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Loss of Control...(long post, looking for support)

1K views 11 replies 10 participants last post by  MsBlack 
#1 ·
This is my first post on Mothering... My name is Lacey. I am a first time mommy and 38 weeks pregnant. My husband, Dustin, and I are trying to navigate our way through this situation that we thought we understood and are now completely lost in... Thank you for reading and responding.
ETA: I didn't know which forum to post in... but not knowing how to get the birth I want made it seem like this was the best place.

Let me begin by saying: I am not a control freak. When I know that I can handle a situation, I like to take responsibility for it, but when the situation is something larger than I can handle I am more than happy to step aside and let someone else take the reins.
That being said-- I believe that childbirth is a natural, non-medical event that (when no other health risks are present) can be handled almost entirely by an educated and well-supported woman. I also believe that a woman should give birth in an environment that makes her most comfortable and that this makes labor easier.
I chose to give birth at home because it is where I feel most comfortable. I spent weeks readying my home, gathering supplies, and learning everything I could about home birth. I had all of my prenatal care with a team of experienced nurse midwives-- one of whom would attend my home birth along with 2 birth assistants. I did research on the benefits of waterbirth and purchased a tub and supplies so that my baby could be brought into the world in the way that I feel is best. This pregnancy, this childbirth, this baby-- they are all things I can handle and I want to be responsible for them.
...
At 36 weeks, I started to have some health concerns: moderate swelling and higher blood pressure. I took responsibility for this, too, knowing it was something I could take care of. I ate better, drank more water, swam almost daily, received acupuncture, gave up coffee for the sake of my kidneys (my kidneys will never know the sacrifice I made for them), and cut back my hours at work. Owning a cafe, it was not easy for me to just step out and turn over the operation to someone else. I felt that I could still handle the happenings of the cafe while training my managers to take over for me in the coming weeks. I worked 4-6 hours a day, mostly sitting, through Thursday of my 37th week and then, knowing that I'd be stepping out soon, worked 11 hours on Friday. On Monday of my 37th week my blood pressure was high. On Wednesday, it was higher. I didn't worry, though, because my labs were all coming back normal. On Saturday, the day after working 11 hours and making a to-list for myself that was at least a page long, my blood pressure was extremely high.
I was able to relax and bring it back down to normal-high and, with the midwife, Dustin and I decided that if we wanted the home birth that we had planned we needed to get this baby out before my blood pressure crept up any more.
Saturday night I went by the cafe long enough to tell my managers "it's go time" and then I went home to prepare for a natural induction the next day. I planned to be holding my baby by late Sunday night or early Monday morning.
Sunday morning began with breakfast and a quarter cup of castor oil. Then every 15 minutes for the next 4 hours I would alternate black and blue cohosh with another herbal tincture for uterine tone. At noon the castor oil had not started to work so I chased lunch with another quarter cup of oil and repeated the 4 hour herb cycle. At 2:00 the castor oil began to work and I began to have mild contractions. At 3:00 the contractions were beginning to increase in intensity so we started to time them. They lasted about 1 minute and were 10 minutes apart. After two hours of these, I thought I should rest up in case I'd be laboring through the night and I laid down to take a nap. When I woke up an hour later, the contractions had stopped.
The midwife came out to the house that night to check on me and the baby-- and my blood pressure was high. We decided that I should go to labor and delivery at my back-up hospital for monitoring.
The midwife came with us to make sure we got checked in and that the nurses had my most recent records. The nurses strapped monitors to my belly and a blood pressure cuff to my arm, drew blood, and then left Dustin and I in the room. The baby was fine, I was still having mild contractions but couldn't feel them, and my blood pressure was dropping. At 1:30 in the morning we were sent home with instructions to contact my back-up OB doctor the next day.
The next morning, I called the midwives to let them know I had been sent home. It was during this phone call that I realized I was no longer having a low-risk pregnancy and I would no longer be able to give birth at home with the midwives. They were asking me to formally transfer my care to the OB doctor. It felt like an awkward break-up: "it's not you... it's your blood pressure."
I met with my OB doc and left with mixed feelings. He seemed to not want to rush the baby out, which I appreciated since my blood pressure was regulating again. He also seemed not entirely judgmental about my desire for a home birth. However, he also ordered up an ultrasound, gave me an internal exam, and told me my pelvis was small. These medical interventions and discouraging words may be the norm in the medical community, but they are far from normal in the midwife model of care that I had been working with for the past 8 months.
I was so confused and lost in the process that I didn't even remember to discuss my birth plan with him. Would he support my wishes for an intervention-reduced birth? Would I be able to reclaim any aspect of control in this situation? The hospital has labor tubs-- but not birth tubs-- so my waterbirth is out. I won't be at home to bake my baby's birthday cake any more, but will I be able to eat for strength while in labor? Can I move about freely and deliver in any position? Will my baby be whisked away from me immediately for tests and measuring?
These are all issues I did not need to think about in my home birth plan. It was my plan; I was calling the shots. I have lost control of the situation.
…
Dustin deflated the birth tub last night. I am on bed rest and just waiting... waiting and sad. I want to be safe-- but if my blood pressure stays down then I feel like I am still safe at home. I know that it is too late to have that back and I am sad because it is my fault. I took responsibility for my health and this pregnancy and I continued to work rather than rest. I can control my blood pressure and I chose not to. And now the locus of control has shifted and I feel completely powerless, and sad.
How can I regain any sense of control over this situation?
How can I still have the best birth for my baby?
 
