From the category archives:

Doctors, midwives, and doulas

It’s bittersweet to report that we have attended our 6 week midwife appointment and no longer have an officially legitimate need to hang out with the ladies at Rainy City Midwifery.

I was really looking forward to the appointment.  I desperately wanted a physical green light to get back to spinning class and, even more, wanted to weigh in my HUGE child.

For days before the appointment, as we looked at our baby who seems to grow larger during every nap, Milton and I would ask each other, “How much do you think he weighs now?”  We took bets.  Fourteen pounds max was the general consensus.

Well?  Our baby exceeded our fattest expectations!  He weighed in, perfectly naked, at a whopping 14 pounds and 7 ounces!  He is 24.25 inches long.  He is above the 95th percentile for both height and weight.

On our way out of our midwife office, we met another baby who is 6 months old.  My 6 week old outweighs her by over a pound!  Can you imagine?  No wonder my back already aches from his sling!

Fatty in the Sling!

In other news, our midwives were surprised to note that my abdominal muscles have already magically closed back together.  This means that I can get back to spinning and all of those other terrible classes that I LOVE going to the gym to take.  Which means that maybe someday I’ll lose this 10 pounds of mom fat…. (but that’s a whole ‘nother entry).

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Reposted in part from a friend in New York due to give birth at home next week:

Basically, in new york state midwives need to have a written practice agreement (WPA) with a institution or a physician. most of the homebirth midwives here had a practice agreement with st. vincent’s, which was essentially the best/most progressive hospital to birth in in new york city. unfortunately it was in a lot of debt and earlier this month it was decided that it would shut down. so as of friday all the homebirth midwives are without a WPA. which means all the homebirth midwives are kind of screwed and have been scrambling to figure out what to do. apparently there is legislation in the senate already to remove the WPA requirement and the only real thing to be done in the meantime is to have a “health emergency” be declared by the governor so that the midwives can continue practicing until either the legislation goes through or they find someone to sign a WPA. of course, the department of health is saying this is not an emergency because all we homebirthing women can and should just give birth in hospitals anyway.

This is really horrible up news, people. Pregnant women in NY will be denied a right to choose their births if something isn’t done very quickly. Hundreds of women are right now planning home births in New York, and have worked for months to provide their families with the comfort and medical assistance they need. Also, there will be several midwives completely out of work for an undisclosed amount of time, forced to send their patients to OB (surgeon!) strangers for labor and delivery!

Please call Wendy Saunders, Executive Deputy Commissioner for the NY State Department of Health, appointed by Governor Paterson. The goal is to flood them with calls tomorrow. the governor’s office number is 518-474-8390. Leave a message with her staff explaining that with the closing of Saint Vincent Hospital in NYC, there are hundreds of families now stranded and it is your understanding that the governor is the only one with the authority to declare a Health Emergency and to issue an Emergency Executive Order waiving the provision of the law that requires midwives to have a written practice agreement.

Please pass this message on to anyone from NY state that you know and encourage them to call!!!

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Head down!

by Milton on Sat, Mar 13th, 2010

in Doctors, midwives, and doulas,Week 31

Every 2 weeks when we visit the midwife I beg for them to tell me how our little baby is positioned in the belly.  Then I get their patient 5-minute tutorial on how to tell the difference between a butt and a head, and they comment on Esther’s rock hard abs.  I blame the abs on my cluelessness.  Also, there are a lot of disclaimers like “he’s still going to move around” and “I’m not 100% sure” but really, I just want to know, right now, at this moment, how is he positioned.  If I can figure that out, and know how to figure it out, then I can figure it out at home and then the poking and prodding sessions would be oh so much more enlightening to me.

Anyway, yesterday I felt his head!  And it was down!  That makes me happy.  He can move the rest of his body all up down and all around as much as he wants, but keep your head down, kiddo.  Right?  Now, the only thing to worry about is him coming too early or too late.  And the endless domino-line of worries marches one domino forward.

