Friday, July 29, 2011

I'm now planning for a homebirth

That's right, ladies and gentlemen, in the past couple of weeks every plan for my labor and delivery has changed. Unexpected, but definitely a positive.

Quick hits:

  • My MD transferred me from her care because her clinic felt my prenatal and delivery care would be better handled by an OB than a family practitioner. This was because I wasn't comfortable submitting to the ultrasounds and non-stress tests they were asking of me (I felt like they were looking for issues that weren't indicated. They felt they needed to check in order to rule them out.)
  • The OB's care to whom I was eventually transferred did, in fact, seem to be competant and friendly and would have been able to handle my prenatal care. He told me he was made of "tough sauce" and everything I wanted was on the table (he'd give me his opinion but it'd be up to me to choose what to do). But he's only on-call at the hospital every 13 days, so chances weren't good that he'd be the one to deliver my baby (he said 20%). This is one of my main complaints about the OB care in Madison--you spent time developing a relationship with a doctor only to get one of their collegues seeing you in labor and guiding you through your medical needs on that date. 
  • My doula (who is also a midwifery student) told my story (with all its weird diagnosis and provider switchero drama) to her instructor.  As it all turns out, this CPM is not only comfortable with primary VBAC attempts such as my own (with the initial c-section performed due to breech presentation) but she was also willing to drive to Madison to attend a homebirth.
  • And drive here she did, to visit with me. This week we've finished gathering all our homebirth supplies and we're now waiting for Baby to decide to arrive. At home! Uli talks positively about the "big wives" and we're all looking forward to having the newest Propson delivered right here in our own bed. Or the futon. Or the bathroom. Or the living room. Or wherever. But here, at home. With no last minute 9 centimeter car ride to the hospital. No random on-call OB. Just us and our midwives.
Conclusion:  I feel great. Excited. Happy. Ready.

    Tuesday, July 19, 2011

    Birth Plan

    38 Weeks

    As promised, here's my birth plan! Kind of.

    For the purposes of this post I'm combining a few separate birth plans. I've written one for my doula (not really represented below) so we could discuss what I anticipate as her role in my labor/delivery and give her insight into my head and what I'm requesting of the doctor and hospital staff. Another version was written specifically for my doctor, to be reviewed prior to the birth so she knows what I'm hoping for and we can discuss any divergence from local hospital policy and get the waivers (going against medical advice) signed if need be. The third (shortest) version is for the hospital nursing staff, whom I will meet for the first time hopefully late in labor, so they have an overview of what I've already discussed with the doctor, and I can share with them how best to assist me in my labor and the short time I'm there postpartum.

    So far I've shared these plans with my doula (and made some changes based on her suggestions and experience) as well as my family practitioner (the doctor and nurse versions, anyway).  Reviewing them with my doctor was incredibly interesting. We had a great conversation and some points I thought she might question didn't make her blink (such as eating and drinking during labor, which I've since removed from the plan anyway since I'll eat/drink if I want to and won't if I don't but I don't feel like I need it in the plan itself) while other things (like not wearing the fetal monitoring belt continually--assuming no distress was picked-up by intermittent monitoring--and delaying automatic pitocin injection post labor--assuming no hemorrhaging) led to detailed discussions about hospital policy.

    (I don't think I've mentioned this yet on my blog, but my provider has since decided she could not provide me the care I hoped for--mostly to do with my refusal to let my delivery plans be decided by the results of fetal weight ultrasounds, not the items on my birth plan--and I, at 37 weeks, have been forced to search for a new prenatal and labor care provider. And found one! But that's a different story for another time.)

    So, here you go, a mix of the lengthier plan I've written up for the doc and the shorter plan for the nurses.

