midwife

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We’re on full-fledged Baby Watch 2015, and in honor of my pregnancy that is now 39 weeks 1 day, I’m publishing a post from September that’s been sitting in my drafts folder.

The lasting affects of miscarriage  |  nextlifechapter.com

I can see my feet if I’m sitting down and I swing them way out.

 

After I wrote this post back in March I intended to write an entire series on my experience with miscarriage, but then, I got pregnant. (Maybe part of it was that I didn’t feel emotionally ready to talk about miscarriage and “out myself” until I was able to start trying again.)

Since I had a history of miscarriage, my midwifery practice let me have an early ultrasound at seven weeks. This is about as early as a heartbeat can be detected. When I was pregnant with Adelaide I didn’t get that reassuring ultrasound until 12 weeks and that’s one of the factors that made my first miscarriage so devastating–I didn’t find out the pregnancy wasn’t viable until 12 weeks into it.

For those of you who haven’t been pregnant before, you’re considered about four weeks pregnant when you miss your period (depending how regular your cycles are) and that’s about the time you can get a positive pregnancy test. Doctors and midwives usually track your pregnancy by the first day of your last period. Most women don’t know the exact date they conceived, but the first day of your last period is a date most women can figure out (especially those actively trying to conceive). So, when you ovulate, you’re already “2 weeks pregnant”–at least for tracking purposes.

Anyway, I say this because between the time of getting that positive pregnancy test and then getting that early seven-week ultrasound, is about three weeks. Three very long, anxiety-ridden weeks. Weeks where you figure out your due date and think about all that would mean, while at the same time trying not to get your hopes up, trying not to think too much about the future, trying to stay “in the moment.”

During those three weeks I thought a lot about mindfulness. Primarily I thought about how little I know about mindfulness and how much I’d like to learn. During those three weeks I told very few people about the positive pregnancy test. Of course, Tim knew. He has been at my side through it all. I even made Tim and Adelaide take photos with the positive pregnancy tests. Adelaide didn’t know what she was holding up for the camera, so no harm done. I also made them do this for the two miscarriage positive pregnancy tests–I’ve kept those images, but they’re hidden on an external hard drive because they just make me sad.

Then, I told my sister (she lives far away but provided moral support over the phone). I also told my friend Brooke. Brooke has been my pregnancy confidant. She is the little sister of my friend Amy who died of cancer a few years ago. Brooke is the same age my sister, and we became friends when Amy got sick and Brooke moved to Philly. Although Brooke doesn’t live here anymore, she has been a great email pen pal. She has been through more than her share of heartbreak and loss (both early and late pregnancy). She was also pregnant this summer and a great voice of positivity–staying positive and thinking about the end result. The mantra: This is the perfect pregnancy. I’m so blessed for my two happy, healthy children.

So, we had that early ultrasound at seven weeks. Unlike my miscarriages, all three components were there. There was 1) a gestational sac 2) something in the gestational sac, and 3) that something had a heartbeat. It was one of the most nerve-wracking days knowing that after the ultrasound we would either be devastated once again or completely ecstatic. The news was good, we were flying high and the next day I had a doctor’s appointment where the midwife said now that a heartbeat had been detected, my chance for miscarriage went from around 25-30% to only 1 or 2%.

Fast forward to now and I’m 26 weeks pregnant. The genetics testing is over, even our 20-week anatomy scan showed “nothing of concern.” Each month at my midwife appointment they check the heartbeat and it has always been great.

Still, I worry. The result of having suffered miscarriage is that I no longer have the naivety of not knowing any better. I know first-hand what loss feels like, and I have witnessed stillbirth once removed as it happened to my dear friend.

A couple of weeks ago, at 24 weeks, I found myself worried to tears over the fact I didn’t feel as if the baby had been moving as much as the several days prior. I know you’re not even technically supposed to be tracking kicks as early as 24 weeks, and I assume that’s because it’s unpredictable. Still, I worried. I worried something was wrong. I worried I would lose her.

 

Now that I’m 39 weeks and anxiously awaiting “the day” at any time, I still worry. I find myself stopping my excitement and holding back on wanting to fill the empty drawers with Adelaide’s hand-me-down newborn clothes. I want to meet this little girl as soon as possible because while pregnant I feel so completely out of control. I want to hold her in my arms and know that she is okay.

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Adelaide turned two years old today. I thought it was time I finish writing her birth story. I consider this a work in progress, but I finally got the whole story out. Warning: it’s a long one, and it may be too much information for some.

