Katie & Avery’s Story
I realize now that all of my childbearing decisions, up until precisely seven weeks before the birth of my third child, were based in fear. My first daughter was born in the hospital for two specific reasons, the first of which is that I was consciously, openly terrified; I was scared that I would lose her, as I had five previous early term pregnancies, and I was afraid that the diagnosed medical issues related to my fertility would cause me never to be able to have a healthy child. The second reason was that I made several, what I only now understand to be, faulty assumptions:
1. There really were no other viable options to hospital birth. I was only vaguely aware of alternatives, and had I been pressed to give more thought, I likely would have guessed that only a fraction of a percentage of women would choose these things, and they were likely more the result of circumstance and lack of resources than actual educated preference.
2. In the hospital with an obstetrician was the safest way to have a baby.
3. My OB's greatest concern was for the health and well-being of my baby and myself.
4. By way of agreeing to every test available, volunteering to be repeatedly examined, take medication, and make use of all available technology, I was further ensuring the health and safety of myself and my child.
5. Doctors know best and there was no reason to question any suggestion they made or research anything on my own.
6. The only way to be able to bear the excruciating pain of childbirth was to be entirely numb.
I got exactly what I asked for: a medically managed birth. This included: a sonogram at every obstetrical visit; hospitalization and medication for suspected pre-term labor; an external cephalic version for a fetus that was breech at 36 weeks; Demoral and an epidural (neither of which "worked" and because I had prepared nothing else, I suffered tremendously, just as I had expected); an amniotomy which caused the baby to decend in an improper position which lead to a forceful forceps delivery (by a doctor I had never met), which lead to a 4th degree tear which necessitated innumerable stitches, which lead to an infection, which lead to an extended hospital stay during which I felt too sick to care for and nurse my baby, which lead to supplemental formula feeding.
I had gone in professing that I did not want any of this...but the choices I made did not reflect this preference.
When it was all said and done, I thought it didn't matter: I finally had a healthy (though bruised and swollen) baby after years of desire and infertility, and I hadn't suffered any permanent physical damage from the delivery.
For the birth of our second child, two factors had shifted: we did not want to repeat our traumatic experience and we no longer had group health insurance which would cover the cost of such a medically managed pregnancy and birth. So, for the first time, I began to become aware of the alternatives. We sought out and visited the only local birth center to discuss with the midwives if we were even candidates for out-of-hospital birth. This is the first time I ever had any reason to become aware that the so-called complications I had experienced were likely caused by the medical management. Where before I had assumed "Thank God I had access to all those doctors and I was in the hospital...." my thinking was beginning to change to "I can't believe what THEY did to me!" It is only now that I understand it is more accurate and necessary to admit "I can't believe I allowed them to do that to me."
We knew immediately we preferred and believed in the midwifery standard of care and we became comfortable with the idea that history would not necessarily repeat itself. We knew that we could never afford (in every sense) to have another baby in the hospital, but we also felt the birth center we had toured was not the best place for us to bring our yet un-conceived child into the world so we chose homebirth, and after interviewing several, finally found just the right midwife.
A short time later I discovered I was pregnant...without any of the struggle we had experienced the first time. We were shocked that she spent as much time talking with us as our OB had spent making us wait. When we asked questions, we were referred to information and encouraged to educate ourselves, rather than chuckled at and dismissed. From the beginning it was an entirely different experience: we felt respected and cared for. It is only now that we understand we should always have expected, sought after, and even demanded this level of care.
Then I became afraid that I would have another miscarriage. The midwife was comforting, offered suggestions on "actions" I could take to try to ensure the baby would stay put, but told me that if a loss was going to occur, there was really nothing we could do about it. This was hard for me to take, but I really felt I had no choice, so I went along with it. We were surprised to learn that we did have a choice in whether or not to undergo standard tests, rather than angry someone would have dared suggest we give them decision-making rights when it came to our pregnancy, our birth, and our baby.
Early contractions began, as they had the first time, and, again, we were comforted, reassured, and ultimately did nothing. I knew I couldn't afford to "double-check" with a doctor or go to the hospital, just to be sure, so I went along with it. At each new experience, I couldn't help but think "shouldn't we DO SOMETHING?" Everything she was saying made sense, I knew I needed to trust her, but I was so afraid. Ultimately, the entire pregnancy was completely uneventful. My breech baby turned herself at 38 weeks this time, without any force.
