Induction Advice

I know someone super pregnant who might have to be induced very soon, and I so badly wanna be my Know-It-All self and DM her this advice. But! That would be just as annoying as everyone was to me the day before my due date. Instead, I’ll put it here publicly so anyone in the future who might be getting induced can also access it.

First, think positive. I know being induced isn’t usually at the top of most people’s ideal birth scenario, but if it’s really happening- so many reasons it could be!- get on board with it. Instead of the rush of “Is this labor? I think so!!” and laboring around the house, calling your partner excitedly to get their booty home, scrambling to get your neighbor to watch the dog, you get to leisurely check your hospital bag, make the bed, and head to the hospital cool as a cucumber (well, relatively.) Every baby comes into this world differently; yours get to show up for an appointment!

My biggest piece of advice is to move your body. Once you’re admitted and the induction method is placed, you’ll likely have to lie prone for at least two hours. If this happens before bed- Yahtzee! I wish you the best possible sleep one can get while lying in a hospital knowing they’re hopefully meeting their baby the next day. There will be a limited window of time you’re off the monitors before you get checked and hooked up to Pitocin– this is the time for movement! I was lucky and got a full two hours to shower and eat breakfast before the doctor started her rounds. I didn’t take a seat until that doctor was at the foot of my bed, ready for my first check. I squatted in the shower, I did lunges across the room, I did high knees while eating toast. Help the induction method help you! If at all possible, don’t just lay there waiting for it to do all the work. Due to COVID, most of us can’t walk the hospital hallways, so make use of whatever space you have.

Finally, know that not all inductions end in the “cascade of interventions” you’ve likely read about if you’re trying to avoid a C-section. Sometimes the baby just needs a little nudge- even if you walk in zero percent dilated- and then it’s off to the races. Try to incorporate as much as possible about your original ideal birth scenario into your new induced one. Be open to pain management techniques you might not have originally wanted to try because, reader? Pitocin contractions are not messing around. I have nothing to compare them to, but Mamma Mia Pizzeria, they’re the real deal. No matter how your induction ends, there will be a baby at the end of it! No birthing person has ever been sent home with a baby to live inside of her forever because they just wouldn’t come out. By hook or crook, the time has come!

P.S. Hydrate. Even if you’re not getting induced. Pack a couple Gatorades.

Advice from Natalie

Natalie had her baby!!!

She’s already paying it forward and sharing words of wisdom to all of our other Natalies who are not-so-patiently gestating their offspring.

“I didn’t know how many people come in & pull down your pants just to check.”

DO THEY EVER!

If you weren’t yet aware, after you give birth, the nurses and doctors will come in quite regularly to push on your stomach (ow.) You’ll think everything inside gushed out when the kid made their exit, but ohhhh buddy is there more! This has a very important purpose– retained pieces of the placenta are no joke and can kill you– and you’ll quickly get used to it. Your postpartum high should keep it from hurting too much.

Aside from the pushing, they’ll likely still be up in your business checking on any tearing and stitching that was done. Even if you don’t want to wear the hospital gown for your whole stay (totally valid; other clothes make you feel a bit more fresh post-birth + HOW DO YOU TIE THOSE THINGS?!??!) this is a reason you might want to opt for a robe/ prettier gown option instead of sweatpants. Oh, and if you can’t pee within about two hours of giving birth, they’ll give you a catheter.

If you have a C-section, people will still be coming in to check on your incision and your uterus will still be expelling… stuff. You aren’t spared the weeks of lochia if your baby is born via Caesarean, unfortunately.

The Birth Story

Natalie is SUPER PREGNANT and will be giving birth this month (!!!!) At this point in my pregnancy, I had stopped consuming birth stories because I didn’t want to hear about anyone’s labor that wasn’t my own. I was a grumpy, frustrated mass of non-sleep over the fact that this kid wasn’t coming out a week or two early as I’d hoped. Since you’re probably not getting much comfortable sleep anyway, might as well read my first baby’s birth story, friend:

My pregnancy was almost boring in how unproblematic it was. We didn’t “see” the baby after the 20 week anatomy scan & the plan was to induce at 41 weeks if he didn’t come on his own. I had been 1 cm and 70% effaced at my 38 week appointment and then had zero change for the next two weeks. I’d had mild, sporadic period cramps for weeks that never amounted to anything, and I’d lost chunks of my mucus plug over the last three weeks. (If you’re reading this like MUCUS PLUG!??!?!? it’s exactly what it sounds like. And that’s what it looks like. If you can’t get your mind around a mucus plug, you might just wanna be completely unconscious for the birth because it doesn’t get any better from here.)

