*If you are interested in seeing what everyone else is talking about today or want to join us, please visit Lara at The Lazy Organizer.I know I have already blogged about
VBACs vrs Cesareans when I first began my research. My
VBAC plans were side railed a little when it was discovered at my 20 week ultrasound that I had a low lying placenta and therefore possible placenta
previa. I didn't stop my research however, because it is possible for a low lying placenta in early pregnancy can move on it's own as baby grows. Also, I had volunteered to give the monthly topic of discussion for my local breastfeeding group and I choose this same topic.
Here is what I had to say:
CESAREANSParaphrased from The Thinking Woman’s Guide to a Better Birth: The goal is not to be needlessly alarming. I would rather you be uncomfortable rather than ignorant. I don’t want you to have cause to say “But I
didn’t know THAT was an option” or “I never would have agreed if I had known THAT could happen”. The important thing is that how we birth our babies is a conscious CHOICE and not one we felt pressured into making.
WHY ARE CESAREANS USED?
Theory: to remove a baby from the mother when a vaginal birth cannot happen or would endanger the health of mother or child
Practice: are often used before the possibility of a vaginal birth has been completely ruled out
In the US, some hospitals perform c-sections on as many as 1/3 their maternity patients and in a few hospitals that number is closer to 1/2 .
In the US, C-section is the most common major surgery procedure performed.
Cesareans are a wonder of modern medicine. They do indeed accomplish what they set out to do: deliver a baby that might not otherwise have survived or would have survived with severely compromised health. BUT, as a routine method for birthing babies, cesareans are not quite as effective. Despite escalating rates (5% in 1970 to 25% in late 90’s) birth outcomes have not improved- mortality rates have not gone down, general health of mothers and newborns has not changed.
Obstetricians once viewed cesareans as more dangerous than vaginal birth. However, improvements in surgical and anesthetic techniques have changed that perception and consequently, the c-section frequency. By rescuing mother and baby from the supposed rigors and hazards of labor, c-sections reinforce the obstetric belief in the superiority of technology over nature.
It is not just
drs who are to blame for the increasing c-section rates. The litigation conscious society we live in has also helped the c-section rates to soar. It is not difficult to understand why the slightest sign of fetal distress may cause
drs to head straight for the operating room in an effort to cover their butts. BUT we as mothers have to cover OURS as well!
Most cesareans are done for reasons that depend on a judgment call.
WHEN C-SECTIONS ARE NECESSARYPlacentia Previa-vaginal birth would tear the placenta, depriving baby of oxygen and nourishment, vaginal birth may be possible if the placenta
previa is only partial, meaning only partially over the cervix
Prolapsed umbilical cord-when the cord comes out before the baby there is a danger that the baby’s oxygen will be cut off
WHEN C-SECTIONS MAY BE NECESSARYActive herpes at time of labor-amount and location should be considered because they can be covered with bandages and a vaginal birth possible
Transverse lie- baby is positioned sideways and unless the baby can be moved into a viable birthing position, a vaginal birth is not possible
Cephalopelvic disproportion-baby’s head is too large to pass through the pelvis. Although
drs often schedule c-sections for suspected CD, this condition is actually rare and can only be accurately determined when in labor
Decision to end pregnancy early- if the baby has a medical condition that can be better treated outside the womb
Severe pre-eclampsia or uncontrolled diabetes- each situation in these cases needs to be assessed individually
WHEN C-SECTIONS ARE UNNECESSARYFailure to progress- does too long of a labor indicate a true risk to the health of mother and baby or does it simply mean labor is not adhering to a
pre-determined time table
Fetal distress- a “longer” and “difficult” labor raises fear that a baby’s health may be compromised. Many experts believe this is done too frequently without good medical cause. Electronic fetal monitors especially when used continuously during labor are a main culprit in causing
drs to incorrectly believe an infant is in distress
Breech position- 4 to 5 % of all c-sections are for this reason. Sometimes is even scheduled before a women goes into labor. But breech does not have to mean a c-section. There are doctors and midwives who are skilled in this type of delivery although they are hard to find. And as more and more breech babies are delivered via c-section the fear is that
drs will become less skilled in this type of delivery.
Twins- studies have not shown c-section delivery to be statistically safer for twins although there may be good reasons to deliver twins via c-section (one or both in distress, very underweight or other health issues that need to be addressed) Vaginal delivery of twins is rapidly turning into another “lost art” delivery like breech babies.
