At 3 a.m. on the morning of April 23, Dan and walked out of our house into a freezing cold spring night and got in the car, on our way to the hospital to meet our son.
That is how I will start the story of Isaac's birth when I get there. But in the final weeks of this pregnancy and particularly since his birth, I have been reflecting on what a completely different experience the last nine months were compared to when we were expecting Kate. In both of our childbearing experiences, we have been incredibly blessed to have healthy, uncomplicated pregnancies and safe deliveries. That really is what matters most and we give all the glory and praise to God. However, from a logistical perspective, the biggest difference between this time and last time was the model of care that we chose for this pregnancy -- a midwife instead of an OB-GYN.
While I was pregnant with Isaac, I was surprised by the questions I got about this choice. Would the midwife have a doctor helping her at the delivery? (No, not unless I need a C-section for some unforeseen complication.) Did my midwife send me to get checked for gestational diabetes? (Of course.) Would my midwife let me get an epidural if I wanted one? (I'd like to see her try and stop me.) And we'd be having the baby at a hospital, right? Really? (Yes, really.) It became apparent to me that there are a lot of misconceptions about the work and qualifications of midwives. The most common misconception I came across was that midwives only attend home births. I am all for home birth. I know a lot of people who choose that setting for their deliveries, and if you want to have one, I think you should be totally supported in that. It's a really personal decision, and as a couple Dan and I know we're not up for that. The midwife who took care of Isaac and I was part of a large practice split evenly between midwives and OB-GYNs who do hospital deliveries. Still, the questions I got made it clear that people really do think only doctors are qualified to deliver babies.
The questions also made me realize that not everyone lives in a state where midwives are well integrated into the health care system, and that New Mexico is actually pretty progressive in this area. According to the American College of Nurse-Midwifery, in 2004, the most recent year for which statistics are available, there were 177 midwives at 119 nurse-midwifery practice sites here in New Mexico, and certified nurse midwives delivered 7,977 babies, 35 percent of the babies born statewide. To pick out another state for a not-so-random comparison, my home state of Mississippi reports just 25 midwives attending at 3 percent of births in the state. Without spending too much time on the many and complex reasons for the state-to-state differences, what I'm hoping to accomplish with this little narrative is simply to talk about what my experience with a midwife was like so that anyone who isn't familiar with the model of care can hear at least one personal story about it. Because I believe information is good. Journalism. It's hard to get out of your system.
One thing I want to make clear is that OB-GYNs do very important work. Right now, I am following online the stories and prayer requests of two friends whose babies have been born prematurely due to various serious issues that arose during pregnancy, and I am thankful that they and their babies have had gifted, compassionate doctors managing their care. Should I ever have a pregnancy that is less than straightforward, I will seek out the services of an OB-GYN in a heartbeat. But in the United States, we structure pregnancy care in a way that funnels even healthy women and babies to an OB-GYN, a specialist and surgeon who is trained in the management of medically complex pregnancies. In most of the rest of the developed world, healthy women having healthy pregnancies are seen by midwives, and OB-GYNs are reserved for women who need their expertise. Again, there are a lot of reasons for this that people other than me have addressed much more eloquently than I could do. (There's a great documentary called The Business of Being Born.You could start there if you want to learn more about this issue.) As for me, to tell the first part of Isaac's birth story properly I feel I have to back way, way up and talk for a while about some of the things we experienced during Kate's birth that lead to us making different decisions this time around. There will be some recurring characters from that birth story, so if you want to read it to start with, go here. And now, Part One of Isaac's birth story, which I call "Why I Broke Up With My OB."
A final note: I realize that by doing this, I am forever alienating my remaining three male readers. I'm sorry guys. I know. I'll try to make it up to you later. Feel free to excuse yourselves. I totally understand. OK. So ...
When I found out that I was pregnant with Kate, we were on a Christmas trip visiting family in Mississippi and Texas. We had been talking about starting a family for a while, but I had not given any thought to what I wanted for prenatal care. Thus began chapter one of our first pregnancy story, which, if it had to have a title, would be called "How Not to Pick a Doctor." Here's what I did. The first morning we were back in town, in 10 minutes I found between getting ready to go to work and getting in the car, I did a quick Internet search to see what OB-GYNs our insurance would cover. I definitely wanted a female doctor, which narrowed the field considerably. Like down to one. Her professional bio was impressive (Ivy League, spoke several languages fluently, etc.), and so that morning I slipped out of my office to make a phone call and get the first available appointment ... three months away. Perhaps this should have been my first red flag, but I was too flabbergasted to really process much. I did ask the receptionist if there was anything I should be doing in, you know, the entire first trimester of the pregnancy. Anything the doctor usually told new patients? Prenatal vitamins? "Nope!" she said. "See you in March!"
