aren't starting from square 1.)

How much does a nursing mom need to have daily?  According to this article from the Council on Vitamin D, about 6000 IU (50 ng/mL).  That's a lot-- far higher than the recommended "400 IU."  How can you get that?  Well, you can partly get it from the sun:  if you are light-skinned, at least 3 20-minute sessions of full sunlight on most of your body (ie in a swimsuit or sleeveless top & shorts)-- just enough to get your skin to the slightest flush of pink. The goal is NOT to burn.  This article includes a fun little calculator, as well as an interesting connection between preterm birth and vitamin D (could be why minorities in the US have such alarmingly higher rates of preterm birth?  They have darker skin, and so need more time in the sun to get the same amount of vitamin D?) Quote from that article:

 "If you want to get out in the sun to maximize your vitamin D production, and minimize your risk of malignant melanoma, the middle of the day is the best and safest time to go. You just need to be very careful about the length of your exposure. Remember you only need enough exposure to have your skin turn the lightest shade of pink. This may only be a few minutes for some. Once you reach this point your body will not make any additional vitamin D and any additional exposure will only cause harm and damage to your skin."

The best source of whole-food vitamin D is fermented cod liver oil, best taken along with butter oil.  When taken together, far fewer IUs are needed to maintain adequate vitamin D blood levels.  Taken alone, 1 teaspoon of fermented cod liver oil gives ~1950 IU of vit D.  I personally can't stand the taste of cod liver oil, so I recommend capsules or the gels, which Eowyn thinks are a treat.  Read up on CLO & recommended brands here.

If you are a pregnant or nursing mother, please read the linked-to articles and spend some time trying to decide how to ensure that your milk contains adequate levels of vitamin D!  Again, this article from the Council on Vitamin D recommends: 

1. Take a loading dose of 10,000 IU/day for a month.
2. After one month on 10,000 IU/day, stop supplementing your infant with vitamin D as your breast milk should now be filled with vitamin D.
3. Take 6,000 IU/day maintenance dose thereafter, except on days you get full body sun exposure.

If you're worried about toxicity, read this article-- getting vitamin D from natural (whole food or sunshine) sources means far FAR less possibility of getting toxic levels of vitamin A or D.  At the very least, head over to the health food store and get some 1000 IU vitamin D3 softgel capsules-- they are made from radiated wool oil, but it's still better than nothing-- you'd need to take 6 per day to get the 6000 IU maintenance dose, or 10/day to start out from nothing.

My strategy?   It's hard to know how much I'm getting without doing some calculations my new-mom-brain can't handle, so here's my "hoping 'tis enough strateg." :)  I didn't arrive at it by any precise science by any means, hah.  Since it's summer, daily I take:  2 capsules each of fermented CLO & butter oil (in winter I'd take 5-10 of each),  4 each JuicePlus fruit chews & veggie chews (these are basically dehydrated fruits & veggies) and 2 softgels of 1000 IU D3.  Once my babies are 4 months old (so still breastfeeding), we also start giving them 1/4 teaspoon of unflavored fermented CLO (it's super-good for their eye & brain development, especially linked to high verbal abilities, as well as stronger immune systems).  I drink raw milk, eat raw milk cheese and plenty of fatty fish, and stock up on spring butter when it's sold.  I'm very big on lots of time outside, building up a base tan by going out daily in the spring, yes, without sunscreen (I know I'm going majorly against the flow there... but that's another blogpost =D), and clothing on my babies while outside is pretty minimal. 

The Birth of our Firstborn Son

Ponderously-Cheeked Pondering

  For all of you wanting the short-and-sweet version, here you go:

William Christopher barreled his 10 1/2 lbs into the air at 11:07 Sunday night, June 24th, 2012.  This fulfilled his daddy's wish for a birthday full of multiples of 6, and his mommy's prayer for a birth far quicker that his sister's.  Speaking of Ryan, you can read his account of the story here.

For those of you wanting DETAILS, ta-da!:

William's birth story begins with my 41-week prenatal visit the previous Thursday.  Measurements showed that I was measuring 42 cm (consistent with a 41-week gestational age estimate), and I continued to display all the signs of imminent labor, from strong frequent contractions to the passing of my mucus plug to loose bowels and an unsettled stomach to a totally dropped baby.  But for whatever reason, I had yet to experience the regular, strengthening contractions of "active labor."  My midwife encouraged me to think and pray about using some herbal means of induction if nothing got started on its own, using her decades of experience.  Her theory was that because I was carrying Liam so far "out there" that gravity was actually working against the contractions-- which were trying to bring him in vertical alignment with my very-posterior cervix.  This would explain why I had so many of my strongest contractions at night or in the car, but why they tended to stop when I stood or walked for long periods of time.  She counseled me to wear my belly band at all times.

Ryan requested a weekend induction attempt, and we had a wedding for a family friend that I wanted to attend on Saturday, so we decided that-- if we attempted to kick-start things-- it would be Sunday.  I was still quite unsure about meddling with the natural order of things, so I was researching and praying and re-calculating my due date, and looking at Eowyn's birth records.  What I found was that the herbs my midwife was recommending-- blue & black cohosh-- would not force a labor on an unready cervix or baby, but would rather help coordinate the efforts my body was already naturally making.  When Saturday brought several hard contractions that petered out true to form, and Saturday night proved particularly un-restful and frustrating, I decided that my body had had enough of this pre-labor (it'd been going on in full force for over 2 weeks... 2 weeks of frequent contractions, many nights of nearly no sleep, stomach upset, etc.).

