Wednesday, February 20, 2013

Three Births, Three Ways Part 1

Every birth is a unique experience - different mama, different attendants, different location, different baby.   I am unique and each of these births are their own event.  I don't want anyone to feel looked down upon or in any way inferior for having different experiences and opinions.  This is my take.  Of course I have strong opinions on my births as I have researched and decided what I believe to be best.  This does not in any way mean I'm the Birth Goddess Guru Supreme.  I only share these for the sake of sharing and perhaps, in a small way, they will either encourage you in your choice or give you a differing opinion to chew on.  I know this is an extremely emotional topic so I want to make sure we're all just sisters here, sharing our stories!

And now, after that lengthy disclaimer, let's talk 'bout birthin' babies!

Having had three, unmedicated births in the hospital, at home and then at a birth center, I thought it would be helpful (and I've already been asked by a couple ladies) to talk about each experience and give thoughts on the way it played out, what I would do again, what I'd do differently and then perhaps be philosophical, shed a few tears, and growl a few growls.


Birth #1
The Natural Hospital Birth

Warning: I mean, duh, this is about birth.  It includes anatomy and stuff.  This is also, astronomically, my most frustrating and disappointing birth.  It has taken me 5 years to process it and come to peace with what it was and what it wasn’t.  If you are currently pregnant and having a rough time with the idea of where to birth, perhaps the hormones will want you to skip the nitty-gritty and go to the conclusion.


Why We Chose A Hospital Birth

Having had a baby precisely zero times and being 1 1/2 hours from the nearest hospital, we decided to go with a hospital birth.  The doctor I chose was the only one I could find that would take a self-paid patient and was recommended to me by three different women I knew. 


Choosing to Go “Natural” and How I Prepared

After researching all the side effects on mama and baby of inductions and epidurals, I decided to go without drugs.  I read about every book there is on the topic of “natural” birth.  And I freaked out.  I was completely confused by LaMaze and the Bradley method, a little weirded out with hypno-birthing, wondered if I should just throw in the towel and let the docs call the shots, wondered if I would melt into a puddle with the first contraction, wondered if I should "accidentally" not make it to the hospital, freaked out that I wouldn't make it at all.  I wrote out the most domineering birth plan ever known to man to ensure they knew I was serious about a natural birth then rewrote it with all kinds of "please" and "thank yous" and smiley faces.  I took the hospital tour, watched the required epidural video and, according to the very sweet nurse, "Honey, you don't REALLY want to go through all that!"  I nearly hyperventilated and then had to cover my face when they had her cross her legs and bend over for that needle.  I hate needles.  I agreed with myself that I didn't care if this child was 15 pounds, they would never stick that into my spine!

I read many books about natural hospital births and requested all the little things they say to nicely request for a "natural" labor.  I asked for a birthing ball, mirror, warm compresses, no IV and the ability to walk around.  I gave my birth plan to my doctor, discussed it, he smiled nicely and placed it in my folder.  He said they would "see what they could do".  He said they didn’t have a ball and it was against hospital protocol to allow a mirror.  He also said he required an IV since a massive hemorrhage would deflate my veins and they would have nowhere for a blood transfusion.  Massive hemorrhage?  Blood transfusion?!?  


Prenatal Care

For prenatal care, I was in the waiting room the same amount of time I spent with my doctor.  I had a few regular nurses and the majority didn't seem to remember much about me, which is fine since they see so many women, anyway.  They asked me every single time if I was allergic to anything, which doesn’t change weekly as far as I’m aware.  My doctor started regular cervical exams as soon as I hit 35 weeks and did one every visit following.  Once I passed 38 weeks, I was asked multiple times by the staff why I was still there and why I hadn’t induced and that I could be holding my baby by now.  On my due date, the doctor stripped my membranes during my cervical exam - without asking my permission or giving me any warning.  It hurt for a good 24 hours.  Tears were shed.  I felt utterly and completely violated.  It also didn't do a thing as Charissa didn't come until 6 days later.  I had no time to find another doctor.  After that particular incident, I really wanted to.


