Tuesday, July 27, 2010

Fabulous Natural Hospital Birth Story...

From my own sister Lori! Lori and I gave birth to our first babies 2 days apart. Her first was one of those amazing, inspiring natural childbirth stories, so she had set the standard high (And also showed me that I COULD do it).

Baby Number 2, Simon Atticus B____ arrived this morning at 2 am. 8 pounds, 9 ounces; 20.5 inches; 2 very superficial tears.
This is her birth story as I understood it (she called me at 5 am to tell me all about it, so forgive me if I get the details wrong, I was tired, though elated):

She'd had uncomfortable prodromal labor for 9 weeks (that's the way we do it in our family) but held out til she was 39 weeks along. She was very patient and ready to wait for a few more weeks if need be (not likely, since she was the farthest any of us girls have ever made it into pregnancy- we bake them fast) until a friend had a baby, then she got a little eager to meet her LO.
They DTD and she pumped and stuff yesterday to try to get things going, and it worked to get contractions really going so they headed into the hospital- she had already been dilated to a 5 for a few days, but her contractions petered out without dilating her further so rather than let them move it along (strip membranes, maybe break waters), she opted to go home and relax and let baby decide when to come. Her "false alarm" from trying to force the baby to come sooner made her realize really he was going to be the deciding factor. She was GBS+ and her first birth was only 3 or 4 hours total, so that was a consideration, but she wanted to give him the option of choosing when to come.

(walking around the hospital during the "false labor")

Sure enough, she went home, relaxed, ate, slept in her own bed one night... and the following night baby Simon decided to get things going at 11:30 pm. They arrived at the hospital at midnight, she went straight to a birthing tub while her husband and midwife took care of paperwork, and got into her zone. She says there was a point where it got super intense and she thought "man, if I'm only at a 5, and it's this bad, I can't do this, I won't last, I'll make them break my water to make it move along". Then another voice answered "no, you know what to do..." and like that she got into her zone and started moaning and letting herself space out to another place. Just after they had told her she was now at a 7, at 1:45 am, she felt her water break while she was in the tub. And within two contractions (which she says felt incredible, she could actually feel the baby moving downward and things opening up), bam, she felt pushy. She says she actually found herself shouting "I'm feeling inclined to push!" (though it was more like "IIIIIIIIIIIIIIII'M feeling inCLIIIIIIIIIIIIIIIIIIIIIINED to PUUUUUUUUUUUSH!")

They got out of the tub, she danced around for a little while figuring out what to do next.
She wanted to push standing but then realized her legs wouldn't last, so her midwife had her get on her knees by the bed, and that felt right for her:

Before the last final contraction (edited to add: apparently Simon's head is already out in this pic, she's waiting to push the rest out):

It only took two primal pushes to get him out- apparently she got the head out and her body did the rest- and her first reaction was "that was IT?!" She was amazed at how short it had been and manageable.
Once she realized he was out (just before 2 am):

(^^we've decided this should be a poster for Natural Childbirth:))

They put him right on her chest where he rested then found her breast and nursed for 25 minutes. It was then that they weighed him, so that might have contributed to his hefty birthweight. He went on to nurse on the other side for 20 minutes.

Big sister Adelaide:

I'm SO super proud of my sister. It takes a powerful woman to manage a natural labor that comes and goes that quickly. She made wise choices, and, I'll admit, has some easy-birthing genes in her, but in the end she made sure she got the birth she wanted. I wish they didn't live 2000 miles away! Her story makes me excited for my own second birth:)

Monday, July 12, 2010

Belly-sleeping and SIDS

When Daniel was about 2 weeks old, I officially gave up the idea of making him sleep on his back. He just wouldn't do it. He was tired, and I was tired. I felt like an evil selfish mom for letting him belly-sleep against all of the SIDS recommendations. When I mentioned it to my pediatrician and asked his opinion (he's generally super laid back) he said "well, if your baby died of SIDS could you live with yourself for letting him belly sleep?" I was dumbfounded. What a thing to say!
Still, I was so tired, as was he, that I continued to let him sleep on his belly. I'm not typically a worrying-type mother, but I would go in and check on him frequently, convinced I was setting him up for death. It wasn't until he was about 6 months old (about when the SIDS risk drastically reduces itself to nearly nothing) that I decided to do some research around belly-sleeping.

I do not wish to downplay the risk or tragedy of SIDS. I just want to point out some factors mommies often do not consider.

