The Haakaa

L is already two months old, and I continue to be amazed at how good of a sleeper she is compared to W as an infant.  We traveled a lot this year in anticipation of L arriving, since we figured it would be much harder to travel once she was born.  We didn’t fly with W until he was 2.5 yo.  But L turned out to be such a chill baby, that we decided to take a trip to Denver last month.  We wanted to take advantage of both being on leave, and the promotional fares there.  It was a city we’d wanted to check out, and had a great time there.  We even drove out to Boulder for a day.  Luckily, L slept most of the time on both flights, so it wasn’t bad at all.

One new baby item that I don’t think was available when W was a baby is the Haakaa.  They call it a breast pump, but I don’t think it empties the breasts as well as an actual pump.  It suctions onto the breast, so that does help with milk removal, but at least for me, I haven’t used it like I would an actual pump.

Haakaa

You simply squeeze the bulb, and place the flange on the breast.  This creates a vacuum so that it stays on the breast.  What I’ve found to be very helpful is that I put it on the opposite breast while I’m breastfeeding, and it catches the milk that drips from the opposite side.  My right side has always been more productive, so I always start breastfeeding on the left, and collect the excess milk from the right.

I still use the Rumina Pump & Nurse bra (and still love it), so I slip the Haakaa into the bra, which holds it in place.  I don’t even apply the suction to the Haakaa.  With each feed, I usually get about 1/2 ounce, sometimes up to an ounce.  So it’s that much milk that would have otherwise made a soggy mess on the right side.  Over time, collecting the extra milk has resulted in a stash of frozen breast milk for later.

Luckily, at this point my milk supply has been good and I’ve amassed a decent frozen stash.  When I’m breastfeeding her in public, I use a second Haakaa that I keep in the diaper bag.  Because it’s not worth the trouble to keep this milk, I dump it and rinse it out in the bathroom.

The lactation consultant I saw early on after having L mentioned that she’s seen ladies get more clogged milk ducts with the Haakaa.  Therefore using it like a breast pump may not work as well for everyone.  Ultimately, it depends on the woman how well it will work.  But there are tons of rave reviews online.  Given how simple it is to use, how portable it is, and that it is inexpensive, I do think it’s a helpful item to have for most breastfeeding women.

 

 

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Fever Scare

At exactly 4 weeks old, L was feeling a little warm to me, so I checked her temperature using our rectal thermometer.  It was 100.9°F.  We have the Baby 411 book, which is great for quick reference, and it said that for babies up to 4 weeks, a fever of 100.4°F or greater is an emergency and requires hospitalization.  For babies 4 weeks to 3 months, it requires seeing a doctor and lab evaluation.

She was right at 4 weeks, and it was a Friday evening.  We called in, and as expected were advised to take her to the emergency room.  There, they recommended checking blood and urine tests to start.  Her temperature was normal there.  They asked various questions- was she bundled up a lot?  Anyone else sick?  Is she acting differently?  Other than the fever at home, everything was normal.  W hasn’t been sick, and he hadn’t even gone to preschool for a few days.  She was acting totally the same, feeding fine and peeing and pooping as usual.

The lab results that came back quickly were normal.  The blood and urine cultures, which look for growth of bacteria, would take much longer to come back.  Because of her age, they wanted to be extra cautious and said observation in the hospital was recommended.  Unfortunately for us, the hospital we went to didn’t have a pediatric ward.  So we had to be transferred to another hospital that accepts pediatric admissions.

It’s interesting being on the patient side, which is thankfully something I haven’t had to experience much.  We were only in the hospital for about 24 hours with both of our children, since thankfully everything went quickly and there were no complications.  After going home after delivering L, I certainly wasn’t expecting to be back in the hospital so soon.

The doctors, nurses, and other staff taking care of us were all great.  What was problematic, though, was the hospital transfer.  Per their protocol, they arranged for an ambulance to take L and I to the other hospital.  After waiting for a couple of hours for them to arrive at 3 am, they told us that they don’t have an infant-specific transport method.  They were basically trying to take our car seat and strap it into the gurney as securely as they could.

Upon inspection, it was evident that in case of an accident, it wasn’t the most secure method to be transporting our baby.  So we decided that it was safer to drive ourselves.  That required us to sign out of the emergency room “against medical advice.”  Because we were doing that, we couldn’t be directly admitted to the other hospital as planned, even though they had already arranged to have a room ready.

Instead, we had to go to the emergency room again at the second hospital.  Thankfully, the first hospital called over and let them know the situation, so they expedited the process as best as they could.  We didn’t have to go through the entire triage process as we normally would have, and instead the doctor and nurse came quickly, did the required exam of L, and then got things ready to take her upstairs to the pediatric floor.

The nurses on the pediatric floor, even though it was 4 am, were the sweetest ever.  They got L situated in her room, which instead of a bed had a crib, as well as one pullout bed for me.  At this point, my husband had taken W home so that they could both get a little sleep.  I, on the other hand, had to be awake to answer questions for L’s admission, and then I realized it wasn’t going to be much longer until her next feed, so I stayed awake until that was done.  Other than when I dozed off for a bit in the emergency room, I finally got a chance to sleep at 7 am.

If she had any further fevers, they would recommend a lumbar puncture to assess for meningitis, and they would start antibiotics.  Luckily, all of L’s temperature readings were normal throughout the time she was in both hospitals.  Her behavior also never changed.  The doctor who saw her during the day felt comfortable releasing her home if her temperature remained normal after 12 hours, and if the cultures were negative up to that point.  That was great news for us, since I’d anticipated needing to be there until the 24 hour mark.

We had confirmed that the thermometer we used at home was accurate.  While back grabbing my toiletries, my husband compared the readings he got with that thermometer to our meat thermometer, and they were similar.  He also later brought the thermometer to the hospital, and compared to the one they had there, and the readings were similar.

