Two different worlds

This week has been somewhat of a landmark week in the pregnant life of DH and me. First of all, we had our first appointment with a midwife. Katie at the Birth Center was fantastic – she spent a full hour talking with us about everything – the course of the pregnancy thus far, our questions, nutrition issues. She even brought up interesting things that hadn’t been suggested earlier during my pregnancy – such as the importance of vitamin D in pregnancy (low vitamin D levels can be associated with pre-eclampsia, though it is not associated with more adverse outcomes), the option of having waterbirth and the potential benefit of water in preventing lacerations during delivery – it was truly a great visit.

And so personal! While my usual physical exam lasts about 30 seconds, Katie started from scratch with me and when she did the belly exam she pointed out our little baby’s body parts and had both me and Tanuj feel them.  I imagine that all of this sounds a bit touchy feely, but as a pediatrician and as a mom, it felt deeply personal and truly felt right.  Every sense I get from being in the birth center is a positive one – one where people have medical expertise, a place that is clean and safe, but also one where we are treated as people going through a natural process and want to experience things in a personal manner.

Which takes me to another end of the spectrum which we experienced last night – our classes with a doula named Amy of Journey Birth Services.  She, too, was great and very personal. As a proponent of home birth she provided me that end of the spectrum that is totally opposite my medical training, in a style that is also different from my medical training – some though much less evidence basis with a very nonconfrontational style, where she admitted that she is there to give us information, but choices are our own and she will never try to interfere with that. So we learned about the wonders of homebirth through the video “It’s My Baby, My Body, My Birth.” Much of last night’s conversation revolved around introducing the role of childbirth education and prevention of worsening risk factors during pregnancy – including exercising properly and dieting properly.  The other half of the discussion was slightly more heavy handed but involved dispelling the myths around pregnancy that are presented by the medical community. This was at times a point of tension for me, given that I have provided neonatology services as a medical resident, but it was also tremendously interesting and enriching. And there was definitely a lot of good information in the discussion that we had, even if I didn’t agree with everything. Pregnancy is a natural part of life and in many ways it seems strange how regimented it has become, how “natural” a hospital-based birth has become to us, and how accepting we have become of medical interventions that may or may not be necessary. I enjoyed exploring this part of the brain and the pregnancy discussion.

Which brings me to tonight, which took me again to the other polarity in the United States pregnancy experience — the hospital. Although we are planning to deliver at the birth center, unexpected events can happen and my labor experience may bring me to a hospital setting. Thus DH and I drove over to the hospital where we originally planned to deliver to visit the facilities. Oh what contrast in the presentation. From the moment you enter the door it feels so regimented, so set in what will happen. It is as though when you do enter the hospital environment one has to be ready to let go in many ways – let go of having everyone around you and limiting it to a select few people. You also have to let go of the delivery you imagined, because a fully natural delivery certainly won’t happen here. My Ob/Gyn had told me that I would be allowed to drink while laboring, but when we went to the L&D suite I was informed that it is an ice chips-only environment. It’s not that I felt lied to, but it was a bit jarring to hear inconsistencies between the words of different providers.

The hospital had a clean and modern design with all necessary amenities, so I know that I would be well taken care of if I were there. But it didn’t have that homey feel of the Birth Center. And so much of it was “what will happen to you when you are here” rather than “what do YOU want to happen?”  And even though they exhorted that we should be clear about our wants and needs with the nurses, it did seem difficult to make that happen. Even if I did know what I wanted, when I would be triaged I’d be alone, and may not have family there to help remind me about my issues and needs. And in the pain of delivery I’d probably cave and go for that epidural sooner than later, especially if I couldn’t move off that L&D bed.

DH observed that it seems like a hospital environment empowers parents less when compared with a birth center environment. In the hospital they encouraged us to let others take care of us as much as possible, to enjoy the epidural, to follow the instructions given to us, to feed the babies in a particular way, to let the baby be bathed by someone else, to not worry about things until we got home. In the hospital IVs were standard, the baby monitor was there to help the nurses monitor the baby from wherever they were, even if they weren’t in the room. The monitors could even be viewed by doctors in their offices, far away from L&D.

I realize that not everyone wants to experience the pain of delivery – and sometimes even after trying to deliver “naturally” unexpected events do happen.  But to me there is some value in that experience if I can get through it without pain medications – as though, I got through this, now my baby is alert at my breast and is feeding, and my husband is here to help and we are already doing things for ourselves.  God-willing, we will get through this together with the plan we have in mind, and if things don’t go as expected, I hope that we will be able to keep our peace of minds!

And this concludes an altogether fascinating class-week in my journey to motherhood!