February 23, 2015

Stuck Between a Hospital and Hard Place: How Risky is a Home Birth for a "Low, High Risk" Birth?

That title was a mouthful, and so is this story. This post has been one I have considered writing a long time, but it is difficult emotionally, so I have avoided it. It's time to get it out there.

In 2009, I had a simple laparoscopic knee surgery to correct an old sports injury. I was naive and foolish to think any surgery was simple. (I think that is why I get especially angry when someone says, "Just have a cesarean, it's so easy.") At the time, I was taking the birth control pill. My doctor never told me to stop it prior to the surgery. He didn't feel my surgery and birth control were counter-indicated. Two days after my surgery, I got an intense pain in my ankle, following by intense swelling and the worst charlie horse I had ever had in my life. I went to a massage therapist who thought I might have a blood clot in my leg, but gave me a massage anyway. I went on like this for a week before a finally went to the doctor. I couldn't find a comfortable position, sitting, standing, laying down. I had to leave work, went straight to my doctor, who sent me to the ER. I jumped into the ER on one leg (not yet knowing the gravity of the situation.) As it turns out, I DID have a blood clot in my leg. The massage had dislodged it from my ankle, but luckily it became lodged in the artery behind my knee, only a 3 small pieces breaking off and traveled through my heart into my lungs. (Which had explained some intense chest pain I had recently experienced. That my friends was a minor heart attack when the clots bounced around in there.) The ER doctors told me I was lucky to be alive. I was young then, and thought they were exaggerating. A week in the ICU, not being allowed to get up at all (not even to use the toilet) showed how serious it was. I know now, I really was lucky to be alive. But I was left with more questions than answers. I tested negative for any type of genetic clotting disorder. I think it was the birth control pill because the estrogens in it can thicken the blood, but my orthopedic surgeon vehemently denies this. "Millions of people get knee surgery on the pill and don't clot," he told me.

Well I guess that I am the exception. Now, I can't take the pill, and any time I get pregnant, I have to take two blood thinner injections to the stomach a day. There is a risk of clotting in pregnancy, which is many times multiplied over the pill. I cannot take a blood thinner orally, because they have been shown to cross the placental barrier. I was covered in bruises on my stomach during my pregnancies. A needle phobia didn't help this situation. My husband had to give me 99% of my shots, because I just couldn't bring myself to do it. I asked my doctor how dangerous it would be for me (and my fetus) not to take these shots. She likened refusing this medication to doing a road trip, driving 85 mph down the highway without a seatbelt. Maybe I'd get to my destination safely (clot free) or maybe not. There's a change I could clot again and have a stroke or heart attack that would be disabling or fatal, or my placenta could clot and kill my baby.

Because of this clotting issue, I am considered high risk. However, in all other aspects, I am considered a low risk patient. I don't smoke, I'm not obese, I'm reasonably fit, I don't have "advanced maternal age". One of the doctors I have interviewed dubbed me a "low, high risk patient". Talk about confusing and frustrating.

When I started having babies, I never thought of a home birth. Hospitals were "just where you had babies." However, my heart has started longing for a home birth, or at least something very close. Six months ago you couldn't have told me this is what I would want. I would have thought you were crazy. I have never wanted a home birth. However, the more I meditate on what I have read in "Cut, Stapled, & Mended", the more I feel like a home birth would be the most conducive to achieving my VBA2C. I'm beginning to wonder though, if I really have any choices in regards to my birth location. I feel like I am stuck between the hospital and a hard place.

  • Where am I going to find a midwife that would take me on as a patient knowing that I have the potential to be a serious bleeding risk if things go wrong. ESPECIALLY after 2 cesareans. 
  • AND where am I going to find an OBGYN that would co-manage me with a midwife so I can get my medications, blood tests, etc.
But most importantly is this dilemma in my heart: Am I putting myself, my baby, and my family at substantial risk by trying to birth at home. Am I being irresponsible, foolhardy? Is the risk to my safety so great that I am willing to leave my children motherless and my husband a widower? Is the danger even that high, or have my doctors exaggerated my clotting risk to scare me into submission? I'm feeling backed into a corner. I'm beginning to wonder if I am going to "be allowed" to have the birth I want. I'm starting to wonder if I am going to have to be satisfied with the birth "I get". This really saddens me. After reading "Cut, Stapled, & Mended", I was full of hope. Now I realize that despite how similar Roanna and I are emotionally and physically, medically we are completely different. I feel a lot of sadness, because I can't image a doctor on the planet would approve of a home birth in my circumstances. Most don't approve of home birth for people with immaculate medical histories. I feel like I don't have a snowflakes chance in hell.

