Friday, April 18, 2014

Why I Used a Midwife and Birth Center

I want to provide some information about the care model I followed because some people are curious, some are misinformed, and I want to provide feedback to anyone else considering a similar option.  This is a long post, so proceed at your own interest.

After a lot of research and education both on my own and during my formal university education, I decided before I was ever married or pregnant that a birth center model would provide me the type of care I wanted through pregnancy and delivery as long as I remained healthy, normal, and low-risk.  I feel blessed that I happened to move somewhere that allowed this choice.

My daughter was born at Mountain Midwifery Center (MMC), an out-of-hospital birth center, attended by certified nurse midwife (CNM) and registered nurse (RN).  CNMs are specialists who are medically trained first as RNs, then complete several additional years of graduate or post-grad schooling and clinical training in gynecology, midwifery, and newborn care.  In hospital settings they often attend births individually or in tandem with an OB.  They are distinguished from direct-entry midwives who are not required to receive prior nursing or doctor training and learn through self-study, apprenticeship, or a private midwifery school.

I wanted to use a CNM for primary prenatal care because for normal, low-risk pregnancies, midwifery care is associated with lower intervention rates, lower mortality and morbidity associated with interventions, fewer recovery complications, and increased positive outcomes when compared with other models of care (such as OB, family doctor, etc).  Using a nurse midwife was important to me because I still wanted someone with general medical training.  Birth centers are associated with the similar positive outcomes.

Since I was healthy and low-risk, it seemed like a no-brainer to me to go the CNM care route.  I figured if my pregnancy wasn't risky, why use the people who specialize in risky?  Its like if I have healthy teeth and gums, why have a periodontist clean my teeth when a hygienist will do just fine (and for cheaper too)?

CNMs perform all the same tests and screenings a doctor would.  They can identify abnormality that will put you outside their scope of care and they have a high interest in doing so. MMC only accepts patients with normal, healthy pregnancies.  Any number of circumstances can result in "risking out", or being referred to hospital care.  They want everyone to be properly cared for, even it means patients must be sent elsewhere.

As their website says, MMC is "an education-intensive program of care".  In addition to qualifying physically, MMC requires all mothers AND their partners to complete classes covering breastfeeding, newborn care, natural childbirth, and expectations for labor and delivery at  MMC.  If you don't do the classes, you have to go elsewhere.  We spent nearly 20 hours in medically-based, researched-backed classes taught by RNs, CNMs, board certified lactation consultants and educators, certified childcare educators, and a research director with a PhD of molecular biology. (All of the teachers held two or more of those titles).  The classes were invaluable for helping us feel prepared for labor, delivery, and postpartum.

Midwives can attend births in a hospital, but I wanted to use MMC because of its flexibility with supporting labor and delivery.  You can labor and birth standing up, kneeing down, squatting, using a yoga ball, hanging onto a sling, sitting on a stool, lying on your side, sitting in a tub of water... basically any position is encouraged if it feels good and helps you progress except reclining on your back with your feet up. Labor tends to be shorter and more effective when the mother feels safe and comfortable in her environment, and when she is able to maneuver in ways that open the pelvis.

One other way MMC helps women feel safe and comfortable is making sure all patients have at least one prenatal appointment with every midwife and clinic nurse.  You don't know who will be on call when you go into labor, and they don't want you to have any strangers at the birth.  And if more than one woman is in labor and may deliver close together, they call in the next on call midwife and nurse so every woman has at least two attending personnel taking care of them.  There is never any "Stop pushing! Wait for the [whoever is supposed to be helping]!"

Nurses use external monitors for tracking mother and baby's vitals which allows mothers freedom of movement.  And thank goodness!  I couldn't take a contraction sitting or lying down.  I could only handle it if I was on my feet and bent over the bed into a pile of pillows moaning.  In retrospect, even if I'd expected to have an epidural in a hospital, my labor was so fast and strong that I never could have stayed in the position required to insert a catheter!  Good thing I'd mentally prepared to do without it in advance.  I think it makes a difference in perceived and actual tolerance.

And do without anesthesia I did.  Not because I was particularly brave, or crazy, masochistic, or virtuous, but because the birth center doesn't employ an anesthesiologist.  Of course they have emergency medication and equipment, oxygen, etc., but as far as medication for comfort you have to go to the hospital for that. I was OK with going the natural route because I'm not comfortable with the risks and side effects of epidurals on the mother or the baby (yes, it does affect the baby), and the other interventions it necessarily precipitates.  For me, the option seemed better reserved for an emergent complication.

If in the course of labor and delivery a mother needs to be transferred to a hospital because of an unforseen complication, or the mother simply decided she wanted anesthesia after all, the supporting hospital Swedish Medical Center is literally around the corner.  MMC has a fantastic relationship with the labor and delivery staff, and all MMC patients have to preregister with Swedish to streamline admission in the event of an unplanned transfer.

