Stressed: Woulda Shoulda Coulda

Shoulda:  One of my strongest feelings from DD’s birth in 2004 is that I shouldn’t have gone to the hospital.  When my husband started to nag me about getting to the hospital (I was severely dehydrated, and he wanted to take me in to get that treated), I thought, “I couldn’t possibly leave my house right now.”  Somehow I did get in the car and didn’t puke or poop myself on the way to the hospital.  The minute I got there, I *needed* a wheelchair.  I was sick. 

I wasn’t treated for illness.  I was treated for childbirth.

I should have hired a doula.  I thought I was “safe” because I was being attended by a CNM.  I should have reminded her that my birth plan stated no artificial rupture of membranes.  I should have insisted on changing positions even though I was peeing out my butt.  What shouldas are ahead?

Coulda:  I could have told my DH no, I suppose.  I certainly could have told my CNM to go jump when she suggested breaking my water.  What sorts of couldas are ahead?

Woulda:  Had I a “do over,” I’d have stayed put.  Or I would have refused AROM.  I would have changed positions while laboring and for pushing.  I would not have purple pushed.  Not gonna do that again.  Thinking too much about future wouldas is overwhelming.  Let’s not go there.

Woulda shoulda coulda is that much more stressful when you aren’t given options.  I’m not supposed to give birth to twins at home.  That’s risky.  I’m supposed to want to give birth at the hospital.  That’s safe.  Yeah, hospital birth is so safe for American women and their babies that our infant mortality rate ties Poland and Slovakia.

Absurdity of the End Game with Hospital Birth

I don’t know how else to title it.  Perhaps “Being Left at the Altar”  Or “Some OBs Value Weekends More Than Moms & Babies.”  Or “Left to the Tribe: Who Will Catch or Cut?”  Yeah, those are good ones, apt titles.  But I’ll stick with my initial title.

I’m not an OB hater, really I’m not.  There are some awesome docs out there who do wonderful things for women and their babies.  When pregnancies are truly complicated, OBs and perinatologists may be necessary.  When natural birth goes awry and babies need to be delivered by cesarean, OBs are necessary.  Most of the time, though, it’s overkill.

And then there’s someone like me who needs RE assistance for pre-conception (or an OB who’s willing to test progesterone and treat low progesterone) and regular monitoring in early pregnancy to be sure that the babies have a chance at life.  But just because I need interventions in pre-conception and pregnancy does not justify the need for interventions at birth.  I’m deemed high risk for many reasons this time – I’m old, my scarred uterus, twins.

My OB and I have agreed . . . no induction, no augmentation.  That increases my risk of uterine rupture.  My OB and I do not agree . . . I don’t believe that having twins puts my scar at greater risk during labor, mostly because I haven’t found any evidence that supports the claim.  If the risk is there in labor then it’s there just being pregnant.  I reminded him that the composition of the lower uterine segment (mostly fibrous, less contraction) is different from the contracting portions of the uterus.  He had to agree.

But most simply stated: I don’t feel high risk.

So why the title of this blog.  Yes, perhaps I digressed.

I am not assured of getting my OB after hours or especially on weekends.  The call group in this town is large and shared among many practices.  Excuse me . . . but I chose my OB specifically for his track record with lower-interventive birth and “natural” delivery of twins.  I didn’t choose him and the rest of the tribe here in town.

Additionally, if it were to turn surgical . . . I may not know who my surgeon is?  What???  In any other medical specialty this is NOT how it’s done.  This is what is absurd – you spend 30 or so weeks cultivating a relationship with a particular provider only to be left at the altar at week 40?  Only to be cut open by a complete stranger?  Only to be cut open by a complete stranger whose surgical skills are completely unknown to you?  Whereas if you need hand surgery you meet with a surgeon a couple of times, be sure that this is the right surgeon for you, and that surgeon does the surgery!

Why is this acceptable?  How do we put pressure on the tribe to be accountable to their patients.  How do we convince docs to break up into smaller call groups of similar-minded similarly-practicing docs and be sure that women know and have interfaced with these docs at least once during pregnancy?

Tribal obstetrics is selfish.  It’s lazy.  It’s unjustifiable.  Docs, if you didn’t want to serve your patients, you should have chosen another field.

Things Change Quickly In Pregnancy

In my last post I pointed out that these babies have been preferring breech and transverse positions.  Well, that has recently changed.  I now sense, and have somewhat confirmed from the nurses’ doppler trackings, that baby A is on my right, and baby B is on my left.  If I were to guess, I’d say that they are both vertex.  I saw my OB the other day, and he said that sounds about right – eventually transverse becomes uncomfortable for them.