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We had our 30 week (or, to be exact, 29 weeks and 5 days) appointment this afternoon!  It went quite well.  My blood tests from our 28 week appointment came back with some interesting results:

1) I have no issue processing sugars.  This was surprising to me!  I ate some white flour a few days before the test and felt horrible.  I’ve also been having some flora imbalance issues that are taking a rather long time to completely work out.  THUS, the pessimist in me felt 78% certain that I must have gestational diabetes.  Alas, this is not the case at all.  My sugar was on the very lowest end of what one’s normal glycemic range should be after consuming sugar, sugar, and more sugar for breakfast.

2) My Hematocrit levels were EXCELLENT.  My iron is off the hook with badassary!  One would think that I paid more than what I feel to be a minimal effort to eat well!  I suppose that it’s a very good thing that I don’t really crave horrible foods.  All this good iron indicates that I will have a much smaller chance of hemorrhaging during our home birth.  If pregnant woman’s Hematocrit is lower than 30%, she has to deliver in a hospital.  I am at 38%.

3) I have gained 22 pounds.  Frankly, I find this a little excessive.  This is because I very suddenly gained a few extra pounds during the month before I got pregnant, so I technically feel as if I am up 27 extra pounds.  She says that my 22 pound gain is perfect for my 5’10″ height.  What she says goes; I guess I’ll chalk these pounds all up to baby fat and pat myself on the back for all of the really really hard work I’m doing on keeping pregnancy so healthy.  Yeah?  Ok, just kidding.

I am serious when I confess that I am a lazy lazy pregnant lady who does exactly as her will tells her to do.   I just now had lunch at Chipotle and then stopped at the Cinnamon Works counter   on my way home for a blueberry bar.  And, no, blueberries are NOT local right now!  But my will made me do it!  Granted, Cinnamon Works bakes with far less sugar a whole lot of nuts- it is definitely the healthiest cookie option in town! But still!  Who needs a blueberry bar after a 790 calorie lunch at Chipolte?  Surely, no single Wednesday evening yoga class could heal this type of gluttony?

Milton did say when we stopped into Chipolte that I was sure to gain 3 more pounds by tomorrow.  But hey!  I have an idea!  Why not just not weigh myself again until next week?  Yeah, perfect.

4) The baby, though still a mover and a shaker who is not necessarily staying head down, seems to have progressed normally according to all the listening, poking, and measuring.  He’s still very playful in his movement, and has always been pretty active.  Go, little Benson, go!

With all of this good news, I have to tell you that the pessimist in me is waiting for the other shoe to drop.  The chubby-cheeked optimist in me is healthy enough to handle 10 pairs of shoes that are really really cute.

Thanks to my girl Kathy T for these!

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The umbilical noose

by Milton on Fri, Feb 12th, 2010

in Doctors, midwives, and doulas,Week 27

Had our 28 week midwife appointment today.  Esther got to drink sugary orange juice plus sugary white bread plus a spoonful of sugary honey and get her blood drawn in order to test for gestational diabetes.  I got to be coached yet again on how to feel for our baby’s head, and butt, and legs, etc.  We all think he’s upside down already (I felt a hard little head way down there, it was cool), and it would be great if he just stayed right there.  Though maybe he needs the exercise and should do a few more warm-up laps around her uterus so he comes out extra strong and ready to go.  That’s up to him I guess.

Today I voiced my somewhat irrational fear of him getting too tangled up in umbilical cords before he comes out.  You know, after reading 3 bazillion birth stories certain fears lodge themselves.  For me it has been the tangling.  Not sure why.  But I guess because I so much enjoy to rock him back and forth in Esther’s belly to try and figure out where he is, what he’s doing, etc and the thought has crossed my mind that I may be making him move more and get tangled more than he otherwise would.

Luckily, Beth reassured me that almost all of those horror stories of hospitalized births “failing to progress” where the doctor later says, “Oh, it was because he was all a tangled up and had his umbilical cord around his head 25 times and that’s why he wasn’t coming down” are really usually confabulated stories where, yeah, there might have been some tangling, but that wasn’t what was causing the labor to halt.  Drugs, anxiety, impatience, etc, much more likely to be the cause.  Yeah, sometimes the cord is in the way, but only once in a blue moon (Beth said once every 10 years even) does the chord actually inhibit the birth from progressing as normal.  Yeah, sometimes it’s around the neck, even twice or three times, but a little looping around and pushing the cord and all is well.  Very rarely they’ll clamp the cord and cut it if the baby is really close to being born, but even that almost never happens.

