Category Archives: Birth

A Journey to Home Birth

When I was pregnant with my first in 2009, I had this idea that women who have their babies at home had some exceptional birthing abilities (or just couldn’t get in the car fast enough). Maybe they had really large pelvises, or were skilled in hypno-birthing, or were just uberconfident. I didn’t fit into any of those categories, and thought perhaps the hospital was the best place for your average Betty Birther like me, who felt pain, had no patience for imagining I was on a beach, and yelled a lot during my first birth. I felt like I had no place having my baby at home–and I wasn’t even really sure I wanted to. My birthing mojo had been stolen, and I had to find a way to get it back…

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Serafina’s homebirth, 2/2014

You could say I was a reluctant home birther. I always assumed women who have their babies at home just know that they know that they know. I didn’t. My first birth was in a hospital, and though there was plenty I could grumble about (you want to take my baby for a hearing test at 3am, really?!), I felt comfortable with the decision after considering both a birth center and briefly, a home birth. The idea of a home birth appealed to me on a visceral level – it felt like the most natural thing to do. Yet, I knew plenty of moms, and they all delivered their babies in hospitals, so how could bad could institutionalized birth be?! Plus, my husband and mother, the two most important people in my life, didn’t support it. At all. It was the “What-if-something-goes-wrong” argument. No amount of Ricki Lake could convince either of them otherwise, and it didn’t seem worth the effort. (I won’t spend time here talking about the safety of home birth, but feel free to check out some studies yourself!)

And really, my hospital birth wasn’t all that bad. It was pretty ordinary, and maybe a little boring for the doctor waiting in the wings, in case the midwife needed support. I didn’t get an epidural, wasn’t induced, wasn’t monitored very frequently. One of the nurses even said in a quiet tone, “We love these kinds of births. We hardly ever get to see them and they seem so real!” (Yes, as I am screaming, I mentally note that there is nothing fake about the intensity of a contraction.) After my baby was born, I requested they not cut the cord, not administer eye drops, or a Vitamin K shot, or bathe the baby, or vaccinate…needless to say, my “birth plan” was pored over by everyone who came in the room, just to make sure they got it all right.

I’ll admit – it was tiring to continually say, “Yes, you read that right. No, no Hep B. No, please don’t wash off the vernix.” And although at firstI chuckled, I got tired of seeing the biohazard symbol on my baby’s little plastic box, just because I refused her bath. (The plastic box is a whole different issue.)

Fast forward 3 years, and despite an enormous amount of research, interviews, and meeting homebirthing moms through writing The Other Baby Book, I still wasn’t sure I wanted to go the home birth route during my second pregnancy. I truly supported and encouraged homebirth as an option for pregnant moms, but still had some hard-to-articulate concerns about the pain (was I prepared to handle another birth like my first again??). I knew at that point a home birth was likely going to be a much better overall experience than a hospital birth, but I also knew my husband’s stance, and didn’t look forward to the push back I thought I’d get from the rest of our family. So, I decided to find a new midwife (mine had moved on from the practice), go back to the hospital, and suck up the emotional drain of explaining myself to each new nurse on shift.

But my first appointment with a hospital midwife was disappointing enough to be my last. After waiting an hour (HOUR!), only to talk about testing, and percentiles, and risks for 30 minutes, I had a sour taste in my mouth. The midwife I met with was supposed to be one of the most sympathetic to natural birth, and yet I didn’t get that impression at all. It felt much more like pregnancy was one big “What if?” The last thing I wanted was for someone else to be casting doubts about the next nine months, and about birth in general. I wanted a birth provider who was knowledgable enough to provide excellent care, who shared the same birth philosophy with me – that birth is a natural, normal occurrence. I felt really discouraged after my appointment, and my thoughts kept drifting back to a home birth. I called a friend who recently had her baby at home, and she came right over to talk me through some of my concerns. I’ll never forget her words.

There are risks no matter where you birth. Do you trust God with the outcome of your birth, no matter where it is and what happens?” I nodded, though I pondered those words for the days and months to come. “Then have your baby where you have the most peace, and don’t listen to anyone who tries to convince you otherwise. Even me.” It’s amazing how friends can speak the words we most need to hear, but don’t have courage enough to speak to ourselves.

The more I thought about birthing at home, the more excited I became. I had moved on from just not wanting to be in a hospital, to embracing the idea of being at home. So, I cautiously brought up the idea of a home birth to my husband, and he agreed to meet a few midwives. It helped that by this time, Miriam and another dear friend had both had positive home birth experiences.

We started by meeting a very experienced midwife, who I knew had an answer for every question under the sun. Mark was impressed. I liked her, but wasn’t sure it was the best fit…especially for over $5,000! From there, I dug through a local list serv and got recommendations for other midwives. I called a few, but when I met Sarafina, I knew she’d be the one. She has a presence about her–calming, empowering, and someone I’d be OK with seeing me naked. Seriously. That’s a factor. In other words, I felt totally at ease around her. Sarafina’s partner, Jessica, has this quiet strength, and bonus: they have an amazing student midwife, Kara, who never stopped smiling, and always complemented whatever I was cooking when she came over (way to my heart – love my food)!

The entire experience went beyond my expectations. What stands out though, is the quality of prenatal and postpartum care. I looked forward to every appointment–and not just to hear the baby’s heartbeat, but to have a conversation about what was going on in all aspects of my life. It felt like a very holistic model of care, rather than a fractionated, numbers driven model. They always presented my options, but never once did I feel like there was any agenda. I could chose what testing I wanted, or how to approach certain issues. I didn’t feel pressured, coerced, or belittled for my choices. I felt informed, and encouraged to make my own best decision. Barring some of my physical discomforts, I was at peace with my pregnancy in a way that I wasn’t for my first.

It’s the little things that make a difference too – Sarafina and Jessica came to my house for the third trimester (rather than me driving to their office), and I can’t tell you how fantastic that was. I didn’t have to disturb Anabella, or rush around in traffic, in snow, to make an appointment on time. I could be in my pajamas, or eating breakfast. There are five (!) postpartum visits to boot. I was so surprised to learn that. Sarafina gave me a great hip massage on day 3, Jessica did some breastfeeding troubleshooting, laundry lugging and folding, and general encouragement on day 7, and all along the way, they were available for any questions I’ve had. I’m going to miss our times together. I may just have to have another baby…

What about you? Where did you birth? What was the decision-making process like?

You can read more about my actual birth here, and if you’re in the MA/Boston area, you can find BirthMatters, Jessica and Sarafina’s practice, here. 

Megan McGrory Massaro is a mother, freelance writer, and author. She wrote The Other Baby Book: A Natural Approach to Baby’s First Year  to empower women to make the best choices for their families.

Surviving the Stomach Bug During Pregnancy

NOTE: This post is about the stomach bug. I use words like vomit and diarrhea frequently. You’ve been warned!

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Well here’s a post I hadn’t intended to write at 39 weeks and 5 days pregnant! Just six days before my estimated due date, I woke up in the middle of the night, and I thought I was getting ready to go into labor. My body was cleaning itself out. I woke up my  husband to give him a heads up…but about an hour later I realized this was not labor. It was viral gastroenteritis–aka, the stomach bug.

I made preparations for illness prevention this winter by praying for health each day, drinking elderberry syrup each morning, washing my hands almost excessively, eating a clean diet, and diffusing thieves oil throughout my home. But despite my best efforts, I couldn’t predict that a small child in my daughter’s gymnastics class would get sick within a few feet of me. (Thankfully, the little girl was late to class, so she was next to the bleachers where the moms sat, and not on the mat with our girls!) I’m nearly certain that’s where it came from, and it was a good reminder to me that you can’t control life!

