THRIVE TV: Diastasis Recti

CALLING ALL MOMS!

This is important stuff.  And unfortunately, pretty common stuff.  Have you ever heard of diastasis recti?  It's essentially when the walls of your abdominal muscles are separated, which can happen most frequently after a pregnancy.  If you're not sure what it is or how to find out if you've got symptoms, it's all laid out in the video below.

It's important to know this stuff because if you do have abdominal separation, you want to be really careful about the types of exercises you do postpartum, so you don't make your symptoms worse.  When you're finished with the video, go to this link and grab a free PDF we created for you which outlines the test to determine if you have diastasis recti symptoms and includes our favorite resources for correcting and healing your abdominal separation.

What Do Amniotic Fluid and Tacos Have in Common?

She's 9 months pregnant and strolling the aisles of the grocery store picking up last minute things to make freezer meals before her baby comes.  Her water breaks and there's a big gush of fluid rushing down her legs onto the floor.  Contractions start immediately and she's panting and groaning through them.  Everyone rushes to get her in a car and the vehicle flies through traffic lights and stop signs to get her to the hospital just in time for her to scream her baby out.  EMERGENCY!!!

I hope you already know that it rarely ever happens that way.  And if you didn't know, I'm here to tell you: It probably will not happen like that to you.  In fact, only about 10% of women have their water break before labor starts.  The majority of waters rupture well into the labor process, and quite often, very near the end.  

Now I bet you're wondering why the title has the word "tacos" in it, huh?  Well, if you've given birth before, you've probably experienced a situation where your care provider asks you if your water has broken yet.  If the answer was yes, they may have asked you a few questions about it.  Check those questions out now so you know what to look for next time and can be prepared to answer them!  If your water breaks, remember "TACO":

T (Time): 

What time did your water break?  Care providers will want to know how long your membranes have been ruptured.  In most cases, there are protocols for how long you can have ruptured membranes before birth.  The concern is an increased risk of infection, as your protective bag of waters is no longer surrounding your little baby inside.  If your water broke and you're not already in active labor, remember to limit the risk of infection by not inserting anything into the vagina, including tampons, fingers, having intercourse, etc.  Take showers instead of baths.  Remember, each time something (even a gloved finger from a care provider) is inserted, the risk of infection goes up.

A (Amount): 

Was it a huge gush of fluid that came out like a waterfall?  Or did you happen to feel a few small leaks here and there?  Could the leaks have been urine?  Have you had sex recently?  Could the leaks have been semen? Could the leaks or fluid be vaginal discharge?  Many women experience a lot of discharge in late pregnancy.  Those may sound like silly questions, but they all happen and that's okay!

C (Color): 

What color was the fluid?  Normal amniotic fluid is colorless and sometimes a bit cloudy.  Occasionally it is lightly tinged with small amounts of blood or mucus. Sometimes it has white flakes in it, which is just vernix that came off of baby's skin.  The reason why they ask this question is because sometimes the fluid can be slightly or heavily tinted with meconium. Sometimes, baby passes his/her first stool while still in utero.  This is common and very rarely an indication of a problem, but the care providers like to know because each hospital has a different protocol for how to respond to this situation.  In our local hospital, they invite a respiratory therapist into the labor and delivery room just before birth.  The respiratory therapist stands in the back and out of the way.  If the baby has trouble breathing on his/her own, the therapist is there to help, so the baby doesn't aspirate any of the meconium in the water.  Usually the baby is born, cries and breathes just fine, and the therapist quietly slips back out.  If you're concerned about this or would like to know the protocol in your own hospital, make sure to ask your care provider during your pregnancy.

O (Odor): 

What does it smell like? Yep, you gotta smell it to answer this question.  Either your underwear or a sanitary pad that you're wearing.  Most people describe amniotic fluid as smelling odorless, sweet, clean, or like semen.  I suppose each person thinks of it differently.  Here's why we smell it.  We want to make sure it doesn't smell like urine, which has a distinctive smell.  And we want to make sure it doesn't smell foul.  Foul smelling amniotic fluid can be a symptom of a uterine infection that you'll want to get checked out.  In most cases, though, you're just trying to determine if it's amniotic fluid or urine.

So, there you have it.  Tacos and amniotic fluid DO have something in common!  If you think your water has broken or are unsure, go through these little questions yourself so you already know your answers for when you call your care provider. 

Now, did I ruin Mexican food for you for the rest of your pregnancy?  I hope not.  If I did, just rearrange the letters and remember the word "COAT" instead!

