Thursday, January 31, 2008

Our new baby, installment #18

Having written a book, read every book, seen every video (except for the dolphin one), it was time to start making some hard decisions about our plan for a home birth. First, did we want a waterbirth? If so, which rental pool should we use? The midwife had a few to offer. She recommended the "lucky" one six feet around and said it should be set up at least a week before I went into labor. But gee, when would that be? Where was I going to put something that big? How would I keep the boys out of it in the meantime? And my mother, always on the lookout for catastrophe, wanted to know if the pool that size filled with water would crash through the floor of our 140-year-old house.

Second, what to do about Strep B, that nasty bacteria that sends OBs running for antibiotics? I had tested negative for that the first time around. Did I need another test? And if I tested positive this time, would it throw the whole plan a curveball?

Little did I know it, but all of these decisions were making my blood pressure rise. Little. By. Little.

Wednesday, January 30, 2008

Our new baby, installment #17

In addition to the copy of Optimal Foetal Position, our home birth midwife each week would send us home from our appointment with something else to read or watch. On one ocassion, it was a vintage VHS of a film called "Birth in the Squatting Position," which was only about 10 minutes long but showed the crowning and births of a handful of babies in stark anatomical fasion. The only sound one hears in addition to the background music is the narrator in his English accent sounding like the host of Wild Kingdom's World of Animals as he explains in awe that women actually give birth squatting -- and smile as they do it! It took many weeks for my husband to bring himself to watch the film, which left him sort of speechless. It left me sort of speechless, too. One of the births shows a baby whose head molded so incredibly that it looked more like a summer squash than a human!

Tuesday, January 29, 2008

Our new baby, installment #16

During one of our regular visits with a home birth midwife, we talked about my first birth (in the hospital, back labor, epidural, hours of pushing, cesarean, yadda, yadda, later to learn that the baby was posterior, or facing the wrong way, face up, as he tried to make his exit.) Recently, I told the midwife, I had heard a statistic that some 30 percent of all first births involve a posterior baby.

"Why is that?" I asked.

The answer seems to be a bit of a mystery but one thing is for sure: Posterior babies in general are becoming increasingly common. Perhaps that is because of our sedentary lifestyle, sitting at desks all day using poor posture, driving home in a car with bucket seats and then lounging on the couch at night...the baby settles into the mother's body as if it were laying in a hammock, its back curved against the slouch of the mother's spine, she explained.

Alarmed, I sat up as the midwife reached over to her shelf and handed me an older book called Optimal Foetal Positioning (I don't even think the book is in print anymore, but please correct me if I am wrong), written by a midwife and a childbirth educator, one of whom had been trained in engineering. They explain that if the mother sits forward and upright, the baby is nudged out of the hammock and will assume the proper position. I devoured the book and began to keep better posture immediately.

Of course it is tricky for a very pregnant woman to sit forward because the belly gets in the way. So I made it a habit of sitting in a very unladylike fashion, legs spread, belly pushed forward, sitting on the edge of my seat. I was pretty sure the technique was working, if for no other reason than I did not feel the same sort of back pain toward the end of my pregnancy that I had felt the first time.

The solution seemed so easy and so low-tech. If every pregnant woman in America could read this book, would the c-section rate still be more than 30 percent?

In the end, I wondered, would the book save me from having another posterior baby?

Monday, January 28, 2008

Our new baby, installment #15

Continuing the drama about my decision to attempt a home VBAC, also known as an HBAC, or home birth after cesarean, I had disinvited my parents from being at the house while I was in labor. This decision was despite my mother having met the midwives over dinner at our home, despite my mother having read my book, despite how strongly she knew how I felt. She just could not change her position. She could not change who she was. And that was fine. We agreed to disagree. Of course, she was not the only one in the family who thought I was nuts. My grandmother, whom I adore, accused me of "going backwards." This, despite that Gram had her three children in the hospital under the spell of Twilight Sleep, a mix of morphine and the amnesiac scopalamine. Thus, she does not remember giving birth except for the fact that "it hurt" and the nurses told her to "shut up." My aunt, who is only 13 years older than me and has always been the "cool" one in the family and saw a midwife (in the hospital) for her oldest child's birth, sort of understood where I was coming from in deciding to stay home. But she kept calling and asking what my backup plan was. In a nice way. There were a couple of surprising supporters. My sister-in-law, who had had a cecearean a few months before, was very supportive, saying I was better educated than anyone in the family on the subject and therefore I would be OK. And my grandfather, who is well into his 80s, was quietly approving, perhaps in his old fashioned way appreciating that women have been doing this forever.

