Half Way There {Progress and Goals}

16 weeks (semi-profile)

18.5 weeks

20 weeks

I'm officially half way there (give or take a few weeks), and I've got the belly to prove it:)

Here's what I've been doing in the last 5 months to prepare myself, along with some of my goals for the near future.


Progress:

*I've interviewed and chosen a supportive health care provider

*Established a "plan B" in case my provider is not on call when I go into labor

*I've interviewed two doulas

*Had our 18wk. ultrasound which gave us the news that we are expecting our first baby boy

*I'm working out at least twice a week at the gym and trying to stay active the other days

*Started using bountiful baskets in order to up my vegetable intake and improve my overall nutrition

*Purchased some Red Raspberry Leaf Tea to help tone my uterus and keep me hydrated during the summer months

*Continue to go to monthly Birth Circle meetings as well as local ICAN meetings


Goals:

*Find a food based, high quality prenatal that has magnesium in it, and make a habit of taking it every day

* Interview more doulas and hire one

*Prepare a birth plan

*Take a childbirth prep class

*Educate myself about the typical hospital protocols and procedures done to babies, and find out what I want/don't want for our child

*Order Hypnobabies Home Study Course and begin the program at around 28wks.

* Read "The Thinking Woman's Guide to a Better Birth" and any other books that I feel will help prepare me

*Continue to work out several times a week and eat well

*Take a tour of the hospital I am delivering at/register

*Continue attending Birth Circle/ICAN meetings

*Stay really hydrated

*Pass the glucose test with flying colors

*Possibly purchase an inflatable pool to labor in at home as well as a birthing ball

*Review my birth plan with my provider

*Pack my hospital bag

*Have maternity photos done

*Come to an agreement with my husband in regards to circumcision (we are on opposite ends currently)

*Talk to/hire a placenta lady for placenta encapsulation

*Have a healthy baby boy and a successful and empowering VBAC

I still feel like I have a LOT of time before this baby comes, but there's plenty for me to be doing until then.

Wish me luck:)

Interviewing Health Care Providers

At my first ICAN meeting the topic was interviewing health care providers. I personally had never interviewed a health care provider, or knew anyone who had, and so it made me a little nervous. Me asking the wise and all knowing doctors questions before I hire them? Do they even let you do that?

Gulp.

Now that I have experience interviewing health care providers, I understand why it is so important. I think that it is essential not only for vbac moms, but any mom who is wanting to find the right match for their pregnancy and delivery. In addition to interviewing, talking to moms and or doulas who have had experiences with the doctor/midwife can also be helpful.

With a vbac things can become more complicated with finding the right provider. Unfortunately many are limited by the medical community. In Arizona there are vbac bans at certain hospitals, a lot of doctors who don't offer vbac, and laws prohibiting midwives from assisting in a home birth after cesarean. With the c-section rate at about 30%, and the vbac rate at about 8%, you really want to do your research to make sure you are finding someone who is going to be on your side come delivery day.

There are a lot of questions to potentially ask a health care provider, and it is important to ask about the things that are most important to you.

Some of your questions/discussions might include:

-their c-section rate

-whether they do vbacs or not/if so how many do they have in a month/how many are successful?

-their protocol for going post dates(past 40wks)

-their protocol on ruptured membranes (when your water breaks) past 24 hours

-their protocol on induction/induction rate, and what they feel are reasons to induce

-how often they are on call/any scheduled vacations

-who the providers are that take over when they are not on call/what are their practices?

-their episiotomy rate

-their protocol on cord cutting, and thoughts on delayed cord cutting

-what positions they will "catch" a baby in (do you have to deliver flat on your back in bed?)

- their vbac rate

-what their orders will be like in the hospital (monitoring/IV/eating/drinking/movement/pain management options)

-what kind of support they can offer to prevent tearing

- with a vbac/vaginal/c-section delivery, ideally how would they like things to go?

and the list could go on and on...

I was also taught that the best way to get a good answer is to pose an open ended question that will allow that doctor or midwife to do a lot of talking. If your questions give obvious clues as to what you are looking for, it could easily sway their answers to something that might not be completely true.

So instead of saying:

" I REALLY don't want an episiotomy, would I have to have one?"

you could ask

"In what situations would you find it necessary to perform an episiotomy/ how often do you perform episiotomies?"

to get a better idea of what to expect

When I was interviewing, I also paid a lot of attention to their tone of voice and general presence. If they wouldn't even take the time to let me interview them via phone or in person, they weren't worth my time and money. On the opposite end, if they were welcoming and willing to answer all of my questions, it told me a lot about them.

