Transporting immediately after Layia’s birth was a very odd experience for me. My head was practically spinning, seeing as how 2 hours earlier I had been turning out the light, expecting to spend the night sleeping a few minutes at a time between contractions. I was very focused on the basics. I got dressed in just a long sleeved t-shirt and a short skirt. I grabbed the electrolyte water that was next to the bed, and then walked to the kitchen to grab a snack. We never even dressed or diapered Layia. She was just wrapped in a blanket. I remembered my insurance card, but forgot my phone.

Rachel called the ER while we were on the road to let them know we were coming. When we pulled up, she grabbed a wheelchair for me (holding Layia). We went in, and were ushered almost immediately back to the the Ped ER. Mike and Martine had to park the cars, but I don’t remember how long it took for either of them to join us. We were led to a bay in the Ped ER where there were several nurses, residents, and an attending physician, I think. Layia was taken from me so they could examine her. That was the hardest thing. I wanted to protest and hold her in my lap while they examined her, not see her in the little infant hospital bed across the bay, and hear her crying but not be able to do anything. There were lots of questions that I had to answer, and I couldn’t tell you what they were or what I said because life was still a blur at that point. I do remember that we realized it had been so long since we picked her name (3 years – it’s the name Conan would have had if he had been a girl), that I wasn’t 100% certain how to spell it! Thankfully Mike remembered.

After a fairly brief exam the doctors and nurses agreed with Rachel that the noise seemed to be coming just from the nasal passages and not the lungs, but it was so noisy and there seemed to be an echo in the lungs so they couldn’t be certain. Then it was up to the NICU. Rachel wanted to try to check me in to Labor & Delivery so that I would have a bed and not be sitting in a chair all night, so once Layia was settled in the NICU, Rachel, Martine, and I went down to L&D. We were told that all beds were full, but they checked me in we waited in the reception area to be seen in triage where I would be able to lay down for a bit. And we waited. And waited. Got some water and waited. It was a busy night in L&D. Then I finally needed to pee, and thankfully they let me use the bathroom in the triage area. After that I decided that this just wasn’t worth the wait. I was starting to feel downright wrong about being away from Layia, and also figured that if I was going to spend the night sitting anyway it made no sense to do it two floors down from my newborn. So we gave up and went back up to the NICU.

I spent the night sitting on the hard rocking chair, with my legs propped up on the wheel chair, nursing Layia and holding her on my chest as near to skin-to-skin as I deemed possible what with there being leads on her chest. I didn’t really sleep much that night, but idly watched her monitor (heart rate, respirator rate, and oxygen saturation). I did doze off occasionally, but it wasn’t until morning that I started to crash. Of course the resident caught me sleeping with Layia on my chest as she did her rounds and wanted me to put Layia in the infant bed as they have had cases in the past of parents dozing off while holding their baby and dropping the baby. But as soon as Layia was in the bed she woke up and started crying, so came right back to my lap to nurse. During the night they had had to come back to draw blood twice, as the blood had clotted before the lab processed it the first two times. It was good to find out in the morning that the third blood draw had been successful, because I wasn’t planning to let them draw any more blood from her.

Friday morning was fairly quiet. Mike came to see us and got me some food. (Which I had to eat in the reception area since food is not allowed in the NICU. The medical team did rounds (and I mean “team” since there was the lead physician, two residents, and two more people whose roles I don’t remember; later the social worker came by and then someone else whose role I don’t remember), and since I was there I got to listen in. At the time I was hoping to be able to get her discharged before the initial 48 hours that we’d been told, since that was based on when the culture would be done to tell us if she needed antibiotics (because I had been GBS positive). When I came back from the bathroom one time there was a sleep chair waiting for me (much more comfortable on the behind!). Layia and I did a lot of sleeping – with her in my lap mostly. Throughout our stay she did not care for the crib at all. I’d always let the nurses know when I left the room so they’d be prepared to have to attend to her a bit in addition to the other babies in the room, but sometimes she’d start crying before I even managed to get out the door. And she didn’t really take a pacifier.

Friday afternoon was not quiet. At some point (apparently while I was down at L&D, using the bathroom, or eating) they had put a catheter down Layia’s nasal passages to determine if there was physical blockage (I did know this was the plan, just not when it was actually done). A 10 French catheter could not go through, but a 5 could. So the initial theory was that she just had very narrow nasal passages, causing very slow draining. By early afternoon her breathing sounded completely normal. The ENT residents came by to scope her nasal passages. They determined that there was nothing clinically wrong, and her passages would grow as she’d grow so there was nothing to do or worry about. But they wanted the pediatric specialist to come by and confirm that it wasn’t choanal atresia (a congenital narrow nasal passage that requires surgery). A while later the pediatric specialist came and attempted to scope Layia’s nasal passages again, but she had difficulty getting a clear view so she stopped. During all of this, the doctors and nurses confirmed what Rachel had experienced at home: suctioning did nothing. Rachel had been using a Delee suction catheter, and the nurses tried the wall suction with the normal tip and using a couple different sized small catheters, but they couldn’t get much of anything out and it made no difference to the sound of her breathing. In order to finish the scoping they used a decongestant spray, and then scoped her a third time.

