Eric and I attended an orientation at the hospital yesterday — the hospital being Virginia Hospital Center. This is where I’ve been going to see my doc since about week 14, when I decided to switch from the local baby factory, Fairfax Inova (the hospital that delivers 11,000 babies a year compared to Virginia Hospital Center’s 3000). My doctor told me early on that Fairfax Inova is a great place to go if you have a high risk pregnancy — they’ve got all the gear to take care of your little one — but that at Virginia Hospital Center, you’ll get more personalized care.
This seems to be the case. As for a more natural birth experience? The word on the street is that you’ll get a better chance at a natural birth at VHC, but the c-section rates are actually pretty comparable — 37% of women end up with c-sections at Fairfax Inova, as apposed to 34% at VHC. It’s probably most dependent on the doctor or midwife you select, and we feel we selected one of the best of the bunch. We’ll see what happens of course … but on to the tour …
The tour started at the Women and Infant Health Center. We saw a bunch of other pregnant ladies waiting around when we came in, and eventually an RN from the education center came around to show us the place. The Women and Infant Health Center was clean, decorated nicely, and had a good feel to it. The nurse led us up to the labor and delivery area, and then showed us the mom and baby rooms where you stay after you deliver.
Overall assessment? It’s nothing to write home about in the long run, but it’s a clean, nice hospital with a guaranteed private room and heck — good doctors. Other pros include a complimentary gourmet breakfast (nice), snacks provided, and a flexibility on when you can leave (24 or 48 hours after a natural birth). The nurse also let her tour group know that VHC supports birth plans (though they might not always go as planned, she pointedly pointed out), and she also mentioned that immediate placement of the baby on the mother is just quite fine. (It was interesting to me that she referred to epidurals, APGAR tests, shots and vaccines, and the immediate bath as the “traditional” method of birth, whereas placing the baby on the mother’s chest and laboring unmedicated is “non-traditional.” Traditional since when? Traditional since … 1920? What about before that? Anyway …)
Cons include that it’s a sterilized, non-homey environment. You have nurses making you get on the monitor and stay still every forty minutes (sounds just like what a laboring woman needs), and they’re more than a bit suspicious of you wearing your own clothes, or bringing in your own food and drink. There’s always someone checking on you, and when it comes time to deliver, they hoist you into the bed, put your feet into stirrup like things and have a doctor or resident catch your little baby. Admittedly, it’s not ideal, but it’s pretty much what all hospitals are like.
And honestly? If you tell me not to do something, I’m going to do it. It’s the reason why I doodle during meetings, speak up when I’m not supposed to, leave products in random places in the grocery store, and it’s part of the reason why I’m planning a natural birth and why I’m intending to cloth diaper (everyone keeps telling me I’m crazy, so the more assured I become). So believe me — I’m rolling with bringing my own clothes to wear and totally eating and drinking when the nurses can’t see me. I can’t do those things because I’m in a pre-operative state? Oh yeah? I’ve been in a pre-operative state right now and have been all my life. A meteor could fall on me right now, and someone would have to operate on me, clothes on and with partially digested carrots and hummus inside! BS on your rules.
At least I can’t get risked out and sent to a doctor I’ve never seen. I’m glad of that. But next time? If all goes well, we’re gearing up the hose for the giant inflatable pool, and getting an awesome home birth midwife. Color me disenchanted with the away-from-home birth options — we’re going in for the big crazy next time, no matter what people tell us.
After six months on the waiting list, I finally got a call from the only freestanding birth center in Northern Virginia. (For those of you who aren’t yet birth geeks like I am, a freestanding birth center is a building not connected to a hospital, where you can give birth, attended by only nurse midwives. There are birth centers connected to hospitals as well … but anyway, this is not that.) They told me that I would soon move off the waiting list. The lady on the phone hesitated when I asked if I could come to the next orientation, acting as if I might not want to do that since I could remain on the waiting list. I said I’d come anyway, and so the husband and I went this past Tuesday evening.
It turns out I’m glad we did. Because it turns out it wasn’t all that we expected.
