Jenny Novak, MEP, CEM®

Emergency Manager | Speaker | Writer

Category: Personal Resilience

Breastfeeding: Challenges and Solutions for New Moms

How is Breastfeeding ‘Hard’?

I was very lucky in my pregnancy because it was relatively easy. I was happy, I was pain-free, I didn’t get morning sickness and I was able to go on long daily walks right up until the day of my induction. By far the hardest part of the whole parenting experience for me so far has been the so-called ‘fourth trimester’ or post-partum period. Particularly the very first 3-4 weeks was the most difficult and the main reason was breastfeeding. As special, important, and beautiful that breastfeeding can be, it can also be an incredibly painful, anxiety inducting, emotion laden imprisonment. I am happy to say that Scarlett and I have a great breastfeeding relationship now, but there were definitely dark, difficult times in the beginning when I often questioned how others could find it so amazing and whether it was for me.

I had heard from many sources that breastfeeding can be ‘hard’ or ‘frustrating’ or ‘challenging’ while I was pregnant. I took a 90 minute class at Kaiser where the instructor basically told us we had no excuse to not breastfeed. It wasn’t very helpful. I really didn’t know what, if anything, I could do to prepare for breastfeeding before Scarlett was born. I focused all my energy on preparing for the labor and delivery because breastfeeding was a big unknown and I assumed we would naturally find our way. I still don’t think there is much you can do to physically prepare for it, but I do think that really understanding what those first few weeks might be like could help you prepare mentally.

In this post I want to share the nitty gritty of my experience in hopes it might help someone. I know my experience wasn’t the easiest that could be had, but I also know that it wasn’t the most challenging. I am not a lactation expert of any kind, all I can do is genuinely convey what my world was like for the first few weeks, explain what makes it ‘hard’ and solutions that I used to cope.

My anchor in the early days.

Time Consuming

The first big surprise to me was how time consuming it was. I don’t think that I really realized how often newborns need to feed before I had one. The rule of thumb is pretty much every two hours and this includes through the night. If you are breastfeeding ‘on demand’ though you watch for feeding cues from the infant and feed them more often if they desire it. Some newborns will ‘cluster feed’ which basically means feeding nearly constantly or with very short breaks between sessions. So be prepared to literally not have time for anything else in the beginning. The frequency is counted from the beginning of the feed, so if you feed at 8AM expect to do so again at 10AM, 12PM, 2PM, etc. In the beginning, my baby wanted her feeding sessions to be extremely lengthy. It was not uncommon for her to go 30-40 minutes on one side before even switching to the next. My sessions sometimes lasted more than an hour, they were regularly 40 minutes. That’s what I planned for every time. So if I needed to feed her in public, it meant excusing myself from the activity to go to the car and feed her for 40 minutes. If we had visitors, I excused myself to her room for a 40 minute feeding. If you do the math, you also realize that it leaves very little time to do much else before the next feeding commences. You get used to living basically an hour on, an hour off, for weeks. And if you are trying to also pump after each feed to increase your supply, expect to spend an additional 15 minutes or so doing that afterward. The pace was grueling, the emotions ran high, I was struggling to nourish this precarious new life and set my motherhood on the right course.

Time itself seemed to transform. It was no longer a marker for my working hours, meeting up with a friend or when the game started. It was a tracking device for my every movement—for a while I was instructed to feed 15 minutes on each side—no more, no less. I then needed to pump for 15 more minutes. I would have gone insane without a clock to time this, to give myself pep talks—just five more minutes to go. When we changed her, we took note of the time. The clock measured my life in a way that I never knew it could. I was “off work” and freed from any time dictated obligations, yet I was more bound to the minutes that passed than ever before. I tracked the time in small increments, without much thought at all to whole days passing or what the date was.

I also didn’t realize that I would need both hands to feed her. One hand to guide my breast toward her mouth and cup it into a ‘sandwich’ and the other to guide / hold her head so that she correctly faced the breast and give us the best chances of getting a good latch on one of the first few tries. This meant that I wasn’t able to read, scroll through my phone, get a drink of water, blow my nose or anything that I might have wanted to do to occupy my mind for 40-60 minutes each session. This is why having some shows lined up to binge watch hands free can be such a lifesaver while breastfeeding!

