You know how they say "time flies when you're having fun"? Well, it flies when life is sucky too and everything else. This last year has been one hell of a roller coaster.
Last February, my oldest (then 17) moved out on bad terms, my baby turned 1 in May, the other 3 turned 11, 4, and 14 in June, my oldest turned 18 in August, my mom received new lungs in early August, I wrote an article that was published in an Australian magazine, my husband got a contract to have a book published (or was that the year before?) and was asked to write another book, my husband's mother died after being told that her cancer was in complete remission, a deer ran into my van and totaled it. Just wow. Oh yeah and I formed a non-profit organization. lol How could I forget THAT!
I'm tellin' ya, it's been crazy. Still waiting for things to settle down. Husband's book just became available for preorders a few days ago, I will be speaking at a conference and possibly a second.
Gotta run, too much to do to be sitting here too long.
Monday, January 30, 2012
Saturday, June 4, 2011
Not Your Typical Cesarean
My very first article written for Special Scars women everywhere!
An Intro to Special Scars by Jessica Tiderman
Most people know at least one person that has had a cesarean. Not many realize that there are a variety of incisions that can be used on the uterus during that cesarean. The most typical incision is a low transverse incision, which is a horizontal cut in the lower portion of the uterus usually called the lower uterine segment (LUS). Due to the lack of shorthand to describe the more unusual uterine incisions such as classical, inverted T, J, upright T or any cesarean incision other than the low transverse incision, I started calling them Special Scars. Without a way to describe these incisions, women weren’t getting the information and support that they needed.
An inverted T incision starts out with a low transverse incision and then the OB makes a vertical incision upward in the center of the uterus. A J incision also starts out with a low transverse incision but the OB makes the vertical incision up along the side of the uterus rather than the center, perhaps because the placenta or the baby was in the way. An upright T incision can happen in two ways; either the OB started with a low vertical incision and then needed more room at the top of the incision or started with a low transverse incision and made a vertical incision down toward and sometimes reaching the cervix. These three incisions are usually used for babies that are severely malpositioned and/or very stuck. The vertical portion of these incisions can range from a few millimeters to several centimeters. These are also usually contained within the LUS, but can extend into the upper uterine segment (UUS).
Classical incisions are vertical incisions and can be placed just about anywhere on the midline (middle) of the uterus but tend to be in the UUS. There is some dispute about the standard placement of a classical incision. They are still commonly used for early preterm cesareans although some doctors have switched to using the low transverse incision for those as well. Finally, low vertical incisions are simply that, a vertical incision on the midline that is contained within the LUS. This is used when the baby is in a transverse lie or if the placenta is in a location where they would typically cut.
Clearly, the Special Scars are a more complicated matter. The cesareans that end up in these incisions tend to take longer due to baby’s position, which leaves the mom more vulnerable to infection or other adverse effects from being open for so long. Moms with these incisions are more likely to have a host of problems that are less likely to occur with low transverse incisions – wound infection, endometritis, septicemia, transfusion, ICU admission, hysterectomy, and maternal death. These incisions can also increase the mother’s length of stay in the hospital. Babies born from these incisions also have increased risks – stillbirth, neonatal death, APGAR less than 7 at 5 minutes, ICU admission.(1)
Emotionally, the moms may suffer from postpartum depression or post-traumatic stress disorder. It is very likely that they were told many times during their stay in the hospital after their cesarean that they would never be able to have a vaginal birth after cesarean (VBAC) after that particular surgery. They likely heard that statement so many times that they believe it. When they find out that it is possible to have a vaginal birth after their Special Scar they may feel shocked, angry, betrayed or any combination of those. Sadly, there is no research about the emotional effects of these incisions on women.
Once the woman decides she wants to have a vaginal birth it can be very difficult to find a care provider who is willing to assist a VBAC after a Special Scar (VBASSC). The search usually requires calling many doctors and/or midwives before locating one that will attend a trial of labor. When a care provider is not initially open to the idea, it is usually best to not even try talking them into it. It is unlikely that you will be the one to change his or her mind. University hospitals tend to be more willing to assist due to their size and staff. Some home birth midwives are willing to attend VBASSCs when not legally restricted from doing so by their state.
