22 Weeks

Your baby weighs about 13 ounces now and measures about 9 inches long. They are very thin, but completely developed at this point! Fat will continue to accumulate from here on out as your baby packs on the pounds getting ready for birth.

The bones inside the ears are hardening and so their hearing becomes more clear. They can distinguish between different sounds such as your voice and heartbeat. Eyes are developed now, but there isn’t any pigment in the colored part. Teeth buds appear beneath the gum line and the lips are completely developed and distinct from the rest of the face.

Lungs are developing. Right now, the lungs cannot transfer oxygen to the bloodstream, but by birth the lungs will be ready. The senses continue to develop at this time and your baby may experiment with touch by stroking their own face. White blood cells are forming now so that your baby can help fight illness and infections.

The pancreas and liver are developing now. The pancreas produces hormones and the liver breaks down bilirubin, a substance produced by red blood cells. Hand strength is very good now and the skin is pink and wrinkly. As the baby gains more weight the skin will become less transparent and wrinkled.

Things are going well. No real complaints. For some reason I don't need extra pillows for sleeping anymore. Sleep is generally pretty good. I'm quite adept at sleepwalking to the bathroom. I've been napping in the afternoons, but it's because I've been going to bed a little too late.

My belly is starting to peek out of the bottom of some of my shirts! I don't remember that happening until later in my other pregnancies. I guess Andrew and I should put together another belly photo shoot!

This morning I woke up feeling quite well rested and energetic. Then after I got out of the shower I felt completely drained, heavy, short of breath, desperate to sit or lay down. This happened once before a few weeks ago. I am guessing it was a low blood pressure moment? They both passed after a short while.

I took out my navel piercing the other day. My belly button is starting to become an outie. The kids are fascinated.

I'm still hungry a lot. We eat supper around 6:30, then I have a healthy snack or two at about 8:30 or 9:00. But often when I get into bed my stomach is growling! At that point I feel like I need sleep more than food so I just push through, though I have been known to get up and make toast.

I don't feel or feel like I look any fatter, but the scale says about 11 lbs now.

We have made some progress on names. I don't know if we've found "the one", but we have found a girl name that we all like. But it's a secret ;)

A blogger I follow, Rixa, had her second baby on Sunday. He was born at home, in water. She has just posted photos, no real details yet, but the photos tell the story of the hopes I have for our upcoming birth. Undisturbed by medical interventions or hustle and bustle, mother catching baby, everything allowed to proceed at its own pace. Doesn't she look beautiful in the closeup of her face when the baby is emerging?

21 Weeks

Your baby is now about 10 ½ ounces and measures about 8 inches long – about the size of a large banana. The rapid growth that has happened over the last few weeks will slow down now. Every week increases the baby’s chance of survival outside of the womb now.

The head is now about 1/3 of the size of the body now. Rapid eye movements begin at twenty-one weeks and baby can hear when you talk or sing to them now. Swallowing, which is believed to help baby’s digestive system function after birth, continues at this point. The heart is growing stronger and can be heard when you visit the doctor’s office. Fat continues to accumulate now and the bones and muscles are getting stronger each day.

By now, most people can probably tell that you are pregnant. Your body is changing rapidly as the baby grows. Be sure to get plenty of rest and eat healthy. Exercise is a great way to stay in shape and keep healthy. Check with your health practitioner to find out what types of exercise would be appropriate for your pregnancy

Oh, there's no doubt that I'm pregnant- the basketball shape sticking out from my midsection would confirm that to the most unpracticed eye. I'm still feeling hungry frequently so I guess this banana is still on the growth spurt. I'm feeling more movements all the time. They're still relatively gentle, and reassuring. Yesterday baby must have been doing jumping jacks because I felt it in my bottom and also up at the top of my bump. Kind of a weird feeling.

My lower back gets sore when I'm standing, cooking or doing dishes. Though last week after going to yoga two days in a row my whole body felt really great for a couple of days. I'm only signed up for two days a week, so maybe that's a sign that I should be doing some work at home on my own.

I spoke with my midwife yesterday and she is totally on board with the homebirth thing too. She confirmed she has a birthing tub. She also said it's important that the three of us get together to talk it all through thoroughly. I agree!

I have been agonizing over cloth diaper purchase decisions. Agonzing, but enjoying the process too. There are so many options to choose from! I am looking forward to this adventure. I am leaning toward mainly diaper service quality prefolds with wool or Bummis cover, mainly because of my plans to practice elimination communication (see my posts on EC here and here) and the fact that I stay close to home most of the time. I'll also try a few other types, like pocket diapers and all-in-ones. I found a Winnipeg company, AMP, whose products are highly rated by reviewers, and I am excited to support them and to get a chance to see their products in person when I am in Winnipeg in June. The rest I'll order online.

I know I've said this already, but I am SO EXCITED about the Humanization of Birth conference I'll be attending the weekend of May 1. Dr. Sarah Buckley, whose book I just read, is the keynote speaker. Dr. Michel Odent is a fixture in the natural childbirth scene. His mantra is "Do not disturb the birthing mother". David Chamberlain speaks about birth memories which is a fascinating topic. I have been quizzing the kids about their birth memories and they haven't come up with anything yet- I'm hoping to get some tips about how to ask during this session. Barbara Harper is a waterbirth expert. So many excellent, well respected, well-researched, passionate speakers. I am also so excited that my OB is planning to attend. And I will get a chance to meet an American woman, Joni Nichols, who runs the birth centre Plenitud in Guadalajara.

Home Birth Safety

Here is a link to a Journal of Perinatal Education document called Birth Can Safely Take Place at Home and in Birthing Centers.

The abstract of the document says:

Although most women in the United States give birth in hospitals, a substantial body of research suggests that planned home birth or birth in freestanding birth centers have equally or better outcomes for low-risk women. Out-of-hospital birth often facilites mother-friendly care. Rationales and systematic reviews of both home birth and freestanding birth center birth are presented.

And only a few days ago the results of a very large study from the Netherlands was released. Here is the abstract from that study:

Objective To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care.

Design A nationwide cohort study.

Setting The entire Netherlands.

Population A total of 529 688 low-risk women who were in primary midwife-led care at the onset of labour. Of these, 321 307 (60.7%) intended to give birth at home, 163 261 (30.8%) planned to give birth in hospital and for 45 120 (8.5%), the intended place of birth was unknown.

Methods Analysis of national perinatal and neonatal registration data, over a period of 7 years. Logistic regression analysis was used to control for differences in baseline characteristics.

Main outcome measures Intrapartum death, intrapartum and neonatal death within 24 hours after birth, intrapartum and neonatal death within 7 days and neonatal admission to an intensive care unit.

Results No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care unit 1.00 (0.86 to 1.16).

Conclusions This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.

Dr. Rixa Freeze's Stand and Deliver blog contains some comments and links to news stories about this study.

Homebirth and GBS

Louise asked a very good question in her comment to a recent post. How would a positive GBS (Group B streptococcus) test impact plans to homebirth?

"GBS is a type of bacterial infection that can be found in a pregnant woman’s vagina or rectum. This bacteria is normally found in the vagina and/or lower intestine of 15% to 40% of all healthy, adult women." (American Pregnancy Association website)

GBS is not a problem or risk to the woman herself, but it is possible that the baby may become infected during the birth and become seriously ill or even die. For this reason many countries have a protocol to test women at approimately the 37th week of pregnancy. If they test positive for GBS, then antibiotics are administered intravenously during labour.

Antibiotics have proven quite effective at reducing the chance of baby becoming ill. However, the Cochrane Collaboration database indicates that there is not an impact on infant mortality. That is to say, though fewer infants get sick from GBS infections as a result of the mother receiving antibiotics during labour, the same number of GBS-related infant deaths occur regardless of whether antibiotics are administered or not.

There are a number of factors which indicate an increased risk of infant GBS infection:

- fever during labor
- rupture of membranes (water breaking) 18 hours or more before delivery
- labor or rupture of membranes before 37 weeks
- A urinary tract infection as a result of GBS during your pregnancy
- A previous baby with GBS disease

According to the CDC, if you have tested positive and are not in the high risk category, then your chances of delivering a baby with GBS are:

1 in 200 if antibiotics are not given
1 in 4000 if antibiotics are given

So. Less than 1% of babies will be born with GBS to a GBS positive woman who has not received antibiotics. What are the risks to the 99.5% of women taking antibiotics unnecessarily? According to Lisa Barrett's blog :

1 in 10 chance of an allergic reaction.
1 in 10,000 chance of a severe allergic reaction like anaphylaxis.
1 in 100,000 chance of death from taking antibiotics.

Also important to consider are the risks and impact of messing with the newborn's gut flora, and adding to the antibiotic-resistant bug problem.

Is there anything a pregnant woman can do to reduce her risk of testing positive for GBS? There are a number of home remedies that women have found effective at eliminating GBS. Natural substances used for treatment include probiotics, garlic, vitamin C, vitamin B6, grape seed oil, colloidal silver, and tea tree oil. Antibiotic treatment prior to labour will not protect the baby during birth, since the GBS could recolonize between the time of treatment and when labour begins.

