Mama Musings: My Journey To Choosing Home Birth and a Provider

This post is the first in a series I hope to complete before the arrival of my second child, who I plan to birth in our home under the care of a midwife in the coming weeks.  I’m always a bit reticent and feel somewhat tender when discussing birth preferences and experiences (my own and those of others) because I full-heartedly feel that birth preferences and experiences are sacred things, things to be respected and honored, no matter what your birth looks like. It’s in that spirit that I compose these posts–in a spirit that respects and honors this milestone in my family’s life and in a spirit that perhaps respects and honors your curiosity and concerns about the processes involved in home birth.  These posts are not intended to be prescriptive, but rather as a peek into what has informed my decisions so far. Please tread gently.

A bit ago I wrote a post sharing my question about where to birth my daughter–in the hospital or in my home.   Several of you shared your insight and support on that matter, and I’m genuinely grateful for the time you took to lend some perspective. A couple of weeks after that post my husband and I came to our  decision: we chose to plan a home birth, and I transferred my records from my obstetrician to a midwife.

photo credit: eyeliam, Flickr Creative Commons

Briefly, these are the factors that bolstered my interest in and my ultimate decision to pursue a home birth: I want to  have a birth experience that is inclusive and supportive of the whole family; I wanted a provider who felt more like an invested partner in my maternity care, rather than the commander-in-chief of my care; I had an unmedicated vaginal birth with my son, and I feel confident in my ability to do this again; my previous pregnancy was and my current pregnancy is healthy and low-risk; and my previous birth experience (in a hospital) was supportive and generally pretty positive, illustrating clearly to me how invaluable this amplitude of support can be during birthing. My decision to pursue home birth was never made from an anti-maternity establishment frame of mind, as some have assumed; it was my positive hospital birth experience with my first pregnancy, in fact, that underscored how invaluable and necessary respect, support, comfort, and confidence are in any birth experience.

There is an overwhelming amount of fear-mongering about birth out in the vast interwebz. Trust me, I stepped in a lot of steaming, fear-stoking crap as I forged my path to my birth choice both times.  You owe it to yourself and your baby to be thoroughly educated about your options and the procedures and processes involved in birthing, no matter where/how you plan to have your baby. You are not merely a passenger in your birth experience. And if you are reading this as someone, like me, who struggled to get and/or stay pregnant, you especially deserve to reclaim some power on your path to motherhood; there is much about the infertility and loss experience that erodes our sense of self-determination and our confidence in our body’s capacity to get things right.

There is a good amount of insightful, balanced reading out there for those seeking to shore up a decent perspective on birth options. My favorite book (I read it during my first  pregnancy and then revisited it for my current one) is The Thinking Woman’s Guide to a Better Birth by Henci Goer. I also enjoyed Active Birth: The New Approach to Giving Birth Naturally by Janet Balaskas. I read many others, but these were the standouts for me. Other very popular and instantly recommended books in the”natural” childbirth community are those written by renowned midwife Ina May Gaskin. (You can also find some additional birth education recommendations from TOBB here.)

Finding My Provider

My initial debate surrounding the venue of this birth had much to do with being in a brand new city with limited insight into community resources surrounding birth and a limited understanding of the  birth culture in this new locale. I’ve always been attracted to the midwifery model of care. It pretty much sounds like a dream come true, no? (I think this brochure is a perfect frame of reference for selecting any prenatal care provider, even if you feel more comfortable with or have a medical indication requiring obstetrical care.)

I had an OB for my first pregnancy because there were only two certified nurse midwives practicing in my small former home city, and both of them practiced in large OB practices. My professional experience as a hospital social worker on a women’s & children’s unit (L&D, mother-baby, NICU, pediatrics) gave me priceless perspective on the limitations of large OB practices, and  I knew I would not be pursing prenatal care with either of those big practices. Instead, I sought out an  OB who practiced independently, as I felt this would give me a better shot at individualized care. Sure, either of those midwives at the other practices would have been able to give me this kind of care…but only on their rotation. I knew that a merry-go-round of OBs (with several of whom I’d repeatedly had dissatisfied professional experiences) was not for me. I didn’t want to run the risk that one of these disliked OBs would be on call the day my birthing began, because that would have been my luck.

