The End Result - Rosalie's Birth

Total Pregnancy Stat Summary
Weight Gain - 40 lbs
Residual weight 1 week post delivery - plus 15 lbs over pre-pregnancy weight
Length of pregnancy 41 weeks
Labor length - 4.5 hours pushing time less than 1 hour

The big question I know you want answered if you've been following my blog is whether or not I developed pre-eclampsia.  The short answer is that I did.  The full answer is a little more complex, and maybe in the end more satisfying. Here's the long version -
My blood pressure as I'm sure you've noticed had been trending upwards, in my 40th week of pregnancy it was in the mid 130's systolic.  On July 3rd one day before my due date it was 143/98, but I was feeling nauseous and having cramps.  As it happens I was in early labor.  I dilated to 3 cm and then my labor stalled and everything seemed to go quiet with my body.  My blood pressure settled back in to the 130's.
My midwife (Aszani) began doing sequential sweeping of my membranes (also known as stripping).  This means that she did it several times (three in total I think).  My acupuncturist (Stephanie) did labor points to help me go into labor.  We were trying to get things started because it was feeling like a game of chicken - which was going to happen first pre-eclampsia or labor.  The monday after my due date I had 1+ protein on my urine dip test.  Tuesday I did a 24 hour urine collection which showed 515 mg of protein (anything over 300 is abnormal).  My blood pressure was on the border 138/95.  The plan as of Thursday morning was to admit me for an induction for pre-eclampsia.
Meanwhile, at my second membrane sweep I had dilated to 4 cm, and on Thursday morning I was 5-6 cm, I also lost my mucous plug on Wednesday morning (eew gross).  During the office visit on Thursday Aszani did another sweeping of my membranes.  My husband and I went home to wait because the hospital was on a deferral until patients were discharged at 11 am.  When we did check-in at 12:30 pm I was transitioning from Early into active labor on my own.
I ended up having my little girl at 2:53 pm.  Because I went into labor after membrane sweeping I did not need pitocin.  My blood pressure never went above 150 systolic even in labor and I was never started on IV magnesium or blood pressure medications.
I had a beautiful unmedicated vaginal birth for my second child.
In the end I did have pre-eclampsia but I absolutely believe that the things that I did to prevent it played a part in delaying it's onset and lessening it's severity.  My second child was born a full four weeks farther along than my first, and I cannot tell you the difference in my body, my baby and my recovery.  Everything has gone so much better this time than last time.  I'm not sure it would feel as sweet a victory or as important an effort had I not developed pre-eclampsia.  If my stubborn daughter had just decided to come when she was due I wouldn't have had it at all - oh well.
I am glad this pregnancy is at an end, and so greatfil to have such a beautiful and healthy baby girl.  not sure at this point if I will post a birth story or keep blogging.  If you've been following or reading - thank you. Best of luck, health and peace to all my fellow mamas.
Annie

Post Partum Kit

In my last pregnancy I bought a pre-made kit from a woman who had had a c-section at a discount.  I found a lot of the things to be very helpful.  Plenty of women I know have told me that their baby's just came sliding out and they did not need ice packs or sitz baths.  Great for them, I'm coming prepared for it to be like last time.
What's in the bag this time?
1. Perineal Ice Packs -
after the birth of your baby you may have some swelling and bruising in your perineal area. In the first 48 hours after the baby is born you can use ice to soothe and reduce the swelling.  These guys double as an ice pack and absorbent pad.  You do not have to buy these, the hospital will give you the option to use baby diapers filled with ice, or you can DIY if you are not at the hospital.  I used both options last time and found that these were much nicer than a baby diaper filled with ice.  It made me feel more like a woman and a mother to use a pad than a diaper.
2. Sitz Bath -

I honestly don't remember if they had these at the hospital or not.  I'm sure they must.  At any point you can use warm water to soothe swelling and bruising.  Your midwife or doula will likely encourage you to take 3 baths a day.  When you are sleep deprived with a new baby it is unlikely you will have time to fill and sit in a tub three times a day.  Also I found getting in and out of the tub difficult in the first few days after my son was born.  This you just fill with warm to hot water and sit - presto.

