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The Decision (sort of)

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Thursday, May 01, 2008

First 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:

Birth Team:
- 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

Personal Wishes:
- 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

Post-Birth Recovery:
- 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!


  1. Blogger Angie | 10:52 AM |  

    That is unfortunate about the hospital not allowing to video tape. 10.5 years ago when I birthed my first, we caught it on tape in the hospital. My 2nd baby in the hospital was not permitted to be taped. My 3rd at home was supposed to be taped, but everyone forgot to press record LOL.

    One thing that I did not see and might have missed is regarding vaccinations. You might be choosing not to display that choice in public, but I just wondered if you have considered it and given instruction in your plan regarding that. The oral vitamin K is what we chose in my homebirth and all was well.

    Well thought out and way to go for taking so much into consideration. Best wishes!

  2. Anonymous jane | 11:37 AM |  

    I was under the care of a practice that has CNMs in Columbus for the birth of my daughter 26 months ago. If I were to do it again, I would do what you are doing - a home birth and/or with a OB that I trust. I realized too late that just because an OB Practice has midwives on staff does NOT mean that are friendly to natural childbirth. In the end, they were manipulative bullies who were eager to perform interventions. I am happy to read that you are going to avoid that! Best of luck to you! Your midwives sound wonderful!

  3. Anonymous Robin Elise Weiss, LCCE | 12:44 PM |  

    I just wanted to say that having twins really shook my foundation and belief in natural birth up. I really had to do a lot of soul searching to make similar decisions. I never felt the extreme sense of calm I desired. Making decisions and having plans helped - some. My blessingway helped - some. Baby B turning vertex at 38w5d - helped a lot. I suppose my point is simply that you may never feel 100% at peace or calm, as I didn't, until I had contractions. Then I was calm and had a peaceful birth of my babies.

  4. Blogger Natalie | 1:03 PM |  

    Wonderful, well-researched, thought-out and, obviously, supported plan. IMHO, I don't think the plan is extreme in any way whatsoever. Your birth plan reads very realistic. You've dotted your eyes an crossed your T's. You sound very well mentally prepared for best and worst case scenarios.

    Your attitude is positive and I love how you treat birth as a normal event and not a medical procedure.

    My last birth with an unmedicated, waterbirth with no interventions whatsoever. I would have to say that it is women like you who give women like me the courage, support and direction to go a step further: trust in homebirth and find a way to make it happen, while staying realistic and open to change of plan...Even if you currently live in Portugal where waterbirth is unheard of and homebirth is, just about unheard of. Possibly evn more rare than in the US. If I get pregnant here, stories like yours will help keep me motivated in pursuing my hope of a homebirth. Thank you for this post! I hope everything goes well and the whole journey is empowering!

  5. Anonymous Carole | 2:04 PM |  

    You sure have done your homework!!

    Can I ask about one thing, though?:

    Why are you doing Vitamin K? I'm not judging -- I'm actually very interested.

    I was under the impression that Vitamin K was given only to encourage blood clotting -- specifically, for boy babies, because they're going to be circumcised on day 2, but their blood won't clot on its own until day 8. (I know they give it to girls too, but I've never heard another reason given.)

    Is there something I've missed?

  6. Blogger Maria | 2:41 PM |  

    Wow! Your plan sounds great! I am in awe... I would probably be freaked out about birthing twins in general, but you have really done your homework. I am sending this post to a friend of mine who is having a singleton soon and about to work on her birth plan.

    Oh, and I forgot about the eye ointment being an issue. I had my son in Germany, and they didn't use an ointment. I asked my midwife about it during pre-natal and she said it wasn't standard there. A lot of things I was concerned about turned out to not be "standard procedure."

  7. Blogger Anna | 9:48 AM |  

    Angie - I do actually have a few lines in the full version of the document that pertain to vaccinations. I don't plan to have any vaccinations administered in the hospital. The version I presented to Dr. Jenkins included only the stuff that falls into his domain.

    Robin - Thank you so much for sharing your birth story! It's so empowering to read positive twin-birth experiences. And yes... oh, how I long for that extreme sense of calm that I had with my other pregnancies! Like you, I've reluctantly accepted that it's unlikely I'll get there this time around. I do trust my instincts, though, and I believe I'll know the right place to be once labor begins.

    Carole - Vitamin K drops (or injection) prevent vitamin K deficiency, which affects about 1 in 10,000 babies. You can read more about it here: http://www.womens-health.co.uk/vitk.asp. We're opting for it because the benefits far outweigh the risks. I'm doing oral drops instead of an injection simply because it's less traumatic for the babies.

  8. Blogger W | 11:07 AM |  

    My wife had twins back in January. We contemplated all the same things you have been mentioning, and ended up with a midwife practice affiliated with a major hospital in Nashville. When we found out about the second fetus at the 16 week ultrasound the midwife practice told us they could no longer see us. She had one actual visit to the midwife before they dropped us. It was very frustrating.

    The OB practice they referred us to actually had one midwife on staff as well. They told us she was taking turns as on-call along with the staff OBs, but if she was on call when my wife went into labor they would bring in a OB.

    She made it to 38 weeks and had to have a section due to some nasty pre-eclampsia that was threatening to turn into full blown eclampsia.

    If anyone is interested, you can read the dad version of the birth story at my blog. Just be warned it's very long and detailed.


  9. Anonymous Anonymous | 4:31 PM |  

    Is external cephalic versioning done on twins at all? My first baby was breech late in my pregnancy and my midwife was able to turn him to vertex at about 37 weeks. I was able to have a natural birth at home. Don't know if the procedure works well on twins, though.

