Tuesday, December 15, 2020

We Out Here: The Fourth Trimester

I think it’s practically obligatory to start a blog post by saying I don’t know where time has gone. Since welcoming our daughter in September, I really don’t know where time has gone because we have made it through the first three months of her life and with each weekly photo that we take of her each Sunday, I’m left feeling so bittersweet. Every moment is temporary, which I suppose has always been the case, but there’s nothing that makes me feel more mortal than knowing that our baby is growing and we are getting older simultaneously. I used to have no qualms about wishing time away to hope to get closer to a specific date on the calendar for a trip or an event. Now I’m so aware that each passing day means she’s a little bit bigger and it’s both heartwarming and heartbreaking because it means she’s a day closer to her own independence, which is a mixed bag of feelings in and of itself.

The fourth trimester has been an unforgettable experience for so many reasons. I’ll try my best to share my thoughts in a semi-organized fashion. As always, kindly note I’m not a medical professional and I’m really just sharing this so I can reflect back on it down the road and possibly give comfort to any new moms in my life that may need a bit of reassurance that things settle down in due time. This post is full of TMI moments, so if you're not into that, then by all means, close this tab. I’ll share my labour and delivery story, postpartum care approach and anything else that feels worth noting. I suppose I should also note that this is our experience welcoming a baby about 6 months into the pandemic and lockdown life. We were fortunate to still have help and be able to see some family members. I know that’s not the case for everyone; we are very lucky to have support around us.

Labour and Delivery Prep
As you may recall from my last post, my pregnancy was not exactly uneventful. I had a few concerning things on the go (fetal ovarian cysts that were being monitored via ultrasound, increasingly high blood pressure that made me super concerned about developing preeclampsia, a prematurely calcifying placenta). While everyone around us encouraged us to wait to go into labour spontaneously, my OB and I discussed the idea of induction. After talking it through with my husband, we decided to schedule an induction just after I would pass 39 weeks. I would go in for cervix ripening on September 13 and then start Pitocin on September 14 if the cervix ripening went well the day before. Those are usually very big “if” statements for first-time moms. I had talked to my dad, a retired anesthesiologist, and he encouraged me to explore the idea of an induction. He also gave me the tip that if I was receiving Pitocin, I should try to get the epidural shortly before the Pitocin drip started or as soon as possible thereafter. Pitocin is the artificial version of oxytocin, which is our feel-good hormone. It pushes your body into labour. As you can imagine, that may cause pain or discomfort as contractions start and ramp up. The epidural can help you relax, but it also means you won’t be mobile. This insight was useful in helping me prepare for the unknown.

This was all a part of my probably excessively thorough research phase of mentally prepping for labour and delivery. I wanted to try my best to educate myself on all the variables so that we could make informed decisions as they were presented to us as labour progressed. I didn’t want to be caught off guard or having to make decisions with minimal info and even less time to figure out what would be best for us. We made a birth plan, but ultimately a lot of our birth plan details and specifics were things that are considered standard practice in Canada (for example, skin to skin is basically a given, your birth team will surely encourage it for both parents). I don’t think we even gave our birth plan to our medical team, which is hilarious because I insisted on having hard copies printed when I was still a couple months out from delivering. Did I mention I’m a little Type A?

Looking back, it feels necessary to just come out and say it—the way it shakes out is the way it shakes out. In retrospect, for us, the true purpose of making a birth plan was to discuss everything as soon-to-be parents so that we could be on the same page with each other. The objective of our plan was always to get our daughter out safely, whatever that required. I’d still say it’s a good exercise for couples to work through if they have not gone through labour and delivery before!