Black cohosh ("snake root") stimulates uterine contractions.  Blue cohosh ("papoose root"-- Native Americans used it in labor extensively) actually calms the uterus, so is useful in stopping preterm or Braxton-Hicks contractions (wish I'd known this about a month ago!).  Taken together the two work to augment and streamline labor.  They are most effective when contractions are already present.  Check!  Normally my midwife recommends a castor-oil cocktail to start contractions, and then uses the herbs, but since I was already contracting, we agreed to start with just the herbs.  (I've heard too many negative things about castor oil...)  So at 10 o'clock Sunday morning, I put the first 2 1/2-droppers of the cohosh tinctures under my tongue.  OOOOOHH talk about burning!!  The tinctures are dissolved in alcohol... so I was popping the gum to make sure I didn't smell like a distillery at church, hehehe.  Every subsequent hour, on the hour, I took a full dropper of each.  Ideally, tinctures are taken under the tongue for fast absorption, but... you try holding whisky under your tongue some time.  By 4 pm I was putting the tinctures into a few ounces of pineapple juice (also good for labor induction).  Contractions were certainly coming but were all too true to form:  irregular.  I tried not to be discouraged as we settled in to our family nap.

I awoke at 4 to a strong contraction.  I tried to rest after that, but noticed that every 20 minutes another contraction came.  They were consistently strong, too.  I tried timing a few and they were about 90 seconds long.  By 5, it was time for my next tincture dose, so I called my midwife & asked if I should keep taking them or wait and see what my body would do on its own.  As contractions were still coming, Mereinda recommended I stop the herbs.  As time progressed, I began to have to "work" to get through the contractions, blowing or saying "oooh" in a deep tone.  Eowyn woke up and needed watching and I had a hard time focusing on her as contractions took more and more concentration.  Ryan woke up and took over Eowyn-duty, explaining that "Mommy's belly is getting really tight, so she makes noise to help it hurt less."  Eowyn accepted this.  I was still reluctant to call my aunt Olga- who would be watching Eowyn- or my Mom- who would accompany us to the birthing center, fearing that this was yet another false alarm.  It wasn't until Ryan pointed out that I hadn't had to vocalize through any of my other contractions that I realized something was different.

At 6 we called in the troops.  I ate some yogurt & started a bowl of cereal, and stayed glued to my birthing ball.  Unlike with most labors, an upright position slowed my contractions (gravity pulling Liam forward instead of down), so sitting on the ball or bed helped keep them intense and regular.  They were 6 minutes apart, then 5, then 4, still lasting 60-90 seconds.  It was a while before my aunt could make it to our house, but thankfully my mom arrived and was able to take care of Eowyn (and wash our dishes =D), since I now needed Ryan to support me through contractions.  He rose to the occasion beautifully, doing his reading in Ina May's Guide to Childbirth justice. I texted some close friends, asking them to pray that this was the real thing, and for a safe (and short!) delivery... while confessing that a part of me wanted to stop the whole thing, because it was starting to hurt!  As Eowyn came to kiss me goodbye, she asked "You not feeling good, Mommy?"  "It's ok, baby girl." Then, with utmost sincerity, "Jesus will help you!"  That comforted my heart.  :) Then she was off, thrilled to be spending the night with some of her favorite people.

We headed to the birth center around 8:30.  I'd tried to hold out a bit because I knew my midwife's son's 18th birthday party was going on, but the labor tub started to sound too appealing to miss.  She tried to check me when we got there, but laying on my back was agony, bringing a seemingly unending contration, and my cervix was still posterior.  By my demeanor and the sounds I was making, she estimated me to be at about 5 cm dilated.

I cannot tell you what a difference that labor tub made.  I will never- NEVER- labor without one again.  I'll stand on my head to stop contractions if I have to. :)  Slipping into the warm water was so comforting.  I told Ryan, "It's actually quite delightful between contractions!"  Mereinda advised me to labor as much as I could leaning back, to try and bring Liam's head over my cervix instead of its current place of low but in front of it.  I could not have complied were it not for the tub.  In the tub, the water's buyoncy provided counter-pressure, supported my legs so I could let them float, and kept the baby's head from jarring against my tailbone as he descended.  Contractions were never pleasant, but they were bearable.  Labor really began moving along.  I entered the slightly-out-of-mind-state of moaning, praying, etc., through a contraction, and then nearly falling asleep.  Ryan kept reminding me to relax my hands, to have loose lips, and my doula-training kept me keeping my tone low and to relax as much as I could (hah- NOT natural for me!).  I told Ryan that these contractions felt more intense than the ones I'd had with Eowyn, and he was surprised, since he thought I was handling them much better.  I count the tub & my doula experience for that.

