Treating my Baby’s Eczema: The case of the itchy scalp

I grew up with terrifically dry skin which, at first handshake, makes people think that I must be 67 years old — that is, unless they are staring me in the face and see I otherwise look about my age. Because of this, throughout my pediatric practice I have made it a point to get good at treating eczema – first through myself, then through recommendations to the many patients with eczema I treated in clinical practice.

Let it be a fitting thing that, just as I gave birth to my picky-eater first child, I should also give birth to a child with skin rougher and drier than my own. And that skin is giving me a run for my money.

Since a month or two of age I could tell that R’s skin was drier than the average infant’s – a bit of scaliness here, some flaking to the scalp there. As a newborn she used to lie in her crib and shake her head back and forth like a miniature Stevie Wonder. This is what I thought, at least, until she turned 4 months old and, with newfound control of her hands and fingers, she began to scratch her head and ears furiously as she shook her head back and forth. All this time she’s been itchy, I realized.

So out came the creams, salves, oils, and ointments. Not just the few that I had on deck, the ones I’d massage into her gingerly every day or every other day after a quick bath. I went from being the one to give advice on skincare to getting advice from every angle – mostly at my own frustrated behest. “Use Aquaphor!” “Give her a massage with [insert name of oil/ointment/cream here]“. Eat this, do that. Unfortunately, no matter what I do, I am not sure that people believe the truth of my predicament (as I constantly advised the same to my patients): no matter what I do, the skin doesn’t get any better.

It came to a head a few weeks ago when, covered with itchy red bumps and her scalp bleeding, my baby saw her to her pediatrician and was prescribed antibiotics and a light topical steroid. At that point, I decided to turn a new, entirely more disciplined leaf regarding my daughter’s skin. But to my dismay, just as we were getting a handle on things and moisturization was working, her skin got much much worse — with a severe viral infection atop the eczema — and we were back on medications. That struggle brought us to the dermatologist and has taken us even further into the realm of understanding regimented eczema care.

Here is what I have learned:

1) Itching really does make the rash worse. I could do all the skin care I wanted for days and days, but within about 5 minutes of finding utility for a particular sharp fingernail, my daughter could destroy weeks of effort. So it’s really important to control the scratching. So I cover her hands with socks, or put a stretchy, light hat on her head, or both, as an effort at damage control.

2) Be vigilant about fingernail length. I cut my daughter’s nails with a clipper exactly every day and a half and “prn” (which means “as needed” in medspeak). I don’t bother using a nail file – it makes her nails short but sharp, so clipper it is. And if I miss a day, she could end up a scratchy mess, so timing is key. Every nail, every other day.

3) Keep ‘em wet. Ongoing through the eczema debateOne question you may have about eczema treatment is whether to bathe multiple times a day and keep children in wet wraps versus the other end of the spectrum – barely bathe them at all. I’ll admit that this is an individual decision based on what works best in your child, but for us and pervading the more recent literature, a frequent moisture source is helpful. For my daughter, this means bathing at least once a day, and no ordinary bath. I no longer use soap or fragrances of any kind, but I am now about to give the colloidal oatmeal bath industry their biggest client. Every bath is an oatmeal bath with a 10-15 minute soak. (One hint – just get the plain fragrance-free 100% colloidal oatmeal – don’t get a “baby” preparation – if it says “baby” it WILL be more expensive and also comes in smaller quantities – save yourself a few bucks and just use less of the packet for one bath. Save the rest for next time.
ADDENDUM 8-6-2014: (See cross-outs above) and clarification here: As my colleague, an pediatric allergist, has noted, whether to keep kids wet versus dry is not really a debate – physicians are in consensus that regular soaking baths and especially wet wraps can improve eczema a lot. There are other treatments which he discussed – and about which I will not go into more detail here – like bleach baths, which can also really improve eczema. You can discuss alternate treatments with your doctor.

4) Selenium sulfide doesn’t work for everyone. As a public health pediatrician this was one of my most frequent treatments for patients with cradle cap or fungal skin issues, but my daughter’s eczema has a scalp component that is itchy, rough, and flaky. Using selenium didn’t do much for her itching and didn’t change the rash, but it did give her head an unpleasant odor that also affected her washcloths. Odor: just a tiny detail. It also stings her eyes and must be removed carefully. It may get another shot as we move into round two of skin care, but I’m not expecting miracles.