Many care providers are unwilling to assist a VBASSC because the risk of rupture is slightly higher than the risk of rupture after a low transverse incision. The generally accepted risk of rupture for low transverse incisions is 0.4-0.9% while the risk of rupture for inverted T, classical and J incisions is 1.9%.(2) Interestingly, low vertical incisions have no more of an increase in the risk of rupture than low transverse incisions.(3) If the cesarean was performed preterm there is a minimal increase in the risk of rupture.(4) As we know from Dr. Sarah Buckley’s writings, if a woman is allowed to labor unhindered her birth much more likely to go as it was designed.
Clearly, there is a need for further studies on these scars, the effects on future pregnancies and the effects on the mother emotionally. The few studies that are available used a relatively small number of subjects. Therefore, without clear evidence of exceptional risk the woman and her partner should be the ones to make the decision whether or not she attempts to have a vaginal birth. Care providers should not be making decisions about VBASSC due to a level of fear or a lack of information. Indeed, if the care provider does have that much fear he or she should excuse themselves from serving the woman and let her find a care provider who is willing to serve her and trust her body to work as it was designed. There are already a number of women who have succeeded in having a VBASSC. To read their stories, for more information about this topic and access to the studies that I have mentioned, please visit http://www.specialscars.org.
(1) Patterson et al. Maternal and Perinatal Morbidity With Cesarean.Obstet Gynecol 2002;100:633-7
(2) Landon et al. Trial of Labor after Prior Cesarean Delivery. N Engl J Med 2004;351:2581-9.
(3) Shipp et al. Intrapartum Uterine Rupture. Obstet Gynecol 1999;94:735-40.
(4) Sciscione et al. Preterm Cesarean Delivery and Uterine Rupture. Obstet Gynecol 2008;111:648-53.
First published in Whole Woman Magazine, Winter 2011.
An Intro to Special Scars by Jessica Tiderman
Most people know at least one person that has had a cesarean. Not many realize that there are a variety of incisions that can be used on the uterus during that cesarean. The most typical incision is a low transverse incision, which is a horizontal cut in the lower portion of the uterus usually called the lower uterine segment (LUS). Due to the lack of shorthand to describe the more unusual uterine incisions such as classical, inverted T, J, upright T or any cesarean incision other than the low transverse incision, I started calling them Special Scars. Without a way to describe these incisions, women weren’t getting the information and support that they needed.
An inverted T incision starts out with a low transverse incision and then the OB makes a vertical incision upward in the center of the uterus. A J incision also starts out with a low transverse incision but the OB makes the vertical incision up along the side of the uterus rather than the center, perhaps because the placenta or the baby was in the way. An upright T incision can happen in two ways; either the OB started with a low vertical incision and then needed more room at the top of the incision or started with a low transverse incision and made a vertical incision down toward and sometimes reaching the cervix. These three incisions are usually used for babies that are severely malpositioned and/or very stuck. The vertical portion of these incisions can range from a few millimeters to several centimeters. These are also usually contained within the LUS, but can extend into the upper uterine segment (UUS).
Classical incisions are vertical incisions and can be placed just about anywhere on the midline (middle) of the uterus but tend to be in the UUS. There is some dispute about the standard placement of a classical incision. They are still commonly used for early preterm cesareans although some doctors have switched to using the low transverse incision for those as well. Finally, low vertical incisions are simply that, a vertical incision on the midline that is contained within the LUS. This is used when the baby is in a transverse lie or if the placenta is in a location where they would typically cut.
Clearly, the Special Scars are a more complicated matter. The cesareans that end up in these incisions tend to take longer due to baby’s position, which leaves the mom more vulnerable to infection or other adverse effects from being open for so long. Moms with these incisions are more likely to have a host of problems that are less likely to occur with low transverse incisions – wound infection, endometritis, septicemia, transfusion, ICU admission, hysterectomy, and maternal death. These incisions can also increase the mother’s length of stay in the hospital. Babies born from these incisions also have increased risks – stillbirth, neonatal death, APGAR less than 7 at 5 minutes, ICU admission.(1)
Emotionally, the moms may suffer from postpartum depression or post-traumatic stress disorder. It is very likely that they were told many times during their stay in the hospital after their cesarean that they would never be able to have a vaginal birth after cesarean (VBAC) after that particular surgery. They likely heard that statement so many times that they believe it. When they find out that it is possible to have a vaginal birth after their Special Scar they may feel shocked, angry, betrayed or any combination of those. Sadly, there is no research about the emotional effects of these incisions on women.