My husband and W came to the hospital in the late morning after getting a little sleep.  W had been very disappointed when he learned that he wouldn’t be able to ride in the ambulance with L.  Now he was sad for us that we didn’t get to ride in the ambulance, either.  Upon seeing her hospital room and crib, he said, “L is in jail!”  He likes pretending to be a police officer and taking bad guys and putting them in jail, so this was all very funny to him.

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That afternoon, she was discharged home, where we continued to check her temperatures, and they were fine.  In the end, it was all a false alarm, and thankfully nothing serious.  We still don’t know exactly why she had the mildly elevated temperature, but I’m so glad that despite the headache of going to the emergency room and being admitted, everything is ok with her.  I can’t imagine how difficult it is for parents when there is something more serious going on with their babies and children.

From Pregnant to Suddenly Not

For simplicity, I will now refer to WZW as W, and LHW as L.

I jinxed myself when I told my husband that I hoped L would arrive at 39 or 40 weeks.  I was enjoying my maternity leave, and hoping to have a week or two more to take care of things and just relax before the newborn craziness hit.  Plus, the way my leave works, I had to pick a date and tentatively planned to return based on her arriving at 39 weeks or later.  If she arrived early, I’d lose out on that time and need to return to work a little earlier.

Of course, L decided to arrive at 38 weeks.  The truth is, only a month in, it’s hard to imagine life without her.  It’s been such a joy, and in the end it doesn’t matter that she arrived at 38 instead of 40 weeks.  Since she is well and healthy, that’s all that matters.

But I was taken a bit by surprise with her coming a little earlier.  In hindsight, I’d started to have some more contractions the week prior to her arrival.  That also happened with W, where I didn’t have any Braxton-Hicks contractions until the week before he came.  Maybe that should have alerted me that she was coming sooner rather than later, but I guess I was in denial.

All of a sudden, I found myself no longer pregnant.  I hadn’t even washed the nursing clothes I’d kept from when I was breastfeeding W, so I had to do that right away.  Initially, I was still wearing my maternity pants because of the newly postpartum belly.  But now I’m back to being able to wear my non-maternity pants, which were generally stretchy at the waist anyway.  Most of my maternity-specific tops and dresses don’t look good on my non-pregnant frame, so all of a sudden I’m realizing that I don’t need them anymore.

In a perfect world, I would consider having a third child, and have a dog as well.  But we live in the San Francisco Bay Area which has among the highest housing costs in the country.  We live in a teeny house.  The reality with living costs, lack of space, and our busy jobs is that another kid would be pretty difficult to handle.  Even if we had two boys, I wouldn’t want to try for a girl that badly.

It’s been interesting suddenly finding myself no longer pregnant, and realizing that I no longer need my maternity clothes.  Ever.  It was nice to be able to pack them away to donate, and to open up space in my little closet.  But there is an ever so slight feeling of sadness that this is it.

Not that I enjoyed being pregnant all that much.  The first trimester nausea was pretty terrible, and I would never want to go through that again if I can help it.  The whole pregnancy, I could never eat normally.  Plus the glucose intolerance limited what I could eat.  So while I didn’t have the worst pregnancy ever, it was more like a state I tolerated as a means to an end.  The sadness that I will never need maternity clothes again is slight.  But it’s not like I’m cheering inside, jubilantly happy that I will never again be pregnant, despite all of the above.

Now I understand what other women have said about their experiences after their last child.  Since they knew it was the last, they took note of the milestones- the last time they were going to be in the hospital delivering, the last time they’d have a newborn, and so forth.

Physically, the recovery this time around has been much better.  The pubic symphysis pain that I was experiencing in the late pregnancy improved dramatically right after delivery.  I felt it a little immediately postpartum, but it soon went away.  I was continuing to use the SI-LOC support belt at first, but realized that without the big pregnant belly, it would tend to slide up more easily.  So I wasn’t wearing it regularly since early on.

With the quick recovery and no longer having the pubic symphysis pain, what’s been great is that I’ve been able to resume exercise quickly.  After having W, I was so overwhelmed and exhausted that getting exercise was not a priority.  This time, I am more determined to stay in shape.  I got used to exercising mainly so that I could get away with eating sweets and carbs.  Now that my appetite is back, and more so increased due to breastfeeding, I want to maintain activity so that I hopefully don’t gain a ton of weight like I did after having W.

Two weeks after my delivery, I completed the same 5 mile hike that I’d done the day before I delivered L.  I couldn’t fathom doing such a thing after having W, but this time around, although it was physically tiring, it was totally doable.  With the pubic symphysis pain improved, and no pain where the vaginal stitches were, it was fine.  I certainly don’t think this is realistic for most women after delivery, and am not necessarily recommending it.

In fact, before doing it myself, if a patient had told me they did such a thing, I would have discouraged doing so much so soon.  But I knew that I felt good pain-wise, and really wanted to maintain the shape I’d been in during my pregnancy.  What it comes down to is listening to your body, within the limits of what your doctor recommends.  It could be based on the physical pain, or how exhausted you feel physically and mentally from the sleep-deprivation.  It is one thing to challenge yourself a bit, but if you’re forcing your body to push through pain, or you’re barely functional from the lack of sleep, there’s no need to be doing any strenuous exercise.  A more leisurely walk or the like would suffice.

Despite the surprise of going from pregnant to not, it has been nice to have my body back.  I can sleep on my back, and bend down to pick stuff up.  I’m not as bothered by strong scents.  I still don’t love the scent of the laundry detergent that I purchased, but it doesn’t make me feel as disgusted as I used to with stuff like that.

As I mentioned before, despite not feeling as mentally prepared for her arrival, I’m so happy to have our little L with us now, and grateful that she has been well and healthy.