So, now here in St. Louis and apparently pregnant, I immediately began asking other moms for recommendations for prenatal care providers, hoping to find a certified nurse midwife this go ’round. I was advised that there is only ONE certified nurse midwife in all of St. Louis who delivers in the hospital. (How is that even possible in a city this size with not one, but TWO schools of medicine?) I belong to an attachment parenting group here, so I lobbed my prenatal care quandary at those moms, knowing that we likely shared some of the same gentle birth ideas and that these women have had broad birth experiences–hospital/birth center/home/high-risk/low-risk/vaginal/with pain support and without/emergency cesarean/planned cesarean. They were a wellspring of knowledge. And this is where I learned that the majority of the other midwives practicing in the STL area are certified professional midwives who deliver babies at home.

There is a difference between certified nurse midwives and certified professional midwives (and lay midwives and direct entry midwives, etc.). Did you know there were so many types? I didn’t. This explains the differences in experience, education and credentialing.

Many of the moms I talked to had birthed their babies at home, and while home birth wasn’t something I’d been considering at the time, I listened to their experiences with an open mind. And I jotted down their providers’ names, just in case.

As I mentioned, I began my prenatal care for this second pregnancy at a small “natural birth-friendly” OB office (with two OBs) in my insurance’s network while I continued to suss out additional resources. At this point in time I was planning to attempt to repeat my previous birth experience: an unmedicated, Hypnobabies-bolstered, doula-assisted hospital birth surrounded by caregivers who value individualized care and who are experienced in supporting mothers through this kind of birth. As my appointments ticked away from 8 weeks to 20 weeks, it became evident to me that my hopes were a little too high for this particular office. I was constantly being shuffled to the nurse practitioner instead of my OB for appointments, even when I had specifically requested to see the OB and had been told I would see the OB; the nurse practitioner told me she was unable to answer many of my birth-related questions because she was not the provider who would be attending my birth, and instead she gave me vague and contradicting answers. In the appointments I was able to have with my OB, she was non-committal and dodgy in her answers:

“I would really like to try a water birth; how do you help manage water births at your hospital?”

–Well, I can’t say right now that you can have a water birth. There are lots of things that could happen that might prohibit that. You just never know. 

Ummm-hmmm. While this is clearly true–you simply can’t guarantee how a birth will unfold–an ongoing pattern of this kind of answer and attitude made my care feel like a bait-and-switch deal. There are better/kinder/gentler ways to convey the message that birthing is not predictable and that perhaps we might discover that I am not a good candidate for this means of birthing support. All of my questions were met with these evasive and glass-half-empty answers. It made me uncomfortable, to say the least. Especially coming from a provider who described herself as “natural birth-friendly.” If *this* was friendly…

Maybe this sounds nit-pitcky. Perhaps to some it is. But what I deeply felt is that I did not want to approach my birth with apprehension about a lack of support or with a foreboding expectation that I’d have to arm wrestle my OB and nurses for consideration of my birth preferences…while laboring.

I began interviewing recommended area midwives, one of which is heading up the opening of a birth center about an hour outside of the city. She was warm, encouraging, and insightful. The birth center’s opening had been pushed back again–this has been an ongoing three-year effort, apparently–and this midwife (a certified nurse midwife) was still delivering babies at home in the meantime. She (and the birth center) are located about an hour from where I live. Not exactly ideal. She casually said, “You do know that you have a couple of exceptional midwives in your very own neighborhood, don’t you?” And she specifically recommended one of these midwives to me. (This particular midwife had also been recommended repeatedly by other mamas in that AP group.)

I interviewed her next. I was instantly comfortable with her–her style, her personality, her frank and articulate answers to my questions, even her office environment. And I especially liked that she was trained/experienced in two skills that were non-negotiable for me: neonatal resuscitation and  stitching. I had a third degree tear with my son, who was both posterior and compound. I recognize it’s likely that I will tear again. And I am not a “let it heal naturally” kind of girl if the tear is significant.

I combed the interwebz for interview questions for my midwife interviews, and culled a list of questions from here and here. Our interview (because, yes, she was also interviewing me–was *I* a good candidate for homebirth?) was more of a comfortable conversation, and halfway through, this midwife asked for my list of questions and just went down the list, answering completely each and every question I’d brought. This was such a contrast to my OB experience, where the answers to my questions were foggy, and where questions, in general, felt like an intrusion on her time.

A few weeks passed before I made the switch from my OB to my midwife. I am an over-processor by nature, constantly turning something over in my hands to an anxious, nauseating fault. For me, historically, it’s the process of making the decision that overwhelms me.  And then, one morning, I woke up and realized, This is what I want and need to do. Once I filtered out all the static, the picture was clear. And when I walked into my OB’s office to fill out paperwork to transfer my records to my new provider, I did it confidently and comfortably and with a great measure of relief. Listening to your gut–honoring your instincts–is a feeling that can’t be overstated.

