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?

Ebb and Flow, Stop and Start, Sprint and Crawl

I've been meaning to write for days, but Valentine's Day has thrown me for a loop. My little home bakery (i.e. myself) put out over 10 dozen cookies over the course of 4 days. That is the busiest I have ever been. Hence, everything else fell off the wagon. Laundry, diet, gym, sleep, spiritual journey…sort of collecting dust. I felt like I was getting nowhere, when I did a quick visit to Curandera. I told her what I had accomplished (which felt like nothing) when she told me that progress sometimes comes in spurts and stops. She reaffirmed how proud she was of me for doing this work. She told me to be gentler with myself.

So, now that the rush is over and I can breathe, I can get back to the purpose.

Highlights on actions that I have taken so far since last we met:

• I am been working to touch my scar.
• Several trips to the gym, and some improvements in diet.
• Called the hospital in an attempt to get my medical records. Gotten a weird voicemail twice and no return call. Grrr.
• I have purchased all the ingredients recommended by my Urban Curandera to do castor oil packs.
• I did my first home castor oil pack last night. 

The idea and mechanism behind the castor oil pack is that it breaks up and softens the scars both internally and externally. They are really easy to do and relatively inexpensive. For an in-depth look at scar healing, you can check out Curandera's workshop here.

The pack itself was fine, again it was the after effects seemed to hit me hard. I have been chatting with Curandera to see what she thinks is going on.

I felt a real looseness in my pelvic floor, somewhat painful, but mostly just a feeling of weakness or low tone. Sitting up and standing up straight posed some difficulty, as well as lifting Lollipop out of her crib. Lifting my 40 lb toddler is almost out of the question. The best way to describe the sensation is that it feels like my uterus just might fall out of my vagina. Not in a bulging or pushing sort of way, but in a heavy weight sort of way.

Curnadera suggested that perhaps the castor oil is doing its job, breaking up the scar and adhesions that had been holding my uterus in its current position. As a result, my pelvic floor muscles (or lack there of) are having to take over, and they are showing me just how weak they are.

The feeling has persisted all day, and then as the day wore on a second symptom popped up: PHANTOM KICKS!

I had heard about phantom kicks before, but I had blown the idea off. Surely it was just mom's that missed being pregnant, or decided not to have another and trying to connect with a past fond memory.

I'm here to tell you they are REAL. Mine have been sporadic in both timing and activity I am doing when the occur. I was reading that they are thought to be the uterus having contractions, trying to get back into its normal shape. Again, the castor oil pack could have helped that, I'm sure.

I've been trying to take it easy tonight en lieu of how weak my mid section feels.

Tomorrow is the Red Tent in our area. I'm both looking forward to it and really nervous. I'm afraid about what might come up. Doula encouraged me to bring a notebook to draw or mediate on my labyrinth. A lot of birth traumas are sure to come up, and I am very sensitive to it. There could be women that talk about their births with a history of sexual abuse. I cannot even watch a movie that has a rape scene it without being upset about it for months. The small "PG-13" rape scene in the teen lit movie, Divergent, bothered me for weeks. I don't know how to explain it other than that I am very sensitive. My emotions are very close to the surface at all times. I can cry over a moving song or a poignant commercial. It's hard to strike them from my mind later. I replay them over and over in my head.

I'm hoping my determination doesn't waver. The weather is poor, and I'm looking for excuses not to go. I thought Doula was going, but she will be attending a workshop instead. We promised to meet up afterwards to discuss it. I'm holding myself to that. Time to take another step forward and breathe.

What Not to Say to Cesarean Mothers

After my first cesarean, I had to know what went wrong. I looked to every avenue as to why I did not have a vaginal delivery. My baby wasn't too big, I'm not ridiculously out of shape, I was generally in good health. WHAT HAPPENED?

In tears, I'm begging my doctor for an explanation. All she could say was, "You have a healthy baby, and you are healthy, too. If we had let you labor any longer that may not have been the case. Healthy mama, healthy baby. That is what I am happy about." I tearfully nodded as I left my postpartum visit with my husband and newborn. I tried to put on a brave face for all the soon mommies-to-be in the lobby. Big smiles! I have a health baby! I should be happy.

I would talk to my mom, my friends, my hairdresser, anyone who would listen and just cry about my cesarean. They all had the same thing to say:

"You have a beautiful baby, all that matters is that you are healthy, and the baby's healthy. Who cares how he got here?!"

