Stuck Between a Hospital and Hard Place: How Risky is a Home Birth for a "Low, High Risk" Birth?

That title was a mouthful, and so is this story. This post has been one I have considered writing a long time, but it is difficult emotionally, so I have avoided it. It's time to get it out there.

In 2009, I had a simple laparoscopic knee surgery to correct an old sports injury. I was naive and foolish to think any surgery was simple. (I think that is why I get especially angry when someone says, "Just have a cesarean, it's so easy.") At the time, I was taking the birth control pill. My doctor never told me to stop it prior to the surgery. He didn't feel my surgery and birth control were counter-indicated. Two days after my surgery, I got an intense pain in my ankle, following by intense swelling and the worst charlie horse I had ever had in my life. I went to a massage therapist who thought I might have a blood clot in my leg, but gave me a massage anyway. I went on like this for a week before a finally went to the doctor. I couldn't find a comfortable position, sitting, standing, laying down. I had to leave work, went straight to my doctor, who sent me to the ER. I jumped into the ER on one leg (not yet knowing the gravity of the situation.) As it turns out, I DID have a blood clot in my leg. The massage had dislodged it from my ankle, but luckily it became lodged in the artery behind my knee, only a 3 small pieces breaking off and traveled through my heart into my lungs. (Which had explained some intense chest pain I had recently experienced. That my friends was a minor heart attack when the clots bounced around in there.) The ER doctors told me I was lucky to be alive. I was young then, and thought they were exaggerating. A week in the ICU, not being allowed to get up at all (not even to use the toilet) showed how serious it was. I know now, I really was lucky to be alive. But I was left with more questions than answers. I tested negative for any type of genetic clotting disorder. I think it was the birth control pill because the estrogens in it can thicken the blood, but my orthopedic surgeon vehemently denies this. "Millions of people get knee surgery on the pill and don't clot," he told me.

Well I guess that I am the exception. Now, I can't take the pill, and any time I get pregnant, I have to take two blood thinner injections to the stomach a day. There is a risk of clotting in pregnancy, which is many times multiplied over the pill. I cannot take a blood thinner orally, because they have been shown to cross the placental barrier. I was covered in bruises on my stomach during my pregnancies. A needle phobia didn't help this situation. My husband had to give me 99% of my shots, because I just couldn't bring myself to do it. I asked my doctor how dangerous it would be for me (and my fetus) not to take these shots. She likened refusing this medication to doing a road trip, driving 85 mph down the highway without a seatbelt. Maybe I'd get to my destination safely (clot free) or maybe not. There's a change I could clot again and have a stroke or heart attack that would be disabling or fatal, or my placenta could clot and kill my baby.

Because of this clotting issue, I am considered high risk. However, in all other aspects, I am considered a low risk patient. I don't smoke, I'm not obese, I'm reasonably fit, I don't have "advanced maternal age". One of the doctors I have interviewed dubbed me a "low, high risk patient". Talk about confusing and frustrating.

When I started having babies, I never thought of a home birth. Hospitals were "just where you had babies." However, my heart has started longing for a home birth, or at least something very close. Six months ago you couldn't have told me this is what I would want. I would have thought you were crazy. I have never wanted a home birth. However, the more I meditate on what I have read in "Cut, Stapled, & Mended", the more I feel like a home birth would be the most conducive to achieving my VBA2C. I'm beginning to wonder though, if I really have any choices in regards to my birth location. I feel like I am stuck between the hospital and a hard place.

• Where am I going to find a midwife that would take me on as a patient knowing that I have the potential to be a serious bleeding risk if things go wrong. ESPECIALLY after 2 cesareans. 

• AND where am I going to find an OBGYN that would co-manage me with a midwife so I can get my medications, blood tests, etc.

But most importantly is this dilemma in my heart: Am I putting myself, my baby, and my family at substantial risk by trying to birth at home. Am I being irresponsible, foolhardy? Is the risk to my safety so great that I am willing to leave my children motherless and my husband a widower? Is the danger even that high, or have my doctors exaggerated my clotting risk to scare me into submission? I'm feeling backed into a corner. I'm beginning to wonder if I am going to "be allowed" to have the birth I want. I'm starting to wonder if I am going to have to be satisfied with the birth "I get". This really saddens me. After reading "Cut, Stapled, & Mended", I was full of hope. Now I realize that despite how similar Roanna and I are emotionally and physically, medically we are completely different. I feel a lot of sadness, because I can't image a doctor on the planet would approve of a home birth in my circumstances. Most don't approve of home birth for people with immaculate medical histories. I feel like I don't have a snowflakes chance in hell.

If you're reading this and have any experience or suggestions, I more than welcome them. Please tell me what I can explore. Who I might see, what avenues might I pursue? What are your thoughts?

One Step Forward, Two Steps…To the Side

After drawing my labyrinth, I hit a wall. I was so physically and mentally exhausted from the effort that went into creating and analyzing my feelings about it, that I have found it near impossible to move forward at this time. I read on in the book, the next step being to meditate on your labyrinth (lab) while adding a slight discomfort. I was just not ready to go there. I felt in a stall, I was losing progress. So, I decided to pause on the "lab work" and move laterally into a more physical form of healing.

