Lola and the whole “Midwife” thing.

Let’s start off with a good laugh, shall we?

I should write this post before I lose my nerve.

You see, I am 100% on board with my decision to use a midwife.  Assuming I have a normal, healthy, uncomplicated pregnancy, I see no reason at all to go back to the hospital to have a baby.  I’ve already had a baby.  My pelvis is proven, ha.  I went into labor, it sucked for about about 10 hours, and then I pushed and out came a daughter.  It really was just about that simple.

But I have to admit, I’m a little gun shy right now.  First of all, I don’t want to jinx myself.  The moment I stand up and say I’m going to have a natural birth with a midwife is the exact moment karma will come and kick me in the butt and it will all go to hell in a handbasket.  My baby will be breech.  The cord will prolapse.  I’ll have placenta previa.  There are plenty of things that could happen that would make me say, “Well, scratch the natural birth.  The best thing for me and my baby now is for me to hop up on that operating table and let ole Dr. D slice me open real quick.”

Detailed-birth-plan-Dump-E-card

Second of all, frankly, I just hate that some of you will think I’m an idiot.  Or think that I’m selfish.  Or think I’m trying to be some all empowered hippie.  And I worry about that, because, well… I used to think that about other women.  If a woman muttered the word “midwife” or “home birth” or anything in that category, I automatically stereotyped her.  Stupid.  Selfish.  Ignorant.  That poor baby.  Yep, I had all of those thoughts.  In my head, it was simple.  A hospital is a safe place to have a baby.  That’s where qualified doctors are.  And a lot of things can go wrong in childbirth, so you need to be where it’s safe.  Period.  What is a midwife anyway?  They aren’t doctors.

But, then I got pregnant and happened to change my mind.  Totally by accident.

So, okay, if you already think I’m a moron, just know that I’m actually okay with that.  I’m not trying to change your mind.  If you want to have your kids in a hospital, I support that 100 percent.  Most women do.  I totally get it.

The purpose of this post is just to explain to you why I am choosing to use a midwife.  It’s not a post that is trying to change other people’s plans.  We as mamas do what we are most comfortable with.  So this is me….

So, it all started with my reading a really basic book about childbirth and breastfeeding.  I think it was something by Dr. Sears, but the first paragraphs discussed something about how mothers who had a natural childbirth typically had a much higher rate of breastfeeding.  I read that and thought to myself that I was not even remotely interested in having a natural childbirth.  I’ve never even broken a finger before, so finding out about my pain tolerance by “pushing something the size of a watermelon out of something the size of a grapefruit” did not sound appealing.  I wanted to walk calmly into the hospital with my hair curled and makeup done, chat on my cell phone while I sat on the epidural drip, and push when the doctor told me I needed to push.  I didn’t want to feel a thing.

If I had gotten pregnant a decade ago, I’m certain I would have done just that.  There was a lot less information available back then.  There wasn’t the obsession with Google.  There weren’t so many blogs.  I didn’t spend a lot of time at Half Price Books or Barnes & Noble.  But this was 2012.  I could look up anything I wanted to in just a few seconds.  And I found out a lot of new facts when I started looking.

Such as these astonishing facts…

  • In 2011, one in three women in the US gave birth by cesarean delivery, a 60% increase since 1996.
  • Today, approximately 60% of all cesarean deliveries occur among women with their first birth (primary cesareans).
  • Although cesarean birth can be life-saving for the baby and/or the mother, the rapid increase in cesarean birth rates raises significant concern that cesarean delivery is overused without clear evidence of improved maternal or newborn outcomes.

Those statements were all copied and pasted directly from the American Congress of Obstetricians and Gynecologists website.

So what’s so bad about a C-section anyway?  I have 13 nieces/nephews.  At least 4 that I know of were delivered by C-section, and guess what?  All 4 of those kids are perfectly healthy.  So are their mothers.  So really, a C-section isn’t such a big deal, right?

Until you learn that, well, C-sections ARE pretty darn risky!

