If you are currently planning a birth, I recommend either not reading this for the negative thoughts contained within, or reading it all the way through so you get to the resolution. It could be triggering for birth fears, so take care of your own emotional state.
The first birthing stone Sam chose for me from the beach
As I said, yesterday I went over our birth plan and experiences with Mikko's homebirth-turned-hospital transfer in preparation for preparing our homebirth preferences for this time around.
There were a couple elements of our birth last time that made us consider, in hindsight, that perhaps transferring to the hospital had been the safest option — that the outcome would, in fact, have been worse if we had remained at home.
Our conversation yesterday with our current midwife turned that idea on its head.
It was both cathartic for Sam and me to relive the experiences with Mikko, and frustrating beyond imagining. To know now that likely our successful birth was sabotaged is a heavy load to bear. The good news is that we have new plans in place for this birth.
My biggest plan? Stay home.
When in doubt, stay home.
And, after that — stay home.
(Barring emergencies, of course. I'm going to be stubborn but not stupid.)
In Hypnobabies, it's standard to do a "fear release" exercise before a birth. I've been trying to release my fears of the last birth ever since it happened.
My biggest fears for this next time around were that the two problems that happened last time would repeat themselves and make our planned homebirth dangerous:
- Dehydration and IV problems: During my long labor with Mikko, I threw up something like six times. By the end, it was just bile coming up — my stomach was completely empty. I could keep nothing down: not the snacks I was eating, not water, not the Emergen-C ice cubes we had prepared in advance. The midwives gave me the two bags of IV fluid they had brought with them, which helped, but it wasn't enough to completely rehydrate me or bring down my dehydration-related fever. Going to the hospital allowed me to receive more IV fluids (and, sadly, antibiotics, since they assumed the fever must be due to infection and better safe than sorry, blah blah blah).
- Postpartum hemorrhaging: The thing that freaked me out the most about my birth with Mikko was the amount of bleeding I experienced afterward. Mikko's placenta was huge — since he was (11 pounds, 13 ounces) — it was about the size of a triplet placenta. (We like to joke that Mikko was originally triplets, but he ate the other two.) When it came out, the bleeding was severe enough that every face in the room was set and grim as the hospital's nurse-midwife worked quickly with the nurses and amid advice from my midwife (who had transferred there with me as a doula) to stem the flow: Pitocin in my IV, some sort of suppository, uterine massage ("massage" in this case meaning very painful mauling of your tender uterus), and one other action that I can't remember now — maybe a supplementary injection of Pitocin? I remember there were four methods they tried. I also remember lying there, thinking, "Am I dying? I don't feel like I'm dying. Do people know when they're dying? I don't want to leave my husband and my new baby."
That last one was the most harrowing. It made me wonder if we would have been emergency transferred postpartum if we had persisted in giving birth at home — primarily to stop the bleeding, and, secondarily, to restore my fluid levels. I imagined what it would have been like to have been separated from my newborn and loaded into an ambulance. I wondered if the delay at managing the hemorrhaging could have meant my death.
Yes, fear release needed, indeed.
I had moments (many of them) of wondering if I shouldn't just plan a hospital birth for the next time — just in case. The idea was repellent to me, given my bad experience in the hospital both during and after birth. Finally, after talking things through with Sam, I realized that the best option was to discuss my fears thoroughly with my midwife for the next birth (whenever that was going to happen — this was decided on before we started trying to conceive again), seek reassurances and evidence that she would have sufficient training and supplies on hand to mitigate the risks, and then determine whether a homebirth still made the most sense for me.
I should mention a couple things here in defense of midwife and homebirth preparedness: First, my original midwives did have IV fluids on hand and were able to administer them; my concern was that there be more than two bags available if I needed them in a subsequent birth, as well as perhaps having a heparin lock so that there wouldn't be as much trouble finding a vein once I was already dehydrated. Secondly, midwives are trained in stopping postpartum hemorrhaging, and I knew my original midwives could have skillfully done the uterine massage and that they had Pitocin injections on hand. I mostly wanted to seek reassurance that two methods (vs. the hospital's four) would be enough.
Anyhow, this is my current midwife's take on my two fears:
Dehydration and IV problemsShe asked me what and how much I ate last time. As I remember, I had half a big sandwich going into labor, and the other half the next day. I also snacked on something or other — apple slices, I remember, and we had popsicles as well. My midwives at the time had recommended having electrolyte solution of some sort and freezing some as ice cubes. One of the brands they mentioned was Emergen-C, and we had some samples on hand, so that was what we used. I also drank water.
All in all, for a 42-hour labor, I don't remember eating or drinking much at all.
