Thursday, July 29, 2010

First Visit to the Midwife

Today's post wraps up our little series about pregnancy. There will definitely be more to come, but it's not likely to be every single day like it has been this entire week.

I wanted to share my first visit to the midwife with you all. I suppose I should backtrack and explain why Matt and I chose to go the homebirth route with a certified-nurse midwife, in case I haven't explicitly talked about it.

I have to say upfront that I am not going to get on a soapbox and pontificate about why the entire maternity care system should switch over to homebirth. I just don't feel that certain about it. In fact, if I am one of those rare cases where something goes horribly wrong, I may wish I would have gone the hospital route.

But as it is right now, a homebirth makes the most sense for our family. Here are my thoughts about it:
  • Personally, I am more uncomfortable with the likelihood of receiving unnecessary interventions in the hospital than I am with the risks associated with homebirth. I am afraid of unnecessary induction and pitocin. I am afraid of wanting an epidural because other interventions changed the nature, frequency, and intensity of my contractions. I am afraid of the situation escalating into a cesarean, primarily because the doctor is afraid of a malpractice suit. I am afraid that years down the road, we will realize that many of the "common" interventions used in childbirth actually have unintended consequences and leave a negative impact on our children.
  • I can't imagine going through the most painful experience of my life while strapped to monitors that hinder me from moving in ways that are most comfortable to me. I can't imagine being encouraged to lie on my back in a very unnatural position, simply because it's convenient for other people. I can't imagine spending hours upon hours in a tiny room with different people coming in and out as the shifts change.
Even as I write all of that, I can imagine that many of you had hospital births and had much better experiences than the one I'm envisioning. I can also imagine someone writing a similarly negative list about homebirths (e.g., "I can't imagine having all that blood in my own home! I can't imagine how scared I would be to deliver a baby so far from the hospital....").

That's the thing about big, life-changing events: We have to do what makes sense to us. And then be okay with it.

And then we have to realize that there's a line between what we can and cannot control. I may very well end up in a hospital with a cesarean, despite all my intentions!

I actually think the most important thing in the whole process is finding someone you trust to be your caregiver, regardless of whether it's a hospital, birthing center, or homebirthing situation.

Luckily, Matt and I adore our midwife. She recently moved her office to our neighborhood, so it takes about four minutes to get to her historic bungalow office. While we waited in the front room, I immediately felt comfortable. It was so much easier to relax in an environment with natural light and comfortable furnishings.

When she called us in, she let us ask questions first. I asked her about how she handles Rh factor since I'm A negative and Matt is A positive. We asked her when our birthing classes begin, as well as her thoughts about eating soft cheeses/runny egg yolks, having sex even though I've had some spotting, and jogging. She then talked through our entire health history, as well as how we're doing psychologically and emotionally with the pregnancy. She even asked questions like: "Sara, how is your relationship with Matt's family? Matt, how is your relationship with Sara's family?" in order to get a picture of our emotional states and our general support system.

Throughout each part of the conversation, she really listened to us and responded to our concerns. She also demonstrated her immense knowledge and connected with us as people. I also appreciated how she focused a lot on action steps. For example, she asked me what was stressing me out most in my life right now. I explained that I am most worried about the fact that Matt and I have different preferences for how frequently we are sexually intimate. I added that I was particularly worried about how our relationship would be impacted once we were more exhausted and stressed than we have ever been. She gave us the card for a couple who does counseling and suggested that we speak to them so they could help us get to the root of the issue. In terms of other next steps, she directed me to a local herb shop to pick up some red raspberry leaf and nettle tea. She also gave me a diet log to fill out and bring to our next appointment.

Although I feel a little unsettled by the fact that sonograms will not be a routine part of our visits, I am overall really happy with the route we've chosen for ourselves. I'll let you know how it goes!

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Rosalie said...

Choosing a homebirth was the best decision I made (that and doing a hypnobirthing course). I had the most wonderful birth, I definitely recommend them. There's a good homebirth site although aimed at the UK:

Anonymous said...

While a homebirth would never work for me ( I am a huge fan of the ) I hope your homebirth is everything that you hope for and more. And I'm sure that it will be one of the best experiences of you life. I think its really cool that you thought all of this out before hand and I wish you the best of luck!!!

Anonymous said...

I agree with Rosalie. Please make space for yourself to read the book "Hypnobirthing" or visit I hear alot of fear in your voice about birthing and I believe you may connect with the principles of this method- most notably that a woman's body is creating for giving birth and through relaxation the body can be permitted to guide itself through the process.