3. Sitz Bath Herbs - 

Add these to your sitz bath and it becomes a spa treatment for your butt.  Honestly it's fabulous.  The trick is getting the herbal without the herbs - those will stick to your backside and cause trouble.  I used a sun tea pitcher to "brew" a sitz bath.  I know your thinking that by this time you could have taken a bath, but it was much easier and nicer to do it this way (at least for me). 

4. Butt Balm - to put on after your sitz bath and make it last.  I also had hemorrhoids really bad after my son was born and this stuff was like magic.

5. Maternity pads - I preferred to use these with mesh panties vs adult diapers.  Diapers are made with plastic, they itch, they make you sweat, they don't breathe.  The mesh pants were not noticeable when I had them on.  I would recommend maternity pads over regular maxi, they cover more ground.  You don't have to buy fancy pants natural ones, I did because I want to pamper myself.

And that's all really.  Like I said a fair number of my friends never needed this stuff.  Maybe I won't either and I'll end up giving a lot of it away or throwing it out.  Meanwhile it's nice to feel prepared and to know that whatever happens my perineum is taken care of.

9 Month Pre-Natal Visit

36 week OB visit summary

Overall weight gain 30 lbs

In the last month  8 lbs

Fundal Height 36 cm

Fetal Heart rate normal 130-150's

Blood pressure 125/85-112/80

I can hardly believe it's here.  This is my last planned entry to this under the heading of Pre-Natal Visit. I will do a separate post on my post-partum kit.  I am currently seeing my midwife Aszani Stoddard every week but I won't bore you with weekly updates, and I am grateful there is not that much to say.

• Blood Pressure - for those of you who have been watching the stats you will notice there has been a gradual increase in my blood pressure over the past 6 weeks or so.  Apparently this is normal in later pregnancy within limits.  Increased blood volume and fluid retention can result in a little elevation of blood pressure.  I have started checking my blood pressure at home and it tends to be better when I am at home.  I am confident that my omron blood pressure cuff is accurate, and am surprised to see that I too might have a little white coat hypertension.  I am still seeing my acupuncturist Stefanie Beniek regularly, and she has me taking some chinese herbs - called quiet contemplative three times a day.  All I can do at this point is pray, and be thankful. At least at this point if I do develop pre-eclampsia my baby is full term which a lot to be thankful for.
• Weight - well I did not meet my goal of 25 lb weight gain for this pregnancy.  However at the end of my last pregnancy I think my weight was about 210 lbs (or more) so I am 20 lbs under that, which I think is something to feel good about.  According to Aszani's charts I am still within the norms for pregnancy weight gain.  I guess the main thing is how my body feels afterwards.  I will let you know when I get there.
• Hip Pain - I had this at the end of my last pregnancy, and here it is again.  It as not as bad as I remember.  I feel like last time I had pain in my hips even just walking, and this time around it only seems to happen at night.  My chiropractor Amber says it has to do with my pelvis wanting to shift forward.  Other possible explanations could be pressure from a growing fetus and the effects of relaxin on the pelvis and hips.  What to do about it?  I sleep with a pregnancy pillow that also doubles as a nursing pillow after baby's birth - this is a leftover from my last pregnancy and I love it.  It goes between my knees and I don't sleep without it.  Also chiropractic adjustments and prenatal yoga help a great deal.  Topical arnica, and calms forte help to reduce crampy pain during the night as well.  I wonder if this is a predictor of another hip pain centric labor like my last one - my poor doula must have spent five hours squeezing my hips god bless her heart.
• Kegels - I bring this up now because I have failed to do so before (I think).  I learned all about the ultimate importance of Kegels at my bradley class in my last pregnancy.  I will say I was proud when the nurses exclaimed over my ability not to wet myself after my son's birth.  I started work on these guys early in the pregnancy when I began having stress incontinence whenever I would sneeze or cough.  Since I have become more regular with Kegels the incontinence has disappeared.  Like everything in this second pregnancy there is less time to do them, I do mine at stop lights and stop signs while driving.  My husband jokes that my car is the Kegel-mobile, ha-ha.
• Drooling in my sleep - also known as sialorrhea -  I know TMI right.  No one ever told me this could happen during pregnancy, but it does happen.  I wanted to put it out there so other women can know that this is normal.  Number of reasons why this is happening - heartburn or reflux, nasal congestion, increased salivation in pregnancy.  It mostly bothers me because having a wet cheek and pillow wakes me up during the night.  Nice soft hand towel on my pillow and problem solved.
• Heart burn - This has not been as bad this pregnancy as it was in the last one.  This related to relaxation of the esophageal sphincter, increased intra-abdominal pressure from growing womb, and increased production of gastric juices.  My symptoms did show up later on in my pregnancy I believe thanks to improved diet.  I choose to treat with 150 mg of Ranitidine or Zantac as needed, you can also try papaya extract, and usually it's okay to take a PPI which will provide more lasting relief.  I am trying to take as little Zantac as possible and try to look at my reflux as a behavior modification tool.
• Fatigue - being pregnant when you already have a kid makes you even more tired that being pregnant alone.  I love my son, but being his mom can be exhausting.  I can't nap when I feel like it, I can't go to bed when I feel like it, and I can't sleep in as long as I want to.  I have scaled back on my work schedule to 60% full time this last month (Using saved PTO).  This has helped a lot.  I sleep when I can, but this is not sleep deprivation - it's fatigue.  That is to say sometimes more sleep is just more sleep and the fatigue will still be there when you wake up.
• Snoring - this also happened in my last pregnancy.  My freak out flags are all up, because my theory was that it happened because of venous congestion in my face - ie a symptom of my preeclampsia.  This time I feel like my nasal allergies are acting up, and it doesn't happen every night.  Snoring in third trimester pregnancy is very normal.  Can you imagine my poor husband his wife is sleeping with a pregnancy support pillow, drool towel, and is also snoring - tres sexi!