Mentally, I was crawling the walls because I’d started self-employed maternity leave when we moved houses at 36 weeks. (Do not recommend moving during the third trimester! But a million percent worth getting done before the baby arrives!) I did all the things: eating dates, having sex, walking day and night, drinking red raspberry leaf tea, bouncing on an exercise ball, labor-inducing massage… nothing happened. I was finally very physically uncomfortable at 39+5– breathing was getting really hard and I assumed it was because the baby had gotten quite big.

My OB practice has many doctors on staff, so I met a new-to-me doctor at my 40 week appointment. I was insanely out of breath just walking the one flight of stairs from the lobby to the OB clinic, but was told “well, yeah, you’re 40 weeks pregnant.” The nurse then said my blood pressure was “a bit high” which bowled me over because I have hereditarily low blood pressure, and my numbers had looked perfect all pregnancy. She read it at 144/80, and took it again at the end of the appointment- 128/88. The doctor didn’t love those numbers, but was pretty cavalier about the whole thing. He said my cervix wasn’t yet favorable so an induction wasn’t a great option. I was scheduled to come back on Thursday at 40+3 to check my blood pressure and see if they wanted to induce before the weekend. I asked if I should get an at home blood pressure cuff and he said no, just go right to the hospital if I experienced swelling or a sudden headache. I tried to not think about it the rest of the night, but I just didn’t feel awesome about the whole interaction. I told my husband if I was expected to just wait til Thursday for news of induction or not, I was at least going to get a cuff to monitor my own blood pressure.

The next morning, my at home blood pressure readings were 128/99 and 119/94. I had a bit of a headache but also hadn’t been sleeping well so didn’t want to read too much into it. The Internet told me the bottom number was quite alarming, but since the top ones weren’t insane, I was confused on what to do so left a message for the on-call nurse at my OB clinic. About an hour later, she called to say they were scheduling me for an induction later that night based on my blood pressure readings and that the baby was full term. Induction wasn’t part of my ideal birth scenario, but I was so ready to be done with pregnancy that I got pretty giddy.

They had me immediately go to a drive thru clinic to get a COVID swab, then we were to arrive at the hospital at 7:30 pm. The house was already pretty clean due to my severe boredom, so I took a long shower, checked and re-packed my hospital bag, told a select few friends what was happening, then curled my hair figuring it’d still look half-decent whenever I finally wore it down again. I think we had chili for dinner and watched an episode or two of Chopped, trying to play it cool but knowing that this was our last night of quiet for, like, ever.

After getting admitted and settled in at the hospital, Cervidil was placed at 8:30 pm. I was warned that for a first time mom at basically zero dilation, it wouldn’t be out of the ordinary to need multiple rounds or for this to take multiple days. (Um, no thank you! I’m here to have a baby ASAP!) They did give me an Ambien for sleep, which was somewhat effective given the circumstances; I got maybe 4-5 hours of broken sleep. The nurses started rounds at 6 am and it was a beautiful thing that they let me eat breakfast, have coffee, and take a shower before my next cervical check. The baby was super low, and the doctor was shocked I had gotten to 3 cm and 80% effaced overnight. We agreed she could break my water and then start Pitocin at a 2 at 8 am.

