Sunday, November 30, 2014

Prior Proper Planning

Prevents Piss Poor Performance. Classy, right? I'm not sure where this saying came from but our family (my sisters and I) use it a lot. We've used it so much in fact that we can just say the first three p's and know what is insinuated with the following without having to say them (which is most oft the case as there are always little people running around nowadays and I don't want to hear my two year old say "piss"). Anyhow - it's kind of a joke really but those who are close to me have more than likely heard me say this a few times and hey, despite it's classiness it rings true! 

Like in any other situation (vacation, starting school, birthday parties, etc) home birth requires prior preparation. Preparations for home birth (with our selected midwife) included things like:
~ reading, understanding and signing the agreement given to us by our midwife
~ regular prenatal appointments 
~ ordering a home birth kit
~ taking a home birth class
~ purchasing necessary/recommended supplies to have on hand when it was "go" time

Prior to our first meeting, my midwife and I communicated a little bit over email and in her very first email she sent me some information rich paperwork that covered some of the following: 
-who she was (her training and her philosophy)
One of my favorite things she had written in that document:  "Birth is unpredictable - I do trust the Lord for His protection and guidance - but it needs to be clear that I have no guarantees of a good outcome for any birth. I am not God or a fortune-teller or infallible - just a human being who believes that God made birth to work without intervention (most of the time) and that, if left to itself, the process will unfold normally, in good time and with the best outcome for mother and baby."
-services offered (detailed breakdown of prenatal, birthing, and postpartum care)
-fee scale/financial schedule

The prenatal schedule I followed was a bit different than those I followed with my previous midwives. I saw her every 4 weeks until I was 36 weeks and then I was moved to every two week appointments. In my particular situation, my midwife saw her patients in her home. She reserved a set day each week to see all of her prenatal appointments. I believe in her agreement she said she would be willing to make herself available for in-home visits if a patient so desired but there was an associated fee and I'm sure her availability for such largely depended on her schedule week to week with women who were due, etc. In my particular situation, prenatal visits included having my blood pressure and pulse taken, getting weighed, leaving a sample for routine urinalysis, being measured, palpated and having size and position of baby estimated, and fetal heart tones heard. I would say the most valuable component to my prenatal appointments was the emotional/physical counseling that they provided. Specifically I just felt like they were eager to be in tune with what I was thinking/feeling, etc. They wanted to know how I was sleeping, how I was eating, if I was active and if so in what way. If I was having an issue in any of the aforementioned areas they were eager to talk through it and address it which truthfully hasn't always been the case with prior providers I've worked with. 

The home birth kit I ordered was through a company which my midwife worked with. I ordered the kit online through the company's website. It included all kinds of necessary items such as (but not limited to): 
-sterile gloves
-alcohol swabs
-umbilical cord clamp
-sanitary napkins
-chuck it pads
You get the picture. I laughed when I got the kit because Tim and I had been watching the PBS series on DVD called "Call the Midwife". As part of their prenatal appointments the midwives deliver a "birth kit" to each mother who is approaching her due date. So: my birth kit came via the UPS man :). 
In addition to ordering our birth kit we had certain things to have ready prior to delivery - clean towels, extra sheets, layette items for baby, flash light, salt for bath water, drop cloth/plastic to protect carpets, bed linens, etc. 
I'm sure it will come as no surprise to those of you who know me that I had all the aforementioned items ready and waiting like 10 weeks prior to my due date

The home birth class I took was with other expectant couples who were planning to birth at home with my same chosen midwives. The class was a long class - I believe 5 hours in all. I couldn't begin to even give you the Cliff Notes version of all we discussed, but just know that we covered EVERYTHING and then some of the what typically happens, what could happen, how we would deal with what could happen, etc. etc. etc. 
I honestly felt kind of sad at how prepared I felt going into this experience the 4th time. I wish so badly that I could have known even a fraction of what I knew prior to this birth before my others. I mean, realistically if each Mom were educated prior to the birth of their first child with the most common complications and how they are handled in a hospital or non-hospital setting it would drastically reduce stress for all involved if one of those things happened heaven forbid because you'd know why/what they were doing next. Does that make sense? For example: "if you experience a cord prolapse, this is what will happen next or if you begin bleeding more than xyz after you deliver these are the action steps that will follow". I just felt super confident going in knowing all of those things. I mean, I know that anything can happen and you can never be 100% prepared for anything but hey...80% prepared is better than 24% amen? Amen! The class reassured me in my choice because I felt like I further trusted the midwives and their ability to handle anything that would/could come and I knew that if they felt unsure or hesitant about mine/babies safety in ANY WAY they would not hesitate to transport me to the nearest hospital possible. 

