Well Rounded Birth Prep

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Tuesday, October 18, 2011

What do prenatal checkups look like with homebirth midwives?

I remembered viewing this video some time ago, posted by another momma who had an OB for her previous pregnancy and was seeing a midwife for this pregnancy. (Not sure of her birth location for either.) She put together this funny but 100% true video outlining the actual time spent and how it was spent, at her OB appointments vs. at her midwife appointments. The average amount of time a pregnant momma spends face-to-face with her OB at each appointment is 6 minutes. This momma actually spent 3 minutes face-to-face with her OB. That doesn't leave a lot of time for asking questions, discussing birth plans and preferences, and scoping out OB's birth philosophy and standard routines/practices, let alone relationship-building. My first pregnancy and birth was with an OB group that had 2 midwives in the practice, but the midwives practices were closely in line with the OBs', both with prenatal checkups and at births. The timeline in this video lines up with my experiences at the OB office.

I've had several people ask me what a typical midwife appointment looks like. It will vary from midwife to midwife, and it will also depend on where she practices (hospital, birth center, or homebirth). Her practices may depend on state laws or on the policies of the hospital or birth center where she works, if she's not independent.

Here's a photo essay of a typical prenatal appointment with my primary midwife of the last nearly-8 years, through 3 home waterbirths (thus far), 1 loss, and this upcoming birth. Angy (Angelita) Nixon, CNM has been my primary midwife through it all. Jennifer Stewart, CPM, was my assisting midwife at my other homebirths, and I love her to pieces, but she has a wonderful opportunity to move to California to attend homebirths. She'll be moving before I have my baby, so Dorothy Kaeck, CPM, will be the assisting midwife at my upcoming homebirth. Dorothy is wonderful too, and I'd have been happy to have had her at any of my prior births, but she has only been in WV for 2 years. Here is an overview of the personalized, one-on-one care I receive from my gentle, experienced midwives.

I arrived at my midwife's home/office for my prenatal appointment. What a view.

I got my kids settled in with the toys they brought and the toys that my midwife keeps in her living room for visiting children.

Unlike OB appointments that frequently require moms to wait with a full bladder in a waiting room for up to 30 minutes, I headed directly for the powder room, where I collected the sample, then tested it myself with the test strips my midwife leaves under her bathroom sink.
*Note* the Urine Collection Container in this photo is clean and empty. You're welcome.

This is my midwife's exam room. I didn't need it today.
My primary midwife, Angy, with her cup of coffee, just the way a prenatal should start.

My assisting midwife, Dorothy, making notes in my charts. I told her my weight from this morning when I weighed myself at home, then I told her that my urine sample was negative for both glucose and protein (which is good news on both accounts).  How freeing it is to have that kind of trust with one's care providers.

My kids think that my midwife's spiral staircase is the most fun part of the appointments. That, and smelling her candles to find their favorites.

Dorothy gets ready to prick my finger for the fasting blood sugar test.  She looks way too happy to be inflicting this... Just kidding. It wasn't bad. (At my previous appointment, she drew a vial of blood for the thorough 2 hour blood sugar test plus hemoglobin check and other blood screens. It all came back with healthy results.)

Explaining to my kids what Miss Dorothy is doing and why.

She checks my blood pressure.

My son tries to get her to smell his feet, while stealing her chair. Successfully. He's a charmer.

Having the fasting blood sugar test behind me, now it's time for breakfast. My midwife made me Starbucks coffee and put half & half and sugar in it and brought it to me. I had brought with me 3 pumpkin muffins I made, and I shared the 3rd one with my midwives.

Leopold's Maneuvers, which allow Dorothy to determine baby's position. He is head-down, Right Occiput Anterior.

My son is the blur on the left, always in motion, taking it all in.

Are your prenatals this fun/funny?

Dorothy gave me the option of listening to baby's heartbeat using fetoscope or Doppler. I prefer to use fetoscope when possible to limit unnecessary exposure to ultrasound waves. Dorothy was able to find his healthy heartbeat.

My son is fascinated. I wonder how this will shape his views of healthy and normal pregnancy and birth, for his own future wife and children?

My 5 year old knows more than most adults do about normal pregnancy and birth.

Dorothy let me try to hear baby's heartbeat with the fetoscope, but I couldn't hear it over my children's (quiet-ish) noise. I was content to take her word for it that she heard it and it sounded great. 