When you first walk into the freestanding birth center in Northern Virginia (I won’t name names, but it’s easy peasy to find on the online), you realize it’s like a lot of other businesses in the Old Town Alexandria area: it’s a converted older townhouse or office building that was probably first built sometime way back in the day. The air conditioning was not fully suitable for the hot, hot day, and my belly started to tighten in Braxton-Hicks contractions some time after we sat down. The furniture was older and dingy, and it didn’t quite seem clean in the downstairs area — not that it wasn’t, it’s just that older buildings give you that sense sometimes.
Everyone who came in was given a folder with brochures about the center, and a long list of medical reasons that can “risk you out” of giving birth at the center. First red flag. These factors include, but are not limited to: breech presentation, carrying multiples, anemia, previous stillbirth or missed miscarriage, previous c-section, being older than 40, post date pregnancy (after 42 weeks), decreased fetal movement, or “any other significant condition which exposes the client or the baby to increased risk,” which really, could be … anything. Most likely a prolonged labor. Risking out? What does that mean? That means at week 36 or whatever, or during your labor, they send you on to a major hospital down the street to be handled by a doctor you’ve never met. How often does this happen? 10% of the time during labor (!!!), and the midwife was majorly vague about telling us how often it happens BEFORE you go into labor. Probably a lot given the list of things that could risk you out, or automatically risk you out.
When the orientation started, there were 20-25 people, mostly well-dressed Nova couples, one hippie couple in homemade clothes, and a couple of single ladies. The range of pregnancy was from just found out, to totally about to bust (me). The midwife who led the orientation gave a brief overview of the center, conveniently skipping over review of the risking out business. But a lot of us had already noticed. The presenter went through a lot of the advantages of birthing at the center, heavily relying on all the things that are great about natural birth to carry her point. (It’s empowering, you can breastfeed immediately, you get an endorphin high, it’s awesome, la la la.) The actual advantages of giving birth at the center seemed to be that you get a midwife and a birth assistant rather than a doctor and nurse. And your appointments last 20-30 minutes instead of 5-10.
Cool enough. I like to chat about my pregnancy. But did it sell me? Not quite. What’s wrong with that equation? Well, you see one of each of six midwives when you go, and you give birth with whomever is on call when you get there. Doesn’t matter if you don’t like her, or she doesn’t remember your name, or you wanted someone else. Sounds an awful lot like my first doctor’s office, where you see one of six docs or a midwife, and you give birth with whomever is on call.
Then there were questions. And continued dissatisfaction. (Note: responses were edited in my own brain’s sarcastic tone of voice.)
- Are most women risked out because of prolonged labor? Yes.
- That’s one in ten women? Yes.
- What are the stats on women who get risked out before labor? I don’t really know. Next question.
- What are the statistics for maternal and infant mortality? About the same as the hospital, but not quite. I won’t really tell you.
- I see you only have two beds. What if three women show up at the same time? Well that doesn’t really happen that often.
- But what if it does? Well there’s a futon in the office. You can hang out on the futon. But it doesn’t happen very often.
- What if two women want to use the jacuzzi? One of them just has to wait. But it’s very rare that two women would be here at the same time. (My mathy husband figured out that the chances are 1 in 6 that two women would go into labor on the same day.)
- Why can’t you give birth in the tub? Is it illegal in Virginia? Um, I don’t think it’s illegal in Virginia. But it’s not safe since the baby could drown.
- It’s legal in Tennessee. Don’t they do it at the birth center in DC? Um, I don’t know. Next question.
- Are the birth assistants all doulas? No, but they have doula-like experience. (WTF does that mean?)
- MY question: So do I have to use one of your birth assistants? Or can I use my own doula? We’ve already paid her. I’m sorry, no, you have to use one of ours. The birth assistants here are trained to clean up. And your doula wouldn’t know how.
- MY follow up comment: But no one told me that when I first got on the waiting list. I paid my doula at 20 weeks. Sorry, no exceptions.
