Our Journey With Hydronephrosis

hydronephrosis_series

Around 20 weeks into my pregnancy, we embarked upon our appointment for the standard anatomy scan. I was feeling a little anxious but mostly excited to see our baby. Having previous pregnancy loss, I felt certain anxieties upon beginning the scan. I have found that pregnancy loss can really affect thinking and emotions surrounding pregnancy, but that is a post for another time. At about 20 weeks gestation, we learned that our baby had a condition called hydronephrosis. I went into a panic about it, searching desperately to find out information about the condition and anecdotes to find assurance that my baby would be safe and healthy. After a few weeks, I felt better about it, but I wish there were more personal accounts with the condition available to assure families and provide education based on their experiences. I remember that I was able to find a ton of clinical information about the condition, but very little recounts of actual experiences. Experiences matter because the condition can mean nothing at all, or it can potentially be serious and cause many challenges for children.

Hydro-what? What is hydronephrosis?

Hydronephrosis occurs when the kidneys become swelled with fluid. If you break down the word, it means something like “water kidney.” The kidneys can swell with fluid as a result of many conditions, most commonly a blockage in the ureter or reflux, where urine flows backwards up into the kidneys. It is not a common condition in infants, and is found in 1-2% of all pregnancies[1] but accounts for at least half of all abnormalities found at a 20 week anatomy scan[2]. The condition essentially affects how urine drains from the kidneys, which can make infants and children more likely to develop urinary tract infections of the bladder and kidneys. Most commonly, the condition resolves on its own with no intervention necessary and does not cause any complications. Sometimes children will develop urinary tract infections as a result of poor urine drainage.

How did the diagnosis affect my pregnancy?

After the initial diagnosis, I was referred to an obstetric specialist for follow up ultrasounds. I had a few extra ultrasounds from about 20-37 weeks to check on the condition and determine whether it was resolving or progressing. One of the main concerns with hydronephrosis in utero is that it (rarely) can lead to low amniotic fluid levels because the baby may not be producing enough urine. Throughout the ultrasounds, the condition worsened from mild dilation in one kidney into hydronephrosis in both kidneys. The specialists termed this mild to moderate. During pregnancy, this is all that I needed to follow up on and it did not cause any health complications for us.

What medical care was necessary after birth?

Before my daughter was born, I contacted our pediatrician and set up the initial paperwork to be referred to a specialist for some newborn testing. I also had an appointment with a great urologist to discuss the condition and the treatment plan after birth. As soon as possible after she was born, we needed to have a kidney ultrasound and VCUG (voiding cystourethrogram) to get a clear picture of her kidneys and determine if she had reflux. We had our pediatrician set up referrals for these tests that were sent out right after she was born. Within the first two weeks after birth, we were able to have a kidney ultrasound and VCUG done. The kidney ultrasound is really easy, and the baby needs to lie on the table on their tummy and back while the technician takes images of the kidneys, ureters, and bladder. The VCUG is more intensive and tests for reflux of urine back into the kidneys. In this test, a catheter is inserted into the urethra and liquid is inserted into the bladder. As the bladder fills and empties, the technician takes x-rays of the bladder as it functions. This imaging reveals how the urine moves through the urinary tract. This test was hard to go through with a new baby, but once it was completed she was totally fine and I nursed her right after in the office. It is not painful, but is uncomfortable. This test was worthwhile to rule out the possibility of urine reflux and other abnormalities.

The ultrasound at this time revealed moderate hydronephrosis and the VCUG revealed that there is no reflux. Our urologist urged us to schedule appointments every 3 months or so to follow up and make sure the condition is not worsening. He stated that he will not recommend any intervention unless the condition gets considerably worse. We currently visit the office for periodic kidney ultrasounds, which she seems annoyed with nowadays but are really no big deal.

How has it affected my baby?

