When I got pregnant with our first child, we decided to go the traditional way. I was nervous, scared and had many questions. My husband and I talked about it and decided it was, at that moment, the best choice.
I was curious about midwives and talked to ''hubby'' about maybe, going to see one, but he was too scared: What if something goes wrong?
So we kept the gynecologist and planned to give birth in a hospital in Montreal, Quebec. I did keep informed during my pregnancy, and even almost switched to a midwife, but I was still too nervous to make the switch.
The birth went well, I had two great nurses that took care of me during labor. It did not, however, go exactly the way I wanted. I was not totally satisfied with my experience. I had Pitocin, an epidural, and constant monitoring—none of which were in my birth plan, which no one read. I had wanted a more natural birth without Pitocin, unless needed as a last resort. I didn't want the epidural. I wanted to be able to move around, to use the ball, and to be in the bath. All options that were all available me at the hospital we chose. I did not want to be plugged into a monitor constantly and thus lose my freedom to move. I hated having to call the nurse every time I needed to go to the restroom.
I especially hated our afterbirth experience; it was awful, everything to wash a mother's confidence down the drain.
I wanted to breastfeed, nobody needed to convince me; they just had to help me!
Instead I got mixed information, mixed concerns and in the end, mixed emotions. I only wanted to be treated with respect. I especially wished to get out of there and be in my home, in my bed.
When I got pregnant with our second child, Things were going to be different.
I had a good talk with hubby and he told me: I trust you completely; I should have listened to you the first time. You're the one that gives birth, not me. You know much more on the subject and I trust your judgment.
The decision was easy I wanted a Midwife.
I contacted L'ordre des sages femme du Québec to ask: what should I do?
They replied quickly and suggested I call the closest birth center to my home, as fast as possible. Spots within a birth center are difficult to get your hands on, many women want midwife service, but unfortunately, not all will be able to have it. There are not enough birth centers in the province. In order to be able to get a registered midwife there needs to be an available spot in a birth center. Our new government promises 125 new jobs for midwives and 7 new birth centers, but that remains to be seen. Until then, women have to act fast and call birth centers as soon as they find out they are pregnant.
I called one birth center in Montreal; they put me on a waiting list and told me that I would receive a call if a spot became available.
Lucky for me, I only had to wait two weeks to get the call that told me there was spot for me.
I went to an information session given at the birth center; they gave us a tour, and answered all our questions. I was satisfied, and my husband as well. I knew I had made the best choice, for me.
I got assigned to my midwife team—in Quebec they work in teams of two. A principal midwife who follows the pregnancy, she was the one I would call first, should I have any concerns or emergencies. With a secondary midwife acting as backup to the team, allowing the primary midwife time off. They alternated weekends off, thus making someone available 24/7. Both midwives were amazing. While I knew my primary midwife better, I did meet with the secondary midwife a few times at prenatal visits. We broke the ice and, actually, formed a good bond as well.
My appointments lasted at least 30 minutes, except the first one, which was one hour. They always took the time to explain everything to me, how my body worked, and to tell me how the baby was doing. Told me all the tests that I could get and explained why it was there and what would or could happen if I chose to do it or not. I always had the choice to refuse though, and never would be judged based on acceptance or refusal of a procedure.
I was also empowered. I got to do some of the testing myself. I was in charge of checking my weight, looking for the signs of proteins in my urine, and also able to the test for Strep B by myself.
I learned a great deal. I felt so confident in my body and my abilities, I was not nervous at all with the upcoming birth, which I was set on experiencing naturally, as opposed to the first one.
I decided to give birth at the birth center.
When my water broke at home, I paged my secondary midwife, as she was on call, and she coached me over the phone on what to do. I stayed home for a little while to see how labor would progress, but after two hours of intense contractions, I was ready to leave.
When we arrived she was waiting for me and took us to our room—a beautiful bedroom with all the comforts we could need. The lights were dim, the only sounds were of another mother giving birth in the adjacent room.
My labor was pretty quick and easy, but most importantly; it was all done in an environment of calm and respect.
I was able to ease the pain of some of my contractions in the bath. I moved around freely within the room and the midwife suggested and helped me get into different positions to help things progress.
She called a backup when I was close to pushing.
And there we were, pushing a baby girl into the world.
