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Thursday, May 01, 2008First of all, thanks to all of you for your support, encouragement, birth stories and resources. It is definitely appreciated! I wish that I had time to respond to everyone's comments individually, but there are a few points that came up that I'd like to clarify:
1 - Hospital birth with a midwife is not an option for me. I think there might be one practice in Columbus that still has midwives on their staff, but I'm not willing to change practices at this point. My understanding is that if a midwife is not a part of an OB practice, she does not have hospital privileges. Feel free to correct me if I'm wrong!
2 - "Home birth" =/ "unattended birth." Whether I birth at home or in the hospital, I will be with skilled birth attendants.
3 - It's true; the vast majority of research shows that for 80-90% of women, and out-of-hospital birth with a midwife is a completely safe, if not safer, option than birth in a hospital with an OB. The trouble is, the research is based on "low-risk" births. Although I don't necessarily agree that twins automatically makes a woman "high-risk," the fact is that multiple pregnancies are considered high-risk by the medical community and researchers. Even Marsden Wagner, a HUGE proponent of midwives and out-of-hospital births, puts multiple pregnancies in the "should probably be attended by an OB in the hospital" category.
So where does that leave me? Well, since I last posted, I've had an appointment with Abby and Kelly (the midwives) and an appointment with Dr. Jenkins. I've also continued researching the topic on my own. I currently have a childbirth mini-library on my nightstand! The research has helped me become even more confident in my body's ability to birth two babies, and even more educated on common interventions, the risks and benefits, and the motivation behind them for a typical OB.
I'm lucky - I don't have a typical OB. Here are the birth preferences I gave him at our last appointment:
- Lee and/or Anna are a part of the birth team, and must provide consent for all interventions
- The minimal number of staff required for optimal outcome should be included on the birth team
- We will photograph and/or record the babies' birth on videotape
- Lee and the midwife will stay with Anna at all times
- Neither baby will be separated from both Lee and Anna at any time, for any reason
Labor, assuming no complications:
- Intermittent, external fetal monitoring only
- No artificial rupture of membranes
- Unrestricted freedom of movement
- Heparin lock insertion only if necessary; attempt forearm insertion first
- Unrestricted freedom to eat light foods and sip clear beverages
- No pharmaceutical augmentation
- Do not offer pharmaceutical pain relief unless specifically requested by Anna
Birth, assuming no complications:
- Unrestricted freedom to push and birth in whatever position is comfortable at the time
- No episiotomy
- Immediate skin-to-skin contact with each baby; Anna will hold Baby A until labor begins for Baby B
- Birth Baby B vaginally, even if in less-desirable position (posterior, breech, etc.)
- Do not clamp either baby's umbilical cord until her respective placenta is delivered, and cord pulsing has ceased
- Spontaneous birth of placentas (no pharmaceuticals, cord traction, etc.)
Emergencies, Complication, and Surgical Birth:
- Please respect that this is not a "routine procedure" for our family
- Anesthesia to be administered by a certified anesthesiologist
- Regional anesthetic preferred, if time allows
- Place urinary catheter after anesthesia is established
- Do not strap Anna's arms down unless she proves physically unable to control them
- If general anesthesia is required, type and dose to regain consciousness as quickly as possible
- If baby's conditions allow, Anna or Lee will hold each baby after birth
- Post-operative pain medication that allows Anna to remain alert and interact with babies
- Healthy babies will accompany Anna to recovery for bonding and breastfeeding
- Delay all routine procedures and examinations for at least an hour after birth
- Use non-irritating eye ointment (no silver nitrate)
- Administer vitamin K drops orally
The ONLY item Dr. Jenkins balked at was our desire to videotape the birth. He said, "I don't mind at all, but the hospital isn't going to allow it." I figure that's a bridge we can just cross if we come to it.
So after all that, you're probably thinking I've opted for a hospital birth, huh? Not so fast. Assuming the babies get back into vertex position (Baby A was breech and Baby B was transverse on Monday), and that I don't go into labor prior to 37 weeks, I intend on birthing at home. I do plan to continue care with both Dr. Jenkins and the midwives until I go into labor. Dr. Jenkins is completely on board with it (or well, as on board as a "conservative" OB can be). Yay!
I will say that I still have some apprehensions about birthing at home. However, I've come to realize that that's ok. If it turns out that, once I'm in labor, I don't feel confident at home, we can always transfer to the hospital. The reverse is also true, but much more difficult to accomplish. I know that sounds a little wishy-washy, but the bottom line is that I need to be where I feel the safest and most confident. Although I trust Abby and Kelly completely, there's really just no way for me to know for sure how I will feel about being at home until I'm in labor. Honestly, though, I have a very strong feeling that everything will be absolutely fine at home, and I'll get to call Dr. Jenkins a few hours later to say, "The babies are here, and everyone is great!"
Now... I just need to convince the little toads to get back into position so that my vision can become a reality!
Labels: Childbirth Issues