My ideal birth scenario was to labor without pain medication. The hospital was super respectful of my decisions and assigned me a nurse who was also a trained doula. She was an amazing support and taught me breathing techniques and suggested many different labor supports and positions. An hour and a half in, the Pitocin was upped to 6 and I was having doubts about my no meds decision. By 10 am (4 cm) I knew there was no way I was meeting this baby without pain management. The nurse was almost too good at respecting my wishes and I had to communicate many times that yes, I know I said I didn’t want an epidural, but that was the before times and I definitely want one now! It took until about 11:15 to get it placed, but it was 1,000% the right choice for me. I’m actually quite proud that normally inflexible me realized my limits. I remember thinking, “If I get to meet this baby today either way, why not take the help and be able to not completely hate the experience getting there?” It was a wonderful epidural for someone who still wanted to feel things– I could move my legs and DEFINITELY still feel pressure and some pain, it just no longer felt like an 18-wheeler semi truck of flames was ripping through my midsection every few minutes.

I was worried the epidural would stall labor, but I was at 7 cm by noon and my mood was markedly less demonic. I started getting the urge to bear down around 1 pm but I didn’t want to get my hopes up, so finally had the nurse check me at 1:40 and I was at a 10! The on call doctor was at another hospital so we tried some practice pushes shortly after 2 pm. Apparently I’m a real effective pusher (thanks, three years of obsessive barre exercise!) and I was told to STOP pushing. The doctor– whom I’d never met before!- delivered my son while running in with her gown untied at 2:43.

The epidural did not take all the pain of pushing away, and pushing was not my favorite part. It felt so unnatural to be pushing that hard and holding my breath- seriously a physical feat. I had a mild second degree tear and thank God I was obsessed with the baby on my chest so I could be distracted from the stitches that I could definitely feel getting sewn in. He was so slippery and cried so loud and for so long! I kept looking over my shoulder at my husband (good job staying away from the carnage, husband) like “Do you see him?! Do you see this?! This is happening?!” We did delayed cord clamping and then enjoyed skin-to-skin for an hour before they took him to get measured and cleaned up. Well, I enjoyed it– the baby shrieked like a pterodactyl for most of it. He was not happy about his sudden eviction.

…am I supposed to tell you about all the gory after parts now?? Maybe a different post. Just know that a lot of fluids will GUSH OUT OF YOU for a VERY LONG TIME after.

Your Hospital Stay

I might be a big birth nerd in that what happens inside a hospital, most especially in the maternity unit, fascinates me. I chose the medical route of doctors & a hospital birth for my first baby, and while I would definitely give birth in a hospital again, I will likely seek out midwifery care if there’s a baby 2.0 sometime in the future. But that’s a post for another time! This is all about the hospital stay, and I’m coming at it from my recent stint in labor + my PRN status as a hospital employee who gives maternity center tours on two area medical campuses. Obviously all hospitals are different, and I highly encourage you to seek out a virtual tour from your hospital or birth center if in-person tours aren’t currently an option.

BRING SNACKS. You’ll need to keep your energy up during labor, you’ll need to replenish your energy stores after giving birth, and your birthing partner will need to eat during their stay, too. Yes, hospitals have cafeterias and food delivery options and some have nourishment rooms with basic food supplies for birthing patients, but you will not regret bringing some of your own favorites. We also packed Powerade Zero because many doctors won’t let you consume anything besides clear liquids once you’re admitted. Ask if your hospital has a mini fridge in the room or a communal fridge so you can bring cold stuff, too!

Get vocal! I’m not talking about labor sounds– though some truly… interesting? primal sounds will escape your throat before that kid comes out– I’m saying use your voice to advocate for yourself and your baby about your hospital stay. ASK QUESTIONS! If you don’t get admitted knowing every single pain management option available to you like I did because I’m a nightmare know-it-all, ask. If you know there’s certain things you definitely want– delayed cord clamping, a certain person to cut the umbilical cord, no one in the room to speak because you want your voice to be the first thing baby hears– you gotta speak up. The hospital staff won’t judge you, they should let you know what’s allowed and what’s not (and why! Not just because they don’t feel like it.) They see hundreds of birthing patients a year; it’s their job to make this experience as safe and positive for you as possible.