The Birth

Charissa's labor was 24 hours long.  It was...long.  And hard.  And gave me the greatest feeling of purpose I had ever known.  Like the natural hospital birth books suggested, I stayed home as long as possible to labor on my own.  I did drive to the city and walked in a nearby park for hours.  By the time I actually walked into my Doctor's office (not L&D), my contractions were regularly 5 minutes apart.  I was escorted by wheelchair to L&D where a young nurse started my "necessary" IV while telling me about her migraine and loser boyfriend. They strapped on my monitors.  I said I didn’t want monitors and mentioned my birth plan which was in the folder…but was told I had to have them until the doctor gave an order to remove them.  Protocol, my dear.  Protocol.  When he came an hour later,  he wouldn’t have them removed.

I came to the hospital at 2pm and had labored for about an hour when I agreed to have my water broken.  They were checking my dilation about every half hour.  I had a wonderful labor nurse who was currently in training to be a midwife.  She respected my contractions during cervical exams – bless her.  

I was also the freak of nature on the hall.  It wasn’t until after birth that I realized there had been multiple nurses coming in and out of my room just to watch me labor.  A "first timer" going natural and I wasn’t climbing the walls or screaming.  This made me very interesting.  I had seen my Mom give birth three times and essentially threw all those fancy breathing methods out the window in favor of deep, hard breathing in through the nose and out the mouth.  Rhythmically rubbing my leg up and down during hard contractions really helped.  Doug gave me counter pressure on my lower back which also helped – we had read about that and a friend had explained it to me.  During transition (the last dilation phase when contractions come one on top of the other), I thought “so THIS is why people get epidurals!” but by the time of transition, it is to late to get one anyway.  I was so thankful I had read about labor phases so I knew that intensity wouldn’t last forever.  It meant a baby would come soon!  

And so the pushing began.  They pulled out stirrups even though I had specifically asked to labor in the position I chose.  It was in the birth plan, doggone it!  I had discussed it with my doctor!  I said I didn’t want them.  I was told they would help and my legs were placed in them.  I said I didn’t want them and took my legs out.  I was told they would help me produce a healthy baby and my legs were put back in the stirrups and held there by the nurse.  When I am in hard labor, I lose my capability to say much and Doug was so wrapped up in his wife about to have a baby that he didn’t say anything either.  I absolutely HATED pushing with my legs in the stirrup.  I HATED the “C” position which felt completely unnatural.  I HATED feeling like I "had" to push since everyone was standing around telling me to push.  Years later, after having Brandt, I realized I never actually had the “urge” to push but was rather told to push.  I felt like I was sitting on her head.  I kept reaching to guide her head down – which my doctor was not doing.  He was to focused on my lower parts to prevent tearing since I had asked to not have an episiotomy unless necessary.  He never used warm compresses and never told me to slow down so I could stretch gradually.  This resulted in the most bizarre upward tear any of the labor nurses had ever seen.  Pushing so hard and fast resulted in internal tearing as well.


Afterward

She was born at 6pm and was placed on my chest as I had asked.  My beautiful baby girl!  I had convinced myself she was a boy because I wanted a girl so very much.  The doctor waited maybe 2 minutes longer before having Doug cut the cord as we had requested.  That was "delayed" cord cutting as I had requested in my birth plan.  I was terrified since she was an ashen purple color and begged the nurse to tell me if she was okay.  They rubbed her into a baby color.  (I now know an ashy purple color is normal for a just-born.)  

The doctor then spent an hour sewing me back up.  During this time, there was a phone call from the cafeteria asking me what I wanted for breakfast the next morning.  Cinnamon rolls!  YES!