Because we had so many friends who were sick, weeks earlier I had talked to my midwives and done research on what happens when a mother has a virus during labor. The vast majority of cases said that our bodies suppress labor until mom is better, and that when in labor, our symptoms often disappear as our bodies put all our energy into birthing the baby. I came across so many interesting stories of women who had respiratory illnesses, broken ankles or bloodied knees, and didn’t even know it while they were in labor. Just hearing this helped me to stay calm. I had a deep sense the baby would not be coming at least until the worst was over.

While this may seem obvious, please do contact your care provider if you get sick. While it’s generally a fast illness, it’s important that they are up to speed on what’s going on, to keep an eye on any issues that may arise.

After about 18 hours I felt better, and 30 hours into the virus, I was out of bed and free of aches and pains. By 48 hours, I had eaten egg pancakes, mashed potatoes, chicken soup and bacon! While I’m certainly not a doctor, I’d like to offer you some strategies I used to feel better fast.

Drinks

I didn’t drink anything for an hour or two after the vomiting stopped. By that time, I was pretty parched, and knew water was not a good solution (despite common practice). If you’ve had several bouts of vomiting, you’ll have lost a good supply of electrolytes, so a rehydration drink is best. You can add some sugar or honey and sea salt to regular water to make a simple drink, but that didn’t really sound appealing to me. I just happen to have lots of coconut water around the house, and it’s been amazing. At first I drank it straight, and then I added a little sea salt, honey, and fresh lemon to it. It tastes delicious, and has really replenished me. I’d caution against commercial electrolyte drinks and flat soda, as they almost always have yucky additives that you don’t want in your body when you’re trying to heal!

I also sipped peppermint, chamomile and ginger tea. The peppermint helps to reduce your fever and soothe your belly, and the chamomile is an anti-spasmodic, helping to reduce stomach cramps. I also had pretty bad nausea on and off for the 12 hours after I got sick, so ginger was a must-have to keep that at bay. Once I moved into the diarrhea phase, I switched to an elder flower and red raspberry leaf tea, both of which are helpful for regulating digestion and improving diarrhea. (Here’s a great list of different herbs and how they can help during cold and flu season.)

While it’s important not to push yourself, dehydration can be dangerous to a mama and her baby, so make drinking a priority! The last thing I wanted was to have to go into the hospital for an IV, so I kept the coconut water, tea, and plain water, (which I actually didn’t touch) next to my bed, each with straws, to make sipping from a reclined position easier. Room temperature or warm drinks are much easier on the belly but if the only way to get it in you is chilled, do what you need to do to amp up your fluids!

Baths

Once I felt well enough to get out of bed (about 24 hours later), I took warm baths with 2 cups of the elder flower and raspberry tea, to help with the diarrhea. If you have a fever but are still up for a bath, make sure it is lukewarm! You can do a lemon foot bath to reduce fever. Just place slices of lemon the bath or a large pot and soak your piggies for about 20 minutes. You can also take a relaxing bath with a bit of peppermint oil to reduce fever.

Food/Supplements

While technically not a food, I have been taking a triple dose of my probiotic to replace the good bacteria in my gut that’s been swept away. I have no affiliation with this company, but I LOVE GutPro. (It seems a bit pricey, but I still have 1/3 of the bottle and it’s been over a year, so it’s actually really economical and recommended by Natasha McBride, founder of the GAPS diet.) It’s unlikely you’ll be eager to eat much in the first few days, but I found it helpful to start with bone broth, homemade applesauce made with just apples and some cinnamon, bananas and fresh pressed juices. I’m steering clear of bottled juices as they have a very high sugar content, which exacerbates diarrhea!

I’m also taking 1 T of elderberry syrup several times a day. Two other options that I have not tried, but seem to work well for others are: Diatomaceous Earth and Activated Charcoal.

Rest

This was a little easier before kids. And nearly impossible at 39 weeks pregnant. Just rolling over hurt. Talking, opening my eyes, having the lights on–it was brutal for a few hours. I didn’t sleep at all that first night, but I stayed in bed for the first 18 hours (really, what else could I do?!) Thankfully, viral gastroenteritis is a self-limiting illness which means it gets better on its own. In other words, this too shall pass! Resting your body is so, so important, especially if you are primed for labor in the near future. I’ll admit, it’s been a bit painful to see my perfectly set up homebirth room turn into a recovery room. My kitchen was meticulous the night I got sick, because just in case I went into labor, I didn’t want anyone to have to deal with a mess. Now…well, let’s just say my 3 year old poured the milk from her cereal all over the floor this morning. Gleefully. But, I have to let go of these things, because a healthy body is far more important than a clean house!

Rest isn’t just for our bodies though. Give your mind a rest too. Stress is powerful, and can completely deplete our energy even when we’re well. So grab a book, that magazine you’ve been wanting to read, or call your mother-in-law to clean or watch the kids if you really have to. Relapses, unfortunately, are common when we push too soon, so do whatever it takes to give yourself ample time to recover and regain your strength! You’ve got this, Mama!

Megan McGrory Massaro is a mother, freelance writer, and author. She wrote The Other Baby Book: A Natural Approach to Baby’s First Year  to empower women to make the best choices for their families.

Part 4: Prepping for Birth — Creating a Nursing Basket

This post is part of a mini-series on preparing for birth. You can see the other posts, or my home birth house tour video here.

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After three years of nursing my preschooler, I feel like I have a pretty good grasp of what I’ll want close by during those early weeks of breastfeeding. While last time around I had a whole “Nursing Nook,”I think I’ll be moving a bit more from room to room as I nurse and play with my older daughter. So, I’ve created a portable basket that I can bring with me wherever we may be!

Burp Cloths/Cloth Diapers

Each mama is different, but since I know that I have an overabundance of milk, having cloths and breastpads readily available at all times is a must. To deal with a fast and furious letdown, I’d often remove AnaBella from the breast, catch the fire-hose spray with a cloth diaper or burp cloth, and then relatch. Sometimes the fast spray can cause gulping, which in turn causes gas, and a frustrated and bloated baby. (Read more about oversupply and forceful letdown here.)

Breastpads or something to catch your milk!

And while one breast was spraying my newborn in the face, the other was leaking down my chest, my stomach, all over my shirt – not exactly a pleasant feeling (or smell, after it dried…). I’d usually put a breastpad on the other side to catch the leaks and keep myself more comfortable. If you’re a heavy leaker, you may want to wear them for part of the day when you’re not nursing, too. I have a few disposable ones for going out and about, but while in the home I’ll use these affordable organic cotton ones or even wool. I also have a stash of cut up old receiving blankets, towels, or cloth diapers. I go through a lot of these each day in those early weeks! If you do buy some actual breastpads, make sure you wash them in a lingerie bag!

Water, water, water

This may seem obvious, but how often did I forget to get a glass of water as I sat down to nurse? It was like the second I had all the pillows arranged and AnaBella latched, a wave of intense thirst would come over me. My husband was constantly running water. I’ll put bottles of water around the house for the first few weeks, in addition to my stainless steel water bottle, but having a few in the basket will ensure that I won’t be left parched.

Snacks

I don’t have any snacks in the basket just yet, but when little girl arrives, we’ll stock it with dried fruit, nuts, fresh fruit, and some energy bars. I found I was much hungrier when nursing than I was pregnant!