Easier with Round 2

Luckily, the second time around has been way easier than it was with WZW.  For one, having been through it before makes one less anxious.  If she cries, it’s not an emergency.  I can finish taking my shower, or whatever I happen to be doing at the time.

The main challenge that I hear from friends and patients is juggling the older kid and the newborn.  It makes a huge difference for us that WZW is nearly 4 years old.  He’s potty-trained, can tell us exactly what’s on his mind, and can follow instructions.  Not that he necessarily WILL do as we say, but he has the ability to.  It helps that we can explain why, for example, he shouldn’t be jumping on the couch if LHW is laying on it, because it’s for her safety.

One of my friends told me about having a toy box that the older kid can only have access to when mom is breastfeeding.  I think it’s brilliant, and have told my patients about it.  In our case, WZW can already play on his own, and hasn’t gotten jealous while I’m breastfeeding, so I haven’t found it necessary.  But for parents of children closer in age, particularly if mom is often alone with the kids, this would be a lifesaver.

The main difference for us this time is that LHW is a much easier baby than WZW was.  With him, I remember waking up to him crying frequently at night so that we can do the usual feedings and diaper changes.  But then it was a struggle to get him to sleep.  We’d carry him, bounce him, sing to him- anything it took to get him to sleep.  And then we’d try to slowly put him down, but for the longest time, he refused to sleep on a flat surface.  He’d finally fall asleep in our arms, and then we’d try to gently put him down, and then of course he’d wake right back up.

We’d borrowed a bassinet and crib, and also had a playpen with a bassinet insert, and he would not sleep on any of them.  We ended up using the Rock ‘n Play, which even back then we knew wasn’t really supposed to be used as the baby’s primary place to sleep, since babies aren’t flat on their backs.  The Rock ‘n Play has since been recalled since a handful of babies died while using it.

With WZW, I was exhausted due to the above, and felt like a milk cow due to all the time spent breastfeeding.  I felt like his slave, and in those early days they don’t reciprocate any affection.  It felt surreal that I was really a mom, and that this baby was mine.  I also felt hypervigilant- every little peep he made put me on alert.  It was hard to sleep during the day, knowing he could start crying any minute.

I went back to work 3 months postpartum, and went back full-time.  The craziness of the sleep-deprivation, and trying to pump at work was a lot.  I don’t think it was until he was 5 months old and started to laugh and interact more, that I finally started to feel the warm, fuzzy feelings towards him.

In contrast, LHW is a sleepy baby.  The first couple of hours of life, she took the breast just fine.  Then she was so sleepy for about 15 hours after that, and didn’t want to take the breast.  She had also swallowed some amniotic fluid, so she kept spitting that stuff up.  Because her stomach was full already, it was another reason not to want to feed.  The nurses and pediatricians all reassured us that this was normal, so I didn’t think too much of it.  During this time, I would occasionally try to hand express colostrum, but didn’t see a single drop.

After that, she did start to breastfeed again.  And she was taking the breast just fine, but I really didn’t think anything was coming out.  We saw the pediatrician on day 2, and she said that if the milk wasn’t coming in, I could put her on each side for 15 minutes, and then offer her an ounce or two of formula afterwards.  Later that afternoon, she hadn’t made any wet diapers in over 24 hours, so we started giving her some formula as directed.

We would time the formula at night, so it was great because she’d sleep until the next feeding time.  Instead of getting woken up by her, I’d have to set my alarm to wake her up to feed her.  Surprisingly, for a baby who wasn’t getting enough breast milk, she’d still go back to sleep just fine.  It wasn’t like she was crying uncontrollably due to hunger, even during the times she wasn’t getting formula.

Much of the time, she falls asleep mid-feed.  In general, she goes to sleep very easily, so we can plop her back in the bassinet, or if convenient on the couch.  Sometimes she prefers to be held, but in general it is such a huge difference from how it was with WZW.  I definitely don’t have trouble sleeping during the day if given the chance.  One of my greatest victories the other day was family nap time.  My husband happened to be out running errands.  As usual, WZW was resistant to laying down right away for his daily nap, but eventually he did.  LHW was also sleeping, so the 3 of us actually managed to take a nice long nap at the same time!

What’s funny is that even in utero, I noticed a difference in LHW’s movements compared to WZW’s movements.  He used to move so much that I’d take videos of my belly moving Alien-style.  With her, I wasn’t exactly worried per se, because she’d be moving regularly.  But she was never all that active.  Her movements were always more subtle, and generally only on my right side.  There were only a few times that she moved so much that it was visible externally, and it happened so briefly that I never caught any of it on video.

I saw a lactation consultant on day 4 after LHW delivered.  She confirmed that LHW wasn’t getting much with each feed.  Her weight increased by 0.3 ounce after I finished breastfeeding her for about 15 minutes on each side.  At that point, it was within the time frame where my full milk potentially hadn’t come in yet.  She gave me a hospital grade pump rental (the Medela Symphony), and advised me to pump for 15 minutes after breastfeeding at least several times per day.

At day 5, it was evident that there wasn’t going to be a sudden influx of breast milk like I experienced with WZW when the milk came in.  This was it, and it wasn’t a lot.  It was pretty devastating to realize that, since I hadn’t had any issues with supply with WZW (well, until I went back to work).  So I was really disappointed and cried, thinking that I may not be able to continue to breastfeed LHW for much longer if my supply continued to be minimal.

Thankfully, after pumping after most breastfeeding sessions, the supply has improved.  For a few days, I tried “power pumping,” which involves pumping for 10 minutes on and off for an hour (so pumping 3 times total).  In recent days, we’ve rarely had to give her formula.  For whatever reason, after our dinnertime is when she is the most hungry, so I’ll need to breastfeed her more frequently and we’ll give her the pumped milk after to satisfy her.