In came the lactation consultant.  Now, they are a respected group of women.  It is an honorable profession.  But this middle age women seemed set to terrify me into thinking I was all wrong.  Oh how I cried trying to get that stupid breast shield to work over the side she said was “slightly inverted”.  I was told if it didn't work I might need to supplement her until my milk came in.  After two days I removed the shield and she latched just fine.  I really beat myself up over not being made “right” to breast feed.  I don’t think the consultant’s attitude helped me much.

Since I had tested positive for Group B Strep and had not been in the hospital long enough to be given the full butt-kicking dose of penicillin while in labor, we were required to stay in the hospital for three days so that Charissa could be monitored for any respiratory distress.  That night, I came down with a fever and later a yeast infection.  I wonder how much that had to do with the penicillin.  I was also worn out from 24 hours of labor.  The nurses took Charissa to the nursery so I could sleep.  After 2 hours, they came back so she could nurse.  The baby nurse looked at us gravely and said “We need to talk about this baby.”  Her blood sugar was low, she had a heart murmur, her body temperature was low.  They had given her formula for her blood sugar and she "needed" to stay in the nursery under the heat lamp.  Looking back I know what she needed was for me to nurse her and hold her skin-to-skin.  I was furious they gave her formula without asking me.  Doug and I were devistated about the heart murmur until I called my mom weeping and she told me many newborns have a heart murmur which is gone within a few weeks.  Why were we not told that?!  It was never mentioned again and had vanished by her first check-up.

The next few days were a blurred waiting period.  It was nice to have my food brought to me, but only I was fed.  Poor Doug!  Since I was sick, it was very nice to be able to sleep but I was awakened at 5am each morning for a blood draw.  My doctor came to see me once a day.  I asked him about my tear being up and how common that was.  He responded that since I didn’t have an episiotomy, this was what I was asking for.  All I could do was cry.

My stitches were re-stitched three times in the course of the next two weeks due to the extremely delicate tissue of that area.  At my 6 week appointment, I had severe scarring and postnatal depression.  At 4 months, I was told he could give me a series of scar tissue eating shots or I could undergo plastic surgery.  I left the hospital in tears.  And I’ve never been back since.

At 6 months, we moved to Oklahoma and I went to a midwife about my scarring.  After listening to the tearful story of my birth with much empathy and “bless your hearts” she recommended massaging with castor oil.  After two weeks, the scar tissue was essentially gone.  No invasive anything required.  I have had no complications with it since.



Priorities of the Hospital Birth

1)  Money – liability and income were the first priority.  From the IV & monitor, to the position I was made to push, to being kept three days, it was all about protocol & covering their tails.  It was NOT about my desires.
2)  Doctor’s Convenience – my membranes being stripped, water being broken, the stirrups and being told when to push.  I felt like I was inconveniencing him by wanting to let my body do its thing rather than letting it be manipulated the way that worked best for everyone else and their schedule.
3) Me  – okay, I guess I fell into the priority list somewhere!  The nurses were nice for the most part but meeting a different one every shift was confusing.  I loved my labor nurse.  The food was good.  The place was clean.
4)  Baby - the baby nurses seemed nice.  They gave her a sweet mohawk.  They obviously thought they would do a better job of caring for her than me.  Bonding with her was not discouraged, but protocol did not encourage it.
5) Doug – he would have starved had it not been for visitors bringing him food because he wouldn't leave my side.  He is my birth hero.


How I Would Have Done It Differently

Honestly, I would never have another hospital birth unless absolutely medically necessary - say placental previa or breech without options.  Many women have had good experiences in the hospital but this one burned me badly.  Here are a couple things that might have made it better:


First, I would have really interviewed my doctor/hospital and tried to find one I liked that would support my decisions.  I did most everything right for a natural hospital birth according to the books except being really picky about my doctor.  Unfortunately, being self-paid, we didn’t have many options.  The doc I chose was not a "bad" doctor.  He was very congenial, thoughtful and has many female patients that love him.  He is good at what he does - extracting babies from women in the most practical, medical, businesslike fashion available.  He's an "expert".  He isn't my style.