I had a bit of a scare yesterday and was sent to L&D for monitoring.  Thankfully, I wasn’t contracting (good, I didn’t think I was), and it wasn’t amniotic fluid that I leaked. 

But I started thinking . . . the two times I’ve had needs after hours, I’ve been referred to an on-call OB.  My OB has a solo practice with a CNM.  It seems like all of the OBs in town pool together for call?  I’m really uncomfortable with this arrangement and need to bring it up with my doc next appointment.  Then I’ll likely write about Tribal Obstetrics, loosely modeled after the chapter of the same title in Dr. Wagner’s Born In the USA.

Vague Musings

It feels like an eternity since I wrote anything authentic and of substance, but I’m fighting my way back.  I’ve been in survival mode, in a way, since finding out I was pregnant in December.  I was excited and terrified, and it was all I could do to stay sane and work my job and meet my family’s needs.  Now that I am 24 weeks pregnant and doing well, the semester is nearly over, and family life will be more simple with me in town, it’s time to direct my attention to me and these babies!

I have had a lot of ultrasounds with this pregnancy.  As much as I have read about the controversy regarding the safety of ultrasound (search for Sarah Buckley’s articles on the subject, for instance), they were absolutely necessary for me and my husband.  I’ve also noticed things . . . like Baby A seems to be a pretty “chill” baby and insists on snuggling down on top of the birth canal.  Baby B, on the other hand, appears to be a terror.  Heartrate is usually about 10 points higher than her sibling’s, and this baby is always in motion.

I’m concerned about my pelvis and sacrum – they’ve already been giving me grief.  Thankfully my visits to the chiropractor help with this immensely.  My chiropractor also helps release excess tension in my round ligaments.  But the babies seem to prefer breech and transverse positions.  Rats!  I’m only 24 weeks, so there’s time, I know this, but again, the pattern they have established has been marked by malposition.

I haven’t talked to my OB about VBAC since our first appointment back in January.  He’s the most likely OB in town to support VBAC, natural birth of twins, and even twin VBAC.  However, my history has him a bit spooked.  Perhaps the babies’ presentations will take all of this out of the equasion, I don’t know, but it is getting close to time to talk with him about natural birth again.  Hopefully by now he can tell that I’m not some ill-informed, emotionally-driven crazy feminist or something.  I don’t know.  But I don’t look forward to revisiting the issue with him.

I haven’t been proactive about pregnancy exercise or further education.  I’m rereading sections of The Business of Being Born, and that’s helping me find my fire again, I think.  I also just e-mailed a doula/CBE in my community for advice.  I’m hoping to review My Best Birth sometime in the near future – I’m sure that’ll help.  I should probably read something by Michel Odent, Silent Knife (Wainer), or Pushed (Block).

I just feel very alone.  Sure on-line communities help . . . they’re awesome support, but they don’t substitute for face-to-face support.  The natural birth community here lost much momentum and power when Dr. Montgomery died.  He ran the only free-standing birth center and employed a handful of talented, caring CNMs.  We’re down to two CNMs in town who have hospital priviledges.  I’ve been risked out of homebirth because of the twins, so I’m forced to “choose” the hospital.  As I posted at another location today, “I’m at McDonalds trying to fashion a crappy meat-like patty into a steak.”

Natural Breech Birth Deserves Our Support!

A friend posted a link to the Coalition for Breech Birth on her gmail status. I’m so thankful to know about this resource now.  The following quote applies to all low-risk mothers (regardless of fetal presentation or previous cesarean):

“However, caesarean surgery, while it presents many advantages for the surgeon, has lifelong ramifications for the birthing woman and her family, including issues with subsequent pregnancies, secondary infertility, vbac availability, and depression, not to mention a risk of death in childbirth increased threefold over vaginal birth. Women should not be obliged to accept these serious risks as ‘standard of care’. . .”

Please have a look at this site which provides links to the original report that caused breech birth to fall off the natural birth map and the subsequent research that DISPROVED the report authored in 2000 that continues to govern obstetrics & midwifery access and practice to this day.

It was a big day

Phew, 7pm and I’m exhausted.  Here’s a summary of my activities today:

The twins – yes, I said twins, look good.  I’m not quite as far along (only by a couple of days) as I would have thought, and this is an agonizing alteration to my pregnancy “schedule.”  What I mean is that as a loss momma, that last thing I want to be doing is backing up in time… adding MORE time into the 1st trimester.

