How to honor a loss anniversary, and other thoughts

A local loss mom friend and blogger over at Surviving the Loss of Baby Sidney is approaching the first anniversary of her son’s death and recently sent an email to family and friends with suggestions for how to mark the occasion, including the following:

First, I am asking people to do something kind for themselves or someone else on May 4th. This can range from smiling at someone in the street or allowing yourself to sleep in, to donating your time or money to an organization that you believe makes a positive difference. I need to know that at least a little bit of good came from Sidney being part of the world for the short time that he was here.

Second, if you would like to, please send us a stone from a place that is meaningful to you, with a slight description of where you found it, so that I can put it at his grave (Jews traditionally leave stones when they visit graves of loved ones. While the reason behind this seems somewhat unclear, my favorite explanation is to indicate that the loved one is remembered and thought of, with an object that lasts longer/is more permanent than flowers).

Finally, do not be afraid to let us know that you are thinking of us, and to say Sidney’s name. Hearing Sidney’s name does not upset me–what upsets me is that he is dead. Instead, knowing that others remember him makes me feel like I do not have to carry him around in my heart alone. Lighting a candle in his memory (or sending us candles, trees, buying us stars, making a dedication in his name etc–I hope I have included everyone/everything) or simply reaching out to tell us that you remember him, has meant so much and will continue to mean so much.

I love the idea of doing something good in his name on that day, and wanted to pass it along as a suggestion to my readers for honoring any lost children that you know. I wasn’t aware of the Jewish tradition of leaving stones, but my daughter loves rocks and always leaves one at Luke’s grave, so I will have her pick one out for Sidney, and we’ll plant some flowers next to Luke’s bench in our garden as well, so our boys can be together.

In other musings …

The other day I was wearing a hoodie (before April suddenly turned to July) and in the pocket I found a memorial necklace that someone must have given me at some point, only I have no memory of receiving it. I received a lot of jewelry after Luke’s death, and it’s hard to keep track of who gave what, but I still feel bad about blanking on this one.

After spending so much time obsessing about fetal movement during Wyatt’s pregnancy, I thought for sure I would be counting phantom kicks for weeks after he was born. Strangely enough, though, that already seems like a distant memory, and I can’t even remember what the movements felt like, or what it was like to be chained to my KickCounter app.

Wyatt has been sleeping for longer stretches, and last night he slept through the night, until just after 5 a.m. So that’s obviously great if he starts doing that consistently, but now I also need to decide whether to throw in a middle of the night pumping session, because, well—holy boobies, Batman.

I took Zoe to her 4-year checkup last week, and when the nurse practitioner asked Zoe to list who lives at home with her, she named myself, my husband, Wyatt, and Luke, which made my heart swell, but then when I said, “Well, Luke lives in heaven,” the nurse practitioner said, “Awww, is that a pet?” and I wanted to punch her, but Zoe kept talking, and the moment passed.

I suppose it’s marginally better than my encounter at Zoe’s third-year checkup, when, after I informed the doctor of Luke’s death, she said she wasn’t aware that losses could occur that late in pregnancy.

At Zoe’s birthday party, while I carried Wyatt in a sling, I struck up a conversation with the mom of one of Zoe’s classmates. She is a perfectly lovely and sweet person, but I don’t think she knows of my loss, and she mentioned that Zoe’s friend was born when her daughter was only 2, and it was difficult to have two children of that age, and it’s so much easier to have a baby around when they are 4, and more independent. And I wanted to tell her that Zoe should have been 2 when her first brother was born, because normally I don’t have a problem telling people about Luke, but I just couldn’t figure out a way to bring it into this otherwise innocuous small talk, and so I didn’t say anything, which made me feel sad and also guilty, like I wasn’t honoring Luke properly. It also reminded me of how much of a gulf will always remain with other moms who haven’t experienced a loss, and how conversations can still catch me off guard, and break my heart.

Recently I’ve attended a few services at our local Unitarian Universalist congregation. I suppose I’ve been searching for something different, as our current church didn’t provide any support when Luke died, and his death also further cemented my agnosticism, wherein it’s difficult to believe in a God who would allow children to die, but it’s also difficult not to believe that some kind of being was responsible for this amazing, incredible universe. Anyway, the UU church actually cares about things like climate change, and people’s suffering, and everyone is really friendly, and the pastor (is that what you call him?) this past weekend gave a sermon (is that what you call it?) addressing a racism controversy among the higher ups of the national organization. His openness was refreshing and something I’m not used to. So I like it there, but when it comes to spirtuality, basically I am still kind of wandering.