Ms Domestic Darling said...

I started watching "The Business of Being Born" last night (and if you haven't watched I HIGHLY recommend that you do) and this post is so in line with that!

This is just further proof to me that I absolutely made the correct choice signing up for your online course. I 100% understand and agree with your sentiments above, even the being nervous about it.

Steph said...

I just had my first baby on May 3rd. We did a homebirth also, it was amazing! I wouldn't have done it any other way. Good luck!

Anonymous said...

Sara, I think you hit the nail on the head -- find someone you're comfortable with and whom you trust! I'm so glad you've found that someone in your midwife -- may it be a wholesome and healthy experience for all four of you (you, Matt, ya'll baby, and the midwife). Cheers!


Autumn Witt said...

Sara, just curious, do you get to hear the baby's heartbeat if you don't have a sonogram? Dumb question, but can you hear it through a stethoscope? Glad to hear your first trimester has been great, and that you're pleased with your caregiver.

julie said...

i am loving all the pregnancy talk because i am so on the same page as you in terms of preferred birth options and stuff! it's good to see a couple who is super-proactive about choosing what is right for them and not being swayed by all the what-ifs of the BIC.

i'm currently reading "the birth partner" by patty simkin (for a doula class) and suggest you guys pick it up as well. it should be required reading for all expectant dads/partners! sooo informative :)

Anonymous said...

You know, it strikes me that the words you used over and over again were "afraid" and "most painful." While OBVIOUSLY those are natural feelings in relation to labor, it might be something you want to address and work through before the birth. I don't think we're at our best when we are preparing and making our choices based on fear. (NOT to say that you are making the wrong choices, just to say that I think you should try to re-work them from a place of affirmation).

People in my life who have given birth say over and over again that the more scared you are, and the more you're expecting pain, the harder it is. And the harder it is, the more likely interventions are needed (which isn't to say we cause interventions, or interventions aren't needed all the time for practical things like a baby in breech). But that is to say, we can lay the groundwork as well as we can, and that means preparing to totally let go, give up all control and ride it. This is, I think, a very literal example of our mind's shaping our realities. This sounds a little woo-woo hippy, but I think it's true, given my experience with pain. In past long illnesses what I learned is that you have to be able to relax and ride the waves of pain (I had a teacher who said we should think of it as intense sensation instead). You have to relax and ride them, and then totally let them go the second they are gone, to give yourself time to re-coop. And then you have to relax and ride them again. The more you fight pain, and the more afraid you are, the more it takes over... in a really literal way.

So. Just a observation. I'd really work on getting to a, "This is going to be a scary and new, but also exciting and life changing experience in my life. I will surrender to what it is, and know that I can't plan it." Maybe. If you can.

Good luck!

amber said...

we are doing the midwife, birthing center option. I would so love a home waterbirth, but in tennessee, insurance is not required to pay for a homebirth.

i cant wait to hear more about it!

i have enjoyed pregnancy week by the way!

#2 due in Feb '10 said...

Your birth plan sounds amazing! I wish you the best, and am sure you will have a beautiful home birth.

I was not such a good planner with my first; my birth plan consisted of 1. epidural, 2. no episiotomy, and 3. no c-section

I didn't get quite what I wished for, because my ob (who I love for her frankness) told me that from her vantage point (better than mine at the time) I could choose an episiotomy or major tearing. Bummed out, I chose the episiotomy so that my healing would be faster and easier.

Anyway, the point of my story is that the birth was fine; but I (not baby) had unexpected complications AFTER I delivered that required pretty immediate medical attention. I was fortunate to be in a hospital.

So, in planning for a home birth, plan for an emergency as well; what hospital would you go to? how long would it take to get there? would baby come with or stay with Matt? if Matt's with baby, who's with you? is your cnm able to attend to you in a hospital? Knowing the answers to those questions ahead may give you some peace of mind.

At the end of the day, what I most remember about #1 is that you really have no control over labor and delivery. You kind of just have to go with the flow and remember that a successful birth ends with a healthy mom and healthy baby.

Anonymous said...

I'm right with #2 (above me here)... It felt so good to know what would happen (to me... to my baby... to my husband) if anything went wrong. We made a plan way in advance! Since I'm a worrier, part of this plan actually entailed driving 8 hours to the "big city" to have my baby at a hospital with a neo-natal intensive care unit. This -- and knowing my husband would not leave the baby's side no matter what -- allowed me to relax and not worry endlessly.