- MY follow up comment, as I walked out of the door: We’ll be going with Virginia Hospital Center. I have some feedback for you. In the future, please tell clients to come to orientation when they get on the waiting list, or tell them not to hire a doula before they come here. Hmm that’s interesting.
We did take a tour. And the jacuzzi is super nice. I mean, really primo. But the bedrooms look like “the motel of your dreams” (quote: Eric), and they don’t really look big enough for a laboring woman, midwife, birth assistant, and significant other. Not to mention parents or friends if you want them there.
Why is it like this?
Oh! I can answer. It’s because of this wonderful thing called malpractice insurance. The midwives have to pay it out of the wazoo to keep their birth center alive. So, new furniture and more beds take a backseat to packing in as many clients as they can manage (up from 20 to 30 women a month), and malpractice insurance stays a whole hell of a lot cheaper when you risk women out to the hospital for any variation of a normal pregnancy. I mean, you don’t get sued and lose your license for being too cautious (which is why c-sections run rampant in this country to begin with). If there’s any risk, you get sent to the big hospital. Sorry, see ya.
Why did I decide to peace out?
Well, besides the fact that our doula is selected and paid for (and we love her), I figure it’s just as, if not MORE likely, that I’ll have a natural birth at Virginia Hospital Center than at the birth center. Why? I’ve done a lot of research and picked out a doc who is friendly to natural childbirth. Besides that, he’s the head OB at that hospital, and works only with other docs whose kids he’s delivered, all of whom are friendly to natural childbirth. He strongly recommends a birth class, reviews your birth plan with you, and talks through your plans in the five minutes he spends with you. Besides that? I’ve been seeing him for most of my pregnancy. He knows my medical history. And? And? He delivers twins and breech births naturally. He once let a woman push for nine hours. He tolerates prolonged labor. And when she said she couldn’t do it anymore? She got an expert c-section, immediately. And? He’s been doing this for 35 years.
There might be disadvantages to going to a hospital. But I’ll have my doula. The one I chose. And I’ll have a doctor who knows his stuff and is a good guy. His office is filled with pictures of him holding babies. My favorite pic is of him holding triplets.
I’m sure I’d get excellent care with a midwife. But better? Debatable.
The jacuzzi can wait. I’ll hang out in the shower. I’ll tolerate the fetal monitoring. I’ll risk getting a nurse who is not natural-friendly. And next time, we’ll probably do it at home — forget the center.
I got a call yesterday telling me I’m off the waiting list, and the birth center would love to see me for my first appointment. Too bad. I like to do things on my own terms, and it seems like the hospital is a better choice for that right now.
As a pregnant lady, you may be interested in getting some good books. I mean, the internet just doesn’t cut it. And as I said, a lot of those sites end up with a bunch of scary comments about miscarriages and illness. I have known of pregnant ladies who stay away from reading any books or sites, but as you might have guessed, I’m not really that type of person. In fact, I highly recommend reading a good selection of books — but you don’t need to go overboard.
You’ll need …
A great reference book. I totally do NOT recommend What to Expect When You’re Expecting. It’s not written by doctors, and it just kinda tells moms to avoid every little thing possible. It’s information light, and condescension heavy. Instead, I highly recommend the Mayo Clinic Guide to a Healthy Pregnancy. This book is a true treasure — if you only buy ONE book for your pregnancy, this is really the one you need. It is divided into three sections — pregnancy, childbirth, and your newborn. It’s written by health care professionals, and has a non-conversational this-is-what-you-need-to-know kind of tone. It provides information on every option for pregnancy and labor, has charts for when you should call the doctor according to the week of pregnancy, and it tells you what to do with your newborn once you get it home. It’s well organized, well laid out, has lots of great information, and it will help you chill out when you perceive a potential problem.
