Wednesday, October 17, 2012

The birth of Beau David Brocato, Part 2: Our Home Birth

It was Saturday Sept. 8th.  My mother had been in town all week visiting one last time before I hit 40 weeks.  She was due to leave the next day but I told her while she was visiting that while we hadn't ever planned on having her here for the birth, I secretly hoped that I would go into labor with her still here.  There was something very comforting and nurturing about her presence and I suddenly hoped that she'd be able to be part of it all.  I noticed that morning that the baby was moving a little less... nothing dangerous or worrisome, just less active than usual, and I took a mental note wondering if that meant he'd be on his way soon.  That afternoon my mom, Andy, and I went out to Reston Town Center for lunch to try and get out of the house for a bit.  While we were out we heard on the radio of a tornado warning for later that day.  I received a text while at lunch from my doula, Marilyn, asking how I was feeling with the drop in barometric pressure and I chuckled telling her that I was fine thus far as it didn't seem to be affecting me at all.  (Many women are sensitive to large drops in barometric pressure resulting in labor).  At the end of our outdoor lunch the rain began to sprinkle, so we headed back to the car to try and head home before things got ugly.  Sure enough on our drive things picked up significantly and boy was I grateful to be in our new safe car!  The wind was strong, rain was pouring, and debris was flying everywhere.  I kept praying aloud that we just make it home safely and that no trees fall on us while we were driving!  As soon as we pulled up to our street we saw that trees were down, some having crushed cars , and there was no way to enter.  Now I was grateful that we had been out instead of sitting home with our brand new car under a tree!  Andy got out in the pouring rain to see if he could pull a fallen tree over enough for us to get passed.  I looked further and saw others ahead so I called for him to come back.  We drove around to the other side of our complex and found a spot clear of any trees that could still timber over.  The three of us ran (ok, I waddled) through the courtyard getting soaked as we tried to make it safely inside.  As soon as we opened the door we saw that the power was out.  We immediately began lighting candles, changing clothes, and couldn't wait for the storm to end so that we could get outside to assess the damage with our neighbors.  As soon as the storm calmed we headed out to try and help each other clear the debris.  (I picked up little sticks to feel like I was taking part while the others helped chop tree trunks and drag branches away).  Once we came inside, the three of us sat and played Wheel of Fortune on my phone to pass the time.  After a few hours we noticed that all of our phone batteries were about to die so we decided to give them a rest in case we needed them later.  I quickly jotted down the phone numbers of Parveen, Marilyn, Ali, and our OB just in case something started and my phone battery was dead...

My face says it all as I take in the mess

That night we all went to dinner with two of our good friends.  While we were out, I couldn't help but notice that Andy was enjoying himself by ordering some drinks.  As the night went on and the drinks kept coming, I said to him.. "um.. honey, remember that thing about me potentially going into labor anytime from 38 weeks onward and that part about you being on-call and maybe not having tooooo much fun with the drinks just in case??"  He quickly informed me that we were totally fine... that I wouldn't be going into labor any time soon.  He was sure of it.  In fact, he was sure that I'd be going into labor after my due date (at this point I was 39.5 weeks).  He quoted the statistic that he'd often heard me say... "the average first time mom delivers at 41 weeks and 1 day".  I chuckled and said, "how do you know??? you have NO idea when I'll go into labor!" and I also added that for some reason, many first time moms begin labor in the middle of the night and that tonight could very well be that night.  He then replied with the ol', "I think I know my wife... I'm going to be able to tell when you're heading in that direction."  Again I had to chuckle... knowing that there aren't always tell tail sings pointing in that direction at all.  I then added, "Ok, whatever you say, but if I DO go into labor and you're too tipsy or tired to support me, I'm going to be awfully disappointed in you!!!"  Everyone at the table laughed at our silly argumentative banter, but none of us were REALLY worried that I'd actually be having my baby just yet.

