The plan

I’ve been thinking about this post for some time now – but it’s the kind of thing that some who I know read this blog might get very upset about what I’m going to write.

You see, I am now with a practice of homebirth midwives.

But let me explain.

A and I went through a lot of discussion about how and what to do differently for the birth of our second child. To this day it makes me sad to think of Z’s birth. My biggest regret is not knowing more about how hospitals typically work in the U.S. One thing I wish I’d realized then is that not only will I not have peace and privacy in which to labor, I’ll get disapproval instead of encouragement for not wanting an epidural, for wanting to walk around, for… wanting encouragement in labor. Which had the effect they’d desired: I got so anxious that my labor stalled completely, after 24 or so hours I did give in and got an epidural to be able to rest, then an hour or two later they put me on Pitocin, and I’m firmly convinced that the only reason I was able to then proceed to a non-surgical birth was because there was a shift change and a nurse with half a brain came on, along with one of my favorite doctors from the practice I was with, and they let A and I sit quietly in the hospital room and wait for Z to be born. The doctor I started with in the hospital just said, I’ve seen it all and I don’t know why any woman would want to deliver vaginally.

But then I had a fever (a not uncommon side effect of epidurals), and Z was slow to start crying (also a possible side effect of epidurals), and it was determined she needed to go to the NICU stat because she might have an infection. In the NICU they started to feed her by IV right along with her antibiotics, and wouldn’t let me breastfeed for more than 5-10 minutes at a time because (and I quote) she won’t eat enough that way. It was traumatic not to be able to take her home with us, not even after various bacterial cultures, lung ultrasounds and whatever other test came back showing she was just fine. No, they insisted on keeping her for a whole 8 days, continuing the IV antibiotics the whole time even though they weren’t needed anymore, continuing her on formula because “she didn’t eat enough breastmilk” (my milk only really came in once we took her home, but then within an hour), not even letting me hold her for more than 30 minutes at a time, every 3 hours. I used to sit next to her isolette just watching her sleep. Once, during the part of the afternoon when the NICU was closed to visitors, I watched through the window as a nurse tried to stuff a bottle of formula into Z’s mouth while she was wailing, wailing, wailing just to be picked up and held. Nothing made her happier than being held.

A and I felt like our child was stolen from us and we were powerless to get her back from the Institution. And we were both, independently, firmly convinced that there was nothing really wrong with her. Except of course who were we to say so? Would you risk your newborn on the off chance that your gut feeling is wrong? I wouldn’t. But… what a waste. Of a time in my family’s life that should have received much more respect. And, not least, a waste of medical resources spent on a mother and baby who more than likely did not need them. (Ever wonder how on earth the U.S. can spend so much on medical care yet do so badly according to most international health statistics, especially ones that pertain to maternal and infant health? This is how.)

I remember how numb I felt after that experience, and how it all seemed to be, somehow, not right. For a long time I tried to explain to myself that it was necessary but in the end I never could believe that it was.

And what happened was so simple: I needed someone to hold my hand and speak kindly to me, someone whose presence would also have reassured A, someone who knew what was going on and paid attention and knew when things were right or wrong, and wouldn’t have been shocked and slightly panicked when I dilated fully because she would have known what was going on with me, not just the fetal/contraction monitor.

I didn’t get anyone like that, not until the very end of labor when the lovely doctor was there. Instead I got pissy nurses and hellishly uncomfortable continuous fetal monitoring and having to stay in bed and being stabbed several times to place a hep lock. And disapproval. I had a doula so first I got disapproval from the nurses for that. And later I got disapproval from the doula that I wasn’t tougher, that I couldn’t resist the anxiety better and wasn’t able to get myself into a mental place to labor effectively. I asked A to send her home.

Turns out I just don’t work that way. I need real human contact and understanding and sympathy. I need being touched and spoken to kindly.

