From Nurse to Gentle Birth Advocate, Part One, J.'s Birth Story

I feel like I am kind of going backwards here, but since I didn't discuss J.'s birth in detail in the story of his first year of life, I'm going to talk about his birth before I move on to other topics and experiences. I believe that how we birth has a strong influence on infant development, and it is something we need to be mindful of so we can make informed choices in our care.

I would say that I went into my first pregnancy with my expectations for birth colored by past experiences. I had supported a friend during labor and was present at the birth of her daughter. I witnessed several births when I was in nursing school. I heard the stories of other women's births. I had a realistic idea of what a hospital birth entailed, and I didn't see anything wrong with that. I wanted to have an unmedicated birth, but didn't really feel too strongly about it. I was just willing to wait and see how things went. I knew I didn't want a c section, but didn't know much about how commonly used interventions increased the risk of having a surgical birth.

I thought I knew pretty much what I needed to know. I had studied maternal/newborn nursing, I was aware of what the hospital routines were like. I signed up for a childbirth class, mainly so my husband would have some idea of what to expect. The hospital where I was to deliver was about 30 minutes away so I ended up taking the class at a closer hospital, just for convenience sake. It didn't really occur to me that there are different types of childbirth classes, so I didn't do much shopping around.

I did ask my OB a list of questions about his practice style, including c section rates and episiotomy rates, whether he used forceps or vacuum, and how frequently, that sort of thing. I had spent some time working in a newborn special care nursery, and had heard some horror stories about the use of vacuum and forceps, so I really wanted to avoid them. My OB said he did not use vacuum, but just the forceps and he wouldn't do anything that he wouldn't do for his own child. I was satisfied with that answer. I wrote a birth plan and went over it with my OB in the third trimester, he was agreeable to it and included the birth plan in my chart.

As I was nearing the end of my pregnancy, an ultrasound was scheduled. I don't recall the exact indication for the ultrasound, but it sounded pretty routine. The scan was done at 37 weeks and 4 days gestation. The baby's weight was estimated at 8 pounds, 2 ounces. I don't recall anyone mentioning that ultrasound estimates of weight could be off by up to a pound, so I was quite content to let the OB schedule an induction. I was getting very uncomfortable. It felt like that baby's foot was a knife sticking directly into my liver. From what I had heard, 37 weeks was considered full term. I thought, why not get him out while he still fit, right? I was actually rather annoyed that they wouldn't schedule it until he was close to 39 weeks. Not that they didn't do that, but his due date was toward the end of the week and inductions were normally scheduled at the beginning of the week. However, inducing for a suspected large baby does not decrease the risk of c section, nor does it decrease the risk of complications like shoulder dystocia. I never received any information on the risks and benefits of inducing from my obstetrician. I did get a heads up from my pediatrician, but unfortunately I didn't heed his warning.

Now, I had heard enough horror stories about pitocin inductions that I really wanted to avoid one if possible. So after discussing this with my OB, he suggested using cervidil to ripen my cervix. I didn't happen to have heard any cervidil horror stories. I was scheduled to come to the hospital on Tuesday April 9th, at 38 weeks 5 days. News flash! There are cervidil horror stories. This is one of them.

When I arrived at the hospital and got through the admitting process, the nurse put on the belts to measure contractions and the baby's heartbeat. To my surprise, she said that I was contracting at regular intervals. The only thing is, I didn't feel the contractions at all, so I didn't think they were particularly significant. I can't recall the details very well, but I believe I was about 1 cm dilated. The nurse inserted the cervidil, which looked like a little piece of gauze with a string attached. This allowed it to be removed if it caused contractions that were too strong. It didn't really do anything. I spent the day at the hospital and used some natural methods that the nurse suggested to try and get labor going. I walked up and down the halls and bounced on a birthing ball until I was sore and aching all over, but I did not go into labor. At the end of the day, they sent me home, but with the plan for me to return the next morning.

I didn't sleep that night, excited and wondering when I would go into labor and have my son. When I came back the next morning, still not in labor, they repeated the cervidil and after monitoring for a short time, sent me home with instructions . I was supposed to remove it if contractions became too strong. Late that afternoon I started having contractions that were uncomfortable, though not painful at first. They were regular. I decided to keep busy, running a few loads of laundry and making some dinner for my husband and myself. By the time I had the food ready, the contractions were strong enough that I wasn't enthused about the idea of eating. I started to time them around 7pm and they were 2 minutes apart for 1 hour. I called the doctor and received a call back from the OB on call. I asked if I should take out the cervidil because the contractions were so close, but she said no. But she did say to come in.