Nipple Cream

As a first time mom, I had terrible cracked and bloodied nipples. I know now that AnaBella’s latch was not right, but the day I got out of the hospital, I picked up some prescription nipple cream. I never used it. Just the idea that I was putting chemicals on my nipples, and then my baby was putting her mouth there, was unappealing. I muscled through the pain, and let my breasts air dry, dipped my nipples in hot, salty water, and expressed breastmilk on them to heal. It worked, but not as quickly as I’d hoped. While I’m more experienced in recognizing a poor latch now, I did make a batch of nipple cream just in case. AnaBella and I have already used half of it on our hands during these dry winter months. I will DEFINITELY be making this again!

Ingredients

1 part cocoa butter

1 part coconut oil

1 part shea butter

Warm all ingredients (cocoa butter may need to be softened beforehand in a double boiler) and mix well. Put in a glass jar and tightly seal. Use on any dry parts of your body!

Books

I read a lot during nursing sessions last time, but somehow I have a feeling I won’t be getting much reading in this time around! I do have two of my favorite nursing books on hand just in case issues crop up though – The Womanly Art of Breastfeeding, and Baby-led Breastfeeding. If you haven’t read The Other Baby Book yet, that’s also a great one to pick up!

Little Potty

For those practicing EC, having a bowl or little potty on hand is helpful. It’s a lot easier to have a receptacle on hand, than have to disturb the nursing session, or clean a dirty diaper afterward! Some people really like these potty bowls. We didn’t have one the first time and I didn’t find it necessary, as I used an old plastic bowl, or something from the dollar store–or even, if I can maneuver it–strategically get her bum over the sink!

Pillows

This is totally personal preference. Some people are comfortable just holding the baby in the arms, some like special breastfeeding pillows (though please do check what materials may be in the pillow first–many are treated with dangerous chemicals to meet flammability requirements) or buckwheat pillows that mold to the baby,  and some just practice laid back breastfeeding, and keep baby on their chest! You’ll figure out what works for you, but having couch pillows and a bed pillow or two handy isn’t a bad idea.

KellyMom also has a great list of items you may–or may not–need for nursing your baby.

Would you add anything to this list?

Check out our other posts here!

Part 1: Staying Hydrated–Labor Drink and Snack Recipe

Part 2: Making a Personalized Birth Kit 

Part 3: A Homemade Sitz Bath Recipe

Part 4: Creating a Nursing Basket

Megan McGrory Massaro is a mother, freelance writer, and author. She wrote The Other Baby Book: A Natural Approach to Baby’s First Year  to empower women to make the best choices for their families.

Part 2–Preparing for Birth: How to Make a Personalized Homebirth Kit

 

This post is part of a mini-series on preparing for birth. You can see the other posts, or my home birth house tour video here.IMG_1630

If you are birthing at home, you’ll likely get a kit list or suggestions from your midwives. I won’t include the basics here, as that is likely covered. Instead, I’ll give you a run down of some essentials that may not be on the list, but will help your birthing experience!

As you can see, I have a “baby” kit, and a “mama” kit. The baby stuff is simply items that the midwives had on their birth kit list.  But on the right, my “mama kit” has a few extra items I pulled them in a repurposed toy bin that I’m keeping in the space next to where the birthing tub will be.

Sleeping bra. I found this indispensable in my first few weeks postpartum. I didn’t want to put on a real bra, but I wanted to be somewhat modest in front of people too. I plan to wear this bra while in the tub as well, especially if there will be any photos or videos taken. It took me a long time to find one in a dark color – white seems to be the majority pick!

Coconut oil. This is for perineal support if I’m not in the tub, or as a carrier oil for an essential oil massage. (I tend to buy from either Tropical Traditions, when they have a free shipping promotion, or Mountain Rose Herbs.)

Birthing aromatherapy blend. I got this for my first birth and loved it. It’s basically a mixture of essential oils, including clary sage, bergamont, rose, and geranium, in distilled water, to be sprayed in the room to stimulate labor and energize mom.

Candles. I have both a patchouli jasmine candle I fell in love with a my local drug store months ago (clean burning – amazing!), and some battery operated ones in case I don’t want the scent.

Essential oils. I have peppermint, sweet orange, and lavender on hand. I printed out portions of this blog post to help remind me when to use which one. I also have an essential oil diffuser on hand.

Lavender sock. Yup, I filled my husband’s old sock with equal parts lavender blossoms and flaxseed, and used an elastic band to fasten it. I’ve used some version of this to ward off headaches, backaches, etc. It can be dampened and warmed in the microwave and placed on your forehead for relaxation. (Though keep in mind some people are stimulated by too much lavender.)

Snacks. I have a packaged larabar in the picture for now, but my 3.5 year old will likely eat it before Labor Day. I’ll probably bring out my homemade ones for labor. I also have a 5 pound jar of honey and some spoons. =)

Bottled Water. This is actually more for my team – our water filter pitcher is woefully slow, so I have two dozen water bottles on hand. I don’t normally buy water, but I thought it would be a lot easier than having to keep track of cups and wait for water pitchers to fill!

Straws. These are helpful for the midwives or my husband to put into my big gulp cup of homemade labor drink!

Scriptures. One of the ways I was able to stay focused and relaxed during the majority of my first labor was by memorizing portions of Scripture and meditating on them during contractions. I have four passages that I’ve “edited” to take me about 60-90 seconds to say in my head…approximately the length of a contraction! (Psalm 31; Psalm 62; Psalm 63; Philippians 4:4-7, 11-13)

Music. My mom bought me Childbirth in the Glory for my first pregnancy, but I didn’t really listen to it much. But after reading about Mama Natural’s experience with the cd, I thought I’d give it another go. I’m enjoying the Scripture declarations, and the instrumental music is SO soothing, so I have a playlist on my phone and some earbuds, should I so desire to listen!

Birthing Ball. This isn’t in the picture, but I found it really helpful during my first birth. My preschooler is really into bouncing on it all.the.time, so it’s hanging out in the attic for now!

Tennis ball. Thanks to a suggestion from one of our Facebook readers, I’ve added a tennis ball to use for counter pressure. (Thanks, Meg!)

I also have arnica, pads, mesh undies, and some comfy front-open pjs for afterwards!

What about you? What did you have in your birth kit?

Check out the rest of the series here!

Part 1: Staying Hydrated–Labor Drink and Snack Recipe

Part 2: Making a Personalized Birth Kit 

Part 3: A Homemade Sitz Bath Recipe

Part 4: Creating a Nursing Basket

Megan McGrory Massaro is a mother, freelance writer, and author. She wrote The Other Baby Book: A Natural Approach to Baby’s First Year  to empower women to make the best choices for their families.

 

Homebirth House Tour

I’ve been prepping our home for my upcoming homebirth for the last few weeks. I thought you may be interested in seeing how things have panned out. There will be further explanations, links, lists, and recipes in the coming days and weeks so check back again!

Please note: I did not “stage” anything. This is exactly how it looks every day. You’ll see my dirty laundry basket, a random screwdriver on our changing table, and that bag of amazing gluten free brownies that I am desperately trying not to eat. My three year old is part of the video, too. I want to show that homebirth is very accesible. You don’t need a huge home (we live in 1300 sq feet, in a second floor apartment), nor do you need any fancy set-up or lots of money. (This differs widely – our hospital birth was $5K – almost $2K more than a homebirth, but for others with better insurance, hospital births cost less out of pocket.) I bartered with my midwives for the use of one of the birth tubs as our bathtub is so small that half my belly sticks out. All of the supplies I need for birth have been borrowed, found at the back of the linen closet, or purchased from discount stores.

I hope you find this video fun and encouraging!

