Tuesday, August 28, 2012

The Reluctant Homebirthers

My midwife calls my husband and me "The Reluctant Homebirthers," a very appropriate title. Yes, we planned to birth at home, but not until the last minute. And when all this started, I did not at all expect to end up giving birth in my own tub. In fact, I believe D said "hell no" when I first brought it up.

I have long been an advocate of natural childbirth and the practice of midwifery. After taking a course my senior year of college called Women & Reproduction, taught by a midwife, my understanding of women's bodies and the natural process of birth made natural childbirth seem not only preferable, but safer and easier. I won't take time to go through all the reasons, but in short, it just makes sense to me that mothers should be allowed to be out of bed (reclining in birth is counter productive!), and that hospitals are more likely to intervene, and one intervention in a natural process throws the entire process out of whack. Women's bodies are designed to give birth, so why mess with it? For those interested, I'd recommend watching the documentary The Business of Being Born for a quick overview, though I think the film skips some opportunities to discuss the scientific benefits of untampered-with birth.

Not me

I feel the need to point out here that I don't identify myself as a hippie. I like doctors. I am pro-vaccine and love science. I once told my husband that I didn't want a midwife who would show up in Birkenstocks and a broomstick skirt with a crystal around her neck. To me, natural childbirth out of a hospital made sense scientifically and logically, not out of some need for me to express my "womanhood" or damn The Man. (I will now say that natural birth is incredibly empowering and hippies are awesome people, smelly sandals and all).

My first birth was at a freestanding birth center. My part of SC does not have any birth centers adjoining hospitals, which would have been my first choice. As a person who always plans for the worst-case scenario, I liked the idea of being close to medical help. Our center was three miles from the hospital where my overseeing doctor practiced, which made it worth the 1.5-hour drive during labor. My experience there was wonderful, I loved my midwives, but I knew (and my birth team agreed) that I wouldn't want to make that drive the second time. I also remained in touch and became friends with the woman who had been the apprentice at my birth, Carey. She is now fully licensed and practicing with an office 10 minutes from my house, so I knew I wanted to work with her. The only trouble was that she only did home births. Just like doctors can't just stroll into any hospital and start practicing, midwives have to be affiliated with birth centers to deliver there. So that was my choice: work with Carey, or find a birth center in Greenville (45-50 minutes away) and find new midwives.

Thankfully, Carey wanted to work with us, enough so that she contacted local birth centers to see if anyone would let her deliver there. A new one had just opened up, and they said yes. We were thrilled -- I could work with the midwife I wanted, have all my appointments be local (for those who don't know, midwives do all your prenatal appointments as well, and wow are they kinder and warmer than doctors' visits!), and still deliver in a birth center that was nearer to a hospital, though still a 50-minute drive for us. We made this decision, booked a tour of the birth center, and then let the months pass by.

So much nicer than a plastic box
We had to cancel one tour. Carey had to cancel one time. The owner of the center, who would be the second midwife attending our birth, cancelled one time, and then didn't show up another time. Suddenly, we were within two months of birth, and we had never toured the birth center, met the owner, seen a contract, or received any feelings of support or trust from the center. We grew nervous. One trait a midwife must have is reliability, and we weren't feeling that from the center's owner. Plus, and this is small but nagging, the center's fees were expensive.  I expressed my anxiety to my overseeing doctor at my 35-week appointment, and he frankly told me this: "If you choose out-of-hospital birth, it makes no difference if you're in a birth center or at home. The midwives have the same equipment, the same training, the same oversight. At a birth center, you're basically just renting a room for the location." He then suggested I asked a friend in Greenville if I could deliver at their house -- a favor too big for me to even think of someone to ask. So we then discussed the "what ifs" of transport, and he assured me that my location to hospitals -- one 15 minutes away, another 25 minutes away, and one with a NICU 50 minutes away -- was perfectly safe for anything that might come up during a home birth (for the record, very few home births require transport, and when they do, it's rarely a dire emergency; you usually have plenty of time to decide when and where to go. For real emergencies, you call 911).