We arrived back home at about 11:45pm hoping that the power would be back on.  Unfortunately it wasn't and we were all exhausted so we headed to bed by 12:30am.  Suddenly at 1:45am I was awakened by a warm gush that just kept flowing into my underwear and out into the bed.  I gasped and sat up yelling, "Andy, ANDY... OH MY GOD, MY WATER JUST BROKE!.  (Along with a few holy shit's I'm sure).  Andy was slow to wake (surprise surprise!!) and when he finally did, he muttered that I must have wet the bed.  "Ummmm no, I did NOT just wet the bed!" I flew out of bed (as fast as a huge, full term pregnant girl can fly) and headed straight to the bathroom quickly lighting a candle to try and see what was in my underwear.  When I sat down, I continued to leak more and more fluid, and I just knew it wasn't urine.  My mom overheard the commotion and quickly came out of the guest bedroom asking what was going on.  I told her my water had broken (Andy was still insisting that it must be urine... I think he WANTED it to be urine because he was still feelin' those drinks!!).  As gross as it is, and yes this is TMI, I asked him to come and smell my underwear.  "Does this smell like semen to you??", I asked. "UGH (incredibly disgusted)...  YES IT DOES!", he replied as I quickly said, "then THAT means it's amniotic fluid and NOT urine!".  

Suddenly I felt nervous.  This was it.  What I'd been waiting for- not only for the last 9 months, but my whole life.  One way or another I was going to have a baby in the near(ish) foreseeable future, and I was slightly concerned since the onset of my labor began with ruptured membranes.  I knew that I was now on a clock to deliver before infection could set in.  Whenever a mom has called me saying her water has just broken at the onset or before labor has begun, my heart always sinks a little for her.  Our work is now cut out for us. We're not going to have a leisurely time just waiting to see when things pick up, but rather we're going to need to be very proactive about getting things going so that we don't run into trouble later on.  Statistically, only 10% of labors actually begin with spontaneous rupture of membranes (despite how hollywood may like to portray birth), yet interestingly enough both my mother and my sister also had ruptured membranes at the onset of their labors.  Knowing this throughout my pregnancy, I supplemented with more vitamin C to try and help strengthen my amniotic sac.  Also knowing that my baby had been OP (posterior) for most of my pregnancy and leading up to labor (see previous posts or spinning babies to learn what on earth I'm talking about), I knew that a common identifying factor of an OP baby is ruptured membranes at the start of labor.  This told me he was likely still in that OP position (despite my many efforts to turn him in pregnancy).  Gulp.  I knew I was probably in for a really long, tough, ride.

