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I don't know if anyone is interested, but I've had a very interesting time this pregnancy with finding supportive prenatal care, and am still in the process of determining where birth will happen (I'm 23.5 weeks). A couple of ladies here have pm'd me about how I'm doing. I recently updated my Livejournal with a loooooong bunch of stuff that summarized my recent OB consultation, sonogram and prenatal appt, and childbirth class. It's full of things that people here might (I hope) find interesting and encouraging. I'm copy and pasting it here, so just keep in mind it was a journal entry, originally...

Last Sunday evening I went up to my birth center for a group consultation with an OB, on vbac. Everyone who vbacs there/with their midwives has to see the OB at least once, and sign consent forms, etc. I didn't find out about it until the last minute, though apparently they had been trying to get in touch with me for a week. As a result, it was hastily thrown together on my part - my sister came with us to watch all of the kids in their play area/outdoor playground, none of us knew it would be HOURS long, and I had no idea there was a fee involved until we arrived. $150!!!! I've never NOT had anything pregnancy related covered by medicaid, before. But apparently since this doctor comes from somewhere else and it's not an appointment so much as a question and answer, it has to be paid out of pocket. I acted a little indignant about not being told about it on the phone, having driven over an hour with 3 children and a sitter in tow, and the center agreed to let me set up payment arrangments. So we'll do $50 a month for the next 3 months, and in the meantime they fronted the doctor the money. That's very nice and I appreciated it, but I can't help but be really irritated whenever anything is REQUIRED, medically, but not covered by health insurance - ?

The Discovery Channel was there, as well. Cameras and lights everywhere, mics all over the place and a lady running around taking polaroids of all of us who would sign a waiver. Apparently this vbac controversy is big business. I signed something saying they could use any footage from that night, but asked that I have more time to decide if my birth could be televised

The doc was a 35-ish black woman who seemed to really know her stuff, school and practice-wise, but had never actually had a baby herself. Grant and I both get this "vibe" from childless people, and when they're 30+ it almost always is a really striking, hard to describe sort of immaturity, even in very "together" people... I hope I'm not offending anyone here. There's just something about staying up night after night after night, worrying, pride, watching someone grow one day at a time, etc, that really changes who you are on a very fundamental level...anyway, she quickly vetoed the Discovery Channel deal, saying it was a private discussion about personal histories and fears, and that the legal climate was too hostile for her to feel comfortable - which kind of dissapointed me, on an advocacy level. But she was by far the most pro-vbac OB I had ever met in person, talking about how in the Boston area where she went to school and did her residency, it was totally common practice, and she didn't encounter any sort of "That's not allowed!!" until she got down here in South Florida. She talked about how it's all lawsuit fears, and that that doesn't actually represent risk factors at all. It's just that if something goes wrong in a c-section the doc's back is covered because he intervened, he did what he could, and you have to sign "I and the baby may die and that's ok" waivers before they cut you. But if anything goes wrong in a vaginal birth, parents can turn around and say "THAT DOC SHOULD HAVE KNOWN! If he had called c/s, my baby would be alive!" and sue. And this is a very sue-happy nation. Then she told us all that she has to inform us that the Obstetric organization, whatever it's called, I forget right now, doesn't reccomend vbac occur in birth centers. This is due to a slightly higer incidence of morbidity, which means complications. She stressed that morbidity is not MORTALITY, nobody in the recent studies done has actually died in a hospital or birth center vbac, she was talking excessive blood loss and other sorts of things like that, and that the risk is still very small - it just jumps from like a 2-3% chance in hospitals to a 4% chance in birth centers, probably due to transfer time and routine hospital procedures that most women don't end up needing but they all get, and hence the reccomendation. But it's not forbidden or whatever.

Then the bulk of the rest of the time, she went over the 2 page form we sign when we agree to vbac. It states that we understand that we have had one or more prior c/s, that we know we have the option of undergoing an elective repeat c/s, that 75-87% of women who attempt vbac succeed, that we know that a uterus can rupture at any time during pregnancy and is only very slightly more likely to be triggered by contractions, that vbac is more of a danger to the baby than the mother, that there may not be time in a uterine rupture to operate and prevent the death or brain damage of the baby, that it's my own decision, and is significantly safer for me than a repeat c/s, and some more hoohaw. Very thought provoking and unsettling stuff. During the Q and A with the doc afterward, she talked about how rupture is very rare, she's seen only one herself though she does and accepts vbac frequently, and that was a woman who'd never had a baby before - but when it does happen it's usually catastrophic. That many women state that they knew or suspected they had ruptured right away, but only in hindsight. And that pitocin and cytotec (induction drugs) are associated with most ruptures that do happen.

