One woman's path through doula training, childrearing, and a computer science Ph. D. program

Sunday, February 27, 2011

An amazing Facebook birth

This post is about Amy, a mom that recently had a baby while updating her friends on her 48-hour labor progress in real-time.  As any mom that has gone through labor knows, this is no easy task!  I commend Amy on her unique labor coping strategy of Facebook-ing while in labor.

About Amy

Amy and I go way back:  We first met in middle school and went though tenth grade together, at which point my family and I moved across the US.  Though we have kept in touch, our closeness and level of intimate knowledge of one-another could not have been possible without Facebook.

I found out that Amy was pregnant with her third child when she posted an update saying her first prenatal appointment was coming up soon.... at 38 weeks.  Difficult financial times meant an unfortunate lack of health insurance, which prevented her from seeking prenatal care until fairly late in the pregnancy.  Luckily, all was well with her and her baby. The baby was growing happily and Amy had no risk factors for things like gestational diabetes or pre-eclampsia.  (However, over the next few weeks and prenatal appointments, the doctor was increasingly antsy to get the baby out -- threatening induction and c-section. My opinion? His reasoning was that the baby would be better off in his care than in the womb of a woman that would forego prenatal care.)

Nine days before Amy's due date (T-9), she mentions how difficult it is to be so pregnant:
Well this baby should be due anytime between now and 3 1/2 weeks from now... Wonder when he will want to come. Hard to roll over in bed!

Amy and I talked over Facebook; she told me this is likely her last baby, and her priority for her birth experience is to birth naturally, and especially without Pitocin, a synthetic oxytocin used to speed up labor or increase the strength of labor contractions.  Her second baby was induced with Pitocin, and she had a difficult time with the labor.

Do you have a doula?

Of course, I asked if Amy had hired a doula.

"No," she replied.  "Isn't it kind of late?  I mean, I am almost 39 weeks along."  Then: "Also, I don't think we can afford a doula."

Will you be my friend's doula?
That night I sent out an e-mail to a volunteer doula organization mailing list asking if anyone in her area would be willing to consider a volunteer birth, due between now and three weeks from now.  The next day, I got an e-mail back with the name of a doula, Joanne, residing an hour and a half away from Amy -- which I immediately forwarded along.  Amy called her.  Joanne said yes.

Joanne explained that there were so few women in her general geographic area that a) wanted a natural birth, b) knew what a doula was, and c) were considering hiring one.  Because of this, she was having a hard time meeting the requirements for the number of births attended, for certification through her organization.

Five days before Amy's due date (T-5), Amy feels large, sore, but excited about Joanne:
Feel rested, sore, and still quite preggo. Meeting with a doula in training today. Should be interesting - hopefully she'll be able to help me get the natural birth I want and avoid ALL unnecessary interventions.
Woot I gots me a doula!
Ug. Up at midnight with HORRIBLE heartburn even after 4 chewable heartburn tablets!! I thought heartburn was supposed to ease up when the baby was low but I guess mine likes breaking the rules.
Amy's due date came and went.  The waiting game set in.  Amy's status updates on Facebook became progressively impatient.


For Amy, labor started slowly, over the course of about two weeks.  In the days before Amy's due date, she mentioned light cramping that would eventually lead to contractions that would open her cervix. Her husband, Bill, noticed that the baby had dropped significantly,.

(T-3) Well I could be wrong, but I feel pretty sure that I'm now in prodromal labor. For those not aware of what that means, that's early labor. But no need to get excited. If I'm right it could still be days away. With my first, I had prodromal labor a week before she was born. 
(T-1) Well when I took a bath this morning I felt like the baby wasn't as high. Bill confirmed, I didn't look as "pooched" as I have been so I'm assuming the baby has dropped. And I feel very very very tired. Standing on my feet more than a few minutes is exhausting. 
(T-1) Off to bed. Baby is still cooking but he definitely is lower. And my blood sugar has been awesome even though I haven't changed anything. 115 or less 2 hours after eating every time. Go figure.
On Amy's due date (T+0), Amy laments waddling:

I am Pengo, the amazing pregnant penguin. At least that's how I feel when I walk... *waddle waddle waddle*. I don't remember waddling quite this much before lol! Then again, this baby is low and has been for some time, so maybe that's why.

The day after Amy's due date (T+1), life goes on:

Well the baby didn't move quite as much last night as in several nights past. Still moving, but not so active. Could mean one of two things, and I'm leaning towards the positive - which is that he's resting for the big day. Got a prenatal today anyways and they'll do a non stress test.