I began to get unbearably sleepy around 10, telling Ryan pitifully after a contraction "I just wish they'd stop so I can go to sleep...I'm so so tired."  Mereinda immediately began trying to get me to eat, but the most I wanted was a few bites of very soggy cereal, so she pushed the gatorade, saying she was concerned about my energy level.  This did perk me up a bit.  I tried a few different positions, but mostly labored on my back.  When I had to get out of the water to use the bathroom, contractions would become far worse.  Even in the water, a few times it felt like someone was taking a hacksaw to my back.  Ryan would provide counter-pressure, rub my head, encourage me, and keep me drinking water.  A few times I was overwhelmed by contractions, having to work very hard to keep any semblance of control, crying out loud to Jesus for strength, and talking to William "move down, baby!"  I remember also repeating "the baby-- I want to see the baby."  A few times I told Ryan I didn't want to do this anymore, or just cried that it hurt.  My first successful cervical check came at 10:45, when I was declared to be 7 cm dilated, with a fully anterior cervix, & a baby ready at +1 station.  I just want to take a second here to praise my midwife's compassion and skill-- she was constantly assessing my progress based on how I sounded, how I described my pain, and how I looked, NOT using monitors and numbers (though she regularly checked William's heart rate with a doppler.). Her voice was reassuring and kind, even as she gave me instructions or recommendations.

By now I knew I was in "transition."  Contrations became closer together, longer, with a more intense peak.  At least I knew I wouldn't have to deal with them long. With Eowyn, I'd had my water broken at 7 cm, and only labored 4 more hours.  I decided to hold off on breaking my water since I hadn't been laboring all that long. Not 15 minutes later I told Merienda that I was feeling "pushy."  She checked me again (can I say how much better being checked is in the water??) and announced that I was nearly complete, with only a tiny little bit of the cervix left in front.  The very next contraction I shouted "I'm pushing and I can't stop!"  Pop!  With a feeling like a water balloon untying, and a burst of fluid, I broke my own bag of waters for the first time. That was a good feeling. :)  Merienda took one look at the water and said "there's a bit of meconium in the fluid, so in case we have to suction him, I'm going to need you to deliver on the bed.  I know it's going to be hard to get out and move, so just give it every bit of strength that you've got!"

Moving wasn't too bad.  I made it to the 4-poster bed, collapsed onto my left side, and immediately started having pushing contractions.  It was absolutely surreal, like a typhoon was sweeping through my body.  I began to roar like a mama dinosaur as the only way to stay somewhat in control.  "Slow it down! Pant a little bit!  I don't want you to tear."  "I'll try!"  The midwife's assistant, Carrie, showed up just in time.  I was on my left side with Ryan holding my right leg bent and at a 90 degree angle.  Mom was at my head, stroking my hair and holding my hand.  I buried my face in the covers and gave unbelievably strong pushes as the contractions swept through my body.  The pushing contractions were nearly continuous, and I found strength and energy in abundance to push along with them.  I only really remember stopping and breathing between 2 of them (there were about 5 total).  Suddenly, there was pressure and a burning and the words "he's crowning!"  Ryan told me "I can see our boy!"  Then they told me to wait a minute as they checked for a chord around his neck because his head was out!  No cord, but he did have a little fist tucked right under his chin.  It felt like a vat of snakes writhing in me as the midwife's assistant swept her fingers around and pulled his little hand free.  Another huge long push, and my son's body slipped into the air.  Seven minutes after I'd started pushing-- 25 after I'd entered "transition"-- and what struck me as a purple giant squid was plopped on my chest. "Thank you, Jesus!  Oh, thank you!" Not having seen him emerge at all, having had no time to process his arrival, it was totally surreal.  In a daze I marveled at his huge hands. "He's so big!" and "I can't believe he's actually here!" were two phrases I kept repeating.  I think we were all a bit in shock.

Mom & Ryan immediately began rubbing him down as I called to him and the midwives tapped his feet, trying to get him to take his first breath.  He never really cried but instead gave a little gasp and protested our efforts a few times.  He started pinking up right away.  We waited a good 10 minutes to cut the cord, and I was relieved when it was finally cut because I was so swollen and tender that even the light pressure of the cord on me was abrasive.  I was overjoyed to learn that I needed NO stiches, only having a tiny tear from where his hand had had to be pulled out.  The little munchkin had been sucking his fist throughout all of labor, which accounted for the spots of awful back pressure I'd felt:  his hand pressed against my tailbone.  He is very attached to his hands. :)

He came out pooping and pooped on me another two times before his first half-hour of life.  He started to nurse fairly quickly, too.  When it came time to weigh him, Merienda laughed that she knew she wouldn't be able to hold the spring-scale high enough to get a reading, since she's short and she knew he was a chunker.  This meant that the proud Daddy got to weigh him, and I was shocked as the scale pulled down past 10 lbs...4, 5, 6 ounces!  Yet another benefit of the tub:  the water softens your perineum so much that tearing is far less likely, as my large baby with a neuchal hand demonstrated.  He was 22 1/4" long, with a 14" head (quite molded though).  "There is no question that that is a 41-week-old baby!" my midwife affirmed, and I knew I'd done fine to use the herbs.

I got everything I prayed for:  a face-down baby, a non-marathon, unmedicated labor, minimal tearing, trustworthy & knowledgeable birth attendants, a supportive husband who was with me the entire time in every sense of the words, and a healthy baby boy with every sign of looking like his Daddy-- from the dark hair to the Szrama dimpled chin and perfect bow lips.

Two hours after the birth, with my mom's home cooking in my tummy and the clearance from my midwife, we were headed home to sleep in our own bed.  In our bags were several goodies, like goldenseal capsules to dry up Liam's umbilical stump, and an herbal sitz bath formula to use as a peri-wash.  I really respect everything our midwife recommends, as so far every bit of her advice or recommendation has proven absolutely right on!  Guess it comes with that whole decades-long-practice thing... :)  We could not have had a better experience, nor more highly recommend Merienda and her birthing practice, Upstate Birth Center.  There is something so empowering about feeling total freedom in your own birth-- the freedom to eat, say, cry out, position yourself, do, or not do whatever your body tells you or your best research recommends.  Psychologically it's amazing.  Even Ryan kept commenting at how refreshingly different this experience was from our hospital birth experience with our daughter-- and we had a totally positive experience there, too!


