Light and Momentary

Peonies

When I called to tell her that Joe was finally going to be born, seven years ago today, my friend Shannon brought me a peony from her garden. It had been tightly furled just that morning, she said, and now it was blooming beautifully. She wanted me to have the visual, so I could think "open open open" through my labor.

Our peonies have been blooming, spilling forth that same luscious pink. I can't look at them without thinking of Joe's birth, which might well have been the finest day of my life so far. It was my first homebirth and I was astonished at how joyful it was. Of course birth is joyful wherever it happens, but I did not know there could be so much joy in the process, joy in the laboring.

It was hard. He was 9#12 and his head was gigantic. But it was my pain and I was not afraid of it. (No matter how much it hurt, when it was over I wasn't going to be pregnant anymore. I was very tired of being pregnant.) I remember using a technique from Birthing from Within in which I tried to ride the pain, like a surfer. I remember seeing kaleidoscopic colors when I closed my eyes; I remember wave after tremendous wave. 

I also remember a confidence that was absent in my two hospital births. I was on my own turf on a glorious day in late spring, there with a doctor I trusted and a dear friend as well as my husband. We laughed all day long -- that's what I wrote about it when it was all over. I said I wanted to live my life, and eventually die my death, the way I had gone through that day -- "with courage and laughter even in the hardest places."

In each of my pregnancies I have asked the Blessed Mother to intercede for my unborn baby and me. Joe came along in late August, on one of the feasts of St. John the Baptist, and so for months I had prayed daily for the intercession of Our Lady of the Visitation. How fitting, then, to wake up in labor on her feast day. I still ask daily for the intercession of Our Lady of the Visitation, in hopes that my children will recognize the hidden presence of Christ whenever they encounter it -- that they might see the truth of their redemption written plainly in unexpected places.

That's what I think of when I see those tightly closed peony buds. You would not guess that they could contain such extravagant beauty, and yet they do. Tonight I am wishing my Joe -- my seven-year-old Joe -- a year full of joy and beauty, hidden in unexpected places.

The Really Long Conclusion

The next stretch of labor was -- there's no other word for it -- fun.

In Which I'm Not (Do You Hear Me? I Mean It!) Going To Have A Baby Tonight

On Monday afternoon, the 22nd, I loaded the two younger boys into the van for what I hoped would be my last prenatal visit. I was anxious, yet again.

I'd Hammer All Day

Yesterday I went to the doctor to check on Miss Olga's position.

An Earful

I wanted my insurance to cover chiropractic treatment for this symphysis trouble, which is much improved but still painful. (I am under strict instructions from my midwife not to do laundry, because carrying things up the stairs is a prime way to make it worse. Yes, ma'am! That's an instruction I'm happy to comply with. Now all I have to do is sustain an injury that sidelines me from washing dishes and I can kick back and lead a life of leisure.) I called my doctor's office to see about a referral, and they told me I'd need to come in first.

Today I saw the other doctor in the practice, and OH MY GOODNESS is she different from her partner. Remember my conversation with him about the risks of homebirth? Lather rinse repeat, minus the friendly. The weird part about both conversations is that they've focused on the risks to me: I could die because nine years ago I had a not-enormous and easily controlled postpartum hemorrhage. Neither doctor has mentioned the risks to the baby, which take up much more space in my head. The studies don't support the idea that the risks to babies are greater in planned attended homebirth, but things do go wrong sometimes. I find myself thinking about that a lot just now.

Since I've had this conversation before, I responded pretty calmly. Nine years ago I had clear risk factors for postpartum hemorrhage: untreated anemia, long first stage, long second stage. This time my hemoglobin is solidly in the normal range (up a whole unit from six weeks ago! I am practically Popeye!) and it is very unlikely that I will contract hard for 24 hours or push hard for two (please God). I have had more babies than the average woman, which is an additional risk factor, but I have also had two perfectly normal third stages, with not a glimmer of trouble, since that hemorrhage. Hm, I'm thinking I probably said all this in that earlier post and you guys aren't the ones I want to argue with anyway. I'll spare you the part about the drugs my midwife carries and how close I am to the hospital where I have already pre-registered.

I am still a little wound up about our conversation, though. It made me want to come home and blast Enya while brewing a pot of red raspberry leaf/shepherd's purse tea and soaking plaster strips for a belly cast. I don't actually own any Enya or any belly-casting materials, but I think I will put the kettle on.

