My situation and how to make the best of it...

[Lucy&Jude'sMama]

My situation is while my family is able to have for the most part all of our needs met. A home, food on the table, diapers on the butt (ha!), warm and cool air, clothing, and the occasional trip to the movies as well as going out to dinner. Basically we live comfortably but not lavishly. We have a very small savings for yearly bills (small as in under $300 but growing.) So I'm not pushed for money every month, but I also don't have any extra money to spend on a home birth midwife.

I've been looking into Unassisted Childbirth and while I love the idea of going it alone. I've realized that in my ideal world I would want my unassisted birth to be I guess half unassisted... Unassisted but not unattended. For instance it would be my ideal to have the midwife sipping tea at my Nana's house which is a few homes down from me and to only have her come if I needed her. Anyways that's my ideal, but sadly not an option. Unless I have $3600 (late transfer option... Typically fee is $4200). Which I don't and there is no way I can come up with the money. Borrowing it isn't an option either because I wouldn't be able to pay it back.

I had a situation with my partner yesterday that made me realize a completely unassisted birth wouldn't work for us. We were on the freeway and his tire started to sound like it was either going to blow or something was really wrong with it. My daughter and I were in the car and he was driving. He started asking "what is that noise", I calmly said "I'm not sure but it might be your tire...you should pull over so that we can check it"... That's when he started freaking out and yelling "How am I suppose to pull over! We are on the freeway! I can't pull over!" ........ Calmly I tell him "Honey I need you to pull over because if it is your tire and it blows you can flip the car so please just pull over and we will check it.. I'm sure it will be fine" He finally pulls over and it was his tire. Thankfully it hadn't blown yet but it was starting to peel.

Anyways you might be asking what that situation has to do with a birth situation... In my eyes everything! While he panicked I had to be the calm one in control. During labor I need him to be the calm in control person. I need him to be my rock and I don't need a panicking rock! haha I love him to death and he has been very supportive of my decisions, but I cant handle doing it alone and comforting him at the same time. Ya know? I just can't do it all by myself. I guess I shouldn't say I can't because I think I can if I had to but I don't want to. I don't want to do it all by myself with my partner freaking out and hovering over me.

So since completely unassisted is no longer an option for me, home birth is no longer an option, there is no birth center around me that takes medi-Cal... I'm stuck with a 2nd hospital birth. This makes me really sad and disappointed but I need to try to make the best of it.

I had my first birth was un-medicated in the hospital. I was able to labor in a tub, but they made me get out when I was ready to push... (very annoying). I had a fairly good experience for a hospital birth but I was really hoping to avoid the many annoyances this time around.

The things that bugged me...

- Being told I needed an IV to keep hydrated. I refused this and drank water instead. So I know I can do this again for #2.

-Fetal monitoring. The belly straps. OMG I hated it! I've done my research and I know there has been no proven better outcome for mother or baby due to fetal monitoring for the low risk mother. I was able to finally get a very nice understanding nurse who started using a hand held Doppler instead. The doppler option works better for me and I'm working to see if I can demand this instead of the belly straps or if possible if I can sign a waiver saying a refused fetal monitoring. I don't mind occasionally every few hours or so... but every hour for 15 minutes! That just doesn't work for me.

-Being refused food! Like hello... STARVING PREGGO! Haha of course this one will be a bit easier to avoid with #2 because I plan on waiting as long as possible before going to the hospital. With #1 my water broke and I thought she would be there with in 2 hours... 20 hours later she was born and I was starving!!!

-Vaginal checks every hour. Yikes... Ouch... For godsakes stop touching my vagina!! This time I would like to avoid them all together. The only time I'm ok with them checking is if I ask or I'm close to pushing stage.

- Position. I was as comfortable as I could get in my labor tub at 10 centimeters when they told me to get out, lay on the bed, and wait for my midwife. HA! Yeah..."wait"... I thought it was pretty funny too. So I gave birth to #1 in a semi-reclined position on the bed with a nurse and my partner holding my legs. I was also coached during pushing. This time I would like to be in the position of my choice and to push when I feel like pushing. I didn't tear the first time and hopefully wont a second time.

