Sunday, October 17, 2010

Show me the midwives, Missouri

First of all, no, I am not pregnant, and no I do not plan on becoming pregnant anytime before, say, they find a cure for hyperemesis gravidarum.

That being said, before I accepted this position in St. Louis, I did a quick little google search on the status of midwifery in Missouri. Again, this was not because I ever want to have another baby, but rather, because I just don't want to live in one of those states where midwifery is illegal. What I found was that until 2008, all midwives were illegal in Missouri. Even Certified Nurse Midwives. Can that really be true? Well, I read it on the internet, so who knows. But still, what the hell, Missouri.

Apparently in 2008, Missouri got its head out of its ass and Legalized It. CNMs, CPMs, the whole she-bang. Birth centers and even homebirth is now legal in Missouri. I was all, sign me up. Coming from Illinois, (where birth centers and homebirth midwives are illegal), this was quite a concept. If I ever lost my mind and decided to have another baby, it was nice to know I could do it at home.

So here I am, living in Missouri. Where midwifery, homebirth, and birth centers are legal, and my insurance even covers all these things. Great, right? Not so. Midwifery may be legal nowadays, but there are no midwives. Seriously. I've googled, I've read the phone book, I've googled some more, and I've studied the practitioners covered by my insurance plan. Although my plan specifically states that it covers all forms of midwives, birth centers, and home births, when I do a search for a midwife in my area, I get nothing. And birth centers? Ha. According to the internet, there is one birth center in all of Missouri. And it's in Kansas City, not St. Louis.

I keep thinking... I must be doing something wrong. I must not be typing the right search term into google when I am looking for Certified Nurse Midwives in St. Louis. The midwives (or at least Ob/Gyn practices that have a midwife on staff) must be listed somewhere in the 10,000 page St. Louis area phone book that I somehow missed.

The whole thing has become more urgent because I have mastitis, again. I've had at least 15 plugged ducts in the same exact area since Will was born, and I've had mastitis now 3 times. Since I don't have any kind of doctor here yet, I have no idea what to do but it seems obvious that this is not going away on its own. Of course I know that. It's mastitis. The affected area is red and as hard as concrete; yes, I know I'm supposed to keep nursing through it, but it hurts so bad each time that it brings me to tears. (On the plus side, Will is thrilled that I've offered to nurse him multiple times throughout the day; he would never dream of turning down an opportunity to nurse). No amount of Tylenol is making my fever go down. Everything hurts. My eyelashes hurt. My teeth hurt. My knees hurt. The stupid insurance company has never sent me my insurance card, and their website is "down" and not letting me print out a temporary ID. If I live through the night, I may try to go to a "Take Care" clinic a couple miles south of here, but I have no idea if they deal with mastitis or not and what they will do if I show up without an insurance card. Can they look me up? Hopefully. Oh, and get this, Will had diarrhea and projectile vomiting today, for the first time ever in his life. I am hoping it was just a fluke, but if he wakes up in the morning and seems sick, then obviously I will have to take care of him first. At least I have found a pediatrician for him, so hopefully they'll be able to work him in if he really needs to be seen. But the larger problem with all of this is that my employer has this policy wherein new employees cannot take any sick or vacation time for the first 6 months of their employment. So somehow I've got to (maybe) get both Will and me to a doctor and recover from mastitis all without taking any time off work.

I feel like that point during labor, when I asked my doula when my midwife would be arriving. My doula had the unfortunate task of telling me that my midwife was not on call that night and the OB in charge of the practice (who I had met only 1 time) would be "delivering" the baby. I became hysterical, beating my fist on the wall of the shower and crying out, "I WANT CAROL!" until I was too exhausted to continue. In retrospect, that is just the tiniest bit funny, but at the time, it certainly wasn't.

At any rate, if anyone out there finds this and has any insight into the midwife situation in Missouri/St. Louis, please do let me know. And if anyone can recommend someone to go to for non-pregnancy related female reproductive care, I am all ears. Ideally some place where I don't have to take 3 interstates to get there. Thanks.

