The Transition to New Motherhood

This month’s Evidence-Based Parenting Blog Carnival is discussing the transition to motherhood/fatherhood, inspired by Mother’s Day.  Our host this month is evidence-based parent Jessica Smock whose blog, School of Smock, looks at parenting from the perspective of a mom with a young child and a research background.  Our topics in this month’s carnival are as varied as you might expect.  You can find them all here.  You can also follow the discussion on Twitter with the hashtag #parentscience and on our Facebook page.  Also, tune in on Twitter this Friday (5/17/13) from 1 to 2pm for a Twitter party with all of our bloggers for a live discussion with the hashtag #parentscience.

Last Mother’s Day was my due date with Nemo, my second offspring.  I was somewhat impatiently awaiting his arrival.  I must say, the transition from one kid to two was a lot easier than the transition to being a new mom.  Some of that was due to a more difficult delivery with my first and some of it was due to the amount of help I had with my second (Mac was home with me).  However, I think largely it was due to the fact that childcare was already routine.  I was used to being woken up in the night.  I was used to breast feeding.  I was used to diapers and swaddling and baby monitors and naps and sleep deprivation.  I’d been there, done that (or in some cases like diapers was still doing it with Mabel) when Nemo came along.  Caring for a baby wasn’t new, it was familiar.  It was habit.

Meeting Mabel face to face for the first time.

My practical advice to new moms, based on empirical evidence of having been one myself, consists of two things:

1.  Keep your expectations low.  (That includes expectations of yourself, your baby, and your partner.)

2.  Give it about a month before anything feels normal again.

I’ve written about #1 before, here.  In all truth, in the early days of parenting, it’s completely necessary and sufficient to just get by.  Your house doesn’t have to be clean.  Your clothes don’t have to be clean.  Your hair doesn’t have to be clean.  This study would indicate that you are not alone- 40% of women reported at 1 month postpartum that there were days they did not get dressed.  This was my experience too.  You can extrapolate from there.

At first, you just get by.  When it’s a struggle to just get all living beings in your household fed and clothed, you need to keep your priorities in order.  Now having had baby #2, I look back to how I did things with Mabel (#1) and feel like I need to apologize for my ineptitude.  We really were just getting by.  Learning as we bumbled along.

Why are these early days so hard?  I know my fellow EBBs (Evidence-based bloggers) are covering some of that.  There’s the sleep deprivation.  There might be postpartum depression.  You may be learning to breastfeed or struggling to breastfeed.  Bonding with the new baby.

I’ve written before about my recoveries (I had a C-section with both kids) in the past.  It’s definitely a transition physically, emotionally, and psychologically.

Meeting Nemo face to face for the first time.

When I had my first child, Mabel, I didn’t feel myself for weeks.  I felt kind of out of place and on edge.  Crawling into bed at night wasn’t a welcome rest, merely a short reprieve.  I couldn’t relax and enjoy the rest because I knew, at any moment, it would be interrupted by a crying baby.  That getting into/out of bed or rolling over was still painful and I was waking up drenched in sweat each night didn’t add to any sense of rest or relaxation.

My experience is pretty typical if you look at the data.  Maloni et al looked at the postpartum symptoms reported by 106 postpartum women who had a singleton high-risk pregnancy and were treated with antepartum (before giving birth) bed rest.  At 6 weeks postpartum, at least 40% of the women were still reporting symptoms like fatigue, mood changes, tenseness, and difficulty concentrating.  In this particular study, the authors didn’t include any kind of “control” group of women (i.e. those who had not been on bed rest, those that had low risk pregnancies, etc.).  If they had included such a group, I would not be surprised if the results were similar. My own anecdotal evidence would indicate that fatigue, mood changes, tenseness, and difficulty concentrating are pretty universal for women after giving birth.

I kind of trudged through the days (and nights) like a zombie- lack of sleep, lack of food (it was hard to find time to eat while caring for a newborn solo), C-section pain, pain medication- the combo wasn’t conducive to coherent thought.  Watching the 2010 Winter Olympics is how I kept from slumping over while nursing in the dead of night (perk- I actually got to watch some of it live).

It also didn’t really help that during that time Mabel was lacking in the personality department.  It was kind of like caring for a slobbery, leaky, screaming sack of sugar.  Her first smile- right around the one month mark was kind of a turning point.  She was interactive and that helped with nurturing and caring for her.  Also, I think we kind of found our groove.  After a month of muddling along, I figured out how to live as a mom, and she figured out how to live outside of my womb.