Second, I would have loved to have a doula - someone to stand up to the doctor/nurse for me and my desires (especially those cursed stirrups).  Expecting that of my husband who was watching his wife go through labor for the first time wasn’t fair or realistic.  Note: My Mom was present for all of my labor but not the birth.  I wish I had asked her to stay!

Third, I would have denied so many cervical exams before and during labor and also not had my water broken.  Both were completely unnecessary and invasive.  I also would have stood up to the doctor after stripping my membranes without permission. 

Fourth, I would have demanded my baby, held her skin-to-skin and nursed her whenever she wanted, not when the nurses brought her to me.  I let them keep her for the first many hours because they kept saying she needed to be in a warmer, needed her temp supervised, etc.  I was manipulated into thinking it was best for my baby.  All needed observation could have been done by my bedside but it was more convenient for them to do it in the nursery.  Many hospitals are finally starting to make in-room care part of protocol. 

Fifth, I would have stayed the night after labor and then denied treatment.  Three days in a hospital wasn’t necessary and created far more stress on our first days as new parents.  Group B Strep complications are identifiable by an observant mother.  If I had been educated by the docs, I would have known what to look for.


Conclusion

In hindsight, I have decided that having a "natural" birth is so much more than managing to bear a baby without medication. 
- It is working with your body and letting it do as its created.
- It is the ability to see birth itself as a journey and pathway to motherhood.
The hospital experience did not provide that.
- It put me in a minority position instantly.
- It required constant vigilance and reminders to my attendants.
- It gave me little support and even negativity regarding my choices.  My labor nurse encouraged me but the only other words of "encouragement" from others were primarily disbelief that I would "go natural".
- It was a constant battle with my own mind to try convincing myself I made the right decision to know what my body was doing since I was surrounded by "experts" telling me differently.
- It required my doing lots of research to try making informed decisions because hospital protocol was not always explained to me.





My gorgeous little girl is turning 5 soon and she is an absolute joy.  Not having my hopes and desires met cast a dark shadow over the beginnings of my motherhood career.  But it has become part of my mothering journey.  It has affirmed my faith in God's creating my body well.  It has strengthened my desire to follow my intuition.  It has shown me the importance of making decisions with my husband in prayer (he is now a huge advocate for midwives, by the way).  It has strengthened my resolve to uphold the women's right to proper birth preparation and actual information on all medical interventions.  I also am vehemently against doctors manipulating any woman into thinking her body just can't handle the pain, the timing, the wonder of birth.    Doctors are needed and necessary for medical emergencies.

But the average birth is not an emergency.

*******
A note on finances: we had health care but no maternity policy.  The cost of prenatal care and an average hospital birth without complications or medical interventions in our area was around $10,000.  We had that saved and were prepared to pay.  Any health complications would be covered under our health care. However, the hospital billing department asked us (many times) to apply for aid after reviewing our request for a discount.  I had been laid off when my boss found I didn't plan to work after baby was born.  Doug was attending seminary and we were living off the income of his part-time job.  We basically qualified for every financial assistance available.  We decided to go ahead and apply.  All costs were covered.

Read Part 2

2 comments:

Erika said...

Oh sweet Hannah! I am so glad that this experience didn't prevent you from further having babies!
This story is very familiar to me as Charissa was born like me, it was my moms first birth and worst experience. Military Dr, in a hurry to birth a baby who was certainly not wanting to come. I was apparently yanked out with forceps and my entrance made hamburger out of my mother. :( she also said she never felt the need to push, but was "told" to.
One of my biggest reasons for doing a birthing inn birth, and my babies both came beautifully. I can't imagine how terrible this was for you.

Libba said...

Wow. Thank you so much, Hannah, for sharing this. I liked your encapsulations at the end and the honesty throughout. What a sad experience... I also feel there is a huge hole in the education of mothers about their bodies (and babies). Looking forward to reading about your other two. :O)