If you're reading this and have any experience or suggestions, I more than welcome them. Please tell me what I can explore. Who I might see, what avenues might I pursue? What are your thoughts?

Follow up on Scar Healing via Castor Oil Pack

Woo Wee ladies. Let me just say, perhaps I had an extreme reaction, but this Castor oil pack did a number on my body.

The first day after my Castor oil pack, my pelvic floor felt very loose. I contacted Curandera telling her that it felt as if my uterus was going to fall right out of my vagina. I had an extreme feeling of weakness in my pelvic floor. She said that this was a good thing! She believes that the adhesions and internal scarring that were holding my uterus in place were breaking up, and now my muscles were taking over. This just goes to show how weak my pelvic floor is. My pelvic areas seems all squishy and loose. Time to start working on that!

Another unpleasant side effect was 4 days of epic diarrhea, and a period that feels like the Red Sea is trying to escape my body. I'm only now starting to get back to normal in the bowel department. Handfuls of acidophilus have been my best friend.

As a result of these bowel shenanigans, I once again missed the Red Tent. I was so pissed off. I couldn't risk a fecal accident though, so what was I to do?

Today, I gave myself permission to spend money…not on the kids or my husband, but myself. I purchased a membership to an online workout for mama's with d. recti separation. I had a last minute cake order that proved wildly fruitful, so instead of doing home improvement, I'm doing ME improvement.

I'm both excited and skeptical I will follow through with it, which is why I have been hesitant to purchase it earlier. I am the kind of person that likes to show up for a class, I need that kind of accountability. I'm concerned that an online class with just get lost in the daily shuffle since I can do it "any time I want."(which translates into maybe never, probably.) Let's see how that goes.

I don't know how I am feel about this whole process right now. Check that, I know exactly how I feel right now. I feel like Sisyphus. Part of me is still very eager, and a part of me feels like giving up. I feel very much on a wire, just trying to maintain a balance. I sometimes feel like my life is so full, that how can I possibly find time to do one more thing. On the flip side, I look at the condition of my home (not immaculate), the laundry pile, the dishes in the sink and think, "you're not doing anything! Get off your butt!" I think a lot of us moms live in this dichotomy. We see magazines and Pinterest with titles of "How I maintain a clean house AND raised quintuplets!" You think to yourself, if THAT lady can do it, why can't I just do the dishes every night?" Then you turn around on Facebook and see videos titled "Why Mommy's Can't get Anything Done." You totally relate to the mom folding clothes, who turns to answer the phone, only to have her baby pull up and knock down the pile she just folded. Which is normal? Am I a slacker or the norm?

My kids are more like, "WAH!" or "Mama I need ____".

February 16, 2015

Ebb and Flow, Stop and Start, Sprint and Crawl

I've been meaning to write for days, but Valentine's Day has thrown me for a loop. My little home bakery (i.e. myself) put out over 10 dozen cookies over the course of 4 days. That is the busiest I have ever been. Hence, everything else fell off the wagon. Laundry, diet, gym, sleep, spiritual journey…sort of collecting dust. I felt like I was getting nowhere, when I did a quick visit to Curandera. I told her what I had accomplished (which felt like nothing) when she told me that progress sometimes comes in spurts and stops. She reaffirmed how proud she was of me for doing this work. She told me to be gentler with myself.

So, now that the rush is over and I can breathe, I can get back to the purpose.

Highlights on actions that I have taken so far since last we met:
  • I am been working to touch my scar.
  • Several trips to the gym, and some improvements in diet.
  • Called the hospital in an attempt to get my medical records. Gotten a weird voicemail twice and no return call. Grrr.
  • I have purchased all the ingredients recommended by my Urban Curandera to do castor oil packs.
  • I did my first home castor oil pack last night. 