Incredibly Painful

As much as I had been told that breastfeeding might hurt, I was unprepared for the true physical pain of it. Somehow between leaving the hospital on Friday afternoon and visiting the lactation consultant Saturday morning Scarlett managed to shred my nipples. They were scabbed over, but the thin scabs ripped and oozed fresh blood each time my hungry baby attempted to feed. I inhaled sharply and yelped ‘ouch’ and other obscenities each time she tried to latch on. I think she could sense my negative energy and instinctively knew that the metallic taste of blood was not the sweet milk her body craved. That Friday night became the night of hell as our baby screamed, wailed, and lashed out at us inconsolably as her face scrunched redder, angrier and hungrier as the hours wore on sleeplessly. When the lactation consultant saw my nipples, scabbed over and adorned with hickey-type purple ridges she knew that I needed a break. I had expected some version of ‘power through it’ which I had heard from countless friends and stories on the Birth Hour podcast. When I pumped only a few drops of colostrum after 15 minutes, she told us firmly that we needed to supplement with formula so that she could get her weight back up after losing 10% of her birth weight. She assured me that it was just a rest for a few days for my nipples to heal and I could still pump to stimulate milk production. I cried raw, unrestrained tears there in the office, trying to come to terms with my failure yet thankful that she had granted me some respite from my torturous endeavor. I also felt ashamed and embarrassed because I had wanted so badly to be a part of the ‘exclusive breastfeeding’ club. While we were able to resume direct breastfeeding after a few days and it became easier when my milk came in it was definitely not pain free until the next month. The latch would send searing pain rippling through my chest and I would have to gear up and brace myself for it when she began feeding. I would exhale slowly and count in my head, using some of the same strategies that had gotten me through her labor. I also felt the strangest tingling and burning sensation throughout my breasts after each feed. It was as if the milk was being regenerated and I could feel that sensation as they refilled slowly. It was uncomfortable and each time I longed for the relief of warm water or a compress. This was every day, 8-10 times per day. It only got better incrementally, so slowly that you could barely notice improvement but by eight weeks nursing was pain free.

Scarlett sleeps after a feeding.

Failure and Rejection

Breastfeeding is the natural way for us mammals to feed our offspring. That is why so many people assume it will be easy or that they can just figure it out. It is also why failing at it feels like the ultimate, deepest, most personal failure. What is wrong with me if I can’t even feed my baby? Am I just not cut out for motherhood? How can some people enjoy this? These types of thoughts ran through my head and tears sprung from my eyes when Scarlett turned her head away from my breast, howling from hunger but unwilling to suckle. She was frustrated with failing to latch too and horribly hungry. I wanted to help her but I felt powerless to force my breast into her mouth in the correct position and stimulate her to suck to extract milk. As we continued to try I swatted away the help or advice my mother and mother in law tried to provide. I wallowed in feeling a deep, personal rejection by my daughter when she would not feed from my breast. I felt so small, like I wasn’t fit to perform this function that should be instinctual. My own child did not want anything to do with momma’s milk and I was miserable. My husband can attest that on more than one occasion I screamed out of despair, pain and frustration, “I hate breastfeeding!” I felt inadequate as a mother and ultimately a human being. How could the wail and turned cheek of a baby reduce me to a worthless, sobbing pile of nothingness the way that it did? Somehow feeding my daughter was more mentally challenging than responding to a disaster, crafting an emergency plan, battling cancer, or any other obstacle I had yet faced in my life.

Scarlett naps on the Brest Friend nursing pillow.

Literally Draining

I did not expect the hunger and the exhaustion. Breastfeeding is draining as the calories and nourishment from your own body is literally sucked into another. I have read that you burn an extra 500 calories a day. I thought I was eating for two while pregnant, but I felt the most ravenous hunger of my life while breastfeeding. I needed to eat immediately in the morning and I couldn’t last from one meal to the next without significant snacking in between. The compounding factor was that I was in the heat of surgery recovery while learning to do this. Physically, I was not at my best to take on this most difficult journey. I was still on pain medication around the clock and there was just so much to keep track of. I had to document my pill schedule as well as every feeding, how long she fed directly on breast, how many ounces we supplemented, whether it was breastmilk or formula, every time she had a wet diaper, a dirty diaper, and even her naps. I felt like I was going mad trying to document all this while it was happening. I was totally sleep deprived and absolutely running on empty. I still couldn’t get up and down from a seating position without assistance. My brain was racing around writing checks my body couldn’t begin to cash. I needed to eat and I needed to sleep, but feeding her was my life’s purpose and I was the only one that could do it. It was incredibly taxing.

The Pressure

Another mental and emotional challenge was the pressure of being the only one that could feed her. As many people that surrounded us offering help and support it still came down to me as the mother to be able to breastfeed her. It was my sole responsibility and I felt that I could never truly get a break. Even when we supplemented with formula I would have to be pumping simultaneously to make sure my supply kept up. Even if my husband or mom offered to take over one of the nighttime feeds, I couldn’t really rest because I knew I needed to be pumping so that my body would know what her demand really was. I had been educated on how critical those first few weeks would be to shape the future of our breastfeeding journey. It was an immense amount of pressure that I had not anticipated. I also did not want to give up. I didn’t want to fail at giving her what had been ingrained into my head as the most wonderful gift a mother could bestow. I had heard and read so much about all the benefits of breastfeeding, the way your body adapts to give the infant exactly what she needs based on a feedback mechanism through her saliva while attached to the nipple. I didn’t want to deprive her of this because I was too weak or exhausted. I felt an incredible amount of social pressure to keep going from the constant dialogue on how superior breastmilk is to formula. Though every day I felt that switching to a bottle would be such a mental and emotional relief. Finally we could share the responsibility of feeding her and some of my burden could be alleviated. But I endured, hoping that I would find a light in the end of the tunnel. And I did.

Tired Mama and Baby.

Solutions

Here are some things that helped me, by no means is this a definitive guide or am I suggesting that all of these things will help every person. But I know I wouldn’t have made it through my own journey without some of these external factors.