Don’t be a hero. You’ll have the option of having baby sleep in the nursery at night (or have them hang out in the nursery any time you need a break.) A lot of first time moms think they’re a monster person if they take the nurses up on this offer, but don’t be a hero, Natalie. Maternity center nurses have chosen their profession because they really like babies– caring for babies in the nursery is kind of their thing. You’ll be leaving baby with the most highly qualified people available, so take them up on it, especially at night when you need sleep. They’ll still bring baby in when it’s time to eat, they should ask you in advance if it’s ok to give baby a pacifier in the nursery, they’ll bring your baby back the second you want them with you. You will be laying in bed, not sleeping, on your first night home with baby thinking, “Where are my angel nurses with their magical nursery and how can I get them to move in with me??”

Visitors? Ha. This is one area in which COVID has a silver lining. Many of our patients were upset at the beginning of the pandemic that no outside visitors were allowed, but have since said, “Best thing ever!” Grieving the moment your parents get to come meet their new grandchild in the hospital is completely valid, and a doctor I talked to said the only thing he misses is seeing a very proud big brother or sister holding their new baby sibling for the first time. But! Once that passes, not having visitors is something I would choose for any subsequent births, even after hospital visitor restrictions are lifted. Physically, so many things are still gushing out of your body even after the baby has exited. You might be trying to get the hang of breastfeeding, and the easiest option is to just kind of have your boobs out 24/7. You likely haven’t gotten a lot of sleep so your face looks like it got ran over with a truck. Hormonally, so much is happening– am I on Cloud 9? Am I not bonding with my baby yet like everyone said I would? How is my partner doing? Add in the amount of interruptions– nurses taking your vitals, pediatricians coming in to check on baby, hospital techs coming in to give them their first bath, lactation consultants popping in, food service employees dropping off and picking up trays– it’s a lot. As sad as my mother was that she had to wait until we were home to come meet her grandson, I can’t imagine when she would have ever dropped by the hospital that wouldn’t have added on a ton more stress to an already completely foreign situation.

Practice the car seat in advance. Legally, you can’t leave our hospital without a car seat, and the nurses aren’t allowed to make adjustments to it or baby. Not only does the base need to be properly installed in your vehicle, I highly recommend taking the time to figure out how the car seat operates before you have a very alive newborn to put in it. We did not do this, and watching my husband and I try to figure out how to get the poor kid strapped in had to be like watching a sad clown car on fire. We were stressed, baby got stressed, we couldn’t figure out the damn straps, and the nurse had to just stand nearby like a cheerleader and lightly suggest, “I think if you push that button, you can get more slack on the straps…” Practice with a teddy bear, borrow a neighbor kid, whatever you need to do to figure out what buckle goes where and which buttons make which handles move.

Take everything not nailed down. Giant pads? Peri bottle? Diapers? Wipes? Formula samples? Water bottles? TAKE ‘EM HOME. They’re yours now.

To bring: phone charger with an extra long cord, Chapstick because it’s dry AF in a hospital, whatever will make you feel slightly more human (fave shampoo? mascara? floss?) baby book if you want a set of baby’s footprints put right on the page, hair ties, a going home outfit that will make you feel a little bit less garbage-y before you go home and spend many weeks or months barely getting dressed, something for baby to wear home. There’s only about a thousand lists + YouTube videos on what to pack, but err on the side of keeping it light. Hopefully you and baby will be healthy, and you’ll only be spending 2-3 nights there.

Fed is Best

Natalie texted me a question this morning about breastfeeding. Instead of keeping this very personal and sometimes sensitive topic between friends, I decided to post the answer on the Internet where people are known for being totally reasonable and respectful, especially when it comes to stuff that is absolutely no one’s business like how you keep your child alive!

When I was pregnant, the plan was to 100% breastfeed my son for a couple reasons. 1- I am cheap and formula costs more cash money than breastmilk. (I’ve read you’re not supposed to say “it’s free!” because, as I learned, you’re paying a LOT in time, mental energy, did I mention time, oh yeah it takes up so much time, time time time. But we’ll get to that.) 2- I fully believe in the health benefits of breastfeeding for both mom and baby. It’s super cool that your body knows what specific antibodies your baby needs based on their saliva. That’s science!! 3- Bottles, formula, foreign stuff in my kid’s body- no thanks. Just whip out the boob for me, easy peasy!

