A large portion of my life right now has been consumed with my current pregnancy. To explain why, I'll have to go back to my pregnancy with Jill. Jill's pregnancy began in 2008. I was very excited about having a baby and pretty intimidated about giving birth. I was pretty sure it was going to be painful, going to be more painful than anything that I had ever experienced. I was scared, but since the baby would have to come out eventually, I tried to not really think about it at all. My gynecologist of the past three years was also an obstetrician, so it made sense to stay with him. He didn't rotate with another doctor, and his office was attached to the hospital facility, so I was already familiar with the hospital as well. I felt comfortable there. The hospital was very small, and all they did was deliver babies and perform out patient surgery. (It was one of three hospitals that were within fifteen/twenty minutes of where I was living at the time, so I definitely had options.) I read the only pregnancy book I had ever heard of at that time, What to Expect When You're Expecting, along with two other publications (a book and a magazine) that my OB gave me. I felt somewhat prepared, as prepared as you can be for a terrifying possibly deadly event. (Keep in mind that this is what I felt then, not necessarily now.)
I thought about taking a birthing class, but we decided we didn't need to spend money to go to a class that talked about something women had been doing successfully for thousands of years. We did the hospital orientation tour, where I learned that some women preferred cesarean sections, which had previously never occurred to me, but the nurse leading the tour had a few different reasons why you might.
Also going on in my life was the declining health of my grandmother half a country away and Jeff's last year of school. Jill's due date was May 8. My last day of work was April 24. That was also Jeff's graduation day, a ceremony which he chose to forego. Jeff was planning on quitting his job a few weeks later, and then we were going to pack up our belongings and move across the country with no job in sight to live in his parents' basement. (Thank you, Daryl and Laurie!) So along with the uncertainty of birth, there was also insecurity due to both of us leaving our jobs, big projects and tests to finish school, packing and cleaning our apartment, and moving to a different state. There was a lot going on.
I had a sister-in-law give me Husband-Coached Childbirth: The Bradley Method of Natural Childbirth and recommend I read it. I asked my OB about it, and he told me that he wouldn't advise against it per say, but he warned me that if I told the labor and delivery nurses that I was a Bradley mom they would think that I viewed them as the enemies. I certainly didn't want that, so on that alone, I decided not to read it. (And don't let this past opinion of mine be your guiding factor on whether or not to investigate the Bradley Method further. It has worked great for women that I know now.)
I was generally healthy. I often walked to work, and I felt great. On April 24, I went to the doctor's office. My doctor told me he was a bit concerned about my blood pressure (which had always been low before) and my urine sample (which had some protein in it). He gave me a list of physical reactions to pay attention to and advised what would be worthy of coming to the hospital immediately.
After the doctor's visit and my last day at work, Jeff and I babysat for two children, and I noticed the symptoms my doctor had mentioned. I had a headache lasting for hours that was not responding to drugs. My ankles were swelling severely; when I pressed down on the swelling, my skin stayed indented. My vision was a little bit off. And I just didn't feel very good. It was night time, and we drove over to a pharmacy to use their blood pressure machine. Red lights went off, and the machine announced that my blood pressure was very, very dangerous. I took it two or three more times to really make sure (possibly even went to a second drug store, I can't remember), and each time my blood pressure had risen from the previous check.
Jeff called one of his good friends from high school who was in medical school and asked him his opinion, and his opinion was to go to the hospital. All of the signs combined, we decided this was a good idea.
I was not feeling any contractions and was not dilated, but Jill was dropped at least. We were escorted to triage where they took samples of my urine and blood. Everything was pretty calm and relaxed. Then all of a sudden the nurses came back, rushed me into a room, and informed me that I had to give birth within twenty-four hours or I would have a cesarean section.
Many delightful occurrences followed: magnesium sulfate, prostaglandins, membrane rupturing, Pitocin, urinary catheter, continuous external electronic fetal monitoring, epidural, internal electronic fetal monitoring, ultrasound, forceps, tearing, the birth of a healthy Jill, placenta delivery, and suturing.
It was not a comfortable birth. I was hooked up to so many different machines. I felt very pressured by the clock that was ticking away toward a cesarean section, which I did not want. I am very grateful to the doctor and hospital staff for saving my and Jill's lives, because severe preeclampsia is very serious.
To this day, I don't know why I had preeclampsia. I don't know if it was caused by stress, or a poor diet, or if it was just something that happened to me.