Another thing - I was going to have a "natural" birth, but realized at about 4cm that I would not be able to handle anymore pain. I was going to exhaust my body to the point of needing a C-section. So I got an epidural for the pain, and labor continued smoothly & my baby arrived safe and sound. I just say this because I had to be willing to admit that things weren't going to happen "as planned" in this regard. In fact, when someone in the room with me suggested I was just "wimping out," I just had to say to myself, "Well, you know what? Maybe I *am* wimping out & can't handle pain as well as other women. But that's me at this point in my life. Am I going to accept that and make a decision based on reality... or fight it and make a decision based on who I wish I was?" For me, being real meant being ready to admit I was less "strong" than I wanted to be & taking actions based on that new (unappealing) information about myself. Strangely, I felt stronger "on the inside" as soon as I "let myself" be the wimpy girl who needed the epidural! How weird is that?!

Sara E. Cotner said...

Hi, Autumn: Yes, we heard the baby's heartbeat! It was through something called a doppler (I think that's it).

Anonymous said...

Just wanted to chime in on the comments above. Many women around me are having children right now and I am friends with someone who worked as a nurse with premature infants who sat in on a lot of labors. I was thinking about he whole epidural thing, and it definitely strikes me that those who have gone without have an air of smugness to them when they say they didn't need one. And the nurse that I am friends with said the pregnancies where epidurals were used were so much calmer than the ones where it wasn't used, and the mom could start being a mom from the second the baby was born. I am just wondering if there is any harm done to the baby by going that route? At the end of the day, I could get my leg amputated "naturally" or I could take advantage of modern anesthesia. Would there be any benefit to me going the natural way in that case, to get the full experience, or would I just be causing undo trauma to myself so that I could go around and brag that I got my leg amputated the "natural" way? Pardon me if I am ignorant about the effects of epidurals on babies, I just want to try to wrap my head around the reasons for doing one or the other.

Anonymous said...

I'm the anonymous above Sara (the wimpy epidural girl, lol!) I just want to say, yes, some people feel there may be "bad effects" of the epidural on the baby. I am not sure exactly what they are -- I was up on this when I was pregnant, but I've sort-of forgotten since then. Check out "What to Expect When You're Expecting" for more info -- it goes into the pros and cons of different pain medications offered, if I remember correctly. Books on natural birthing will also give you lots of cons of the various medication options, although I can't recall exact titles of some of the great natural birthing books I read.

Bottom line, I think a big part of raising healthy kids is discerning, as parents, what's "essential" and what's a "support" to the essentials in our family. Then we just have to accept that not all of us call the same things "essential." When I meet moms who are smug about un-medicated births, I just remind myself that my "essential" was not "to give my child a medicine-free entrance into the world" but "to be a calm, loving presence to welcome my child joyfully into our family." In my case, I needed a good hospital and an epidural to be able to achieve that. :)

Anonymous said...

I like what you said, that what was essential to you was to be a calm, loving presence to welcome your child joyfully into your family. I am going to keep that in mind if I cross that bridge. It seems like a lot of women go the natural route just so they can wear that badge of honor rather than because it is the best for them and the child, and I hate that. It just seems like a new form of abuse towards women - that you need to do it naturally to be a real woman

That said, I am all for doing things as naturally as possible, I just feel like there is a new extreme that is in vogue right now. And most of my friends and I are the products of epidurals, and I can't see anything that much wrong with us (oh, except that I have three belly buttons, but other than that, I am perfectly normal) :)

Anonymous said...

I personally think people are crazy to go through birth without pain control, but to each their own.

#2 due in Feb '10 said...

I think we need to get away from judging and labeling each other based on our individual birthing choices. We are all different and have different perspectives, priorities and experiences. At the end of the day we all do the best we can for ourselves and our children.

I felt more comfortable in a hospital, with an OB and nursing staff and the NICU one floor up. But I ended up laboring at home until I was halfway there (5 cm) because that's what felt right at the time. I went to the hospital, got my epidural, took a nap and then delivered my son a few hours later. My sister (who happens to be a doula) wanted a birth center, non-medicated water birth. She ended up in the hospital with pitocin and an epidural because my niece didn't get the memo that once mama's water breaks, you have to come out.

Its easy to develop a philosophy on birth and birthing options. That can all fly out the window when you are actually in labor. Let's be respectful of each other and each other's birth preferences!

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