Sunday, August 19, 2012

Adele's Pre-Birth Story

When I first found out I was pregnant, I knew right away I wanted to use a midwife, rather than go the traditional OB/GYN route. The whole reason I'd gone to nursing school was to start myself on the path to becoming a midwife so I knew that I wanted to experience the midwifery approach to prenatal care. Last summer I had been invited to attend a home-birth with a friend, so I had met and really liked the local midwife, Trinlie Wood. I called and made appointments with both the OB/GYN and the midwife, figuring I'd make a choice once we'd met both. After one visit with the OB/GYN, where I was only allowed to see the oh-so-unhelpful nurse that took a urine sample and confirmed that, "Congratulations, you are pregnant!" (Duh, this is my fourth time and I know the signs of pregnancy), we settled on the midwife. We weren't entirely comfortable with the idea of a homebirth since we live so far from the hospital but we thought we'd just see how we felt as the pregnancy went on, knowing that we could always just walk into the hospital in labor and be delivered.  

As the pregnancy went on both John and I felt more and more comfortable with Trinlie's ability and the decision to plan a home-birth. The kids got super into it, attended most of the prenatal visits and were super excited to "cut the end-ba-dill-ic-al cord." Some of my most vivid memories of childhood were when my last 3 siblings were born at home so I was hoping this birth would be a great experience for them also.  The pregnancy was uneventful (unless you count nursing school while puking and clinicals while hobbling with my hips issues) until around 32 weeks. A friend was visiting and as we were palpating the baby through my stomach, I felt her move almost 180 degrees. Sure enough, the next day when I noticed the hiccups they were now directly under my ribcage instead of low in my pelvis as they had been earlier. I brought it up with Trinlie at the next appointment and she confirmed that the baby was currently breech but we knew only 3-4% of babies end up breech at full term so we were confident that she'd flip back. 

In the meantime, I tried everything I could to encourage her to flip around - ice on the top of my stomach with a heating pad on the bottom, loud noises up where her head was (Nathan's screaming could make her jump, but that was about it), hanging upside down from the pool ladder, hip tilts with my bum up in the air and my chest down low (very uncomfortable with a big belly and pubic bone issues), and lots of rocking on all fours. Every once in awhile I'd think I'd feel her hiccup somewhere else or maybe move, but within a few hours I'd feel her head right under my ribcage again. 

Around 36 weeks we got serious about trying to move her. Trinlie doesn't do home-births with breech babies and neither John nor I were comfortable with trying it either. I knew from nursing school that quite a few of the local OB/GYNs would not be receptive to me coming to them at the end of my pregnancy because of the home-birth plans and I knew that with my history of fast labors I'd need a close hospital if that is what we ended up doing. Luckily, I had met most of the doctors with my clinicals and had a favorite from the start. I made an appointment with Dr. Jeffrey Bell and was extremely relieved when he told me he'd have no problem trying to turn the baby without me committing to his care for the delivery. We made an appointment for 37 weeks to try an external version, which is where they manually try to turn the baby by pushing on my stomach. This involved an IV, meds, continuous heart monitoring and 3 hours in the hospital with the possibility of an immediate c-section if something went wrong. Trinlie also tried a much gentler version of this at our house a few days before Dr. Bell with no luck in getting her to turn. Unfortunately, Dr. Bell wasn't able to get her to turn either and we had a quite a scare when her heart rate dipped down into the 50s during the procedure. It came right back up with a little oxygen but she stayed firmly under my ribs. 

The only other option left was a chiropractic maneuver so I drove 1.5 hours to have my hips adjusted to "give the baby more room to turn." But nope, that didn't help either so plans were made with Dr. Bell to schedule a c-section for 39 4/7ths weeks to avoid me going into labor. Although some breech babies can be born vaginally, it takes everything lining up just right to make it happen and most doctors, including all the local hospitals, won't attempt it.  I had at least 3 strikes against me - first, my history of fast labors, second, my history of big babies (Elias was 9.6lbs) and third (and most serious), the position of our baby - footling breech. Each time Trinlie or Dr. Bell would check me they would tell me they could actually feel her little feet, which is the least common type of breech and the most serious. Since there is nothing filling the birth canal except feet, the chance of a cord prolapse is high when your water breaks with a footling breech. So we scheduled the c-section for August 8th, hoping and praying that something would change and she would flip around before then. 