  10. Anonymous Carole | 10:08 AM |  

    Thanks for the info!

  11. Blogger JudyBright | 9:27 PM |  

    I think I'll cut and paste this for my birth plan if I have a baby in the hospital. Sans the twins part ;)

    The catheter AFTER anesthesia is also a great idea ;)

  12. Anonymous Anonymous | 2:52 AM |  

    Wasn't this supposed to be a breastfeeding blog? When did it turn into a homebirth / midwife / everything else blog? The last post about breastfeeding was seemingly months ago.

  13. Blogger Jennifer Laycock | 6:39 AM |  

    Actually, it's a parenting blog with an emphasis on breastfeeding.

    If you look back in the archives, you'll find there were a ton of posts on this very topic back when I was pregnant with Emmitt. Why? Because a horrible hospital birth absolute tanked breastfeeding with my first child and ended up me having to exclusively pump for 13 months to get breast milk in her.

    You'll also find posts on general parenthood, healthy eating, natural living and quite a few other things.

    Anna has come on board to write because despite having successfully breastfed three babies, she's in new territory. She's now expecting twins and is trying to setup a birth that leaves her and the babies healthy and gives them every opportunity to establish breastfeeding successfully.

    The Lactivist may be a blog about breastfeeding, but it's also a blog about questioning the status quo and learning about our many options as parents.

    It's easy enough to skip past the posts that don't interest you.

  14. Anonymous radical mama | 8:11 AM |  

    That's fantastic. I think you are right to be positive but prepared.

    I am expecting my fourth baby and this will be my first home birth (any day now!). I am really looking forward to avoiding the trauma of invasive birth practices.

    Best wishes to you on this journey and I sincerely hope things go fantastically for you. :)

  15. Anonymous Anonymous | 5:24 PM |  

    I would so love a homebirth this time around I have looked and looked and am not making sense of the information I have found about ohio and homebirth. If you could help me figure it out email me... mr204105@ohio.edu p.s. I live in chillicothe an hour south from columbus. Thanks!!

  16. Anonymous Kathryn | 10:48 PM |  

    In all honesty my first inclination is to warn you. I'm young. I have 2 little ones, and you probably don't need my warning, but I have lost trust in many hospital care providers. Though I've had good and safe births, my experience so far has been that they are willing to lie or mislead to get their own agenda taken care of without much resistance on the part of the pregnant lady... I know this probably sounds terribly pessimistic. I'm not usually that way at all. I know this isn't everyone, but it seems to be more and more common.

    You said you didn't want to switch care providers this late, and I'm just sayin, please make sure you can trust whoever you are with to do what's best and right, not act out of fear or their convenience. I wish you the absolute best. This is a beautiful birth plan. Very thorough. I hope you all enjoy a fantastic birth.

    (I hope this doesn't sound terribly dramatic, I read this shortly after it was posted, and I haven't been able to get it out of my mind. I'd rather this be encouraging than anything. Way to go for what's best for you and the little ones. Also, I wanted to leave this link: http://wonderfullymadebelliesandbabies.blogspot.com/2008/05/twin-and-triplets-new-standard-of-care.html )

  17. Blogger Anna | 6:25 AM |  

    Anonymous #9: I'm not sure if ECV can/should be done with twins or not. That's a question I have for the midwives at my next visit with them, if the babies haven't turned by then. I actually think that Baby A might be head-down again, but I'm not all that confident in my self-palpation ability.

    Radical Mama: Congratulations, and I wish you a beautiful birth!

    Kathryn: Thank you SO much for that video... it brought me to tears. I do appreciate your warning, but rest assured that if I end up in the hospital for any reason, I absolutely do trust my doctor. I've been with him for three births already, and all have been wonderful. Believe me, if I didn't trust him, I'd have switched practices a LONG time ago. :)

  18. Anonymous Anonymous | 5:47 PM |  

    Happy Mother's Day! Hope everyone had a great day. We went to Cape May- it was a bit windy, but it was nice to see the ocean again. Reese loved the wind in her face. She was a stinker in the restaurant, screaming loudly "MA MA MA MA MA MA" and turning beet red while she threw her sippy cup on the floor. Man, I still wish I was nursing, if for nothing more than to quiet a fussy baby! Jen

  19. Blogger julesborealis | 7:29 AM |  

    I have an idea why the hospital may not let you videotape.....you may catch something they don't want you to have a record of.

    Your birth plan is well thought out and written. Don't be surprised if your doc pulls the bait and switch with you....agreeing for now but as time progresses getting aggressive and pushy about his "concerns". I had an OB who did that to me and I had a perfectly wonderful normal pregnancy. She knew from the beginning that I would most likely be having a homebirth attended by a midwife and was "completely on board". That was until I went over 41 weeks and she became a bully about inducement.

    I wish you the very very best and I'll be checking in on the blog.

    By the way, I've been happily breastfeeding for 2 months now. What a wonderful, satisfying, amazing act of love for my girl. I honestly don't know why somebody wouldn't even want to give it a try.

  20. Blogger AzĂșcar | 11:20 PM |  

    This is very exciting! I can't wait to follow the journey.

  21. Blogger ecb | 7:32 PM |  

    So cool! I'm working towards a homebirth in July, though for a singleton - but I'd still aim for a homebirth if it was twins. Congrats and very cool that you've taken the time & effort to be so well informed. If only more women would research their options so thoroughly.. :-)

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