But the remark about me going backwards is one that I keep thinking about. Was shunning the hospital and its malpractice fears, its MRSA infections, its aggressive obstetrics, its lack of support for VBAC, really going backwards? Or was it the most progressive thing I could do? Should the new post-modern reality be all about less is more, whether we are talking about calories, house size, miles driven or medical interventions?

What do you think? Was I going backwards?

Friday, January 25, 2008

Our new baby, installment #14

As I was saying in my previous post, it is a statistical fact that the majority of women around the world tend to labor through the night. (For nocturnal creatures, the opposite is true.) Why? Well, some scientists posit that laboring at night is the result of evolutionary biology. Going back to early human times (and as is the case with the majority of other mammals) we want to give birth safely surrounded by those we trust - our tribe, clan, family etc. During the day, the men would have been off hunting woolly mammoth and the other women far flung gathering nuts and berries. At night, everyone would have been around to protect the space from predators.

I wondered whether I would fall into that pattern with this birth. Of course, I hoped I would because my mother, whether she remembers it or not, was disinvited from coming to the house to take care of our other two boys during labor. And having an active four-year-old and an 11-year-old who did not really want to see or hear any of this birth, we were worried how it would work out.

Thursday, January 24, 2008

Our new baby, installment #13

After the home birth midwife and my husband and I discussed the logistics of who would watch the kids when I went into labor (like, on a Saturday afternoon)I called my parents.

"Do you want to be there?"

"Of course," they said. "We would love to."

"Can you check your nervousness and negativity at the door?" I asked.

"Yes," they both said.

So I went and reported this back to my husband and the midwife, who both looked at me skeptically.

Then, a few weeks later, having Sunday dinner with my parents, we discussed this plan some more.

"Well, just tell me what to do if you say you want an epidural," mom said, knowing that such pain relief would require transfer to the hospital.

That was the deal breaker. It was clear that the default setting in her brain was THIS WILL BE UGLY AND MY ROLE IS PROTECTOR.

I called mom later to tell her she and dad were off the hook. We now had no plan B for childcare.

Mom admitted to being relieved. I guess I was too.

There was one phenomenon working in my favor, however. It is a statistical fact that the majority of women tend to labor through the night. (For nocturnal creatures, the opposite is true.) In my next post I will explain why.

Tuesday, January 22, 2008

Our new baby, installment #12

Continuing the story of our experience with a home birth midwife, at one of our visits we discussed the logistics of what would happen when I went into labor -- who would watch the other two boys, a four-year-old and my 11-year-old stepson. We have many nice neighbors with kids of their own, and we could probably ask them for a favor. But still, I felt as if the right person for the job was my own mother. She's a very attentive grandmother. The boys adore her. But she is a terrible Nervous Nelly. Could she deal with being in the house when I was in labor? With my first son, I vowed I would not call her until after the baby was born, to save her the fret. (I crumbled, and called her on the way to the hospital.) She did, however, keep it together when she saw me wheeled out of the operating room, post-unwanted c-section. I was devasted and exhausted. She was nothing but supportive. Still, she and I were not on the same page this time. She was horrified by the idea of a home birth. It was time for a heart-to-heart with her.

Monday, January 21, 2008

Our new baby, installment #11

As the summer progressed, I saw my midwife regularly. And everything was fine. My belly grew and so did my confidence.

