Thursday, January 15, 2009

Working through some conflicted feelings

This pregnancy has been marked by a series of conflicting feelings about what I want for the birth. Zari’s unassisted birth was fantastic and really could not have been improved upon. I also felt strongly drawn to having an unassisted pregnancy and birth with her. While I of course had some doubts, fears, and hesitations along the way—doesn’t every pregnant woman at some point?—I just knew that an unassisted birth was what was right, what I needed to go through.

When I was a graduate student in Iowa and trying to conceive my first child, I was working as a doula and apprenticing with a direct-entry midwife. After we moved to Illinois, I started assisting a home birth CNM at prenatal visits and births occurring in my area. This pregnancy, I am living in a new state and for the first time in several years, I am not a part of the local midwifery community. This is part of the reason that I felt the need to initiate care with a home birth midwife here; I no longer had access to midwifery care, advice, or skills except through a formal, paying midwife-client relationship. There are a few things that I want access to: during pregnancy, I like checking my hemoglobin levels early in pregnancy and again around 28 weeks to be sure that my blood volume has expanded adequately (hemoglobin levels should drop by the 28-week check; if they are stable or rising, that is cause for concern). I want someone to check me for tears after the birth, suture/Dermabond if necessary, and to do bloodwork in case I want a Rhogam shot. While I could in theory go to a hospital for those postpartum services, it would be extremely disruptive and kind of pointless to get in the car hours after having a home birth!

I also find myself wanting the option of having skilled assistance during labor for certain rare emergency situations: shoulder dystocia primarily, and to a lesser degree rapid postpartum hemorrhage or the baby needing resuscitation (the latter is the least worrisome to me, even though it is probably the most common of the three scenarios I listed, since I am trained in neonatal resuscitation). This wasn’t as much of a concern during my first pregnancy, but I find it weighing more heavily on my mind this time. I suspect it’s because, now that I have a child of my own, the idea of losing a baby is no longer an abstraction to me. I wouldn’t say at all that I was simply being callous or naïve the first time around, just that the possibility of losing a child is more palpable to me now.

I was happy to learn that a home birth midwife lived only 20 miles away from our new house—the closest I have ever lived to a home birth provider in many years. Although I could pay out-of-pocket for a midwife, I was quite happy to find that she was a CNM who could accept my insurance. This means that instead of paying $3,600 for her global fee, my out-of-pocket expenses are around $1,000 ($500 for the deductible and another $500 for the 20% co-pay). Labwork and birth pool rental are additional; she rents out heated, jetted Spa-In-A-Box pools, but I won’t need that now that I have a free La Bassine.

I met with the midwife early on in my pregnancy to talk about what I was looking for and figure out if she would work for me. I talked about my first birth and how I was looking for a hands-off midwife who would respect my need for privacy. I had a few specifics I quizzed her about: was she willing to not listen to heart tones at all? (No; she’d like to listen every 30 minutes. But otherwise she is fine staying out of the room while I am laboring.) Was she willing to stay in another room during the actual birth? (No, she’d prefer to be in the room as the baby is being born to keep an eye on possible problems). I am actually quite fine with having heart tones checked. I understand from a midwife’s perspective why it is important to listen. If I am inviting a midwife to the birth, she does need to have a way to know if the baby is responding well to labor.

