Planning a UC for woman with serious modesty issues

[eliofamily]

Hi!

I'm 32 weeks pregnant with my 6th child and my midwife just dumped me. Shortest summary: I went to the hospital with abdominal pain, my pancreas was enlarged, but then my pancreas became normal in 4 days. I have no diagnosis, and I'm completely back to normal. My midwife is a licensed midwife who practices under a religious exemption (I'm not completely sure what that means, but I know it means she "can't provide medical care"). She said that because I was hospitalized, she can no longer attend my birth, but can still provide my prenatal care. Oddly, she's planning a trip to her mother in law's home the day before my due date, so...

So. My last birth was a successful homebirth. The midwife arrived about ten minutes before the baby and there were no complications. My only birth that was "complicated" was my first, because I had an OB who induced me because he had to get to Italy the following day, and I ended up with...lots of interventions (but still a vaginal birth). The subsequent births were unmedicated birth center births, and the only intervention I had was with the fourth baby, when they massaged my uterus so that I would stop bleeding, which didn't work, so they ended up just letting the baby nurse, which stopped the bleeding.

Everything I'm reading so far talks about letting go of fear and letting your body do what it knows how to do. However, I ALWAYS have fear and panic during childbirth because I feel upset and anxious when I have to remove my clothing for the baby to come out, and when people look at me when I am exposed. I think that not having anyone present will hopefully HELP these issues.

Furthermore, I'm pretty uneducated about what constitutes "too much bleeding" or "needs medical attention." Generally, I don't seek medical attention for any reason and haven't seen a physician in *coughs to conceal actual number* years, other than my recent ridiculous pancreatic hospitalization which resulted in no diagnosis anyway.

I really, really want to have a homebirth. I CAN'T have a hospital birth; I know that, and there are no freestanding birth centers around here. No other midwife will take my insurance and frankly, the midwives I've had before didn't actually *DO* anything but provide reassurance.

Is it realistic and responsible for me to have an unassisted birth? I tend to think of UC as something done by women who are SUPER educated about EXACTLY what to do in every circumstance of birth, are UBER fit and have spent nine months eating a storybook diet of everything that makes for a perfect pregnancy, and are basically so incredibly prepared for everything that there is no question of whether those women can do it. As for me, I feel like I'm a regular mom who just freaks out at the thought of going to a hospital.

[JamieCatheryn]

If you're not high risk and you could do a homebirth anyway I don't see why you couldn't UC, so long as you know learn what is normal and are comfortable without a pro there to tell you everything is fine.

I labor in a skirt and a shirt until around transition, when clothes just feel hot and bunchy and in the way so I take them off and drape a sheet or towel on myself. No reason you couldn't wear a loose skirt the whole time. For most of us some measure of anxiety and fear and doubt is a normal hurdle in labor though, usually with transition.

You and your DH or DP should read on signs of real problems and work through things to be open to transfer if there is an emergency/emergent problem. Midwifery texts would be your most thorough resources about diagnosing any problem and dealing with it until you could get help, or dealing with it yourself if it can be handled at home. It shouldn't take long to get the gist of it, maybe a couple weeks of earnest study. Of course if you are really in tune with what's going on you may just know intuitively if something is wrong and to get help.

You mentioned bleeding after birth. To see what the threshhold of normal bleeding is: mix 2 cups of water with enough red food dye that it looks like blood, and pour it on some of your disposable underpads. 2 cups (1 pint) of blood is the upper limit of normal. You'd also watch out for dizziness, weakness, and an irregular heartrate.

[MeepyCat]

I don't think your hospitalization was ridiculous, and I wouldn't plan to birth unassisted if I were in your circumstances. I don't think that UC is only for the flawless, but I do think it's only for uncomplicated pregnancies, and even though the pancreas thing has resolved, the fact that it happened at all means you are not having an uncomplicated pregnancy.

Abdominal pain is sometimes mysterious, and does sometimes resolve on it's own, as yours did. I have done my share of what feels like pointless lying around in the hospital, and I can only imagine how much worse it must be with five children who need you at home. But given the wide range of very bad things that severe abdominal pain could potentially indicate, I would still take it to a doctor, especially if I were pregnant.

