Saturday, July 28, 2012

How I Came to Choose a Homebirth This Time

I've had a lot of interest from friends wondering how I wound up deciding on a home birth.  This post is the story.  It's not a post on home birth, or things to consider about home birth, or even why home birth is great.  It's just the reasons why I personally saw this as my best option for this birth.  

Flash back,
to the early days of me and my husband.
(I can't remember if we were engaged or newlyweds at this point.)
I clearly told my husband, who had been born at home, by choice (his mom had their first two children in the hospital, and their last two at home) this statement:
"I hope you don't expect me to have any babies at home.  I'm just not made for that."
(And for the record: He was totally fine with that.)  

So yeah...
As you can see, home birth wasn't something I had ever dreamed of for myself.

A couple months after my c-section I met a mom at a BBQ who had recently done a home birth --- I remember processing that conversation long and hard.
Conclusion: Homebirth --- still not something I was up for.

Had our family not moved from Illinois to Iowa, I am sure I would have stayed with the providers I had used with my first birth and tried to have a VBAC at our "VBAC-Allowed Hospital."

But we opened our lives up to another pregnancy knowing we would be moving away, all while not knowing where we would end up.  THAT, took some faith for me.  Any time Blake applied for a job I immediately looked up the hospitals in the area, to see which would allow for VBACs.

When we found out we were moving to Ames, IA I did the same.  And immediately saw that the hospital in Ames did not allow for VBACs.

At this point I am pregnant.
My first step was to ask my current care providers if they knew of any good options in Iowa.

At some point after J's birth, I told Blake that I would like to hire a doula for our next birth.  This shocked us both, as previously I had been adamant that I did not need a doula.  (I had been upset by internet sites constantly stating having a doula lowers your risk of c-section, because in my case , doula or not, I would have had a c-section for my first delivery --- so I was offended at that statement and therefore saw no point in having a doula.)  Then one day a switch flipped inside me.  I wanted, needed, would have to have a doula for the next birth.  Initially, I didn't have much logic behind it.  It was just the sensation that I  should.  I think that was God's leading.
Later I realized it was a good idea to hire a doula when you are 6 hours away from family and friends and know nothing about the medical system (VBAC friendliness) of your new area.

So me and good-old-Google started searching for doulas.  And I ran across the lady that I eventually hired.  She sounded perfect.  She had been in the business for 15 years and basically specialized in VBACs.  That's all I needed to hear --- she was hired.

I spoke to her over the phone on Thanksgiving weekend.  (We would be moving in February --- halfway through my pregnancy.)
She was really insightful about which hospitals were available for VBACs, and how realistic it was to actually be allowed to attempt a VBAC at them.

(Depending on where you live, as well as your personal scenario, finding a VBAC-friendly provider can be a rather convoluted thing.  There are many areas of the country where you can basically "accidentally" VBAC.  But there are also other areas where you have to fight for your life to do it.  I'd rate Ames as a middle ground.)

So here were my options:

1) Ames: Not a VBAC hospital.  It is 7 mins down the road from our house.  There are really good midwives there.  But I am not able to get prenatal care there under the assumption of anything but a repeat c-section.

2) Des Moines: 45 mins to an hour away from us.  They have two "VBAC allowed" hospitals there.  (I may be leaving out a third, I don't remember at this point.)  All of these hospitals have doctors and no midwives.
What I was told by my doula was that its fairly common to have the rug pulled out from under you at the end of your pregnancy if the doctor thinks something looks unfavorable.  That could mean something like your baby looks "too big."
And I also knew doctors in general are not always fans of letting VBACers go very far past their due date (and you know me, I like to incubate a baby for a LONG time!)
I also was told that I would need to be monitored the entire labor and their fetal monitors were not waterproof, so that would mean no water for me again.

3) Iowa City: Nearly two and a half hours away.  Apparently this is a fairly common choice for VBACers in my area, despite the distance.  (Goes to show you how important VBACs are to women, and how crucial it for us is to be seen by supportive providers!)
I was told this practice has extremely supportive midwives who have a really mother-centered approach.  They are very willing to allow labor to progress naturally.  And they also have waterproof fetal monitors, so water is allowed for pain management in a VBAC labor.  They do not however allow for water birth.

4) Sheryl the Midwife: Her office is in Des Moines, 45 mins from me.  She only does home births, and is not associated with any hospital.  I was told she was very supportive of VBACs.  And she was very knowledgeable, skilled, and trustworthy in regards to knowing when a hospital should be used.  I was also told that she serves women who would normally not receive any or good prenatal care so her office was not fancy and wasn't in a great neighborhood.