My current midwife says the problem was the amount and the type of snacks I was eating. She said recent research (I haven't looked this up to confirm) has shown that, despite the digestion slowing down, birth burns about 1,000 calories an hour! It really is akin to running a marathon or some other endurance event.
Her advice is, as soon as contractions start, begin eating. And don't stop. She turned to Sam, who will be my faithful birth partner once more, and told him to pop in a bite and offer me a sip of water between contractions, using a glass with a bendy straw to make things simple. She said not to ask me if I want something to eat or drink, but just gently and confidently offer. She says (and I agree) that women are very suggestible in labor (suggestibility was the whole reason I ended up in the hospital!), but direct questions are harder to process. So suggest the things that will help a birthing woman, rather than confusing the issue by asking.
She said what likely happened last time was that I had too little in my stomach, which increased its acid content. Then I had acidic snacks on top of that (she didn't like the Emergen-C, for instance) and too little protein, and the throwing-up became a cycle, triggering ever more stomach acid, which in turn triggered ever more vomiting. And once you're truly dehydrated, it's hard to keep anything down (kind of a catch-22).
Now, I don't want to pretend that vomiting isn't typical in labor, because I've heard enough stories that I know it is. And, certainly, after the birth, I ate a whole meal and kept it all down and felt fine. Then again, I'd also at that point had several bags of IV fluids pumped in me so was no longer dehydrated.
Anyway, if you're curious for her suggestions for good labor snacks, here they are.
- Lukewarm/cool (not ice cold) flat water in a cup with a bendy straw
- Protein drinks: She recommended Bolthouse Farm Vanilla Chai Tea. I don't normally drink protein drinks, but I can see her point that they'll be easy enough sources of protein to consume and digest during this event.
- Electrolyte drinks: She recommended Recharge, which apparently has no sugar but is still very sweet. She suggested diluting it in half with water because of that.
- Fruit, but nothing too acidic. Bananas are a good, easily digestible choice for a quick potassium boost.
- Yogurt: Easy to digest, shot of protein and fat. (Well, if you get whole-milk yogurt, anyhow!) We actually have actual yogurt frozen (not to be confused with frozen yogurt!) that could be a nice, cooling snack as well.
- String cheese: Easy to nibble on in between contractions.
She didn't mention any carbs, but I know from experience that she favors whole grains. I plan to have some whole-grain crackers and bread available as well — for the midwife and her helpers as well as for myself.
Before active labor begins, any contractions can be a call to start eating a good meal with plenty of protein in preparation.
So I haven't tested this, but it seems like a solid enough plan to keep the vomit cycle from starting up again this time around. Which would render the IV situation moot.
I'm not really mad at my previous midwives for not giving me the same advice — for one thing, as I said, I haven't tested it yet anyhow. And every birth is different, and Mikko's was undeniably long so maybe that was just how my body needed to react. This midwife is older, as well, so I assume she has more experience under her belt.
I'm just glad that Sam and I have something to do this time to improve our chances of a good outcome, instead of worrying uselessly about history repeating itself.
This topic was the most interesting — and infuriating.
I had mentioned in my birth plan yesterday that we wanted the cord to stop pulsating before it was clamped and cut, and I mentioned my doubts that enough time had passed for that to have been the case.
Well, we were talking with the midwife yesterday about hemorrhaging, and she seemingly turned the conversation by asking if the cord had stopped pulsing before it was cut. I thought we were getting distracted, but I described my memories of the event and that I wasn't sure.
She said, "Well, if it happened within the first three minutes, it absolutely had not stopped pulsing." She said that cords take at minimum 7-8 minutes for the blood to stop flowing — and up to an hour.
Sam and I were both jumping in to say, No way was it 7-8 minutes. It seemed very fast.
The midwife said she's seen doctors — even one she recommends and works with in partnership as needed — slyly pinch the cord below the sight of the parents and then say, "See? It's stopped now." She said she had to kick a doctor recently for doing just that.
(In my admittedly limited research so far on cord clamping, I've found that doctors tend to view "delayed" cord clamping as anything from 30 seconds — seriously — up to, generally speaking, 3 minutes max. That's not what I would consider delayed, which makes it hard to find relevant research results. I already had known I wanted truly delayed cord clamping with Mikko, since I was near-anemic going into the birth, and then he was a big baby — I wanted to be sure he got as much cord blood as he possibly could. It's a shame that hospitals don't value this passing of the blood to the newborn.)
She explained to us the afterbirth process. The contractions that occur after delivery gradually pull the placenta from the wall of the uterus, shutting off the open blood vessels that are left behind. When the cord is cut too early or — worse — the placenta is yanked off the wall, the natural process is interrupted and all those open blood vessels — no duh — bleed. A lot.