The second point is more of a stickler for me, and it’s been on my mind a lot recently. I feel very strongly about keeping the “birth bubble” intact in the immediate postpartum period. Even many home birth midwives tend to do a lot of stuff right after the birth: putting a hat on the baby, rubbing it gently with towels, speaking with the mother, suctioning the baby’s nose and mouth, taking a full set of vitals every few minutes (baby’s heart rate & respiration rate, mom’s blood pressure, etc), feeling if the placenta has detached, etc. While these activities are not terribly interventive in the grand scheme of things—after all, baby is usually still in the mother’s arms—they do “wake the mother” and take her away from that critical time in which her primary task, physiologically speaking, is to produce high levels of oxytocin to help the uterus clamp down efficiently, the placenta to detach cleanly and completely, and thus prevent a postpartum hemorrhage. In Michel Odent’s article “The First Hour Following Birth: Don’t Wake the Mother!”, he explains how midwives ought to behave in the immediate postpartum period:
They first make sure the room is warm enough. During the third stage women never complain that it is too hot. If they are shivering, it means the place is not warm enough. In the case of a homebirth, the only important tool to prepare is a transportable heater that can be plugged in any place and at any time and can be used to warm blankets or towels. Their other goal is to make sure the mother is not distracted at all while looking at the baby’s eyes and feeling contact with the baby’s skin. There are countless avoidable ways of distracting mother and baby at that stage. The mother can be distracted because she feels observed or guided, because somebody is talking, because the birth attendant wants to cut the cord before the delivery of the placenta, because the telephone rings, or because a light is suddenly switched on, etc. At that stage, after a birth in physiological conditions, the mother is still in a particular state of consciousness, as if "on another planet." Her neocortex is still more or less at rest. The watchword should be, "Don’t wake up the mother!"
Pamela Hines-Powell has written about this as well (and I interviewed her more in depth about what she does/does not do at births for my dissertation). Immediately postpartum, her default routine—what she does unless the mother requests otherwise—is to stay silent, out of the mother’s line of vision, and quietly observe the mother and baby from several feet away. No one but the parents touches the baby for the first hour or so after the birth. The midwives only step in to assist or interact once the mother initiates contact (barring, of course, an emergency situation). For example, here are a few of her common birth & postpartum practices, taken from a longer post about her midwife identity crisis:
  • Routine vaginal exams - during labor or prenatally. It’s not uncommon for us to never touch a woman’s vagina - or even see her vulva - until the baby is crowning (if we can see it) or afterwards when looking for tears/lacerations.
  • I’m not going to do perineal massage or even support of the perineum (some women with land births like to have some rectal counterpressure) as baby is being born…but I’m not likely to do anything at all during second stage in water births…blame it on me trying to protect my back and not wanting my shirt wet, but really it’s because the mother does it all on her own - and she knows best.
  • I do not - nor does my wonderful assistant - usually touch the baby for a good hour or so after the birth. No routine checking the heart rate - we look and observe tone and respiratory effort. Only if that is in question will we come closer and do vitals or listen to heart rate.
  • I typically do not do much face to face labor support, breathing reminders or talk women through labor contractions other than a very occasional gentle reminder of why she is doing this or that her body is working so well with her baby. If a woman needs more than that, I’m there, but my default is to stay in the background and support women to find their own way of laboring (and they have a tendency to breathe pretty well without instruction, too!) .
I have found myself fretting unproductively (since I haven’t had the chance to actually talk these things over with the midwife yet) about whether or not I would be able to have an undisturbed labor, birth, and especially third stage with a midwife present in the room. It’s this fruitless feedback loop of worry and anxiety that has been weighing heavily on me. On the one hand, I have had an unassisted birth and can’t really see how it could be improved upon. On the other hand, I have felt a need this time around to have access to a midwife, and I need to respect that as much as I listened to my need to have an unassisted pregnancy and birth with Zari. How can I reconcile my desire for an undisturbed birth with the presence of outsiders at my labor, when even having my own husband in the room felt distracting to me, made me feel self-conscious, like I was being watched, like how it feels when someone reads over your shoulder?

I talked over these things at length yesterday with my good friend Jen, who has experience both giving birth and attending births. She had her first baby in a birth center, her second at home with a CNM, and her third unassisted, with a midwife hired as a photographer. She is also apprenticing with a home birth midwife, so has seen birth from the other end of things, so to speak, including several more complicated/complex births. At the end of our conversation, she suggested that I, or this new baby, might need something that this midwife can offer. Perhaps my task this time is to learn how to move past my fears about having a midwife and to embrace this pregnancy and this birth journey for what it needs to be, rather than always comparing it against Zari’s pregnancy and birth. I think she was very wise to say this. Maybe there’s something unexpected that will arise during this pregnancy or birth that is spurring me to seek midwifery care. Maybe I need to learn how to let people into my life and accept assistance. I am a very independent, self-reliant person, and I always want to do things by myself. I have already proven that I can give birth alone, that I can do it all without assistance. Perhaps I don’t need go through that particular rite of passage this time.