I finally went and saw my local Curandera, a traditional healer that uses natural remedies to cure ailments of the body and spirit. It was a spur of the moment decision. I knew I had to keep moving forward or I would keep sliding back. I booked my appointment, and was promptly at her door at 10 am Saturday morning.

I drove up to her bungalow and parked in a grassy lot across the street. Wild plants adorned the yard, and beautiful chickens scratched for worms behind a large iron gate. She sauntered off the porch to greet me like an old friend, and welcomed me to her home; a charming 1950's bungalow. My apprehension was mounting for what I was about to experience. What was she going to say? What was she going to do to me?

We step inside her living room, and towards a front bedroom which she has turned into a professional den of relaxation. Paintings, a belly cast, oils, candles, a large massage table. It should be an anxious person's dream escape. She must have seen the apprehension in my eyes.

She cheerfully asked me what I was there to work on. I started matter of factly: "sore back, a tight neck,  a scar to look at." But only a few moments later, I teared up a bit and managed to spit out that it had been a long road to get to her because of all the trauma surrounding my birth. We had perviously talked at two of her lectures, so she wasn't completely taken off guard. She could tell I was on edge.

She has a history of working with mothers, as a doula and a massage therapist. She has also work with women who have been assaulted. She understands the body-soul connection and how they can help or hinder a birth, or even healing in general. She could see that I was reaching for help, but at the same time scared to confront a trauma. So she did the most comforting thing she could:

1.) Told me how brave I was for coming to work on this. And
2.) Talked about the four agreements:

• Agreement 1: Be impeccable with your word - Speak with integrity. Say only what you mean.  Use the power of your word in the direction of truth and love.

• Agreement 2: Don’t take anything personally - Nothing others do is because of you. What others say and do is a projection of their own reality. When you are immune to the opinions and actions of others, you won’t be the victim of needless suffering.

• Agreement 3: Don't make assumptions - Find the courage to ask questions and to express what you really want. Communicate with others as clearly as you can to avoid misunderstandings, sadness and drama.

• Agreement 4: Always do your best - Your best is going to change from moment to moment; it will be different when you are healthy as opposed to sick. Under any circumstance, simply do your best, and you will avoid self-judgment, self-abuse and regret

These agreements served to address boundaries and eliminate fear of what was going to happen. She would not assume that she could touch my body without it truly being okay. It was also true that it was my responsibility to not assume that she knew where my boundaries were, and to be clear with my words and expectations. As a result, no one would be offended (because we are speaking only the words we mean), no one was getting upset (because were not taking anything personally, and asking for clarification if something said seemed off-putting), and everyone was committed to giving 100 percent of themselves from where they were at that moment.

Before we got started I asked to use her restroom. Ever since my 1st cesarean, I can hardly stand up without having to go pee. My second cesarean surgeon had mentioned that I had a lot of scar adhesions to my bladder. It is possible they have returned. I passed down her hall, and admired her phone nook, which had been turned into an alter. Sitting on her toilet, I knew had come to right place.

Surely a woman with herbs drying in her tub knows what she is doing.

Now, this was by no means my first massage. As someone with high anxiety, I used to get them all the time when I was working. As a stay at home mom, I've had to adjust my expectations of comfort. Usually, I request total silence during a massage so I can FOCUS on being relaxed. It sounds ridiculous even saying it. But with Curandera, I prattled on and on. She let me unload on her…like catharsis.

We had a few laughs as she worked on my tight muscles. She applied a castor oil pack to my scar, and kneaded it to assess where my innards now lie. She has a strong suspicion that my uterus is tight to the left side of the scar and that is tilting forward, possibly pulling my back muscles in the process. What was surprising was that she was able to work on it as long as she was. At home, as I had previously mentioned, I can't touch or look at my scar without getting physically ill. My husband can barely touch it. Overall, she was pleased with how it looked, but asked me to continue to do weekly castor oil packs to soften the scar and underlying tissues. So, without further ado…a moment of bravery:

UGH. There it is: A low transverse cesarean scar. I put my hand there to show a size perspective. Gross.
#NoMakeup #NoFilter

Our session was over way too fast. She recommended that I come back after my next menstrual cycle, but continue to try to touch my scar often, even over clothing if I must, and do weekly castor oil packs.

I expected to be a little sore after a massage since rubbing on your muscles always releases toxins built up in your system. I drove the 45 minutes home, (FYI: It's an hour to anywhere in Houston) As I drove, and became increasingly fatigued. Almost alarmingly so. By the time I arrived home, I felt like I had been in a car accident. My entire body ached, my mouth was parched. This was nothing like I had ever experienced post-massage. I downed at least 4, 30 oz glasses of unsweetened tea and water, and tried to nap. Unfortunately, X-man and Lollipop had other plans. As the day turned to evening, I continued to down water. My limbs became heavier and heavier, my stomach churned. This went on for two days.

