Letter to the Sesame Seed--Week 33

Dear Sesame Seed,

During this past week my belly has grown another centimeter, my pillow requirements have increased from two to three (one each for head, belly and legs), and my encounters with severe back pain have gone from none to one. Pretty much everything is expanding.

Since I'm feeling pretty great and there are no other major developments since the last time I wrote, I think it's time we talked about something I've been avoiding sharing with the world: my birth plan.

If I were one of the 99% of women in the US who deliver in hospitals, there wouldn't be much to talk about beyond epidural or natural. But let's get this right out into the open--your mommy and daddy are weird. We don't always do things like everyone else. And because of that we fall into that 1% of people who have decided to have our baby at home.

There are many people who didn't even know home birth was an option in this day and age, lots more who think it's criminal to suggest such a thing, and a small percentage who couldn't imagine doing anything else. Because this is such a heated topic--and ultimately a personal one--I haven't shared our plan with many people. But rather than avoid discussing it any longer, I'd like to share with you the reasons I think it's the safest, most emotionally sound choice for both of us.

There is a wealth of information out there for anyone who is interested; Gentle Birth Choices, The Complete Book of Pregnancy and Childbirth, and The Ultimate Week by Week Pregnancy Guide are just a few of the books I've read that have lead me to believe that a controlled, medicalized hospital birth could be very detrimental to both you and me. Statistics about the success rates of home vs. hospital births, the use of medical interventions, and the emotional impact to baby and mother of various birth experiences are all readily available with a little looking, so I'm not going to get into that. Suffice it to say, I've studied those issues very closely, and if I tried to impart all of that knowledge here, I'd be writing my own book.

When I first became pregnant, I was like the majority of women and just assumed your birth would take place in a hospital, under the care of an OBGYN. Then, in my fourth month of pregnancy, I took a tour of the hospital and everything changed. As soon as I walked into that sterile, controlled space I could feel my throat constricting and my limbs tightening. I knew I would never be able to relax in that kind of environment and that I'd have to find a different way to deliver successfully.

(I think it's important to note here that many women have the completely opposite reaction I do to hospitals, and for them, the feeling of safety and security of that environment makes it the best choice for them.)

Before that fateful visit, I'd imagined your delivery in great detail, and I've done the same with your planned birth at home. To let you know the full extent of the options before us, why don't I give you a picture of the two different kinds of births I've imagined? Let's assume I don't have a debilitating distaste for hospitals, I've had a healthy, low-risk pregnancy, and I go into labor within two weeks of my estimated due date.

A Hospital Birth
Under the best possible conditions--a liberal, uncontrolling doctor, a hospital with "home-like" comforts, and a supportive nursing staff--here's what your birth might look like:

Once I felt contractions coming on regularly, I would call my doctor and hope that she was on call that day; otherwise someone else from her practice would attend the birth. I would labor at home for a while, able to move around and continue normal activities, eat light meals, and wear my own clothes. When my water broke or my contractions started becoming more intense your dad would drive us to the hospital where I would be checked in and given a wrist band and hospital gown. I would be hooked up to a fetal heart monitor for half an hour, during which time I would be immobile in bed. If my doctor had arrived, I would likely be given an initial vaginal exam to see how effaced and dilated I was. Heart monitoring and vaginal exams would continue intermittently throughout labor.

If everything seemed fine on the heart monitor, I would be allowed to move around as I pleased. Your father and grandmother would be present to help me labor, but no other visitors would be allowed. I would use whatever tools were available--chair, bed, balance ball, toilet, shower--to make me more comfortable. I could dim the lights, play music, and receive massages to help me with contractions.

After laboring for a while, I might start feeling hungry, tired or dehydrated, and I would be given ice chips or an IV (limiting my mobility).

Nursing staff would come in to check on us every now and then, and by the time we came to the end of labor they would have gone through one or two shift changes. Other hospital staff might also enter uninvited: cleaning people, equipment repairmen, etc.

If, through these disruptions, I was able to stay focused and relaxed and I didn't labor longer than deemed "appropriate" and I was very lucky, I wouldn't be subjected to unnecessary interventions. Some of those include: artificial acceleration of labor using Pitocin or breaking the water, epidural or other pain-relieving drugs, episiotomy, forceps or vacuum extraction, or Cesarean delivery.