Friday evening was as pleasant as a stay in the hospital can be. Lesley (midwife) came by to see us, and Mike came back and got me food before the cafe closed for the evening (that cafe has some strange night hours).

Friday night was pretty miserable (but at least I was in a comfortable chair and could put my feet up). All night long Layia would try to nurse about every half hour. Her breathing was horrible and while she tried to nurse her oxygen saturation would drop. When it dropped below 85% an alarm would go off, and the nurse would have to come over and silence it. This happened every half hour, all night long. It became part of the routine of the night. When her saturation dropped below 60% (I think that was the second level anyway), a more insistent alarm would go off and the nurse would have to come silence that and would usually stay and watch the monitor until Layia finished nursing and her heart rate, respirator rate, and O2 saturation came back to normal. A couple times during the night her saturation levels dropped to the 30’s and I could visibly see her skin going from pink to grey even in the dim light. The cherry on the miserable was spending the whole night staring at my own swollen ankles. My ankles hadn’t ever swelled up during pregnancy, and it worried me that they were swollen now.

After that miserable night, I couldn’t argue when the medical team did rounds and Dr. Rottkamp said that she wanted Layia to stay another night to make sure that the problems of the previous night were just due to swelling as a result of the scoping during the previous day. It was no longer an arguable issue of whether she needed antibiotics. So instead of arguing, I asked about the requirements for discharge and the nurse wrote down the checklist for me to work through in advance so that when we did get discharged there wouldn’t be a hold up.

Saturday was almost pleasant. I started actually taking care of myself and making sure I got enough water to drink and food to eat. I felt good enough to walk myself down to the cafe for food. Layia and I slept plenty. Mike’s mom and sister came to visit, bringing Conan, so I got to spend a few minutes in the reception area with him. My mom arrived in town and spent the afternoon with us. Mike came in the early evening after managing a booth at the gun show and we all got dinner before they went home. I learned how to recline the seat back, so I could adjust my position more. And Layia’s breathing was perfectly normal all day and all night. So Sunday morning she got discharged and we went home.

The experience of sitting for over two days in the NICU with a healthy baby (Friday night  was the only time when she was less than healthy, really) was very different. I’m extremely appreciative of the health of myself and my family, and the support that I have from family, midwives, and friends. And I’m very grateful that there’s nothing wrong with my daughter that a little time and growth won’t cure. (I just need to remember that when she gets her first baby cold.) I was sitting in my little bubble while hearing about women seizing during labor (and then I think later that baby was in the same NICU room as us), listening to a lumbar puncture being done on a baby, hearing the nurses celebrate a weight gain in one of the premies (and trying to picture a 2 lb baby in my mind), trying to imagine myself as one of the mothers or fathers who I heard visiting their babies every night or morning, trying to imagine setting an alarm to wake up and pump every couple hours all night long like one of the mothers of a premie, and hearing the various alarms going off throughout the night and day. Neonatal nurses are amazing people!

(If you missed it, here’s the link to Part 1: The Birth)

“They” kept telling me that subsequent children “always” come earlier than their siblings. However, I had I discounted such “information”, right along with all the “Are you actually going to make it to October?” questions. We did occasionally ask Baby #2 to wait until Grandma Key arrived, but we didn’t emphasize it like we had with Conan. (I was too concerned with asking Baby #2 to be a sleeper, or at least a napper.) Whoops. At least I went on maternity leave two weeks before the due date so that I could give Conan some focused parent time before Baby #2 arrived . I had neglected to realize that sibling rivalry can start in the womb. Since Baby #2 couldn’t have a cooler birthdate than her brother (12/12/12), she had to go for dramatic entry!

Thursday, 24 September 2015, shortly before 18:00
I was helping Conan to put away toys in the play room before dinner. Sitting on the futon, I leaned over to pick up a toy from the floor and felt a rush of fluid. My first thought was “I hope that was just pee. That better have been pee!” So I went to the bathroom, changed clothes, and went back into the play room to continue helping Conan pick up. When I walked into the play room I looked down to see drips down my legs. Back to the bathroom I went to change clothes again. When I walked into the dining room I told Mike “My water may or may not have just broken. It’s possible that I just peed myself twice.” Mike looked at me with a completely pole-axed facial expression. We were not exactly ready to have Baby #2 yet (yes I was full term, but still a week and a half from the estimated due date). My biggest worry, though, was that I was GBS (group B strep, a common bacteria that can cause problems in newborns) positive so if my water had just broken then baby had to be out within 18 hrs.

