Thank you!

Thank you all for making 2014 a great year for Combat Boot Mama!  It means so much to me to be able to share my story with all of you and help spread awareness for issues like natural birth, birth trauma, cesarean sections, gentle parenting, and Thyroid Cancer. The WordPress.com stats helpers prepared a 2014 annual report for this blog, and it blows me away! Go and check it out!

Here’s an excerpt:

The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 23,000 times in 2014. If it were a concert at Sydney Opera House, it would take about 9 sold-out performances for that many people to see it.

Click here to see the complete report.

Switching Providers

If you’ve been following my story, you’ll remember that I’ve struggled a bit with the care that I have gotten thus far for my Thyroid Cancer.  The Endocrinologist that I have been seeing put me through a lot during this pregnancy – including taking me off of all of my Thyroid medications for three weeks during the first trimester.  I felt like they weren’t listening to me and respecting me as a patient.

Last week, I went for a second opinion appointment with another Endocrinologist based off of a recommendation from fellow mama and Thyca survivor.

After having a week to absorb everything I think I can finally say – I feel so blessed to have found a new provider!  I left the appointment feeling that my concerns had not only been listened to, but a plan that met with my expectations has been made! He was extremely concerned about the lack of medication for a prolonged period of time during first trimester, and stressed that they could have jeopardized my pregnancy and caused a miscarriage.  I praise God that my baby is healthy and strong and arriving soon!

He has agreed to return me to a natural desiccated thyroid (NDT) medication after the baby arrives, instead of continuing on the synthetic version. We decided that switching medications again during pregnancy is a risk, and although I am not feeling well I don’t want to jeopardize the baby by changing everything again. I was on NDT before we conceived, and felt so healthy and strong while I was on it! I will start NDT soon after birthing, and we will adjust it based on my symptoms – not just the lab numbers.  Once I have my Thyroid removed, he will work with me to make sure that the transition to being completely dependent upon the hormone replacement goes smoothly.

I am so thankful that I have been able to find a provider who hears my concerns, and takes me seriously as a patient.  I feel so relieved to be supported as we move forward. Having the freedom to switch providers to get the best care for me is amazing, and I want to emphasize again how thankful I am to not have to rely upon a military treatment facility for my care.

~Mama

CombatBootMama

Birth Plan Series: Cord Clamping

I’ve gotten a lot of feedback on my Visual Birth Plan post, and I love hearing from my readers!  An important part of making your birth plan is being informed of your choices.  I am starting a series of posts in which I look into the benefits and risks of different procedures throughout the birthing process that you can include on a Visual Birth Plan.

We are going to start the series by learning more about the umbilical cord and what our options are for cord clamping.

The umbilical cord has a key role during pregnancy:  It carries nutrients and oxygen to the baby from the placenta.  It has one vein that carries oxygen and nutrient rich blood from your placenta to your baby, and two arteries that return deoxygenated blood and waste products, like carbon dioxide, from your baby back to the placenta.  After birth, two clamps are placed on the cord and it is cut in between them, leaving a small stump that is about 1-2 inches long on what will become the baby’s belly button.  5-15 days later, the stump will dry out, turn dark and fall off. It’s important to keep the area clean and dry while it is healing to prevent infection.

Cord Clamping

According to ACOG, the umbilical cord is usually clamped between 15-30 seconds after the baby is born, but the ideal timing for clamping hasn’t been established so there is a continued debate on what is best. 80 mL of blood transfer occurs by 1 minute after birth, reaching approximately 100 mL at 3 minutes after birth.  This means that if the cord is clamped within 15-30 seconds of birth, the newborn is not receiving up to 140mL of blood.  In one study, this accounted for a 61% increase in blood volume (2). So what are the benefits and risks of delaying cord clamping?

Benefits:

  • Increased blood volume reducing the risk for blood transfusion; 30% increase in blood volume and up to a 60% increase in red blood cells (4)
  • Increased iron levels, decreasing and preventing iron deficiency in the first year of life (3)
  • Increased immunoglobulins and stem cells passed to baby (3)
  • Decreased incidence of intracranial hemorrhage in preterm infants (3)

Risks:

  • Increased risk of jaundice requiring phototherapy in term infants (3)

It is also important to note that a 2008 Chochran review found that there was no difference was found in early/late clamping in regards to immediate birth outcomes such as Apgar scores, umbilical cord pH, or respiratory distress caused by polycythemia (3). The same review also found that delaying cord clamping did not increase the risk of maternal hemorrhage.