 

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Just feed the baby, they said

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Warning: If you aren’t comfortable with boob talk or don’t want to read a bunch of detailed information about breastfeeding, feel free to skip this post.

In a recent post I mentioned that Wyatt is exclusively breastfed, and how I was proud of that achievement, since I never got there with Zoe and had to supplement with formula her entire first year. But it’s been a long road this time around, and we still have our struggles.

It started in the hospital when we learned that, like Zoe, Wyatt had both a tongue tie and a lip tie. (Ties are hereditary and my husband has a tongue tie.) I didn’t learn about Zoe’s ties until she was six months old, and so in the early days, when my milk supply was being established, she didn’t transfer enough milk, which killed my supply. I also had know idea what I was doing and didn’t seek help until it was much too late.

We were prepared with Wyatt and had his ties revised when he was 5 days old. But by then he was already using a nipple shield, because the lactation consultant at the hospital forced one on us, for reasons I don’t entirely remember, and because I was too doped up and exhausted at the time, I didn’t fight her. Anyway, soon he became too used to the nipple shield and wouldn’t nurse without it. In the meantime, he developed thrush, a fungal infection, and we spent several weeks sterilizing all bottle and pump parts after every feed and applying medicine to his cheeks and mouth four times a day, in addition to doing stretching exercises to helping his tie revisions heal.

Also for the first few weeks, he was incredibly sleepy and would fall asleep before he was full, so I had to pump after every feed and we would supplement with expressed milk, first in a feeding syringe, and then as he got bigger and ate more, with a bottle. He was so sleepy that it was often difficult to rouse him, or he would fall asleep halfway through, and feedings often took an hour. Apparently this is due to something called wimpy white boy syndrome, where, for example, premature white male babies require many more interventions in the NICU because they just can’t get it together. (My husband and I joke that this must be due to evolution, in that white males basically don’t even have to try, because they automatically get plenty of help, whereas African American baby girls, who are apparently the most robust in the NICU, have to fight for every little thing. Well, we joke about it, but sadly it’s probably true.)

Anyway, eventually we got past the sleepy phase and no longer had to wake him up for feeds, and eventually he got over the thrush. But then we were still using the nipple shield, which was preventing him from getting a full feeding, such that we still had to supplement with pumped milk. So I started to wean him from the shield, which took about a week, and for a few brief days things were great, as he was nursing without the shield and without supplement. But then without the shield serving as a barrier, nursing became excruciating, and this past weekend I had to switch to exclusive pumping and feeding him expressed milk with a bottle. We’ve since learned that he hasn’t learned how to use his tongue correctly after his revision and doesn’t bring it far enough forward in his mouth, and that’s why it’s so painful. We’re doing exercises several times a day, and hopefully I’ll soon be able to go back to directly nursing and we can put this last obstacle behind us.

A few days ago I said I wasn’t going to share a lot about Wyatt to protect his privacy, and yet here I’ve just gone and relayed a lot of medical information about him. But this is leading up to some tips I wanted to share with breastfeeding moms who are struggling, even though this is a grief blog, and not a baby care or breastfeeding blog. I didn’t know about any of this stuff when I was a first-time mom; I assumed you simply put the baby near the boob, and everything would just work out, so the amount of struggling we did hit me like a ton of bricks. Even this time around, I still had much to learn, so I hope it helps even one person out there. Pick none or one or all of these, if you like—whatever works for you.

Seek professional help. If you can only follow one of these tips,  let it be this: Schedule a home visit with an international board certified lactation consultant. A good IBCLC can not only assist you with latch issues but help you develop a feeding/pumping strategy, assess the suction on your pump, help you choose correct flange sizes for your pump, and recommend herbal supplements to boost supply if necessary. I’ve found that hospital LCs, while qualified, tend to be most knowledgeable about short-term goals of getting baby to have a sufficient number of wet and dirty diapers before leaving the hospital, as opposed to helping moms build a long-term milk supply. Likewise, LCs at pediatrician offices can be most concerned with making sure baby is gaining weight. And these are important goals, but if you are supplementing with formula because your bub isn’t efficient at transferring milk, and you feel that the hospital or pediatrician LCs are not sufficiently focused on helping you wean off supplementation, seek help ASAP from an IBCLC in private practice. You can find one here; the members of the IGT/Low Milk Supply Facebook group can also recommend one in your area.