Both babies are measuring about the same size.  Both babies’ heartbeats were easily detected and measured right around 130 which is good for 6 weeks 4 days or so.  We were so thankful to see those sweet flickers again.

My husband and I found out definitively about the twins about a week ago.  A nurse at the RE’s office recommended a scan because my HCG numbers doubled too quickly.  At about 5-1/2 or 6 weeks we were able to see two sacs and even visualize the heartbeats for both babies.  I call them my little flickers.

Health Reform:  I was thrilled to have been invited to attend a local health reform meeting to represent consumer concerns.  I introduced myself as an University professor and a professional opera singer which of course got a couple of laughs.  Then, I continued by saying that I’m a consumer advocate and come to this gathering as a woman with a scarred uterus.  The main concerns I articulated as a cesarean mom were:

  1. A high local cesarean rate (around 31%); a low VBAC rate (about 1%) at the hospital
  2. A lack of support for the local birth center
  3. Decrease in numbers of CNMs locally
  4. Insurance and health care costs
  5. Insurance company driven health “care”

Additionally, it alarms me that even with my supposed “good” health coverage, I am struggling to pay last year’s medical bills.  The bills are overwhelming, so they pile up, and my credit score is suffering as well.

Arts Advocacy:  I am one of the educations outreach directors for a new opera company.  We had a meeting today to help prepare for the next board meeting and our upcoming educational outreach program.

I even managed to mop the floors.  I’d say it was a pretty darned productive day.

Vivid Dreams

I have been having unusually vivid dreams for about a week now. Here are some of the things that I’ve dreamed about:

One night I saw the aurora borealis and sparkly shooting stars. I was so curious about these images that I started looking up possible interpretations.

According to Dream Moods,

To see the aurora borealis in your dream, represents renewed energy, vitality, awe, insight and youth. A situation or relationship will be made clear to you or a positive spiritual experience will fill you with warmth and love. You will gain some amazing new wisdom and knowledge. Alternatively, the dream indicates that you know what you need to do, but may be too lazy or too afraid to jump into action.

I am expecting a situation and a relationship to be made clear to me on Wednesday. Also, it is likely that I am too afraid to embrace what is happening right now.

To see a shooting star in your dream, is a sign of self-fulfillment and advancement. A shooting star is also symbolic of a new birth and changes in your life.

Ooo, I like this – “new birth” and “changes in my life.” Very good.

Twice I’ve dreamed of people committing suicide. One time it was some random man who took all of his clothes off before he collapsed. One time I dreamed of a group of boys, probably around 7-9 years old, sitting on a bench eating poisoned caramel or taffy. That was quite disturbing.

To see someone commit suicide in you dream, highlights your concerns for that person. Also consider what characteristics and qualities in that person you may be trying to “kill” and annihilate in your own self. Perhaps you hope that you are not like that person in some way and are making attempts to get rid of those traits within your own self.

I am trying to rid myself of fear, doubt, insecurity, and stress. Perhaps this dream keep happening because of these efforts. I’ve been doing positive affirmations, meditation, yoga, and prayer.

Two nights ago I saw a beautiful sunrise in my dreams. I had just seen a beautiful sunset in real life, so it doesn’t surprise me that I had a dream like this. However, I know that it was a sunrise and not a sunset.

To see the sunrise in your dream, represents new beginnings, renewal of life and energy, and fulfillment of your goals and purpose. It may also denote that you are about to embark on a new adventure in your personal life.

Last night I dreamed that I was going to the bathroom and saw red blood. I’m not terribly surprised given my history of recurrent pregnancy loss. I really wish that I didn’t remember that dream. I dreamed that I miscarried right before I lost my last baby. This dream wasn’t about a miscarriage, but it was blood, and it was coming out of me.

To dream that you are bleeding or losing blood, signifies that you are suffering from exhaustion or that you are feeling emotionally drained. It may also denote bitter confrontations between you and your friends. Your past actions has come back to haunt you. Women often dream of blood or of someone bleeding, shortly before or during their periods or while they are pregnant.

Ok, so this makes sense since I’m pregnant, exhausted, and emotionally drained. I’m also dealing with something hurtful that a family member directed at me and am not wanting to confront the issue further.

Any more vivid dreams, and I’ll have to start a Dream Journal page.

Update (1/5/09) – it seems as though the vivid dreams have subsided, or maybe I’m just not remembering them.  I’m somewhat relieved and somewhat disappointed.