Monthly Archives: November 2014

On Hospital Birthing

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Even before I thought much about having children, I’ve always leaned towards natural childbirth. I’m not out to demonize medical interventions during birth; I think that they exist for a reason. Sometimes, a very exhausted woman needs an epidural to allow her body to rest during labor so that she can finish the job. Sometimes, there are complications with a pregnancy that translate into induction being the best route for both the mom and baby. Sometimes, lives are saved by emergency c-sections. All of these things serve a purpose and I’m not opposed to consenting to any of them myself if there is a true need for them. What I don’t agree with is administering these procedures for the sake of convenience, speed or routine. If there’s no risk to the baby or mother, labor and delivery SHOULD be allowed to progress at a natural pace, even if that takes some time (and often, especially for first-time births, it does).

Birth is intense. Duh. People who try to talk about birth being this beautiful, orgasmic experience sort of freak me out. I don’t’ know if we’re talking about the same thing, to be honest. But just because something is painful doesn’t mean that it’s bad. The pain that comes with contractions is what actually tells a woman’s body to birth a baby. If you mess with that pain either by ramping it up way too quickly with an induction or by dulling it with narcotics or an epidural, you interfere with the natural flow of birth.

I haven’t had great experiences with doctors and the Milwaukee medical system in general in the past few years. Lots of careless, quick diagnosis, appointments being goofed up by clinic staff, and unnecessary prescriptions that turned out to be a waste of money. I understand that this is NOT everyone’s experience with western medicine and that some of you have had access to lifesaving procedures as a result of the type of healthcare we have available in our country. I’m just saying that my experience has been mostly negative. Case in point: I don’t have a family/general doctor. I’ve tried three different ones over the past few years and have been pretty disappointed in all of them.

One bright spot in the whole thing was that I began getting midwifery care for all of my more “feminine” exams about two years ago. One of the hospitals in Milwaukee has a HUGE staff of Certified Nurse Midwives (CNM). I knew that they were a good fit for me when they mentioned taking vitamins and probiotics at my appointments – something I’ve NEVER heard come out of the mouth of a more traditional OB or even GP. When we found out that we were going to have a baby, I immediately scheduled my first prenatal with them and began working with a midwife that I absolutely love, Emmy.

The only issue with that midwife group was that in order for me to actually deliver the baby with them, I would have to birth at their hospital. We gave it a shot. We really did. We toured the labor and delivery floor and I got about halfway through my pregnancy feeling undecided about the whole thing. On one hand, I was comfortable with Emmy and had only good things to say about her. On the other, I simply didn’t want to give birth in a hospital setting if I could avoid it.

Especially since finally owning a home and coming to love being there so much, the idea of birthing in a hospital seemed less and less appealing. I considered a home birth. I think the idea was a bit daunting to Jason, and so we decided that an out-of-hospital birthing center might be a better option. It would be a more comfortable setting but it would also be staffed by people who were professionals in natural childbirth. Plus, we wouldn’t have to be the ones cleaning up the tub after it was all over, ha.

I talked to Emmy and got quite a bit of encouragement for an out-of-hospital birth. At that point (and this is still the case) my pregnancy had been very healthy and low-risk – she said that I could probably have any type of birth that I wanted to. While I was sad to say goodbye to her, I felt this was a good choice for us.

There are two birthing centers in the Milwaukee area. Both are mainly staffed by Certified Professional (CPM) Midwives. Why is this important? Well, some people will tell you that nurse midwives aren’t “really” midwives; they’re mostly just labor and delivery nurses who will try to push all of the routine medical stuff on you. As a side note, this has NOT been the case with Emmy or any of the other CNMs at all. Every single test and procedures has been explained in detail to me and I’ve been given the option of declining them if I want. Anyway, here’s the real difference: most insurance companies will cover midwifery care if it’s administered by a CNM. What they won’t cover is midwifery care from a CPM. We weren’t entirely aware of this when we switched from Emmy to one of the birthing centers and had a long conversation with our health insurance company. Basically, none of the birthing center services would be covered or count towards meeting our deductible.

At this point, we were over halfway through the pregnancy, had done my first round of labs, had two ultrasounds, and multiple prenatal appointments. I don’t know the exact amount all of this came up to. However, I do know that the thought of starting over from scratch and paying everything out of pocket was really, really difficult for us to stomach.

I’m not going to lie. I was really upset about it. It was one of the first times in my pregnancy where I felt like my hormones were wildly out of control and I could cry at any moment. I’d think about a hospital birth and all of those machines and the food and the smell and this constant (unfounded) fear that I had about some procedure-minded OB standing outside of my room just waiting to order me to have a c-section and completely lose it. Pregnancy does some weird shit to your brain at times.

