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?

Hey guess what… I’m PREGNANT!

Well, d’uh! Right? Well, apparently I’m a little slow.  I know I’m pregnant. I’ve known for about 20 weeks that I’m pregnant. But it really just hit me in the last couple days.
Ok that sounds stupid, too. I’m sitting here trying to figure out how to not sound like a total moron but get my point across.
I’ve been wearing mostly maternity clothes for the last 16 weeks. My belly is expanding. I haven’t had a period since about June. I’ve had the ultrasounds and heard the heartbeat. We’ve named this little person I’m building and talk about her like she’s a relative coming to visit (“When Georgi gets here…”). I go to the doctor and I’m gaining weight. Doug lays his hand on my belly to feel her kick. I can’t remember the last time I was actually able to see my vagina! All of this and there just seems to be this disconnect between planning for a baby while caring for a large family like ours and having the complete realization that holy hell, I’m pregnant!  And the ridiculous thing that did it?  This picture…

No kidding. That was it.
I’ve seen pictures of myself recently where I look very obviously pregnant. But there was just something about this one that just flipped the switch for me.  And the picture isn’t even really of me.  It’s just a picture I’m in.  This is cropped with 90% of the picture cut out.  Still, sometimes there’s just something that makes it really, really, really REAL. I don’t know how else to explain it. I think if you’ve had kids before you understand. Otherwise, this is the best I can do.
I know, I’m a dork.
So we are down to about 16 weeks or so left. There’s still a lot to get ready for but we’re on the right track. I just hit a great Going Out of Business sale and got pretty much all of the clothes Miss Georgiana is going to need until she’s about 6 months old. I think I’ve picked out the double stroller I want and the co-sleeper I like. I’m working on sewing/designing a diaper bag.
Sometimes you just have to laugh at yourself and the ridiculousness that goes on in your head. At least I do. A lot. And most of the time I subject you nice people to this craziness, too. It’s an odd place in here, but I’m glad I’ve got good company. 
OK, now I’m hungry and I have to pee. Again. I am, after all, pregnant.

Belly Cast

While we were in Hawaii Doug and I saw a belly cast in a little shop we were wandering through. It was actually Doug who said that when I got further along it was something we definitely had to do. I've had mixed emotions about it as I've gotten bigger. I also wanted to do maternity portraits but that was just one of those things that we haven't gotten to and I don't think we will. The end of the pregnancy has come upon us faster than we thought and with the wedding, honeymoon, job changes for us both and everything else, it just didn't get to the top of the priority list. I'm not entirely heartbroken about it since I'm not too fond of having my picture taken these days anyway. It's hard to prioritize portraits when you're not feeling your most attractive. And I think there's enough photos floating around to document my ever expanding size that I'm OK with it.
Actually doing the cast was a blast. The girls watched and took pictures. Luckily they are girls and my own modesty is not something that I am particularly protective of. If the girls had their way (and Doug too) we'd have half a dozen of these. It was pretty fun!

Getting everything ready!

Reading the instructions carefully

This part was yucky! You have to cover yourself in Vaseline so the plaster doesn't stick to your skin. You know where you don't cover well later!

Censorship at its finest!

Pretty much covered

Helping

And waiting...

And being goofy!

Just waiting for it to dry now.

An obviously messy process!

The inside

The end result! Now we just wait for it to dry!

We'll add some plaster to smooth out the lines and do a bit of sanding before we paint. I'm still trying to decide how I want to decorate it. I'm thinking a Hawaiian theme since that is where the inspiration came. Plumeria flowers, pineapples, palm trees and sea turtles. We'll see!

The Good, The Bad and The Ugly

Whew! What an exciting weekend.

Doug finally got me convinced that not only do we need a bigger car (that's kind of obvious) but that a minivan (bleck!) was the best option. And with ever fluctuating gas prices and the fact that I cringe when I even fill the jeep I had to eventually agree that while the thought of a nice shiny Suburban would be awesome, it's just not the smart choice. So Friday night we headed down to the dealership and left with a 2003 Chrysler Town & Country.

It handles nice and doesn't feel like a giant beast of a car, which I was worried about. The kids absolutely love it. There's what we thought was a DVD player (turned out to be a VCR!) for the kids - we'll get that switched out. They have lots of room to spread out and there's even a plug for Krysty's car charger in the back. So no more fighting with Mom over who gets to plug the phone in.

Saturday we finished our Hypnobirthing class. The techniques we learned have really helped me relax and I know will help make the labor easier. It is nice now that we don't have to be there every Saturday morning at 9! Doug and I are not morning people and it just doesn't do will for us to have to be up and functioning together that early on the weekend. It was nice to spend the time together. There was lot of focus on closeness and it was something that we had to stop and work on together. With our opposing schedules it was nice to just sit close.

