Tuesday, July 21, 2009
Monday, July 20, 2009
I guess it would be best to begin my birth story with my first birth, the birth of my son, Max. Being pregnant with him was as glorious as any first pregnancy could get, zero illness and with all the delightful firsts, thankfully. Like many births that begin in the hospital however, Max's went the way of the c-section. The records show that there were multiple reasons for this, ie, not specifically conclusive; fever (fear of infection - even though I had had IV antibiotics the ENTIRE TIME), fetal heart rate decelerations, CPD, FTP, ETC. Let me just say, I thought I'd "listen to my body" and wrote out a "birth plan". To be fair, "listening to my body" often meant having that 5-inch thick sandwich or going on a Hagen-Daaz run in the middle of the night while pregnant. I believed myself young and fit enough to forego extra Yoga and workouts, that I knew enough about birth in general to do a 3-hour birth class, alone. Sixty-plus pounds later and about 3 weeks overdue, I “listened” to my body and begged to be induced, all day long, crying in hormonal desperation until they admitted me into the hospital. My mother, husband and I waited an hour until we were able to get into a small, triage room, where we stayed for 12 hours until my water broke with little to no fanfare and zero pain. We were then allowed to move into a true L&D room. The birth ran the gamut; IV for GBS antibiotics, Pitocin to get “going”, crazy, intense and inconsistent contractions, birth plan out the window, self-administered Fleet enema, fentanyl, an epidural, 3 hours of pushing, all eyes but my own seeing my son’s head, all eyes on the monitors, not me, 7 very different labor nurses, 4 Ob's, a pack of interns, a nice 1.5 hour wait for an anesthesiologist, busy with 3 other cesareans, for my URGENT cesarean, during which I actually had to let them know my leg was not on the table...After a total of 32 hours, Max arrived. I sent my anxious husband away to accompany our son with instructions to not let his eyes off of him. The next 9 hours before I saw my son were spent catching sleep in dopey, exhausted bits, interrupted by rounds for stats and sudden panics about Max’s whereabouts. I couldn’t even hold him when he was there. All that I could manage to voice was an inaudible whisper to bring him closer. I consoled myself that I needed the rest. The maternity ward was no better. Waiting for the next 3 days as per protocol and an additional day for blood test results to show Max was infection-free, was almost as bad if not worse. What might have seemed a not unusual tiff with my mother, saddled with the coming off of drugs and hormones and no sleep, my nurse interpreted as a situation to remedy. Herself a young mother of a 3-month old without decent rest, she took it upon herself, even when I emphatically said I wanted no such thing to happen, to tell my Korean mother that only spouses were allowed to sleep over, shoving the Patients Rights book at her and asking if she could read English. My mother has only lived in the US for 35 years. Unfortunately, mom thought I had orchestrated the whole thing. It was flat out awful, even with my linebacker-sized baby finally with us. I felt assaulted, traumatized, disappointed, misled and totally distrustful of my own judgment. The minute we walked through our own doors and put the carseat with Max still in it down, I bawled into my husband’s shoulders. I never wanted another baby again and I’m sure my husband believed I meant it.
At my 6-week check up, I broke down when asked how it all went. Semi-jokingly, I said I was finished with having kids, but mentioned a possible future birth, a possible VBAC. It was quickly stated that I had an 8% chance of successful VBAC, and a 50-60% chance of having the EXACT same traumatic experience, whatever that meant. As soon as I was pregnant again, I could easily schedule a cesarean again and choose the birthdate, bypassing all of the trauma I had previously experienced. I was stunned. Something was deeply unsettling to me, made obvious when my husband asked, "When are you going to write those thank you notes to the doctors?" and my reaction, borderline violent. A year and a half later, a nurse handed me some tissues to dry my eyes after a routine Pap and suggested that I might try some therapy for PTSD-like symptoms. I cried ANY TIME someone asked how the birth was, no matter how hard I tried not to shed a tear.
Though I know not all cesarean births go this way, I also know many do, leaving women severely shaken in their views of everything birth related and sadly at times, in their views of themselves. This very fact should make us reexamine birth from beginning to end more closely.
