Tag Archives: homebirth

Update on home birth

So at this point home birth is a go.

My midwife did research. I did research. She conferred with other birth professionals.

Then we talked. Then I talked to Stephen. Basically we feel we are where we were at a month ago.

Yes, I have had complications in this pregnancy.

I’ve also managed to get all my problems under control.

When my midwife took me on she recommended I continue prenatal care with my OB so that if anything serious came up we’d know about it ahead of time.

None of the things that my OB listed as possible complications on Tuesday would just show up suddenly in labor.

Goiters can be detected by ultrasound ahead of time… something I plan to ask for at my next OB visit because regardless of whether I’m having a hospital or home birth I’d want to know ahead of time if my kid is going to have a goiter that could cause breathing difficulties upon birth.

I was also reminded in this situation by good friends that I can’t get too caught up in getting my way. One friend in particular said it best:

We educated ourselves so much and we set so many plans, but what we failed to do was to plan to be flexible. While we as parents have a say in our birth process, there are some things that will happen whether they are fair or not. Just like in life. We cannot control everything that happens to us and at times we may be put through unnecessary hardship. I would encourage you (and Stephen) not to get too caught up in the statistics, the facts, what the books say, what the doctors say, what your friends and families say, and what your own plans are. Its easy to lose sight of the forest by focusing too much on one tree. Especially as it relates to childbirth. I hope that my experience encourages you to do what you need to do to prepare yourself mentally for the flexibility that childbirth requires. Not every birth is cut and dry like a doctor or a book would describe. Each experience is unique and the most important part is who arrives in the end… …I would encourage you guys to do what we failed to do. Let the situation flow naturally and ask the Holy Spirit for guidance along the way. Above all else, do not let any change of plans mark your childbirth experience with discouragement. Whether you have to have a hospital birth or you end up with a home birth that goes slightly different than you had pictured; no matter how small the change do not allow yourself to get discouraged. And do not allow yourselves to look back and say “I really wish it had gone a different way.” If you are flexible, then you and Stephen will be able to have an enjoyable birth experience no matter what the chain of events.

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Next day feelings and findings…

Well first of all I was able to talk to my midwife.

I don’t want to completely throw my OB’s opinion out the window at this point, but some of the things he said yesterday were just so erroneous that it is hard to take the other things as seriously. It doesn’t completely discredit what he had to say, but it does call his credibility into question.

The sterile thing is just a big load of crap, obviously. This is for a lot of reasons. First of all L&D wards are not by any means sterile. You have people coming in and out (like dads, family and friends), eating snacks, going to the bathroom, etc. Nurses and OBs do wash their hands, but not like they do when prepping for a surgery. Also, Stephen’s point about super-bugs was very valid. The antibacterial soap they use to wash their hands is what causes the super-bugs because it doesn’t kill everything and what stays alive is stronger and resistent to the soap, etc. And what else is in hospitals? Sick people and diseases. Furthermore, if doctors were really concerned about home environments being sterile enough they wouldn’t let you bring your baby home 24 hours after the birth (sometimes less), or maybe not ever. We would all raise our kids in hospitals, wouldn’t that be fun?

Then the fact that he just went into the general homebirth is unsafe thing until we actually prodded him makes me think that he was just going to say anything he could to make me think I was making a dangerous decision. Plus the research at this point does not support the statistics he tried to throw at me. If that was the case the UK’s ACOG equivalent wouldn’t be trying to increase the number of homebirths. Countries where homebirths are something like 30% of the population wouldn’t be doing better than us as far as infant/maternal mortality is concerned.

As far as pre-eclampsia/eclampsia and stressed out heart rate concerns… those things don’t just show up suddenly in labor. Yes, hyperthyroidism does put me at a higher risk for them (if left uncontrolled), but we would know through monitoring whether that was an issue before the birth. Also part of the reason my midwife has me continuing my care with my OB is to have these things monitored if something serious does come up. And she assured me that if anything with either my heart rate or the baby’s heart rate was abnormal that would be immediate cause for transfer. She’s not going to ignore the signs of something going wrong. Plus, something I think I haven’t mentioned on here is that she’s also worked it out with one of the other licensed midwives in town to have her attend my homebirth as well. So I will have two trained women at my birth monitoring me and making the situation as safe as possible.