 * * *

birth story | http://nextlifechapter.com

Our baby girl was due August 13, 2011. (For the story of our gender reveal check out this post.) At our 12-week ultrasound, the technician said she thought the baby was measuring an August 17 due date.

“August 17?” I asked. “That’s my birthday!”

The technician said she wouldn’t want to be laboring on her birthday, and Tim and I joked that I would never have a birthday again. From then on, the day would be baby’s day, not mine. My doctor decided to leave the due date as August 13 since it was only four days off from my original due date. And while I knew that a “due date” was just an estimate and that I could reasonably go any time two weeks before or two weeks after, I knew it was likely baby and I would have birthdays very close together.

Fast forward to July. My sister bought plane tickets to visit me for a week beginning August 14, the day after my due date. She just found out that she got a new job (yay!) and no longer had the flexibility to come whenever the baby arrived (boo!). I’ll admit I was nervous. I thought there was a good chance I’d go into labor while she was here, and I wasn’t sure I wanted another person around while I was laboring at home and waiting to go to the hospital. I also worried that the baby may be late and my sister would miss her all together. My sister assured me it would be okay. Even if there was no baby yet, we’d hang out, finish getting ready for her, and celebrate my birthday. As it turns out, I didn’t need to worry.

On Tuesday, July 26, I jokingly told Tim I thought the next Wednesday, August 3, would be a good day to deliver. My work had already hired a temporary worker to assist while I was out on maternity leave. I was supposed to start training her Thursday and Friday, July 28 and 29. I figured that by the following Wednesday, I’d have most all my top priority projects wrapped up. My parents were “on call” to drive out from Illinois whenever they got word of baby’s arrival. If she was born on August 3, my parents could come out the following week and still have a week here before my sister arrived on the 14th. I was born on a Wednesday, and August 3rd seemed like a nice day for a birthday. I had it all worked out in my mind.

Still, it was all said tongue in cheek. While at 37 weeks I knew I was technically “full term” and could go at any time, I still figured I’d be late. Even though both my sister and I were early, I had heard that most first-time moms don’t deliver until after their due date. So, when I went into labor in the middle of the night, around 2 am on Thursday, July 28, I totally wasn’t expecting it.

It’s so weird. Wednesday we were eating dinner at IHOP and looking at lamps for the nursery at Lowe’s, and then the next day we had a baby. She was here. No more planning. I didn’t have my hospital bag packed. I didn’t have my birth plan written out. I didn’t have a glider or breast pump. I didn’t have nursing bras or a diaper bag. Our house was a mess. I wasn’t yet organized. The nursery wasn’t complete. The dirty dishes were taking over the kitchen. We also had a maternity photo shoot planned for Sunday, July 31. I had been telling people for the last nine months that I was due in “mid August” and it wasn’t even August yet. Then, I became a mom.

I woke in the middle of the night with an intense urge to pee. This wasn’t an unusual occurrence. At 37 weeks pregnant I was regularly getting up in the night to use the bathroom – sometimes even twice in one night. Still, this sensation felt different – like, “wow, I must get to the bathroom now.” As I sat up and started to exit the bed, I ran my hand across the mattress to make sure that I hadn’t leaked or wet the bed.

When I walked toward the bedroom door, I felt a wetness in my panties. As I walked down the hall, I felt a trickle down my leg. Right before going to bed that night, I was reading about incontinence in What to Expect When Expecting. I even told Tim that a mutual friend of ours had recently confided in me her incontinence issues after giving birth. So, as I’m walking (very quickly at this point) down the hall, I’m thinking that I’m peeing my pants. Still half asleep, it was instinct to run to the toilet as quickly as possible. As I got to the doorway of the bathroom, I started to “leak” more and although I thought, “I should tighten my kegel muscles and try to stop it,” I was already to the toilet. There was a gush, but it all happened so fast that I wasn’t sure if it was my water breaking or just my bladder bursting with relief now that there was release. My panties were completely soaked.

I had heard that amniotic fluid smelled distinctive – sweet, not like the ammonia of urine. I smelled my panties, but to tell you the truth, I couldn’t tell what it was. At that point I thought, well, I won’t flush the toilet in case I need to come back and reference this liquid. I’ll just wait and see if I start to have contractions. I knew that few women actually have their water break before contractions – in our birthing classes they told us this was more of a TV sit-com phenomenon than true life. But, when talking about it with my mom in the weeks prior, she said it happened that way for her both times.