"Do I bring to the moment of birth and not give delivery?" says the LORD. "Do I close up the womb when I bring to delivery?" says your God."  (Isaiah 66:9)

"Every good and perfect gift is from above, coming down from the Father of the heavenly lights, who does not change like shifting shadows."  (James 1:17)

41 Weeks & Waiting On

41 Week Belly (42 cm)

Another week and William is still enjoying his watery world.  Contractions fill my days-- usually not painful, but at times feeling very much "the real thing."  However, they never are regular, nor do they get closer together or more intense.  I do get tired of them, especially at night, or in the morning, after a night of very light sleep, when my abs feel I've overdone it on the crunches.  But with all the "going nowhere" contractions, I was starting to wonder if I was seriously misreading my body-- maybe these weren't contractions at all; maybe I was just feeling Liam stretch?  I had a midwife appointment today, and was gratified that when, true to form, I had a contraction right on the table, my midwife confirmed "oh, that's a good, strong contraction!"  William performed a beautiful heart-rate acceleration and deceleration during the contraction, just like he's supposed to, proving that he just likes it in there. :)

The numbers for the week:  166 lbs (up one from last week), 42 cm fundal height (2 cm gained in one week again-- this boy is apparently growing like, well, a watermelon), good BP & pulse, good glucose & protein levels, no swelling or any other alarming signs.  Apparently William is following in his sister's footsteps of making it quite impossible to "check" my cervix for dilation-- with Eowyn the checks were super-painful or downright impossible until I was very far into active labor-- 8 cm and going into transition!  So there's absolutely no telling if or how much these contractions have "progressed" me.  At least we know his head is very well engaged and he's currently in a great position to deliver.  Now... if he would just decide to "make like a baby and head out" already!

Many of you prayed for us on Sunday when I suddenly was in quite a bit of lower round ligament pain.  One minute I was fine, the next the baby had dropped drastically and I could hardly walk or move without great pain and difficulty.  The Lord heard your prayers and my body adjusted to the new position by the following day.  I've also had quite a good amount of energy.  Tuesday my friend Kristen came over and we swept, mopped, vacuumed and cleaned, and then I pulled Eowyn to our neighborhood playground in her wagon.  Wednesday (yesterday) our friends from Louisville came for a quick visit (they're on a massive East-Coast road trip), and I had the energy to take them downtown to Falls Park and hang out all day. 

Since we're both doing great and I have a history of carrying longer than 40 weeks, delivering a largish baby with no problem and then having that baby seem developmentally younger than her dates would have led us to expect, we have plenty of time to play with before Mr. William is considered "post-date."  However, my midwife is a bit baffled by my body's apparent readiness to deliver, with my baby's apparent unwillingness to commit.  She's also pretty sure this guy is getting fairly, um... large.  She's given us the go-ahead to consider some herbal "pushes" towards active labor-- nothing that will force a delivery if my body or William's is unready, but that just might tip the scale into full-blown L & D.  We'll see.  As of now I'm happy to wait a few more days at least... another night like last night, though, might change my mind. :)  Either way, we are both doing very well and I'm so so so so thankful to be as comfortable and energetic as I am, all things considered!  Check out this blogpost on natural childbirth from my buddy Blythe!

A few pics from the past week:

Avery (5), Nora (6) & Eowyn all with rapt attention at the Library Story Time (the Suitcase Circus)

She's LOVED having little pals to play with

Nora's Nonnie helped them do sillouettes

Eowyn's love affair with bags (full of stuff)-- that's my new diaper bag (from 31)

I love her face as she comes in to "get my brudder!"

Telling William to "Come Out!"

(Almost) 40 Weeks!... and 2 1/2 Years Old

40 cm belly in all its glory!

Technically I'll be 40 weeks by the midwife's little wheel tomorrow, with an "estimated due date" (EDD) on Saturday.  But my visit was today, so I figured I'd go ahead and post the stats... for all those wondering. :)  Feel free to skip!

The feeding frenzy that has been my nights was clearly evident, both in measurement and on the scale.  I gained a good 5 1/2 lbs since last week (164.5), and expanded 2 cm (40 cm).  My heart rate was a bit high for me (90), but Liam's was steady and sleepy at 127.  My b/p is great, but my blood sugar was all wonky... I was clearly sleepy when making my oatmeal and forgot to add the butter.  Those 2 T of fat make all the difference between having wildly high and crashing blood sugar and a steady, satisfied full tummy.  Oops.  William's in a great position to come, though I have NOT appreciated feeling his head very very very clearly.  Those who've experienced the "ring of fire" while pushing will know what I mean.  Enough about that.  As far as "signs of impending labor" go, I've had pretty much all of them on and off for the past week, including LOTS of regular contractions, nausea, etc.  So... I have no idea when the little man will make his appearance.  I guess he likes surprises. :)

Update: 40 weeks today!