On the way home from the class we were in a minor fender-bender. Nothing major, but enough to dent the new bumper! Someone just pulled out to make a left turn. Luckily I was paying attention and the damage was not as bad as it could have been. By the time we collided we were almost stopped. There was a split second that I thought we missed but it wasn't to be. So we exchanged information and called the insurance companies (this is why they make you talk to your insurance company before you leave the dealership!). Then we took Krysty over to Ma and Pa Strange so we could go have me and baby monitored.

Everything was fine. They did blood tests and monitored Fiona's heartbeat for about 4 hours. She was showing off by moving around a bunch and kicking the monitors and even had a bout of the hiccups. Which is funny when you can "hear them" on the monitor. I had a few contractions but nothing that the doctors said we should be concerned about. He checked my cervix manually (damn I was hoping to get through this whole pregnancy without one of those!) and said that everything still seemed fine. My cervix is still high and closed but it is softening. This particular doctor said that since I'm at 30 weeks that I should expect another 6 weeks but not much more than that. We have another doctor's appointment on Friday for a cervical length and will talk with them then about what they think. Our midwife is comfortable delivering at 36 weeks here at home and so are we. Besides, we need to get firmly out of October anyway. I'm hoping to spread the birthdays out at least a little bit!

Sunday was a little more relaxing. We are trying to get the house in order. Doug finished up the touch-ups in the bedroom and he'll finish the ceiling this weekend. We got the crib put together and set up, the room rearranged, the changing table painted and set up and the carpets cleaned. Pa Strange came over too and expertly took on the task of sanding and staining the dresser. That turned into a bigger project than any of us anticipated but I know it will come out so much more beautiful than if I did it. I think he's coming over today to work on it some more. As soon as it's all pulled together I'll post some more pictures. It's really looking great! Of course now all the girls want to know when they get to have their rooms painted! Oh boy. Well, guess we'll have to start working on that.

Well that was our exciting weekend - my new, albeit broken in car, good baby news and slow but sure progress on getting the room ready for an extra occupant. I'm hoping for a much calmer one to come. We've got our midwife appointment next weekend is all and so hopefully we can all get some much needed rest!

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.

Completely ready for today to be over!

Ok, first I'll start with the good stuff before the bitching. LOL
We mailed the invitations out on Monday (most of them)! YAY!


So, hopefully we start getting response cards and all of that good stuff back. I've got about a dozen more to put together and send out. I'm getting the final details hammered out and we're starting to make final payments. WHEW! I can't believe it's getting so close.

And now the bitching!
I'm just feeling like CRAP! I'm exhausted, moody, hungry and ready to vomit at a moments notice. All day. It's even to the point I threw up at work today - 3 times! UGH. I'm so not motivated and just want to nap. Or sit in my chair and read my book. Pretty much anything that doesn't require any thought or movement.
Luckily the girls have been really good and have pretty much cleaned the whole house. They're my little life savers. Although they may only be doing it to save their own little lives since I'm not exactly what one would call pleasant! And I think Doug is happy for his schedule, since it keeps him out of the direct path most of the time. I haven't seen him for more than a few minutes since the weekend. Probably best if we're going to make it that 58 days to the wedding without him choking me. I think the cure for pregnancy hormones should be a straight-jacket. What I need is a glass of wine. What I'll get is a hot bath.

The Girls

Well, the girls were SO VERY excited. I was bombarded with questions; when will he be born? where will the baby sleep? can I help feed him? Is it a boy or a girl? what are we going to do if it's another girl? Can we name him? Are you going to get fat?
Hey, at least they're happy right!?
There's been lots of questions as to whether or not my wedding dress will fit. I'm not worried. At this point its early and there's not that much time left until the wedding (67 days to be exact!) and I'm confident everything will be fine.
So, we're working on names and cleaning out closets and every now and again any one of the girls will come up and hug me.

Life is good

Latest and greatest

On Friday March 28 Doug and I found out that I am pregnant! This is such wonderful news. We have been talking about having a baby right after we got married and we've apparently just flipped the time table a little bit. It was actually a big deal to me that I not get pregnant before we got married - but now that I find that I am and we're not it's not the big deal I thought it would be. So, sometime in late November or early December we will be welcoming a new little one to our family. I was so amazed by Doug's reaction. The pure unabashed JOY. While I am in a state of shocked stupor he is bouncing and hugging and can't stop smiling. I could not have asked for what was the best reaction to this news.
After we spread the news to friends and family I did what any woman would do and drug him out shopping! I wanted to look at maternity clothes and baby stuff and just kind of wander. I bought my first pair of maternity pants and a dress! Neither of which at this point look like maternity clothes, but that's kind of the point. Still being cute when you feel like a house.
We haven't told the girls yet. Since they're at their dad's house we decided that we wanted to tell them in person and not have them hear it over the phone.
Right now I'm just so tired. We're pretty early into this. 2 weeks 4 days (about) and it's already kicking my butt. I know it'll take some time to get used to the changes, but today I'm wiped.