Sunday, May 16, 2021

Kian's Birth: Photo Edition

Warning: some pictures display sensitive content.  

My constant support!

My favorite labor position 

Lavender

The big gush 

Ice

Resting with Stadol 


My 2nd favorite labor position

Getting close to the end

Getting closer to the end, beyond exhausted

Doubting that the end will ever come

Feeling like my body is being ripped apart 


Yelling out with all my strength, it helped me find the physical strength to push 

The moment I've been waiting for is almost here

Some feelings cannot be expressed with words

                    Beyond relieved 


Relieved and grateful 

The moment we've been waiting for


In awe





Dad and the midwife (Jess) cutting the cord 


Thank you, placenta, for all you've done for 36 weeks to grow and nourish my baby 

Papi (Dad) hold Kian for the first time


The postpartum journey begins

8 pounds, 20.5 inches tall!

A strong heart 


A very good breastfeeder from the start!

My family

Tuesday, April 27, 2021

Kian's Birth

On Tuesday afternoon, April 13, I was 38 weeks and 2 days pregnant. I started having several strong contractions, very spaced out. I was glad because although I had had some Braxton-Hicks during the early third trimester, I had them less and less until I wasn't having them at all by 36 weeks. I continued having the contractions all afternoon and through the night, waking up about every hour with the discomfort. 

The next day, April 14, it continued, and I struggled to get comfortable. That night, I tried sleeping in the recliner chair. The contractions continued to wake me up throughout the night, so I called the clinic. Since I did my prenatal care in Wilkes-Barre, they automatically transferred me to the on-call provider at that hospital. I forgot to tell them to connect me to the Scranton hospital (where the midwives are) which is where I planned to give birth. The OB at the Wilkes-Barre hospital asked "what's going on?" and I explained my situation. He replied, "with first-time moms, we like to try to wait until at least 39 or 40 weeks. Try drinking plenty of water and taking 1000 mg of Tylenol, and try to find a comfortable place to rest. If the contractions get stronger and closer together then call us back." I found him to be rather dismissive of what I was feeling. At the same time, many people going through this for the first time think that they are in labor when in fact their early labor is just very drawn out. 

Continuing to wake up with the contractions throughout the early morning of April 15, I called the Scranton hospital this time, and the midwife asked me several questions to gauge how I was doing. She told me I could come in a be checked if that would be make me feel better, and that I could go home if it wasn't active labor yet. I decided to try to wait and see if the contractions would start getting closer together. They didn't, but they were becoming so strong, and I soon vomited all the water I had been drinking. Around 04:00, I called the midwife again and told her I wanted to come in to be checked. I was getting desperate because I couldn't rest anymore and I wanted to know if I was making progress. Around 05:00 we arrived to the triage and when the midwife checked me, I was already 5cm and 100% effaced! (Meaning my cervix was half was to being completely dilated, and it had already thinned out completely). I was very relieved that I was to be admitted and that the baby would be born this day. I was 38 weeks and 4 days, and I had thought all along that I would surely go past my due date, per the usual for my family. 

The hospital unit was beautiful, and I felt very fortunate to be there. The nurses and midwives were very kind and attentive. I told them I wanted to to have the baby without an epidural. They were very supportive of me and helped me with position changes to help the labor progress and help me find the most comfortable positions. Nothing was comfortable, but I found that standing, leaning over the side of the bed was most tolerable and helped my back hurt the least. I also used the TENS unit (per the recommendation of my doula/photographer) on my lower back which helped, but I couldn't use this while the fetal monitor was on. When my legs tired too much, I laid in bed with the peanut ball between my legs. For some reason, I did not like sitting on the yoga ball as I felt like it put too much pressure on the perineal area. 

At some point in the morning my water broke with a large gush, soaking through my clothes. I was glad to see clear fluid. 

When several hours had passed and I only progressed 1cm, I began to feel discouraged. I hadn't slept well for the past 2 nights and I was worried my energy would run out before I the labor was over. They offered me the nitrous oxide to help me cope, but I was so uncomfortable in the bed and the mask or the gas had a scent that I did not like. After only about 2 contractions I didn't want that anymore, though now I wish I had tried to use it longer. They then gave me a dose of Stadol. That put me out and allowed me to rest though contractions for a while. 

