I switched from a traditional OB/GYN group to midwives at 32 weeks and it was the best decision of my pregnancy.

Note: This is the extended version of my birth story ... the abridged version can be found on my favorite website, OffbeatMama.com 
http://offbeatmama.com/2011/04/switching-to-midwife 
 

When I got the mind-blowing “pregnant” reading one snowy and dark December morning, I ran into the bedroom and jumped on the bed until my groggy husband caught on and started giggling along with me. It was wonderful. I had little doubt about my first order of business that morning: call my gynecologist’s office and schedule my first prenatal visit. I had been going to the group for years so I scheduled my first prenatal with Dr. R. Done and done. I was much more into daydreaming about the microscopic bean floating around in my belly than worrying about little things like picking a caregiver. I skipped the first chapter of every new pregnancy book I read. I didn’t need to know the difference between midwives, doctors and doulas. Get onto the fun stuff like when I was going to start showing.

Throughout my first two trimesters, things went pretty well. I decided early that I wanted my delivery to be natural – no medication, no epidurals, and no pitocin. I had been present at all three of my sister’s births where she had all of the above and it worked perfectly fine for her. I held no judgment or feelings of superiority over her. But my instinct was telling me that the hundreds of thousands of years of women giving birth without epidurals were evidence enough for me that my body was equipped to get me through a strong and powerful birth. I shared this plan with Dr. R and she told me to keep an open mind. Not necessarily a natural childbirth battle cry, but she didn’t fight my wishes either. It would do, I decided.

At 16 weeks I started going to prenatal yoga and found my instructor to be a new strong and centered being I could tune into. She was a doula and pointed me in the direction of a doula group in the area that offered free (donation-oriented) natural birthing classes. The first night I went I met Amber, a massage therapist and doula who I connected with immediately. My husband also felt a great vibe from Amber and so she became part of the birthing team.

At around 20 weeks, I started to think twice about my OB/GYN group. Through the birthing classes, I learned more about the different hospitals in the area and from others’ anecdotes I started to dread picking between my two unsavory choices that my OB/GYN group would go to. We went in for the ultrasound around this time as well and although that was another mind-buzzing high that we’ll never forget, we happened to have our appointment with another doctor in the group because Dr. R wasn’t working that day. He was totally arrogant and defensive when I told him I was reading a book on the Bradley Method, and all I could think was “I could end up getting this guy if he’s on-call…!” Despite the gentle reassurance from my doula, yoga teacher and prenatal chiropractor that it’s perfectly acceptable to switch caregivers, and that 20 weeks was a great time to make that switch, I was hesitant. The three of them were my circle of pregnancy care that gave me energy. Dr. R was just a means to an end. The dichotomy would be fine.

I continued to put off touring our two hospital choices. My yoga teacher-doula-chiropractor triangle all gushed about a local hospital with a midwife program and a focus on supporting natural childbirth if that was a person’s wish. Their cesarean rate was 12.7%. My hospital choices had rates hovering around 30-35%. Eventually our hospital tour date came along and the whole place just felt wrong. But somehow I still wasn’t allowing myself to think about switching groups. I even asked my husband on our way out if he thought we should pick up the subsidized parking passes. He wisely suggested we wait on that detail. Even so, I felt resigned to our fate of a medicalized birth with a sterile practitioner in a cramped and pitocin-focused hospital. I devoutly read “Ina May’s Guide to Childbirth,” I pored over every offbeat mama childbirth story that popped up in my google reader, and I faithfully attended as many of the doula group childbirth classes I could squeeze into my schedule. I felt strongly that my focus on natural childbirth would rise above the melee and that Amber, Chris and I would make it through with our plans.
One of the biggest blocks I had to switching was my good ol’ fashioned Midwestern guilt over offending Dr. R. Once you pick someone, you stick with them. I would feel so bad switching on her without talking it out with her, but my Midwestern passive tendencies got in the way of that plan and I couldn’t possibly imagine having that conversation face to face. Or even over the phone. And I didn’t have her email address. Cest la vie. Dr. R it was.

The weeks marched on and my belly grew and grew. My little Miyagi squirmed and kicked and got the hiccups every day. Chris and I were both blissfully geeked out at my gorgeous new body and the amazing life inside it. Time piled yet another reason not to switch onto my list. Clearly (to me, at least) there wasn’t nearly enough time to get to know a new caregiver before my birth. It would be like starting out from scratch and Dr. R and I had built something together. