Friday, October 16, 2009

The perils of midwifery, home edition

I was thinking I wasn't going to post Julia's birth story here, because like many things about birth/newborns/parenthood, it didn't quite turn out how we expected.

And then, I thought, well, perhaps that's all the better reason to post.

I have a few magic minutes while one daughter sleeps and the other enjoys a playdate, so I'll take some time to process here, and then I suspect I won't be posting for a good long while.

2/3rds of Julia's birth went so smashingly. Labored in the tub, a little more leisurely than last time, pushed her out. It was hard, but nice to feel a little more acquainted with what my body was doing.

She was born, and I got out of the birth tub and went over to our bed (with the help of my midwife and others, of course) to await the placenta.

This is where things started not going so well. The placenta did not come out. Instead, a lot of blood did.

To give some context, with Lucy's birth, the placenta came out fine, but a lot of blood did too. Enough that my midwife considered calling 911. The bleeding stopped well short of the danger zone, though, and I stayed home and later got an IV to restore the lost fluids. It was a little scary, but still safe.

This time, we called 911 after a few frantic minutes, Pitocin injections, and some attempts for me to push. Big fire fighters arrived from the fire station around the corner, lifted me onto a stretcher, and turned on the sirens to get me to our local hospital. It took about 5 minutes to drive over there.

The hospital staff and OB/gyn worked their magic, and got me stable, got the placenta out, and gave me 2 IVs and 2 units of blood.

Let me be clear: it wasn't a whole lot of fun. It was scary, and it was not very safe.

After the chaos died down, the OB that worked on me (brilliantly, I should add) came over and said, "Unless you want to leave your daughters without a mother, you should never have another home birth again." Let's just say that her tone was less than gentle.

I want to say a few things about her comment. One, in some ways I agree with her. So does my midwife. I would not be a good candidate for another home birth. Obviously, this bleeding thing is a pattern, and home birth midwives are not prepared to give emergency transfusions or to transfer directly into an OR if needs be. So. If we do decide to have another baby, I will be doing it under the care of an obstetrician. These kinds of situations are what they are trained to handle. And as I've said before, I am grateful to live in a country where that kind of care is available to me.

However. What I didn't appreciate about her comment was her assumption that I would try to do a home birth even if it wasn't safe.I'm sure there are people who would refuse hospital births even under these circumstances, but I am not one of them. Part of her tone, I think is a general problem with our treatment of mothers in the US: an attitude that we are not competent to make informed decisions about our own treatment. Just look at the hysteria about having a glass of wine every once in a while during pregnancy. Sure, don't imbibe every day, or even every other day, but a little alcohol a few times in pregnancy is probably not going to cause problems. The French, I'm sure, are not ignoring the cabernet during pregnancy.
So doctors, hospitals, and just about everyone assumes, that if left to their own devices, moms will make poor choices for their children. Great message!
Also. If you choose not to follow their advice, and say choose a home birth instead of laboring in a hospital, you have proof positive that you make poor decisions.

I have a few other things to say about our experience. We went to our local hospital, which is very baby friendly. They have a team of nurse midwives, and desipte the one doctor's comment, I generally felt supported and affirmed in our decision to birth at home. All this to say, I think this hospital is a pretty good choice for laboring moms. Probably one of the best choices in our county.
But even so, I would not be excited to labor there. I would do it, but only because home birth is no longer an option for me.
The main reason is that I saw about 20 different caregivers while I was there, none of which I had ever met before. If I had gone the hospital route, and planned to be there, I still would have only known one: my OB, and that's if he or she was on call. Also, most OBs would not stay with me during labor--they would arrive only at the end or if there were a problem.
As it was, we saw two OBs, about 6 nurses, one lactation consultant, sundry nurses aides, a pediatrician (not mine) from our ped group, and a partridge in a pear tree.
In contrast, this is what I get with a home birth midwife.
--All prenatal visits.
--Her cell phone number and pager to call anytime if I have questions during my pregnancy. When I got close to labor, she returned my phone calls in about fifteen minutes, even if was late at night. That was kind of nice when I thought (I think wrongly) that I was leaking amniotic fluid.
--She comes immediately over to my house when I go into labor and want her there.
--She stays with me, checks my vitals during labor, and coaches me through labor if I need it.
--She holds my hand if I get transferred to the hospital, and coaches me through the not-so-pleasant procedures that must be done.
--She coordinates care for my newborn while I'm incapacitated.
--She visits me in the hospital and drives my newborn over to me so I can start breastfeeding as soon as possible.
--She serves, post-partum, as not just my caregiver, (checking bleeding and such) but also as a preliminary lactation consultant and quasi-pediatrician. She comes over at 9 at night if I get mastitis or I'm worried about my newborn. If she's concerned, she tells me to go to a real pediatrician or lactation consultant or whatever immediately.