Lactation Consultants

I must give a huge shout out to Kaiser Permanente’s South Bay Lactation Center. We met with two different lactation consultants there and both were extremely helpful. It was amazing to already have the appointment set up for the day after we were released for the hospital. Even though we were struggling so much I feel like I still would’ve hesitated to reach out for help, too stubborn to accept that I needed assistance. They always set follow up appointments for us, taking the questioning of whether to go back out of the equation. They made it seem normal to struggle. They were able to hook me up with two free months of a hospital grade breast pump for home usage, which was oh so helpful. They have a super precise scale that will weigh baby before and after a feeding so that you can actually know how many ounces (or milliliters) he or she is transferring. This was extremely helpful, validating that we were making progress and giving me peace of mind that she wasn’t going hungry after I fed her directly on the breast since we had no way to measure at home. They also would observe the latch and make sure you were getting it right. I felt like I had the opportunity to ask questions and better understand what was happening. They gave us a detailed print out of instructions after each visit, which was so crucial since my mind was literally mush at that time—trying to keep track of all the tiny details of Scarlett’s life made it hard to remember what was said during conversations.

The gel soothing pads and nipple butter I used.

Accessories

There are a few things I would recommend for those of you embarking on your first breastfeeding journey. Gel soothing pads were a huge, huge help for me in the first few weeks. My nipples were always some degree of sore around the clock and these really helped to take the edge off. I would put them in the refrigerator during each feed / pumping session and then they’d provide instant cool relief as soon as I was done. Nipple butters were also a regimen that I indulged in, I had two different kinds and I kept one in the bathroom and one next to my nursing station so that I could apply as needed. It may seem basic but showering was huge. I always hear moms say that they go days without showering while taking care of little ones, but I seriously don’t think I could’ve functioned without it. Each day it was the one activity that allowed me to feel human again, the warm water rinsing over my body and reminding me that I existed for more than just to feed a newborn. It felt amazing on my sore breasts and it was the one time of day they were free from a bra. I seriously would not skip this, it was the highlight of so many of those early days. I also had gel compression pads that could be heated or cooled for relief, I didn’t use these as much as I wanted to frankly because I was so exhausted at the end of each feed it seemed like too much to even get up and microwave them. The few times I did use them it was with assistance from one of my supporters and they felt awesome! While you’re pregnant, download a baby tracker app and get prepared to track away—at the lactation consultant and the doctor’s offices they would always ask how many feedings, how many wet & dry diapers in the last 24 hours. I literally don’t think I could have remembered this if I hadn’t been meticulously tracking it in my app. The Brestfriend pillow has also been my most prized possession. We still use it and I highly recommend it, it’s the perfect level for baby and it buckles around you so that it stays in place. The pouch that it has is also perfect for storing your essentials—I have nipple butter, headphones, my Kindle and her nail file in there. I also highly recommend making sure you get all your essentials together before settling in for a session, since you never know how long she’ll want to nurse for or if baby will want to fall asleep on you right after! Cell phone & charger, water bottle, Kindle / ipad, the TV remote, a burp cloth for baby, a snack if you need it…

Eating dinner over my baby thanks to my helpers.

Helpers

I can’t stress enough how important it was to have my husband there to help me. I really don’t know how single mothers do it and I am so incredibly thankful for his support. I also had my parents come visit for a week in the beginning and they were amazing. So seriously, don’t be shy! Enlist friends and family. The most helpful things they can do are help with cooking, cleaning dishes, washing your breast pump parts, refilling your water bottle, doing laundry, even feeding you directly! There were so many times I was grateful for my mom to literally put food in my mouth while I was starving but using both hands to feed the baby. Your helpers might not be able to help with directly breastfeeding, but they can help with everything else. It really does consume your whole life, so any help you can get with your other normal functions is going to work wonders for your sanity.

Alternatives to Direct Breastfeeding

Knowing when to take a break from breastfeeding (with the help of a lactation consultant) really saved our long term breastfeeding relationship. I thought that it might be ruined when we fed Scarlett formula. But it was absolutely crucial for my mental health and to let my breasts heal. I was able to pump during this time to continue stimulating my breasts and help my milk come in. We bought formula and my husband being able to feed her formula with a syringe was a lifesaver. I felt like a weight was lifted. I would recommend researching and even purchasing a small store of formula to have on hand for after birth even if you plan to exclusively breastfeed. We had to frantically go to the store and procure some, and I found myself falling asleep out of pure exhaustion while trying to figure out which brand was best to feed her.

Learning to multi task after a feed.

Light at the End of the Tunnel

Gradually, these difficulties got easier. I got stronger I guess, or we just learned together through practice how to make the symbiotic process work. I became accustomed to the routine and learned what to expect. I am so thankful now that I stuck through those very dark, very low days. Breastfeeding now seems like it is actually the easier way to feed her—no bottle or pumping accessories to worry about washing multiple times a day, no mental inventory on formula that I have to keep up and remember to buy. I can give her everything she needs freely and easily from my body and it carves out skin to skin cuddling time for us each day. It wasn’t easy but I appreciate the benefits that this most difficult battle has bestowed on my daughter and I hope I can prepare and inspire others to undertake the journey. I hope this knowledge can help you mentally prepare and know that it isn’t all the perfectly lit, peaceful Instagram posts you see. It’s ok to not love breastfeeding, and it’s ok to choose not to do it. And if you suffer while embarking on this endeavor, know that you are not alone.