So then Grant and I went in a private room with her where I explained my case, with the 3 c/s, and she basically told me nothing. She said that Jackson Hospital (where I'd basically been told I have to go) is very c/s-happy because they deliver 15,000 babies a year and have to rush people through, and that I would absolutely have to have a full iv, not just heparin lock, and constant monitoring, and that pitocin was likely. She acknowledged that all of these things make laboring harder, pain harder to deal with, and a rupture or c/s more likely, and that I'll probably end up with more tearing from pushing on my back, or an episiotomy I don't need...but still seemed to insist that the very slightly increased risk of non-fatal complications in birth centers was the deal she had to go by. She seemed to think the late miscarriage I had at home, alone, was really good and encouraging, as far as my "uterine capabilities" go. Then she floored me with talk of how she tries to talk patients OUT of initial c/s, and warns them of all the trouble down the road, that it causes....what I wouldn't give to have gotten *that* little talk 5 years ago with Augustus! (my old OB) And she went on to say some weird crap about how epidurals are "magic", allowing women to relax and open up.

After that Shari (renegade, uber-experienced midwife o mine) came and asked what she had said to me, and I told her how scared I am about trying to fight my way through labor at a place that's "Really c/s happy", and what she said about 15,000 babies a year and how during my miscarriage at home, I coped by walking, crawling, rocking, getting in and out of the shower - but I see myself screaming and flipping out strapped down on a table the whole time. She was obviously really distressed about the whole situation, and she said that if I get there in active labor, it would be more risky to transport and they would *wink wink* have to let me birth there, which is different than what she told me a couple months ago, which was if I got there ready to push. She also had a very "We'll see" air about her in general that gave me new hope. Then as we were leaving she was telling us all (Grant, Laura, and I) stories of how she knew a woman in Texas who was hit by a car, pregnant, and went into a coma, and gave birth totally unconscious, spontaneously, to a healthy baby months later at term. And how Northshore Hospital, down here, is being sued right now because a woman who had an epidural started having fetal distress, and was then left alone for 20 minutes after the nurse turned her epi UP instead of DOWN. During which time, her body pushed the baby out, and she was so numb she didn't even feel it...the baby died, having never taken a breath, between her legs, and they found it there when they came in and pulled back the sheet! UGH!!! Shari was talking about how ridiculous it is that women are told the whole time they're pregnant how awful drugs are, watch the tylenol, no ASPIRIN, no CAFFEINE, etc, but as soon as they go into labor they're pumped full of narcotics? And how it just makes no sense..

So all that night I couldn't sleep, couldn't concentrate, couldn't do anything but THINK. About tiny but catastrophic possibilities, about slightly increased percentages, about how it would be to transfer to a hospital vs just going to one, about everything under the damned sun. Then the next morning I got up and, scrolling through my journal, I found a comment posted by Norwegian_Wood (of all people :p) -

this is an area in which your faith in god should carry you!
isn't your god opposed to men thinking/acting like gods? OB's/others who manage birth are fucking around with something that your god intended to be left between the woman and her baby. you can't let god's will be done if you have so much ambivilence! let me tell you that 90% of your success will be based on your perceptions. if you fear tearing, you won't relax. if you fear rupture, your labor won't progress. you have to work on these things, and i think that in your case, really giving over to your god's (not your midwife's, not your own) will might help you do this, and strengthen the relationship you have with your religion.

That made me pause. No, it was a full-on STOP. Seriously, why haven't I been thinking that way? About "What's meant to be, will be" and "God is in control" and FAITH?

