Homebirth After Cesearean....Safety and Choices

A member of my extended family recently had a scare because of the experiences of someone she knows and has started to worry over our decisions concerning the birth of this baby. I don't want to downplay her fears, so I reviewed some of the resources I consulted while making the decision to have my baby at home after having had one cesarean birth.

Here are a sample of the pages/links that I read and thought about as I came to my decision. I have spent years reading about VBAC and birth and weighing my options should I become pregnant again. DH, fortunately, is completely behind me on my decision, which makes things all the easier:

Risks of VBAC vs. Repeat C-Section


Safety of Planned Homebirth with a Certified Professional Midwife


Thoughts on Homebirth After Cesarean

Some other materials I have read included A Good Birth, A Safe Birth by Diana Korte, The VBAC Companion by Diana Korte, and Ina May's Guide to Childbirth by Ina May Gaskin.

My midwife has been attending homebirths for 20 years; she is trained and experienced in knowing what complications are and when a transfer to a hospital would become necessary. I will go to the hospital if I feel that the baby and/or I am at risk from complications that arise.

Some reasons I feel hospital births are more risky:

• To me, a repeat cesearean section is more risky (for me, my baby, and my possible future children) than a vaginal birth (see the first link above for a comparison of the risks of VBAC versus repeat c-section).

• Many hospitals/doctors will not even let you attempt a vaginal delivery if you have had a previous c-section.

• Despite the research that shows inductions increase the risk of uterine rupture, I have repeatedly heard about hospital VBAC attempts being induced.

• Two factors that increase the risk of uterine rupture are having had repeat c-sections and having had a c-section within the previous year or two. I have only had one c-section, and that will have been roughly six years ago when this baby is born.

• I believe that my labor will proceed more naturally and more quickly if I am at home in a comfortable environment without interventions that will hinder it. These include continuous fetal monitoring, possible induction, artificial rupture of membranes, and of course, c-section.

As with anything, there are risks. Who knows what will happen between now and then? In the meanwhile, as I do my best to plan for this birth, and after reading and reviewing data, I feel the risks during a normal birth for me and my baby are greater in the hospital than they would be at home.

Feel free to comment/email if you would like to discuss this issue further.

It's a Girl!

Well, that about says it! I had my ultrasound a little bit early and learned that our little baby is a girl! I already have a DS, so having a girl will be completely new and exciting!

I was walking with DS last night and just saying that she'll be "my daugther" was thrilling :) I haven't got to use that term yet. I'm definitely not a girly, girl, more of a tomboy, but I had to go right out and buy some little onsies with pink on them and one that says "I Love Mommy" just for her. It seemed sort of symbolic.

It will be a whole new set of worries, I'm sure. DH has already threatened to buy a shotgun ;) I worry myself that girls are more common targets of abusive situations, but I've always worried about that even with DS. I guess worrying is part of parenthood. Finding the balance between protectiveness and paranoia is quite a challenge!

I had sort of secretly hoped that there would be twins, but I'm not disappointed, especially since that means that my plans for a homebirth are still a go. She was even head down the whole time during the ultrasound (hope she's that way when it's time to be born!).

One thing I want to mention is that as far as interventions go, I've never thought ultrasound to be top on the list of causing too many problems. However, it did affect me, mostly because the technician and radiologist won't tell you if anything is wrong. They insist on sending it to your "doctor" (how many times do I have to tell you it's my midwife, people?!), so they can tell you. So, you have to wait until they send the report and then your provider gets back to you.

My little one (as yet unnamed...that's another debate) looked great as far as I could tell. Let me first say that I have a lot of scientific knowledge, but I am by no means an ultrasound expert. From my lay perspective, everything looked good: all ten fingers and toes were present, as well as all four chambers in the heart. The spine looked complete, and the placenta was not covering my cervix. But still, I've been having nagging worries that maybe there was something wrong...was the radiologist just brisk or was he trying to hide something? You get my point. The test itself instigated the worries. I'm pretty good at telling myself to calm down and not cause problems where there aren't any, but what if I'd had a whole pregnancy full of tests (actually I had many more with DS)? It might just make the whole thing more stressful and less pleasant, but that's just a theory.

