Tuesday, April 27, 2010

Why I Chose a Midwife for Round 3

When I got pregnant with Ayden, I was so unprepared to have a baby that I could not emotionally cope with ANYTHING, including entertaining the idea of looking for a midwife. I wish I had, but I was nowhere close to ready to take charge of my health at that point. It took me three months to be emotionally ready to take prenatal vitamins. Yes, I am serious. Dead serious. I remember my mom gently suggesting a midwife a few times until I snapped at her to leave me alone about it. I just couldn't cope. And I knew that in 2003, finding a midwife who was taking patients was a feat that took some doing. There was HUGE demand, and very few midwives. Since then, the supply and demand have come closer together in my geographical area, so it is not a feat any longer. In fact, you can shop around a bit and find a good fit for your personality. Imagine that! In Canadian health care!

And you know the story. Ayden was breech. My doc referred me to an OB, who cut me open, and out came Ayden. On the one hand, I wonder if fate or providence or my subconscious was directing me away from 'birth' as an action that I performed because I was not ready. I mean, I still gave birth! I didn't say the subconscious was logical....

At any rate, I felt cheated. The instant my OB recommended a cesarean, I knew I would try a VBAC. It never occurred to me not to, because I knew it was possible. Is it because my parents and closest aunts and uncles were hippies who embraced all things natural, including birth? Is it because my mom had three vaginal births and spoke very positively of them? Is it because she was a maternity nurse? Was it because of a conversation I remember with her about natural birth, where she said, "Well, yes, [birth] is painful, but giving birth without drugs for pain is better." "Why?" "Because it's better for the baby."? I'm positive the conversation went much deeper than that, but this is what I remember most distinctly. Probably all of the above. Plus I had lived so much of my life anticipating becoming a mother by giving birth naturally. It actually didn't really occur to me that I wouldn't be successful--though my OB assured me at a post natal appointment, "There is no reason why you can't give birth vaginally next time." I remember thinking, "Well, duh. I never considered anything else." But I'm infinitely grateful for her, because she obviously believes in natural birth and the encouragement of an OB in a moment like that could make all the difference for a woman who wasn't quite so certain. And because she did the best she knew how at the time. And because she did a very good job with my surgery.

For my second child, of course I had an adoption agent to facilitate my airport birth. Adoptions are not necessarily a midwife's expertise per se. That birth was fabulous. Painful. Lovely. Unique. Miraculous.

For round 3, I was determined to have my VBAC. I knew from word of mouth and the small amount of research I had done that midwives had better statistics than doctors when it came to cesarean rates. I also knew I was higher risk for a cesarean for round 3 than your average woman, because I had already had a cesarean. So the #1 reason I chose a midwife was to maximize my chances of having a successful VBAC. Period. Doctors in my area have a cesarean rate approaching 30%. Midwives have cesarean rates between 5 and 10%. Done deal, no debate, no question, that was what I was going to choose!

Sometimes I can be a bit single minded, when I have a purpose or a goal in mind. I'm not sure if you noticed.

So, because I was looking for One Thing when I went midwife shopping, I was very pleasantly surprised to encounter a million and one other enjoyable or beneficial things about having a midwife for baby #3: VBAC, take one. I was so determined to go VBAC, I remember being surprised and a bit miffed when my midwife wanted to investigate my medical records to see whether I was a good candidate for VBAC in the early months of my second pregnancy. Like, duh. I TOLD you I was going to have one. What more do you WANT?

Ha, ha.

I was happy to discover that at every appointment, my midwife scheduled me FORTY FIVE MINUTES! And allowed 15 minutes between appointments, and so often spend an HOUR with me. EVERY TIME. Holy crap. I mean, what do you fill forty five minutes with in a healthy pregnancy? Let me tell you, I filled it. Always. There was the regular weight check, pee check, how are you feeling check, fundal height check, and doppler heart rate check. So that took ten minutes. But we always seemed to have lots to discuss, like which hospital to deliver at (based on 'friendliness' towards midwives and VBACs), which tests were available at that point in my pregnancy, and what those might divulge and what the risks and benefits were, diet and exercise, aches and pains, vitamin supplements, my eternal battle with yeast infections (worse when I'm pregnant), how my work is going, how my family feels about my pregnancy, who will be at the birth itself and around afterwards to help me at home, and a million small but significant emotions and thoughts and turmoils and happinesses and fears, which always seemed to leak out in the last ten minutes of our visit. It takes time to build trust, and to reconnect after a few weeks of not seeing each other, so those long appointments are critical to getting to those emotional bits. Midwives do their job so well because they know the women they are serving. You can only expect someone know how best to support someone as they journey through birth if you KNOW that person, at least to some degree, on an emotional and intellectual level.
Sometimes I suspect my doctor doesn't remember anything about me at all, unless she looks at my chart. My midwife remembered, because we had a relationship.

I was also happy to discover that my midwife asked me to weigh MYSELF, and to test my pee MYSELF, which made me more in control of my prenatal care.

I was also happy that she was available to me via pager 24 hours a day throughout my entire pregnancy. I got an ear infection late in my pregnancy and I paged my midwife to check her opinion of my doctor's prescription. I paged her when I thought my water broke the day I went into labour. I paged her the week after Riley was born to ask a question. No way could I EVER page my doctor directly. Let alone 24 hours a day.

My midwife was happy to make a backup plan where in the event that each of the three hospitals she had privileges at was full, we would set up to give birth at home. I preferred this to losing my care provider by going to a different hospital.

I was very happy to discover that when I went into labour, my midwife would COME TO MY HOUSE!!! To be with me in early and active labour, and help me decide when would be best to go to the hospital! And that she would STAY WITH ME from that point on, through active labour, transport to hospital, transition, pushing, delivery, and several hours after the birth. That was incredibly reassuring and felt very nurturing. I didn't have to worry about the logistics of any of that: she would watch over me and I would focus on LABOUR. Awesome.