I did a ton of reading, I got a breast pump, I got a hakaa, I got milk storage bags, I got nursing friendly clothes… you get it. Thankfully I wasn’t completely naive, and when people asked if I was planning to breastfeed (can we talk about THAT, by the way?? I know they’re just trying to be… I don’t know, helpful? But it’s weird. Don’t ask people that.) I would say, “If we’re able! That’s the plan, but I’ll do whatever we need to get him fed.”

After he was born, we did the golden hour of skin to skin and he did what so many newborns have biologically done before him & he wriggled his little brand new self down and latched like a champ. Success! I felt super lucky that it came so easy for us– he was a great eater in the hospital and we were on our way to my dream of exclusively breastfeeding for at least six, if not 12, months. What follows are a few things I’ve looked back on since and wondered if they contributed to the fact that I’m writing this next to a kid who’s been exclusively formula fed for over a month now, but I’ve had to accept that it doesn’t really matter. I can’t go back and change the past. I can learn from it if we have a second child and I want to try again, but in all the ways the fourth trimester have handed me my own ass, I choose to not let this be the thing that breaks me.

When the hospital lactation consultant came to visit, our son wasn’t in the room with us. I was a little concerned that she wasn’t actually able to assess him eating, but the nurses all reported things were going great, and the LC encouraged me to do follow up after we got home if we needed. He wasn’t in the room because he was getting circumcised (there! I said it! If you comment anything about our decision that doesn’t affect you AT. ALL. I will <insert empty threat here.>) This is important info, though, because after this procedure, babies are VERY TIRED. A newborn that is very tired will choose sleep over eating.

I was already pretty distraught that day because they told us the procedure would be happening that morning, then they said maybe not til the afternoon, then they came and got him for it just before 11 a.m. He was due for another feeding around 11:30 and I said, “Uhhhh isn’t he supposed to eat?” and long story short, he missed this feeding and wouldn’t wake up for his next one so he ended up going for like six hours without food. Six hours without food for a teeny tiny one day old baby is too many hours without food. He ended up finally waking up just enough to eat, but that night when they weighed him, the nurse said he was “close” to having lost 10% of his body weight and asked if were ok with them supplementing him with formula.

I knew from all my reading that this was a possibility, and I didn’t want to say, “No, please don’t feed my son if he needs it” so I agreed. They supplemented him with a couple mL of formula and no one died. He was just fine in the morning so he didn’t need any more supplementing. I found out later that the nurse was just being preemptive and that the hospital pediatrician never had a problem with his weight. A lesson for everyone doing this for the first time, ask questions! “Close” to 10% weight lost is not actually 10%. Turns out it was closer to 9 and while that doesn’t sound like that big of a difference, apparently it is when you’re only seven pounds.

ANYWAY– we get home, things are fine, then it’s nighttime on his third night of life. Around 10:30 p.m. it becomes apparent that our happy breastfeeding situation has come off the rails. Kid is HUNGRY and I don’t have enough of what he wants. I’d heard tales of women waking up nearly needing a new mattress after their milk came in, but mine just… never did. There was no, “Ta da! I’m here! We’ve officially switched from colostrum!” It did change to regular ol’ breastmilk, but in paltry amounts. Like, if we were on the prairie in the 1800s and I was his only source of food, this kid would have died. (Am I being dramatic? I don’t know!! I’m sure in the 1800s my body would have done what it needed to and hopefully ramped up production? But it didn’t in 2020!)

Thankfully before we had left the hospital, we had three little Similac sample bottles in our bassinet drawer from when they had supplemented him, so I just threw ’em in the diaper bag (Natalie, take everything in that hospital room that’s not nailed down. Seriously.) As I’m trying to comfort a screaming, hungry baby that first night home, my husband asked if he should go get one of those bottles. Every “Breast is best!” and formula-feeding horror (shame) story I’d read flooded my brain, but I was too tired to be proud in vain. I said yes, we popped that bottle in the kid’s mouth, and I promise you that was the most content I’d yet to see him.