I was so overjoyed by that experience.
As soon as the baby was born, a plate of fruit was set on the bedside table.
My baby was in my arms the whole time the midwife was stitching me up (only one stitch). She took the breast by herself, and we simply cuddled for one hour.
During the three hours after the birth, the midwife did all the exams and tests needed. Baby was administered the vitamin K shot (which I had chosen to give her), she was weighed in and all her vital signs were checked. The midwife also showed me the placenta, which I had asked to see. It was fascinating.
I was completely relaxed.
My midwife paid us a visit the next morning to examine us again. We left for home that afternoon. Even though it was sooner than my fist birth (where I had spent 36 hours, in the hospital, post birth), I had much more energy.
Two days later, the midwife visited us at home and came back three days later. I had follow up appointments, at the birth center, for six weeks after the birth. They did all the same tests my doctor had done during my first pregnancy, including a pap test. They also verified the baby's weight, reflexes, and general health.
My last appointment was bittersweet; I was going to deeply miss these women who had become so important in my life and the bond we had created.
Of course when I found out that baby number three was on the way (8 months later) my choice was obvious. I wanted a midwife, again. But his time I wanted a home birth, and what an adventure it was.
Childbirth Education Classes? What’s that you may ask? Shouldn’t I already know how to birth a child? Well maybe, especially if this isn’t your first child. However, while the body becomes autonomic during labor, it maybe hard for you to allow yourself to go into the mind frame of birthing. It has by far been the most mysterious and inspiring moment of my life.
Childbirth Education classes can be taught by just about anyone. There are several options out there: Hypnobirthing, Hypnobabies, Birthing From Within, The Bradley Method, Lamaze, Hospital, or Birth Center. Most Hospitals and Freestanding Birth Centers have their own child birth education classes that you can choose or you can do any of the above or several of these. What are all these classes? Well lets look at them.
Hypnobirthing uses a long term training (start early in your pregnancy), of putting yourself in a sort of trance by using a set series of touches to help you deal with your contractions. There are classes you can take taught by certified people or there is a home training that you can do. Here is their website to learn more: http://www.hypnobirthing.com/
Hypnobabies similar to Hypnobirthing but rather than use touch as the corner stone for the self hypnosis it is using actual hypnosis to help through pregnancy and labor. It helps you learn a closer bond with your baby and makes it more of a symbiotic process rather than autonomic. This can also be taught by a certified trainer or by a home class using cd’s. Here is their website for more information: http://www.hypnobabies.com/index.php
Birthing From Within this class uses imagery and visualizations to help you move through pregnancy and birth. The class is taught by a certified trainer, but there is a book that you can buy to do your own self study. Here is the website for more information: http://www.bfwnewmexico.com/index.html
The Bradley Method
The Bradley Method is often referred to as the Husband Coached Birth. This was created to allow spouse to be more involved in the birthing process. Again they are taught by certified trainers who have used this method or taken an extensive training program to become certified. Here is the website for more information: http://www.bfwnewmexico.com/index.html
Lamaze has long been used in labors as a breathing technique to get through labor. The organization has grown from just birth to doing more about pregnancy and raising children. This is taught by a certified trainer. Here is their website for more information: http://www.lamaze.org/
Most Hospitals and Freestanding Birth Centers also offer a childbirth education class. These may include little bits of all the above or their own information. As with choosing a birth center, finding a birthing class that fits you will be come the next most important decision. Ask your care provider about the class that they offer. Another thing to consider is the cost of the class. There maybe a significant price difference between all the options.
Go back to Step #5: Tests and Ultrasounds
Go ahead to: Step #7: Developing a Birthing Plan
When you come home with baby, it is good to be prepared as possible and enable things to taken care of as the first few weeks with baby will consuming, exciting and tiring. A few things to do to prepare is:
Go back to Step #8: Preparing for the Big Day
Finally the day has coming near so you need to make arrangements for what to bring to the birthing center and care for any children or pets not coming.
What to bring to the Birthing Center
Your provider may have already given you a list of things to bring with you. If not here are some items that you may want:
If you do forget anything, don't panic because someone can always run back and get whatever you need.