5) Massage two or three or six times a day with the most nourishing ointment or oil that you can find. My current concoction is a homemade preparation of coconut oil, vegetable shortening, olive oil, shea and cocoa butter, and jojoba oil. But to be honest just the plain coconut oil or shortening works fine. It’s important to check the melting temperatures of your products (it’s easier to apply if it melts easily in the hand) and check labels before you buy – a cocoa butter cream typically has a very small percentage of cocoa butter and lots of other additives. Same goes with other preparations that include the ingredients I have listed above. Probably the cheapest and easiest thing is to just buy a tub of vaseline or unflavored vegetable shortening and call it a day, and boy do they both work well! I haven’t tried Aquaphor, but there are also other more expensive creams I have recently tried which contain ceramides, which are a component in skin cells that are generally lacking in skin with eczema. Unfortunately these preparations haven’t helped my daughter much, so I don’t bother with that anymore.

6) Be willing to try steroid creams for the skin, if the doctor recommends them When my daughter’s eczema started to arise I was the last person who wanted to try steroid creams, but with her most recent flare they did wonders to calm down the rash with just a few uses, and now we are willing to have Judicious use of creams as prescribed by the doctor. It is important, however, to use these very sparingly and only as needed because steroid creams can thin the skin and are absorbed by the body – and too many steroids can affect hormones in the body, so still be careful.

7) Diet can be related to eczema As a very young pediatrician this was something that I didn’t buy into before, but now that it’s my own kid – dietary restrictions were some of the first changes that I made in my daily routine. The dermatologist mentioned that in her experience food allergies can be related to eczema, and I will never forget a child who I met in residency who had a terrible infected eczema case and when I met him a few months later, when several food allergies had been identified, he also had much improved skin. There may not be credence to me restricting my dairy and egg intake, but I have been able to manage this change and I do notice a change when I do “cheat” on the diet.

In any case I hope that this was helpful and I welcome questions and commetns. I have had lots of people suggesting various guidance and as I learn more I will try to post. In my new job I am writing a ton, so scratching that itch has made me blog much much less than I normally would, but staying off my computer at home has also meant me enjoying each day with the kdidies. Now time to enjoy a good night’s sleep!

Posted in Baby, Pediatrics, Personal Tagged with: , , , , , , , , , , , , , , , , , ,

6 things you didn’t know you needed for your new baby

Now that my second child is nearly 5 months old, I’m wiping the sweat from my forehead and wondering where the first half-year went?! She rolls around, sings a warbly “ahahahahaa” for me and her dad, and genuinely wins all of our hearts. Aside from her being a girl and needing girly-type clothes (which I didn’t endorse at first, until my sister-in-law’s retort the constant blues, greens, and browns: “I’m all for thrift, but this is getting ridiculous”), I didn’t think I really would need anything for #2 (heretofore known as “little R”).

But, lo and behold, the wallet had to open and the online purchases began anew. Because who has time to go to Babies ‘R’ Us? And a few items became added to the queue which I just didn’t realize would happen:

1) Silicone bottle nipples – Unless it’s been a scant few months between your last use of baby bottles, you’ve probably noticed the flexible bottle parts in your collection can get cracked, split, or generally distasteful, leading to a need to replenish certain items. But, like me, you may have thought that everything was hunky dory when you saw a slight yellowish cast to the silicone nipples and other bottle parts. Hopefully you didn’t think like I did and try to salvage these disasters. As it turns out, silicone breaks down more quickly than I thought, and once the bottle parts – most often nipples from bottles or pacifiers – become slightly yellow, the silicone is on the way to breaking down. Next it gets sticky and more yellowish, and the stickiness (as I came to realize), does not resolve with 2 handwashes and 11 runs through the dishwasher. I’m a persistent recycler, but with your new baby, it’s time to throw out the old bottle nipples and get some new ones.

2) Sleep sacks – with my first baby I gave up on swaddling pretty quickly – he broke out the swaddle right away and from a few months into life was sleeping very close and cuddly with mama. Well, as it turns out, my second baby also tried to break out of her swaddles, but I decided to persevere in this case and found that even though she was also a mover, she liked being squeezed tight and I ended up buying a special type of sleep sack to help keep her arms in but which was also flexible to the contours of her body. This definitely helped turn her into a 4 or 5 hour sleeper.