Overall, it never affected my daughter until she was about 4-6 months old. We were having challenges with weight gain, and she was the same weight at 2 months as she was at 6 months old (she was 14lbs). I worked with a lactation consultant and our pediatrician, as well as a GI specialist and nothing nutritional was making any difference. She wouldn’t nurse more often and generally seemed uninterested in eating. I always felt like I had to convince her to be interested in nursing, day and night. It was exhausting. I had many experiences where I was told I must not be making enough milk for her and that it was “okay to supplement, many women have to at this age.” It was a very hard time for me, because I never felt at all that I didn’t make enough milk for her. I had the opposite problem, where she would not take any more milk. So my body was doing what it was supposed to do by making the amount of milk that baby will drink. It is basic supply and demand. Essentially, I felt like I was losing it and my postpartum anxiety kicked into overdrive and it was a really terrible and dark time for us. The GI specialist labeled my daughter with a diagnosis of “failure to thrive” and wanted us to complete a wide array of testing. We ran some blood work and noticed that her white blood cell count was high. With knowledge of her hydronephrosis, the specialist recommended we test her urine for a urinary tract infection. Sure enough, the urinalysis test strip lit up like a Christmas tree for nitrites, which revealed that she had an infection. We went to our local children’s hospital and completed a catheterized urine sample to submit for a culture, which then revealed very high amounts of many bacteria – primarily E. coli. Finally, after months of what was thought to be a breastfeeding or nutrition problem, we had a solution!

Since we now know that she can potentially continue to have urinary tract infections because of this condition, we decided to purchase urinalysis test strips to test at home. When she is fussier than usual, I place a bag inside her diaper cover to catch urine to test. It’s very easy and can be done quickly and cheaply. It is easier to test at home than to bring her in to a doctor’s office to test on suspicion. It is important to remember that children with hydronephrosis often have white blood cells and trace amounts of blood in their urine as a result of inflammation. We did a baseline urinalysis as soon as she was healed to understand what levels are normal for her in order to track any changes. When bacteria are present that cause a UTI, they convert nitrates in the urine into nitrites. In urinalysis, high nitrite levels reveal a strong probability of an infection. If she has high levels of nitrites, then we will take her to see our pediatrician. We will then have a “clean catch” catheterized urine sample taken (uncomfortable but necessary) to determine the bacteria causing the infection to match with an antibiotic. I am not a proponent of taking antibiotics liberally, but at this time I am unaware of a natural solution that will help cure a strong urinary tract infection and prevent it from spreading to kidneys and causing damage. We use natural medicine to try and boost immune health and avoid infections through nutrition and chiropractic care.

Since she never had a fever with her infection, it is important for us to look at behavioral signs. We have been working to learn sign language with her so she can communicate her feelings with us more easily. We have also been using chiropractic care monthly to help ensure that her spine and nervous system are aligned to promote immune system health. My hope is that we remain infection free and she outgrows the condition over time.

Hopefully this post can shed some light on what the condition may be like for your child and help put your mind at ease. Do you have experience with hydronephrosis? What was your experience like?

[1][1] http://www.childrenshospital.org/conditions-and-treatments/conditions/hydronephrosis

[2] http://urology.ucla.edu/body.cfm?id=478&ref=14&action=detail

Birth Story: Alana Artemis

[I am excited to share my daughter’s birth story, which was written shortly after she was born. Before reading, I want to add a disclaimer to this story. I suppose I had a challenging birth, and sometimes when I tell people my challenges they assume that I had a negative birth experience. That couldn’t be further from the truth! I had an amazing and empowering natural birth experience that was the most proud and powerful moment of my life.] 

 Alana Artemis – Born April 22nd, 2015 (11:17am)

As we evolve and grow throughout our lives, pivotal moments become pillars that define the skeleton of our soul. We build muscle and tissue around this structure as we challenge our expectations of ourselves and derive new meaning from our simple daily existence. Evolution, like the metamorphosis of creatures small and large, requires us to heed the call of our wild, natural selves. Cultures around the world have named this call as the criatura. The criatura represents the wild woman within us that exists in nearly every culture across time and distance. Every woman is left to discover their own criatura. As I reflect upon Alana’s birth, I am called to recognize the change that occurred in my spirit and my own metamorphosis into this new phase of our lives. Concealed facets of ferocity and a tenacious mental focus reigned supreme over the wisdom of relaxation and peace in birthing.

