Week 9

So all the details are settled and my first appointment will be set soon. We are still debating between and Ob or a midwife. Our preference is a midwife, and a birthing center, but insurance companies don't seem to like that. Seeing the mw of our choice and visiting her at a birth center for all my prenatal care and delivery of our baby would ensure that I get lots of attention (something a newly pregnant woman needs for all of her questions and 'what ifs'!) at each visit (we take as long as we want at each visit, but mw's often set aside an hour). It would also mean that I get plenty of nutritional advice and guidance, so that issues like high blood pressure and high blood sugar (both common and dangerous during pregnancy) are avoided. Responses to phone calls and emails would come readily (midwives keep their clientele list short so they can pay very individual attention to each patient). While laboring, I would be encouraged to move around, stroll the nearby part or trail, eat if I'm hungry and drink plenty of fluids. I could have as many friends and family around as I liked/needed, and I could use non-medicinal pain management (ie. soaking in a tub, changing positions often, using a birth ball or birthing stool). After the baby is delivered, we'll be encouraged to lay with him and get to know him, breastfeed if he's hungry, and rest.

Most prenatal care through an Ob and hospital are quite different, unfortunately. Doctors often have a large client load and may only be able to spend a few minutes with you at each prenatal visit. It is very difficult to get in touch with them, or even a compassionate nurse for that matter, in between visits. Prenatal screenings are often routine. These screenings often have no treatment value - they simply tell the doctor if something "may" be wrong and warrant diagnostics. So, diagnostic tests are often commonly performed (testing for genetic abnormalities or birth defects). Again, these are have no treatment value, but usually serve just to inform the parents (and doctor), when something is wrong. Doctors may say this can help parents to prepare for the worst, or offer them the option to terminate the pregnancy if they so desire. Moms who do not want to screen or test for any of these conditions that cannot be treated prenatally may not have the choice (or are told it's "necessary") to opt out of them. Pregnancy is a serious medical condition that often results in death and critical injury! This is far from the common truth, but may be the underlying attitude. Most women seeing Ob's for prenatal care are not given adequate nutritional counseling. Medical doctors are trained exceptionally well to treat current conditions. Unfortunately, they often neglect the value of prevention be the condition ever presents. Once labor begins and women check themselves into a hospital, they officially become a patient and subject to the hospital's rules and regulations (even if they have a doctor whose philosophy of practice is more "relaxed"). In many cases (though not all), under the care of nurses, the new patient will be advised to get in bed and stay there. She will have an IV placed in her arm ("just in case she needs it"), restricted from food and beverages (except ice chips) and told to lie on her back. This will be her position for the next 6-12 hours. The increased stress due to needle injection and vaginal exams every hour, no food or hydration, and lack of circulation because she's lying on her back, will likely cause her labor to slow down. This frustrates nurses and they often encourage women to accept a Pitocin drip to "get labor going" again. Pitocin is an artificial labor inducer. The contractions it causes are stronger and longer than natural labor contractions. Because of the unnatural pain caused by the Pit contractions, mom is in agony. Nurses tell her she needs an epidural! So, she allows another doctor to insert a needle into her spinal cavity and tape a tube there with a constant flow of anesthesia which may or may not fully numb her pelvis and legs. As the nurses monitor the baby's heart rate with an external monitor, they begin to notice "decels" (the babies heart rate drops during contractions), which are to be expected, given the medication and it's effects. They are alarmed, so they tell the mom they need to apply an EFM (electronic fetal monitor). This monitor, attached to a wire, is placed on the babies scalp through the cervix and kept in place with a small staple or screw (to the babies scalp). If the mothers amniotic sac has not ruptured yet, the doctor will do this for her. Studies show that artificial rupturing of the amniotic sac (called an amniotomy) is often directly related to umbilical cord prolapse. When this happens, the umbilical cord gets trapped in between the babies head and the opening to the uterus, causing restricted blood flow. EFM commonly leads to episiotomies and cesarean surgery because of the complications from pitocin, amniotomy, lack of food for hours on end during labor, and lying on one's back. When the doctor finally comes in to deliver the baby, he assures the mothers that the drastic measures taken were necessary to save her bay's life. After getting a quick peek at her new baby, nurses will often take the baby away for measuring, cleaning, testing, and warming. Mom may not see her baby for an hour or more after birth. All of those procedures could have been done with baby on mom's chest - one of the most effective newborn incubators around!

So, this is my dilemma. Every thing I described was best case scenario (at the birth center) and worst case scenario (at the hospital) and I know that things will not go exactly as planned either way. My only hope is that whatever doctor/hospital or midwife/birthing center we choose, we can avoid all unnecessary medical interventions and have as peaceful, reassuring, pure birth experience as possible.

-Mandi