Sterilization... Easier Done Than Said

I have made the decision to have my "tubes tied". The hospital and doctor's office call it Voluntary Sterilization.  Doug and I went to a class on Monday where they talked all about the different options and gave us all the information for Informed Consent.  I had to fill out paperwork and then waived my 30 day waiting period.  I don't need 30 days to think about it. I've been thinking about it before I got pregnant with Georgiana, and it was something Doug and I have talked about already.  One more, we said.
  The nurse giving the lecture said that we need to be 100% sure of what I am doing and repeatedly stressed that this decision is mine and that no one should be making it for me.  No one is making this decision for me. In fact, Doug would prefer to go under the knife instead of me (bless his heart).  I have made my decision and I have decided that since I am done getting pregnant and having babies that I am the one that needs to go in and do the sterilization.  Am I 100% sure as the nurse said? No. But I never will be.  Making babies and giving birth has been the most amazing things I have ever accomplished. I can MAKE PEOPLE! I don't care what stupid-human-trick you have, you can't top that one. It is an amazing thing that women can do. If I was 10 years younger I'd have half a dozen more. But I'm not. And we'd like to retire one day.  I have five happy, healthy daughters and I am blessed. Can I say with 100% certainty that I don't want any more babies? No. What I can say is that my family is complete.  I have an amazing husband that is the best father any woman could ask a man to be to her children and who loves me more than I deserve.  My girls are my light and my world. 
When the scheduling office from the hospital called and scheduled the procedure for next week I had to sit for a minute and process.  I am anxious. I am changing a fundamental process in my body. I am altering the way my body functions as a woman.  I will no longer be able to create and sustain a life with my womb. There is a sadness in that.  While all women come to a point in their reproductive lives where this happens, I am forcing the issue. This will not slowly happen over a long period of time as I get older, instead it will be over a couple months after a visit to my doctor. 
Even now, after the decisions and the appointment have been made there is doubt. As it stands I would be on birth control for rest of my reproductive life trying to prevent a pregnancy.  I have no intention or desire to have another baby.  However, if I was told tomorrow I was pregnant I would be happy and would celebrate. Being a mother and having the ability to be a mother has been the greatest gift I have been given. 
There will be sadness as well as relief. There will a bit of grief as I, with intention and forethought, close a chapter of my life.  There will also be celebration as I wait for the new beginning that it will bring, although I'm not yet sure what that will mean.

To My Doula

Six months ago Georgiana Grace made her grand appearance in our lives.  She is an amazing little girl that fills the house with such joy. I am so blessed to  have such a happy baby.  She is all giggles and fat rolls.  I wanted to take some time to acknowledge my amazing doula, Jen. 
There is rarely a day when I don't think of her. Jen is an amazing woman that has such joy and love that it radiates from her.  I first met her at a VBAC support group run by the doula she was apprenticing with.   I had hired Patti and Jen to be with me for Georgiana's birth.  Patti had gone to a conference in Portland and was away the day I went into labor.  I called Jen and she spent the day with us. She gave me a support that was such a gift I can hardly put it into words.
Jen you were amazing. You gave me a gift during my labor that I will never be able to adequately say thank you for.  There isn't a day when I don't think of you when I play with Georgiana. You were such an important part of her birth! It is difficult for me to come to terms with not being closer and not being able to have you as a regular part of our lives.
I'm glad that we are able to stay connected through the wonderful power of the internet.  But I miss you, Lady! I miss your amazing face and smile.  I miss the love that just shines from you (and Patti, too).  I miss the wonderful community that I was able to be a part of with you.  I want you to know that you will forever be in a very special place in my heart. The world is a better place because you are in it. 
I love you, Friend.

Home Birth vs. Hospital Birth

As it gets closer and closer to my due date we are starting to get things in order.  At some point I have to pull out the infant clothes and wash the tiny diapers. It might be a good idea to order some more snappis, too.  I’ve paid the deposit to our doula. At my next appointment my doctor wants to check my cervix for changes. Baby has dropped. Significantly. 