So, I went back to the bedroom, changed my underwear and crawled back into bed. I don’t even think Tim noticed I had gotten up. Then, almost immediately, I felt mild cramping in my lower abdomen, similar to period cramps. I knew I should relax, that I should try to go back to sleep because I could have a long day of laboring ahead of me. But of course, my mind was racing.

What? A July baby? What is today? July 28? Is July 28 even a Leo?

Our photo shoot! We were supposed to have maternity photos taken on Sunday.

And work! Oh, there’s still so much to do. Our temp was supposed to come in and train today. And all those invoices on my desk – how will they know how to process them? Who will set up the new budget spreadsheets?

I didn’t want to wake Tim. I wasn’t sure what was going on and there was no reason for us both to be awake and anxious. After about half an hour of lying in bed, I decided to grab my netbook laptop and come downstairs. Plus, I had to pee again already.

I opened my laptop and Googled “water breaking vs. peeing.”  There were a few message boards that came up, but nothing that answered my question to my satisfaction. I then downloaded a contraction counter to my smartphone.

I wasn’t really sure if I was having full-fledged contractions at this point, and they definitely weren’t regular. I figured I’d go back upstairs and try to sleep again.

I may have dosed off briefly, but I couldn’t sleep. I didn’t even have my birth plan written out. After attending our Mindful Birthing class and doing lots of reading, I knew birth plans rarely went as planned. One of the midwives told me “they’re more like goals.” Still, I wanted to have something in writing that I could hand the nurse when we got to the hospital. I wanted something that said we wanted a low-intervention birth, that I intended to at least try for a natural, non-medicated birth with a midwife in the hospital’s birthing suite. I didn’t want to be tethered to a fetal heart monitor if it wasn’t medically necessary; I wanted to be able to walk around. I wanted in writing that I wanted my husband to cut the umbilical cord and that I wanted to hold my baby and try to initiate breast feeding before she was taken out of room – that I wanted her with me skin-on-skin as long as possible.

At one point (it all seems like the middle of the night to me), I got back up and went downstairs to type this up. I basically summarized everything in the above short paragraph, but on that night, while beginning labor, I just couldn’t concentrate enough to write it all out. Plus, the contractions were getting more and more painful. I realized that if the contractions were too painful to continue typing, it was probably time to wake up Tim.

By this time it was about 5:15am, around three hours after my water broke. I told Tim I thought I was in the early stages of labor, that I thought my water broke. He wasn’t as surprised as I thought he might be. He was just very matter-of-fact about it “alright.” We laid in bed together for a bit, but my contractions were getting more and more painful and it wasn’t comfortable for me to lie down anymore.

Tim got up and started looking for someone to cover his shifts that day. He took the dog out for a walk. That period is now a haze for me. I remember throwing a bunch of stuff in my backpack. I didn’t know how long I would be laboring at the hospital, so I packed things for both my time laboring and my hospital stay afterwards – my camera, my laptop, the yoga ball, a book to read, an outfit to change into, my journal, some snacks.

I was trying to following the 4-1-1 rule we learned in our birthing class: don’t go to the hospital until your contractions are four minutes apart. one minute long, for one hour. My contractions weren’t a minute long, but they were closer than four minutes. What did that mean? I was so confused. I remember going down to the basement bathroom and laboring on the toilet. I felt better there, and I didn’t feel anxious about leaking fluids when I was sitting on the toilet. I bounced on the yoga ball, I leaned against the banister and Tim pushed my hips together (a technique we had learned in class). I tried to envision each contraction as a wave coming in and out (I had read that somewhere), but I don’t think I was very successful. I was loud. I moaned with each contraction and didn’t care that it was fairly early in the morning and that we lived in a rowhouse with neighbors close on both sides. I figured they could hear me and hoped that they didn’t call the police for some kind of domestic disturbance.

I remember Matt Lauer being in the background as I know the TODAY show was on the TV. By 8:00am I had Tim call my midwife practice. They weren’t open yet, but there was an emergency line to call and leave a message. A few minutes later the on-duty midwife at the hospital called us back and Tim answered. I didn’t feel much like talking to her, but she wanted to speak to me. I told her I thought my water broke around 2:15am and since my water broke, she told me to come on in.

Tim went and pulled the car up in front of the house. I was not looking forward to that car ride. At this point, I was in a severe amount of pain, and I was wailing pretty loudly. I leaned the chair back in the passenger’s seat and braced my feet in front of me. The ride to the hospital didn’t have to be a long one – we didn’t live far from the hospital. However, it was morning rush hour. Then, Tim took a left when he should have gone straight.