My mother was also a little upset by me. "You were a c-section baby and it was SOOOO EASY!""I'd have a baby every time by c-section!" As if my disappoint was an affront to her delivery choice. She's the same way about formula, too, but let's not get ahead of ourselves.

I quietly accepted this, and stifled my grief as best I could. It's true. We are lucky. In other parts of the world, we both might have been dead. In another era, not too long ago in fact, we might be dead. I needed to suck it up and be thankful. After all, I have two friends that can't even GET pregnant. Surely I'm luckier than them. I had one friend miscarry; definitely luckier than her, right? I remember sitting in the speech therapist's office, waiting for our weekly oral motor appointment to help with X-man's nursing issues. I'd look around out the small children, so disabled from a genetic disorder or some other unknown circumstance. I cried and hugged my healthy baby. Surely, I was luckier than these mothers, right? How can my sadness even be justified by comparison to these other women? I felt guilty even feeling sad. I was disgusted with myself.

After Lollipop came around and my VBAC failed, I came to my postpartum visit seeking out answers. The OB that attended be in the hospital had mentioned that I had surgical adhesions from my previous c-section. Had this somehow caused a problem with Lollipop's position? I went in determined to get clearer answers this time around. Again, I was disappointed. "I know you were hoping for a vaginal delivery, but it didn't work out. As your doctor, I am just thrilled that we have a healthy mama and healthy baby! That's all I care about!" There is was. The number one sentence I loathed to hear.

We have to stop telling c-section mothers, "Who cares how the baby got here."

We hate it. Full Stop. Do Not Pass Go.

It makes us hate ourselves (We are selfish and ungrateful.)
It makes us hate our bodies. (We were too fat, too petite, too weak, too unprepared.)
It makes us resent our babies (They were too big, in a bad position, too weak, breech, multiples, had poor heart tones, broken waters, meconium in the fluid.)

While our rational sides can understand the facts of our birth, our emotional sides cannot.

Saying "Who Cares!?" completely undermines our grieving and healing processes. It marginalizes the loss of the birth story that we had written for ourselves from the moment we learned a life was growing inside of us. There are those who marginalize the importance of a birth story, but why is it that every mother whether 19 or 90 can so vividly describe her own? A birth puts a mark on your soul, and anything so momentous is worth value.

So to answer, "Who cares?"….Well, WE DO.

WE care that are babies were cut, wrestled, and separated from our womb.
WE care that we can no longer feel sensation in parts of our body.
WE care that we have a nagging sense of doubt.
WE care that we feel assaulted.
WE care that we are disfigured.

Most importantly…

We care that me missed out on a fundamental Rite of Passage. That's what hurts the most.

© Amy Swagman 2011

The Seemingly Insurmountable Goals, The Mountain Before Me

Lai Tzu once said, "The journey of of 1000 miles begins with one step." Creighton Abrams famously stated that in order to eat an elephant, you must take one bite at a time. Why is that first step so hard? I've been procrastinating over an hour trying to even figure out how to start this very post.

Everyone seems to make New Year's resolutions that are tossed aside almost as quickly as they are formed. "This year I am going to eat better, exercise more, save more money…" they all say. By February 1, we are back to our old habits: eating ice cream in front of re-runs, paying for gym memberships we will never use.

When I got pregnant with Lollipop, I vowed to do better, to try harder. But somewhere in the middle of managing a very active one year old while feeling constantly exhausted during my pregnancy, I mostly gave up. I did some things better, but for the most part, I failed.

I FAILED. Full Stop.

I let my daughter, Lollipop, down. I let my husband down. I let my doula down. I let myself down. I gave up.

Now here from the ashes, we are brought to believe we can rise, be reborn. Be a phoenix. I'm no phoenix. I have the willpower and patience of most my generation, which is nil. At best I'm a one eyed, single eared, three-legged dog named "Lucky". Good things that happen to me, well they happen to me by good luck. Bad things that happen, well those things happen because I am lazy, slovenly. I want miraculous changes without miraculous effort.

For seven months I have had a list of things to achieve to attempt optimal conditions for my VBA2C. And what have I done…pissed away seven months.

Oh, now don't be gentle with me and make excuses:
"Oh you were recovering from surgery, you needed 2 months at least to get over that!"
"You have two children under two years old, you're doing great if you shower everyday."
"Once the kids are a little older and more independent you'll get on track fast."

Nope.Nope.Nope.

I'm so paralyzed by fear that I can't even write what my goals are. I'm sitting here quibbling over word usage and grammar. Sigh

Deep breath.

