You need “shadow care?”

Many women who plan homebirths feel the need to consider the question, “Do I need ‘shadow care?'”  What exactly is shadow care, and when might you need it, want it, or not?


I take shadow care to mean accepting obstetric oversight, planning to birth at home, but not telling the care provider about plans to birth at home.  I distinguish this from concurrent care which means that both woman and care provider are engaged in an open, consensual, and honest relationship.  For those of us who have planned homebirths while maintaining some sort of relationship to a medical care provider, the best situation is to have concurrent care.  However, it would be naive of me to suggest that all women will be able to enjoy this relationship.  Most OBs will not or cannot back up homebirth midwives.  So I recommend entering into this ‘care triangle’ very carefully and cautiously.


Here are a list of situations that have prompted women to seek shadow care:

  • Desire for medicinal-grade pharmaceutical therapies/treatments for things like low progesterone, insulin-resistance, blood pressure issues, etc.
  • Desire for viability ultrasounds in the 1st trimester; desire for the 20 week ultrasound; desire for a biophysical profile late in pregnancy
  • Desire to be treated like human beings when hospital transfer is necessary during or after birth
  • Desire for continuous care if/when transfer from homebirth care to hospital (obstetric) care becomes necessary
  • Desire for a ‘contingency plan’ for if/when labor presents unexpected variables

WHEN YOU MIGHT REJECT SHADOW CARE (or someone who suggests it for you)

  • If your midwife suggests shadow care, you must must must get to the bottom of this request
  • If you suspect that your midwife is ‘using’ your shadow care as her backup care – that’s why midwives should carry insurance; if you can’t get to the bottom of this issue, find a different provider
  • If you are experiencing unwanted or unnecessary pressure from friends, family, other care providers that are unsubstantiated


  • It is unethical for a care provider to abandon you for any reason in your final month of pregnancy – speak up!
  • Investigate your options as thoroughly as possible in the time you have remaining in your pregnancy
  • Distance yourself from the care provider (and his/her network) for the duration of your pregnancy & post-partum period – don’t invite them into that special time!
  • Consider filing a complaint – to the hospital, to the local board of doctors, to the local board of midwives, whatever is most relevant
  • Make sure other families in your sphere of influence know about your experience

I welcome your input on this post via comments.  Please understand that I am not a medical doctor or someone who is in a position to offer medical advice.  I’m offering advice as a mother who has had to deal the BS mentioned in this article or know other women who have been dealt with unethically as a ‘patient.’

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?

Re-Birthing Catherine

Background:  I spend a lot of time mulling over the amazing information on kmom’s Plus Size Pregnancy site.  Today I was drawn to the “Emotional Homework” suggestions found under Increasing the Odds for a Safe and Successful VBA2+C.  I started tearing up and getting a lump in my throat . . . not that it takes much to touch my poor lil feelings these days.

Try ‘rebirthing’ your cesarean births – Although it is often a very emotional exercise, many women find it particularly helpful to recall every detail of their cesarean births, and then later re-script the labor and birth so that it goes the way they would have wanted it to go.  Start by recalling (either verbally or by writing it down) every sensory detail of a prior birth. [ . . . ]  Then, when you feel ready, re-script and re-experience the labor and birth the way you would LIKE it to have gone.  Change whatever needs changing, as small or as big as needs be.  Concentrate particularly on healing things with your child, having the wonderful birth and nurturing time afterwards that so many of us grieve missing.  Write out the storyline of the changed birth so you will have it and review it as needed.

My 2004 birth story (the hind-sight is 20-20 version) is here.  I will say that re-reading my surgical report and going over it with my midwife recently was quite illuminating, and that makes this re-birth process a bit easier on my left brain though my right brain is in agony right now.

Deep breath.  [Contraction]  Ppphhhhhhhhh . . . here we go.

my last belly pic 12/2004!

I went to my 40 week pre-natal appointment with my CNM a day after my guess date passed.  I was a bit disappointed that nothing was going on – very little effacement or dilation, but also wasn’t terribly surprised since I had learned that many first time moms go into their 41st week before natural labor sets in.  All of our family had been in town for Christmas, but the brothers and sisters had to head back out to jobs and school and stuff.  It was just us, our dog, and both sets of parents left in town at this point.  Still we’d both had enough family time, so after a good lunch at one of our favorite burrito places, DH and I left for home ALONE to just chillax.  I think I spent most of the afternoon on the couch sleeping through movies.  DH was gaming on-line.