I can't find the source of this percentage right now, but I believe that 90% of babies experience early onset GBS infection, where symptoms present within hours of birth. They include:

- Breathing problems, heart and blood pressure instability
- Gastrointestinal and kidney problems
- Sepsis, pneumonia and meningitis are the most common complications

Baby is then treated with antibiotics.

When I was pregnant with Eva, I believed that if I tested positive for GBS at 37 weeks, there was no way around IV antibiotics. If I had only known, I could have tried some of the natural remedies and been retested prior to going into labour. As it was I dragged around an IV for the 14 hours of active labour, had at least two courses of antibiotics, and I blew up like a balloon from all the fluids. Unattractive and uncomfortable. I would have at least asked them to turn off the IV between course of antibiotics. I was so relieved when I tested negative when I was pregnant with Micah. But who is to say that I wasn't positive at 39 weeks- GBS comes and goes, without symptoms. Or that I wasn't negative by the time Eva was born.

The protocol isn't perfect, that's for sure. It tries to reduce risk, but it also assumes that antibiotics are free of risk. Which isn't true.

So to answer the question. If I tested positive (and continued to test positive- because I would aggressively pursue the home remedies and retest at least weekly) and chose to accept antibiotics, then probably my OB could hook me up to an IV here at home. In Canada or the US it may be a different story as I don't believe midwives are allowed to administer drugs. I have read of labouring women going to the hospital for their antibiotic treatment, then returning home to give birth. And there are also women who refuse the antibiotic treatment despite a positive test.

If I tested positive right up to going into labour, and didn't have any of the high risk factors, I'd think long and hard about accepting antibiotics. It's just not such a straightforward decision as many of us have been led to believe.

Actual Weight Gain to Date

About 9.5 lbs.

I looked back at Eva's baby journal and by 20 weeks I had gained 13lbs. By 27 weeks I had gained a whopping 25lbs. I would really like to keep the weight gain more moderate and healthy with this baby. I would be shocked and disappointed if I balloon up since I'm not stuffing my face with junk food this pregnancy. Or sitting at a desk all day and in front of the tv all night. ;) Live and learn... live and learn....

20 Weeks

Your baby now weighs about 9 ½ ounces and measures about 6 ½ inches long. You’re halfway through your pregnancy and baby is very active by now! Over the next few weeks the baby will move so much that it may be hard to sleep. This will continue until it gets very crowded for the baby. Babies that are born at 20 weeks have a 50% chance of survival.

From now until your little one is about five years old the brain is developing very quickly. Nerve cells that have already developed are making complex connections and sensory perception development peaks this week.

Little boy’s testes will begin dropping from the pelvis into the scrotum. Legs have getting close to the final length and are very proportionate at this point. The skeleton is getting harder and the hands are getting stronger. Babies will blink more now and the lunago (fine hair that covers the body) is very thick around the head, neck and face. Hair on the scalp is growing as well.


My belly is definitely getting bigger and my pelvis seems to be adjusting accordingly as I have been having some lower back discomfort and some pain on the inside of my legs when I move certain ways. I have to organize myself more carefully now when I sit or lie down. When I am sleeping I have an extra pillow propping up the side of my belly and supporting my upper leg. My slouching days are over when I am seated. I am starting to use the balance ball to sit on or lean over while I watch tv and I may soon start using it as an office chair while I'm at the computer. I can still see my toes though!

I am wearing almost all maternity clothes now, though I do also wear some larger sizes of pants which I bought after Micah was born to take me through that awkward postnatal period before I found my way back to prepregnancy size and weight. I also have some too-big maternity clothes waiting in the wings.

I am feeling more hungry now, which also tells me that the baby is gaining weight.

Eva told me the other day that God told her the baby would be born on Sunday. I said, "Hopefully not THIS Sunday!". It will be very interesting to see whether a baby girl is indeed born to us on a Sunday.

Grrrrrrrrrreat Prenatal Appointment!!

All signs of urinary tract infection are gone! I was dreading the possibility of needing antibiotics so that was a relief. Seems that the vitamin C tablets and copious amounts of cranberry juice did the trick. That or the sterile sample container vs the jam jar I used for the first lab test ;)

My blood pressure was good at 110/70, though perhaps slightly elevated due to the doctor's scale indicating a 22 pound weight gain since my first appointment!!! Definitely wrong. Most definitely incorrect. Heart good, kidneys good, reflexes good, no edema, fundus height bang on. Baby's movements very good. Too early to detect a heartbeat with a stethoscope unfortunately, but the movements tell most of the story.