Labour and Delivery For Real
My last OB visit before delivery was Wednesday, September 9, during which I opted for a cervix check. That was probably the worst feeling I had experienced in a while (I’m also not a huge fan of paps, quelle surprise!). My husband was miraculously able to attend this final OB visit with me after a bit of pleading (it was his first and only visit that he came along with me for during the entire pregnancy due to COVID protocols) and it was purely to discuss the induction details and answer any questions we had. He witnessed my full-body tensing and flinching during the cervix check and was pretty concerned about how I’d handle the induction since I was so rattled about the cervix check (it wasn’t even a proper cervix sweep). I began spotting after the cervix check and, after much inquiring with mom friends, I learned that was normal. I had a massage scheduled the next day (September 10) and my RMT had actually helped induce labour before when her clients had sought her out to do so, so I did the same. She focused on acupressure points in the lower half of the body and wished me luck as we wrapped up our appointment. I began experiencing signs of labour on Friday, September 11, right at 39 weeks pregnant. I had random contractions that day, but nothing too noteworthy or worth timing. Contractions picked up the next day. We had decided to go for a walk and grab a late lunch. At lunch, we saw a couple with an infant sitting at the table across the patio from us. It was kind of like looking ahead at our future. We snapped some photos of the two of us with my belly round as ever around 4:00 p.m., not knowing what the next 24 hours would hold.

Unknowingly less than 24 hours
away from delivering our baby 

It was a rough middle of the night Saturday, September 12 going into Sunday, September 13 with contractions picking up around 11:00 p.m. on Saturday, spurring me to call the triage and ask if we should come in since they were definitely every 4-5 minutes for an hour. We were told to wait until they were 2-3 minutes apart since I was a first-time mom and early labour can often be a lengthy process. This was sort of surprising, as every prenatal course or literature we had read references the 5-1-1 rule (when contractions are five minutes apart, 1 minute in length for 1 hour, you need to get yourself to the hospital).

We went to the triage at 1:00 a.m. and the nurse and OB on call confirmed I was 2-3 cm dilated (not enough to be admitted), and they sent me home after a shot in the thigh to help with pain. They said that the injection would buy me 4-6 hours of relief. They did do my blood work and had me sign epidural paperwork before I left so that things would run smoothly upon my eventual return, which was smart on their part and a step I’d recommend if that’s offered (or even if it’s not - suggest it!).

I went home and told my husband to sleep in our bed and I sat in the nursery in our soon-to-be-nursing chair with a heat pad on my lower back. I started having back labour (our baby was apparently sunny side up at that point) and I was really having a time with that pain. It was pretty tough, but not unbearable for the stretch of time that I endured it. Counter pressure is the best way to get through back labour, which I didn’t know at the time and frankly couldn’t really do much about as we drove to the hospital. I was rubbing my back as best as I could while remaining safely buckled up. We had packed the car up with the car seat and our hospital bags before our last outing to the hospital, so we were basically ready to be admitted if labour was progressing enough.

The nurse and OB in triage were spot on, as we went back at 5:30 a.m. (my sleep-deprived husband was stuck waiting in the car as I did these hospital visits solo due to COVID protocols). The same kind nurse confirmed I was 4-5 cm dilated and she excitedly said, “Do you know what that means? We can admit you and you can get an epidural!” I was admitted right away and did the epidural at 6:00 a.m. (my husband wasn’t even in the hospital at that point, and honestly, the pain was at a level that made me not want to wait for him). The epidural was magic. It allowed me to calm down and from what I recall (it’s a bit hazy), we just kinda waited it out. I was 8 cm dilated by 8:30 a.m. I was 10 cm by 11:30 a.m. Sometime in there,, they broke my water. We had to wait for baby girl to drop down into position, which they gave me a small dose of Pitocin for and she thankfully rotated and dropped down. I started pushing at 2:00 p.m. and had to stop pushing at 2:07 p.m. to wait for the OB to join us in the delivery room, and she was born at 2:11 p.m. as Frank Sinatra’s “My Way” played in the background.

Nine days postpartum


What I Took Away
You know that saying, “We make plans and God laughs”? That’s basically how I’d sum up labour and delivery. Any preconceived notions you have about labour and delivery can and should fly out the window. Do your research to feel informed and confident as you approach the end of pregnancy, but know that being flexible is key and that regardless of what happens, you are in capable hands of professionals who do this every single day. Advocate for yourself, and know that the best part of the whole situation is that you will have your baby in your arms in due time. My motto going into the homestretch of pregnancy was, “You can do hard things” and our prenatal course featured a reminder that any pain I would feel could not be greater than me if it was coming from within me. These two notions served me well, even when I had a mild meltdown right before we started pushing. What can I say? It was a big moment and I had big feelings about it.