I know it isn't fair or rational, but I found myself frustrated and upset with the whole situation.  I had finally gotten my courage up for a home-birth, found an incredible midwife, gotten my kids all hyped for this baby to be born here at our home, and then, bam, nope, no go, not happening. I wanted that baby to flip and I wanted her to do it now!! After having 3 kids with not even as much as an IV, I was in denial the whole time about the c-section. It wasn't until the last 3 or 4 days before the birth that I got serious and put together my "birth plan." When I took it into show Dr. Bell he chuckled, since most people don't even think of birth plans normally and definitely not for a c-section. But he was a great sport and told me that everything there looked rational and he'd try his best to make it happen. Just for posterities sake, here it is: 

Birth Plan for Baby Genho

Dear All Hospital Staff at Fauquier,

Thanks for helping us help this wrong side up baby into the world! We know we are in good, competent hands and you all are very experienced at your jobs. We have chosen to come here for just this reason. This is our 4th baby (all others have been born naturally without so much as an IV) so this surgery is a new experience for us. While we understand that things will be different because of the nature of the birth, we would love to recreate the peaceful atmosphere of our other births as much as possible. It’s with that understanding that we request the following during this birth. Thank you so much for helping us transition through this unexpected plan of events with patience and support.

Birth Wishes:

I wish to have my husband accompany me in the operating room at all times.

IV placed in forearm, not hand so I’ll have full mobility of hand after birth.

Warm blankets during surgery.

Catheter put in AFTER spinal.

Volume down on heart monitor beeping.

Own choice of music if possible during surgery.

Please keep my hands free and not strapped down.

Please lower the drape as the baby is born and provide a mirror so I can see procedure.

Please communicate with me and my husband about the procedures and update us a things are being completed (incisions, baby being born, closing up, etc – I’m using this as clinical experience!)

We request the option to take pictures as the baby is born.

Husband to announce Baby's gender.

Keep cord long for daughter to trim afterward in room.

If at all possible, please place the baby on my chest immediately after delivery while the incision is being closed.

Please delay all newborn procedures, including wiping down and cleaning the baby, until the baby and I have had some skin to skin contact and we have had a chance to get to know each other as a family. APGAR can be performed while the baby is with me.

If Baby is doing well medically, please bring Baby to me as soon as she is suctioned, weighed, and measured. Please do not worry about cleaning her up much before bringing her to me.

I would like to hold Baby (or husband hold baby) while Baby is being foot printed, getting bracelets on, and while the paperwork is being filled out.

No Eye Gel, No Hep. B vaccine or Vitamin K shot. I will sign the waiver ahead of time.

Please bring Baby within sight and close to me during measuring & weighing.

Please use double layer suturing for the incision closure.

Please no sedatives after birth. I want to remember my Baby's first day of life.

We do not consent to the baby being removed from my presence at any time. If the baby must go to the NICU or nursery, my husband, or another person we will assign, will accompany the baby at all times.

I would like to nurse the baby as soon as possible in recovery.

I am willing to be up and walking as soon as possible so I can get leg compressors off sooner.

Newborn Procedures:

We would like to give our baby its first bath as a family. Please direct us in this process at the hospital.

Our baby is to be exclusively breastfed.

We do not consent to giving the baby a pacifier, formula, glucose water or any form of supplemental food without our express knowledge and permission.

We prefer full rooming in, unless our baby is sick.

Please no visitors until we have indicated that we are ready (we would like for siblings to meet their sister before others do).

If baby’s temperature is lower than desired, I would like skin-to-skin contact vs. the incubator. 

So there we were, a week before the scheduled birth with nothing to do but wait and wonder if she'd turn. The suspense of a normal birth is bad enough, but this one about killed me with wondering not only if she would turn, but if we'd then get to have the home-birth we had planned if she turned or if it would go completely the other way and end up with the most medically complicated situation - a scheduled c-section.  All because of a pair of little feet… 

1 comment:

  1. I can't wait for the rest of the story. I hope all went well! I have always had birth plans for my labors, too, but yours is definitely more thorough!