I arrived at the hospital around 9pm. I was still about 1 cm dilated. The admission was pretty straight forward, but the contractions were really intense so I was a little snappy. I believe there was some bad language involved. My husband commented on that later, but you know, he wasn't the one in labor. There were several painful attempts to get an IV in. I tried walking the halls but the contractions were coming every two minutes and I found it really hard to cope with them. A They were about a minute long so that meant I was contracting 50 percent of the time I was in labor. I learned later that a contraction pattern like this is not typical for early labor, and was almost certainly due to the use of cervidil. I tried getting into the shower but it didn't provide any relief. I thought I was such a wimp for not being able to handle the pain. Around 11 pm the nurse gave me a dose of Stadol in my IV. I felt nice and relaxed, for about a minute until the next contraction hit. After that it did nothing for me.

By 1 am I was about 2cm dilated, which was rather disappointing, and had an epidural placed. I wanted to wait longer but I felt like I couldn't cope with the contractions being so close together. It felt like a bolt of lightning went down my right leg when they put it in, and but it seemed to work. I felt myself jump involuntarily, thank goodness that I wasn't injured! At first one side was better than the other but after rolling onto my side it evened out. The contractions were no longer painful but I had severe heartburn with every single one of them. I tried to chew on ice chips for relief, but it didn't work very well. After the nurse left the room and the lights were turned off, I felt a pop and a warm sensation. I was pretty sure my water had just broken. I used the call button and the nurse came back in. I was correct. She checked the fluid, and got me settled again with dry bedding, then left.

After that, my husband and my only support person went to sleep. I was supposed to try to get some sleep too, but I was wide awake. Who could sleep with fire in their throat every two minutes? The husband was snoring, which irritated me. I threw some ice chips at him and growled at him to stop snoring. This, my friends, is why you hire a doula. Trust me, it's worth it. YOU are worth it. After a while I finally asked for something for the heartburn and was given some medication. At 4 am the nurse checked me, and to her surprise and mine, I was fully dilated. Did I want to push? Sure, I wanted to see the baby, why not? No one suggested that I labor down a little until I felt an urge to push. This mistake would lead to hours of pain and frustration.

There were a few decelerations throughout my labor at various times. I was told to quickly roll onto my left side and I did. I didn't think too much of it at the time, had seen similar scenarios when I was in nursing school. His heart rate did come back up with position change. They may have given me oxygen doing one of the decels, but I don't recall for sure.

Around the time that I was entering the second stage of labor, I started having severe pain very low in my abdomen that I felt through the epidural and which did not stop between contractions. They had been giving IV fluids for hours and I had not been up to use the bathroom. The nurse got 700 cc of urine out of my bladder with a catheter. That took care of the pain for the moment. I'm a little fuzzy on the exact timing, but I did start pushing soon afterward. I would guess that it was sometime around 4:30 to 5am. After about an hour I was in a lot of pain. The contractions hurt. A lot. I asked them accusingly, "What happened to my epidural?" They said it was still going. After 2 hours I said "this isn't working, I want you to use forceps." I wanted that child out, it seriously hurt. It hurt to push and it hurt not to push. They reminded me of my birth plan, that I said I didn't want forceps unless the baby was in distress.

I have to give the doctor credit for something, because he stayed with me from about this point on. Not too many obstetricians will spend more than 2 hours with a woman in the second stage of labor, but he did. He had far more empathy than the nurses or anyone else did. My husband was holding one leg when I pushed, and there was a nurse orienting that was holding the other leg. The only problem was, as soon as a contraction was over and I stopped pushing, they would just let my legs go. I was completely numb so I had to reach out and catch my legs with my hands so that they wouldn't hit the side rail. The doctor noticed this and set up the bed so that I could relax my legs in an elevated position without anyone having to hold them. He told them to help me hold my head up when pushing instead. I know stirrups get a bad rap, but since I was numb from the waist down, the leg supports were actually a huge relief. My neck was soooo tired, and having both neck and leg support for pushing helped tremendously. I didn't feel able to advocate for myself during this stage of labor, it was difficult even to speak. When I needed a sip of water after each push, I gestured toward the cup and made a noise. Why did I feel so helpless? In retrospect, I probably should have had them shut off the epidural and let me get out of the bed to push. I couldn't have imagined it at the time though, it was so painful even with it.