I am eager to talk through these issues with the midwife the next time we meet, since I need to move beyond the unproductive anxiety that I have been feeling. I don’t like that this pregnancy has been so dominated by these unsettled concerns. Now that my birth is drawing nearer, I need to turn my emotional and mental energy in a more positive, productive direction, towards creating the birth that I desire rather than worry that it might not work out the right way. I know that my concerns are minor in the grand scheme of things—you know, compared to people dying of AIDS or extreme poverty or domestic violence or whatever—but they are still real and important to me.


  1. Rixa, I have learned that pregnancy is a great transformative time, and sometimes that transformation takes us places we neither expect nor particularly want. And yet, it is necessary. It may be that this midwife and her skills are needed at sometime during this pregnancy or birth, or it may not, but it is good you are listening to your intuition. I don't see the point of loading up this comment with a bunch of advice since you are one of the most knowledgable women I know on the subject of birth. I guess all I can say is that each pregnancy, each birth, each baby really IS different, and those differences make the experience of parenthood amazing.

  2. Hi,

    I found it intersting reading your post. I am a midwife and I did attend a conference here in New Zealand last year where one midwife described her experience of providing safe care for someone who had lost a baby with her first pregnancy had horrific complications but who this time wanted a home waterbirth and didn`t want her to listen to the baby`s heartbeat during the labour. As she described the story and events there were audible intakes of breath from around the room. I must admit that I have never cared for someone during labour and not listened into the baby`s heartbeat but as I listened to this midwife`s story I found myself asking what would I have done in the same situation with the same request? This midwife described how she and the woman concerned discussed normal baby`s movements during labour and they agreed to monitor movements rather than the heartbeat there was that 'trust' issue which I am always thinking about. I find that I worry about the effects on me and my family and the woamn concerned if anything should happen. The ensuing investigation and often courtcase can drag on for years is it fair that i inflict that on my family for the sake of not listening in? And why if the woman understands i have a duty of care to ensure the safety of her unborn child does she not want me to listen in? Why bother having any birth attendant at all? I also wonder sometimes if we are suppose to work in partnership and such requests are made does she give any thought to the position she puts me in or does she not care at all?
    These are the many stimulating, thoughtful questions which I`ve asked myself.

  3. Rixa, during years of listening to mothers share their birth stories, I have learned one beautiful truth. Our instincts during pregnancy are powerful and meaningful. If you feel the need for assistance this time, even minimal assistance, trust that instinct.

  4. I find the points you bring up very inspirational to me as I contemplate what I want for my next birth (even though I am not yet pregnant). I have been reading your dissertation, and I absolutely love every bit of it. My whole soul craves the UC that I wanted and didn't get with my first child. It is interesting to think so deeply about why I still feel like I NEED to go unassisted. I am particularly interested in your section about intuition. It seems as if that is what you are working with right now, and perhaps what is guiding me for my next pregnancy.

  5. Once again you've proven yourself a wise woman. I agree that if you strongly feel that you should have a midwife present at this birth, then you should definitely heed that urge. And maybe, with time, you can come to terms with having your ideals of a "perfect" birth altered just a little. This might be the tradeoff you have to make in order to have the assistance you need.