If delayed cord clamping sounds like something you would like for your providers to do for you, add this icon to your Visual Birth Plan:

14 - BE8oZWw

There is not an “Early Cord Clamping” icon, as that is the routine time in which they perform this procedure and unless told otherwise, that is when your providers will most likely clamp the cord.

Did you have delayed cord clamping as part of your birthing experience? Do you think that it made a positive impact on your baby?  I’d love to hear more in the comments!

~Mama

CombatBootMama

Sources:

1. NHS. (15 NOV 14) What is the umbilical cord? Retrieved from http://www.nhs.uk/chq/pages/2299.aspx?categoryid=54

2. Robert Usher, Michael Shephard, and John Lind. (15 Nov 15) The Blood Volume of the Newborn Infant and Placental Transfusion. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.1963.tb03809.x/abstract

3. American Congress of Obstetrics and Gynecologists. (14 NOV 14) Committee Opinion Number 543, December 2012 “Timing of Umbilical Cord Clamping After Birth.” Retrieved from http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Timing-of-Umbilical-Cord-Clamping-After-Birth

4. Gina Eichenbaum-Pikser, CNM, MSN, Joanna S. Zasloff, CNM, MSN. (15 Nov 15) Delayed Clamping of the Umbilical cord: A Review with Implications for Practice. Retrieved from http://www.medscape.com/viewarticle/708616

Decluttering Social Media

Lately, it has felt like the posts that I most want to see on Facebook – my friends and family – are the ones I have the hardest time finding. They are buried by all of these other pages that are vying for my attention: news outlets, random brands, non-profits, even the social media page from the base I was stationed at five years ago…

During my first pregnancy, I went through this big urge to really reduce the “drama” in our lives. We worked hard to really focus on the friendships that we wanted to nurture because they were fulfilling to us, and to let the ones that felt like a burden go. If I remember correctly, my friends list on Facebook went from over 1,000 to less than 200 over a period of a few days. Phew! It made such a difference! No more “random-person-I-met-on-that-trip- that-seemed-cool-freshman-year-of-college” keeping me distracted from those who are closest to us. I didn’t make a big fuss about it, no flourish of a post to say goodbye, I simply just clicked the button. If they missed me, they would send me a new request (in which case I would usually reconnect).

I think it’s a very normal thing to take a moment and re-evaluate what we allow ourselves to be distracted by in our relationships, especially when going through a big life change like expecting a child. Social Media has helped us to increase the interaction between those we care about, but it has also allowed us to become obsessed with knowing the latest and greatest information and also increased our distractions.

My husband and I were sitting at lunch today and he (who by all means does not use Social Media that much) even commented that he is going to be stepping back a bit by reducing the pages that he gets notifications from and sees in his news feed.

What he said stayed on my mind as I returned to work this afternoon. So I went into my FB (don’t tell my boss!) and out of curiosity looked at how many pages I had “Liked.” 367 pages! Whoa! It made me wonder how that compared to my friends list. 256 friends. It is no wonder I feel my friends are being drowned out! I have so many other things – random things! – taking my attention away from the people I care about.

I started looking through those pages and discovered many that must have meant something to me at some point, but now they don’t hold as much appeal. I decided to go through the list and “unlike” anything that I didn’t need to see every day: Sports teams, random politicians, brands, places I had visited, news media outlets, online shopping websites and much more.

So what did I keep?

  • My church. Including the Women’s Ministry and our Church home from a previous duty station.
  • Personal Blog/Charity pages of people that I actually know – like my husband’s Ruck to Remember page, and the blog created by a friend chronicling their child’s battle with HLH.
  • Previous Army units that I want to stay updated on.
  • Team Red, White and Blue.
  • My Sorority.
  • My Chiropractor – they announce specials like BOGO massages on their page ya’ll!
  • The Hospital where I am to birth
  • My local news channel
  • Humans of New York – if you don’t already get their updates, it is an amazing page.

Now, this might seem counterintuitive, especially for a writer who is trying to get more people to “Like” my page on FB and to visit my blog. But my goal is to have an enriched life, and to enrich the lives of others, not to be distracted or be a distracter.

And as I switched my page back to my newsfeed, after purging more than 320 pages, my feed was filled with the faces and stories of my friends again! It was like a breath of fresh air! I can hardly believe that I didn’t do this sooner.

The next thing that I noticed is that it was now filled with posts to various groups that I am in – so I promptly decluttered my groups as well. I left several – “Fans of ____” pages and other random ones that frankly, I had even forgotten that I was in. And I “Unfollowed” the ones that remained so I have to make an effort to actually go into them and see the posts. As I returned to my newsfeed again – it was filled with even more amazing posts from friends and family! What a blessing!

Have you tried decluttering your Social Media connections lately? What real connections has it helped you to rediscover?