There were some good things that happened in the second stage. The hospital staff were very mindful of my birth plan. I got to see the baby's head with a mirror. I got to touch his head and feel his hair. I was really happy about that. It put me in a better frame of mind and gave me some strength to go on. The doctor that cared for me during the second stage of labor was NOT one of the doctors that has recommended the induction, nor was he involved in the process. My primary doctor went off call at 7 am and his partner came in at the end of this chain of events. In retrospect, I think we were lucky that this happened because he was probably the most supportive of vaginal birth of all the doctors in the group. He certainly had a great deal of patience, and a calm, soft spoken demeanor.

After another hour, the doctor looked at my husband and I and said "I don't think this is going to work." We thought he meant that he would need to do a c section, so when he asked if he could cut an episiotomy, it actually sounded good at that point. I was kind of thinking, if that is all you needed to do, why didn't you suggest that already? So he cut. I think he may have cut mediolateral incisions on both sides, but I'm not sure now. Our son entered the world about 15 minutes later, at 8:45 am.

After J.'s head and shoulders were born, the doctor told me to reach down. I think he realized how hard I had worked for this, and wanted to be sure I got the maximum reward for my efforts. I thought the baby was all the way out, but when I took hold of him under his arms and tried to lift him, I realized that he was only delivered to about his waist! Then he slid out and I lifted him onto my chest. I helped dry him gently with blankets and I talked to him. He looked right into my eyes and he didn't cry at all. My husband was a little worried but I knew the baby was fine. I was blissfully unaware of anything else for a few minutes. I do recall the doctor doing fundal massage and me telling the baby that "the doctor is really hurting me right now." A little mild panic in the room over bleeding and "we would like to give pitocin." Ok. I didn't even notice the birth of the placenta, I never saw it. J. had my complete attention. He was here and he was beautiful!

Of course it was a bit hard to look at him while laying flat on my back. But I didn't really notice that at the time. Wasn't our nurse pretty? She's making me look worse. LOL


I opted to allow the nurse to do his routine newborn care on the warmer while the doctor spent about 20 minutes stitching me up, as the process was rather uncomfortable. I was unaware at this time of the benefits of skin to skin care of the newborn. Interrupting this bonding time immediately after birth effects neurological development, breastfeeding, and the development of gut flora in the newborn. I now wonder how our first hours, days, and weeks and beyond might have been different if J. received uninterrupted skin to skin care in his first hours of life.


J.'s first cries came as he was transferred to the warmer. At the time we believed this was a normal part of newborn care. It never occurred to me that new babies should be cared for differently.

8 pounds, 1.5 ounces.

Dressed with hands covered. Eye ointment blurs vision.

I did feel much better, had a chance to change clothing and now sitting upright so I can see the baby better. J. nursed within an hour of his birth.

J.'s daddy holding him for the first time. My husband looks like someone who has also been up all night. Except for the nice, long nap after my water broke, of course.

It's been a long 8 years since this day. It's hard not to look back and think "What if things had been done differently?" We are sporting a few wrinkles and grey hairs. Can we blame him? ;-) Nah, he's too cute. Let's just blame the doctors. It's more fun.

Happy 8th Birthday, J. We love you!

Early Concerns to Autism Spectrum Diagnosis, The Toddler Years

As we moved beyond's J.'s first birthday, we were amazed at some of the skills that we saw developing. He rapidly added new words to his vocabulary, and his articulation was, for the most part, clear and distinct. However, subtle gaps in J.'s development began to slowly emerge. As new parents, some of these were quite difficult to recognize. It is important to note that developmental delays associated with some autistic spectrum diagnoses can be difficult to detect with commonly used developmental screening tools, such as the Denver Developmental Screening Test which our pediatrician uses.

Some early indicators of autism spectrum disorders include: problems with eye contact, orienting to one’s name, joint attention, pretend play, imitation, nonverbal communication, and language development. Most of these indicators were not assessed by out doctor's developmental checklists that we filled out at each visit. Because our son seemed to respond to his name and was actually advanced in language development, we thought there was no reason to be concerned.