Andy kept suggesting that I come back to bed and rest for a while.  He reminded me that I always tell my moms that they'll need their energy later and that they should get some sleep while they can, especially if the onset is at night.  I was wired though... adrenaline was through the roof.  Anxiety was setting in.  I couldn't just lay there and sleep... NOT NOW! Not to mention the fact that I knew I was on that damned clock... I wanted things to pick up so that slow or no progress wouldn't bite me in the butt later.  I got up and it wasn't long before the crampy contractions began.  Within an hour or so they picked up to the point where I had to at least make noise during them... nothing unbearable, but they weren't mild either.  It was on.  I had a sanitary pad in my underwear but during every contraction I would completely soak the pad and my underwear entirely with fluid.  Within what felt like minutes I'd gone through all of my maternity underwear which Andy had to go fish out of my drawer by candlelight (you should have seen some of the tiny thongs he brought me initially that would now probably not make it past my knee!). I was also apparently using way too much toilet paper when using the bathroom (or so I was told). After one of my many trips to the toilet I suddenly heard a pouring sound behind me as I walked down the hall.  I grabbed a flashlight and pointed it toward the toilet just in time to see it completely running over.  Seriously???? NOW??, I thought,  First no power, then my water breaks in the dark, and now the toilet is overflowing ALL when I finally go into labor???? Andy ran with towels as fast as he could to clean up the mess in the dark.  We just had our floors replaced a few months back due to water damage (for the second time in a year)... and honestly, at this point I didn't care what happened to those floors one bit.  But Andy worked diligently in what little light he had and cleaned it all up before it buckled the wood.  So I was now told not to use that toilet and to use much less toilet paper in the other bathroom to which I immediately thought, "um... I'm in LABOR.  I have to use the toilet every few minutes (literally), and YES, I have to use friggin' toilet paper!".  So I decided since we were already doing things like they did hundreds of years ago without power, I may as well keep that theme going.  I had my mom grab a bucket that we had car wash supplies in... and yep, you guessed it.  This became my new toilet.  I didn't have to leave the room... I just shifted from my birth ball to aiming over my bucket and let 'er loose... over and over again.  It was kind of brilliant to be honest :)  A few other times I missed the bucket or splashed amniotic fluid all over the place (we also had chux pads on the floor)...but like the sweet husband that he is, Andy kept cleaning up after me without one complaint.  He was still really tired so I begged Andy to go back to bed as I reminded him that I would be needing his support much more later on.  He kept saying that he wasn't sleeping unless I was sleeping...but  after much head-bobbing on his end, I finally convinced him that I was nowhere near sleep and he agreed to go back to bed for a while.  My mom, being the night owl that she is, stayed by my side.  So grateful that she was there, I began to labor away sitting on my birth ball, rotating my hips, and doing some belly dance techniques.  At this point all of my labor pains were in the front (like very strong period cramps), which made me feel hopeful that maybe our little one had rotated from his OP position into a more ideal spot to descend.  The contractions were definitely coming, 5 minutes apart or less, but at this point they weren't quite a minute in length.  As they started coming more and more, I noticed that the pain was both in the front and also moving around to my lower back (a sign that the baby was likely still OP).  At around 5:45am I contacted Parveen to keep her updated.  I told her that the contractions were definitely painful and definitely coming, but that I thought that it was more because of the baby's position rather than actual progress.  I'd seen this pattern unfold time and time again... ruptured membranes at the onset, contractions coming back to back in an early stage growing progressively stronger into back labor, shaking due to hormones almost like transition and after hours and hours of hard work, often little to no progress because it's actually an OP baby rather than one that is descending properly...  darn it!  I definitely felt anxious knowing this, but kept at it and continued positions that can help turn an OP baby.  Parveen sensed my anxiety and said that she knew I was only in early labor but that she would still head over shortly just to check in on me.

Now during all of this our power was still out.  At first, I thought "eh, no biggie... laboring by candlelight will be lovely and peaceful!" (and in some ways it was)... but then I also realized that this meant no hot water which is a pretty major part of home birth!  Showers and the birth pool are the best way to relieve even the most painful labors and without the best trick in the book, I felt even more anxious.  When I mentioned this to my mom, she said in her usual southern accent, "well then we'll just have to do it the old fashioned way and heat that water up on the stove!"....wishing that was possible I said, "We have an electric range mom.".........she gave a thoughtful pause and said, "oh.... well shoot!".  Suddenly, however, after about 5 or 6 hours of laboring in the dark, the house lit up, the AC revved up, and we squealed, "Thank you God, we have POWER!"!!

Andy awoke around the same time that Parveen arrived which was around 7am.  She decided to check my cervix, if I wanted, so that we would at least have a baseline.  I knew the progress wasn't going to be much and didn't want to grow discouraged, but agreed that it would be good to have something to go off of.  Sure enough, I was only 2cm dilated, 80% effaced, and the baby was still at a -2 station.  Parveen suggested at this point that I try and rest.  I knew it would be difficult, but I tried since I'd only had 1 hour of sleep and this was clearly going to be a very long journey.  I laid down in the bed and with contractions coming every 5 or so minutes, I was able to catch little cat naps between and then crawled out of bed (as quickly as I could) during each contraction to move through them.  I think Andy was sitting there with me, but I was groggy so it's hard to remember. This up-and-down-from-bed- pattern went on for about 2 hours where the contractions then became too strong for me to rest and I gained a second wind.  We decided to take advantage of the gorgeous day outside and tried to go for a walk to keep things going.