But hospitals don't care, she said. Because they already have you hooked to an IV to push in Pitocin, and they have plenty of other ways to stop bleeding, and even access to blood transfusions if necessary.
Sam asked incredulously if there were any medical reason to clamp the cord early.
Nope, she said. It just made it more convenient for the doctors because it wrapped up the process that much faster.
A possible title I had in mind for this post was, in light of this, "Hospitals can bite me." I decided not to be quite so inflammatory, but I really am livid.
Why would it be routine to interfere with the body's natural processes (ha! why, indeed? the question that will never be answered) and endanger the patient and imprint her with inescapable fears about birthing?
So this time, the plan is to let the cord stop pulsing. Really, truly just wait.
And, then, if needed, she still has the Pitocin and the uterine massage at the ready.
Her take on my homebirth planI didn't intend to hand over my birth plan for the homebirth to her, but it ended up being less awkward than having me read from it to her. She confirmed what I already expected — that most of what I wanted was de rigueur with midwives any-old-how.
I had almost felt like I was writing it for myself, anyway. To reiterate what I wanted to do this time around, such as staying put and trusting in my body and my baby.
Here were a few notes she had:
- I will be performing Hypnobabies birth hypnosis. I'd prefer a quiet environment with my hypnosis tracks or soft music running in the background and dim or natural lighting. Please allow me to focus inwardly during contractions and avoid references to pain.
This was kind of a strange reaction, and the most negative aspect of an otherwise good visit. She said she attended the birth of a woman who'd "watched a HypnoBirthing video" and then was disappointed that her contractions weren't pain-free. First of all, I did Hypnobabies for Mikko's birth, and it helped me stay calm. Did it take away all the pressure of back labor? Not at all, but it kept me calm. For 42 hours. Of back labor. Secondly, Hypnobabies does not equal HypnoBirthing, though many people confuse the two. (HypnoBirthing in particular is often used the way we say "Kleenex" to mean any tissue.) I have an appreciation for both methods and a suspicion when people confuse the two that they haven't done much research into either. Thirdly, watching a video is not the same thing as studying and practicing childbirth hypnosis. Any childbirth hypnosis plan requires either classes or (AND!) dedicated home study. Fourthly, I don't know how accurate my midwife's perceptions of this woman's preparation and experience were. Fifthly, I don't much care if she thinks hypnosis is a bunch of hooey, as long as I get left to do it in peace, and it sounds like she'll respect that much at least.
- Sam will be present with me throughout the labor as my birth partner. I don't require the continuous presence of other attendants, though I am open to intermittent monitoring and conversation as I'm able.
At this point, she specifically said she and the other midwife assistants are "good at napping." She said they tend to stay out of the way and can make themselves at home, find their own snacks, and keep themselves quietly occupied. See, I love midwives!
- We plan to have Mikko downstairs with his aunt, although we'll make alternate arrangements if needed. Mikko is free to be present in the room with us or not as he wishes. He's indicated a preference to steer clear of the birth, so we're respecting that. Natalie has a tendency to become, unconsciously, very loud and converse and play boisterously, so anyone is free to remind her to keep things low-key as needed. We will leave out several quiet activities for Mikko to do, and Natalie is free to take him outside as well if either of them needs the break, or to put him to sleep in the other bedroom or at her home if the timing suggests this.
She listened to our directions that anyone was free to tell Natalie to pipe down as needed. Her only comment on finding out Natalie is a baby-loving nanny was that she hoped Natalie knew she was to be present for Mikko, not to ogle the birth. We have the same concern and are crossing our fingers — well, and discussing it thoroughly with Natalie beforehand!
- I'd like very few if any vaginal exams, and would not like Sam or me to hear any of the numbers, unless I'm confirming that it's time to push.
She reiterated that she barely ever does vaginal exams unless requested, and then usually only to clear the way for pushing. That's perfect. After reading this, I'm feeling confident about not asking for confirmation even then.
- I plan to eat and drink during labor. However, last time, I could not keep any food or drink down and needed several bags of IV fluids. I have veins that are hard to find in the best of circumstances, and which can be nearly impossible to locate when I'm dehydrated. If the same situation seems likely to present itself, I'd appreciate a heparin lock placed as soon as possible so that I'm free to move around between IV sessions as needed.
- I intend to use a birthing tub during labor. I am open to having a water birth but will consider my own preferences at the time. Due to our small water heater, we will likely need help keeping water heating on the stove, electric kettle, and crockpot to add to the tub.
