Posted by hippiehousewife on July 6, 2009 · 5 Comments
It was recently suggested on a (mainstream) pregnancy forum that those who birth with a midwife at home or in a birthing center do it only for the “experience”, and that the safest place to give birth is in a hospital “just in case” anything goes wrong. When I replied that midwife-attended homebirths were statistically safer than OB-attended hospital births, I was asked why that was. So, in my typical concise fashion (ha!), I replied.
An obstetrician’s training is in the pathology of pregnancy – finding and treating the things that go wrong with pregnancy. A midwife’s training is in normal birth. The difference in training focus typically means a difference in the way the two caregivers approach birth.
OBs who provide maternity care for healthy women often apply unnecessary interventions to those healthy women, rather than solely to the complicated pregnancies for which said interventions would be appropriate and necessary. This is the case both during routine prenatal care and during the labour and delivery itself. These interventions often lead to complications that otherwise would not have arisen.
Midwives provide a far more holistic maternity care, viewing pregnancy and birth as a normal and healthy part of life rather than something to be micromanaged and intervened with. Intervention happens only when medically necessary, and midwives are trained to recognize complications which require transfer of care to an OB.
Family doctors typically have lower rates of obstetrical intervention than OBs do. (A family doctor was my caregiver of choice for my first pregnancy. A midwife is my preference this time, with temporary care being given by a family doctor as we are currently in between cities for the summer.)
North America is unique in its common use of obstetricians to provide prenatal care for routine low-risk pregnancies and deliveries. Most countries use OBs only for high-risk cases, with the bulk of prenatal care provided by midwives. These countries, incidentally, have lower maternal and newborn death rates.
Aside from the use of OBs in normal, healthy, low-risk pregnancies, the hospital environment itself is not conducive to the safest birth experience for the typical pregnancy. Fortunately, steps are being made to improve that, with some hospitals far ahead of others, but the typical hospital birth still involves being denied food and drink, having continuous fetal monitoring which requires being in bed during the labour and delivery, and giving birth lying down on your back with a doctor directing your pushing and breathing (the most inefficient way to give birth, but the most convenient way for the doctor). Episiotomies, forceps deliveries, and vacuum-extractor deliveries are all performed with little restraint. Pain relief is encouraged even though it commonly leads to problems with the delivery (inefficient pushing, fetal distress, etc) and thus in turn leads to a disappointingly high number of unnecessary c-sections. Time limits placed on the length of labour, coupled with the pressure of doctor hours, result in drugs frequently given to speed up labour, which again leads to more unnecessary c-sections. Any unnecessary surgery introduces risks that would otherwise not be present.
None of this is to say anything of the emotional state of a woman labouring in a hospital versus labouring at home. Most often, the woman feels that she and her labour are under the control of her doctor, becoming a passive participant rather than empowered to direct her own labour. The L&D room is often full of various nurses, residents, and doctors, any of whom may interrupt the labouring woman at any time. She labours under the constant threat of interventions and, ultimately, “failure to progress” (AKA, in many cases, your doctor wants to go home). None of this promotes the sense of comfort, security and focus that enables a woman to labour efficiently. Unfortunately, the connection between a woman’s state of mind and the ability of her body to labour is often ignored in the hospital setting.
Finally, there is concern about the safety of many prenatal tests and postnatal procedures performed, both for the mother and the child, as well as the difficulty a woman often has in declining any of those tests or procedures.
Any one individual midwife is not guaranteed to provide holistic maternity care, nor is any one individual OB guaranteed to encourage unnecessary interventions on a normal healthy pregnancy/birth, but the trends are there nonetheless. I am wholly confident in the care that a good midwife can provide, as I am wholly confident in my body to be capable of doing what women have been doing since the very beginning. On the (very low) chance that something does go wrong, I am grateful that hospitals are there to provide care where care is needed – in cases of disease and trauma, not in cases of normal, healthy, life-giving events.
So no, I have not planned a homebirth for the experience, for my own personal satisfaction, or because all the cool pregnant ladies are doing it. I have a planned a homebirth because for my low-risk pregnancy, a homebirth is the safest option.
Posted by hippiehousewife on July 3, 2009 · 6 Comments
17 weeks tomorrow – approaching the halfway mark!
I’m at that point where I don’t really “feel” pregnant. I’m no longer sick and exhausted, but the tiny little movements I’ve been feeling are still small enough to be debatable (was that Baby? maybe?). I do have a bit of a tummy already, much different from last time when even at 6 months I still didn’t look pregnant! I’ve gained a little over 4 lbs so far. At this point, Baby should be about 5 inches long – that sounds so big to me. Wow.