Continuing this history, it is now 2010. Jeff and I are hoping for another baby. I start bleeding in February and bleed daily until almost a month later in the middle of March. I learned that I had been pregnant and miscarried. I am grateful that I did not require a D&C. A few months pass, and I am pregnant again. Daniel's due date is February 7, 2011.
Again during this pregnancy, I felt great. I read the literature given to me by my women's health care provider. I choose the hospital located across the street from their office. I was now rotated between five different obstetricians. (For checkups, I also occasionally saw the nurse practitioner or one of the four midwives as well.) I was exercising regularly and was excited about having another baby. I knew it was unlikely for me to have preeclampsia again (because while always rare, it is more common in first time moms), but I was still afraid of preeclampsia. I really wanted to have my child naturally this time, and I worried that I might not be able to.
On January 7, I woke up wet. At first I thought I had wet the bed, but since I was pregnant, I also wondered if my water had broken. It was around 4:30 or so in the morning, so I quietly went to the bathroom and tried to determine whether I had lost all control of my bladder as the fluid continued trickling out or whether perhaps my membranes had indeed ruptured. I decided it was unlikely that I would just be peeing slowly and continuously like that, but by the time I decided that, I knew Jeff's alarm would go off soon, so when he woke up, I was sitting on some towels half naked, facebooking. His reaction was definitely one of "what in the world are you doing?" I informed him that I was pretty sure my water had broken. We woke up his mother, and she came over to be there for Jill, and we went to the hospital. Four tests later, they agreed that my water had broken, and I was admitted to the hospital.
Due to my ignorance, I did not ask if I could go home and come back in when I was actually feeling contractions. (Although since I wasn't term yet, I don't know what the doctors would have allowed.) For a second time, I was admitted to a hospital with no contractions and no dilation. I also knew no ways to manage contractions. I tensed my entire body with each one. I don't think I received prostaglandins this time, and obviously my water was already broken, but they did hook me up to Pitocin, and due to risk of infection I was again under a strict clock for when I needed to have the baby. At some point I asked for an epidural, which required me to be hooked up to the electronic fetal monitor and to lay on my bed. Daniel was born that same day, late in the evening. Blessedly, he was just as healthy as his sister, and only a few ounces lighter.
So, Daniel was born at 35 1/2 weeks, and Jill was born 1 day past 38 weeks.
Now, my history has finally brought me to 2012. I am obviously pregnant again. Alice is due to arrive on February 24.
During the last few years, I have been influenced by a few people. One is my sister. She has had three babies without being induced in any manner or having an epidural for pain management. Another is a friend who had a home birth. Another is a friend who, like my sister, had a natural birth in a hospital. This friend is actually a nurse and married to a doctor, so I found her reasons for going natural to be very interesting. (And I am sorry if the word natural makes you feel like I am implying that your medically managed birth or my previous two births were unnatural. That is just the current term for not having any interventions. The only other way I've heard it described with one word is a pure birth, but that seems to imply a medically managed birth is impure, so I choose to use the word natural.)
And since embarking on this new path, I have learned of other friends who have had babies without epidurals, or used the Bradley method, or used the Hypnobirthing method, or had doulas present.
These "counter-culture"/natural birthing experiences of my friends and sister made me envious. When I look back on the birth of my two children, these are the words that pop into my head: "glad to be alive," "grateful for a healthy baby," "not in my control," "pressured against a clock," and "managed."
When I hear my friends describe their natural birthing experiences, some of the words they use are the same: "difficult," "exhausting," and "painful." But they also use words that are completely out of place with my experiences: "in control," "empowered," "ecstatic," "exciting," and "guilt free."
I have never felt in control of either of my births. Granted, I'm aware that having severe preeclampsia and having my water break at 35 1/2 weeks eliminates a lot of the control that any woman can have over her labor and birthing, but I see no reason to plan on having either of those occur again. Statistically, it is not very likely that either will, so I'd rather deal with disappointment if it does end up being out of control than not prepare myself to have the best possible experience.
In my quest to discover what is my personal "best possible experience," I have traveled far, slain many dragons, and rescued many a knight. Okay, that was just random. :) I have watched documentaries and online videos, read many books, and interviewed many people.
I watched The Business of Being Born, More Business of Being Born, and Gentle Birth Choices. I won't list all the youtube videos, but if you're curious, just let me know, and I can send you some. I read Ina May's Guide to Childbirth by Ina May Gaskin, Gentle Birth Choices by Barbara Hooper, Hypno Birthing: A Celebration of Life by Marie Mongan, Natural Hospital Birth: The Best of Both Worlds by Cynthia Gabriel, The Thinking Woman's Guide to a Better Birth by Henci Goer, and Birth Your Way: Choosing Birth at Home or in a Birthing Center by Sheila Kitzinger. I still have more books to read, but I only have so much time to give to reading!