    My Birth Plan: 

    • I plan on laboring at home for as long as possible, transferring to the hospital only in advanced labor (8-9 centimeters at least).
    • Justin (husband) and Hannah (doula) will be present with my throughout the labor as my birth partners.
    Environment / Pain Relief / Medical Assistance
    • I will be attempting deep relaxation akin to self-hypnosis. I prefer a quiet environment with dim or natural lighting. Please allow me to focus inwardly during contractions an avoid references to pain.
    • Alternatively, if I abandon the self-hypnosis/relaxation method, I may decide that to best manage my pain I need to vocalize. If this is the case I anticipate it may get quite loud! (Please allow me my voice.)
    • I intend to move about during labor as I feel the need. I may avoid the hospital bed entirely, laboring and delivering instead on the couch, floor (I'll bring a "sit-upon" and/or use towels), birthing stool, toilet, and/or shower/tub.
    • I will wear the clothing I brought--no need for a hospital gown.
    • My doula and spouse will support me in non-pharmaceutical comfort measures (showers, baths, birth ball, movement, changing positions, etc.)
    • I am aware of my pain medication options--please do not offer pain meds unless I ask for them. If I do ask, please note whether I am asking in the middle of a contraction and, if so, wait until after the contraction, provide encouragement, and see if I was making a true request (versus just vocalizing).
    • I am receptive to an initial 20 minute monitoring/strip of the baby's heart rate and regular intermittent doppler checks of the baby and monitoring of my blood pressure thereafter. Please check vitals wherever I am laboring (versus asking me to move to the bed).
      • I may consider continuous fetal monitoring if a mobile monitoring unit is available that will not restrict my movements.
    • Please ask my permission before every routine procedure including internal examinations, medication or interventions such as AROM. If it is not an emergency situation I will consider my options and review the alternatives before consenting to routine procedures.
    • If I am unable to keep swallowed liquids down and it is determined I'm dehydrated I'd appreciate a saline lock placed somewhere that allows me to freely bend my hand so I'm able to move around between IV sessions as needed and crouch on hands/knees for pushing.
    • I look forward to freedom of movement and the ability to change positions frequently during labor, including going on walks, talking showers/baths, bouncing on the birth ball, slow dancing with Justin, etc. I'd also appreciate suggestions for pushing positions if I need them. It's my understanding that many unmedicated women instinctively move into squats or onto hands/knees when it's time for pushing, but that they're also highly suggestible. Please suggest I stay off my back.
    Time to Push!
    • In the interest of opening my pelvis as wide as possible I intend to totally avoid the lithotomy position; instead I would like to be encouraged to push while seated on the birthing stool, while using the squatting bar or my spouse or doula for support, or in a hands/knees position.
    • I would like to push instinctively and as gently as possible. Please do not announce a time to push--I want to follow my body's prompts. I'd appreciate support (not stretching!) of the perineum if needed, but it's not required if things are going smoothly without. 
    • I prefer to tear over an episiotomy.
    • I might like to assist in catching my baby if possible and if I feel comfortable with it in the moment. I would appreciate support and direction at that time.
    • Please allow me to learn my baby's sex on my own.
    • Please do not cut the umbilical cord until after it stops pulsating.
    • I plan to hold the baby skin-to-skin immediately after birth.
    • I am open to vitamin K being administered to the baby once we have had time to snuggle. Please administer this while baby is in my arms and weigh the baby next to me at that time. Please, no other routine post-birth interventions for my infant (including blood draws, eye ointment, Hep B vax, or bath).
    • I would like to allow my body time to expel the placenta naturally, with no immediate injection of pitocin. At the half-hour mark I would like to discuss with you what other measures (besides continuing to wait) may be possibilities. 
      • I plan to take my placenta home with me--please do not dispose of it.
    • If baby is a boy:  no circumcision.
    • The majority of my/baby's post birth care (bilirubin and blood sugar watches, weight checks, PKU, etc.) will be completed by a nurse midwife at my home. I will keep my and my baby's hospital visit very short in order to return home soon after the birth so this care can begin.