Two days past the due date (T+2), Amy mentions how low the baby is:
The waiting game begins. Last night when Bill and I were walking around the pharmacy, I could feel the baby pressing down as I walked. I know it's going to be very soon.

Four days past the due date (T+4), the baby still has not come, and Amy's stress level is rising:
Getting mixed reviews on whether stress induces or hinders labor. Either way, trying to chillax. 
Twelve days past the due date -- that's a week and 5 days! -- Amy updates her friends and assures them that there have been no babies born (T+12):
Ok just posting an update because apparently if I don't people worry. :). Still preggo but I think the cramping may be getting regular. Should be soon!

Early labor

On the thirteenth day after her due date (T+13), the real early labor contractions came.  They were light, and Amy did the right thing: relaxed, ate, drank, and continued her positive attitude.

Been feeling some contractions tonight, close enough together to make me wonder. So I'm up, eating something, watching some tv, keeping hydrated for a bit, to see if it progresses to anything further, or if it's just false labor and my high hopes for baby due on T+14 lol. Will keep this updated.

Well they seem to be regular contractions at least. About every 20-30 minutes, just not near strong enough yet. Regular is good. Going to stay up a bit longer then get some rest. Could just be a T+14 baby yet!

The next morning (T+14), Amy finds the contractions have not developed a pattern (meaning that, if this were labor -- which it was -- it is still early labor):
Baby is still moving and I believe I'm still feeling contractions. Half asleep right now seeing Bill off to work but have felt like two since I woke up. I can only assume they kept going overnight, they're just not strong enough to wake me up or keep me up. Would be funny if he was born at 2 in the afternoon today... You know... 14:00 military time. T+14. Ok anyways we'll see!
By the evening (T+14) the contractions were still present, but not consistent.  By now it was clear that this was the real thing: labor.  Her husband Bill, Amy, and I all joked on her status messages.
Contractions are now averaging about 10-15 minutes apart. May be tonight, maybe tomorrow... Time will tell!

Me 8:21pm
Let's see if you post all the way through labor. E.g., "Pushing. Baby at +2. Crowning eminent."

LOL I don't think my pain tolerance is quite that high lol. Right now I'm at the pain level of noticeable, I breathe through it and manage. I seem to remember it was like this a day before my first was born... The night I slept in the bath tub for 3 hours because I couldn't get rest any other way lol

Bill 10:04pm
Don't tempt her. She'll be in the middle of pushing and posting at the same time. You watch.

Me 10:33pm
I subscribe to this thread. Let the labor/posting commence! ;)

Lol just painful contractions at the moment ten min apart. Give or take. I'd rate it at about 5 right now. Well at least as far as I can remember. It was 6 years ago lol.
At this point, I thought I should ask about her doula.  Given that Joanne lives an hour and a half away, she should probably have been notified by now.  A surprising (for the readers) turn of events is unfolded.  But Amy still kept her positive attitude.
Me 10:36pm
Have you called your doula???

Turns out she won't be able to make it. She told me last night. She is now pregnant herself and has bad morning sickness. Sucks but it's ok. I'm just thrilled I went into labor naturally.

Me 11:10pm
Doesn't she have a back-up? :(

I have no idea. It was free and she was in training so I guess I can't complain too much.

That evening (still T+14), Amy turns in for the night as she normally does.
Going to try and get some sleep. We'll see how that goes.

Active labor

On the 15th day after her due date (Amy is now 2 weeks and one day late) (T+15), in the wee hours of the morning, Amy is awakened by contractions:
Contractions are waking me up. I'm saying they're pain level 6 or 7 right now. I'm not quite ready to rush off to the hospital just yet though.
Nearly three hours pass; Amy decides to go to the hospital.  There, she is admitted, and is delighted to discover she is at 5cm -- active labor.  The current thinking is that hospitals will not admit women under 3cm dilation because the risk of unnecessary (and costly) interventions increases the smaller the dilation upon admittance.
Going to the hospital now. Contractions are pain level 8 lasting a minute or longer and 5 min avg in between

I can only go based on my experience with my first but with her they never got closer than 8 min or so apart during transitive labor. The pain feels similar now just they're closer together. Each pregnancy is different I guess. We'll see how accurate my self assessment is in like 40 minutes

5 cm dilated

My muscles are so tired already
A mere two hours later, Amy enters transition.  This is fantastic progress, and she should be proud (though, at the time, I am sure pride was the last feeling on her emotion stack).
In [transition] phase now. 7 cm.
Half an hour later, during what women frequently consider the most intense part of labor, Amy posts a verbose status update.  She had just talked to her doctor, who requested antibiotics for Group B strep, and asked her to refrain from eating.
Just got done talking to the doctor. I will be able to get pretty much everything I wanted except two things: I need an iv for group b strep but labor is almost over so that's ok. And no eating. They let me drink though