“Where are you going?” I asked. “You should just go down Passyunk.”

He wasn’t thinking clearly, and we hadn’t previously discussed the most direct route to the hospital. We also hadn’t planned out the “drop off.”  When we got to the hospital, he went straight to the Emergency Room drop-off when he should have turned and let me off at the main entrance. I didn’t want to wait for him to go around the block again, so I just had him pull over so I could get out and walk around the corner of the building. He went to park in the garage and said he’d meet me inside with all our stuff.

Having been to the hospital several times for classes and appointments, I knew there was often a line to get up to the reception desk where you had to sign in and get a pass to go inside. I walked directly to the font of the line and said, “I’m in labor and I need to go upstairs.”

The expression on my face must have looked very serious, because she just waved me on. “Third floor,” she said. I walked to the elevator and felt another contraction coming on. I was relieved there was no one else in the elevator. Then, right before the doors were about to close, a female doctor got into the elevator with me. I tried not to be too dramatic about my pain and purposefully didn’t “let loose” like I’d been doing at home and in the car. She immediately came over to see if I was okay. I could tell she was worried. I knew where I was going (I’d been on the hospital tour), and although she tried to get me to go the wrong way on the floor, I started walking toward the registration desk. “Okay, you clearly know more than I do,” she said. “Good luck.”

When I got to the desk, they were expecting me. I’ve heard stories about women having to wait in the waiting room or wait in the triage room for a long time. I was taken into the triage room, right as Tim arrived. They wanted me to pee in a cup and I tried, but I just couldn’t do it. The pain was all-encompasing.

I remember wearing a gown and laying in a hospital bed at one point. They checked me and said I was 5 cm and 100% effaced. “I guess it’s a good thing we had you come in,” the midwife told me.  They asked if I wanted to deliver in the birthing suite. “That was the plan. I’d like to try if I can.”  (If you have an epidural, our hospital doesn’t let you stay in the birthing suite, you have to be monitored in a standard hospital room).

A few contractions later, they checked me again. 7cm. Someone explained that most women increase a centimeter an hour, not a centimeter every 15 minutes. (Had it really been a half an hour?) Things were moving quickly.

Although I was told the birthing suite wasn’t available, the next thing I knew I was being wheeled up the elevator and into the birthing suite.

All modesty went out the window. I’ve had other soon-to-be-mothers ask me what to wear while laboring. Well, I guess you could wear a nice tank top or some other “laboring outfit,” but once in the birthing suite, I birthed completely naked. I think part of the reason was because when I first got into the room they asked me if I wanted to get into the bathtub. I had heard from friends that this relieved some pain, so I was really looking forward to getting into the water.

“If you feel like you need to push, let me know,” the midwife said. “We can’t let you have the baby in the water and if we do, I’ll get in a lot of trouble.” She said with a laugh.

I only lasted in the tub for a couple of contractions – sitting on my knees and leaning forward over the edge of the tub.

I remember the midwife trying to get me to trill my lips while I was mid-contraction, a way to relax and breathe. I couldn’t do it, I just couldn’t get my lips to work. After trying a few times I remember saying, “that one’s not working – try something else.”

Next, I moved into the shower. Standing, with the water flowing over my back and leaning with both arms on Tim’s forearms, I felt better than I did in the tub. But we weren’t in there long either. The next thing I know, we were back in the main birthing suite pushing. I started out in the bed on all fours, many pillows stacked up underneath me for support. The nurse left to get me some ice and a drink of what I think was seltzer and cranberry juice. Tim was next to me the whole time, but the midwife was the one in command.

We moved to a birthing chair – a weird wooden chair with no middle. I pushed through a few contractions there as well. The midwife asked me if we had a named picked out. “Adelaide” Tim and I both said. “Adelaide.”

I believe we then moved back to the bed where I pushed on all fours again. I remember liking the bed better than the chair because at this point I was getting really tired and I could rest all of my body weight on the mattress. I can picture Tim there to my left with the drink and the ice saying supportive things.

“I can’t do this. I can’t do this,” I repeated. “Yes you can,” they all told me. “You ARE doing this.”

“I don’t feel good,” I said, not knowing what else to say. The swearing I belted when I was laboring at home had subsided in the company of strangers.

“In what way don’t you feel good?” my midwife wanted to know.