    I felt sort of the same way during my pregnancy with Jacob. I was so utterly paranoid of every little thing, thinking it would "ruin" my birth. From internal exams, to people talking! Some of these things didn't even happen during his birth, and some did. Yes, some were disruptive (I love that my midwives were respectful enough to whisper to each other during labor, but it was still distracting), but all in all I was still able to "lock in" to the "zone" and give birth. Because after all, a midwife recording heart tones at a homebirth is pretty small potatoes compared to having an internal fetal monitor in a hospital bed. And I still had a fantastic birth even though it was a pretty far cry from what I'd imagined as the ideal.

  6. I too have been thinking about how to maintain the "birth bubble" this time around. Last time, we had a really great midwife. But there were some slight punctures in the bubble toward the end, and I ended up kind of sitting back and just following her instructions. It was a very subtle shift, and I wonder sometimes what would have happened if we had not brought her in the room until after the birth. Also I wonder how to discuss it with her for the upcoming birth.

  7. Don't give up. You can have a UC. Alot of those things you mentioned your husband I'am sure is capable of doing.

  8. FWIW I found that although I was surrounded by people during my homebirth, I really didn't sense anyone who wasn't within 12 inches of my face. It may be that even if she is in the room, you will not find her disturbing or care that she is there. I was just thinking about you and wondering if you'd settled on care -- I'm glad it's an option for you.

  9. So honest of a post-good to know what's on your mind-thanks for sharing. Maybe you'd like to hear my experiences...

    I wanted to say that you shouldn't feel like you working through your feelings is a minimal matter-they are very real and important right now to you and your family. I'm sure you know this, but take the time to get to a comfortable place and let go. It's important to get to a comfort zone and then let go. I learned that now comparing my #1 and #2 birth.

    I had so many conflicting feelings inside about care for, some reason, with my first birth that I just couldn't put my mind at rest even though I loved my HB midwife. I feel like the birth went just that way...mixed up because I didn't find comfort. I know now it was intuition. I knew I wanted a HB, but in the back of my mind I wanted to have many other things lined up that didn't really seem needed at hospital 1+ hour drive away (that hospital that I wanted there, but didn't want to ever set foot in). Well, I ended up exercising my back-up and I think that there was some intuition all along...

    With #2 I really felt so different, probably because it was #2. Haha. Also, I had a different feeling of just letting go and just feeling like I would be ready to make the decision when I needed to. This was following the intuition for this one. I did have different birth options here (thanks to being in WA state!) so I had a great flex with that which added to my comfort. But either way, the idea of being alone with my husband was important to me in both experiences and I think that intuition guided me in how to hand both differently.

    I basically was alone for most of #2, so that heeled the experience of #1 for me, but in the final hour I did have husband and midwife there and I feel like I still had this srong "bubble" around me that didn't even really notice them in the room or not. (sorry to husband-he was helping me I know). I was just doing what was already established with the time I had alone.

    So that could be a thought if you do have someone set up to be there-you would have your time alone until the last moment. I'm sure you've thought of this (maybe the last moment is the time you want to be alone the most). I even feel like there is no cloud of someone else over me in the moments during stage 3 though. Even when baby was being peeked at and touched by more hands then my own, I actually felt like baby was just as close as it was within me. If you have the right midwife, she will just blend as part of the birth that is really all about you and baby.

    Intuition is a tricky thing, but it's great it's making you think and look into each birth differently. I wish comfort for you.

    I wounder if you could have your own inner feeling of birth established yourself, even with another there? Then again, I don't know what complete UC is like-what a powerful moment that must be. I agree with Jen though, maybe something that you needed to do once to know that you can do it. And either way, you are still powerful just for giving birth!

    So these are my reflections-thanks for listening-fun for me to think about my births again. looking forward, as always to reading and learning from you...

