Monday, October 21, 2013

Settling in to Wait

So today we were supposed to get some answers. Answers about what keeps causing me to bleed and what our plan is for our birth (birthing center or hospital). So we went to the OB who is the back-up doctor for my midwife practice. Now, this isn't a doctor I've selected, she's just a doctor who agreed to act as the back-up physician in case of hospital deliveries. Why do I caveat that? Because...well, she's interesting. Her bedside manner leaves a bit to be desired, so to speak.

So we get to her office and I am armed with my expansive medical knowledge what I gleaned from reading some medical journal articles about low lying placentas and vaginal births. I am prepared and determined to get answers. That determination started to fade away as I watched the minutes tick by in her overly crowded waiting room. Seriously, this is a solo practice and her waiting room was so packed there were pregnant women with nowhere to sit just standing around looking miserable. I think she triple books appointments.

Anyhow, I've been spoiled by our birthing center. Once I got escorted to a room, I found myself sitting on the cold exam table with a piece of paper wrapped around me (leaving my butt exposed to the door behind me) and paper sticking to my bare bottom underneath me and missing our spa-like experience with the soft blanket throw to cover me. Ha. Anyhow, so doctor walks in and I try to make some chit-chat but I'm not sure she knows what that is. She just starts doing the ultrasound. Ok. No problem. But what do we learn from the ultrasound? Nothing. The same thing we learned on Friday. The placenta is "low" (yes we knew that the whole pregnancy) and the baby's head is out in front of the placenta (which we knew that too and yes that is a good thing). I ask if she got the records from our perinatologist who measured the placenta to cervix distance before and deemed it to be "safe for vaginal delivery." She says, "Oh I think I saw something on my desk about that..." Then I tell her that I have read that it's better assessed via transvaginal ultrasound, so she whips out the dildo wand and jams that into me. Now, that has never hurt me before, but today it was really painful AND we didn't learn anything new. She says, "This is really better assessed between 25 and 30 weeks. I can't see anything now." And I said, "Well, those records I told you about were from an assessment at 28 weeks and he said we were fine in terms of the placenta location." So she looks at me, ultrasound wand still jammed up inside of me, and says, "Well what do YOU want to do?" Seriously? Seriously? So I made a joke about her asking me serious questions with an ultrasound wand in my vagina and she realized maybe that was not good bedside etiquette and pulled it out.

But then she starts organizing all of her papers and getting ready to leave the room. Again...seriously? She asked us to come in today so we could decide. How about she sits down and actually talks to us about it? So, we peppered her with questions about risks, possible outcomes, her recommendations, etc. And we got no clear answer at all. She basically said she had no idea what is causing the bleeding, she couldn't locate any specific risks, it was a good sign that the baby's head is out in front of the placenta, but there is no way to know what could happen during labor. She pointed out, "In any pregnancy you can have bleeding. In any delivery, regardless of placental location, you can have placental abruption, you just never know what could happen." Well thanks lady. Thanks for pointing out the risk factors of an out of hospital birth...which we obviously considered when we made the original decision! Finally, she says, "Hey, I'm biased. I delivery babies in a hospital, so obviously I'm going to say that's where I'd feel safer. But it's up to you guys.

And then she left. Oh! Oh wait! I forgot to tell you guys the best part. In the hospital on Friday, when she did a cervical check, it hurt so bad I wanted to crawl backwards away from her and the nurse had to remind me to "breathe." I felt like a wimp. So I made a joke today to the doctor about being nervous it would hurt again. And she looked at me weird and said, Oh. Well, I can be gentle this time." Um? Thank you? Shouldn't that just be standard procedure when sticking your hand into someone's cervix??? And guess what? Didn't hurt at all today. And she still was able to get the info she needed. No pain needed. Wow. Oh, and I haven't dilated anymore since Friday.

Ok, so we leave that appointment and have to head immediately to the midwife appointment. I am feeling distraught. I wanted clear answers. As in, someone to tell us that we are going to be "fine" or someone to tell us we need to be in the hospital. Either way. I hate this ambiguity. B keeps pointing out that really we are in the same boat as we were in before all of this...taking the chance that something could go wrong. Also, he pointed out that she could not identify any clear problems or risks and in fact said that the position of his head looks good and safe for delivery. I also pointed out that we had already been cleared by the perinatologist who had warned us more bleeding could happen and that it would be normal for me and not a risk to the baby. But then I got mad all over again. Why didn't she look at those records?? I was completely torn between my rational side that was telling me that nothing had really changed and my emotional side that was screaming awful things about blood and babies losing oxygen and....well, you know.