    And that's that. Now, whenever a woman discusses her birth plan inevitably someone starts in saying, "But what about if you pass out or change your mind about the drugs or the baby is in distress?" or "You can't plan something like a birth so why write-out anything?" or "This is what the nurses are for, so you don't have to think about these kinds of things." And I mostly understand what they're saying. Generally they mean well. But I nevertheless totally disagree with them. 

    I think it's essential that you talk about these sort of things, from the mundane and perhaps not even all that direly important to you (I want to wear my own clothes but I'm not going to go all gladiator style on someone if they toss me a hospital gown) to the your preferred method of pain meds (whether you were hoping for an epidural as soon as you crossed into triage or whether you hope to soak yourself in a warm tub for hours to cope) to the big and bad (few to no cervical checks! No AROM! [I've personally decided to leave these firm 'no's off my plan, though I believe I'll refuse checks and artificial rupture of membranes. I'll just keep my legs together and say no at that time if that's how I'm still feeling.]) 

    This is the stuff that a woman can remember and may make/break the memory of her child's birth (one co-worker just mentioned to me that the nurse at her son's birth pulled her hands away from feeling his head at crowning. 18+ years later that still bothers her. It was her baby and her body and she was denied that moment. And it makes me sad that that happened to her and still lingers in her mind.)  So when possible I think it's good for these things to be discussed by a woman and her providers (and at least the quick notes written down for the labor attendants). So we all know where we all stand. 

    And if things change because circumstances change, they do. Hopefully, by that point, we'll have enough knowledge of each other's leanings that no one will be surprised by anyone else's stance or reaction to the changes. Going in with an understanding of the other, essentially. What else can you do when you're facing something as amazing and as unpredictable and as important as the rite of passage of giving birth? Prepare and believe. 

    Prepare and believe.

    Friday, July 15, 2011

    Fresh From the Needles

    I've known how to knit since I was... well, since I don't remember when. For a long time. My mother taught me (thanks, Mom!). But I haven't been very adventuresome nor confident enough to dive into patterns until recently (imagine my previous knitting years spent whipping up many many rectangles. cloths. scarves. afghans).

    Then I picked-up a Stitch & Bitch knitting book and found its descriptions and illustrations not only a great refresher but so clear that I felt I could and should start working from patterns to expand my knitting experience. I was also very pleased to see that the Stitch & Bitch books give equal ranking to my Continental method (also known as Left-handed knitting or the German method) rather than only focusing on the English method that dominates most other English-language knitting instructionals.

    And YouTube has been a wonderful resource;  it's so simple to search for and watch videos of the specific techniques I want to see (I used this when turning the heel of my first pair of socks,   when I needed to learn the 3-needle bind-off for a pair of fingerless gloves, and when I wanted to learn the Norwegian cast-on [which is awesome and is now my favorite cast-on method, but for which I'd found the written instructions crazy confusing]).

    So, knitting is cool. That's what I'm trying to get at.

    Here are some of my more recent recent items (baby & child related of course).

    Legwarmers for baby legs!

    Hats for baby heads!

    Vest intended for a newborn but then mistakenly big enough to be for a two year old!

    Vest detail

    Vest in action

    And I'm finishing-up a pair of baby pants (reworked twice so far so they would actually perhaps fit a baby and not a five year old---I don't know what's with my gauge, I knit things SO BIG!) and starting another set of baby legwarmers. And next:  I'm going to make a coat cover to wear over the baby when I babywear. If I can manage to find time after the baby comes. Goodness knows it's challenging enough now, with the baby hangin' out quietly in the womb!

    Anyone have favorite knitting patterns/sites to recommend? I'm always hoping to be inspired.

    Monday, July 11, 2011

    She Wants What She Wants

    Uli:     I want a papercut!
    Me:     ????
    Uli:     I need a papercut right now, please!
    Me:     ?????
    Uli:     Now! I want a papercut now!

    Justin:  She means 'apricot.'
    Me:     ::grateful for a husband who speaks two year old::

    Saturday, July 9, 2011

    High Risk Evaluations

    I had my consultation with the high risk doctors this week. Let me spoil the ending by shouting loudly from the rooftops:

    "They didn't want me! I'm not high risk!"