  10. I've noticed this thing with third stage and midwives too, and I find it disturbing. When I watch BOBB or Orgasmic Birth, it seems that the sacred home birth thing gets thrown out the window as soon as the baby is born. Then it's Chatty Cathy midwife at your side wanting to talk to you about how awesome everything just went, and rubbing up the baby, and putting on a hat, and making sure the baby is crying, and moving you to a different spot, and making sure the placenta is coming out, and doing so many disturbing and loud things. It's just so confusing, especially because they interview Michael Odent who basically says to do the opposite of what they are doing, and then they show this chaotic scene as if it is what he is talking about. It doesn't bother me when something is done for a reason, like taking heart tones. But none of that third stage stuff has a purpose that I am aware of. I have posted on a discussion board asking why this stuff is done, and the midwives who responded basically said it is done because it is what the mothers expect and want, and if they don't do it the mothers will think that they aren't getting their money's worth. I thought that was a pretty poor answer and I challenged it, but no one had a better explanation.

    Are there any other midwives in your area? Have you talked to anyone in your area about the midwives who practice there? Maybe is there one who practices in a more hands off way so that you don't have to demand a different way then what she is used to or comfortable with. I know they are rare, but maybe it is worth asking around a bit to find someone more suited to your style.

  11. Would this midwife (or another in your area) be willing to just be on call for you during the birth? See her during the pregnancy for the reasons you mentioned (i.e. hemoglobin checks) but only call her during the birth itself if you feel like something isn't right. From reading your posts it seemed like you had a good sense of how things were going when Zari was born, so I'd assume you'd have the same intuition with this birth. Good luck in your decision.

  12. All I can say for now is: NO SECRETS. No wishes, no wonderings, if you cant discuss this stuff in a SUPER comfortable way with the proposed midwife then reconsider. Any teeny passive aggressive or unspoken stuff can get magnified and funky.

    That being said, the midwife is traditionally there to protect your space so YOU DONT HAVE TO "asess the newborn" and time placentas and stuff. To me that would break the bubble. Having to get back in my thinking-brain and be some doctor.

    Dr Jen? In the backroom?
    I wish I had deeper insights but hopefully these cool folks will help you work it all through. But DONT second guess wanting someone there. It is is pretty understandable. and if they are not intrusive, it could give MORe peace of mind than solo. and no, it doesnt negate your position in the UC movement or any such stuff. I love how motherhood changes everything--but its hard, too.

  13. Thing is, it's easy to read my narrative and think "oh well, that is her intuition telling her to find a midwife." But I am not so sure it is or isn't. I felt very much at peace with my decision last pregnancy, while this pregnancy has been marked more by indecision and fretting.

    I do, of course, reserve the right to call her as early or late as I wish. Part of me hopes that my dilemma will be solved by a fast birth! I keep reminding myself that I don't have to call her if, in the moment, I really don't feel the need to have someone around. Barring something funky going on early in labor, I probably wouldn't call her anyway until quite late in the game, even if I did want her there for the birth--basically I'd try to call her to come over at the same point I'd leave for the hospital, if I were planning a hospital birth. As close to pushing as possible, basically. Well, of course, it's always hard to know exactly how close you are until it happens...

    At this point it's not worth looking for another midwife. First because I think she will probably be fine; I just need to talk through more of these things with her and be clear about what I am expecting. Second, because I am not relying on a midwife the same way that other home birthers might. I really don't feel like I need her there except to assist in a rare emergency situation and to do some specific postpartum services; I'm not expecting or wanting emotional "support" or guidance during labor, something that other women really want and appreciate from their midwives. And--let's be honest--any other midwife would be a direct-entry midwife and I'd be paying completely out of pocket. And they'd all be much, much farther away.

  14. No words of wisdom as I don't have any babies yet, but I very much enjoyed your dissertation. It was easy to read, covered a lot of angles, and I do have a better sense of what drives a woman to choose UC.

    I also very much liked the juxtaposition that you presented regarding midwives vs ob compared to midwives vs UCers. I'm chewing on that one right now.

    It's also enormously helpful and fascinating for me to read about your thought process throughout pregnancy, so again, thanks for sharing your life with us.

  15. Great post, Rixa. I had a client who UC'd the first time with no problems and then felt led to have me there for her second. Of course she wanted it as hands-off as possible, which we did. She called us late and I think we did no more than two checks on the baby's heart before she was born. It was quiet and peaceful and beautiful.