Thursday, January 17, 2008

Our new baby, installment #10

Continuing the story of our visits with a home birth midwife, there were a couple of occasions where there was very little talk about childbirth. On one day, when my husband could not make the appointment, the midwife had an antique book of poems on the table waiting for me. She had selected some readings in advance and, after I peed in the cup but before she listened to the baby's heart, she read them to me. They weren't about birth. They weren't about courage or anything thematically related to birth. But they were lovely and relaxing and she must have known that as I crammed this appointment between the insanity of work/end of the school day/dinner/laundry/kid baths/bed, that I needed a quiet moment. Maybe the fetus needed a quiet moment too. I am sure she was right. I remember thinking, what would an OB say if he/she witnessed this moment?

On another day, again sensing that I was tired and stressed, she encouraged me to sing. HA! I went along with the gag, but I really don't sing. Maybe I should. Maybe I would be less tired and stressed. But mostly I smiled and watched her sing. What a voice. Regardless, the trick worked, and although I had begun swelling like a tick as I reached the final trimester, I left her office feeling lighter.

Tuesday, January 15, 2008

The Business of Being Born reviews

Before my next installment about my own recent childbirth esxperience, I wanted to comment on several reviews of the "The Business of Being Born," Ricki Lake's documentary about home birth, which is about to come out in select theaters and on Netflix. (Disclaimer, I am in the film).
Boo Hiss. My big complaint here is the "kicker," which is journalism-speak for the ending. The reviewer says birth is nobody's business but that of the woman doing it. Fine. But this is the sort of attitude that has stopped women from discussing childbirth in any meaningful way. Stifling conversation leads us down the road of ignorance.
Pretty enlightened for a guy.,,2237865,00.html (written by a home birther in London who tells me an editor inserted the words "gross" into this piece...)

Our new baby, installment #9

With a home birth midwife on board, my husband and I would meet her at her office, a little detached structure behind her house, every two weeks. Unlike the OB visits with my first son when a nurse would have me pee, stand on a scale and offer an arm for blood pressure and pulse, all in less than five minutes, time with the midwife was more relaxed. Altough the appointments were scheduled for an hour each, they often ran over, sometimes by 30 minutes, as we talked. Yes, I peed in a cup in the private bathroom, but the midwife showed me how to take a special dipstick, put it in the Dixie Cup, and watch it change colors; the test would check everything from protein to sugar in the urine. She even encouraged me to perform the test myself, which I did. (I often showed her the results to make sure I was doing it right, though she never asked). This was not laziness on her part. Clearly she had me do it myself as a way of making me feel empowered about my care. There was nothing paternalistic about these visits. She trusted that I could read a dipstick! Alas, I could!

Of course the visits also included weighs-ins, though she would ask me if I wanted to step on the scale -- again a subtle but nice gesture. I did not have to get weighed, and a couple times, I skipped it. She could tell by looking at me if my weight was in check or if I was retaining too much water. She took my blood pressure, and listened to the baby's heart using a fetoscope. She would also measure my belly and feel the baby's position. There were no internal exams, except for one, at the very end.

For the most part, the time was spent talking about how I was feeling, not just physically, but emotionally. She asked about my family, the other kids, if I was stressed out at work. Was any of this relevant? Maybe, maybe not. But my midwife and I were getting to know each other.

Two hundered years ago, if a midwife was called to attend a birth, she likely would have been a member of the extended family or a woman who lived in the village. Everyone would have known her. Trust would have been inherent. It is important to feel comfortable and trust your birth attendant. It takes away the fear and helps you to relax.

I watched the movie "Knocked Up" recently and there is a scene where the expectant mother interviews all these OBs and settles on one after he tells her (falsely) that he would be there for her birth, not someone else in the medical practice. Of course, he was not there when she went into labor and she flipped out.

I was getting to know my midwife. And one of the first things I came to know: She would be there for me.

Sunday, January 13, 2008

What Hemingway had to do with my birth

We knew immediately when we walked out of that first meeting that we would sign the contract to hire the midwife. And indeed, we did. One of the reasons was that when we asked what her depth of experience was with VBACs she said she had done many -- especially lately, since so many women were increasingly feeling pressure from hospitals to have repeat cesareans. When we asked her if she treated VBAC clients differently than those who have never had a cesarean, she replied without blinking: "No."