As we are looking how quickly this is all approaching we are at a point where the “where” of the whole thing is looming before us. And honestly I’m torn. The midwife we’ve chosen is wonderful. But she lives an hour and a half away. North of Seattle, without traffic. Which is fine if I have the good sense to go into labor around midnight.  But truthfully it’s not a big deal when it’s someone I trust and have faith in their experience. Not like I have a plethora of options either. I’ve talked to other midwives and while I’m sure that they’re fine, I haven’t quite gotten that “feeling” with them that I have with her. So I’m willing to accept the travel time and even the possibility of an accidental “unassisted” birth. My doula has been with laboring women almost as long as I’ve been alive so I don’t feel like I would be alone.

I have been adamant that I wanted to have this baby at home. I want to crawl into my bed and pull the covers up and snuggle my husband and our new baby and all my girls all at the same time. I want the sights/sounds/smells of my own home and relax in the familiarity of it all. I want my house and my family all together.

Or do I?

I reluctantly took the hospital tour.  St. Elizabeth’s is a wonderful, brand spanking new, hospital. I’m pretty sure they’re still walking around taking that plastic film-y stuff off of the electronics. They are supportive of natural birth and have never had a ban on VBAC. My doctor lives in town. All things considered it’s really rather nice.  When I was there the nurses were very sweet.  I asked what the average stay was and she said “24-48 hours, depending on your doctor. I know if I had four other kids at home I’d enjoy the quiet time!”. It was cute and jovial and with no malice in it.  I kind of laughed her off and thought of this blissful picture I had of us all puppy piled in my bed while my birth team puttered around the house. 

But the last couple weeks have been rough. I keep hearing that nurse in my head. How nice would it be? Just a day. Maybe two. Just me and Georgiana and Doug. Other people to bring me stuff.  Not feeling like I had to get up and do anything. Time to sleep and nurse and just love on my newest daughter.  Let’s face it, this house and this family are my whole world. This is my stress and my joy. My accomplishments and my failures.  I feel guilty for thinking that at some point my husband might have to leave his wife and daughter and come home to sleep in an empty bed. Is it fair for me to think of this as time for myself.  I’m having a baby, not going to a spa. It’s a hospital not a resort.

On one hand I have my belief that I am having a baby, not sick, so I have no need to go to the hospital.  I have had four children already and two VBACs I can look back and be proud of.  I don’t need to go to the hospital. But am I standing on principle only in this decision? I trust my doctor to be understanding of my desires and to follow my birth plan. I don’t anticipate a fight against interventions. I trust my body to do what it is designed to do. It doesn’t matter if I am at home, in a hospital or on the moon – I am having this baby. Am I looking for a home birth to simply be able to say that I have fought the system and have done it? Malpractice and insurance policies and social conformity be damned? I just don’t know. At this point I think I’m just a crazy person and should probably be committed. (Preferably somewhere sunny, sandy and with a pretty Jose to bring me umbrella drinks.) I don’t have the traumatic c-section stories that I hear. I don’t have a panic-inducing distrust of hospitals as a whole. My c-section was 100% necessary and life saving for Allie. I don’t need to heal from that experience, like so many women I have come in contact with.  My VBAC with Jane was handled horribly and dangerously but we both came out just fine.  I can even put a funny spin on it when necessary.  My VBAC with Fiona was awesome and empowering and while there are a couple things that weren’t “perfect” they aren’t things that I hold any real animosity because of. Could it have been easier? Absolutely. Am I scared or afraid because of what happened? No. I pushed that 9lb 7oz baby out of my vagina without drugs and with limited interventions. I did it and I have that to hold dear.  I don’t live in an area where I will have to fight for every natural, intervention-free moment.  I have support and love that will surround me.

Financially we will come out about the same. It’s either in cash up front to the midwife or in payments to the hospital because of our deductible. Either way the money is spent. It’s just a matter of who I write the check to.

Honestly as I write this I feel like I’m leaning more towards the hospital. That day or so break sounds good. I know what I am like and the responsibility of the house and the family weighs on me.   My mom will be here to visit with the girls and help.  I just don’t know. I guess we’ll wait and see. 

Does anyone have any thoughts?

We Found One!!