Initially, my labor with Alana slowly came into its own powerful rhythm. I experienced prodromal labor, waves of inconsistent labor contractions that would become regular than fade, for several days before I fell into a consistent labor pattern. This time was exhausting for me, it was impossible to sleep much and I really couldn’t relax because I was always wondering if the “real” labor would start. At one point, I leaked what looked like a few tablespoons of clear fluid with some pink bleeding. I was concerned that my water broke or was leaking, and it was enough fluid to arouse my suspicions. Shea (one of our midwives) asked us to come into the birth center to have the fluid checked out, revealing that it was not amniotic fluid. Thankfully, it was just a good amount of normal discharge. We went home and relaxed and I went out with a friend that evening and we walked around the neighborhood for a while. Within the next few days, I had a copious amount of bloody show and lost my mucus plug.

A few days later, after experiencing more early labor contractions, I was fed up and my whole body was aching. I had a very intense rash called PUPPP at the end of my pregnancy, most likely caused by the development of cholestasis (which I found out I had after she was born, coincidentally). Because of the rash, I was unable to take more than a slightly warm shower for a few weeks. I had enough and needed some relief from the aches I was experiencing, so I decided to take a relaxing hot shower. While in the shower, I noticed I started having contractions much more close together than I had been experiencing previously. After the shower, I started timing them and they grew to be about 2-3 minutes apart and getting stronger. I set myself up in my kitchen with some music on (Ani Difranco’s albums Evolve and Little Plastic Castle) and went through the contractions while standing for a while. After a few hours of these contractions, I decided I should have my husband, Tom, come home from work because this was markedly different than the early contractions I had before. Tom arrived around 5pm and started helping me through the contractions I was having and preparing some things around the house. I had Tom call our midwife (Hope) to let her know that regular contractions were happening. We wanted to wait around the house for a while because I wanted to make sure these contractions weren’t going to fade away like they had over the past few days.

After about 4 hours of regular contractions at 2-3 minutes apart, everything started to feel much more intense. I continued to labor around the house using the yoga ball and standing positions. I felt better able to manage the pain I was experiencing while being upright at this time and moving around. I could move and sway with the music and create my own soul space. I had Tom call Hope to let her know that things were getting more intense and I felt that maybe it was time to come in to the birth center. In the car, I started having contractions that I had to moan through and work out with a different type of energy than the relaxation I called upon earlier. When we arrived, Hope checked my cervix and it was only open to 1 cm. Bummer! My initial thought was, “How could I have been having contractions for days and be hours into labor and still only be at 1cm? Some women walk around for weeks dilated a few centimeters.” However, she did explain that the baby was in a posterior position (facing out instead of turning towards my back) and she gave us some important tricks to try to get her to turn over during labor. I had a feeling she was going to end up in this position, even though I did a whole series of Spinning Babies exercises daily. I felt frustrated, but understood the science behind what needed to happen for further dilation to happen. We went home to try and get her to turn and let the contractions dilate my cervix further.

I worked through contraction after contraction on my hands and knees or using the yoga ball, resting on my side every so often to give my knees and arms a break. I made a floor nest using practically all the pillows in our house and we kept the lights low. After every few contractions, I would ask Tom to use the rebozo technique in between to sift the baby into the proper position. The rebozo method involves using a long piece of woven fabric to gently pull up the baby belly and gently sift from side to side, prompting the baby to move and shift. During this time, I went deep inside my mind and spirit and blocked out everything else that was happening around me. I had to disconnect to maintain mental acuity while working through the intensity of each contraction. I also used deep breathing exercises, and I recognized that ten deep breaths with some vocal expression on the exhale were all it took to get through each contraction. During each wave, I could soothe myself by recognizing that by the time I reached the count of five, it would soon pass. Eventually I felt like I needed a break from the floor and laid down on our futon. A contraction started and I felt a strong pop and an intense amount of pressure previously unknown to me. My water broke and things started to get much more intense when I didn’t think they possibly could. By 1:30am we had arrived back at the birth center and I was 5cm dilated.