My husband piped up: "Isn't there a greater risk for uterine rupture?

She did not take the bait, saying that the scar just does not come into play.

"We grow stronger in the broken places," my husband offered, quoting Hemingway.

The midwife nodded. I cried. Love that guy.

Friday, January 11, 2008

Our new baby, installment #7

This post is for Vanessa, who commented in response to installment #6, saying she is not telling her family about her home VBAC (HBAC) for her third child...Vanessa, I don't blame you. Although I told my side of the family -- before we stopped talking about it -- I was initially selective about whom we told of our plans. My mother-in-law is a Freudian analyst. I did not mention this to her, as you might imagine. (Remind me later to elaborate on her at the end of the installment series.) Also, I was reluctant to mention the decision to colleagues and neighbors and anyone else who asked what hospital I was going to. Eventually, however, as I became more resolute in the plan, I was straightforward even with strangers. "The baby is being born at home," I would say, as if it were an affirmation.

In early fall, I attended a Birth on Labor Day Event in Cambridge and shared the Q&A session with a very nice OB I knew from my research. An OB who might be a midwife in another life. She noticed I was pregnant and after the program we chatted on the sidewalk.

"Where will the baby be born?" she asked.

"Not where my last child was born," I said coyly. (She knew where my last child was born.)

"Come on," she begged. "Where?"

"Oh, at home," I 'fessed.

She then lectured me on a VBAC uterine rupture that she had to section in emergency fashion just weeks before.

"Really?" I asked? "Did the woman have Pitocin?"

"Yes," she said.

"Well why would you give a VBAC Pitocin?" I pressed. Pitocin, of course, can hyperstimulate the uterus, causing it rupture - and much of the VBAC studies include rupture cases caused by Pitocin, thereby skewing the actual safety of a VBAC with no intervention, part of the reason why many hospitals are now not even allowing women to attempt a VBAC.

"I guess we were impatient," she conceded.

She wished me luck before we parted ways.

I remember thinking that I don't need luck. I just need a midwife who is patient. I just need to be in a place where there is no Pitocin.

Thursday, January 10, 2008

Our new baby, installment #6

Despite the pressure, we made an appointment to speak with another midwife. When she gave us directions to her home office, she described her house as being the color of a clay pot. Her office, actually a detached cottage-like space, was comfortable and welcoming. There was a bowl of cherries between the plush chairs where she told my husband and me to sit. She pulled up a stool and told me to put up my feet. As she answered our questions -- all the tedious ones that I now grow impatient at answering, I gazed out the backdoor, which was slightly ajar. This being summer, I could see birds and bees keeping busy in the garden. Inside, on the wall, along with some artful birth photos and oil paintings, was a neon sign that read "open." I appreciated the metaphor. We took a contract home.

Wednesday, January 09, 2008

Our new baby, installment #5

My husband and I may have been sure about a home a birth, but no one else among my family or friends could understand our decision. What was frustrating for me was not being able to penetrate their logic. Some knew that old saying "once a cesarean always a cesarean," though they may not have known why, unless they read my book, that that saying even came into being. Others could not stop asking, "What if something goes wrong at home?" The answers to these questions, even now, are (I concede) so fundamental, but so tedious that I cannot even bear to write about it.

The conversation with family came to a head at a birthday party last June. My sister-in-law was about a month away from her due date with her first baby. I suggested that we all chip in and hire a doula for my brother (who was very nervous about the process) and his wife. I explained how the hospital can actually inhibit birth if a woman feels afraid or not totally supported through labor. Well, the doula idea didn't fly. And instead, the conversation turned to focus on my own birth plan. Tears were shed. And from that day on, we decided not to discuss home birth amongst ourselves.

To find out how my sister-in-law's birth went, see my blog post from that time.

My parents witnessed the above birth and finally started to understand where I was coming from.