I’m looking forward to my first ultrasound in less than two weeks. (Unfortunately, my husband will be out of town looking at potential houses to rent for when we move in the fall, so he won’t be there this time. My sister will be joining the boy and me instead.) No, we will not be finding out the gender. We didn’t last time and won’t next time either. I just can’t give up that wonderful moment, after all the hard work of labour and delivery, when someone shouts out “it’s a ___!” That moment is too perfect for words. I was never one who liked to peek at my Christmas presents anyway.
Fortunately, I don’t have a nursery to worry about (pink or blue? green or yellow?), as Baby will sleep with us for at least the first 6 months, but likely longer. We don’t need a new carseat for Baby, who will get the boy’s Britax Roundabout while he gets a bigger model. We don’t need a fancy travel system, as we look forward instead to the “second nine months” (nine months in the womb, nine months outside the womb) with baby snuggled up in a sling or wrap next to Mom or Dad rather than strapped into a baby bucket to be lugged or rolled everywhere. Some cozy gender-neutral zipper sleepers will get us through those first days, with some gender-specific ones added in eventually if this bambino turns out to be a little girl. No, I may be an obsessive type A planner, but I don’t need to know the gender to be wholly prepared for this tiny one.
What we are beginning to prepare for, though, is the birth. I have found a midwife and have my first appt (by phone) next week. My childhood family doctor is providing temporary prenatal care in the interim. What a difference between his five minute whirlwind appointments and the personal care provided by a midwife! I do admit, though, that I would have had a much harder time choosing a care provider if we were still in Ottawa, as we loved our family doctor there. She was wonderful through my last pregnancy, but unfortunately was not the team doctor on call the night I went into labour. I think it would be that – as well as hospital births in general (but that’s another entry altogether) – that would have convinced me to switch to a midwife for my maternity care this time around. Still, moving made the decision easy. We are looking forward to birthing at home under my midwife’s care.
We have also been preparing the little guy for his upcoming role of big brother. He likes to sit on my knee and talk about the baby growing in Mommy’s tummy (he seems particularly focused on the baby’s arms – “Baby grow big arms!!”). We talk about what he can do with the baby, and most of the suggestions have come right from him – sing to the baby, read stories to the baby, show baby “gentle”, give baby hugs and kisses, and, of course, play cars with the baby (okay, so some things will need to be clarified when the tiny little bundle of joy is actually here – but at least his heart is in the right place). We talk often about who we love. “Who does Jacob love?” “Opa!” “Who else?” “Daddy!” And so on and so forth. Then, “who does Mommy love?” “Jacob!” “Yes, Mommy loves Jacob very much. And Mommy loves Daddy.” “Daddy!” “And Mommy loves Baby too.” “Love Baby!” We talk about how Baby will drink Mommy’s milk too, something he brings up quite often now (“Share Mommy milk?” “Yes, honey, you will need to share Mommy milk with the baby.”) And on and on, in many different contexts, making this unborn child very much a part of our family and something for him to be excited about.
On the other hand, I don’t think I’ve yet managed to wrap my head around the idea that in just a few short months, we will have two little ones to love and raise. Who knows, maybe it won’t really be driven home until I hear those first cries, but it did become a bit more real a couple weeks ago. It was a very strange thing. I had just gotten the boy to sleep and was walking out of his room when he let out a tiny little cry in his sleep. Immediately my breasts tingled in that familiar let-down feeling – familiar and yet no longer familiar, it having been so long since they’d actually let down that way. It was that very strange sensation that made me take in a deep breath, suddenly vividly aware that I would have a newborn around the house again. The constant nursing, the sweet milky breath, the sleepy baby nestled next to Mom, the perfect tiny lips, that newborn cry – it all came rushing back in that moment. We’re going to have a baby.
Thank you, God.
Speaking of nursing, I had the bittersweet realization earlier this week that it had been a few days since my toddler had nursed – or had even asked to nurse. I wasn’t even certain I still had milk. The following night, wouldn’t it figure, he did ask for milk at bedtime, and I gave it to him. He seemed to be getting milk – but then last night, just to confuse his poor mother, he wanted to nurse again but most definitely was not getting milk this time (and wasn’t upset by the fact). I’ve never been able to hand-express, so I can’t tell that way. It’s just this surreal period of my baby possibly weaning, my milk supply possibly changing, and me feeling partly sad, partly happy, but mostly just accepting of it all. I’m content with where he is right now. He’s entirely nightweaned, he accepts his Daddy’s help when he wakes up at night (and sometimes going to sleep in the first place at bedtime), he nurses no more than once a day, and he himself seems quite fine with the whole thing.