Last night, I worked on building a safe, sacred space to work on my scar and my emotions about my birth. I was at a loss of what to do for my extreme fatigue and pain, so I poured an epson salt bath. I soaked while trying to clear my head, gazing through the darkness at a candle and some flowers I had recently purchased.

"To thine own self be true."

I pulled myself reluctantly from the tub an hour later. I put a heating pad on my back and proceeded to sleep four hours straight. I am quite sure it is the first time since Lollipop has arrived (8 months) that I have gotten four hours of uninterrupted sleep. The following morning, while still sore, the fatigue fog had lifted.

I continue to seek the comfort of hot water to sit in, and cool water to drink to purge my body of what Curandera calls "trauma energy". It's time for bed now, one more glass of water, one more hot soak.

Cut, Stapled, on the Mend?

I was approximately six weeks postpartum when I finally broke down and asked my doula to come for her postpartum visit. She had been asking me since week two to come, and I just couldn't bear it. I had been delaying this visit as long as rationally possible. I anticipated a judgmental tone, a "you let us all down" undertone to the whole meeting. I just couldn't face her.

When it finally became embarrassingly far out from my delivery date, I couldn't stall any longer. She had other clients to see, loose ends to tie up. She stopped by on a hot summer day, quiet and thoughtful.  She asked me how I was feeling, but she didn't need glasses to see through the pleasantries I was offering. I was in bad shape and she knew it. There was nowhere to hide.

She started off delicately, sticking to the "factual" type details of the visit: "How's the baby feeding?" "Are you feeling any pain?""Any concerns?"I tossed her a bone: "the baby spits up a lot, it's kind of worrisome." After that exchange, she stepped up to the plate, boldly stepping into the fire:

"How are you doing?"

"I'm okay."

"Mmmhmmm…?

"You know, kind of having a hard time." I said nonchalantly with a shrug. I couldn't look into her eyes. She knew. She knew I was a total mess. She looked at me expectantly, waiting…the silence was cacophonous.

Before I knew it, words were tumbling out faster than I string them together. The tears flooded my face. I cried that pitiful cry; the one where you're gasping for air as you try to talk. And she let me. She let me fill the space with my sadness, anger, and shame. Then, I was holding back something. Things that I'm not sure I am even ready to write.

I worried she secretly resented me as a client, no matter gentle and attentive she was coming across. At the time, I can say that this silent presentness upset me very much. It was like a friendly tabby, quietly sitting in the corner watching, listening, an occasional flick of the tail. The eyes are watching thoughtfully, the ears listening attentively, but what does that tail flick mean?

I didn't want a quiet, thoughtful response. I didn't want space. I needed someone to catch me. I was drowning, but I couldn't ask for a life preserver. I should have told her, but I didn't. I couldn't be any more pitiful than what she was already witnessing. So, I just shut it down. Numbness, information seeking, compartmentalizing.

Self preservation.

One of the first things she recommended was reading "Cut, Stapled, and Mended", which she confessed would be a difficult read. I dutifully wrote down the title and scrawled "difficult to read" next to it on a scrap of paper from an old spiral notebook.

This scrap of paper has been beckoning from the junk drawer for 7 months. Every time I picked it up, my hastily scribbled note scared me away. The scrap went back into the drawer, back into the dark. Another time, another day perhaps.

After my previous post, putting it out there for the world to see, I very well couldn't back down. To the drawer, out comes the paper. The search was on, the book ordered. This was Monday.

Today is Friday, and guess what folks:

BAM!

Truth be told, I liked it. It was a quick, candid read. It felt authentic, real. Half of the words were the very same that I had shared with others about my own negative birth experiences. All I could do was nod along as Roanna chronicled her sadness, her desperation for answers, her trials and failures. She went to extreme measures, even beyond what I think most would consider Eastern or homeopathic measures to achieve her goal. Without giving too much away, she knew what she had done did not work the first or second time, but undeterred she kept trying. Kept growing.

A question formed in my head: "Why did my doula have me read this?" Was she trying to tell me I needed to resort to the extremes that Roanna did? (drinking frog extract, seeing a psychic, boiling a root for 30 days and drinking the tea it produced, taping magnets to my body) Or was it simpler?

Well I asked her today over coffee. Her simple answer was: "I wanted you to know it could be done."
Simple as that. Did I have to go through all Roanna's extremes. No. But it is important to know what my personal limits are, and then take it to that level. That way, I can tell myself, as Roanna did, "I did everything I could."

I'm frustrated that I didn't do this sooner. The book was not the big, bad, scary beast I thought it was. Although, it might have been the day, the week, the month after my doula's visit. She told me she could see a change in me, one that I cannot yet see. Maybe this is a sign, a sign to keep on going. To try the next hardest step.

Maybe it's time to talk about Lollipop's birth…well, at least try to talk about it while I tackle, "The Labyrinth of Birth." It serendipitously arrived on my front porch this very afternoon.