When I did finally meet my doctor, three months later, I really liked her. She was very intelligent, personable and obviously very good at her job. This is what I gathered about her in the ten minutes I spent talking to her during that first appointment, and to this day it's still all I know about her even though I was her patient for nine months. I realize that a doctor's job is not to become my best friend. But the tenor of office visits in this practice seemed designed to impress upon you, the patient, that everyone was in a big hurry, most especially the doctor. I quickly learned that if I had questions I had better write them down and fire them off while the doctor was moving through her checklist of things to do during each of my prenatal appointments. Once she was gone, I was left to communicate with her via her nurse, a woman who greeted me at every appointment by asking if I was pregnant month after month until I was so huge that the question was absurd. It didn't exactly make me feel like I had a personal connection there.
Me near the end of my pregnancy with Kate.
Aside from some heavy duty morning sickness in the first three months, we sailed through the pregnancy. As the summer of 2007 wore on (and on and on and on it seemed to me, giantly pregnant in the hottest months of the year) we began making plans for the delivery. I had chosen my doctor because she was a woman, not considering that since the rest of her practice consisted of male doctors, there was a pretty good chance there would be a male doctor at my delivery. I wasn't thrilled about this. With apologies to the many gifted male OB-GYNs of the world, my feeling is that the only man I really want in my delivery room is my husband. The rest of you I don't want to see. But since we couldn't control that, we did make the very good decision to hire a doula through the hospital's in-house doula program. (Score another point for living in a progressive state -- this program was very affordable and the doulas were well-respected by the medical staff at the hospital rather than being treated like intruders into the process.) At least I would have one female professional in the room.
And if you read Kate's birth story, or if you want to head on over and read it now, the doulas surely did earn their money. The short version is this: I was in labor with Kate for more than 24 hours. It was long, slow and frustrating. I had an epidural after about 16 hours, which incidentally is also about the first time I saw a doctor from my practice. Then in the last half hour, a male doctor who makes a brief and mostly humorous appearance in the birth story as I wrote it then materialized out of nowhere to deliver the baby. He was very competent. He was courteous. He did good work. But I have had more warm personal encounters with cashiers at the grocery store than I had with that man. I do know that it had been a very long day on the labor and delivery floor. We gathered from the nurses that some unheard-of number of births were taking place at once, and it's possible he was just exhausted. Still, if your job is to bring life into the world I would hope that you actually enjoy it on some level, and that didn't really seem to be the case for this guy. Maybe he would have made a better accountant. He had the bedside manner for that.
The story as I wrote it then ends when Kate was born, and there are some good reasons for that. The main one is that I am not really one for disclosing super personal facts online. That sounds hilarious considering that I blog under my real name and have basically chronicled our entire marriage with photos on this blog. You'll just have to trust me that there is plenty I don't write here. But what happened after Kate was born actually had a big impact on my decisions down the road, so I'm going to briefly sketch it out here. Look away if you are squeamish.
In the moments after Kate was born, we were totally elated and relieved. We got a quick look at her before she had to be whisked to the side of the room to be checked out by a neonatologist because there was meconium in her amniotic fluid, no doubt caused by the stress of the long, difficult labor. The specialist handed her back to us as soon as she could, but in the meantime we began to notice that my doctor and the nurse working with him did not have the look of people who feel that things are going well. I say we noticed this because they weren't talking to us, only to each other, which was very disconcerting. After a few minutes, Dan asked directly what was going on and we were told that I was hemorrhaging, and they were working to stop that, but that they were also arranging for a transfusion, as it was beginning to look like one might be necessary. Shortly thereafter, things did improve and the transfusion was called off. But we were in that delivery room for a long time after Kate arrived, and it was because our very competent but not very communicative doctor was working on me. When it was all over he gave instructions that I was to be kept for observation before being transferred to a room on the mother-baby unit, and we sort of flagged him down and asked what had gone on. He gave us a brief and not especially reassuring rundown on what my issues were and then left. We never saw him again.