First family photo a few hours after Nemo was born.

Have you ever heard somebody say it takes 30 days to make a new behavior into a habit? Well, it turns out that there is some science to back up that notion- that it takes time for new behaviors to become habits, to become acclimated to new situations.

So is 30 days some kind of magic threshold?  I don’t think so.

By that one month mark, I was able to feel more relaxed at bed time, it no longer felt like there was a stranger in my house, I felt much less tense and on edge.  I still wasn’t ‘normal’- the house was still messy, I still spent days in my PJs, but they felt more like a lazy Saturday than futile struggle for self-care.

A few years ago, a group at the University College London, led by Phillipippa Lally studied 96 people who wanted to form a new habit (the article is behind a paywall, but you can find the abstract here).  Lally et al looked at how long it took individuals to report that the new behavior had become automatic- basically, had become habit.  They found a wide range (from 18 to 254 days) with an average of 66 days.

“When the researchers examined the different habits, many of the participants showed a curved relationship between practice and automaticity of the form depicted below (solid line). On average a plateau in automaticity was reached after 66 days. In other words it had become as much of a habit as it was ever going to become.” Source.

In a lot of ways, parenting becomes a habit.  Mac and I take turns getting up in the night, and a lot of times, in the morning, we can’t remember how often or what time or for which kid.  We’re on autopilot.  On the rare occasion we are childless, we still go to open the rear car door to extract a small child or still tiptoe up the stairs at nap time.

I think this force of habit is what made the transition to motherhood so challenging with my first child, and much less so when adding a second.  When transitioning to a new mom, I had to learn A LOT, adopt a whole new way of living, new skills, new routines, new patterns.  When transitioning to a mom of two, all of that was old hat, there was just one extra kid to juggle.

So, to those expectant and new parents, hang in there.  You can do it.  Give it time.  Cut yourself and each other lots of slack.  This too shall pass.  You’ll find your new normal.

What were your experiences becoming a new parent?  Adding another child to your family?  If you are expecting, what are you anticipating?

Read about the experiences of other evidence-based parents on School of Smock and follow our discussion on Twitter with the hashtag #parentscience and on our Facebook page.

Other posts I’ve done that might be useful for new and expecting parents:

My best parenting advice:  Keep you expectations low

The Science of Breastfeeding (already a little out of date)

My experience with a C-section birth

Recovering from a repeat C-section (and some info on my recovery from the first) and here

Recovering from late onset, pregnancy-induced hypertension

Introducing potentially allergenic solids

Baby-led weaning, and here

Double X Science: Childbirth and C-sections in pre-modern times

There is a timely post over on Double X Science today- Childbirth and C-sections in pre-modern times.  I found it particularly interesting for several reasons:

1.  Almost 6 weeks ago I had my second C-section.

2.  Yesterday I finished reading The Crossing Places by Elly Griffiths a mystery novel about a female forensic bioarcheologist who studies bones.

So when I saw the Double X Science post, I was intrigued.

I’ve written before about my birth experiences (with Mabel, and with Nemo) and my desire to avoid a repeat C-section.  However,  with both of their births, the thought crossed my mind that without modern medicine childbirth very well may have killed me and my child, at the very least jeopardized one or both of us.  It’s a scary thought.

Mabel was born at 42 weeks and 1 day gestation.  It is known that going past 42 weeks of gestation can increase the risk of fetal death (source) and at 41 weeks and 5 days, I showed no signs of going into labor on my own.  I was induced and 36 hours later had been stuck at 7cm for hours and hours.  With my midwives, we made the decision to have a C-section.  Turns out, Mabel was acynclitic, meaning her head was crooked and tilted to the side preventing her from descending into the birth canal.  When she was born, she had the crooked cone head to prove it and the OB, upon seeing her, exclaimed, “This was never going to come out on her own!”

With Nemo, I was in labor for 24 hours, including 7 hours of active labor in the hospital, and was only 1 cm dilated.  He also didn’t descend and enter the birth canal.  After all of that time, and with me in excruciating pain at the site of my scar from the previous C-section which was very distinct from labor pains, the decision was made to proceed with a repeat C-section.  When my OB performed the surgery he said that, unlike most of his patients that need a C-section, Nemo hadn’t descended at all.

It would seem that I am a true case of cephalopelvic disproportion– meaning my pelvis just can’t fit the enormous heads of babies.

I’m grateful for the modern medicine that helped me safely deliver my two little ones.