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#2 ·
I think, actually, you're taking too much responsibility. You can attempt to control your blood pressure, you can do things to improve the odds, but at the end, it's not in your hands. I've had two babies, and the one thing I know about birth is that I'm *not* calling the shots. The shots are called by the baby's needs.

Working rather than resting is really common - the landlord keeps collecting rent while you're pregnant, after all, and the utility companies still want to be paid. Don't kick yourself over this.

(Incidentally, I have no very good opinion of your midwives here. You describe an induction attempt so drastic that I feel like a responsible HCP would have told you in advance that she was trying to throw a Hail Mary pass before handing you off to the hospital, and should have encouraged you to transfer care *before* recommending twice - eventually four times - the usual dose of castor oil for induction. I have no idea how much black and blue cohosh you took, but the amounts sound awfully high.)

It's totally understandable that you were too blitzed to remember birth plan discussions when you talked to the doctor, but you can have another conversation. Call back. Ask for an appointment to discuss this. Ask your midwives if they can still act as doulas, and ask them what they know about hospital policies and procedures. Find out what is likely to happen, and what you can and cannot change.
 
#3 ·
I have to say that I think everyone is overreacting here, among your caregivers, anyway. High Blood pressure with a healthy baby and no other signs of pre-eclampsia is ONLY a sign, to me as a mw, of a mom's need to rest and relax.

I do not believe induction is called for--not yet. Not if your b/p is moderating and is the only untoward sign you are having. I might, in your shoes, have a great big cry, and then look around to see if another mw could be found to help you have your homebirth. I have taken on clients at the last minute before, sometimes mamas like you get lucky that way. It couldn't hurt to try; you won't lose anything that you haven't already apparently lost.

Otherwise, if that seems out of the question or you just can't find anyone else, then I'd stay home, take good care of myself and relax as much as possible until labor starts on it's own--and labor as long as possible at home. Go in pushing and not sooner! With a first baby, you are unlikely to have a 2nd stage so rapid that you can't make it there in time.

As a midwife, it sure sounds to me like you have simply pushed your limits too much, and that the b/p is more stress-and-fatigue related than anything else. Again, as long as you and baby are fine--and hey, baby has well demonstrated now that s/he is NOT ready to come out yet--there is no medical reason to induce. Your CNMs are restricted by practice protocols imposed by OBs. The OBs are limited by a fear of lawsuits....but I don't see that you are being given evidence-based options!

You might want to make another post to Birth and Beyond and the Homebirth forums--not necessarily telling this whole tale, but asking for input from mamas who had high b/p (or unstable b/p) but no other sign of trouble showing from tests. Find out who went on to have a normal birth, even a homebirth. I've helped some high b/p mamas have homebirths--and they and their babies were fine. Maybe you will get some support, some info, some encouragement. I hope so!

Sorry if this is OT, and not answering your question. I couldn't help but present this other point of view for you to consider.
 
#4 ·
Quote:

Originally Posted by laceymr View Post
How can I regain any sense of control over this situation?
How can I still have the best birth for my baby?
You need to take a deep breath. Call your OB and discuss your concerns. I was allowed to eat during labor etc. I had severe pre-e and GD, and hoped for a drug-free birth. I didn't get that. I am (slowly) coming to terms with the fact that I did have the "ideal" birth. But, I did have a vaginal birth and a healthy baby.

Don't be so hard on yourself. IMHO, we (as women) build our ideal births up in our heads so much, and we beat ourselves up too much when those don't pan out. Remember, the best birth for you and your baby is a healthy one! Try to rest and keep your BP low. If you can keep it under control the chances of additional interventions is low.
 
