Friday, January 4, 2008

Midwife vs Doctor

My first prenatal appointment with my new OB/GYN went fairly well. She was personable, gave time for answering questions, and talked with me about what kind of schedule I was looking at for tests, etc. I asked about birthing options and she basically broke it down to drugs or no drugs. Induction and/or a c-section was possible, but wholly dependent upon the circumstances of my labor (or lack there of) near term. I didn't really know what else to ask about, so I took my prescriptions for prenatal vitamins and progesterone (I had a history of miscarriages), made an appointment for the next month, and went on my way.

I was really interested in having a water birth, but quickly learned no hospital in Phoenix allowed for water births. However, there was a free-standing birth center that would. Bethany Birth Center (now Bethany Women's Wellness Center) was comprised of two buildings, an office for Women's health care and a birth center where women can give birth in a calm, home-like environment without the aid of drugs or fear of surgery. Better yet, water birth was not only an option but highly encouraged. BBC had four midwives and two OB/GYNs, but the OBs would only deliver in hospital. If I wanted to give birth at the birth center, I would have to become familiar with what exactly a midwife is and does. After about 3 months with my doctor everything seemed to be going well for my pregnancy, so I contacted BBC for my first appointment, all the while reading as much literature as I could about midwives, water birth, and natural birth. I still scheduled my next prenatal appointment with my doctor, just in case I found myself uncomfortable with the birth center.

My first appointment with the midwife was similar to seeing the doctor, and yet different. Instead of urinating into a cup and then sticking into a little alcove for the nurse to take and test, I was given a cup and a test strip, then told to follow the directions posted on the bathroom wall. I tested my own urine for protein and glucose, which meant I knew my status without having to ask later (the doctor, incidentally, had not told me what the urine samples were for). I was weighed and had my blood pressure checked, just as had been done at the doctor, except the nurse encouraged me to write these stats down and keep them logged. I was given a little purple log that would hold the stats for the length of my pregnancy. When I finally got to the exam room it was carpeted instead of tiled and much warmer than the doctor's office. The nurse practitioner saw me and talked to me about what they do at the birth center and the different classes that were offered and required. My doctor did not have birthing classes that ran out of her practice, instead she had referred me to the hospital in which she contracted with. The birth center provided the classes as well as support groups and a 24-hour number in case I had questions or concerns. I had been instructed by my doctor to go to the hospital or call 24-hour nurse line (not associated with her practice) if I had concerns or problems that occurred outside of normal office hours. The difference between the birth center and the doctor came down to a feeling more than anything else. I felt like I was in control of my pregnancy at the birth center and that my voice was important. At my doctor, I felt like just another number with a voice that needed to be silenced when heard. Thus began my prenatal care with nurses and midwives.

When you are pregnant time seems to slow down. Because you are counting every day of every week, you wonder if you will ever make it full term. Birth classes help with the waiting. I attended 5 different classes at the birth center on various things. "Body Works" was a class about what changes happen during pregnancy, labor, and delivery. "Baby Works" taught pregnant moms and soon-to-be-dads about basic baby care for the first three months of life. "Labor Day" included an introduction to all the options available at the birth center, as well as what to expect when you came in during labor. My partner and I also attending a breastfeeding class and a relaxation class. I spent hours putting together a six page birth plan that covered everything from episiotomies to having myself or my partner with our newborn at all times after birth. I read up on everything I could think of related to being pregnant, giving birth, nursing and newborns. When I ran out of new information, I dragged my partner to the hospital tour of the hospital that contracted with the birth center in case of emergency (or patient choice). My partner painted the nursery, my sister threw me a baby shower, and we had just about everything we could possible need to take care of a baby. And yet, after all of this preparing I still felt unprepared.