Grant and I talked the whole way to my appt Tuesday about that, and it helped his perspective, too. It was just Isaac and the two of us, that day. We also talked about how though there is a tiny risk to the baby in vbac, in the vast likelihood that the baby is fine, it will get SUCH a better start in life - not pumped full of morphine and whisked away to a nursery for hours, but lifted, alert, from between my legs and put to the breast. Without any of the delayed bonding from pain and recovery that I experienced with Aaron.

That appt was really interesting. First of all, I was scheduled for my sonogram. They don't have their own machine, so they have a sonographer come in and do it, and it's ANOTHER out of pocket expense I had no idea was coming until I got there. And the same woman was at the front desk to tell me about it as I had just dealt with over the OB cost 2 nights before. Argh. I hate money constantly being this huge freaking deal! She sent me to Caroll, the office manager, who agreed that I could just make my 3 already planned $50 payments 3 $75 payments, and it would be covered. Which, on the one hand, is so nice of them, and floored the front desk lady who thought I'd get a no way. But on the other hand...we can't afford this stuff. We stress everytime we go up there about the GAS that it takes just to arrive at a FREE appt (It's like $13.50 per visit, round trip, and that's groceries...if Grant Sr wasn't paying for all the SunPasses in the household, there would be significant highway tolls, as well) I'm sure to a lot of you I sound really ridiculous, but for all three of my previous babies I've gone literally around the corner, to a man who doesn't even bother to charge when people go over Medicaid's limits for anything. And even though I would just never go back to him, that's always in the back of my mind, that that free option is still right around the corner. The kids' birthdays are already breaking us this month, as "extras" when we can't do basics, even though we're only really paying for cake supplies and one present each...

Anyway, Grant and I both ended up thinking it was TOTALLY worth it, for the sonogram. I have only had my old OB do it before, and he was really, really bad at it, very brief, didn't explain anything, and would give you like one shot of who knows what blurriness, at the end. This lady was able to show us toes, and facial profiles, and the beating heart, and everything. *HE* is absolutely perfect...a pound and a half of flawless spine, great bones, lots of fluid. Just great placenta on top, head down, posterior goodness
This baby WANTS to be born naturally
She examined his kidneys and measured his femur, which are things I didn't even know you could DO, with an ultrasound. Isaac chowed down on a banana in Grant's arms while we watched. I want to scan in the pics, but our scanner is out at Shaun's house right now. This baby is already measuring almost 2 weeks large for date - my due date by ultrasound is September 22 (by lmp ((last menstrual period)) it's October 1).

Then it was appt time, and I had a midwife I hadn't seen before - Angela. I LOVED her. She reminded me of my old friends Cindi and Jenny the whole time. When I asked her if we could skip the doppler, since we just had an ultrasound, she actually got out a fetoscope! I had never even seen one before (for those who don't know, doppler technology is kind of invasive, and a fetoscope is not - it's like a stethoscope that also fits around the examiner's head and then she applies this thing coming off of her forehead to your belly, and can listen to the heartbeat all through like the vibrations of your bodies...). She said she also thinks dopplers effect babies on some level, and was excited to "finally get to use this thing"
Even called Grant in to see it (he'd been pacing the hallway with Isaac). Then she looked through my file and asked me some questions and we started talking a lot about where I'll birth, etc. She was saying that Shari is in a really hard place, because she wants to help me A LOT, but she knows that if anything at all went wrong in my birth and it got out, the place would be shut down, and then they wouldn't be able to help any of the many many other pregnant women who they're helping. And I bitched about how I get that, but it is so lame because statistically I'm not really any more risky than a LOT of other people who birth there...and she said she knows and agrees, but that those people aren't labeled with the particular risk that is so hot down here currently. Their risk wouldn't be one that would get Shari labeled negligent or insane, like mine is. She suggested the fascinating alternative of birthing in a hotel room across the street from Jackson Hospital, with a midwife from there. So that if anything did go wrong I was super close, and nothing was on the center, but I could have it my way, with a shower and tub and room to walk around and all of it. I thought that was a really ingenius idea, that I'm still considering, but I wonder what you do if you get to a hotel obviously in labor with a bunch of medical supplies, and they say no way in hell are you checking in here, the hospital is across the street, fool. Or maybe I could get in fine, but would Medicaid cover the birth at a hotel? I doubt it somehow...

