Ask Yo Mama: Does Size really matter?

askyomamaOkay, so before you delete this and think it’s a crazy porn site, let me extrapolate. I got an email from a mama this week and wanted to respond more fully on this site so that all can be served from this nonsense.

Dear Yo mama,

I’m hoping you might have some thoughts/advice as it’s looking like I’m turning out to be a statistic… Yesterday, they did a special ultrasound to figure out how my baby is. She weighed in at 8lb 10oz (at 38 weeks 1 day). I’m dilated ½ centimeter and not hardly effaced although baby has dropped pretty well. I’ve had my membranes swiped twice now and have been aggressive with acupuncture and chiropractic to bring on an earlier labor…. All that said, it has been pretty strongly recommended I go for a c-section based on the size of the baby. Because I’m not very effaced and hardly dilated, they are not even recommending medical induction as it seems it could well lead to unscheduled c-section, considering how not ready my body seems to be, despite baby’s size. (Baby is very healthy with healthy placenta and amniotic fluid levels and it seems she’d be happy to float around for 2-3 weeks more, gaining ½ to 1lb/week, so I’m told….)

As it stands now, I’m scheduled for a c-section next Monday and of course my hope is I go into labor before then… I was just wondering if you have any specific thoughts or ideas and/or if based on your experience you agree with this view.                        Signed, Big Baby

Dear sweet Mama (and Big Baby),

WTF.  Sorry, but this is one of the most crazy-making parts of the birth industry right now.   I will highlight what you yourself wrote:  “Baby is very healthy with healthy placenta and amniotic fluid levels and is seems she’d be happy to float around for 2-3 weeks…”  SO LET HER!  I’m going to take a few moments on my virtual soap box here, but I am so frustrated with this ‘cesarean or induction based on size’ thing that I gotta have some words.

here are a few quick facts:

1.  BIG BABIES ROCK.  They nurse better, sleep better, and basically come out like big bouncy buddhas.  They are fully cooked, lovely munchkins and are a delight to be around (in general).

2.  Big babies navigate the pelvis beautifully!  Sometimes even better than a smaller baby, because of reason #1.  ANY baby of any size can get stuck in the pelvis, and very tiny women can rock a vaginal birth of a big baby with no problem. (my delicious daughter was almost 10 pounds, and I am on the smaller side of mamas)

3.  Ultrasounds have no idea how big your baby is.  Ultrasounds have been known to be multiple pounds off.   So, to say we have to induce or do a cesarean birth based on this ultrasound is nonsense.  It’s like making a map with GPS points in Wyoming while you’re in Colorado.

4.  Babies do better who have labor.  Even if it ends in a cesarean birth.  Apgar scores are higher in babies that had a trial of labor before a cesarean birth.  The contractions are essential for helping baby transition into this new world.

So, Big Baby, Here’s the conclusion.  I don’t know if your doc has a little hawaii vaca planned or is having his/her in-laws to visit, but this recommendation is not in the favor of you or your wonderful (and potentially small) baby.  Take your time.  Say no thank you.  Hold steady.   Your baby will pick a perfect birthday, and on that day, you’ll both see how you can navigate getting baby through your pelvis.  Stay active (see Happy, Healthy Pregnancy) so you can walk and do a lot of stairs in labor.  And potentially, if you and your doctor keep not meeting eye to eye, consider making a switch.  I know it’s super late in the game, but as long as you’re not in labor, it is still possible.  (See Three Steps to A Great Birth).

And if you can, avoid empty calories like refined sugar.  These do tend to make babies a little fluffier.  Eat five colors of veggies a day, eat good proteins (vegetarian or meat).  Think of each day as the potential day that your great birthing adventure will begin.

Sending you all my love and patience, to you and your gloriously big baby.

Yo Mama

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Ask Yo Mama: Tdap in Pregnancy