Part 1: Staying Hydrated–Labor Drink and Snack Recipe

Part 2: Making a Personalized Birth Kit 

Part 3: A Homemade Sitz Bath Recipe

Part 4: Creating a Nursing Basket

Megan McGrory Massaro is a mother, freelance writer, and author. She wrote The Other Baby Book: A Natural Approach to Baby’s First Year  to empower women to make the best choices for their families.

 

A Homebirth Story

img_2388I’m pretty sure it never occurred to me I’d ever give birth at home. The first time around I headed straight to the hospital, hooked up to the epidural, pushed her out and breathed a sigh of relief.

After researching homebirth extensively while co-writing The Other Baby Book, my perspective on birthing began to shift. Birthing was not a medical event in most situations, I realized. It was a lifecycle event that belonged to the realm of the family, and it could be meaningful and loving and powerful.

Eight days ago I gave birth to my second child, at home in my bedroom. My three year old was watching raptly, making me laugh, bringing me presents and playing with the midwife’s birthing stool. My husband and two midwives rounded out my team of supporters, helping me to move through resistance and bring a beautiful new soul into the world.

When my midwives came by the day after the birth to check on us, one remarked that my labor was a million births in one. What did she mean by that, I asked, having only been present at two myself. It had its boring parts, she said, like when she showed up and I was laboring in the tub. It had its intense parts, like when we were all shouting “yes!” in unison and pushing the baby out. It had its restful parts, like when I fell asleep between contractions during transition. It had its calm parts and its fearful parts, and its dramatic parts – like when the baby’s head was out and he began kicking his body visibly inside me, trying to work his way out, something my midwife had never seen in her 35 years of practice. It had its funny parts, like when I initiated a round of laughter yoga, and my midwife joined in. It had its romantic parts, like when I asked my husband to kiss me as I pushed the baby out.

For me, though, the birth came down to a tremendous physical and psychological challenge – overcoming my fear of the intense sensations I was feeling and finding my way through them using tools that shifted with each contraction. One contraction could be mitigated through rhythmic breathing, another through back massage, another through hugging my husband tightly. I was afraid, not of what could happen to me, but of what was happening to me, of why I was unable to mitigate the sensation through relaxation, as I’ve been able to in yoga. My midwife wisely explained to me that my goal wasn’t to relax my uterus, that it actually needed to be clenching and tightening in order to push that baby out.

When I finally pushed, then pulled my baby out and held him on my chest, I felt a huge sense of relief, as if I’d conquered a physical challenge akin to a marathon or massive mountain climb. I felt humbled by the experience yet elated by the magnitude of what I’d achieved.

Everything about birthing in my home environment was perfect – being available to my 3 year old, even nursing her back to sleep while I was in active labor; having free range of my house, including bed and bathtub; having access to my clothing, blankets, pillows, and food; being surrounded by skilled caretakers who were followed my lead and contributed helpful suggestions when needed; and not needing to go anywhere when it was over.

My birth experience was challenging, it was exhilarating and it was memorable. I’m glad that I had the courage to stick with it while living a society which has been trained to think of birth as a medical event fraught with danger. I’ve added birthing to my personal list of mothering experiences that I’ve been able to reclaim as my own.

Given my new mommy status, The Other Baby Blog will be going on hiatus for the summer. In the meantime, please check out our active community on Facebook at https://www.facebook.com/TheOtherBabyBook.

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Miriam J. Katz is co-author of The Other Baby Book: A Natural Approach to Baby’s First Year, where you can find a guide to safe co-sleeping and other fun tools. Miriam is a career and life coach whose passion is to help women realize their life purpose. She lives in Boston with her husband and two children.

4 Things I’ll Do Differently – Preparing for Baby #2

img_6116I’m two weeks away from my due date, anticipating the birth of my second baby. Since becoming a mom, making my way through the first three mystifying years of parenthood, and sorting through mountains of research while co-authoring The Other Baby Book, my perspective has shifted. As a result, so have my decisions. I’ll give you a brief run down of what I plan to change this time around.

1. Birth. We’re preparing a natural home birth, a huge departure from the epidural hospital birth I planned the first time around. After sorting through the data, I found that home births were as safe or safer for healthy moms and babies, and I relish the thought of being surrounded by family and caring midwives who see birth as a empowering natural process. I also value being able to call the shots about how I labor and what happens to my baby immediately after birth.

2. Sleep. The first time around, I famously said that the baby would sleep in her crib, in her own room from day 1. I had all sorts of illegitimate fears about how bringing a baby into my bedroom might negatively impact my marriage, and misconceptions about healthy and appropriate sleep environments for newborns. This time we have a co-sleeper on hand, but we now know that the best way to optimize sleep and care for our baby will be to bring him/her safely into our bed from the start. (For a safe bed-sharing checklist, click here.)

3. Diapers. The first time around, I was afraid of the stigma and workload involved in cloth diapering. We used disposables for the first 4-5 months, though we pottied our baby beginning in her first week of life. This time around, I plan to use cloth from the beginning, and to be a bit more pro-active about pottying the baby both at night and when out on the town. With a 3 year old who’s very nurturing and attuned, I’m hoping that my little helper can help me keep our baby attuned to his/her pottying needs.

4. Baby Wearing. The first time around, I was terrified of putting my newborn in a carrier, and spent many hours holding her and sitting. With an active toddler to care for, this time around I’m planning to make a lightweight cotton wrap that I can use to tote the baby to all our activities. I’ve learned that there’s little cause for shlepping those heavy carseats everywhere, that the freer my hands are and the closer my baby is to me and to milk, the happier we all will be.

Mama Musings: The Home Birth of Auden

It’s boggling to realize that it’s been over nine weeks since the birth of my second child, Auden. I marvel at this stunning little person, so easily distracted by her hair, her cat-like stretches, the downy fuzz on her ears and the way she purses her lips in a way that instantly recalls memories of her brother at this age.  In the span of her little life, parenting has become a strange experience of contradictions. Life is both easier and harder; clearer, yet more disorderly; more expansive, yet also very limiting. My days are measured in moments of undiluted joy and blinding exasperation. Now that I think of it, these are all ways in which I would also describe her birth.

The evening before Audie’s birth, my husband took our toddler son to our local children’s museum for the evening. I decided to use the time alone to indulge in some needed solitude. I poured some tea and a bath and read a little in the tub. I got lost in the quiet, watching my belly thump and stretch to the rhythm of the one-girl dance party inside.  I took my time shaving my legs. A friend had given me lovely handmade lotion bar, and I used it generously afterwards. I blow-dried my hair and dabbed on a little perfume. It occurred to me that I was behaving as if I were getting ready for a date. Maybe I kind of knew on some level she was coming, I remarked to my husband later the following day as we lay next to each other for a nap in our bed, a freshly born daughter dozing serenely between us.

I had woken up around 3am on my due date with contractions. This was not a new experience; I’d been awoken numerous times by similar sensations over the course of the previous weeks. I laid in the bed watching my husband and son sleep for a few moments, realizing that these contractions were coming pretty regularly. I got up to use the bathroom, thinking, If I could just go to the bathroom I’d feel better. But I didn’t feel better. For about an hour, I used an app on my phone to time the contractions while I stayed in bed, unconvinced that these were the ticket to the big show.

With my son’s birth, I lost my mucous plug early one morning, had bloody show that evening, and about 5 minutes after that my water broke. Contractions started within the hour. That was my only frame of reference for how my body managed birth, so this is what I expected to unfold again. But I hadn’t lost my mucous plug; I’d had no bloody show; my water had not broken. The contractions were lasting anywhere from 50 seconds to a minute, coming every 4 – 5 minutes. When I was no longer comfortable laying in the bed, I crawled out of the covers and creeped over to my husband’s side of the bed. I told him in a whisper that I was having regular contractions and was going downstairs to take care of a few things. I encouraged him to stay in bed and told him I’d let him know if I needed anything.