#6 ·
This happened to me with my first baby. I was planning an out of hospital birth with a midwife and ended up needing an in hospital birth- but I was able to have a midwife anyway. My blood pressure spiked six days before my son was born and was very high but I did not have preeclampsia either.

I thought I would feel jipped having to be in the hospital but I didn't. I ended up having a great birth experience anyway. I am currently pregnant with number 2 and hoping it doesn't happen this time. My midwife said I only have a three percent chance of a repeat problem.

I work as a paralegal and my work environment can get incredibly stressful. I also gained a lot of weight during that pregnancy-55lbs-and I am only 5"4'. I think also aniticpation of labor contributed to my HPB.

Try not to beat yourself up over it. As a first time mom it's not uncommon AND there are going to be many things as a mother that you envision going a certain way that end up going completely differently. You can always try for a homebirth if you decide to have more children.
 
#7 ·
Yes, I agree with everyone - listen to Ms. Black in particular - she always has good advice.

I wonder if there are some other options out there for you. My blood pressure went up near the end of my last pregnancy and I was NOT able to get it back down. I was eventually induced but by hospital-based midwives. Eating and drinking in labor was no problem. I had monitors, but telemetry ones. If my blood pressure had remained reasonable (it did not) I could have been up and about and even w/the high blood pressure, I was planning to get in the tub, but I ended up getting to 10cm first. I delivered my 9lb 10oz baby vaginally w/no interventions beyond pitocin and artificial rupture of the membranes. Our baby girl went pretty much immediately to my chest and stayed there for over an hour. She didn't leave my sight or our room for a good long time - and then only with my DH for a hearing test or something. The hospital had the full array of newborn tests available and we were able to pick and choose what we wanted, no problem.

Point is, this is NOT your fault. And, there is a TON of space between a home birth and a full-on intervention filled event. I think if I were you, I would explore other care providers. I don't like that small pelvis comment one bit. You might find some info about local care providers by posting on the Finding Your Tribe geographic thread for your area. Good luck!
 
#8 ·
Hi Lacey! I just wanted to say that it is not your fault about the BP issues - I am sure you did everything you could in your pregnancy to facilitate a healthy body and birth, but sometimes crap happens. It stinks to switch providers at the last minute but all is not lost. Best of luck to you.
 
#9 ·
You really have done what you could. You didn't choose to have high BP, and your cervical ripeness has nothing to do with your self-worth or how well you've done as a pregnant woman. It's okay.

Don't be too concerned about whether you can get the (now hospital) birth that you want, until you have spoken to the OB. Also, remember that the OB doesn't have nearly as much to do with your labor as your L&D nurses. Be really nice to them, and express your wishes as clearly as possible. Get them on your side, and they can be your best friends!

Can your midwife act as a doula for you at the hospital?
 
#10 ·
I really want ot send good labor and birth vibes your way and offer a hug. You do not need to be so hard on yourself, as we can't always control what happens to our bodies, especially when it comes to pregnancy and childbirth.

I dont have any farther advice as I feel Ms. Black really has the best advice here.

Best of luck to you and your new family, and keep posting as there are so many ladies here that are great and more than happy to help you process all you will be going through.
 
#11 ·
Thank you all so much.
I was in panic mode when I woke up yesterday-- ashamed that I didn't push for more info with the new OB. Now I know I was just in shock when I met with him. I called and made an appointment to go over my birth plan with him tomorrow. I want to find out what the hospital is and isn't comfortable with before I start throwing in the towel.
I also called my midwives to find out about one of them acting as doula. I am beginning to feel that the natural induction attempt was a rash decision and not the best option... but I still feel that the MWs know me and know what kind of birth I want and can advocate for me so my husband doesn't have to. I feel better about this option than about switching providers again.
I also got some advice from a friend of mine that I could set up the birth tub and take a bath with baby when we get home-- to heal and bond. I like this idea.
I also plan to get a bp monitor so I can be watchful while laboring at home as long as possible. And bake that cake.
Thank you all again for your support and feedback and advice. You are a wise group of women.
 
#12 ·
So glad to hear that you are moving past the shock and starting to feel ready to organize your next steps. And especially glad that you are thinking of laboring at home as long as safely possible--it's the best way to avoid unwanted interventions, really.

Settle in, make your new plans, and enjoy! Wherever you birth, it is your feeling safe, and at peace with your choices, that will make it the best it can be for you and your family.
 
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