Later in the day I started getting really sick.  I guess it could have been as early as 6:30pm or as late as 8:30pm, but regardless, I was a sick puppy.  My blood pressure runs a bit low, so vomiting + being on the toilet = passing out for me.  It was a fun game to see if I could finish my business before falling to the floor.  So, I was in and out of bed and the bathroom.  There wasn’t much DH could do for me, and I was so sick that I wasn’t staying remotely hydrated.  And I was contracting (though I hardly even remember that detail).

DH insisted on calling our midwife, and of course she just advised that he do his best to get me hydrated and not to worry about the contractions, because of course, there’s no way that I’d be in labor!  That made sense to me.  I certainly didn’t feel like I was in labor.  I felt sick as a dog, and I was getting sicker and sicker.  After a few more hours of this, DH called the midwife back saying that even if I wasn’t in labor, he was worried about how dehydrated I had become.  (We’re both professional singers, so we’re very conscious about hydration.)

This was after midnight.  He’s scurrying around the house trying to figure out what to put in our hospital bag, and I’m thinking that he’s nuts for trying to take me out of the house in this condition.  I remember not wanting to leave the house.  No, no, no – this is just NOT right.  And how the hell am I supposed to get to the car without passing out, pooping myself, or vomiting everywhere?  Hmmm??  And once I’m in the car, how the hell am I supposed to ride in the car without pooping or vomiting everywhere?  Hmmmmmmm???  Oddly enough (thought I get it now), I stopped getting sick.  I became more aware of the contractions, I guess, but I was more curious about why I had suddenly stopped getting sick!

We arrived at the hospital a few minutes later.  The intake gal wasn’t the slightest bit concerned about me . . . taking her sweet ass time while I’m contracting away and wondering when the next wave of sickness would take over my body.  I didn’t think I could get to L&D on my own, so once DH got back from parking the car, I think he wheeled me away to L&D.  I was kind of excited in a way!

Get to L&D.  Everyone is in slow motion.  They knew that I was on my way, but yeah yeah . . . 1st time mom thinks she’s in labor, yeah right.  They didn’t have a proper L&D room ready for me, so they put me somewhere else for my initial assessment.  It didn’t bother me any.  I was just trying to manage contractions.  So blah blah whatever questions that I couldn’t focus on but DH was mostly able to answer.  Taking their sweet ass time.  They check my cervix and holy moly SHE’S 9 CM DILATED!!!  GET HER MIDWIFE HERE STAT!!!  All hell breaks loose.  It was comical.  They readied a L&D room and transferred me.

So here we go!!!  We get set up in our room and our midwife arrives looking a bit sheepish since she insisted TWICE to my DH that I was NOT in labor.  After confirming that I was 9cm dilated, she offered to break my water to help move things along faster.  I knew that she was just trying to help since I was so sick, but DH reminded her that we were not interested in any unnecessary interventions.  He asked again about my dehydration, and they said the quickest way to remedy this was IV fluids.  It sounded like a good choice even though I was bummed to be connected to tubing that could restrict my movement.

At some point the labor nurse noticed fluid coming out of me.  I think she thought that was amniotic fluid, but no . . . ick, it was from uhhhhmmmmm, somewhere else in the vicinity.  I was a bit embarrassed that I was having diarrhea everywhere, but I knew that in order to bring this baby down, I needed to move and change positions.  For some reason, it seemed logical that I would turn my butt to the room and sort of drape myself over the back of the elevated head of the bed.  That was just a great position for me, even though I was making such a mess.  Thank God for chux pads, people!!!  Anyway, from this position, I was able to sway my hips and bounce like a maniac and still ‘rest’ my head.  Upright positions definitely felt the best and seemed the most productive.

I didn’t ever really ‘hit the wall’ like I had expected because obviously I transitioned either at home or in the car when I was still so sick.  Once I got to the hospital, I was still having diarrhea, but I stopped vomiting thankfully!!  I started feeling pushy, so my midwife examined me again and encouraged me to push.  However, she had me on my side for pushing and was having me push for counts of 10.  This was horrible.  They had to give me oxygen, and the position was excruciatingly painful.  My contractions were one on top of the other even though the stupid monitor was telling them that my contractions were ending.  I hated that damned machine.  I wasn’t making progress.  I was getting tired.  I was frustrated.  I was sick.  I was contracting and grunting and moaning and getting nowhere fast.  My midwife estimated that the baby was stuck at 0 position and not tolerating pushing particularly well.