In the term of my care under my midwife, I’ve done the same kinds of tests that I would have received under my OB’s care, such as a glucose tolerance  and GBS tests. She takes my blood pressure and pulse, checks my urine and weighs me, and listens to the baby with either a fetoscope or doppler. She measures my fundal height and palpates to determine the baby’s position. The difference in the care, wholly, is the quality of the interaction. This kind of maternity care has been a good fit for me.

And that’s ultimately what it comes down to–what feels like a good fit for you? What kind/venue of care makes you feel more supported about birth? Because if giving birth in your home feels scary or uncertain, it’s not for you. You need to feel confident, and sometimes that confidence comes from knowing you can deliver in home-like environment (a birth center) or within the structure of the medical model (hospital). Wherever makes you feel emboldened and safe about birthing is where you need to be.   If home birth is something that appeals to you here are a couple of  posts written by other home birth mamas about their experiences: here and here and here.

Tell us about your birth experience: Where did you birth/where are you planning to birth? What informed your decision? How did you find your provider? Do you have any suggestions for handy resources for informing yourself about birthing? 

Rhianna is currently 39 weeks pregnant and feeling every bit of it. There’s an inflatable birth pool in her closet and a length of hose coiled next to her bathroom sink, and she is ready to put them to use. Stay tuned for her next post on home birth supplies and her home birth to-do list. She lives in St. Louis with her husband and two-year old.

Paleo Series Part II: Paleo for the Whole Family

This is the second installment of a four-part series on the popular Paleo way of eating and lifestyle from a mama’s perspective. You can find Part I here. Although Kate is not a medical professional or nutritionist, she’ll share her thoughts and experiences of implementing Paleo in her household. 

Paleo: a simple, whole foods way of eating that focuses on meats, vegetables, fruits, and fats. It is also a lifestyle that places importance upon restful sleep, functional movement exercise, and interacting with and enjoying the outdoors.

Kale/Spinach Smoothie: A regular in our household

WARNING: Reading the following might result in improved health, more energy, and a desire to swing from a tree branch. Oh, and your kids will benefit as well! 

This morning my husband, my mother-in-law, daughter, and I shared a simple breakfast of scrambled eggs, sautéed fresh squash from the farmer’s market, and cups of coffee for the adults (no cream/sugar.) Vivi wasn’t crazy about the squash, but tasted it several times, examined the texture, and eventually decided to enjoy her eggs without. She still seemed hungry, so I quickly blended up some raw kale, frozen fruit, coconut milk, and water. She gulped down three small cups.

This meal, while simple enough, met the complex and diverse needs of all of us. The low-glycemic index of the squash and eggs satisfied my diabetic mother-in-law. My husband, who seems to be always trying to slim down and get a six-pack (I support ya, sweetie!), appreciated the low-carb aspect of the meal, but felt satiated by the coconut oil used to cook the squash. And my daughter? Well at 16 months, a meal like this is normal, tasty, and unbeknownst to her, nutritious. When we eat Paleo as a family, every meal is a home run: nutritious, tasty, and satisfying.

Paleo is a total change of lifestyle and can be tough enough for adults. So often, there might be one person in a family eating Paleo, while the rest stick to what’s familiar. I want to assure you that it doesn’t have to be this way! But inevitably, there are usually two questions floating around when you mix Paleo and kiddos:

• What does Paleo eating look like for babies, toddlers, and older children?

Paleo eating for kids is pretty simple: if you’re eating Paleo, they can eat all the same things as you. No more cooking two meals and loading the shopping cart up with “kid-friendly” options!

Babies and toddlers will naturally gravitate toward a more veggies/fruit/fat based version and less meat. My daughter will often refuse meat for a week at a time, while devouring everything else. Paleo and baby-led weaning naturally go hand in hand: think soft pieces of fruit and vegetables, egg yolks, homemade broths, and slow-cooked meats that are easy to chew for the baby who is at least 6 months old. Don’t forget the breastmilk…your cavewoman ancestors would be proud!

Independent toddlers will relish the opportunity to eat what their parents do, rather than something else that looks and tastes totally different. Having options to choose from will allow these headstrong babes to feel in control.