The Birth of Eden

Local mom Amanda retells the story of the birth of her second child, Eden.  We're sharing this story on October 15, Pregnancy & Infant Loss Awareness Day.  Eden's story is powerful, real, raw, and beautifully touching.  I hope you can find some time in your day to remember baby Eden and send some good thoughts and prayers to Amanda and her family.

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I’ll never forget the moment I found out I was pregnant with our second child.  I had gone in for my annual gyno appointment, expecting to discuss birth control options with my provider because our daughter was 7 months old and I was finally feeling human again. To my surprise, my bloodwork came back positive.  How could I be pregnant? Ok, I knew how I could be pregnant, but I was exclusively breastfeeding. Don’t the old wives say you can’t get pregnant while nursing? Aren’t the old wives educated medical professionals that bar out all acts of God with the collective wisdom of the ages?  After informing my husband (and subsequently reviving him), I sat down to sort through my feelings.  Fear and an overwhelming worry of how we would provide for two kids on one income and how I would mother two children under two all wrapped up in the promise of an even greater sleep deficit crept in first.  I did what any overwhelmed mother would do in this situation-- feed the child snacks and pray I make it to bedtime. After some ice cream and the metaphorical “bedtime”, hope arrived.  Excitement at the promise of a new life and all the potential love and laughter that would ensue filled my heart.  I would just embrace the chaos, and take it one day at a time, cherishing the small things.

            A few months, a handful of doctor appointments, and one sonogram later, we were ready to announce.  It was December, and now that we had sonogram photos, we decided to do a Christmas themed announcement.  Our daughter held a stocking that said “Big sister” and a photo of our newest bundle to be.  The congratulations poured in over the next few hours.  Here we were, about to be a family of four. I still wasn’t sure totally how to feel. 

Three days later, on 12/13/14 I began to see spotting.  Immediate dread filled my heart.  I knew that blood, no matter how minute, was never exactly a good thing.  We called the doctor, but of course it was the weekend so I had to wait for a call back.  That was the longest 20 minutes I’ve ever experienced.  Again, my thoughts wandered to “How?” This baby was perfect 72 hours ago during the sonogram.  Perfect development, strong heart beat.  How could it have ended so suddenly? The on call physician told me that there was really nothing that could be done at this point, that my body was “taking nature’s path.” They said only to come to the hospital if I was experiencing hemorrhaging, and that it was probably best to just ride it out at home because my fetus was 6 weeks short of being viable.  They gave me no advice on what to expect next, so I tried to google without being sucked down the web-based medicine rabbit hole. 

After laying down in bed, I tried to come to some sort of peace with what was happening.  Spoiler alert: I’m still trying to come to terms with it, 3 years later.  As the bleeding increased, I migrated to the only place I felt I could be, the bathroom.  It was night, and I couldn’t bring myself to turn on the light to see what was happening.  I knew when it was over, and I sat there pondering if I could bring myself to reach down into the toilet bowl and hold my child.  I couldn’t.  I felt like a terrible mother.  Not only could by body not provide and protect this baby, but I couldn’t muster up the courage to hold him or her before having to just dispose of him or her because they were not “viable”.  I didn’t deserve this angel, and that’s why the opportunity was taken away.   My mind was a dark place thinking that somehow this was my fault. 

I went to the doctor the following day, where a sonogram showed my empty womb.  While the doctor tried to be sympathetic, I saw what she entered in my chart.  “Complete abortion” hit me like a brick wall.  I always felt like abortion was something you chose.  I did not choose this. I would not in a million years choose this.  There had to be a better term.  When it’s referred to it as a miscarriage, I feel like that defines the death of the child but not the birth.  The process IS birth.  I only really noticed that’s what it was because I had already had a vaginal delivery.  The waves of contractions, the overwhelming instant relief as soon as the baby is born are exactly the same.  I can’t speak on the variations of the degrees of pain, as it may be less for someone who experienced loss earlier in their pregnancy.  I was 18 weeks at the time but this was birth just the same.

Six months later, there were two pink lines.  Nine months after that, on Valentine’s Day, our rainbow baby boy was born [read that birth story here].  Full of love and laughter, escorted earthside by his angel sibling.  It was a healing moment for me physically because I spent my entire pregnancy expecting to lose him too.  The anxiety was a constant burden, and that was an unexpected side effect from this whole experience.