Well that was a much bigger post than I anticipated.  Keep your fingers crossed for me!

Birth Plan or Letter

Dear Hospital Staff:
Thank you for working as a team to care for our family during and after the birth of our daughter.  We would like very much to have a vaginal birth with a minimum of medical intervention.  We understand that certain circumstances may require various approaches to care.  Our request is that in these circumstances you engage us in making decisions about our care and be open to discussing whatever options are available to us.  Thank you in advance for your care and support during this time.
                                                Sincerely Annie and Jeff
 Environment     We would prefer a calm, quiet and soothing environment in our room
      We prefer that no students, interns, residents or other non-essential personnel be present.
      *** will take photographs
Labor       Do not ask Annie to rate her pain.
      Do inform us of all vital signs taken – this should be done without our having to continuously ask for the information.
      We request not to have Annie’s cervix checked unless the information is critical for decision making.  If an exam becomes necessary please advise us of the findings.
      Annie would like to labor and deliver in whatever position is most comfortable and natural
      Annie will stay hydrated by drinking liquids, and will eat lightly for energy.
      Please do not put any medications or fluids into Annie’s IV without her full knowledge and consent.
      We prefer intermittent or hand held fetal monitoring if possible.
      Annie will push when she feels the urge to push
      Annie will receive labor support from Jeff, Amber or Nicole, Aszani or Carrie
Medications      We would prefer not to artificially augment labor with pitocin or other medications.
      Please do not offer medications that are not necessary from a clinical standpoint.  If Annie desires any form of pain relief or pharmaceutical intervention she will discuss this with her care providers.
Delivery      Annie would like to catch the baby if possible
      Do not clamp the umbilical cord until it has stopped pulsing
      Jeff will cut the cord
Immediate Post-partum      Immediate skin-to-skin contact between Annie and the baby
      Baby to be held by Annie or Jeff at all times unless separation is clinically necessary
      Please delay the newborn assessment until we are ready, we will advise staff when we are ready to separate for assessment.
Baby care      Do not offer the baby artificial nipples of any kind
      We waive antibiotic eye ointment
            We waive hepatitis B shot – we will do this at the 2-month well child

8 Month Pre-natal Visit

32 week OB visit summary

Overall weight gain 22 lbs

In the last month  10 lbs

Fundal Height 32 cm

Fetal Heart rate normal

Blood pressure 120/80

ARRGH! I accidentally deleted by 7 month pre-natal post!  I was using my iphone and trying to select my heading details and somehow managed to push cut with my fat finger instead of copy, there was no undo, no saved version.  It is gone. *sigh*

So this post has been much delayed due to dismay and aggravation over losing my 7 month post.  