Dorothy measures from my pubic bone to my fundus. Baby is measuring 31.5 cm when I'm at 30 weeks, but that's within normal, and could just be a growth spurt or a due to his position.
I arrived at my midwife's home/office right at 9:30 for my checkup (9:30 checkup time). I had 0 waiting time. In between photos, we discussed how I'm feeling, whether I've experienced swelling (some but minimal), how frequently I've been noticing baby's movements and how/when to do kick counts, whether I've had Braxton Hicks contractions, whether I've had any troubling physical symptoms (I haven't), how to recognize symptoms of preterm labor, how and when to get rid of Braxton Hicks contractions, benefits of perineal massage and when to begin, benefits of Evening Primrose Oil and when to begin, what kind of birth control plans we have, what plans I'm making with my doula, scheduled my next appointment for 2 weeks from now, and chatted about what's new in the last 2 weeks since I saw them.

All inclusive, I was there 1 hour 15 minutes, with everything covered at a leisurely and relaxed pace. No wonder I so look forward to prenatals. It's just about the only time I have to devote to real focus on my pregnancy and baby, since life gets so busy with the everyday functions of running a house of 6.

I realize that there are a lot of variations in care among OBs and midwives. This is just *my* experience with *my* midwives. What have been your experiences? Have you changed care providers and experienced different practices?

Monday, October 17, 2011

"Look, Mom! I made a placenta!"

"Look, Mom! I made a placenta!" My 7 year old said this to me, completely not staged. This was with her brand new Silly Putty. See the umbilical cord attached to the placenta. I was a mixture of amused and proud of her. I guess it's pretty clear that she's the child of a childbirth educator. I'm sorry the pic is a bit blurry, but it's the only one I took, and I can't go back and re-do the whole thing and force her to make *another* placenta out of Silly Putty.

Sunday, October 16, 2011

30 weeks along belly pic

Yes, I'm 30 weeks along. Yes, I'm aware that's only 7 1/2 months. Yes, we're sure it's not twins, and we're as certain as we can be about our due date range.

I'm doing OK. I exercised so faithfully until a little over a month ago, then discovered that I couldn't manage to get myself and all 4 kids to the YMCA and back in a reasonable enough time to exercise *then* do homeschool when we got home, so something had to give. "Something" turned out to be both my Pilates class and water aerobics class. I am still trying to find something I can do that doesn't interfere with school (either with the time slot or with my energy level and ability to keep up with other life responsibilities). With my third baby, I did a great job getting on the treadmill 4-5 days a week, walking 25 minutes, but I have so much hip/pelvic pain that walking (waddling) is a challenge. I'm still seeing a chiropractor weekly for upkeep, maintenance, and prevention of malpositioning. I'm still taking the "right" supplements for my needs. I am still doing Spinning Babies inversions daily for prevention of malpositioning. I had lots of SPD pain and pelvic/hip pain with my last pregnancy. Sacroiliac pain began months ago. SPD started about a month ago, but not yet as painful as it got with my last baby. I guess it's the fault of relaxin + 6th pregnancy.

Reflux started several weeks ago, as well. I avoid eating late in the evening, and if I'm feeling refluxy, I eat ginger products that I have around from morning sickness prevention/remedy. The best solution, for me, has been sleeping on a wedge pillow. You know, ones from the home health section of pharmacies? I don't like sleeping on an incline, but it's the best of the available options. It beats getting up, going downstairs, then attempting to sleep alone on our recliner. It also beats sitting bolt upright every 20 minutes with reflux.

Church friends of ours, Kim and Dave, gave us an upright freezer for our garage! This was the most exciting baby gift I could have asked for. How was that a baby gift? I'm hoping to fill it before baby comes, since I won't have time or energy to cook for quite a while. Maybe I can get by with fewer grocery store trips if I stock up now, too. I have been saving an article from Better Homes & Gardens since October 2009 with brilliant organizing ideas for an upright freezer. Just wait til I'm done with this freezer. It'll be a work of art.

I guess we're cruising right along, trying to tread water with the same everyday things we all have with children this age (school, afterschool activities, feeding our family of 6+, and trying to keep up with the laundry). I just figured it was about time for an update, in case anyone was wondering.

Saturday, October 15, 2011

Pregnancy and Infant Loss Remembrance Day, whether I wanted to or not.

October 15th rolled around again: Pregnancy and Infant Loss Remembrance Day. I haven't mourned my loss of Evan Michael in so long I can't remember. (If you want to read the backstory, here's my post on The Day My World Came Crashing Down.) There are lots of reasons, I guess, but primarily because I've been too busy with responsibilities, deadlines, and other emotionally demanding issues that I haven't devoted any time to grief. I think I mistakenly tried to convince myself that I'm "making progress" or "moving forward" or some such baloney, since I haven't cried about it in so long and I can almost always talk about what happened calmly and with a level voice, as if I were recounting something that happened to somebody else, or maybe something I read about. On the anniversary of my loss this past April, and on the anniversary of burying Evan's remains in May, I didn't even get out my memory box or photo album.