So I came home from that appointment and sat down my husband for a chat. He agreed to a home birth before I had even finished my spiel. I asked how he had changed his mind from being so clearly opposed to the idea just a few months before. "Well," he said, "I'm going to be worried about you [he may have actually said "terrified" because he's not a big fan of the labor process] wherever we deliver. If you feel more comfortable at home, and that seems easier, let's just do that." So, at 35 weeks pregnant, we became part of the fringe.

So much nicer than a hospital bed
We discussed how our families would feel, fearing the worse, but they were all surprisingly supportive. In fact, most people I told said something along the lines of "good for you! I hope it works out." We received a lot more support than I expected, and though I know it wasn't a decision many others would make, no one called me crazy.

Thankfully, our birth went smoothly. It was so easy to labor at home, not worry about when to leave, what to pack, where to go. There were no forms, no people to meet, no sterile environments. I watched the Olympics in my living room, sipping Powerade. My mom moved in and cooked. After the birth, the baby and I walked to my own bed and didn't leave it for three days, a wonderfully calm and healing experience. If we were to have more children, I would certainly birth at home again -- and this time, without reluctance.

Sunday, August 19, 2012

Amelia's Birth Story

This post contains frank details and photos of birth - read at your own risk.

After missing my LMP due date on Saturday, Aug. 4, I was watching every sign, eager to know when labor was beginning. On Monday and into Tuesday, I had started to feel a lot of low pressure and a bit of an ache between my legs, so I figured things were underway. Monday night I had some discharge, likely the start of my mucus plug, which set off my adrenaline so much I couldn't sleep but a few hours. Tuesday late morning, I had some bloody show and felt more low pressure and aching. I called my mom, who lives nine hours' drive away, and advised her to pack and maybe leave the next day. I wasn't having contractions but I knew things were starting. I awoke Tuesday night with mild cramping but got back to sleep after an hour or so awake. On Wednesday morning, Aug. 8, I felt enough mild cramping to say that labor was starting, but it was clearly starting slowly. I sent D to work, advising him it might be a short day, and called my mom. She had already decided to start her drive that morning, so she was in the car before I even called.

I did some organizing around the house, and noticed that the cramps stopped. I decided to go wear out Sylvia, so we headed to the playground. I tried to stay on my feet to get contractions started again, but I was also rather tired. While pushing Sylvia on the swings around noon, I felt the cramps start up again, this time much more like contractions. I had about 4 within that hour. We came home for lunch, and I napped after, and felt no contractions while sleeping. I had been texting Carey, my midwife, throughout the day, but at this point I expressed frustration that the contractions had stopped. She realized that I had Sylvia with me, and suggested I pass her off so my body cold stop being a mom and get down to work. D came home around then, and we decided to go as a family to get ice cream, and then take Sylvia to her grandparents' for the night. By the time we had gotten everything ready to go, though, I realized the contractions were back and stronger, so I hugged my daughter goodbye and sent them out without me. Almost immediately, the contractions picked up to being more noticeable and less easy. It was around 5pm.

I decided to paint my toenails - one last act of personal indulgence - which I thought had gone fine but now see is a smudgey mess. I wanted to shower, but put it off until things got more intense (it never happened). D returned home and I helped him prepare dinner (artichokes and pork chops). I gave him permission not to sit and watch me, so he hung out upstairs and I watched some Olympics while timing my contractions on my iPhone app. We ate dinner together, but sitting at the table was the first time I began to feel real discomfort. I called Carey to explain that I was having trouble timing things, because I had classic contraction waves, but also short bursts of cramps (I had the same combo of feelings with Sylvia). Intense feelings were happening every 5 minutes or so, but not all were long contraction waves. Carey advised me to pay more attention to my brain: as long as I was rational and thinking through these kind of details, I wasn't yet in active labor...but I could call her to come over any time.