At the birth center, I labored in the birthing tub for quite a while. I held myself mostly on my hands and knees and could rest my upper body over the side of the tub when needed. A strong inner focus and perseverance through each wave was crucial during this time. Tom was a great coach by wiping my face with a cold cloth, providing water and juice as I would take it. I had little desire to eat anything during most of my labor, as I also was experiencing bouts of vomiting. After hours of laboring in the tub, I felt my body starting to bear down uncontrollably. Hope checked my cervix and I was almost there, but there was a small lip of cervix left. Eventually, she told me to push while she pulled back the remaining cervix. The goal was to try to push baby’s head past the remaining lip to continue to move her down through the birth canal. Some of the details are foggy in my mind at this time as I transitioned into the pushing phase.

I worked at pushing in the birth tub while on my back, pulling my knees toward my shoulders. Some progress was being made, but not enough. Hope suggested I switch to pushing on my back on the bed, pulling my feet back towards my head to help move the baby down. With each contraction, I bore down with all my might using every ounce of strength I had in my muscles and tried to summon any kind of spiritual energy I could put behind each push. Each contraction yielded progress, albeit very slow progress. We tried to shift to a squatting position using a stool with Tom’s support, but my muscles just didn’t work efficiently that way. Back to the bed, continuing slow bouts of pushing the baby down with all the ferocity I could muster. I had to keep pumping myself up because this was exceptionally draining, telling myself I could do it and that she would eventually come out after all of this energy. Hope, Jen, and Tom were incredible during this time, telling me that each push was moving the baby.

During this time, I had to summon ferocity unknown to me and a determination like no other. Keeping my eye on the prize, I slowly worked her down with each push, with everyone reminding me that we were making progress each time. Between contractions, I moved deep inside myself and stored up more energy to regain my roar for the next push. Jen, our birth assistant, and Tom helped by providing cool cloths, water, and juice as necessary for some physical fuel to assist my mental flow. The cool cloth was key for some reason, magically relieving the pain and tension after each pushing contraction. Finally after five long and fierce hours of pushing, she was crowning. I felt the infamous “ring of fire” but it was nothing compared to the process of pushing her down to that point. I felt so relieved to be feeling it, knowing that an end and a beginning were simultaneously coming into fruition. Her head came out fairly quickly, and her body easily slid out. Hope discovered that her arm was wrapped around across her head, making it more difficult for her to move under my pubic bone and down the birth canal. She did eventually turn over on her way out, relieving my anxiety about birthing her face-up.

The moment she was born was a time of sheer bliss and relief that I have never experienced before. I was so happy she was here, and so relieved to have gotten her out after working so hard during the birth. She had passed a little meconium during the birth, but once I heard her loudly pronounce her presence in our lives with her first cries, I knew she was well. Hope placed her on my chest and I was absolutely in love with her. I held and kissed her while we waited for the placenta to pass, which was relatively painless. I did have a small tear, but nothing that needed to be repaired. Alana Artemis was born at 11:17am, weighing 8lbs 4oz, and measured 21 inches long.

Upon reflection on my birthing experience, I feel that I really surprised myself. Throughout our Bradley class, we focused on relaxation techniques for labor that would help us to have a peaceful birthing experience. When I pictured my labor, I expected to have a peaceful, serene, calm, and quiet birth using all the different techniques I had learned during my pregnancy. I watched videos of mothers silently birthing their babies in water, seemingly painless and totally at peace. I thought for sure this would be my birthing experience, since I had so much practice with relaxation. I don’t know if it’s because I spent so much time in my teenage and college years getting straight A’s in relaxation, but I am normally very proficient at relaxing when the conditions are right. I called upon these skills in the early phases of my labor and through each wave of contractions to dilate my cervix. However, the experience of bringing Alana into this world forced me to wake up. I had to summon a new ferocity within myself and roar my baby out with each contraction. We had to fight our way into this new world of ours together, a metamorphosis into our own little family.