The last preparatory details before baby came included:
~having someone "on call" in the event my kids woke up during the birthing process. 
~making sure the house stayed relatively clean as we "patiently" awaited the arrival of our new baby
~making sure the bathroom was ridiculously clean (I may have been cleaning it every 2 days) *This was not specified as a "pre-requisite" but I have a special neuroses about bathrooms and potentially giving birth in one took it up approximately 5,492 notches. 
~keeping up with laundry since I would be out of pocket after baby arrived
~having some meal prep done ahead of time for kids and Tim and I so when baby arrived we'd not be stressed about that in particular. 

That pretty much wraps up what we did to prepare and our prenatal care experience! Next up (& sure to be the most fun): my home birth story! 

Sunday, November 16, 2014

A long awaited post

Long awaited indeed...not only for me to draft and publish but for some of you to read. I've got so much to much swimming around in my head. This will be the first of multiple posts about our home birth story: why/how we chose, what we did to prepare/prenatal care & I'll end with my home birth story. 

 It's no secret...I'm a sharer. My sister says I'm an open book. I think that "open book status" caused people to feel at liberty to share with me their questions, doubts, concerns, etc. about Tim and I choosing to have baby #4 at home. Home birth. Even typing it...even saying carries a stigma. Mostly negative in my experience (as far as people's reactions go) but negative or positive, people have quite a bit to say and ask about it. 

I can't say for certain why some people choose to have their babies at home, but I can say why we chose to have our baby at home and I can also potentially shine a light on some of your burning questions about home birth in general. 

Let's get to it! Shall we? 

I guess I should start where it all started for me...6 years ago in Kentucky when I heard about a gal named Katherine who had her baby at home. At the time I had mixed emotions about it truthfully - I was in total awe and wonder about it but also kind of like "whoa, that's alternative".  I mean, let's be honest - the general birth story occurs in a hospital and we rarely hear of much else. Katherine was a friend of my then nanny to Kennedy who is now one of my closest & dearest friends. Throughout the years of my friendship with Chelsea, she has shared with me that Katherine has gone on to have 3 more babies at home...all successful and all without complication. It was also through Katherine that my curiosity into midwifery was peaked. I delivered under an OB with Kennedy and at the time I felt it all went fine but in hindsight now having delivered my other three under the supervision of a midwife...for me and my story (not for all OB's and everyone's story) midwifery has been a drastically better fit for me and my "birthing style" (if you will). 

Between Kennedy and Avery we joyously realized we were expecting and I switched OB practices to a larger practice in the hopes that whomever I saw for the majority of my prenatal visits would in fact be who delivered me. Well, I never got that far because a short ways into that pregnancy we realized we were miscarrying and the office handled it in such a sterile and medical fashion that I would never enter that practice again and instead decided that if I became pregnant again...I would see a midwife. All the "it's probably for the best, it was probably a chromosomal defect, at least you miscarried early, etc." were just too much for me...I needed a hug, I needed some bedside manner that wasn't all medicine and science...I needed empathy and and reassurance. I had read and heard that one of the benefits to using a midwife was that they (for lack of a better way to phrase it) would most definitely have a more favorable bedside manner than what I had experienced. 

Luckily the Lord didn't make us wait long to conceive again and I began seeing my first midwife. Her name was Melissa Courtney and she forever changed how I would view complete prenatal care and birth. My journey with her was a bit of a long one as she left where she was practicing in the middle of my pregnancy but I was determined to stick with her and so I followed her on her solo pursuit which is now a thriving midwifery practice in Lexington, KY. My experience with her versus the OB I had with Kennedy was different in so many ways, but to highlight what made me never want to use anything other than a midwife for future pregnancies, I'll list a few: 
~She seemed to REALLY care about mind, my body, my emotions...not just my medical state of well being and the babies'. 
~She helped me to understand more completely what was actually occurring inside of my body and also partnered with me to address each and every area where I needed resolve or relief. 
~There was never any doubt that she would be at the hospital to labor with me when it was time to have our baby...I KNEW she would be there and the comfort that provided me was indescribable. 
~Through patient tones and pointed explanations she helped me accomplish a birth with minimal medical intervention. I delivered Avery without an epidural...despite getting induced with pitocin which I now know is an extremely difficult thing, but I credit her assistance to being able to accomplish that delivery in the way that I did. 
~Because of knowing how to take better care of my body and because of not getting an recovery was drastically better (emotionally and physically) in the weeks following Avery's birth than it was with Kennedy. 

