Not sure how I feel about Maryland

I just read a press release from Maryland’s Department of Health and Mental Hygiene. First, how strange is that term . . . mental hygiene . . . MENTAL hygiene?

Anyway, on the one hand I am glad that steps are in place to give women access to home birth. And if physicians and CNMs will actually attend these home births, then it’s possible that insurance will cover these births. Hooray!

However, I don’t believe that a physician or CNM is necessary for a great outcome at home. A trained midwife, CPM or otherwise, should be just as capable of handing low and lower risk births at home.

Furthermore, many women who fall outside of the definition of low risk will have better birth experiences outside the confines of a hospital. Typically, physicians and CNMs are not able to provide homebirth services to these women and their babies. I don’t recommend limiting their ability to find qualified providers who will attend them at home. I hope this board will use better mental hygiene and reconsider their ban on lay midwifery.

Empowered Birth Week

I’ve been so overwhelmed with the start of a new academic year, raising four young daughters, and trying to reserve some time for fun . . . that I have neglected other important aspects of who I am.  I am this blog!  And I am an empowered birther!  Are you?

Even if you had pain meds . . . or an induction . . . or a cesarean . . . you might have had an empowered birth.  Who decides what constitutes an empowered birth.  YOU DO, and don’t you forget it.  It’s not for medicalists or luddites to determine though many are happy to throw in an oar.  You have to be ok with your birth experiences, and if you’re not, I encourage you to figure out why and try to resolve that.

Did I have an empowering birth experience?  I suppose the answer depends on the moment you ask me about it.  Sometimes I think that if I had gone a different direction in terms of care providers that I’d have had a birth experience perhaps more resemblant of the one I so deeply desired.  Sometimes I think that my pain-in-the-ass, scare-tactic OB was an angel.  He was the best birth coach ever, as far as I’m concerned, especially considering that I had NO idea where my ass was nor how to push from that imaginary ass.

And it’s ok to struggle with being ‘ok’ with your birth experiences whether they are au natural or full-service medicalized.  It’s ok to question (or not) the validity of your birth choices (or the choices made on your behalf).  Wherever you are on the spectrum, I encourage you to think of yourself as an empowered woman.  You have the power to be fully present and accepting and/or participant in your health care decisions.  For me, being fully present and a participant are at the heart of being an empowered ‘patient.’

Birth Snapshot: The Epidural

Labortrials got an epidural?!  Oh me oh my.  Yes, friends, I consented (begged for, even) to the bleepin’ epidural.  How did this happen, and how do I feel about it now?  Well . . .

I arrived at the hospital worried that something was wrong.  The labor contractions came fast and painful, and I knew that less than 24 hours previously I was not dilated but a smidge.  I also felt as strange ‘pop’ down there and knew it wasn’t my water, so that in conjunction with the scary contractions (tetanic, perhaps) sent me packing to the hospital quickly.

The OB arrived, checked me, and found me to be 2cm dilated, but the baby was high.  According to the monitor, the baby was not handling the contractions well.  (She was having late decelerations.)  The OB restricted me to laboring on my side; the labor nurse told me I had to relax my body in order to dilate.  The contractions really were more than I could handle with the position restriction.  The OB checked me a few hours later, and I was still stuck at 2cm.  I knew that as soon as I could get an epidural that I needed to have it put in.  There was no way I was going to withstand the contractions, restrict my movement, and relax enough to dilate without pain management.

Interesting that this evening on my twitter feed, I saw @RobinPregnancy’s tweet about epidurals:

Did you ever have an #epidural that didn’t work quite as well as you’d hoped? http://ow.ly/6ejKI #pregnancy #About

I had an intrathecal with an epidural placed.  The idea was that the intrathecal could possibly get me through the next several centimeters of dilation more quickly and would wear off.  If and when I wanted the epidural, it would be ready and waiting for me.  The intrathecal improved my quality of life dramatically, and indeed I did progress quickly from 4cm to 8cm dilation.  Then I got stuck at 8cm and for a few hours, so I wanted the epidural.

However, the epidural was slow to work, and when it did, it didn’t provide enough relief.  My labor was not progressing very well, so I was concerned that if the epidural didn’t work and I needed a cesarean, that I’d feel the surgery.  I was terrified, actually.  This caused me to over-react.  The anesthesiologist gave me a bolus of something (yes, it’s horrible that I can’t recall this information), and when that didn’t seem to give me enough pain coverage, I received another bolus of something (nope, can’t remember what that was either).

So, when it came time to push, and thank God I got to that point, I couldn’t feel a darned thing.  I could sense when a contraction was beginning, but that was about it.  I had some sensation in my toes.  I had no idea where my vagina was or how to push.  That was terrible.  My OB was a tremendous labor coach, so he talked me through every contraction . . . every push.

Ideal?  I suppose that depends on how you look at it.  The purist in me says “technically, you had a vaginal birth, but you missed the whole darned thing.”  The practical-ist in me says “honey, if you hadn’t gotten that epidural, who knows if you’d have dilated quick enough for the OB, or if the epidural is what helped calm the baby’s response to the labor contractions (stressed mom can lead to stressed baby), or if you would have outlasted the pain.”  No one made me get an epidural.  I told them on entry that I wasn’t interested, and they left me alone.  I asked for the epidural – it was my request; my choice.