So, that was all good to hear.  Nature wasn’t silly enough to put a noose in the womb.  It’s stretchy, and easy to move around, and not a problem at all.  After I voiced this fear, Esther also confessed to having the fear, so it was good for us both to talk about it and then move on.

Weird how fear works like that, sometimes.  It’s a full-time job to worry less.

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We found a doula!

by Esther on Sat, Jan 9th, 2010

in Doctors, midwives, and doulas,Week 22

Walking through the doors of pregnancy and all of it’s unknown factors, Milton and I have had lots of questions and lots of aha moments to answer them.  At first, we weren’t even totally comfortable talking about a home birth.  At first glance, it didn’t seem like the safe option.  One book in the right direction and suddenly we found ourselves on the path of home birth research.  This has led to us meeting some pretty amazing people in the Seattle Midwifery community.  We feel very cosy at our monthly midwife appointments and like we can call their office with any questions or concerns that we have.

It was at Rainy City Midwifery that we were approached about possibly hiring a doula.  At first, it really didn’t feel necessary.  Between the 20 books we’ve already read, the 40 books we’re bound to read, the class we’re going to take with The Mother of all Doulas, and the 1,394 people we talk to who give us advice (unsolicited or otherwise), it seems like we could lasso in this whole laboring experience and take it to the moon, right?

Well.  Sort of.

The more we started to visualize our birthing experience, and the more we talked to the midwifes at Rainy City, the more we started to think that we should look for someone else to help us on our journey.  It’s not that we don’t trust ourselves.  It’s certainly not that I don’t trust my body.  It’s not that I don’t trust my midwifes to act in my favor and do everything they can to support and protect my family.  I have trust in all of these things!  It’s more that I am fairly certain that much of what my husband and I learn about pregnancy and labor will fly out the window without a good mediator who has a whole lot of experience with the process of saying hello to babies.  I could be in labor for 3 days, after all!  No matter how much my husband and I adore each other, he is going to need a break.  I am going to need a break.  We are going to need encouragement and knowledge to help us along so that fear doesn’t take over the experience of  bringing life.  There is potentially a long stretch of time between when labor begins and when my midwife arrives when I am going to need a woman who knows what she’s doing to help me out with crazy things that I have never really thought about… like calming to heck down when I feel as if I’m about to break in two, or like breast feeding after the labor is all said and done and the actual taking care of a newborn begins.

I met Cheryl Murfin while I was working at my salon.  I was tending to another lady when Cheryl marched right up to my chair and asked which one of us was pregnant.  Since both my client and I are pregnant, all we could do was laugh and say “Me!”  Turns out, Cheryl is a doula who had heard through salon scuttlebutt that I was a pregnant lady and decided to come around with her card.  I immediately took to her direct approach!  I love Seattle, but am not native to the Pacific NorthWest and am often a little turned off by the typical north-westerner’s politely standoffish way.  This woman came over and told me what she did in 20 words or less!  She was practically New York in my book.   I made a mental note to ask my midwife if she had any more information on this lady.  As it turns out, Lynn at Rainy City knew Cheryl very well.  Cheryl was the director of the Seattle Midwifery School and is very tied in to the community here.  I decided to call her for an appointment…

We met today and it all felt so comfortable!  I feel like she’s the other hand on deck we need for this delivery, which will make the total of people in the house during the birthing a whopping 6 (Milton, me, 1 midwife, 2 midwife students, and our doula)!  7 if you count our baby!  Practically a party for our small loft (if it doesn’t sell by the end of February, we’re staying right here, folks).  I can’t imagine that this baby will feel anything but love and support when he gets here.

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Just in case you haven’t heard, our 20-week ultrasound went smoothly and our very friendly nurse played along with our request to have her write the gender in a card that we could open at our leisure (away from the sterile confines of the hospital).