The hardest thing the past week has been sleep.  Usually I have to stretch, do inversions, soak in a bath, etc., for 1-2 hours each night, usually eating intermittently, before I can finally go to sleep (due to restless legs), usually around midnight.  Then I've often jolted awake around 4 am with the jittery feeling of low blood sugar, sometimes occasionally with a deep gnawing hunger.  I then eat whatever I can think of and usually finally go back to sleep around 6... thankfully Ryan's new work out schedule has him up at 5:30 4 mornings a week, so by the time Eowyn wakes up around 7:15, he's home and able to take care of her until I am rested enough to stumble downstairs.  She's a pretty low-maintenance kid in the mornings:  give her a cup of milk, a saucer full of soaked nuts & raisins, and she'll play quietly and happily by herself until at least 9.  I just have to supervise clean up when I wake up. :)

Since not much is going on in the pregnancy department, well, not that we can SEE anyway, I will give a little Eowyn-at-two-and-a-half update:

Playing at the chiro's office in one of my
FAVORITE of her outfits (thanks, Grams!)

Some things I've noticed about her this week have been her adorable tendency to substitute a compound word ending in one word with another beginning with the same word.  Two examples:  lollypop & popsicles, or rubber band and band-aids.  It's pretty cute.  She's sitting beside me in a fairy costume right now- occasionally giving me instructions on my lines ("Say "bye" to the fairy, Mom-- I'm leaving for a while.  But don't cry very much, ok?").  She has mastered Daddy's Nook, loving the few children's books we have on there-- either read aloud by a narrator or recorded by Mommy-- or the puzzle games.  When she gets stuck in a game, she calls me over with an "I'm in trouble, Mommy!  Help, please!"  Story Time at our local library (followed by lunch at Nina's!) is a weekly highlight, with the hand stamps at the end possibly being the best part.  Getting to go "work" on the computers (like Daddy) afterwards is a close second.  Of course the books and puzzles and movies we check out are great, too.  :)  (check out our guest performer for our story-time today: Sarah Dippety!)

She's showing more empathy than ever.  When I bemoaned the fact that I no longer had a favorite food in stock, she rubbed my arm and looked right into my face, the picture of compassion, saying "You can get more at the store, Mommy!  Don' worry!"  Other new favorites are "kipping" (skipping), walking on tiptoe, and saying the "sad questions" in the children's catechism (#20-25 that deal with sin).  She continues to be very excited about having a baby brother, and just the other morning discovered that I have a heart-beat too, just like William.  She was cuddled on my chest and sat up, asking me "What's dat?  It's like a hammer!"

Showing new independence on
the swings (wearing her "work-out shorts")

Speaking of heart-beats, Eowyn was SO excited to have her very own check-up at our family doctor's earlier this week.  She comes with me to all my midwife appointments and my one check-up, so she knew EXACTLY what our doctor needed to do, and told him so. :)  He checked her nose, and found a cow in there, just like he used to do in mine when I was little!  He let her listen to her own heart beat, which was priceless.  (My favorite moment was when the nurse asked if she was speaking in two-word sentences, to which I said "definitely."  Right on cue, Eowyn burst in "When Doctor Taylor comes in, he's gonna listen to my heart-beat!" The nurse laughed and said "I think that was about a ten-word phrase!")  She has everyone in our doctor's office swooning over her, from the nurse to the lab tech who did her finger prick.  E just held out her finger bravely and barely whimpered.  She's a healthy, strong little girl with everything looking great.  She's jumped percentiles weight, at 28 lbs she's now in the 40th % ile (as opposed to the 20th), and at 37" tall, she's in the 95th % ile for height!  The reason we even did a check-up in the first place is that we are looking to enroll her in a little 2-morning a week preK program at a local church.  Eowyn is such a social little creature that we know she will LOVE the interaction with other folks, especially while Mommy is taking a lot of time with her new brother.  Mom & Dad welcome the chance for E to learn to obey someone besides us, and to learn to function in a classroom setting.  We got her first classroom supply list and everything... Eowyn cannot wait to start buying things for 'cool, and asks regularly if she can go yet.

Today's Library Story Time featured an EXCELLENT magician!

She generally still takes a 2 hour nap from 2-4ish, and we put her to bed at 8, and usually hear her chipper little voice around 7:30 each morning.  While eating is NOT a struggle with her, sleeping is more challenging. She wakes up in the night fairly frequently, hungry, scared or needing to go to the bath room.  We have to be militant about our "no-fussing-at-bedtime" rule, or else she'd be keeping herself awake 'til all hours asking for this or that or the other thing (like a two-handed hand squeeze, or a kiss precisely in the center of her right cheek...).  We seem to have settled on a good routine now, though:  a book or two, a Bible story read by Daddy, potty, teeth-brushing & hand washing, 1 or 2 songs, family prayers, kisses, hugs, squeezed hands, and then blown kisses, with the door left open a crack, the "frogbert" night-light turned on, and a few songs playing off one of her lullaby CDs.  We're working a lot on politeness/respect (manners!), ASKING v. demanding or commanding, and obeying right away without asking "why" first.  Also trying to train her to be less picky and more flexible... or at least to request help if something isn't "just right" without dissolving into tears!  She's growing up so much and we love our little Eowyn Grace!!

39 weeks!