We're now leaning toward using the midwife's tub with our own current kiddy pool as backup. She rents out the Birth Pool in a Box — doesn't it look lovely? It's quite deep and roomy and has a seat and handles inside to make changing positions and bracing easier. She said you can even sit on the inflatable sides without crumpling them. We would get the pool about a week before our due date, or on the day if I go into labor before then. For that reason, we're keeping our alternate kiddy pool inflated and ready to go just in case. We're having problems getting a replacement hose, so we're trying convoluted methods to clean the mildew out of the old one. The midwife's pool comes with a pump, (clean) hose, and attachments. The downside of the Birth Pool in a Box is that it's even bigger than our current kiddy pool, so we will have to move furniture for sure — and even then we'll have to measure to make sure it fits. Otherwise, we're back to considering our options.
One thing I incidentally found discouraging about my experience last time was that my midwife did not want me in the birthing tub during the labor. Because things were going so apparently slowly, she wanted me up and moving — walking, lunging, anything upright that might turn the baby and get labor moving along faster. The compromise was that I was allowed to shower all I wanted, as long as I did lunges on the shower edge during contractions. Let me just point out that, even if I were not in labor, 42 hours of straight movement is a hard job. But I would feel guilty whenever I bounced on my birth ball instead of doing something more active. But to bring this back to the birth tub, it started seeming like a waste that we even had it. I'd enjoyed it a lot during the early stages of labor before the midwife arrived, but now I didn't get to use it again, and in fact we ended up draining it partway through since all the water had cooled anyway, which was kind of the death knell to any hopes of using it again. Our current midwife, though, just had sensible guidelines for how to use the water. She said to keep the temperature about 96 degrees and then follow this timing: in for an hour, out for a half-hour. And that's that. She said anything over an hour without a break saps your energy (again, she cited a study I haven't looked for yet), and that she's tested this herself with her own hot tub. It's best to give your body a break between immersions so you retain those feel-good endorphins without setting off the sluggishness that results from too long a time spent in warm water. So I thought that was interesting and encouraging for how we best can use the tub this time around.
- I would strongly prefer not to transfer to the hospital this time except in case of emergency. Even if the labor seems long to you, please don't suggest a hospital transfer unless I convey to you that I am in distress, or birth monitoring indicates an emergency situation.
Sounds like she's with me on this. This is one of the points that was written more for me.
- I am receptive to intermittent doppler or stethoscope checks of the baby's heart rate, and intermittent monitoring of my blood pressure.
It sounds like they do the same sort of regular half-hour to hourly checks as our previous midwives, and they come to where you are and don't require you to stop what you're doing. (Like lying flat to get that stupid hospital monitor to quit beeping at me!)
- We would love any photos or videos of the labor and birth. There are no angles I'd feel uncomfortable having photographed or filmed. We understand you have jobs to do and don't expect anyone to be dedicated to providing photography services for us, but we will have our cameras out and free for use if we're too busy to record anything. Anyone who wants can take as many pictures as desired (including of yourselves!). We hope to set the video camera on a tripod to make it hands-off, but the still cameras will need manual operating.
She sounded noncommittal that she would actually take any pictures, but I'm glad I put it in there, and I plan to tell (or have Sam tell) the midwife assistants the same thing when they come over. Also, Sam knows that I think it's important to have pictures during the labor as well as the birth itself, so he's now planning to take what he can. I even looked into hiring a professional photographer, but it's pricey and seems odd to me to have a stranger around. The only other person we could rope into something like that would be Natalie, and she'll be busy. We hope.
- I'd like the freedom and encouragement to change positions frequently during labor, including going on walks, taking showers, bouncing on the birth ball, slow dancing with Sam, etc. I'd also appreciate suggestions for pushing positions if I need them.
No probs. She said she finds that most women move into the positions they need to, which I found lovely and reassuring. For instance, if a mother is squatting with one knee to the side, she'll find the baby comes out with a fist on just that side where the mother was intuitively expanding her pelvis to fit it through.
- I would like to push instinctively and as gently as possible. I'd appreciate support of the perineum if needed, but it's not required if things are going smoothly without.
We didn't really talk about this. I'm hoping to breathe the baby out without quite as much commotion as last time.
- I might like to assist in catching the baby if possible and if I feel comfortable with it. I would appreciate support and direction, however.