The walk was tough.  It happened to be a weekend (one of the very weekends that our photographer Ali was unavailable to be with us), so plenty of neighbors were walking around and I was doing my best to mask the pain and/or noises that I was making so as not to scare anyone off (especially the children running around)!  Andy and I took things slowly but I was definitely having to work hard through the contractions.  We also took the stairs which I completely dreaded, and thought of allllll those mamas prior to me that I had taking those stairs to get their labors to progress!  Andy was a great coach... he didn't let me stop or wuss out.  He just kept encouraging me to keep going and going.  Then at one point I turned to Andy, teary, and told him that I thought I knew the baby's name.  His eyes immediately teared up as he asked "Which one?".  I told him- now through full fledged crying- that I really wanted the baby to be named after my grandmother that I'd been so close to.  {Her nickname was "Bo" and she and I were sort of 'kindred spirits'.  She had always recognized this and told me my whole life how alike we were, but I didn't truly see quite how much so until my adult life after she had passed away.} Throughout our whole pregnancy I'd felt Bo's presence surrounding us often, and it just felt right to use her nickname.  So our sentimental choice was Beau (we wanted to give him his own spelling) and David is my father's name.  It was currently the day before my father's 70th birthday and it was looking pretty likely that our baby would be sharing a birthday with his granddaddy, so sharing his name also felt appropriate.  Andy immediately choked up, tears down his cheeks, and said "that's it then!". "Are you sure??", I asked, knowing that he had originally preferred our other name choice... the one that wasn't sentimental but a name that we both really liked.  "Yep... positive", he said.  So it was settled!  Our baby boy finally had a name... Beau David.  We decided not to tell anyone until after he was born.

After what felt like a really long time we returned inside.  Somewhere in there we spent some time alone in our bedroom so that we could use nipple stimulation to get things to pick up (sorry again for the TMI but nipple stimulation is a wonderful way to release oxytocin which thereby increases uterine contractions).  We also took a shower to help me relax.  Also during this time we ate a little, though I wasn't very hungry at all-- more nauseous really, and Marilyn also arrived.  The second I saw her, she hugged me and I started crying.  I just needed to release my emotions-- excitement and fear-- and I felt a sense of calming relief knowing she was joining us. I had worked with Marilyn many times before, and it was really nice to have something familiar to my 'birth world' around me.  I tried to embrace everything I was feeling... the calm moments, the scared moments, the predictable ones and the unknowns.  I tried as best as I could to be present which truly can be difficult when your body is taking over as it does.  Your mind just wants to shut down (and needs to!) so that your body can let go. This was the hardest for me... letting my mind just shut down so that my body could do its job (which I have to say I never completely allowed it to do).

