Ambivalence about the Birth *UPDATE*

I spent a good half hour tonight filling out hospital pre-registration forms for the upcoming birth. I have to drop them off at the inpatient services desk on my way to the midwives' office tomorrow.

I kept telling myself I have good reasons not to plan a homebirth. It would be more money, I wouldn't have the time to develop the kind of relationship I want to have with a midwife, I'm not the cleanest person so the chances of me giving birth in a pigsty is very high. My mom keeps trying to talk me out of it, and her opinion matters very much because she's one of my major support people. She's in charge of Naomi. And when my mom doesn't like something, her negativity is fearsome. I don't want that at my birth.

Logically I know that the chances of having the care I want at the hospital birth center (HBC from now on) are good. A few things worry me: it is only staffed 85-95% of the time. I have told every midwife I've seen so far that I am going to be keeping track of when the birth center is staffed around my due date. I'm sure it's in big bold red letters on my chart that I am going to be a Pain In The Ass. To their credit, most of the midwives I've had appointments with see this kind of behavior as a good thing. They know how proactive and persistent a woman has to be to get the kind of birth she wants. I am hoping that the fact that I am incredibly threatened by the possibility of a hospital birth for no good reason will keep me from going into labor on those dates. A girl can dream, right?

Another thing about the HBC that bothers me is that I will probably have to go through triage at the main hospital L&D unit. It's a teaching hospital, there is NO privacy, and I just know some hyperactive resident is going to come in and diagnose me with some ridiculous iatrogenic problem, delaying, or maybe even completely derailing, my move across the street to the HBC. The fact that I will be seen by the midwife on duty is only slightly soothing.

The final thing that bothers me is the possibility of a hospital stay after the baby is born, for no reason besides "that's the way it's done". I know how I feel after giving birth. All I want is a good meal and my own bed.

The only thing I found useful about the hospital after Naomi was born was the lactation services. I hated the food and the bed and I couldn't sleep without her beside me. The bed was so narrow that both of us barely fit. And there was always the danger of some nurse coming in and yelling at me for falling asleep with the baby outside her bassinet. The air was so dry, I had to keep chugging from those awful plastic pitchers in order to keep from getting dehydrated. The nurses were (understandably) too busy to keep refilling my pitcher so by the end of the first day I found the refilling station and did it myself every few hours. They all looked at me like, what the hell is that crazy woman doing out of bed??!

The HBC has an early discharge option, which I qualify for as long as everything is "normal". I can stay for 8 hours in the HBC and leave directly from there, as long as the pediatrician comes in time. I'm worried that they might have a more narrow defintion of "normal" than I do.

I have visited the HBC and asked all my questions; they gave all the right answers. I have also been impressed by the midwives and their support. I get the feeling that the people who work there believe in the value of natural birth just as much as I do, but they are constrained by being a part of the hospital system. I know there have been power struggles in the past between the HBC and the hospital administration. I know they struggle for more autonomy. In essence, that's what worries me: the gravitational pull of the hospital is just too strong, and I will be sucked in again.

In my perfect world, I could straddle both options: I could see the hospital midwives and plan to give birth at the HBC, but if I should go into labor and change my mind, someone could attend me at home. When I'm a midwife someday, I want to offer women the ability to choose between home and the hospital up to the day they give birth.

I don't know how I'm going to feel the day I go into labor. Whether or not I feel comfortable at the HBC depends on the day of the week, the time of day, how fast I seem to be dilating, whether or not Naomi is sleeping, how I'm coping with pain, and so many other things. It pisses me off that I had to make this decision so early when there are so many unknowns.

I filled out all the hospital forms and signed all the consents today against my instinctive feeling that I will give birth at home. It's too late to hire a homebirth midwife. For better or worse, I have thrown my lot with the HBC. I figure I at least owe it a chance. I'd like to work in a place like that someday, and be instrumental in bringing true choice and empowerment to the way women birth their babies.