  • Anywhere from 1-6 women out of 100 will require a blood transfusion following a C-section.   There is also a risk of infection at the incision site, possible injury to the organs such as bowel or bladder, and the obvious fact that the recovery time is much longer.  Most women spend 3-5 days in the hospital following a C-section (as opposed to 1-2 days which is more of the norm for a vaginal delivery) and 1 in 14 women report feeling pain even 6 months after their C-section is done.  (Source is here.)

And once you have a C-section, it’s almost a certainty that you’ll be pressured to have another one.  It can be really, really hard to find a caregiver that will help you have a VBAC (a topic on which I am certainly no expert), and then you have to worry that the more C-sections you have, the more dangerous it becomes…

  • The risks of placenta accreta [which has a maternal mortality of 7% and hysterectomy risk of 71%], cystotomy [surgical incision of the urinary bladder], bowel injury, ureteral injury [damage to the ureters – the tubes that connect the kidneys to the bladder in which urine flows – is one of the most serious complications of gynecologic surgery and ileus [disruption of the normal propulsive gastrointestinal motor activity which can lead to bowel (intestinal) obstructions, the need for postoperative ventilation [this means mom can’t breathe on her own after the surgery], intensive care unit admission [mom is having major complications], hysterectomy, and blood transfusion requiring 4 or more units [mom hemorrhaged], and the duration of operative time [primarily due to adhesions] and hospital stay significantly increased with increasing number of cesarean deliveries.
  • Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery.

Those bullets above are copied and pasted from a study published here, which was also quoted here.  I don’t know what half of those words mean, but I’d like to avoid things like blood transfusions, ruptures, and time spent in the ICU.

There are also plenty of studies out there that discuss how a baby’s health can be less than optimal if not delivered vaginally.  Babies come into contact with all kinds of beneficial bacteria when delivered the old fashioned way, for example.

So okay, after reading that cesareans can put me in danger, put my baby in danger, and maybe even decrease my chances of breastfeeding, I was pretty determined to avoid an unnecessary cesarean.

The more I researched, the more I learned that the best way to avoid a C-section is to have a natural birth.  If you do any amount of research you will find that once you involve an epidural and/or pitocin, your chances for having a C-section skyrocket.

So, I reluctantly began to consider a natural birth.  I took a childbirth class called The Bradley Method for 12 weeks during my pregnancy.  I read every book I could get my hands on about natural birth.  I talked with my OB at length about my wishes to avoid being induced.  I felt very, very comfortable with my OB.  For the record, I like doctors!  If anything were to happen to me, I know that he would have done anything in his power to get me and my baby out of harms way.  He actually had a very low C-section rate himself – less than 15% is what he told me.  (When compared to the national average of 31-35% that is pretty darn good!)  He didn’t exactly do a cheer when I told him I didn’t want an epidural, but that was fine with me.  (His exact response was, “You know there is not a special place in heaven for moms who give birth naturally.”  Thanks for that, Doc.)

Even though I really liked my doctor, really trusted my doctor, and felt the most comfortable planning a hospital birth, I had one lingering concern…

That whole due date thing.

My doctor told me from the beginning that if I didn’t go into labor by 41 weeks, he would induce me.  “Non-negotiable” were his words.  He never told me a medical reason why that would need to happen, but from what I have read it probably has more to do with his insurance than anything.  (Now I do realize that placentas don’t last forever and that sometimes it can be really really dangerous to let a mother go too far past her due date – but there are tests and things to consider before slapping someone with a non-negotiable deadline in the middle of a normal pregnancy.)  In my case, this was a really big deal because I just always knew that I would be overdue.  There are a lot of women in my family tree, including my sister, who far surpassed their due dates with their pregnancies.  And in my Bradley Method class we learned that actually, first time mothers who are not induced will go into labor an average of 41 weeks and 1 day.  That’s 8 whole days past due! 

I was especially scared because I actually got to see my sister have her third baby.  She was overdue and decided to get induced.  She went into the hospital and they gave her pitocin and an epidural, and for 24 hours very little happened.  I don’t remember how long exactly she was in that bed, unable to eat or drink (chime in anytime here Sissy!) but it was a LONG time!  And most of the hospitals here will not allow a mother to labor that long before they call it a day and order a C-section.  So since I’d seen firsthand that my particular gene pool didn’t respond so quickly to an induction – even after a due date – I just couldn’t help but worry about it.

