Be there!

Okay, so last night K and I went to the information session at the Cambridge Birth Center.  All in all, it seemed like a nice place to give birth.  Though the one birthing room we saw was small, apparently the other two are much bigger.  I did have a couple of problems with the center: one, they don’t seem to keep detailed statistics.  This is something I expected from reading the books by Ina May Gaskin – that a birthing center would be able to give more information than “It is our policy to break the waters of a laboring woman if they haven’t broken already by around 8 cm dilation.  This happens in a minority of cases.”  Oh, a minority of cases?  That’s informative.

They also have a clear list of reasons for transfer to a hospital, so it’s not just willy-nilly.  And it is possible to refuse procedures or be clear about what you will and will not allow beforehand, which reduces my fear of being pressured into unnecessary medical intervention.  The birth center does not have a time limit on labor, which is fantastic.  And they welcome expressions of sexuality during birth (for instance, breast and clitoral stimulation and kissing your partner, all of which are supposed to make the birth faster and easier).

But they were very clear that the midwife you see for labor and delivery will probably NOT be the midwife who you see for prenatal care.  The way the presenter explained it was pretty funny – she said that the birth center values a model they call primary midwife care, where you see the same midwife for all your prenatal visits and develop a relationship with them.  And the presenter went on to say that the person attending your birth is whoever happens to be on call, which is unlikely to be your midwife since the midwives work only 1-2 shifts a week.  BUT she would absolutely trust any of her colleagues, it’s a great group.  I was like, huh?  I mean, even if you see an OB-GYN in the most medico-technocratic setting, you can expect that your primary prenatal care provider will at least make an attempt to be at your labor and birth.  We see Mt. Auburn next week, so I wonder if their policy will be any different.

Yesterday was my worst day for nausea.  I have found that the magic food that makes my nausea disappear is a vegan version of a McDonald’s hamburger: I lightly toast a bun and K cooks me up a flame-grilled garden burger, and then I add a bit of ketchup and mustard (sloppily, just like Mickey D’s) and 3 dill pickle chips.  It’s amazing.  I’ve had three already this week.

Finally tossed my cookies

…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.

Back at work

It’s January 2, and I’m 9 1/2 weeks pregnant. I’m back at work today after the holidays, and so far it is going well. I am still a bit nauseous, and I’m hoping that goes away in a few weeks. I now have a substantial library of books on pregnancy and birth, thanks to my sister, mother, and mother-in-law. I also ordered a book called Pregnancy and the Vegan Diet online, which I hope arrives soon. The next thing I want to tackle is choosing a place to get prenatal care and give birth: over the next two Mondays, I am going to visit the Cambridge Birth Center and the Midwives at Mt. Auburn Hospital. I would like to have a natural birth in a relaxed, less institutional setting. I am also confused by the differences in prenatal care between OB-GYN practices and CNM practices. Do midwives offer the same prenatal tests and screenings? Can they prescribe medications? I’ll have to find out.

My appetite seems to have picked up again, but foods still smell and taste all wonky because pregnant women have an increased sense of smell.