The books (and movies) have been fascinating. I had not really realized before how much variance of opinion existed in the pregnancy, labor, and delivery community. Once I discovered that two care providers could have completely different opinions and methods, I realized that it would be worth my time to find a provider who had viewpoints most closely aligned to what I hold dear. That would make it the most likely that I will have a birth I want.
I live in Cincinnati, so I began to research the climate here. I called the two hospitals nearest me (and spoke to women who had delivered at other hospitals further away). I called the hospitals on more than one occasion and spoke to different nurses and asked questions about their common procedures, intervention statistics, and what was available there for laboring women. I asked friends and looked into online forums to try and find which providers I should interview. I interviewed/met four home birth midwives, one hospital delivering midwife, three obstetricians, and seven doulas (if you don't know what a doula is, she is a support giver rather than a care provider—click here to learn more about doulas).
I learned that Cincinnati used to have one obstetrician who would come to your home to deliver your baby and back up home birth midwives, but that he had retired quite a while ago. Since then, two more obstetricians in the area are willing to provide hospital back up to home birth midwives (of whom they approve). I learned that Ohio is not an ideal state for home birth. No hospital midwives will deliver at home, and no home birth midwives can deliver at the hospital, so if a transfer were necessary, your care provider would have to change as well. I learned that Cincinnati's only birth center closed six or seven years ago and despite interest in the area, nothing has replaced it here. I learned that all hospitals in the area require a HEP lock and that while some will allow you to labor in water, none will let you birth in water. I also learned that none of the Cincinnati hospitals allow you to eat while laboring, although some will let you sneak it on the side and avert their eyes. I also learned that the natural delivery percentage in Cincinnati is very low; somewhere less than 10% of women birthing in Cincinnati have no interventions. And no OB practice, that I heard of or found at least, did not rotate between providers. None let you pick who you wanted to have be there and who actually would most likely be there unless something very unlikely occurred. (I do not claim to have done an exhaustive search. I definitely did not contact every single hospital and care provider in Cincinnati. I had to stop searching at some point and just pick, since I was already pregnant.)
I thought about a home birth for a while. It appeals to me in many ways, but at the end of the day, I couldn't shake the fact that if something occurred like it did for my previous two pregnancies, I would have been required to deliver in a hospital anyway and the midwife who had offered me care for all the preceding months would not be able to follow me there and provide my care. And knowing my personality, I think I would worry the whole time that my house wasn't clean enough or tidy enough. And I really didn't want to worry about dishes in the sink or crumbs on the carpet while I was laboring. It did appeal to me to have the heightened level of prenatal care that you receive from a midwife. You choose who will be at your birth, and you know it will be her (unless some unforeseen reason occurs, which is not very common). She provides all of the postnatal care at your home. She spends a lot more time with you and is more likely to notice warning signs before they become high risk, because she is very well acquainted with your living conditions, diet, exercise, relationships, and stresses. You're not just numbers: gestational age, mother's age, blood pressure, + weight. You're a whole person, so she's able to diagnose much more accurately whether you are high or low risk. She is able to feel with her hands things that OBs are simply not taught in medical school. She has pain management techniques to offer you that do not involve drugs. She will be by your side for your whole labor, rather than just the last pushing part. She will never have a shift change and leave. It would be really easy for my children to be present as much as they want, because they could walk in and out of the room and leave and play as they desired.
It is possible that you have heard horror stories about home births. When I talk about the midwives I was choosing between, I am not discussing quacks or dangerous, ignorant women. I am talking about very intelligent, wise, experienced women who the OB was willing to backup, who were recommended by other mothers they'd help deliver, and who were recommended by doulas who had been present at their births. I am talking about women who know how to resuscitate babies and stop hemorrhaging. (Although, statistically, it is much less common to have a baby have breathing problems or for a mother to hemorrhage when there have been no interventions.) When you have a qualified, knowledgeable midwife, home birth is just as safe as birth ever is. Some people will disagree with me on that, and that's fine. Write an article on your blog or website with your opinion. :)
So, I decided against a home birth, but I did not want to deliver in any of the Cincinnati hospitals. That is when I decided to look more into the Family Beginnings option up at Dayton, connected to the Miami Valley Hospital. It was mentioned in one of the books I had read as an example of a real birthing center, not just a labor & delivery unit with redecorating and a new name.