While this is probably the single most important investment you can make on your breastfeeding journey, your insurance may not cover visits from a lactation consultant, so if you cannot afford one, consider asking friends and family for a bit of help—you can let them know you’d rather have this than more clothes, which you likely already have too many of anyway, or toys that the baby won’t even be able to use for months.

Invest in a hospital-grade pump. A hospital-grade pump is your single best bet for boosting supply, especially if LO is not good at transferring milk. You can rent one from your hospital, like a Medela Symphony or Ameda Platinum, or you can buy an affordable, high-quality one such as the Spectra S2. Under the Affordable Care Act, many insurance companies are even providing Spectras for free. With Zoe, I used an Ameda Purely Yours, then a Medela Pump in Style Advanced and eventually a rented Symphony from my hospital, as the Spectra wasn’t available in the U.S. at the time. This time I have the S2 and it blows the other pumps out of the water in terms of suction and comfort.

Have your LC test the suction on your pump using a vacuum gauge, and replace parts regularly. I’ve had to use my S2 frequently, so I replace the backflow protectors and duckbill valves about once a month. (Side note, the tubing that comes with the S2 sucks and constantly falls off the backflow protectors. I ordered the Nenesupply replacement tubing from Amazon and I no longer have that problem.)

Not every mom responds to every pump in the same way. Some moms actually respond better to hand expressing or manual pumps. So if you don’t have a lot of money to spend on multiple pumps, your best bet is to rent or to get a free one through insurance.

Pump after every feed the early weeks, especially if your LO has transfer issues.  Start as soon as you can in the hospital. This is a lot of work and can be time-consuming, and it can be especially challenging after your spouse goes back to work, and if you have more than one child, but you’ll figure it out eventually. Get a hands-free bra, consider hands-free pumps like Freemies, and learn how to pump while driving. If you have an older child, come up with special activities that they can do only when you are feeding/pumping. For Zoe, we created some craft boxes that we keep high on a shelf and bring down only during Wyatt’s feeding time.

Since breastfeeding is based on supply and demand, there is little that is more important in building your supply (in addition to using a pump with maximum extraction), especially if your LO doesn’t transfer enough. If you are supplementing with formula, pumping after every feed should eventually help build your supply to the point that you can start supplementing exclusively with breast milk.

Learn about herbal supplements. Fenugreek is usually the go-to supplement recommended for boosting supply, but for many moms it has no effect or, for those with thyroid issues, can actually decrease supply. There are other options, such as goat’s rue and moringay, and this is where an IBCLC in private practice can really help, as many hospital and pediatric LCs seem to be f fenugreek.

Enlist helpers. If you have a spouse or partner, now is the time to enlist as much of their help as you can. Up to this point they haven’t born the brunt of bearing your child. They weren’t pregnant, didn’t deliver the baby, and aren’t nourishing your LO directly from their body. So don’t feel bad about asking them to pitch in by washing pump parts, bringing you snacks, getting up with you for middle of the night feeds, or any of a thousand tasks.

Don’t stress, and don’t give up. “Don’t stress” may seem laugh-out-loud crazy, and I certainly am guilty of not following this advice, but seriously, make a plan, push through the hard parts, and try to trust that everything will eventually work out if you stick to the plan. Find a mantra that you can recite any time things get hard—this one has worked for me:

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Find other moms that you can connect with for advice and inspiration. I’ve gotten so many great tips on pumping from the Exclusive Pumping Mums Facebook group, and it also helps to know I’m not the only one who struggles.

If you’re having a bad moment and feel like giving up, see if you can postpone your decision to the next morning. You may find that with a little distance from whatever it was that was pushing you to the edge, you feel just better enough to keep going for a little bit longer. If you keep doing this, things may start to get easier until the woes of the early days are far behind you. Remember that with very young babies who are just figuring all this out, every feeding is different, so if you have a feeding where baby doesn’t latch or doesn’t transfer enough milk or it’s excruciating, try to push through it and forget about it as soon as it’s over, because the next feeding may very well go better.

But if you feel like you’re not enjoying your time with your baby, or that feeding and pumping are taking too much time away from your baby, or that you just want your body back and to get some sleep, there’s no shame in stopping. You can bond with your baby and be a great mom however you choose to feed. It’s your body and only you can decide how you want to nourish your child.