Large baby- many
drs will schedule a c-section because the baby looks too big for them. This is not a valid reason as true CD is rare and can only be determined in labor.
Health problems in mother-hypertension, diabetes and other conditions do NOT necessarily mean a c-
setion but many
drs schedule them “just to be safe”
Convenience-some women request a c-section even when there is no medical reason. Maybe to ensure the baby is born at a specific convenient time or too avoid labor all together. Some women and their
drs may believe that they are too small to deliver vaginally but this is RARELY true.
Previous c-section- “Once a C-section, Always a C-section” Vaginal birth after Cesarean (
VBAC) is a subject of ongoing debate. Previous c-sections are one of the primary causes of current high cesarean rates. A repeat c-section is not always medically indicated, but it is commonplace.
It is important to remember that c-sections are major surgery and carry with them all the potential complications and discomforts of surgery. Babies born vaginally are immediately more alert and better functioning which makes breastfeeding easier. This is also true of babies who experience labor even if a c-section is the end result.
ELECTIVE REPEAT C-SECTION: JUST SAY NO!Unfortunately, typical obstetricians are all too ready to grant requests for C-section without giving you the information you need to make an informed decision, much less helping you over come the psychological obstacles that may prevent you from making the best choice for you and your baby.
“Once a Cesarean, Always a Cesarean”The reason behind this outdated
cliché is that a woman who had undergone a previous c-section had a scarred, weakened uterus that could more easily rupture during the stress of another labor and delivery. C-section surgery has changed and improved over the years. Once upon a time a woman was cut vertically from the naval to the pubic bone and now the cut is a lower, horizontal “bikini cut” only 3-4 inches wide. This is much more stable for future deliveries. For most women, a vaginal birth, even after a previous cesarean, is a realistic possibility.
WHY VBAC?SIMPLE: a vaginal birth is SAFER than surgery. 1 in 1000 death rate for a c-section is a 2 to 4 times higher rate than a vaginal birth.
Most women want a trauma free birth experience and post-
partum period. Women want to feel in control of their experience and a vaginal delivery is the best way to do this.
Two most important ingredients in a woman’s decision about
VBAC vrs repeat c-section is her knowledge about
VBAC and her doctor’s attitude. DON’T rely on your doctor to give you all your
VBAC knowledge. Take charge, educate yourself and then ask your doctor questions you may have.
Women who would rather have a
VBAC believe vaginal birth is better for their child and their own bodies and health. They also have an intense desire to avoid repeat surgery that is unnecessary.
*Worldwide, 1 in 3 women will not even consider a
VBACHOW EFFECTIVE IS VBAC? The success of a
VBAC is greatly influenced by environment. Women who have had a previous c-section are generally treated as high risk and therefore usually require
efm and iv lines as precautionary measures. These and other routine procedures tend to necessitate chemical inductions, pain relief, and then ultimately another cesarean.
While there is physician support for optional c-sections, when a woman expresses a preference for
VBAC, some physicians are not so obliging and will try to discourage it.
Carefully research
practitioner and facility you plan on using. Aim for a
practitioner with a 70% success rate with
VBAC and feels you are a good candidate. Also check the other staff at the facility. You want/need them to also be encouraging about your
VBAC.
VBAC is a terrific example of how and when one on one woman to woman support by a
doula is the number one aide to a smooth delivery. Even a friend, who is a mother and understands your want for a
vbac, who can speak on your behalf can help.
Several studies have found that when doctors genuinely encouraged women to have
VBACs, most of then did, and when they said nothing or acted neutral, most women
didn’t. And when they discouraged
VBAC in women who wanted to try it, NONE of the women did.
Roughly 3 out of 4 women, if given the chance, will have a successful
VBAC.
IS VBAC SAFE?The main concern with
VBAC is uterine rupture. Uterine rupture evokes a terrifying image of the uterus tearing in two. Typically it happens slowly, not all at once, and is accompanied by noticeable symptoms. Attempting a
VBAC has a 99.8% chance of birthing WITHOUT a rupture. In addition, MOST studies show no woman or baby has died from an uterine rupture, no matter the type of previous c-section incision. However, women HAVE died from complications of cesareans and the death rate is higher in repeat c-sections. Uterine rupture can happen to any woman in any pregnancy, even before labor, although this is very rare.
