Here is my story.
I’m now “term” and could have my baby anytime in the next month. Well, I’m early term anyhow – but within the time frame when babies are typically born and when homebirth is considered safe. Some babies arrive all on their own ‘earlier’ than they’re ‘due’ and some arrive ‘later’ than they’re ‘due’. The due date is just a guess in a month long window.
Because of the increasing blood pressure and concerns about the potential small size of the baby, having a homebirth was on the line. Having worked as a doula for more than 10 years, I was averse to having a hospital birth unless there was a very clear indication that the benefits would outweigh the risks. Ontario midwives only attend homebirths where the pregnancy is deemed low risk. High blood pressure can be the first silent symptom of preeclampsia, which can lead to HELLP - a life-threatening condition that is only ‘cured’ through the birth of the baby. Untreated, HELLP results in both mother and baby dying. Preeclampsia & HELLP aren’t something to take lightly, and both require medical intervention in a hospital setting. Knowing all this, knowing my own body, and knowing that the preeclampsia bloodwork was completely normal, I remained confident that baby and I were healthy and that homebirth was still a safe choice for us. BUT the bottom line in reality was that if I wanted a homebirth, I needed to have the baby before noon the next day when it would be time for me to go back to the hospital for follow-up. I wasn’t opposed to a hospital birth IF it was truly indicated because baby or I were experiencing complications that required medical intervention. I also recognized that even under the care of midwives, giving birth in the hospital changes everything. Practically speaking, the power rests with the hospital and their policies and if the birthing woman wants something the hospital doesn’t support she has to fight for it. Just knowing that a fight may lie ahead triggers the release of adrenaline, which works in direct opposition to the oxytocin needed to allow labour to progress well. The hospital setting interferes with the optimal birth process in a myriad of ways which I personally considered to be risks so it wasn’t something I was going to choose unless absolutely necessary.
Before leaving the hospital I asked my midwife to do a good stretch & sweep for me to encourage my body into labour sooner than later. A stretch & sweep isn’t a guarantee, and it isn’t entirely risk free, but *if the body and baby are ready* a stretch & sweep will often allow labour to begin within 48 hours and the risks associated with it are minimal. Cramping and spotting are the most common risks. It is possible that your water will break in the process but that is uncommon. It had been effective for me when I gave birth to Levi 4 years prior (in combination with evening primrose oil and homeopathics) so I was hopeful my body would respond positively again.
I moaned. I walked. I swayed. I held onto Nathan. Hope offered to go home and have someone else come be with Levi for the birth as had been the plan but things were too intense for me to consider changing who was with us. Kim our doula arrived around 10:15pm and immediately stepped in to offer her support. With Hope caring for Levi, and the house organized, Nathan was free to labour with me which is something we missed in my labour with Levi and had really hoped for this time.
About 10:30pm our midwife arrived. She knew right away that things were progressing quickly and went straight to work setting up. Nathan was my anchor – I leaned against him constantly. Levi was hanging out with Grandma in the living room, and asked to watch Call The Midwife (an appropriate choice. lol). Of note – our house is pretty open concept and under 1000 square feet so even in the living room Levi was still very much a part of the birth. From time to time he’d have a question for me which I did my best to answer as I wanted him to feel like he was an important part of what was happening.
Soon I was feeling a bit of pressure at the peak of contraction-expansions. Our midwife asked if it was time to call the second midwife but I told her not yet. She asked if I wanted her to check my cervix to decide if it was time to call the second midwife and I agreed. Part of my plan for birth was no vaginal exams except possibly to assess whether we needed to call the second midwife. I was fully dilated so the call was made. Another contraction-expansion arrived, bringing immense pressure with it. I moved to my hands and knees and told everyone the baby was coming. My body was doing all the work – there was no need for me to actively “push”. While that may seem unusual (to not push for hours), when birth conditions are optimal Dr. Michel Odent refers to what he calls the Fetal Ejection Reflex where essentially the baby is born rapidly, with no coaching from others and with little to no added effort on the part of the mother. It simply happens. The mother is typically in an upright/bending over posture, and the placenta usually follows quickly. Elevated blood pressure can result in a very intense rapid labour too, and so can the homeopathics I used. Whatever the cause – labour was moving fast.
The placenta was circumvallate, which means that when it was developing the amniotic sac doubled back on itself, pulling the placenta with it so that it covers less surface area in the uterus than is typical. A circumvallate placenta occurs in roughly 1-2% of pregnancies, for unknown reasons. It is theoretically detectable by ultrasound but most of the time it is missed. Depending on the severity (ours was mild), a circumvallate placenta can bring with it an increased risk of pregnancy loss (miscarriage or stillbirth), pre-term birth, placental abruption, subchorionic hematoma, low amniotic fluid levels, and IUGR.
Before long everything was cleaned up and cleared away. The trash and laundry were gathered. The bed was made. Our midwives and doula and Grandma Hope all headed home. And we were ready for bed. Our family was now 4 instead of 3 and we were grateful.
Lutka lost 3.5% of his birth weight in the first couple days (7-10% is common) and was back up to his birth weight by day 4 (newborns should usually be back to their birth weight by days 10 to 14). At his two week visit Lutka weighed 6lbs 2oz and by 4 weeks he was up to 7lbs 10oz. He doubled his birth weight by 2 months, which is usually expected at 6 months, and tripled it at 6 months, which is usually expected by 1 year. Today he is 1 year old, and weighs 20lbs.
Our story wasn’t necessarily typical, and some of the choices we made were outside the recommended standards of care. Many factors influence how a particular birth story unfolds and having an honest, respectful relationship with your primary healthcare provider - so that you can work together to achieve the optimal birth *for you*- is key. Every mother-baby is different. Our history, education, values, support systems, how we assess and weigh risks vs benefits etc all impact the decisions we make and ultimately what our births will look like. The choices that are best for one mother-baby aren’t necessarily the best choices for another mother-baby, even when their stories look similar on the surface.
Our choices weren’t all standard, however they were made consciously and after having explored information from a wide variety of sources. To fully embrace the idea of “informed consent/choice” you must be willing to fully OWN the choices you make - and their outcomes – whatever they may be. That includes the good outcomes, the bad outcomes, and the unexpected outcomes, and it includes recognizing that if your primary healthcare provider truly and deeply believes that your choice is too risky for them to support, s/he reserves the right to not take you on as a client, or to transfer your care to a more suitable healthcare professional. We are grateful to our midwives for walking with us even though the choices we made for our family stretched the status quo.