Otherwise, for most of the day and night, she continues to be a sleepy baby, and I usually have to wake her up at the 3 hour mark to feed her.  The nights are toughest, because once the feeding session is over, I have only 2 to 2.5 hours to sleep at a time, and it is so painful when the alarm goes off each time in the middle of the night.  For the nighttime feeds, my husband installed some new sconces that turn on if we tell Siri “moo.”  Once it’s daylight, particularly because it’s the summer, it helps to have the sunlight to wake me up and feel human again.

It’s exhausting, but this time around, those warm and fuzzy feelings have developed early on.  Despite the fatigue, I love my little LHW, and best of all WZW does as well, so we’ve been very happy.

 

Introducing LHW!

LHW arrived on August 9, weighing in at 6 lbs 9 oz.  Here she is with her big brother:

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As other parents have been telling me, it was such a huge joy to see how happy he was to meet his baby sister for the first time.  The three of us are still adjusting to calling her by her real name instead of Ayfee.

I was 38 weeks and 1 day on the day I delivered.  Since WZW came two days before his due date, I was thinking/hoping I’d have a little more time before she arrived, but I guess she had other plans.  Because of the glucose intolerance, I’d made it a priority during my maternity leave to stay active.  Honestly, my main motivation was still to be able to get away with eating carbs and sugar thanks to the workouts.

The week before the delivery, I’d done my usual long hike a couple of times, including two days before she came.  Because of the pelvic instability pain limiting me from hiking daily, I’d found a local pool where I can do laps and pay a daily fee (as opposed to many places requiring membership).  The morning of the delivery, I’d gone to the pool for the second time.  I’d contemplated if I’d go enough times before I delivered to warrant purchasing a monthly pass, but good thing I didn’t!

I swam at a leisurely pace but did swim a mile.  Right after, around 10:15 am, I went to the restroom and saw blood.  It didn’t look like just bloody show, which is more mucous with some blood, and often happens close to delivery as the cervix is starting to open.  With WZW, I’d had a small trickle of bloody fluid when I first broke my water, but it didn’t look like that, either.

I knew that the appearance and amount of blood I saw, since it wasn’t either of the above, was a little worrisome.  So I called Labor & Delivery and headed straight there after the pool.  I didn’t even have a chance to shower all of that chlorine off.  In some cases a lot of bleeding could indicate a placental abruption, when the placenta starts to separate from the uterus.  This can happen with an event like a high speed car crash, or can happen for unknown reasons spontaneously.  If it happens, the baby would be losing oxygen and would need to be delivered via emergency C-section ASAP.

Once in Labor & Delivery triage, they monitored the baby and her heart rate pattern looked great.  I was 4 cm dilated, 80% effaced, -2 station and having mild contractions, maybe about every 7 minutes or so.  Thankfully nothing concerning like abruption appeared to be causing the bleeding.  So even though I hadn’t been feeling any significant contractions, the bleeding must have been from my cervix changing as I was entering early labor.

Since my labor went pretty quickly with WZW, considering he was my first baby, I’ve been concerned that things might go a little too quickly this time around.  I certainly didn’t want to deliver in the car.

They monitored me on Labor & Delivery for over two hours, and I didn’t appear to be going into full labor yet.  The bleeding slowed down.  They rechecked my cervix, and it was 4-5 cm dilated; minimal change from the initial exam.  I was aware that by going home, there was a risk that things could move quickly once I started active labor.  But I preferred to go home and wait it out, not to mention shower.  It also gave us a chance to arrange for WZW to go to my parents’ home for the night.  At that point, it was the early afternoon.

I continued to feel mild contractions throughout the day.  At about 8:45 pm, I started to notice them get stronger and closer together.  Not horribly painful like full on labor, but definitely a change.  Again, given my fear of delivering in the car, I called the hospital and we went back in, because I had a feeling I was transitioning into active labor.

When we arrived, the midwife checked my cervix and I was now 6 cm dilated, so I was definitely staying in the hospital this time.  She said that once things were situated, she could potentially break my water.  That often helps things progress more quickly, especially in women who have had babies before.  If the baby’s head is still high, it may not be safe to rupture the bag.  But if the head is low enough, it’s something that is often done on L&D.

We are a little more cautious with women having their first baby of doing it really early.  In case the labor doesn’t progress quickly, you’re now introducing a higher risk of infection because the barrier between baby and the outside world has now been broken.  So if a woman remains with a broken bag of water for many hours before she delivers, there is a risk of her developing an infection called chorioamnionitis.  The baby’s heart rate could go up, and the mother could develop a fever.  She would receive antibiotics.  Even after the baby delivers, he or she would be monitored more closely and have additional testing done.

In my case, once the nurse finished the admission, placed my IV and such, I told the midwife I would like to go ahead and have her break the bag of water if she thought it was appropriate.  At that point, I was having more regular contractions that were uncomfortable, but not the level of pain I remembered with WZW when I was in full-on active labor.  She checked my cervix, and it was now 7 cm dilated, and she went ahead and broke the bag.  It was 23:32.

From there, I noticed that the level of pain with contractions intensified to the active labor pain I remembered with WZW.  I wouldn’t be able to maintain a conversation through them, and I would need to try my best to breathe through them.

Then before I knew it, the contractions started coming super close together, to the point that I couldn’t get relief between contractions because the pain never fully subsided.  I felt pain all over.  The nurses ask you to let them know if you feel the urge to push or urge to have a bowel movement, because that usually indicates that the baby is about to deliver.  I can’t say I felt that necessarily, but rather I was in so much pain, I didn’t know what to think.  I wasn’t necessarily sure the baby was about to deliver, but thankfully had the wherewithal to tell my husband to call the staff because I did know from experience that sometimes things can go very quickly after breaking the water.