    It was freezing out and I had concerns about the baby's head not being covered (something the mother insisted on), so I was okay as long as the blanket was on the baby's head. In the video, you can see me putting the blanket up and she pushing it off, it was interesting to see my actions and I learned where I could chill out better after that.

    I brought an extra heater and she had one in the room. We blew the fuse and it got freezing and black in the room; the placenta had not yet been born. We were very quiet, but checked for a separation gush under the blankets and on the video it looks like a group of girls telling ghost stories at camp. The mom LOVES the video and loved her birth. It was totally different than her 3rd birth, the UC. She doesn't know why she was led to have a midwife there - nothing untoward occured at all, but she still felt very glad we were there.

    If I were to sit in front of you, I would ask if it wasn't REALLY because you DO know more having attended births. You *know* much better now what *can* happen and that the things that can happen are not always (in fact, I would say rarely) because there was interference. Stuff just happens and having *skilled* hands can make the difference between life and death.

    I see transformation. I see growth. I am proud of you for facing these thoughts. Good job.

  16. You need to have a good honest conversation with your midwife about what you want for third stage, and why.

    At worst, she won't be comfortable with it and you will realize that you need to call her late or not at all to avoid interference that you don't want.

    At best, she will be open to your ideas and may change her practice not only for you, but for other women as well. Practitioners do learn and change what they do over time, and clients asking for something different is probably the most frequent impetus for such change.

  17. I think you are right, you need to talk with her about it and see if she is able to meet your needs. Remember you are paying her and she is providing a service, so if she won't provide what you want, you don't have to hire her.

    Do you think that your concerns come partly from knowing more about births and issues that can arise? Sometimes I think the more we know, it can make it more challenging to not worry.

  18. Responding to Barb & Sheridan:

    "If I were to sit in front of you, I would ask if it wasn't REALLY because you DO know more having attended births. You *know* much better now what *can* happen and that the things that can happen are not always (in fact, I would say rarely) because there was interference. Stuff just happens and having *skilled* hands can make the difference between life and death."

    I'd actually say that my experience attending births has made me lean more toward the unassisted route than not. It goes both ways, of course, but the only situation I have seen so far that could have turned out badly--baby born before midwife arrived, gray and floppy, didn't respond to initial stimulation, signs of secondary apnea--would have been better served with parents prepared for the possibility of an accidental unassisted birth. It took a few minutes of mouth-to-mouth resuscitation, which I performed; the baby was fine by time the midwife arrived. Some people would take this as a lesson about how dangerous birth can be and how you need to have a skilled attendant present, but I take it as a lesson about the importance of learning how to handle certain complications. Even if you're planning on having an attendant, you can't guarantee that they will be there when/if you need them. You might give birth en route to the hospital. Your midwife might not get there on time if you're planning a home birth. You never know!

    I have been to some great births and a few where, from my point of view, the midwife was inappropriately interventive and/or controlling of the laboring woman. This is said with the caveat that it might have been what the woman wanted from the midwife. But caused me, personally, to have some hesitation about inviting an attendant into the process.

    Of course, I am aware of all the rare but scary things that can happen, but more on a theoretical level than from my personal experience at births. You have to go to a lot of births to see some of these things! I've never personally seen shoulder dystocia or cord prolapse or AFE or uterine rupture, for example.

  19. Oh! I meant to mention that instead of waiting for the face-to-face meeting, perhaps you could email with her. I email more with my clients than talk on the phone with them anymore. I also text like crazy with my clients. I love using the technology we have available!

    And thanks for your afterthoughts. :)

  20. Hi Rixa, does your new midwife read your blog?
    You know my last birth and that my concerns were pretty much the same as those you list here. So you know where I'm coming from with this.