Lessons I’ve Learned From My 12-week-old

For the past 3 months I have been spending all my time with our 12-week-old daughter, Scarlett. It’s been quite a change of pace for me as I’ve been watching the wildfires take off from the confines of my couch, fighting the urge to get out there and get involved to help coordinate response. My husband JB worked long hours at the Saddle Ridge Local Assistance Center for 4 consecutive days and on the fifth day when he was supposed to be home earlier he had to stay late to work a new EOC activation for the Palisades Fire. This meant more FOMO for me and more hours of one-on-one time with Scarlett. As much as staying home goes against my nature to get out into the field and dive straight into these emergency management challenges, I have tried to really embrace my new, non-permanent role as a stay at home, full-time mother to Scarlett G and use this new lens to expand my viewpoint on the human experience.

Having spent every day and night of her life with her so far, I have had the priceless opportunity to watch a brand new human being emerge from the womb, adjust to a shockingly different environment, and begin to grow into a little person who tries to communicate. It has been nothing short of miraculous. I recently took some time to reflect on what she has shown me firsthand about the innate abilities of human beings to adapt and overcome the incredulous challenge of being helpless, immobile, and incapable of speaking in a massive obstacle-laden landscape. Before we fill our worlds with layers of experiences and years of learning, what are the native traits that we develop immediately, to cope with such a traumatic transformation as transitioning to life outside the womb? Spending time with Scarlett has allowed me a unique ‘back to basics’ perspective on our human resilience before it is colored by the complexities of adulthood. She is simply trying to survive, and it’s been fascinating to watch her develop behaviors that promote growth and endurance in this whole new world.

The thumb.

The Power of Self-Soothing

In the first few weeks after we brought her home from the hospital, Scarlett would sometimes cry unconsolably. As a newborn, crying was really her only way to communicate and I am sure there were many things that she found frightening and uncomfortable about her new home. It used to take mom and dad spending serious time rocking her, swaddling her, cuddling her or speaking to her softly to get her to calm down. But as she has grown, she has found her own way to calm herself down and has gained a very powerful tool. My baby sucks her thumb, and it instantly pacifies her. She constantly resists the pacifier, which we’ve come to terms with although we still offer it from time to time. Scarlett has learned that her own two lips can form the perfect fit to cradle her thumb and turn it into a readily available calming tool. Now whenever she gets bored, mildly uncomfortable, cranky or tired she will simply turn her head, find her thumb, and breathe a sigh of relief. She puts herself to sleep this way and wakes up in a much better mood! This has really shown me how powerful it is for adults to discover effective tools of self-soothing that we can practice in our daily lives.

Now, I’m definitely not advocating that we suck our thumbs, but it is incredibly empowering to be able to take control of a stressful, irritating mindset and transform it into peace and clarity. Practices such as deep breathing, stretching / yoga, meditation, walking or exercise, writing or reading, going outside, or having a hot cup of tea can really work wonders on helping to soothe our anger, anxiety, or irritation. It is important to try a few soothing mechanisms and learn what works best for you as an individual so that you can keep it in your back pocket as a frontline defense when you are thrown into high-stress, crisis situations. I think coping tools which rely the least on external resources are the most reliable since you need only to exercise a behavior within your own reserves. For me, it’s walking that will immediately calm me down. Stretching and deep breathing also help me to eradicate stress and center myself during times of crisis.

Big smiles.

The Power of a Smile

I struggle to identify when Scarlett’s first smile occurred because I feel like she has been smiling since day one. But she has certainly learned to utilize her smile as a tool to break the ice with new people and to melt mom and dad’s hearts into giving her whatever she wants. It might seem simple, but I think there is an important lesson behind the fact that smiling is one of the earliest behaviors that babies develop. A smile is the gateway to friendship, to developing social capital with other humans around you. As a helpless baby, she’s learned quickly that smiling gets people to smile back at her and emit affection and love. Smiling gets people on her side. I have noticed this as her mom as well that walking around with a smiling baby instantly endears me to strangers at the grocery store or on the streets. People who would normally walk by me with their hardened big city expressions, completely open up to me and I feel more welcomed and acknowledged wherever I go.

While it’s very basic, smiling and establishing good relations with our colleagues, neighbors, and fellow human beings is a crucial survival tool. The more that community resilience is studied the more it is shown that having a strong social fabric within a community is correlated with the ability to bounce back more quickly after a disaster or crisis. Exercising good relationships makes us happier people and gives a network to rely on when times get tough. It is also well known within the disaster world that you are most likely to be helped by neighbors or people around you when a disaster occurs since first responders will be spread so thin. A smile today is an investment in your future social capital—it’s easy and completely free.

Tummy time in the backyard.