They came back in, and the midwife checked and said the baby’s head was right there.  They quickly got things set up for the delivery, and she told me to push.  Unlike with WZW when I pushed with my contractions, this time I was just in constant pain.  I didn’t wait for the next contraction to push, but rather had my husband and the nurse help me get my legs up to hold, and then pushed a little to nudge her out.

I was in the most intense pain of my life for a short time, and then before I knew it, she was out and it was over.  She was born at 23:45, just 13 minutes after the midwife broke my water.

She delivered in what we call OP (occiput posterior) position, which is when they are facing front.  It doesn’t happen as often, as babies usually prefer to fit through the birth canal facing towards mom’s back.  And usually ladies who deliver OP tend to report feeling back labor.  In my case, I think because she was small (WZW had weighed 7 lbs 5 oz) and delivered so quickly, she happened to come out that way.  I never felt any particular back labor symptoms.

Postpartum, I’ve definitely noticed that the physical pain is less than I had with WZW.  After having him, I remember feeling that my whole pelvis hurt- like all of the bones in the areas around the vagina where things presumably had to separate a bit to let him out.  It wasn’t just from the stitches.  This time around, I had a smaller tear, a first degree laceration that was more on the inside of the vagina, so less bothersome for me using the restroom.  I don’t even need that bottle to rinse after using the restroom, and can use toilet paper like usual.

The pelvic instability pain is there but not as bad as it was before I delivered, so I haven’t been wearing the SI-LOC support belt 24/7 like I had been.  I feel for the ladies who have more significant physical symptoms, and for sure after a C-section, because the pain and immobility would be way more significant.

One reader commented after having her baby that it was nice to get her body back.  It was much easier for her once the baby was out, compared to being very pregnant and dealing with a small child.  I feel the same way, though I’m lucky that WZW at nearly 4 yo didn’t require me to lift him in the late pregnancy.  While I’m still a little sore and recovering since it’s only been a few days, things like bending over that were uncomfortable to do while very pregnant are now much easier.

Not to mention, I feel so free now that I can eat whatever I want.  It is wonderful to be able to eat carbs and sugar without worrying I am affecting the baby’s blood sugars.  For the entire pregnancy, I’d feel gross after eating too much, which limited how much I ate.  That is also better.  This new freedom plus the sleep-deprivation is a recipe for weight gain, so I will have to be cautious in the long-term.  But it’s really nice for now.

 

 

SI-LOC Support Belt

I’m 36 weeks today, which means today is my first day of maternity leave!  I don’t think it’s quite set in yet that I’ll be away from work for months.  I usually have Thursdays off, so today kind of feels the same as my usual day off.  I unfortunately woke up in the middle of the night with a bad leg cramp that required me to get out of bed to stretch out and relieve.  And then I couldn’t go back to sleep for hours.

While that hasn’t happened before, sleeping has been more uncomfortable, and that’s the main reason why it’s nice to be off of work.  I’ve been extra tired, since I’m usually a back sleeper, and sleeping on my side is just not as comfortable.

At about 32 weeks, I started to feel pain at the pubic symphysis (the pubic bone), particularly as I turned from side to side in bed.  That’s the main reason sleeping has been more uncomfortable.  That never happened to me in WZW’s pregnancy, but I’m not surprised that I’m having new pains this time around.  Anecdotally, it seems like my patients having their second or more baby seem to have more physical discomforts.  As the pelvic bones separate a bit in preparation for childbirth, many women have pain of the pubic bone (labeled symphysis pubis below), since that area separates.  Pain can also occur on the sides of the low back from the separation at the sacroiliac joints.  I have a bit of that as well.

Pelvic Bones

I have the good fortune of having a pelvic floor physical therapist in my office.  Some of her work includes helping women with strengthening the pelvic floor muscles, such as helping with Kegel exercises in women with urinary incontinence.  Other women have pelvic pain symptoms, and she helps them relax certain areas of the pelvic floor.  Unlike other physical therapists, she does “internal work,” meaning she places her fingers in the vagina to assist with the therapy.

I recently saw a patient who had been suffering from pelvic pain (pain in the lower abdomen) for several years.  She’d had an extensive workup already- ultrasound, CT scan, colonoscopy, and nothing had solved the issue.  It just so happened to work out that our physical therapist had a patient that didn’t come for her appointment, so she was available to assess my patient right then and there.  It was like magic- the physical therapist was able to pinpoint the muscle that was causing the patient’s pain.  So it’s anticipated that with the patient doing work at home and having follow-up with the physical therapist, her pain should improve.

Prior to having my own pain, she had recommended the SI-LOC support belt for patients with what we call pelvic instability, or the symptoms I described previously.  Well, since I was having symptoms myself, I went ahead and purchased it to see if it would help.

There are two versions, the regular SI-LOC and the maternity version.  The regular one is for people with pelvic instability who are not pregnant.  Both sit lower than the standard maternity belts, which I used previously with WZW’s pregnancy to help support my pregnant belly.  The standard maternity belt helped prevent feeling like I needed to pee when I went for walks.

The back of the SI-LOC belt goes over the sacrum, which is that big bony plate of the lower back, and the front dips down closer to the pubic bone.

SI-LOC

The regular SI-LOC, shown above, has the little black loop through which the belt passes and then overlaps back.  You can tighten it by pulling on the end, and then secure with Velcro at the point where it’s snug but comfortable for you.

The maternity version has two belts that overlap:

SI-LOC maternity pad

This first one, shown above, serves as padding for the main belt, so it doesn’t dig into your skin in light of the pregnant belly.

The second belt goes over the “padding” belt:

SI-LOC maternity both

The difference is that the maternity belt doesn’t have the black loop to help cinch and tighten the belt.  The main belt is a simple loop that goes over the padding belt, and you Velcro the end in the desired location.