Six weeks

Wyatt turned six weeks old on Thursday. I’ve been debating about sharing too much about his birth and life on here as I want to protect his privacy. But here are a few things I thought I’d relay.

Both Zoe and Luke were born vaginally, and Wyatt was a planned induction, but he ended up being delivered by c-section. On ultrasounds, his head had consistently been measuring above the 99th percentile. He was also crooked in the birth canal. So when his ginormous head met by pelvic bone, it couldn’t get past. I was in immense pain by that point thanks to pitocin, which can induce incredibly strong contractions, and after over an hour of pushing (and six-plus hours of contractions) I just didn’t have anything left. Unfortunately, the epidural didn’t take full effect until I was being wheeled back to the OR. Then it took like four hours for me to regain full feeling in my lower body.

The rest of our two-plus days in the hospital passed in a haze. He had jaundice, and while he didn’t have to go under the special lights, he wore this weird glowing pad/blanket thing under his swaddle, so we called him a glow worm. For a while he was making these little critter-like sounds, so we also called him a guinea pig.

I’m incredibly proud to say that he is exclusively breastfed. With my daughter, I had low milk supply and had to supplement with formula her entire first year, which isn’t the worst thing, but it wasn’t how I envisioned my breastfeeding experience. With Wyatt, we have also encountered a fair number of roadblocks, which I may detail in a future post, but nonetheless I have been able to maintain sufficient production. I say this not to boast, as I have endured the pain of low supply in the past, but because I am proud of myself for persisting.

I’m not a particularly materialistic person or much of a consumer, and clutter stresses me out, so I’ve never had a traditional baby shower for any of my kids, and I’ve passed on a lot of the traditional baby items that people purchase. For example, we never had a true diaper bag for Zoe. We used a big black bag whose origins I don’t recall. But then the handle broke. For Wyatt, we’d been using a bag that a nonprofit sent us as thanks for a donation, but it’s a little smaller than I’d like and doesn’t have many compartments, so I found myself drifting to Etsy to order a real, actual diaper bag for which, like everything on Etsy, I paid way too much. I’ve also ordered a few pairs of pajamas that he doesn’t need and a couple of nursing tops that, truthfully, I don’t really need. I’m not really sure where these impulses are coming from, other than to reward myself for enduring the incredibly difficult experience that is pregnancy after loss, and to celebrate in some small way the birth of my rainbow child, which I had previously been too scared to celebrate.

With both of our living children, my husband and I have found humor to be a great coping tool for the intensity and stress of the early newborn days. Hence, when he cries over something like being slightly jostled or having his diaper changed, we pretend we are Wyatt and say indignantly, “Why would you DO that?” Or when he starts crying, it’s fun to shout, in my best George Costanza voice, “I’m gettin’ upset!”

Speaking of stress, I think that postpartum depression is something that needs to be addressed more honestly in the baby loss community. No one wants to admit that they are overwhelmed or stressed by caring for the rainbow baby they so desperately wanted and wished for, or that they feel trapped in an endless cycle of feeding, calming, and diaper changes, with no hope of ever returning to a sense of normalcy. I had these feelings with Zoe, and while they have existed to some degree with Wyatt, and caring for two children simultaneously is an adjustment, I have much better coping tools this time, and I also have Zoe as proof that eventually it all does stop and get easier. Still, I think it’s important for a loss mom who is caring for her first living child to be comfortable acknowledging these feelings, and not feel a lot of guilt and shame in the process.

Wyatt is already in three month clothes, and we just had to adjust his car seat, and he no longer smells like a newborn, and the past few days, he has been giving us adorable huge grins, and staring at lots of things in his surroundings. So he’s already growing up fast, and just like everything with raising kids, both living and dead, time passes so quickly, even when it seems like a lifetime.

To the friend who stopped calling

To the friend who stopped calling,

We exchanged texts when my second son was born. You expressed your happiness for me. And then you went radio silent.

And your silence hurts.

My grief didn’t end the day Wyatt was born. Luke is still not here, and he never will be. I held him in my arms, but I will never get to see how his hair would grow out, or what color his eyes would be, never got to hear his voice, never got to do tummy time, never even got to dress him.

You listened to me in the days and weeks after Luke died. Expressed empathy when I detailed my countless anxieties. Shared advice for how to deal with the shitheads at my last job, and when I should quit.