At around 5:00pm- 15 hours into labor- Parveen decided to check me again.  Hoping for some progress after all that work, I was somewhat discouraged to hear that I was now only 3cm dilated and baby was still at a -2 station.  At this point she said that she'd like to chat about my options.  She had spoken to my OB on the phone and he expressed that he wasn't comfortable with me going past 16 hours with ruptured membranes due to the risk of infection.  I was shocked.  Usually we have at least 24 hours with ruptured membranes before really thinking much about infection, so I wasn't expecting this conversation until well into the middle of the night.  Parveen agreed that it felt early to her too and said that from a health perspective she was perfectly comfortable waiting at home until 24 hours as both baby and I were looking great.  However, with that said, she said that the backup OB that we had chosen wasn't comfortable with me waiting, so I had to make a decision knowing that I wanted him to continue to support us on this journey.  I spoke to him briefly on the phone between contractions.  He said that in his experience, for some reason, he often saw a rise in infection rates after 16 hours of ruptured membranes and so he'd feel more comfortable with me coming in to be monitored and to have IV antibiotics.  It'd be one thing if I was close to delivery, but seeing as though I had so much further to go, we had some decisions to make.  I felt frustrated.  I wanted to stay longer... I wanted to get in my birth pool and see if my body would let go and if I would dilate faster. I wondered if the Dr's experience of increased infections was because of all the hospital protocols... increased vaginal exams, bacteria present in the hospital etc. etc., but I also didn't want to chance developing a fever and putting our little guy in danger.  Of course I was disappointed by the idea of not getting our home birth, but what made me more nervous was knowing what my options were going to be upon arrival at the hospital.  I knew they would give me IV antibiotics.  Fine.  I'm not really a fan of antibiotics and have spent years taking probiotics to increase my good intestinal flora, but whatever.. I could handle the antibiotics and deal with that later.  I also knew that he would suggest Pitocin.  Something I have NEVERRRRRR wanted to experience (not that anyone really hopes to experience Pitocin contractions).  Pitocin is a synthetic form of oxytocin that our bodies make but being synthetic it doesn't cross the brain barrier and therefore doesn't give us the sense of wellbeing that natural oxytocin gives.  It increases uterine contractions wellll past what your body would naturally create (despite what they try to tell you), and of course has risks-- including baby's heart rate reacting unfavorably because of less recovery time from intense squeezing between back to back contractions.  On top of all of this, I was already just about at my pain threshold.  I knew that I could keep doing what I was doing at the current level-- tough as it was-- in order to have my natural birth, and I was ok with them coming closer and closer together....but I also felt like I couldn't take but so much stronger-- which Pitocin contractions very much are.  The other option, however, was to be left alone... possibly develop an infection and then have to be ushered back to the operating room for a cesarean much faster.  DAMN IT, DAMN IT, DAMN IT!!  Since danger was in no way imminent, we took the next hour or 2 talking through our options so that our decision was something we would feel sure about.  As soon as we began discussing heading to the hospital, my contractions began to space apart.  The adrenaline response to anxiety tends to halt labor and it was doing just that with mine.  After much back and forth, one lone statement made the decision easy for me.  I mentioned that I just didn't want to feel that we made the call then to end up in surgery and always wonder what would have been had we just stayed home a littler longer.  Parveen responded by saying, "alternatively you also don't want to take too long at home and always wonder what would have been had we gone in sooner."  That was all I needed to hear.  "Let's go", I said immediately.  We began to pack a bag (no I hadn't done this sooner in hopes that I wouldn't need it)... Andy and my mom were trying to grab things and I just didn't care what went in there.  I think the bag ended up with one or two baby outfits and a robe for me.  We did grab my pillow and some of my essential oils and then I think we were on our way.

During the car ride I had four or five hard contractions but I stayed focused and got through them (it was really tough to sit down with excruciating back labor).  My mom and Andy stayed quiet for me and Andy drove very calmly.  I was nervous but I always knew that hospital transfer was a possibility and I felt grateful that our reason for transferring wasn't because of anything "wrong" just yet.  I tried to take in some of the advice I'd often told my clients:  We know that we gave it a great shot at home and now we just have a plan B that we are grateful to have as an option when it's needed.  Of course it was disappointing knowing that I wouldn't be having the beautiful, peaceful home water birth I had so desired,  but at this point I just wanted everyone to be safe and healthy. We arrived at the hospital and Andy dropped us off at the main entrance so that he could go park.  My mother ran ahead to get a wheelchair as I was having a really tough time walking during my contractions.  Parveen and Marilyn were on their way behind us.  Ali (the photographer) had been alerted, but we knew that it was unlikely that she would be able to come.  I slowwwwly put one foot in front of the other as I entered the main lobby all alone.  I stopped immediately as a huge contraction hit and an older couple, on their way out, passed with concerned faces asking if I had anyone with me or if I was coming to have my baby all alone.  I nodded and pointed in the direction of my mother while breathing as deeply as possible.  The security guard came and helped me into a wheelchair.  I think he thought I was about to have that baby right there in the lobby-- which I told him I was nowhere close to delivery-- as he said "just hooooold on" and took off like a bat outta hell racing me upstairs and leaving my mother to run after us.  As we rode the elevator and rolled down those familiar halls that I'd walked so many times before with my own clients, I prepared myself to keep looking forward and not back.  This baby deserved to be welcomed into this world with the same love, joy, and excitement no matter where or how he decided to join us...