Both belts are available on Amazon or on the OPTP company’s website.  I was accidentally clicking too quickly on Amazon and saw the cheaper price for the regular SI-LOC belt and ended up purchasing it.  Once I received it and realized it was the wrong one, I then purchased the maternity version.  While I don’t recommend doing this, I ended up keeping both, because I figure after I no longer need them, I can show them to my patients who might be interested in purchasing.

What I found was that if I use the regular SI-LOC by itself and put it over my underwear, underneath my pants, it digs in and gets uncomfortable when sitting.  So the maternity padding layer is definitely helpful.  However, the downside of the maternity version is that because it doesn’t have the black loop to help tighten and cinch the belt, it doesn’t feel as sturdy and secure.  So what I’ve ended up doing is using the maternity padding, and then using the regular SI-LOC belt over it.

For pregnant women who don’t mind having the belt be visible, I would recommend purchasing the regular version, and then wearing it on top of your pants.  That way you get the secure fit, but it won’t dig into your skin.  Overall, I find the regular version to be more effective, so I’ve only been using that one.  At night and while exercising, I’ll just wear the regular belt by itself over my clothing, which avoids it digging in.

The sizing is a little confusing because the regular version is based on a circumferential measurement, while the maternity version is not.  The maternity version has you measure from your hip bone, around your back to the other hip bone.  They refer to it as the ASIS, or anterior superior iliac spine.  Those are the most prominent bony areas on either side of the hips.  So be mindful with the measurements to make sure you get the correct sizing.

The physical therapist assessed me quickly, and she confirmed that I do in fact have pelvic instability and made the right decision to purchase the belts.  It was interesting because one of the things she had me do was to lie on my back and raise one leg.  That caused the pain in the lower back on that side.  But if I sucked in my belly, engaging my abdominal muscles, the pain went away.  So in addition to using the belt, she recommended pulling in my belly to help with the pain.

Sucking in my belly was something I’d been doing earlier in the pregnancy, partly because of vanity but also since I thought it would help support my core.  Well, as I got farther along, I stopped bothering because I didn’t think it would matter given my much larger belly.  It’s good to know that it does make a difference.  So ladies, suck in those bellies, especially while walking, because it will help support the core, and it’s way less trouble than doing other abdominal exercises on a regular basis.

Blood Sugar Checks

It’s been an interesting experience checking my blood sugars.  For one, it turned out that I was initially checking at the incorrect time.  I had always been taught that the sugar checks are one hour after meals, but didn’t realize the timing was one hour after the first bite.  Even as a physician, it was one of those details I didn’t learn until I had to do it myself.

I have to acknowledge that unlike a true gestational diabetic, I don’t have to check my sugars regularly.  After checking the fasting sugars in the morning and seeing that they were generally normal, I stopped bothering to do that regularly.  I don’t check my sugars one hour after every meal, but rather when I know I’ve eaten food that’s questionable.  And honestly, there are times that I ate what I felt like eating, and didn’t want to feel more depressed by seeing the elevated number after.

Initially, I experimented to see what raised my sugars.  Even though I was told that in pregnant women, fruit and dairy tend to elevate sugars in the morning, it turned out that my morning fruit smoothies were fine.  It turns out that I don’t have to be super strict with what I eat, but I do need to be careful.  If I go too crazy with bread, pizza or the like, my sugars will be high if I don’t go for a walk right after.

We wanted to travel before Ayfee arrives, so we took a trip to New York City a couple of weeks ago.  It turned out that it worked well with my glucose intolerance, because we walked a ton, which allowed me to eat more freely.  It wasn’t practical for me to check my sugars too often while out and about, but when I did check, they were generally ok.  It was exciting to see on the activity tracker on my phone that I’d walked 5 or 6 miles each day.

Here’s WZW in Central Park:

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More recently at home, I’ve been hiking a trail that’s about 5 miles with a lot of uphill areas (25 floors according to the tracker).  It’s a pretty tough workout for me at 32 weeks, and takes me about an hour and 40 minutes.  Even afterwards, I can eat freely and my sugars will be fine.  Like I had a fatty ice cream treat after my  last hike, and my sugars weren’t even close to being high.  Besides the fitness aspect, it’s a huge motivation for me to do the hikes so that I can reward myself with carbs and sugar after.  I can pretty much eat whatever I want right before and right after the big hike.

Even later in the day, it seems like I can eat more carbs, and my sugars will remain normal.  I doubt I could eat something really sugary, though, many hours after the hike.  Definitely by the next day, the effect wears off.  If I’m sitting all day in the office, I have to be careful even eating a sandwich for lunch.

Unfortunately after my last hike, I noticed more pubic symphysis (pubic bone) pain and low back pain.  It’s probably due to the separation of my pelvic bones in preparation for childbirth.  I never had that with WZW’s pregnancy, but I’m not surprised.  It seems like my patients having their second or more baby seem to have more pain symptoms on average.  One of the physical therapists I work with recommended a support belt for pelvic instability that I’ve been recommending to my patients.  Now that I’m having symptoms, I decided to order one for myself.  Will let you know if that helps.

Glucose Intolerance

Hitting the 24+ week mark means doing the glucose test to check for gestational diabetes.  Different institutions test differently.  At mine, we start with a 1 hour test involving drinking a 50 gram glucose load, then checking a blood draw for glucose an hour later.  If the value is elevated, then you have to go in fasting, get your first blood draw, then drink a 100 gram glucose load and check your blood sugar every hour for 3 hours (four total blood draws).

The rationale for doing the testing this way is that the 1 hour test catches more women than actually have gestational diabetes (it’s a more sensitive test), without requiring everyone to do the full 3 hour test, which would be painful.