I lost a child, but I found a village. People sent their condolences, and hidden in quite a few more of those condolences than I ever expected were privately messaged stories of their own losses.  Because of the stigma, especially for older generations, I never knew how many mothers were in this horribly cruel club.  Losing your child is a pain I wouldn’t even wish upon my worst enemy.  Part of the healing for me was sharing in this web of collective grief.  I was not alone.  So many others understood my pain.  They felt the crushing guilt that I was feeling.  “Maybe if I had been better, healthier, more vigilant, etc.” was the general consensus, even though we all know we couldn’t have prevented it. You can’t keep the darkness from creeping in, but it’s comforting knowing that others came before you to help show you the light.

The village wasn’t all that came from this. I learned how my husband grieves.  During the loss, he was distant.  He kept saying things to assure me that I was fine and was trying to be optimistic.  We never spoke much about it.  A few months after, a teacher from my high school, who is now a genetic counselor, had posted a link to a research survey about how couples deal with pregnancy loss.  There was a questionnaire to be filled out separately by both the mother and the father.   This survey is finally what allowed him to open up and express his grief.  He tried to be the strong one for me, and I mistook his distance and nonchalance for apathy.  Our marriage grew from this new understanding, and I was able to tell him that I had silently named our baby.  Seeking out something gender neutral as my loss occurred two weeks before the anatomy scan, I had decided upon calling him or her Eden.  My paradise, lost.   

I learned a lot about myself as well.  I learned to be patient with my children because some are not so lucky.  I must be more empathetic to strangers, as they are the only ones who know what they are carrying around today.  I cannot be jealous of those that haven’t felt this pain because for some unknown reason I was chosen to shoulder this load and I will do it to prevent their pain.  Most importantly, I learned how to be kinder to myself.  There’s good days and bad days, days where I fail to notice the absence of our other child and days where the soul shattering emptiness feels like it will swallow me whole.  On days like the latter, I must take time to grieve.  One hearty, ugly cry at a time, I hope to be slowly reassembled.  The memories I make with the children I get to keep here on earth with me will fill the cracks and become the glue that holds me together.  Until we meet again, my angel baby, Eden.    

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If you're living on the Eastern Shore and would like to share your birth story with our community, please email us at maria@thrivebirth.org.

The First Day

I would have 100 babies just so I could have the first 24 hours back again 100 times.  But then I'd have 100 kids and I'd have to give birth 100 times. #nothanks

The entire pregnancy you're anxiously waiting to meet this little baby.  Toward the end of pregnancy (or maybe throughout the entire pregnancy) you're growing uncomfortable and the physical symptoms are starting to take over.  You're excited, but you may be experiencing pain, sleeplessness, heartburn, morning sickness, pelvic pain and pressure, etc.  Then you have to move through an entire labor and birth experience, which may be short or long, difficult or not, possibly involve a major surgery, and is guaranteed to be a very intense mental, physical, and emotional experience.  

And then it happens.  The baby is here. YOUR baby is here.

And somehow, all that stuff melts away.  Time stands still.  The world stops turning just for you.  I've often thought that there could quite literally be a tornado directly out my window at the moment of birth and I wouldn't have cared less.  The largest rush of oxytocin IN YOUR WHOLE LIFE is directly after your baby's birth.  Oxytocin is a love hormone that is designed to facilitate bonding, love, and also stimulate uterine contractions to expel your placenta and stimulate the uterus's postpartum work.  This rush of oxytocin is why we can feel on top of the world after birth.  And that, combined with all of the other hormonal work, gives us the feeling of immediate relief, love, joy, ecstasy, shock, and everything else that instantly comes with giving birth. 

Not too long afterward, we begin to notice the aches and pains, but this time we have a baby in our arms.  You're hungry and thirsty, and you don't care how food and water gets to you but simply that it does.  There's no sweating the small stuff the day of birth.   

Because remember?  The world stopped.  There's nothing to worry about.  

It's such a strange and weird feeling.  To have a soft, squishy belly.  To feel for your baby and realize she's not there anymore, but instead laying beside you.  Everything is new again.  You go to the bathroom and quickly realize that everything is new there, too.  You are about to take a nap, and then remember you have another little human to consider.  You look in the mirror and aren't quite sure what you see. Your friends and family may be around, but you are almost on another planet.  Not in a bad "checked out" kind of way.  But more like you're only thinking of you, baby, and that birth.  Everyone else is just kind of "there".  