So, we get to the midwife appointment (after a quick stop at Taco Bell to assuage my dropping blood sugar...SHhhh don't tell the midwives!) and we get inside the room and I instantly feel better. So, of course, I start to cry. I tell her how I was feeling so excited and peaceful about labor and now I just feel fearful and fragile. We spent some time talking about my fears and then we got down to business of what exactly could go wrong. First of all, the midwife pointed out that the doctor, by not telling us we had to be in the hospital, had been giving us the green light for an out of hospital birth. In a litigious society, this is the best she can do. Then we talked details. According to the midwife, we will alter my plan so that I will not wait so long to go into the birth center (think 5-1-1 contractions or cm's dilated), but will either have a midwife come earlier to my home or will go over there earlier, so they can monitor me for bleeding and baby's heart rate. She explained that her main concern is not about the baby, but about me losing too much blood (exactly what the peri said to us). This is based on the fact that we really have no evidence the bleeding is coming from my placenta and actually have much more evidence it's coming from my cervix as it dilates (or, in previous episodes, in reaction to sex or exercise). We discussed hospital transfers and how we would do this quickly if needed, but more likely it would be just in reaction to slight decrease in baby's heart tones or my own fear holding me back from progressing in labor out of hospital. And basically, we just felt heard. We felt heard and I felt like someone finally considered all of the factors, the history, and possible scenarios. And we made a sound plan.

Most importantly, we spent the second half of the appointment (we were there for an hour and a half) discussing the fact that BABY IS COMING! And that we should focus on the excitement about that and not feel so fearful and apprehensive that something is wrong. Because, this bleeding is part of prelabor. It came in conjunction with bloody show and it's just part of my body's progress. She examined me and said that she anticipates we will have our baby within the week. She also cautioned me that I could still go past my due date, but that she doubted it at this point with all of these signs.

So here I am. Back to where we started. We are still planning a birth at the birth center. We are still expecting our baby very soon. And I am trying to focus my energy on feeling positive and peaceful again. I haven't had any other new signs since this weekend, with the exception of one stronger contraction that made me stop talking in the middle of a sentence. My mom gets into town next Tuesday and so anytime now would be just fine with me or if he wants to wait for Grandma I'm ok with that too.

To end, I will say that many of you reading this may have your own reactions about our decision. In fact, my original post about this decision had some of the most views and comments of any of my posts. And that is because there is no correct answer here, but everyone feels very strongly about it. I believe there are cultural aspects, personal aspects based on your own experience, and also, within the US, problems with the way the system is built that pushes us to go to one extreme or the other. I don't have a huge agenda here or preach to people about how I feel (hey...the hospital birth is very alluring to me in its safety and assurances), but I just feel right about this. Both times I have made this decision, I walk away feeling secure and grounded and right. It just works for me. I'm curious what others think... on both sides of the coin.

24 comments:

  1. I think the most important part here is that *you* feel safe and comfortable, as opposed to scared and anxious, excluding major medical emergencies (but that's the thing... you never know how things will go until they are happening, which is what makes *me* uneasy). Since you asked how we feel about this, here goes:
    I understand that some people actually fear the cold, controlled atmosphere of a hospital, and I believe that feeling is very personal, but in my case I know I will feel safer at a hospital (probably because I have been medically trained, and I love the biological side of things, monitors, being able to see the baby's heartbeat on a screen). Even so, if the birth is "normal" (if no risk situations arise) I will most probably not see a gynaecologist. (Here they do hospital births led by midwives, the same that see you through your pregnancy). I know I would not be able to do it at home, which is the alternative, I would majorly freak out. And yes, though I know that most of the births do not need medical interventions, I do want to feel that *if* something should happen (high pressure, blood loss, baby having trouble breathing....) we are already at a place that is full with experts ready to take over.
    And well, I am a scaredy cat so I do want pain relief (aka, an epidural). Breathing techniques might be great for coping through labor, but I don't think I want to experience the whole physical pain that comes with this.

    I am glad you were able to make a plan, and meeting with your midwives *earlier* in labor sounds reasonable in case you need to be transferred.

    I will be thinking of you 3 and I hope everything will go smoothly. Your baby is almost here.

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    1. Amanda...yes I totally understand your perspective. I have the same "trust in science" side of me too. It makes me feel more comfortable too, in terms of my fears and feeling safer with the access to all of the medical interventions. But, the side of me that has not had the best experiences with OBs during this pregnancy and that wants the delivery to have that "magical" component keeps pushing me this other direction. And it just feels right to me. I WISH there were a middle ground (birth center attached to a hospital) and it is more readily available in other countries, but here in LA specifically, the medical field is very polarized. I hate it because I am not a person of extremes and it forces me to be polarized as well.

