Caitlin's Birth

If I had one word to describe this labor, it would be intense.  Yes, there was pain, but mostly it was just incredibly intense.

At 4:30am, I woke up with what I figured was probably just gas.  After two weeks of thinking gas pains were contractions, I had finally given up and figured everything was gas.  I tried to go back to sleep but lying down made it worse.  So I got up to watch TV.  I watched a few shows (I believe it was “The Middle” and “Modern Family” in case you were curious), and by 5:30, I was pretty sure these were actually contractions.  At 6, I woke Collin and told him it was time to set up the birthing tub.  I was watching SNL, when Caedmon woke up.  He came into the living room and sat on the couch with me where he soon fell back asleep.  By 7, the contractions were getting so intense that I stopped being interested in the show and could only concentrate on what was going on within my body.  So I got out my handy iPhone because there’s an app for that!  But seriously, the free contraction timer was nice because all I had to do was hit a button with the contraction, and it told me everything I needed to know (Well, at least as far as timing contractions.). 

It was around 7:15 that I told Collin is might be time to call my midwife.  At this point, my contractions were between three and five minutes apart, but were lasting less than a minute, so my midwife said to time them for an hour and let her know what they were like for that hour.  By 7:30, my contractions had increased to less than three minutes apart and they were lasting for a minute or longer.  I had moved to the birthing ball and couldn’t do anything but deal with labor.  I think it was Collin that decided we should call my midwife again.  This time she said she was heading our way.  Once I knew she was coming, I stopped timing contractions, and from then on I didn’t look at a clock again.

I moved to the bedroom.  I think at that point I decided that with no one to direct my labor (unlike last time) that I would follow the advice of Ina May and let my monkey do it.  In other words, I simply followed my instincts.  I was pacing around my bedroom making goodness only knows what kind of noises.  I kept trying to sit or lie down but that made it hurt worse.  I had to be able to move.  I kept thinking about those women who used to be tied down during labor, and I could not imagine what kind of hell they went through.

All this time Collin was filling the birthing tub which meant draining the hot water heater into the tub, waiting for the heater to fill and reheat, then draining it again.  Once the tub was full and the water reheated, I moved to the shower where I felt some relief.  That’s when I started dry heaving.  I never experienced actual transition with Caedmon so this was new.  I think I knelt down in the shower and my water didn’t just break, it exploded – it was like opening a shaken soda can.  Things were starting to get pretty intense (as if they weren’t already), and I felt the need to get out of the shower and move around. 

I moved back into the bedroom and got down on all fours.  I was beginning to feel a very slight urge to push, and I began to think, “Okay, if it’s time for this baby to be born then it’s happening, and it will be okay.”  I moved back to sitting on the bed, and the doorbell rang.  In came my sweet midwife who asked if I wanted to be checked.  Yes, I did, and I was 9 cm!  So I moved to the tub.  Not long after I got in the tub, Caedmon woke up.  We had read him a book about birth where the mom “roared like a lion.”  So of course, Caedmon comes in and says, “Mom, are you roaring like a lion?”  “Yes, Caedmon.”  “Mom, are you swimming like a lion?”  “Of course.”  And that was that as far as Caedmon was concerned.

The water was a bit of a relief, and I soon felt the need to start pushing.  I think the nice thing about the water is that it really allowed me to relax between the contractions.  I thought it was taking a while.  Caedmon was born after twenty minutes of directed pushing.  But when my midwife told me it had been an hour, I couldn’t believe it.  She asked if I wanted her to check me to see if she could help.  I was feeling pretty ready to be done, so I did.  She gave me a homeopathic to help the stubborn cervical lip that was getting in the way.  Not long after that I needed to get out of the tub to use the potty.  While in the potty, I felt the baby’s head start to crown. 

(I have to make a side note here.  One of the things that makes this experience so amazing is how involved I was – yeah, I know that sounds funny since in both situations I was birthing a baby.  At the hospital, they had to practically force me to touch the baby’s head, and even so, I don’t remember much of anything about it.  I think I’ll remember what Caitlin’s squishy little head felt like for the rest of my life.)