Jeff and I went through the orientation session, and it offered everything I wanted. A queen-size delivery bed. No HEP lock required. A large Jacuzzi tub for labor and birth. Dimmed lighting. One patient assigned per nurse. Nurses versed in natural pain management techniques. Squatting bars. Ten different shapes and sizes of birthing balls. No induction or analgesic drugs available. A private living room for your children, and children welcome at the birth. No "tummy pummeling" to deliver the placenta. Delayed cord clamping. Breast feeding support. Assumption that the baby will stay with you in your room. Possible early release, if desired, with signed paper from pediatrician. Eating and drinking are encouraged to keep up your stamina. (When I say eating, don't think of like pizza or huge sandwiches. Think of high energy snacks, like what a marathon runner might eat to ensure stamina.) And probably much more that I'm not thinking of.
And if I fall into the small category of women who do have problems, they'll put me in a skinnier bed (because theirs are queen sized) and wheel me across the walkway over to the actual hospital's labor and delivery unit. Or my baby will be taken to the hospital's nursery, which includes a Level 3 NICU. Of course, if I fall in with the majority, then nothing will go wrong, and I'll stay on the Family Beginnings side of the campus.
I looked into doctors and midwives who delivered at Family Beginnings, and I have found a practice that I love. They rotate only three obstetricians, so I will have an opportunity to know them better than practices with five or seven! And they are completely in line (based on their verbal responses to my questions and the reviews of other people who have gone there) with my natural hopes. I seriously fall in love with them more each time I go. I'm very happy.
The downside to Family Beginnings? It is seventy minutes from my house. And Jill and Danny don't have bedrooms there, so if I am laboring or birthing in the middle of the night, they won't be present, but I decided that both of those issues were not as important as all of the benefits.
Here's one plus, the nurses bake bread while you labor, so right after you deliver, it's hot and fresh whenever you want it! And you get to smell it baking while you labor. They have different flavors of bread you can choose from. How random and nice!
I looked into different methods of natural childbirth, and the one that appealed the most to me was Hypno Birthing. I used to think it was really weird, like is someone else controlling you under hypnosis? But I've since learned that it is really just you teaching yourself how to deeply relax and how to go to a "happy place" almost where you can handle what your body is doing.
I also hired a doula who makes me feel very at ease. She has over thirty years of experience and just exudes calmness. She knows all of the tricks I can try, and while the nurse assigned to me will know what to do, she will still be a complete stranger. But my doula has been to my house, and I've gone to hers, and we email and call frequently. We have a relationship, and that trust will be very important during the end of labor. She will also be able to take pictures and video of any part that I want, so Jeff will be free to continue to support me.
My sister is also making some recordings for me to listen to while I labor that I am thrilled to hear!
So to sum everything up, I have always been excited to have a new baby, but for the first time I am actually excited to deliver the baby. I am looking forward to the discomfort and pain of contractions/surges. I am looking forward to discovering how strong my body is. I trust that since my body knows how to create a baby from almost nothing, it will also know how to get that baby out of me. I'm viewing the whole process differently, and it is so different from how I felt for my first and second when I knew basically nothing.
I have been a little nervous writing this, because I am worried that someone might feel that I am belittling the birth she has chosen, and that is not my intention. I also remember that I used to think that home birth was dangerous, that water birth was weird, and that hypnobirthing was really weird. But, I really am excited to have this baby, and I wanted to share with you why.
This Monday marks 26 weeks along in this pregnancy: Hello Third Trimester!
What I've really learned through all of this is that your best experience will be birthing in a location where you feel safe and comfortable (whether that be home, hospital, birthing center, or general practitioner unit) with a care provider who is qualified and cooperative of your birth vision.
The rest of this post is excerpts from the books I've read so far.
"If you don't know your options, you don't have any."
by Diana Korte and Roberta Scaer
"Whether birth is difficult or easy, painful or pain-free, long-drawn-out or brief, it need not be a medical event. It should never be conducted as if it were no more than a tooth extraction. For childbirth has much deeper significance than the removal of a baby like a decayed molar from a woman's body. The dawning of consciousness in a human being who is opening eyes for the first time on our world is packed with meaning for the mother and father, as it can be for everyone who shares in this greatest adventure of all.