The Power of the Unknown

New babies spend the majority of their time on their backs exerting minimal energy to look up at people and things around them. When placed on their bellies, babies typically struggle. They have to work extremely hard just to lift their massive heads off the ground and look around. For some reason, Scarlett loves ‘tummy time’ and I think I know why. Even though she must push her neck muscles to new extremes, she is mesmerized by this different perspective on the world around her and will work as hard as she can to be able to access this window into the unknown. From her belly she isn’t stuck staring at ceiling fans and drab white paint. She can see blades of grass, plants, the lower shelves of bookcases, the print on the bedskirt, mommy’s feet, and the detailed pattern of the rug. There is so much to see and discover from this new perspective. The added bonus is that if she works hard enough she will be able to crawl very soon from this position, which will add the whole new dimension of mobility to her human experience.

It’s easy to look at things the way that we always do, the way that we always have. We can simply lie on our backs and see a sterile, clean cut version of the world with minimal complications, where we see the people that choose to come in and out of our scope of vision.  It’s much more challenging to force ourselves to turn around, seek out new places, try new activities, interact with different people, languages, sights and smells. Sometimes we have to take on a new challenge to open up a new dimension of ourselves and unlock the next level of our lives. If you want to someday be able to move up or move on, take some time today to open up a new portal into the world around you by analyzing the challenges you have in front of you, perhaps one that you have been ignoring just because it seems too difficult to even begin to tackle. Think about what it would take to overcome this challenge and begin by taking baby steps toward surmounting it. It’s not about improving what you know, it’s about embracing what you don’t know.

My teacher.

Even though I’m the mommy and she’s the baby, Scarlett G has taught me a lot about the human experience. I hope to be able to use the lessons I’ve gleaned from her survival mechanisms to better my own adult life. When you strip away the complexities of our adult world and truly go back to basics you can discover more than you might have imagine. Even though I’m not jumping out to coordinate the next wildfire response I am learning something new about resilience right here, in my own home. So today I challenge you to practice one of your self-soothing powers, to smile at a stranger and to identify a challenge in your life that you can work to overcome. You never know what new worlds will open up to you on the other side.

Approaching Labor with Resilience

Lessons Learned from a Long Labor

It’s taken me some time to write about Scarlett’s birth and to process the whole experience. It almost goes without saying that these past 2 months have absolutely changed my entire life, yet I am saying it because that fact can also not be understated. Newborn babies are incredibly sweet and angelically cherub-like in their chubby, rosy cheeked aesthetic. Their earliest smiles will pull at your heartstrings in a way that you can never have fully anticipated before you see their little faces and big curious eyes. Yet the first month also brings a suite of new challenges the depth and intensity of which you never fully understood, certainly not leaving much time for anything extra.

But I’m happy to say that now that we are nearing the 2-month mark, we’ve gotten into a pretty good routine that’s allowed me some time to get back to the computer to write. As a follow up to my earlier post on how my experience with cancer affected my outlook on pregnancy, I wanted to share some nuggets of advice now that I’m on the other side of the experience. In short, I was induced and had a 43-hour labor, including 3.5 hours of pushing and a diagnosis of ‘failure to progress’ through the pushing stage. The whole thing ended in a C-section. It wasn’t a great experience, but I’ve bounced back and my little angel is more than worth it. Here are some recommendations I have on what you can do ahead of time to maximize your resiliency through a difficult (or even an easy!) labor.

Education is Empowerment

I went into pregnancy with very little knowledge of what it would be like, and what factors to consider when planning a birth. Like most young American women, I just assumed you go to the hospital and they guide you through it. I thought home births were for new age hippies. I didn’t have many close friends or family who had gone through pregnancy and I had never seen a birth.

The books I referenced throughout my pregnancy.

Like a good former academic, I purchased some books about pregnancy when my pregnancy test first lit up positive. What to Expect When You’re Expecting and the Mayo Clinic Guide to a Healthy Pregnancy were my first purchases. But it was 50 Things To Do Before You Deliver, a light-hearted, brightly colored listicle of a book that brought me to the best resource I discovered during pregnancy. The book suggested listening to birth stories, and specifically recommended a podcast called The Birth Hour. After my first listen, I was hooked—it really changed how I thought about the whole process and broadened my perspective of what birth could be. I was already midway through my second trimester by the time I started listening, but I have to say that it was the single most valuable way that I learned about birth.

Learning through listening to real birth stories from other women allowed me to be exposed to a very wide range of possibilities. It was striking to hear how each experience was unique, yet as I began to listen religiously during my daily walks, I began to pick up on common patterns to labor and delivery. Investing the time in hearing these different perspectives was so much more educational than just reading a medical article or book chapter that listed out different medical interventions or the stages of labor and what to expect. I really felt like I understood how certain decisions—like whether to get an epidural and when, might impact the course and outcome of labor.

I learned why many women chose to go the route of home birth or birthing center rather than hospital, after hearing multiple stories about pushy hospital doctors or the detached, nonpersonal experience of having a stranger who viewed you as a medical record number rather than a person deliver your baby. I listened to women describe how real and beautiful it was to experience all of the feelings throughout the labor—pain, relief, and pure joy. Many women believed they really benefited from developing an understanding of the full capabilities of the body and how we are meant to reproduce by going through the delivery unmedicated.