Fast forward to my pregnancy with Grey. Early on in my pregnancy with Grey I watched a documentary called Pregnant in America. I learned a great deal in watching that documentary but watching people actively choose home birth just intrigued me. I thought it was SO cool. I mean it just seemed amazing to me, but also a little un-touchable for some reason. Tim and I entertained the idea but it would not become a reality because we learned that we would be moving to NC (near my sister and closer to my Mom) towards the end of the pregnancy and since my sister was already under the care of a midwife she loved, I elected to join that same practice as I would deliver 3 short months later. Even if I'd realized home birth would be an attainable reality for us then, we didn't even have a home...we were living with my sister! I received wonderful care at that midwifery practice, but sadly as with my first delivery years before, I was greeted at the hospital the night of my delivery by a midwife I'd never met prior and because of that it just felt less intimate...less special. Does that make sense? I realize it may totally just be my need/my style, but nonetheless I was disappointed. I had a fast labor - super fast. You can read more about it here, but I felt like she caught the baby and we were wheeled out and that was that...only to then stay in the hospital for the next two days. It was another non-medically assisted birth and it literally almost seemed comical how fast it went and how much it felt like wow, all this packing, rearranging our other kids schedules and planning and accepting visitors in a tiny cramped room and it just seemed like it could have been easier. It felt like it COULD be easier. She was an incredibly kind midwife and she was perfectly competent and performed her job well, but I didn't know her and she didn't know 

When we found out we were pregnant this time it was a TOTAL surprise which you can read more about in this post. Tim and I began discussing the potential of a home birth early on. He was no stranger to this desire and thus considerations began. Little did we know the journey we were embarking on would be one that was hard to walk and filled with questions and uncertainty. Said journey began with the same practice who delivered Grey...they confirmed pregnancy with the typical dipstick test but also performed a gestational scan to determine exactly how far along I was (remember me saying it was a Total surpirse? That was not an understatement). After that initial scan I began my home birth pursuit which led me to a birthing center in SC right across the NC/SC state line - about 45 minutes away. I was referred to that particular midwife and practice by a gal at my church whom I've come to adore and she had delivered her firstborn at her home with this midwife. She raved about her experience and encouraged me in my desire and pursuit of doing the same. I saw this midwife up until about my 20th week of pregnancy and I loved her and the practice but we came to realize a few things pretty quick out of the gate: 
~Our insurance would not be covering our care with said practice because they were licensed midwives not practicing under the supervision of an OB and our particular plan would not cover the practice because of that. 
~The only way I'd be able to perform a home birth under the supervision of the licensed midwives at the birthing center was if I delivered in SC. Luckily because my Mom had just purchased a home in SC that was an option to which my Mom and Jim quickly agreed to. 

This is going to be a Cliff Notes version of what would happen next but to save you all the drama it's just the best me. After LOTS of going back and forth with Tim's HR department and Aetna their final decision was one they guaranteed me would be firm - I would not be covered to continue care with the birthing center and or if I chose to have a home birth. I honestly was shocked. I understand liabilities and yadda yadda yadda but I've had three extremely successful birthing experiences and I KNEW I could do this at home. I think also shocking to me is that they would a) try to force my hand based on coverage/money but also b) my desire to deliver at home would in the end save them TONS of money. Regardless, knowing all of the above and having tons of discussions with the manager at the birthing center we ended up being referred to a NC home birth midwife who we would pay without the assistance of insurance or flexible spending account money but we would get exactly what we wanted...a birth in OUR home...not another facility or someone else's home.