FACTORS THAT DO NOT EXCLUDE VBAC:*While cited as reasons for not trying labor, they are not always valid
Prior c-section for poor progress/failure to progress/ labor
dystocia/
cephalopelvic disproportion
Suspected large baby
Type of uterine scar not known *unless the surgery was from many years ago or preformed in another part of the world (such as South America) the chances of the scar being anything but the “bikini cut” is minimal.
Low vertical uterine scar
More than one prior c-section
Twins
Breeches
THE LOADED LANGUAGE OF VBACS:“successful
VBAC” implies that a labor that ends in a repeat cesarean is a “failure”
“attempted
VBAC” suggests that labor is not the norm and vaginal birth is doubtful, as does “trial of labor”
“uterine rupture” is a term that creates so vivid an image that it’s a wonder any woman tries
VBAC after hearing it.
WHEN IS VBAC UNSAFE?This is a subject of controversy in the medical world.
-the classic cesarean (vertical) incision (strongly recommended against)
-health condition such as placenta
previa and
abrupto placenta
-if a baby is clearly in distress, a c-section will be done, regardless of a mother’s previous birth history.
One common reason for an elective repeat c-section is body size. Many petite women and their
drs are convinced that they can not handle a vaginal birth. There is NO EVIDENCE to back this up. Small women can give birth to very large babies even if they have had a previous c-section. Many small women are also given an elective repeat c-section for CD which can not be diagnosed until labor.
FACTORS THAT EXCLUDE VBAC:Vertical/classical uterine scar or extensive prior uterine surgery – while no longer the norm, the classical incision can be used with placenta
previa, breech babies and sometimes emergency c-sections
VBAC FEARS
Some common fears women having about
VBACs include:
-my scar will rupture and my baby will die
-my body can’t handle labor and give birth like other women
-my baby is too big for me to give birth to vaginally
-I fear the unknown of another labor, where as a c-section is already “known” to me
-I can’t take the pain of labor without medication
-I will get my hopes up only to be disappointed again
-what happened to necessitate my previous c-section will happen again
MANAGE YOUR VBAC FEARS-appreciate that you did your best with your previous birth
-get to know other women who have had
VBACs-understand that it is normal to worry that you will fail where other women have succeeded but that it is not necessarily correct that you will fail.
-read and re read
VBAC stories
-practice visualizations and affirmations of a successful
VBACADVANTAGES FOR BABIES BORN BY VBACThey are born when they are ready, not prematurely by surgery. Babies born by c-section have lower birth weights and have completed fewer weeks of gestation because the repeat c-section is done early hoping you won’t go into spontaneous labor. These problems of course are less frequent with a c-section that is preformed after a trial of labor. Babies that are born through the birth canal have the benefit of a surge of hormones called
catecholamines (like adrenaline), have healthier lungs, have higher
APGAR scores, enjoy early, frequent contact with mom and are much more likely to be breastfed.
ADVANTAGES FOR VBAC MOMSThe risk of infection after birth drops from as high as 35% down to 2-4%. The surgical hazards obviously decrease; such as extra blood loss, need for blood transfusions, urinary tract damage, placental disorders. The recovery is quicker, sometimes by months. There is no such thing as
VBAC depression, unlike with a cesarean. They feel more attached to the baby sooner.
Note: The amount of blood loss in a c-section birth is quite higher than a vaginal birth. In fact, what is considered normal in the operating room while conducting a c-section is considered a
hemorrhage when giving birth vaginally.
Vaginal birth after Cesarean (
VBAC) should be a non-issue by now. The official guidelines of both the
ACOG (American College of Obstetricians and Gynecologists) and the
SOGC (Society of Obstetricians and Gynecologists of Canada) is that in the absence of a specific reason for cesarean section, the routine policy for women with prior cesareans should be labor.
SOGC policy states:Provided there are no contraindications, a woman with 1 previous transverse low-segment
Caesarean section should be offered a trial of labour (
TOL) with appropriate discussion of maternal and perinatal risks and benefits. The process of informed consent with
appropriate documentation should be an important part of the birth plan in a woman with a previous
Caesarean section.
In Canada, a concerted effort to persuade obstetricians to follow their own professional organization’s
VBAC guidelines had only a slight effect. They argued that women preferred repeat cesareans and their preference should be respected.
Women chose repeat c-sections for such reasons as wanting the convenience of scheduling the delivery, knowing what to expect, fearing the pain of labour or believing that
VBAC is riskier for women. The first three reasons are hardly indications for major abdominal surgery, and the last
isn’t true.