Baby breathing difficulties… my midwife was able to find one study last night that dealt with this issue. It was a really small study though. Out of 248 births, two babies had breathing difficulties. One was exposed to high levels radio-active iodine (one of the drugs used to treat hyperthyroidism, but you’re not supposed to take it in pregnancy) and had a goiter so big it caused the collapse of the baby’s esophagus. The other baby’s mom was treated with PTU and had some difficulty breathing upon birth, but there isn’t much information given about this case including the dosage of PTU that the mother was on. We could have a late ultrasound to see if the baby is doing things that are helping it to practice breathing too like swallowing amniotic fluid (something I’ve witnessed on our previous ultrasounds). Also the fact that she gets the hiccups all the time is another good sign that she’s getting prepared to breathe.

So after she found this study my midwife called me again and told me about it. Then she said that she was going to call my OB and talk to him about his reasoning for declaring my pregnancy high risk. She also wants to know what information/studies he is basing his opinions on.

I’ve also gotten several responses to a post I put on a message board about this and everyone from midwives to those with the same condition as me have said that thyroid issues do not risk you out of homebirth as long as your TSH levels are closely monitored throughout the pregnancy (which mine have been). Also hyperthyroidism is more of an issue if it is something you’ve had for many years rather than something that developed as a result of pregnancy. My midwife said if the former had been the case she would have told me that I needed to have my baby in a hospital.

It was very nice of my doctor to make the offer that he did as far as attending my birth. That has not gone unnoticed in my mind because that was actually a concern of mine. To go from a 1 in 10 chance to 95% is pretty good.

Also he did say that he wouldn’t run from caring for me even if I did decide to ultimately go ahead and homebirth. My midwife has had many patients with OBs that have refused to see them anymore for making this decision.

Stephen said he’d still support me in my decision, but he also thinks that based on what the doctor said the best of both worlds for me would be to go to the hospital and have our midwife as our doula.

At this point I’d say things are more up in the air. I’m just really anxious to see if my OB is going to be willing to talk to my midwife and what will come of that conversation. I’ll probably know more tomorrow. I just didn’t want to leave things hanging like I did yesterday. I covet your prayers and even little tidbits of information/research you come across (thanks Ruth!). I definitely have a lot to think about.

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This is how the appointment went…

