Thursday, March 3, 2011

L's Birth Story - Part 4

What I learned during my pregnancy and birth of Baby #2 (now L)

Between the births of my first and second children, I did A LOT of research on pregnancy and childbirth. I literally started writing my birth plan for #2 about 2 weeks after #1 was born. Around the time he was 18 months old, I started wanting another baby. The only reason I wanted to wait even that long was so that he’d be walking on his own – due to the risk of preterm labour, I didn’t want to be carrying a heavy toddler everywhere during my pregnancy. Hubby wasn’t ready though, and it was 2 more years before God decided to bless us with L.

My cousin’s wife during her pregnancy received prenatal care from midwives. She told me how they spent 45-60 minutes per appointment and talked about how the pregnancy was going, how she was feeling, and anything else she wanted to talk about with them. I was very impressed by this. I felt comfortable with my doctor in that I was confident that she would find anything wrong AND (this was huge) she’d come to the hospital and “deliver” my baby rather than me having to use the on-call doctor. However, our appointments were 5 minutes long on average. She’d take my blood pressure, check the baby’s heartrate, measure my fundal height (height from my pubic bone to the top of my uterus), and I’d leave a cup of pee with the receptionist. If I had any questions or concerns, I frequently had to stop her on her way out the door in order to ask them. Her replies were rushed, as she had many patients and was often overbooked and running behind. We could count on waiting 1-2 hours past the start of our scheduled appointment time in order to see her. I did like her as a doctor. She rarely puts pressure on us to do things that we don’t want to do. She’s just very, very rushed.

So when I learned I was pregnant in the spring of 2008, I immediately called a group of midwives. They were closed so I left a message and got a message on my machine to call them back before I was 6 weeks along to make sure I got in as they’re usually booked up by 7 weeks. Wow. Unfortunately, I miscarried that baby so I never called them back. I was so devastated that, despite my passion for pregnancy and childbirth, I wasn’t able to read any books or watch any shows about it for a couple of months. After I had healed for a bit, I decided to get more involved in the birthing community through doula work. Hubby and I didn’t feel ready for another pregnancy, but I still loved pregnancy and childbirth and didn’t want to be totally cut off from it. I’d wanted to do this for years and it felt like the right time. I signed up for a doula workshop through DONA and sent in my fees. About a week before the workshop, I learned I was pregnant. After 4 consecutive miscarriages, I was very concerned but also hopeful. It was pretty special doing the workshop while pregnant as I was looking forward to this baby’s birth. It was very emotional as we heard other women’s birth stories and learned how to support women in the childbirthing process.

I was only 3.5 weeks pregnant when I called the midwives this time. The receptionist laughed that I’d called so early, but I wanted to make sure that I got in. They booked my first appointment for when I’d be 10 weeks along and it was a LONG wait – both for fear of miscarriage and because of my excitement to meet my midwives. I was under the false impression that all midwives were like the famous Ina May and had never even heard the term “medwife”. Hubby and I met our primary midwife, Wendy Wong, and the appointment took about an hour. What a huge transition from the 5 minutes at the doctor! I was already convinced when I walked in the door that I wanted midwifery care, but since it was our first time with them, she explained what they do and don’t do (They don’t do epidurals, cesareans, etc but they can be in the room with us still for emotional/informational support. They do pretty much anything else.) She told us that they’re experts at taking care of low-risk pregnancies but also know how to recognize signs of problems – in order to determine that a woman is low-risk, she explained, they have to first rule out any problems that would place her in the high-risk category. She gave us a list of what would put a women into high-risk and would require that she seek maternity care elsewhere. Some of the things on the list were questionable, “red flags” were how she put it. If I had one red flag (twins, VBAC, breech, etc) then I could possibly remain under their care, but if she saw more than one, then she’d likely recommend that we transfer to an OB. There were a lot more to the list but that’s all that I remember now. I remember thinking, “wow, that’s a long list and I’ve read lots of birth stories where the midwives handled these issues just fine, even when there was more than one issue in the same woman.” But I figured it was probably just a CYA thing and wouldn’t be much of an issue. Besides, I didn’t have any of those issues so far. The only exception was the preterm labour last time. However, since he hadn’t been born early, she said it didn’t really count but they’d still watch for it.

At the next appointment, my mom and I met my backup midwife, Tracy Franklin. I’m not sure why, but I didn’t feel as comfortable with her initially as I did my primary (this feeling didn’t last though and I soon felt even more comfortable with her than with my primary). She took about an hour again, as we told her the medical history from both sides of the family.