Dear Yo Mama,   
I am feeling very nervous and scared about something I read.  My wife and I both did the tdap vaccination.    I was fine with it until I read on Facebook that somebody was saying you shouldn’t do it while you are pregnant.  This has me worried about autism.  I am trying to surrender but I woke up concerned today.  I don’t want to talk to my wife because I don’t want to freak her out. So that leaves me with no one to talk to.  If you have anything you could say that will take a good chunk of this concern off my back that would be awesome.  I don’t trust the cdc. 
I want to let go of my fear and move forward.
Thanks,
Shot in the Dark
Dear Shot in the Dark,
I’m so glad you reached out!  It takes bravery to give a voice to these fears.  When it comes to vaccines, there is no perfect answer.  There are risks with vaccines, and there are risks with the illnesses they prevent.  Each vaccine decision means weighing the specific risks of that illness (and the liklihood of contracting that illness) with the risks of the vaccine.  And we are always making our ‘best guess’ and can’t know the future.  It sucks.
But vaccines are useful and amazing, and a very good thing that we have them.  At the moment, there hasn’t been any consistent or convincing proof of a link between autism and vaccines.  Most studies have been debunked.  It seems there may be a slightly higher correlation in african american boys, and there is a question out there of whether the CDC covered up that subset in their studies.  I know the internet can be a scary place, and I trust my pediatrician (Dr. Roy Steinbock) the most when it comes to these things.  He’s smart, he’s well researched and he’s obsessed with the safety of kids.  A good pediatrician is a parent’s best ally.
I think the decision you made to have the Tdap during pregnancy is a smart one.  Whooping cough is pretty prevalent in Boulder (because so many don’t vaccinate).  And it can be fatal if a baby is very young, and it’s a pain in the butt at any age (6 weeks of coughing).  It’s the one vaccine I feel pretty strongly about.
As for having it during pregnancy, it’s listed as a slightly higher risk than some other drugs (class C), but again- you probably won’t give your baby the Dtap directly until later in the flu season (when your baby is a little older), so keeping it out of the house (by vaccinating the two of you) seems prudent.
Having a baby is shockingly anxiety producing, even before they are here. And it doesn’t end when they arrive.  As parents, we have to make a ton of decisions on behalf of our kids, and it’s overwhelming.  But you get more and more practice, and start to trust yourself- both your research and your instincts.  What I hear in your email is that you’re going to be an awesome dad 🙂
With love and support,
Yo Mama

Ask Yo Mama- Where should I give birth?

askyomama Dear Yo Mama,

 As you know, our baby catcher’s practice just closed. We were thinking of another hospital based midwifery practice, but discovered that the hospital has a higher C-section rate than we are comfortable with.

 You come across as an expert in this area, and we would like to ask you what you would do if you were in our place. We’re considering a Freestanding Birth Center, but it’s expensive and may not be covered by our insurance — however, we may look into insurance options if it seems like the right path. Home birth feelss scary to us, but making a decision based on fear isn’t always the best one.

Would you mind providing us with advice? We’re just lost on what to do.

Sincerely,

Belly without a Baby Catcher

 

Dear Belly,

I’m so glad you reached out to me!

It’s a hot topic right now, with so many feeling ‘lost’.  And midwives and doctors are human- sometimes something changes that forces them to not be able to carry out their original commitment to ‘catch’ your baby.  Choosing a care provider (and birth place) is tricky– it’s a little like dating- which is not very fun-  but if you use the same feelings of ‘chemistry’ along with some good research, you can find your way to a choice that fits your family.

I think the first thing to consider is where both you and your partner will feel the most safe.  With choices like whether or not to use an epidural- you, as mama, get 100% of that vote.  With birth place, I would say it’s 60% (mama)/40% partner.  both of you need to feel that it is a safe place for you and baby.  Since you have to push a baby out that day, you get an extra 10% of the vote.

Safety can be found in different ways.  For some, it is knowing that every possible medical intervention is at your fingertips.  For others, it could be knowing that the medical interventions are as far away as possible, or at least used as a last resort.  For many, it can be knowing that they feel at home with the environment- smells, sight, and feel of the place.  Looking at cesarean birth rates is one important factor for sure.  Most hospitals, nationwide are around 33%, which is shocking, but true.  So you want to look at individual practices within each hospital (Nurse midwife practices tend to be more like 10-20%).  Out of hospital birth centers tend to be 6% or even lower (Ina May’s center is 1.5%- but that’s a long drive to Tennessee).  You are in a good birth class, and preparing yourself with good tools, so you should be in a good position to avoid a Cesarean birth (see my post:  3 most important things you can do to Have a Great birth)

It’s also super important to consider the care provider or team you’d be working with.

And I tend to go both for the letters by their name as well as the ‘gut instinct’   I would ask yourself the following two questions after you meet with a care provider:

  1. would I go on a road trip with this person?
  2. would I go into a one-stall bathroom with this person?

Birth is long and winding like a road trip, and as intimate as any bathroom event you’ve had so far.  If you couldn’t imagine taking your pants off in front of someone- they might not be the right fit for your birth.

Freestanding Birth Centers can be a wonderful option.  You have Certified Nurse Midwives, and a beautiful facility, and medical interventions are truly a last resort.  Home birth can also be great, but is not for everyone.  I think some of the pluses are:  not having to drive while in labor, the postpartum care is extraordinary, and you’re in your ‘own space.’  And for any higher-risk pregnancies, or those that feel the ‘safety net’ of medical intervention should be close by for any reason, a Hospital based midwife or OB practice is usually the best way to go.

I would meet with individual care providers and feel into how you could imagine your birth experience with each of them.  Ask all the questions you want, listen to the answers.  And then listen to your inner answer.  Your belly will know.

Thanks again for reaching out!

All the best,

Yo Mama

 

ASK YO MAMA welcomes your letters and questions- please email katie@yomamayoga.com with ASK YO MAMA in the subject line.  We will edit your letters and respond on the blog.  We respond to as many as we can.