Progress! Recovering from a repeat C-section

As I mentioned in a previous post, I had a minor complication post-delivery with my blood pressure being high (165/85 instead of my usual 120/70) and lots of swelling with pitting edema.  Oddly, while I was recovering in the hospital, none of this was a problem.  I had some swelling that was thought to be just from all the IV fluids I got with the surgery, and my BP was totally normal for me.  However, once I was discharged, things got worse instead of better.  Finally, about 6 days postpartum I had a splitting headache that not even the percocet and ibuprofen could help and my swelling had gotten precipitously worse.  None of my rings fit because my hands were so swollen.  I could only wear my house slippers because my feet didn’t fit in ANY of my shoes (not even flip flops!).  When I got on the scale at home, I weighed only 2 lbs less than I did when I went into the hospital to deliver a 9+lb baby!

Nine days postpartum. This was right around the worst of the swelling and blood pressure issues.

My OB was concerned I could be developing late-onset preeclampsia and has been monitoring my blood pressure as well as doing some blood work and urine analysis.  Thankfully, other than the swelling and the blood pressure, I’ve had none of the other symptoms of preeclampsia.

I was put on bed rest for a week, basically from from 7 to 14 days postpartum.  It was really hard to sit/lay around doing nothing while Mac picked up all the slack- diaper changes, meals, cleaning, bathing, errands, etc.  It was tough with him having Nemo, Mabel, and I to take care of.

Thankfully, it was only for a week, because I got my birthday wish!  The 6th of June was my 33rd birthday and started off with a visit to the OB.  I was hoping he would take me off the bed rest and he did!  While my blood pressure wasn’t much improved (about 140/86), I had lost about 15lbs since I’d seen him the Friday before.  So in 4 days, I dropped 15 pounds!  I was able to wear my shoes again.  My wedding rings (while a little snug) would actually fit on my finger- instead of getting stuck at the knuckle.

Two weeks postpartum, celebrating my 33rd birthday!

I was so relieved to finally be improving.  I’m happy to say the progress has continued.  I’m still taking it easy, but I’ve since dropped over 10 lbs more- for a grand total of 28 lbs lost in a matter of less than 2 weeks!  It’s crazy.  I gained very little weight with this pregnancy (about 11lbs), so I’m actually weigh less now than I did when I got pregnant with Nemo.

I go back to the OB next week for a 4 week postpartum check and I hope the progress continues.

This past Saturday, 2.5 weeks postpartum, at my hometown’s bicentennial parade.

Other than the blood pressure, the recovery has been pretty good.  I’m still dealing with wound care of my incision.  Unbeknownst to me, my OB used surgical glue instead of stitches or staples to close my skin incision.  I HATE surgical glue.  I have never had a good experience with it- whether it was when my dog needed surgery or a friend needed stitches.  It never holds as far as I can tell.  So, of course, I have a portion of my incision that has opened and is weeping.  Not only is it super gross and disconcerting to see, but it’s annoying to care for.

With my C-section with Mabel, I had staples for a few days, then steri-strips for a few more days, and then it was pretty much healed.  However, my pain was much higher, and I needed pain medicine for much longer.  This time around, even though the incision isn’t healing as quickly, I had very little pain and was off the percocet within a week and half.

I’m not sure why the recovery has been so different this time around.  Perhaps it’s because I was on bed rest and had lots of help those first weeks.  With Mabel, I was solo at home caring for her 6 days after the section.  This time, I have barely been alone at all since giving birth- with Mac and/or our families being here to help.

I was dreading the recovery, given my previous experience I am so glad that it’s been easier/quicker this time.  I’m looking forward to being 100% so I can enjoy my maternity leave like a vacation instead of a recuperation!

He’s (finally) here!

I’m no longer holding a hostage.

“Nemo” has finally arrived!

I went into labor early on Tuesday morning with intermittent contractions continuing all day at work.  In the late afternoon, just when I thought I’d call the doctor, they stopped.  Later in the evening they started up again and when I called my doctor, he said to come in.

By the time Mabel and the dog were headed home with my dad and Mac and I got to the hospital around 10pm, contractions were 5 to 7 minutes apart.  It quickly became clear this was the real deal.

Unfortunately, after being early labor all day, and active labor for about seven and half hours at the hospital, I was not making any progress.  Nemo was still not moving down.  Given my previous C-section, the lack of progress, and the type of pain I was having, we made the decision was made to proceed with a C-section.

Nemo was born on Wednesday, May 23rd at 5:20 in the morning, at 41 weeks and 5 days gestation.