People can be sooooooo judgmental about the use (or refusal) of epidurals.  Read this woman’s story over at Unnecessarean.  Don’t miss the comments which are QUITE polarized.  Given what I’ve been through, you may laugh at my comments.  Would I recommend an epidural to my closest friends and family members?  Yes, with caveats.  Would I recommend my closest friends and family members NOT accept an epidural?  Yes, with caveats.  Would I recommend epidurals for VBACs?  Yes, with caveats.  Is the epidural the beginning of the end in terms of natural childbirth?  Yes and no.  Does the epidural cause a cascade of interventions?  Yes and no.

Yes.

and

No.

Yes, it’s not that simple . . .

Birth Snapshot: Out the Vagina

No, I still haven’t finished my 4th and final daughter’s birth story.  I’ve been too busy and too distracted, and honestly not terribly motivated to share all the gory details.  This is why I’m trying to post these ‘snapshots.’  I wrote about my VBA2C for ICAN’s blog, so if you’re interested, go read that post – it shares a lot of what went ‘wrong’ with the birth.

I’ve never enjoyed one of those ‘perfect births.’  You know – the ones you do hear about in the homebirth community – the candles, the soft music, the water, the privacy.  I’m still left so unsatisfied . . . and yet thankful.

My baby did come out vaginally.  I still don’t know how that happened.  Sheer dumb luck?  God?  A little of both??  In spite of all of the interventions at the hospital, the stress, the loss of my quested homebirth, she came out vaginally.

Praise God!

Browser Buzz

My husband finds it incredibly frustrating that I will keep open a gazillion tabs or browser windows open for days . . . errrr . . . weeks at a time.  Here’s a taste of what’s hanging around my browser these days:

All quality stuff.  Check out a link or five!

Birth snapshot: Two weeks ago today…

Two weeks ago today I was utterly hopeless.  By 1pm I had lost my midwife and pissed off the only medpro that was ‘in charge’ of me.

Two weeks ago today and at this time I should have been getting prepped for a repeat cesarean.  Instead, we called the hospital that morning and called the OB’s office to cancel that surgery.  We felt the surgery was at best premature but more than likely completely unnecessary and scheduled out of medico-legal fear.  The only reason I allowed the scheduling of that surgery was because I didn’t think I’d still be pregnant at 41 weeks and 4 days and didn’t plan on needing an obstetrician anyway!

Two weeks ago today and by this time of day, my husband had called my midwife.  He thought her suggestion to just show up at the hospital on that day (with relatively no labor signs) just to appease the doctor was quite strange.  Little did we know that she no longer felt comfortable helping us at home.  Thank God my husband was able to pull that out of her.  So . . . by this time of day I was that patient who goes against medical advice (AMA) and cancels a scheduled surgery and doesn’t check back in with the OB and doesn’t show up at the hospital during business hours.  And my midwife abandoned me when I needed her and expected her the most.

Two weeks ago today and an hour from now, I took a 2.5oz dose of castor oil that did nothing but make me feel sick to my stomach.  We started getting ready to go to the hospital.  I had no idea what you put in a hospital bag . . . couldn’t remember.  I tried to rest but was restless; tried to sleep but was too wired.  Sleep was way to passive for me at the time – I had walked a big blister onto the bottom of my foot; I had bounced on the ball; I had squatted.  I researched ways to help get my baby better positioned if and when contractions resumed.  I researched post-41-week birth outcomes.  I looked and looked for any justification for a pre-42-week cesarean.  I looked and looked for evidence that stillbirth rates doubled at this point in a healthy pregnancy.

Two weeks ago today . . . by 1:02pm, I had no faith in myself.  I had no faith in my birth community.  I had no faith in my care providers.  And yet I had so much . . . an amazingly supportive husband, my in-laws who dropped their plans and raced up her from Denver to take care of us, my 3 sweet girls, and my cozy happy healthy baby in utero.  Why did it have to be such a hopeless day?

Against All Odds: Gillian, VBA2C

I have neglected to post an announcement about my daughter’s birth.  I was thinking that I would have a birth story ready to post within a few days of her birth, but clearly that is not the case.  Actually, in addition to her birth story, I will be drafting additional posts related to this crazy birth experience and a couple of guest posts for other blogs.  Stay tuned!  For now, here are some stats for your enjoyment, and a picture of my latest love bug.

Gillian, day 2

  • Gillian, born Tuesday, July 12 around 5:30 am
  • 8 lbs, 14 oz
  • 21.5 inches long
  • 15.5 inch head!
  • HARD labor commenced at 7pm on Monday, July 11, about 5 hours after a second dose of castor oil while pumping, at 41w4d gestation, the same day I cancelled the ‘required’ 41.5w cesarean (scheduled for 1:30pm on July 11)
  • About the only thing that was physiologically NORMAL about all of this is that she came out of my vagina and I was not given pitocin (well, not until stage 3)

I must give particular thanks to the women of ICAN and Birth After Cesarean for lifting me up, particularly during the last trimester of this pregnancy.  The last week of my pregnancy was sheer emotional hell, and I wouldn’t have made it through without these networks of amazing women.