18:15 – Just in case, according to plan, I tucked into dinner. (I couldn’t keep food down during labor last time, so the extent of my birth plan this time was: #1 Conan to go to Grandma Sheldon’s house and #2 eat early and frequently.) During dinner I had a contraction. Since I was GBS positive, I decided it was time to call one of the midwives for advice. Since I had seen Rachel F-T just the day before, I called her and left a message. Then I called my mom and left a message for her, since her flight to Sacramento wasn’t for several days yet. I continued having mild contractions approximately 15 minutes apart.

19:00 – Rachel called back and we discussed what I needed to be doing since I was GBS positive. She needed to check with the other midwives about schedule to find out exactly what time Rachel K was going off-call that night and when Lesley was coming on-call for the next day. At that point, Mike and I decided that Conan needed to go to grandma’s house. Baby #2 was not being very considerate of grandma, since Thursday is bingo night. Between 19:00 and 19:45 I had no contractions while I finished packing Conan’s overnight bag, brushed his teeth, and put on his pajamas. As he walked down the front walkway holding grandma’s hand and his stuffed friend Bunny, and looking like a confident little boy, he turned to wave and say “bye” and I had a contraction.

19:45 – Now that Conan was gone it was time for post-dinner snack #1, and then Mike and I frantically tried to finish getting things ready (all of the final things that I had planned to do over the subsequent week). The play room had to be cleaned up to where it would function as a guest room again, the bassinet had to be set up and co-sleeper harness attached to the bed, chest moved into our bedroom to serve as a second diaper changing station, and birth kit/supplies set out. My mom also called back and I told her what was going on. Throughout this time I continued to have mild contractions 15-20 minutes apart. Rachel F-T checked back with me at 20:15 and gave me the specific call schedule.

Shortly before 22:00 – Once the last minute prep stuff was done it was time for post-dinner snack #2. By now I was finally slowing down and felt like it wouldn’t be pointless to go to bed. So I got ready for bed and laid down to journal before sleep. The contractions were still 15-20 minutes apart, but seemed stronger than what I recalled from this point in labor for Conan.

Around 22:15 – After lying down to journal it seemed like contractions started coming every 10 minutes, and were strong enough that I was not sure I’d be able to get much sleep at all.

22:45 – I finished journalling at 22:45 and turned out the light, hoping that when I rested the contractions would slow down. I checked my phone at the next contraction: 10:51. And the next one: 10:56. I thought to myself that if the next one came in 5 minutes, for three in a row, I would call Rachel K. Next contraction was 11:01, had me rocking back and forth in a half kneeling/half prone position, and left me too spent afterwards to pick up the phone right away. (Mike was in the office trying to relax for a bit during this time, before coming to bed himself in case it was an early morning birth.)

23:05 – At 11:06, I groaned and moaned through the next contraction, which brought Mike running. I managed to gasp out that he needed to call Rachel K, which he did. Then he unlocked the door, and jumped into the shower for a quick wash. As soon as Mike was out of the shower I got in to rinse off (from using the toilet). The warm water felt so good on my belly and I think I went a bit longer without a contraction, or so it seemed. Then the warm water didn’t feel so good any more as a contraction came on. I shut off the shower, grabbed my towel, walked out of the bathroom, dropped the towel on the floor next to the sofa, and dropped to my knees on top. After the contraction Mike helped spread out the towel so I could sit on it and rest. He asked if I wanted the tub and I said I did, since my legs felt like jelly, the warm water of the shower had felt so good, and I was hoping it would slow down contractions. So for the next few minutes Mike was running back and forth between the dining room where the tub was and the bedroom where I was. At some point my cloudy mind remembered that we needed to plug in the heating pad for the blankets, which was thankfully sitting next to the outlet that I was sitting next to. And at some point, I also realized (sometimes I’m a little slow) that this was fast labor: in just a few minutes I had gone from “resting” in bed to kneeling against the sofa in the bedroom, unable to move anywhere else. A voice in the back of my head reminded me that if this was fast labor, then we needed to spread out chux pads underneath me to protect the carpet. I didn’t have the mental power to actually voice that to Mike as he tried to be in two places at once.

Shortly before 23:30, Mike texted Rachel “Hurry, bitte (German for please)”.