3) New clothes for mama - now that it has been several years – almost 4, to be exact, since I’ve been in tasteful non-maternity big mama clothes, my wardrobe is woefully out of date and any pieces to which I am particularly attached are pilling like crazy. And my skinny mama clothes are far from being wearable, as I am now convinced that I may never be able to fit into them again. So I’m treating myself, buying some nice looking clothing that will be suitable for work and not feeling guilty that one day it may not fit me the same. Gotta wear something now so might as well look decent and love what I got that’s not going anywhere yet! Now – quick plug which I won’t link to – I just signed up for Stitch Fix and am really enjoying the new duds! Cool choices and a nice surprise in the mail every so often!

4) Extra diapers / replacement parts for cloth diapers - Unfortunately, elastic ain’t what it used to be anymore. I have things made with elastic from 1992 which are in great shape and for some crazy reason a lot of my more recently elasticized stuff gets worn out often – translate, cloth diapers cannot hold anything anymore and are very stretched, and this is only for child #2. Unfortunately I’m not a great seamstress so the worn diapers are sitting in a drawer awaiting repairs and new elastic. But to ease the tide I purchased a few new diaper covers and, let’s face it, while having a full time job and two kids, well, cloth diapering has become less of a priority (though still is being used by me, if not by the rest of the family). So this also meant buying a boatload of (ugh) disposables – for daycare and for hubbie. Oh well, I’ll keep working on this one!

5) New Medicines Check the labels on your bottles, folks, because chances are that the acetaminophen and ibuprofen and vitamin D drop sand who knows what else are, that’s right, expired. And (like us) you will probably have that day when your 2+-month-old child gets a fever and you are plum out of medicine that you are willing to give your kiddie. And we had a lot of other things to hunt down as well, which fortunately we didn’t have to repurchase – like the thermometer for instance. Another essential.

6) New Breast Pump and Accessories At first I intended not to get a replacement breast pump; mine seemed to be working fine and I didn’t want to be wasteful, but with the Affordable Care Act it is now mandated that women be provided breast pumps through their insurance plan, and if you want to buy into this offering you must order the pump within 30 days of delivery. This meant that, if my old pump were to conk out today for instance, a new one would not be covered. So for that extra peace of mind I ordered a new pump, which ended up being very convenient because now I have extra pump parts as well so that I have a little less dishwashing to do!

Fortunately outside these items the list of purchases for the new baby (outside of clothing needs for a girl) is small, and when she was VERY tiny we were able to use a lot of the clothing we already had. It is nice that we got a lot of neutral linens/onesies for her as a youngster since that didn’t have to be replaced. And though I’m tempted to to go to the children’s stores and look for all the latest gadgets for kiddies (and there are many), my wallet is happy that I’m trying to open it a little less!

Posted in Baby, Cloth Diapering, Green Living, Personal Tagged with: , , , , , , , , , , ,

Before and After: The Haircut

Hair Donation Banner

 Part II

Here is the before . . .

Before the CutAnd here is the after!After the cutWhaddaya think?

Posted in Charity, Personal Tagged with: , , , , , , ,

My Kicky Spring Do(nation)

Hair Donation Banner

All you readers know that lustrous hair is one of pregnancy’s legendary desirable side effects. But what happens afterward? Yes, you may say, it’s simple but unsatisfying. The hair, having sustained a prolonged phase of anagen (hair growth), transitions to catagen (no growth) and then into a stage of telogen (hair falls out). And all that beautiful hair disappears.

Well, THAT hasn’t happened yet. And my hair is now weighty with leaden thick black hair. Not sure how it hasn’t turned gray yet with the way I feel like I’m up all night and day. Of course, I’m not crossing my fingers for the gray transition either.

But this coif is getting to be somewhat of a nuisance. When it’s down, my 1-month-old daughter’s tiny fingers with dagger-like Lilliputian fingernails wreak havoc on the hair, which gets tangled up in knots resembling those of my childhood. When put up, my hair breaks the clasps of my hair clips and stresses the elastics of my hair bands. And it feels like an anvil dragging me down. I know, I know, I shouldn’t complain when one day my hair will be thin and white, but there it is.