I could tell she was concerned that there might be something more than just the pains of a natural childbirth. “I’m just tired,” I said. “I just want to meet her.”

Although I’d heard it over and over that delivering laying on your back is counter-intuitive to how our bodies are built to birth babies, I found myself on my back. I guess I was technically sitting more than laying on my back. I was propped up by so many pillows that I was in an upright position. An intern held my left leg up near my chest. Tim held my right leg. I remember having a hard time keeping that left leg up while pushing through the contractions. They really had to hold my legs tightly to help give me some leverage.

I remember the midwife and nurse talking about all the hair they were seeing. “Oh she has a lot of hair. There’s so much hair.” They asked me to reach down and feel the top of her head. Yeah, it was pretty cool I guess, but at the moment, I wasn’t having it. I didn’t care about her hair and I wanted them to talk about something else.

I remember feeling as if the pushing took a really long time. However, in retrospect, Tim said it was only about 45 minutes or so. I just kept envisioning the moment I would meet her.  “I just want to meet her. I just want to meet her,” I repeated to myself.

Then, on the final push Tim said, “Oh wow. Oh Wow. Oh WOW” – each time a little louder as he saw her head, then shoulders, then whole body emerge.

The nurse immediately placed her on my chest. Things at this point were a bit of a blur. We arrived at the hospital around 9am and just after noon, she was born. I believe my first words were, “It is a girl isn’t it?” still paranoid that the ultrasound had been wrong. The nurse lifted her back up to double check. “Yes, it’s a girl.”

She was beautiful and there was such a swell of emotion and relief.

Tim wanted to cut the umbilical cord and he did, but I wasn’t really “present” for that moment. I think for our next child, I’d like to delay the cutting and then when we’re ready, I want to make sure that I’m paying attention and present in the moment – the one down side of not having a doula or a written birth plan.

I held Adelaide for a bit and she found my breast. After a while (my memory loses track of time here), they took her to be weighed, checked her vitals and footprinted her. Tim took photos as I rested in bed across the room. Eventually they took her to get cleaned up and rolled in some lunch for me.

I was disappointed there was no photo shoot in the park, and I didn’t get the chance to train my temp at work. I felt guilty for leaving several things up in the air when I went on an earlier-than-expected maternity leave. I imagine I would have felt differently had I been scheduled to be induced and knew what day I would give birth, or if I had reached my due date and was more prepared that she could come any day. In many ways, I know I was lucky to have avoided the anxiety of being overdue. And the hospital staff made sure to tell me that most women would’ve been envious of my quick labor.

When we got home from the hospital, I missed being pregnant (at least parts of it), and I felt as if I didn’t get to properly say good-bye to that stage in the cycle. But, I had a new job. I was a mom, and I didn’t have time to think twice about it. I was doing it and trying to digest it all. In the days ahead, I tried to survive the sleepless nights, to sleep when she slept and to enjoy her bright eyes, many facial expressions and calming coos.

birth story | http://nextlifechapter.com

Born at 12:03pm, 7 lbs, 7 oz

birth story | http://nextlifechapter.com

The birthing suite at Pennsylvania Hospital

birth story | http://nextlifechapter.com

birth story | http://nextlifechapter.com

birth story | http://nextlifechapter.com

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On Monday, September 3, in 100 cities across the country, Improving Birth is organizing a “National Rally for Change on Labor Day.” In Philadelphia, the rally will take place in front of Independence Hall from 10:00 am – noon. The hope is that the movement will bring awareness to the lack of evidence-based maternity care in the United States and will serve as a launch to Empowered Birth Awareness Week.

What is evidence-based maternity care, you ask? I asked myself the same question when I heard the term earlier this week. (Read the info at the link – it’s interesting).

I know that for me personally, I wanted as low intervention a birth as possible. I tried to remain open and flexible knowing that very few birth plans go as planned, but I felt empowered with knowledge. I wanted to try and avoid a cesarean section if I could; I wanted to try for a natural labor without medication. Having never given birth before (and knowing that every birth is different), I didn’t know if I would be able to handle the labor pains without an epidural. I couldn’t predict unexpected complications that might have lead to a cesarean. Armed with everything I had read and was taught in my Mindful Birthing class, I was able to have the birth I wanted.

Not everyone is as lucky, and not everyone has the information to make informed decisions.

According to the Improving Birth website, their mission is to:

  • Reduce the unnecessary induction and unnecessary c-section rate in the United States by bringing education and awareness to birthing families, birth workers and hospital administrators.
  • Promote evidence-based maternity care and support the normalcy of birth.