If I could afford it, I would do what a friend of mine did. She had a high-risk pregnancy (because of her "advanced maternal age") and saw an OB, and had a homebirth midwife as well. The midwife attended her at home until it was time to go to the hospital, and the plan was for her to act as the doula once they got there (they didn't make it: she gave birth at the bottom of the stairs on her way out the door).

I struck me today that I should plan for the possibility of giving birth at home unassisted. It's not something I would do lightly, by the way. I consider it kind of like swimming in the ocean without a lifeguard on duty: you'll probably be fine, but a glitch can be catastrophic. Shoulder dystocia? Yikes.

It's possible that my labor will go very quickly. It's possible that I will wait too long because I don't want to get there too early and stall. I will feel better if I at least have some supplies and knowledge, like I have all of my bases covered.

*UPDATE*

My appointment went really well. I saw the director of the program, and I asked all the tough questions (again). She assured me that they can be quite creative when it comes to my care at the HBC. A lot of things that are stated as policy actually are more flexible. I talked to her for a long time, she told me about her start in midwifery and how inspired she is by the birthing process, how she likes to make as many choices as possible available to birthing women. We talked about my previous births and she told me how she would have handled it, and again, she said all the right things. We even talked about my future plans to become a midwife. She was visibly excited. I could have talked to her all day.

I am more relaxed about the whole thing. If this is the woman doing the hiring and firing, dictating the policies and dealing with the hospital administration, then I'm in good hands.

Comments

[Lisa V]

My birthday and Daughter #1's birthday is December 11. December babies are the best.

Daughter #1's birthmom had another beautiful girl yesterday. Between that and Jo's birth story and your plans I am nostalgic for those days. I can't believe I will never give birth again. I don't want anymore kids, but I loved that part of my life.

Hope all goes smoothly.

[Andi]

Sounds good! And FYI -- I didn't know this until my then-med-student husband told me, but you can *always* request that there be no medical students involved in your treatment. You can request that residents not be present at the delivery, but it's usually residents who are doing the rounding, checking in, etc. So don't be afraid to request that if that's what you want!

[Lilian]

I truly hope all goes well. How were your previous births? (did you blog about them?). I'm about to write a post reminiscing about my boys' births (Jo got me really inspired :)

[Beanie Baby]

Good luck!

It is hard to be making decisions so far in advance, when you really have no idea of what will happen or what you'll want. But it sounds like you've got all your bases covered.

[Casey]

I guess it's because we're due about the same time that I totally know what you're going through right now. We're planning a homebirth, but I'm having a hard time coming to terms with it. I don't want to go to the hospital, but it makes me nervous that I don't really have a physician (or CNM) back-up. We're also preparing for the possibility of UC, not because I want to go unassisted, but because I worry that my midwife will flake out and miss the birth. I'm hoping this is all just normal third trimester jitters.

[Deirdre]

I can understand your ambivalence. I kept toying with the idea of a homebirth (especially after reading Ina May Gaskin's Guide to Childbirth), but in the end the tipping point to a hospital birth was cost: I can't justify $3000+ when insurance covers the hospital completely (except for "phone fees" and any difference if I'm lucky enough to get a private room). Luckily, my midwife told me that I can labor for a long time at home rather than hurry to the hospital even if my water breaks (like the first time).

Of course, I don't want to be too ambivalent or wait too long - a friend of mine had a really hard time deciding between a home birth and a birth center (hospital) birth. ...She ended up having an UC in the car on the way to the hospital.

[Moxie]

All I have to say (having had a planned homebirth that was partially attended only by my mother because things turned on a dime for me) is that if you truly want to go to the hospital, go when you start weeping. The weeping means you're in transition, even if you don't feel anything different physically. I don't know how your first two births went, so I don't know how able you were to experience just your own feelings, but I missed that the weeping was trnasition, adn if I'd wanted to go to the hospital I would have left our apartment too late to have the baby anywhere but in a cab.

[Adria]

Reading your entry, the first thought that came to mind was "unassisted home birth". It sounds as though that's not what you want, though, and the HBC will be a good choice. I have no complaints about my homebirths. I'm a huge advocate. I don't know that I would plan to go unassisted though, so it sounds like you're doing what's right for you. The HBC sounds wonderful.