After many weeks of searching we have found a midwife that will help us birth our baby at home!!!!
I'm so excited I could just burst! Doug and I drove up to Kirkland (42 miles away) and Issaquah (51 miles away) to interview the only two women in the area who are willing to assist with a HBAC (home birth after cesarean). They are both wonderful women, with fabulous hearts, doing an amazing thing for women who want the choice of where and how to birth their babies.
It amazes me that at this point that women are still not trusted to have the mind enough to make an educated, informed decision regarding our own health and that of our children. Having a baby at home can have some negative connotations from society and even the medical community. The American College of Obstetrics and Gynecology was recently quoted as saying "They certainly realize that medical liability reform is nothing more than a band aid and that increasing access to midwives and birth settings is critical to fixing our maternity care system and ensuring that rural, low-income and uninsured women don't fall through the cracks.” This is assuming that the only women interested in a natural home birth for their children are the uneducated, poor, and the rather unfortunate souls that just don't have access to the fine medical model that birth has become. Perhaps I'll get down off my soapbox now before I fall and hurt myself.
Anyway, we met with these two generous women for about an hour each (I haven't seen my OB for an hour total since I got pregnant) and discussed our plans for this birth. We talked about my history, my past struggles, and what has brought me to the point of wanting a home birth for our baby. They asked what we wanted to achieve and what our ideal birth was. They offered background of their own experiences and how they would approach our birth and how things would be handled and what their own beliefs about birth was.
This morning I sent off an email (what a digital world we live in) inviting Charlene to share this with us. She just seemed to fit with our philosophy best. She is a wonderful woman, and after only a few minutes I knew that she was the one I wanted to help us. She lives about 60 miles away so she will be traveling quite a distance to help us. She only requested that we call her early when I start laboring. Hopefully Fiona will not choose to make her appearance during peak traffic times! Charlene will come to the house to make sure that she knows how to get here before the Big Day. For anyone that's been here you know it can get tricky - especially at night.
We will continue to see Dr. Fassler for the remainder of the pregnancy. If I should actually go into labor early we want to make sure that we are prepared and are working with a doctor that we are comfortable with. The other midwife we met with said that she and her team have worked with him before and we are lucky to have him. Plus if insurance is going to pay for us to have bi-weekly ultrasounds then I am ALL for it!
This is such an amazing weight off my shoulders. I have been very anxious about this for the last few weeks. Even just waiting once I knew that we had interviews was difficult. I know that Doug and I will be able to bring our baby girl into the world in the best way that we know how. That we will be calm and comfortable in our own home and that we will be in total control of the whole birth. We know what we want and who we want to participate will be honored. That neither the labor nor the birth will be subject to "protocol". The first touch Fiona will feel will be that of her father (who has decided to be the one to "catch"). She will be surrounded only by close friends and family.

Risky Behavior

As we get closer and closer to the end of my pregnancy I am frequently asked how things are going. Instead of answering with a generalized "oh we're fine" lately I have (somewhat mistakenly) opted to be a little more open and expressed my excitement about getting further in our quest for a natural, midwife attended, home birth. Much to my surprise I have been faced with a lot of shock and very little support. Doug says that I should just smile and nod and not be so upset by it. He says that I should not take it quite so personally and that everyone is just expressing concern for our well-being. I will concede that perhaps I am being a tad emotional - but this is something that I have been struggling with and hoping for since before I was pregnant. I do understand that with my history and with my family history that most would find that I am tempting fate to even consider not spending the last precious weeks of my pregnancy under the tight supervision of trained medical staff. However, like Doug is so fond of reminding me, this time is different - that continued dwelling on the past difficulties will make them current difficulties. Are we not evolved enough for mind over matter? Do I not have the right to want, desire, expect and even DEMAND that this time it is different and better? That is what we have decided that we are going to do. We are treating this as if it as new of an experience for me as it is for Doug.
I do understand every one's concern and I am grateful for it. I know it must have been difficult to stand idly by and watch someone you love struggle and the worry that they will have to go through those things again.
I thought the best way was to answer the questions that I am so often getting. To reassure those that have not yet had the opportunity to voice their concerns, and to calm the minds of those who weren't entirely convinced. In researching my birth options I came across a website from a midwife in Mountain View, California, Ronnie Falcao. In her FAQ section I found a list of questions and answers that I thought I would post here. Hopefully this reassures some people, or at least prompts them to study further.
I would hope that this would go without saying, however, because it has come up SO many times let me say -
Yes, if I do go into pre-term labor I will go to the hospital!! Doug and I would NEVER put our child at risk. This is our decision when (we choose not to think in terms of IF) I am full term and Fiona chooses to make her appearance. Should we encounter the complication of labor before 37 weeks we will be under the best possible care at a near by hospital.