Yes, You CAN Travel With Your Baby!

Our cross-country road trip with a 7 month old became the most stress free trip we’ve ever taken. Here’s how:

“Somebody give that baby a bottle!” proclaimed the 1960’s classic television show, The Honeymooners. The comedic legacy lives on today, where many moms lament the challenges of having an exclusively breastfed baby. This holiday season, my family embarked on a cross-country road trip with my 7 month old breastfed baby and 50lb dog in our tiny Ford Fiesta. Many people told me that I must be crazy or courageous to take such a trip with an infant. However, our cross-country road trip with our 7 month old became the most stress free trip we’ve ever taken.

My Thoughts on Packing

Packing for a trip has always been a stressful, last-minute rush for me and is usually a pretty dramatic experience. I decided that I didn’t want to live on the last-minute edge anymore and created a packing list for each person. This helped me to see the things we needed and pack only the necessities. We traveled in a Ford Fiesta, which is a tiny subcompact car. With very little space to carry luggage, packing light became a necessity.

For the adults, my husband and I, we packed about five to seven days of clothing, basic toiletries, and some cold-climate gear. We knew we had access to laundry, so we didn’t worry about packing too much clothing. We only packed the basic natural toiletries that we all use, and skipped anything we don’t use every day. For the babe, we packed 8 outfits, onesies, pajamas, socks, and a coat. In the car, she wore knitted legwarmers or a sleeper rather than pants for quick diaper changes. I also brought her blankey, although it was probably not necessary. This all fit into two carry-on sized suitcases in the trunk.

For diapering, we brought 2-3 days’ worth of cloth diapers (prefolds and covers) and made a gallon sized freezer bag full of wet cloth wipes. We also brought a few disposables for backup in case we needed them. We also brought our small travel wet bag for our stops and a larger laundry wet bag to store dirty diapers in the trunk. We put all of this, including our laundry detergent, into a cloth shopping bag.

Many people believe that kids need to be entertained constantly with technology to be content on a long car trip. I remember being plugged into headphones constantly in the car as a teenager (we didn’t have the fancy digital toys that are available today, but I see this as a predecessor to today’s technology). In the past, when my daughter was really struggling in the car, I used some baby sign language videos on my phone to cease the endless screaming and fussing. However, I thought about how that sets up a precedent of expectation for a young child. If they are exposed to dvd’s and digital media in the car as a way to stay occupied, they may come to expect that level of stimulation while traveling and develop a need for this technology. The American Academy of Pediatrics recommends that television and other media should be avoided for children under 2 years of age, as children learn best through interaction with people rather than screen time[i]. The AAP also links the use of infant screen time to language learning delays[ii].

I want my children to be able to be focused on the present and live in a connected way, not zoned out into a screen while traveling with family. I want my daughter to experience her surroundings through movement, play, and human interaction. However, I am not a luddite. As our children grow older, it will be increasingly important for them to make smart independent decisions about their technology usage and we can set this example in our family life. I don’t think there is any harm in trying some educational media if your older child is exceptionally fussy or cranky in the car, but I don’t want to set the precedent for my children as infants. If you have a cranky kid, you do what you gotta do to get through it and drive safely.

Instead, I allowed us to bring one electronic toy. We brought the top of her play table with us because we were able to set it up on her lap to play with. It has a few lights, plays music, and makes different sounds while interacting with buttons and spinners. However, I saved this toy for times when she really had a hard time focusing on anything else and became really restless in the car. The electronic script talks about colors and animals in songs, so it also had a bit of educational value.

Other items I brought for her in the car included a selection of books (especially touch and feel books) from our local library, some wooden toys like the Skwish and blocks with patterns, cloth books, teethers, rattles, music CD’s that we can sing along to and practice our signing, and some stuffed toys. The key was to select some new things for the trip that she hadn’t explored yet, and to keep a good rotation of some toys handy. She especially liked the new touch and feel books from the library, giving her new items to explore. We didn’t have any fancy car toys or new products.