Now I know.
That's what I've got.

I told my options to just a couple friends and our families.

And wouldn't you know that I was given good reason to not go with any of my options.
One person would say this option sounded no good.
Another person would say this other option was just out of the question.
Some people kinda hinted at it being easier to just do a repeat c-section.
Others were outraged that I couldn't be seen in Ames unless I had a repeat c-section.
Most people quickly ruled out a home birth for me, because of my "history."  (And I wasn't sure about it for me either.)

Basically, if you asked them, it boiled down to having no good options.  


But I mean, 
come on, 
I had a baby inside that would need to be coming out, 
I had to pick something!  

So, what I did was... 
sit on it.  
Let it simmer.  
I quit sharing my thoughts with people.  
And I just waited.  

I waited a long time.  

I learned that stuff in November, and I gave myself permission not to even think about it until we moved in February.  
And when we got here, I gave myself a month to keep it simmering in my heart, 
just feeling what my heart was saying.  
I was waiting for a peace from God on one of my options.  
I had been praying about all of the options.  
And really all I had gotten back (while we were still in Illinois) was that God couldn't tell me yet.  (I assume now, in retrospect, he couldn't tell me I should/would do a home birth yet because I would have passed out and then told him NO WAY JOSE!)  
So I just kept waiting.  Waiting for his still small leading.  

The more I let it sit, the more I was feeling this way: 

1) There was no way would be signing up for a repeat c-section without a trial of labor.  Ames was out, no questions asked.  

2) I was not comfortable seeing doctors who didn't fully believe in me.  And I most certainly wasn't going to let a guess at my baby's size derail a trial of labor, because I know full well how wrong those guesses can be!  I also knew I could not physically withstand the stress I would endure wondering if I would be allowed to try.  

3) Iowa City sounded like the best option because it was a hospital and it was midwives.  AND I could get in the water!  
BUT two and a half hours is a crazy far distance to go.  First of all, I did not feel comfortable with the idea of laboring in the car for that long.  Second, I didn't like the idea of needing to leave as soon as I knew I was in labor, in case I went quickly.  I wanted that long-wished-for sensation of laboring at home before going in.  (Induction disappointment.)  And third of all, how on earth was I supposed to make it to all my prenatal appointments???  I have a toddler and I don't know anyone in Iowa.  So J would either need to sit in the car for 5 hours in one day, plus deal with appointment time, OR I would need to seriously like put out an ad in the newspaper for a baby sitter for the days I had appointments.  (And you need to realize that I am a worrywart of a first time mom who hasn't let anyone but family babysit J since she was born.  I could only imagine that some serial killer would apply for the job, I just couldn't fathom leaving her with someone I didn't know really really well.)  

4) This unknown (to me) midwife, Sheryl, was starting to feel more and more like the right answer in my heart.  Out of my options, this was the only one that didn't make my heart tighten with fear.  But I still had a lot of reservations.  Home birth after needing a c-section is a pretty big shift in mentality.  

I talked it over with Blake, and he was really supportive.  He had NO reservations about doing a home birth.  

So what I decided was that I would make an appointment to see Sheryl, just to talk with her about everything.  If it didn't feel right, I would be going with whatever seemed to be the best option out of what remained.  

So I did what I think many people assumed I didn't do.  I formed a list a mile long (more like 10 typed pages long) of questions to ask Sheryl.  I did not just let my emotions guide me.  I gave my heart a lot of room in this process, BUT I also used boatloads of logic and research.  
I spent days and days on the internet looking up all sorts of terrifying things, making sure I left no stone unturned in regards to ensuring me and my baby's safety.  This was a very UN-fun process.  Let me tell you, no one wants to spend time reading the horrors of what could go wrong.  But I needed to know what could go wrong so that I could find out how Sheryl would handle it if it did.  

So I went in with my list.  And I asked my questions.  