Another benefit to learning through birth stories is that you are inherently learning through multiple sources. Whenever I delve into a new subject I make sure to use multiple avenues of learning so that I can cross-reference the most salient points from each and get a more informed perspective. We also took a La Maze class through Kaiser, which added another layer to my education. The class didn’t start until I was 35 weeks pregnant, so I was at the tail end of my pregnancy and we weren’t even sure we’d finish if the baby came early. The class reinforced much of what I’d picked up through the Birth Hour and allowed us to practice breathing and movement techniques together. The instructor had given birth 5 times—all unmedicated. She had a strong preference for natural labor but discussed medication options as tools that you could turn to in your toolbox—under certain circumstances they could be very beneficial.

Know Your Birth Philosophy

I recommend becoming educated about the wonderful world of birthing as early as possible. This allows you to choose from the beginning what type of care provider you want to seek—midwife or OBGYN, and to begin advocating for yourself and your birthing preferences up front. You may hear about a Birth Plan and how you need one. You’ll probably find it on the checklists of the pregnancy apps you’re using. Or you may be handed a standard paper birth plan to fill out with check boxes from your doctor’s office, like I was. However, I would advise against developing too rigid of a birth plan. I don’t believe it’s a checkbox kind of activity—these are not simple black or white, yes or no type questions.

The more I reflect on my experiences, it becomes clearer and clearer what a grey world it is. That’s why I recommend understanding the different techniques that might be used, particularly if you are being induced, and evaluating how you feel about each one so that you can develop a sort of birth philosophy rather than a hard and fast plan. In my case, they used a foley balloon to mechanically induce dilation for the first 12 hours of my labor. While it didn’t work well in my case, I’m glad we went this route rather than the cervix softening medications that are sometimes used to start labor. Understand each of the tools in your toolbox and set an overall goal for your experience. Then, you can match your tool selection with the way your labor progresses to help you meet that goal. It is definitely important to have a birth partner / labor coach / doula to discuss this with beforehand, this person should understand how you feel about the different options and be able to advocate on your behalf if you are not able to during labor. Believe me, it can get intense quickly, especially if Pitocin is involved, and your ability to have a rational conversation may be greatly diminished.

The Birth Vision Board I created.

In my case, my birth philosophy was to approach the experience as naturally as circumstances would allow but I was not against utilizing pain medications if my labor became particularly long or difficult. I researched alternative pain relief measures and prepared to use tools such as aromatherapy, visualization, music, massage, breathing, and movement. I was against being induced, but given my doctor’s stern recommendation that I was at high risk of developing preeclampsia due to my pre-existing chronic hypertension, I was willing to undergo induction. However, I was not comfortable with inducing any earlier than 40 weeks, despite her initial recommendation of doing it at 38 or 39 weeks. Due to hearing the many induction stories on the Birth Hour I was well aware that beginning labor through medical methods often leads to a ‘cascade’ of medical interventions until the baby is born. Knowing this beforehand, I came to terms with the fact that I would be a lot more likely to ask for the epidural if I was induced—I had heard time and time again about how Pitocin can create extremely intense contractions as the chemical forces your uterus to contract, and often does this overly well.

Having a birth philosophy ended up suiting me very well. I did not feel like I had failed when I asked for the epidural about 24 hours into my labor when I had failed to progress in dilation at all (I was 1.5 the entire time) and was exhausted by the frequency and intensity of the Pitocin induced contractions. With the epidural, not only was I able to get some rest overnight, my body was also relaxed enough to dilate to 10 centimeters. I’m not sure if I would’ve gotten there without it.

A year earlier I had used my emergency management skills to plan my own wedding, developing a full event action plan complete with a down to the minute timeline, set up diagrams, contact rosters and organizational charts. Unlike weddings, birth is one of the few things in today’s perfectly planned, calendar-centric world where you cannot anticipate the timing and progression of events. It was both freeing and a little intimidating going into the birth experience knowing that I must relinquish control of the process. My baby and my body would guide me through and I had to trust them. For our La Maze class, we were instructed to identify an object to serve as a ‘focal point’ during our breathing and laboring. I decided to make a vision board with relaxing imagery and motivational quotes. One of the phrases I selected was: Birth isn’t scripted, it unfolds. And through 5 weeks of practicing with the focal point in LaMaze, I think I truly came to believe it.

This mentality helped me greatly when the doctors recommended that I be moved to the operating room for a Cesarean Section after nearly 4 hours of pushing. While my birth philosophy had always involved a preference for birthing through a vaginal delivery, I knew in the back of my mind that a C-section was a possibility. My own birth was via C-section, and I had known a few friends recently who had to give birth this way even though it was not planned. One in three births in the United States occur via C-section, and I knew that even though Kaiser prided themselves on having a lower rate than most and doing everything they could to encourage vaginal deliveries, the possibility was there. I remained calm and was, at that point, grateful that we were most definitely going to meet our baby very shortly.