I called in my midwife, who told me there was still time to get to the tub if I wanted to have her in the water.  So I quickly waddled back to the tub.  In one big push, her head came out.  The cord was wrapped around her neck and it was too tight to unwrap, so I pushed like a mad woman to get the rest of her (ahem, ginormous and somewhat stuck) body out.  After one or two more big pushes, she was born into the water, my midwife handed her to me, and it was amazing.  I feel like there should be better words to describe something so awesome, but I’m not the writer I used to be, and those words just aren’t there.  She was beautiful, Collin was right there, and Caedmon came in almost immediately to meet his new little sister.

Next blog, I’ll tell you what a great day that was after she was born because the benefits of home birth don’t stop with the birth!

Caedmon's Birth Story, Part One

I think most birth stories start at least as early as the pregnancy.  And I think it’s a good place to start this one.  When I was eight weeks pregnant, my husband left for a seven month deployment.  One day before my twenty-seventh birthday and four days before my first prenatal appointment.  My due date and his date of return were pretty much one in the same.

The only thing I knew about pregnancy and childbirth was what I had been told by my mom and grandmother.  This mostly consisted of foggy birth stories.  In a lot of ways, I was a blank slate.  So the first thing I asked myself was Do I want an epidural?  I went to Google, found a pregnancy website, and read how they do the procedure.  I didn’t even get to the side effects and risks.  A giant needle in my spine?!  Nope.  I knew there had to be a better way than that.  Thus began my adventures into learning about natural childbirth.  I checked out The Thinking Woman’s Guide to a Better Birth by Henci Goer.  I began to learn about “the machine that goes ping” and all the unnecessary interventions that I might be offered.  I learned about doulas (a lesson I should have taken more to heart, but we’ll get to that later).

Other than the obligatory What to Expect When You’re Expecting (Oh, how I wish someone had given me The Pregnancy Book by Dr. Sears.),  I think that might have been all that I read until I started Hypnobirthing classes about halfway through my pregnancy.  Natural childbirth just seemed like the obvious choice to me.  And it also seemed fairly simple.  It’s the way God made it, right? 

This is how I started on my path to natural childbirth.  In my next blog, I’ll tell you about my experience with the Naval Hospital Jacksonville during my pregnancy.

At this point, I think I need to put out a disclaimer.  I have nothing against doctors or medicine.  I think we are so blessed to have good doctors who use their tools appropriately and when needed.  But I think maternity care in the United States is sorely lacking.  And it’s going to take the good doctors, midwives, and women to stand up and demand that the situation be put right.

And now for your viewing pleasure...

It Happened on the Way to the Midwife, Part 4.

 As promised, here is Collin's letter to Dr. Miller.  He's much more subtle than I am.

***

I understand that you no longer act as a contingency physician for home births, as you have in the past.  I have no qualms with your decision to provide care in the best manner you see fit; that is wholly within your purview and I commend you for your carefully considered philosophy of care.  That being said, my wife clearly communicated to your staff that she intended to have a homebirth, and rather than inform her of your recent change in policy, they nevertheless scheduled an appointment with you, a needless appointment for which she waited one and a half hours.  I hope that your staff was ill informed rather than deceptive by omission.

The decision to have a non-hospital birth is one that we have made with deliberate risk management, weighing with great gravity the risks and benefits of both hospital and non-hospital births.  The extremely high rate of caesarian births at Ridgecrest – at 22% for a low-risk pregnancy, versus 10% for Bakersfield Memorial, per the Census Bureau  – gave both of us pause.  Hearing that Ridgecrest categorically does not conduct VBACs, contrary to the recently revised (August 2010) guidelines issued by the American College of Obstetricians and Gynecologists, makes me think that the OB/GYN standard of care in Ridgecrest is less than what it should be.  If we lived in a city with a birthing center affiliated with a hospital, we would have preferred that, but given the option between a well-briefed home birth with a certified professional midwife versus a birth in a hospital in which one in five women with a normal, healthy pregnancy leave having had a c-section, I am compelled to think that the two options are at worst equal in terms of risk, to say nothing of other factors.  I am supported in my opinion by the paper “Outcomes of planned home births with certified professional midwives” from the British Journal of Medicine, volume 330, which I commend to your reading.