 There was just one thing of which I was to be informed prior to making this decision: NC does not license Certified Professional Midwives (this is the credential that both the birth center midwives and the home birth midwife we hired have). All of NC's neighboring states license Certified Professional Midwives but NC does not. NC does license Certified Nurse Midwives but they must also be supervised by an OB. Certified Nurse Midwives can perform home births but most don't due to stringent regulations and costly malpractice insurance. I should add, also that CNM's are not trained in home birthing practice so they don't have that "skill set" so to speak. The main problem I perceived with Nurse Midwives under the supervision of an OB is that they  can be credentialed and licensed but yet.they cannot (despite training, experience, education, etc.) practice on their own...make their own decisions, etc. So: what I learned is that there are midwives who are knowledgeable and experienced and just as capable as the ones I've seen in all my other pregnancies but because they cannot be licensed and do what they want to do...provide women with the birthing experience of their desire in a home setting: they elect to not be licensed and operate in a kind of "under the radar" fashion. I was shocked...I gotta be honest. There was an element of "so am I choosing something illegal" going on in my heart and head but also an element of "are you kidding me...who can tell me what I can and cannot do? This is absurd!" 

In the end, after much prayer and consideration....after lots of inner turmoil and contemplation...we chose to meet with a NC home birth midwife and pursue delivering this precious babe at home...exactly how I desired and dreamed. I wasn't sure how we would figure out the finances and I wasn't sure about all the other questions and concerns I had about delivering at home but after meeting the midwife and her apprentice: I KNEW...I just KNEW they were the ones...they were the ones I wanted walking through this pregnancy with me and assisting me in bringing my baby into the world when it was time. I had done some research before our meeting and I was prepared with a list of interview-like questions I wanted answered. There are endless amounts of articles, blogs, & general advice online that can assist you if you are walking the same road - I wasn't sure of all I needed to ask but the internet was super helpful in that quest. They were honest about their experiences and  inability to predict or control scary circumstances but they were also adamant that they felt their chosen career path was one to which they felt called and that the Lord never failed to direct their steps and their hearts/minds in each and every delivery.

I find birth itself to be a spiritual experience. I mean, I'm sure you've heard people say before that once you've experienced birth you know without certainty that there is a God. For me, as a believer, I've drawn strength from the Lord in childbirth. Strength that I've felt and seen and witnessed in that particular physical's tangible, whereas the strength I draw from Him in my day to day is more spiritual...more mental and emotional. I remember when I was a teenager, I would go to youth camps and or retreats and after returning my peers and I would discuss having "mountaintop experiences" where we just felt SO close to God...just connected and in communion with Him in a way we didn't normally feel. If ever I've had a mountaintop experience, I assure you it pales in comparison to the closeness I feel to the Lord during childbirth. When giving birth the pain is only manageable because in my mind I know the Lord not only created our bodies to be capable of bringing life into this world, he also told us it would be painful. He knew...He knows what we are going to feel and in my heart and mind in those moments of intense pain and physical struggle...during hard labor I rest in that truth. He made me for this. He hears me...He comforts me...He reassures me in my mind and in my heart and I just know that with him, I.AM.ABLE

My desire for that spiritual closeness with my Heavenly Father, coupled with a midwife and apprentice who felt spirit led in their every move brought me to a place where I was committed to home birth and pretty much after meeting the midwives who would in the end deliver my sweet babe, we never looked back or questioned ourselves again. 

We did elect to participate in something called "parallel care" which is basically where you see two medical providers. I saw my home birth midwife and also saw my midwife inside of an OB office in Charlotte. My reason for staying in a medical practice was multi-fold. It was (if I'm totally honest) for the following reasons: 
-I wanted to have a 20 week anatomy scan with all the bells and whistles (if you will)
-to calm the worries of my family members who hadn't the benefit of doing lots of home birth research like Tim and I
-to have an ongoing patient relationship with a medical professional who could see me in a hospital setting if such was necessary at any point of the pregnancy

In hindsight, I don't regret choosing to participate in parallel care. It reaffirmed my decision to birth at home if at all possible and I felt like in the event that something did in fact go wrong during the pregnancy, I was prepared to the best of my ability to handle it and keep baby and I safe. 

So...that is my long winded answer to how and why we came to choose home birth for the birth of our fourth child. Now, most of the people who will read this are friends and or family. There may, however, be someone reading this who did a Google search about NC Home birth and ended up on my blog and to any of the above I would say this: ask away...any questions you have - SHOOT! I'll answer as honestly and accurately as possible. I've found since having Micah that people have LOTS of questions about the whole home birth thing and I'm happy to share my experience with anyone because in the end (which I'll blog more about soon) it was an INCREDIBLE experience!