39 Weeks Along

There it is:  pictures of The Belly, especially for all my far-away family that was sure 4 weeks ago that I was already impossibly large...  I have indeed done the impossible and grown more. :)

Yesterday's midwife appointment was fun as ever.  Daddy kept Eowyn so I could have more concentrated time with the midwife, and I was actually glad I had to wait (a HUGE rarity in her office!) about a half hour to be seen-- I happened to have a new book with me, and it was a very pleasant wait alone in her sunshiny waiting room.  The stats:  my belly stayed at 38 cm-- I personally think this is because it's almost permanently contracted.  Definitely feels like a bowling ball most of the time now.  I'm at 160 lbs, meaning I lost a pound since last week, which is kind of encouraging because that's a hint that labor is near (of course, I know it's coming in the next 3 weeks anyway so no huge light bulb there, lol).  So far I've gained 30 lbs with Mr. William, which is right at what I gained with Eowyn.  What's interesting to me is that I gained it earlier and steadier with him and much of it at the end with her... and this trimester I've hardly gained any at all.  My pulse and b/p are good-- his heart beat was a bit lower than usual (124), as he was actually sleeping for once.  Usually at my appointments he's kicking the doppler and making my midwife laugh at his poking-out-body-parts.  But everything looked and sounded good.  She tried to check for dilation but William's head is so low that it was pretty impossible.  Oh well, not like it matters anyway.  I don't think I'll ask to be checked again until labor.

It's not working out with Daddy, but 'tretching with Tia Anna is pretty cool, too

I have tons of "toning contractions"-- more than I remember having with Eowyn-- usually accompanied by back twinges and crampy feelings.  I really thought he might be coming around the full moon (Sunday or Monday), but many of the labor-symptoms passed as the moon waned.  Now I'm settling in for the long haul.  :)  I can't believe my baby niece is 3 weeks old already-- time is flying by so fast that I know I can hold out another 3 weeks if I need to just fine. 

My round ligaments are super-stretched, and Liam seems to know JUST where to kick to make me feel like I have a terrible side stitch.  He's got long little legs (wonder where he gets those...)!  But the weather is gorgeous-- highs in the low 70s-- so I honestly have no complaints.  If there was perfect pregnancy weather, this is it!  Eowyn and I go on walks to our neighborhood playground or with Ryan downtown, and it's completely pleasant.  Our little garden is growing and so far I can keep up with it no problem.  Our house is mostly unpacked-- I still have the task of putting pictures up in all the rooms, but I'm putting that off until William's here and I can bend & lift more easily! 

Eowyn has been testing a lot of limits lately-- trying to obey on her terms ("I just doin' this first, Mommy...") or ask repeatedly for permission to do something she's already been told she can't do, or outright ignore instructions. I do praise the Lord that her heart is teachable right now, despite all her little sin. Talks about "listening to the Snake" who lies and tells her disobeying is more fun than obeying actually often stop a fit in its tracks, and the other day she melted my heart by uttering a heart-broken little "I'm sorry, Mommy!" on her own after a fit. I daily pray that the Lord gives her a new heart very soon! Every night she asks me "Mommy, why do I not need to be 'cared? Who is with me?" And I answer "Jesus." And she asks "and who else?" And I finish "The angels." So precious that that actually comforts her in the dark! Her little mind continues to grow at an astounding rate! She puts things together and talks so much more every day... it's a little bit intimidating at times! I'll try to upload some cute videos soon. (EDIT: they're up!)  We have a great one of her trying valiantly to show 2 fingers at once (she can do it now, with MUCH pride), another of her dancing at our local Highland festival, and another of her proclaiming that she does NOT want to taste beer because only "mans" drink that, and "I a GIRL, Daddy.... Maybe when I a man, I will like it." She cracks us up so much and we are really enjoying her. I'm so glad we have a two year old... Ryan & I joke we're going to keep having kids just so we can always have a toddler in the house-- they are so much fun!

How tall is Eowyn? Almost 3'!

Our other family news is that Ryan's been getting into Cross-Fit training with some guys at the church we've been attending.  Mr Not-a-morning-person has been getting up 3 mornings a week at 5:30 am, working out muscles he'd forgotten he had... and coming home sore but learning so much!  (We sound like senior citizens getting into and out of bed at night, hah.)  I am rather proud of him. :) Eowyn went with him to buy his new work-out shorts, and proceeded to insist that she needed work-out shorts, too... so she can "be 'twong... in the Lord."  My mom obliged and our newest entertainment is her donning them and trying to "work out like Daddy."  Her push-ups and squats are very... creative.

It just keeps going, and going...

Ok that's all, folks... my back can't take sitting much longer!  Too many contractions!!

Group B Strep- What's Up with That?

Around 35 weeks of pregnancy, most women begin hearing the initials "GBS."  Standard protocol in the West is to have a pelvic exam that includes a swab which is tested for the presence of "Group B Strep," a bacteria that many of us carry around in our bodies in various concentrations at different times.  If a woman is "GBS+," meaning that she has Group B Strep bacteria colonizing her birth canal, she'll be told she will have to have IV antibiotics (usually one in the penicillin family, most often ampicillin) every four hours during labor and delivery, to keep her baby from getting a Group B Strep infection.  (Moms allergic to penicillins will likely receive vancomycin, cefazolin or clindamycin, depending on their care provider & situation.  These aren't as effective as penicillin & have their own risks.)  If a mom comes into the hospital too late or progresses too quickly to get the antibiotics, the babies are usually given antibiotics and have several blood samples drawn to ensure they aren't infected. Signs of early-onset Group B Strep infections in newborns include: fever or abnormally low body temperature, jaundice (yellowing of the skin and whites of the eyes), poor feeding, vomiting, seizures, difficulty in breathing, swelling of the abdomen, and bloody stools.