The idea and mechanism behind the castor oil pack is that it breaks up and softens the scars both internally and externally. They are really easy to do and relatively inexpensive. For an in-depth look at scar healing, you can check out Curandera's workshop here.

The pack itself was fine, again it was the after effects seemed to hit me hard. I have been chatting with Curandera to see what she thinks is going on.

I felt a real looseness in my pelvic floor, somewhat painful, but mostly just a feeling of weakness or low tone. Sitting up and standing up straight posed some difficulty, as well as lifting Lollipop out of her crib. Lifting my 40 lb toddler is almost out of the question. The best way to describe the sensation is that it feels like my uterus just might fall out of my vagina. Not in a bulging or pushing sort of way, but in a heavy weight sort of way.

Curnadera suggested that perhaps the castor oil is doing its job, breaking up the scar and adhesions that had been holding my uterus in its current position. As a result, my pelvic floor muscles (or lack there of) are having to take over, and they are showing me just how weak they are.

The feeling has persisted all day, and then as the day wore on a second symptom popped up: PHANTOM KICKS!

I had heard about phantom kicks before, but I had blown the idea off. Surely it was just mom's that missed being pregnant, or decided not to have another and trying to connect with a past fond memory.

I'm here to tell you they are REAL. Mine have been sporadic in both timing and activity I am doing when the occur. I was reading that they are thought to be the uterus having contractions, trying to get back into its normal shape. Again, the castor oil pack could have helped that, I'm sure.

I've been trying to take it easy tonight en lieu of how weak my mid section feels.

Tomorrow is the Red Tent in our area. I'm both looking forward to it and really nervous. I'm afraid about what might come up. Doula encouraged me to bring a notebook to draw or mediate on my labyrinth. A lot of birth traumas are sure to come up, and I am very sensitive to it. There could be women that talk about their births with a history of sexual abuse. I cannot even watch a movie that has a rape scene it without being upset about it for months. The small "PG-13" rape scene in the teen lit movie, Divergent, bothered me for weeks. I don't know how to explain it other than that I am very sensitive. My emotions are very close to the surface at all times. I can cry over a moving song or a poignant commercial. It's hard to strike them from my mind later. I replay them over and over in my head.

I'm hoping my determination doesn't waver. The weather is poor, and I'm looking for excuses not to go. I thought Doula was going, but she will be attending a workshop instead. We promised to meet up afterwards to discuss it. I'm holding myself to that. Time to take another step forward and breathe.

February 2, 2015

One Step Forward, Two Steps…To the Side

After drawing my labyrinth, I hit a wall. I was so physically and mentally exhausted from the effort that went into creating and analyzing my feelings about it, that I have found it near impossible to move forward at this time. I read on in the book, the next step being to meditate on your labyrinth (lab) while adding a slight discomfort. I was just not ready to go there. I felt in a stall, I was losing progress. So, I decided to pause on the "lab work" and move laterally into a more physical form of healing.

I finally went and saw my local Curandera, a traditional healer that uses natural remedies to cure ailments of the body and spirit. It was a spur of the moment decision. I knew I had to keep moving forward or I would keep sliding back. I booked my appointment, and was promptly at her door at 10 am Saturday morning.

I drove up to her bungalow and parked in a grassy lot across the street. Wild plants adorned the yard, and beautiful chickens scratched for worms behind a large iron gate. She sauntered off the porch to greet me like an old friend, and welcomed me to her home; a charming 1950's bungalow. My apprehension was mounting for what I was about to experience. What was she going to say? What was she going to do to me?

We step inside her living room, and towards a front bedroom which she has turned into a professional den of relaxation. Paintings, a belly cast, oils, candles, a large massage table. It should be an anxious person's dream escape. She must have seen the apprehension in my eyes.

She cheerfully asked me what I was there to work on. I started matter of factly: "sore back, a tight neck,  a scar to look at." But only a few moments later, I teared up a bit and managed to spit out that it had been a long road to get to her because of all the trauma surrounding my birth. We had perviously talked at two of her lectures, so she wasn't completely taken off guard. She could tell I was on edge.