So sleepy
Four hours go by with no dilation progress.  Is this cause for concern?  No.  The cervix has two jobs in the first stage of labor: to dilate, and to efface.  This means it needs to thin out on the bottom.  The muscle gets displaced to the top of the uterus, where it will be used in the second stage of labor for pushing.  Before pushing can begin, the cervix needs to be 10cm dilated and 100% effaced.
100% effaced. 7 cm dilated. Baby at 0 station. Contractions make me feel like I'm going to die


Forty-five minutes later, after dilating 3cm and after just three big pushes, the next status update is one of jubilation (note the exclamation marks).
Baby is born!!! 3:28 pm!!!

Meant to post this earlier but he was 9 lbs 15.5 oz and 21.75" long. He's doing great. Both mom and baby's sugar was great (surprise surprise). He nursed well and fell asleep in my arms.

Facebook baby

Later, in the day after the birth, Amy explained: "I was not confirmed 10 cm when I pushed. I had been measured about 10 minutes earlier, and was still at 9[cm], but I didn't care."  The contractions pushing contractions were too overwhelming.  "Actually, after three hours at 7[cm] I pushed a little through contractions because it made it hurt less."
I pushed on hands and knees -- two pushes for the head then rolled over to my side for one body push.  When I got on my hands and knees I could not help but push.  They kept trying to tell me I'd know to push if I felt like pushing between contractions but that didn't happen. It was an incredible need to push during contractions that did it for me. Bill had a good analogy: He said that when I was squeezing his hand, he had to squeeze back as hard as he could so it wouldn't hurt. I told him that is exactly how I felt about pushing through contractions.
Amy added that the nurses begged her to get on the bed in the traditional supine (on the back) position, knees by her ears, to push.  Loathing this position, she abstained: "I can't."  Pushing, the head was born as she was on her hands and knees.  It was only then she was able to roll onto her side.

Congratulations, Facebook Mom!


There are a few key points to take away here.

The first is that babies do not always come on their due dates.  First babies are usually late; even subsequent babies can be very late.   Amy's baby came over two weeks after her estimated due date.  Due dates are just that: estimates.

Next, labor can start very slowly and progress over the course of weeks.  This does not mean that life stops: Amy showed how to handle a slow-starting labor and the rest of her life.  She did not let pre-labor alter her routine.

Then, the in-labor measurements of effacement and dilation are also estimates.  The way these are measured is largely subjective.  For dilation, the nurse or doctor inserts two fingers into the vagina, spreads them gently, and estimates the distance between them (this is why measurements are frequently preceded by "probably" or "around").  For effacement, the thumb and forefinger lightly pinch the cervix, and the doctor or nurse estimates how thin it is compared to other women's cervixes they have seen.  This is more of an art than a science, and is sometimes not totally correct -- as in Amy's case, in which she began to feel like pushing before the necessary 10cm mark.

Finally, Amy showed that, by listening to her body and under the care of her medical professionals, she could have the strong, empowered birth that she longed for.  Maybe it was not the ideal birth, both from the medical perspective (they wanted the baby out before the 2-week overdue mark, and they wanted her to push supine) and from her own (her doula did not make it, she had to struggle or argue for her body's rights, and she took some serious risks by skipping her prenatal appointments until so late in pregnancy), but it was within the realm of possibilities and, in the end, everyone was healthy, happy, satisfied.

Saturday, February 19, 2011

Advancement to candidacy

I advanced to candidacy (O glorious day)!  It was a strange advancement with an unpredictable outcome.  In this article I itemize the six surprises, much like the seven gates of hell (with one reserved for future implementation) through which I passed on the way to the positive outcome.

The Gates of Hell by Auguste Rodin
share little resemblance to advancement
to candidacy.

In my department, the advancement to candidacy signifies several simultaneous milestones that, in other departments or in other universities, are separate events.  First, it implies that all courses for the program are complete satisfactorily.  This includes core and required classes, electives, breadth requirements, and the requisite number of units within the department.  Second, part of the advancement is the qualifying exam, which takes the form of an in-depth question-and-answer session with the advancement committee members (like an oral examination for which you do not have the questions in advance).  Third, it is a defense of the research proposal and n-year plan.  Approving the research defense is an indication that the student has enough background and domain knowledge to venture off on his or her own research topic.