What do you do with an 8-inch lock of hair?

I’ve taken a ruler to my hair and lookee here, I can donate to a child who really needs it! We’ve all seen the viral video “Emily’s Hair” depicting the adorable three year old donating to Locks of Love. But to whom should I really donate? Pantene? Locks of Love?

20140314-110756.jpgAfter a bit of research I’ve decided to give my hair to Children with Hair Loss. This nonprofit organization creates 300 hairpieces a year for children with all sorts of illnesses leading to hair loss. They, like Pantene, accept hair of shorter lengths – as little as 8 inches – and also accept gray hair – which I think is nice because people with gray hair want to be able to donate, too!

Why not other organizations?

Well, this article from Forbes diverted me from Locks of Love, not to mention the fact that I don’t think I could donate the 12 inches of hair they require. Imagine, $6 million dollars of hair unaccounted for at the organization that probably gets the lion’s share of hair donations?! Pantene, which creates 1 hairpiece from 19 hair donations, is definitely worth a donation with the great and beautiful focus of women with breast cancer. But I figured that they probably get many many donations anyway through larger programs.

And finally, I’m a pediatrician – of course I want to donate my hair for children! So Children with Hair Loss it is. And I’ll get a “kicky spring do” to boot!

How do I feel about going short?

Love it, love it, love it. I can’t wait to be tangle-free. I can’t wait to not have to pull my hair back and to have it styled in 5 minutes and done. Okay okay, I don’t wear makeup. Neither do I use any type of product in my hair aside from a little oil here and there. But at least now when I am finished my hair will look like something, not the shapeless ponytail to which I usually relegate it. I’ve gotten my hair chopped off every few years, and it was the very year of 2006 when I last took the plunge that I met T, the man who would become my husband. So the aspect of short hair looks much more promising than not.

Not sure why I never thought of donating it but there’s a first time for everything. Here are some of the styles I’m considering. Your thoughts?  Stay tuned!

Posted in Charity, Personal, Pregnancy Tagged with: , , , , , , ,

Birth Story of My Second Child: An Induced Delivery

Baby R

Baby RIt is funny how maternity leave with child #2 makes the element of sleep all the more important. These days I feel like I am juggling between children’s rooms at night, comforting one, then the next, and spending the days in a bit of a haze, trying to catch up on lost sleep. Despite this, the time brings me even more happiness as a parent. Close cuddling with my son in the early hours of the mornng means pure joy. And after breakfast, once the tyke is at school and busy with his day, I get cuddles and nuzzles with my little one-month-old R.

Yes, it has now been a month since my first meeting with my new daughter.  I’ve been working on her post here and there and just hadn’t completed it yet.  T and L and I feel incredibly fortunate to have her in our lives.  It was a little rockier than birth story #1, let me tell you.  Given that I’d been having Braxton-Hicks contractions since Christmas and had several instances where I thought I was going into labor – subsequently fizzling out, I really thought I’d be delivering before my due date.  But suddenly the due date came and went and still no baby.  That due date was Friday January 17th.  My next midwifery appointment was scheduled that Monday when I was 40 weeks and 3 days along.

My Birth Plan (and how it changed)

For my second baby, I expected a quick and slippery delivery along the lines of my first – go into labor, get to birth center a few hours later, deliver in 1 hour and be home by midnight.  Sounds crazily simple enough, but that’s pretty much how I remember my first birth experience.

Unfortunately, luck was not on my side on the Monday morning of my 40-week-visit with the midwives.  For starters I wasn’t feeling quite right. My little one did not seem to be moving as much as she should have been over the past 1-2 days.  But whenever I lay down on the couch and counted movements, they seemed to add up to 10 or so within an hour. So I was trying not to worry too much.  Otherwise things seemed to be normal. I was eeking along, just extremely tired and sleepless during my last days of pregnancy and very impatient for my butterfly to emerge from her cocoon.

T set out to drive me to the Birth Center for my checkup.  We were fortunately between winter storms and the sun was shining brightly–giving me more optimism. I asked T to load the hospital bags into the car ‘just in case’ and we set on down to Delaware. When I arrived the midwife reassured me that everything seemed to be all right. To try to push me along, the midwife stripped my membranes (do not be fooled, this is an excruciating but brief experience and makes you very crampy) and also noted that I was 1 centimeter dilated. She said that pregnancy was progressing as per usual but just to make sure that the baby was well, we would do a fetal nonstress test (NST) in the office.

