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

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