    Picture yourself at this birth. You see the doppler or baby hat or whatnot approaching. You have a choice. You can allow your mind to run in its usual circles around 'here we go, this isn't necessary, it's just going to distract me/disrupt bonding/mess with our experience etc.' Thinking so does make it so.

    Definitely, you and your midwife can and should work towards understanding and meeting each other half way. Communication, like Joy and others said. But you also have the power to train yourself to stay focused on what matters to you, remaining grounded in your body, immersed in your own positivity.

    I think we attach value judgements to these really, in the grand scheme of things, minor 'interferences' (I can't think of a neutral term myself either). I know I engaged in quite a bit of negative thinking. Then I figured that if I invite a midwife, it is to eliminate stressing about the really worrisome things, and to treat myself to the emotional benefits of the security of having that helping hand. So why not I relax into it?

  21. Thanks for sharing all that with us, Rixa--I feel honored by your trust in doing so.

    You know, it *could be* that you chose a mw this time because of some underlying sense that you will actually need a mw due to some difficulty/problem with birth or baby. Yet it strikes me also--drawing here from my own varied pregnancy and birth experiences as a mom and mw--that the issue of 'safety' is not necessarily one of 'physical health' at all. You moved fairly recently, you are no longer surrounded as you were when pregnant with Zari by a community in which you felt deep belonging and friendship.

    With Zari, you did not need a mw nor any of those friends to be with you at birth--it was enough that they were in your heart, 'there for you' in spirit, very much a part of all the ways you cared for yourselves and enjoyed spiritual and emotional health along with physical health. Of course, you also knew who you could call upon at need, should that have become necessary...but I truly believe that one reason it did NOT become necessary was because those people, that community, *was* in your heart and mind, *was* so intimately a part of your sense of well-being and safety at the deepest levels of yourself.

    Things are different for you now. I wonder if that missing (or perhaps only less-developed) sense of intimate belonging, safety, in your new community is at the root of your feeling about needing a mw for this birth. Of course, only you can know for certain.

    I mention it because it is something that really impacted my 4th birth, having moved in early pregnancy from a longstanding and intimate community situation to a new place. After 2 UCs, I also hired a mw there, though in retrospect I eventually concluded that she did not help matters any--only because having a mw's skills wasn't the issue. It was the feeling of belonging and safety, which ultimately she only provided in a small degree anyway (and provided it mainly, I think, because we became friends in the course of care--not because of her 'skills'). Also, I have worked with women in similar situations, being fairly new to their community and lacking that established sense of belonging as they approached birth. It was plain that this was a source of stress for these moms, something we worked with during pregnancy and afterward.

    Well, just another way to look at this. I hope you find it useful in some way.

  22. Wow Maggie, what an interesting way to look at this! Rixa will let us know how it resonated with her, but heres' how it resonated with me... I had a home birth with my first and I know that preparing to give birth thousands of miles from where I myself was born and raised, and where my family of origin still lives, had a lot to do with me choosing the most personalized care I could get my hands on. Midwifery met a very deep psychological need, over and beyond sophisticated intellectual opinions about natural birth and such.

  23. Maggie,

    Your response was very interesting and I appreciate your suggestions. It's an angle I had never thought about and, like Judit said, I can see how authentic midwifery care can really bridge that gap for women living in geographic or social isolation.

    It would be tempting to apply your analysis to my own situation, except (and of course you wouldn't know this unless you were a close friend of mine) my 3 years in Illinois--where I was when I became pregnant and gave birth to Zari--were characterized by social isolation. I had just moved from Iowa City, where I had a huge network of friends, birth-related groups that I was an active part of, and of course all of my interactions as a full-time graduate student. So when I had Zari, I didn't have any kind of real-life supportive network or community at all. I really had no close friends at all during my time in Illinois; the internet was my lifeline to friends I had made before that move.

    Where I'm living in now is much less isolating for me than when I was in Illinois, and I already have more social interactions and people who I could become friends with than I did in IL. So for me, I don't know if I could really say that the lack of a supportive community is what is driving me to midwifery care. Hmmmmm...