Tuesday, October 12, 2010

Dear William (14 months)

Dear William,

Today you are 14 months old. You have learned a lot of new things this month. For example, you can now pick your nose. You find that hilarious. But your biggest new thing is waving. For many months you have been doing a 2-handed wave, which was really more like clapping than waving per se, but this past month you have started waving for real. You wave all the time, like crazy. You wave at me first thing in the morning when you wake up. You wave as I lay you down in your bed at night. You giggle and wave at the baby in the mirror.


Your dad claims that you have begun stacking blocks, but I have yet to see it. Just tonight, we were playing blocks, and you enjoyed banging them together and taking them in and out of a box, but there was no stacking. I think maybe your dad may have "helped" a little in this picture he took:

Stacking blocks

You have become an expert hugger. You always underfoot, standing and hugging me about the knees. When I pick you up, you wrap your arms around me in a big ole hug. It is so sweet. You also make your preference known as to who you want to hold you. For example, if your dad is holding you and you decide you want me, you hurl your body in my direction, while reaching your arms out.

For most of the month, the entire family unit has been sick, and that hasn't been fun. First, you got sick (presumably from daycare), and then I got sick (presumably from you), and then your dad got sick. It just keeps lingering. You haven't been sleeping very well, probably because your nose has been stuffed up. You haven't slept through the night in a very long time. Usually you wake up at some point in the night and I cannot get you to stop crying and go back to sleep unless I bring you to bed with me. You like to stretch out in the big bed with mom and dad. I don't like being woken up in the night, but I do like curling up with you in bed. One night the only way you would sleep was with your head on my throat. It was kind of uncomfortable for me, but to tell you the truth, I didn't mind. Now that I am gone at work all day, I don't get to see you as much, and I miss you a lot. Maybe you miss me too, and that is why you are waking up in the night and insisting on sleeping with your head on my throat.

We Broke Vegan this month, William. It just got too hard to keep you vegan at daycare. So finally I just gave up and said, fine, give him Nilla Wafers (they contain milk). And then I said, alright, he can have a cheese sandwich. And yogurt, of the non-vegan variety. It has been very hard for me to deal with. I've tried to give you the best, most healthiest foods your whole life. But the past several months, it has been so hard to get you to eat anything, that I've just run out of options. The irony is, you don't really go for the non-vegan things either. Well, you'll eat Nilla Wafers or crackers that contain milk protein, but you won't touch cheese or anything blatantly non-vegan. I don't blame you. Dairy is disgusting.

Speaking of vanilla wafers, though, I found some organic vegan ones at the store and got them the other day. Last night after dinner, we were all eating some, and you got this crazy idea to "feed" some to your dad and me. It was so cute. We would open our mouths and you would giggle and feed us each a cookie. You're great.

Love always,


Cheers to Cheerios

Tuesday, October 5, 2010

Is this normal?

I've been at my new job for around a month and a half now, and things are going well. Before all of this started, I had been terrified at the prospect of partially weaning Will. At 12 months old, he still nursed at least 5 times a day, and nursing was by far his favorite pastime. If I went too long without nursing him, he would begin to wail, crawl over to me, and pull down my shirt. I almost did not take this job because I didn't think Will would be able to handle going 8+ hours without the boob. He steadfastly refused to take a bottle, so it wasn't like sending him off to daycare with pumped milk would be an option. Besides, my bottle-feeding mom-friends told me that by this age, you're trying to get them off the bottle, not start them on it.

I just sort of closed my eyes, took a deep breath, trusted that it would somehow all work out, then called the department head and formally accepted the position. As soon as I hung up the phone, I wondered what the hell I was thinking.

But it has worked out. Somehow. Not perfectly. My god this has been stressful. You don't even know how stressful. I couldn't even begin to tell you the half of it. I'm pretty sure Will has developed dental enamel hypoplasias from drinking my stressed out milk and from living and breathing all the stress around him. It continues to be ridiculously stressful, but luckily, I am so busy that most of the time I do not even have the time to notice how stressed out I am. So I just keep going.