DH & I thought back on our childbirth education series.  We knew something had to change.  So, I got back into that other strange position of draping myself over the top/back part of the bed and pushed in that position.  The counting to 10 was driving me crazy, and I yelled for everyone to stop.  I just decided to push whenever for however long and see what that did.  I felt my baby girl making her way down.  Eventually, that is.  My midwife wanted me to lie down so she could check the baby’s position, but I didn’t see how I could possibly do that, so she contorted herself and checked me and found that I was +1 or +2 . . . can’t remember.  Aha, progress!  That was all I needed to invigorate me.

Some rights reserved by Travis S.

I do remember wondering when pushing would end.  I thought I recalled reading that 1.5 hours was fairly standard, but I had been pushing for twice as long at least.  However, I was surviving (I think thanks to that bag of fluids), and the baby was now doing better with the pushing.  Hooray!  What seemed like an eternity later . . . eventually resulted in me feeling like my vagina was on fire and going to explode.  Baby was crowning!!  My midwife applied counter pressure to the perineum so I wouldn’t tear and encouraged me to ‘go easy’ with the pushing if possible.  Eventually I couldn’t resist any longer, plus I was tired of the out and in game that the baby was playing.  I pushed really hard – I think I was on all 4s at this point – and her head came out.  Relief.  It feels so much better once the head is out, I can’t even tell you.  A couple more pushes and the shoulders and body were out, and my sticky gooey baby was in my arms.

Many women feel like birthing their babies was a transformative experience.  I am one of those women.  I felt like, if I can do that, I can do anything.


Closing in on 39 weeks

image by Ixionx

Man, nothing like a really bad flu bug to just knock your butt down.  I feel miserable.  It started with soft palate irritation and has resulted in me being in bed for 2 days.  I finally took some extra strength Tylenol today, so I’m less achy, but I’m coughing and congested and my head hurts.  I FEEL TERRIBLE!  And I’m cuh-RABB-y!!!!!  (Yes, I know I’m *only* 38+ weeks.)

This is the last thing I need right now when I’m feeling the pressure to get out and walk, have ‘relations’ with my husband, do lots of deep squatting, and other things to remind my body that it wants to go into labor.  Really, it does!  (Yes, I know I’m *only* 38+ weeks.)

My 38 week appointment with Mr. Dr. Hyde was uneventful.  He wanted to check my cervix, and he confirmed what I already knew – that my cervix was posterior and closed up like a little clam.  Since then, I’ve been contracting more, I guess, but nothing spectacular or indicative of immanent labor.  (Yes, I know I’m *only* 38+ weeks.)

Last night I had a horrid dream about my baby not only kicking her way out of my uterus but out the side of my gut.  In my dream I start screaming for my mom to call 911 and then pass out . . . and that’s when I woke up.  I know it was just a dream and that it doesn’t mean anything, but pairing that with being sick has just deflated me.  Now all of a sudden, I can’t imagine lasting in labor.  Not only that, I don’t want to be in pain, and I sure as hell don’t want to in pain for hours and hours.  Maybe I’ve watched too many YouTube birth clips as I’ve laid here in agony?  (Yes, I know I’m *only* 38+ weeks.)

My amazing husband – he said to think of what I’d be telling any woman at 38-39 weeks pregnant who is losing steam and gaining doubt.  He says such fantastic things about birth and trust and intuition; I’m not sure he recognizes how wonderful he is.  All I know is that he’s talked me down off of several ledges.  I’m not quite off the edge this evening, but maybe once I get to feeling better, I’ll regain my trust and faith in myself and in the amazing process God designed for me, my body, and my baby.

My OB: Hello Dr. Jeckyll? Or Is It Mr. Hyde?

I decided to blog about my OB, Dr. Jeckyll & Mr. Hyde, over at My Best Birth.  Here’s an excerpt:

So, I arrive this morning with my husband.  After the nurse weighs me and takes my blood pressure, she tells me to unclothe waist-down.  I then notice the ultrasound machine right by the bed.  “Uh oh,” I think.  Compliant-patient side of me agrees to undress (though I know my cervix is still high and posterior).  Not-gonna-comply-patient will not agree to an ultrasound!

This week, instead of having a big baby, I have “not a very big baby” (based on external palpation) . . . “maybe 6 6.5 pounds right now.”  I’m measuring “right on” (which he didn’t say last week).  Everything looks good.  No worries.  Who is this guy!?  So, a very straight-forward appointment with Dr. Hyde this week.  At this point, I am planning on keeping my 39 week appointment, just so he doesn’t get suspicious of anything.  Suspicious of what, you might wonder?