Through all of this, she knows my whole history, from my last birth, my prenatal visits, has been in my home, met my husband and my daughter, my parents. There is just no way I'd get this kind of care through the hospital. No one can tell me that her having that kind of information is not safer than having relative strangers take care of me.

One more note: Why, why why do hospital workers wake you up every two hours during the night to do things like take your temperature and see if you need a sandwich? They are kind and well-meaning and so annoying. During my first night in the hospital, I definitely needed someone checking these things, and I was so out of it it actually didn't bother me that much. The second night, I did not. And funnily enough, I kind of needed some sleep. Between waking to pee, waking to nurse my baby, and dealing with hospital policy, I got about 2 very non-consecutive hours of sleep. How can this be good for recovery?

Finally, I think my experience would have been safer were there more integration and acceptance of midwifery in our hospital system. The paramedics would not have wasted time asking my midwife if she had covered the baby's head. I might have had a backup OB (currently, OBs cannot do backups, at least in our city. The one I know would be willing has said he'd be pilloried by hospitals and possibly lose his privileges if he did). A backup might have been already acquainted with my medical history, instead of learning it while doing life-saving interventions. The hospital staff might have some history with my midwife, some relationship that would facilitate good care. Instead, as one very nice and supportive nurse said, "We don't see many successful home births like yours." I thought it was great that she thought my home birth was successful (it was, sort of) but this is a telling statement. How are they supposed to have a good opinion of home birth if they never see any of the people that succeed at them?

So all things considered, even knowing i shouldn't birth at home again, and knowing it is not a safe choice for me, having somewhat of a worst-case scenario happen has not convinced me that home birth or the midwifery model of care is a bad choice. If anything, it has done the opposite. I wish we had known that home birth was not a good choice before this birth, but I'm glad I had the chance to experience it.

And I wish more people did.


Miss Julia Noel Caliri, 6 lbs 14 oz, born on Monday, October 12 at about 8:30 pm.

Lucy on name choices before the birth: "Let's call her Turtle."
Lucy on name choices after the birth: "Let's call her Princess."

Nuff said.

Friday, October 9, 2009

sickie sickie

We're all sick over here.
Yes. I am sick with the cold or flu, and I'm also waiting to deliver a baby.
(Due date, blah blah blah, is like now, okay?)

I have been trying my darnedest not to get any sicker, and to get better quickly, and to not panic that labor will start while I'm congested and run down. Cause I had a pretty smooth labor last time, but it was kind of like running a marathon on a treadmill I couldn't get off of, which I wouldn't really want to do when not in the best physical health, no?

But tonight, I'm feeling a little more Zen about it all. Here are a few reasons:

1. For some reason, I really feel like the baby will come when my body is ready. True story: with Lucy, one afternoon about a week after my due date, I got really sick of the waiting game, and I said to God, "God, just make this baby come out already, okay?" And about six hours later, she did. I think this prayer was partially a prayer, and partially a surrender that my body was cued to pick up on. And while I'm excited to meet this new person, I know I am not physically ready for her to make her way into the world. So I'm asking her to please hold her horses.