Once the woman decides she wants to have a vaginal birth it can be very difficult to find a care provider who is willing to assist a VBAC after a Special Scar (VBASSC). The search usually requires calling many doctors and/or midwives before locating one that will attend a trial of labor. When a care provider is not initially open to the idea, it is usually best to not even try talking them into it. It is unlikely that you will be the one to change his or her mind. University hospitals tend to be more willing to assist due to their size and staff. Some home birth midwives are willing to attend VBASSCs when not legally restricted from doing so by their state.
Many care providers are unwilling to assist a VBASSC because the risk of rupture is slightly higher than the risk of rupture after a low transverse incision. The generally accepted risk of rupture for low transverse incisions is 0.4-0.9% while the risk of rupture for inverted T, classical and J incisions is 1.9%.(2) Interestingly, low vertical incisions have no more of an increase in the risk of rupture than low transverse incisions.(3) If the cesarean was performed preterm there is a minimal increase in the risk of rupture.(4) As we know from Dr. Sarah Buckley’s writings, if a woman is allowed to labor unhindered her birth much more likely to go as it was designed.
Clearly, there is a need for further studies on these scars, the effects on future pregnancies and the effects on the mother emotionally. The few studies that are available used a relatively small number of subjects. Therefore, without clear evidence of exceptional risk the woman and her partner should be the ones to make the decision whether or not she attempts to have a vaginal birth. Care providers should not be making decisions about VBASSC due to a level of fear or a lack of information. Indeed, if the care provider does have that much fear he or she should excuse themselves from serving the woman and let her find a care provider who is willing to serve her and trust her body to work as it was designed. There are already a number of women who have succeeded in having a VBASSC. To read their stories, for more information about this topic and access to the studies that I have mentioned, please visit http://www.specialscars.org.
(1) Patterson et al. Maternal and Perinatal Morbidity With Cesarean.Obstet Gynecol 2002;100:633-7
(2) Landon et al. Trial of Labor after Prior Cesarean Delivery. N Engl J Med 2004;351:2581-9.
(3) Shipp et al. Intrapartum Uterine Rupture. Obstet Gynecol 1999;94:735-40.
(4) Sciscione et al. Preterm Cesarean Delivery and Uterine Rupture. Obstet Gynecol 2008;111:648-53.
First published in Whole Woman Magazine, Winter 2011.
Saturday, November 6, 2010
Home Schooling Success
Brittany is quitting home school. She isn't quitting per say, she is going to take her test for the GED and move on with her life. When she first told me, I was disappointed and pissed, I felt like she was selling herself short. Colleges and employers don't look at GEDs the same way they used to since home schooling has become more prevalent. Is she really selling herself short? So what if she wants to be a housewife for the rest of her life and raise her babies at home? What the hell is wrong with that? Who says that she won't be able to create some fabulous job for herself. The girl is nothing if not creative. I can't function as a WOHM, I have to be home with my kids or I get a little batty. I think *I* suffer from separation anxiety.
When I started home schooling her I wanted her to grow up to be an independent thinker and do whatever she wanted to do. lol I got that in SPADES! When she told me she wanted to get her GED I thought I failed her, that I failed at home schooling her. In reality, she is a true home schooling success. It took a conversation with my mom (who originally was very worried about us home schooling) to see that.
As a little update, Brittany found an online high school where she could take a test and if she passed they would give her a high school diploma. We checked them out, they are accredited. She has already passed their test and did quite well on it.
When I started home schooling her I wanted her to grow up to be an independent thinker and do whatever she wanted to do. lol I got that in SPADES! When she told me she wanted to get her GED I thought I failed her, that I failed at home schooling her. In reality, she is a true home schooling success. It took a conversation with my mom (who originally was very worried about us home schooling) to see that.
As a little update, Brittany found an online high school where she could take a test and if she passed they would give her a high school diploma. We checked them out, they are accredited. She has already passed their test and did quite well on it.
Elimination Communication (EC)
Elimination Communication sounds like something that would require years of training right? lol Basically, it means learning your baby's cues that tell you when he or she is going to go potty or teaching your baby cues when to go potty. Yes, I know, it sounds crazy right? How could my infant possible know when they are going to go potty? Talk to someone who has done this and they will enthusiastically tell you about the moment when they made this connection with their child.