During the second year of J.'s life, we took pride in his noteworthy accomplishments, and didn't notice the subtle areas in which his development lagged behind. He began to speak in short sentences by around 15 months. "Open the gate, go see Mommy?" J. began to sing parts of a few simple songs. He could also accurately name almost any shape, clearly articulating the words. Not just square, circle, triangle, but quickly moving on to even more complex shapes, like cross and octagon! He could also accurately name the color of each shape in his shape sorter. At 18 months he could count to 10, and he especially enjoyed counting the stairs as he climbed them. By 20 months J. could sing the entire alphabet song from memory. Before the age of two he learned to recite his address. By two years of age he could accurately name every capital letter, just from playing with his Fridge Phonics magnets. We read the book Ten Wriggly Wiggly Caterpillars, and within a couple weeks he was recognizing and naming the numbers,as well as counting the caterpillars. He appeared to understand the meaning of numbers, to grasp the fact that numbers indicate quantity.



In other ways, however, J.'s development seemed to lag. But there weren't really glaringly obvious red flags, at least not for us as first time parents. For example, J. liked blocks, but if they fell when he was trying to stack them, it was all over. He wanted us to build a tower so that he could knock them down. So I bought him duplo, and bristle blocks. I didn't really think much of it at the time. I believe that my son pointed to show us things, but when we pointed, he looked at our hands instead of what we were pointing at. He forgot to look at us when we would throw a ball to him to catch. There was also no pretend play developing.

My son did make eye contact during social interactions, but only briefly, and his gaze quickly and frequently shifted elsewhere. What we didn't realize then, was how much information is missed when eye contact is not maintained. Neurotypical children learn during the first year of life that the eyes convey important information. We often don't realize how many clues we gather by looking at another person's eyes. For example, most of us realize intuitively that what a person is looking at usually offers a valuable clue about what he or she is thinking. Most of us know, by looking at another person's eyes, in which general direction that person is looking. Most of us are able to use that information to guess what the other person is looking at and thinking about. But this information is often missed by an ASD child, as are subtle, or even fairly obvious mood changes in others. And looking back through a number of photos of J. in the first year or two of life, I saw only one in which J. is gazing directly into the eyes of another person. In that photo, he was less than 2 weeks old.



As my son gradually weaned from the breast to solid foods, our cuddle time seemed to rapidly disappear. He really had very little interest in being held when he was not nursing. He was in constant motion, but he didn't focus on any one thing for very long. My husband liked to refer to his behavior as "constant motion, constant destruction." J. had a real talent for getting into things he shouldn't. All the high spots in our house were filled with items that we needed to place out of reach. It looked like we were preparing for a flood. Even simple things, like the board books, needed to be kept out of reach when we weren't sitting and reading with J. Otherwise, J. would literally eat the books. Quite a few of the board books ended up having large bites taken out of them. The corners apparently were the best part!

When J. was around two years old, we began to enter a stage which I now like to refer to as "playdate disasters." J. absolutely enjoyed getting together with other children, but the visits sometimes were not as enjoyable for his friends. One of the problems we saw appeared to be impulsive behaviors combined with a lack of age appropriate awareness of cause and effect. Several incidents come to mind. The first one involved a set of wooden play food that we had recently acquired. I brought the toys out for him to share with his young friends who had come to visit. They children played nicely for a while, side by side, though not interacting, as I chatted with their mother nearby. Suddenly and without warning, J. picked up a wooden apple (which closely resembled a ball) and threw it at one of the children with all his might, striking his friend in the head. J. had thrown the toy hard enough to leave a "knot" on his friend's head, but he appeared totally dumbfounded by the outcome of his actions. I spoke to my son about the incident and he apologized to the friend when asked. However, within 6 months we had a similar incident, where J. struck the same child in the back with a wooden, toy sword with a great deal of force. This was not an act of anger. J. was equally dumbfounded by his friend's reaction, as he apparently believed that this was the normal, expected use of the toy. Finally, at 3 years of age, J. was playing with a group of children who were chasing each other around with blades of grass, tickling. J. picked up a rock and, when he had caught up with another child, hit the child on the head. He looked shocked when the other child began crying, as if it were totally unexpected. Fortunately, this was the last of these type of incidents, but, needless to say, we found it a bit difficult to find playdates for J. at this point.