VBAC is safer for the mother.
THE BOTTOM LINE: PROS AND CONS OF VBAC VRS ELECTIVE REPEAT C-SECTIONVBAC PROS- The consensus of research is that
VBAC is safe.
Elective repeat c-sections pose greater risks to the mother’s life and health than a vaginal birth. It also poses hazards to the baby as well, especially with succeeding pregnancies and more than one c-section
Most women, including women whose prior cesarean was for lack of progress or who are believed to be carrying a big baby, will birth vaginally if allowed to labor.
VBAC CONS- The healed uterine scar is tough, but in a few women, the scar will open enough for the umbilical cord or the baby to pass through of for bleeding to occur. The number usually quoted for women with one prior c-section is less than 1 %. Even when this does occur however, few babies will be harmed if an emergency c-section is performed promptly.
ELECTIVE REPEAT C-SECTION PROS- No labor means no chance of symptomatic scar separation (at least during labor). Pre-labor c-sections have lower infection and other complication rates than c-sections done in labor
ELECTIVE REPEAT C-SECTION CONS- Compared to vaginal birth, higher risk of infection, injury to other organs, hemorrhage and anesthesia complications
These complications can result in prolonged hospital stay, hysterectomy and death
Repeat c-sections are technically more difficult because of scar tissue
Scar tissue formation can cause chronic pain and bowel problems
Increased risk for poor condition of baby at birth, breathing difficulties and jaundice
Each successive c-section greatly increases the risk of developing placenta problems.
Placenta problems pose life-threatening risks to both mother and baby
C-sections also increase the odds of infertility and ectopic pregnancy (also life-threatening)
Women with multiple prior c-sections have a slightly increased risk of symptomatic scar separation during VBACs
FACTORS THAT PROMOTE SAFE VAGINAL BIRTH
*if you experience continuous abdominal pain or vaginal bleeding that is more than streaking or spotting (bleeding which looks like the start of your period), get to a hospital immediately for further evaluation
Have a confident dr/midwife with a high vbac rate
Commit to a vaginal birth- if in the heat of labor you don’t care how the baby gets out, you just want it out, the dr may take this as a sign that you now want your repeat c-section
Give birth in or near a facility capable of performing a c-section within 20 minutes of making the decision and that can care for a possible distressed baby
Avoid induction of labor
Refuse oxytocin to strengthen labor before active labor (3-5cms dilation and regular,painful contractions)
Avoid an epidural
While it is best to avoid these, know that prostaglandin gel to ripen the cervix for induction, oxytocin to induce or strengthen labor, and epidural anesthesia CAN be used in VBAC labors
No arbitrary limits should be set on labor
Consider having continuous electronic fetal monitoring (EFM) as abnormal fetal heart rate is the most common indication of uterine scar problems requiring intervention
limit vaginal exams and avoid having membranes ruptured and internal fetal monitoring as they all can increase the likelihood of infection
FACTORS THAT PROMOTE A POSITIVE BIRTH EXPERIENCE
Use a midwife
Take care of emotional issues and fears surrounding labor
Hire professional support
Plan on having an epidural if you are worried about pain
Have realistic expectations
Take an active role in planning a VBAC that will meet your emotional and physical needs and barring an emergency in making decisions during labor and birth
Refuse the routine use of intrauterine pressure catheter or manual exploration of the scar after birth
Refuse a routine IV and insist on being allowed to drink clear liquids
PLAN A SUCCESSFUL VBACTake responsibility for what happens to you, don’t expect your doctor to educate you. Educate yourself and then ask your doctor questions.
Have your VBAC at the safest place for you.
Avoid people who will discourage you from a VBAC.
Eat well and exercise regularly.
Always know your options.
IF YOU HAVE A PLANNED REPEAT C-SECTIONChoose a doctor with lots of cesarean experience.
Find a doctor and hospital that are prepared to perform the surgery only AFTER you have gone into labor.
Have every step of the c-section and preparation explained to you (again).
Arrange for regional anesthesia.
Review the possibility of a blood transfusion with your doctor.
Make sure you can have your partner and/or labor assistant in the OR.
Request to hold your baby as soon as possible and to have the baby examined near you.
Arrange to feed the baby as soon as possible, especially if breastfeeding (and make it perfectly clear that NO formula is to be given if that is your wish).