We tried to play it cool the rest of the day, running errands, watching a movie (Avatar was great), and walking around.  Around 7pm we started getting fidgety, and I asked Esther if she had any new guesses for the gender.  She admitted to having a pretty confident guess about it, as she think she spied some balls in one of the ultrasound shots inadvertently.  I asked Esther if she wanted to swap her bet and go for a girl at 10/1 odds (so that she’d get 10 pizzas if it was a girl and I’d get one pizza if it was a boy) and she declined.  I sighed and admitted that I too thought I spied something on the screen.  (It was pretty funny at the time, and I think we were probably giggling a little.)

We decided to open the card while she sat on the pig in Pike Place Market.

Our suspicions were correct!  We are going to have a son!

And to prove I’m good for my word, here’s the pizza:

We spent the rest of dinner (and a good part of the last couple weeks) talking excitedly about what this means for us, and how much more tangible it all feels now. A son. A little man. Amazing.

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Today was the momentous occasion we’ve been looking towards for some months:  The 20 Week Ultrasound!

This means that we are OFFICIALLY at the half-way point.  I also officially have a baby bump and officially know the sex of my baby (though I won’t be sharing that quite yet!).

Things are looking pretty sweet.  I have a great heart rate, have gained the perfect amount of weight and have a uterus that has grown right where it should have grown.

As far as our baby is concerned, (s)he is doing very well.  Good heart rate, good skull shape, no signs of the dreaded  spina bifida, no sign of a cleft palate, skull in good condition. 10 fingers, 10 toes…

Speaking of toes, the baby has my husband’s feet.  My big toe is considerably longer than my second toe, while my husband’s second toe is longer than his first.  While we both have long toes, Milton sports tingers, which simply means that his toes are freakishly long.  We can see in the ultrasound that our baby also has tingers.  I am also convinced that the baby has my husband’s leg proportions, which means another family runner.  This is all good stuff.

I did have a moment of nervousness after the ultrasound tech left the room and returned with (dum dum dum) The Doctor.  It was obvious from the start that The Doctor was summoned into the room to give us Potential Bad News.  First, he confirmed my age, “You’ll be having the baby when you’re 34 and a half,” he says, and suddenly I am filled with fear.  My brain immediately starts telling me that this will be my only child, that the risks are too great as I approach my dreaded (and absolutely youthful) 35th birthday.  The Doctor goes on to tell me that the baby’s heart is showing a sign of Echogenic Intracardiac Foci, as told by bright spots on the heart.  This increases my chances of having a baby with Downs Syndrome by 2.  Broken down, this means that while my age and history indicated a 1 in 350 chance of having a baby with an extra chromosome when I woke up this morning, appearance of EIF ups my chances to 1 in 200, or .5%.  SPECIFICALLY, babies with the EIF marker have a 1 in 188 chance of T-21 (Downs).

Of course, there is no indication of a chromosomal problem as far as the bone structure of the baby’s face is concerned.  The ridge of the baby’s nose and cheekbones appears to be strong and “normal”.  AND, further investigation (thanks to an immediate iPhone google search) indicates that a full 30% of Asians have EIF.  Further race investigation indicates 11% of caucasians and 6% of black babies show symptoms of EIF.  Thus,  I don’t think that there is anything to worry about… and if there is, it’s out of my control to do anything but love whatever baby we have.  I do find it odd that it’s required for a doctor to put extra fear in you, but not required for them to say, “But, hey, your baby is Asian, so there was a 30% chance the baby would have EIF anyhow.”  I mean, really?   I would hate to be a doctor who gets called into examination rooms to only deliver red flag news.  I was thinking the whole time about how awesome the job of the ultrasound technician was… and later I thought about how the stony-faced-bearer-of-bad-news doctor ‘s job was NOT awesome.  Also, WAY TO MAKE A GIRL FEEL OLD, doctor.  34 and a half. Geez louise.

All that EIF business aside, it was AMAZING to see our baby moving around in there!  S(he) is far more active than I even imagined!  Lots of times there is whole moving around that I can’t even feel.  I didn’t realize that!  The baby flips and flops into all sorts of different positions without my even knowing, all of the time!  I need to really be punched and kicked to know that something is going on in there… which means that I’m being punched and kicked all the time, too, because I feel it plenty!   So great!!

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I read Jenny McCarthy’s Belly Laughs book a couple days ago.  Wow.  It’s scary to think that she’s encouraging women to act like her, in my opinion.