Your organs feel like they're dangling in free space in your belly.  They used to be all squished up in there and now they're making their way back to their original spot and it's a strange feeling.  This alternate reality?  It feels suspiciously good.  Is it possible to feel so out-of-this-world without drugs or alcohol?  The birth high is real.

You don't really jump back into any type of reality that's worth thinking about until the next day.  There's so much to celebrate! I could do the first 24 hours 100 times over.  They're so special, sacred, rare, and dare I say it?  So, so strange.  And I like to savor it.  And I hope you do, too. 

^^^ Within the first hour of birth with my first daughter, Clara, who will be turning 4 this week.  I'm feeling super nostalgic about her birth, which prompted this blog post today.  XO-Maria

The Birth That Changed My Life: Part I

This week in our Delmarva Community Birth Stories series, we're doing something a little different.  This story is shared by Thrive owner and doula, Maria Mengel.

I don't normally share birth stories as the doula.  The stories belong to the families!  But this story is one that I couldn't keep in.  Because while it is always all about my clients, and while it is my intention during a birth to make them feel like the most important people in the world, this story had a big impact on me and my life, too.  

This is the story of the birth that changed my life.

I met Meghan and Wes nine years ago in college.  We were all studying music at West Virginia University when we met each other and our spouses.  We were in the same classes, went to the same parties, and played in the same ensembles.  We were in each other's weddings and vowed to stay in touch.  The year after my husband and I received music jobs on the Eastern Shore, Meghan got one, too!  We were so excited to be close again and for Wes to bring his clarinet business to the Eastern Shore.  

Naturally, we all became best friends again.  We shared dinners on the weekends and even lived together one weekend when their home was evacuated for a hurricane.  They were the first people we told when we had our girls.  And they have been there to watch my girls grow up and see all of their "firsts".  

Last December, Meghan and I were taking my girls to the Salisbury Christmas Parade when Meghan shared the fabulous news that they were expecting!  I knew that they had been trying for a while, and I was equally happy for them and excited to meet their new baby that would get to grow up with my girls!  

Almost right away, they hired me to be their doula.  They were planning a natural birth at the same birth center that I birthed my first daughter. I was excited to be going back and so thrilled to witness the birth of this baby, who I already loved.  Meghan and Wes were some of the first participants of the class I worked so hard to design, Thrive Childbirth Education.  They were so excited and adamant about their natural birth plan, and I had planned to support them in whatever they needed and wanted.  

While they were pregnant, I had decided to study through Stillbirthday to become a certified Birth and Bereavement Doula.  I was unlike many of my class members, as I had never experienced a pregnancy or infant loss before.  To be completely honest, I had no clue what motivated me to take this training.  But I was completely committed to it and finished the program in March.  I wasn't yet sure if I would ever put myself out there as a bereavement doula, but knew that I had learned some valuable information, should I ever need it.

As their due date drew nearer, Meghan began telling me that she was measuring small (the measurement in centimeters that they take from your pubic bone to your fundus at OB/midwife appointments).  However, both Meghan and Wes are small people, and nothing seemed too concerning.  But when her belly wasn't growing at all after 3 or 4 appointments, her midwives recommended a biophysical profile to take a closer look at baby... just to be sure.  Meghan and Wes originally wanted to decline the ultrasound, as they had declined other ultrasounds in their pregnancy.  They weren't sure whether the potential risks of a long ultrasound at 38 weeks would be worth it to find out that everything was perfectly normal in the first place.  

They decided to go ahead with one biophysical profile, just to be sure baby was still growing normally.  I went with Meghan while Wes was working on Thursday, July 21st.  It was really cute to see their baby up on the big screen.  The ultrasound tech seemed like she knew what she was doing and was busy chatting a bit, while taking measurements and snapping pictures.  After it was all over, the tech said she'd be right back.  She was supposed to report back to Meghan's midwives with information.  When she came back she said that they were busy, and as soon as they were able to connect, her midwives would give Meghan a call.  She seemed perfectly happy and didn't look concerned to me at that point (although I now know that she was).

When I got home, I had to teach some private music lessons almost immediately.  I was in my first lesson when Meghan called back.  I didn't answer since I was teaching and instead texted "Hey I'm teaching. Everything okay?".  I waited a minute and got a reply, "No.".  