• Is a home birth safe for you and your baby?

Yes, definitely. Evidence has shown that, overall, home birth is safer than a hospital birth for both me and our baby. Some study results follow:
Perinatal mortality rate for home birth was 9.5 per 1000 compared to 20.3 per 1000 for hospital births in California. Mehl LE et al. Outcomes of elective home births: a series of 1146 cases. J Reprod Med 1977.
Neonatal mortality rate for hospital birth in North Carolina was 7 per 1000 and for home birth was 4 per 1000. Burnett CA et al. Home delivery and neonatal mortality in North Carolina. JAMA 1980.
Neonatal mortality at out-of-hospital births in Kentucky from 1981-83 was 3.5 per 1000. Hinds MW, Bergeisen GH, and Allen DT. Neonatal outcome in planned v unplanned out-of-hospital births in Kentucky. JAMA 1985.
“There is no evidence to support the claim that the safest policy is for all women to give birth in the hospital.” Campbell R and MacFarlane A. Place of delivery: a review. Br J Obstet Gynaecol 1986.
Perinatal mortality rate with OBs was 24.3 per 1000 babies. PMR at homebirths was 2.4 per 1000. Eskes TK. Home deliveries in the Netherlands--perinatal mortality and morbidity. Int J Gynaecol Obstet 1992.
One book summed up home birth outcomes as follows: “Excellent outcomes with much lower intervention rates are achieved at home births. This may be because the overuse of interventions in hospital births introduces risks or the home environment promotes problem-free labors.” Goer, Henci. Obstetric Myths vs. Research Realities, 1995.

• Why would you want to have the baby at home when there is high technology available at the hospital?

The short answer: Hospitals are for sick or injured people, and a woman giving birth is not sick or injured. The long answer: Technology used routinely actually causes more problems than it solves. Hospital procedures, including routine IVs, external or internal fetal monitoring, taking nothing by mouth, and episiotomy all increase the risk to both mother and baby. Of course when used appropriately, technology can be life saving. Another couple of incentives to stay away from hospitals: A recent study reported in major media showed that the number one cause of death in hospitals is medical error. Also, a hospital hosts a variety of unpleasant bacteria which you will not find at home.

• What if you or the baby has a problem--what does the midwife do?

My team of midwives is fully experienced with the normal course of labor and birth, so that they are able to identify anything that could be problematic as soon as it comes up. In the event of an emergency, they are certified in infant resuscitation. They carry necessary equipment such as oxygen and medication to control bleeding. They either resolve emergency situations or control them during transfer to a local hospital for care with the backup OB.

• But, didn’t you have a cesarean with Allie? Shouldn’t you be in the hospital?

Being in the hospital is one of the reasons I had a cesarean with Allie. If I go back to the hospital, my risk of cesarean is even higher this time because OBs insist on managing VBAC (vaginal birth after cesarean) as a high risk situation. In most cases the cesarean is actually more risky for both me and our baby. The only increased risk in VBAC is an unlikely uterine rupture. Because rupture is so rare, less common than both prolapsed cord and placenta previa, there is no reason for my labor to be considered more high risk than anyone else’s. If you believe VBAC is too risky, then it follows that every woman should have a cesarean before labor starts. Ridiculous, right?

• But you will feel horrible if something happens to your baby at home!

Of course I will be devastated should something happen to our baby. But, I actually see it just the opposite. If I were in the hospital and something happened, I would feel worse, because I would know that that outcome would have been less likely to happen at home.

• Don’t you think you are taking a big risk by doing something like this?

Life is full of risks, and there are no guarantees of absolute safety in any endeavor. However, we have weighed the risks and benefits of these options over the last few months, and there is no doubt in our minds that home is the better place to be.

• And a final question we hope you will ask-- What can I do to help?

We hope you can see that we have made the best choice for us. Even if you don’t agree with us, we hope that you will respect us enough to support us and not criticize us. We need your support, encouragement, and prayers. Practical help after the baby is born will also be welcomed. Thank you for your love and support!

We understand that the criticism and questions come only from love. So does our decision to birth our baby at home.