Care for Other Children or Pets
Ensure you have a plan for your older children when you go into labour. Most birthing centers allow children but it may be a long wait for a young one. It is a good idea to pack an overnight bag ahead of time for them to take if they are going outside of your home. It is hard to determine how long you will be in labour so it is a good idea to be prepared in case you cannot get home in 24 hrs and you may want someone to check in on your pets as well.
Go back to Step #7: Developing a Birthing Plan
Go ahead to Step #9: Preparing for Coming Home
Creating a Birth Plan is a great idea no matter where you are birthing. This makes sure that you and your care provider are on the same page in terms of what you want for and from your birth. This is a great place to write whether you want interventions or if you want as few as possible.
This will take some time to document but it helps you decide what you want for your birth and baby. This is everything you want in your birth. Here are some suggestions of things to include:
Go back to Step #6: Childbirth Education Classes
Go ahead to Step #8: Preparing for the Big Day
Now that you have scheduled your appointments, it is important to find out how they do tests, what tests, and when. If there is informed consent then you should receive a form that states why it is recommended, whether statistically speaking is worth while, any possible side effects or contra-indications to the procedure or test.
Also, not all tests are mandatory, some are and some are not whether it is dictated by local government, care provider policy or hospital policy. If you are not sure, ask. They will tell you if it is mandatory, recommended or simply voluntary/encouraged. Ensure you know your options and are comfortable with everything going on in your body
On your visits, your care provider will probably have you pee in a cup and will check you protein and glucose (sugars) levels, many midwives will even let you check your own. The purpose of this is to monitor for a conditional called pre-eclampsia. Blood pressure evaluation using a bp cuff, fundal height measurement (this is a measurement using centimeters going from the top of your pelvic bone to the top of your uterus), this measure meant is a way to see if the baby is growing along the way it should without relying on an ultrasound at every visit.
Your provider will also listen to the babies heart beat either by using a hand held doppler or using a fetoscope. The doppler uses sound waves to detect the heart rate and depending on the unit may be played so you can hear it. A fetoscope is a stethoscope style listening devise that has a horn attached to the end that gets put on your belly, while the headset portion has ear pieces to be placed in the ears to hear the heart rate. Some styles of fetoscopes have a double headset so that the care provider and someone else may hear the heart beat. The down side to fetoscopes is that they typically can’t hear a heart rate until 20 weeks, where as dopplers can do it around 8 weeks.
At your initial appointment or even the second appointment, your care provider may ask to do blood tests and a pelvic examination. The blood test is looking for several things:
In the pelvic examination your provider may do a pap smear if it has been more than 2 years since the prior pap smear. This helps look for Gonorrhea, Chlamydia, and HPV (Human papilloma virus). The other purpose is using pelvimetery (a specific set of points to measure how big your pelvis is) which the provider can use as an indicator as to whether or not vaginal birth is right for you. Please note not all providers use this form of measurement, and if you ‘measure small’ doesn’t mean a vaginal birth is off the table. The pelvis does amazing things when in labor.
Around 20 weeks an ultrasound may be suggested since at that point and time everything is well developed and visible. The bones can be measured to get a slightly more accurate picture as to your estimated due date. The heart is fully visible and you can see that everything is there. This is also the check up where gender can be determined with fairly accurate readings.
At 28 weeks the tests at that point are Gestational Diabetes (GD). Gestational Diabetes is an inability to use glucose. This is a process of either drinking a glucose drink or eating 18 jelly beans or having a cup of apple juice (depends on brand) and then drawing blood after an hour. Depending on the results additional testing for GD maybe done.
Group B Strep (GBS) is something that 30% of the female population carry. It is a bacterium carried in the vagina and rectum. GBS doesn’t cause any problems to the carrier and is treated using antibiotics during labor and after birth.
The majority of these test can be done in both types of Birth Centers. However, depending on circumstances, the Freestanding Birth Center may refer you out for some of them, like the ultrasound. Other tests such as Quad (Alpha-fetoprotein screening) testing (genetic testing looking for specific malformations like Down Syndrome). This is typically offered around the 20 week mark but has a 20% false positive rating. Amniocentesis should only done when there or other indicators from the earlier tests. Most of the tests here have very little impact on you and very few side effects or risks. Make sure you ask any questions with your provider and research yourself to see if they are truly right for you to take.
Go ahead to Step #6: Childbirth Education Classes
So you have decided on your provider. Congratulations!