I posted some pictures to lighten the mood. Enjoy!


Baby Girl's Profile 


A Hand! 


Her Foot! 

Ultrasounds and choices

Well, I thought I would update everyone on the ultrasound drama. After many phone calls, faxes, and emails, I have an ultrasound appointment for one week from Monday. It turns out that my midwife could "prescribe" the ultrasound (approved my health insurance company), and so she did so. I guess the laws concerning licensed midwives are so new in this state that people are still getting a handle on them.

I do wholeheartedly agree with her that women's health care (and mens' for that matter) should be in their hands, not someone else's. Fears of litigation seem to mean that even for an ultrasound, you must go through an "approved source" instead of just getting it done yourself, even though it is a pretty standard procedure nowadays for pregnancy (I've known women to have 5 or more during pregnancy; I had at least 4 with my son). For now, I'm happy to take it one step at a time and hope that the worst we have to worry about is whether this baby is a boy or a girl! :)

The baby is really active this morning, so I'm just enjoying sitting here typing and feeling those kicks until it's time to go up and make my husband his much-deserved Father's Day breakfast.

In response to something I read in the paper this morning (I refuse to make it worth more than it is), let me just say that the men in households where women stay at home or work at home do do housework and they often also work twice as hard so that this choice (made by both mom and dad) can be supported because they both believe it is best for their family. Also, if their is no intellect involved in raising children, then I've been going about it all the wrong way. Working is a fine choice (I do it myself and "stay home"), but it's not the only choice. It's also not the only worthy one. Sorry, had to get that off my chest.

Happy Father's Day, all!

All's Well...Well, Mostly

Pregnancy is going well this time around. I am 16 weeks along now, and while it's not completely gone, the nausea is definitely more manageable now. I still get tired what I consider to be pretty early in the evening (I'm sleeping at least 9-10 hours a night--this from the woman who could last on 3-4 hours if there was a really good episode of Smallville that I wanted to stay up and watch!).

I have felt the baby move (including one big "kick" this week) and have heard the heartbeat twice now (one of the most thrilling things any expectant mother can hear!).

We've been really busy lately, which has made the time pass by faster. Birth time will probably be on me before I know it, before I've bothered to order diapers (I'd like to try cloth from the beginning this time) or pick a name!

As I mentioned in a previous post, we are planning a homebirth, specifically a homebirth after cesarean (HBAC). I would like this birth to be as peaceful and as comfortable as possible with few or no interventions.

Toward that end, I have found a midwife with whom I am very happy. Appointments with her are a totally different ballgame than appointments I've had with doctors/obstetricians. Most of the appointment is spent talking. She asks my input on what tests I would like done and discusses risks openly and honestly. By the time the birth rolls around, I'm sure it will feel like I have a good friend, who happens to be an expert on natural bith, attending me. I will also have the choice of who to have present (or not) and will be in a place where I spend most of my time and in which I am comfortable. I am also confident in her ability to identify problems that indicate the birth needs to take place in a hospital.

It is definitely a transitional period here in my state, though, as far as midwives go. Direct-entry midwives (e.g., Certified Professional Midwives, like my midwife) were just re-legalized last year, although many were practicing previously anyway to provide women with that choice. I believe new legislation was also passed this year to allow Certified Nurse Midwives to practice without the direct supervision of a doctor, which will give them more freedom to attend homebirths, etc. (In England, they just announced that the government is actually going to start ENCOURAGING women to have homebirths!! *wow*)

As a result of this transition in my state (and probably in much of the U.S.), it's hard to walk the middle line. I've barely begun, and I'm finding the red tape required to get an ultrasound done daunting. My insurance will cover it, so that's not a problem, but it seems I have to go through a doctor to get it. I don't NEED one but would like one in 6-8 weeks just to check that everything is developing well and to be prepared if necessary for any problems.

Do I go through a primary care doctor or make a single appointment with an OB to get it done? I don't like to be dishonest, but I just want one single thing done, and attitudes toward homebirth are not typically rosy among obstetricians these days. I am searching to find someone who might be amenable to the situation and who might also serve as a backup if a transfer to the hospital is necessary during birth. Health insurance is also a problem, just because the two doctors I know of so far that might be okay with it are not in my plan, and I can't afford to go outside of it.