Let me be clear that I was not so much upset about the cesarean section as I was about the entire chain of events that led to it. In all honesty, the surgery was the easy part. For the second time around, I simply wanted a different experience, one that I owned, one that I was consciously aware and in charge of, with people around me who supported that very wish and respected me enough to talk to me informatively and sensitively.
The same nurse who suggested therapy also reassured me of my willingness to try for a VBAC, vaginal birth after cesarean. I undertook much research before getting pregnant the second time. The occasional homebirth story simply came along with the information that I found. My intention was to go for a VBAC in a hospital setting. I never sought out homebirth as an option, but after getting pregnant again, everything slowly began to point in that direction. After several interviews with OB's about protocols and management of VBAC's, an open house visit to a birth center, more interviews with doulas, I felt somehow stymied and disconnected to my choices. Everything was very what THEY’D do and not what they’d do WITH ME. Tons of emphasis on cesarean prep, just in case. Even a more stereotypical doula was excitedly talking about EFM and quicker access to epidurals so I could just wait and then vaginally birth. What about birth prep? I appealed to a great neighborhood resource, the Potrero Hill Parents Association, for names of anyone, anything VBAC related and one name appeared several times. It was the name of a midwife who has practiced for over 25 years in San Francisco. I decided to meet her as a possible doula candidate.
The same thing happened as always whenever I was asked about my first birth - tears, big, bitter, pitiful tears. Only, when I met Maria, it was the first time I felt like someone understood where exactly those tears were coming from. It wasn't so much that I was disappointed in myself or the hospital, but that I believe in my core of the value of birth, perhaps in the same way one might hold high the experience of pregnancy or breastfeeding as nonnegotiable aspects of early parenthood. I firmly stand by the motto, "To each his own". To me, a VBAC at home was what became the best decision for our family.
It took months more of work at my midwife's behest. Utmost, I had to make sure I was a good candidate for VBAC at home. This was hotly contested between hospital staff. Where one said I was fine and could follow parallel care between midwife and hospital, another said any birth at home is atrocious and irresponsible. However, according to them all, my VBAC chances shot up significantly once the news was out that I was even remotely considering homebirth. One thing was agreed on after that, that my body had the "memory" of getting all the way to pushing and nearly crowning. This was only encouragement.
I had to "deal" with my anger and flatly come to the conclusion that what happened before was the only way my son was going to come home to me, that I couldn't dissect the experience in any way and find one particular person or thing to blame. It was what it was, but it was a big deal. Ok. Fortunately, as time went on, I began to view the first birth as a benefit, an advantage: EXPERIENCE.
My partner, my husband, had to be on board, and this was difficult. One can only imagine the total helplessness he must've felt after going into our first birth supposedly prepared and witnessing what may have looked like sheer torture for me. His impression was that his wife and son were saved. I would like to say I won the case through all the bookmarked pages of studies and journals that deem homebirth safe, the statistics on successful VBAC anywhere, etc, but it was really our deepening trust and in our relationship with our midwife, our birth instructor and ourselves that closed the arguments. We simply came to feel prepared for birth wherever it would end up. Even back on the table.
The last half of my second pregnancy, I knew I wanted to try anything and everything that might up my chances of a successful home VBAC, or HBAC. These things included prenatal yoga, chiropractic care, acupuncture, massage therapy, psychotherapy, hypnotherapy, a doula also seeking a VBAC, meditation/visualization, reading, exercise, a well-managed diet (no more Hagen-Daaz), all of which were practiced and administered by a network of people who were very familiar with each other - a family if you will. Most importantly, however, I very much consciously worked on surrounding myself with "believers", those who believed in me, nay-sayers be gone. I canceled lunches with people who said, "You're nuts!". To my surprise, supporters were found in those I thought would be negative. I simply had to be genuinely wholehearted in my sharing the wish for a homebirth and own the work involved.
For our back up hospital, we chose UCSF. Four main reasons brought us to that decision - nurse midwives attend the OB patients, a practice that made us more comfortable in knowing, mobile EFM so I could walk around, bathtubs for each room to relax in and the knowledge that many critical neonatal emergencies end up there. The last, we didn’t focus on, but was nice to know.