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  2. I'm glad the midwife was able to actually spend time with and listen to you, so you guys could come up with a plan. I know very well the fear of the what-ifs this close to labor! It feels like caregivers can make SUCH a difference in a woman's experience of all this, and we're both lucky to have found providers who seem to care.

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    1. Yes, I totally agree! As in, it's nice to know someone else is in the same place thinking of the What-Ifs and I completely agree that the caregivers make all the difference. I'm happy for both of us :)

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  3. Your midwife practice continues to sound wonderful! And that doctor sounds awful! I remember the loooooong waits in the waiting room with my OB when I was pregnant with Little K, but he also took his time during the actual appointment and never made me feel rushed. Which, I'm sure, contributed to the longs waits.

    Being comfortable with your care provider is so important! Your mention of being calm and peaceful before and the doctor making you feel fearful really resonated with me. Calm and peaceful all the way!! If the Peri gave you the green light and the doctor isn't giving you a red, I say go for it! (Not like an anonymous opinion on the internet matters. Heh.)

    Just so excited for you!

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    1. Yes...about the waits...I am okay waiting, as long as I feel the doctor is really present and listening when I finally get to meet with her. And once again, similar to my last doctor, she is "fine," but she is just rushed, rushed, rushed.

      Your opinion DOES matter! It makes me feel better to hear that you agree :)

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  4. Ugh. I'm kind of hating that doctor you saw. Everything about that experience just sounds terrible. People use the argument that "good" doctors are always busy but I'm not sure I agree with that...
    Anyway, it has already been said but the important thing is that you feel safe. It sounds like your midwife has done a great job of presenting the pros and cons of your situation, and also of coming up with a plan that does make you feel better. If I were in your position, that is exactly what I would want.
    And I totally agree with your comment on how our health care system pushes us to one extreme or another. It is pretty sad that we really don't have the happy medium that so many other countries have when it comes to prenatal care.

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    1. Yes...I totally agree. I want the happy medium. I really do. I hope the system will start to change somewhat, but I'm not sure....

      And yes, I think it's about feeling safe. Most of the time I feel safe with the midwives, because of how they are. But I have to remember to not get stuck in my fears about what could go wrong.

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  5. Can I just say that I love your midwives? Seriously. They have the bedside manner that ALL doctors should have. Maybe your doctor likes to put people in pain but WHY WOULDN'T SHE BE GENTLE DURING A CERVIX CHECK ALL THE TIME???!??? Ridonkulous.

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    1. I love them too!! And yes, it IS ridonkulous! hahah...crazy, crazy. What was her medical training like? "Well, if you do this slowly and gently, it causes less distress to the patient. However, it is much more efficient if you just jam your hand up there and focus on getting the information you need, not the patient's comfort."

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  6. Oh man, that doctor sounds shit. I wonder if you had received different crate from her if it would have influenced your decision any (I think you are doing the right thing, by the way) I just mean that you are uncertain and a bit scared, so naturally you will want to deliver with the team that tried to ease that rather than ignore it. In the same situation I would have done the same thing.

    You know we're essentially having opposite births, but like Amanda my nursing background makes me more comfortable with hospitals than I would be somewhere non-medical. I've also got a great doctor I adore, who I can't see for the next two weeks as week one she's doing emergency work with Medicin San Frontiers in Guatemala and the week after is fully booked because she doesn't double book appointments. like dspence I've had a few long-ish waits when an emergency has come up but I've never felt rushed, un-heard or disrespected. There's NO need to run a practice like that. Grr. Rant over!

    Anyway, I agree that you guys feeling comfortable with the plan in place is the most important thing. Full stop. If you are, the you've done the right thing! x

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    1. I do think it may have influenced me more if she had been supportive and kind. In fact, maybe we would have changed our minds. I dunno... but in the grand scheme of things, it could be representative of how she would be during the birth.

      You know what is funny? It's fine that we are having totally opposite births, because we both are able to understand the other person's views. As in, I TOTALLY get a hospital birth and I TOTALLY get having an epidural. And, if I had started with your doctor, I would have never ever switched my care.

      I'm looking forward to seeing you Thursday and we can chat more about the fact that holy-shit-we-are-both-having-babies soon!!