Just after 4am, I went to the kitchen and brewed some coffee, but no sooner than the pot had filled, coffee suddenly seemed like a terrible idea. Feeling a little hungry, I pulled out a sauce pan and started gathering ingredients to make oatmeal, but no sooner were the ingredients all collected, oatmeal suddenly seemed similarly disgusting. The contractions still continued to come, and I braced myself on my cold granite countertop until each one receded. There was a fresh pineapple in our fruit bowl on the counter in front of me, and it was all I could smell. I took deep breaths of pineapple and swayed through a few more contractions. I swept the kitchen floor and wiped down my stove top in between contractions that made me feel increasingly unsteady. You know, because insignificant chores are what all ladies who are in slight denial that they are about to have a baby do. In hindsight, I think I was desperately trying to distract myself from from the intensity of it all.

I texted my midwife, Linsey: 4:16AM, Feb 9: Having regular contractions this a.m. since about 3am. About 50sec-1min long every 5min or so. Feeling ok, trying to rest. Will check in again soon. 

A minute later, she responded: 4:17am, Feb 9: Ok. Thx.

I pulled some bagels out of the freezer and gathered some apples and bananas. I grabbed the pineapple, thinking I might slice it, too, but just the thought of that suddenly seemed like way too much effort.  I plucked a sampling of tea bags from the cabinet and arranged them next to a jar of honey, some lemons and a few mugs. You know, just in case we’d be having guests–the kind who birth babies for a living–for breakfast.

I texted my in-laws, who were on-call for birthing day toddler duty: 4:40am, Feb 9: We might be having a baby today. Will keep you posted. Reg contractions since 3am. Everyone here still asleep. XO

My husband came downstairs briefly to check on me a few moments later. I told him that I was managing, that I might try to sit in the bath for a little bit. He asked if he should get the birthing pool ready. Fearful that a poorly rested toddler might present some challenges for us as the morning wore on, I told him that we should probably let our still-snoozing son sleep as long as possible. The plan had been to inflate the pool in our bedroom, but I worried the pump for the pool would likely wake him. If that didn’t, our scurrying in and out of the room surely would.

I went back upstairs and poured a bath. I couldn’t get comfortable in the bathtub. I weathered just a couple of contractions there, got out, dried off, and put my pajamas back on. Apparently the idea that a baby was on her way was beginning to sink in because I didn’t bother putting my underwear on under my yoga pants.

My head started to feel a little fuzzy. I’d been listening to Hypnobabies scripts for the last half of my pregnancy, but suddenly couldn’t remember which script I needed to listen to at this point.  I went to our tv/playroom and rifled through my Hypnobabies home study book trying to find the answer, but I couldn’t focus on the words and quickly gave up and laid down on the couch. (I had a great Hypnobabies birth with my son, and I knew these scripts by heart–I think my gridlocked brain had everything to do with the tsunami of intensity of this fastly unfolding birthing.) I tried to breathe through a few more contractions, but my breaths involuntarily came out as groans. I was toppled by a wave of nausea. I grabbed a bowl from my my birth supply basket, convinced I was about to vomit. I felt like I was on fire and started profusely sweating. I opened the door from our tv room that leads out to our front balcony and stood in the doorway taking in the winter morning breeze. When another contraction came, I braced myself on a nearby rocking chair. The contractions were so powerful, almost paralyzingly so.

I started to feel my composure slip away; I started to vocalize a lot. It came reflexively, the loudness. The I-don’t-care-who-hears-me-ness. My husband came into the tv room and closed the balcony door. I thought he’d done it so that neighbors wouldn’t hear me. Later he told me that he’d actually closed the door because the room was freezing in the 30 degree breeze. The chill never registered to me. I was somewhere else.

I texted my midwife: 5:39AM, Feb 9: I think I forgot how intense this can be. Got in my bathtub for a bit but could not get comfortable. frequency is slowing some but each wave feels harder. 

She messaged back: 5:41AM, Feb 9: It is intense but its manageable. 🙂 Let us know when you’re ready for us. We can come any time. Sounds like you must be having some nice alone time right now. 

With one of the following contractions, I sank to my knees. I was kneeling in front of my couch, prayer-like. My husband kneeled down beside me, and I started to openly sob. This hurts. I am struggling. I don’t remember it being this hard.  It wasn’t like this with Arlo. Oh god, this is awful. He would whisper, You’re doing great. And I would breathlessly say, But you don’t understand. 

Oh, transition, you wicked, wicked thing. 

I could feel everything shifting between my legs. There was this uncontrollable force of downward motion in my body. My body was moving the baby. I tugged down my pants, but couldn’t get them all the way off. I was frozen in that kneeling position and could not pull the waist of my pants beyond my knees.

My husband scuttled between the bedroom, checking on a sleeping Arlo, and the tv room, checking on me. I was still kneeling on the floor in front of my couch, burying my head into the cushion and reflexively vocalizing with each contraction. I tried to be quieter, but my body was in control, not my mind. In my head I kept repeating, This is only temporary. Listen to your body. This is only temporary. Listen to your body. 

At some point my husband had returned to my side, and I heard him say, Hey, buddy. Our two year old was standing in the doorway. He’d woken up, padded down the hall to the tv room and was surveying the scene. As my husband scooped our toddler up, I said, Call Linsey. Call her now. It was just a few minutes before 6am.

My back was to the door, so I didn’t realize that Linsey, my midwife,  had arrived until she was suddenly kneeling next to me. She listened to the baby quickly with the doppler and then began gently placing big waterproof pads under me. She was quietly empathetic and encouraging.

I felt my body pushing again, and I joined with it, pushing a little too. I had one of my hands between my legs, and with that little push I felt a trickle of water on my hands. My bag of waters. Good, Linsey encouragingly said to me.

My husband was out of the room with Arlo, who was protesting his ban from the room. He began to cry.  I was so worried about scaring my toddler. I don’t want him to see me like this, I said to my midwife. She said, He’s okay. He just wants to be with you. I needed my husband, and I was worried he’d miss something. I asked for him to come back into the room, and with him came my happy, unfazed toddler, who hopped up on the couch next to where I was resting my head between contractions. He gave me a bubbly greeting, Hi, Mommy!

I buried my face into my folded forearms with the next contraction, and Arlo said, I hide too! and he buried his face similarly. He handed me a book, Mommy, read? We all laughed. 

The baby will be here very soon, Linsey said. My in-laws still hadn’t received our texts and calls. Arlo, it appeared, would be there to see his sister born.

She checked the baby with the doppler again. I pushed when my body pushed, and a gush of water came with it. With the next push, the baby was crowning.  I could feel that she had hair on her squishy head. Keep your hand down there, Linsey encouraged. I think it’s helpful.

I pushed carefully with the next couple of contractions, fearful of repeating the third degree tear I’d had with Arlo. It was so hard to be patient–it burned to hold her there like that. Her head was nearly out.

And with the next push, her head was out. From behind me, I heard Arlo chirp, Hi, Baby! I later learned that Arlo had been very interested in one of Linsey’s flashlights, so she had given it to him to play with. The kid I was so worried about scaring was actually standing behind me with a midwife’s flashlight taking the scene in like it was zero amounts of a big deal. So incredible.

We were so blitzed by this labor that we’d completely forgotten to call our birth photographer. Our midwife snapped a few pictures with her phone for us, and there is one particular shot that absolutely steals my breath. It’s grainy and dim, which adds to its magic. Audie’s head had just emerged, and there is her face, so perfect, peaceful, and recognizable. Beneath her head is my hand, cradling her head, and under my hands are my husband’s two hands, open and ready to catch her.  Oh, how I love it: that perfect face, those three eager hands. 