Although she may not have presented her reasons for non-hospital births so succinctly, my wife nevertheless articulated her decision to have a home birth, a decision that you should have respected.  Rather than politely informing her of your disinclination to provide care under the circumstances, you continued with what was in essence a sales pitch in an attempt to change her mind.  Clearly, what transpired was a mutual waste of time, a waste that certainly could have been obviated by early, clear communication in what you do and do not provide and a respect for her articulated wishes.

Your comparison between appendicitis and pregnancy summarizes the gulf between our respective views of pregnancy and childbirth – pregnancy as a malady to be cured rather than a process to be observed and in most cases allowed to follow its natural course to fruition.  I wish you well in your practice, and that you may better inform your staff of the care you have elected not to provide.

It Happened on the Way to the Midwife, Part 3.

Since this is the part where Dr. Miller gives me a sales pitch for himself (who is one of only three OBs in Ridgecrest) and the hospital, I think I should give you a few stats about the hospital.  They do not do VBACs.  Even though this isn’t a concern for me, it tells me they are seriously behind the times.  As of 2007, their overall c-section rate was 40%.  Their c-section rate for normal, low-risk pregnancies is 22%.  Compare that to 10% just two hours down the road in Bakersfield.  I have other reasons for being suspect of this hospital, but I think the statistics are enough to give one pause.

At this point, I’m pretty well shocked.  I had no indication that the meeting would wind up like this.  I wasn’t really sure what to say.  If he’s already made his decision, what point is there to arguing.  I’m hungry, tired, and ready to leave, but that wasn’t going to happen any time soon.  So I mostly tried to stay quiet and listen to his spiel until I could get out of there.

He starts giving me reasons he doesn’t do this.  He says (and I quote) “1 in 100 babies died before hospitals.”  I don’t have internet right now so I can’t check the accuracy of this statement.  But I do know that a statistic like that doesn’t apply to modern home births attended by professional midwives.  I also know that some of the darkest days of maternity care were the early maternity wards that were unsanitary.  Doctors didn’t even wash their hands and antibiotics hadn’t been discovered to treat infections.  But I digress.

He tells me he can’t be sure about some of the midwives “around here.”  He says that there are a lot of midwives in the area practicing without licenses or even any training.  In case you were wondering, my midwife is licensed by the state of California.  Since he has worked with her before, he should know this.  However, it’s fairly easy to check that kind of thing.  We do live in the information age, after all.

I think it was around this time that I finally interjected and told him that I wish he would have told me this over the phone so that I wouldn’t have had to spend an hour and a half waiting to find this out.  He says, “Well, we didn’t know what you wanted.”  Liar, liar, pants on fire.  I said, “Yes, you did.  I told the nurse on the phone that I was having a home birth and looking for a back-up physician.”  He didn’t really have anything to say to that.  Now, I know there’s a chance that this was a miscommunication among his staff, but if you have a hard and fast policy regarding home births, I would think you would communicate that to your staff.  But I would have to remind you that I left a message telling them what I was looking for.  I reminded them twice on the phone when I made the appointment.  And when the nurse brought me to the exam room, she knew what I was there for even though I hadn’t mentioned it that morning.  I never asked for a consultation on home births versus hospital births.  If I had known he wasn’t going to accept me as a patient, I wouldn’t have made the appointment.

I mentioned that I have a friend who had a home birth in May with my midwife, and he was her back-up physician.  He didn’t really have much to say to that either.  It seemed like he really wanted to pretend that this is always the line he’s walked, and he can’t remember ever doing anything differently, even if it was only four months ago.  He continued to act like he doesn’t know anything about my midwife. 

He says he doesn’t like backing-up home births because then he “misses out on all the fun.”  He says he likes to develop relationships with his patients.  He would meet my husband, and we would do ultrasounds together.  First, I never declined having a relationship with him.  In fact, I think it would be great to have a relationship with my back-up.  That’s part of the point, right?  So that if your care has to be transferred or you do have an emergency, it’s not a stranger working on you.  Second, I don’t want a bunch of ultrasounds, thank you very much.  They’re unnecessary and haven’t been proven to be completely safe.  Once again, the fact that he sees this as central to my care shows me that he is not be on the same page as me.