Anatomy of an advancement

The advancement goes like this.  First, the student (and student's friends, if any are available) arrive to set up some snacks.  This is very important, because the whole procedure takes at least three hours, and everybody knows that hungry advisors are unhappy advisors, and unhappy advisors are likely to fail their students.  Quality food is best, though sweets and carbs are usually a hit.  At one advancement I attended, the student's wife made fresh, home-made chili and zucchini bread.  Another had a giant bottle of organic orange juice.  Yet another had an assortment of pastries and chocolates from an organic foods store nearby.

Ideally, the student arrived with enough time to set up his or her computer, connect it to the projector and Internet connection, and mentally and emotionally prepare him- or herself for the ordeal to come.  It is not exactly a snake fight portion of your thesis defense (that part comes in a few years), but it can be a long and exhausting test of mental strength.

Colleagues, cohort, and friends arrive.  The committee members, of which the student has at least four, arrive promptly, and the student begins his or her research goals presentation as other audience members filter in.  Motivation, prior work, theoretical underpinnings or significance, proposed contribution, work plans, and a timeline.  Then, the floor is opened to questions from the audience.  When the student has sufficiently satisfied the easy audience questions, everyone leaves the committee alone with the student.  The committee members ask their tougher questions (this is the oral examination).  This can take over an hour.  Having satisfied the committee, the student leaves, and the committee deliberates in private while the student paces outside in the hallway, waiting to be called in.  Soon, the committee calls the student and discusses their decision (which is hopefully a positive one).  The decision along with key points of the deliberation are written up and submitted as evidence of completion of this milestone.  The student pays a fee and -- poof! -- is a Ph. D. candidate.

Anatomy of my advancement

I arrived with half an hour to spare for my 9:30am advancement with a collection of bagels and spread, nuts, chocolates, and other snacks from Whole Foods, and a gallon of Peets Coffee with organic cream and fancy brown sugar cubes (my husband was amazing and did all the shopping).  While my husband and some friends were setting up the food,  I went to pick up the projector I had reserved the night before.

"Just pick it up from me," the graduate advisor for my department, a sweet older lady in a darkened room lit by only a 25-watt table lamp, said when I made the reservation in person.

"My advancement is at 9:30am... will you be here?" I asked.

"Yes, I will," she said, and went to hang up the announcements with my name and abstract printed on them.

So, on the morning of my advancement, I was met with...

Surprise #1.  The advising staff lady for my department decided to work from home that day.  OK, no problem, I thought.  I'll ask the other department's grad advisor, whose door is right here.

I knocked, but no answer.

I walked down the hall to faculty support.

"My advancement is in half an hour, and I have no projector," I said.

"You needed to have reserved one through your department's advisor," the girl behind the counter said.

"I did.  She isn't here today," I replied.

We both leaned over and looked down the long hallway to the row of closed advisors' doors.  She looked down at her reservation book.

"I don't have any projectors available," she said, with a sad note in her voice, "and no access to your grad advisor's room."

At this point, my friend Cat found me.  "I have one in my lab," she said.  "I'll bring it down."

I went back to the room of my advancement to set up Skype for the committee member with a sick baby to connect from home.  Then, I was met with...

Surprise #2.  An e-mail from another committee member that said he was sick and would not be coming.  Just like that.  It is probably no big deal, I thought.  That's right.  No big deal.

As the time drew near and passed, the room filled with people.  Eventually the majority of my committee arrived, and I began my talk.  Much of it was about a childbirth video game that I had invented, developed, and deployed, and where I planned to go next with the topic.   When I finished, there was a lot of discussion among the audience, and I fielded questions.  And then...

Surprise #3.  My committee chair said, "I don't play games, and I don't have children, so I'm not probably the worst person to be on your committee."  (At this point, I amazed myself with my own poker-face ability.)  "How are games better than pamphlets you can get at the doctor's office?"

Hang on, what?

"It's just that I don't see how playing this game ---"

"Simulation," I corrected.

"How playing this simulation is going to prepare me for childbirth. I'd rather read a book."

Before I could reply that he, esteemed committee member, was clearly not my target audience...

Surprise #4.  One of my colleagues in the audience replied, softly yet firmly: "If you were going to learn to fly a plane, would you specifically avoid flight simulators as training tools just because you don't believe in games?"

Then, a games-as-learning-tools debate ensued... one in which I was not involved.  Very surreal.

The public Q&A ended, and nothing particularly out of the ordinary happened behind closed doors.  My Skype-advisor asked some tough questions but was on my side throughout the whole process, even flashing me a big grin and double-thumbs-up on the screen when she thought nobody else was looking.

One committee member said, "Now we will talk alone and vote.  You can leave the room."

"Should I just... uh, how will I know you are done?"