I tested positive for Group B Strep again. As per protocol in the hospital, I would be given antibiotics intravenously. What were my options now? Maria was great. We discussed a month long course of oral antibiotics, which didn’t come about. Instead, we decided to loosely follow a diabetic diet to greatly reduce sugars which feed the bacteria and continue to qualitatively test the GBS, high, medium or low growth. After several weeks we got it down to low, but not zero. I had read a Bay Area Homebirth Collective newsletter about a mom using the surgical cleanser, Hibiclens, directly on herself since GBS is passed through contact. We decided to go this route. At this point, I felt all boxes were checked and bases covered.
Even after all of this, my conviction and confidence stronger than ever, I could not avoid the last panic late into my pregnancy. "What if I have to transfer and have a cesarean again?" As I waited for one of my lovely, long prenatal appointments, serendipity prevailed. My midwife's office is a shared space with chiropractors, one of whom was a patient of my midwife and happened to be there. She simply started telling me of her homebirth experience without my asking. Her experience ended in a transfer and cesarean AND she was pleased. How? Because she went for it, was prepared, respected, consulted, advised, supported and sincerely cared for. I was calmed and mentally began to consider how I'd want to handle the least sought after of my scenarios.
One term used to describe a doula, or midwife acting as doula, is advocate. Key to my comfort with a transfer to a hospital was that my midwife would then be my advocate, like a lawyer to consult with once given some terrible news. This seemed much more supportive and protective than a doctor handing over a clipboard to sign surgical consent in mid-contraction. I actually imagined the comfort in saying, “Talk to my advocate.” But, I had to go deeper. Worst case scenario would be that a baby would not come home with us. I was reminded of a question we asked Maria very early before working with her. We asked if she had ever dealt with the death of a baby whose birth she attended. To be sure, this was extremely unpleasant, but I felt it necessary to ask. I felt I should've asked for my first birth in hindsight. The ensuing story obviously brought us to tears, but after processing it further, I realized how comforting in that event that that young family had an advocate, a gentle care provider, a MIDWIFE who’d been with them throughout the process, a friend to humbly share and support in that harrowing moment.
My due date came and went, my calm and patience wavered. Three days later on a sunny afternoon, my water broke. I was elated to finally feel that sensation, not having done so the first time. This was it! I had had a couple of "practice" labors, or "false" labors that lasted about 4 hours each, in the two weeks before. They were helpful in getting me somewhat dilated and really “prepped” to step up to the real deal. Our family went out to Indian dinner, while I had mild contractions 10 minutes apart or so. I literally tried to welcome and savor every one. We came home, bathed and put our son to bed. Max was 2 years and 8 months old and had been told of a new sibling, a sister on the way. I kept quiet that I was in labor to him so he wasn't anxious. We had hoped he would sleep through it all as I labored on another level of the house and if not, a sitter would take him elsewhere. Two and a half seemed too young for me to not worry about him and be able to focus on birthing. My husband and I lay down and listened to relaxation tapes I'd made during hypnotherapy, trying to stay rested and calm. The contractions were like clockwork - coming quicker and stepping up in intensity - all very manageable.
Around midnight, the contractions were 3 minutes apart and I had to stop what I was doing and breathe through them. I couldn’t even stand to be talked to, no outer focus, only in. We called our doula and midwife who said they'd be there in about an hour. The birthtub was made ready downstairs near our guestroom, easy after the practice of two false starts. My doula arrived at the same time as my midwife and her apprentice. At the same time, my son woke up. We called the sitter. My contractions were strong and I wanted nothing more than to get in the tub. I was checked to be 7 centimeters! And all of it accomplished before anyone had arrived. We quickly used the Hibiclens, which stung like alcohol, but otherwise, forgettable. The sitter took my son to her house, sadly without a g'bye, but gladly without a clue, I relaxed in the warm water, in the dimly lit and heated room. I only came out twice to check the cervix, it was that comfortable.
