It’s Been A Long Day…

Long Day

One morning, I called my Mom, almost in tears, saying that I’d already yelled at my kids “at least 25 times” that day and it was only half past nine in the morning! I asked how she’d done it with twice as many kids as me, and without ever yelling at any of us.

“What?” she’d asked incredulously. And I’d responded, “I don’t ever remember you even raising your voice at us.” And my wonderful Momma laughed out loud for a full five minutes before saying, “That’s what you’d call ‘having a selective memory’, sweetheart!”

Then she shared with me some epic tales of losing it and going off on us kids (none of which I remembered) and then told me something important: “Honey, when your children are small the truth of the matter is that the days are long, but the years are short.”

And now that I have one child talking about college, the two in the middle are rocking their High School & Middle School years, and my youngest is turning eight (tomorrow!) – I’d have to agree with her.

I was teaching this past weekend to a room full of expectant parents who must have thought I was crazy when I told them how jealous I was of them. But, seriously, I am.

I don’t envy the sleepless nights, the sore nipples, or the diaper changes to come. And to be sure, age three was unbelievably hard for me! (ALL four times!) No, I don’t have hazy, rose-colored memories of parenting infants and toddlers.

I vividly remember being attached at the hip to at least one of my babies all day long and what it felt like when the only hours that belonged to me were either those when I was sleeping or when I was alone in the bathroom without one of my children walking in on me, or asking me a litany of questions through the closed door.

(In all honesty, these bathroom moments continue to be few and far between…)

But I do envy expectant parents the opportunity to be transformed by the awesome power of birth: to find a strength that has yet to be tapped, and a vulnerability that has yet to be explored. I am jealous that they get to discover a whole new person they never even new existed inside themselves being born on the same day as they welcome their new baby.

I love being a Momma and my kids are absolute gifts in my life. But parenting has been, by far, the hardest job I’ve ever had! And on the eve of my “baby’s” 8th birthday, I’m starting to appreciate the nostalgia expressed by parents who are no longer in that intense phase of parenting little, littles.

You know what I’m talking about…

You’re in the middle of Target with a 6-year-old who always manages to be where you can’t see her, a 3-year-old who keeps trying to get out of his seat in the shopping cart, and a newborn who’s decided that NOW! is the perfect moment to have her first real meltdown and is screaming inconsolably.

As you struggle to wrestle the baby out of the front-pack carrier, unhook your bra with one hand, corral the other two and sit down in the middle of the storage container aisle to feed your baby, you catch the eye of an older woman walking past. She sees your frustration rising to a breaking point, walks over, gives your arm a tight squeeze and says, “You’ll miss all of this one day! They grow up too fast!”

And in that moment, you can’t decide if you want to hug her – or punch her in the face!

(This may or may not have happened to me about 11 years ago…)

What does she mean?! She can’t possibly mean that she wishes to switch places with you (she doesn’t). Or that she longs for the days when her children were all moving in different directions and demanding so much energy, time, and attention that she remembers feeling like she never had enough for herself (she doesn’t).

But maybe with the passage of time, she’s realized the wisdom in my mother’s words: the days are long (and let’s face it – some days longer than others!) but the years are oh-so-short! And maybe she too, has a somewhat “selective memory” when it comes to what it was like to have babies and toddlers underfoot. Maybe she honestly forgets (or chooses to, anyway) all that made that time in her life so challenging and instead focuses her attention on all that she loved about that time as well:

~ the softness of her newborn’s cheek

~ the delicious smell of her baby’s head

~ the dimples of her toddler’s hands

~ the chubby feet and rolls upon rolls of her little one’s thighs

~ the sing-song call of “Mommy! Mooooooommmmmmy!”

She doesn’t envy you those incredibly long days. But, maybe she wishes that she could freeze time for the days that went by too fast. It is a blessing for us all that selective memory exists when it comes to parents – and children. 

This selective memory allows us to decide what we choose to focus on. I really cannot remember my Mom raising her voice at us – in fact, as I got older, she mastered the use of lowering her voice for emphasis to great effect!

But this imperfect recording of my childhood gives me hope! Maybe the same will be true for my own children. Maybe they’ll also have a selective memory of their childhood and focus mostly on just how much I loved them, not on how often I failed to show it because my temper or my impatience got the better of me – and I lost it once or twice. Or more.

This is my hope for all of you Mommas out there who’ve had that moment of regret – that you weren’t “perfect” in your parenting today. And if today has been incredibly long, may tomorrow be easier, but not necessarily shorter. And may you and your children have beautiful and imperfect memories of your day-to-day together, and instead someday feel wistful and nostalgic for those years that went by too fast.

Does this ring true for you in your parenting? It does for me… I’d love it if you’d share your comments. And I found this super cool Amy Winehouse song that I don’t think has ever been released… But it seems so fitting to the topic, that I offer it to you here

In My Humble Opinion…

bees

So, the world of birth is abuzz this month as ACOG (The American Congress of Obstetricians and Gynecologists) has released their newest Committee Opinion: “Approaches to Limit Interventions During Labor and Birth.”

This opinion might have left some scratching their head and saying, “Duh!” But I want to jump up and down squealing with joy! I think this is a fantastic step in the right direction from the OB/GYN leaders of America. They’re asking their members to consider: “If a pregnant Momma is low-risk, how can we keep her low-risk?”

The answer is: “Don’t intervene unless it’s medically necessary!”