The final red flags for an autism spectrum diagnosis were more subtle. A friend or two had pointed out that our son had an unusual manner of speaking during his third year. One suggested that we speak to our pediatrician about it, but was very vague about what it was that she was concerned about. Now that I know more about the speech patterns associated with Aspergers, I would guess that what she was referring to was a rather monotone manner of speaking, with little or no inflection. Since J. also had a rather advanced vocabulary for his age, she might have been referring to a pattern of careful and precise speech that is typical for Asperger's children, earning them the label of "little professor." Whatever it was that she noticed, our pediatrician was apparently not familiar with, because he found no specific problem at that point.

We did notice, that our son had an unusual manner of both asking questions and responding to them. However, since he was our first child, we assumed that this was a part of normal speech development, and were unaware that this signified a problem. If someone asked J. "How are you?", he would respond with some form of repeating the question, such as "How am I?" If J. wanted to ask an adult for something, he would phrase the question in a very odd manner. The most memorable example of this occurred when J. was about 28 months old. I had brought him to a McDonald's with a large play area so he could have a little outdoor time in a safe area. J. had to go down a short flight of steps to get to the play area. He had a tendency to be overly cautious about stairs, so even though he was holding the railing, he also wanted to hold my hand. Except that I was not sitting at the table nearest to the stairs. Another adult was sitting at that table, probably the father of another child. J. looked up at the man, and asked "Do you want to hold Mommy's hand?" Yes, I wished for a hole in the floor to swallow me up, but the man thankfully realized what J. meant, and responded "No, I think you want to hold Mommy's hand." It wasn't until years later that I became aware that these are forms of echolalia, which frequently occurs in toddlers with autism. J. also repeated lines from movies frequently, which is yet another form of echolalia. Verbal autistic children do often echo back what they hear, but it can be and is often delayed so they repeat what they have heard later on and in another context. This is clearly what we saw with our son, but unfortunately did not understand it well enough to bring to the attention of our pediatrician.

To be continued...


Want to see some video clips comparing normally developing infants and toddlers with children with social cognitive deficits, such as autism? Autism Speaks has a wonderful autism video glossary that you can use if you register (for free).

Early Concerns to Autism Spectrum Diagnosis, the First Year

Our oldest son was diagnosed with Asperger Syndrome at the age of 5 years. For me, it was in many ways, a relief. An explanation for what was from the start, a difficult transition into parenting a child. A reason for the problem behaviors that were so hard to work through with our son. An answer to some of the puzzling questions about J.

While the timeline begins to fade from view, there are still many memories that come to mind when thinking back to the first days and months with J., now nearly 8 years of age. He was our first child, and despite my experiences working as a pediatric nurse, often in the Newborn Special Care Unit, the beginning of motherhood was rocky and unfamiliar. My recovery from his birth was painful and it was accompanied by insomnia, anxiety, and difficulties with breastfeeding.

We brought our son home from the hospital about 36 hours after his birth. We could have stayed another night, but I requested an early discharge, thinking that I would be able to sleep better and be more comfortable at home. Sleep problems continued, and breastfeeding was difficult and painful. My doctor prescribed Ambien to help me sleep for the first couple of weeks. I was put on antibiotics about 10 days after J.'s birth for a urinary tract infection. Though my postpartum symptoms gradually improved, the antibiotics I was taking seemed to make my son very irritable. At 2 weeks, my son was still below his birthweight, but only by an ounce. He received his first vaccination at this time, for Hepatitis B. I went to see a lactation consultant to work on breastfeeding, which continued to be painful. The irritability continued, but we were hopeful that things would improve once I had finished the course of antibiotics.

The lactation consultant, a pediatrician whose practice focused solely on breastfeeding medicine, diagnosed thrush as the cause of painful breastfeeding. We supplemented my son with about one bottle of formula per day to help him catch up a little with weight gain, but she was not overly concerned. I pumped while his father fed him the bottle every evening. My son began gaining more quickly, but I noticed that the formula seemed to make him more irritable at night, so we stopped it quickly. Through reading internet sources and speaking with the IBCLC, I quickly became aware that I had far more milk than I needed for my baby. Though my son wanted to nurse constantly and for hours on end, he choked with every letdown, clamped his jaws, pulled and tugged, and had some serious diaper blowouts. He grew rapidly in both length and weight. He continued to be very colicky for the first 4 months or so.