After dinner I settled in front of the TV, watching first some Olympic track and then diving events, still tapping my phone app to try to time things. I sat on a birth ball at first, but then moved to my knees on the ground to lean on the ball. Around this time (about 7pm) my mom walked in. D helped her empty the car and get settled while I stayed on my ball. Mom was concerned that the midwife wasn't there, but I still felt "with it" and didn't see a need for another person to come hang out. I called D over to rub a tennis ball into my back during some difficult contractions. I then realized that they were lasting about a minute - a sign Carey told me meant she needed to come. So I texted her this at 8:08pm: "still rational, but cons are 1min+ and intense." She promptly responded that she was on her way (her house is about 15 minutes from mine).

Contractions were indeed intense, and I found the need to walk  around some. Jenn A, one of two apprentices, came in, and I greeted her but left her to do her thing. I gave instructions to D and my mom to put down a tarp on the carpet, the last set-up item on my list. I remember leaning into the bed for contractions, and D and Mom whispering that I was indeed "different" now. I walked out of the bedroom to return to my ball, but only made it as far as the staircase before having to double over. Carey and the other apprentice, Jenn C, walked in at that minute to find me on my knees, groaning on the stairs. I asked Carey to please check me quickly so I could get in the tub (I remembered that the bath had provided a lot of relief in my last labor, and I was ready for that).


Baby crowning as Carey supports physically, D emotionally
Carey asked me to get on the bed to be checked, but my body would not let me lie down. She managed to check me while I was on all fours, but all she could confirm was that I was indeed dilating and progressing. If I wanted an exact number of centimeters, I was going to need to lie down. That did not at all sound worth it to me, so I headed right into the tub. I was disappointed that the tub didn't make everything better. I instead began moving around in positions like a partial squat that admittedly weren't very comfortable or relaxing, but it was all I could manage. D sat on one end of the tub, Carey knelt on the other end. I was not happy because I wasn't getting much rest between contractions (I should have realized this meant I was near the end). Carey encouraged me to try to feel the baby, so I reached in and felt a soft joint. I blanched and said, "Carey, that's not a head." The room collectively took in a breath, but Carey promptly assured me it was a head, it just might not feel like one to me because a) baby heads have lots of shifting plates on top, and b) my water hadn't broken yet, so there was still a gelatinous layer covering it. She quickly checked me and confirmed it was indeed a head - thank goodness!

Concerned/amazed Mom

I continued to contort into weird squatting positions while trying to vocalize my two pre-decided laboring words: Down and Out. Occasionally, my body would release large bubbles, which I found strangely encouraging, like I had made progress. I really wanted to feel my water break, as I had read in other birth stories that it creates a huge feeling of relief, followed quickly by crowning. Instead, my chants turned to NOOOO as things got very intense. Then, I realized that I was pushing while contracting, even though I never had a clear pushing urge. I just had a LOT of pressure on my bottom, and then pain (most of labor really is pressure and waves, but this was rather acute pain around my rectum). My brother had made the joke that I would be "pooping out a baby at home," and that is exactly what it felt like.

Now, let me tell you the definition of selfless service: Carey leaned into that bath and provided counter-pressure to my rectum so it wouldn't hurt so much. I was then shocked to realize then that the baby was crowning - my water hadn't broken, but I could  feel her head exiting my body, and I cupped the head as it slowly lowered out of me. At this point it suddenly dawned on me that my mom, who had been in the kitchen staying out of the way, might want to see the birth, so I yelled at the top of my lungs "MOMMMM!" She replied from 2 feet away, "I'm right here," and everyone in the room laughed. And then...pause. I lost my urge to push, and whoop! Baby went back up the birth canal. It was such a weird feeling, almost like an upward suction. I sat there for a minute, shifted position  to be fully up on my knees, and felt her exit and then suck back up again. I was done with this. Even though I didn't have a contraction to help, I pushed anyway. Carey's hands and mine together supported my body and led Baby's head out. She came easily and slipped right from my body into my arms.

Baby born!

I saw immediately that the cord was loosely wrapped around her shoulder and her neck. Carey untangled her as I held her, and Baby began hollering right away. She was pink and perfect, not slimy or beat up in any way. I checked to make sure she was a girl and announced that to the whole room. I asked Carey what to do next, and she suggested it would be easier to birth the placenta out of the tub. Elated, I carried my new daughter against my chest as the midwives helped me walk the few feet from the bath to my bed. I lay there, gazing at my perfect, squawking daughter, as Carey and Jenn C helped me birth the placenta and put it in a bowl next to us. They then inspected me for tears or problems, and everyone helped wipe and clean me and the baby. I was feeling blissful, only a little crampy, and a bit overwhelmed that we were already done. She was born at 9:48pm, so I'd only been in active labor for about 2 hours.