Thursday, October 4, 2012

The birth of Beau David Brocato, Part 1: The Plan

So it's been really difficult for me (like any new mom) to find the time to sit with two hands and actually type the birth story of our son, Beau.  From just trying to sleep when our little guy is sleeping to having a baby in my arms and on my breast when I'm actually awake, it's tough to find a moment to run and pee or quickly shove food in my mouth much less type!  So I've decided to put our birth story together in sections... I guess more like chapters (yep, I have that much to say!).  Everything is already a bit hazy in my memory, so I'm doing my best to sit and type out what I can when I can.   It's tough to know where to begin... Beau's journey was a long one but at the end of the day (ok days) it was all so wonderfully worth it!

I'll start off with our "plan" before our birth even began.  I put this in quotes because we all know that plans, especially when it comes to birth, are just preferences that we have so little control over.  We often detour from these plans, but do our best to honor our preferences along the way.  I realize this isn't the juicy "what actually happened" chapter, but many have asked and asked what I would do when it's my turn.  So I'll start from the beginning... get your popcorn and hunker down... as usual anything I have to say is going to take more than a few minutes :)

The most common question that I've heard through my pregnancy was where I planned to give home, birth center, or hospital?  As soon as we learned we were pregnant I knew that I wanted a home birth.  Knowing what I do for a living and all that I've witnessed at both home and hospital, (and after some discussion of course) Andy was on board and supported me 100%.  So right away I started going through our options for home birth, thinking of all the wonderful midwives that I knew and loved and which would be the best fit for us.  We wanted someone who- aside from having reputable credentials, positive energy, and plenty of experience- would come to our home for all of our appointments, who I had worked with before, and who wasn't taking on so many clients that we had to wonder exactly who would be the one showing up on our special day.  Immediately I thought of Parveen Kelly, CPM.  Her calming presence was there to reassure me right off the bat as she completely understood that while I work in this business, all of that knowledge somehow goes right out the window when it's your body and your baby.  Filled with questions (that I often knew the answers to but just had to ask), Parveen would take her time in answering each and every one no matter how irrational many of them were.  Throughout my pregnancy I noticed that my history of anxiety (see previous posts) was definitely bubbling up to the surface, and so I worked long and hard at trying to keep those thoughts in check, not only for myself, but for my baby.  With all of that said, I was hell bent on covering all of our bases to try and ease my anxieties (or maybe just hell bent on control?!) and  one of those bases was insuring backup- knowing that there was a very real possibility, like with any home birth, that I would need to transfer to the care of a Dr. at any point during my pregnancy or labor/delivery. So I decided I wanted to find my own backup OB... someone who I could trust implicitly and that I felt comfortable working with just in case.  Those who work in this business know that not all hospital transfers are positive.  When you get just any doctor who is on-call you really can't be sure of how you'll be received and sometimes it's not exactly kind.  So I immediately knew who I wanted as my backup and called my favorite OB to see if he'd be willing.  Thankfully he was... he said that he trusted me and knew that if I had to transfer that I wouldn't be like some of the other transfer moms out there: angry upon arrival and unwilling to do what it takes to keep mom and baby safe.  This doctor and I had worked together many many times and have a great relationship, so I knew it was a perfect fit.  He kept in touch with me throughout my entire pregnancy, and saw me frequently as we continued to work together... but at the end of the day we both hoped that we wouldn't need to see each other on the big day at all. Either way, my mind was at ease knowing that if I had to go in at any point, that I was covered and my experience would still be positive.