We attended Hypnobirthing classes toward the end of the pregnancy and, while I believed the overall premise, I thought: Yeah, I've had a baby before, and I know what childbirth is really like. I listened to the tapes every night, I practiced the scripts, and I hoped if I just worked hard enough at it, there might be a chance it could work for us.
On the day that Jamie was born, I felt ready. My sister-in-law picked up McKenzie, our older daughter, and we waited for the baby to come. Several hours of 10 minute apart contractions. I began to get anxious...why was this taking so long?! I kept waiting for them to be 8 minutes apart, then 6, then 4...I just wanted her to hurry up and come out! I was consumed by considerations over everything that was going on around me, including that I had been away from McKenzie for longer than I ever had before, and though I knew she was perfectly safe, I was watching the clock, ready for her to come home. Finally, we asked for McKenzie to be returned since this was clearly going to take forever. Then, our one and only toilet broke just as the castor oil I had ("secretly") taken in order to speed things up kicked in. Just as soon as McKenzie came home, the first "real" contraction hit. I began screaming, McKenzie began screaming. Calls were made so that she could be picked up again. The temperature of the water in our tub wasn't maintaining...there was bailing and water boiling...I began to try, for the first time that day, the hypnosis techniques we had learned. But I was thinking: Okay, this is it, this is the excruciating pain I knew I would experience, no matter what these people say, and just like last time, I likely have at least 16 hours of this ahead of me, and I'm not going to be able to handle it, but I have no choice.
By the time we finally called the midwife to come an hour and a half later, she almost didn't have time to unpack her things. She stepped into all the chaos and quickly realized there wasn't much she could do to help me at that point because I wasn't willing or any longer able to put effort into changing the situation. Finally, she told me "if you need to make that much noise, growl instead of scream, so at least all your effort won't be wasted...." I was very concerned that I was failing and that I was disappointing everyone else. But all I wanted was another healthy baby, and I believed that circumstance dictated that this was the only way I could get that.
Minutes later, our second child was born. Immediately, I was aware of everything...conscious enough to bring her out of the water and into my arms, conscious enough to appreciate that, while it had hurt like crazy, I had been able to really experience the birth of this child, rather than being a removed observer. I thought (and said) "if I had known it was almost over, I wouldn't have freaked out like that...it wasn't so bad after all."
My first daughter had been 7 pounds, 12 ounces, and the OB present at her delivery blamed all the tearing on her size, saying specifically: "I wouldn't recommend you have them any bigger than that." This child was 8 pounds, 10 ounces, and the stitches were optional.
When we conceived our third child, common sense and experience told us that we needed to get back in touch with our beloved midwife. This time, we did have the insurance and resources to choose either, but we believed that our second pregnancy and birth were clearly better and that was the experience we wanted again, even though the financial cost was greater (our hospital co-pay was roughly half of the midwife's fee). But now that we did have the coverage, I insisted on "just one ultrasound" to find out the sex of the baby and make sure it has all it's parts, so that if something were wrong I could be prepared. There was no danger in that. I had subjected myself to a sonogram at every single obstetrical visit the first time, and that child was just fine....
We were told we were having another girl. We were delighted, but sometime later when the official report crossed the midwife's desk, it suggested that there was evidence of placenta previa. She outlined our options. I chose the repeat sonogram because if I was going to have to have a cesarean, I wanted to know in advance.
In fact, I was not prepared for what happened next.... The following day, our midwife called to say that the ultrasound technician believed there was a problem with the baby. It appeared that, while I was now about 29 weeks pregnant, the baby's body was the size of a 19 week fetus, and her head was measuring 39 weeks gestation. I tried to picture what the baby she discribed looked like as I checked on my very normal looking seven-months-pregnant belly. She proceeded to outline my options and to attempt to discuss with me what this might mean and what I might want to do about that. However, throughout the conversation I was frantically searching for my insurance company's provider listing and flipping the pages to find a Perinatologist. As far as I was concerned, I needed to get to a doctor as fast as possible....there was something wrong with my unborn baby and I would do anything and everything I could to help her, fix her, save her, protect her...ANYTHING. And it was clear to me that the only way to do that was shift everything to medical management...I wanted every test, every procedure, every medication that might help the child that was inside of me whom I was being told was damaged in some way. I spoke with an OB who told me it was likely that, since this problem was not apparently present at the first sonogram, it was likely the result of a virus I had had. To me, this news was the most frightening because, if they couldn't specifically identify the problem or it's cause, there would be no way to predict the outcome. My husband and I discussed things like: If she was stillborn or died shortly after her birth, should we have a funeral? Should we go ahead with our plans to decorate the nursery, or would it just be too hard to have to take it all apart if we never got to bring her home? How would we, as a family, handle raising a severely deformed and impaired child?