Throughout most of the active labor, I was frequently nauseous and vomited a lot. They gave some smelling oils which helped (lavender, peppermint, eucalyptus), and I also got one dose of Zofran. 

As the hours passed, I kept feeling like I needed to push, but with each cervical check I was getting more discouraged that I was only progressing by 1cm... so much time and pain only to be at 7cm... hours later, 8. 

The rest with the Stadol gave me a bit of energy and I was up again, on my knees leaning over the head of the bed. I had to be leaning forward with pressure on my lower back to relieve the pain. The whole time, Kennet was there to offer this support and give me ice chips for my parched mouth.  

At 14:10, 9 hours after arriving to the hospital, I was finally completely dilated, but the baby hadn't moved down much in my pelvis. He was at -1 when I arrived, and had only moved down to 0 by the time I was completely dilated. I pushed for an excruciating 2 and half hours. I tried several positions, including leaning over the head of the bed, squatting in the bed leaning over a support bar, and finally laying back when I didn't have the energy to hold myself up anymore. My contractions never got very close together, so I had long breaks in between pushes, but by the end waiting for the next contraction felt like an eternity. His head came out ever so slowly and I felt as though my body was tearing apart. I do remember asking the midwife if she could just pull him out, which is funny looking back now. In that moment I wanted anything to be done to relieve the pain; it felt like this would never end. 


He was finally born at 16:42, April 15, 2021, at 8 perfect pounds (the exact weight that I was at my birth!). Kian Demesio Silva Haas. The relief and gratitude I felt the moment he was out and laid on my abdomen is something can only be understood by experience. He cried immediately and had beautiful Apgars of 9 and 9! I could not contain my tears of relief and gratefulness to be holding him in my arms


We waited until his placenta was birthed to cut the cord. 


I am very thankful that he had no problems latching to the breast and has been a good eater from day 1! 





My postpartum care was excellent. We stayed 48 hours, and I was so grateful for the continued supply of perineal ice packs, clean pads, and ibuprofen and Colace around the clock. The nurses, midwives, pediatrician, and lactation consultant were very attentive. The nurses helped Kennet change the baby's diaper throughout the day and night. I was so grateful the support, the electric bed, and the meals delivered to us. 

Kennet was a constant support during the entire experience. I love to hear him recount the birth from his perspective; all of this was a first-time experience for him and he has been loving being a dad since the moment Kian was born, and even before while he was still growing inside of me. 

During this time, I began thinking of all the people who birth around the world every day in less-than-ideal circumstances. I thought of those who didn't plan or want to become pregnant, the young girls and teens I cared for in Guatemala. Those who birth alone at home, with no running water or electricity. They don't have medical care, much less any form of treatment for the pain of labor and the recovery. No ice packs, no ibuprofen, no disposable pads, no nipple cream or breastfeeding support, no warm showers, no comfortable nursing bras, no education or provision of contraception postpartum. I had so much discomfort, and am still recovering, almost 2 weeks later. How do people manage without all of theses extra supports that I had? I also thought of all the people who long to have the experience of birthing their own baby but have never been granted this privilege.
I can definitely say that going through this experience has informed me very much and will help me better care for my own patients. 

Friday, February 26, 2021

Update 2021

Every time I go to write a new blog post, I cannot believe how much time has passed by since my last post. During the last 9 months, a lot  has happened! 

-In mid-August 2020, I found out I was pregnant. In early December, we found out that we are having a boy. I was very excited by this news! 

-At the end of December, I graduated with my master's degree as a CNM-- certified nurse-midwife. I finished my clinical time on Jan 6th, and on Feb 6th, I passed the AMCB board exam! I was very thankful and very relieved!
Pictured here at 29 weeks with the paper stating I had passed the exam (right) and when my diploma came (left, around 31 weeks). 

-Next came the time of waiting for the licensure to process, and in the meantime, searching for employment. Filling out all the forms, paying all the fees, updating the CV, cover letters, phone interviews, video interviews...etc, etc. The lapse between graduation/passing the board exam and waiting for licensure to be completed and finding a job feels long. Because I am not currently working as an RN, I have all this free time so I am trying to take advantage of continuing learning with taking classes such as OBGYN ultrasound and participating in various webinars on topics of women's health. I know that soon I will be busy with a new baby and a job, so I am trying to enjoy the time of sleep, ample time for exercise and yoga, and wandering the groceries store aisles looking for new recipe ideas (I am not naturally a good cook so this is good for me!) 