With WZW, I had an elevated 1 hour test, so I had to do the 3 hr confirmatory test, and it was normal:

https://paleoob.wordpress.com/2015/06/09/the-3-hour-gtt/

I was hoping that last time, I had an elevated 1 hour value because I was following more of a Paleo diet, and my body wasn’t used to handling such a large glucose load.  This pregnancy, I’ve been much more lax with the carbs and sugar.  Alas, I was wrong.  This time around, I had to do the 3 hour glucose test again.  And one of the values after the glucose load was high, meaning I was diagnosed with glucose intolerance.

Glucose intolerance is basically a step below gestational diabetes.  I was certainly relieved not to have overt gestational diabetes, which would have meant being on a strict diet and checking my blood sugars 4 times per day (fasting in the morning, and an hour after each meal).

With that said, I was told that I essentially still need to eat like a gestational diabetic.  I found that frustrating- they tell you things like not to fast over 10 hours, and to avoid fruit and dairy in the mornings since pregnant women tend to have higher sugars in the mornings.  I’d been making smoothies for breakfast because it was a convenient way to add fiber and hydration in the mornings.

I found it difficult not knowing how strict I really needed to be, and not knowing what my blood sugars were actually doing.  I would love to go back to being Paleo, but it’s not that easy.  During pregnancy, it’s like something takes over you- you can’t eat the same, certain things smell terrible, etc.  For many of us, the draw of carbs and sugar are really hard to resist.  At 27 weeks, I am just now approaching my pre-pregnancy weight, and I still feel nauseous after I eat.  So it’s been an annoying existence of not being able to eat normally, and I’ve been tending to snack on starchy crackers and the like.

The not knowing, and inevitably still eating some carbs left me feeling guilty.  So I decided to get a glucose meter to be able to see for sure what was going on.  Normally, a glucometer is not given to women with glucose intolerance, but if a doctor thinks it’s appropriate, it can be ordered.  Lucky for me, I can just ask my doctor/colleague.

The glucometer comes with a bunch of test strips and little needles (lancets).  For each blood sugar check you have to insert a new lancet into the part of the device that detaches to prick your finger.  You also insert a new test strip into the meter itself.  You prick the side of your finger, squeeze to get a droplet of blood, then touch the test strip to the droplet to get your reading.

It’s been interesting to see the results.  For the most part, my fasting values have been fine, though I’ve had some mildly elevated values here and there.  My fruit smoothies with no added sugar have not raised my blood sugars.  But some other things, like a gluten-free bagel (made of mostly tapioca, eggs, and cheese) for breakfast have raised my blood sugars.  But then I also once had a regular full-carb bagel and was ok.

The results are a little inconsistent, but overall it’s a relief that I don’t have to be super strict like a true gestational diabetic.  I still can’t be totally cavalier and eat a ton of carbs, and certainly need to be careful with the overt sugar.  I’ve stopped downing mountains of crackers as snacks switched to nuts, chia seed pudding, cheese, and the like.  It also helps if I walk after eating some carbs, so that my sugar doesn’t end up as high after the meal.

I feel for all of the ladies who have gestational diabetes, because it is a huge daily challenge.  I know my pregnancy hasn’t been terrible, but it’s still been difficult dealing with the daily nausea and the constant battle of wanting to eat certain things even though I know it’s better not to.

This all does go to show that sticking to a more Paleo lifestyle long-term is the best for me, since I do apparently have a propensity towards diabetes.

Ayfee

So far so good- in addition to the genetic testing, the anatomy ultrasound was also normal.  All of the available testing for the baby has come back normal, so we are relieved.  We’d been dropping some major hints, but we finally told WZW after the ultrasound result came back.  He was really excited to hear that he’s going to have a baby sister.  We had been asking him if he wants a baby brother or a baby sister, and he’d said sister.  I suspect it’s because he thinks it’s less likely that he’ll have to share his precious toys, particularly his trucks.  He’s probably noticed from his preschool classmates that the girls are less interested that stuff.

We told him that we’d name her once she’s born, but that he can choose what we call her while she is in Mama’s uterus.  He chose Ayfee, and we have no idea where that came from.  It makes my heart feel warm and fuzzy as he often asks to kiss “my baby,” ie Mama’s belly, and will say that he’s going to take good care of her.

It was really interesting to read the comments after my last post.  One reader essentially has the opposite opinion of me- she preferred having two girls, and will be totally fine with having a girl for baby #3, whose gender is a surprise until delivery.

Now that I know it’s a girl, there is a lot to be excited about.  First of all, I’m happy for my mother-in-law, who has four sons (my husband has a half sister through his father).  I sincerely hope that our daughter can have a special relationship with her grandmother, who never had a daughter of her own.

There are also various girly interests to experience together.  I myself wasn’t super girly as a child, and my mom wasn’t all that knowledgeable about things like makeup, hair, and fashion.  While I’m no expert in those areas, either, I do love Sephora and my favorite color is pink.  So I think it will be fun to do stuff like paint each other’s nails and other girly endeavors.  I would do my best to offer makeup advice, and even my husband will tell her no cakeface as he calls it (the ladies who have an obviously thick layer of foundation on).  My mom didn’t have Google to help her when I was a girl, but I do.  So it will certainly make it easier to find ideas for hairstyles even if Ayfee ends up with a different hair type than mine.

As a girl, I kept diaries, and my parents have kept them all.  I think they’re still stashed in my old room.  Hopefully at some point if I can get it together and get them all organized by date, it might be nice to share them with Ayfee.  I’m sure the contents of them at this point will be silly or embarrassing to me now.  I envision letting her read my diaries as she gets to the age I was when I wrote the entries, so that hopefully she can relate to them.  I guess it will be a little weird to hear the voice of your mother as a child.  I even kept a journal of when I started my period, and kept track of when each of them came.

I also think that being an OB/GYN, there is a lot for me to share as she gets older, such as what’s normal with periods, and what is normal with our bodies.  A lot of my patients aren’t all that knowledgeable about what goes on “down there,” and hopefully I can raise her to be more comfortable with her body and to know what’s normal.