And then I started to hear from you less and less. Perhaps I remind you of your worst fears, or maybe it’s a hard thing to keep up, providing support to someone who’s grieving, day after day, week after week. The thing is, it’s even harder to be the bereaved one. Every day that you wake up, you must confront the fact that your son is dead. There is no escaping it.

The last time I saw you, I was 28 weeks pregnant. We had our kids with us (well, you had all of your kids with you; I had only two of them), and it was hard to really talk. But I mentioned the anxiety I was experiencing over fetal movement. It was like talking into an abyss. There was no comprehension there. And in that moment I was reminded, once again, how much of a chasm now exists between myself and people who have never lost a child. Of how the relationships I had before Luke’s death are, in a sense, gone forever, irrevocably altered by the worst thing to ever happen to me.

I don’t know why I haven’t heard from you again. When you have a child after another child has died, it’s an emotionally tumultuous and confusing thing. You are grateful for your rainbow child. But you can’t help but think that he wouldn’t be there if your first son hadn’t died. Likewise, you can’t help but think that your rainbow is here only because your other child died. You feel guilty that one lived and the other didn’t, that perhaps if you had exercised the same level of care the first time around, Luke would have made it. And as your new baby boy grows and develops every day, it hits you viscerally, in a way it hasn’t up until now, what you have missed out on with Luke.

So no, my grief didn’t end the day Wyatt was born. In some ways, I need your friendship more than ever. But I guess this is time to accept the fact that we can’t go back again. We simply aren’t the same two people anymore, ever since that day, 20 long and short months ago.

Five days

Our induction is scheduled for Thursday, March 9. We have five days to go. I have spent the entire pregnancy not knowing whether we would make it this far. Now that we have, I find that the huge burden of responsibility for another’s life still has not been lifted from my shoulders, even though I am seeing one doctor or another three times a week. Monitoring of fetal movement still rules my life, and my brain. And in that regard five days seems an eternity away.

And also, the end of this pregnancy is bittersweet. This is my last pregnancy. Feeling their babies move is what many mothers cite as their favorite part of pregnancy. And it has been mine as well, and there are definitely times that I savor the movement, but I hate that it has also become such a source of fear and anxiety, something that most moms in “normal” pregnancies, oblivious to the fragility of life, will never experience. Just one more hard fact on this planet where my baby died.

Counting kicks, AKA how not to lose your mind during PAL

It’s 7:00 on a Monday evening. I’m suffering from a small cold, tired, and mentally whipped following my third trip to labor and delivery earlier that day due to concerns over possibly decreased fetal movement (during which everything, once again, checked out OK). There are many things I could do. Head into the kitchen to help Zack with the dishes. Play games with Zoe. Collapse into bed. But I’m rooted to the dining room chair, unwilling to move from my spot, because the baby is kicking up a storm. And I’m afraid that if I get up, he’ll stop, and I’ll start worrying again.

Welcome to pregnancy after loss. When you’re so focused on monitoring fetal movement that your mind plays tricks on you and the slightest pause or decline can send your levels of anxiety skyrocketing. When you wake up in the middle of the night and don’t fall back asleep for hours, because you’re paying attention to how your baby is moving. When you can’t take a nap, because the baby is moving and you’re monitoring the movement, or your baby is not moving and you’re waiting for him to start moving again. When you’re constantly afraid that your baby has died or is about to die. When most of the people in your life fail to comprehend how much of an ordeal it is just to make it through the day, and you start to feel even more isolated on this Planet Where Your Baby Died.

6 kicks, 10 kicks, your baby’s pattern—what’s a mom to do?

Now into the mix let’s throw a heaping a dose of confusion and disagreement over what constitutes normal fetal movement.

Here’s what the American Pregnancy Association has to say on the topic:

The American Congress of Obstetricians and Gynecologists (ACOG) recommends that you time how long it takes you to feel 10 kicks, flutters, swishes, or rolls. Ideally, you want to feel at least 10 movements within 2 hours. You will likely feel 10 movements in less time than that.

But over in the UK, the Kicks Count charity offers starkly different advice:

There is no set number of kicks you should be feeling, what is important is that you know what is normal for your individual baby. If you notice a decrease in your baby’s regular movement pattern contact your midwife.

There is a common misconception that you should be feeling 10 kicks over a set period, this is no longer recommended as all babies are different. You can find out more here about the origins of ‘count to ten’ and why it is not used. Baby’s movements can vary from 4 to over 100 every hour so counting to 10 kicks would be irrelevant for most of the population. It is important to know what is normal for your baby and report any change in that.