I was nervous about all the possibilities of labor and birth. I was nervous that I wouldn't be able to nurse for whatever reason, that I wouldn't naturally find myself attached once my daughter was born. Emotionally I was ripping myself to shreds with worry and doubt. At 34 weeks everyone around me was anxious for me to give birth, including my partner. People would ask me if I was ready for to give birth and for pregnancy to just be over already, but I would shake my head and tell them I was enjoying pregnancy and hoped it lasted full-term. I gave excuses like "Never before have I been so healthy and happy" or "She has everything she needs in the womb, why would I want that to end for her?" But really, I was just terrified of becoming a mother, of the new vulnerability that my baby would have once she was naked in this world. Instead of sharing my feelings, I just kept smiling and telling everyone I was in love with being pregnant.

From listening to other pregnant women and mothers, I gathered that on average OB doctors don't ask you about how you feel about being pregnant, and when they ask you how you are they are generally looking for a positive, blanket answer that will not involve them personally. This is not only accepted by most women as normal, but is expected since your OB specializes in female parts and delivering babies, not feelings. But as a pregnant woman I expected a whole lot more from everyone around me, including my prenatal care provider. This is why when the midwife asked me how I was feeling at 36 weeks pregnant, I said I was nervous. If she had been a doctor I imagine she would have told me some stock line like "there is nothing to be nervous about, you are healthy, your baby is healthy, and if anything happens then my staff and I are here to make everything go as smoothly as possible." This answer would have made me even more nervous and uncomfortable, because it wouldn't have addressed why I was nervous in the first place. But I was talking to a midwife, not a doctor, and her reply was a question "why are you nervous?" Suddenly the tears started falling and I realized that I had no idea what all the built up tension was from. So we worked through it. "Are you worried that something will happen to you or the baby?" "No." "Are you worried about being a mother?" "Yes." "Why?" "Because I don't have my mother and I don't really know what mother's do anymore, it's been so long..." BINGO!

We talked for maybe 20 to 30 minutes about my fears and worries, leafing through thoughts that had troubled me in the middle of sleepless nights but had been buried without bothering to talk to anyone about them. The midwife hugged me a few times and gave me an assignment, to express my thoughts and worries through art and bring it in to talk about the next week. I did end up writing, but I never brought it in to show the midwife. Instead we talked each time until I felt better about giving birth and becoming a mom. By my due date, I was anxious to meet our new daughter and ready to begin motherhood.

I started laboring at home the night of my due date, moving into all kinds of positions to deal with the pressure and pain of labor. I labored for three hours before heading to the birth center to meet the midwife. Once at the birth center I labored for another 30 minutes, standing and moving around, until I felt the urge to push. My partner had prepared the bath tub soon after arriving and after reluctantly letting the midwife check to make sure I was fully dilated, I told her I was heading for the tub, striped off the last layer of clothing I had on, and got into the tub to labor another 30 minutes of pushing. My daughter Madilyn was born in the water at 3:33am. My partner Ishmael caught her and lifted her out of the water, then promptly placed her across my chest for warmth. He cut the umbilical cord and I stayed in the water holding Madilyn while I gave birth to the placenta. The only people in the bathroom while I was giving birth were Ishmael and the midwife. There were no monitors beeping or nursing rushing about. In fact the only person touching me was Ishmael, who had his arm around me. Occasionally the midwife checked the baby's progress and told me what she could see and feel. When the baby's head was crowning, she let me know so that I could reach down and feel it for myself. The feeling helped me concentrate and focus on pushing. Throughout the labor and delivery I felt in control. After all, I was the one doing all the work, I should be the one in control of what is happening.

I so enjoyed the birth of my daughter Madilyn that immediately after giving birth I wanted to do it again. During my pregnancy I had told many different people, friends and strangers alike, that this would be my only child, mostly because I was so afraid of labor and delivery. After giving birth I was no longer afraid. If anything, I was motivated. I was home and in my own bed 6 hours after giving birth, resting. For lunch we went to Olive Garden, so I could satisfy my craving for bread sticks, minestrone soup, and endless salad. I cannot imagine giving birth any other way.