Their purpose is educating and empowering mothers so they are able to make informed choices about their births,” and their goal is to “reduce the unnecessary induction and unnecessary c-section rate in the US by bringing awareness to birthing families and the people who love them.” They do believe that induction and c-sections can be life-saving interventions when necessary.

From what I understand, the long-term effects of unnecessary inductions and cesareans are just starting to be realized. However, it takes an average of 20 years for proven research (evidence-based maternity care) to become practice. I’m all for education, and I think empowering women (and families) with information about reproductive health and childbirth is invaluable.

Speaking of invaluable, click here for great resources regarding inductions, c-sections and vaginal birth after a cesarean (vbac).

It’s not about judgement. It’s about education. Join me on Monday at the Philadelphia National Rally for Change, or find a rally location near to you.

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We’ve got a crib! And a dresser with LOTS of clothes in it. (Seriously, this girl is going to be so well dressed.) And we have paint on the wall, too.

Tim set the crib up in the living room a few weeks ago, and it doesn’t fit up the stairs. If it will fit, it needs to be lifted above the banister, and I won’t be much help with that. It’s still sitting in the living room, but it can’t stay there. Uncle Ben, are you reading this? Looks like we need you to make a visit to Center City.

Tim told me he’s getting even more excited. Having the crib set up makes it seem more real. Our little girl is going to sleep in that. The classes we’ve taken have been a wealth of knowledge, too.  Even though they’ve been on Tuesday nights and I’ve had to miss the last four weeks of knitting with my girlfriends, I’m really glad we decided to shell out the money and take them.

For the first three weeks we took a Mindful Birthing class at our hospital. It’s specifically designed for couples who are considering natural childbirth with a midwife and prefer a low-intervention labor and delivery. Tim and I both learned a lot about the woman’s body and what happens during labor. Our bodies are made to do this!

We also learned to stay home and labor as long as possible.  When people get to the hospital too early, they are often sent home or if they are admitted but not far enough along, it’s the start of inductions and other interventions that have a domino effect.  Being induced brings on stronger contractions. The stronger contractions lead to more pain and the request for an epidural.  The epidural slows down labor which then requires more pitocin for induction.  Then, a stronger epidural line. At this point, many women still aren’t progressing fast enough and that puts strain on the baby’s breathing and the heart rate lowers causing them to require an emergency c-section.

If I can help it, this is not the route I want to go. Our Mindful Birthing instructor told us about the 4-1-1 rule.  Don’t go to the hospital until your contractions are 4 minutes apart, they last for 1 full minute and this has been happening for 1 hour.

Last night, we took a Breastfeeding class.  Tim wasn’t sure why he would need to be there, but partners were encouraged to attend and he was a good sport.  My friend Leslie who is due 6 weeks after me also signed up for the course.  Her husband wasn’t too keen on going either, but he said he would go if Tim went.  So, they were both there for support.  The instructor said that one of the main reasons she likes partners to attend is so we’re more likely to remember the information.  If I’m too exhausted or in panic mode, perhaps Tim will remember some tip from the class that will be helpful to me.

The Breastfeeding class was just a one-time class from 6:30 – 9:00 pm taught by a lactation consultant at my hospital. I’m so happy we decided to go (and I’m grateful Tim came with me). Tomorrow night we’re taking one more class.  It’s Baby Care Basics where they’ll cover diapering, burping, bathing, swaddling etc… Then, we’ll be totally prepared, right?  Ha!

Today I’m 36 weeks and 4 days. Only 3 days until I’m full term and just 3 and half weeks until my August 13 due date.

While birthing still seems overwhelming — it will likely be the hardest thing I’ve ever done in my life — I’m feeling prepared and really good about breastfeeding. Bring it!

 

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I had my first appointment at the midwifery practice on Monday – finally!  I’m 28 weeks so it was also the day for my glucose test and RhoGAM shot.  (At this week’s Tuesday night knitting I realized that everyone is as confused about the RhoGAM shot as I was, so I’ll explain that in a following post.)  When I made the appointment, they told me to make a half day of it and I’m glad I did.  I arrived 20 minutes early for my 9 am appointment and didn’t get to work until almost 1 pm.

When I met the midwife she asked how I’d heard about the practice.  I told her a friend had recommended them, and also mentioned how hard it was for me to get my paperwork transferred there.  (If you missed that  frustrating tale, you can catch up here.)