The official recommendations about no longer belly-sleeping came about because of the "Back to Sleep" campaign in the early 90s (previous recommendations were to make them sleep on their belly to avoid suffocation from spit-up). The scientific community noticed a huge correlation between the time the campaign ran and a reduction in SIDS deaths- an over 50% reduction by some accounts. That, and that alone, is the reason for the recommendation. I'm not doubting the correlation exists- I do believe less belly-sleeping will mean less SIDS. Just like other common-sense guidelines that were also a part of the Back To Sleep campaign (no soft bedding, and importantly- no smoking near baby) can also be tied to the reduction in infant deaths. But a correlation does not establish cause-and-effect. It's also important to note that while the number of SIDS diagnoses went down drastically, the overall number of infant deaths hardly changed- just the number of SIDS diagnoses (by the way, the only way to really diagnose SIDS is to rule out every other possible cause of death.) It's also important to note that during this period- where the reduction in SIDS deaths is tied to just back-sleeping- there was a huge cultural push for breastfeeding (shown to reduce your SIDS risk by 2 or 3 times) and stopping second-hand smoke, and could also be tied to the drop in SIDS deaths.

To this day, there is no official stance on what causes SIDS. Most lay people think it's a kind of suffocation- though officially a SIDS diagnosis rules out death by suffocation- that's a different diagnosis. Some think it's a genetic defect. Recent studies favor the idea that it's a form of sleep apnea. That makes the most sense to me, though I wouldn't be surprised if it's a combination of genetics and sleep apnea or maybe something else entirely.
But why, if it's apnea (or even genetics), would belly vs. back matter? Because SIDS affects babies when they're in their deepest form of sleep. And most babies sleep much more deeply on their stomaches. ALL of the SIDS guidelines (back-sleeping, keeping the room cooler, having a fan blowing on the baby- they've even noticed in studies a decrease in SIDS when caffeine was administered to the babies) have one thing in common: they keep the baby from sleeping as deeply.
Now, some babies are deep sleepers no matter what you throw at them. This, I believe, is why some babies still die of SIDS even while sleeping on their backs. Unfortunately, that means there isn't much their moms can do to reduce the risk of SIDS. You can follow every SIDS guideline and still lose your baby. The odds are low to begin with and lower if you follow all the guidelines- but there is no way to eliminate the risk altogether. Sorry if that's a depressing way to view it.

 This study shows that babies who slept on their bellies had far more "efficient" sleep but also more instances of apnea (the non-fatal kind)- which goes hand-in-hand with the SIDS-is-linked-to-apnea-during-deep-sleep theory. Babies that were studied who later actually died of SIDS were much less likely to have arousals during their sleep than babies who were never affected by SIDS. In other words, belly-sleeping babies slept more deeply, and longer, than their back-sleeping counterparts. But the deep-sleepers were also at more risk for SIDS.

The problem is, not letting a baby sleep deeply carries its own set of risks. I'm borrowing this straight from the wikipedia article on the Back to Sleep campaign (I added the emphasis):
"...According to the study, at 6 months of age, the infants who were placed to sleep in the prone position had statistically significant higher social skills scores, gross motor scores, and total development scores than those infants who were put to sleep in the supine [back] position. [A different study] reported that "Typically developing infants who were sleep-positioned in supine had delayed motor development by age 6 months, and this was significantly associated with limited exposure to awake prone positioning."" (to be fair, it goes on to note that how much time the babies had on their tummies while awake was not factored into the study and might have an effect).

In other words, babies need that deep sleep for their development. Without deep sleep, they are likely to hit their milestones later. On top of that, back-sleeping leads to an increase in problems like cradle cap (not a huge deal), asphyxiation from reflux (a very big deal), and since the Back to Sleep campaign, there has been a huge increase in the amount of babies with plagiocephaly or cranial asymmetry problems (funky-shaped heads from laying on their soft skulls)- not to mention the temporary and less worrisome cradle bald spots.

In other words, there is a set of risks, whether you sleep your baby on the belly or their back. I won't judge a mother either way. The risk of SIDS for a normal, healthy baby is very small compared to the risks that come from back-sleeping, but obviously death is infinitely more tragic than an asymmetrical head or hitting milestones a few months later. I do think that parents of babies that are more prone to SIDS (respiratory problems, prematurity, diagnosed apnea, snoring...) should consider follow all possible SIDS guidelines to the letter. But if a mommy lets her baby sleep on his or her belly, it's possible that instead of being a negligent parent, they are choosing a different set of (scientifically based) benefits and risks- longer sleep periods, deeper sleep, and more likely to meet milestones on time.
If it's worth the risk to you, then go for it. I do. I personally feel that letting my baby sleep deeply is more important than the small risk of SIDS. But, I also understand that there's validity to valuing protection from SIDS above deep sleep. I really don't think you'd be "right" or "wrong" either way- or rather, I think both ways can be right, depending on what risks you're most comfortable with. No mother should ever feel judged for making an informed decision.