For natural birth planners, you’ll need: Your Best Birth by Ricki Lake and Abby Epstein. Ricki Lake — she’s at her least ridiculous in this book — and Abby Epstein are the minds behind the eye-opening documentary, The Business of Being Born (available on Netflix instant). (I recommend this for natural birthers as well.) This is the companion book, which details why pregnancy and childbirth are treated differently in the U.S. than in other countries, and it tells American mothers about all of their options when it comes to their own births. Ricki and Abby both tell their own birth stories in Your Best Birth, all of which are vastly different experiences (hospital birth with an epidural, home birth with no medication, and an emergency c-section). The best part about this book to me was the lists of questions to ask your doctor, midwife, hospital, and doula. They also go over how to write a birth plan and the things you may want to include. A quick, easy, fun and thoroughly informative read!
For the natural birth planner, you’ll also want to read … Ina May’s Guide to Childbirth. I’ve already written a full review of this fabulous classic, and yeah, I still think it’s pretty much the best thing ever. Ina May Gaskin is a total badass — a rogue, self-trained midwife who started her own birthing center at a commune in Tennessee. This book is her guide, her philosophy, and her experience. The best thing? The first third of the book is written by her patients, giving glimpses of their positive, natural birth experiences. Then, Ina May details all of the different ways and methods to cope with labor — particularly the more difficult labors. She is unflappably calm and amazingly creative, and gives you a lot of ideas to hold in your personal labor arsenal. For example, if you open your mouth during pushing, you’re less likely to tear. If you’re muscles are tight, and someone rocks you back and forth, you’re more likely to relax and have it easier. And you get to read Ina May’s amazing statistics for her commune birthing center at the end. Also, it’s well written and has a good sense of humor!
For coping with labor pain in a natural way, check out: Birthing from Within by Pam England and Rob Horowitz and Hypnobirthing by Marie Mongan. Both of these books are designed around a “method” to deal with labor, so you may want to choose one ore the other. However, I think checking out a little of both is important because it gives you a chance to gather more tools for your labor arsenal. Birthing from Within does have some wacky stuff about creating birth art to express your fear, which I’m not really into, but some people might find cool. What I really liked about Birthing from Within is the varied methods of coping with pain and the suggestions for how to cope with post-partum stress. Hypnobirthing has a lot about the history of childbirth, and it explains the self-hypnosis methods for dealing with labor. It has a great deal of wonderful information about pregnancy, and it explains meditation you can practice and use during childbirth. Also very well written and engaging. Highly recommended!
Breastfeeders will need … A good breastfeeding book. The Womanly Art of Breastfeeding By La Leche League International comes highly recommended. It’s the one I have, and there’s a ton of great information in it … but … it gets a bit preachy. If you are someone who knows you’ll get cranky at super preachy breastfeeding dogma (i.e. “There’s no such thing as not producing enough milk. If you’re not producing enough milk, there’s something wrong with you.”), then don’t get this one. I haven’t checked any other ones, but The Nursing Mother’s Companion comes highly recommended as well, and I would definitely give Ina May’s Guide to Breastfeeding a good try since Ina May pretty much rules.
Everyone needs … Baby Bargains! As you know, I totally support Baby Bargains. The authors claim they’ll save you lots of dough when buying your baby gear, but I’m not sure if that’s the main benefit of this tome. The main benefit? I found out about everything available on the market, got familiar with brands, and got good ideas for what I needed and didn’t need. From this book, I got the crib recommendation that led me to choose Westwood, the idea to purchase the Arm’s Reach Mini Co-Sleeper, and the suggestions as to what brands to include on my registry. That said, the authors, Denise and Alan Fields, are parents and not consumer reports experts. It’s also good to get opinions from other sources — I choose friends and family, and Amazon reviews!
And if you’re interested in a book for your partner … Get The Birth Partner by Penny Simkin. This is the to-go reference for the person in your life who will be supporting you through labor — significant other, friend, mom and dad … etc. This has all the information that that person can tell you throughout your pregnancy — exercises, health, nutrition, and all the stuff they can tell you about labor while you’re in it — medical interventions, options, and positions, and what you can expect after the birth — how to identify postpartum depression, how you can be supported in breastfeeding, and how to clean your baby. It’s good for that person in your life to have all the info. As much as you can cram in your brain, you won’t remember all of it, and it’s good to have someone there to remind you and make sure you’ve got what you need.