Is that a threat?

I wrote a letter to my HMO. I said, "You should cover my CNM's services. It will save you a ton of money. Outcomes for low-risk out-of-hospital birth are just as good for babies and much better for mothers. Also: much much cheaper for you! Save money! Support great (and did I mention cost-effective?) care for women! Cover my homebirth!"

They said no. I figured they would say no, but I also figured it was worth a try. One sentence in their reply, though, gives me pause. It says that if I pay privately for her services, they will refuse to cover any resulting complications.

Now maybe that's just boilerplate for out-of-network denials, aimed at keeping in-network doctors from having to pick up the pieces after out-of-network poor outcomes. If I were to pay for a nose job that went wrong, say, they wouldn't want to get stuck with the cost of follow-up care. But I've been wondering all afternoon -- are they threatening to refuse to pay for a transfer to hospital care if that's needed? If I hemorrhage and need monitoring afterward, are they going to attempt to stick me with the bill? If the baby needs help, are they going to deny the claim?

The doctor who wrote the letter quoted the ACOG statement. (For you non-earthy-birthy folks, the ACOG statement said essentially, "We don't like homebirth, evidence be damned." They cited no literature, because there is no literature for them to cite -- not a single study supports their contention that planned attended homebirth is more dangerous for low-risk mothers or their singleton full-term vertex babies.) But the C-section rate in my town exceeds 40% -- wouldn't you think the insurers would be on a mission to cut costs while improving satisfaction? Isn't it silly for them to turn me down when I hand them just such an alternative?

Risks, Benefits, Looming Catastrophes

I saw my OB this morning. He is a very pleasant guy, UK-trained and personable, and he seems to be convinced that I'm going to have a catastrophic hemorrhage when this baby is born. My two younger sons were born at home, one with a family practitioner and one with a CNM. While I would go back to the hospital in a flash if this pregnancy turned high-risk, I plan to stay home this time too. We've had an HMO for a couple of years now, and along with prenatal visits to my midwife I'm seeing an in-network OB so I can have my tests covered. I was up-front with him about my plans to stay home as long as I stay low-risk.

He has spent a fair amount of time telling me I could bleed out and die.

When my second son was born in an Edinburgh hospital, I was quite anemic going into the delivery and the third stage was actively managed (i.e., more tugging on that cord than I was comfortable with). I lost an estimated 850 ml of blood, but the hemorrhage was easily controlled -- one shot of methergine and that was that. I have no wish to repeat the experience, since the recovery was rather grim, but I also don't think it's an enormous red flag in my obstetric history. I have since had two perfectly normal births with utterly unremarkable third stages, and while I accept that I could hemorrhage again, I'm not losing sleep over it.

When I met my midwife during my pregnancy with Pete, the first question I asked her was what she carried to manage PPH; she said she always had pitocin, methergine, Cytotec, and IV fluids. I live half a mile from the hospital. I will pre-register there, just in case. I will transfer in a heartbeat if there is a problem. My midwife is licensed and legal; she would accompany me, chart in hand.

It doesn't seem very likely to me that I'm going to exsanguinate under those circumstances. Hemorrhage, maybe; lose my uterus, remotely possible; die, improbable. Call me an optimist.

I spent some time this morning trying to respond to the doctor's concerns: I didn't have even a hint of uterine atony after Pete's birth. I'll reconsider my plans if I'm anemic in the third trimester. My midwife can take the same first steps to intervene at home that she can in the hospital. I think, though, he has it burned in his brain: Homebirth = Too Risky. (Oddly, he has focused exclusively on the risks to me, not the risks to the baby.) But I believe I have read every paper published in English on homebirth safety in the past 15 years, and the results are clear: planned attended homebirth is a safe option for low-risk women carrying full-term vertex singletons. (Don't even get me started on Amy Tuteur, who should serve as a caution to any would-be amateur epidemiologists.)

I  am feeling a little cranky today because I threw up my breakfast (at 16w5d! on Unisom! enough already!) immediately before going to the doctor to hear about my impending demise. But I will end on a happy note: I am grateful for this baby, whose kicks and flutters are making me smile every day now, grateful for a thus-far low-risk pregnancy, grateful for my midwife. My first visit with her was such a welcome contrast to my first OB visit. Afterward I told my husband, "I wish every pregnant woman could see someone like her." I'm glad I can.