She has a history of working with mothers, as a doula and a massage therapist. She has also work with women who have been assaulted. She understands the body-soul connection and how they can help or hinder a birth, or even healing in general. She could see that I was reaching for help, but at the same time scared to confront a trauma. So she did the most comforting thing she could:

1.) Told me how brave I was for coming to work on this. And
2.) Talked about the four agreements:

  • Agreement 1: Be impeccable with your word - Speak with integrity. Say only what you mean.  Use the power of your word in the direction of truth and love.
  • Agreement 2: Don’t take anything personally - Nothing others do is because of you. What others say and do is a projection of their own reality. When you are immune to the opinions and actions of others, you won’t be the victim of needless suffering.
  • Agreement 3: Don't make assumptions - Find the courage to ask questions and to express what you really want. Communicate with others as clearly as you can to avoid misunderstandings, sadness and drama.
  • Agreement 4: Always do your best - Your best is going to change from moment to moment; it will be different when you are healthy as opposed to sick. Under any circumstance, simply do your best, and you will avoid self-judgment, self-abuse and regret

These agreements served to address boundaries and eliminate fear of what was going to happen. She would not assume that she could touch my body without it truly being okay. It was also true that it was my responsibility to not assume that she knew where my boundaries were, and to be clear with my words and expectations. As a result, no one would be offended (because we are speaking only the words we mean), no one was getting upset (because were not taking anything personally, and asking for clarification if something said seemed off-putting), and everyone was committed to giving 100 percent of themselves from where they were at that moment.

Before we got started I asked to use her restroom. Ever since my 1st cesarean, I can hardly stand up without having to go pee. My second cesarean surgeon had mentioned that I had a lot of scar adhesions to my bladder. It is possible they have returned. I passed down her hall, and admired her phone nook, which had been turned into an alter. Sitting on her toilet, I knew had come to right place.

Surely a woman with herbs drying in her tub knows what she is doing.
Now, this was by no means my first massage. As someone with high anxiety, I used to get them all the time when I was working. As a stay at home mom, I've had to adjust my expectations of comfort. Usually, I request total silence during a massage so I can FOCUS on being relaxed. It sounds ridiculous even saying it. But with Curandera, I prattled on and on. She let me unload on her…like catharsis.

We had a few laughs as she worked on my tight muscles. She applied a castor oil pack to my scar, and kneaded it to assess where my innards now lie. She has a strong suspicion that my uterus is tight to the left side of the scar and that is tilting forward, possibly pulling my back muscles in the process. What was surprising was that she was able to work on it as long as she was. At home, as I had previously mentioned, I can't touch or look at my scar without getting physically ill. My husband can barely touch it. Overall, she was pleased with how it looked, but asked me to continue to do weekly castor oil packs to soften the scar and underlying tissues. So, without further ado…a moment of bravery:

UGH. There it is: A low transverse cesarean scar. I put my hand there to show a size perspective. Gross.
#NoMakeup #NoFilter
Our session was over way too fast. She recommended that I come back after my next menstrual cycle, but continue to try to touch my scar often, even over clothing if I must, and do weekly castor oil packs.

I expected to be a little sore after a massage since rubbing on your muscles always releases toxins built up in your system. I drove the 45 minutes home, (FYI: It's an hour to anywhere in Houston) As I drove, and became increasingly fatigued. Almost alarmingly so. By the time I arrived home, I felt like I had been in a car accident. My entire body ached, my mouth was parched. This was nothing like I had ever experienced post-massage. I downed at least 4, 30 oz glasses of unsweetened tea and water, and tried to nap. Unfortunately, X-man and Lollipop had other plans. As the day turned to evening, I continued to down water. My limbs became heavier and heavier, my stomach churned. This went on for two days.

Last night, I worked on building a safe, sacred space to work on my scar and my emotions about my birth. I was at a loss of what to do for my extreme fatigue and pain, so I poured an epson salt bath. I soaked while trying to clear my head, gazing through the darkness at a candle and some flowers I had recently purchased.

"To thine own self be true."

I pulled myself reluctantly from the tub an hour later. I put a heating pad on my back and proceeded to sleep four hours straight. I am quite sure it is the first time since Lollipop has arrived (8 months) that I have gotten four hours of uninterrupted sleep. The following morning, while still sore, the fatigue fog had lifted.

I continue to seek the comfort of hot water to sit in, and cool water to drink to purge my body of what Curandera calls "trauma energy". It's time for bed now, one more glass of water, one more hot soak.