One of the reasons I would encourage you to reach out to a doctor now is that your modesty issues CAN be handled well if the hospital has some warning. You can talk to your doctor about how you want to be treated. You can visit the OB unit and talk to the nurses. You can write up a birth plan that communicates the things you need to be comfortable and you can get it to the managing nurses ahead of time. However, if things go wrong at home and you have to transfer to a hospital you're totally unfamiliar with, there may not be time or opportunity to make these statements. There is no guarantee even if you do everything you can to set things up ahead of time that you won't get a CP who is just horribly insensitive, but if you don't set things up ahead of time, you guarantee yourself that NONE of the CPs will know that they should be trying to be sensitive.

[elmh23]

Originally Posted by JamieCatheryn

You mentioned bleeding after birth. To see what the threshhold of normal bleeding is: mix 2 cups of water with enough red food dye that it looks like blood, and pour it on some of your disposable underpads. 2 cups (1 pint) of blood is the upper limit of normal. You'd also watch out for dizziness, weakness, and an irregular heartrate.

2 cups is a severe hemorrhage! It is NOT normal. Having lost 2 cups during my second birth, I can say that it took me months to recover. Sadly, as a result, I do not remember a good amount of my sons babyhood.

[blessedwithboys]

actually, i've always heard 500cc is the upper limit, that would be about 16 oz or 2 cups...

[seattlemamma]

I would try to figure out why my pancreas might have enlarged...before I felt comfortable UC'ing. Was there any idea at all as to why it enlarged?

[elmh23]

Originally Posted by blessedwithboys

actually, i've always heard 500cc is the upper limit, that would be about 16 oz or 2 cups...

Trust me, as someone who has been through this three times, the definition of a pph starts at 500 ML, not cc's. http://emedicine.medscape.com/article/796785-overview

[mwherbs]

500 ml and 500 cc are the same amount about 2 cups - considered a hemorrhage for vaginal birth , for c-section 1000 ml/cc (4 cups) is considered a hemorrhage
here is a write up about pancreatitis in pregnancy - most common cause is gall stones or sludge ---
http://pregnancyandpancreatitis.blogspot.com/

[MsBlack]

A couple things:

1. A 'cc' (cubic centimeter by 'dry volume') IS THE SAME THING as a 'ml' (a millileter by 'liquid volume'). Same thing! And yes, '1 pint' is about the same, also.

2. 500 cc (or ml, or roughly '1 pint') is considered the normal blood loss for birth, though some women lose more or less. HOWEVER, what constitutes a 'hemmorhage' is how the woman reacts to any blood loss. I've seen women lose close to 1000ml, with no ill effects...and some lose a pint and have definite ill effects. Many factors enter into this, in terms of an individual woman's health and constitutional tendencies. So, of course it's possible for a woman to have ill effects after losing only a pint of blood at birth--just fairly unusual. And it's more likely for a woman to have some degree of illl effects from losing more than a pint of blood--but not a guarantee.

3. White coat hypertension is 'real'--hehehehe, I mean that even though 'it's all in your head' so to speak, some people just can't get a normal reading from a provider! But they get fine/normal b/p readings at home with their own cuff. And this is especially true if the HCP is scaring the woman about her b/p. I've known some women with White Coat--they kept track of their own b/p at home, HCP didn't insist on doing readings.

4. Pre-eclampsia is NOT just high b/p, as others have said. It is more complex than that--there is plenty of info here and elsewhere on what it is, and various ways to prevent it--and test for it, if it seems needed.

5. SO, ELIOFAMILY--get you a b/p cuff, they can be found at most pharmacies for anywhere from about $20. and up. I suggest buying one of the 'better' ones, but no need to buy 'the best'....you could spend $40. and get a fairly reliable, durable meter that you can keep and use for years.

6. If you are going to get prenatal care from this mw, then I think as long as all remains well enough for you and baby, you could UC. But you need to get informed and prepared for this! The info is available--both here and at other sites; I particularly recommend Born Free, the UC discussion forum of Laura Shanley's unassistedchildbirth.com. There is a great deal of well organized info there, and a group of fantastically smart, informed, dedicated and helpful moderators to help you navigate the site for the info you need.

By the way, BornFree does have good info on pre-eclampsia....

And finally--yes, UC will likely solve the serious modesty issue for you. And yes, some women remain fairly clothed for birth (though in the privacy of your home, with no outsiders looking on, you may not need the kind of loose skirt/shirt that some use).