OB: So, how’s it going? Any contractions or issues lately?
Me: No.
OB: Well what about the morning sickness?
Me: I haven’t thrown up in awhile. I think the last time was 30 weeks. I have had a lot of heartburn lately. I still had some Pepcid you prescribed, but that didn’t really work. Tums seems to be the only thing that helps.
OB: Well we could prescribe something else if you are having a lot of reflux. Probably Reglan would be what I’d recommend, but only if you think it is bad enough that it warrants a prescription.
Me: I think I’ll just stick with the Tums for now. I don’t want to take something more serious unless I have to.
OB: OK then I’ll leave that up to you. Any other questions for me?
Stephen: Well yes, actually there was something else we wanted to bring up with you. I don’t know, Lisa do you want to do the talking or do you want me?
Me: Well, I know I had told you before that we were thinking about this and you gave me ACOG’s stance which I was aware of already, but I wanted to let you know that we’ve decided we do want to go ahead and birth at home with a midwife unless there are some things specific to my case that would put me at a higher risk.
OB: Well, first there’s just the risk of homebirth in general. Death is a real risk in about 2-3 percent of homebirths. There have been cases where the midwife didn’t monitor things closely enough and when signs of distress occured they were ignored. There is also a higher risk of cerebral palsey if interventions do not happen when they need to.
Stephen: Right, well we are aware that there are risks with homebirth just like there are risks with hospital births and even driving in our cars. I’ve gone through all the information with her and we discussed with the midwife what the risks were, I was very concerned about that. Ultimately though I’m not the one having the baby, so it is her decision and I want to support her. What we want to know is if there are reasons specific to Lisa that would make a homebirth more risky for her.
OB: Well you have not had a low risk pregnancy by any means. You have to remember that you have had hyperemesis gravidarum and hyperthyroidism. The PTU that you are on does cross the placenta and could have an effect on the baby. She could have problems breathing, latching on and even have a goiter upon birth that would need to be treated seriously and right away. Plus the stress of labor could cause your thyroid to get out of control. It could increase your heart rate. With hyperthyroidism you are at an increased risk for eclampsia and pre-eclampsia.
Stephen: We also want you to know that this is by no means a statement against you or your abilities. We think you’ve done a fabulous job with Lisa’s care and we’re happy with you. It’s more about her and her being in a comfortable environment.
OB: Oh yeah, I know that. I’d never think anything like that. I completely understand you wanting to be someplace that you are accustomed to. Another concern I would have is the home conditions. Homes are not sterile and babies are very susceptable to viruses and other things. Now I’m not saying that you don’t clean your house, but with a home birth one of the things you have to be concerned with is e-coli, among other things. In a hospital everything is sterilized and the baby is welcomed into that environment.
Stephen: Well doesn’t that increase the chances of the baby being exposed to a super-bug like MRSA?
OB: Super-bugs happen when doctors and nurses don’t wash their hands. We’re very diligent about that around here.
Stephen: Well I know some of the things she was concerned about was being able to move around in labor and have that bonding moment with the baby right afterwards. How likely is that?
OB: Those are all fine. You have to remember to that I’m not your typical OB. I was actually trained by and have worked with many midwives over the years both in the Indian Medical Service and when I did my residency at KMC. I don’t do routine episiotomies, if you want to labor your own way I will let you. I encourage you to have as natural a birth as possible because the more interventions you add into the mix the higher the risk of complications. However, there are just too many times I have written high risk on your chart that I cannot from a medical standpoint endorse this decision. I wish it was different for you. I wish you were a low risk pregnancy.
Stephen: And what are our chances of us actually getting you as our doctor at the birth and you being the one on call?
OB: Let’s see your due date is Sept. 13, the chance is very good. Actually, I’ll even make sure that I don’t go out of town during that time and make myself available to you guys at nights and on weekends. So I’d say your chance is about 95% that I’ll be the one attending your birth.
Stephen: Well thank you for that offer. You’ve given us a lot of information to consider. I know the midwife also tries to rule out as many things as possible ahead of time and wouldn’t take us on as candidates if it was beyond her scope of abilities.
OB: Well you see that’s what baffles me. Does this midwife you’re seeing know about your hyperthyroidism?
Me: Yes. She said she consulted with the other midwives in town and her overseeing OB and they said that it doesn’t rule me out from having a homebirth.
OB: Hmm. I just don’t understand that or agree with that assessment at all.

I measured at 33cm and the baby’s HR was 156. My TSH levels from my last blood test were normal.

I just… I don’t know where to go from here. I feel like my dream of my perfect birth story is already been ripped to shreds. I came home and cried. I left a message for our midwife to see what she has to say, but she hasn’t called me back yet. And now I’m afraid I might have put her in a sticky situation because my OB asked who her backup OB was that told her it was OK for me to have a homebirth. They work at the same practice and my OB said he was going to consult with him about his advice to my midwife.

It just feels so ruined. I wanted this so badly after 8 months of crap. I feel like I’ve been placed in this giant dichotomy of life or death though and if I go with what I really want I’m chosing death.

I also feel like the biggest dork for crying over this and being so upset. I mean I’m lucky to have made it this far in the pregnancy. I’m lucky that I’m affluent enough that I can even make a choice between these two forms of care. I can hear the responses now, “Just remember that the most important thing is the health of you and the baby.” Or maybe even a few “I told you so” things like, “Duh, Lisa anyone who’s watched you go through this pregnancy or read your blog could have told you that you were high risk and this was a crazy decision.” Or maybe a few along the lines of, “We told you not to get your heart set on an elaborate birth plan. You can’t plan birth.”

It just sucks at this point. That’s all I have to say.

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