Plan to have daily help both at the hospital and at home.
Consider ways to cope with post surgical pain and discomfort.
Women who seek a VBAC or vaginal birth after Caesarean are under great pressure to “perform,” meaning that their labors have to be near perfect to avoid a repeat surgery, which is a lofty goal indeed for more reasons than we could ever fit in this article. VBAC also stands for very beautiful and courageous. Indeed.
I closed by reading an
open letter to Christina Agueilera written by Jennifer Block, author of
Pushed: The Painful Truth About Childbirth and Modern Maternity Care.
In my own personal situation, my ultrasound last week showed that the placenta has moved so I am hoping my doctor is agreable to me going for a vbac. I see him later this week and I am anxious to see what he has to say. Of course now that the placenta previa seems to no longer be a concern, I wonder if my failed 1 hr glucose test and the resulting longer one I had to take will now become an obstacle in my path to a successful VBAC.
Since our previous 2 boys were born via c-sections after unsuccessful labours, we went the planned c-section route with Anthony. So early (5am) on the 18th of March, Brad and I woke up and headed to the hospital. I was officially 38wks and 6 days. It had snowed/sleeted the day before and through the night so the roads were wet and a little slick. They had told us to be at the hospital, registered and upstairs on the 3rd floor for 6 am so we could be in the operating room first thing- but it didn't quite go that way.
Even with a planned c-section, apparently they need to hook you up to the monitors and check on mommy and baby before surgery. They needed to take blood again (two days before hand they took 3 or 4 viles of it), and start an iv. I've always been afraid of needles. I remember when they put in my iv with Ryan I thought to myself "Yay! My last needle for a long time." Little did I know they would draw blood again a couple of days later- or that I would get a spinal a couple of hours later when we went into the operating room for c-section #1. I don't think anyone tells you about all the needles during pregnancy and birth. There are a lot...at least I've always had a lot. But that is besides the point. My point is starting an iv. I've gotten used to needles. I even had myself more or less pumped for the spinal again (more about that in a bit!). What I was not prepared for, was the botched attempts at starting an iv at 6 in the morning. This was not the first time I have been on the unsuccessful side of starting an iv. Long story short...freshman year of University, week one, parents in Florida, middle of the night trip to the ER at the U of A hospital and three attempts at starting an iv...my hands and arms were black and blue for weeks. This time, two third floor nurses, two attempts each and still no iv. They brought up a nurse from the ER and she finally was able to get my iv in...weird spot too I thought, in my hand, by my thumb. 
It was frustrating and alarming for me that the iv was not going well because I was afraid that meant the spinal wouldn't go well either. Maybe my own nerves were playing a part in it, but I was trying to be as calm, cool and collected about it. But after failed attempt #2, I started to loose it. And if you've never had a failed iv attempt or a blown vein, let me just say, I don't recommend it. My dr. came in then, and asked why we weren't already in the OR. We just left it at, "we're having a couple of issues this morning". They tell me I was even having contractions; I don't know if that was to make me feel better, or if it was true but I do know I wasn't feeling them. Although that wouldn't be a first for me either! 
Once we were in the OR, it was time for the spinal. I had a different anaesthesiologist this time and after our pre- op meeting I was a little worried. It's not that I doubted her abilities, it was just she was someone new doing this to me, and since this was a scheduled c-section for the first time, we had the pre-op meeting and she went over all the "what if's" and worst case scenario- these were things I never had been told previously. For instance, I was informed that she would only try twice to get the spinal in, and if she wasn't able they would put me under general and because of the small size of my mouth, that might mean the loss of a tooth or two as they tried to put in the breathing tube. For me this was a scarier than heck thought! I couldn't stop thinking about it for the days between our pre-op meeting and my c-section. When the nurses started having difficulties putting in my iv, I grew less and less confident that things would go well in the OR. 
I am extremely happy to report however, that things went amazingly in the OR and the anaesthesiologist was an excellent member of my surgical team. I had a brief wave of nausea before they began but she was able to give me something for it. I felt a little more this time than the other times but it wasn't painful. With Ryan I couldn't remember feeling anything; with Adam I felt the cutting open but it didn't hurt (it felt more like someone drawing on me); this time I could feel the cutting again (again not painful) and I also felt the pulling and tugging as they took the baby out. Just after 8 in the morning, baby Anthony Murphy was pulled out. (You may notice that some of the pictures are time stamped for 7:41am but that is because I had the settings on my camera wrong.) 