Cultivate Endurance

One of the reasons I was able to remain calm and matter of fact during a time when the doctors said many women are in tears and extremely frightened, was because I took some time during my third trimester to reflect on my strengths. Going into labor, I wanted to visualize myself as strong, as a survivor. Writing has always helped me process things and create deeper understanding in my own life, so I wrote about how my experience as a cancer survivor shaped my mentality as I approached labor. While not everyone may have as dramatic of an experience to reflect on as I did, I challenge you to think critically about life experiences where you were strong–physically or emotionally–and channel that inner strength as you go into labor.

Our LaMaze teacher told us that she would rather give birth than have strep throat. In her experience, strep throat was way more painful. I think most of us were skeptical about this, given the many horror stories out there about labor and the way that it is depicted in popular culture. But, her point was that this pain has an end game, it has a purpose, whereas illnesses and broken bones do not. You can recall an experience like an illness, injury, training for a marathon or sport, or even getting through a difficult divorce where you were resilient and use that documented example to show yourself why you will get through labor.

After a yoga class in my third trimester.

In addition to using a past example, you can also strive to cultivate endurance while you’re pregnant. Doctors recommend walking and other moderate exercise while pregnant as healthful for both mom and baby. As you get further along it can feel pretty challenging just to walk for 30 minutes, especially if there are hills or heat waves involved! As you continue to conquer physical milestones during your pregnancy you will be creating an endurance in your body that can be called upon during delivery. Yoga and meditation have also been shown to promote wellness in pregnant women, and fostering this strength of mind-body connection can work wonders on boosting your stamina during labor. I walked pretty much every day right up until the date of my induction, and practiced yoga regularly throughout my pregnancy—both of which I credit with helping me build the power to push for nearly four hours.

While I was ultimately unsuccessful, I have not let that bring me dismay. My baby’s positioning wasn’t great—her feet were crammed way up in my left ribcage for the entire second stage of labor and she refused to budge even though the nurses told me I was pushing correctly (as evidenced by the three stools I passed in the process!). I chalk it up to her not being ready, and the induction process as a whole not being effective in convincing her it was time to make her appearance. But the important thing is that she is here! Her apgar scores of 8 and 9 upon birth and she was happily average on all accounts, well except for her thick mop of lovely hair.

Already smiling on the day of her birth!

In this post, I’ve tried to summarize some of the main takeaways, but if you’re interested in more details on my lengthy labor, you’re welcome to read my full birth story (be aware it is 8 pages long!!).

Pregnancy as a Cancer Survivor

As I approach the due date of my first child this weekend, I am reflecting on how this pregnancy journey has been shaped by my experience as a cancer survivor. For many young moms, labor and delivery will be their first / most serious experience with the medical system, and possibly their first overnight stay at a hospital. And many cancer survivors are older, already mothers and not trying to conceive while in recovery. As someone who was diagnosed with cancer (a very rare clear cell sarcoma within the colon) at 26 years old, and becoming a mom afterward at 33 years old, I find myself in a unique position—with both benefits and drawbacks.

When I got the diagnosis in 2012, becoming a mother was one of the primary goals that I quickly realized I still wanted to accomplish with however much of my life that remained. I made a bucket list of sorts and having a child was right up at the top. Of course, to create the ideal environment to raise one would take years. I had not yet found my partner, my career was not yet well established and certainly living in a house with four roommates was not the best place to raise a child. It took time, and I’m forever grateful to have had these 7 years to get where I wanted to be; here, as I am about to experience the joy and journey of motherhood.

In the hospital recovering from cancer surgery
April 2012, recovering from cancer surgery with therapy dog Jackson at UCLA Hospital.

With the goal of ending on a positive note, I’ll begin by addressing downsides to going through pregnancy as a cancer survivor. The first is that you can’t go for your normally scheduled follow up scans. After primary courses of treatment such as chemotherapy, radiation, or surgery, cancer survivors are typically kept under surveillance for years through follow up imaging to ensure our bodies are still cancer free. Unfortunately, MRI’s / PET Scans and babies in utero don’t mix. Depending on the frequency your doctor is recommending, this can certainly throw a wrench into your follow up care plan since pregnancy is more than 9 months and many people are supposed to go multiple times per year. Skipping recommended scans can certainly make a survivor nervous because the fear of recurrence is omnipresent, very real—always there, just out of sight. Clear scans keep you reassured of your health and help you continue forward on your life track with reduced anxiety. I am very fortunate in that being 7 years out with no recurrences I have only been going annually for the past couple years. My oncologist actually approved an even longer gap for me to accommodate my pregnancy and recovery—waiting about a year and a half until Spring 2020. While it’s a little nerve-wracking to be unsure of what your body is up to for that length of time, at over 7 years I am feeling pretty good about this–perhaps I’ve graduated to the 18-month interval from the 12.

The second downside of approaching this as a cancer survivor is the heightened worry with all that can go wrong in pregnancy. There are a lot of tests, many different criteria for levels in your blood draws, blood pressure, your weight, protein or glucose in urine. I actually did experience elevated fear and paranoia that I know is a kind of PTSD from my cancer. At the beginning of my 2nd trimester, my liver enzymes (AST/ALT) mysteriously shot up and I had to go for several repeat blood tests, which continued to escalate to levels over 200. This can be a marker of liver damage or of Intrahepatic Cholestasis of Pregnancy or possibly preeclampsia. Trust me, Google will show you lots of different disorders this can be a foreboding symptom of.