-Being told I had to stay in the hospital for at least 24 hours and being pushed to stay longer. I did stay 24 hours but with #2 I plan to leave as soon as I feel I want to and I don't care if I go against doctors orders.

Anyways I think that's pretty much all of it. I could go into just the general hospital feel. Hospitals are for sick people kind of thing... but this is already super long. So if you made it this far thanks for reading!

I guess I just need advice on how to make the best of this situation. Coming to terms with it has been very hard on me. Granted I'm 6 months preggo and super emotional so that probably doesn't help. I'm planning on this being my last pregnancy (looking into getting tied up) so I think that's partly why I'm having such a hard time. I dream of a home birth and yet can't afford it. So what things can I do to make the most out of this fast coming second hospital birth?

[LadyCatherine185]

that does sound like a tough situation. If I were you, I would be upfront with my OB about all of the things you mentioned in advance. I especially don't get the hourly cervical checks? Wow! Find a good doula. Or find a good friend who is willing to be your doula and have her read some books/internet articles, etc so that she is as educated about birth as you are. Having good support is very important. And lastly, don't go to the hospital until you are close to the end of labor. Or at least not until active labor has been progressing for awhile.

[womenswisdom]

I'm sure you can find a better way that that! I would talk to some local doulas about which care provider and hospital they've had the best experience at and hire one of them to support you in preparing for the hospital experience and during your labor. The things you mentioned are all things I've had clients put in a written birth plan, approved by their care provider ahead of time, and not contested at all by the nursing staff at the time of labor. Staying home as long as possible, packing food and drink to enjoy while you're at the hospital if you choose, saying "no thank you" to vaginal exams - these are all things you can do to make this experience a better one than last time. Good luck!

[MegBoz]

Originally Posted by womenswisdom

Staying home as long as possible, packing food and drink to enjoy while you're at the hospital if you choose, saying "no thank you" to vaginal exams - these are all things you can do to make this experience a better one than last time. Good luck!

+ a doula or good friend who could help advocate for you. (For example, saying, oh-so-politely, "No thank you" to the VE if you're in the middle of a ctrx so the nurse will just leave you alone & you won't even have to deal with it.)

It sounds like you're fine with not birthing in the tub. & that's good because that would be the only thing I'd say you'd have a hard time achieving. Everything else sounds doable to me!

I had on my birth plan no VEs, I only consent to 1 upon admission to confirm I'm in labor & one when I feel the urge to push to confirm full dilation. None of the 3 MWs had a prob with that!

I also had on my birth plan no IV fluids - I'll drink. No prob with that as well. Official hospital policy was "clear fluids only" in labor but one MW flat out TOLD ME to disobey! She rocks! She just said, "Well, I would say, don't ask, just eat." I think that's good advice - so I would say the cooler of food is for your partner & doula/friend-acting-as-doula. Besides, IMX hospital food is lousy anyway, so I wouldn't mind bringing our own.

I've also read the suggestion to request an NCB-experienced (or friendly) nurse when you first arrive. So I'd imagine that nurse would be much more accommodating to using the doppler instead of having you get out of the tub for EFM.

I also had no coached pushing - I think I said, "I'd prefer to push when I feel the urge without counting." Again, they had no problem with that & didn't really say ANYTHING at all! actually my doula did give me a few tips & I was glad she did speak up because the MW & nurses really said not much. Again, your doula & partner can speak up to remind them that you're able to feel ctrx, so you don't need to be shouted at & counted too if they DO pipe up with that .

As for hospital stay, my MWs were happy to discharge me after way less than 24 hours. My Pedi said she may have also discharged DS promptly, but it turned out she was on vacay. Well, I was GBS+ & got no ABTs (no time, but knowing what I know now, I'd decline anyway) & hospital policy in that case was to keep baby 48 hours for observation. I decided not to fight it. But, you may be able to find a pedi to discharge your baby in under 24 hours.