Older children might be a bit more difficult to get on board if they haven’t eaten this way previously. The best thing you can do is to only keep nutritious options in your home, make Paleo meals, and don’t worry about the rest. Kids are so resilient and adaptable: give them the chance to make healthy choices, and I think you will be surprised.

• And is Paleo eating even healthy for kids? 

Immediate answer: YES! Do you know anyone who has ever become obese/sick/diseased while eating plenty of vegetables, fruits, and high-quality meats, eggs, fats, and fish? Children thrive on this type of diet, and you may have seen something similar prescribed for kids with Autism Spectrum Disorder, the GAPS diet.  The Paleo way of eating provides such a varied, nutrient-rich diet that allows a parent to relax about food choices. No need to worry if your little one is getting enough of one nutrient or another because, most likely, they are getting them all and in ample quantities.

However, there are two big issues that concern many parents: no grains and no dairy. Aren’t kids supposed to have both for the fiber and nutrients (grains) and the calcium and vitamin D (dairy)?

The short answer is this: kids will get all of the above nutrients from a Paleo diet. Vegetables and fruit provide ample fiber (yay poop!), leafy greens and nuts take care of calcium, and vitamin D can be sourced naturally from a short play session outside (step away from the Wii, my friends.) Instead of cow’s milk, my daughter drinks plenty of water, kale/spinach shakes, and an occasional cup of straight coconut milk. I’m pretty positive (at least 99% sure) that she is not only meeting the government’s snazzy RDA (recommended daily amount) of nutrients, but blowing those old-school recommendations out of the water. But if you want scientific charts, medical studies, etc., and not the word of some random mama on the internet, you can’t do wrong with reading a little Robb Wolf.

Kids on a Paleo diet are healthy, happy, don’t experience sugar-induced mood swings, and will typically sleep pretty soundly. If the warm and fuzzy image of your kids growing lean and strong on whole, nutrient-dense foods and plenty of play outside has you clamoring for more info, take a gander at these oh-so-helpful resources:

Books

• Family-friendly recipes, “games” (OK, exercises) for the whole family, and great information: Everyday Paleo by Sarah Fragoso
• Looking for the science behind all this? (I’m with ya, sister…or brother.) Then look no further than biochemist, research nerd Robb Wolf’s book The Paleo Solution. 

Blogroll

Who doesn’t love a good blog? (Ahem, TOBB.) Feast your eyes on these great internet writers:

• Growing Up Paleo
• Paleo Parents
• And for the ladies: Paleo for Women

And please, by all means, shoot your questions my way, and I’ll do my best to either answer them or point you in the right direction. Now go whip up a spinach smoothie, and get with it!

When Kate is not sharing a coconut-kale smoothie with her little one or planning/throwing together a Paleo meal, she enjoys writing about women’s issues, endlessly (virtually) redesigning her place a la Pinterest, and chatting with friends over coffee. 

Toddler Nursing, Through Sickness and Health

Enjoying some time together at the park

Have you ever nursed a toddler? If you haven’t, just ask someone to poke your eyes, stick their fingers in your mouth, and repeatedly pinch you as their “soothing mechanism.” The only thing soothing about nursing a toddler is that when the wind is blowing just right and all the moons align, I can sometimes catch up on a half episode of “Property Virgins” on HGTV. Sometimes it still surprises me that we’re going strong with nursing at 15 months, an age when most little ones have ventured into cow’s milkland, never to return again. Alas, my little one is hooked on the boobjuice.

When my daughter was 7 months old, I experienced a nasty breast yeast infection (in medical terms, candida). Painful, raw skin was my burden and every nursing session was equal parts patience and mild torture. My husband said I should stop nursing. My mom, a lactation consultant, even gave me “permission” to supplement. I dreaded nursing, but hated the idea of giving up more. All I can say is that I pray my daughter doesn’t inherit too much of my stubborn streak.

After a couple of months (and a bout of mild eczema, thank you very much), it magically went away. OK, well it went away after I tried every natural and not-so-natural method under the sun. Let’s just say, if you experience thrush, let me know because I’ve got the lowdown. I sampled every method out there: elimination diets, coconut oil, grapefruit seed extract, antibiotics, garlic, APNO (all-purpose nipple ointment), prayer, etc. God help me if I ever get it again!

So we stuck with it, my little nipple biter and I. And it hasn’t been all “suffering.” Nursing a little one is a pretty sweet gig, and might I say a very useful tool when sickness invades your home as I found out all too recently. You see, my little peanut caught strep and a bacterial infection, one after another, and was sick for nearly two weeks. She was miserable, feverish, and crying for nearly that entire time. And there was one thing that was her nearly constant comfort. No, it wasn’t fruit popsicles (which did help, by the way) but nursing.