My husband said the two days we spent in the hospital after our daughter arrived were the best days of his life, and while I was dealing with a lot emotionally and physically (hormones are insane), I’m inclined to agree. It was like being in a hazy, loving bubble. Granted, there were a few learning curves on the go for us (breastfeeding, diapering, hearing our daughter’s cry for the first time and trying to decipher what each cry meant), but it was full of baby snuggles with this little nugget that we had waited so long to meet and that was truly awesome.

What to Expect - Postpartum Care
I debate being super upfront or being a little more muted about this part of motherhood. On one hand, I feel like people don’t share enough info about what to expect. On the other hand, I suppose it’s important not to scare people away from having a baby. This all goes back to the notion that postpartum recovery, like everything, is temporary. You do heal eventually, physically and mentally. Your hormones will settle down in time. Your physical tearing will heal. Everyone’s recovery experience obviously ties back to their delivery. I had a vaginal delivery and an epidural. I experienced second degree tearing, which is very much the standard level of tearing. Was it painful after? Yes. Was it unbearable? No. Did it feel a bit trickier when factoring in the notion of also nursing? A bit. Here’s the lowdown on postpartum recovery after a vaginal delivery in my experience, as well as other random tips that have helped us get through the fourth trimester:
  • Have overnight pads (cotton ones - I would avoid Always pads personally, as the top layer can sometimes stick to stitches; I personally am allergic to Always pads, so they aren’t an option for me regardless) or Depends on hand in your house and hospital bag for postpartum bleeding, as lochia can be a wild ride. My hospital provided the initial pads and then you were on your own for postpartum care - your hospital may differ in what they offer! Find out when you submit your preregistration paperwork! Make padsicles if you want. I did and didn’t use them much, but I did use the FridaMom cooling pads and witch hazel liners (friends gifted these to me - thanks y'all!). They’re worth the investment, the liners especially, if you want to feel some fast relief!
  • If postpartum bleeding persists past your 6 week postpartum check-up, speak up! I wound up getting a D&C almost 11 weeks postpartum to remove retained product of conception (aka placenta or other lingering tissue from pregnancy) since my bleeding persisted. All that is to say - if it doesn't seem to be improving, tell your OB and keep an eye on your symptoms.
  • A peri spray bottle is essential to take the edge off when peeing and keep your perineum area clean in the early days and even weeks after delivery; my friends hooked me up with a FridaMom spray bottle and it was superb, but the hospital-provided one is perfectly fine. Lukewarm water is likely most comfortable for this!
  • If you are nursing, and even if you aren’t, eat. Eat everything that is nourishing and healing, eat protein, eat healthy carbs. Your body needs energy for recovery. I couldn't eat a ton in the third trimester due to heinous heartburn, and I didn't have a crazy appetite after delivery, but looking back, I definitely wasn't consuming enough calories in the first few days after delivery and I think my nursing journey was harder because of it. 
  • Drink water. Drink way more than you think you normally need to. It’ll help flush your body of any meds that were administered. Your body may be swollen if you opted for an epidural and/or received an IV drip, so do your best to keep up on fluids. Your feet will eventually go down in size. No comment on if they will actually normalize to your pre-pregnancy shoe size! That’s a true toss-up. Sad truth!
  • If you’re nursing, pee before you feed your baby. You’ll be experiencing contractions while nursing as your uterus shrinks down to its former size and emptying your bladder beforehand helps reduce discomfort you’ll feel in those initial days of nursing.
  • Sitz baths with Epsom salts and/or witch hazel are great to soothe and promote healing. I found it hard to find time to fit this in to my day in the early weeks between nursing and the hard decisions of whether to shower/sleep/eat when given a few spare moments, but do what you can to prioritize your own care. If you can’t take care of yourself, you cannot effectively take care of anyone else. Baby is important, but so is mama.
  • I’d read that postpartum bowel movements can be intense. This is where avid water consumption and a few other tricks comes into play. Your pelvic floor also has a role in this (another reason to seek out pelvic floor physiotherapy before and after delivery). I stuck to my prenatal probiotic through pregnancy and delivery and had no issues after birth and delivery in this department, but I’d encourage anyone struggling to seek out prune juice and prenatal probiotics instead of opting for laxatives. 