So they strapped monitors to me – a contraction monitor and a heart rate monitor, to check the baby’s activity level as well as my body’s movements and the baby’s response to them.  In order to pass the NST, during a 1 hour period the baby needs to show two sustained episodes of ‘reactive’ heart rate during awake periods.  There are numbers that tell you how “reactive” a reactive heartbeat is. While my baby’s heart rate was increasing by about 10 beats per minute above baseline, this was below the required difference of 15 beats per minute.  Furthermore, the heart rate showed this inadequate level of reactivity fleetingly and for short periods of time. The usual tricks of the trade–drinking two big glasses of ice water and eating a popsicle–did little to improve her activity.

My heart sank when my midwife instructed me to go across the street to St. Francis to get a Biophysical Profile (BPP). A BPP is an ultrasound which detects five major areas of fetal wellness. In preparation, T and I grabbed a [delicious] lunch at a local pizza shop and then headed to the appointment. I felt like the baby was moving well at the ultrasound, but sadly, the activity level was still not up to par.  And more concerning with this picture, my amniotic fluid index (AFI) was found to be low. They were detecting a fluid level of 3.5 which is below the normal range of 5 to 25.  We returned to the birth center for a repeat NST but unfortunately the results were the same. Individually neither the low AFI nor the decreased reactivity may have been overtly concerning, but together they were worrisome. With low AFI (also known as oligohydramnios, or low amniotic fluid) and the nonreactive stress test, one could infer that my baby was having some difficulty and possibly outgrowing what my body could provide for her.

Bottom line: she needed to come out.

So that same afternoon I found out that I would not have the natural birth that I desired. I’d be going the route of Pitocin and all that follows. It helped that they planted the seed early in the day. I had about six hours to process the idea of being induced before the decision was made for me to be admitted. Bracing ourselves for a tough few days we headed to the mall. there we picked up some entertainment and a big chicken sandwich for me to eat before going to the hospital, where I knew that they’d make me either liquids only or the dreaded “NPO” – nothing by mouth. This unexpected mall detour brought us a little happiness, however.  As we mentioned our predicament to salespeople at the mall (“We have to go to the hospital to get induced because our baby needs to come out.”) it felt heartening to hear their reactions: “Wow!” they would say, “Your baby is coming! That is so exciting!”

Yes, it was, rather. Within the past day we had faced uncertainties, but at least we knew that we’d soon be meeting our daughter!

As we arrived to register at the hospital I wolfed down my sandwich (to the horror of our registering nurse who turned the other cheek). We headed to a waiting room and were quickly shuttled to labor and delivery room where a kind nurse took some blood, hooked me up to an IV and started to tank me up with fluids and put me on the monitor. The plan put forward by my obstetrician was simple enough. Rather than starting with a chemical induction (Pitocin), I would be induced manually using a foley bulb – a process which is possible as long as you are at least 1 cm dilated. I had never heard of it but it makes perfect sense. They insert a foley catheter into the cervix and inflate it with water to about 30mL (imagine 6 teaspoons of water) – This creates a diameter of about 3 centimeters. They then tape the foley end to my leg and allow it to come out on its own. When it does, you are thought to be 3 centimeters dilated.

What I learned from a foley induction.

a) It is painful to have the foley put in but once it is in there are no issues
b) labor isn’t so bad and is pretty tolerable IF you can move around and get in comfortable positions, BUT when you have a heart rate monitor and contraction monitor strapped to your belly and one arm is attached to an IV pole, activity is pretty difficult. The only thing I did willingly was go to the bathroom to void every half hour. So labor is much more painful.
c) I am glad that I had to get up to void every half hour because at least it helped me get a little comfortable during labor.
d) Night nurses who want to sit at their station and don’t want to spend time with the patient don’t believe you when you tell them you are having a contraction. They only believe the monitor.
e) The monitors just don’t work that well – they displace, they don’t pick up. And for me I think they only picked up 2 out of every 3 contractions I was having.

