Friday, October 10, 2014

The Difference Between the First Birth and Third Birth

Previously, I posted on the differences between the First Child's baby stuff and Third Child's necessities. All clothing and toys have been sorted at this point, and just tagging clothing remains for the garage sale!

What helped the process along was that Nick and I went to my 18 week ultrasound last Wednesday. It's the only ultrasound that I'll have (not even a 'date confirming' one earlier, just doppler heart beat check). Planning to unload so much stuff, we found out the Third Child's gender, to be revealed later.

The rest of that day, I kept thinking back to my first two children's births. We had a wonderful doula present, Meg, who took notes and wrote up a one page summary for each child. Those are tucked into the baby photo albums along with prayer letters Nick and I wrote each child about 2 weeks before they were born.

The reflections below aren't what's in the kids' baby albums, but rather what's been on my mind as we approach the Third Child's birth.

The First Birth

Abigail was born at a private hospital. Due to working 12 miles from home with a 30 minute commute, I had chosen an OB/GYN practice that was only 5 minutes from my house and right next to the private hospital... on my way home from work. I had also chosen the practice because they were the only one in my town who had a Certified Nurse Midwife (CNM), but was rookie enough to not switch practices after two disappointments. The first downer was that the CNM only did prenatal appointments, no delivery. The second negative was that I didn't much care for the attitudes about birth of two of the five OB's. I used the first 20 weeks to meet with every OB and interview them about natural birth practices that I had read up on in books like:

Guide to Childbirth, Ina May Gaskin

The Womanly Art of Breastfeeding, La Leche League International

Birth Your Way, Sheila Kitzinger

Three of the OB's were open to the natural birth and breastfeeding practices that I wanted in my birth plan, but their attitudes were largely indifferent, "If that's what you want, then that's fine." The most discussion occurred around how I planned on declining the eye ointment (for an STD I don't have), delaying cord clamping, and that I wanted to use the squat bar (to push upright with gravity, not against it on my back). It should have been a tip off that in this private hospital, where OB's just show up to catch the baby as I push, it's really the nursing staff who would be working with my birth plan or not.

For the firth birth, Nick and I attended 30 hours of birth class education apart from the hospital. 3 hours weekly, for 10 weeks! It was worth so much more than the one day intensives offered through hospitals. We watched so many films like The Business of Being Born (2008), Birth Day (2007), and a film from Brazil where baby rotates unassisted and the woman 'catches' her own baby squatting. Every first time pregnancy needs to work through all types of fear, from pain to 'what if something goes wrong?' Seeing so many natural births alongside women who had interventions like IV's, forceps, C-sections, etc, helped me realize at a very late stage that only prayer and God's intervention would help me have the natural birth I wanted in this private hospital setting. We prayed mostly for the nurses who would be on shift as I labored.

Our saving grace --praise God -- was the second nurse on shift as I labored with Abigail: she had previously worked 7 years with midwives! My water had broken at 1am (41 wks) after a bathroom break, with contractions starting right away. I labored at home as contractions picked up until 5am, when the contraction timing was right for me to head to the hospital. Still hadn't called the OB practice at this point. At 3 cm dilation and -1 station, they admitted me to L&D. The crazy intake nurse kept expecting me to talk in the middle of contractions and started procedures without reading my birth plan. For the rest of the 2 hours that she was working, labor didn't progress much, which was no surprise since I felt like all my energy had to be given to watching her and advocating for my birth plan.

At 7am there was a shift change and the nurse with midwife experience brought a totally different feeling into the room. She turned off the sound to most machines, closed the curtains against the morning sun, checked the heart beat with the doppler instead of the belly band, and immediately suggested I get in a warm shower. No progress for 2 hours from 5-7am... but with the new nurse, I was ready to push in 3 hours by 10am, at 10 cm dilation and crowning. The only problem was that the OB on call was at home in her shower! I know now that trying not to push for 25 minutes while squatting at the squat bar and the baby's head is crowning is crazy... I should have just listened to my body and pushed with it. While I squatted, Abigail was born on the second push, at 10:30am. Some calculate labor from 3 cm dilation, some from when contractions actually start. From 3 cm, labor was only 5.5 hours, and from when my water broke it was only 9.5 hours -- on the faster side of the average first time labor of 12 hours.