She was outstanding.  
Nothing I came up with phased her.  And everything I asked she had a wonderful response to.  She was so well balanced on allowing for the natural process of labor, but also being on guard for dangers.  She put me completely at ease in her answers, showing me she did know how and when to transfer you to a hospital --- whether that be during your pregnancy if something looked amiss, or during labor if the signs presented themselves.  She did not try to over-sell herself, she spoke of her limitations.  (Things like: travel time for her to get to your house, and how you need to take that into consideration --- she said she's never missed a birth because she wasn't coming... but she has missed births because the labor was too fast, or the women didn't call soon enough.)
I felt very safe with her.  
But then she went a step further, 
she showed tremendous insight into what went wrong with my first labor and delivery, without even having me mention all the details.  She explained what no one had to me, and even gave a solution to try and avoid it this time.  (This was the idea that my first daughter was always malpositioned, keeping her from engaging, keeping me out of labor so long that I had was induced at 42 weeks, and since she wasn't able to correct her position, a c-section was needed.  And she immediately suggested seeing a Chiropractor during this pregnancy to get this baby in the right position and engaged.)  I was awestruck at how clearly she saw it, and how no one ever mentioned anything like that to me before.  
And then she said what every VBAC women needs to hear: 
"I believe in you.  I really do."  

No medical person had ever said that to me.  
In fact, back home in Illinois, at my VBAC-allowed hospital I was treated ever-so-cautiously and gingerly by the midwives there post-c-section.  They gave me no indication they believed in me.  In fact, they gave every impression that I was quite possibly broken --- Double checking my pelvis: telling me that while the lower part seemed to be okay, they didn't know about the upper part, stating regularly that they had no guarantees on any topic that was brought up.  (Believe me, that statement was wasted on me, I KNEW full well how vaginal birth was not a guarantee.)  I was really shocked at the difference in my treatment pre-and-post-c-section there --- and by midwives!  I had assumed midwives would always root for you.  Not all of them will.  
But Sheryl did.  She did right off the bat.  
And that meant something to me.  
It didn't come off as fake, or some attempt to drum up business.  (Actually, Sheryl could probably use a little less business.)  It just is what she believes.  She believes in you.  

So I left that appointment pretty sure, 
but still hesitant, 
that I would be aiming for a home birth.  

Blake and I talked about it some more.  
He was on board before we even talked to Sheryl.  
He was constantly telling me how I could do it.  
It took me a while to believe it. 

Honestly, I'm not sure I believed I was really doing a home birth until I had gotten in the pool in my spare room.  

In both a nervous way, but also in a yielding to good sense, as well as to God's leading way, I always left the door open to a hospital birth.  It wasn't that I was rearing to go to the hospital.  (Actually I desperately wanted to avoid the hospital because emotionally it equaled c-section to me.)  But I knew that if at any moment I felt God telling me I needed to go to the hospital, I was going to listen and go. 
And Sheryl always leaves the door open to the hospital too.  We had numerous conversations about why we might need to go to one, and which one(s) she would recommend going to (if it were a non-emergency situation.)  (Emergencies, of course, require the closest place.)  

But there was never any point during this birth where I felt like I shouldn't be at home.  I always felt very safe and very at ease.  
It felt surprisingly normal and good to be at home.  
I loved that I never had to think about when to leave.  
I love that I never had to labor in the car.  
     For more than just the easiness aspect, but also for the ability it gave to me remain in a constant state of focus and calm.  

There are downfalls to anywhere you birth.  
For me the downfalls with home birth could be: 
  • Your insurance may not cover it.  
  • If something like your air-conditioning breaks around your due date, that can be stressful/worrisome.  
  • For about a month I was needing to diligently clean my house, since I felt like I would most like laboring in a clean home.  
  • There is no option for pain medication.  (I did have numbing for stitches, but that's it.)  For me that turned out to be no big deal, because this birth was so much more comfortable than my last one.  
  • You need to make sure to have enough support on hand after the birth, because there is no hospital staff to care for you or the baby.  
  • If you pass out like me, you need strong people to carry you to your bed!  :)  (No hospital equipment to help with that.)  As well people around who are able to walk you to the bathroom later on. (If you are like me and are still lightheaded for a day or so.)  
  • You need to provide yourself with bedsheets, towels and plastic (for bed and floor) that you don't mind getting messy.  
  • You need to have people there during and after the birth who don't mind cleaning up for you.   (This could mean: laundry, dismantling birth pool, or clean up after your less-appealing bodily functions.)  
  • You should have food available for you midwife and support people.  
  • You need to think ahead to what you (and your midwife) will need in labor and have it all prepped and placed in one place.  (Stuff like towels, washcloths, garbage bags, flash light, Tucks pads, paper towels... )  
  • No fun hospital freebees like: baby hat, nose sucker bulb, diaper bag, etc.)  
But for me, that was all a fair trade off.  