So after learning items “a” through “e,” I realized the inevitable: my nurse began the dreaded Pitocin that night. Basically she was following the order set that she had been given, but rather than admit that, she told me that I wasn’t contracting adequately, that I wasn’t dilating, that the doctor wanted me to have this medication before the other doctor came in during the morning. Nothing seemed to add up because among other things, as it turned out, I learned the same doctor would be covering me for the duration of my admission. Furthermore, by my own experience I knew I was contracting every 5 minutes or so.  Thus, based on her inadequate explanations I was quite ready to turn down the Pitocin.

But . . . .rather than go that route we elected to call the midwives and discuss what was going on. It was enough for me to be able to talk it over with Sarah Grace in detail and hear from her that Pitocin sounded like the right course. The baby’s health was a concern and she needed to be delivered. I also learned that to start at a level of 1 mL/hour and to increase very slowly was a conservative approach (compared to physicians who normally started at 2ml/hour and increased by 2 ml/hour each hour). Personally, the concept of “pitocin contractions” induced me with a sense of fear from the words of other mothers.  Sarah Grace provided me with some relief here, saying that because I was already in labor for several hours it wouldn’t be too much of a transition in terms of pain – the contractions are basically emulative of active labor right away. And, as it seemed to me, the doctor was going as kindy and gently as possible and if the baby truly was in mild distress – which looked like it was the case, if I wasn’t able to get labor to progress more I might be on the road to cesarean anyway.  So on went the pitocin and I decided to brave it without anesthesia. Initially.

The Labor Song, or How I managed through Pitocin for a night

It certainly helped that I was able to embark on a fairly normal unmedicated labor to begin with. When they started the pitocin I was that much closer to active labor and was already used to breathing carefully through contractions.  I had developed a “labor song” early on – basically a low pitched melody which I repeated during each contraction. I based it on Tzchaikovsky’s Sleeping Beauty.  Coming from a singing background I found the strategy helpful ; the melody had given great focus to my first labor and suddenly came back to me during this one.  It did help me in a similar way to both relax and to keep focus. Of course, singing seemed strange to my night nurse.

The night nurse – the same one who wanted to turn on the Pitocin without really explaining the “why” of it – took it upon herself to coach me through one of my contractions when she was helping me to the rest room. Considering that I had been dealing with painful contractions for the previous 6 hours I found it unnecessary for her to tell me not to sing through my contractions – which was helping me a LOT this time.  She thought it would be better if I breathed in through my nose and out through my mouth like a straw.  Pish tosh, I thought to myself. Forget trying to breathe in through my nose – it was already thoroughy clogged from the hospital air and a very cold winter. Plus, I can sing a heck of a lot longer than I can blow my mouth out through a straw, and singing makes me forget I’m having a contraction.  You get zero points on that one, nurse.

The Next Morning

By the morning the Pitocin had inched up to 4 ml/hour. The contractions began to get longer and more painful. The day nurse who came on offered to reposition me into a seated position. She placed pillows around me to make me comfortable, but once the Pitocin was up to 5ml/hour I was undergoing each contraction and hoping it was the last of my labor. It hurt a lot and the nurse and T could see it.  The nurse was highly recommending the epidural. In the event that I couldn’t relax and could not dilate, she said, I may have to go to cesarean and at that point they said it would be too late to use epidural anesthesia and that I would have to go under general – which I was clearly not a fan of doing.

Also, while I consider myself very suggestible to recommendations like this nurse’s, I also felt that I was tiring out. My concern was that if I couldn’t stay relaxed during contractions, I wouldn’t have the strength during the pushing stage. And relaxing my body was getting harder and harder. So again we spoke with the midwives over the phone and got some reassurance that we had labored a good portion unmedicated, and that hopefully the epidural would not cause labor to arrest at this point – if I was already significantly dilated.

Within about half an hour of my agreeing to the epidural the anesthesiologists came and inserted it in a matter of minutes. – at about 10:00 a.m. The feeling of the needle insertion will be hard to forget. It was a nerve wracking and mildly painful procedure to be sure, but once you’ve gone through a night of labor pains the needle isn’t such a big deal. And it goes quickly. The strangest feeling was the mild euphoria of being suddenly pain free and the importance of changing the dependent leg when starting the epidural. As I changed position I felt myself getting numb in the right side, the the left side, then again on the right side. It was interesting to suddenly feel like I could go through several hours ore of labor and not care at all.