    With that out of my system, I do have some comments on the appointments themselves. (Of course I do. You know me well enough by now, right?)

    Appt #1
    Provider #1 reads through my sugar level notebook and downloads my glucose meter's chip to verify that the blood sugar numbers I've recorded are accurate (i.e., I haven't "adjusted" any numbers in my favor).

    She seems concerned that I won't be able to manage my blood glucose via diet without nutritional counseling. Except that I have been managing. Which is perhaps why she doesn't provide any nutritional counseling during the appointment. (?)

    Appt #2
    Provider #2 dismisses the blood sugar numbers printed out by Provider #1 because it's in a graph form and his brain doesn't like looking at graphs. He prefers to read summary reports. Since my file doesn't have one we will skip discussion of my blood sugar numbers and he will defer to Provider #1's assessment that my numbers are fine.

    He waxes eloquent about what Type 2 Diabetes is and what Gestational Diabetes is (mainly, he explains, for the benefit of the medical student sitting in on our meeting). The lecture begins with the question "You know that your body is made up of small pieces called cells, right?" and ends with a detailed description of the liver and pancreas and what he believes are ideal postprandial numbers.

    Once he hears my first baby was born via c-section because of breech presentation he completely drops all concern over my VBAC attempt. Absolutely fine with him. Go for it.

    He recommends additional thyroid testing due to concern over my Grave's Disease and how it may affect the baby's thyroid. He says that if the baby's thyroid is having issues they can treat the baby in the womb. I ask for details. He says he will not discuss the treatment until after the testing. I surmise it must be rather intense/worrisome treatment. He will not confirm nor deny and tells me not to concern myself about it--just leave it to the doctors. [I have since talked about this with my family practitioner and have received confirmation that the testing I plan to have for my baby after the birth includes thyroid testing. No need to do any special tests during pregnancy.]

    He suggests getting the ultrasounds previously recommended by my family doc to help estimate the baby's size. He says that the ultrasounds are especially helpful to doctors when women fake their good blood glucose numbers--the ultrasounds can help "catch" those mothers in their lies. How flattering. I voice my concerns about the inaccuracy of sonograms and sizing and my worry about being induced for "big baby" when in reality the baby may not be too big at all. He assures me that never ever should any woman ever be induced for suspected big baby based on an ultrasound. He says that sort of thing puts the academic OBs into fits of despair. But he does understand that this sort of thing unfortunately happens in clinical practices, so he will put into my file a note that I am not to be induced due to suspected big baby. I am pleasantly surprised. "No, no, don't worry worry," he assures me. "If we suspect a big baby based on the ultrasound, you will not be induced. We will just automatically [c-]section you. Never an induction and trial of labor." Well, consider me relieved! :p

    Both providers were very pleasant, certainly very smart, and neither had anything helpful to say at all, other than I'm not high risk. Best estimate is that I'll be charged a total of at least $600 for the two visits. I used nearly a full day of ETO time and lost 6 hours during which I could have been earning wages. Overall, a totally awesome way to spend a day. I absolutely recommend that every healthy pregnant woman check out their local high risk perinatology clinic, just for kicks and giggles.

    Monday, July 4, 2011

    Picnic: just the two of us

    36 weeks today. Not much longer and I'll have a baby in my arms.

    I don't exactly know how it's going to be, moving from one child to two. The more I think about it the more I'm tempted not to think any further---it's kind of scary/overwhelming.

    But for now I have a belly and a two year old and am able to spend time with both, mostly without competition (though the belly does restrict my movements a bit, and Uli does sometimes get too wiggly to comfortably hold).

    But picnics? I can do picnics! Eating is something we all thoroughly enjoy.

    Front yard picnic! With strawberries!

    Almond butter & jelly sandwich

    Enjoying the summertime us-time

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