She was very receptive to this and said I could absolutely handle it. I feel more confident now about giving it a go. It's definitely one of my birth "fantasies." I loved the way Luschka from Diary of a First Child put it in this Natural Parents Network Wordless Wednesday post:
"Through my whole pregnancy I carried a great sadness, wondering how many hands would touch my baby before mine did. When I was lying back in the birthpool I said out loud how I wished I could raise her out of the water myself, to which the midwife said I could, no problem. I was so surprised and elated. I have no idea why I assumed I wouldn’t be able to, but it was the most amazing moment of my life. It’s the clearest memory I have."That brings tears to my eyes. Then again, I'm very much pregnant.
- Sam would like to cut the cord after it stops pulsating.
I also have this secret desire that Mikko will have come in to the room by then and want to cut the cord with Sam. I won't force it, by any means, but that sounds lovely to me, just as Jenny's older daughter did at her brother's recent birth (Babyfingers). (I've been reading some good birth stories lately.)
- I plan to hold the baby skin to skin and breastfeed as soon as possible after birth. We'd appreciate a continuation of the peaceful environment. Again, Mikko is free to come to us to meet his new sibling as he wishes.
This is one of those well-yeah-obviously things for midwives, not so much for hospitals.
- I am open to vitamin K being administered to the baby. In the absence of any risk factors (of which there are none currently), I'd rather the baby have no other post-birth interventions.
We didn't get to talk any post-birth routines. I'm glad that, for instance, circumcision and vaccinations aren't the norm at homebirths, so I don't even have to worry about those. I would like to hear her take on vitamin K, as my previous midwives were quite vocally for it.
- I had a great deal of postpartum hemorrhaging last time. I'd like assurances that there are adequate preparations and supplies for stopping postpartum bleeding, and I am open to any measures that are necessary, including uterine massage, pitocin injection, suppositories, and other methods.
Well, that was kind of the point of the above, so I won't repeat it here!
- I'd love for the weighing and checks of the baby's wellbeing to be done next to me on the bed if possible.
Again, this is expected with a homebirth and will be lovely.
So that's that. A couple weird-bedside-manner moments with scary stories as I've come to expect from her. But maybe my Hypno-Bubble is more firmly in place, because they didn't bother me much this time. I'm just cruising through to this birth and really looking forward to it. A friend the other day asked me if I'm getting scared (or maybe she said nervous). I really am not. This time around, I even know how uncomfortable and how much hard work it can be, but I'm still (unaccountably?) excited.
The only thing dragging down my mojo is (still) the timing of the homebirth vs. the horrific state of our home. We're working on the latter, but I thought I'd have at least two weeks (which sounded paltry as it was) to get the place shipshape before we could possibly imagine having a homebirth here. See, I'm four weeks from my due date, but the baby could come early, because it doesn't know that. (Silly baby.) I'm not expecting it to come earlier than right around the due date, but I don't get to choose. (Despite the fact that I don't believe in due dates, I also have fallen prey to the typical foolish thought pattern that the baby most likely has a little calendar in there and has circled the appropriate day to appear.)
I figured a homebirth would be ruled out, for insurance and licensing reasons, any earlier than 38-ish weeks. Before then, I imagined I'd end up in the hospital or, at the very least, the birth center. "Nope," my midwife cheerfully assured me, "any time after 36 and a half weeks is fine. So" — she glances again at my chart — "anytime from now on."
That's good news, ish. But, holy crap, do we ever have to clean now!
Stay in, baby. Stay in!
On that note, I'll finish with one other random story about the power of mind over matter (in this case, the matter involved in birthing). The midwife said she recently had a client who was going through a very stressful situation — her mother-in-law had died, and the family was in turmoil. The woman thought maybe her water had broken, and she was having contractions off and on, but they would stop whenever she lay down. But, anyway, she told the midwife on the phone, she couldn't have the baby now! There was a funeral to plan! We're grieving! It was all too chaotic! So she continued the whole weekend basically clamping her legs shut.
My midwife sent a fellow, geographically nearer midwife to visit her, and that midwife confirmed that the waters had indeed broken. But the woman's contractions were still only starting and stopping, halting entirely if she lay down.
After the funeral, she was talking to my midwife on the phone again, and my midwife said to her, "It's all right now. It's time. You need to let go and give birth."
And an hour and a half later, her baby was born. My midwife was still on her way, so she had once again called on the other midwife to hurry over, and that midwife made it two minutes before the birth.
While a sad story with the whole death aspect, I thought that was hilarious, too. Just how powerful our thoughts and hangups are, how much control we have over our own bodies (or how much control we concede to others, or have stolen from us), and how we welcome or block our births.
I'm on the razor's edge right now between welcoming and preventing. I can't wait until our place is cleaned up and serene enough that I can breathe out and say, "It's time. You are welcome here, little one, whenever you're ready."
I can't wait to meet my baby.