Wednesday, October 22, 2008

Birth plans

I am not sure yet about what my plans will be for this birth. Barring a pressing medical need for hospital care, I will give birth at home. That's a no-brainer. But whether I will do it unassisted or hire a midwife is up in the air. During Zari's pregnancy, I felt very drawn to an unassisted birth, while having a midwife did not feel right. This time around, I don't have a clear sense yet. I find myself wanting to have more options than UC or the ER. My ideal would be to have an undisturbed birth with a supportive midwife on call, waiting somewhere if I wanted her assistance but not managing the birth or getting in my way. Basically if I could beam Pamela out here, I would!

I want to have a midwife available for these main reasons:
  • assess for tears and suture/Dermabond if necessary
  • do my Rh- bloodwork and write a Rx for Rhogam if needed
  • assist in the case of a shoulder dystocia or rapid postpartum hemorrhage
I met with a midwife yesterday, a CNM who attends home births. I really liked her and felt very comfortable with her. We talked about both of our expectations for the birth and where we could meet. I knew she probably wouldn't be comfortable doing no heart tone checks at all, and I was right. I had hoped that she would be okay otherwise staying in another room, even when the baby was born, but she does want to be present for the birth itself to keep an eye on things. She says she is usually pretty hands-off at births; I'd like to talk with her more about what this means in practice. She does understand my need for privacy, as she herself also craves solitude during labor.

One thing I think I would really like about choosing her is that she does group prenatals. All the women due around the same time meet together once a month for two hours (then once every 2 weeks after 36 weeks). The midwife or one of her assistants has a discussion topic or presentation. There's time to chat and to have one-on-one visits with the midwife, too. I feel fairly isolated here, having moved recently and having no friends nearby. This would give me some much-needed socialization and birth talk!

For the moment I am leaning towards going with her and staying open to what I feel is right on a spiritual and intuitive level. It is, admittedly, a little bit strange to be looking into midwives after having done it unassisted. It's not that I worry about my ability to give birth or to recognize and address situations in labor. I also don't want emotional support or coaching during labor. I just want more options at my disposal. I think, also, that I feel a bit more fear this time around. Not about the birth or anything; just in general, knowing how much I love Zari and, as a mother, how much I have to lose (as well as gain).

So that's where I stand at the moment. My pregnancy is going very smoothly. I started feeling better about four weeks ago; the dizziness and queasiness gradually subsided and now I feel totally normal again. And food tastes good again! How lovely...I lost a few pounds since becoming pregnant, although that might be as much related to my exercising regularly since I got back from France as to my lack of appetite. Plus those pounds aren't really "lost" since they were "gained" back after I ran a half-marathon last fall (not immediately after the race, of course, but over the course of the winter since I stopped running after I accomplished my goal and--lame excuse?--I don't enjoy running in cold weather). I am almost 3 months along at this point and look forward to all of the fun parts that are coming: feeling the baby move, finding the heartbeat with the fetoscope, watching my belly grow.


  1. Your thoughts are really interesting! Thanks for sharing them. I look forward to hearing more about your pregnancy.

  2. Happy second trimester!

  3. I appreciate your sharing your fears and uncertainties. (I remember your similar post from last time vividly). Your credibility as a UC advocate is strengthened by your willingness to be honest and open.

    I find myself scared to have a fourth child at all, feeling so blessed and lucky to have three normal, healthy children already. I think it's perfectly plausible to be more afraid the second (or fourth) time around, having now even more of a sense of the fragility and preciousness of life.

  4. you probably know my thoughts on having a midwife attending having had a SD in my last homebirth. Its an intereesting progression from birth to birth and like the commenter above, your honesty is valuable. Its interesting reading US blogs about midwives attending homebirths. my impression here in OZ is that the vast majority of homebith midwives are incredibly hands off, it sounds like US HB midwives practice a much more 'aggressive' approach?

  5. Glad to get a baby update!

  6. Kel--I think it's quite hard to make any generalized statement about how US midwives practice because there's such a wide variety of practice styles. I saw this even with the two home birth midwives I worked with. Both were DEMs who had gone back, or were in process, to become CNMs so they could provide home births legally. One, especially if that's what her clients wanted, could be very hands-off (as in, sitting quietly in a corner while the woman gave birth and not really doing much at all to the woman, no vag exams, no touching the baby or even getting in the woman's line of sight after it's born unless of course there was something amiss, etc. The other generally wanted to be more hands-on: helping deliver the baby's head and shoulders, checking for and manipulating cervical lips, doing a full set of vitals on baby every 15 mins after the birth. Neither one is inherently wrong, but I definitely lean towards a very hands-off style myself.