23:30 – I don’t remember if I heard the front door open, but I heard voices, then Mike came back to let me know that Rachel K was here and I heard footsteps in the hall. How I heard these things I’m not sure, because I’m pretty sure I was screaming at the time (this was the first screaming contraction). I felt Rachel push the lined blanket under me on her way past to wash her hands. While she was washing her hands I felt things moving: fluids and a large something. I gasped something like “there’s something between my legs”. For whatever reason I didn’t want to say “is that a head between my legs?”. I just couldn’t believe that it had happened so fast, and without that “ring of pain!” But indeed, seconds later I heard Rachel say that the head was out and the shoulders would come out with the next contraction. She had arrived just in time to catch the baby! (and save Mike from having to do it, something he really didn’t want to have to do.) Layia Celeste Sheldon was born at 23:32.

It took several seconds for me to be able to look down and see her, and several more before Mike and Rachel could lower me down to sit and I could pick her up. Then they lined a path to the bed with plastic sheets and layered chux pads on half of the bed. After a couple of minutes, with their help I was able to stand up and walk to the bed. Layia and I got a little skin time, but her breathing was really noisy and her mucous was not draining at a normal rate. So Rachel did suctioning and postural drainage a couple times.

23:50 – I cut the cord and Rachel took Layia to the steamy bathroom to continue suctioning and doing postural drainage, in hopes of clearing her nasal passages. She was pretty sure the lungs were clear, and Layia had a strong cry, but the breathing was so noisy it was hard to tell. While Mike and Rachel were in the shower I could hear Rachel K on the phone with Rachel F-T, and could tell from her voice that she was concerned. Everything had happened so fast, though, and I was trying to catch up mentally, so it didn’t make me worry. I trust my midwives, and at that moment I needed to focus on myself.

Around midnight – The student midwife, Martine, arrived shortly after Rachel and Layia went into the bathroom. Martine stayed with me and helped me to get into a better position to push out the placenta. I was still feeling weak so I really had to lean on her.

00:20 – Within minutes after the placenta was born, Rachel suggested that we transport to the hospital. She was concerned that while the extremely slow drainage of Layia’s nasal passages might not be a problem, she couldn’t say for certain and didn’t want to risk us having a blue baby later in the night. For the next few minutes Rachel and Martine did a rough clean-up, Mike helped me get dressed, and I (carrying Layia) went to the kitchen to fuel up with crackers, dried cranberries, and the rest of my electrolyte water. I was HUNGRY!

00:45 – Just over an hour after Layia was born we were in the car on the way to the ER. Oddly enough, my only regret about transporting is that Layia and I didn’t get “birthday cake”, so Layia doesn’t have a birth day candle like Conan does. (A candle that was lit on the actual birth day, and that can be part of subsequent birthday celebrations.)

Continued in Part 2: The NICU

I have found myself missing blogging very much during the past year. On a regular basis my mind comes up with ideas for blog posts, but the reality of being a new mom has meant that I never managed to get any of those ideas typed up. I’m hoping to resume blogging, maybe on a monthly-ish frequency, now that Conan is a year old.

Shortly before Conan’s first birthday, I finally got resolution from my health insurance company regarding coverage for the cost of his birth and I’ve been wanting to write about my experience with the cost of homebirth. I must emphasize that this is my experience and should not be generalized.

Cost was not a significant reason for why I chose to give birth at home in the first place, and it probably doesn’t make an difference to someone who is not comfortable with the idea of homebirth. In retrospect I feel that within my values it is a strong plus in the homebirth column, though. There is a lot of complaining going on now about the cost of health care, and this is an example of how we have the power to make choices that affect the cost of health care for ourselves and others.

When I looked up the cost for a normal vaginal delivery last summer while writing my grievance letter to my insurance company (story to come later), the estimated range for Sacramento was $10k-21k. Checking again right now the website says the estimated range for three major hospitals in Sacramento is $15k-23k (approximately $3k of that out-of-pocket and the remainder paid through insurance). My total cost was $4,955, with $2,932 of that ultimately out of pocket. Yes, my cost was $5k. Between one fifth and half the cost of a normal hospital birth. My out of pocket expenses ended up being on a par with what they would have been for a hospital birth, but that is because I fought for reimbursement.

What was included in my total cost?

• Midwife care (13 prenatal checkups, attendance of 2 midwives for the birth, 6 postnatal mother & baby checkups)
• Two ultrasounds (nuchal translucency and 2nd tri)
• Genetic Disease Screening Program
• California Newborn Screen
• Other lab tests
• Birth kit
• Six visits to a chiropractor

Nearly all of our costs were initially out of pocket. We paid our midwives out-of-pocket because the total fee is less if you pay out-of-pocket instead of having them go through insurance. And since I assumed that my insurance company would reject the claim, it just made sense to go the route with less cost even if it meant more effort on my part (to submit a member claim to insurance). I have a high deductible health insurance plan, so for the first $1.5k (in-network) each year it is all out-of-pocket, and the only thing that put us over that deductible was the charge for midwifery care.