I was referred to the high-risk doctor and a liver specialist. They even performed an ultrasound on my liver to check for any damages or suspicious lesions. Boy was that scary for me, it was the first time since my original diagnosis that I had been told something was abnormal and needed to be investigated. It was so tough to relax and think positively as the creeping, agonizing panic of something being wrong with my body began to sink in from the sidelines. When your body has psyched you out once already by throwing you a super-rare-cancer-at-26-years-old-wildcard you are constantly on your toes at any little sign that something isn’t right. Even after 7 years, I continue to be a bit of hypochondriac, but this was the first time that doctors were concerned too. In my case, my liver enzyme levels simply began dropping until they returned to normal levels. No explanation whatsoever. The body is still nature’s mysterious machine in a lot of ways. For as much as we seem to decipher about it there is so much more that we have yet to understand. But as a cancer survivor, it is difficult to trust your body to just be normal sometimes. You know all too well that just because you feel fine and you’re functioning perfectly well that doesn’t mean there isn’t something sinister at play in your cells.

22 weeks pregnant with cancer surgery scar on stomach
22 weeks pregnant, camping in Anza Borrego State Park.

I think the biggest benefit of approaching pregnancy as a cancer survivor is that I’m not afraid. The idea of labor and delivery isn’t really scary to me the way it is to some first-time moms. A lot of people are afraid of getting a C-section, afraid of the recovery, afraid of the scar, and fearful of infection. But having already gone through a major, exploratory, emergency surgery on my abdomen I’m not scared of the possibility of a C-section. It’s not my first choice for how I deliver my baby, but I have no anxieties about undergoing the procedure if it’s necessary for a safe delivery. The video we watched in LaMaze class talked about how they slice through the abdominal walls and the layers of fat and muscle, then pull it apart so the baby can come out. It made it sound kind of gory and I almost wonder if it’s designed to scare you—but 7 years ago that happened to me. It was even worse, a large vertical incision was made through all my layers and my intestines sliced open, a section removed, then stitched back together. They poked around at my other organs too since they didn’t know what they were dealing with at the time, hence the term ‘exploratory.’ That sounds a hell of a lot more intense than a small, measured, horizontal incision on the uterus. The recovery? Yeah it was no fun. But I made it, I was able to go on short, slow walks tethered to my IV pole within a couple of days. It took a couple weeks for me to be able to go on longer ones around my neighborhood, after the wound vacuum was removed. Yes, my wound did get infected. Due to the emergency nature of my surgery I couldn’t do a proper bowel cleanse / fast beforehand. So I had to wear the vacuum for a week after the infection was discovered, then do ‘wet-to-dry’ dressings and change them myself twice a day until it healed from the inside out. What are the odds of that happening with a C-section? Very low I’m sure. The Cesarean is such a controlled, well-practiced procedure. One in three births in the U.S. occurs through this method. Even the emergency ones are nothing in comparison to the major, complex surgery that I’ve already been through, recovered from and owe my life to.

In terms of vaginal delivery and the whole labor experience, I know many people are afraid of the pain, so many want to request an epidural immediately to spare themselves from horrible contractions. I am not so afraid of it, although it is the unknown so I’m also not opposed to the epidural as a tool for a difficult and prolonged labor. While it’s true that I have never experienced labor and probably nothing similar, I did experience prolonged pain and discomfort in my stomach for months before the surgery. The doctors told me that I must’ve had a high tolerance to pain to not have come in sooner. This gives me hope that I’ll be able to endure labor pains.

Am I afraid of the epidural? I’m a bit hesitant about it, since I’ve never had a needle in my spine before. I’m hoping not to get one, but again if it will help me relax to get through a prolonged labor I will. This is a routine procedure that I am confident the anesthesiologist is well-practiced in. I do have the benefit of knowing I’m not allergic to anesthesia, having undergone general anesthesia for my surgery.

I’m comfortable in hospitals. They’ve saved my life once before and got me on the road to full recovery. Needles, IV’s, and blood draws don’t scare me at all because I’ve gotten used to these medical tools through the sixteen MRIs / Pet Scans I’ve had for follow up care. None of these interventions bother me because I literally owe my life to the benefits that modern medicine can provide.

38 weeks pregnant on the couch with cancer surgery scar on stomach.
38 weeks pregnant with a big belly, resting my feet on the couch.

Most importantly, I think the cancer has prepared me for this experience in a positive way because I know I’m a survivor. Because I’ve gotten through something far more horrific and menacing than childbirth. I know that my body can recover, that I can heal and fight off infections. I know that I can take small quantities of necessary opioids for pain, I’ve felt the itching side effects, and I know that I can wean myself off them successfully. I have been through a much scarier, bigger battle than this and I am still standing strong.

I approach my first birth with confidence, with wisdom, with gratitude, and with excitement that this time when I go to the hospital it will be for something beautiful. This time, my body has been growing a human being, not a malignant neoplasm, and the birth of this baby will be spectacular and celebrated. I am experiencing a normal human condition—a womanly rite of passage that has given longevity to the humanity for generation. My body is meant to do this and this is one of my dreams.