I am really glad I met Sheryl.  

Honestly, I'm not sure I would have gotten to do a VBAC without someone as amazing as Sheryl.  
I think because I take so long to go into labor, many (if not most) providers would have cut me off prematurely from a trial of labor.  Especially because I had an "unproven pelvis" and I had a big baby the first time (and semi-arguably big the second time too.)  

I am really glad I got to do a home birth.  

Honestly, I'm not sure how well I would have labored in a hospital for this birth --- because of the emotions that I would have fought in that environment based on how my last labor went.  
Being given the blessing of laboring and delivering in my own home was something I will never undervalue.  

I feel like I owe Sheryl some kind of amazing thank you gift.  But nothing is big enough, or special enough to even come close to the gift she gave me.  She gives her whole life (the woman probably gets no sleep, ever --- I woke her up at 3 am so she could drive two hours to my house!) to allow women in my area of the country the blessing of being believed in, and the relief and reward of being allowed to try.  

I've had some friends express interest in my possible water birth.  
     If you read my story, you can see my baby wasn't born in the water.  Baby A's heart rate went down at the last stage of pushing, so to expedite her delivery I was asked to push laying on the floor.  I also got the rarely-done-by-my-midwife-episiotomy to make sure my baby could get out fast enough for her safety.
I just thought I'd include this thought while I'm doing this post:
I never had my heart set on a water birth.  Yes I rented the birth pool, but really I was just excited to get in the water during some part of my labor.  (I was soooo excited about water as a pain relief measure.  I love water.)  Which is exactly what I got to do --- and I will say it was awesome!  I knew ahead of time that some women don't end up wanting to deliver in the pool.  Or that sometimes there is a good medical reason (like mine) to move elsewhere.  
I do think it would have been cool if it happened that Baby A was born in the water.  But, honestly, for me, a VBAC is all I was going for.
I have heard good things about birthing in the water in regards to not experiencing the ring of fire, and how it lowers the rate of tearing.  So it does sound like a great way to go.
I will say, that I actually had no ring of fire --- maybe an episiotomy takes that away?  I don't know.  I know the cut itself hurt, but the rest of pushing didn't hurt me.  It just took hard work for me.
And my episiotomy hurt while healing, but I will take it over a c-section any day.

A friend of mine just asked me if I would do a home birth again... 

Well, first of all, I'm still taking a huge deep breath after the emotions of this last worry-laden pregnancy, so I'm not committing to another baby yet.  (But I do want my heart to stay soft to God's leading, I will say that.)  
But if we do have more babies...  
If for some reason we still live in the area (more than likely we will move again, Blake's job is short term) then hands-down I would see Sheryl again in a heartbeat for another pregnancy.  

if we are living somewhere else.  I am pretty sure I will do exactly the same thing as I did this time.   Look into all my options (talk to people who really know --- I have learned that all "VBAC-allowed" hospitals are not VBAC-friendly) and let them sit in my heart until I have peace about one.  

I don't think having one home birth under my belt guarantees me endless home births.  I would certainly do it again based on how this birth went.  But I want to be wise and stay open to what I feel God is telling me.  If we have another baby who wants to tilt their head or something, I want to keep the ears of my heart open to God's prompting on where would be best to deliver that little one.  

And now that I have a positive birth experience, I feel emotionally I could labor in a hospital.  

So it really will come down to finding another provider who will believe in me (whether it be a midwife or a doctor) and who will let me stay pregnant for a long time (since my babies like to cook for about 42 weeks.)  


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  3. Hi, i know this post is old so hopefully you will get this. I am expecting my second child this year and really want to do a homebirth. My husband and i visited Sheryl today. We had heard some vague negative feedback about her from another midwife but we really tried to keep an open mind. The building was old but no biggie. I was a little uncomfortable when she showed us into a room with dirty furniture and dirty toys strewn around and a floor that hadnt been vaccummed in what looked like a month or two. My hubby was really turned off when she said she had the flu and probably should not have come in that day, and that she does not have an assistant. She didnt show me the exam room so i dont know if it was the same cleanliness. I know its been a while since this blog post and S mostly has great reviews so Im confused. I was just kinda taken with the lack of basic cleanliness in what seemed like the waiting room. Wondering if you have any expeirences like this. She is the only provider in network that does homebirth.

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  5. Hi did you end up going with Sheryl? If not, who'd you decide on?


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