"Just wait outside the door and pace the hallway nervously," he replied.  "It's tradition."

Rather than pacing, I looked down the hall and saw that the other department's grad advisor, a younger woman with a lot of blonde curly hair, had come in.  I thought I would use this opportunity to ask about my missing advisor.  When I told her what had happened, her eyes got as big as dinner plates and she picked up the phone, dialing a number with her long fingers, without taking her eyes off me.  Then, she turned away and tersely described the situation to the person on the phone: "There's an advancement candidate here, and one of her committee did not show up.  What does she do?"

Then: "I see."

Then again: "I see."

Surprise #5.  Turns out, you actually do need all of your committee members.  See, there need to be three tenured faculty that vote on whether or not the student passes.  Failing that, the advancement is nullified and must be repeated.  I had two tenured and two untenured present (including my Skype-advisor).  My heart skipped a beat before sinking; my face paled and reddened and paled and reddened in rapid succession.

The grad advisor turned to me, placed both hands palm-down on her desk in front of her, and looked at me sternly.

"You tell your committee to get him" (the missing committee member) "on the phone. Drive to his house.  Whatever.  He needs to cast a vote."

"And," she added, "we never had this conversation."

As I paced outside the room as required by tradition (I was ready to do so now, as this was the killer that finally broke my confidence), I waited.  I knew the gallon of coffee would come in handy: as the committee left, one at a time, to go to the bathroom, I notified them of this new development.

Over an hour passed.  There was no way it was so hard to decide to pass me.

Finally I was called back in: "Congratulations, Candidate.  We got his vote on the phone."  But I was not prepared for...

Surprise #6.  "We want you to switch departments."  So that's what all the deliberation was about.

To be continued...

Friday, February 18, 2011

Why StarJeweled should be a co-op game

In this blog post, I admit to cheating.

How I cheat in StarJeweled

In StarJeweled, a custom map for StarCraft 2 (Blizzard, 2010), you summon units and cast spells  to destroy the enemy base.  The units and spells cost energy, which you get from forming 3-in-a-row combinations on the right-hand side of the screen in a seemingly-unrelated mini-game similar to Bejeweled.  When one move creates a cascade of combinations, you get tons of energy, up to 1000, which is the highest number of energy you can have at one time.  The game awards points based on the total amount of energy collected and the number of enemy units destroyed.

Now, as a casual gamer that is not really into real-time strategy (RTS) games (and, frankly, is very bad at them) and vehemently opposed to violence in games, the right-hand side of the screen, the part with the jewels, is great.  The rest of it, not so much.  My husband, on the other hand, is an RTS ubernerd.  So, we play together.

I use a small Wacom tablet as a pointing device and play the jewels portion of the screen.  The Wacom is a necessity for ergonomics: when I use a mouse for this task, I hurt for days.  So, my chair is pulled alongside the desk and the tablet rests in my lap.

My husband uses the keyboard and has memorized the key shortcuts to summon each unit.  He watches the energy bar and performs the appropriate RTS-y action.  When he needs a spell cast, he hits the appropriate hotkey, points with his finger at the screen, and barks an order: "Need a lightning, here."  Or, "Freeze the big guy."

Needless to say, we outscore everybody.  Despite my blunders such as locking our own unit, casting heal too late (and healing our free units), and generally not having the slightest idea about what is happening on the battlefield.

A lesson from a predecessor

Warcraft 3 had a fun little mini-game called Tower Defense.  In this co-op game, three teams of players would face off in planting towers to guard the lanes down which enemy creep (units) would run.  The towers are paid for in money, which you get from killing creep, which are summoned from the magic base at the bottom of the screen.

My friend Mike and I had a winning strategy here too.  At the beginning of the game, we would share resources, which allowed us to pool our funds.  He would build the minimum number and power of towers, and I would do all of the summoning.  At the start of each new level, I would transfer money to his account and he would build more towers.  I could monitor the upgrade level each opponent's base, and he could monitor his towers.  (Bonus points because my computer was incapable of rendering the towers shooting more than about 5 creep at a time.)

We won every time.

But it affords two players

But StarJeweled game simply lends itself to two players so beautifully.  Like pair programming, we share a single computer and think aloud to each other.  It is truly a cooperative experience.

If StarJeweled supported a co-op mode in which, as in Tower Defense, we could share resources, it is likely that my husband and I would play on two different accounts, on two different computers.  It is likely that we would not cheat by using two players for one game; instead, we would buy a second StarCraft 2 account, like normal people, and play the mini-game on an even playing field.

Just a heads up if you come across us in StarJeweled... we will kick your butt.
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