When I submitted my member claim, my insurance company applied the charge to the out-of-network deductible ($3k) and stated that only half of the fee was allowed for the procedure. I submitted an appeal arguing that since there are no in-network midwives I couldn’t choose an in-network provider so I should not be penalized and the cost should be applied to the in-network deductible. I also pointed out that even applying the cost to the in-network deductible and reimbursing me at that rate, their total cost is still significantly lower than it would have been had I had a hospital birth. I’m guessing that the reason their allowed cost was so much lower than my actual cost was because their allowed cost was for the “childbirth, normal vaginal delivery” procedure only. When I got a $2k reimbursement check I figured that was good enough.

I did get a laugh when I got the response to my appeal. It read: “This administrative decision represents an exception and does not change Anthem’s position regarding plan benefits, as detailed in your EOC form. … Please note that your EOC specifically states that if there are no contracted midwives you may call customer service for a referral to a participating OB/GYN. …” Why on earth would I trade the awesome care I received from my midwives in my comfortable home for mediocre care by a doctor in a medical facility? (No offense to the vast majority of people who prefer birthing in the hospital. I’m just a li-i-ittle bit jaded about medical doctors having had more negative experiences than positive.)

For weeks leading up to the due date we asked Baby to come maybe a little bit early, but not until grandma Key (my mother) was here. It’s a good thing that we specified a contingent event and not just a date. We picked up my mother at the airport at around 7pm on December 11, one week before Conan’s due date. In the airport Mike leaned over to my belly and told Baby that now that grandma had arrived, it could come at any time. Personally, I was hoping for a few more days before the birth. We picked up dinner on the way home, and my mom and I enjoyed tacos while watching NCIS:LA. Afterwards she went to bed and I started putting away the sheets and baby laundry that I had done that day (all those tiny little socks!). At slightly before 9:30pm I felt a rush of fluid, and then another shortly after. I felt like I had peed my pants, but my bladder was not the cause. I went into the bedroom to check that I didn’t actually need to pee and change my clothes, then went back to putting away the laundry. After another rush of fluid I decided to put on a menstrual pad. I was starting to wonder if this could be my mucus plug or water breaking. The fluid was relatively clear and odorless, so there were no signs of a problem; but I had really hoped that the sack would stay intact for much of my labor to make movement easier for the baby. At 9:47pm I was sitting at my computer and felt what I thought could be a contraction. When I stood up I felt another rush of fluid. At that point I decided that I needed to call one of the midwives to let them know what was going on just in case something happened during the night. I sidled up to Mike and told him with a shaky voice, “Don’t freak out but I’m going to call one of the midwives. I think my water may have broken or the mucus plug may have come out and I may have started going in to early labor.” He was calm, responding that he was excited and the timing was perfect. I was the one who needed the “don’t freak out” admonishment. After all, I wasn’t supposed to go into labor only 2 1/2 hours after my mom arrived in town!

At around 10:15pm I went alphabetical in my phone and called Rachel F-T and left a message, then called Rachel H and talked to her about what had happened. She told me that she’d check in first thing the following morning unless we called her with an update. In the meantime I headed straight for bed to attempt to sleep. Attempt to sleep. Over the course of the night I was woken up at 15 or 20 minute intervals with contractions. I tried really hard to find comfortable positions (or rather positions that made the contractions more bearable): on my side, on my back, and partially sitting up. I kept a rough eye on the clock each time I was woken up so I knew that the time between contractions was variable with 3 or 4 per hour, and they hadn’t really increased in intensity through the night. Come morning I didn’t really want to linger in bed since laying down had not proven to be a very comfortable position during contractions. We got up around 6am, and Mike updated Rachel H over the phone and then called work to let them know he wouldn’t be in and would be starting his FMLA leave immediately. When my mom came out of her room we told her that I had gone into early labor. There were a few tasks that needed to be taken care of first thing, like washing the diapers so we’d have something ready to use! Sometime after 8am Rachel H came to check on me. It was comforting to have her tell me that sometimes the water breaks twice when only the outer membrane ruptures and what comes out is the fluid between the membranes.