Three more hours passed with the rhythmic progression of contractions, rest, heart rate checks, dilation checks, peppered with calming voices of support and encouragement. When it seemed about an hour or so was left to the main event, another midwife arrived. This is standard practice. My team then consisted of husband, doula, two midwives and an apprentice. I was surrounded by believers and in fact, a team of women who felt honored in the presence of birth ~ amazing. My mantra was that I be yoga's corpse pose in between contractions. It worked. I slept. I had prepared by meditating on a chart given by my hypnotherapist of a typical hour of active labor - a 1.5 minute contraction divided into three equal parts is, 30-seconds rise, 30-seconds peak, 30-seconds fall. Being 3 minutes apart, as contractions usually are in this stage, means that in one hour, there is 15 minutes of contractions, only 5 of which are peak, leaving 45 minutes of absolute nothing - REST. I focused on the resting for endurance, my husband in the water supporting me as I leaned into him.
The final stage kicked in. I started to question my resolve. I was too tired. I vomited. I was ready to get this over and done with. I thought of my visualization exercise about an animal. For me it was the mother wolf, and her deeply impressive message that our strength and authority as mothers is inherent, natural and unquestionable. I got motivated. Because of the way I asked for counter pressure on my back and hips, it was thought I was having back labor, baby facing up, so I floated on my back in the water when it was time to push. I could feel her head, but to tell the truth, that made me lose concentration. I focused on the contraction. Not wanting another contraction, I pushed a bit quicker than I should've, resulting in a tear and need of stitches.
Eva was born in the water at 4:15AM on a wet Spring day in April. My husband laughed so hard while I sat in the water feeling a mixture of amazement, joy and great relief, like something was lost, but found again and better. I joked to get pregnant and do it again, right away. A far cry from the first experience. So tired after that last push, I leaned my sleepy head onto my laughing husband's chest as he sat behind me. But then, Eva was placed in my arms and everything hit me. I didn't just DO IT, have a natural childbirth, as one OB said she understood as my sole reason to choose homebirth. No. I totally overcame a very dark and disappointing obstacle, place, thing that had resided within me, through this birth experience. Something that weighed me down as I tried to accept it and go on loving my first bundle of joy. I came out on the side of bliss that all parents want to have somehow, something that is your new baby AND the birth. I was wholly transformed. The experience carried me through most of that first sleepless year and to this day, perhaps for always, and made an impact on those in the room and others in my life. When I think back on that entire process culminating into that moment, I feel the most tender kind of joy. It has become a touchstone. I own it, but I share it. Everyone's experience is unique. To each her own.
Friday, July 17, 2009
The MAMA Campaign had a very significant meeting with the Centers for Medicaid Services on Wednesday, July 15, 2009.
How We Secured this Important Meeting:
Due to the connections that Health Policy Source has with the Centers for Medicaid Services (CMS), the MAMA Campaign secured a meeting with CMS this week to present information about Certified Professional Midwives, about the state of maternity care in the U.S., about our request to have CPMs included in Medicaid on the federal level, about how including CPMs will help to improve quality and outcomes and reduce costs to Medicaid. It is very difficult to get meetings with the CMS and this was a significant accomplishment for the campaign.
What is the Significance of this Meeting to our Campaign Strategy:
As we increase our support on and increase our chances of getting our amendment into the health care bills, legislators will director questions to the CMS and ask CMS to weigh in. If CMS was not briefed on Certified Professional Midwives and the contributions we offer to the system and could not answer these questions, our amendment would have very little chance of sticking in the bills.
Who Attended the Meeting:
Six of the top administrators at CMS attended the hour-long meeting, including the right hand person for the new Director of CMS. The campaign's delegation was Mary Lawlor, Jo Anne Myers-Ciecko and Carol Sakala from Childbirth Connection.