I think it was about halfway through the pregnancy before we decided to prepare for a homebirth. Hubby was uncertain of it. He fully supported other women’s right to choose a homebirth, but didn’t feel comfortable with it for HIS wife. We watched BOBB (Business of Being Born) together. The first birth is a wonderful, peaceful waterbirth at home. He said, “Can you have a birth like that if you birth at home?” Knowing how many variables there are to birth, I didn’t promise him that my birth would be exactly like that, but did tell him that I *could* have a birth like that. It was an option. It definitely would not happen in the hospitals as no hospitals close to us allow waterbirth. He said then he would support it, as long as no issues showed up during the pregnancy that would necessitate a hospital birth. I was so happy to hear this!

We spent most of the appointments discussing what could happen during the birth and grilling the midwives about what they’d do.
- What if my water broke and there was no labour? How long would they wait before recommending induction? (72 hours from time of SROM – if I hadn’t started labour by then they’d recommend induction. Of course, it was imperative to keep EVERYTHING out of there – no vaginal exams, no s*x to try to induce labour, etc. There’s hardly any risk of infection as long as nothing going inside and introducing bacteria to an otherwise usually sterile environment. They said I could still take baths because bacteria can’t swim and the nature of the birth canal keeps itself clean) I was satisfied with this. Many doctors induce labour immediately when the water breaks, or maybe give the women a few hours if they’re exceptionally patient doctors, and they do copious amounts of VEs, and restrict access to water – showers only, no baths.
- What if I went into preterm labour? (Then they’d have to transfer care to an OB, but they’d still try to stay there with me and assist during the birth.)
- What if the baby got stuck? I don’t know what made me ask this question – probably just covering all my bases. (They’d put me flat on my back, McRobert’s position. I did not like this. I asked about the Gaskin maneuver (hands and knees) and she said they used to do that but now do McRobert’s. She said I could try the Gaskin maneuver but if that didn’t work, they’d do the McRobert’s. I was satisfied that I could at least try it. In the end though, I was not given the option to try it.)
- I asked them about not doing immediate cord clamping/cutting. She (Wendy) said that was fine, as long as the baby was doing well. If the baby needed oxygen or suctioning, they’d have to take him over to the table (had to be a flat surface, preferably at waist height in case paramedics had to deep suction him). She said this did not happen a lot, and usually just when there was meconium present. I asked her what about studies that showed that suctioning did not improve outcomes for babies born with meconium and may in fact cause them to gasp for air, increasing the chance that they will aspirate some meconium. Suctioning can also cause oral aversions, negatively affecting breastfeeding. She asked me to email her the link to the study, which I did, but I never heard a response about it and didn’t see her again until the day after the baby’s birth.
- They said if I had Strep B, I could still have a homebirth. They’d come as soon as I was having contractions to give me the first dose, leave a hep-lock in and leave for awhile and then come back closer to the birth and give me the second dose. I thought that was pretty cool. I didn’t have it so it was a non-issue.

Overall, I was pretty satisfied. On the areas where what they routinely did conflicted with what I wanted, they agreed to make compromises as long as it was still safe. This CAN be a warning sign. Frequently care providers, especially doctors but occasionally midwives, will revert to what they always do, regardless of what you’d asked them for. For example, many doctors will reassure first time moms that they only do episiotomies when they feel it is absolutely necessary. What they do not tell her is that many feel that an episiotomy is necessary for every single first time mom. Some doctors will “allow” a woman with a prior cesarean to do a trial of labour (TOL), and then something will happen (or not actually happen, but the doctor will invent it or say s/he is afraid it might happen) at every single one of these births that the doctor feels requires a cesarean. If your doctor says s/he will allow TOL but has close to a 100% repeat cesarean rate, RUN don’t walk to find a new caregiver.

One HUGE warning sign was when Wendy was going over what would probably happen at the birth. We’d already decided to prepare for a homebirth. She started out with, “When contractions are x amount apart and x seconds long, (I forget the numbers now, it’s been awhile) then you’ll go in to the hospital. If I’m already there or close by then I’ll come assess you, otherwise a triage nurse will check you and if you are not dilated enough they will send you home. If you are, then they’ll page me to come. If you’re past 4 cm, then I’ll break your water (AROM).” I stopped her there and asked why she would break my water. She said, “Oh, I just usually do that in order to speed things up.” I told her I did not want AROM as it often makes the labour a lot more difficult, unbearable even, without pain medication. She looked at me very strange (I suppose wondering what kind of a woman does not want something that could speed up the labour) but agreed not to break it for no reason but routine. I expressed that I wanted to be consulted and to give my permission before ANY interventions were done, which she agreed to. I was still uneasy that she’d assumed I’d end up at the hospital even though I wanted a homebirth and that she routinely did AROM at 4cm. I wondered what else she did routinely that she might be forgetting to tell me about. This, combined with the suctioning discussion made me question if I wanted her at the birth but I felt I didn’t really have a choice. Midwives are booked up by 7 weeks here and I was close to full-term. I had long talks with Hubby about what I wanted and he assured me that he’d defend me and would make sure I got what I wanted in case something else was being pressured on me. In the meantime, I prayed that she would be off-call at the time and I’d get my back-up midwife. As it turned out, this is exactly what happened.

