Week 19

This part of my pregnancy has been such a breeze, I'm finding it hard to think of anything monumental to talk about. I feel terrific (most of the time... nothing that a nap can't fix), Bean is hanging out and doing just fine, and we're talking a lot about our childrearing plans. It's hard to believe that I'm halfway there! (I'm still waiting for my big, round belly. Where is it?)

Tuesday, May 5, 2009 (18w4d):
This may not seem Bean-related, but it is in a way, so I'm including it here. I was called in as a back-up doula to attend a birth today. I met with the family last night. Mom was 40 weeks exactly and anxious to get the baby out (her 4th child, she had never carried a pregnancy this long before), even though she didn't physically feel like it was time. She'd been having prodromal labor for about a week and a half (4cm dilated, 80% effaced and -1 station at last check), and I showed her and her husband how to look at the curve of her belly and feel for baby's body parts (like palpation, but not at all in a clinical way), and we clearly saw that baby was not completely anterior (rather ROA, not quite ROP) which was very likely contributing to her slow progress. We did some "spinning babies" moves and talked about waiting for labor to begin on its own. Mom had already kind of settled on getting induced in the morning, and I don't know if she wanted me to talk her out of it or give her the green light, but it's not my job to do either, so we just talked about the pros and cons of each option and I left the final decision up to her and her husband with the assurance that I would support whichever decision they made. She did go in for a low Pit drip this morning. I checked in with her a couple of times and she wasn't ready for me, but her husband called just before noon to let me know her water had broken (on its own) and I got to their hospital room within 15 minutes. She was in bed, on the monitors, and obviously uncomfortable, but she said she didn't want to move. I supported her through 2 contractions before she started feeling pushy! I had her do some panting/blowing while Dad ran for the nurse, and baby girl was out within 3 pushes (nurse caught)! It was a lightning fast birth (water broke at 11:50, baby born at 12:15!), and due to moderate meconuim staining, baby was whisked away but otherwise pinked right up and scored 8 and 9 on her Apgars. Mom was amazing (as they all are!) and we reveled in her superhuman powers for quite awhile. Doctor arrived just after the birth and set up camp for 3rd stage.

This is where it got hairy.

I was actually impressed with the doctor for waiting for the placenta to be born. Other docs I've seen at this hospital just start yanking on the cord within the first 3 or 4 minutes. But this doc sat there, waiting, waiting, waiting. Occasionally, she would give a light tug to see if there was anything moving, but she wasn't aggressive and waited some more. She probably waited for 15-20 minutes (which is a long time for a doc!) before she really got in there to see what was up. It was then discovered that Mom had a placenta accreta with a velamentous cord insertion. Doc ended up doing a manual removal of the placenta (it came out in I-don't-know-how-many pieces), and eventually brought in a curette to finish the job.

It was brutal.

Now, I have a very strong stomach when it comes to birth goo and all the "blood and guts" involved (as John likes to call it. ha.), and this was my first real-life velamentous cord AND accreta, so I was very curious to see it, and worked very hard to focus my attention on Mom's comfort in spite of my curiosity. But as I was attending to Mom I started to get really dizzy and "fuzzy" and thought for a moment, "if I don't sit down, I'm going to fall down," and had to excuse myself to a corner of the room. It really was all I needed, but what I did not need was the nurse fussing over me and bringing me water and and making a big deal out of it (maybe because I told him I was pregnant; I can't fault him for being attentive). It was embarrassing for me, but not as embarrassing as it would have been to pass out in the L&D room. I really think it was just a case of locked knees. I hadn't been there long enough to become exhausted or hungry, and I certainly wasn't freaked out by the blood. I just wish it hadn't happened, because I feel like I failed Mom in some way by ducking out at a pretty crucial moment (although Grandma was there and I was back by Mom's side again in 5 minutes).

So, the placenta was finally taken care of after an hour of agonizing manhandling by the doc. Ouch! Mom was a super-trooper!!!! Why she ever described herself as a "wuss" is astounding to me. Really. She deserves a featured title in the "SO not a wuss" hall of fame.