I know that if it had been a big enough issue in the end Jason would have supported whatever choice I made, even if it was paying all of fees out of pocket to continue with the birthing center option or even take another look at a home birth. But I gave myself a good week to process our options, get my emotions in check, and then scheduled another prenatal with Emmy. We had a heart-to-heart on the subject. Suffice to say, she totally got it. She explained that, as long as I had a healthy pregnancy and labor, she and the other midwives were 100% in support of a natural childbirth, even in a hospital setting. One of them would be assisting me when I deliver, not an OB. I would be allowed to walk around, use the labor tub, use the shower, bounce on a birth ball, even push the baby out in whatever position I felt was natural. They would respect my desire for intermittent monitoring and immediate skin-to-skin contact with the baby after she was born. I asked her if I needed to write up a birth plan. She told me that, even though I should so that the nurses had something to go off of, their philosophy would likely already match up with whatever I would put in there.

So, that’s why we’re birthing in a hospital.

As a bonus, I get to continue receiving prenatal care from a midwife that I trust. At Emmy’s recommendation, I’ve had appointments with a few other midwives and have found them to be equally supportive. Emmy might not actually be there when I go in to deliver (it depends on the day) but I feel confident enough in her colleagues that I would be in good hands with any of them.

That being said, there have been some irritating parts about routine hospital stuff – gestational diabetes tests, for one. I failed my one-hour test and then spent a week panicking about it only to come back in for my three-hour and find out that my levels are totally normal. My hospital doesn’t induce until 41 weeks 5 days (which is pretty much the most generous time frame of ANY hospital in the Milwaukee area) but I do have some concerns about needing to comply with their policies in that area. Emmy has recommended some herbal and natural methods to get labor started and you can be sure that I’ll be all over those after I reach full-term. If it comes to it, I CAN always say no to an induction but that’s not a battle I would prefer to fight if I can avoid it.

We do have a few things in place to help both Jason and I feel more comfortable:

  1. We’re taking a natural childbirthing class.
    While we couldn’t birth at a birthing center, we could certainly justify taking a class through them. It’s a sort of modified version of the Bradley Method. Which, for all of you folks out there, is a childbirthing method that focuses on support and relaxation to deal with pain instead of drugs. We’ve learned different types of deep breathing methods, relaxation techniques, massages, aromatherapy…all the good stuff. I, for one, am definitely looking forward to a good hand massage to calm me down. Jason’s quite skilled at it J.
  2. We’re hiring a doula
    This was a recent development. Originally, it was just going to be Jason supporting me through labor. Yet the more I thought about it and the more we learned in class, the more we both realized that being a supportive birth partner in a natural birth is quite a bit for one person to handle. Basically, it would mean that I was asking Jason to be emotionally, mentally, and physically present all throughout labor. Don’t get me wrong – I want him there and he wants to be there. He’s done reading. He takes great notes in class. He’s super thorough and pro-active. But I also want him to be able to step outside and take a break once in awhile without feeling anxious about what’s going on with me. The doula that we’re going to be working with is also a Registered Nurse in the NICU at the hospital we’re birthing at, so she’s fairly familiar with the whole thing.
  3. I’m being pro-active
    Healthy pregnancies often help to alleviate unnecessary interventions during labor/delivery. That being the case, I’m eating lots of protein, drinking close to a gallon of water a day, taking all of the recommended supplements, and trying to get between 20-30 minutes of intentional exercise during the work week (when I’m mostly sedentary due to the nature of my job). Weekends are a constant flurry of activity anyway and I have no problem getting good exercise on Saturdays and Sundays. I don’t know how much of a difference my efforts will make come birth time, but I can honestly say that they’ve already made a world of difference in how I feel at 8.5 months pregnant. I can still sleep well. I’m measuring/weighing just right. The baby is very healthy and active. I haven’t had any swelling issues (yet! Fingers crossed).
  4. We have a birth plan
    Not a four-page manifesto or anything…just some clear bullet points on what our preferences are for things like IV’s, monitoring, and cord-cutting. Jason and I are also discussing different scenarios that might arise between the two of us. For example, if I start begging for an epidural (which I might!) we’ve both agreed that we will wait a set amount of time before we actually request it to see if it was just a wall I needed to get through or if I still legitimately want it.
  5. We’re laboring at home for as long as possible
    The fact is, I’m more comfortable there and we’re only 15 minutes from the hospital. I will be checking in with my doula throughout the first stages of labor so that we have an idea of where we’re at. The less time we labor at the hospital, the less time I’ll be in a more stressful environment with semi-strangers in and out of my room while I’m trying to relax and focus on delivering my baby. Don’t worry, we’re not going to wait until the very LAST minute to go. We have some good, standard guidelines for counting contractions and keeping an eye on my emotional state.
  6. We’re not taking visitors
    We’ve already explained this to our family. The hospital isn’t what I would consider a great place for people to meet your newborn. It’s crowded, it’s impersonal, and for pity’s sake, we’ll all be recovering from a pretty intense experience. I intend to have as short a stay as they’ll allow so that we can get back home and be in our own space before everyone comes over.

So, there you have it folks. That’s the long saga of why I’m birthing in a hospital and why I’m (mostly) comfortable with that choice.

For the record, if we ever have another child I plan on working with a birthing center or homebirth midwife right away to make the most of expense. Live and learn, I guess.

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