On the Road

Overall, I was really surprised that it took us about the same travel time overall with the whole family as it did with just the two of us adults in the past. We stopped on average every 2-3 hours or so. We found ourselves getting into a routine in the car. I sat in the back seat with my daughter for most of the car riding time. She would start out hanging out in her car seat with her blankey for a while and taking in the environment. Once she seemed bored, I would offer her toys, books, and music to play until she got fussy. When she was fussy and upset, that became a sign that she was tired and wanted to fall asleep. I would tuck her in with her blankey and sing to her gently until she fell asleep for a nap in her car seat. She would sleep for about an hour or 2. When she woke up from a nap, we would make a stop to rest, nurse, eat food, walk the dog, and change her diaper.

One of the most irritating challenges we encountered on this trip was the lack of changing stations in public restrooms. In the south, we encountered very few baby changing stations. I do give credit to Georgia though for having a changing station in their trailer-style welcome center. I ended up changing her in the car (ugh), on counters, across sinks, and other random places. On the way back, I learned it was much easier to leave her in a fleece footed sleeper for the car trip to make changes easier. Then we didn’t have to struggle with a coat and pants while changing a diaper.

Like most moms, I tend to get stressed out about my baby getting upset and fussy. While she was sleeping in her car seat, I used breathing and meditation techniques to make sure that I was not carrying any tension around with me while we were traveling. I also brought a book for myself to read while she slept, keeping me engaged in thoughts and ideas aside from baby keeping along the way. I think this helped me keep my energy up so that if she did become cranky or unhappy, I was able to soothe her without becoming stressed.

During our breaks from driving, it was really important to make sure that everyone got out of the car and stretched. I set my daughter down to play in the grass or on the ground as much as possible. I allowed her to play with leaves, sticks, and dirt while roaming around. I feel that this connection with the earth is really important for grounding, especially having a baby away from home for the first time. She was able to feel the earth before we were held captive in the car for a few hours. It helped the adults feel connected and refreshed also, as we stretched and walked with the dog outside.

Breastfeeding

My daughter has been exclusively breastfed since birth, and started eating some solid foods around 6 months. She still doesn’t consume very much solid food and doesn’t need it right now because breast milk supplies all the nutrition she needs. While traveling, we didn’t worry about giving her solid foods unless we were stopped somewhere at a restaurant and we happened to have something healthy for her to eat. We do baby led weaning, so she has never eaten a puree at all, making it really easy to go out and travel. No need to bring jars of baby food or spoons. Many people believe that babies need to eat solid foods at this stage, but it is a “nice to have” and not a “must have.” Traveling with a breast fed baby is really easy, since you don’t have to worry about washing or sterilizing bottles or pump parts, or mixing formula. My daughter never wanted to take a bottle anyway, as well as a pacifier. Potentially, this led is to making stops more often at times for nursing breaks. But really the best thing is that I was able to provide her with warmth, comfort, and nourishing milk during these breaks which kept her really content through the stretches of driving. The car cuddles were invaluable in between riding in her car seat for long stretches, and I saw this as nature’s way of making sure we all were rested, comfortable, and loved throughout the trip. In the past, I traveled with a manual breast pump and a bottle just in case of anything, but this time I just left it all behind.

This cross country road trip was one of the most stress free travel experiences I have ever had. Using minimalist principles helped us to feel connected and bond with each other throughout the trip as well. If we ever take this trip again, I hope that it goes just as smoothly. Also, this trip was a huge confidence booster for me also. It convinced me that I am able to easily travel with my daughter, and helped me to feel more confident as a parent. Happy travels!

[i] https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Pages/Media-and-Children.aspx

[ii] https://www.healthychildren.org/English/family-life/Media/Pages/Tablets-and-Smartphones-Not-for-Babies.aspx