Photo courtesy of Ali Caudill Photography

I'll stop myself right there before continuing and paste some information below for those who are gasping and thinking that home birth is "crazy" or "negligent".  Normally I wouldn't even bother explaining our choices, as they were ours to make and really no one else's business.  But I noticed throughout our pregnancy that a lot of our friends, family, and even acquaintances had big eyes and "you're crazy" comments (or at least looks) when really they knew very little on the subject of home birth.  I've written posts about birth choices in the past, never revealing what ours would personally be as I've always supported everyone's personal choice in where and how to birth their babies... so now I'll just paste something I wrote to a very concerned friend during my pregnancy in response to our choice:

*Please note that the following is in no way meant to try and change the view or opinion of those who don't agree with us nor is it meant to start a debate, but rather is to help others simply understand why we chose as we did.

 In terms of home birth, our midwife is incredibly skilled (she was trained in the UK where ALL moms visit a midwife as the norm and are only referred to an OB in cases of high risk pregnancies.  She has worked in both hospitals and at home and has seen very high risk situations in her training in the UK.  She is conservative in that she doesn't just wait for things to progress into sticky situations, but rather is incredibly proactive about her decisions to either stay home or head out for help.)  Many good OB's are supportive of home births as long as mom is a good candidate for one.  I often have OB's tell my own clients (who are planning a hospital birth) that if they don't want to be "messed with" and truly want a natural birth, then to stay home until the last minute.  Even they support staying home if mom wants to avoid unnecessary interventions.  In terms of emergencies, what is hardest for most to understand is that the emergencies seen in the hospital are often caused by the procedures performed at the hospital itself. (Of course, not always, just often). We currently have a very high cesarean rate in the US from hospital births. Most "emergency c-sections" are because of either Pitocin which can negatively effect baby's heart rate and send moms quickly into the OR; epidurals which often cause moms blood pressure to crash, thereby causing baby's heart rate to drop incredibly fast, again leading mom straight to the OR; or artificial rupture of membranes which can cause uterine infection, putting baby in distress and again an emergency visit to the OR.  And these are just the 3 most commonly used medications/procedures in hospitals.  So admittedly, some Dr's will agree... stay away if you want a natural birth.  Now I also realize that without enough information, many would ask "then why not just have a natural birth AT a hospital just in case?" And while it IS sometimes possible, there are still some difficulties with that.  First and foremost the staff often doesn't allow moms the same amount of time for their bodies to do what is necessary to get the job done on it's own... so while they often say they are fine with mom having a natural birth, they seem to grow impatient and truly do step in MUCH sooner to "mess with things" (ie. speed them along) which can often have an unfavorable effect on the process.  Even simple protocols like IV fluids and artificial rupturing of membranes can create a cascade of interventions that are unfavorable.  Also many moms have a harder time relaxing in a hospital environment, and the adrenaline response to anxiety, or white coat syndrome, can lead to a major stall in labor.... then guess what happens?  They mess with it! (I've often seen moms having nice strong productive contractions 3 minutes apart at home, only to then stall completely upon arrival to the hospital).  The energy at a home birth is very peaceful and calm, and not treated with constant anticipation of something going wrong.  None of this is to mean that there aren't times where we NEED medical intervention, a little push in the right direction, and for that I am incredibly grateful for what our hospitals have to offer.  I've been a part of home birth transfers for those very reasons and they tend to be very smooth and proactive. Sometimes the at-home methods just aren't enough and we need to go in for a little help. I realize that those in a more medically minded environment argue this because they only see the emergencies that they see... they often haven't witnessed both hospital and home births and don't understand that often those emergencies that they see are caused by their own interventions.  They have no clue what a home birth looks like and imagine it being without proper medical care (i.e. just some lady having her baby without a clue what to do in the middle of her bedroom).   And not all hospitals, or doctors, or nurses are "bad" at all.  I've had incredibly positive experiences in hospitals with wonderful birth teams.  I just prefer to try at home first where I don't have to worry about the unnecessary interventions.  With all of this said, I realize that there is (of course) a possibility that we will need to deliver at the hospital or even have a surgical birth, and so I have enlisted an amazing OB who has been in touch with me this entire pregnancy along with some Dr's visits to him to make sure he remains comfortable with my choice.  He will be alerted as soon as I go into labor and is part of the birth team- just from a distance.  He too will be part of deciding if I should head in should things start to look that way. In terms of post-birth care, my midwife is trained in emergency response as well as neonatal resuscitation. She will be monitoring both my vitals and baby's vitals through the entire labor, delivery, and for approximately 5 hours post-birth. She will also perform the same blood testing etc. on baby after the birth and we will take the baby in to the pediatrician within 24 hours to have him checked (the pediatrician was also incredibly supportive of our choice to stay home, and only said to bring him in within 24 hours which is when they would usually check baby themselves at the hospital). In terms of baby care, so many studies point to immediate mother-baby bonding...unlimited skin-to-skin contact, breastfeeding, and delaying 'convenient' procedures (weighing, measuring, vaccines, baths etc). Studies are also supporting delayed cord clamping and cutting in order to give baby his full blood volume from the placenta which helps in his transition to breathing well and his blood pressure along with other benefits. While many hospitals are coming around as they learn this information, they are still known for often rushing these procedures, and breaking that contact/bond that is so crucial during those first hours after birth.  None of these things are issues at a home birth.  Midwives fully support what all of this research suggests.  And finally, the maternal mortality rate in US hospitals is sadly quite high.  So much research is now pointing to the interventions and hospital procedures themselves being the cause.  Without going into all of that data, we do feel that we are making the safest choice for both myself and our little one to stay at home given my low risk status.  