  • Feeling sad or like you kinda blew up your life that you were perfectly happy with before baby is pretty common in the first two weeks. Those first two weeks are an emotional rollercoaster dubbed the baby blues. I told my husband that if I was struggling past that point, he should push me to find help, whether it was counselling, therapy, medication, whatever I needed. I did exactly that and am still speaking with a counsellor via public health and it has been helpful to process the transition from being an individual with no dependents to being a mother. There’s no shame in admitting that things are difficult or weird or that you’re feeling unsettled. Everything improves with time, but definitely know that in that transitional period, you’re not alone and talking through whatever you’re feeling will inevitably help you process the wildly multi-faceted changes you’re experiencing.
  • Bonding with baby may feel instantaneous or it may take time. Don’t feel guilty if you don’t spend every waking moment loving your new role as a parent. It is hard work taking care of a tiny human. Try to get on the same page as your partner about how you can support each other as you navigate your new roles as parents. I am lucky my partner stepped up to take on the responsibility of managing the house and cooking while working from home as I focus on nursing and figuring out her routine and daytime activities/naps while still doing a handful of chores, like the ever-present amounts of laundry. He still spends a ton of time with our daughter and we were able to get through those overnight feeds without completely losing our minds (the sleep deprivation has thankfully subsided) because we approached them as a team.
  • Accept help and try to nap. Lack of sleep exacerbates any anxiety or feelings of sadness you may have. It can be hard to accept help, but ultimately, you will implode if you don’t give yourself the chance to take some pressure off yourself and step back, even if it’s just for an hour. Start small and take baby steps with this. Try to rationalize with yourself when your hormones put you in Mama Bear mode and you feel territorial. Remind yourself that you may feel how you feel because you need a break.
  • Practical baby tips: Struggling to burp your babe? Try making a zig zag motion with your hand on their back from the base of their back to the base of their neck. An osteopath gave me this tip and it’s remarkable how well it worked for us. If your babe experiences diaper blowouts more than a handful of times in the span of a week, it’s probably time to size up. You will be amazed at how quickly your baby sizes in and out of diapers and clothes. A damp washcloth draped over your baby during bath time will keep baby warm and quasi-content.
  • Maybe this is the pandemic talking, but all we *really* needed for our kid was diapers, wipes, a bum cream of some kind, sleepers, swaddles, a car seat (couldn’t leave the hospital without one) and a safe place to put baby down to sleep (bassinet then crib). Everything else is largely superfluous (cutesie outfits included), but I do suggest expectant parents get a wipeable change pad, white noise machine (for everyone’s benefit in the beginning - babies can be really loud sleepers in their active sleep phase from 3:00-7:00 a.m.) and somewhere to safely hold baby (we have our crib on the top floor, a Baby Bjorn Bouncer on the main floor and a Snuggle Me lounger on the ground floor because we have 3 storey house to contend with) when you need your hands free for a moment.
  • Don’t worry about how you sleep or how your baby sleeps in the beginning. Just follow baby’s lead and know that the the early weeks are pure survival mode. Do yourself a favour and learn what your baby’s wake windows should be based on their age (spoiler alert - newborns should be awake for 60-90 minute windows). It’ll help curb a cranky baby and give your day a bit of structure. Explore baby wearing, as that’s how many babies find contentedness and you appease your need to get shit done around the house. Also, don’t compare baby’s sleep to that of other children. It’s a fruitless exercise that will only lead you to question if everything is going as it should and that can lead to guilt, shame and anxiety as a new parent. Sleep training is probably a great thing to seek out, but there’s a reason they say that babies aren’t ready to sleep train until 4-6 months of age. It takes time for babies to figure out how to sleep and get into a routine or rhythm of any kind. Just know there are lots of options as far as sleeping setups go, so do what works for you and your family.