It might have been October 15th last year when I last cried about Evan. I didn't pay much attention to October 15th coming up today. I didn't make special plans to memorialize his short life, light a candle during the Wave of Light around the world, or even post anything in particular about it on my Facebook. In fact, I rather wanted to avoid the subject altogether because I felt that if I ignored it, I'd be able to go along with my weekend as I have any other weekend.

Today snuck up on me and overtook me. Part of the difficulty of October 15th, for me, is that it coincides with Evan's due date/week, October 21, 2007. I feel on edge and melancholy from October 15 through 21, most years. Maybe I'm hormonal, at just-now 30 weeks pregnant. Maybe I needed a release valve for a number of other (unrelated) stresses. Or maybe I'm *still* ignoring the obvious: it was time to remember Evan, whether I was ready to or not.

I cried on and off all day. I managed to busy myself doing laundry, re-organizing the laundry room, culling outgrown kids' clothes, changing out seasonal clothes and new sizes for some of the kids, and using my label maker to get my laundry room and kids' dressers better organized (on the off chance that we could have people helping us with laundry after the baby comes). Anything that involves using my label maker substantially brightens my day. Additionally, Rick took me and our two older girls (ages 9 and 7; the 2 youngers are at their aunt's house tonight) to a Japanese Hibachi for dinner, which is a great show and an amazing meal. It was the girls' first time at a Hibachi, and they thoroughly enjoyed it. I felt much better once I got out of the house. I was too afraid to leave the house earlier in the day because I was afraid I'd have a blubbering meltdown, completely unprovoked, in the middle of the grocery store, at 7.5 months pregnant (but looking full term). I couldn't risk it.

Today, it felt like my emotional dam burst. I wanted to get it over with and move on with my day, but it kept resurfacing. I couldn't control or contain it. I just had to ride the waves.

I'd like to say, "Tomorrow will be better. Tomorrow is a new day," but I know that I won't truly feel the shroud removed from me until October 21 has passed, which would/could/should have been Evan's 4th birthday.

I guess I'm not immune to grief. Few are, and the odds were against me. It's part of the process, so I may as well embrace it, rather than feel like a failure for crumbling, for revealing vulnerability.

Wednesday, October 12, 2011

Midwifery = witchcraft???

One of my midwife friends, Laura Matthews, shared an experience with me recently that left me aghast. She gave me permission to post her story here.

Let me set up the backstory. Laura is a CNM with 12 years of clinical experience. She has supported births in both hospital and in birth center settings. She got her undergraduate degree at Bates College, her nursing degree at Fairview Hospital School of Nursing, and her Master of Science in Nursing/Midwifery at Case Western Reserve University. She has nearly completed her Masters in Biotechnology at West Virginia State University. She is researching her options to see which medical school will be the best fit for her as she pursues her goal of becoming an obstetrician. I'm thrilled that such a capable, qualified, holistic-minded midwife will serve in that capacity, and I'm really hoping she'll stay in our geographic area after she graduates from medical school. What an asset and a resource she is, and will be.

All this to say, Laura is a very educated midwife who has worked extensively to help and support mothers "within the system."

Laura was speaking with a recruiter of a prestigious medical school, who was set up at a table in the front hall of the science building to recruit medical school students and talk to them about the school and the admissions process. There were numerous current and potential medical students around the table. The recruiter introduced Laura to the group of students as, I kid you not, "Laura Matthews, who has 12 years of clinical experience as a witch." A worse Freudian slip has never been spoken. The crowd fell silent. Many of them turned bright red in embarrassment for the recruiter who so horrifically misspoke. Some of the students even tried to rescue the recruiter with jokes. The recruiter then stammered and tried to backpedal and salvage his introduction with a series of, "What I mean is..."

I realize that he didn't intend to call Laura a witch, nor did he deliberately attempt to publicly call midwifery "witchcraft," but that's the deep-seated-truth-telling essence of Freudian slips. Unless he had just concluded a prior, unrelated conversation with someone else about a witch costume for an upcoming Halloween party, it's my opinion that he must have accidentally revealed his true bias against midwifery and its legitimacy as a profession.

Midwives were the targets of persecution and literal witch hunts for several hundred years. Apparently, some modern-day medical school recruiters are *still* under the misimpression that midwifery = witchcraft. How sad.