Having one boy and one girl will be different than having two of one gender, so we are very lucky to get one of each.  It’ll be an interesting experience to see how our two kids differ, not just due to inherent personality but also based on gender differences.  Since I grew up with a brother, I think it’ll be good for WZW and Ayfee to have each other, as they can learn more about the other gender.  I have no doubt that there will be plenty of fighting as they get older, but what I look forward to is the joy of seeing their positive and loving interactions as they grow up.

 

It’s a Girl!

Since we didn’t have the embryos tested for genetic disorders, we did the blood tests to check for chromosomal and other disorders.  My particular healthcare system offers the NIPT (non-invasive prenatal testing) to women 35 and older.  This test is a blood test drawn around 11 weeks, and checks for trisomies 13, 18, and 21.  Trisomy 21 is the same thing as Down syndrome.  The test also checks the sex chromosomes for disorders, so the fun part is that you get to learn the gender early.

For women who are not yet 35 years old, they are offered the California state screening that everyone in the state is offered.  The first blood draw is around 12 weeks, and there is an optional nuchal translucency ultrasound (NTU) that is also performed around that time.  The ultrasound mainly measures the nuchal translucency, which if thicker than normal indicates a higher risk of Down syndrome.  But younger women are also at risk for structural deformities (whereas those of us over 35 are at higher risk for chromosomal abnormalities), so sometimes the early ultrasound can pick up some major malformations.  The NTU is not performed for those who have the NIPT done.

The women who have the NTU done get a preliminary result regarding risk for Down syndrome, but have to wait for the 2nd trimester results to come back to get the final results.  One benefit of the NIPT is that you receive the chromosomal testing results earlier, which can be helpful in case there is an abnormal result.  From there, patients can opt to do additional testing like an amniocentesis, which involves taking a sample from the amniotic fluid and testing for chromosomal disorders.

Since the blood tests are screening tools, the results can rarely be incorrect.  While the amniocentesis is not 100% accurate, it provides a much more definitive diagnosis.  Some people (especially those with significant risk factors) can consider skipping the blood tests and going straight to amniocentesis, but a lot of people hesitate because of the slight risk of pregnancy loss associated with the procedure.

Women who have the NIPT done also have the same 2nd trimester blood draw that is done with the California state screening test.  That’s because it checks for things like neural tube defects that are not assessed in the NIPT blood draw.

I’m 18 weeks now, and I’m still waiting for the results of the 2nd trimester blood draw.  But thus far, the NIPT results were normal and showed that we’re most likely having a girl.  I also have my anatomy ultrasound coming up.  This ultrasound is performed on all patients, even those who decline the state screen and NIPT.  It will check for major organ malformations of the brain, heart, kidneys, etc.  In our offices, those who don’t do the NIPT typically find out the gender with this anatomy ultrasound.

My husband and I would have been happy with another boy- we just want a healthy baby, and I’m hoping all of the tests and ultrasound results come back ok.  So far, until the results come back normal and we feel comfortable sharing the news of the pregnancy with the masses, we’ve held off on clearly telling WZW that I’m pregnant as well.  He definitely wouldn’t know how to keep it a secret.

To be honest, I’m a little scared to raise a girl.  Not that my fears are necessarily based on any real facts.  Since we have a boy, it seems like a known, as in we generally know what to expect, although of course every child can have very different personalities.

It’s probably more of a reflection of my own issues growing up.  I have this impression that it’s so much more complicated to raise a girl.  I would be concerned about cliques and Mean Girls-type situations.  I’d also be concerned about raising her with self-confidence and to have a good body image.  I would want to avoid stereotypes of what are boy interests vs girl interests.  We’ve certainly come a long way from the days my mother grew up in.  She was told that since she was a girl, she didn’t need to go to college like her brother, and all that really mattered was for her to get married and have children.

I think about two of my good friends that I’ve known since elementary school.  One comes from a family of 4 girls, and the other a family of 3 girls.  Growing up, and even into young adulthood, it seemed like they had more complicated relationships with their sisters.  I only had one brother growing up, and yes we fought a lot as kids, but it wasn’t the same as what I saw with the families of all girls.

One of my colleagues’ wife is a life coach.  They have two adult sons, and she once said how much respect she has for mothers of daughters.  Based on her experience as a life coach, she thinks it’s more challenging raising daughters.

So I’m not crazy to feel this way.  But I also realize that you can have challenges with children regardless of gender.  I once read an interesting quote from actress Kerry Washington in Marie Claire magazine,  “We think children come into the world and it’s our job to mold them and create them and teach them who to be so that they can be the best version of themselves, but it’s actually completely upside down. We get sent by God the kids we need so we can grow in order to be the parents they need us to be.”

As an aside, my husband played football at Cal with Kerry Washington’s husband, Nnamdi Asomugha.  Nnamdi also played for our local 49ers.  So it was funny when the news came out and I told my husband, “Nnamdi married Kerry Washington.”  My husband responded in all seriousness, “Who’s Kerry Washington?”

Going along with Kerry Washington’s quote, I suppose we’re having a girl because it will be a learning experience for us.  I had a feeling it would be a girl, partly because of our fear of having one.  We are happy either way, and I am excited to be able to buy some baby girl clothes.  Actually, since it’s been a few years, I’d be happy to buy baby clothes for either gender.  But I have a thing for (tastefully done) rainbows, and it’s much easier to find girl clothes with rainbows.

It’s funny how it worked out that my parents had a boy and a girl, my brother has a boy and a girl (twins), and now I will, too.  What’s also spectacular is that we can get all of my niece’s hand-me-downs.  She was born in July and our daughter is due in August, so that should hopefully work out well with clothing sizes and seasons.  But I will still want to buy a few things for her myself.