I’ll have another addition after Sam is born — the best books for having a baby!
For those of you who knew me before Eric and I started planning to get pregnant, you may have at least guessed that I wasn’t exactly a natural birth advocate. I thought the idea of a scheduled c-section sounded like a great idea, and the thought of breastfeeding totally creeped me out. I had a colleague who had had an all natural birth that lasted thirty-six hours, and that was enough to convince me that ALL THAT was something I did not want. After all, as Americans in the twenty-first century, we’ve been given the opportunity to do away with pain during labor. Why wouldn’t you want to do away with pain? Why wouldn’t you want to do away with the strangeness and ickiness of breastfeeding? Knock me out, and give me the drugs. That was quite and very much the way of my reasoning.
Fast forward to July 3, 2009. That’s right — almost exactly a year ago. Eric and I formally decided to go off of birth control that day. I only remember it because it was the one week in the summer that Eric was home from a business trip to San Diego (one that he thought I’d be able to go on, but that’s another story), and it was the night that we saw Away We Go, the day before the fourth of July. Yes, a baby. We decided we were going to have a baby in 2010. Exciting. As you might have guessed, I hadn’t given labor too much of a thought, except that I still thought it was a yucky, painful process. One that I clearly wanted to avoid.
And then I read this post on one of my favorite blogs. (And this one and this incredible, beautiful conclusion to follow up. If you read one of those posts, read the last one, please. Yes. So amazing.) And with those words, and her experience, I began to question what I once knew. When I went to stay with my husband his last week in San Diego, I told him that I thought I wanted a natural birth. Of course, he’s always been a big supporter of this, pretty much calling me crazy for wanting a c-section — I mean, that’s major surgery, and why would you want to schedule that when you don’t have to?
Fast forward again to January 2010. I find out I’m pregnant on the day that we go to visit Eric’s family. I read What to Expect When You’re Expecting that weekend, and it only makes me nervous. After that, I start to do my research in earnest. I read everything I can get my hands on about healthy pregnancy, natural birth, and labor: Ina May’s Guide to Childbirth by Ina May Gaskin, Birthing from Within by Pam England and Rob Horowitz, Your Best Birth by Ricki Lake and Abby Epstein, Pushed by Jennifer Block, Hypnobirthing by Marie Mongan, and The Birth Partner by Penny Simkin for my husband and coach. (And I just got The Birth Book by William Sears.)
I began to realize that I was seriously under-educated about pregnancy and childbirth. I began to realize that most of us — women and men — are seriously under-educated about childbirth. As Americans, we’ve also been seriously mis-educated, misled, and misguided about PAIN. We hear a lot of cliches about labor in particular, and we see them on our television and movie screens. We hear this: “You wouldn’t undergo a root canal without anesthesia, right?” or “It would be like trying to push a watermelon out of your nostril.” We hear about how painful it is, how it’s unlike any other pain you’ve experienced, how it’s pure insanity to go it without pain relief. We see women in terrible pain on A Baby Story, lying back as the doctors swoop in to save the day. We see Ellen Page in Juno and Katherine Heigl in Knocked Up begging for epidurals when they go into labor (and Amy Poehler in Baby Mama celebrating her choice to have one in a rather public way). Think about it: do you see any positive portrayals of natural birth in the media? Do you see any portrayals of women being empowered as they choose the way their child comes into the world?
Let me know if you think of some. I can’t.
In fact, I would posit that we’ve been taught to fear labor, fear the natural signals of our bodies, and fear the pain that is associated with those natural signals. We’ve put our trust instead in doctors, who are incidentally, mostly dudes. (Side note: there are lots of great doctors, and natural-friendly ones to boot. But there are plenty who keep on pushing the fear.) By putting trust in someone other than ourselves, and by passively absorbing the fearful images we see in the media, we give up a valuable part of our birth experiences. We get swept away in the wave of fearing pain, and we don’t give ourselves the opportunity to become educated, take control, and guide our birth experience as captain, rather than passenger.