I was due April 16.  Every day after April 16 was miserable.  I’d wake up and cry that I wasn’t in labor.  I went on a 6 mile walk twice a day.  I ate all of the spicy food, pineapple, and raspberry tea that I could tolerate.  I was so desperate at about 4 days overdue that I rode a horse bare back (stupid, stupid idea) in the hopes that it would bounce me around enough to trigger something.  People were telling me left and right, “You need to have sex so that you’ll go into labor!” and I’d look at them like they were idiots and retort, “Do you really think I’m not already doing that?”

Sorry.  But seriously y’all, I was doing everything I could.

On the 7th day I was an emotional wreck.  I had pleaded and bargained with my doctor until he gave me 1 extra day.  I now had until 8 days overdue before I was supposed to check into the hospital for Cytotec and pitocin.  I decided to try an old remedy and use castor oil to self induce.  I took two doses and it actually worked.  I had contractions for an hour, and then my water broke.

If that was the end of the story, I’d probably be having another hospital birth.  But to be honest, I just didn’t do so well in the hospital.  I found that it was a very difficult place to have a baby.  I was self-conscious from the moment we arrived.  I hated the moment where I had to hand the nurse my “birth plan” because I felt like they were probably rolling their eyes at me.  I got the sense that I was an annoyance for having certain requests, such as not being hooked up to the fetal heart monitor.  Honestly, I just didn’t feel like anyone on the floor (other than Oatmeal) was rooting for me.  Don’t get me wrong, everyone was professional.  Everyone did their job.  But being in a lot of pain in a bright hospital room with a very to-the-point nurse just made me feel extremely nervous.  In hindsight, hiring a doula would have been a FANTASTIC idea.  The American College of Obstetricians and Gynecologists just posted on their website today that “continuous labor support, including support provided by doulas, is the one of the most effective ways to decrease the cesarean rate.”  Sadly, I just didn’t feel a lot of support during my labor.

Other than just feeling like a nuisance, I hated that there was no way for me to take a shower or try any other “comfort measures” while in labor.  I’d read over and over again that many women felt a lot of relief if they took a shower or bath.  During one really bad hour of contractions, I asked Oatmeal to go into the bathroom and start the shower for me.  When he pulled back the curtain of the hospital shower, we saw that it was stacked with folding chairs and shelves.  Not awesome.

I’d discussed with my doctor and written in our birth plan (which he signed) that I would like to push during contractions, and rest in between contractions. Our childbirth instructor had told us that women generally tears less when this happens because it allows your skin to slowly stretch.  But when my doctor came into the room and told me to push with all my might, well, I felt like he was the boss.  I pushed so hard that veins popped in my forehead (or it felt that way), and sure enough, I tore pretty badly.  It took 4 months before I could squat or jog again.  Ugh.

Finally, I just didn’t like all of the interventions that occurred after Poppyseed was born.  We were overjoyed to have her and hold her and finally get to see this wonderful child.  But I was so busy looking at her that I didn’t even realize that they hooked me up to pitocin to make me deliver the placenta more quickly.  Honestly, I didn’t even know that was a possibility.  I wish they’d at least asked, you know?  It immediately made me feel freezing cold and shaky.  I think that if not for that, I’d have actually felt pretty normal after the birth.  Because it was otherwise drug-free, I was able to stand up immediately after having my baby and use the restroom.  I’m grateful that there weren’t any other bad effects from the post-birth pitocin, but again, what would have been so bad about just letting me deliver the placenta on my own instead of adding the pitocin?

We got so many weird looks for what we thought were simple requests, such as, “Can you please bathe her in here with us, instead of taking her to the nursery?”  We felt as if the hospital staff was a little bit annoyed that we insisted that our child always be in the room with us.  If she left for any reason, Oatmeal went with the nurses who took her, and they seemed uneasy about that.  But really, what other animal in nature gives birth and then lets a stranger walk away with its offspring??

Every time a nurse came into our room, they would swaddle her and put a cap on her head.  The cap didn’t both us, but we were trying to nurse and get as much skin-to-skin contact as possible.  We’d learned in all of our reading and classes that the best way to keep a baby’s temperature stable was to provide skin-to-skin contact with the mother, not to wrap the baby in blankets.  Yet one nurse sighed loudly as she watched me unwrap my newborn and put her back onto my bare chest.

