April 20, 2011

A Midwife Story

I never in a million years thought I would be seeing a midwife for one of my pregnancies. I always imagined that I would be one of those cheerful moms who showed up at the hospital, got my epidural, and delivered with grimaced-but-pain-free expression surrounded by a team of (mostly male) doctors--just like in all those episodes of TLC's "A Baby Story" that my friend Sarah and I watched in college. And in fact, that is exactly what happened when I gave birth to Colin--only the experience wasn't so cheerful.

While the outcome of my first labour was good--a big, healthy baby boy--the experience was awful. I showed up at the hospital in the dead of winter in active labour, only to be parked in "receiving" for eight hours because all the labour and delivery rooms were full. There was just "no room at the inn." Then Kevin and I were pretty much left alone for eight hours to deal with my back labour.

Finally, when we were given a room, I was so exhausted from the experience that I begged for some pain relief, which I had been hoping to avoid. Thus began (in labour parlance) the "cascade of interventions" that resulted in morphine, stalled labour, a Pitocin drip to start labour again, an epidural, doctor-assisted breaking of waters, a baby stalled in the birth canal, and two hours of forced--and pointless--pushing. Around Hour 28 of labour, the doctors began threatening a C-section but agreed to try a "last-chance" forceps-assisted birth even as they had the nurses prep for surgery.

Thankfully, Colin emerged screaming, pink and healthy, but after all the stress and confusion and uncertainty and drugs and terror, I was so out-of-it I barely registered his arrival. In fact, I promptly fainted. Within an hour, Colin and I were parked in our (shared) recovery room, with a stranger and her baby, while Kevin was forced to leave for the night. It was not at all the birth I had hoped for.

Trying to grin and bear it after my birth plans went awry. Really, I think the morphine makes me look totally stoned here.

Colin, just after his birth. I think I had passed out at this time.

However, my experience was in many ways identical to all those births my friend and I had watched on TV. In retrospect, it had been the many escalating minor medical "emergencies" that made the show so dramatic and interesting. And statistically that is the standard for hospital birth in North America. When discussing our birth experiences with the members of my New Mom's group some months later, I was surprised to find that of the eight moms in our group, five or six of us had had near-identical experiences. (The only anomaly being that we had all avoided C-sections; which occur in about 30 percent of U.S. births and about 25 percent of Canadian births.) I knew that for my next baby I wanted a different birth experience.

Our road to midwifery was long--so long that I almost didn't get a midwife at all! In the months after I had Colin I read up on birth practices in a way I hadn't before. When I was pregnant, I steadfastly avoided reading too much about the birth experience. "What did it matter?" I thought, "It will be what it will be. You can't control it." But after having Colin I realized how foolish that was. Of course, you can--and should--prepare yourself for childbirth, just as you would prepare for anything that is difficult: a job interview, a test, a marathon. No, you can't "control" the outcome any more than you can control your grade on a test, but you can sure study up so that you have a better chance of succeeding. It seems silly to me now that I actually spent more time preparing myself to get a puppy than I did to have my first child.

So, I began preparing myself for Baby #2--long before he was a twinkle in the proverbial eye. I read Ina May Gaskin's seminal Guide to Childbirth and other books like it. I poured through back issues of the Alberta-based magazine Birth Issues, and I watched the documentary "The Business of Being Born." And everything I learned kept pointing me to midwifery as the best option for our family.

Why? First and foremost, I think it will be my best chance for a "natural" (as in medically unassisted) birth. I'm really eager to avoid all of the minor interventions that I believe made my first labour so difficult and my recovery so long and painful. From everything I've read and learned from talking to other mothers who have given birth both ways (including my own), the natural birth was much the better of the two. In my mom's own words, "I felt like I could have run a marathon after having your brother." After having me, she could barely move for six weeks.

Of course, this is also what I believed before going into labour with Colin, but, in addition to being woefully under-prepared to deal with the pain by myself, I found the hospital environment totally unconducive to natural child birth: the glaring lights; the cold, sterile, semi-public atmosphere; the constantly rotating cast of characters; a doctor who popped in at 8:00 and again at 5:00 to check on me but who couldn't really do much to help me deal with the pain other than offering drugs or a C-section.

To me, the greatest appeal of a midwife was that here was a woman who would be by my side throughout my labour offering suggestions and physical support and coaching Kevin in how to support me. Unlike most doctors, who have rarely sat with a woman throughout her labour or even been present at a totally natural birth, a midwife knows natural childbirth intimately and has a different bag of tricks to help make it run more smoothly: massages, visualization, positioning, waterbirth, etc.

By the time we were pregnant again, I knew I wanted to work with a midwife, I just hadn't let Kevin in on the plan yet. So as I continued to see my obstetrician (who, for the record, is an excellent doctor with a patient ear and a great bedside manner), I worked to win over Kevin to the idea. And I'll be honest, it took some time, but the scientist in him had to admit that their method has outcomes as safe as any hospital, and their C-section and forceps- or vacuum-assisted deliveries are much, much lower.

Finally, after I had Kevin's buy-in, I began calling midwives. I called every midwife in the city--even every midwife within a 25-mile radius--but they were all booked. There are only about 15 midwives in the area (and Alberta as a whole has only one midwife for every 73,000 women in the province, one of the lowest ratios in Canada). And, since Alberta Health began fully covering midwife services in 2009, their practices have been full to bursting. I gave up hope that I would get a midwife for this birth. Then, when I was about five month pregnant, I got a call from one midwife that her group suddenly had an opening after a patient of theirs became high-risk and had to switch care to a specialist. Could I come by tomorrow for my first consultation, she asked?

The next day I actually had an appointment with my obstetrician in the morning, but I booked an appointment with the midwife in the afternoon. I think that the fact that I had those two appointments back-to-back really confirmed my decision. Where my visit with the obstetrician was 15 minutes long and mostly conducted by a resident-in-training who inexpertly handled my lady bits, my visit with the midwife lasted an hour and did not at any point involve a hospital gown. "Why would I need to check your cervix now," she asked. "You're not going into labour for four more months, are you?" Where the obstetrician talked mostly about what prescriptions he could offer me for my morning sickness, the midwife talked mostly about my previous birth experience and how we might troubleshoot some of the problems I had encountered the first time around without medical intervention--all of the things that were most weighing on my mind. It seemed a perfect fit.

But before I could in good conscience switch care, I told my obstetrician about my plan and asked for his expert opinion. Much to my surprise, he told me that I would be a great candidate for midwifery: my first pregnancy and delivery had been relatively uncomplicated, and "second pregnancies are always much easier," he said. In fact, historically in England, where he was born, most mothers had their first babies in a hospital in case of emergency, he added. And, then, if all went well, they had all their subsequent babies with a midwife.

And with that, the decision was made. I even had my obstetrician's blessing. And so we embarked on this new road to midwifery.

(Tomorrow: Part 2. It's much shorter, promise.)

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