The fight for our natural birth plan continued, despite handing out print outs, with an IV pitocin hook up being pushed (Why? I've come this far without anything hooked up. Is my uterus not clamping down correctly?). We had to repeat everything at least twice, from cord clamping, and declining eye ointment and vaccinations (Abigail did get a Vit K shot and the genetic testing heal stick), to rooming in with her. The maternity ward nurse came back three times in one evening from 7-10pm to ask if I wanted Abigail to go to the nursery so that I could sleep. No, thanks, I'm getting less sleep because you keep interrupting me! She also didn't have any thought to when labs were scheduled, and a tech arrived at 4am to draw my blood for an iron test, and then she came on her rounds at 5am. More sleeplessness...

Thanks to those 30 hours of natural birth classes, I knew to eat lots and right away. Due to a natural birth, eating right away, and rooming in together, my milk changed from colostrum to milk before 48 hours. Such a satisfied sleep look on Abigail after nursing :-) The lactation consultant who came at my request, took a cursory glance at Abigail's latch, declared it fine, and was gone within 10 minutes. She took zero time to really listen or care. We had to ask 4 times in 4 hours the morning we tried to go home, because the nurse on shift would say "Yes" and nothing would happen for an hour! Finally, she came at 11am with all the papers, and she kept pushing a bag of baby formula swag on me. After the third decline, which she ignored and just set the bag by the door, I accepted the stuff and donated it all unopened to a women's shelter within two weeks.

In all, I had the natural birth that I wanted at 5.5 hours of labor and no interventions, but it took a lot of vigilance and self-advocacy in this private hospital setting that was used to OB's and women who don't choose natural births.

The Second Birth

When I found out that I was pregnant with Evan, I immediately researched midwife practices on our insurance plan. Rather than opt for a location at my convenience, I chose one based on their reputation and mother-baby-friendly choices. I had to drive 40 minutes one way in traffic sometimes, but it was worth it in my thinking. Five midwives practiced with an OB (who delivered like a midwife but could do C-sections), and two doulas were on staff for labor and mother education. I chose to continue with the doula, Meg, since I knew her and her demeanor during labor. I rotated through all the midwives before 20 weeks, and only one midwife had a difference of opinion with us. When we found out the baby was a boy, we asked her to give the pros and cons of circumcision or remaining intact; the difference of opinion was that the way she educated us was not even handed, and kind of put us down for evening asking the question. I expected a more professional handling of the question. BTW, we did opt to leave Evan intact but it wasn't because she 'convinced' us!

Most of the reading I did during this pregnancy was just personal refresher reading on the stages of natural, unassisted birth, the beginnings of breastfeeding, and whether to circumcise or keep the foreskin intact. No classes this time around. No delving too deeply into sibling adjustment.

My estimated due date came and went. The midwives kept thinking that I'd go into labor over the weekend (40 wks days 1-3), but that unprofessional midwife was the one on-call. In other words, I knew that my body would be unlikely to go into labor knowing that she was on-call! Monday I walked 2 hours in the morning, and 2 hours in the afternoon, then at 4pm started bouncing on the exercise ball among other things to get contractions going. Nick was on break only through Friday of that week, and if Evan arrived late Monday or early Tuesday (40 wks 5 days), all the better. Within 1 hour of bouncing, contractions were slow but regular and increasingly close together. I was able to help Nick with dinner, eat lightly, put 24 month Abigail to bed and see my mother-in-law arrive home, and shower before contractions picked up to the point of not talking during a contraction. It was around 9pm, after the shower, that I had to concentrate and we called both the midwife and our doula at 9:15pm due to timing. Given the timing and our 40 minute drive, they had us head to Adventist hospital.