To my surprise, the midwife explained that since my previous practice was also part of the University of Pennsylvania Health Care System, all I really need to do was sign a release form (which I did back on March 24!) and they could pull up all my records on the computer.  They didn’t really need hard copies of my records at all.  I knew it!  The midwife said she would talk to the receptionists and make sure they all knew this.  I kind of doubt she’ll remember to mention it.  Some other innocent soul will have to go through the same rigamarole as me.  So annoying!  I almost wish she hadn’t told me.

After all I had been through to get the appointment, it was pretty anti-climactic.  The baby’s heart beat was good.  My blood pressure was also excellent.  My appointments will now be scheduled every two weeks instead of once a month.  I’m in the third trimester!

After my quick consultation/examination, I had to walk a few blocks to the hospital to get some lab work done.  First, they took four vials of blood.  Then, as part of the glucose test for gestational diabetes, I was given a bright orange drink.  It looked like Tang or orange Gatorade.  It didn’t taste much different, kind of like a VERY sweet Kool-aid.  It was actually better than I thought it would be.  I finished the drink at 10:53 and had to wait an hour with no food before coming back for them to take more blood.  I started to feel kind of dizzy/headachy as my body tried to process the sugars. It was almost my lunch time, and I was getting hungry. I also felt guilty for being away from work for so long.

After the hour was up and I gave the vial of blood, they sent me up to the 7th floor and gave me the RhoGAM shot.  They didn’t administer the shot, they handed the shot to me in a little baggie. I had to then walk it back to the midwifery practice where a nurse administered it into my upper arm.

It was a long day, and I felt a bit “off” the rest of the afternoon. The day was made even longer because we had tickets to see the Phillies play the Cincinnati Reds that evening. It was still a fun night.  The Phillies had an exciting 3rd inning and led 9-0.  The rain held off (with just a few sprinkles), and we won 10-3.  Plus, it was dollar dog night!  Who would pass up the chance to get $1 hotdogs at a major league baseball game? Not this girl.

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I am so frustrated.  I just don’t even know what else to do at this point.

A week ago Monday, on April 18, I started a new post and wrote those two sentences. Then I saved as a draft and left it. By Thursday I was nearly blubbering into the phone as I tried to explain my situation to yet another person on the other end. I don’t understand why our health care system has to be so hard.  And bureaucratic.  And expensive.

I’ll focus on the “expensive” in a later post, but for now I’ll concentrate on the “hard” and “bureaucratic.” For nearly a month I’ve been trying to get my paperwork transferred from the Family Care practice where I am currently to an Ob-Gyn/Midwifery practice.  I received my initial prenatal care with my primary care physician knowing that I would likely change mid-pregnancy. That was probably my first mistake.  As early as 10 weeks or so I was “looking into” this midwifery practice and had pretty much decided that’s where I wanted to be.  I liked the idea of having a midwife and having a natural birth in one of the hospital’s birthing suites.  I liked that the midwives in this practice deliver at Pennsylvania Hospital, so I will have access to their Ob-Gyns, epidurals and other measures should they become medically or otherwise necessary. I’ve obviously never done this before, so while I would like to try a natural childbirth and stay away from a C-section if at all possible, I am trying to be open to other options and the reality that birth plans don’t always go as planned.

At my 12-week ultrasound appointment, they went ahead and scheduled me for my sequential screening’s second blood test (at around 16 weeks?) and my 20-week anatomy ultrasound.  Since I had a good experience at my first ultrasound (and since I had agreed to be part of a University of Pennsylvania placenta study), I decided to remain under the care of my primary care physician through that 20-week ultrasound.  I didn’t try to get an appointment at the Ob-Gyn/Midwifery practice until I was nearly 19 weeks. In retrospect, this was another mistake. When I called to see if I could get my paperwork transferred to the Midwifery office and schedule an appointment, the receptionist said they usually don’t accept new patients past 16 weeks. Since I had been under regular care, the receptionist said the decision to accept me would be up to the midwives after my paperwork was transferred and they had reviewed my files.  (Apparently, some people try to come into the practice after 16 weeks without having previously seen any doctors–I had been having regular care since 8 weeks.)

The receptionist at the Midwifery practice was kind and told me I could go into my doctor’s office and fill out the release forms, or I could go to their office, fill out the forms, and they would fax it over to my practice.  Knowing the over-worked, never-particularly-speedy-or-responsive office of my primary care physician, I decided to go to the new office and fill out the paperwork.  That was on Thursday, March 24.

