Thinking Through Birth

You may be surprised to discover that I’m pregnant again!  I’m due in late June or early July 2011, and this means that I’ll have three babies under the age of 2.  I’m excited and terrified, let me tell you.

I’ve been back on the ICAN yahoo list, the ICAN forums, and Mothering’s forums getting back into the swing of things.  This has forced me to really look at my birth experiences, my fears, and my hopes for this future baby’s entrance into the world.  It’s quite uncomfortable.  I’m a huge fence sitter.  Which means that I do poorly on multiple choice tests.  Which means that I can see both sides of political situations and most conflicts.  Which means that I am afraid to let go of the medical birth model that I claim to so strongly resist.

Why wouldn’t I be afraid.  My first birth ended with medical interventions and a cesarean.  I suffered three consecutive losses that couldn’t really be explained until I saw a specialist.  I naturally conceived twins and had to have early pregnancy supplemented with hormones which led to other interventions.  I was risked out of homebirth.  My OB was in love with his ultrasound machine which means that I had a ton of baby pictures.  I didn’t really have a viable choice for homebirth care.

Even this pregnancy has been medically supervised and supplemented beyond the norm.  First trimester progesterone supplementation and already two ultrasounds to check viability and growth.  How am I going to sever this link?  Even though I am planning a home birth, I am now so used to medical intervention, that I’m having a hard time ripping off the bandaid, so to speak.

Here is the link  to the twins’ birth story for anyone interested in reading it.  It’s not terribly thorough, but I guess that’s because what can I say about it really?  I had double footling breech twins which was a no go for vaginal birth at the hospital.  (Twins and breech are not in the scope of practice for homebirth midwives in MT.)  So, I got cut.  It sucked.  Recovery was long.

What I’m noticing this time around is how many women are UCing their twins, even breech twins.  I was not brave enough for that even though I talked as thought I could be.  Honestly, I didn’t see how I could be prepared to UBAC twins, and I didn’t want to put that kind of pressure on myself or my husband.  I think it’s a real failure of the “system” that I couldn’t be attended by a capable midwife at home.

These stories are great to read and make me feel so much better about my own plans to HBA2C, but they also make me sad.  It’s another slice of the knife reading that other women successfully birth breech twins in the comfort of their own homes.  My good ICAN friend, L, rightly challenged me on my belief that I had no choice.  These stories are proof of this.

But then I think back on the fear mongering . . . the claim that my lower uterine segment is too thin at the end of pregnancy to VBAC safely.  And I think of the statistically significant higher rupture rate with VBAmC – why wouldn’t it be higher for VBAmC than it is for VBA1C?  Considering how many bizarre statistics have applied to me during my childbearing years, the fear flag is raised regarding my potential to rupture.

And then I remember that the risks of repeat cesarean and the risks of serious complications with a VBA2C are about even.  And I realize that it’d be hard for me to have a successful VBAC at the hospital even if there was a provider who would attend me, which there isn’t.  And I think about my recent conversation with my family practice doctor who reminded me that my midwife will transfer me to the hospital if anything goes wrong, and that emotionally/mentally it would be hard for me to be successful to birth normally in a hospital setting.

So this is the snapshot of where I am right now with it all.  And in case you’re curious, here’s my current reading list:

And I’ve placed holds on a couple of Ina May Gaskin books to read during my winter break.  I’ll also review Simkin’s The Birth Partner.

Flashbacks

2007 – 2008 were really tough years.  I suffered three consecutive pregnancy losses.  I nearly lost myself.  I look back on those years and shudder.

I was driving down the road the other day and couldn’t get these losses out of my mind.  I gave birth to twin girls in August 2009, but this doesn’t mean that I don’t still grieve for those lost souls.  Ugh, I don’t like thinking about it.

Perhaps these losses are on my mind because I had that evil Mirena IUD taken out last month.  My cycle has returned.  I had my first real menses since 2008.  The blood reminds me of all I have lost and all I have gained.

I’ve just ovulated.  The lovely CM and pains of mittelschmerz remind me of all I could lose and all I could gain.

My heart craves another child.  My body begs to be useful . . . and to be complete . . . and to bring my childbearing years full circle in the comfort of my own home with my husband and perhaps a midwife or doula.

Whoa! This pelvic pain sucks!!

I’m 34 weeks pregnant, so these girls need to stay put for at least another couple of weeks.  But I’m in so much pain.  My entire pelvis feels WRONG.  I know part of it is pubis symphysis pain, but then there’s this other pain that started about a week ago.

female_pelvis1Ok, what is this pain?!?!  Not only do I hurt in the front (pubis symphysis) but also in my groin on both sides.  The worst thing, besides moving in general, is to sit on something that’s hard.  It’s like I rode a century on my road bike in one day without training.

It it the psoas?  Is it the sacro-iliac joint?  Here’s a link to some possible conditions.  Ice… heat… ice… heat… can’t lie down… can’t sit up… can’t walk.  (Can’t is an over-statement.  I’m still mobile, but it hurts like hell.)

Here’s a great resource for women suffering from pubic pain:
http://www.plus-size-pregnancy.org/pubicpain.htm

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.