All of this to say, I learned that it’s worth putting effort into seeking out caregivers that have the same birthing philosophy as you do. I was afraid that I would offend her by asking her too many questions or by requesting a different midwife. I even mistakenly assumed that all midwives were the same and provide the same type of care that I’d read about – with utmost trust in women and their ability to birth their own babies without intervention. Midwives are people too and as such, are as different from each other as anyone else is. Most people put more effort into finding a good mechanic than finding a good health care provider during pregnancy and childbirth.

Soon after L’s birth, I wrote the following paragraph at the end of his birth story:
“I wouldn’t say that it was the best birth I could have asked for. I would have loved to have been in less pain. I would have loved for his head to have been straight in the birth canal instead of skewed to the side. However, a lot did go right. I actually prefer my secondary midwife and ended up having her as my primary for the birth. Had I been in the hospital, I most likely would have gotten an epidural. Considering his size and how difficult it was to get him out with no pain medication, had I been numbed, I most certainly would have had at least an episiotomy, and probably a vacuum assisted delivery or caesarean. I’m very glad to have avoided that (despite having begged for it during labour). I’m glad that I was able to approve of every intervention (homeopathics, AROM, pitocin) instead of it just being done out of routine. I had wished for a totally intervention free birth, but everything that was done had a purpose so I’m completely okay with it. My baby is perfect and I couldn’t ask for more than that.”

Over time, though, my opinion has changed. I do believe that some of the interventions were unnecessary. I didn’t even think of them as interventions at the time. Vaginal exams, holding back the cervical lip, and birthing flat on my back did not seem to “intervene” with the birthing process. However, I got so hung up on the numbers that I believe the VEs were detrimental. I know that women can go from barely dilated to baby in arms in less than an hour. I know that women can stay at 7 cm for hours or even days. Believe it or not, babies will be born even if there is no vaginal exam! I know, crazy talk eh? Putting fingers up there is not in any way required by nature for a baby to be born. There are other ways for midwives to tell how dilated a woman is (yes, really! See the link below) than performing a VE. I forgot to mention this to my midwife yesterday, so I’m glad that I am writing this as it reminded me to bring it up next time.

Also, it was due to the VE that I was asked to change from the only comfortable position that I found during the labour. I was leaning over a birthing ball. I think this was taking the baby’s head off the cervix, allowing him to find a better position to be born in. However, because the baby’s head was not putting full pressure on the cervix, it closed up a little bit. Had my midwife and I just trusted my body, I believe I would have stayed in that position for longer, baby would have turned his head straight, and we would have gone on from there. Instead, I got upright, put his head right back on the cervix – still tilted, and this caused continuing incredible pain, a cervical lip, and possibly, why he was stuck.

I also felt pushy at one point. My body was making small bearing down movements. I pushed with it once and it didn’t feel right so I stopped. MW performed a VE and said I wasn’t 10 so not to push. So I worked against the urge my body had to push, possibly prolonging the dilation. Those small, grunty pushes can push the baby’s head against the cervix and assist it to open up. Telling me not to allow my body to push encourages me to distrust my body. Perhaps the MW could have encouraged me to allow my body to push if it wanted to, but that I didn’t need to push along with it if it didn’t feel right.

Holding back the cervical lip was probably unnecessary. My firstborn was born with a cervical lip, as are many babies, and no one held it back. I could have attempted to push without anyone holding it back to see if it moved out of the way, or moved to hands and knees to put more pressure on that part of the cervix. Instead, the MW offered to push it aside and, seeing a possible quicker way to the end of the labour, I consented. This meant that I HAD to push flat on my back so that she had access to the cervix so that she could push it out of the way. Having her push it to the side was extremely painful. I put up with it, hoping that it would all be over soon.

Pushing flat on my back was extremely uncomfortable. I had wanted to try other birthing positions and was disappointed that that was the very first position that I was asked to get into to try pushing.

I learned a lot during the pregnancy and birth of my firstborn and learned still more during that of my secondborn. I hope that with all of this knowledge and experience, and having midwives that are much more on the same line of thinking as I am about pregnancy and childbirth that the birth of baby #3 will be all I imagined it to be. Don’t get me wrong. I know birth is unpredictable. I just want to be listened to, respected, and left alone to do what I need to do as much as possible. I like the analogy of a lifeguard. I know how to swim, however, even with a pool full of people who all know how to swim, there is still a lifeguard just in case something unexpected happens. Most of the time, they sit on the sidelines and watch. This is what I want in a midwife. Someone who trusts that I know how to birth and I’m capable of birthing, and just sits and watches in case something extraordinary happens and I need her.

I was going to blog about my midwife appointment yesterday, but I think this is long enough so I’ll blog about it another day.

Here are some links that I found useful that you may too:

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