~Mama CombatBootMama

Weight Gain in Pregnancy

“I just left my OB/Midwife appointment and they told me that I’m gaining too much weight!”

This same or similar post has been posted in the birth month group that I am in on Facebook several times over the past few weeks.  It seems that providers all over the US and around the world are reminding their patients not to overdo their weight gain during pregnancy.

In 2009, the Institute of Medicine (IOM) released new guidelines after nearly two decades since their initial release.  The new guidelines are based upon the pre-pregnancy Body Mass Index (BMI) of the mother (Table 1).  It indicates a range for the total amount of weight that the mother should gain, as well as a rate per week during the second and third trimesters. In addition, the IOM indicated in their report that maternal obesity increased the risk of “high blood pressure, gestational diabetes, and an increased chance of needing a Cesarean delivery.”  But I wasn’t able to find how much your risk increases for those conditions. Whether it is a 1% increase or a 90% would make a big difference.

Institue of Medicine Maternal Weight Gain

So where do all those pounds go? According to the Mayo Clinic, here’s the break down:

  • Baby: 7 to 8 pounds (about 3 to 3.6 kilograms)
  • Larger breasts: 2 pounds (about 1 kilogram)
  • Larger uterus: 2 pounds (about 1 kilogram)
  • Placenta: 1 1/2 pounds (about 0.7 kilogram)
  • Amniotic fluid: 2 pounds (about 1 kilogram)
  • Increased blood volume: 3 to 4 pounds (about 1.4 to 1.8 kilograms)
  • Increased fluid volume: 3 to 4 pounds (about 1.4 to 1.8 kilograms)
  • Fat stores: 6 to 8 pounds (about 2.7 to 3.6 kilograms)

By that count, there are 31.5 pounds total to be gained. And that is if your baby is not more than 8 pounds (My son was 10!).  So is it realistic to expect women who are overweight or obese to gain less than that? These guidelines are important because providers want to ensure that women aren’t gaining too much weight – more than they can safely lose post-partum.  But what do they mean for those of us that already struggle with our weight in the first place?

Before this pregnancy, I weighed 170 pounds and I am 5′ 4″ tall, giving me a BMI of 29.2.  According to the IOM table, I should only gain 15-25 pounds during my pregnancy. So here I am, 25 weeks pregnant and I’ve already gained my allotted 25 pounds.  Which makes me wonder: What is more important, gaining within the guidelines or maintaining a healthy lifestyle?

I have continued to run during this pregnancy, even participating and finishing in long distances races like the Army Ten Miler at 23 weeks pregnant.  I usually run 2-3 times per week for 30 minutes at a time – the same as before pregnancy just at a slower pace.  I have continued a healthy and balanced diet, and added several vitamins to my intake to ensure that I’m getting everything that I need to stay healthy.  On average, I have been gaining one pound per week.  I was unable to find well reviewed research regarding the direct effect of Thyroid Cancer on weight gain during pregnancy, but my assumption is that it would not help the situation.

During my first pregnancy, I gained more than 60 pounds.  I did not monitor my diet at all and only took the prenatal vitamins given to me at the military treatment facility.  I participated in the Army Pregnancy Physical Fitness Program, but it was largely a joke to me – mostly walking in slow circles around the small on post gym because they were so averse to us running on our own outside. As my due date approached, the pounds piled on.  After my son was born, I lost all but five pounds of it within the first six months and lost another 20 by the time he turned one.

I think it is more important for women to maintain a healthy lifestyle than to chain themselves to a weight gain requirement. My goals for this pregnancy have included:

  1. Run two to three times per week until I must switch to walking, and then continue to walk.
  2. Decrease cravings based on deficiencies by adding vitamin and nutrient supplements with the goal of eliminating unneeded calories due to cravings.
  3. Gain less weight than I did during my first pregnancy (60 pounds).

So far, I’m doing well in sticking to these goals.

I think it is unrealistic for providers to expect every woman to stay within the boundaries of the IOM guidelines. I think it adds unnecessary stress for some women to worry about their weight when it may not necessarily be a dramatic risk factor in their pregnancy.  And as these providers continue to tell most women that they are gaining too much weight, it starts to dull the effect of their concern. Like the boy who cried “Wolf!” they will be less effective at getting women who truly do need to be concerned to pay attention.

~Mama CombatBootMama

 

Sources:

http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Weight-Gain-During-Pregnancy

http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

http://www.mayoclinic.org/healthy-living/pregnancy-week-by-week/in-depth/pregnancy-weight-gain/art-20044360

Being Proactive with Cancer and Pregnancy

I’m 25 weeks pregnant now, well into our adventure.  Over the past few weeks, I have felt more driven in making sure that I am well educated and proactive in my treatment – both for Thyroid Cancer and for Pregnancy.