When I stepped out and called, Meghan was crying.  She told me that the midwives called and told her that there was basically zero amniotic fluid with her baby.  This could be life threatening to her baby, so they wanted her to drive immediately to our local hospital for a non-stress test and possibly a cesarean that very night.  I was, of course, completely shocked.   Since Meghan lived about 30 minutes away and she was still in town, I told her to come to my house and that Wes could meet us here.  

We hugged and talked for a little bit.  She was scared, of course, but wanted to be sure that her baby was as safe as possible, so we were just calm and hanging out with my two toddlers while we waited for Wes.  He brought the whole birth bag just in case they would be having a baby tonight!

At the hospital, the midwife and nurses did a non-stress test, which showed that baby seemed perfectly fine and healthy.  The care providers at PRMC told them that low amniotic fluid alone wasn't a clear indicator for induction.  They advised them to go home and rest.  Of course, after the providers at our hospital told the midwives at the birth center, and after the birth center consulted their maternal fetal medicine (high-risk) specialists about her case, they recommended that Meghan and Wes made the 2 hour drive that very moment for an induction that night.  And they politely declined, but agreed to come in the morning for a second biophysical profile with the specialists, just to be sure.

We had dinner together that evening at my home.  We talked about the crazy day we had and how they really didn't think anything was wrong.  We were all surprised at how insistent the "holistic" midwives were that the baby come out tonight, when our doctors at our local practice told her that her baby seemed perfectly healthy on the non-stress test.

The next morning, they made the trip to Annapolis for a second opinion on the biophysical profile.  I had my bags packed to join them just in case they ended up with a baby that day, but I didn't really think it would happen.  I spent the morning pulling weeds and working outside while thinking about them and how it was going.  As I jumped in the shower after working in the August sun, I finally got a text message from Meghan:

"Amniotic fluid is basically zero.  They can't find any kidneys or bladder.  Without kidneys, the baby will die after birth.  We're going to AAMC for induction.  You should come now."

**Click here to continue to Part II**

***Of course, I have received full permission from Meghan and Wes to share my version of this story and use their real names***

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If you're living on the Eastern Shore and would like to share your positive and empowering birth story with our community, please email me at maria@thrivebirth.org.

Community Question: GBS Testing

It's our first installment of "Sincerely, Your Doula"!  We're here to answer a question submitted by our community that will hopefully be helpful to you, as well!

"I'm 34 weeks pregnant today.  My doctor said that at my next appointment I'll be tested for 'GBS'.  What is that?  How do they test for it? What if I test positive?"  -Jessica (Princess Anne, MD)

Thank you for your question, Jessica!  Every pregnant woman in the United States who is being seen by a medical care provider will be offered the GBS screening around the 36th week of pregnancy.  You may want to know what GBS is and what it means if you're tested positive for it.

GBS (Group B Streptococcus) is a colonization of bacteria living in the gut of many healthy people.  In pregnancy, it is possible that what was once a "normal" colonization, may become an over-colonization, spreading to the vagina.  The risk is when baby is born vaginally, and may pass through the bacteria, becoming colonized as well, and subsequently ill.

So, at or around your 36th week of pregnancy, your care provider will likely request a swab (Q-tip) of your vaginal tract (and possibly rectum as well) for a culture test to determine if GBS has colonized there.  If your culture comes back positive (as it does for up to 30% of pregnant women!), then your care provider will likely recommend intravenous antibiotics during your labor process to act as a prevention against illness for your baby.  

GBS colonization in your vaginal tract is NOT harmful to you and the risk of your baby becoming ill is very small.  So, as I often share with my clients: GBS is something to be aware of, not something that you should lose sleep over.

Of course, in our childbirth education class, we always suggest asking questions and learning as much about your pregnancy and body as you want/need.  There are many layers to every test, routine procedure, and treatment, and we encourage you to do your research, ask your doula for more resources, and talk with your care provider about all of your concerns and options.  Here are some of the most common questions we get from our childbirth education class and doula clients concerning GBS (click on these links for statistics if you're a research gal like me):

1. What is the risk of my baby becoming infected with GBS?
2. If my baby is infected, what are the chances that they will become ill?
3. Are there risks to antibiotic use in labor for me or my baby?
4. Do I have to be tested?
5. Can I prevent GBS colonization in my vaginal tract?
6. How accurate is the test?
7. How effective is the antibiotic treatment?

What are some other questions about GBS that you have or have had?

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If you have a question that you want our doulas to answer, please submit it here in the comments or email us at maria@thrivebirth.org.  We're happy to share our expertise about anything concerning pregnancy, birth, our services, parenting, feeding, etc!