Throughout the morning I continued having contractions. I stayed mostly in the living room, and moved from the sofa to one of the birthing balls at intervals to change positions. Walking was not appealing to me, as I felt weak and wanted to conserve my energy. I never had the “happy chatty” phase of contractions that we had been told about; probably because I was asleep for much of my early labor. Instead, during contractions throughout the morning I would stop talking (mid-phrase or mid-word) and focus on breathing and making it through the contraction. The morning is mostly a blur to me. My mom and Mike timed the contractions occasionally during the morning. It was pretty easy for them to do I guess because they could tell by my face, body position, breathing, and/or break in talking when a contraction had started. The contractions gradually increased in frequency over the course of the morning. Mike’s mother came for a while during the morning, then left for a while and came back in the afternoon. Listening to her conversation without joining in was very soothing. Around noon Mike talked to Rachel H again. My contractions were approximately 5 minutes apart at that point, and she told Mike to call her again when the pressure started moving down “like a bowel movement”. Around that point I had started standing up occasionally during contractions, leaning on the window or Mike or someone else. Shortly after 1pm we called Rachel back to let her know that I was starting to feel pressure moving down. The contractions were still around 5 minutes apart. Rachel arrived at the house at around 1:40pm.

At some point in the early morning I had had to rush to the bathroom to throw up the remains of dinner. So for breakfast I had toast. Which soon followed dinner down the toilet. We resorted to warm honey water, since I often do that when I’m sick to provide my body with energy without taxing the digestion. The honey water didn’t stay down either. Rachel H advised that I should stick to not more than 1 cup of room temperature water per hour. In early afternoon we decided to try a little more food since I hadn’t had anything to eat since the toast attempt, and had only been sipping the electrolyte water all morning. I managed to eat 3 pita chips, and 1 or 2 dried apricots. Later my mom fed me a few spoonfuls of plain yogurt with honey mixed in.

I don’t really recall, but according to the labor record by around 2:45pm I started moaning during contractions. I attempted to go to the bathroom sometime after that and just the walk from the living room to the bathroom was exhausting. When a contraction came on as I was returning to the front of the house I got on my knees leaning against the bed. I was feeling weak and scared at that point, on the verge of tears. For some time the world around me had been a blur and I wasn’t really sure what other people were doing as I was so internally focused. When I was kneeling at bedside I thought that I wanted to get into the tub with warm water. Mike helped me stand up and I remember gasping out the question of whether the tub had been filled. I think it took me so long to ask the question that it was interrupted by a contraction. They immediately started filling the tub while I continued kneeling against the bed.

As soon as the tub was full at around 3:15pm, I got in and I didn’t leave it until Conan was born. I don’t think I could have. I floated in the water, sort of sitting on my side at first. The contractions were still around 5 minutes apart, but getting stronger and longer. Rachel F-T arrived not long after I got into the tub. According to the labor record by 4pm the contractions were back to back. I just remember trying to float in the water using as little energy as possible and trying to let the warm water help me relax and ease the pain a bit. I don’t remember it working all that well at the latter. By around 4:20pm I started bearing down at the peak of some of the contractions. When that started I remember again being almost near tears thinking that this just meant several hours possibly of more intense labor. It turns out I’m close to being a screamer when pushing. It took constant gentle reminders to lower my pitch into more productive “oooo” sounds. This is surprising to me as I had expected that I would make similar grunt/groan sounds as when weightlifting. I tried to keep the “I am woman hear me roar” mantra in mind to help me stay low pitched and strong. I remember hearing my mom say that it was really hard to watch me go through this. I was really worried that I wouldn’t have the energy to see the labor through to the end. As dusk fell, other lights in the house were turned on to provide some illumination, but the dining room was left dusky. My world was the tub, Mike or my mom at the head of the tub supporting me and giving me sips of ginger ale between contractions, and the Rachels. Everything else faded into the background. Every once in awhile something would filter through. I remember hearing people talk about lights and suggesting that the entry light be turned on. I remember Marlene’s phone making lots of noise as she got emails about several EBay auctions that were ending. I remember looking up at some point and seeing her and my mom sitting at the dining room table. I remember that my arms and legs felt tingly and heavy.

One of the Rachels suggested that I move to a kneeling position with one leg up at around 5pm. They asked if I wanted to reach down and see if I could feel the top of the baby’s head. I didn’t want to at first because I was afraid of not being able to feel anything, since that would just confirm that I had lots of laboring left to do. When I did finally get up the courage to feel, I felt something smooth and thought I would have a bald baby. I was also frightened by the correlation of the magnitude of pain with how little of the head was visible. I started trying to visualize a blooming rose during contractions and while I was pushing, as a way of trying to visualize the tissues stretching and the head crowning and passing through. Not sure how effective that was. At some point I started praying that I would feel the “ring of fire” soon, if for no other reason than that it would mean I was almost done. Throughout this whole time Rachel F-T would periodically use the doppler to monitor Conan’s heart rate. It was so incredibly comforting to hear her say what the heart rate was since it stayed around 120-130’s. No matter how much I was struggling, I took that to mean that the baby wasn’t being traumatized and was not in any danger.