At the time I am writing this I am actually almost 9 months pregnant.

What's new?

• Swollen ankles - it must be some cruel cosmic joke that as soon as the weather got nice enough to wear shorts and skirts here in minnesota my ankles decided to turn into cankles.  Luckily for me it has been a very late and cool spring here so I haven't roasted to death with my compression stockings.

Are compression stockings really necessary? No.  Will they prevent varicose veins?  If I had thigh high stockings they would but mine are only knee high.  I wore them in my last pregnancy and I have a little bit of spider veins on one of my legs from that.  So why wear them?  Swollen ankles and feet makes me uncomfortable in a way that is difficult to describe, also one day it was bad enough that it made my toes a little numb.  I just plain don't like having swollen ankles.  The recommendation is for 20-30 mmHg of compression.  The socks are expensive $30-40 a pair.  My insurance did cover half of one pair, but who is going to wear the same pair of socks every day -ew.

Last pregnancy I had three pairs that I washed with soap and water at night and wore each one twice with one day off on laundry day.  This pregnancy I filled in with three more pairs, so I have a wealth of compression stockings.  You know you're jealous.

• Weight gain - my weight gain has been exponential these last 6-8 weeks.  I am outside of my goal of 25 lb weight gain now.  I try to focus on protein, and foods with low sugar and saturated fat.  However, despite my best efforts I have had a return of some days (evenings really) where I am so unendingly hungry that I eat the equivalent of two dinners and two snacks.  I don't really feel bad about this.  I don't eat when I'm not hungry, and when I do eat I try to choose things that are healthy for me and my baby.  I'm not going to go hungry, and that's final.  So I guess it is what it is.  And I'm still a good 20 lbs under what I was at this point in my last pregnancy so there.
• Anemia - my hemoglobin has remained low but stable at 10.7.  I have upped my iron to twice daily (with a nice dose of senna for constipation).  My family has made some effort to eat more red meat and dark leafy greens as well.  Hopefully it will come up a little more before I deliver.
• Doulas - we have had our first and second meetings with our Doulas Amber Kay and Nicole Strekker.  We have ironed out our birth letter which I will post for those who are interested.  We are also working on packing our bag for the hospital - all information for the 9 month post.

All in all I'd say things are going along well.  Thanks for following, the end is near!