And then she and I talked about the risks, the OB consultation I had just had, etc. And she gave me the most candid talking to I've had yet, it really put my mind at ease. She said, the remote possibilities in vbac are very very grave - you have to know you can deal with it, live with, etc, in the event that your baby dies or is severely mentally impaired, due to a choice that you made. And you have to consider that from several angles. For instance, if you are a person of faith that believes in letting nature take it's course or God's will being done, then to some degree it is NOT really your choice that causes anything. It is the elective surgery that would be causing whatever problems may or may not come from that, screwing with what's supposed to happen, etc. In addition, and this is huge, is that I am a mother of three already born children, and MY chance of dying is over ten times higher in another c/s than it is in a vbac - and that's *without* considering my blood platelet issues, or all the scar tissue they have to get through and re-sew, after 3 prior surgeries. So, to what degree does my older children needing their mother around to raise them play into my choices?

It plays in a lot. I don't even think of death in terms of personal loss,'s just my greatest nightmare to leave Ananda, Aaron and Isaac behind with no mother. It's also one of the biggest fears Grant can muster (trying to do it all himself), and when I mentioned that part of our talk to him, I watched his vbac confidence grow by leaps and bounds. It's like his whole body just settled into "We're definitely doing the right thing, here". I understand I run a huge risk of being misinterpreted as choosing my own safety over the baby's, here, and I hope I can reassure you all that I already care deeply about this new little boy, that I would be EXTREMELY upset in the event of any sort of tragedy, and that I'm just very pro-life in all my "fetal philosophy"...the baby is not expendable, and I was originally persuing vbac largely for his (or her, then) safety, after seeing Isaac wind up in the NICU for c/s complications. I genuinely believe that the tiny risk to the new baby's safety is offset by the much greater start in life he'll receive through natural birth in the vast likelihood that he is fine...and I also feel that it's irresponsible to take a MUCH greater risk to my own life, particularly with my complications factored in, possibly leaving Grant with 3 kids to explain my death to, and a motherless newborn he'll undoubtedly have shameful resentment of...

Does that make sense? However grave all of those concerns are, I really did leave that appt feeling much better. About my choices, and my birthing options, all of it. She sent me home with some great books to read, too, and let Grant and I tour the birthing rooms, and all that jazz. She also made sure to point out a few of the many many vbac shots they have scattered around on walls, of babies (polaroids of mothers and newborns together, that were born there, that are tacked up ALL over the place...lots and lots of them). The two she really mentioned were one woman who was given a c/s for not being big enough to birth a 7 pounder, then had a vbac with a 9lbs+ baby, there - and the other was a woman who just vbac'd after 2 c/s last month
Discover Channel was there again, filming someone going home with their new baby. And I found out they have a chiropractor, who comes on Friday mornings! And he accepts my insurance! I can't start that this month, because I can't go up there every week TWICE, for childbirth class AND that, with the gas costs. Not to mention it cramps Grant's style a lot, as far as trying to work with all of the kids by himself. But hopefully next month I'll be able to.

And then 2 nights ago I went to my first childbirth class. Laura came with me, and Grant stayed home with the kids. Hopefully that situation will be reversed for some of the other classes, but it was nice to have company at this one. I'm taking the June session of classes because Shari is teaching it herself, even though most of the people in there are due sooner than I am. It was over 2 hours long and there are many things I could say about it, but I'll stick with the pertinent:

---She started off by saying that Miami-Dade and Broward Counties now have a 55% c/s rate, for all women. When you consider that c/s is 10 times more likely to result in maternal death, is MUCH harder to recover from, and has a much higher incidence of complications like impaired breathing and injury to the baby, and infection, blood clots, etc, for mom, but the rates are STILL that high, due to lawsuit fears and OBs' busy's *sick*! She talked about how the OBs are lobbying right now to get Jeb Bush (our governor, the president's brother) to make it illegal for medicaid to cover midwives, which would mean that low income women only had the choice of the 55% c/s rate caregivers. This is because Medicaid just started paying more for vaginal deliveries, and DOUBLE what they use to, for c/s, and so the docs who used to push patients towards midwives and refuse to take them, when the pay sucked, want all of them now...Grr.
---We did a lot of excercises that she wants us to continue at home - tailor sitting, pelvic tilts, squats, etc, to prepare for birth. And man, I did it all with a fair amount of ease, while I was there...but 2 days later I'm still walking like the Tin Man and falling backwards onto the toilet, my thighs are so sore. So yeah, I'm really glad I'm getting ready NOW so I'm not recovering from freaking torn muscles after I have a baby :p I actually like the sore from excercise feeling, it makes me feel like my body is getting stronger. And I think that if I really keep up the birth excercises every night like I should, and start doing prenatal yoga (they offer that there free, too, and it's supposed to help with labor, but there's just no way I can even think of making the trip regularly for THAT a priority right now - I did get a dvd from the library, though, that looks promising), and keep trying to walk for 30 minutes a few times a week, I could be in better shape when I have this baby then I ever have been. I feel so good chugging water all the time, and eating right - SO much better than I ever have in pregnancy before. It's easy to imagine dropping down to my goal weight, after birth
I'm so motivated about all of this, I love feeling strong. Another excercise she had us do, is tensing one part of your body (like a fist, or a leg and the opposite arm) while totally relaxing the rest of your body, then switching the tense part. Holding it for a minute or so. It's to teach you to isolate your muscle groups, so that you can relax while you're having contractions. SO MUCH of the pain women experience, is due to tensing their whole body everytime a contraction comes. They get charlie horses and hand cramps and come away from labor with sore shoulders, etc. That all makes a lot of sense to me, I'll definitely be doing lots of that. And she taught us about how to and not to sit and lay, for optimal presentation of the head when labor comes.
---She explained a lot of things I already knew but like to hear, about how problems that happen at the hospital are CAUSED BY the hospital. Like, there is so much more fetal distress, because they make you lay on your back, which suppresses the vena cava and reduces blood flow (and, hence, oxygen) to the fetus. Or because the pitocin is giving the mother horrible 3rd stage contractions that should only last 20 minutes for 6 hours. And more babies need to be rushed to the NICU because they come out unresponsive or not breathing - because they got the drugs their mother used for pain, during labor. And so on. During this portion the freaking Discover camera guy was like RIGHT up on me, filming me sitting there listening for like a solid minute while I tried not to glance up at him too often.
---And we all went around and told our stories and introduced ourselves, and it was SUCH a diverse group. A Swedish couple, a french couple, two British couples, a Dominican couple - and I'm talking just moved to the States, thick accent kind of peeps, not like that's their ancestry or whatever. Along with the standard Miami hodgepodge of various varieties of hispanics and blacks. It was neato. The couple next to me, the Swedes, they were apparently set on birthing in the ocean with dolphins until Shari convinced them that labor with nothing to hold you steady in the waves, and all that blood to attract sharks and crabs, was a bad idea. So due to logistics, they were using the center. Hahaha... Many shared bad first time birth experiences from local hospitals, including a couple of c/s - and when it got to me I realized how much my perspective has shifted. Because what popped out of my mouth was, "I've had 3 c sections, for total nonsense reasons having to do with obstetric convenience and being too ignorant to fight it. I've had everything from nightmares and hallucinations from the morphine, to a bruised lung, to nearly dying from blood loss while under general anesthesia. And my last baby was misdated and born with his lungs still full of muccous, and spent his first two weeks in the NICU - that's when I realized that EVERYTHING has risks, and I was done with it. So I spent the first 16 weeks of my pregnancy without any prenatal care, searching for anyone who would take me on, until I found Shari...and I'm still trying to twist her arm to have my baby here. If not here, it will still be midwife attended, just at Jackson. And I understand the hard position she's in. But I really believe in natural birth, and everything about being here has been night and day from the awful experiences I've had in my past pregnancies." She was really nice about it, too, I knew I wouldn't be "putting her on the spot" or whatever...there's no way to make that woman self-conscious. She's too up front and candid all the time to be vulnerable to on-the-spotness.

So. That's doins. I hope some people made it this far. Feel free, please, to comment or question or whatever.

Sidenote: The baby is in love with my bladder. He lounges all over it to rest, he dances with it for fun, he kicks it when he gets angry. Basically what I mean is, I have to pee 45078346987 times a day. Also...I think his name is Jake. As part of Jacob Luke. But I'm not sure yet.
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