I don’t want to make this long story longer, so we did combo feeding for two months. We would still breastfeed and I would pump, but he also got formula. I’d say about 20% of his consumption was breastmilk. Some breastfeeding zealots reading this are probably thinking, “Well duh, your body never made more milk because it never needed to.” i understand that if we had done a 24-hour lie in where I did nothing but offer the baby my boob for a full damn day, my body likely would have responded by ramping up production. But reader– I didn’t want to. Ooh it feels so spicy saying that aloud! Do you know how much time of your life is spent breastfeeding if that’s how your exclusively feeding your kid? A LOT. I’m not saying this to discourage anyone– I have so many friends who are doing it and they deserve a million dollars and a year’s vacation. I’m just telling you because I didn’t know. You can hear the statistic that you spend 40 hours a week breastfeeding your newborn, but until you’re living those 40 hours, you can’t yet feel them in your exhausted bones and soul.

Finally, a note on pumping. Again, it’s not evil, just want you to know that it’s not always the breezy set up the breast pump companies want you to believe it will be. It took me a few tries to find the right sized flanges for my pump, and I had a real not-loving relationship with it. I learned about myself that if it’s 3 a.m. and I’ve been up twice already since going to bed, I’m going to choose sleep over pumping every time. If I had a 40 minute window when baby was napping, pumping didn’t win out over feeding myself and showering. Of course I had a ton of guilt around this, and I felt shame when people (family… it’s always family) would ask how breastfeeding was going or offer tips to increase my supply.

I had to consciously work to reframe the narrative and think, “I’m giving my son what I can, and that’s enough. I’m proud of what I’m able to produce for him. No one’s story looks like anyone else’s story.” I’m thankful to have a very supportive partner who never pressured me either way. If anything, he felt thrilled he could contribute when we added bottles of pumped milk and formula so he could bond with the baby while feeding him. The overachieving part of my brain reads through this and sees the places where I “failed” or made choices that maybe could have produced a different outcome for our feeding tale, but I’ll never know. I had to let go of the dream of having a freezer stash of breastmilk, and instead be grateful for the reality of the (now very chunky) baby sitting in front of me. He’s happy and healthy, no matter how he came to grow that way.

Pregnancy Resources

Aside from my wiser, already-parent friends, there were a few places I turned to often for information in my pregnancy. God knows I’ll remember about a 100 more in the coming weeks, so this will be an evergreen post, possibly it’s own page! If you’re reading this & have something you think would be helpful for all our Natalies to check out, comment away.

  • The Birth Hour podcast: I was obsessed with listening to birth stories prior to my own labor experience. There’s a ton of birthing podcasts out there, but I appreciated the simple format of this one and the variety of birth stories shared by guests. Approximately .003 seconds after delivery, I couldn’t have cared less since I’d finally lived the real thing, so it’ll be interesting to see if I re-subscribe if this sucker ever gets a sibling.
  • Nurse Zabe on YouTube: She’s just so damn likeable! Nurses are the real MVP of the whole hospital experience, and Nurse Zabe (pronounced zay-buh, like the middle of EliZABEth) has a ton of experience as a labor & delivery and postpartum nurse in the southern USA. She just announced her third pregnancy and is making videos in real time about that, plus she’s famous for her “what your nurses do & don’t want you to pack in your hospital bag” videos.
  • Reddit. Yes, that Reddit. Even if you’ve never been on Reddit or think it’s the devil’s butthole of the Internet, there are private subreddits for expecting parents for each month of each year. It’s a community of thousands of people from around the world who are going through exactly what you’re going through at the same-ish time. Generally you search for yours towards the beginning of your pregnancy, then they go private around 20 weeks or so (each mod runs them differently.) For example, r/October2020Bumpers was my go-to for “Is this thing happening to you?” “How is pregnancy kicking your ass today?” and then they stay active after the babies are born and you have community from around the world when you’re posting “It’s 2 a.m. and I haven’t slept for weeks WHHHYYYYYY?!?!?” Warning: as people in your subreddit start giving birth, it will give you the false sense that you will also go into labor early. If you are, say, me, this will make you absolutely despondent that you’re still pregnant by week 39 and you should take a break from your beloved online community.