When you fear something, it gets a lot worse, right? It hurts worse, it feels more painful, it is more intimidating, more frightening … so it is with labor. If you fear it, you will automatically tighten up, which works against the natural contractions your body is producing to guide your baby forward. When you work against your own body, and cannot relax, it can hurt a lot worse. Common sense, right? But still, over nine months (and indeed, the many years before we get pregnant), we are developing an image of an intensely painful experience that we cannot cope with, that will control us, that is compared to an illness in the medical world. How can one be expected to work against that fear when it comes to the day of labor?
Adrenaline plays a role here too. If you see a bunch of people you don’t know in your labor room, you get scared at the onset of a painful contraction, or your doctor gives you a rough exam while you are laboring, it can trigger an adrenaline rush. According to Birthing Naturally, “Adrenaline is the “fight or flight” hormone that humans produce to help ensure survival. Women who feel threatened during labor (for example by fear or severe pain) may produce high levels of adrenaline. Adrenaline can slow labor or stop it altogether.” And if your labor stops, you need the drugs, right? So say the doctors.
Well what’s wrong with the drugs? Pitocin and pain relief medications of all varieties help a tremendous amount of women through labor, but they can also mess with your body a bit in ways you might not expect. I’ll comment here about pitocin — it’s a synthetic version of the natural hormone that makes your uterus contract. But it doesn’t work in the same way that your natural hormone, oxytocin, does. It makes your whole uterus contract rapidly and all at once. You might guess that causes pain — not so great pain that might cause you to start seriously needing the pain meds. Pitocin also doesn’t trigger the natural pain relief mechanism your body has to offer — endorphins. So when you get the pitocin, you start needing the epidural, and the epidural, while innocuous to the body in many ways, can slow labor as much as 25%. And when labor slows? That’s right … “emergency c-section.” Sounds nuts right? It certainly happens.
Understandably, many remain frightened of the pain. But many remain unaware of the benefits of laboring sans drugs. You heal faster, you can walk around and try out different positions, you don’t have to have a catheter to pee, you can get in and out of the shower or tub, and you can sneak in a snack or a drink of water every once in a while. Too, you can listen to the signals of pain that your body gives you as positive markers of where you are in your labor. Finally, you are connected to the millions of women who have come before you — your ancestors — who labored naturally. But how do you cope with the pain in a society that tells you pain is unnecessary? Well, that’s the question. How can you?
In all the books I listed above, there are tons of relaxation techniques, exercises, and guided meditation that many women say can help. The Bradley Method encourages slow, abdominal breathing, while Hypnobirthing touts self-hypnosis. Birthing from Within tells about non-focused awareness. There are a lot of options out there. Hypnobirthing even claims that labor was never meant to be painful, and Mongan’s book all but promises a pain-free labor. (We’ll see about that … ha.) Whatever the technique is, the important thing to me is that I get to choose it. I manage the pain, and it doesn’t manage me.
I can’t tell you where I got so confident about this decision, but it happened early on in my pregnancy. I didn’t want this to be something that happened TO me, but rather a whole event that I guided in the best ways I knew how. I’ll state here that I’m not belittling anyone who chooses a different path — we’re all trying to be mothers in the ways that we think will benefit our children the most. I’m also not going to say that I won’t consider pain relief if I’ve been laboring for 36 hours. And I’ll certainly go with a c-section if my baby’s life is in danger. But the important thing to me is that I have chosen to become educated about my options, and not close my eyes in order to let someone else manage the process for me.
That’s all for now.
Welcome to the Savvy Mom Space
I’m a liberal feminist that believes that liberal, feminist ideals should gel with embracing your gender and motherhood (if that’s what you feel like doing). I support all kinds of moms and dads and parents. Oh and, although I totally love that natural vibe and not harming the environment, I supplement my organic milk and fresh fruits and veggies with the occasional Twix, the frequent Oreo, and the daily Coke Zero. I’m opinionated, not easily offended, and a loudmouth in person and on the internet. I am what I am. Welcome.