As I entered the second trimester, I was looking forward to an increase in energy and a decrease in several symptoms that are generally associated with the first trimester.  As the weeks continued however, they did not cease but worsened.  I spoke with my Endocrinologist about increasing my medication, as I believe that the continuation of the symptoms was due to my ThyCa and a continuing rise of my TSH.  She refused, I appealed to her with several articles including the Endocrine Society guidelines on the Treatment of ThyCa during Pregnancy and she was steadfast in her refusal.  My labs continued to show a rising TSH week after week.  So I fired her.

I don’t recall ever firing a doctor before. Usually, I would just go along with whatever recommendation that they placed in front of me because they are the experts and they are supposed to know more than me.  Recently though, my intuition and my quality of life has become my priority.  If a care provider isn’t willing to listen to me – the one person who knows my body best – then they aren’t the right one for me.  It was actually rather anti-climactic.  Upon her refusal I made an appointment with someone else, and called and canceled with her.  Her receptionist asked if I wanted to reschedule and I said no.  And that was that.

I found a new provider who was willing to increase my medication as I requested, and since then I have started to feel better.  Increased energy, decreased hypothyroid symptoms, better healthy feelings overall.  I am still exploring a long-term solution, as this new provider does not want to prescribe my preferred medication, but in the mean time I feel more at ease about being heard and understood.

I am being seen by a midwife group that practices out of a large women’s hospital in the city nearby.  Up until my 20 week appointment, every midwife that I met there made me feel at home and comfortable and that my care was a priority.  My 24 week appointment was the first that I felt like I had a less than stellar appointment, and the midwife that I saw that day and I just didn’t click.  She was concerned about my weight gain (23 pounds at the time, an average of one pound per week – not the best but MUCH better than I was doing last pregnancy) and threatened to classify me as high risk which would jeopardize my chances for a VBAC.  I was really taken aback by her attitude.  But it was a great reminder to me that when you are being seen at a practice with ten different midwives, you really don’t know what you’re going to get every time you walk through those doors.

The next day, I called my Monitrice and set up a time to meet and talk over my 24 week appointment.  We discussed what was going on and it really helped me to focus on what I can and cannot control about when my baby arrives.  I cannot control what midwife is on duty at the time.  But I’m mitigating that by having a designated labor helper, my monitrice, be there through the whole labor.  What that means for me is that I can put out of my mind the uncertainty of who will be there at the hospital and I can focus on myself, my husband and my monitrice being on the same page and working together.

After that meeting, I knew even more that we made the absolute right decision in hiring a Monitrice.  Only 15 more weeks until our estimated birthing time, and I am feeling so blessed to have a great support team behind me.  God has really moved in our lives to make all of this possible, and I know that he wants what is best for me and my family.

 

~Mama

Halfway There – 20 Weeks Update

Thank you so much to all of my readers that have reached out to me with support! It has been a great blessing to know that there are prayers being said for our family and our health.

We are now halfway through the pregnancy – give or take depending on how late the baby arrives 😉 – and things are going well.  We had our anatomy scan a couple of weeks ago, and the baby is actually measuring a little bit ahead of where it should be but they didn’t change my due date at all.  But the baby is doing great! Ten fingers, ten toes, a healthy heartbeat and moving like crazy! We’ve decided NOT to find out if the baby is a boy or a girl – some surprises are just too good to get early!  We actually didn’t find out what our first was until his birth day either and I loved having that to look forward to.

I have continued to have hypothyroid symptoms during the pregnancy – and let’s face it a lot of pregnancy symptoms and hypothyroid symptoms are the same.  But I have been getting my labs drawn and kept in touch with my Endocrinologist.  I have started to have some concerns with how much experience she has treating patients during pregnancy with Thyroid Cancer though.  So I have reached out to a couple of other doctors in the area to get second opinions.  I think it’s especially important to use as many resources as possible to make sure that I am getting the best care that I can to keep both me and the baby healthy.  My days of not advocating for better care are behind me!

I also had a midwife appointment about two weeks ago, and she said everything is looking great.  Every time I go for an appointment I feel more and more secure and at peace with my decision of care providers for birthing.  I haven’t met a midwife in the practice yet that has not been supportive of our plans for VBAC.

It seems amazing that I have already made it to 20 weeks!  It seems like just yesterday that we found out we were expecting again!  I am excited to see what the rest of the pregnancy will hold for us as we wait to welcome the next member of our family.

~MamaCombatBootMama