Adventist is so mother-baby-friendly, that the midwives work with them for deliveries (instead of a birth center) and it allows for no transfer in the case of VBAC's that don't work out. In 2012 this didn't exist when Evan was born, but now they have a birth center within the hospital! Our favorite midwife was on-call (I knew that she would be Mon/Tue), she arrived 30 minutes after us, and stayed with me in the room the entire labor and delivery, about 3h. The nurse on shift was training another nurse, and they just stayed out of the midwife and doula's way, quietly observing and doing the data entry. When I arrived at 10pm, I was 6 cm dilated and -2 station; after spending most of my time in the shower, by 12:15pm I was 9 cm. My water had yet to break, so the midwife gave me the pros and cons, but we did take her suggestion to break my water and push within the next 2-3 contractions. She would slip the remaining 1 cm of cervix over Evan's head like a headband (didn't feel it). Evan was born just before 1am, after 3 pushes. Since I'd been awake since 7am, did so much walking, etc, I was too tired to squat at the bar for pushing. Instead, I chose my side and this was more work with less gravity (3 pushes) to meet Evan, who was also 10 oz heavier than Abigail.

Post-delivery was so different! Evan snuggled chest to chest until the placenta was delivered, then the nurse asked permission to weigh and check his heart beat. My birth plan had been followed closely, and we didn't have to re-articulate our wishes even once: no eye ointment, no vaccinations at birth, delayed Vitamin K and heal stick for about 8h to promote bonding and latching, etc. We were given 2 hours pretty much alone with Evan to wind down and initiate breastfeeding, before being moved to the Mother and Baby room, where the nurse had a turkey sandwich and juice waiting at 3:30am! I didn't even request it!

The nurse consolidated her visits with the pediatrician and midwives -- all back to back --so that we were largely alone all day and night. We declined to bathe Evan (rubbed the vernix in instead), and were invited into the nursery for his hearing, heart, and genetic testing heal stick; the nursery visit occurred at 16 hours post-delivery and I was much more satisfied with the chance to breastfeed and bond with him than I had with Abigail. Because I delivered at 1am on a Tuesday, I did choose to stay at least 24h, but was home Wednesday afternoon after lunch; a 36h stay total with bleeding largely done and milk in. No baby formula swag offered, pushed, or in view.

The Third Birth

Living in a new city and state, I am glad to have prayerfully waited 12 months since we moved. I feel confident that Evan has matured and 3 years was the soonest he could handle becoming a big brother. 12 months in a new city also gave me time to sound out some other moms on their midwife recommendations. Missouri has friendlier laws for both midwives and home births but Saint Louis has an emerging birth center network. There are no midwives who deliver at hospitals and only one birth center (40 minute drive from home); the birth center has plans for a second, more centrally located birth center in the next two years. I've met two of the three midwives so far, and like their demeanor and professional opinions. We're incredibly blessed -- all prenatal, labor, and delivery services are covered at 100%. Until Nick and I sat down for a longer "Who is this baby?" conversation after the 18 week ultrasound, I felt undecided about going to the birth center or opting for the home birth; 40 minutes is just within the midwives' range for home births.

A birth center birth would mean a 40-45 minute drive on inter-state highway. After giving birth, we would have the room for about 3 hours, but then would return home. Abigail and Evan could attend the birth; we were considering whether to invite an adult friend or doula/midwife intern to supervise them, or to just have a friend come to our house to care for them.

A home birth has the benefit of no need for driving. Even if Nick biked to campus, he's only 20 minutes away from home, 10 in the car. It's an environment that is completely comfortable to me, and less adrenaline usually speeds labor. I'm guessing that labor will be at night again when I feel most comfortable and "mama bear in den", but we'll have back up plans for Abigail and Evan. We provide many materials and clean up. The one downside in my mind, is that our shower doesn't have a detachable wand to aim the water right on tight muscles.

In either scenario, our family is responsible for pediatrician checks and Nick will make all meals (there's a kitchenette at the birth center). I'm ambivalent about water birth in each case, too, having done just fine without it in the past.

After spending an evening naming this child, and talking through birth scenarios, we've decided on a home birth. We're looking forward to the experience, and meeting the Third Child!

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