I mentioned that in Jacksonville, the midwives and the OBs work together so that you have a relationship with both (I could be totally off on that, but it seemed like it worked that way from what I saw).  He told me that Jacksonville is a big city, and they do things differently.  Thanks, I needed another reminder of why I hate Ridgecrest and miss Jacksonville.  I don’t really think I should have to sacrifice standard of care because I live in a small town.

I pointed out that some people who are planning a home birth also go to an OB but don’t tell the OB about their plans.  I told him that I was trying to be honest and upfront with him.  He told me he could tell when someone was planning a home birth.  Of course, you can.  (As a side note, I wouldn’t do that.  Part of the reason I’m going to a midwife is because I want joyful prenatal care that is in line with my beliefs.  But even if I did, I wouldn’t be with him because he’s not the OB that my insurance approved.  I’m certainly not going to pay out-of-pocket to be berated and treated like my pregnancy is a disease that needs to be cured.)

I think it was around this time that I told him I felt like I was wasting his time and keeping him from his actual patients.  That didn’t seem to concern him.

Then he offered to help me with a home birth if I did all my prenatal care with him.  I told him that was ridiculous.  Not that it’s something I would even consider to start with, but what midwife is going to do a home birth with someone who has received all of her prenatal care elsewhere?

He told me he wouldn’t charge me all the extra fees my midwife charges me.  What?  I’m paying my midwife a flat fee that covers all of my prenatal care, the birth, and postpartum care.  Maybe he’s talking about the cost of the birthing kit?  Yeah, that $60 is really going to put us in the hole.  Or the birthing tub rental?  Not required and wouldn’t be an option at the hospital.  I don’t know how much he charges, but I know that between OB appointments and the cost of a hospital birth, a midwife is a bargain.  Of course, why should I worry about that?  Tricare and the tax payers foot the bill for the hospital birth, right?

He told me getting a birth certificate would be easier.  And that’s the rubric by which I measure everything.  Sure, just go ahead and do a c-section.  As long as the birth certificate is easy to get.

He told me he could give me if I had nausea, he could give me a prescription.  Okay, this is another one of those “how different could our philosophies be” moments.  First of all, I already told him my morning sickness was mostly over.  Secondly, I don’t even take Tylenol for my headaches or Zyrtec for my allergies.  I don’t do prescriptions unless it’s a continual quality of life issue and even then, not during pregnancy unless it’s absolutely necessary.

He said he could help me pick out a pediatrician.  I informed him that we have Tricare Prime; my pediatrician is at the base clinic.  “You don’t get to choose?”  Um, no.  That’s how Tricare Prime works.  (Besides that, I have a two year old.  Shouldn’t I already have a pediatrician picked out???)

I think by this time my face was red, and I was shaking.  I was incredibly frustrated with him.  He told me I was just upset because I wasn’t getting what I wanted.  It’s at this point that I started having flashbacks to my pediatrician who used to diagnose my stomach problems and severe allergies as “schoolitis.”  If you want to treat a seven year old like a silly little girl, that’s understandable.  But I’m a twenty-nine year old, college educated, second time mom; I think I deserve a little respect.

Then he told me I should go home and discuss it with my husband.  I informed him that my husband is 100% behind my decision to have a home birth.  He said, “Well, I’d really like to talk to your husband; I respect what he does.”  That was the point where I blew my top and left. 

I know that some of this may seem inconsequential, but it was really upsetting to me.  I was not interested in being sold on the hospital or transferring my care.  I wanted to add him as part of my birthing team.  What really irritates me is that it all could have been avoided.  If he doesn’t back home births, he shouldn’t have made an appointment with me.  I feel that if nothing else, he was deceitful and treated me like I was an idiot.  And maybe because I didn’t really feel like spending my morning chewing the fat with a doctor who just declined me as a patient, he didn’t get the chance for me to prove him wrong.