The organization further notes:

One of the greatest challenges is the lack of consensus on what is a ‘normal’ number of fetal movements and over what specified time frame. Fetal movements vary from four to 100 every hour and so definitions of reduced fetal movement based on counting less than 10 movements in two, 12 or 24 hours are unhelpful.

For a mum who usually feels her baby move 50 times over 12 hours, if the baby reduced their movements to only 20 it could be a sign the baby is in distress. However if she used the count to ten method, she would not seek help as she met the ‘recommended’ number.

Likewise a woman who usually only feels 8, may end up phoning the hospital unnecessarily every day as she never meets the ten required.

The other issue with fixing a set number of fetal movements is there is no way to know what a woman is classing as her baby’s movements. Because it relies on perceptions from individuals rather than an independent monitoring system, there may be major differences between what one mum counts as her baby moving and what another counts as hers.

Therefore the safest and most reliable method of monitoring baby’s movements is to encourage the mum to get to know her baby’s own pattern of movement. She will then be able to determine if her baby has a period of reduced or increased fetal movement.

Count the Kicks, an effort of the admirable Healthy Birth Day stillbirth prevention organization, recommends a sort of amalgamation of these recommendations, instructing women to count the amount of time it takes to feel 10 movements, noting that could be hours for some babies and minutes for others, and to call the doctor if there is any significant change in movement.

With all of these recommendations out there, the obstetric community seems to be all over the map in terms of the type of fetal monitoring they recommend to moms. After one of my visits to labor and delivery, the hospital sent me home with a paper that alternately recommends contacting your doctor if:

  • You feel a change in the number of movements
  • You feel fewer than 10 kicks in 2 hours after counting twice

Meanwhile, my MFM’s office, which is generally pretty with it when it comes to stillbirth prevention, sent me home with a piece of paper that contains such alarming recommendations as:

  • If you have felt NO MOVEMENT by 2:00 pm on any day, call your doctor for advice.
  • If you haven’t felt 10 movements by 8:00 pm, write down the number you actually felt and call your doctor for advice.

The paper also recommends to stop at 30 during kick counts and to look for at least 6 movements in one hour during your count; “if you do not get 6 movements during the second hour, call your doctor at once.”

What constitutes normal?

The recommendation of the Kicks Count charity seems to make the most sense to me (and indeed, the folks over at the Star Legacy Foundation inform me that the 10 kicks in 2 hours guideline is based on 30-year-old research that many believe was improperly conducted, while the UK guidelines are based on a 2009 study). It’s quite common for my baby to move more than 100 or even 150 times in an hour, so if movements suddenly dropped to 12 or 8, while technically more than the recommended number of 10 or 6, it would be a cause for alarm. I certainly wouldn’t wait until 2 p.m. without feeling movement to call my doctor, nor would I wait until 8:00 p.m. if I’d only felt 10 movements.

However, determining what is a “normal pattern” for my baby has been quite a challenge, simply because he is a human being and doesn’t move in exactly the same way or at exactly the same time every day. He can have active days followed by sleepy days, active mornings followed by sleepy afternoons, sleepy mornings followed by active afternoons, and so forth. Many kick count guidelines recommend drinking juice, counting after a meal, and/or lying on your side, but my baby’s response to these actions has been everything from kicking up a storm to stirring in his sleep. Sometimes at 8:30 p.m. he’s got the heebie jeebies and sometimes he’s deep asleep.

Consequently, I’ve spent quite a bit of time since the second trimester crafting a kick count strategy that minimizes my anxiety and maximizes the amount of control I feel over the outcome of this pregnancy (although I am the first to admit I haven’t always been successful in this regard). I wanted to share some of my tips here, in case other baby loss moms find them useful.

Choose a number that works for you. In the second trimester around 24 weeks, I would often count all day long, or frequently throughout the day, in order to build up some objective data on how much baby was actually moving and to begin to look for patterns. Although it helped me to see that the baby was much more active than I’d made it out to be in my mind, this was tedious and mentally and emotionally exhausting. At the end of the second trimester and beginning of the third, I cut back to four hourlong counts a day (first thing in the morning, lunchtime, late afternoon, and nighttime). Now I’m at the point where I’ve been monitoring for so long that I have an instinctive feel for when the “pattern” is off (and I’m also being seen by a doctor three times a week), so I’m more often doing 1-2 counts a day, and less frequently 3, depending on how much activity there is on a given day. On active days I am likely to do fewer counts.