  24. My bad!

    I misinterpreted things you mentioned in your original post, I guess.

    Only you know what fits, and clearly my ramble on the topic was not so much on the mark. Maybe the only potential benefit to that ramble is the more general suggestion that there are a variety of possible reasons to feel a need for midwifery care after wanting and enjoying UC in the past. That is, your inclination could be an intuition about your own/baby's physical health/safety--could be about safety on another level.

    I trust you'll work it out in time, either way :)

  25. Hi! I stumbled on your blog after seeing it on my friend, Angela's blog. I just wanted to say that my mother gave birth to 7 children naturally and she always had a "feeling" about something specific to be prepared for/pray about. For example, one time it was meconium (and there was, but no problems related to it) one time she was concerned about a disfiguring birth mark (and there was, but it was small and in the shape of a heart) and one time she was concerned about hemmoraging- and she did- but they caught it in time. Perhaps your spirit knows something that your mind does not...that this birth may need something more than your last one. Or maybe not, but it's a thought. =) Blessings to you on your special and unique journey to bring this baby into the world. I'll be thinking of you as I prepare to have my own little one in the next few weeks. ~Shannon

  26. I find, with many areas of my life, if something `feels` like it needs attention, even if I don`t know why, that I should listen to my inner voice. Intuition doesn`t always use the same words or even language, as our heads use. But just being aware that our psyche knows something is up, is important, and trying to figure out what `it` is, is less so.
    What if your midwife watched the birth on a video monitor from another roomÉ She would be available if needed, but would certainly be hands off :)

  27. TracyKM, I've thought of that and maybe that will be one way to solve my need to be alone and her need to keep an eye on things. I'll have to see if she's willing to consider that. I do have a computer up there as well as a laptop, so I could easily hook up the camera to transmit to the laptop. They could even hang out on the front porch if the weather is nice and enjoy the show, so to speak!

  28. Wow, Rixa, sometimes reading you is like reading my own thoughts reflected back to me. I've gone back and forth on this same issue (to uc or not, to mw or not) with this pregnancy, too.

    I think part of it, for me, is that I keep learning more and more and sometimes knowledge is a hindrance to trust. Also, I have reason to be concerned about meddling people doing things like calling DSS for medical neglect and whatnot.

    Anyway, in the end, it looks like I'm UCing again because of circumstances (I don't have $1000, for example, even if that is all I'd have to pay, which it wouldn't be) and the mw I hired is not going to be willing to travel 400mi after I move (and i wouldn't ask her).

  29. Hi Rixa, I just breathed a huge sigh of relief. At first your choice in having a midwife this time around alarmed me, I even felt somewhat confused and betrayed as I saw you as such a wonderful spokesperson for UC moms. But as I read this last blog, I realized that pregancy and birth are so personal an intimate it is so difficult to make the choices we make. I truly hope you have the birth you desire and that your baby is healthy and that you are happy. I love your response to the Naval Gazing Midwife, btw.

    For myself, the only reason I would want a midwife around would be for the afterbirth - in case of an emergency situation and to help with the cleanup but the pros are pretty even with the cons as my need for privacy and birthing alone would definately result in more complications (I learned that with my first birth too, even having hubby in the room slowed my labor a lot, I really needed to be alone). So I think that for myself, having a midwife around would ease some concerns but ironically open up pandora's box to a slew of new concerns and perhaps complications that could have otherwise have been avoided.

    Thanks so much for your blog. I am sorry that I at first somehow felt betrayed by your desire to have a midwife, I guess you made me second question UC but after reading this blog (I do check your blog but not too frequently so I missed this one at first, stating your reasons for wanting a MW), I realized just what a tough position you are in. In a way I think you are looking for what we all want - privacy, autonomy but a midwife would provide the added benefit of security. Ironically, I midwife would also take away some of the privacy and autonomy so really it is such a tough call.

    I look forward to reading your birth story.


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