2. I was kind of bummed to be a shut-in before becoming a shut-in. But you know, today I'm just enjoying some very quiet time with my daughter. I don't have enough energy to do anything terribly exciting with her, and she's a little run down too, but this time of just being together, alone at home, will not happen again. So I think I can hang with being quiet and still and just appreciating the one miracle I'm already blessed with.

3. I felt so panicky about dates and times last time, so panicked and yet impatient for the whole show to get on the road last time. And this time? Not so much. I was feeling a little more panicky a few days ago, before I got sick, and now that I'm sick, I am remembering that I have no control, really, over when this baby comes, or what she is like, and that I will soon be doing a lot of very hard work, but also have a lot of once-in-a-lifetime things happening, and I'm just okay being quiet, and thinking about what's coming, and waiting for it, rather than hyperventilating about it.

4. I feel like a lot of the mental work I needed to be do to get ready for round two of motherhood is having space to get done right now. Now, because of the resting and the quiet, and the lack of activity to distract me. Motherhood is an awesome experience. Terribly awesome. And to be forced to be quiet and still before taking it on is probably a good thing.

Today I came across a verse from the Psalms: "Show me the road that I must walk, for I lift up my soul to you."
Ah, yes, Lord. The road I must walk, even if it's not necessarily the one I imagined or counted on. Because it's the one you have chosen for me, and that's enough.

cuddle buddy notes

For those of you uninitiated, a "cuddle buddy" is a sock or little pillow filled with rice or flaxseed or other grain that you can put in the microwave and heat up and get a nice little hot pad. My personal favorite use for this is to prevent me from coughing when I have a cold.

Note: When sewing the cuddle buddy, finish the fabric edges, because otherwise they fray.

Note: When the fabric frays, the seams come apart and leave little holes.

Note: Rice or flaxseed leaks readily out of those little holes.

Note: When people talk about not eating cookies in bed, they should also mention how a liberal sprinkling of grains inside the sheets also does not feel so great.

Note: You can try temporarily fixing the frayed hole with a bulldog clip in the middle of the night. This will seem like a good idea because it's the middle of the night.

Note: Fixing the hole with a bulldog clip is not a good idea.

Note: When you want to re-heat the cuddle buddy in the microwave, remember to remove the bulldog clip because (duh!) it's metal.

Note: You won't remember to remove the clip because (duh!) it's the middle of the night.

Note: When you scorch fabric (luckily not enough to make a fire, like that infamous cookie incident a week ago), it tends to disintigrate.

Note: Even more than when you don't finish the seam edges.

Note: You will notice this as you are getting into bed. In the dark.

Note: There is a lot of flaxseed in one cuddle buddy.

Note: When you try to think of some way of repairing the now hopelessly holey cuddle buddy, give up. Just do without--or, better yet! find a different, unscorched, intact cuddle buddy. Somewhere in the room. Because what chance do you have of sleeping if you're hacking up phlegm, anyway?

Note: Next time, leave the bulldog clips where they belong--in the pencil drawer.

Sunday, October 4, 2009

road safety notes

Yesterday, Dyami made a right turn. I saw a car barrelling through the U-turn right into our lane--right at us--just as Dyami was looking away.
I kind of yelped as a warning.
But instead of looking at the oncoming traffic, Dyami looked at me. I thought--why the heck are you looking at me instead of traffic? Don't you hear me yelping? I was so flustered, I couldn't say anything until we were (thankfully) out of danger.
"I was trying to warn you that a car was there," I said. I think I sounded a bit exasperated.
"I thought you were going into labor," he said.

Ah. That's why he was looking at me.

Note to self: In the next few weeks, use words, not grunts or yelps.

Friday, October 2, 2009

you're frickin' kidding me.

She is asleep, folks. Honest to God.


Me: Lucy, please go in your room and be still and quiet for a few minutes. You're sick, and you need some rest.
Lucy: Oh.
She turns and (?!?!) goes into her room.
It remains to be seen whether she will actually nap. But! I had to write this down because I don't think I'll believe it actually happened.