I’m going to break down the recommendations and conclusions section of this Committee Opinion for you here, because there are lots of big, fancy words – and you might appreciate my attempt at a simpler translation. Also, we know that when information comes from people who wear white coats and carry stethoscopes around their necks, it sometimes carries more weight – even if we’ve already heard this same information from different sources. Just saying… In our culture, there’s a hierarchy when it comes to medical advice and opinion – evidence or bias, be damned!

So, this is not a perfect translation (and my editorial comments are included in italics) but in a nutshell here’s what the ACOG has stated in it’s Committee Opinion, Number 687 for February 2017: Approaches to Limit Interventions in Labor and Birth.

  • If a woman is between 39-41 weeks, and is in labor that’s started on its own, and has a baby that’s head down, the use of intermittent fetal monitoring and unmedicated comfort and coping techniques is a good idea. (Full-term according to ACOG. Intermittent – the fancy word that means there are breaks in between periods of monitoring.)
  • If a woman is still in early labor, she doesn’t have to come to the hospital right away as long as she and the baby are doing okay. It’d be great if she was offered frequent contact and support, as well as unmedicated comfort and coping techniques. (See what I wrote here, here and here (It’s a 3-part series!) about how to stay comfortable and pass the time of early labor at home before coming into the hospital.)
  • When women come into the hospital in early labor due to pain or exhaustion, they should be offered education and support, water to drink, encouraged to try various positions that might provide more comfort, and other unmedicated comfort and coping techniques like massage and how using the shower or sitting in warm water can be very helpful. (Hydrotherapy – the fancy word for drinking water, showering and/or sitting in the tub – are great ideas for comfort and can also help labor progress!)
  • OBs and other providers should inform those women whose water has broken at the onset of labor about any risks associated with waiting for labor to start on its own. If there are no other reasons to be concerned for the baby’s health, an informed woman can choose, and should be supported in her choice, to wait for labor to start on it’s own. The exception would be if a woman has tested positive for Group B Strep – antibiotics shouldn’t be delayed, and there may be a preference from both the provider and laboring woman to induce labor immediately, rather than wait for it to start on its own. (Many providers already use “expectant management of labor” – the fancy word for “watching and waiting,” but more providers might now be encouraged to wait before inducing immediately if water breaks at the start of labor.)
  • Evidence suggests that in addition to regular nursing care, continuous one-to-one emotional support is associated with improved outcomes for women in labor. (YAY DOULAS! And partners, and Grandmas, and BFFs and… DOULAS! You can read my post here about how a doula can be a great addition to your birth team.)
  • For women with a labor that’s progressing and a baby that’s doing well, routine breaking of the bag of waters is not necessary unless needed for internal monitoring. (Amniotomy – the fancy word for breaking the bag of waters before it has broken on its own – is often suggested as a way to “speed things up” but can be associated with more interventions and increased risk for Cesarean Birth if it doesn’t work.)
  • In order to promote intermittent monitoring, hospitals should adopt protocols and train staff on how to use hand-held Doppler monitors for low-risk women who would prefer this type of monitoring. (This one even surprised me! I thought they would suggest using the external monitoring belts less frequently, but hand-held Dopplers would be a fantastic improvement over current practice. So much easier and comfortable for laboring Mommas!)
  • Using a coping scale and the use of medicated and unmedicated coping techniques will help providers tailor interventions to meet the needs of each woman. (Some hospitals have already adopted the use of a coping scale instead of a pain scale, but this little tool can be very helpful in changing the mindset of a laboring woman from focusing on the level of pain she’s feeling to whether or not she’s coping well.)
figure-1-the-pain-intensity-scale-0-to-10-adapted-from-wong-baker-faces-pain-rating

Figure 1. The Pain Intensity Scale: 0 to 10. Adapted from “Wong-Baker Faces Pain Rating Scale”

coping

Figure 2. The Pain Coping Scale: 10 to 0, developed to assess coping during labor and birth. Adapted from “Wong-Baker Faces Pain Rating Scale”

  • As long as there are no complications and fetal monitoring is still possible, a woman should be encouraged and supported to change positions often during labor – it will make her feel more comfortable and will help move the baby into the best position for birth. (Being upright and changing positions as often as possible, for as long as possible, allows babies to make all the twists and turns necessary to be born.)
  • Women should be encouraged to use whatever kind of pushing technique she likes and is most effective. (Gone are the days of telling women to assume certain positions and hold their breath for ten seconds! Yeehah!)
  • Unless it’s medically necessary to deliver quickly, women (especially those with an epidural) can be offered a period of rest before pushing – unless she feels a strong urge to push sooner. (“Laboring down” is a really nice way to allow your body to catch up with your labor. Your contractions might have already opened your cervix all the way, but until your baby moves down into a better position for birth, pushing just because “You’re 10 cm dilated – let’s go!” might not be as effective and could lengthen the overall time of pushing, causing undue exhaustion.)

Can you see why I’m so excited about this Committee Opinion?! It aligns so beautifully with what I know to be true for women in labor. Interventions are not “bad” and can be life-saving in certain circumstances.

But if we limit the routine use of these interventions and only use them when medically necessary, we are protecting the normal physiology of birth. And this will result in better outcomes for Mommas and babies.

I am so heartened by this statement from the ACOG and excited to see the impact this will have for laboring women and birth in this country. My sincere hope is that members of ACOG will review their own personal practice based on this Committee Opinion and see where they might step back from intervening too soon or too often. I also hope that pregnant women will read this and know that they should talk with their provider about limiting the use of intervention in their own pregnancy and birth.

Knowledge is power. Be informed.

(You can access the entire ACOG Committee Opinion here in all of its medical terminology, further explanation and extensively cited form. It’s a great read, in my humble opinion…)