Another important thing is not to make assumptions before interviewing the provider. For example, assuming that because they are a midwife they will not try to use a lot of interventions during labor and will automatically follow through with your birth plans. Or that because your best friend loved this doctor, that you will love them too.

Going from hiring my last provider just based on my insurance coverage, and a tip from a charge nurse, to hiring a provider based on a personal interview and lots of referrals has made me feel so much more confident that I will actually get the support I need.

The Perfectly Passive Patient

{if you looked it up in the dictionary you would see this picture next to it}

I am a very passive person, and it has always been part of my nature. So when someone cuts in front of me at the grocery store, or if the Mary Kay lady blatantly lies to me about "winning a so called prize" just so she can get into my house and get me to buy stuff, I turn the other cheek. I avoid confrontation at all costs, and I magically transform into a doormat. Call me nice, a little too nice, and too afraid to be anything but that.

My nature wasn't any different in the hospital, and lucky for them it transformed me into the perfect patient. I rarely asked any questions and just did what they told me to do when they told me to do it. I agreed to do things even when it felt wrong or didn't make any sense.

I complied to the IV and having to lay in bed during contractions.

I complied to being starved for 21 hours because they weren't ready to define what was happening as "real" labor or not.

I complied to staying the night, even though they had promised to decide whether I was in active labor my midnight and never did.

I complied when the nurses came in every 30 minutes throughout the night to adjust the three monitors that were digging into my 38wk pregnant with twins belly, leaving me with little to no sleep.

And all of this happened while I wasn't even in real labor, although I didn't realize it at the time.

And this was just the beginning.

The bottom line is that a LOT of things that happened to me and my children at the hospital felt VERY WRONG, and I didn't do anything about it. Blame it on me being a first time mom and not knowing what to expect, or blame it on the respect I have for medical professionals. Blame it on my fear of confrontation or my want to be a good patient and to be like able.

I like to think that I've come a long way since then, and I have tried to convince myself that I will never be that passive patient again. I've learned so much in the last year and half, and I look at things so differently now. I'm done with having things done to me or my children without my consent, or without any information. I'm done with being the doormat.

Unfortunately my first appointment for this pregnancy had me repeating these same patterns. The nurse practitioner told me they needed to do a "swab" even though I had a current pap. They proceeded without even telling me why they were doing it, or asking me if I wanted to do it. I didn't realize the error I had made until my drive home. I just started crying and at the time I couldn't figure out exactly why it made me so upset. It was just a stupid swab...right?

When I got home I did some research on the Internet to find out why they did what they did. Knowing the purpose didn't really help, because although I was mad at them for not discussing the purpose of it first (aka informed consent), I was really mad at myself for just letting them do it without asking why or whether it was necessary or not. I couldn't help but feel like a failure all over again.

Coming out of my passive shell is a work in progress, and to be honest I still worry about how I will fare in the hospital setting again. While I have a lot of control over who my immediate birth team will be, I have no control over the nurses and other hospital workers that will also be there. Will they be supportive of my wishes? Will they try the same things they tried last time? Will I be the same passive patient I was last time and end up losing all control? I don't know...

So I'm arming myself

with

research

childbirth prep classes

hynobabies

a supportive health care provider

a great doula

a husband (who is also birth educated)

and faith

that Heavenly Father can make

the seemingly impossible possible

because in the end

He is in control.

Why Choose a Midwife?

So now it's time for me to get serious about finding a health care provider that is truly supportive of my wish to vbac, along with my other birth plans. It's easier said than done. With my last pregnancy and delivery, I used an OB/GYN, but after meeting midwives and learning about the midwifery model of care, I am really hoping to find a midwife this time.

The Midwives Model of Care

(from the citizens for midwifery website)

The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.

The Midwives Model of Care includes:

•Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
•Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
•Minimizing technological interventions
•Identifying and referring women who require obstetrical attention

The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.

With this birth, I feel that it would be best for me to have a health care provider that:

-views pregnancy and birth as a natural process

-believes in a woman's ability to give birth naturally

-doesn't use unnecessary interventions during labor or delivery

-offers plenty of one on one time with their patient during pregnancy as well as support during delivery.

-tries to minimize the risks that can arise in pregnancy and birth by providing information to the mother on how she can be healthy during her pregnancy and prepare for a healthy delivery.

-views vbac as a safe option for mom and baby, but can also make quick decisions if complications do arise.

-respects the mom's wishes and offers support

-gives the mom real informed consent when it comes to all of her options and the risks involved.

-isn't afraid of "big babies" or a mom going past 40wks.

-allows the baby to come when they are ready.

-genuinely cares about the mom and baby's health as well as their birth experience.

Here is a great video from YouTube that talks about some of the benefits of choosing a midwife.