[47chromosomes]

I agree with other posters. Talk to doula's or HB midwives in the community and ask them for their best recommendation of care providers that are natural birth friendly. It sounds like you would not be able to afford to hire a doula, but you may look into finding out if there are any programs in your area that provide doula's free of charge to lower income families (such a thing exists where I am from, but it is a pretty progressive area of California). If there is not such option, a natural birth minded friend who is also assertive would be a great birth companion to put in charge of your birth plan so you do not have to be bothered by the annoyances of the hospital. Or, you could try to find a person working on their doula certification that needs to attend a few births free of charge. I just think having one other person there besides your dp would be helpful to you to protect you from annoyances, and advocate for you while you do the hard work of labor and birth. Someone to protect that "space" that needs to feel more sacred this time around.

I know it is disappointing, and I think you are looking at your situation very realistically. If only we didn't have to be realistic in life! You are doing a good job by working to make the best of what is available to you. Good job, mama.

[AlexisT]

Originally Posted by Lucy&Jude'sMama

-Fetal monitoring. The belly straps. OMG I hated it! I've done my research and I know there has been no proven better outcome for mother or baby due to fetal monitoring for the low risk mother.

I think I know what you mean, but this is poorly phrased. There is no better outcome for continuous fetal monitoring in low risk women. They didn't compare EFM to nothing; they compared it to intermittent ascultation. That's still a form of fetal monitoring. (The other term for EFM, which is used in some other countries, is CTG [cardiotocography]--I think that's clearer and less confusing.)

A good provider/hospital will be willing to use Doppler, but they will want to do it more frequently than every few hours. The study showing that IA was equal to EFM had them checking every 15 minutes during the first stage and more frequently in second stage. Some will do it every 20 or 30 in first stage. Outside of some home birth midwives, you're really unlikely to find a provider who will do it less frequently.

[Lucy&Jude'sMama]

AlexisT- Yes I was talking about continuous fetal monitoring. I don't mind the doppler although I still would prefer it to be less frequent than every hour. I'm working with the hospital right now to see if there is a waiver I can sign.

[Turquesa]

Originally Posted by 47chromosomes

Or, you could try to find a person working on their doula certification that needs to attend a few births free of charge.

This. My friend just had an AWESOME student doula....all of it free! OP, do you have insurance? Most states require insurance companies to grant exemptions if there is no particular in-network type of provider within a given area. A good MW can coach you on how to do that.

Otherwise, to the hospital and definitely with a doula and the best OB or CNM that your research can lead you to.

[rparker]

Originally Posted by Lucy&Jude'sMama

- Being told I needed an IV to keep hydrated. I refused this and drank water instead. So I know I can do this again for #2.

That is what I did with my first birth and will do with my second. You can do it again too! If it makes you feel any "better" about refusing this, my husband is an MD and thinks that having a pre-emptive IV/heplock is totally unnecessary if you haven't taken any medication because nurses can and WILL get one in in a true emergency.

edit to add: We actually just had another conversation about this topic today after my doctor explained his reasoning for recommending (but not requiring) a routine heplock for his OB patients... apparently there are rare cases involving postpartum hemorrhage where it's impossible to get an IV inserted after a patient goes into shock, but in the event that that happens medical staff can do an alternate procedure called an intraosseous insfusion. It's all incredibly rare and wouldn't keep me (personally) from having a home birth where NONE of these interventions are possible if we had better midwife access locally, but it's still kind of cool to learn yet another reason why routine IV placement isn't necessary.

-Fetal monitoring. The belly straps. OMG I hated it! I've done my research and I know there has been no proven better outcome for mother or baby due to fetal monitoring for the low risk mother. I was able to finally get a very nice understanding nurse who started using a hand held Doppler instead. The doppler option works better for me and I'm working to see if I can demand this instead of the belly straps or if possible if I can sign a waiver saying a refused fetal monitoring. I don't mind occasionally every few hours or so... but every hour for 15 minutes! That just doesn't work for me.

I hated the tiny bit of intermittent EFM I had with my first hospital birth too. My doctor this time has said that I can forgo EFM altogether and only have doppler monitoring. ACOG actually has guidelines for this and in many ways it's more evidence based than EFM.