When we asked if she could sleep in our room at night instead of going to the nursery, they told us that was okay as long as one of us was always awake with her.  (That’s pretty tough after laboring from 6pm-6am, you know?)

I thought that the number of weight checks were RIDICULOUS.  Our baby barely lost any weight in the hospital.  (Probably because we insisted she stay with us and nurse around the clock instead of going to the nursery.)  She was at her birth weight at check out.  So, why did they have to weigh her every few hours?  Why did it seem like someone needed to examine me or examine her around the clock?  Do you know how hard it is to sleep when people come into your room and turn the lights on that often?

Honestly, the two days that we were in the hospital were the worst.   I will never forget the second morning.  I’d spent the whole night with her on my chest, trying to stay awake so that the nurses wouldn’t take her from me to the nursery.  Finally Oatmeal said he would watch her and let me sleep.   Just as I drifted off, someone barged in and turned on a light.  I lost it.  I started sobbing and told the nurse to please, please, PLEASE just do whatever she needed to do and then leave us alone.  I was over it.  She scowled and said, “‘I’m sorry, I didn’t know you were like that.”  I still don’t know what she meant.  I didn’t care.  I just wanted to go home.

I came home thinking that there had to be a better way.  Over the next year and a half, I made friends with over 10 women who had used a midwife.  Some of them had their babies at home, some at a birth center, and some did end up needing to go to the hospital for medical assistance.  I’ve asked each and every one of them, “Would you do it all over again?  Would you have your baby at home again?  Would you use the birth center again?  Would you attempt a home birth again after having to abandon your first attempted home birth and go to the hospital after all?”  Again, I asked at least ten of my friends this question.  In person, face to face.  And the answers were all pretty much exactly the same.   Every girl responded that they would do it again in a heartbeat.  Everyone felt like they got the best medical care possible by using a midwife.  Even my friends who labored for 18 hours and didn’t progress said, “You know, my midwife eventually recommended that we go to the hospital so that I could get some pitocin and help me along, and I trusted her advice.  We went to the hospital and she stayed and supported me throughout all of it.  It was a great experience and I wouldn’t change it at all.”

I couldn’t help but shake my head in jealousy when my home birth friends talked about how nice it was to have their babies and then get into their very own beds to bond and nurse.  No strangers giving them odd looks if they wanted to hold their babies around the clocks, no hospital food, no strangers asking to take your baby into the next room.  Their midwives just came by their home periodically for weight/health checks on mother and baby, but otherwise they were in the comfort of their own homes with their own schedules.

I learned that a new study came out examining births with midwives at home, and over 95% of the women had successful vaginal births.  Less than 6% needed cesareans at all, and the infant mortality rate was actually lower than that of hospital infant mortality rates.

Yes, I know you were wondering that.  I wondered that too!!  Do more babies die in a home birth setting with a midwife than in a hospital with a doctor?  Evidently, the answer is no.

I met a midwife in my area with 28 years of experience and an excellent reputation. I absolutely trust her.  I find it very comforting that she has been working with mothers for as long as I’ve been alive.  And I actually love the fact that delivering babies is her ONLY job.  Just think of how much your OB/GYN has on his plate.  Delivering babies, hysterectomies, other various surgeries – I mean just try to imagine how many patients he has to keep up with in a given day.  Can you really blame him for saying, “Push as hard as you can – let’s have this baby now” when he probably has 10 other patients who are scheduled to see him that morning?  Frankly, I don’t blame him at all.

But I hope that no one blames me for loving the fact that my midwife is 100% focused on pregnant mamas.  Her patient load is WAY less than the average doctor.  I may be the only delivery she has in a whole week.  Each of my prenatal appointments is an hour long.  Usually I tell her I’m ready to go before our time is up.  It’s a far cry from having a list of 3 or 4 questions and not being able to ask my OB, who is rushing in and out of my appointment because he has an emergency across the street at the hospital.