We're on our way...

( Charting showed we were pregnant 4 days before my expected period)

We are expecting baby #3 in September!

VBAC here we come!

VBAC Success for Joy Szabo

I posted a few months ago about Joy Szabo's story. She was the woman from Page who was planning a VBAC with her third child, and then found out that she would be forced to have a repeat c-section due to the new guidelines of her hospital. After relocating to Phoenix and finding a supportive health care provider, hospital and doula, she was able to have her VBAC.

You can read the CNN article about her VBAC experience here.

You can also read an ICAN article where they interviewed Joy here.

I think that Joy is an amazing example to other moms out there who would like their bodies and birth choices respected. She didn't give up, even when it meant moving hours away from her home and family, and accruing expenses she had not planned for. Joy had to sacrifice a lot, but she did it anyway, because she felt it was the right thing for her and her family.

I feel that it's unfortunate that she had to sacrifice so much just to have the natural birth that she should have been able to have in Page. Hopefully all the attention and media that has surrounded her story will help others to realize that there are a lot of changes that need to be made when it comes to hospital guidelines.

In my opinion, no woman should be denied the choice to birth the way she feels is best for her and her child. Mothers need options and support based on evidence based medicine, not bans and restrictions that are largely influenced by insurance policies and finances.

13 VBACs and Counting

I'm not sure how many people are fans of the TLC show 18 kids and Counting, but I LOVE it. I enjoy watching the Duggar family, and I think very highly of them. On the episode last night, Michelle and Jim Bob were celebrating their 25th wedding anniversary. They have been married for 25 years and have had 18 children in the process. The producers gave Michelle (the mom) the challenge of sharing about each of her children. They asked her to tell about each of their births as well as their personalities.

This is what I got from watching. I can't say that I'm 100% correct but it was my interpretation of what she shared.

Josh- Hospital birth with epidural

John David & Jana (twins)- C/S for pre-eclampsia

Jill- Natural VBAC

Jessa-Natural VBAC

Jinger- Home VBAC

Joseph- Home VBAC

Josiah- Natural VBAC

Joyanna- Natural VBAC

Jedidiah & Jeremiah (twins)-Natural VBAC

Jason- Natural VBAC
James-Natural VBAC

Justin- Natural VBAC

Jackson- C/S for breech presentation

Johannah- Natural VBA2C

Jennifer- Natural VBA2C

Jordan- C/S for transverse presentation

Michelle is a big supporter of VBAC and home birth, choosing to have cesarean sections only when it is medically necessary. I think she is a great example. It is amazing to see how many VBACs she has had even though some of Arkansas hospitals have VBAC bans.

Here is an excerpt from the Duggar family website where she discusses her decisions surrounding her births.

"As with any first time birth experience you might have fear of the unknown. As we approach each birth there are still the concerns of the unknowns such as the labor and delivery, each one has been different but having had the experience over and over does help some. Each time we have prayed for the health of mom and baby, and asked for a healthy, easy delivery.(As much as possible when were talking about labor!)

I’ve had three C-sections, one with our second birth, twins, Jana and John-David, with our 15th, Jackson and with Jordyn-Grace. All the rest have been vaginal births, 13 of which have been VBAC’s. (Vaginal Birth After Cesarean) We were hoping to have another VBAC with this last delivery.

I would say the greatest change that I have seen in the field of obstetrics, and I might add that it is very troubling to me, is the idea that once you’ve had a C-section you must have a C-section for any other pregnancy. It is much healthier for mom and baby to avoid major surgery and all the complications that go along with a C-section if possible. Granted, there are health situations that would warrant such, but for years obstetrics encouraged TOL (Trial Of Labor after previous C-section) with many successful healthy vaginal births. It was quite alarming to be told that I could no longer have a vaginal birth due to hospital or insurance companies regulations. It appears that what is best for the patient is not the priority with this decision.

I feel our health care is being jeopardized by this unhealthy approach. Doctors are having to tell their patients that they no longer offer VBAC assistance due to hospital regulations and some might even state to the patient that they are not safe so as to avoid confrontation. Statistics prove much differently.

For the many women that find themselves in this situation, ICAN is an organization that is very helpful in gaining more information on this topic. One of which I believe will be reversed in the near future as more women make a clear statement to health care providers and insurance companies as to how they would prefer to deliver there babies in a safer, healthier manner. (Now I will step off my soapbox!)
We are thankful our hospital allows trying a VBAC as long as they have an anesthesiologist on hand in case there is an emergency."

Michelle is expecting again, and I am curious as to whether or not she will have the support of her provider to attempt another VBAC after 3 c-sections.