Good old mom and her battle wounded “nanees” (her word, not mine) saved the day. The combination of comfort, nutrition, and hydration helped heal my little girl (OK, along with some antibiotics). For a brief period, I felt like I was nursing an infant again with our round the clock sessions. I’ll admit, I felt slightly frustrated with the (nearly) nonstop nursing she needed over the past few weeks. But I am so grateful I didn’t give up on nursing months ago and could be there for her in such an intimate and loving way.

My little girl and I have come a long way in our nursing relationship, and I’m not sure when the ending point is. But really, does it matter? Every day with her gives me incentive to continue for now, pinching, giggles, and all.

 

 

Kate keeps a secret stash of APNO in her bathroom drawer “just in case” and will, without a doubt, attempt to nurse any future nipple pinchers that may or may not be in her future. When her little one isn’t nursing, they enjoy reading books together, making farm animal noises, and playing with the dogs.

Play, the Natural Family Way

The value and significance of childhood play has been broadly documented. Once believed to be an activity of indulgence, play is now understood to be a vital component of a healthful childhood and a springboard for adaptive and positive functioning in adulthood. It promotes emotional and cognitive development, cultivates social skills such as conflict resolution and cooperation, and stokes creativity. In my social work education and career, I have even studied and observed the brilliant, skilled use of play as a means of therapy for children. Play is powerful stuff!

I’ve learned in my relatively short parenthood journey that it is ridiculously easy to get pulled in by the promise of “educational” toys, music, and DVDs. Our love and dedication as parents makes us vulnerable; we lovingly want to give our babes every possible advantage towards becoming well-thought, kind, creatures. Studies have revealed, though, that those blinging, singing educational toys actually fail to deliver on their marketed promises. And others now recognize what we as attached parents have always understood: the best, most influential toy your child can have is  you.

We’ve tried hard to stem the surge of those kinds of toys into our home. We don’t buy them. Usually these toys have been given us to as thoughtful, well-intentioned gifts, and we’re grateful that someone cares enough to think of our son in this way. We pull those toys out as a matter of exception, usually for specific circumstances (like, for example, a long road trip), and as we rotate one in we rotate another out.

We’ve visited the homes of friends where shelves bulge and erupt with toys, where even I feel a bit overstimulated by the bounty of bright, loud, plastic playthings. In our home we’ve deliberately chosen to limit not just the types of toys, but also the amount of toys present. I especially love this perspective on why having fewer toys actually benefits your children. (Really, if you click on only one link from this post, make it this one. It’s an insightful read. And if you are interested in ways to cull your current toy stockpile, here are some pointers.)

We focus, instead, on time spent and activities enjoyed together as a family. Play is darn fun and can serve to expend our little ones’ bottomless energy, but it can also be a delightfully effective way to enrich attachment. And, you know what? These kinds of activities are often free or awesomely inexpensive–just one more example of how natural parents are richer.

Taking walks is a huge hit for us right now. We live just blocks away from a sprawling park with towering old trees, winding walking paths, and a safe playground. We collect leaves, smell flowers, pet moss on tree trunks, wave to robins and count squirrels. We take our shoes off and kick balls in the grass. Nature is free and wild, and little ones benefit from time spent outdoors with their caregivers.

Looking for other ideas for easy, mostly inexpensive ways to play with your toddler? Here are some fun ideas. Or perhaps other nifty ways to get your nature on with your half-pint? Here is a good place to start.

What kinds of toys does your child dig the most? What kind of activities do you enjoy doing with your kiddos? Have any favorite resources for natural play?

Best play space Rhianna ever made for her 17-month-old son? Dedicating a whole kitchen cabinet to him and filling it with random inexpensive kitchen related items like egg cartons, empty spice containers, herbal tea boxes, wooden spoons, and play food. She lives in St. Louis and spends a good deal of time in Tower Grove Park, where her toddler enthusiastically gifts her with sweetgum balls, chunks of mulch, pebbles, and beheaded flowers.

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Did you know The Other Baby Book: A Natural Approach to Baby’s First Year is now for sale? Are you interested in learning more about gentle, mom and baby-friendly practices that foster a joyful, connected relationship? Want to introduce a pregnant friend to natural parenting? Check out our website or head over to Amazon to grab your copy today!
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