Over and over again I have heard horror stories from women who have given birth in a hospital and never again want to give birth. I hear about pushy nurses who are nasty with laboring moms. I hear about doctors who are barely there during labor, some who order cesarean sections after a few hours of labor because they are tired of waiting for the laboring woman to progress far enough to push and some who induce on particular days so that their patient's labor and delivery won't interfere with their golf game or out-of-town vacation. What is common to all of the stories I hear is the feeling of helplessness that the woman felt, of being completely at the mercy of the doctors and nurses. They were told what they could and could not do, and believing that it was out of concern for their health they listened, only to find out it had much more to do with insurance and the "baby assembly line."

The "baby assembly line" is what I call hospital tailored births, because in a hospital birth it is all about protocol. Rather than consider the individual needs and wishes of a woman in labor, they look at her physical stats and proceed from there. Women are not allowed to eat or drink while in labor, no matter how long they have been in labor, just in case the doctor decides to admit the patient for a c-section. Reread that last clause. "In case the doctor decides to admit the patient." An IV is hooked up to every woman in labor to keep her hydrated. She is allowed to have ice chips, but nothing more. In some hospitals she is allowed to walk around while in labor, but once she is dilated past a certain point she is no longer allowed to leave the labor bed. While the midwife was checking my cervix I had to lay down on the bed in the birth center through one contraction, it was the most painful contraction of my entire labor and I was thankful that it was the only one. Many women have to spend their entire labor laying in bed dealing with that kind of pain... which is why many women ask for epidurals. When I consider all of the conditions that a hospital environment dictates to a pregnant woman, it is not surprising to me that so many women are afraid of giving birth, are unhappy with their experiences, and request so much medical intervention to combat what is already being forced upon them.

I am a woman who trusts her body, who listens to the needs of my body, and refuses to deny those needs to satisfy a doctor, or anyone else for that matter. When my body is healthy and functioning in a natural, healthy way, I refuse to relinquish control of my body to anyone. In this way, I take responsibility for my experiences and my happiness. I am more satisfied than most because of it. Pregnancy is a natural process for the female body and should be treated as such until extenuating circumstances change how well the body is prepared for such a complex process. All of the medical inventions that surround birth and labor came about in order to make child birth safer for those women who have extenuating circumstances, NOT to standardize birth so that every woman must endure the same medicalizations for the sake of time and money.

6 comments:

Stacy said...

I thought I would always have my babies in the hospital... now I may be rethinking that assumption.

Martin said...

My wife had ALWAYS wanted a home birth.
Midwives that are allowed to do anything are illegal in Illinois
and doctors will have nothing to do with home births, even as a backup.
We were lucky enough to find a
woman who had run a birth center in a second world nation, tho she
was not certified in any official way and was practicing illegally.
It was a fabulous experience to see your daughter fly out with eyes open and smiling with no wires or tubes attached and no hovering strangers trying to apply
eyedrops for syphillus, or sticking her heel for a PKU test, or blood typing or demanding a
name for their damn records.
She got great prenatal and postnatal care. The labor was not uneventful, which made us very glad we had someone attending who had experienced about everything that could go wrong with a birth.
To top it off, it cost $500 total.
I could fill a small book with the interesting details of both our kids' home births, and the skill
demonstrated by our midwife, at my
wife's labors, and that of friends.
Unfortunately, she has been scared out of the business by Illinois's aggressive prosecutions of those illegally practicing medicine, on behalf of the legal monopoly holder, the AMA.

Benitta said...

I recently came across your blog and have been reading along. I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.

Lucy

http://toddlergirls.net

Alisa Diane said...

You know I never considered having a midwife and home birth instead of at the hospital, but I watched a documentary called "The Business of Being Born" and I couldn't believe how many women hated the experience so much. I will definitely have a home-birth when I decide to have a baby, I hate the idea of being uncomfortable and pushed/bullied around while giving birth.

Vee said...

Loved the way you explained every detail of your journey to motherhood. I am upto convincing my dear hubby into birth with the help pf a midwife. He reasons out why go in another direction when 90% of the population goes to the doctors. I just cannot seem to be winning this argument...I still have time..just 10weeks into pregnancy. Hope I can get him to see my side of the world...

Naturallysta said...

Great post! I had a similar experience in that I went with an OB to begin with and later transitioned to a midwife. The difference was eye opening!

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