I passed along my Dr. Sarah J. Buckley Gentle Birth, Gentle Mothering book with a few chapters marked for his special attention (Ultrasounds, Undisturbed Birth, and Third Stage). He seemed interested in reading through it. He is also planning to attend the conference in Monterrey at the beginning of May at which she will be speaking. I'm SUPER DUPER EXCITED to be planning to attend this conference.

Then we talked. I told him that I have been thinking, dreaming and praying about the birth... and I am seeing it at home. His response? "Why not?" My heart leaped! I love how this has fallen into place so naturally. At first I received a lukewarm response to the idea from Andrew, Dr. Lopez and from Lucia. I didn't want to push for anything with which my support team was not comfortable so I focused on planning a waterbirth in hospital. But every time I thought about having this baby, I was labouring in water at home. I have even been looking at appropriate kiddie pools and daydreaming about it while I'm grocery shopping. I spoke again with Andrew about it a while ago and he was much more open to it, quite supportive in fact. Dr. Lopez's response seals it.

We are officially planning a home birth!

For those who are concerned about my and the baby's safety, here is a link that might help to ease your mind: http://www.gentlebirth.org/format/myths.html

I am thrilled for so many reasons. I won't have to endure the uncomfortable drive to the hospital or dance through contractions while trying to answer questions about who I am and how I'm paying or deal with the limbo that is triage. I will be able to focus entirely on relaxing into the process of birth and letting my body do the work God designed it to do. I won't need to worry about childcare (assuming Mom can be here at the time that baby chooses to join us on the outside). Eva and Micah will get a chance to witness the miracle of birth if they choose. We will all five get to climb into our deliciously cozy bed and get to know the new member of our family very soon after he or she is born. I will have my own food, my own bathroom, my own familiar spaces and things, my whole family surrounding me during and afterward. There is less risk of infection and unnecessary intervention. With no hospital staff waking us up to poke and prod us, baby and I will be able to enjoy the beautiful undisturbed restorative sleep of two people who have worked hard and need the rest. (I experienced this with Micah, coming home a few hours after his 1pm birth; that first night was a wonderful gift).

My hope and desire is for a straightforward, undisturbed birth and I believe I am doing my part to that end: nutrition, education, exercise and prayer. In the event that this birth requires medical help, I will have three skilled and prepared caregivers in attendance (midwife, OB/gyn and Pediatrician) and a top quality hospital within 15 minutes drive.

WOW I'm excited. :D

19 Weeks

Right now your baby is about 6 inches long and weighs about 7 ½ ounces. If you haven’t felt baby move yet, hang in there, because baby is moving all around and soon you’ll recognize and feel those movements.

Your baby’s brain is continuing to develop at an amazing rate. Millions of motor neurons are forming inside the brain, this allows the baby to make voluntary muscle movements, including thumb sucking and moving away from lights. The forebrain is dividing into two hemispheres that will become the two cerebral hemispheres of the brain. The nerve cells that serve the senses are also developing quickly now.

Your baby continues to mimic breathing, with their chest moving up and down taking in amniotic fluid to practice for their birth. Reproductive organs will continue to grow and develop and can be distinguished on an ultrasound. Be sure and tell your technician if you do not want to know the sex of your baby so that they won’t spoil your surprise!

Things are good! Belly is growing nicely and my fundus (the top of the uterus) is just a little below my belly button- right on target as it should be about at the belly button by 20 weeks.

I feel little flutters now and again which I thoroughly enjoy. The kids have been talking to the baby more lately. Today we sang B-I-B-L-E and Jesus Loves Me to the baby. Eva told me that God told her it will be a girl.

Sleeping is not as comfortable as it used to be... I am starting to strategically wedge pillows around my body now. Nothing terrible... just not as comfortable. Micah and I cut the breastfeeding back to nothing in the last couple of weeks because of nipple sensitivity, but now it's not so bad so he's nursing a little again.

My tailbone is tender again when I sit back on it. It is not so bad as it was during Micah's pregnancy and hopefully if I'm careful about how I sit it won't be a big problem this time. I wonder if it broke when Eva was born and it didn't set properly? Who knows. But if it's the worst of my worries, I'm in great shape. Better than sciatica or heartburn by a mile, I think.

I am supposed to see the doctor again this week but with it being Holy Week and Eva being home from school I'm not sure that will happen.