All this to say: Everything turned out beautifully. Everybody there had a job to do, and everyone (except for one absent-minded doula who didn't bother to shift her weight for a couple of minutes) did what they were there to do. Nobody was afraid. A velamentous cord can potentially be catastrophic, but in this case, it wasn't. An accreta can be ugly, but in this case, it was just "one of those things." I can't speak for the Mom but in my eyes, it all went seamlessly. In spite of witnessing these bumps in the road, I'm still so excited to give birth. That's not something you hear every first-time mama saying, but for me, it's the truth! I know I can do it! And it's going to be amazing. I don't expect any major complications (and I refuse to dwell on the "what-ifs"), but I'm totally prepared to follow through on whatever it takes to resolve a complication should it arise, and I trust my midwife 100% to be able to direct that resolution. Bring it on!!! :)


Wednesday, May 6, 2009 (18w4d):
Today we met with a family practice doctor who was highly-recommended to us by a doula friend of mine. In spite of the "controversy" among homebirthers about the necessity of hiring a back-up doctor, John and I felt strongly that we needed to find someone now, for any "just in case" situation. I don't want to deal with finding a doctor at 34 weeks because I've risked out of my homebirth, or showing up in the ER as a transport with no doctor to vouch for my sanity. Docs around here are notoriously unsupportive of homebirth, and mothers get treated pretty cruelly by hospital staff and docs alike, and I was not about to put myself in a hostile situation at a time when I need and want medical care. I certainly don't think it's foolish or irresponsible to not have a back-up doctor lined up (indeed, if this doc was a jerk, we would have just cut our losses and run with Plan B), but having survived and witnessed the brunt end of criticism from well-meaning-yet-tactless individuals, covering my bases on my own terms seems a logical choice.

So we met Dr. Clark for an interview. I was very straightforward and assertive (being very careful with my words to avoid sounding aggressive) about our plans and our wishes, what I expect from medical personnel should I require their help, and how I not only know my rights, I know when they're being violated in the name of "protocol" and fear of litigation. I still think it's asinine that people assume that just because I'm planning a homebirth, it must mean that I'll avoid or refuse life-saving medical treatment if it becomes necessary. I don't know how many times I've had to explain this. Nobody sits around in the hospital during their entire pregnancy (or life) just so they'll be in the "safest" place "in case something goes wrong." IF something happens that my midwife is not equipped to handle, I'll see a doctor or go to the hospital. IT'S WHY THEY'RE THERE. And Dr. Clark gets that. He didn't talk down to me, didn't try to scare me straight or give me the "dead baby" speech, he actually agreed with me on some of the more "alternative" ideas like refusing routine procedures just because they're routine (i.e. not medically indicated). He's supportive of homebirth and seemed relieved that I actually wanted to be an active participant in the birth of my child. I think too many women throw their care away to whomever they decide is "in charge" because all they ever hear is how "scary" and "risky" birth is and they maybe feel overwhelmed by all the choices available to them. Well, I'M in charge of my body and my baby. I value this experience too much to sit idly by and be an observer. I want to educate myself and advocate for myself (which I've been doing!). I do not claim to be an expert on birth, but I think I know a little more about it than the average mama off the street, and I know when something's necessary, and I know when I'm being snowed. I'm not going to let that happen. And now I have a doc on my side. :) I hope I never have any reason to see him during my pregnancy, but as a family practice doc, he'll make a very agreeable pediatrician for Bean, so if nothing else, we've found a winner. :) *HUGE SIGH OF RELIEF*


Friday, May 8, 2009 (19 weeks):
One great stroke of luck (or fortune, or the universe smiling upon me) has turned out to be getting on Medicaid, which covers chiropractic visits for pregnancy-related back ailments. :) When my sciatica hit me at 9 weeks, I thought I was doomed to suffer from the crippling pain and disability for at least the rest of my pregnancy and possibly well into my postpartum recovery. I was so distraught. The chiropractor I visited cured me in a matter of weeks, and thankfully I haven't had a recurrence of my sciatic pain for over a month. I do get little twinges now and then, and my lower back does get sore and stiff on occasion as well. I sometimes wonder about the sciatica coming back with the same ferocity that it landed on me 10 weeks ago. So I've found a new chiropractor who takes Medicaid, and I'm starting up a new treatment schedule to keep my back "honest" and hopefully stave off any comebacks. He's a nice enough guy, regrettably not as gentle a touch as my last chiro, but I'm very grateful that I get to continue the treatments and can call on someone if I need it. And if Bean is being stubborn and sideways 20+ weeks from now, I can get an adjustment and maybe help move this kid out. ;)