Tuesday, January 08, 2008

Our new baby, installment # 4

So there I was, 12 weeks pregnant, in for an "early risk assessment," which is a blood test and an ultrasound, intended to take the place of an amniocentesis, which I had ZERO interest in having. However, there is an additional step in the ERA that I was not aware of. Before the ultrasound or bloodtest, you are ushered in to see the "genetic counselor," a sanitized name for someone who basically scares the living daylights out of you. After taking a family history (no issues, either side) the counselor began to explain everything that could go wrong with the fetus. To illustrate her points, she matter-of-factly flipped through laminated pages in a booklet showing missing chromosomes. I was flabbergasted.

Stopping briefly on one page, she explained: "This child would not live."

"Why are you showing me this now? I haven't even been tested yet?" I pleaded.

"Well, we just want you to know what we are looking for," she said, totally unaware of how alarming her whole performance had been.

Spare me. It was a horrible hour, and when I retreated to the waiting room to be called in for the ultrasound, almost every woman I saw come out of the counselor's office had been reduced to tears. To make a long story short, my ultrasound showed a perfect fetus, my blood test was fine, and I was angry that I was put through that display for no good reason.

I vowed that I would have no more tests and was more sure than ever that I had to sign a home birth midwife.

Of course, there was just one more glitch: Despite spending hours on the phone with our blue chip health insurance plan, it did not appear that they would spend a dime to pay for a home birth. Unfortunately, they paid plenty for the ERA, which did nothing but elevate my blood pressure.

Sunday, January 06, 2008

Our new baby, installment #3

So how does one choose a home birth midwife exactly? In some states, they aren't even legal. In Massachusetts, there are various, well, levels of legality related to home birth. Regardless, I was focused on finding someone who was understanding, experienced and, to use an old midwifery adage, knew when to use her hands and when to sit on them. In the last couple of years, in doing research for my book and in doing readings after it was published, I had met lots of midwives. And I think I can honestly say that I have not met one that I did not like. Still, finding the right midwife was alot like finding the right spouse. There had to be chemistry. I spoke and met with several, asking them all the same questions about their qualifications and experience. We invested many hours in this process and it dawned on me that, years before, when I had signed up with an obstetrician, I did so simply because her name was listed among providers in my insurance booklet, and she could squeeze me in for a pap smear this side of six months. What had I been thinking? Or, more precisely, not thinking? I guess I was just so busy, and perhaps so totally realistic, that having a 'relationship' with my OB (gotta love those five minute appointments) was a non-issue. Of course, she was not on call the night my first son was born and he was surgically delivered by someone whose name I do not know and have never heard of again.

Anyway, in our search for a midwife a couple months passed and we still had not settled on one. I wondered if I was being irresponsible letting time pass without having regular prenatal visits with SOMEONE. But I did not want to get sucked into a medical practice, with all of its tests, only to leave.

Meanwhile, family and friends were nudging me about getting an early ultrasound/blood test at 12 weeks given that I am 38 and considered at higher risk for fetal abnormalities. I really did not want an ultrasound, and didn't think I needed one, despite that I was quite intent to have one with my first son. I am not sure why I had a change of heart about the procedure between pregnancies. Perhaps it was seeing my sister-in-law, among others in my family, go through hell when ultrasounds raised false alarms and caused months of unnecessary stress (oh the hysterics)! I did not want or need any negativity. I knew my baby was fine and if it wasn't, it wasn't. That was OK, too. But my husband was particularly uneasy, so I relented.

It was a decision that really cemented how this birth would unfold.

Our new baby, installment #2

So here we were, dealing with the news that continual fetal monitoring was now the standard policy in the maternity unit at the one hospital in the Boston area that I thought would be truly supportive of a VBAC, or vaginal birth after cesarean. Why, some may ask, is continual fetal monitoring a bad thing? Afterall, all the machine is doing is making sure the baby is not in distress. Well, having asked the question of so many experts during the course of writing my book, I knew all too well that the machines are often mistaken, indicating the baby is in distress when it is not, leading to many unnecessary c-sections; that hospitals use the machines to protect themselves from malpractice; and that cerebral palsey cases have not declined since the machines became popularized in the 1970s, perhaps because, as it is now believed, fetal oxygen deprivation can frequently happen before labor even begins. Meanwhile, much research has shown that intermittent monitoring is effective and has the bonus of allowing the mother to move into a comfortable position during labor, as well as facilitating the baby to ease into the birth canal.