6 Month Pre-Natal visit

25 week OB visit summary

Overall weight gain 12 lbs

In the last month  6 lbs

Fundal Height 25 cm

Fetal Heart rate normal

Blood pressure 111/74

   Now more than half way through this pregnancy and I'm starting to get a little tired of this gig.  I have to keep reminding myself that this is the easy part and in four months I'll have a new born, a toddler and a post-partum body to deal with so I should really just sit tight.
     My belly is getting bigger although pictures reveal it is not as big as it feels.  It is roughly basketball sized.  I find I can't really wear most of my pre-maternity pants with much comfort anymore.  Even with the belly band the zipper itches and my pants are in constant plumber butt mode.  I hated my maternity pants that are still serviceable, and the ones I wore did not live.  My maternity clothes were sold cheap and made cheap.  So it's off to find some new ones.
     My appetite has definitely increased.  I am at times experiencing moments where it seems I can't get enough to eat.  I am sorry to say that I have been giving in to temptation and regularly eating baguettes with butter and jam - bad, bad, bad.  I was a little surprised by the weight gain of the last four weeks none-the-less.  To make up I am re-upping the protein, and cutting back on the carbs with renewed zeal.  Favorite protein snacks include beef jerky that is locally made low salt organic blah, blah, Cheese, nuts, hard boiled eggs, tofu chocolate mousse (see problem of raw cocoa post).
     Plus of this point in the pregnancy is regularly feeling the baby move.  My girl likes to dance and do somersaults.  Her dad has not really been able to feel her kicks from outside yet, still too light, or too infrequent, or aimed at my back or butt.
      Sad symptoms this month include fatigue and anemia.  The one pro of fatigue is that it is a really good empathy building exercise for me as a medical provider.  Fatigue is depressing, and it's debilitating.  Just walking up the stairs makes me short of breath.  A trip to the grocery store leaves me washed out.  It is difficult to make myself use my treadmill but I am making myself do it for at least three hours a week.
     I did find out at my recent visit that my hemoglobin is 10.8 (11.5 is low normal for women).  This can commonly happen in pregnancy, your blood volume has to increase by 50% as much, that's a lot of red blood cells to make.  If you're like me and you surf a line of being normal and anemic there's nothing like being pregnant to push you over the edge.  One of the main symptoms of anemia is fatigue.  So I have been trying to increase my intake of iron rich foods.
List of iron rich foods 1. Mollusks 2. Liver 3. Squash seeds/pumpkin seeds 4. Beef or lamb 5. beans legumes 6. dark leafy greens
      I am also full into night time charlie horses again.  These are also known as nocturnal leg cramps, and are common in the second half of pregnancy.  I have heard or read several theories as to why these occur including pooling of increased blood volume, shifting pelvis, and low calcium and magnesium.  I definitely notice an increase in severity and frequency of cramps if I forget my liquid magnesium before bed.  Chiropractic care also seems to help.  But man oh man they sure are painful, and the last thing my tired self needs is to be woken up by leg cramps during the night.
      In the next four weeks I am planning to have a 3D ultrasound, for fun, and so my son can see the baby (he has not been allowed in to any of our insurance covered ultrasounds).  I am hoping to go for more walks outside as the weather here in Minnesota warms up.  I am also committed to doing pre-natal yoga at least once a week, although I have yet to start.  Wish me luck in sticking to my diet and exercise goals.

The Problem of Raw Cocoa

Here's a problem I've been struggling with - Raw Cocoa tastes awful.
It may have tons of anti-oxidants, and be good for cardiovascular health but it tastes like the most bitter paste imaginable.
Here are some of the things I've tried to bring it into my diet.
1. Adding to protein shake - Consummate Fail.  This made the whole shake taste awful and I had to throw it out.
2. Adding to morning coffee - Moderate Fail.  The powder falls to the bottom so I had to constantly stir the coffee to make the powder stay in the drink.  It also made my coffee more bitter, and drinking it started to feel like a chore instead of a pleasure.
3. Adding to cups of pudding - Moderate success - Two tablespoons of cocoa powder mixed with pudding did not alter the taste of the pudding too much to make it inedible. Problem with this is it was kind-of chalky and I just didn't feel like eating it very much.
Total Calories 150, Protein 3g Carbohydrate 27 g
4. Tofu Chocolate Mousse - this is a recipe that my friend/midwife shared with me before I got pregnant and was trying to lose weight - as a way to get a chocolate fix that would be high protein and low fat.  Problem is once you crunch the numbers it's not that much protein and a lot of Carbs.  I am trying today with mixing in the cocoa powder to see how it tastes.  I used a small amount of cocoa powder the first time because I didn't want to have to toss the whole batch.
It takes the following
1. 2 containers Firm silken tofu
2. 1 bag semi-sweet chocolate chips/chunks
3. 2 tsp of vanilla extract
And this time 5 TBSP of cocoa powder
Makes 8 servings - each serving 270 calories, Protein 7 g, Carbohydrate 32 g
jury is still out on whether this will be successful.

Other suggestions from friends include mixing cocoa powder with milk and sugar - doesn't sound like it would work to me but I haven't tried it.
And mixing cocoa powder with chocolate ice cream - this sounds delicious but also very bad for you.
I am open to other suggestions.
Oh and another thing that worked but at a high dilution was adding cocoa powder to taco beef and chili, granted it was a very small amount of cocoa - but I got it in there.

Open to suggestions here if any body has some..