Pure joy.
A flurry of activity happened around me as the midwives cleaned up and assessed, and Baby tried her first nurse. About 45 minutes after birth, the cord had gone flaccid, so Carey helped D cut it, and they then showed me the placenta. It seems like my membranes had been really strong, and instead of my water breaking, one membrane had just torn slightly and slowly leaked (which I never felt, maybe because it all happened in the tub?). I could still clearly see where my baby had lived for the past 10 months. The placenta is in the freezer now, but will soon be planted under a magnolia tree we bought for the occasion.

Around 11pm, the midwives weighed and measured the baby: 8lbs, 0 oz, 20.5" long. Her Apgar scores were 8 and 10. We couldn't come up with a name (none of our three finalists were immediately standing out; it would take us three days to name her), but no one seemed to mind. Mom brought me an amazing grilled cheese sandwhich and a peach, and a few people toasted some Stellas. The midwives all left by 11:30 or so, and D joined me in the bed to sleep just before midnight. We were joyful, overwhelmed and exhausted. Baby nursed and cried (a comical, froggy wail) until 4:30am before finally taking a long snooze. She certainly made her presence in the world immediately known.

Many thanks to Jenn Anderson for taking photos with my camera. Also, I'll follow up soon with a blog on how we (relunctantly) chose homebirth.

Wednesday, August 15, 2012

Baby!

I had a baby! At home! On purpose! I will write up my birth story, as well as our reasons for choosing homebirth, as soon as I have a computer again (my laptop died 3 days before I went into labor - ugh). I'm also just a smidge busy nursing my very hungry new daughter Amelia and gazing at her perfect little face.

Thursday, August 2, 2012

It's Time

I am large and slow. I feel uncomfortable pressure against a variety of organs. I cannot stand up or sit down without omitting some kind of grunting sound. I am always hungry and yet feel overfull after eating. My mind is foggy. I am always, always hot (the 95+ degree temperature and unrelenting humidity don't help). It's time for this baby to be born.

In late June, after returning from all our trips, I made a "July To-Do List" on the Notes of my iPhone. As of today, all but one item have been completed (that outstanding item is a research paper I was supposed to edit, but my brain is just not capable of completing that task, despite multiple attempts). That list was so overwhelming at one point, but now I walk around the house with great satisfaction, eyeing the completed nursery, the lovely painted walls of our bedrooms, the sorted garage, the refurbished cloth diapers, the clean car seats. I've had time to make some deposits in the karma bank, taking food to three friends who have had babies in the past month. And D and I have even carved out a few nights for socializing with friends, soaking in some adult time out in the world before we are confined to the home. It's time for this baby to be born.

I've had some great talks with Sylvia about what is about to happen. She understands that when the baby decides to come out, she will be going to play with Hanna, our wonderful babysitter, for a while, and then she'll come home to meet the new baby and throw a birthday party. She understands that Baby will sleep with Mama, and that Mama will have to be in bed for a while. She knows that her Grand is coming to help, and that soon after that she'll start school (which she is very excited about), and then gymnastics class (which she is thrilled about). She seems to understand how small and helpless the baby will be, though I fear she is also envisioning a playmate. But we can talk about these things, and she seems so much more prepared, more capable of understanding, than even a few weeks ago. It's time for this baby to be born.

D has completed this semester of teaching. He hosts an exam tomorrow, but that can be proctored if need be. He's been working hard to plan out the next few weeks and remove most items from his desk. He had a wonderful night out with friends earlier this week, but yesterday seemed to shift to a focus on home. It's time for this baby to be born.

My fundus has dropped and baby's head is very, very low. Tonight is a full moon. There are thunderstorms in the area. My midwife tells me that all of these are indicators of birth. It's time for this baby to be born.