I guess what I’m saying is… again, I love doctors.  I trust doctors, I do.  If anything goes wrong with my baby, I’ll personally hand a surgeon a set of scrubs and a scalpel.

But the bottom line is this.

Option A:  Using a midwife, where the national average for a healthy vaginal birth is over 90% and cesarean rate is less than 10%.

Option B: Going to a hospital, where strict policies result in over 30% of mothers having C-sections.

I’m going with A.  I hope I did an okay job of explaining myself.

If you’re like me and you like looking at hard numbers, here are a few things to read.

New Studies Confirm Safety of Home Birth With Midwives in the U.S.

Safety Statistics for Midwives in Texas Years 1990-2000

Safe Prevention of the Primary Cesarean Delivery

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Comments

  1. Great post. Although haven’t been brave enough to do a home birth and loved both my OB’s I can identify with feeling like I was annoying the nurses with my idealistic desires. Plus being required to stay can be stressful. I asked very nicely if I could leave a few hours earlier than designated time (OB and peds both said okay and released me btw), fill out a form to release them of liability etc. and was told if I left early insurance wouldn’t cover the birth so I stayed the full time which was fine. However, for a healthy baby and mama being at the hospital seems more stressful and less comfortable than how I imagine a home birth potentially being. With my first, if I hadn’t had a low c-section (10%) and super-relaxed MD, I would have definitely had a “failure to progress” diagnosis and probably c-section with my slow but very healthy 26 hr labor.

    • You know it’s funny that you say that, because honestly if I could strike up some kind of deal that I could leave the hospital (with the baby) within about 12 hours of the birth, I’d probably be way more likely to have another hospital birth. I mean my labor was only 11 hours, and only 5 of them were in the hospital. So the birth part wasn’t that bad – but AFTERWARD – woah. Difficult.

  2. Wonderful post! I am in the exact same position as you- I had a hospital birth with my first and am planning a homebirth with the same midwife as my first pregnancy. I have had moments of fear or nervousness but overall I am so excited to be at home with my baby! It’s interesting the way my perspective on birth changed after one healthy, normal pregnancy and birth and lots of reading on what normal birth really is – not a medical condition that requires you to become a patient, but a normal process that your body was made to do! Of course there can be complications, and thank God for hospitals and Doctors!

  3. Good job on this, sister. The thing I always tell people is that when it comes to the actual birth, what you discuss with your doctor actually doesn’t matter at all. I wish I knew with my first that the folks you need to make yourself comfortable with are the nurses because that’s who are there the WHOLE time. With #2, I went in several times during my pregnancy and made sure they recognized me and everyone there knew my plan. The head nurse gave me the “you’re not special for delivering naturally speech” but she came around when I told her how much I love my tiny hospital. And I do. I’m so lucky to love my hospital staff because I’d be right there with you. But when I got to the hospital, they asked me one time if I wanted medication and then it was never brought up again. They were all on my team. 🙂

    The mama/baby bond is the most important thing after the birth, and if the hospital doesn’t treat it as such, anyone should seek other avenues. Watching the human body work it’s magic is one of the blessings in life, and their job would be so much easier if they stayed out of the way. 🙂

    • Thanks Jamie. 🙂 I would love to give birth at a more supportive hospital. I have high hopes that with the new ACOG recommendations, hospitals and birth centers will soon be one in the same.

  4. DO IT! Homebirths are awesome!! I had an unnecessary emergency C-section with my first, then had a successful homebirth/vbac with my 2nd daughter. Hands down best.experience.ever! I am crunchy, so I won’t judge or take offense 😉 One of my midwives had a great way at looking at hombirths…as a choice. ‘Isn’t it great that a woman can choose how/where she wants to have a baby?’ It’s a choice-not a birth sentence. I would absolutely do it all over again, pain and all! It was the most beautiful thing I have ever experienced, in the comfort of my own home. Don’t discount midwives and homebirths…they are on the rise.

    Here’s my post on it if you’re curious:
    http://crunchyhotmama.com/2013/10/28/having-a-home-birth/

    PS: midwives don’t worry about baby being ‘late’ so no pressure on mama (provided all is going well). My other midwife delivered a baby at 45 weeks! Us crazy crunchies 😉

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