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  7. I love your decision, and I would go the same way if I had one baby and not two. In fact, my dad, who is a pediatric ICU doctor, is a huge proponent of midwifery and was even supportive of my light musings on home birth when we first started trying to get pregnant. With two, I know that my own fears about the increased risk would ruin an out-of-hospital birth experience for me, so I haven't even considered it. Maybe next time (har har). Anyway, I think your plan makes sense. I agree with the midwife. The doctor is not going to be all gung-ho in her support of the out-of-hospital birth. She can't be. OBs are the highest sued of all of the medical practitioners. She does sound terrible, by the way, and I'm so glad you're going to only be in her hands if absolutely needed. She seems like she would make labor scarier and more painful than it is on its own. Your midwives take you to the opposite place. I'm behind you all the way!

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    1. Aww thanks for your support and also great to hear your dad is supportive of the general idea as well. The perinatologist we went to was very supportive as well and that meant a lot to me.

      If I were having twins, I would be right there in the hospital with you. I trust my body (mostly) and i trust the midwives (completely), but I believe that some births need to be in the hospital for a reason. Modern medicine is a good thing! Again, this is where a birth center attached to a hospital would be perfect.

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    2. YES. I love that idea. We actually live 3 minutes from the best hospital in the state and the Level III NICU where I'd definitely want my babies if something bad happened. We're practically attached as it is. I might as well wait to head to the hospital until I'm ready to push. ;)

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  8. I'm just catching up on your blog and am so sorry to hear you've had more scary bleeding episodes without explanation. But holy moly, you are close! That doctor sounds like a nightmare, and I can totally understand why you would continue to lean towards your warm and fuzzy midwives' practice, which sounds awesome and so so personable. Like you, I wish these things weren't an either or choice. My mom was and is on the militant homebirth/natural birthing end of the spectrum and while I don't agree with the extreme attitude, I still remember my youngest siblings being born at home and probably always imagined I'd lean in that direction...If we progress with this pregnancy though, it's not meant to be for us, because of my age but moreso my medical history. And truthfully, I don't really trust the midwifery profession here in the UK. They are more like nurses (so very medicalized in their approach anyway), and on the whole, don't strike me as well educated. I think if you're given some choice, you have to do what feels right for you and just skip all the polemic.

    You know what I think? That at the end of the day, when you're holding your little guy in your arms, *whatever* birth experience you had will have been perfect. And he's on his way very soon! So exciting!

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    1. How neat that you remember your siblings being born at home. Were you born at home too? I always wondered what that's like for kids to be present at a birth. I wondered if it would be scary for them?

      And yes, you are totally right. In the end, we will have our baby and that is by far the most important thing to remember.

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    2. Not at all scary! I suppose it all comes down to how the parents handle it, which for us was very natural, so I think as kids we picked up on that vibe and were just really 'whatevs'. But I do remember being amazed, in a good way, that all of a sudden there was just this extra human being there for me to play with and cuddle. Top priority for my five yr old self!

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  9. You're doing everything right!! I'm in no way a medical professional, but your bleeding seems dilation based, not placental. Any idea how far your placenta is from the opening? I think anything over 2.5cm is considered safe, and any ultrasound would have caught that. Your doc just seems like an ass! Go with your gut. My mucus plug came out in "bits and pieces" for a week, and then the day of my labor, it was more of a lot of light pink blood with clots. I know you will be able to do this!

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    1. I completely agree with you. It really feels like it's coming from my cervix and is in reaction to dilation. And yes, I was measured and my placenta was at 3.5 cm so I feel good about that, based on what the previous doctor told us and the medical articles I read.

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  10. Your midwives sound amazing and I am glad there is no real reason you can't deliver at the birth center. It sounds like that OB would just make the whole thing much more stressful. My OB actually had a fantastic bedside manner. He was comforting and supportive through my whole ordeal. I really think he felt bad about having to do a c-section since he knew I didn't want that. I was lucky to find him.
    I am excited for this baby to get here and I can't wait to see pictures. Then we need to start our LA blogger playgroup :)

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    1. Yes! An LA blogger play group sounds like a great idea!

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  11. What a terribly frustrating visit - especially so when you have the amazing, warm and fuzzy, honest and comforting midwifery practice to compare it to. Ugh. So sorry you're back in this scary bleeding business but also kind of incredulous at how close you are to holding this lucky little baby boy. Hoping for answers but more than anything, a safe, healthy mama and baby, wherever and however it happens. Godspeed!

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    1. "Incredulous" is the right word. I can't believe I am standing on this cliff edge. It is completely surreal right now!

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