-My last semester of grad school (Sept 3, 2020 to Jan 6, 20201) was difficult as I was very fatigued and nauseous until about week 14/15 of the the pregnancy. I would often have to go to the bathroom to vomit while caring for a patient in labor, or in between seeing patients in the office. It was so difficult to find food/drink that I could tolerate, and I felt so dehydrated all the time because I could not keep water down. The typical textbook recommendations for first-line treatments for nausea and vomiting did not seem to work for me, so every day it was trial and error and trying to eat/drink what I could tolerate, even if that was just ice cubes and diet Coke. 
I never did end up getting prescription medication, but if I ever had a second a pregnancy, I would consider it early on to avoid going through this again.  
However, before going straight to prescription antiemetics, there is an option that works for most people. To avoid nausea and vomiting before it starts, I do highly recommend taking vitamin B6 (10-25 mg up to 3x daily) along with 1/2 tab or 1 tab (12.5/ 25 mg) of Unisom before bed. This is sold as a prescription called Diclegis, but these can easily be bought over-the-counter as separate supplements. These have to be taken daily in order to the prevent the nausea/vomiting. I started taking this around week 6/7, and if I forgot to take it one day, I noticed a huge difference. Next time I know to start taking them right away, before the nausea sets in. By week 16 I didn't need it anymore. 

-Other than some musculoskeletal discomforts, I haven't had any major issues during my second trimester. I am now almost 32 weeks, so we will see how these last 2 months go! 
Since week 29, I have had pain in my symphysis pubis. This has been causing my quite a bit of discomfort with certain movements, even rolling from side to side when in bed, and when I go for walks for extended periods of time. Sadly it is too painful that I cannot jog/run at all. Thankfully, I can still do many exercises with no discomfort. 

-When it was time for the glucose tolerance test around 27 weeks to screen gestational diabetes, I had a high result of 171. For reference, this number should be below 130 ideally, some guidelines use 140. While many people do not pass the first screen, most people pass the second (diagnostic) screen. Still, this high result motivated me to begin exercising every day, and for the past ~5 weeks I seldom have missed a day, even if it's an easy day of prenatal yoga. Below are the links to the routines that I have enjoyed. Although I enjoyed working out daily before becoming pregnant, after I was over the extreme fatigue and sickness of the first trimester, I never reincorporated regular exercise other than occasional walks or hikes. 
Do you have a favorite indoor workout (for when the weather is freezing/icy/terrible) for pregnancy, postpartum or otherwise?

- THIS is my favorite prenatal YouTube channel
- THIS is my favorite prenatal/postpartum routine
- THIS is my favorite overall quick & effective workout, but may need modification during the 3rd trimester. 
- THIS is a fun stretch! 
- THIS is for a calmer, easier day (and to work on flexibility) 
- THIS routine has helped with symphysis pubis pain

I had also gotten used to eating anything I could tolerate, not focusing on nutrient-dense foods. Thus, after my initial glucose screen, I began monitoring my blood sugar levels daily (for 1 week to diagnose/rule out gestational diabetes) then every morning I continue to check my fasting glucose level out of my own curiosity. 
These became my favorite protein-dense snacks/meals. Do you have any favorite protein recipes?

-Sugar-free beef/turkey jerky 
-Turkey & cheese rolls 
-Greek yogurt (with low-sugar granola)
-Tuna (skipjack or other low-mercury type!) 
-Eggs (in every form!) 
-Peanut (or any nut) butter with celery/apples 
-Almonds, pistachios, pumpkin seeds
-Roasted chickpeas/ hummus
-Cottage cheese
-Chia seed pudding (chia seeds mixed with almond milk and a bit of stevia, refrigerated overnight) 
-Avocado & chicken 
-Oatmeal 
-Peanut butter balls (favorite recipe here)





















Until next time, when I will likely have a baby in my arms and hopefully employment as a CNM!