Thursday, 4 August 2011

Everyone Has to Start Somewhere

I could sit here and write out every detail surrounding my two pregnancies and births in the order in which they happened.  I could probably fill pages with this kind of stuff and would gladly share my stories with you any day.  But it might bore you to death.  If you were interested in reading a bit more about this kind of stuff, I have touched on it on my other blogs.  You can find it all here:
Life on the Bay - Finn's Pregnancy
Life on the Bay - Finn's Birth (VBAC)
Dear Children, Love Mommy - Tristan and Finley Birth Stories

As I have briefly mentioned, I did not put a lot of thought into my first birth.  I read about labour, the stages of it, and the options for pain management.  I knew early on that I wanted a natural birth, free of medications that might harm me or my baby.  But midwife care vs OB care?  Hospital vs home birth?  Cord clamping and cutting?  Birth plans?  How to breastfeed?  Fetal positioning?  Nutrition and exercise?  There was so much information that got overlooked.  I guess I just figured it would all play out, that I didn't have to do anything to prepare.  Sure, we took our Hypnobirthing classes (with Jennifer Elliot from Life's Journey) and we did learn a lot, but somehow so much of it went over our heads, like we somehow didn't need that knowledge because it would just fall into place.

When I found out I was pregnant, my first move was to see my family doctor.  I was curious about midwife care but didn't know anything about it (and assumed that I would need a referral as with an obstetrician).  I enquired about midwife care through my family doctor and she really did not have any information for me but said she would look into it.  A few weeks later the only thing I heard from her was that she referred me to an OB and my appointment was booked.  I figured that was that.

I was under OB care for the first two trimesters of my pregnancy, and never felt satisfied.  It's not that she was doing anything wrong per se, it was just so....impersonal and cold.  I would go there, the receptionist would hand me my stick to pee on and tell me to bring it back.  She would check it, write down the results, then I would sit and wait.  The waiting room literature consisted of pamphlets about cord blood banking, and long outdated fashion or home magazines, with maybe a parenting one thrown in.  Finally I'd get called in, the receptionist would weigh me, then I would wait in the examination room for the doctor.  She would usually come in, head down reading my file, rush over and feel and measure my belly, listen for the heartbeat quickly, then rush back out again.  Sometimes she'd ask if I had questions, and other times she was gone before I could say a thing.  If I did have a question she gave me this look like I was ridiculous.  It was not a particularly enjoyable experience, not to mention the fact that under OB care your baby is not guaranteed to be delivered by your own doctor, rather it would be whoever was on call, and I was not really comfortable with this.

It wasn't until 29wks pregnant that I wised up and switched to midwife care.  We were moving anyway so I took the opportunity to make sure I was under the care of someone I trusted.  We were fortunate that the practice took us so late in our pregnancy, but they accommodated us no questions asked, and from the minute I stepped into their office I knew this was the care I wanted.  It was open, bright and comfortable, with shelves of books about pregnancy, birth, breastfeeding, parenting, and everything in between.  The atmosphere was warm and inviting.  You peed on your stick and relayed the results to the midwife yourself, not having to hand it into someone else to look at (gross!).  There was a scale in the bathroom if you were interested in how much you weighed, but it was not necessary to use it. 

When I would go to my midwife appointments, I never felt rushed.  We would sit and just chat.  She would always ask me if I had any concerns.  She would listen to the heartbeat if I wanted, but didn't make a big deal about it being necessary.  She had so much more information for me than I ever hoped to get out of the OB

Not that I would say having an OB is the wrong choice.  For many women pregnancy holds complications and being under OB care means peace of mind.  And I am certain that so many doctors are warm and inviting, and offer more information to their patients.  But the choice between OB and midwife care was just one more thing that had I been more informed and done more research from the start, I would have done differently right away.

A healthy woman with an uncomplicated pregnancy should consider midwife care.  Birth need not be a medical event, and unfortunately all too often it becomes one when medical interventions are offered with what would otherwise be a normal, healthy pregnancy. 

Now, in my case even with midwife care, medical intervention was still present and was a huge factor in how my son was born.  I do not in any way think it was anyone's 'fault', but I do find it interesting to think about the circumstances and what could have been different.  While I felt very comfortable with my midwives and was happy with their care, something stands out to me now after having gone through pregnancy and birth with another practice.  As I have mentioned, my son was breech, and we wanted to try a technique called a External Cephalic Version or ECV.  I had done a little bit of reading about the procedure and from my understanding it would usually be done without any type of medications, and although uncomfortable it is not generally considered painful.  I had also heard through a friend who was also pregnant with a breech baby, that the midwives at her practice performed the versions themselves.  At my practice they did not do them, and referred me to an OB at the hospital who did.  When I met with her I was told that it would be painful, and therefore they recommended performing it under epidural anesthetic and also scheduling a c-section at the same time so if the ECV failed they would go ahead and deliver via c-section.  Additionally, if it did work they would go ahead and induce me the same day.

Well you can imagine that this was not what I wanted, and did not sound right to me.  But at that point I felt like I was entirely in the hands of the OB, and she more or less told us that it would be too dangerous to allow me to go into labour with a breech baby.  When I asked about having the ECV without the epidural, I got a bit of a "tsk tsk" and "Well, you can....but I would not recommend it".  For me, with my limited knowledge from what I had read, I was almost ready to stand my ground.  But my husband, who had not read a thing, was of course ready to follow everything the OB said.  And I did have to respect his wishes too.  I was not nearly as informed then as I am now, and as new parents we only wanted what was best for our baby (according to what the doctor said).

I think what surprises me the most here is that in this case the midwives did not have more to offer.  I know now from talking to others, from my own research, and from my experience with a different midwife practice that this should not have happened.  I should have been more informed.  Someone should have said to me "it would be better for you and your baby if you wait to go into labour", or "you do not have to do this if it's not what you want".

Also at the time, to attempt a vaginal birth with a breech baby was not entertained.  I might have tried, if someone had said to me "You can do this, we can do this" and had been confident in it.  But I was given a flat out no.  I do know that there were practitioners who may have tried, but I didn't know where to find them at the time. 

After my son was born though recommendations have changed, and I am happy to hear they no longer automatically suggest booking a c-section for a breech baby.  A trial of labour is recommended providing there are no complications.

Of course I do not blame anyone for anything.  If anything I should have been more informed myself.  I was clueless at the time, and my lack of knowledge led to a lack of voice to stand up for what I would have wanted.

I am happy to report that although our ECV failed and they were unable to turn my son around, I did have as wonderful a c-section experience as one can hope.  There is always a bright side, and ours it that everything went smoothly, and both my son and I were healthy and had no complications.  I have learned from this experience, learned to be more knowledgeable when important things are at stake.  And this is one part of what makes me want to be a doula, so that I can inform others and help them to find their voice.

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