I held her there again, waiting for my body to guide me through the next push. And then she was out, into my husband’s hands, with a big gurgly cry. My husband was positioned behind me and passed her to me back through my legs, and there she was, the baby I never expected, but wanted so much: slick, pink, whole and perfect. Lots of hair. Long fingers. I sat back on my heels, admired my daughter, and clutched her to my chest in relief. And joy. But lots of relief.

And there was our birth photographer, quietly on the scene after finally being summoned by our mindful midwife, snapping pictures of these first few minutes of our daughter’s life.

I nursed Audie briefly and marveled again at her features. She reminded me so much of Arlo. I handed her to my husband, and with my midwife’s assistance I stood and delivered my placenta with ease.

I walked back to my bedroom so that I could get cleaned up and changed, and there at the foot of our bed was the half-inflated birthing pool. The limp sight conjured up a little sad trombone for a moment, but I could really only smirk at it–yet another thing that I’d ardently planned out, but went in a completely different direction. We’d planned a water birth, but instead my baby was born about two feet from a pile-up of Arlo’s matchbox cars. Hah! I never mourned the whole not-in-water thing; once I was down in that kneeling position, I knew that’s where my baby would be born. There really was no moving at that point, and it was a very easy thing to accept. I had no choice, really. I did what my body told me to do.

I changed, nursed and cuddled my gooey baby some more, and then turned her over to my midwife for her exam. Audie checked out beautifully. She measured two inches longer than Arlo and was nearly a pound heavier. My midwife checked me out. I had a tiny labial split (not significant enough for a stitch), and no tearing of my perineum this time. Huzzah.

My midwife and her assistant cleaned up where we’d birthed, took down the birthing pool, and completed paperwork. Linsey spent some time peeking at Audie’s latch, and she went over all my postpartum aftercare information.

It was a blessing that my son was present for the birth. I’d thought I was pretty certain I didn’t want Arlo there, and I am now so thankful and excited that he is a part of his sister’s birth story. I love that  he was the very first person to greet this little girl and that he took the whole birth in with curiosity and ease. He may not remember being present for her birth when he grows up, but he’s a charming part of the story of the beginning of their siblingship, a story that we will tell them both over and again. May it be just the beginning of the all the times they are there for each other. 

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Arlo and Audie

Rhianna, a former social worker and current stay-home parent/human napkin, blogs from her adopted hometown of St. Louis. She has a masters degree in social work and credits this education and experience for priming her to be a gentle, attached parent. You can read previous posts about her home birth experience here, here and here

Prodromal Labor:  The Story of an Undiagnosed Mother

The Journey Begins

I was absolutely elated to be welcoming our first child.  Everyone had told me to make a birth plan, and for some reason, I did not feel the need, thinking that whatever occurred organically was the order in which the birth should take place.  I had very simple plans:  I would birth naturally, with no epidural or induction, and with my doula and my husband by my side, we would welcome my son into the world.  I had read enough about birth, taken my child labor class, and I felt well prepared.  I was not interested in over-educating myself, because I felt like instinct should play a part.  I know now that even if I had read every book I could get my hands on, I still would never have learned about prodromal labor, what it was, or how to recognize it.  It was a condition I would experience during the births of both of my children, and yet, the term was one I would not learn for almost two more years.

It was December 2008, and I started labor slowly.  Over the course of the day, my contractions progressed to be about 15 to 20 minutes apart, coming in strong groups, then calming.  By the following afternoon, about 24 hours later, contractions were about 12 minutes apart.  I waited for them to come closer together, and my doula came by to check on me.  I was only 1cm dilated, so we waited for another day until they reached five minutes apart.  I was completely shocked at the intensity of the contractions.  What was odd was that they would get close together, then slow again after a few hours. The pattern didn’t resemble anything I had been told to monitor when determining true labor.  I tried to keep relaxed as I felt my body pressing down on itself, seemingly trying to turn my insides out.  I have an extremely high tolerance for pain, but this was unlike any pain I had ever felt.  I was grateful that we had reached this moment, and that labor had finally begun.

We headed for the hospital and were met by my doctor, who I liked very much.  I was excited for him to assess the situation.  None of us could believe it when he said I was only 1cm dilated.  I told him I had been in labor for almost three days and asked how this could be!  He was stumped. Told me sometimes it happens this way. Offer #1 for an epidural came (there would be many more, from every hospital staff person with whom I spoke).  I adamantly declined.  He said that, at times like this, he can speed up labor by reaching in and manually stretching me open, but tended to only do this under an epidural since it was extremely painful.  I told him to do it anyway.  I did not want any drugs.  The pain was surreal.  But we were on our way.  My contractions continued, and the nurses put a monitor around my belly to make sure the baby was okay.  Several hours later, my doctor returned to check on my progress.

I was still at 1cm!  I absolutely could not believe it.  I was really hungry!  And frustrated.  And baffled, as was my doctor.  He said all we could do was wait.  I was about to begin day four of labor.  He suggested that perhaps we throw Pitocin into the mix to speed contractions.  At this point my contractions had been three to four minutes apart, during which I would bury my head into my husbands chest and he would rub his hands down my spine, trying to lessen the intensity.  I had no idea how bringing the contractions closer together would make me feel, but at this point I was willing to cooperate and see where it took us, since nothing seemed to be working.

My doula gently advised me to wait, telling me that sometimes one intervention could lead to another (meaning a potential c-section).  I heeded her words, but hours later opted out of desperation to try the Pitocin, bringing my contractions 60 to 90 seconds apart, with each lasting at least 30 seconds.   I continued that way for about five hours, and by 11pm, I collapsed in tears on the bed.  I was so tired, and I felt I couldn’t do it anymore. I was trying to be a hero, but for whom?  My goal ultimately was to deliver a healthy baby.  My body, it seemed, was retaliating. I had not planned on turning my fate over to the doctor, though here I was with my own course of action yielding no result.

I remember it like it was yesterday, even though it has been four and half years.  My doula again urged me to wait a bit longer before making any decisions.  Eventually, though, I buckled under the strain of so many days without sleep and pain that, even now, I cannot find words to describe.

By midnight, I asked for an epidural.  At four am, my doctor came back to check me.  I was 2 cm.  He suggested we schedule a c-section for 6 am.  I was so exhausted.  My spirits, despite everything, were still high.  I was so optimistic, still making jokes and trying to be lighthearted in the face of what secretly had been my worst fear.  My doctor would be going home at 8 am, he told me.  I could hold out, or he could deliver the baby via c-section at 6am.  I asked him if we could wait and check again at the time of surgery, hoping that if I progressed, we would hold off.  He agreed that this was a good plan.  At 6 am, however, my status was the same.  We prepared for surgery.  I remember I was shaking so much, teeth chattering, and I could barely talk; like a shivering child just out of the bathtub.  I don’t know if I was scared, or cold, or…what.

My husband and I held hands during the surgery.  Tears streamed down our faces during the immeasurable joy of meeting our beautiful, perfect little Oliver for the very first time.  I was still shaking.  They closed me up, and I held our son.  We had our baby, and that was all I cared about.  I thanked G-d and felt everything was right in the world.  I didn’t care that I’d had a c-section, because I had our son in my arms. As I nursed him and kissed his tiny little mouth, I felt like the most fortunate person in the world.