I still feel that a home birth is the best chance I have for a safe, natural birth, and that’s what I’m doing.  But I am deeply disappointed that I have to do it without a “back-up plan.”  I was already uneasy with of the thought of having anything to do with Ridgecrest Regional Hospital or the OBs associated with it, now I’m terrified.  It is really unnerving to have to spend the next two and a half years of my life in a town where going to the hospital is such a scary prospect.

 

It Happened on the Way to the Midwife, Part 2.

I know some of these things are going to seem nitpicky, and under other circumstances, I wouldn’t bother with them.  But rather than try to make this super interesting by trying to decide what’s important and what mundane, I’m just going to tell you what happened.  So here it is...

I got there.  I filled out paperwork.  I wasn’t sure what to think when the paperwork asked me question like “What is the nature of my problem? How long have I had this problem?  Is there pain associated with this problem?”  I think you get the idea.  I’m filling out paperwork for a pregnancy and nowhere did I answer questions like “When was the date of your last menstrual cycle? When is the estimated date of conception?  When is your projected due date?”  Oh, wait.  I’m not supposed to know these things, right?  Heaven forbid I know what my due date is before the almighty doctor gets out his magical wheel or gives me an ultrasound.  (See what I mean about being nitpicky, but things like this drive me crazy!)

While I was waiting, I heard the receptionist (Or is it a nurse?  I don’t know.) on the phone with a lady saying, “I know you’re getting big, but the hospital isn’t scheduling any more inductions this week.”  Okay, I know I don’t know the whole story here, but I’m still amazed that people ask for inductions!  I could go on about this, but I won’t.

So after waiting over an hour in the waiting room, I finally get back to the exam room.  They weigh me, but I’m not sure why since they didn’t take any vitals.  The nurse gets out her magical due date wheel and calculates my due date.  Then she says, “So you just want to get Dr. Miller’s opinion on homebirth, and ask him to be  your back up doctor.”  This is where I started to suspect things were not going to go as well as I hoped.  I didn’t get that degree in Literature for nothing; I know foreshadowing when I see it.

By the time Dr. Miller comes in, I have been waiting over an hour and a half.  There are a few pleasantries like “Where does my husband work, What does he do,” etc.  He asks a few medical questions like “Am I taking prenatal vitamins?, Was my last birth full term?, Who’s taking care of me?”  Then he asked me why I want a home birth.  This is the part where I’m kicking myself now, because my answer was total crap.  I don’t know why I was surprised that he asked me that.  I don’t know why I didn’t give him a better answer.  Honestly, I don’t think many people have asked me why.  Most people who have known me more than five minutes can figure it out.  So I told him that my first birth didn’t go the way I wanted.  They didn’t follow my wishes.  And of course he gave me the classic OB line, “But it was a good outcome, right?”  Yes, nobody died.  That’s the rubric by which I measure everything, of course.  Seriously, Dr. Miller should be the poster child for “typical bad OB that you always hear about.”  I also mention that I don’t like hospitals.  So he counters, “What will you do if you get appendicitis?”  A little dumbfounded as to how you can compare having a baby to appendicitis (and I speak from experience here, my mom almost died from a ruptured appendix), I told him that I would of course go to the hospital.

So at this point, I’m feeling like I’ve just been presented with a pop quiz, and I’m failing miserably.  This is when he looks at my chart (not at me) and says, “Well, I’m sorry but if you want me to help you with a home birth, I’m going to have to decline.  I don’t think they’re safe.”

I’m going to leave off here for tonight.  But let me just make a quick commentary on what I’ve written so far.  Even though, I can already tell that this man would not, under any circumstances other than a life or death situation, be the doctor I chose to help me with anything, I respect his right to make his decision.  It is how he handled telling me his decision that I have a problem with.  More in Part 3. 

It Happened on the Way to the Midwife, Part 1.