With Eowyn, I was tested and was GBS- (I didn't have any Group B Strep bacteria colonizing me at the time), so it wasn't an issue.  This time around, I had the option to not have a GBS test done, as well as having an interest as a doula in the issue.  So... I set off researching.  First off, I wanted to know the risks of having GBS and not being treated.  Second, I wanted to know the risks of standard practice (IV antibiotics to all GBS moms).  Thirdly, I wondered if there were more selective, less invasive means of treating GBS (if it needed to be treated), both before birth, and after birth.  Lastly, I wondered what steps could be taken to help babies and moms treated in the standard way.  Here's what I've found out!

First off, I wanted to know the risks of having GBS and not being treated.  
About 10-30% of all women have GBS colonizations (and generally have no symptoms). I'll use 25% as a steady figure:  1 in 4 moms are GBS+. According to CDC estimates, without treatment only 1-2% born to moms with GBS will become infected (2% of 25% is 0.5%, or 1 out of 200 babies), and of those, 6% will die.  So death is a risk of about 3 in 10,000 babies born to GBS+ moms with no treatment.  Infections in newborns are never good things-- GBS infections affect the brain, spinal cord, or lungs.  The risk of a baby getting a GBS infection goes up if the mom has a long labor (18+ hours with water broken), a fever above 100.4 in labor, or goes into labor before 37 weeks.  For perspective, about 1 in 150 of all delivering moms in the US will have some form of placental abruption, and 1 in 300 will have a prolapsed umbilical cord.

Second, I wanted to know the risks of standard practice (IV antibiotics to all GBS moms).

my belly at 35 weeks

IV antibiotics are a pretty big gun to pull out, as they kill bacteria that we need.  Not only are there thousands of beneficial bacteria in our bodies, they are all over our bodies!  They help us digest our food all along the digestive tract, they act as our immune system's main line of defense, they are our main source of Vitamin K, they keep harmful yeast and bacteria in check on our skin, in our guts, in our ears & sinuses, in our urinary tracts, and in the female reproductive tract.  Wiping them ALL out is pretty drastic-- we've heard a lot about the dangers of overusing antibiotics lately.  From yeast infections to weight gain to chronic gastrointestinal problems to super bugs, killing off all the little guys in our bodies opens us up to a whole new can of, umm... bacterial worms. :)  New babies especially need to receive a healthy dose of bacterial flora as they journey into the world, so that they are able to digest food properly and begin to form their own defense mechanisms against pathogens.  They get this through their eyes, nose, mouth, and skin as they are born, and later through breast milk. If they are born to a mom whose bacterial eco-system has just been severely thrown off-balance by antibiotics, they aren't going to be able to get that colonization, and it will take weeks for her breast-milk to return to normal --provided she doesn't get a yeast infection in the meantime.  What about the baby who is born during IV antibiotics who is also formula-fed?  Has anyone ever tried to nurse with thrush (a yeast infection)?  NOT FUN.  Obviously, the risk of dying from an infection is more severe than the risk of starting off life with bacterial imbalances, but if the risk of dying of infection is so low in the first place, yet a fourth of all moms and their babies are being put on IV antibiotics, it bears considering.

Another, more dramatic risk of the antibiotics, is the risk of anaphylactic (allergic) reaction-- this can happen even if a mom's never reacted to a drug allergically before, at about a 1 in 10,000 rate.  These cases put both mom and baby at a very real risk of dying.  I'll quote again from an overview of the topic in Mothering magazine:

"We can compare this to CDC estimates that 0.5 percent of babies born to GBS-positive mothers with no treatment will develop a GBS infection, and that 6 percent of those who develop a GBS infection will die. Six percent of 0.5 percent means that three out of every 10,000 babies born to GBS-positive mothers given no antibiotics during labor will die from GBS infection. If the mother develops anaphylaxis during labor (one in 10,000 will), and it is untreated, it is likely that the infant, too, will die. So, by CDC estimates, we save the lives of two in 10,000 babies-0.02 percent-by administering antibiotics during labor to one third of all laboring women. We should also keep in mind that this figure does not take into account the infants that will die as a result of bacteria made antibiotic-resistant by the use of antibiotics during labor-infants who would not otherwise have become ill. When you take that into account, there may not be any lives saved by using antibiotics during labor."  (emphasis mine)

** The linked-to article is very helpful, and is a GREAT starting point to thinking through this issue!  Every GBS+ mom should read it and use it as a jumping-off point-- there are plenty of citations to journal articles and scientific studies that bear reading!**

A final risk of the routine IV treatment is non-GBS infections (often anti-biotic resistant), especially E. coli infections.  
A study published in 1998 on the effects of the use of ampicillin before delivery concluded that:

"The increased administration of antenatal ampicillin to pregnant women may be responsible for the increased incidence of early-onset neonatal sepsis with non–group B streptococcal organisms that are resistant to ampicillin. At this time penicillin G, rather than ampicillin, is therefore recommended for prophylaxis against group B streptococci. In addition, future studies are needed to determine whether alternate approaches, such as immunotherapy or vaginal washing, could be of benefit. "