I still never knew that what I had experienced was prodromal labor.  No one told me.  Everyone seemed amazed to hear I’d had such a lengthy effort.  But not even my doctor addressed in my follow-up appointment that what I had experienced had a name, not to mention that there was a positive way to navigate around it should it reoccur.  Never mind, I thought at the time; I had no reason to be ungrateful.  I was blessed.

The Second Time Around

Fourteen months later, I became pregnant with our second child.  After my first appointment with my OB, where he casually said, “When you have your c-section…” instead of “if,” I knew I had to find someone else to deliver the baby.  I was not having another c-section.  It was 2010, and VBACs were still so much less common than just following precedent.  I interviewed a number of midwives and eventually settled upon the midwives at Mt. Auburn Hospital in Cambridge, MA.  What really sold me was when they said, “Western doctors go to medical school and read a thick book that has a small section in it devoted to what can go right.  Midwives go to school and learn from thick book that is all about what can go right, with just a small part about what can go wrong.  It shapes our perspective and keeps us focused on the positive, beautiful experience of child birth.”  Perfect.

When I went into labor, I was fully prepared.  Apart from wanting a successful VBAC, my birth plan, as it had been the first time, was flexible.  This time, I decided that if my pain became intense, I would have an epidural.  Simple.  I wanted to be happy and strong to welcome my daughter.  I felt good about knowing this.  I went into labor a day after my due date, even though the contractions were still 10-12 minutes apart.  They continued to get closer, but not close enough; about every 7-8 minutes for hours, then further apart, then close again.  I went to bed, hopeful, only to wake up with the same status and same pattern.  I went through the day this way, and by evening, I called my midwife as the familiarity of this situation hit me.  Suddenly I feared a repeat of my four-day labor from my son’s birth.

My midwife advised me to have a glass of wine, then lie with my backside in the air, knees to chest, to slow my labor.  This was around 7pm.  I obliged, but by 11pm, the intensity of the contractions brought me back to memories of my previous labor.  They were coming closer together, but somehow I knew I was not dilating.  At 11pm, I called again, worried, knowing my contractions were only yielding pain.

I told her, panicked, that this was alarmingly like my previous labor.  I begged her for any insight she could provide that might explain how a person could labor for so long and yield no result.  I was heading into day three of unbelievable contractions, and I needed any kind of hope, wisdom and motivation she was willing to share with me.

Prodomal Labor

It was at this point that I heard the term prodromal labor for the very first time.  One definition I found describes it as:  An early phase of labor that does not progress in a normal pattern: contractions do not increase in intensity and cervical dilatation is minimal.  Yes, sort of.  What my midwife said was that, for whatever reason—and often due to the fact that women spend more time sitting these days than they used to—the uterus tilts in a way that can put us into unproductive labor.  She told me we needed to get my labor to stop so that my body could reset.  How?  Somehow I needed to get rest.  At best, I should try and sleep.  At worst, I could go to the hospital and they could give me narcotics to force me to sleep, which would stop the labor and allow it to come on when my body was truly ready.  It seemed fine in theory, but I was waking up every 5-7 minutes in sheer pain.  Sleeping wasn’t really happening.

At 1am, we headed to the hospital.  There were no rooms available, so we waited until a nurse finally checked and told me I was 1 or 2 cm dilated.  Each contraction hurt SOOOO much!  I burrowed into my husband, and he did his best to soothe me.  I knew I wasn’t supposed to wince or tense with the pain, that I should go with it and ride the wave, but I simply could not withstand the intensity.  I wish, in retrospect, that I could say it had been doable, though to this day, I don’t know if I could have endured much more.

By 3am, I had an epidural, and I finally slept.  When I awoke at 8am, my body had restarted, and I was in legitimate labor.  My midwives came together to help me birth our sweet baby Penny, and she was born at 12:30pm.  Everyone cheered for Penny, and for our group success with the VBAC.  I felt hugely triumphant and SO very happy.

Looking back, there are a few things I know.  If I had been made aware of what prodromal labor is, I am certain that I would have understood how to pace myself.  I am a runner.  I have run sprints, and I have run marathons, and it is all about the mind.  You just have to know what distance lies ahead.  Because none of the videos I had watched and none of the books—not to mention my birth classes or weekly OB appointments!—had mentioned this remote possibility, it was impossible for me to envision a positive, let alone finite, outcome.  I thought I was defunct. I know now I was, and am, perfectly fine.  My body was just doing what some bodies do.  This was information that would have helped me so much.

If someone had simply said to me, “Danielle, this is prodromal labor.  It feels real, but you need to zoom out and see the bigger picture.  The pain will be really tough, but it will go away, during which time you will need to rest to gain strength for when it returns.  It’s a pattern, but you can handle it, because it WILL end.  It WILL result in labor, and you WILL be okay.” I needed someone to tell me that.  Instead, I tensed up amidst a lack of knowledge and eventual worry.

I am still incredulous that no one ever brought up this possibility.  How had my original OB never even known about this?!  Had he known but just not thought of it?  I don’t know. Frankly, it seems irresponsible to me.  My doctor didn’t tell me about something that other women experience whose criteria applied to my situation, and that makes me uneasy.  I am, above all else, grateful that my two babies reached their destination!  I’m also grateful I can tell others that prodromal labor is not insurmountable, and that with the right support and awareness, giving birth will absolutely be as beautiful as you had hoped.  Probably more.

Resources

Update as of 6/14/14 – a must-read post on cervical scar tissue, one cause of prodomal labor: http://thedoulaguide.blogspot.com/2012/12/cervical-scar-tissue-cause-of.html?m=1

Here are some links to other helpful information and stories about prodromal labor:

http://spinningbabies.com/more-info/in-labor/362-starter-broken-when-early-labor-lingers-or-starts-and-stops

http://thechroniclesofbubs.blogspot.com/2012/06/andrews-birth-story-week-of-prodromal.html

http://belladolcebirths.blogspot.com/2012/01/prodromal-labor-what-is-it.html

Here’s a great one:

http://www.nmfrogblog.blogspot.com/2010/01/prodromal-labor-from-doulas-perspective.html

Did you experience Prodomal Labor? Please share your words of wisdom with our readers.

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Danielle_bioDB Gottesman, a stay-at-home mother, Pilates instructor, and [dormant] artist with a formal marketing background, fills her days observing and relearning the world through the eyes of her wise and generous two-year-old and four-year-old.  She is in the throes of parenting toddlers and wonders constantly what adventures lie ahead for her and her lovely, silly, sweet little family.

 

Mama Musings: How I Secured Health Insurance for Our Home Birth

Here’s the short story: I developed an instant respect and fondness for my midwife before I began seriously exploring the extent of my health insurance coverage for midwifery care. Afterwards I learned that I had no coverage, and I spent more than two months running through an infuriating gauntlet of insurance red tape in pursuit of some measure of coverage for my home birth. I’ll walk you through my journey to help those of you who may be navigating the same maze.

Here’s the longer version. After discussing with my midwife the fee for her care, some quick mental math told me that I’d likely be paying close to what I paid for my previous hospital birth. My midwife charges a sliding scale fee of $2500 – $2900 (you determine where you wish to pay in that range).  With my first pregnancy, my OB charged $900 for the term of my prenatal care, and the hospital bill from my first son’s birth was $1600. (The sum of these two costs doesn’t include the various co-pays and bills for labs and such that are a part of general prenatal care.) The expense for a home birth, I quickly concluded, was pretty much on par with my out-of-pocket responsibility for a hospital birth. I figured we’d just roll with the expense as we did the first time.

But there are many differences between my current pregnancy and my previous one, and the critical one is our family’s income level.  It was notably easier to absorb the expense of my first pregnancy when we were both working outside of the home. But now, as a single-income family, we have to be considerably more mindful of how we spend our money. There really is little room for unnecessary spending.