We were particularly grateful for the time and attention that Carol gave to this meeting. Her participation created an impressive and important partnership opportunity with our campaign to further the efforts of Childbirth Connection to bring deeply needed attention to the importance of addressing quality and cost, in addition to access issues, in maternity care reform in order for birth centers, will provide the core of an effective approach to improving quality in maternity care in the decades to come. to be successful. Their emphasis on improving quality makes such a strong argument and creates a powerful and effective context for the inclusion of CPMs in Medicaid. Carol spoke strongly to the point that mandating a strong set of quality improvement measures for maternity care, as Childbirth Connection is advocating for with Medicaid, combined with mandatory Medicaid reimbursement for CPMs and
The Reception We Received:
The CMS officials were receptive to our presentation, asked for clarifications, made no objections: it was a very positive meeting. Questions were asked about the differences among the credentials. They received information about the CPM credential favorably. We were able to present the numbers of CPMs, the geographical distribution and the growing nature of the profession in a way that speaks well about how far we have come. One official said that our description of the plight of so many women around the country in regard to basic lack of access and the poor quality of maternity care is a powerful argument for expanding Medicaid reimbursement to CPMs and birth centers.
Wednesday, July 15, 2009
You can see the Senate Bill here:
Saturday, July 11, 2009
Thursday, July 9, 2009
Monday, July 6, 2009
He was born a whopping 9.5 lbs on his due date of Monday, May 4th at 3:39pm. As planned, he arrived at home to his parents who were waiting for him in a pool of water. It was quite an amazing experience. :)
We have a blog where stories, video and pictures are available, please feel free to check at your leisure. We will post periodic updates, but not alert you every time we do so:
We look forward to sharing him with you!
Holly, David & Oskar
Thursday, July 2, 2009
The sun shown bright and I listened to the neighborhood children play outside as I labored calmly in my birth tub. I had wonderful rests between surges where I listened to birds and dosed off to sleep. My doula whispered, "You are having a beautiful birth, Thais."
I was, but I also struggled with doubt the whole time. I was scared that I might not be able to pull it off. Even when West's head had crowned, I thought that he would get stuck and Maria would have to transport me to the hospital for another cesarean. And then, the hospital would have birthed my baby not me. But somehow, I managed to overcome those doubts right before each surge with my simple chant, "This is MY baby." Sometimes I would say, "Let's just get through this next one. Just one more."
The realization that only I can birth my baby in the way that I want was an on going theme for me throughout my pregnancy. People that I felt dependent on and wanted at my birth didn't work out for one reason or another. Even Maria had to go lobby in on my due date, and I had to come to terms with the fact that she might not be there for the birth. Luckily, West came when she got back. I am so grateful for that.
For my first son's birth, subconsciously, I always thought that I'd be saved like is saved from her evil step-sisters. I assume that it is a cultural message ingrained in my psyche since I was a little girl. It's important to have support, but the reality is that only the Mama can birth the baby. It is hard to be alone on such a hard journey, but the belief that I could do it and my two years of preparation allowed the baby to come. I pushed as hard as I possibly could. I wanted him to arrive protected at home and in peace.
"This is MY baby," I chanted over and over again to myself. And I did push him out. He came right out like he should. It took only one hour of pushing after seven hours of active labor. Baby West was born at home on a gorgeous, sunny day. His demeanor is as peaceful and calm as the way that he joined us. And, he is so loved by me and so many others who have followed my recovery from my first son's birth to the discovery and actualization of a with my second. When Maria put him on my chest, I rejoiced, "I did it! I did it!" Kara, my doula, cried with joy next to me as she listened to my reaction. I feel so powerful. Birth really is empowering.
As I celebrated holding my new baby in my arms and watching him nurse perfectly without any instruction. Maria said, "Now that is an unmedicated baby." After a brief celebration, Maria was looking serious again because I still had not birthed my placenta. We waited an hour and tried everything from angelica root, to nursing, to a shot of pitocin. Finally Maria had to make the decision to call 911 and have an ambulance transport me to UCSF. I needed a manual removal of the placenta. It was only Maria's fifth ambulance transport in her 23.5 years of being a midwife. Four of the five transports were placenta related.
Maria can perform the procedure herself, but since I had had a previous cesarean the chance of hemorrhaging was too risky. The procedure at UCSF was short and I was back at home shortly afterward. I am happy to have had a good hospital experience rather than one of a victim. It was a necessary part of my healing.
As Maria and I waited for Zack to pull the car around in the quiet lobby of the hospital at midnight, she said, "This is what home birth is all about, it's a collaboration with the hospitals. We come to them when we need their services and we only use what we need."