If you write a goal, it's out there for the world to see. If you write a goal, there's accountability. Just another thing to disappoint myself with if when I give up.

Deep breath.

After my VBAC failed, my doula came to visit me. She spelled out some things I should try if I were to attempt another VBAC. They are as follows:

1. Join my local ICAN support group and attend the meetings.
• To date I have liked their Facebook page and attended ZERO meetings.
2. Read the following books: "Cut, Stapled, and Mended" by Roanna Rosewood and "Labyrinth of Birth" by Pam England.
• To date I have successfully NOT lost the scrap of paper these titles have been written on.
3. Contact a local midwife that specializes in assessing pelvimetry to see if what my OBGYN said to me after my births is true: (that I likely had a small pelvis inlet, which is why my babies didn't "could not" descend into the birth canal.)
• To date I have followed the woman's Facebook page and checked out her website. Before I see this lady, I must obtain my surgical reports from my doctor. So this is a double demand.
4. Attend a Red Tent event hosted by our local midwives and doulas. A red tent is "a space where women gather to rest, renew, and often share deep and powerful stories about their lives." The Red Tent movement is changing the way that women interact and support each other by providing a place that honors and celebrates women, and by enabling open conversations about the things that women don’t want to talk about in other venues
• To date I RSVP'd for 2. Bailed out on the first one, the second one is happening soon.
5. Contact our local "Curandera". If this sounds like hippy dippy bullshit to you, allow me elaborate. Our curandera specializes in scar mobilization, Maya Abdominal Therapy, and postpartum support in the way of standard massage techniques, herbalism, spiritual support, and down right badassery. The goal being to help my scar to heal flatter, and promote internal relaxation of the pelvic organs by reducing surgical adhesions. 
• Arguably my most tackled step. To date I have listened to her give two talks. Liked her business page on Facebook, "friended" her on Facebook, spoken with her via private message and email briefly, purchased a massage certificate to redeem, asked her to meet for coffee. (unfortunately she was too busy :-/ ) AAAnnnnnddd, I told her about this blog when she checked up on me. She knows my PPD (postpartum depression has be by the throat.)
6. Find a new birth provider that supports me in having a VBA2C.
• This requires me to find a new doctor and a new hospital. To my knowledge, the only hospital that openly supports VBA2C in our city is the dreaded county hospital, Ben Taub. (more on this eventually, I'm sure.)

That's a tall order for an anxious, lazy ass like myself. These items are on top of my personal goals:

1. Loss weight to the tune of 20 pounds. *groan*
2. Exercise twice weekly. *Louder groan*
3. Talk to current OBGYN to assess my pelvic floor damage *Loud, painful groan with a bowl full of embarrassment*
4. Learn to relax, stop being hyper-vigilant ALL THE TIME. 
• This is arguably the toughest goal. I am high strung by nature, and probably should be getting some kind of treatment for my anxiety. I had my first panic attack in 3rd grade. How do you change something so ingrained in your personality? I used to take medication, but I didn't like the way it made me feel. I have a master's degree in clinical psychology, so I have the knowledge necessary to continue to skill build in this area. I work regularly to check in with myself to see how I am holding my body. I catch myself locked up at the shoulders and jaw almost every time I check. I am even tense while sitting on the toilet. I'm so locked up tight. My poor husband; my lady parts are essentially closed for business. It's just too painful.
5. Correct my separated Diastatsis recti. Which look something like this:

"Yea, a picture!"

I'm currently at a 2" separation (This is not me by the way)

I have been assessed, and have located a trainer. I have not joined the program.

As you can see, I have quite a list in front of me. Some of these steps are hindered by fear of failing. Will I invest all this time and energy only to end up on the operating table a third time?  Other hindrances come in the form of logistics (how on earth am I going have a pelvic exam with 2 little ones), and financial barriers (skills cost money, and they ain't cheap.) Is their such a thing as vagina scholarships?

In the coming weeks, I hope to explain to you why these goals are important for a VBAC journey. This post has already gotten out of hand in length. So I better call it quits for tonight.

The Dark Cloud Descends & Lingers

Tonight is a rough night. I read a birth story about a botched home birth that triggered my own trauma. Despite our completely opposite birth scenarios, we were both left feeling an overwhelming sense of grief and brokenness.

The cloud that descended nearly immediately after X-man's birth rarely leaves me. Even in happy times, it finds me...almost always at night when I'm alone with my thoughts.