To read the entire post, click here.

Blog it out: 38 week OB appointment

As I get ready for my 38 week OB appointment tomorrow, I feel the need to just ‘blog it out.’  Ya know . . . as a way to relieve some tension and stress from last week’s appointment.  I’m maintaining ‘shadow care’ with the only OB I know in town who would ‘tolerate’ babysitting an ill-advised VBA2C in the hospital.  Only thing – I’m not planning on going to the hospital.  However, I’ve been encouraged to keep up this disingenuous relationship just in case I do need to transfer during or following the birth.

I blogged last week about his ridiculous statement that “short, Mexican women” have the best births.  Here are some of his other de-motivating tactics:

Sketch by American artist, Ben Murphy

  • “So . . . we still doing this?”  He likes to begin my appointments with this rhetorical question.  He knows the answer, but yet, he continues to ask.
  • “You’re not gaining weight but you have a BIG BABY.”  Such bullshit.  He doesn’t share my fundal measurements with me, but I know I have been and continue to measure ‘right on’ each week.
  • “When you have a bad outcome, ________.”  He’s filled in the blank with a variety of scary things.
  • “When you need a cesarean, you can’t freak out on me.”  I told him that was way too much for him to expect.
  • I have to have a perfect Friedman’s labor.
  • CEFM, IV, yada yada.  Ok, whatever.  I’ll agree to the monitoring assuming they have telemetry.  I’ll consent to heplock but not an active IV.
  • As soon as I’m in labor, I’m to go directly to L&D.  (Yeah, right, doc.  I’ll do that.)
  • I asked him why my rupture risk is increased since they went through the old cesarean scar.  His response: “Because it just is.”  My response: “Come on, you know that’s not a good enough answer for me!”
  • When I told him that I gestate longer than 40 weeks, he said “that’s bad!”
  • Doesn’t believe vaginal delivery is best for healthy babies (?!?!?!?!!!!!)
  • Places VBAC in the “want” not need category, though he seems to understand that I have my reasons
  • Doesn’t seem to believe that the pelvis expands during pregnancy and birth?  The only way to get more room would be to break my pelvis (not that he was suggesting that route).  Does he not ‘get’ the physiology of birth?  Does he not understand the role of hormones in preparing the body to birth??
  • Seems to consider 37 weeks as term . . . not early term as I suggested.  (A newly released NIH study asserts that babies born in the 37th and 38th weeks are more likely to die before age 1 than babies born in the 39th and 40th weeks.)
  • “You know I’d prefer not to do this.”  In response to my objections over having him and an anesthesiologist breathing down my neck during my entire labor and birth.  Which is a mis-representation anyway of what would actually happen.  If I’m in labor during the day, he can continue seeing his patients.  If I’m in labor at night, he’s welcome to go sleep somewhere in the hospital or at his office.  And our hospital has 24-hr anesthesia immediately available, so he shouldn’t be guilting me about an anesthesiologist having to be there for my labor.  If a hospital isn’t safe for a VBAC . . . . it’s not safe for any birth.

Wow, when I write all of that down, I just get angry.  I’m going to crawl under the covers with my Hypnobabies tracks, strengthen my bubble of peace, work on fear cleansing, listen to my pregnancy affirmations, and call it a day.  My husband will go with me tomorrow to my appointment, so I imagine it will be uneventful.  I have a mind to bring in my “birth preferences” just to see how the doc would react, but really . . . is it worth it?  Probably not.  At this point, I’m no longer interested in his opinion because he continues to skew the ‘truth.’  I don’t want to argue about laboring in water or delayed cord clamping or any of it.

Point is – I’m not going to the hospital to have this baby unless the need arises before, during, or after the birth.  I fully recognize that at any point between now and my birthing time, that I may need hospital services.  My husband and I will decide if we agree with recommendations to abort our homebirth plans.  Otherwise, I’m not planning on needing the hospital or an obstetrician.  So the last thing I want to do tomorrow morning is have an off-putting, destabilizing, stress-inducing discussion with someone who begrudgingly is putting up with my wingnut idea to have a natural birth but very vocal about what all “will” go wrong.

You can read my last pregnancy update (34 weeks) here.