E seems unimpressed with the idea of IV antibiotics for GBS

In English (:D), they found that there is an increase in infections from bacteria besides Group B strep (especially E. coli) which don't respond to normal antibiotic treatment.  Especially scary is that this risk is even more pronounced in preemies, and labor before 37 weeks is one of the #1 signs of GBS infection, and therefore moms of preemies are the women most likely to get IV antibiotics.  The researchers recommended the use of penicillin G instead, and research into another approach, such as localized use of antibiotics.  (Mind, this was 14 years ago... WHY are IV drugs STILL the treatment of choice for GBS??) Two more quotes from Mothering magazine highlight the risk of antibiotic-resistant infections:

"We should not take lightly the use of antibiotics for 200 women and their babies to prevent only a single blood infection-however serious that infection might be-especially in this age of increasing resistance to antibiotics. [Edit:  remember the figure that 1 out of 200 babies get a GBS infection if their moms are untreated.] Concerns have arisen in several areas regarding the use of antibiotics for so many laboring women. One dilemma is that colonization of the vaginal area by GBS is, at best, a poor method of predicting whether a newborn will develop a GBS infection. As mentioned, even without any intervention during labor, fewer than 1 percent of infants born to carriers of GBS develop infections."

"A study of 43 newborns with blood infections caused by GBS and other bacteria found that, when the mothers of the ill newborns had been given antibiotics during labor, 88 to 91 percent of the infants' infections were resistant to antibiotics. It is unlikely to be a coincidence that the drugs to which the bacteria showed resistance were the same antibiotics that had been administered during labor. For the newborns who had developed blood infections without exposure to antibiotics during labor and delivery, only 18 to 20 percent of their infections were resistant to antibiotics."

So, are there more selective, less invasive means of treating GBS (if it needed to be treated), either before birth, during labor and after birth?
YES!!  The more I've read about IV-antibiotics, the more they seem like using an AK-47 to shoot a fly:  waayyyyy overkill.

First line of defense:  help the body regulate its own bacteria before birth.  If a mom is re-tested before she goes into labor and is GBS-, this whole issue is removed from the table.  This occurs without any intervention in some moms, and it can be helped along by non-invasive natural means, the biggest of which are:  probiotics (in capsules and in fermented foods like saurkraut and yogurt), garlic, and echinacea.  My own midwife puts any GBS+ moms on doses of garlic & echinacea, and retests in 3 weeks.  Read here about using garlic & goldenseal.  A fuller listing of suggestions is here.  As far as probiotics go, L. rhamnosus GR-1 and L. reuteri RC-14 are really helpful in regulating vaginal flora, and S. cerevisiae boulardii, Lactobacillus rhamnosus GG, and Bacillus coagulans GBI-30 are good for regulating digestive flora, so probiotics containing those strains would probably be most helpful.  (See a great article on using probiotics to fight various ailments here.)

Second line of defense, during labor: avoid cervical exams (and stripping of membranes), dilute the bacteria by giving birth in the water, or use a chlorhexadine vaginal wash (once every 6 hours) during labor once water has broken.  Not only are these methods less invasive, they target the only area where the GBS is located, as opposed to flooding the entire body.  To use the wash, a mom is handed a periwash squirt bottle and irrigates herself... no needles, no invasion of privacy, it's simple and done.  This has the added benefit of reducing other, non GBS infections, such as E. coli, as well-- remember, IV antibiotics INCREASED the risk of those!

"In this carefully screened target population, intrapartum vaginal flushings with chlorhexidine in colonized mothers display the same efficacy as ampicillin in preventing vertical transmission of group B streptococcus. Moreover, the rate of neonatal E. coli colonization was reduced by chlorhexidine." (from “Chlorhexidine vaginal flushings versus systemic ampicillin in the prevention of vertical transmission of neonatal group B streptococcus, at term.” J Matern Fetal Med 2002 Feb;11(2):84-8.-- Read its abstract and other related articles here.)

Third line of defense, after birth: as has been stated before, if a mom goes into labor without knowing her GBS status, or as an untreated GBS carrier, her baby can be tested for GBS infection and treated immediately if infected.

Lastly, I wondered what steps could be taken to help babies and moms treated in the standard way.
Probiotics!!  Both mom & baby will desperately need to rebuild their bacterial ecology.  One study found huge reduction in "colic" in infants who received the probiotic L. reuteri.  It would make sense to proactively give antibiotic-exposed infants such probiotics (the specific brand in the study was BioGaia, and it's readily available online at Amazon or at drugstores such as Walgreens), and to have moms taking therapeutic doses of the above mentioned probiotics.

One final note I'll make is that there is no real need for an expectant mom to have to have a full pelvic exam to be tested for GBS.  Many midwives simply hand their patients a swab and send them to the restroom to privately culture themselves.  I must say I greatly prefer this method. :)  As a dear friend put it yesterday, "they're called PRIVATE parts for a reason-- I'd like to keep it that way!"

[Personally, I feel the proactive measures of taking probiotics-- both in fermented foods and capsules (I'm taking first Renew Life Ultimate Flora Extra Care Probiotic- containing 10 probiotic strains including L. rhamnosus, L. acidophilus and several Bifidobacteria strains, then Nature's Way Primadophilus Reuteri, which contains L. reuteri, L. acidophilus & L. rhamnosus)-- as well as planning a water birth are the way to go.  If I'd had the option, I would have cultured myself and been tested that way... next time!  If I were GBS+ I'd first try the preventative measures of probiotics & garlic, etc, and if those weren't enough, I'd do the chlorhexadine wash.  :)]