…or rather, breakfast cereal.
Blech. I just barfed in the bathroom at work. I shouldn’t have had such a big breakfast. Now my mouth tastes like barf and I don’t have any gum. That was the first time I barfed, which is good…on the other hand, I was kind of hoping that my nausea would lessen, not worsen.
I had an appointment with a midwife at Cambridge Birth Center on Friday. It was my first real intake appointment, and I was disappointed by it. First of all, they run a lot of tests at the first intake: they took 6 tubes of blood, I peed in a sterile cup, and I had to get a Pap smear and multiple vaginal STD swabs, as well as a complete physical exam (heart, lungs, reflexes, breast, and manual vaginal exam). The Pap smear was incredibly painful. I think it was one of the most painful Pap smears I have ever had. The midwife did not use lubricant, and when I asked her about it she told me that you can’t use lubricant when doing a Pap smear. LIES! Recent studies show that lubricant does not adversely affect pap smear results. I have a chronic vulvar pain issue, possibly exacerbated by increased sensitivity because of increased blood volume during pregnancy. I could not believe how much it hurt to have the speculum forced inside. You would think that if they knew you were going to have to have an unlubricated thing inside you, they could warn you so you could do some kegels or something to get yourself a bit more aroused and relaxed and wet. Or they could let you do it yourself – can you imagine someone else putting an extra-large tampon inside of you? How much more painful would that be than doing it yourself. I thought a midwife would have gentle hands, but this one definitely didn’t.
(A friendly coworker across the hall gave me some gum. Score!)
The second reason I was disappointed is that I thought that the first appointment would include time for the midwife and I to talk about our goals for the pregnancy, to get to know each other, and to talk about the model of care used at the birth center. How can I meet other moms-to-be? Are there opportunities to hear birth stories from women who gave birth at the birth center? I asked a number of questions, but the midwife said that usually it is the second appointment at which the patient asks questions. Well, sorry I am doing things out of order!
Finally, I am disappointed by the statistics offered by the two birth centers I am considering. For instance, Cambridge Health Alliance has a primary (first-time pregnancy) cesarean section rate of 16% and Mt. Auburn has a primary c-section rate of 14%. Neither of these seem particularly good. The Coalition for Improving Maternity Services’ Mother-Friendly Childbirth Initiative says that a mother-friendly hospital, birth center, or home birth service has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals. This means that Mt. Auburn is within the threshold, barely. I was also disappointed to learn that at Cambridge Birth Center, fully 20% of women who begin their labor at the birth center are transferred to the hospital. This becomes more disturbing when you realize that few women are even allowed the opportunity to use the birth center: you must have a completely “normal” birth with no complications and desire to give birth without pain medication or medical intervention. Once women are transferred to the hospital, they no longer have contact with the midwife they have been laboring with. Instead, there is a single hospital midwife who was described to me by the midwife I saw as “extremely busy” and who apparently tends to all of the women giving birth in the hospital at one time. To be considered mother-friendly, a hospital, birth center, or home birth service would have clearly defined policies and procedures for communicating with the original caregiver when transfer from one birth site to another is necessary.
Oh man, am I going to barf again? (Stomach of iron, stomach of iron)
I am in the process of getting a referral to a nutritionist, and hopefully I can make an appointment today for sometime in the next week. I have to figure out ways to get more protein – maybe I should get some of that soy protein powder so I can put it in the fruit smoothies I make. I was so happy this weekend because it looked like I was getting my appetite back. Now I don’t even want to see any food.
On the K front, everything is going well. We had a really good talk yesterday about our fears and expectations, and while we’re both still like, “aaaaaaaaaah!” about our financial future, we’re also looking forward to increasing the love and joy in our lives with a child. Also, we had sex for the first time while pregnant (well, while KNOWING I was pregnant), and it was pretty good. There was no bleeding afterwards, which I guess can happen (but isn’t a problem), I wasn’t freaked out about the cervix-bumping, and there was no pain even after that horrible exam the day before.
January 7, 2008 at 12:14 pm
It is funny what a vast spectrum of care midwives cover. That is a high rate of caesareans. I wouldn’t worry about the levels of women that go to the hospital. For first time birth, the most common reason is the length of labor (first time pregancys are generally longer). However, I do think the rate of caesareans is nuts. Maybe ask what the most common reasons are.
I do take offense to your statement: “This becomes more disturbing when you realize that few women are even allowed the opportunity to use the birth center: you must have a completely “normal” birth with no complications and desire to give birth without pain medication or medical intervention.”
The vast majority of women do have a “normal birth,” and most often, when a woman decides to work with a midwife at a birthing center, it signifies her faith in her body to undertake birth without medication.
January 7, 2008 at 12:19 pm
No need to take offense. I put the word “normal” in quotation marks to indicate that I was using the term in the sense used by the technocratic medical establishment. As you know (because you gave me the book), statistics from The Farm show that only a very small number of women actually need medical interventions during birth, but within the medical establishment what constitutes “normal” is much more narrowly defined and because of this more narrow definition, more interventions are then justified.