The IBCLC referred to my son as a "Zero to 60 baby." He could go from asleep to screaming bloody murder in about 3 seconds flat. We tried Mylicon. We tried gripe water. Nothing seemed to help much. He also earned the description of "one of those babies that swears." We wanted to practice attachment parenting, but this high need baby was a serious challenge.

There were a few concerns in the early months that, in retrospect, were probably sensory in nature. While my son did seem to have a great enjoyment for music, he certainly seemed to hate the mobile that I had chosen for him, at least at first. When I placed him under the mobile he would scream and look away. When the mobile was detached and he only heard the music, he was more likely to be calm and listen briefly. We also had a "Kick and Play" type gym that he seemed to enjoy occasionally, but he would kick it with so much force that it would quickly slide away from him. One he had teeth, he chewed his toys more like a puppy than a baby. I could not believe the deep gouges that J. could put into a teething toy. I shudder to think of what types of plastic he probably ingested.

As the months passed, J. began to meet some developmental milestones, seemingly in timely fashion. But something didn't seem quite right. He rolled over maybe once or twice by the time he was 6 months old. Generally when placed on the floor, he would flail helplessly like a beetle that was turned onto its back. He would scream until I picked him up. Tummy time seemed like a wonderful way to make him very angry, very fast. But he continued to meet gross and fine motor milestones on target. Sort of. For example, he did go through the motions of crawling, briefly. But what he mainly did was drag himself around on his butt. When he learned to pull himself up and cruise, that was pretty much the end of any attempt at crawling. At 12 1/2 months, he began to walk.



However, speech was a different story. Our son made a lot of sounds very early on. When he was a few months old, a nurse who helped run a mother's group I attended pointed out how my son was very attentive to the conversation. I looked at J., and saw that he was following the conversation around the room, turning his head and fixing his gaze directly on whoever was speaking. I recall taking him for his 4 month checkup. He was babbling away, having a wonderful conversation in baby-talk. The nurse said "He's going to talk early." And she was right. At 7 months, J. uttered his first word. My husband noticed it before I did, but I didn't believe him. Then I saw J. look up at a photograph on the wall of our dog. He said "Kay-ee." My 7 month old son had just said the name of our dog, Katie. And he knew exactly what he was talking about. By 9 months, my son had a half dozen words under his belt, and his speech was quite intelligible.

During the second half of his first year, my son continued to nurse very frequently, though the marathon sessions were slightly less frequent. I started him on some solid foods, mainly preparing my own baby food in batches. We used some organic jarred food occasionally. I tried to introduce a variety of vegetables and fruits. We also made a homemade porridge from brown rice and later added a few types of beans. He liked sweet foods but introducing new foods was very difficult. Being anxious to see him cut back a little on the constant nursing, and not realizing the importance of developing a taste for a variety of foods, I simply mixed the new foods with banana or sweet potato. Things that he already liked hid the new foods. By the time he was a toddler, mealtime was beginning to become a battle. But even with his preferred foods, we noticed some difficulties. As a toddler, J. began to eat preferred foods very rapidly without chewing. Sometimes he would overeat, vomit his entire meal, and then ask for more food.

Speaking of battles, somehow J. missed the memo on naps for babies. While my son slept very well between feedings at night by about 6 months of age, daytime was a whole different matter. In the early months, it was difficult to move him at all once he was asleep. I would nurse him to sleep, then slide him from our bed into his cosleeper, at which point he would immediately awaken. He would scream until I nursed him, yet again. He slept in our bed for a while, and when I caught up on my own sleep, I tried moving him to the cosleeper again. Eventually we worked that out, and we all rested better at night. But I still found the lack of a clear napping pattern to be quite frustrating. He would sleep, but wanted to remain latched on the entire time he was asleep. By the time he was approaching one year, I managed to work in an afternoon nap for J. through a combination of cry-it-out and using a pacifier. Eventually he could be transitioned from breast, to pacifier, to crib. It wasn't an easy feat to accomplish, though. For the record, I no longer believe that crying it out is an answer to sleep problems. At the time, I felt desperate for just a little time to myself, a brief reprieve from the very intense 24-7 of parenting J.

To be continued...