Now you arrange your appointments. Up to 28 you will probably see your provider once a month. Then at 28 to 34 weeks you will probably seeing your provider every two weeks. At the 34 week visit you will start seeing your provider every week until you deliver.
Your provider will also schedule you in if you are having problems or if you need the extra support.
Go back to Step #3: Schedule Interviews
Go ahead to Step #5: Tests and Ultrasounds
Most Free Standing Birth Centers will offer a meet and greet free of charge. This will include a tour of the facilities and possibly a video about births in birth centers. Just to give you an idea as to what to expect. Hospital Birth Centers may ask for a co-pay you can verify when you call for an appointment.
Be prepared for your meeting with questions that are important to you so that you can have the birthing experience you really want.
Here are a few suggestion questions:
Here is a list of other questions you may be interested to ask.
Keep in mind that this is a meet and greet and you should not feel pressured to commit to anything. Go with your gut and ensure you feel comfortable with the facilities and care providers before making any final decisions.
This may also be a good time to interview Doulas if that is something you are considering. Interview a Doula is very similar to interviewing your care provider so you can ask them many of the same questions. Here are a few qualities to look for in a Doula.
So to decide which you want, search on the internet, poll your friends or ask your local medical center to see if they have any information or first hand experience with any of the Birth Centers in your area. You can also use things like Yelp.com or google.com for other people’s insights regarding the Birth Centers. Once you have gathered your list of facility options, make a list of what you is important to you such as your expectations, facility's ambiance, care provider background, intervention tactics, common practices and procedures, etc,
Schedule initial meet and greet appointments with the ones that meets your criteria and make a list of questions you want to ask. Here is a list of questions you may want to start with or include in your own list:
The biggest differences between a Free Standing Birth Center and a Hospital Birth Center is the closeness to a hospital and whether the people working for them are constrained to hospital procedures, timelines and the type of medical staff work for the facility.
Free Standing Birthing Center
As these facilities are not affiliated with a hospital, they are ran by midwives, either Certified Professional Midwives or Certified Nurse Midwives. Nurse Midwives have gone to nursing school and then have done an additional study course specifically just on birthing and helping mothers and babies. Certified Professional Midwives have typically gone through a midwifery program and then spent a significant amount of time within an apprenticeship studying under a senior midwife.
In comparison to a hospital or Hospital Birthing Center, a Free Standing Birthing Center has the autonomy to establish custom procedures and have more flexibility regarding timelines and protocols regarding birth. This often gives the pregnant mother comfort if they have experienced rushed hospital deliveries in the past. However, the facilities are often moderated by a local government body thus have to abide within a framework of medical limitations. This also means that they have limited resources should a serious medical emergency occurs that requires a hospital, but often the facility is within close proximity to a hospital specifically for that reason.
Hospital Birthing Centers
Hospital Birthing Centers are run by employees of a hospital such doctors, OBs and nurses. These facilities act as a subsidiary of the local hospital and the employees are an extension of the hospital staff, often from the maternity ward. As an affiliate of the hospital, the facilities must follow the protocols established by the hospital but given a few more freedoms over the hospital’s maternity ward. For an example, the facility's rooms often are equipped with birthing pool and showers, allow you to move around more, allows more people to support you through the labour and have more flexible timeframes and protocols with birth than maternity wards.
Either place also allows you to bring in a Doula who can be with you every part of the way and it is highly encouraged. Here is a link to help you decide whether a Doula is right for you.
Go ahead to Step #3: Schedule Interviews
Go back to: Birthing Methods Menu
Birth Centers are a great middle point between a Home Birth and a Hospital Birth. Many women want the freedom and ambiance of a home birth but still want the medical convenience and a Birthing Center acts as that go between so women can have pieces of both options.
To find Birthing Centers in your area, you can search of them on the internet, ask your local women's centers or check with your local medical center or hospitals. Often you have to be within a specific geographical region of the birthing center for them to accept you as a patient. This is so you can safely get to the facilities when you go into labour, which is especially important in situations where pregnancy progresses rapidly.
Did you know that there are two you can choose from? There are Birth Centers that are affiliated and run by hospitals and Free Standing Birth Centers typically run by just midwives!
So how do you decide what you want? See the information under each of the steps and see which one will work better for you by thoroughly researching your options.
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