My husband and I knew we could sign a release rejecting the continual EFM but because of my previous experience giving birth, at a major teaching hospital here, we also knew that when you walk into a maternity unit saying all the things you DON'T want, the staff sort of lines up against you, viewing you as trouble. And who needs that during labor?

This time, I wanted nothing but support, encouragement...heck just NICE people around me. Was that too much to ask?

After digesting the situation for a couple weeks, my husband and I both intiutively knew that going to that hospital would not work.

Not long before we made this decision, we had gone to New York, to the Tribeca Film Festival, for the screening of the "The Business of Being Born," Ricki Lake's documentary about birth at home vs. the hospital.

I was interviewed at length for the film, and we were excited to see it. We were truly captivated, my husband especially. Although he had read my book (so many times, the poor guy!)he was really moved by the evidence in the film that home birth can be a wonderful, safe experience. He also finally understood in his gut some of the problems hospitals can actually trigger during labor. Of course, I knew all this already, but the film had driven it home for both of us and now the one hospital that we considered for a VBAC -- purely on the level of 'Oh, let's just check it out...' -- was off the table.

Also, several months before, I had written a magazine article about how women who wanted a VBAC were choosing home birth because they did not believe they could get a fair shake in the hospital. Those I interviewed were overwhelmingly happy with their choice to stay home.

All of these experiences pushed me to start interviewing home birth midwives, not for another article, but for my own needs.

Saturday, January 05, 2008

Our new baby

Installment #1. I've sort of been keeping a secret -- a cyber secret, anyway, because it was obvious by looking at me --that I was pregnant over these nine (10?) long months, culminating in the birth of a gorgeous boy five minutes past midnight on Dec. 8. The delay in posting since then has more to do with the avalanche of work and sleeplessness that a newborn brings than my desire to withhold the information about Harrison's arrival. In fact, I have a lot to say about this most recent birth. Including where and how it happened. But I think I will serialize the story on my blog, starting today.

After writing a book about the history of childbirth, processing the unexpected cesarean birth of my first son, born 4 years ago, and hearing from some hard-core readers pick apart my book for not being forcefully anti-hospital or decidedly pro-natural enough for their taste, you might imagine how difficult it would be to discuss the pregnancy and birth and my choices as they were happening.

Well, when we found out I was pregnant, my first stop was not at the office of my former OB. I knew enough that five minute office visits, curt answers to my questions and the rash of tests they throw at you without even fully explaining them was not how I wanted to proceed. I wanted to slow down. Be seen by someone whose was not afraid of being sued, who accepted the idea that a vaginal birth after a cesarean was not just OK, but a good move. I decided to see a very well respected midwifery practice at a smaller local hospital that supports VBAC. (No way will I ever go back to one of Boston's enormous teaching hospitals unless I am in cardiac arrest, need an organ transplant or have cancer.)

Anyway, the midwife I saw was delightful. She asked about my previous birth and I burst into tears. She said she understood. When we talked about VBAC, she was encouraging, and when it was time to leave she handed me a red folder with all of the hospital's obstetrical practices explained. I asked about electronic fetal monitoring, and whether they offered it intermittently. She looked me in the eye, said they had always offered EFM intermittently, giving the mom the ability to get up and move around during labor, but that practice had just been ceased weeks before.

"You can sign a form saying you do not want continuous monitoring," she said.

I was devastated. I intuitively knew that being flat on my back, hooked up to an epidural and an EFM for hours had doomed my ability to give birth vaginally with my first son. And if I chose to go to this hospital, I would walk in having to fight against standard procedure.

My husband and I had to make a decision about what to do.

In installment #2, what happens next.