On the other side of the spectrum, we watched the Business of Being Born last night.  That’s a pretty great documentary.  I think it was meant to be controversial, and to show the worst of hospitals, and I don’t think all hospitals are as ignorant and backwards as the ones depicted (Seattle’s Swedish, for instance). However, I think the fact that more light should be brought to the midwifery traditions and practices is definitely called for.

According to our midwife, that documentary and the book Pushed have both contributed to a surge in business for midwives in the last few years.

Only 1% of births in the United States are done via midwives, and only a fraction of those are home births.  Seattle’s a little different, and actually has between 4-7% of births through midwives.  I think it might be because of the better insurance policies that allow them to be covered.  So hopefully this number will grow.

One of the great and unexpected things about The Business of Being Born is that the film-maker is pregnant during the making of the movie.  Of course, after all this talk about home births and everything, she ends up having pre-term labor and a C-section at a hospital, and had to keep her baby in NICU for 3 weeks.

The reason I think that’s great (in the documentary’s sense, not in the sense that the baby had such a scary beginning) is because every doctor in the movie is like “what if something scary happens?” and this is the answer… you go to the hospital.  Hospitals aren’t inherently bad, it’s just that they are designed to deal with emergencies and dangerous medical conditions.  Most births, however, are not in this category, and could just as easily (and some argue more safely and nicely) be handled outside of the hospital system.  For the 10-15% of births that have complications, it’s awesome that hospitals are there to help, and this fact has a lot to do with the lowering maternal mortality and baby mortality in the last 100 years.

Anyway, it’s just so interesting to think about all of this.  I keep trying to remember how we first started down this midwife/home birth track–I remember being just as pro-epidural as the next person before Esther got pregnant.  We are trained to be afraid of birth.  And, as the non-participatory husband, of course fear is even more justified because all of this is happening to Esther, not me, and therefore the lack of control is scary.

This is merely how I feel now, and reserve the right to change my mind at any point along this pregnancy.

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I think today we went from being pretty certain about having our baby in a hospital with a doctor and all that that implies to going to the complete opposite end of the spectrum and deciding to do a home birth with a midwife.

I totally think it’s the right thing for us to do.

We met with a midwife group called Rainy City Midwifery and the difference between what we learned in the 60 minutes there versus the 3 visits and many hours of being at the Polyclinic was stark, to say the least.

Beth Coyote (great name, right?) at Rainy City Midwifery was amazing. Right away she talked about how this is not simply a medical procedure involving a uterus and a baby, but something that is happening to our family.  The creation of a family even.  Imagine that.

3% Cesarean rates, with 85% of the births taking place without transferring to a hospital.  That’s a stark contrast to the 30% Cesarean rates at Polyclinic (even though even that’s lower than the national average).

They have 3 midwives and 2 students, with one midwife always on call, while all 3 are always up to date on everything happening with every mother.  The 2 students attend every birth.  So there are at least 3 people with their full attention on you at all times.  If things end up going to the hospital, they come with you and stay through the end.

Listen to this.  They visit your home 1 day after the birth and 3 days after the birth, and also continue to help out for the following 6 weeks.  That alone was a huge deal to me, and illustrated the difference between getting the baby out and starting a family.

They are cheaper than a hospital.  Mostly because they don’t bother running up every single bill that they can.  When we explained our insurance situation Beth even suggested that some potential payment plans were available.  We might need those.

On every visit (about the same number of visits as you would for a doctor) they spend most of the time talking with you, answering questions, etc.  Contrast that to our 10 minutes of doctor time that we’ve had during our first 3 visits, and however many minutes waiting in waiting rooms and little rooms.

I was ready to sign up right then and there this afternoon.  Esther wanted to talk about it, so we left, talked 10 minutes, and then made our next appointment and canceled our future appointments at the Polyclinic.

We’re gonna try to do a home birth.  1% of births in the US are through midwives, and only a fraction of those are done outside of a hospital.  So we’re going a pretty radically different route than most people do.  But, outside the US, plenty of other countries do it this way.  We both strongly feel that this is the right decision for us.

Exciting.

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