In order to keep this from being too long, I'm going to assume that you know me.  But if you don't, I would be happy to tell you about my previous pregnancy and birth experience, my strong belief in natural birth, or about how I live in a town where it seems the majority of people (including doctors) don't bother to pick up books and educate themselves or in the rare case that they do, they don't bother to do any research on the credentials of the authors that they are reading.  Where to start?
I am planning a home birth.  In a perfect world, OBs would be willing to work with midwives so that home birthing mothers have a back up OB who is not a complete stranger in the event of an emergency.  But we don't live in a perfect world, we live in a country with a very broken system for maternity care.  Nevertheless, I was advised by my midwife to visit the local OB who has provided unofficial back up for her in the past.

I'll say this right now, I was not excited about having to meet his man.  I'm not excited about anything that takes me onto the property of the local hospital.  Ridgecrest  Regional Hospital scares me.  I was even more apprehensive when I went online to get  Dr. Miller's phone and saw the absolutely terrible reviews of him.  But this was a hoop I had to jump through, so I picked up the phone and dialed.  I left a message with them.  I said, "I am planning a home birth, and I would like Dr. Miller to be my back up physician.  My midwife said that I might be able to just talk to him on the phone."  They called me back a couple of days later and left me a message with their phone number and office hours.  Helpful, aren't they?  I called back and left another message.  The next time they called I was home to answer.  They told me Dr. Miller didn't do phone interviews, and that I would have to make an appointment.  I made the appointment.  The earliest appointment they had was a month from the  day I called.  I reminded them once again that I was having a home birth with a midwife and that I did not want an exam.  They said it would just be an appointment to set me up as a patient and talk to the doctor.  Okay.

I wanted to be prepared for what to expect.  I didn't even see an OB when I was pregnant with my first child.  I saw a nurse-midwife during my pregnancy and a family physician attended his birth (all within the military medical system, so there was no drive for profit - it makes a difference).  So I called my friend who had a home birth with my midwife in May.  She told me he would make you thankful for our midwife.  But he was used to this and would talk to you, offer you a prescription for prenatal vitamins, and an ultrasound.  But overall, he was friendly, and it wasn't that bad.

Since I actually have to leave in a few minutes for an appointment with my midwife, I will go ahead and post this.  I'll get the long story of the actual meeting up as soon as I can.

Brandy's Funny Pregnancy Moment of the Day

I've had to put a roll of paper on the counter next to the toilet because I can't lean over far enough to reach the paper on the wall. I hope this wasn't TMI.

Thoughts on Thermometers

Oh, the things you learn when registering for babies. Luckily, I worked at Toys R Us for three years, and baby registries were part of my job. So I know that baby registries aren't all fun and games, baby needs things like nail clippers and thermometers, too. So I'm scanning thermometers, a "normal" one for under six months (you know where that goes...eww) and an ear one for over six months (I can't believe how cheap these things are now!). Then to my surprise I notice a new thermometer, a pacifier thermometer. It's a pacifier with a little digital read out on the front - genius!

So I scanned it and pointed out the genius to Collin who said, "But it takes 90 seconds."

I replied, "Yes, but it doesn't have to be stuck up our babies butt!"

"I don't know," Collin continued. "90 seconds seems like a long time."

So I flip over the rectal thermometer for the read-out time..."60 seconds," I announce.

"60 seconds!" Collin says incredulously.

Suddenly 90 seconds with a pacifier didn't seem so bad.

Cravings and Aversions

Well, today is Sunday. Sunday is always a crappy day because that means we have to go to a church. I emphasize a church because we have yet to really know which one is ours. This is the rough spot in what is otherwise a very happy and harmonious relationship. The only church Collin and I have ever agreed on is Eastgate. Every church we visit we over-analyze. Collin goes in on the doctrine and theology; I start on the worship and atmosphere, and by the time we're done, no church works for us as a couple. It is beyond frustrating. And to be facing a deployment and a pregnancy with no church home is just downright scary for me.

In other news, the whole "morning" sickness thing is kicking into high gear. Everything makes me queasy from morning til evening. The stew that I ate last night now makes me feel ill even if I just smell it on Collin's breath. Cantaloupe is the only food that is always good to me right now, and every night comes a craving for an appetiser sampler from somewhere like Fridays or Applebees or a brownie sundae...or both. Ahh...the joys of mother-to-behood.