With this pregnancy, I began seeing an OB whose practice very strongly advocated natural childbirth, and has super-low c-section rates, and is on the faculty of a hospital with an in-house birthing center. It started out well – I really liked the OB for the first few visits. Then, starting with the third visit, I started to feel like she was lying to me. Maybe that’s putting it too strongly: maybe all she was doing was trying to influence my behavior in a way that she felt is most likely to lead to the outcome I desired. I am not completely sure of this yet… I have to get a good look at my medical records, which my midwives now have, before I’ll feel like I know what really happened. But whatever her intentions were – and I’m entirely willing to assume she meant well – what I felt is that here’s someone who’s lying to me in order to bully me. And that feeling alone was enough to give me so much anxiety that I had to face the fact that even if the OB was right, I would have a fairly troubled pregnancy and birth if I stayed with her practice. Because that’s how my body reacts to anxiety: it begins to mess things up that it could otherwise do without any problems.

I began looking at midwives who deliver in hospitals first but I kept getting the feeling they were uncomfortable with the idea of perhaps having to contradict an MD and, more disturbingly, seemed more concerned with following hospital policies than doing things that really make sense.

At this point, I’ve read enough international studies about maternity to be fairly certain that U.S. hospital policies are pretty far from infallible, and in many cases make fairly little sense. I’m sort of past the point of resenting that I have to do all this damn research because it’s actually quite interesting. But I’m going to save that for another post because Z is set to come back from the playground in 10 or so minutes and then I won’t have time to finish this post, at all.

I know two (now three) people in person and a bunch through blogs who did planned homebirths. It always seemed so… unrealistically lovely to me. The part that seemed especially lovely, though, was the prenatal care. That the midwife would actually look at them and not just their chart. That there was more to their pregnancy than the number of pounds they gained between visits. That – and this is the best part – their midwife talked to them and knew them by name.

I began to research homebirth in New York City and it seems there’s kind of a great community of homebirth moms here. Eventually I settled on a practice of two midwives, both of them amazingly lovely, who incidentally also have priviliges at a hospital 10 blocks from our apartment, and are backed up by some very good doctors. Given that I have a low-lying placenta which needs keeping an eye on, this seemed important: if it stays low enough I will need a scheduled c-section. Odds are it won’t – and in any case I need to get to the end of the pregnancy feeling supported and cared for, not bullied.

But what sealed the deal for me was that I got in touch with one of their former clients, a fellow Hungarian woman, who gave birth to two of her babies with them, and described her experiences as both peaceful and comforting (albeit hard and occasionally very painful), as well as reassuring in terms of the midwives’ medical knowledge. Not to get into details but they have the skills necessary to resolve things that would have become emergencies in a hospital – before they become emergencies.

Homebirth is… not well-received in Hungary, to put it mildly. This despite the fact that countries in the EU that have the best maternal-child health statistics, and the best birth statistics, like the Netherlands, actively encourage prenatal care and birth with midwives and giving birth at home, whenever possible. Actually, the Netherlands actively discourages birthing with OBs and in a hospital, when not medically necessary. So I have no idea how much my family will flip out about our plan: they are Hungarians to the core, and roughly one-fourth of my extended family is made up of doctors of various specialties. But… they practice in a way that’s totally different than is typical here. No four-minutes-if-they’re-lucky-per-patient visits for them: they consider taking the time to make their patients feel comfortable with them important to the healing process.

From my point of view, getting my prenatal care from the midwives we chose is a super-important part of the process. I may not end up being able to plan an actual homebirth and won’t know for sure for a while yet but in the meantime, I’ll be cared for in a way that feels comforting. And then if the placenta doesn’t do what it’s supposed to – we’ll go from there. And it’s not as though I won’t need professional handholding if I need to plan a c-section. I’ll need it even more, I think.

The one irony: our current insurance, as per their efforts to “lower medical costs,” doesn’t cover midwifery care. Because we all know how much cheaper doctors and hospitals are, right? I’m going to be appealing this, of course.