Breastfeeding
Like I mentioned above, we intended to try breastfeeding after delivery. I went in knowing that it may not be automatic, that it may take time. Our baby latched right away and ate for a good 30-40 minutes after being placed on my chest for skin to skin. I was admittedly relieved that she was so keen to eat. They monitored her eating and weight and eventually, our nurses suggested we stay an extra night in the hospital to switch nurse (nursing on each side alternating 3 times through the course of a feed) to stimulate my milk supply and get the hang of nursing. I’m glad they suggested we stay another night, as it did help build my confidence in feeding our baby.

Overall, it was a bit of tough start. Our daughter lost about 12-14% of her birth weight by day 4-5 of her life (average is 10%). This was very stressful, as she wasn’t a big baby to begin with. My milk took time to come in, and my hormonal shifts made it a very emotionally and mentally draining stretch. As irrational as it was, I didn’t want to see anyone or have anyone come over, pandemic or not. We still had family around and I struggled with handing our baby off or wanting to see people face to face. When people came over, I felt like I was losing my connection with the baby when other people held her (this was semi-rational; keeping baby close to mom helps bring her milk in, which was still a work in progress/concern for us).

Our family doctor met the baby the Thursday after she was born and mandated that we supplement with formula, following a triple-feed approach of nursing on both sides, supplementing with formula and pumping every two hours. This schedule was absolutely gruelling and we easily reflect on the 2 days we were given to help our baby gain 60 grams (which isn’t that much weight in retrospect, but at the time it felt like Everest) as the most stressful 48 hours of our lives. She ended up gaining a whole pound in 2 days. From there, nursing got better and we dropped the formula supplementation by week 3 of her life. At this point, she's exclusively breastfed and things are going well.

Baby has recently decided to reject the bottle, so I’m not even really pumping at this point or using a Hakaa to collect letdown on the opposite breast. I was never keen on pumping, as freezer stashes made sense to me in a pre-pandemic life, but honestly, these days, where am I going without her for more than an hour or two? All in all, we found our rhythm and it was not without struggles (leaking milk, milk blisters, blanched nipples, spilled milk from the Hakaa gone absolutely everywhere....stop me if you must because I could certainly go on) or support from our hospital’s lactation consultant, who I called every Monday for the first 4-5 weeks with questions. Our daughter had a huge growth spurt between 4 and 8 weeks of age that certainly was a huge vote of confidence for me. I don’t know how long I’ll nurse in the grand scheme, but I’m happy to feed our baby even if it sometimes feels like it’s the vast majority of my time spent with her. 

Huge, endless love and gratitude to my husband for supporting me in every aspect of pregnancy and postpartum care, including breastfeeding. One day, he made it very clear that he understood that he couldn’t do what I was doing (nursing!), and that he was happy to do all the other things around the house because I was nourishing our daughter. This was a moment of clarity for me, as I was trying to help with food prep and run around the house doing my usual chores, but priorities have certainly shifted for me and I accept that this is a temporary stretch of our new reality that entails a lot of other stuff being moved to the back burner while I prioritize feeding our kid. I still have house stuff that I tackle as much as I can. It’s not nearly what I did before, but it’s working okay for us.


What To Remember
I suppose that’s a lesson - give yourself a goddamn break. 
Whatever frustration you’re feeling is fleeting, as is the moment that is causing your frustration. 

Parenting is hard, nursing is hard work and that’s without a pandemic dragging on and on to limit what you can even do on a daily basis outside the house with your child for your own sanity. Just be nice to yourself and each other. 

Try to enjoy your kid because they change every day and no day is the same, even if the early days are a total blur. 

The days are long, but the years are short.
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