To fast forward through all the small details, I was told it would take 7-14 days for the paperwork to get transferred.  I thought that was completely ridiculous.  The practices are both part of the University of Pennsylvania Health Care System – why would it take so long?  I wanted to just go to the office and photocopy the documents myself. Still, I accepted the red tape as part of the process and decided not to bug them until the end of the 14 days.  Of course, the 14 days came and went and no phone call.  I called to the Midwifery practice to follow-up, and although my contact on the other line was always friendly, she always said “no,” they had yet to receive the paperwork. Finally, I got confirmation that the paperwork was mailed on April 7.  The receptionist told me it could take a week (April 14) for the new practice to get it in the mail.  Okay, at least it was in the mail. I decided not to call back until after the 14th.

Meanwhile, I had a routine appointment scheduled with my primary care physician on April 14.  I decided to go as planned because I didn’t want to get behind on my care, especially if I wasn’t able to get into the new practice for some reason.  At that appointment, my primary care physician said she could see in my file that this other practice had requested my paperwork and that it had been sent.  She thought 7-14 days sounded absurd and when I expressed some concern that my April 14 appointment wasn’t going to be in the paperwork that was sent over, she told me I could call her and she would make sure that it got to them quickly.

I waited until Monday, April 18 to call the Midwifery practice and follow-up.  I figured surely they would have received my paperwork by this point, and while I knew a midwife would have to review my file before anyone would call to schedule an appointment with me,  I just wanted to confirm that they had indeed received it.  When I called on Monday, they said “no.”  They still hadn’t received it.  That’s when I opened my blog and drafted the first two sentences of this post.  Tears of frustration overflowed, and I closed my office door to compose myself. Then, I called the emergency number my primary care physician had given me.  I felt a little silly for calling her cell phone for such a request, but at this point I had had it.  I nearly broke down as I told her they still didn’t have my paperwork.  She told me she was going to look into it for me, and called back a little while later saying it had been faxed over.

When I called the Midwifery practice the following day, they still didn’t have it. They didn’t seem to know what I was talking about.  I like my primary care physician.  She went out of her way for me. I don’t think she was lying. Most everyone at the Midwifery practice was friendly, but there was obviously a communication breakdown somewhere.

I called my primary care physician’s emergency line again and told her they still didn’t have my paperwork and that they had no recollection of speaking to anyone from the Family Care practice.  At this point I think my doctor was pretty perturbed herself.  She said she would fax it over personally that night.

The next day, last Wednesday at this point, I didn’t get a chance to call the office until almost 5:00pm.  My regular contact wasn’t working, and the woman I was supposed to speak with was already gone for the day.  I would have to wait and call again on Thursday.

I called early on Thursday morning and the receptionist who has been my main contact was out of the office again.  I was trying to be assertive, but it’s likely  I was also being slightly bitchy. The receptionist informed me I was never to call that direct line again.  Apparently, the number I had been calling was a doctor’s only line.  I had called it at least a dozen times as I misunderstood it to be the direct line given to me by my contact.  Never before had anyone expressed  that I had the wrong number, and at this point it was more than I could take.  When she transferred me to “records,” I was already beginning to cry – my voice cracked as I introduced myself and it was clear that I was at my breaking point.  Although I felt embarrassed for not keeping my composure on the phone, I realized the woman deals with pregnant women everyday and is probably used to them getting emotional.  Finally, she confirmed that “yes,” they had indeed received my paperwork.

Amen.

 

Sorry this post was so long-winded. I didn’t intend for it to be so detailed, and clearly it was more for me than anyone reading.  However, if there are any other first-time mom readers who are considering changing practices, I’d definitely recommend trying to put things in motion sooner than I did.  I’ve also heard that someone in a similar situation went to her doctor, told them she would be traveling the following week and requested a copy of her paperwork to take with her on the trip.  They released the paperwork to her within days, and then she copied it and handed it directly to the new practice.  I don’t know if this would have worked for me; I have the feeling they only would have accepted the “official” paperwork straight from the doctor’s office, but I guess it would be worth trying.

This process has left me exhausted.  When I finally spoke with one of the midwives on the phone last Friday, she asked me what I was looking for in a midwife practice.  She was friendly/helpful/personable.  I think we’re on the same page, but I won’t have my first appointment for another four weeks. Now that I’m in, I hope my experience there is as positive as I’ve built it up to be.

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