If I was unbelievably lucky the hospital staff would respect my desire to birth naturally, in a dark, quiet room, they would look me in the eye (not in the crotch) when they spoke to (not about) me, they would have faith in my ability to give birth, offering support, and they would treat labor as a miracle of nature not an illness.

Under these conditions, I might be able to go into the final pushing stage of labor in any position I desired (on all fours, squatting, on my knees). Otherwise, I would be put on my back with my feet in the air, where gravity would be working against us, but at least the doctor would have a good view.

Finally, after some painful pushing, you would come into the world and take your first breath! You would hopefully be welcomed into a quiet, darkened room, handled gently, and not be too upset about your dramatic entry.

The doctor would clamp and cut your umbilical cord, suction out any mucus from your mouth and nose, and show you to me. You'd then be taken to be washed, measured, weighed, and given an apgar score before you were wrapped in a blanket and handed to me. Your daddy and I could then bask in how beautiful and perfect you were.

If you happened to be born between 1-9pm, our friends and relatives could come visit us, otherwise they'd have to wait. We would all stay in the hospital for another day or two, your daddy sleeping on the chair in the corner, and you in a bassinet in the room with us.

We'd then check out of the hospital, drive home, and start "real life."

A Home Birth
Let's start with the same assumptions: I've had a problem-free, low risk pregnancy, and labor begins within two weeks of your estimated due date.

A few weeks before my due date, my midwife, Deborah, would have come over to the house to get a lay of the land, check on any supplies we might need, and help set up the birthing pool in my bedroom. When I felt labor coming on, I would call Deborah to let her know and we would check in periodically by phone as I progressed.

Your daddy and I would spend the early stages of labor making you a birthday cake, taking a walk, or watching DVDs with your aunt and uncle and grandmas to the pass the time. When the contractions became more intense, I would retreat to my bedroom with your daddy, grandma, Deborah, and her assistant, and we would begin filling the birthing pool with warm water.

I would be surrounded by the images and art I've prepared in anticipation of your birth, secure in the safety of my own familiar room. The lights would be dim, music would be playing, and we might even have some essential oils burning to relax me. I would use the tools available to me--balance ball, shower, pillows, toilet, and bed--to work through contractions. Your daddy and grandma would help me move into new positions, bring me warm or cool cloths, massage my muscles, and be there to support me in any way I needed.

After a while Deborah might do a vaginal exam to check my effacement and dilation, but mostly she would pay attention to the timing of my contractions, my breathing, and my mental state to follow the progress of labor. Periodically, she would check your heartbeat with a Doppler or stethoscope to make sure you were doing well.

As the hours progressed I might get tired or hungry, and I would eat something light to boost my energy. When my contractions gained momentum or the pain became too intense, I would get into the birthing pool where the weightlessness and warmth of the water would ease some of my pain. I would focus on opening up my body, moving around in the water or being still. As we moved into the final pushing stages I could stay in the water if I wished or get out.

I imagine staying in the water, surrounded by the loving support of my family and midwife, and encouraged through the last difficult stages of labor. Finally, after lots of hard work on both our parts, I would push you out into the world. You would fall into welcoming hands--Deborah's or your daddy's--under the water. Slowly, gently, you would be raised to the surface of the water where you would take your first breath. You'd be brought immediately into my arms, where we could gaze into each other's eyes. Deborah would suction out any mucus from your nose and mouth and give you an initial apgar score (while still in my arms). Your cord would stay attached until it stopped pulsing, to make sure you get all the oxygen rich blood inside, and ease your transition to breathing.

When we were ready, we'd be wrapped in towels, dried off and moved to the bed where your other family members could meet you for the first time. Then you, your daddy, and I could have some quiet time together to discover our new family. After maybe an hour (and depending on the time of day) we could have a little birthday celebration with the rest of our guests--sharing a bottle of champagne and eating the birthday cake we baked earlier (sorry, but you're on an exclusive breast milk diet for a while).

And there we'd be, a family in our own home, having already started our "real life" together.

It's obvious what my personal bias is, and why I think a home birth is the right choice for us. Your safe and gentle entry into the world is my foremost concern, and the best way for me to insure that happens is to deliver you at home. I know we might be met with a lot of opposition on this decision but your daddy and I have confidence and faith in our choice, and if your very first lesson in life is that you should think for yourself...well, I can be pretty happy with that.

I love you,
Mommy