I may just skip this whole ultrasound thing as I don't want my pregnancy filled with unnecessary stress and complications. For now, I'm just trying to take it one step at a time and see how it goes.

Life and Death

I haven’t posted in a while and for good reason. I’ve been pretty sick for the last couple of months and exhausted to boot. However, there’s a good reason for that, too. In late February, I found out I was pregnant again!

I am very excited but, after the miscarriage in November, very cautious as well. It’s been hard to be fully happy about it because I’m always afraid it’s going to end. Well, I’m 11 weeks along now, almost into the second trimester and feeling a little more optimistic. I was about 9 weeks along when I miscarried last time. People know now, and I hope there’s no reason to bring bad news. I am ready to be a mom to a second child again. There is so much to think about, but I’ll probably put it most of it off for a while.

It has been fun, though, to buy some maternity clothes (I am a few sizes smaller than I was when I got pregnant with DS and already showing a bit!). Other than that, all those wonderful first trimester symptoms have kept me home a lot and in bed a good deal of the time. We’ll see how long the nausea, etc., last this time. I’m keeping my fingers crossed for the whole thing!

I have my first appointment with my midwife Monday. I’m hoping to hear the heartbeat for the first time, which will be terrific. Besides all my symptoms and my growing belly, it will be a very concrete way of saying, “Hello, little one!”

We are planning a homebirth, and I’m thinking more and more on the possibility of waterbirth or at least laboring in the water, where I find great comfort.



On a more somber note, in the past two days, two friends of the family have passed away.

Max was a friend of my extended family and was always a “grandfatherly” figure towards me. He always had a smile for me and was very sweet, even when I was an ornery kid. He lived next door to my own grandparents for many, many years and was just an extended part of the family. His wife Jean, a very sweet and loving woman, has lost her son-in-law, daughter, and husband now in the past year and a half. My heart goes out to her and the rest of her family.

Evelyn was a friend of my husband’s family. She had a vivacious personality and was very opinionated, but she was also very giving and generous even when things were tough in her life. She always brought a little something over for DS whenever we visited my husband’s parents and also helped them out as much as she could. She had a heart transplant (in her 70s) a couple of years back. She just died today, and it was very sudden. She knew something was wrong, but it apparently did not seem too severe, so she went to the doctor and hospital. The doctors knew there was some heart damage but were still trying to determine what the exact problem was when she died, quite unexpectedly. (This is the story I got from my husband, who talked with his mother just an hour or so ago.) She will be missed, and we were very sorry to hear about her death. It also reminds me of how you just never know when someone is not going to be here the “next time.”

Treasure every moment.

Extended Breastfeeding Rant

Today, I received an email about a mother who is tied up in divorce proceedings. She has two nurslings. She has apparently been issued orders from a judge to wean her oldest (of unknown age) within 60 days and to wean her youngest by the time she turns 3. His logic is that nursing the children for so long will cause psychological harm to them in our culture.

Exactly where does this judge get his information? It’s all hearsay and conjecture. How many kids does he know that were nursed past 1, let alone past 3? I would bet not many. However, I know plenty. All of these kids are normal, healthy, playful, intelligent kids.

I guess my experience is not enough, so what about the “evidence”?

I don’t have the biggest amount of respect for the American Academy of Pediatrics on the subject (as they always seem to be backing out of their support of breastfeeding when the formula companies flash their wallets), but even they say “There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer” and “Increased duration of breastfeeding confers significant health and developmental benefits for the child and the mother, especially in delaying return of fertility (thereby promoting optimal intervals between births)” (Source: American Academy of Pediatrics).

I guess I just wish that people would do some research before they suppose that a very loving and thoughtful practice (done only at the mutual desire of both mother and child) will somehow cause the child psychological harm, when in fact, in most cases, it does just the opposite. Breastfeeding provides both physical and psychological benefits to both parties, as proven by numerous scientific studies.

Breasts are primarily for feeding our children; the sexual thing is just a side benefit (for men, at least). If people could look at a breast and see it for what it is (full of milk and comfort), maybe this misconception wouldn’t be so widespread.