While I really wish I hadn’t needed the surgery, the outcome is what I had hoped for: a safe delivery, a healthy baby.

Just like with Mabel’s birth, Mac kept his poker face in place, no matter what the circumstance- like seeing my disembodied uterus.  He was the only person I wanted with me and he was all the support I needed.  While I am always grateful for him, the feeling is never more pronounced than when I’m at my most vulnerable and he keeps me feeling safe.

So far the recovery has been much easier than after the C-section I had with Mabel.  The way I’m feeling today, 10 days out from surgery, took several weeks after my previous C-section.  I’m getting around well, I’m already off the prescription pain medicine, managing my pain with just ibuprofen.  For that I am very grateful.  The only complication I’ve experienced has nothing to do with the surgery- it’s late onset pregnancy-induced hypertension.

While my blood pressure was fine the whole time I was in the hospital, since I got home, it’s become elevated.  Nothing dangerous (yet, or hopefully ever), but high for me.  So, there’s been extra visits with my doctor and doing my best to follow his recommendation to stick with bed rest.  The doctor is not calling it late-onset pre-eclampsia, just hypertension, and said that most cases resolve within 8 weeks of delivery, but with bed rest it may resolve sooner.

The bed rest has been really challenging for me, and I feel like such a burden on Mac.  It’s like he has three beings depending on him for everything.  Before Nemo arrived he was already doing the bulk of the housework and childcare.  Now that I’m laid up, he’s doing even more- with a whole additional child to care for.  I really hope that my blood pressure is improved at my next OB visit- which will be my 2 week postpartum visit, and my birthday.  So I know what I will wish for when I blow out my candles.

Nemo is doing great.  From the start he’s nursed like a champ.  At his first pediatrician’s appointment, he was 6 days old, and he’d already surpassed his birth weight (which the ped said they usually give babies up to 2 weeks to do).  While he was a cranky pants today, he slept GREAT last night- 11pm to 4am, and again from 5:15am to 7:30am.  I’m crossing my fingers it wasn’t a fluke!

Mabel is also her usual self.  She loves her baby brother, is always eager to help out, etc.  While we have seen some additional tantrums and she is having a little trouble with me being incapacitated and Mac’s attention being so split, she’s only two and this is nothing that was unexpected.  Overall, she’s a wonderful kid and it’s great to see her growing and changing.  I honestly think that the transition is harder for me than for her.  I miss having tickle fights with her, snuggling her close, going for walks, and all the other stuff we normally do that I can’t right now because of the surgery and the bed rest.

Mabel holding her baby brother for the first time.

We were lucky that my in-laws were here until yesterday helping out- entertaining Mabel, making meals, etc.  Now that we are alone, things are fine.  We’re adjusting to life as a family of four!

Poker Face

Mabel’s birth wasn’t pretty.  There was vomit and poop, amniotic fluid and catheters, lots of needles and blood, then the whole ‘uterus removed from the body to be sutured’ bit.  Did I mention there was a lot of blood?  Like enough for a bloodbath scene from a horror movie?

Yeah, so Mabel’s birth wasn’t pretty.

My husband, Mac, was privy to it ALL.

While I admit that I wasn’t always fully aware of my surroundings, Mac maintained his composure (at least around me) for the entire ordeal.

Well, he was a little shaken up by the bloodbath scene the first time I got out of bed 8 hours post-C-section.  It was clear that what was running through his head as it happened was, “Holy crap my wife is bleeding to death!”  However, that was understandable since I too was perplexed and unprepared for it as well.  Had it not been for the nonplussed reaction of the nurse, I might have worried about my own imminent death as well, instead of just wondering if/how they could clean it all up before my in laws came to meet the baby.  (I’m no neat freak when it comes to my lovely mother in law, but nobody wants their in laws leap-frogging over pools of their blood.  Right?)

So given my husband’s world class poker face despite all he witnessed, I laughed out loud when I come across the Universal Birth Reaction Assessment Tool on How to be a Dad.

Source: How to be a Dad

While Mac passes out quite readily when he gets a shot or IV placed, he appeared unaffected when it happened to me, or my actual spinal column.

Through the whole birth and recovery, I’d say the worst he got on the Expression/Grimace Scale was “Whoa!”  Except for the bloodbath which was something more like a “Aaaahhhh!”

Now, as I said, I’m pretty sure he had a great poker face.  From our talks about the birth since it happened, I’m pretty sure he had moments that scored a 10/ “Ngaaaa!” on the Birth Reaction Scale (like when he caught a glimpse of my disembodied uterus in the operating room).  However, he never let on that he was feeling anything more than a 2 or 3.