Shortly thereafter, my OB came in and checked my amount of dilatation (which was much easier once I had the epidural. 4 cm, good effacement, and +1 station). So all in all, baby was descending). He broke my water bag and my dilatation increased immediately to 6 centimeters. He estimated that my baby would be born in a few hours and headed back to his clinic (which was a drive a way).

During the next few hours my nurse came in and was extremely attentive. I believe she spent more time with me than with any of her other patients because she was so busy checking my monitor and holding it to my body. It didn’t have to be held so closely once I had the epidural because I had stopped changing positions to relieve pain. But the baby’s heart rate continued to be nonreactive. But the contractions became just barely sensible to me and suddenly got very close together.

I started to feel the need to push around 12:15 p.m. or so. I had no desire to request any more epidural anesthesia. In fact, I wanted the epidural to wear off so that I’d have the right bodily cues to push. The nurse called the OB who started his drive over in about a foot of snow and zero degree temperatures outside. Not the ideal situation, and I held onto the side of the bed and breathed out as long and deeply as I could so as not to push the baby out on my own. This feat, which felt like it lasted forever, was in my estimation my biggest accomplishment of my delivery. It was SO HARD not to deliver before the obstetrician came. Just as I felt desperate to push and nearly asked for the residents to come in and deliver my baby, my OB arrived, up went the bed and they asked me to start pushing. AT this point my sensation had pretty much returned and I was certainly experiencing regular labor pain. It took a few minutes of pushing and the baby was out. I could describe it in more detail because the memory is still there, but I’d prefer to leave it at that.

However, I will mention that natural labor is far superior to medicated labor in the respect of positioning. It was a far better thing to be able to get into a position that was comfortable for me as a patient to deliver a baby. When you are on Pit with an Epidural you are basically in a labor position that is convenient for the doctor. And it feels so counterintuitive. Rather than push down and have gravity assist you, I felt like I was pushing my baby up and out against gravity. With that very odd position, it was all the more difficult to keep the same intensity of push that I was able to during my first labor.

But my daughter was born and all was well. Apgars of 8 and 9, which is to say that at 1 and 5 minutes of life she had healthy color, pulse, cry, breathing rate, and tone. Immediately she was on my chest, nursing, and looking great. Although I was very sure that starting to nurse her would be tough since I had an epidural, she seemed well enough awake and nursed immediately.  I think my milk came in a bit sooner than with my first simply by virtue that I hadn’t stopped nursing since my last delivery.

The rest I am afraid is a blur. If you haven’t already guessed, I wrote a lot of this blog post weeks ago and now it is all a distant memory. I remember having to get a rhogam shot, remember having to get stitches, remember having difficulty with normal bodily functions after the delivery – but not so much compared to my first delivery.  I remember getting the epidural out and finally the IV out and being able to walk again, phew. I remember our hospital room. While I wasn’t particularly surprised by the hospital room we ended up in, I think it was a slightly rude awakening for my husband, who remembered the cozy, softly colored and comfy room of my first delivery at the birth center.  The towels here were tiny, the meals were not our home-cooked ones, but jello and all that a hospital can provide. The nice thing was that because of the snowstorm they were generous with the meals they provided my husband at the cafeteria downstairs, and we were all cozy and didn’t have to brave the snow.  We elected not to have my son visit initially when I was on the floor because of the cold weather, but by the time I had spent about 20 hours in the postpartum room I was itching to go home.  So rather than let them keep me another night we clamored for the nurse to get our discharge done and we were out on hospital day 2.  It’s a good thing to be lying down in bed and resting – which they make you do while you are in the hospital. But I missed my home and was incredibly bored.  So my son did end up coming late in the afternoon to meet his sister.  That day happened to be his own birthday so we celebrated with a chocolate birthday cake and then slowly made the drive home in frigid weather.

Ok, I’m going to give up on this post since it just took me waaayy too long and so much more interesting things are happening in life now that labor is over. Yes, it was tough to have an induction and I would not choose to do it, but it helped put in perspective that labor is a millisecond in the grand scheme of parenthood and there is so much more to it all. If things don’t seem to work out – which at the time it didn’t seem to be – I still had a healthy baby in the end, and that meant the world to me.

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