A Response to M...

My friend M recently wrote in her thoughtful blog about living like you were dying. What started out as a comment on her blog got kind of long, so I decided to put it here instead.

Living like I were dying is toooo hard to swallow for me. As a mother of a young child and potentially more young children, I adamantly refuse to think of my own demise, except in practical terms (like making sure I have enough insurance and making sure I've established guardianship should DS lose both of us).

I've got too many plans!! (Of course, I've been like this since I was 2, I'm sure—ask my mother!)

The thought of my own child's demise is enough to knock me over and make my heart sieze up, and that's just the thought!

That said, I understand M's viewpoint. Myself, I like to just do what my momma said and live "one day at a time." Unfortunately, if I lived like I were dying, I'd throw work to the wind (who needs money if you're dying anyhow?!). Maybe that indicates that I need another profession (I'm working on it—more plans!). However, I do try to be a "good person" everyday and show my affection to those I care about.

Perhaps that's why I'm not that confrontational. I usually avoid the negative scenarios unless I think there is a really good reason for them, unless I believe there is some potential for positive change (not that I haven't been known to beat a dead horse so to speak). I think I could be a little more confrontational, to tell the truth.

Like at a recent get together with fairly new friends, I thought there was too much drinking going on for the driving that would follow for some. I am not a real drinker, so I didn't say anything, but I worried for them and hoped that they (and other people on the road) got home safe. How would I have felt if something had happened to them? I probably wouldn't blame myself, but I would have definitely felt more than bad and surely could have offered them a ride home—why not try to make the world a little better and safer? Sure, there's that bit of anxiety involved with suggesting that someone doesn't have the best judgment right now, but I'm sure it can be done tactfully, and if you do it often enough, you probably get used to it, right?

See, I did go off on a tanget! Thanks, M, for getting the juices flowing so early in the morning!

Thanks and Scrapping

Thanks all for your help and comments about my last post. Things are not resolved, per se, but I have decided to keep myself out of the situation unless my friend asks me for help. I also apologize for the vagueness of the post, but I needed to vent without implicating anyone personally.

***

On another note, I had a lot of fun out scrapbooking with a friend last night. I chatted on and on about birth (said friend is thinking about getting pregnant and is very indulgent of me and my soap boxes—gotta love her) before I got down to some serious work—I got 5 whole sides done and have cropped pictures for even more pages! My scrapbooking consultant friend (you know who you are!) would probably kill me for scrapping 3 pages for one event, but I can't help myself. It's hard not to ooh and ah over every picture and not get anything done. I just love pictures, and I'm glad I'm making these albums, even if I am behind and even if I'm the only one who ever cares about them! :)

Set up

Ever feel like you're being set up or that someone you know is? I am in a situation where I have suddenly, and unwillinging, been put between a rock and a hard place, between two people.

It's a fragile situation, and I'm not sure whether the best course of action is to do something or do nothing. Fortunately, another friend has been put here as well, and I've called her for advice. I'm sure she'll say, "Leave it alone. Don't do anything. You didn't ask to get involved, so just wait and if someone asks you directly for help, then help if you can."

It's disturbing, though. My heart is aching for a friend who might be in trouble, but really, it's not my call.

Holding Back

It’s kind of funny, the way some of seem to be “out there all the time” and some of us hold back depending on who we are with. Even with our closest friends, I know I hold back some parts of myself in order to maintain balance or avoid burdening someone or just because I wonder, “Would they like me so much if they knew this [whatever this may be]?”

I discovered recently that some things didn’t need to be held back because I wasn’t alone in my feelings or experiences. I’m lucky to have close friends who are not judgmental (and I try not to be judgmental myself about their thoughts and experiences).

We grow and change and what we were yesterday may not be what we are today, but our past and our feelings make us who we are. It’s nice to know that there are people who will accept us for who we are and that I’m lucky enough to be friends with some of them.

There are some people I know from whom I will always hold back some things in order to avoid confrontation or to avoid offending them (which can be hard sometimes) or simply because it is not necessary to share (and this is a lot coming from me, the Talker). Each friendship has its place in my life, and each person has a place in my heart, even with this caveat.