    During the US midwifery renaissance of the 1960s and 70s, there were quite a few practices that were accepted as "the way birth is done" that have gradually become questioned. Such as hands-on perineal support & massage, birthing on your back, etc. Depending on who the midwife learns from and what practice style they learned, you can see a large range of differences.

    Pinky--it's not that I'm opposed to taking heart tones per se, it's just that when I labor the presence of other people in the room is incredibly distracting and it breaks my focus. As in, I had to send my husband out because I needed to not have anyone watching me. I understand why midwives want to do them and I am fine with having them done if I invite a midwife there, since she cannot have access to what I am feeling and what I know inside my own body. I do, however, know some midwives who will not do heart tones if their clients feel strongly about it and insist that they will take responsibility for not having FHTs taken; this is usually the case when the woman strongly wanted an unassisted birth but her husband, for example, didn't feel comfortable without a midwife present. It's pretty unusual though.

  7. Rixa, thanks for sharing your thoughts on your personal journey with us. You are right to give yourself a better plan B than driving yourselves to the ER for something that a midwife could take care of at home. Even if everything goes perfectly normally, I think every mom deserves the convenience of having an simple perineal repair done at home, etc. Hope you find someone you're happy with, it might be well worth it!

  8. I am a new reader and very much enjoying your blog. It's interesting that you should mention your evolving feelings about the presence of a midwife for this second birth. I went through something similar myself. For our first, dh and I both felt very strongly that we wanted only my dear midwife mentor (we worked together for five years) there and no one else. She drove 4 and a half hours to be here with us-- it was very quiet and a hard job to do (anterior cervical lip caused by some structural issues in my pelvis, longish labor).

    This last time, my feelings were totally different, we had my mom, my sister, the m/w, her assistant and our daughter all filling our tiny house. It was a totally different atmosphere-- a "party" birth :) But still just as precious to me.

    I think these types of choices are so different for each child, each birth and the flexibility to go with your instincts is why we do homebirth.

  9. Have you given thought to the presence of a Doula. She provides a non-medical presence at a birth. They are a great resource for empowerment, strength, ideas, information and comfort.

  10. I am a doula. I have no desire to have one at my own birth, though; I need privacy.

  11. I love your openness and look forward to what's to come.

    I've had two "party births" as a previous commentor called it. Whenever our third baby comes, I'm thinking not so many people. Every person there stayed out of my way and "did my bidding" as I needed it. Very in tune and I couldn't have asked for better "doulas" for the births.
    But i'm feeling the need for something different next time. I'm not even pregnant!

  12. Well, you kniw I understand about each birth and pregnancy bringing about new feelings, ideas, ideals,m plans, fears, dreams....thanks for sharing with us and for following your heart. You are a role model and people have come here for a few years now and you hold alot of "cred" in my book. I hope you find something that feels right as you go along. We are all here for you and excited for following your journey! please take lots of pics like you did with Zari-in-the-tummy, those are so fun!

  13. Reading this makes me want to be pregnant again, which I never thought I'd say! :)

    I think it's a wise move to think about having options. I tore with my birth and am glad I could get sutured on my couch while holding my baby. I have a friend who didn't have that option and had to transfer -- I just can't imagine how shitty it would be to have to go to the hospital after an amazing birth experience to deal with stuff like that!

    I'm kinda surprised about FHT, Kathy didn't check those at all during my labor. Maybe if you just call her in as last minute as possible so she can be there for the 2nd/3rd stage stuff but none of the leadup. I'll be really interested to read more about this!

    Group prenatals sound SO FUN!!!

  14. Lauren,
    Kathy was one of the midwives I was thinking of in my earlier comment about FHTs...I loved apprenticing with her!

  15. Each birth is different and your intuition will lead you where you need to go! :)

  16. I'm glad to hear your pregnancy is progressing so well. It's interesting to hear your evolving thoughts, and I really do understand what you mean. After my 3rd, I fully intended to have a UC with my 4th. However, hubby wasn't okay with that, and as it turned out, as the pregnancy progressed, neither was I. You know my story, but I'm really glad I switched mid-stream to a midwife I adored rather than sticking with the one I initially picked. That really made a big difference. Now I can look back and know that I got exactly what I wanted.


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