[WildKingdom]

Who said anything about blood pressure? She had pancreatitis, not pre-eclampsia.

[elmh23]

Originally Posted by mwherbs

500 ml and 500 cc are the same amount about 2 cups - considered a hemorrhage for vaginal birth , for c-section 1000 ml/cc (4 cups) is considered a hemorrhage
here is a write up about pancreatitis in pregnancy - most common cause is gall stones or sludge ---
http://pregnancyandpancreatitis.blogspot.com/

Ok, yeah, this is why I shouldn't post so late... When can I nap?

[MsBlack]

Originally Posted by WildKingdom

Who said anything about blood pressure? She had pancreatitis, not pre-eclampsia.

OOOPS!

Mixing up my threads...I read a few in a row, then decided to answer this one but got my parties and problems muddled. Oh well.

And mwherbs is correct--a pint of blood IS considered a 1st stage hem. But it's also true that many women lose about this much (some far less tho), and it's normal. Not sure why they call it a level 1 hem (or whatever the exact term is).

BornFree site has a good thread about blood loss estimating, with pics.

[L J]

Not going to talk technical stuff with you, the others seemed to have covered that just fine. But mama, I wanted to let you know that you do NOT need something close to a degree in midwifery to have a sucessful UC. My first was a UC, and this one will be as well, and other than reading online, I wasn't super-educated. There is a lot you can read online to learn more, but most of what I read just reminded me that women have been doing this for years, your body knows what to do.

I have never read Emergency Childbirth, I didn't spend much time dwelling on blood loss or complications. I figured I would KNOW if I was losing too much blood, and I trusted my DP (the only one there) to be just as informed as I was.

Not everyone here, by far, takes my rather laid back attitude toward childbirth and after, but that is how I approached it, and everything was great.

Sure, I was healthy during pregnancy, ate right, took my vitamins, etc. But I also threw a fast food cheeseburger in there occasionally and more brownies that I can count. You don't have to do everything "perfectly" to get the end result right.

As for your modesty issues - it sounds like UC will be perfect for you! I have some similar issues, but mine revolve more around hating to be touched (By strangers). I freak out inside, I just can't stand it. That was a big reason I was initially pulled to UC.

Good luck mama - sorry I don't have any great advice, but I wanted you to know you don't have to have some secret knowledge or supernatural power to UC - lots of us "regular moms" do it, all the time.

[zoebird]

what you need to know is different for each person. learn what you need to learn to make you feel comfortable. LJ is an example of how she didn't need to focus on that end so much, and others focus only on certain things that spring up in their minds, and others really really go the distnace with learning about this stuff.

find your balance.

[Sheryl1678]

My approach was to prepare by knowing what was an actual problem (bleeding over 2 cups for example) and what is just a variation of normal. I researched it in advance and knew when I needed to go to the hospital.

During the labor and delivery I put the research out of my mind and let my body do its work.

I delivered on my knees on the floor and then spend some time in the same area over a bowl while I got to know my new baby. I caught all the blood loss in the bowl to totally eliminate the guesswork.

[Banana731]

If you feel like you are the kind of person who needs to know as much info as possible to be comfortable, I recommend Heart and Hands. I really like that book. Your local library may be able to get it for you, but even if you buy it yourself but don't want to keep it, it has good resale value on Amazon. I felt MUCH better after reading it.

I don't think it's that easy to estimate blood loss, for anyone. And certainly one the reasons that MWs hang out for a few hours after the birth is to make sure that your blood loss isn't too severe. Sometimes blood loss becomes a problem later on if the uterus isn't clamping down properly, not just immediately after the placenta is born. I think if PPH is a worry spot for you, you have to work it out with knowledge.

Using common sense things can help prevent PPH, or at least help you recognize that something is off. Keeping the baby at your breast right after birth (to nuzzle, if he's not ready to nurse) will help your uterus contract, not messing with your placenta. Emptying your bladder sometime soon after the birth. Paying attention to how you feel after, if you feel light-headed or woozy, or start to look ill or pale to your DP. It's certainly not a bad idea to have a BP cuff, and to know what your baseline at home is.

Most of that stuff is just par for the course in a UC anyway. You doing what feels natural and right. I feel like I was better able to follow my own instincts and relax when I was very educated about the process, but certainly not everyone feels that way. I think that with UC , at some point it will click for you if it's right, and you'll feel confident with your decision. Good luck!