There are some people who sit their baby on their choice of potty many, many times a day. I applaud them, however, having 5 kids and being in school, I don't have that kind of time. I take a more relaxed approach to ECing. Whenever I change my baby's diaper I put him on the potty for a few minutes. I started this with Thalea, my 4th daughter, when she was about 2 months old and she was out of diapers during the day by the time she was 18 months old. In the last few months that she was in diapers, she wasn't using nearly as many as a toddler who hadn't been EC'd.
We started with my son, Thales, much earlier since we already had the potty and the theory. He's done fairly well so far, we've caught quite a few pees and poops. He started rejecting the potty a few weeks ago, so we have taken a little break, but will be starting again.
The way that I look at it is - every pee or poop that we catch in his little potty is another diaper that I don't have to wash. ;-)
There are some people who sit their baby on their choice of potty many, many times a day. I applaud them, however, having 5 kids and being in school, I don't have that kind of time. I take a more relaxed approach to ECing. Whenever I change my baby's diaper I put him on the potty for a few minutes. I started this with Thalea, my 4th daughter, when she was about 2 months old and she was out of diapers during the day by the time she was 18 months old. In the last few months that she was in diapers, she wasn't using nearly as many as a toddler who hadn't been EC'd.
We started with my son, Thales, much earlier since we already had the potty and the theory. He's done fairly well so far, we've caught quite a few pees and poops. He started rejecting the potty a few weeks ago, so we have taken a little break, but will be starting again.
The way that I look at it is - every pee or poop that we catch in his little potty is another diaper that I don't have to wash. ;-)
Sunday, August 15, 2010
So much to do, so little time.
Here is my first real post here. lol I got all my old posts moved over, that was a total PITA, but it's done.
My boy is 3 months old and is over 16lbs. He still nurses all the time, he will space those out eventually right? lol He does every once in a while, but usually it's still pretty frequent. We've been testing the EC waters with him and caught our first poop the other day! Yay!! Breastfeeding is going SO much better now, have a lot to write about that.
Haven't been able to do a lot of studying yet, the boy just won't let me. ;-) He's pretty cute and he's growing so fast, so it's ok that he's taking up so much of my time. I do sneak in a little here and there.
Still working on my Special Scars article and presentation, have lots more work to do though. Started a website for that purpose, but it's still under construction.
There's more but it's just boring day to day life stuff. ;-) Will be posting more soon!
My boy is 3 months old and is over 16lbs. He still nurses all the time, he will space those out eventually right? lol He does every once in a while, but usually it's still pretty frequent. We've been testing the EC waters with him and caught our first poop the other day! Yay!! Breastfeeding is going SO much better now, have a lot to write about that.
Haven't been able to do a lot of studying yet, the boy just won't let me. ;-) He's pretty cute and he's growing so fast, so it's ok that he's taking up so much of my time. I do sneak in a little here and there.
Still working on my Special Scars article and presentation, have lots more work to do though. Started a website for that purpose, but it's still under construction.
There's more but it's just boring day to day life stuff. ;-) Will be posting more soon!
My son is 8 wks old :-)
This was originally posted on my old blog on July 9, 2010.
I'm such a dork when it comes to this blog. lol I fail at Twitter too. ;-)
I posted a while back that I was almost 40 wks and then didn't post anything else. My son was born May 11th at 2:24pm, his story is here - http://www.jessicas-haven.com/pgnb/thales-birthstory.htm. He's so beautiful. :-)
We've had our share of breastfeeding problems, mostly latch issues. He's really run me through the gamut. :-/ He's really lucky that I like him and that I really want to breastfeed him. ;-) It would have been really easy to give up a few times, I nearly did.
There is a lot on my mind that I'd like to post about, but can't sort it all out enough to make a post that actually makes sense. lol
I'm such a dork when it comes to this blog. lol I fail at Twitter too. ;-)
I posted a while back that I was almost 40 wks and then didn't post anything else. My son was born May 11th at 2:24pm, his story is here - http://www.jessicas-haven.com/pgnb/thales-birthstory.htm. He's so beautiful. :-)
We've had our share of breastfeeding problems, mostly latch issues. He's really run me through the gamut. :-/ He's really lucky that I like him and that I really want to breastfeed him. ;-) It would have been really easy to give up a few times, I nearly did.
There is a lot on my mind that I'd like to post about, but can't sort it all out enough to make a post that actually makes sense. lol
Respect for OBs...
This was originally posted on my old blog on May 5, 2010.