I relive what happened; question the choices I made or didn't make. I curse myself for the things I should've said but didn't. I get angry with myself for letting the cloud rob me of the joy and presentness I could've experienced if I would just let it go. I hold onto the dark cloud, as it spirals darkly over me.

I'm consumed by sadness, anger, and even jealousy. There are times when my anger is irrationally out of control. Rage flares so bad I have images flash before me of hurting my son. I immediately call my husband home from work. I pace anxiously in the driveway until he arrives. I get in my car the second he arrives without a word. I drive for hours in silence. I cry with guilt about the dangerous thoughts I just danced with. I drive until past the kids' bedtime. I've calmed down, they'll be asleep so I won't trigger...but they're not. They're still awake, hubby watching tv. There's lightening in my eyes, fire in my hands. A flash, the rage is back. I couldn't escape it after all. The cloud followed me home.

I hate the person my cloud has made me. I cannot be happy for other mothers. I'm so overcome with jealousy when I hear they have had an uncomplicated delivery. How is that fair!? She didn't prepare AT ALL. She got an epidural the second she THOUGHT she was in labor. She was obese with total disregard, while I was meticulously mindful of appropriate weight gain! I find myself secretly hoping they have to get cesareans, too. I'm happy in a grinch-like way when I hear they too failed. Ha!  Now you're broken, just like me.

I am a horrible human being.

I'm surrounded, engulfed in misery by my big, dark cloud.

The Beginning of a New Birth Journey

If you are reading this, I am happy you found me. I am a woman, struggling to have a natural birth in a medically crazed society. A place where an intimate event that used to take place in the safety and quiet of our own homes has turned into an impersonal, fearful…and almost mechanistic act. As birth has moved out of the home and into the hospital, we have lost some of our rights to our own bodies. While one can argue that we can always have the "right to refuse any procedure", in reality women are coerced, lied to, acted upon without consent, threatened, and scared into accepting procedures that they otherwise would have, and arguably could have, done without. How do I know? It happened to me, and countless other women I have read about.

That being said, my two darlings, X-Man and Lollipop, wouldn't be alive today without cesareans. I developed cholestasis with X-man, a liver disfunction that can cause stillbirth in otherwise healthy fetuses. My doctor let me labor for 40 hours before he became distressed and was taken. He spent 4 hours in the NICU with respiratory distress before being returned to me. Lollipop's water broke and after 48 hours of trying to jump start labor with Pitocin, I would not dilate and she went into distress. My VBAC (vaginal birth after cesarean) had failed.

I'm not here to be a martyr for natural birth. If you had a cesarean, loved it, and would schedule another one for every future baby, that is your prerogative. This blog is not intended to shame, defile, or otherwise persecute c-section mothers. C-sections have and do save many, many lives. What bothers me is that c-section rates around the country have been on the rise for decades. In Texas, we are at 35% of births being via c-sections (according to ICAN network). Some hospitals have a 100% cesarean rate.

What are we telling women in this country when one third or more of us don't have a normal, uncomplicated vaginal delivery? We are telling women that their bodies don't work and not to trust their instincts. We are telling women that they need expensive, invasive procedures to insure that they do not kill their infants by entertaining the idea that they know what is best for their bodies and babies.

This is where I am…

Even though my c-sections were medically justifiable, I cry every time I think about them. I can't look at my scar. I can't touch it. My husband can't touch it. I get nauseous when I put the slightest pressure on it.

I feel broken. Lost. Physically in pain. My body is not my own…

This is what brought me here.

In one year, I would like to start trying to conceive (TTC) our next baby. I have a huge, what feels like insurmountable, obstacle in front of me. I started writing to help process my feelings about what has happened, and to hold myself accountable for the changes I feel need to happen to get me to my goal of a successful VBA2C (Vaginal Birth After 2 Cesareans).

If you are reading this, you are reading a part of my journey. You may be a mother or mother-to-be yourself, looking for answers. I don't have all of them. All I know is that I am in a vulnerable place, as are many other women in similar situations. I may write about things that trigger uncomfortable emotions. You may feel anger or sadness, shame or frustration. Do not take those feelings out on me. Trolling the wounded does nothing. I welcome your comments and questions. They may serve as inspiration for me to open, learn, and share more. To relax more, to trust myself more. However, under no circumstances will I tolerate shaming, cruelty, rudeness, or fear mongering. Perspectives are different, we are allowed to disagree, respectfully.

So…I guess let's get started with the backstory: X-man's birth.