When I did start feeling the “ring of fire” of course, I just wanted it to be done. I was also afraid at that point that despite a honey straw I had been given shortly before, I’d run out of energy and the baby would be stuck in the birth canal. May seem crazy now, but at the moment… So I pushed long and hard with each wave. According to the birth log there were only five minutes between “almost crowning” and “baby born” notations. Conan Yeager was born at 5:57pm on 12/12/12.

Conan’s birth brought Mike to tears as he got to introduce his son to the world after having kept the gender a secret for so many months. My first thought was decidedly less emotional: “It must be a sea monkey, there’s no way I pushed out anything that big.” In my defense my first sight of him was of his back tinted slightly greenish from the water as he was floated between my legs and up to my arms. (After a water birth the baby is brought to the surface face down.) He was 21.25″ long and weighed 9 lb 2 oz.

Mike and I got to hold him for a few minutes in the tub before I was helped up and out of the tub, dried off, and almost carried into the bedroom by Mike while I held Conan. The placenta was delivered as I rested on our bed and then my mom cut the umbilical cord. Conan rested on Mike’s chest right next to me before he was moved to my chest to nurse. While I was being checked out and stitched up our mothers were sent off to get sushi. It wasn’t my first postnatal meal, since the Rachels had brought “birthday cake” of toast with almond butter and sliced apples, complete with a candle right before I nursed Conan for the first time, and I had finished the honey yogurt and indulged in some snack Bunnies shortly after moving into the bedroom. Some of our friends and family will remember us half joking/half serious that Mike was going to get me sushi while I was in labor, well that was tweaked a bit when we developed our actual birth plan.

When they inspected the placenta they found two holes, so when my water broke it was just the outer membrane that broke and released the fluid between the membranes. Just as I had hoped, Conan was in a fluid cushion until just before emerging. When I felt his head what I was feeling was the inner membrane, not a bald head.

Overall, with the exception of not being able to keep food down, this was a great experience. I am so so so glad we did a home birth. I could not imagine having to pack up in the middle of this to go somewhere unfamiliar with unfamiliar people around me. I do think it is funny that one of my reasons for home birth is that I would be able to move/eat/etc whenever & whatever I wanted; and then I couldn’t keep food down! And while I didn’t necessarily think that I would have a water birth, I knew I would want the tub at some point and am extremely glad that I had that option. I also really liked the fact that no one was tracking my dilation. It was freeing to not know how much time had passed and how much “progress” had been made, and just go with the sensations and experience. Our midwives were awesome, and really calming for me.

Contractions

In the birth tub

Our new family

Conan, our little grub

Come this December, whenever Baby decides to come, there will be no packing a bag, taking out the trash, and driving to a hospital for us. Instead we’ll be relaxing at home, calling the midwives, and filling the birth tub. Barring complications, of course, I cannot imagine a better scenario.

This decision is the culmination of a long evolution of thought for me, and I don’t even remember when it started. For as long as I can remember I have felt that the act of giving birth is a natural act, and unless there are distinct risks of complications, not a medical procedure. Even as I teenager, as I recall, I did not like the idea of giving birth in a hospital. This may have been an attitude partly (subconsciously) influenced by cultural attitudes at the time, because I think that was when the labor and delivery rooms in hospitals started being redesigned to be more comfortable and private. But to me even a nice private birthing room with a non-metal bed and room for spouse/visitors is still located in a hospital. Maybe another contributor to my attitude is the fact that my father was an emergency physician. Other people visited hospitals to see their doctors for regular health care visits; but when I visited the hospital it was the emergency room to see my dad either for fun or for care. I was much older before realizing that my mental picture of a hospital is very different from the average person’s. In any case, I vaguely remember as a teenager not wanting to give birth in a hospital and wanting to celebrate the natural part of childbirth instead of smothering it in medical procedures. I’ve also always wanted a natural birth with no drugs, especially after I found out what an epidural is. At the time, though, the thought of home birth was extremely scary. Over the years I heard about birth centers and figured that would be a nice compromise, but that still felt like a compromise. I have no idea when the idea of home birth went from scary and unsafe in my mind to being the ideal birth setting.