I think the person I hold back least from is DH, and that feels good. He knows pretty much all there is to know about me--not that he likes it all, but he still loves me despite it all (or maybe even because of it). He is definitely not the most “feely, sensitive” type of guy, but he is solid, strong, and loving. He is dependable and makes me laugh. I wish he could/would share more with me, but he knows I’m here if he wants to share. I feel we are strong right now, but part of that has come from me accepting that he will never be the type to talk a lot about those things. I do know I’m pretty lucky and still in love.

Love, family, friends. What more could I ask for? (That’s a question for another day!) :)

Horsing Around

DS and I have our old tried and true playgroup about two hours from where we now live (we moved to the “country” about 1 1/2 years ago). We still go there once a month or more to see our old friends and play (okay, we go at least as much for me as for him). We also have a group of homeschoolers we meet with every couple of weeks about 45 minutes from here.

We are also slowly getting to know people right here in our own little town. Today, we went to playgroup only 10 minutes away. The moms are really wonderful, and the kids range in age from 15 months to 5 years old. It turned out to be a really nice day for January (in the 60s at least from the feel of it). My friend lives out on a horse farm. We walked through the horse pasture past the horses and ponies (all gorgeous and winter fuzzy). DS was a bit leery about all the horse poop. “Just walk around,” I said :)

We crossed a little creek on a board and meandered on to a bigger creek. Who knew you could spend 45 minutes to an hour throwing rocks into water or walking through a mega-puddle (or for one of the babies, eating dirt ;)). DS was picking dried hay and using it as play money by breaking it into small pieces. I can’t believe I lost (dropped) $100,000! It’s okay; he gave me $1,000,000 instead! :)

One of the moms almost ran over a little brown bunny in the middle of the field on the way back. It just froze, I suppose. We told the kids not to touch it, but you know how hard that is! The bunny decided that was enough and took off. It was so cute though! Then, again, isn’t that what bunnies are inherently--cute? Although my friend’s two Jack Russell terriers met that definition, too. My ten-month-old puppies definitely knew I’d been “cheating” on them when I got home!

We had a great time: moms talking as moms will, sharing stories; kids playing; moms playing with kids; everyone eating snacks and drinking tea.

Hopefully, it’s the start of a more regular thing. In any case, it was a really nice surprise for this winter day!

The Weight Thing

Just a short note this morning as I have work to catch up on. DS was sick Friday, and now DH is. Nothing like a stomach bug! *blech* I am lucky so far not to have caught it.

Anyway, I was just reading about weight loss/not overeating on my family’s web site. It’s funny, I lost 80 pounds once upon a time. I’ve gained 30 back, but I still feel as if, whenever I want to, I can lose it again. I found a healthy method that works, and I know it’s only a matter of me deciding to really stick to it. I’ve been back on the program for a little while now, and I’m holding steady because I am pushing it to its limits, but I am aware of this, and its better than the gaining I was doing before then. I had only gained about 15, but with the pregnancy and the miscarriage, it’s made it harder for me to care or to want to bother with it.

And yes, for me it is a bother because eating a lot is a part of who I am. Not being overweight/obese is fighting part of my personality in order to be healthier and to let other parts of my personality shine through. When I am thinner (and not even close to model thin), I feel powerful and in control. I feel pretty and sexy. I also am able to do more of those yoga moves I love so much, and they, in turn, give me more power and control. It’s a real rush, one I’m looking forward to feeling again as soon as I am ready. In the meantime, even maintaining keeps me from feeling like I am losing control, which makes a world of difference.

Sportsmanship and Weaning

Today, I took DS to a homeschool group game day. It went pretty well, although I think I might have had more fun that he did. He is at that stage where he wants to make all the rules. He hates the fact that he can’t always win and wants to change the rules if it doesn’t look like he’s going to win. It’s frustrating for me, just because you so don’t want to think that your child is going to grow up to be a spoiled little boy that doesn’t realize that what’s important is spending time together and not winning. It’s hard to explain to him that yeah, we all like to win, but it’s okay not to.