He was an excellent birth partner.

As we get closer and closer to welcoming Nemo (baby #2, baby brother) we’ve been talking more about Mabel’s birth.  How it happened, how we felt, how I coped with the labor, what worked, what didn’t, what I most appreciated, what we want to do different.  The talks are enlightening at times.  Mac remembers details and hours of time that are completely absent from my memory.  I know that helping me through the labor was hard for Mac- it’s hard to watch someone you love in pain and not be able to stop it.  I hope that him hearing me say how much of a help and support he was to me, how much I needed him, how safe I felt knowing he was there, and how he came through for me, will be valuable for the second go-around.

I’m also looking forward to him reading this post and telling me what his reactions really were and how little his face revealed.

Didn’t think I’d be here.

I’m 21 weeks pregnant today and having a consult with a new OB.  When I first got pregnant and went to a well-regarded midwifery group that was comfortable with taking me as a VBAC (Vaginal Birth After Cesarean) I thought I was all set.  At my first appointment, they mentioned I would need to have a consult with an OB from the hospital where I’d deliver, but did not seem concerned that I would not be an acceptable patient.

Fast forward a few months and last week I finally met with that OB.  True to form for the narrow-minded, lawsuit-fearing, fat-hating, knife-happy bad guy OB stereotype, the OB was not on board with my having a VBAC at his hospital.  His reasons- my weight (I am obese) and the size of my first child (9lb 6oz, deemed by him to be “humungous”).

Now, both of those reasons are medically accepted risk factors (although from what I gather, the “obesity means increased C-section rate” isn’t well-studied to correct for doctor-perceived risk, meaning OBs are more likely to insist on a C-section because they think there is a danger, versus a C-section is actually necessary).

If the doctor had said, “We are a small community hospital and don’t have surgical teams at the ready 24/7 or a NICU, thus your risk factors exclude you as a VBAC candidate under our hospital’s VBAC protocol,” I wouldn’t have been mad, disappointed, but not mad.  However, he didn’t leave it at that.  He had to tell me how poor my chances for a successful VBAC were and advise me of the futility of trying.

Um, he’s a medical doctor not a fortune teller.  My single previous pregnancy and birth are not a sufficient sample-size on which to extrapolate.  Also, even if my chances of a successful VBAC are low, it doesn’t mean it isn’t worth a shot to try and avoid major abdominal surgery.

So frustrating.  And thus, I am 21 weeks and searching out another practice/hospital that will take me so that I may attempt a VBAC.  After my c-section with Mabel, the midwife and OB who attended the birth assured me that there was no reason I couldn’t try for a VBAC in the future.  They chalked my failure to progress with her poor positioning (neither face-up, nor face-down, but cock-eyed) and felt it was a fluke and not an indicator that I was incapable of a vaginal delivery.

I’m a scientist.  I know there are risks.  I also know that you can plan all you want and you aren’t guaranteed the birth you planned on.

However, I also know that the American College of Obstetricians and Gynecologists (ACOG) issued the following guidelines:

Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans, according to guidelines released today by The American College of Obstetricians and Gynecologists.  Source.

Based on the science and recommendations, the doctor should have said, “You don’t fit in this hospital’s protocol, I encourage you, based on ACOG guidelines to find another provider at another hospital that is better equipped to help you attempt a VBAC.”

Thusly, I am searching for a new provider.

With impeccable timing, today, my cousin posted a link to this article in The Sun about Ina May Gaskin- the most well-known and well-respected midwife in US and probably the world:  Oh Baby:  Ina May Gaskin on the medicalization of birth.  I love that Gaskin speaks in citations- she mentions her facts and data and their source.  When there is insufficient evidence for her to draw a conclusion, she doesn’t offer an opinion, she states that there hasn’t been enough research.  What a breath of science-minded fresh air.

The two particular quotes (out of many) from Gaskin that stood out to me are below:

The U.S. maternal death rate steadily decreased between 1936 and 1982. At that point it leveled off for a few years and then began rising. Women today actually face twice the chance that their mothers did of dying from pregnancy-related causes.

…..

A vaginal birth has always been safer for the mother. The risk of death of the mother is three times greater for c-section than for vaginal birth. If we’re talking about emergency c-section only, this figure rises to four times greater. (Source)

I will continue to advocate for myself, I will push to receive care informed by science and medicine, not unsupported opinion and baseless predictions.  That I have to go to such great lengths to find a practitioner to provide such care is a terrible shame.