Like always Brad went with the baby while I was stitched up, cleaned up and moved to recovery. I was very tired in recovery and tired to rest a bit but I watched the clock very carefully and hoped that the nurses would allow Brad to bring Anthony in to see me (with Ryan, Brad was able to bring him into recovery with me but not with Adam). I was moved from recovery to my room and thankfully one of the daytime nurses remembered me and got an electronic bed for me (much easier for me to get in and out of) but it wasn't quite as nice as the electronic bed I had with Adam (but much nicer than the crank style bed I had with Ryan). Brad was still in the nursery with Anthony and so I sent one of the nurses to go find them for me. I began to get very nauseous back in my room and in fact did get sick a couple of times. Brad stayed for a little bit but then he went home to let everyone know Anthony was here and to let us get some rest. He also needed some rest since it had been a very early morning. 
Later that day, Brad came back and brought the boys and my mom to come visit us. They were officially our first visitors. Adam was very happy to see me. Ryan and Adam were very happy to meet Anthony and fell in love with him instantly. We had a nice visit but I was very tired and I was ok with them leaving once the nurses brought me my supper. I was surprised that they brought me a sandwich for supper since I didn't think I was allowed "real" food yet and was still feeling a little nauseous. I did eat the rest of my supper though as it was liquidy (soup, jello and milk). The nurses agrred to take my sandwich and put it in the fridge in case I wanted it later. Anthony and I had a more or less quiet night alone getting to know each other. There were a couple of "code reds" that I remembered hearing later in the evening and that put me a little on edge. I did ask for my sandwich a little later that evening. 
The next day, the nurses came and removed my catheter and they put a lock on my iv and unhooked me allowing me to get up and move about a bit. I put on my own pyjamas (so nice, thanks mom for the cozy pants), and watched a movie. After lunch, I read a little of one of my books (more Christmas gifts) and had a nap. Then Brad's mom arrived to visit her newest grandson. We had a nice visit with her alone at first before Brad, my mom and the boys arrived again. Brad was surprised to see me up and moving around and that I had even gotten dressed. Again, everyone left as the nurses brought me supper but thankfully my mom bought me a couple of snacks from the snack vendor lady before they left. Brad came back later that evening and we watched a movie before they made him leave. I was so hungry later that night, I was glad for the snacks mom had bought for me. I watched another movie or two that night and read a little in my book.
I don't know if it was all the movement that day, but I just couldn't get comfortable in bed that night. I hated bothing the nurses to help me all the time and sometimes I would push the call button and it would take a long time for someone to either come help me or bring what I asked for- if they came at all. I was very greatful that at one point after I had nursed Anthony, they took him for a bath and his stats and kept him with them for a bit at the nurses station allowing me a little sleep. I was a little apprehensive about having him away from me, but the sleep was welcomed.
The rest of the night did not go as well. I still had difficulty getting into a nice sleeping position while Anthony was with me, I couldn't put him in the bassinet on my own and the nurses wouldn't come and help me with it because they didn't realize that I couldn't reach it properly on my own. Before breakfast came the next morning, I had already called Brad and begged him to come and help me sooner rather than later. I also warned him that if Dr H came by I was going to ask to be released. As nice as the quietness of the hospital was, I felt very alone at the hospital and was anxious to get home where I could get help when I needed it. And there is something to be said about sleeping in your own bed, even if it isn't an electric bed. 
When my doctor came by to check on Anthony and I that morning, he was ok with releasing me since I had help at home. He gave me a prescription for some pain relievers and my discharge papers, including when to come and get my staples removed. Brad and I still had some paperwork to fill out, including officially naming Anthony, and I still needed to shower before we went home. A shower is not an easy thing to do after surgery like this. Especially when you are trying to remove all the sticky tape residue. We dressed Anthony in his coming home outfit and then we left. As an aside note- while dressing Anthony, his little ankle bracelet slipped off his foot. The same ankle bracelet they are supposed to compare to my bracelet before allowing us to leave. Thankfully I was able to slip it back on him. 
We stopped to fill my prescription on the way home and grabbed lunch from the Tim Hortons drive thru. The boys stayed up (it was nap time) until we came home (and I had brought them home a treat from Tim Hortons) to welcome Anthony and I home. After a light lunch, everyone had a little nap. Home sweet home- to begin our journey as a party of five!