The point is to pick an amount of monitoring that gives you the reassurance you need to get through the day without being in a constant state of panic. It’ll be different for every baby loss mom, I think. Some may find comfort in counting all day and some may be content with just one count. Do whatever helps you to feel more in control. You may need to play around with it at first, and you may find yourself adjusting as the pregnancy progresses.

I use the Baby Kick Counter by Michael Kale app, recommended by Christine over at the chickydoodles blog (in the App Store, you’ll find it when you search for “kick counter”). It allows you to count all day whereas other apps stop at 10. You can also hit a button to easily count for an hour or count to 10. And it charts movements for the past several hours and days, and logs all the results of your hourlong and 10 counts.

Find your prompt. As I mentioned earlier, kick count guidelines often recommend counting after a meal or some juice or while lying on your side. If that works for you, go for it! Personally, I am just as likely to get a count above 100 while sitting up in a chair on an empty stomach than while lying on my side immediately after dinner. Ditto with a count of 50, which is low for my baby. So unfortunately, I haven’t been able to rely on a consistent prompt.

Chart the data. At around 28 weeks I started a spreadsheet for recording kick count results. This is much more objective than relying on memory and also helps me to compare results and to see how much movement has been consistently increasing the past two months. With placental insufficiency the cause of Luke’s death, I’ve been on the lookout for a gradual decrease in movements over a period of days or longer. Having all the data in the spreadsheet allows me to better assess what’s going on.

Enlist a buddy. I report most of my kick count results to my husband. This is helpful for a few reasons. First, if a count seems low we can decide together whether to go in for monitoring. And it allows my husband to also be aware of how the pattern is developing over time, so that he has more context if movement starts to drop. This helps take some of the pressure off me and involves someone who can be more objective and rational and is not caught up in and worrying about movement 24/7.

Let sleeping babes sleep. When I first started doing kick counts, I would often wake the baby up if I thought it had been too long since the last movement. However, I’m now familiar enough with his pattern to know that he rarely goes more than 45 minutes without moving. Since I want him to be a good sleeper on the outside, I no longer disturb his sleep by trying to get him to move.

When in doubt, extend the count. Since my baby isn’t always active at the same time of day, I can’t always expect the same result each day. If I do a count and get a result that’s lower than normal, or simply lower than I’d like it to be, sometimes I will extend the count for another hour. Usually in that time the baby will wake up some and I’ll get a better result.

Dial up your doctor. Each mom will determine whether there is a change or “significant” change in pattern differently. For me, on occasions when I’ve gotten kick count results that are on the low end of normal, or when the period between counts seems sleepier than usual, or when the baby has gone longer than normal without a sustained period of activity, I’ve gone in for monitoring. (In my previous two pregnancies, I doubt I would have even noticed these subtle variations.) I’ve been doing this so intensely and for so long now that I know that each of these scenarios can actually be “normal,” and while I won’t say that I don’t start to panic and worry, I don’t immediately go to Def Con 5. I give it a little more time and if after a few hours I still feel something isn’t right, I pick up the phone.

The point is that in a pregnancy after loss, and really in a pregnancy in general, there’s no such thing as going in too frequently to have something checked out if it doesn’t feel right. And if your doctor isn’t on board with that, then he or she isn’t doing the job.

Having an itchy trigger finger can be exhausting, though, and lead to burnout. So I do think it’s helpful to establish guidelines for what you yourself feel is not normal for your baby. Unfortunately, no one can tell you what that is, nor will it always be crystal clear, especially if you have an independent mover. And that’s one of the things that makes pregnancy after loss so tough.

Celebrate your milestones. In a pregnancy after loss, when fetal movement is never far from the back of your mind, just getting through the day can be exhausting. I think it’s important for baby loss moms to celebrate the passage of their pregnancy. For me I do that with a simple highly visible sign on my dresser that notes the number of days until the next gestational week, as well as the number of days remaining until week 37.

I hope other BLMs find these tips useful, and pick the ones that work for them. In reading back through this blog, I realize it may sound like I’m somewhat functional and on top of things. The reality is that this is the most intense period of my life I’ve ever had to endure, and on some days completing just small tasks can be a struggle. It’s difficult to enjoy life when you’re on constant alert for whether your baby has died, or is about to die. And so while my carefully crafted kick count strategy helps me get through the day in a marginally functional way, the marking of yet another day off the calendar continues to bring sweet relief.