-Being refused food! Like hello... STARVING PREGGO! Haha of course this one will be a bit easier to avoid with #2 because I plan on waiting as long as possible before going to the hospital. With #1 my water broke and I thought she would be there with in 2 hours... 20 hours later she was born and I was starving!!!

Bring food with you. If anyone asks, lie and say it's for your husband (Both doctors I've used for OB have been fine with food during labor though so you may want to ask ahead of time.)

-Vaginal checks every hour. Yikes... Ouch... For godsakes stop touching my vagina!! This time I would like to avoid them all together. The only time I'm ok with them checking is if I ask or I'm close to pushing stage.

You don't have to consent to these. I had two: one in triage and one before pushing. This time I may not even agree to that many. If I do have cervical checks I'm making them do it in a position that's comfortable for me... I'm thinking hands and knees?

- Position. I was as comfortable as I could get in my labor tub at 10 centimeters when they told me to get out, lay on the bed, and wait for my midwife. HA! Yeah..."wait"... I thought it was pretty funny too. So I gave birth to #1 in a semi-reclined position on the bed with a nurse and my partner holding my legs. I was also coached during pushing. This time I would like to be in the position of my choice and to push when I feel like pushing. I didn't tear the first time and hopefully wont a second time.

My pushing stage was like yours (except I tore) and I didn't like it either. I could have refused to push on the bed, but I was too focused on pushing at the time. I'm having a doula this time and hopefully she'll remember to encourage me into a better pushing position. Can you get a doula?

-Being told I had to stay in the hospital for at least 24 hours and being pushed to stay longer. I did stay 24 hours but with #2 I plan to leave as soon as I feel I want to and I don't care if I go against doctors orders.

I left about 14 hours after my daughter was born. It would have been sooner (I was cleared to go by my doctor) but the nurses "forgot" to call her pediatrician. Good for you for being prepared to leave AMA!

You sound like a strong, well-informed woman and I think you can totally have a better hospital birth experience this time. You should definitely look into free/low-cost doulas. (In my area the ONLY doulas are volunteers and actually refuse to take payment for their services...)

[kcparker]

If you do end up in the hospital,

-Fetal monitoring. The belly straps. -- I'd ask for intermittent ascultation with the doppler. Listening for a contraction or two every 30 min., then every other contraction during pushing is standard of care, though I am sure there is some variation. See if you can get a nurse who is supportive of unmedicated, active birthing and doesn't see it as a burden to work with you.

-Being refused food! Don't ask, don't tell. Bring your own, and nobody can refuse you if they don't see you eating.

-Vaginal checks every hour. Yikes Yikes, indeed! You can totally refuse vag. checks, though they like to know where you are when you arrive, and the like to know you are fully dilated before you push, but other than that, I'd tell them no thanks. Refusing the other two is, in my experience as a doula, not impossible, but you get some nasty treatment for being an 'uncooperative patient.'

- Position. -- Again, balky mule strategy works. Just tell them thanks for the suggestion, but you prefer to stand/squat/be on hands and knees, or don't even tell them, just don't comply. They can't physically force you to do this, and if they try, I'd give them a good donkey kick in a place where it hurts.

Have you talked to any homebirth MWs in the area about barter or payment plans? Where I live, the HB MWs will really work with whatever you can do, even if it's pay them $300 upfront and then $50 a month for two more years. Don't assume you "can't have a homebirth" because of the money - ask around. Same goes for doula services if you end up with a hospital birth - ask if they payment plans, sliding scale, take knitting or HVAC work or turned wood bowls or whatever you/partner can offer in the way of skills and services in lieu of a whole fee. Ask if any of your family would be willing to sponsor (pay for) a doula or MW, even partially. Maybe if somebody is planning a baby shower, people could buy you "one hour of doula support at $20/hour" instead of more onesies that you don't need. (I know, it's not really the way doula payments work, but people would get the idea that they are contributing to your birth in a meaningful way.)

We didn't really have tons of money, but I set aside our tax return for the birth, and we paid the midwife in installments. Birth is a one-time-only, no do-overs event. Money is just....money. There's more where that came from, and what better thing could you spend it on than the birth of your child?