At any rate, since the beginning of August, I slowly worked at cutting down the amount of times I nursed Will each day. His nursing took a more dramatic hit when I started work on August 23rd, and an even more dramatic hit when he formally started daycare on September 7. Since then he has nursed only twice per day. I nurse him early in the morning as soon as he wakes, and then I nurse him once again in the evening before he goes to bed. On the weekends I sometimes nurse him more.

The thing is, it has been going pretty well for the most part. At least, I thought it was. He is just shy of 14 months now, and he is perfectly fine going without nursing all day long. That part is wonderful. It is a huge change from an entire year of my life, when I nursed him pretty much every 2 hours, all day long, just to keep him happy. In many ways, I feel like this is the best of the all possible worlds. I'm still nursing him, so he's getting all the health and immune benefits of breastmilk, I'm just only doing it twice a day instead of all day long like we had been doing for his entire life.

Here is the problem though. Now that we've been on this twice a day nursing schedule for a month or so, I am starting to feel like I've got no milk at all. It felt frighteningly like the first several months of his life when we were dealing with the hellishness of Low Milk Supply. I mean, I knew that I should naturally expect my milk supply to decrease as I decreased the amount of times I nursed him. But here is what I am afraid of: I am afraid that my milk will totally dry up and he'll end up weaned before either of us is ready.

Within the past week, I've really noticed how astonishingly little milk I have left. My nursing bras are gigantic on me. There are times when I'm nursing him when I don't feel a let-down and it really doesn't seem like there is any milk coming out at all. That's the thing that worries me the most. I really noticed it over the weekend when we were all sick. Will and I were both feverish and congested; he was fussy and I was too tired to do anything else to entertain him, so I just decided I'd nurse him multiple times throughout the day. And nothing came out. At least, it seemed like nothing came out. I was kind of too sick to notice or care about it a whole lot, but by now I am starting to freak out. Is my milk going to dry up completely? I am so not ready to wean him.

I realize, in the greater scheme of things, having nursed this baby for 14 months (and never given him one drop of formula, not one drop!), is nothing to sneeze at, and even the most dedicated lactivist (is that a pejorative term? I don't mean it to be so) would probably congratulate me on a job well done even if I were to stop nursing him today. Hell, I practically got a standing ovation at a La Leche League meeting when I told my story of everything we had been through to keep nursing and fend off formula when Will was just 4 months old. But I am not ready to quit nursing. I don't really have a target weaning age in mind, other than say, kindergarden. I mean, I personally see no reason not to nurse him until he is at least 3. Or at least 2. Whatever. Just something older than 14 months.

So, I just don't know... is it normal to have vanishingly little milk left at this point in the game, or have I reverted to the terror of Low Milk Supply that I somehow managed to get us through after Will was first born? Am I just extra paranoid about milk supply issues because of everything we went through? Is my milk going to completely dry up? Should I take something to prevent that from happening? Recall that I tried everything and nothing worked. Except for Domperidone, after about 8 weeks of 9 pills per day. I rifled through my stash of nursing supplies and found that I have about a week's supply of Domperidone left. Should I take it?

It's just that this is all kind of emotional for me. Realistically, I will probably never have another baby. I don't think there's anybody out there working on finding a cure for Hyperemesis Gravidarum or Babies That Cry 12 Hours Per Day, and I can't imagine ever living through either of those things again. So once we're done, we're done. Nursing has been hard, unimaginably hard, what with the low milk supply and the constant crying, and did I mention the low milk supply? But I am nowhere near ready to end it, and it makes me very sad to think that one day Will will be done nursing and that part of my life will be over forever.

At any rate, I'm in uncharted territory. I would appreciate feedback from anybody who's been there, done that. Is what's been happening a sign that my milk is on its way out? Or is it normal to have a low milk supply at this stage and maintain it for as long as you and the baby see fit?

Thanks for reading.