I am reading Christ Centered Childbirth by Kelly J Townsend and really enjoying and appreciating it. Among other things, I really like how she summarized Dr. Grantly Dick-Read's findings. He is recognized as the father of the natural childbirth movement, and wrote Childbirth Without Fear. I loved it, though its more technical style made it a tougher read than most childbirth books. I always enjoy a depth of information and it was through his book that I learned about how the muscles of the uterus work and are impacted by a woman's environment, feelings and attitude. Here is an excerpt from Townsend's book:

The uterus is made up of three muscle layers called the Myometrium. Each layer has a separate function during birth, yet each are intertwined and become one large muscle.

The outer layer of the Myometrium has fibers that are laid out in a vertical pattern. These fibers are similar to those that you see in a piece of red meat at the supermarket, laid out in one direction forming a distinct visible pattern. The fibers of the outer layer start at the cervix, run up over the top of the uterus and down the back until they reach the cervix again. It is this part of the uterus that is responsible for opening the cervix and pushing the baby out.

The middle layer of the Myometrium is rich with blood vessels that supply the uterus and baby with nutrients and oxygen. The muscle fibers of the middle layer are arranged in a figure-eight pattern around each artery and vein. The purpose of this layer is to support the blood vessels of the uterus.

The inner layer of the Myometrium has fibers that are laid out in a horizontal pattern that encircle the uterus. Most of the fibers are close to the cervix and spread out until there are very few at the top. The main function of this layer is to close the cervix back down after the baby is born. The secondary function of this layer is to become rigid in an effort to stall labor if the mother has become fearful.

When a woman is experiencing fear, she begins to resist the contractions by tensing up her body. By doing this, she triggers the sympathetic nervous system, which causes the inner layer of the uterus to resist dilation. Think back to a time when you were startled by something. What happened to your heart? It started beating faster, didn't it? Your heart began beating faster because there was an external stimulus that affected your mind, which triggered the sympathetic nervous system. Then your brain responded by dumping out adrenaline into your blood stream, which caused your heart to beat faster. The purpose of this was to prepare you to protect yourself or to run.

In just the same way, your uterus is affected by the sympathetic nervous system. The brain reacts to external stimuli (tension and/or fear) that can cause the inner muscle layer of the uterus to become rigid and resist the dilation efforts of the outer layer. As these two muscle layers work against each other, the uterus begins to feel stressed and real clinical pain develops.

Imagine yourself flexing your biceps. When your biceps are flexed, the opposing muscle (triceps) is relaxed, and vice versa. What would happen if another person were to try to straighten out your arm as you continued flexing? It would only take a few minutes for your arm to begin to hurt, right?

When the inner muscle layer of the uterus becomes rigid, it puts resistance on the outer layer that is trying to dilate the cervix. Essentially, both opposing muscles are flexed at the same time, which induces a type of pain during childbirth that is unnatural. As you begin to feel this pain, you understandably become more tense and afraid. This increases the resistance of the inner layer and thus, a vicious cycle develops.

[bicep/tricep activity suggested]

Not only can pain be increased by tension and fear, the length of labor is greatly increased as well. As a matter of fact, some women are so frightened that they can get "stuck" at 3-4 centimeters and have to have a cesarean section due to dystocia (failure to progress). While all this is happening, the two muscles opposing each other pinch the blood vessels in the middle layer. Oxygen to the baby and uterus is reduced and serious complications can result.

Women are understandably afraid to go through labor and delivery. When a person is afraid of something, they tend to resist it by becoming tense. This inability to relax during labor is normal, yet can result with the inner layer of the uterus becoming rigid, creating much more pain than they would have normally experienced, as well as a lengthy labor, exactly what they were afraid of in the first place!

A Certified Nurse Midwife in Iowa had this experience:

This was a lady on her 4th baby. I asked the nurse to listen to heart tones while I did a check. Her cervix was 8cm, 100% effaced, and that very soft, melt-away consistency where it would stretch open as wide as my fingers could spread. Just then, we heard a big dip in the heart rate. Immediately I felt the cervix close up to 6 cm or less, and a rigid half-centimeter thick. I believe this was due to the drop in the baby's heart rate frightening the mom. Heart tones recovered, mom was reassured, and she was complete in another 10 minutes. .. I am a definite believer in the effect that fear has on the cervix during labor. Bernice Keutzer, CNM

Dreaming of a Home Birth

I can't stop thinking about having this baby at home. When I told Andrew, he told me he was supportive! He trusts me to do my research and make a good decision. My heart leaped! I have been daydreaming about where it would happen in the house and the more practical aspects of preparation. I will have long discussions with Dr. Lopez and with Lucia in the next months.

I left this in draft after I wrote it so as not to freak out any mothers and mothers-in-law unnecessarily ;) But I wanted these thoughts to have a place in this journal.