I try to comfort myself that it’s just a stage and try to keep reinforcing how I feel about it, but I never know if I’m doing the right thing or giving the right feedback. I guess that’s how parenthood is. You never know until they’re older how they are going to turn out. You just do the best you can.

Like breastfeeding. DS reached a major milestone this month. He weaned on January 1. He set the date after we talked about it in late November. He was not at all traumatized, which told me that he was really finally ready. He also hasn’t been needy or clingy, another good sign.

I still enjoyed nursing him, but I really could take it or leave it, and some other factors made me test out the waters with him to judge if he was ready, and it seemed he was. Immediately after we discussed it, he started going days between nursings. He stopped on the agreed-on date, and we even got some cute pictures of his last nursie. I’m glad I’ll have that to remember.

Now he’s holding me up to the weaning party I promised him (with ice cream cake)! We’re planning a small thing with a few friends. Should be fun!

Career Change?

I decided yesterday to “go public” with my blog. I don’t know if it will attract anyone to my site, but we’ll see. I’d love to connect with others that share my same interests.

Speaking of interests, I am seriously considering becoming a midwife someday. I get so angered reading and hearing about all of the things that mothers go through that I’d like to do something to help correct the situation. I also care very much about mothers and about babies getting off to the right start in life. I guess you could say I’m pretty passionate about it, just as I am about breastfeeding. I guess that’s why I became a La Leche League (LLL) Leader (http://www.lalecheleague.org).

It’s funny how I believe that this wouldn’t have been possible if I hadn’t gone through each consecutive phase of my life so far.

Eleven years ago, I was a sort-of coach to a friend who gave birth as a single, Medicaid-assisted mom in a local hospital. I was outraged that they had let her go nearly 24 hours without “assisting” her (with Pitocin—bad, J, bad!). I believed that they were treating her unfairly because she was a Medicaid patient. When I look back on it, I feel differently that they let her go on so long and no longer believe in inductions and interventions, but I still feel that she should have been encouraged to move more instead of lying flat on her back throughout the labor (she was told to walk to get her contractions going, but after that, she was basically laying down the whole time!). I have learned so much since then. I have learned a great deal just since DS was born via c-section five years ago.

So, first I have that experience. Second was my own birth experience. I was initially happy with the birth just because my son was born healthy and happy, although I by no means thought that this was how birth “should be.”

When my son was 10 months old, I started attending LLL meetings and met other women who believed that it was good to keep your baby close, to breastfeed, and to pick your baby up when he cried. It changed my life. I took the great step of breastfeeding in public for the first time. Between my birth (shaving, catheter, etc.) and breastfeeding (although I always tried to be as discreet as possible), I lost quite a bit of modesty (my little group of LLL friends has seen quite a lot of nursing breast!). How else could I be considering this career? You can’t really be modest or ashamed of the human body in all its glorious forms if you want to be a midwife.

Next, my training to become a LLL Leader taught me a lot about birth and about what could be done to make birth safer and what could be done to avoid c-sections. Between that and seeing friends go for the homebirth option, I became a homebirth proponent myself, realizing that my chances of a c-section would go up so much just by stepping foot in a hospital at the end of pregnancy.

I still don’t think I would have been ready except for my two final “experiences.” One was reading Ina May’s Guide to Childbirth. I bought it for my LLL Group earlier this year and absorbed the whole thing. It made me want to run off to The Farm in Tennessee.

The last step (so far) was my second pregnancy and subsequent miscarriage at 9 weeks. The miscarriage (in which I actually delivered the baby in what could have been considered labor) taught me that, despite the sorrow of the situation, my body was competent and was capable of giving birth. Before that point, I felt somehow inferior to all those women who had birthed babies. I never even really went into labor with DS! My miscarriage gave me confidence in my body, in every woman’s body, and my ability to do what I had been designed to do.

We are capable of so much!

I know this is sooo long, so I’ll wrap it up. I am going to finish my book before making any big decisions or committing to anything, but in the meantime, I may try to get some books, etc., to look into seeing if this is something I really want. We all think of career changes now and then (I’ve thought of scrapbooking consultant, lactation consultant, yoga instructor, etc.), but we’ll see if this idea sticks. That’s usually the best way to find out!