But at the same time, we tried to comfort ourselves with thoughts that the only explaination for such information was that it was completely wrong. There was no way that there could be something wrong with our baby...no family history of birth defects....we were very careful, responsible, knowledgeable parents, and we had done everything "right" with the pregnancy.
Three days later we met with a genetic counselor who took down our family history and a Perinatologist who performed a more detailed, comprehensive ultrasound. It was confirmed that there was nothing in our history to indicate a propensity for any sort of problem, and that their findings were not as significant at the original testing had indicated...this might be a normal variation. Because of that, I chose not to undergo an amniocentesis...no reason to chance a preterm delivery since the capabilities of the test were clearly limited and it wouldn't change anything anyway. I did agree to return in three weeks so that another sonogram could be performed in order to graph the baby's measurements and give further information regarding whether or not there actually was a problem. We were so relieved and chose to believe that this was all likely a mistake. But I still had every intention of birthing in the hospital, surrounded by doctors and technology, just in case.
I informed the midwife of my intentions, and she again outlined our options....ultimately saying that she would be there to support us in any way we needed. I was frustrated that she would suggest there was a choice in the matter at all...there might be something wrong with our baby...how could she even suggest that we might ignore that. It was clear to me it would be an entirely irresponsible decision not to go to the hospital, but I agreed it would be useful for her to be our doula.
We went to our next ultrasound, expecting everything to appear okay. We held our breath almost consistently throughout the 90 minutes of testing. The technician measured and re-measured all of the baby's long bones. Our hearts sank and tears rolled out of the corners of my eyes as I saw the numbers she was getting pop up on the screen...I knew it was not what we were hoping for. Down Syndrome was suggested. Dwarfism was a possibility. The only way to indisputably confirm or deny either was by way of amnio, but again, I knew the capabilities of the test were limited and the results wouldn't change anything. I was assured I could expect a vaginal birth because the head circumference appeared to be within a reasonable range, and I was not a first-timer.
I wanted to research everything I could, but I didn't have enough information to do that. The searches I could conduct on the internet were too broad and the information I was receiving too frightening.
Then several things began to happen all at once. We started seeing the doctors and midwives who we expected would be involved in our delivery and care; we met with everyone we could to make our beliefs, wishes, and concerns known...and we were reassured at every turn that our desires were reasonable and would be respected...BUT...BUT...but there was alway some reasonable sounding reason to submit to a test that I had previously believed unnecessary...of course everything would be fine, but just in case...
We continued to see our midwife and through discussions with her, we would return to the hospital refusing the testing because it was confirmed unnecessary in our minds. We began to understand the kind of birth we were going to have under the circumstances...similar but a magnified version of our first, awful experience. We began attending our "refresher" Hypnobirthing classes and within the practice of the Fear Release script, I was invited to imagine a snapshot of my ideal birth. I pictured what I knew I wanted, hoping that would somehow be possible. And I was offered an opportunity to purchase Kim's book.
I started reading that very night, and my first thought was "well that was a waste of money." I mean, I believed what she was saying, but I knew it didn't apply to me. I aleady knew what hospital, medically managed birth was like, I knew what homebirth with midwifery standard of care was like, and I knew which was better. I had experienced both firsthand, but this time, I did not have a choice. I was no longer one of the healthy mother-babies that she was referring to, and, yes, I believe that 97% of the time homebirth with the assistance of a midwife is the ideal, but I was now in that 3% where it is not possible. I kept reading because I found it all very interesting, and I thought maybe I could use what I learned to help another mother someday. All the while I kept silently defending why this information did not apply to me.