In Kate's pregnancy I became very anemic. I was given iron supplements, but the only conversation I had with anyone from the practice about that was with the nurse, who called to tell me my blood work indicated the anemia and that I should go get some iron. Anemia on its own is a really common, non-serious complication in a pregnancy, but mine didn't respond very well to treatment, and when I lost the amount of blood that I did during the delivery, it became a significant problem. Interestingly the most informative and helpful conversation I had about that fact was with a midwife who checked me out when I was in the hospital, read my chart, and then gave me some advice about how to help my body build itself back up. Even so it was a really long time before I could exert myself physically at all without becoming completely exhausted. That combined with the normal sleep deprivation that comes with having a newborn fueled what I now believe were a few months of mild postpartum depression. I was so happy to have Kate in our lives, but I also felt physically terrible, emotionally worn out and afraid that I would never feel OK again. Meanwhile I felt guilty for feeling that way. I went to my six week checkup, which was as much of a blur as my prenatal appointments had been, and that was that. It never occurred to me to mention any of what I was feeling to my doctor. Why would I? We didn't talk.
When I write it all out like this, it sounds like it must have felt like a bad experience at the time, and I must have been really upset about it all. Really, I wasn't. It was my first birth experience, and I had nothing to compare it to. For all I knew, everyone felt this way after having a baby. But in the two years between Kate's birth and when I got pregnant with Isaac, I did a lot of thinking about what I wanted to be different the next time around. Clearly, setting out without any real goals had been a mistake -- all I wanted was a female practitioner, and in the end I didn't even have that at my delivery. Obviously, I was going to need to take a lot more ownership of my care. Maybe it's something to do with being an English major, but for me that process started with doing a lot of reading. In talking to other women, I noticed that the ones who had been cared for by midwives seemed consistently happier with the experience they had. So I read about midwifery. I read about the history of childbirth care in the U.S. I read birth stories, lots of birth stories, mostly from people who had natural births, which I still had no interest in having. Holy cow those women were crazy, going on about the high of natural childbirth. "Whatever, hippies!" I thought. But it was informative. It made me realize that things could be different. More than anything, it made me wonder why I should choose to see a doctor when I am not sick. And when I found out that I was pregnant in August of 2009, I didn't even look for the phone number of my old OB-GYN practice. Instead I called a friend who had told me how much she loved her midwife.
I knew I had made a good decision five minutes into my first appointment. My midwife came in and sat down. In a chair. It didn't seem like she was in a hurry. She asked me where I was from, and how I felt about being pregnant. She asked about my previous pregnancy. Had I had any complications I wanted to talk about now? Did I have any major goals or desires for this pregnancy? How did I feel about my previous birth experience? How did my toddler feel about the new baby news? Did I like staying at home with Kate? We talked for probably a half an hour. It was shocking to me. I kept expecting her to jump up and run out of the room. And maybe she's just really good at her job and she couldn't care less about all that information, but by the time I left I felt like this was someone who going to really be there for me in the next nine months. That was a great feeling.
Around the same point in my pregnancy with Isaac. I would like to thank Kate for keeping me on my feet non-stop during this pregnancy. Thanks to her, I gained about 20 pounds less this time than I did when I was pregnant with her. Two-year-olds would make excellent personal trainers.
To wrap this up, my entire prenatal experience was different during this pregnancy. I told my midwife up front that avoiding the severe anemia and hemorrhaging that I experienced in Kate's pregnancy and delivery was a big priority for me, so from the start I was on iron supplements and eating in a way to try to help my body absorb as much of the nutrients I needed as possible. When I still had trouble keeping my levels at a good place, we got even more aggressive with the iron, and while that wasn't a fun process for me (Iron does awful things to your system), it gave me some confidence that I was at least doing what I could to be in better shape this time around.
As the final weeks of the pregnancy rolled around, we had a lot of conversations about what I wanted for labor and delivery. I didn't want to be induced. I wanted to labor at home as long as I could because last time around we were at the hospital for hours before there was any reason to be. Once I got to the hospital, I wanted an epidural. A good one. When I was done listing my demands, my midwife filled me in on the plans to help avoid a hemorrhage -- what medications would be on hand, what they were for, and what I would experience if they became necessary. I was still really anxious about the possibility of going through that again, but the communication helped me know that if it happened, the midwife taking care of me would know exactly what to do. Moreover I felt sure that we would not be left to guess what was being done to me should some intervention become necessary.
My mom came into town to help with Kate on April 19. On April 22, I went to an appointment with my midwife. And then the story took on a life of its own. So stay tuned for part two, posting tomorrow.