While I choose not to actively wean my toddlers, nursing boundaries are definitely put in place along the way. Babies may not “twiddle”, a distracted baby will be given an opportunity to nurse at a later time when s/he is more focused on eating, a biter will immediately be set on the floor for a few seconds (and possibly be startled by my involuntary gasp or yell), older babies and toddlers must ask politely rather than tug on Mommy’s shirt for milk, and toddlers no longer get to nurse on demand – sometimes Mommy’s busy, and sometimes she just plain doesn’t wanna nurse you, hon. Because of my body’s sensitivity to nursing (extreme delayed return to fertility), I do limit nursing for toddlers slightly more than I perhaps would otherwise – morning, naptime, bedtime, nightwakings (though increasingly discouraged the older they get) and occasionally at one or two other moments during the day, but this is a gradual and gentle process that evolves along with the individual child. We tried, for example, nightweaning at a couple different points with the boy, only to find that he most definitely was not ready. When he was, the process went much smoother and with very little upset.
We’ve also found that a change in circumstances is a good time to change habits – moving to a toddler bed meant nursing for a while and then climbing into bed to sleep, rather than falling asleep while nursing as he used to. Moving to an entirely new house meant no more nursing in Mommy’s room – you can fall asleep in Mommy’s room, or you can have milk and fall asleep in your own room. Pregnant Mommy just can’t quite handle what she used to be able to, so we find options that we can both live with instead. It’s what we’ve always done, and I suppose it’s why I don’t feel as much worry as perhaps I should over the idea of adding another child to our family – we simply adjust the way we do things as they need to be. When something works well for us, we leave it. When circumstances change, we change it. “Flexible consistency”, I suppose I would call it. I know that things will change with a second child. Some of those changes we are already preparing for. Others we can’t do anything about until the baby arrives. The rest we can’t even begin to anticipate, having never experienced raising a toddler and a newborn before, but we can rest calmly in knowing that our lives will adapt to these changes, regardless of how much or how little we worry about the “how’s” and “what if’s” ahead of time.
Anyway! I can see the length of this entry is quite getting away from me. Time to leave some baby talk for another day – and time to get back to analyzing those strange feelings in my belly. Was that a tiny little baby kick??
Posted by hippiehousewife on January 5, 2008 · 5 Comments
I’m trying to be patient. I really am. But when people can’t even understand a concept so basic as “risk”…well, it becomes rather difficult.
Risk is the possibility of an event occuring. When I say there is a risk of such-and-such, I don’t mean that it will happen. I mean there is a possibility that it will happen.
So the fact that it didn’t happen to your sister/mother/friend/etc is, I’m sorry to say, really quite irrelevant.
There are risks associated with epidurals. There are risks associated with being induced. There are risks associated with medical tests. With formula. With babies watching television. With vaccines. With leaving a baby to cry alone. There simply are.
I just want people to think. To have all the knowledge they need to make an informed decision. Not to necessarily make the same decision I would – just to make an informed one. Maybe for you the benefit is worth the risk, while for me it isn’t. That’s fine – just be willing to recognize that the risk exists in the first place! I can respect that sort of decision. What I can’t respect is the poor logic of “such-and-such didn’t happen to so-and-so, therefore there is no risk”, or, perhaps even worse, “it won’t happen to me.”
Those two statements are so hurtful in the way they completely disqualify and invalidate the experiences of all those to whom it did happen. So it didn’t happen to your sister – that doesn’t mean it won’t happen to you. That doesn’t mean it hasn’t already happened to countless numbers of other women. Show some respect for those women – recognize that the risk exists. Just recognize that it exists.
Posted by hippiehousewife on August 23, 2007 · Leave a Comment
The more I learn about the world, the more I find myself saying I don’t wanna.
I don’t wanna do what I’m told.
I don’t wanna do it just because it’s normal.
I don’t wanna do it just because it’s expected.
I don’t wanna do it just because it’s mainstream.
I don’t wanna.
The more I learn about the world, the more I find myself noticing. Considering. Thinking. Deciding. Changing. Leaving the mainstream behind.
Countless unconscious decisions I once took for granted are now becoming conscious choices.
Maybe this is called growing up? (Except that I don’t see most people doing it!)
I don’t want to fill my house with chemicals just because P&G wants me to. I don’t want to eat food filled with crap just because it’s what the nearest grocery store sells. I don’t want to take every medicine known to man for every little sniffle just because the drug company needs to up their profit. I don’t want to give birth to a drugged-up baby just because the nurses tell me to have an epidural. I don’t want to pump my kid full of toxins just because the doctor says he should be vaccinated. I don’t want to leave my baby to cry it out just because society says he needs to learn to be independent. I don’t want to send him off to public school in a few years just because it’s normal.
And on and on and on and on.
So this is me, finally stepping up and saying, “Hey world! I don’t want to do it just because it’s mainstream!”