She was able to describe the circumstances of my first birth experience, and she didn't even know me. I saw my sister, my friends in her writing. I began to become angry that, not only do these things happen to women, not only do women allow them to continue to happen, not only do most women not realize that these things are happening and they have the right and responsibility to expect better, but angry that I DID NOT HAVE A CHOICE. I was going to have to go to the hospital and have this baby in conditions of which I did not approve.
The same message came back to me over and over again: What is it that you're afraid of? WHY are you making these choices which are proven inadequate and unacceptable in many ways....WHY? As if she were speaking directly with me, I was arguing:
Of course I am afraid! There is something wrong with my child! What if, I MEAN WHAT IF?! Do you understand that we are talking about the life, health, and safety of MY CHILD!....I have to be where she can get the help she needs, just in case.
Over and over again, the reader is encouraged to explore the fears, face the what ifs, and expose the "just in cases". And, finally, I began to think that maybe I could benefit from doing that. Sure, my situation was somewhat different, but it couldn't hurt anything to go over these things...at the very least, I would confirm in my own mind that I really did need to be in the hospital, I would arm myself with facts to use as the doctors attempted to convince me that they needed to do things to my baby, as I knew they would, and then, whatever happened, I could know that I DIDN'T HAVE ANY OTHER CHOICE.
We continued to undergo ultrasound testing and we were told that it was likely some form of dwarfism, likely caused by a genetic mutation at conception, for no known reason, as this was one of the most ancient birth defects on record. So I began to research as Kim demands parents do.
The ultimate result of this quest for information through medical research, interrogation of our medical team, acknowledging and facing my fears one at a time, and analyzing the behaviors of the medical staff which was always contradictory to their words, I began to believe that, not only did I have a choice in the matter, not only was it my right and responsibility to question everything and become informed, but my baby, even if she had the problem they suggested, would be better off at home. To have her at home was the only way to ensure our caregiver...because based on the limitations of the medical system, there would be no way to know who would deliver our baby. If an unknowledgeable care provider employed the use of inappropriate tools, he or she could cause irreparable damage to the child especially if she had the problem that was suspected. And I began to understand, from my research and from what I was seeing with my own eyes, that the biggest concern of the medical staff was to do anything and everything they could to ensure that they covered all their bases so that I could not sue. It became clear that the motivation of our midwife (who did not have an administration, insurance companies, lawyers, and superiors to answer to) was to ensure my health and the safety and well being of my daughter...because she really knew us and really, genuinely cared about us. That's the kind of respect I wanted for my baby. That's the kind of dignity and care I knew I had the right and responsibility to seek out and expect. I knew what I wanted for my daughter, ESPECIALLY if there was something "wrong" with her, not in spite of, and now I had the tools I needed to take the steps to ensure I got the result I desired rather than giving in to something in which I could not believe because I was too afraid.
Because I now had facts, I no longer needed to fear ambiguous possibilities because I had real evidence of the potential (or lack there-of) for complication. I began to regard my daughter as a much anticipated and welcome addition to our family rather than a medical anomoly reduced to numbers on a graph. I began to believe in the possibilities and look forward to her arrival, rather than fear disaster. I realized my choice was an entirely responsible one because I wasn't going in blindly, simply hoping despite the situation, things would turn out okay...I had real information to support my decision. I knew that all options were available to me and I was making the one that best reflected our desired outcome. I felt complete confidence in the abilities of our caregiver to assist us in the decision making process and to help us gain access to medical treatment should that be necessary. I knew that if we ended up in the hospital undergoing medical testing and treatment, it would be only because the baby needed it and not simply because it was available and part of standard procedure. I began to allow myself to envision the birth I desired and believe that it was possible because I was making the decisions that were necessary to realize that vision. I addressed every one of my fears about this particular pregnancy and birth in general. I developed a level of courage and confidence I had never experienced, and actually believed that I was more capable and qualified to make decisions about the future of my family than anyone else. And I realized that I had the right to get off from the roller coaster of medical care that I didn't want to be on anymore. Though I had initiated it, I still had time to make it stop.
I said NO MORE. No more tests, no more graphs, no more guessing. We're having a baby. We're going to be excited about that. We have all the information we could reasonably have which is necessary in making our decisions. OUR DECISIONS about our baby and our family.