MMC's statistics speak for themselves.  Their rate of transfer to the hospital for any reason (both emergent [i.e. placental retention, excessive hemorrhage] and non-emergent [mainly for anesthesia]) is around 12%, and their overall c-section rate is around 6%.  For comparison, Colorado's hospital c-section rate is 30%-40%. The statistics can't be directly compared since it pits normal, low-risk pregnancies against all risk categories, but the chance of ending up with a c-section is still much lower for a low risk pregnancy when delivering at the birth center than at a hospital due to the lower rate of intervention.

Like I said in my last post, delivering a child was the hardest thing I've ever done.  But even though it hurt and I did not enjoy it like some people reportedly do, I don't regret choosing this route.  I felt safe, healthy, educated, and well cared for throughout my entire pregnancy, labor, and delivery.  We were released to go home 5 hours postpartum to rest and recover in the comfort and privacy of our home, fully trained to monitor and care for our child and recognize signs of abnormality requiring immediate medical attention.  Six weeks later, I'm fit as a fiddle and my daughter is a model of infant growth and development.

Heaven knows how many people implied or outright told me I was crazy, or uninformed, or weird, or irrational for using a midwife and/or a birth center.  I'd never had a baby before.  I don't know what I'll want when it comes down to it.  I will for sure be crying for anesthesia, blah, blah, blah.... spare me.  I trusted myself and my capabilities so I was not assuaged by discouragement though I was hurt sometimes when people I respected tried to undermine or dismiss my plan.  I kept in mind that all advice is autobiographical, and someone else's experience did not have to be predictive of my experience.

God bless the women who did the opposite of the people above-- who told me I was strong and could do it.  They didn't sugarcoat the guts it would take, but they also reinforced my confidence.  It meant a lot to me to feel understood and empowered.  It also helped to talk to or read about women who had the same plan as me but ended up with induction or c-section because of special need.  Their stories helped diffuse my anxiety and helped me feel OK if things didn't turn out the way I wanted.

Yes, birthing carries risk, but not everyone carries the same risks.  I was fortunate to be low risk and have the low-intervention birth experience I wanted.  If that is a possibility for you too, consider it!  And if you want it, you can do it!  Be strong and informed and don't fear.  The default is success, not failure.  If it wasn't so, Homo sapiens would not still be around.

Whatever your situation, plan for the birth you want and need, then surround yourself with people who support it.  Pregnancy is full of enough anxiety that you don't need to add to it by fraternizing with downers.

Now, a treat for those of you who made it through the whole post:

Gassy smiles

First trip to the park!

Wednesday, April 2, 2014

The Spice of Life

As I approached 40 weeks, I was convinced baby wasn't going to arrive for at least another week.  They told us the average first time mom goes 10 days overdue, so I just prepared for that circumstance.  I felt like my pre-labor symptoms were diminishing instead of increasing so physically it felt like baby would hold out a bit longer.  I told myself and everyone else I was shooting for March 14 because I thought Pi Day would be an awesome birthday.

I went to my 40 week prenatal appointment by myself.  My husband usually came to appointments with me, but missed this one because he flew to Utah for the day to attend his best friend's wedding.  I convinced him the baby wasn't going to come on the due date and I was right.  Once he was home, mentally I let go and thought "OK, we're set.  It can happen any time now."  The mind has a lot more to do with when labor starts than a lot of people give credit.  

The next day I decided I needed to walk because I hadn't been very active my last trimester and it would be good for my circulation.  I made plans with a friend to go get ice cream in the afternoon while my husband was at work.  We slowly walked around the Highland neighborhood near downtown.  Then we went and picked up my husband when we was home from work and went out to eat at a local pizzeria.  

An hour after we got home, my water broke.

Two hours later, my contractions began in earnest. 

After about four hours of laboring at home, I slipped unknowingly into transition.   I threw up my pizza and my husband called the midwife concerned about my hydration.  She told him to bring me in immediately. 

Twenty minutes later, we arrived to the birth center.  I was checked and I believe the midwife's exact words were "your cervix is gone".  I could start pushing. 

Just under two hours and many pushes later, we introduced our baby girl to the world.

Birthing a human was the hardest thing I've ever done.  I love my baby and I'm glad she's with us, but it was not enjoyable getting her here.  I didn't have any complications or anything during labor and delivery, quite the contrary, but dang if it didn't take every ounce of fortitude I had to stick it out.  However, I don't regret any of my birth experience.  While it hurt, at the same time I felt empowered afterward in a way I've never felt before.  I know I'm tougher than I used to be, and that's worth a lot.

We took a few days to settle on her name.  I still mostly call her Baby because I call all babies "Baby", just like I call all cats "Kitty" and all dogs "Pooch", but legally she is Pepper Lee.  Now, enjoy our obsession: 

Heading home.  Those clothes did not fit at all.  The hat kept falling over her eyes

One day

Two days

Baby's first staring contest.  She won.

5 days. First family picture.  It just sort of slipped our mind to do one any sooner.

First shower

Almost 2 weeks
3 weeks.  Don't be fooled by Blue Steel.  It means she's filling a diaper.

Shout out to follower Sarah who correctly identified the book (Anne's House of Dreams) alluded to in the previous post.  Honorable mentions to Lara and Benji for correctly associating it with Anne Shirley.
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