After many conversations with other home birth mamas, I learned that some of them were able to get partial reimbursement for their births, and a seed was planted. Any amount of money that we might be able to save ourselves would be worth the effort, I figured, no matter the hassle. Further, we pay for our health insurance, and we should do our best to make it work for us, rather than against us. Midwifery care is as valuable, substantial, and worthy of insurance coverage as obstetrical care is, and not trying to secure some coverage seemed like I was, I don’t know, conceding that this type of care is inferior to obstetrical/hospital-based maternity care.

My midwife contracts with a billing service specifically trained and experienced in billing for midwifery care and interfacing with insurance companies to suss out coverage. I swallowed a lump in my throat as I read the notes on my Verification of Benefits document from the billing service: Midwives are not covered. In-network exception is not possible; home birth and midwives are not covered. 

BLERGH.

At this point, I reached out to the human resources department for my husband’s job  and started a dialogue with her about this lack of coverage. I wasn’t sure where this effort would take me, but I figured that she likely had worked with other families who may have experienced network gaps. I wish I could say that this exercise was helpful. It was not.

The HR staff person was receptive and eager to assist; she contacted her counterpart at the insurance company to see if this individual could also help suss out the details. That insurance person (who was responsible for structuring policy) repeatedly provided incorrect guidance over the course of several weeks. (No, this was what we needed to do next. No, wait, it’s actually this. I’m sorry, I was mistaken. Your next step should be this.)  Perhaps this repeatedly wrong guidance isn’t the insurance person’s fault; perhaps this just serves to illustrate how insanely cumbersome and confusing it is to navigate insurance policy.

With each new piece of instruction, I would contact the care coordination department of my insurance’s member benefits office. I would tell the care coordination person what I had been advised by their very own personnel–their personnel implicit in formulating our current policy–and the care coordination staff would contradict the information I’d been provided. Lather, rinse, repeat.

Because there were no midwives covered within a 30 mile radius of St. Louis (how is that even possible????), I was eligible to request an exception that my midwife be considered in-network for our policy.  At first I was told that my midwife’s billing service could do this on my behalf. They tried, but were told they could not. I was then advised that I could personally make the request, and when I tried, I was told that I could not. It took weeks–not an exaggeration–to simply identify the correct process for pursuing this network gap exception request. We’d make these requests, they’d languish somewhere in the insurance company’s cosmos, and when I’d follow up that’s when I’d be informed that the request hadn’t followed the specific procedure for my policy. MADDENING.

For anyone, however, who is able to make their own request, here is a sample letter to accompany your request. This template was given to me by my midwife’s billing agency:

Date

Insurance Company
P.O. Box 12345
City, State, Zip

Member ID # [123456789]

Request for In-Network Exception

To Whom It May Concern:

I write to request an in-network exception for maternity care to be provided by my midwife, XX. I am requesting that the midwife services from dates of service [May 04, 2012] through [April 20, 2013] be authorized to pay at the in-network level for based on the following reasons:

1. XX is educated, trained and licensed as a midwife. Maternity and newborn care is within her scope of practice per state code.

2. The services provided by a midwife are very cost effective. Midwife services on average, will cost an uninsured individual $4,000 – $6,000. A typical hospital birth will range from $10,000 to $60,000. This reflects a savings for both you as an insurance company and me as a member.

3. There aren’t any contracted midwives within a 30 mile radius who will perform a home birth (use this sentence if you know this to be true).

4. Basic CPT and diagnosis codes that will need to be approved are as follows:

Mother’s Dx: V22.0

CPT Codes for professional services to be billed on a CMS1500 form:
59400-Global OB care
99232-Hospital Visit/Care
59410-Delivery & PP Care
99356-Prolonged Care
59425/59426 Global AP Care
99357-Prolonged care
99203/99204/99205 Office visit
A4550-Supply Kit
99123/99214/99215-Office visit
99348-Home Visit
99354-Prolonged Care
99349-Home Visit
99355-Prolonged care
99350-Home Visit

Baby’s Dx: V30.2
CPT Codes:
99461-Newborn exam
99464-Birth assistant
S3620-Metabolic screen
99212/99213-Office Visit
99348-Home Visit

5. Please put your personal reasons for wanting a home birth with a midwife here.

I trust this information will help you in your decision to authorize these services at the in-network level. If you have any questions, please feel free to call me at phone number.

Sincerely,

The final bit of instruction was this: I needed an in-network provider to make this gap exception request. I was first told that my former OB–the one whose practice I’d left over birth philosophy differences–needed to make this request. I attempted to explain that my OB was no longer my prenatal care provider. Why would a provider no longer providing care to a patient make such a time-involved request on their behalf? My records at that point had already been transferred to my new provider. Nevertheless, I called my OB’s office and respectfully and directly explained my issue; they respectfully and directly told me that they would not make the request, as I was no longer receiving care there. Made sense.

I was then told that ANY in-network provider could make the request on my behalf. Problem? I was connected with no other in-network provider. I didn’t have a primary care doctor or a family doctor. I haven’t needed one since I moved to STL less than a year ago. It seemed completely ridiculous that I’d have to set up an appointment with a PCP or family MD  for the sole purpose of having them interface with my insurance company to request that my midwife’s care be covered.

I obtained a few recommendations for area doctors who have a reputation for supporting home birth and made an appointment. I felt so ridiculous explaining to the nurse at the beginning of my appointment that I was perfectly healthy and was essentially using them in an effort to make a gap request. The nurse was good spirited about it. The doctor was even kinder. She boggled at the bureaucracy of it all, said that she was a big advocate of home birth and that she felt I deserved to have the birth I wanted, and instructed her nurse to initiate the whole process for me. RELIEF.

An additional hiccup later (the nurse supposedly made the wrong kind of request–surprise) and the network gap exception request was finally and legitimately sitting in someone’s inbox for review. It only took 10 weeks.

A week later I had a letter in my mailbox explaining that my request had been approved and that my midwife would now be considered an in-network provider. I nearly shit myself. If there had been any alcohol in the house, I would have consumed it in teary-eyed celebration. Finally, it appears that my home birth will be covered. I will hold onto this letter for dear life. (Well, it should be covered beyond the satisfaction of my in-network deductible, which has been nearly met.)

So, tips for pursuing coverage for your home birth?

  • Enter this process with an expectation that it will be time-involved and cumbersome. If your process flows more smoothly, awesome! But, um, don’t count on it.
  • You are, basically, the foreman of this whole process. Do not take for granted that someone on the other end of the phone has done their job. Do not wait for them to call you back. You call them–follow up every day if you have to. Be persistent, annoyingly so if you must.(For example, my new family doctor’s office called to tell me that they’d put the gap request in. The following morning I called the insurance company to ensure that this had been correctly done. It supposedly hadn’t. I made sure that the request was then submitted again, this time correctly. If I’d have waited, more time would have been lost.)
  • Seek coverage for your provider. I posed the entire inquiry as provider-based–here is this caregiver whose services I wish to have covered. I never once explained that I was planning a home birth. No one ever asked where I planned to birth my baby, and I did not volunteer this information at any juncture. Would that knowledge of an intended home birth have colored the insurance company’s decision? I wasn’t about to risk the chance.

Here are some additional resources regarding pursuing insurance reimbursement for home birth:

What was your experience securing coverage for a home birth?

Rhianna's biopic

Rhianna, a former social worker and current stay-home mama of two, composed this post in the very room in her St. Louis home where she birthed her daughter nearly 8 weeks ago. She now feels like a seasoned home birth ninja in the battle for insurance coverage.