In our previous house (rental), I would not have been comfortable giving birth. It was just not up to my standards (old, drafty, moldy, almost entirely carpeted), and so I was trying to adjust my feelings to be okay with some kind of birth center. Then we realized we could afford to buy a house, and moved into a house that will work quite well for a home birth. So when I first met the midwives who will assist us, and they gave me a packet of information, I needed no convincing but still enjoyed the reading. Luckily for me, I didn’t have to talk my husband into it as he is pretty much willing to along with whatever I want to do in this arena. It did make for interesting reading. Apparently the World Health Organization recommends that birthing be done outside of the hospital setting for normal pregnancies. It was really comforting to read statistics, articles, and stories about the experience of homebirth. Maybe it’s because I’m already fairly granola, but I have no problem believing that homebirth is just as safe if not safer than hospital birth, involves less pain, and will leave us with more satisfaction. I’ll be able to wear what I want; walk/sit/lay down when and where I want; eat or drink what and when I want. I’ll be in my own comfortable surroundings, if I want we can watch a movie during the early stages of labor to help me relax. It’s my domain, and not the doctors, so if I decide that I want no one in the room but the midwives and myself so be it, but if I feel like I want/need the support of others it is within my control to ask for them. In any case, there won’t be anyone in the house who is a stranger or with whom I am not intimately comfortable. When the baby is born, I don’t have to go anywhere, and over the course of the next few weeks the midwives will come to my house for the postpartum check-ups on both Baby and me. For that matter even now I don’t have to go anywhere as prenatal visits are also in my house. (Obviously not things like blood draws and ultrasounds, though.) We have an emergency plan, and the hospital we transport to will depend on time of day (read: direction of rush hour traffic). The midwives have many years of experience and I feel very comfortable with them. Like I said, barring complications this could be a dream. Painful, yes, but still a dream come true.

One other aspect of homebirth that I had been told but didn’t know until recently whether or not it is true is the cost. Our cost will be $4k for prenatal visits, birthing assistance, and postpartum visits for 6 weeks. My health insurance organization’s website has a cost estimator tool that I used because I was curious how that number compares to a typical hospital birth. In the Sacramento area, apparently the total cost for normal (no complications) birthing in a hospital is $10k – $14k!! Of course that includes costs for the blood draws etc that aren’t included in our $4k, so for comparison sake we’ll bump it up to $5k to include three blood draws, two ultrasounds, and the birth kit. Granted, if I went to an in-network facility, my direct cost would only be $3k. We’re assuming that the midwives will be considered out-of-network and so my deductible is $6k. Maybe we’ll get lucky when we submit the claim afterwards and we’ll get some of that back, but I doubt it. So basically, as far as direct costs go it is significantly more expensive to give birth in a hospital vs. home without insurance, but slightly more expensive at home vs. hospital with insurance. However, by keeping my company’s overall health care costs a little bit lower this year, I do my part to keep our premiums from going up next year and since I work for an employee-owned company that means more money in my pocket next year.

Back in December when I first met with the midwives we plan to use when we finally get pregnant, they lent me a video to watch with my husband about home birthing from the father’s perspective. For various reasons that video has just been sitting in the living room getting in the way all year. We finally sat down to watch it this past weekend and my official review is “eh”. For one thing, it was ONE HOUR AND 9 MINUTES LONG! It was a compilation of interviews with several homebirth fathers about their experiences, and while some of the questions were interesting many of the questions were rather fast-forward-able. And some of the guys just droned on and on. It’s supposed to be like talking to your guy friends about the experience of homebirth, but I’m not sure it had the desired effect. At least it didn’t scare Mike away from doing a homebirth. And it wasn’t full of statistics and other stuff to convince you one way or another, it was just a bunch of guys telling their stories.

I honestly can’t remember when I decided that I wanted to give birth at home. I remember a looong time ago feeling fairly strongly that birth is a natural part of life and not a medical procedure (unless there are complications), and being inclined away from birthing in a hospital. I think that was back when birthing centers were uncommon, but first coming into the mainstream. I remember thinking that using these “newfangled” birthing centers was a great idea as an alternative to hospital birth and homebirth. At the time the thought of giving birth at home was scary and unpalatable. Fast forward a decade or so and my mind has changed, but I can’t remember when, how, or why I changed my mind. When I was looking at the prospect of giving birth while still living in the old house, I was really disappointed that I would have to use a birthing center (I didn’t like that house, and didn’t think psychologically or logistically that it would be a good idea to give birth there). In our current house there is no reason not to, and I’m really looking forward to this wonderful celebration of life (assuming, of course, that I have a healthy pregnancy).

After meeting the midwives and reading through the packet of information they gave me I can say that I’m even more strongly a fan of homebirth, even though I haven’t yet done it myself. There was lots of interesting information in with the propaganda. For instance, the World Health Organization recommends attendance by midwives for normal birthing, preferentially taking place outside of the hospital, with no routine use of electronic fetal monitoring, drugs, or induction of labor. And yet in the US the vast majority of women give birth in a hospital under the “care” of a physician using drugs and electronic fetal monitoring. And to top it all off in the US the rate of voluntary c-sections is growing, possibly not coincidental with the rise in maternal fatalities in the US. As a person who values natural living, I find that sad. I’ve known someone who had the delivery date scheduled months in advance so that she could schedule her life around it. Choosing to give birth at home under the care of a midwife may be too radical for most women, but scheduling a c-section in advance is a certainly on the other end of the spectrum of “natural”.