So that's where we stood in terms of hoping to try at home with a skilled midwife and an OB in the background.  And that just covers the medical side of why home birth is safe.  Overall I trusted this process when all is progressing normally, and wanted to give it a good go without messing with it!

Photo courtesy of Ali Caudill Photography

The second most frequently asked question throughout my pregnancy was whether I planned on having a doula.  It took me forever to decide as I wasn't sure what I would actually need in labor.  I knew that in early labor, I would be fine with Andy by my side as my mind would still be "with it" and I would be well aware of what to do and what to ask of him.  My only concern was for later in labor... when experienced hands and words are very necessary for relieving pain. (I can't exactly reach around and squeeze my own hips nor can I script what to say!). I figured that mentally I would know what I wanted, but did I even want to have to think about the doula role during labor or just be the laboring mom??  I also knew that Parveen was beyond skilled at what she does and that with her by my side we would likely not need the extra help.  With that said, I kept tossing the thought back and forth... did I need a doula too?  Did I just want one?  Then one night my good doula friend Marilyn Alger and I were on the phone and I heard exactly what I needed to hear.  "Juli you just need a standby doula.  No contracts, no expectations, no pre-birth meetings, just someone who will show up IF you need it during labor, and I'd be more than happy to be that person for you."  I immediately started crying... this was exactly what I needed to hear!  (Plus I could pay her back in massages!!)  So grateful for her generous offer, I felt like my team was {almost} complete.  I had a supportive husband, an amazing midwife, an awesome OB, and now an incredible doula waiting in the wings just in case!

The cherry on top to my birth team was the addition of one of my favorite people~ Ali Caudill of Ali Caudill Photography.  I asked if she'd be willing to photograph our special day.... she was ecstatic and said that there were a few dates during our on-call window that she absolutely couldn't be there due to other contractual obligations, but otherwise she wouldn't miss it for the world. I was SO excited at the idea of her capturing our birth journey so that we could forever remember and share those images with our son.  I trusted that if she was meant to be there, then our birth would fall on a day that she could make it.

Photo courtesy of Ali Caudill Photography

So our team was now complete!  Over the next months Andy and I gathered the appropriate supplies for our home birth... our birth kit, receiving blankets, mattress protector, birth pool, hose and sump pump, essential oils, etc etc. Plus I had my own doula bag filled with all things birth, so I knew we were ready.   During the final weeks leading up to our birth I felt calm.  I felt ready.  I was so excited to meet our boy!  We hadn't yet decided on his name but had narrowed it down to 2.  One we just liked and one that was sentimental.  We decided we would likely just meet him and make our decision then.  So now all we had to do was wait...

Photo courtesy of Ali Caudill Photography