Then, after the baby was born and I was discharged, she would COME TO MY HOUSE AGAIN!!! And as many times as I needed in the week after that she would also COME TO MY HOUSE!!!

She had training on baby care, breastfeeding, postpartum healing. herbs for my sore perineum, advice, support, and care. I really felt well taken care of. Which was amazing, empowering, and totally positive. I seriously wonder how on earth I found the midwives I did, who seem so well suited to me and my personality. (Thank you, Jesus). I also wonder how women DO IT without that constant, reassuring support of a medical expert on normal birth sitting beside them during the entire process. They held my hand when I asked. They encouraged me when I needed it. They cheered me on. I felt NO FEAR of the birth itself. I feared some other stuff--germs, infection, failure, exhaustion--but I did not fear giving birth. And fortunately none of my fears became problems.
Of course, Riley came out unconscious and needed resuscitation, which I had not anticipated and not thought to fear--and which would feature as a rather large fear for me in future labours--but I didn't know about it so I didn't fear it in advance with #3. And the fact that he needed resuscitation was a fluke of his birth, and did not reflect the skill of my midwife.

I wish deeply that I had been encouraged to or had initiated flipping onto all fours for Riley's actual delivery, or asked for the squat bar when I wanted it late in the pushing stage but was so deep in myself and labour hormones that to speak or ask for something took more effort than I had the energy for. I am sure Riley's birth would have been slightly faster and involved less tearing had I tried these positions instead of being semi reclined, which makes the pelvic joints slightly less mobile and flexible, and shortens the diameter of the pelvic outlet by up to an inch. With a large baby this would have been a beneficial inch to have at my disposal! And perhaps Riley would not have needed my midwife's hand to be slid up beside his head to aid a tight squeeze at the chest/shoulder level, and a third degree tear would not have ensued. And perhaps even his birth would have been faster, which would have meant a shorter time with his cord pinched between his shoulder blade and my pelvic bone, and he would have needed very little, if any, resuscitation. But who knows? And we all make split second decisions when giving medical care to people, and in retrospect other decisions could have ended in better results. I respect my midwife totally, and am grateful to her for her skill and support. My position at the end of pushing is the only thing I would change in retrospect.

I was happy that my midwives followed me an extra two weeks past the normal six weeks that is standard, because I had post partum anxiety. They did not let me go until they knew I had support and treatment started. And then they encouraged me to keep in touch. And if they had not both moved away, I would go back to them in a heartbeat with another pregnancy. The relationship I built with them was something that will stay with me forever. I feel a lot of love and respect for them and gratitude for what they were willing and skilled to give.

So I sought out midwifery care for a statistically better chance at a successful VBAC, and look at all the amazing benefits I was surprised with!

Oh, yes, and statistics won out, and I had my VBAC. I didn't need, want, or wish for drugs, an IV, an epidural, continuous fetal monitoring, or manual help during labour, because I had emotional support and an uncomplicated labour. Oh yeah, and the shower. I would have died without that shower!!! Women praise the heck out of birth tubs but I tell you I absolutely wanted nothing but to STAND in the shower with hot water pouring over me!
Which makes sense. 5'1" me, and 10 lbs of Riley: we needed us some GRAVITY!

I often wonder how much Ayden would have weighed at birth had he been left to cook as long as needed. He was 9 lbs at one week early~would he have been 10 lbs or close to it had he gone to his full term? Most first babies go 'overdue,' so perhaps. Maybe I had GD based on the size of my babies, but maybe I didn't after all. Because when I was pregnant with Ayden I sat on my ass and ate bags and bags of candy and boxes of oranges and bowls and bowls and bowls of white flour macaroni and high fat cheese, and when I was pregnant with Riley I ate carefully measured portions of high protein, low fat, complex carbohydrate ONLY, strict no sugar (except for Sara's baby shower) diet, and exercised daily and intensively, and my babies were relatively the same size.

Strictly conjecture, since I refused the GD test.

Anyways, I came for the statistical probability and went away surprised, challenged, nurtured, and totally changed. Lots of healing went on for me when Riley was born. Lots and lots and lots. Thank you, midwives.



Caryn Ouwehand said...

You made me want a midwife. I'm not pregnant... but somehow after reading this I want to find an excuse to get one anyways.

Rachel Clear said...

Great post. I love hearing all of these details and re-living those moments with you.

My midwives are awesome too, and I just love them. We have at least hour long appointments as well, which both Cam and I are really loving. Paging day or night? Yep. Totally awesome.

After having OB care followed by midwife care, I can't understand why ANYONE would choose an OB, unless they just simply didn't know what they were missing.

Dana said...

Awesome post. I feel the just same way. My midwives hold a very special place in my heart and indeed our family, forever.

I actually got to see my midwife for Eva just today! I was in the area and dropped in to congratulate her because I had heard she's expecting her third. Incidentally, neither of her first two babies tolerated labour well for some reason and she's going for VBA2C with this one. She totally remembered baby Eva.

God bless the midwives. And aspiring midwives! xo

Anonymous said...

I love Caryn's comment! Yes, midwives are so awesome, and I am so glad that you went down the path that you got you great midwives and now you are going to become one!

And yay for past hippie moms who embraced all things natural, and somehow passed that concept on to us even when they moved out of their hippieness! There was never any doubt in my mind about wanting a natural birth and 100% breastfeeding my babies, and I know that's because of my mom.

Jen said...

Love this! Your story is so inspiring. Your midwives have done the profession well. We need more of them!

Tonya said...

What a wonderful post. Midwives are awesome!