I'm sure you are all familiar with the brain fog that coincides with the last few weeks of pregnancy and how exciting it is when it lifts even if only for a few minutes. :-) I had one of those moments this morning while responding to a post on BBC forums and I wanted to share.
The title of the post was "New respect for my OB". (Oh come on, you knew I'd have to respond to THAT.) The poster just had her 36 wk appt and her OB was talking about the 5 successful VBACs he had the previous week. Good for him, I'm glad he does them. He went on to tell her that he has to be immediately available for VBACs and exactly what that meant (that he be in the hospital the entire time the patient is in labor in the hospital). He went on to tell her that he lost $3000 because he had to cancel 2 days of appointments because of all these VBACs. "And he just does it because it's the right thing to do. He did say that its getting to the point where he is going to have to limit the number of VBACs that he accepts because its just too much and he doesn't want his wife getting out the divorce papers." She went on to say that she's sooooo happy to have found such a good doc and suggested that ins cos should provide incentives to docs who do VBACs, etc. All the responses that she got were yay, cool, good for you, etc.
Here's what I posted:
"Immediately available is an ACOG rule, which many hospitals/OBs use as an excuse to have VBAC bans. I think it was bad form, however, for him to try to elicit sympathy from you by telling you how much money he lost last week by having "so" many VBACs. If ACOG would encourage OBs to lower the primary c-section rate they wouldn't have so many VBACs to worry about.
And finally, I can understand the wife of an OB getting frustrated because of the amount of time that he spends away from the family, but that is his freaking job. If he already was an OB when they got married, she knew before she married him. If he decided to go to school while they were married, I'm sure they had many discussions about his future schedule. As a student midwife, I've already had many conversations with my husband about the fact that I might be gone for days at a time, might have to leave in the middle of sex, dinner, birthday parties, we might have to drive separately if we are going somewhere and I have a mom that's due. It's part of the job and you have to prepare yourself and your family for it. If you don't it's your own damn fault and if you do and then they get resentful either they didn't fully understand or they don't get the importance of what you're doing.
Sorry - overdue and getting pissy here. I just get tired of the OBs "Oh poor me" attitude because of what their trade union (ACOG) makes them do. If they don't like it they should leave the union or fight for changes in policy. *sigh*"
I'm sure you are all familiar with the brain fog that coincides with the last few weeks of pregnancy and how exciting it is when it lifts even if only for a few minutes. :-) I had one of those moments this morning while responding to a post on BBC forums and I wanted to share.
The title of the post was "New respect for my OB". (Oh come on, you knew I'd have to respond to THAT.) The poster just had her 36 wk appt and her OB was talking about the 5 successful VBACs he had the previous week. Good for him, I'm glad he does them. He went on to tell her that he has to be immediately available for VBACs and exactly what that meant (that he be in the hospital the entire time the patient is in labor in the hospital). He went on to tell her that he lost $3000 because he had to cancel 2 days of appointments because of all these VBACs. "And he just does it because it's the right thing to do. He did say that its getting to the point where he is going to have to limit the number of VBACs that he accepts because its just too much and he doesn't want his wife getting out the divorce papers." She went on to say that she's sooooo happy to have found such a good doc and suggested that ins cos should provide incentives to docs who do VBACs, etc. All the responses that she got were yay, cool, good for you, etc.
Here's what I posted:
"Immediately available is an ACOG rule, which many hospitals/OBs use as an excuse to have VBAC bans. I think it was bad form, however, for him to try to elicit sympathy from you by telling you how much money he lost last week by having "so" many VBACs. If ACOG would encourage OBs to lower the primary c-section rate they wouldn't have so many VBACs to worry about.
And finally, I can understand the wife of an OB getting frustrated because of the amount of time that he spends away from the family, but that is his freaking job. If he already was an OB when they got married, she knew before she married him. If he decided to go to school while they were married, I'm sure they had many discussions about his future schedule. As a student midwife, I've already had many conversations with my husband about the fact that I might be gone for days at a time, might have to leave in the middle of sex, dinner, birthday parties, we might have to drive separately if we are going somewhere and I have a mom that's due. It's part of the job and you have to prepare yourself and your family for it. If you don't it's your own damn fault and if you do and then they get resentful either they didn't fully understand or they don't get the importance of what you're doing.
Sorry - overdue and getting pissy here. I just get tired of the OBs "Oh poor me" attitude because of what their trade union (ACOG) makes them do. If they don't like it they should leave the union or fight for changes in policy. *sigh*"
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