Then we went back to low-tech. We trusted in ourselves, nature, and birth. We were aware that there was likely something uniquely different about this particular child and believed, based on well researched facts, that it didn't matter. We would face what happened when it actually happened.
I went into labor three days after my estimated due date. I had the older children picked up, knowing they would be safe and well-entertained. And then we waited. We spent the day almost like it was a long-awaited grown-up date, doing things together that we, as the parents of small children, rarely have the opportunity to do alone. We went to breakfast....we rented and watched movies...and all the while, I knew that this was the beginning of the process of welcoming our new daughter and we had all the time in the world, so whether it took hours or days, I vowed to be patient and allow things to unfold as they were meant to. I trusted my body and my baby completely. I was not afraid...I knew we could handle anything that arose, and I would not waste time on the consideration of those possibilities unless they actually presented themselves. I relaxed in the water of our birth tub. I listened to the Hypnobirth scripts on CD. And then, suddenly, I knew it was closer. I knew that things were getting to the point where more attention and effort on my part were required. We called the midwife to come. I reminded myself that everything I was feeling was normal, natural, and perfectly safe. And in the dim light and the quiet with music playing softly in the background, our baby girl was born. She was brought up to my chest, and I held her to me in a picture that was exactly what I imagined it would be. And I knew without any confirmation that she was fine and I told her out loud that I was so glad that she was finally here. Avery was 8 pounds, 8 ounces, but at only 18.5 inches, she was a fat little baby with a 14.5 inch head circumference. Again, the stitches were optional.
Three weeks later, when we were ready, the diagnosis of Achondroplasia, which is the most common type of dwarfism, was confirmed by a specialist. We suspected this because of our advanced knowledge and because of the characteristics we recognized when we saw her. Ultimately, it didn't matter anymore because we knew what we needed to already: that we had a beautiful daughter who was healthy in every way that was important.
I no longer believe in inappropriate birth technology, including unfounded prenatal testing. I've often heard, and used to myself say, that it's better to be prepared. In my situation, there was nothing for which to be prepared. In the end, we did exactly what we would have done if we never would have known, our choices were just a lot more difficult to come by. Would I have been shocked when I birthed a child who was not exactly as I had expected? Probably. But I have my doubts as to whether or not we would have noticed right away, if we hadn't known to look for anything. And once we did discover that she had something different about her, we would have had immediate access to the specialists who could have immediately answered our very specific questions with very specific information that actually related to our specific living breathing child. Instead we experienced much ambiguous information for which there was absolutely no perspective. I do appreciate what I gained from the experience, and I know that I am a different and better person for it, and I know all this will have a profound and beneficial effect on my family's entire future. But the emotional cost was very high...not just for me, but for my family, our parents, our siblings...all those who love us and were as devastated as we were when we first got the news and agonized during the weeks remaining until her arrival. It's hard to think what could have happened, what might have happened, if Kim had not come to us when she did and enlightened us and given us the tools to make better decisions. The three months leading up to our new child's birth should have been very exciting for all of us, but we allowed ourselves to be robbed of that, and to this day, I feel still traumatized by what we went through thinking we might lose this very real, very much wanted baby we have today. The simple fact that it all ended well does not negate the immeasurable fear and sadness we experienced.
I am very grateful to Kim for her words of wisdom. And, importantly, I am grateful we were blessed with a midwife who stood by us through everything, as we were challenged in every way, and was so willing to be there for us to support all our decisions, guide us when she could, and support whatever we believed was right for us, despite this level of uncertainty we invited into the situation. I attribute the large majority of Avery's well-being today to our midwife's committment and skill in her practice. I know our baby would have been exposed to unnecessary and even dangerous things that would have prevented her from being as strong and healthy as she is were it not for the fact that these two women have chosen to dedicate their lives to helping families like mine.
I would encourage anyone who has taken on the responsibility of caring for pregnant women not to allow themselves to become discouraged by current standards and realities in our society because there are women out there, just like me, who need you, and who are listening, and what you have to say has the potential to make a very real, very lasting difference.
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Art Copyright © 1996-1999 Ann Stretton. Intellectual material © 1997-2004 Kim Wildner.
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