At least, that is how many women see birth. Not all of us, of course. There are women who think too much fuss is made about the birth experience. They simply want it to be painless and over with as soon as possible so that they can get on with their lives. That is a valid point of view. Some women are happy to accept induction, an epidural, and a forceps delivery, or a planned cesarean section, and feel more secure knowing that childbirth is being managed by a top obstetrician with skills to augment or replace the natural process. I believe that women should be able to have what they choose in childbirth. It is our bodies to which this is happening, and other people should not make decisions for us or make us feel guilty because they would have chosen a different way." Birth Your Way: Choosing Birth at Home or in a Birthing Center by Sheila Kitzinger
"Labor will hurt. Probably a lot. But whether this is negative is another matter. Pain and suffering differ, as anyone who engages in activities demanding strength and endurance can tell you. A laboring woman can be in a great deal of pain, yet feel loved and supported and exhilarated by the power of the creative forces flowing through her body and her ability to meet labor's challenges." The Thinking Woman's Guide to a Better Birth by Henci Goer
"Why do American women so seldom experience natural hospital birth? Why can't American women endure the pain of labor? While many birth researchers blame doctors and a century of medicalized childbirth, I have a different idea. I answer this question as an anthropologist. Two aspects of our culture seem particularly vital. The first is structural. We all live with constraints imposed on us by the structures of our health-care system, the insurance business, and laws regarding liability. (Obstetricians are the most-sued doctors in the United States. Russian doctors and midwives are paid by the government; Russia has virtually no insurance companies; and none of the Russian doctors whom I interviewed had ever been sued by a patient.) The second aspect is related to our cultural values: Simply put, our culture does not honor birth pain.
Here in the United States and Canada, our culture doesn't teach us that birth pain leads to something valuable. Our society fails to recognize the merit of most pain, not just birth pain, and we go to great lengths to avoid unpleasant feelings. So many North American women have experienced the pain of labor, and then an epidural, that our collective memory about birth is now full of hurt but is missing the feelings of ecstasy and success that natural birth provides. In Russia, by contrast, suffering is considered an admirable pathway to becoming a better person. Russians from all walks of life can speak eloquently about positive transformation through pain. Russia is not unique. Most other cultures in the world provide a lifelong message to girls and women that the physical labor of birth is not just valuable, it is heroic. To embrace the pain of labor, we must reclaim its value." Natural Hospital Birth: The Best of Both Worlds by Cynthia Gabriel
Hypno Birthing: A Celebration of Life by Marie Mongan
"The United States offers the most technically advanced obstetrical care in the world. Ninety-eight percent of all births in the United States take place in hospitals, and the majority of them are attended by physicians. Yet when this country is compared worldwide, it ranks only thirty-first in maternal and infant mortality and morbidity rates, with 6.63 newborn deaths for every 1,000 live births. (Mortality reflects the number of deaths and morbidity reflects the number of illnesses associated with birth.) Every single European nation has better maternal and infant outcomes than the United States. As of 2004 one of the safest countries in the world in which to have a baby was Sweden, with only 2.7 deaths per 1,000 births. The majority of the industrialized nations that have good statistics have one thing in common that the United States lacks—midwives, and lots of them, who see birth as normal and natural and are the gatekeepers for all pregnant women." Gentle Birth Choices by Barbara Hooper
"Birth pain is different from other pain. The women at The Farm know that birth usually hurts—at least the first time you do it—but they know it as a different kind of pain from the pain of injury. When you are injured and feel pain, its message is 'Run away!' or 'Fight! You are being damaged!' This is survival information. The pain of labor and birth has an entirely different message. It says: 'Relax your pelvic muscles. Let go. Surrender. Go with the flow. Don't fight this. It's bigger than you.' This is far different from the message of 'Protect yourself!' or 'Run away!' that accompanies injury.
Yet many women react to labor pain in the same way they react to the kind of pain they experience when wounded. They think of medicating it and see no gain from experiencing labor without medication. They don't know that a change of position, of attitude, of atmosphere in the birth room, and a host of other factors can utterly change the inner sensations of labor. They usually aren't aware of the extent to which you can ease your own tense reaction by declining to think in terms of 'uterine contractions' and thinking instead of 'interesting sensations that require all of your attention.'
Some have characterized giving birth without painkilling drugs as some sort of 'extreme sport.' Women who choose natural birth have been derided as martyrs or superwomen exhibiting some demented female version of machismo. This is caricature, not reality. In fact, many women who choose to labor without medication do so because they fear the consequences of unnecessary interventions.
Please realize that I'm not promising you an orgasm or a completely painless labor if you refuse pain medication in labor. No one can make such promises. I just know that when I was facing my childbearing years, I wanted to be aware of all of the possibilities of women's responses to labor." Ina May's Guide to Childbirth by Ina May Gaskin