Recurrent Miscarriage: My happy endings

I am somewhat pleased and sad to know that my post about Pregnancy Hormones and Miscarriage is consistently one of my top posts.  I wish I could hold everyone who comes by looking for answers.  I remember being there.  It’s still a healing wound that opens up from time to time.  I still grieve that I’ll never know those souls I lost.  Or do/will I?

Nutshell background:

After an uneventful first pregnancy that produced my 6 year-old daughter in 2004, I suffered three consecutive first term losses.  Getting pregnant has never been my issue; staying pregnant was becoming a real problem for my body and my psyche.  The last straw, the one that nearly killed me, was the 10-week loss, and the OB standing over me as I woke from the curetage telling me my uterus was too thin to ever consider a vagina birth, and this same OB wanting to put me on Clomid to treat my losses.  This OB had also refused to test my progesterone levels, saying that even if they were low she’d not treat for low progesterone.

Here’s what I had to do:

  • Change providers – I’m in a small town, so no one is super specialized in this area, but I at least found a doc willing to work with me; he had also dealt with infertility personally
  • This OB did ultrasound to check for PCOS (which he thought he found in me) and HSG to check for uterine abnormalities
    • PCOS markers may include u/s, but that’s not the only determining factor, so I ruled that out myself
    • The HSG showed an abnormality, alright; the OB thought it was a double uterus
    • I decided it was time to find a specialist
  • I found a yahoo group that supports women with Mullerian Anomalies (double uterus is a type of MA)
    • This group has an anonymous consulting doc who looked at my HSG film and believed the anomaly to be either a septum or bicornuate uterus shape
    • This group had a fantastic resource – a database of recommended reproductive endocrinologists and repro surgeons
  • Because I have family in Denver and was planning on being in Denver the Summer of 2008 for a voice science research program, I chose a RE in Denver.  Tough stuff when you’re essentially ‘out of network,’ but thank God we ponied up and did it.
    • The RE looked at my film and didn’t think it was a MA; he was sure it was a fibroid
    • SHG confirmed his suspicions
    • Extensive blood work revealed . . . LOW FRIGGIN’ PROGESTERONE . . . actually, really really crappy luteal phase progesterone (I am still so angry with the OB who refused to test my progesterone; I still blame her for that loss.)
  • The RE also recommended a myomectomy to remove the fibroid
    • He wanted to do it laparascopically which means cutting through connective tissue and the fundus to reach the fibroid
    • I didn’t want the integrity of my uterus further compromised and requested a hysteroscopic myomectomy instead; he agreed
    • Folks, do your research so you can advocate for your needs!!  I can’t stress this point enough!!!!
  • Thank goodness we did the hyst myo because instead of a regular fibroid, he found adenomyosis which he attributed to the PREVIOUS CESAREAN!
    • Hyst myo turned out to be the best way to remove as much of the adenomyosis as possible
    • Otherwise my uterus looked normal, no thin LUS, cesarean scar wasn’t even visible
  • This RE had a drug protocol that worked to address my progesterone deficiency
  • 3 months later my local OB examined my uterus via ultrasound and said that I was healed and ready to TTC!
  • I also made sure that the RE confirmed that the integrity of my uterus was not compromised from the surgery; my OB was nervous about ‘letting me’ VBAC

My happy endings:

I naturally conceived twins in 2008.  Luckily, I was in Denver over Christmas, and the RE was involved with my early pregnancy care.  My HCG levels were abnormally high, and an early early ultrasound revealed twins.  I enjoyed an easy term pregnancy (39 weeks!) with di-di twins!  My twins are such a blessing – can’t believe they’re almost TWO!

I became pregnant again in October 2010.  God has a sense of humor for sure.  I followed (more or less) the same treatment plan for low progesterone.  The first week of my pregnancy was stressful because I was having a hard time getting ahold of my OB and who had different ideas of how to treat low progesterone that conflicted with the RE’s protocol.  Can you believe this RE’s nurse was still supporting me through this stressful time . . . 2 years later?!  I was able to e-mail her and call her and they were willing to oversee my meds for the 1st trimester if I couldn’t get it worked out with my OB.  I had to ‘correct’ my OBs script a couple of times, and thankfully he was compliant.

Again, you have to advocate for what you need.  Right this minute.  Trust your intuition.  Know that infertility and pregnancy loss is more ‘art’ than ‘science’ at this point.  Know that there are widely disparate ‘camps’ when it comes to treating infertility and loss.

Currently, I am 37 weeks pregnant with my Happily Ever After baby.  May you find a way to yours!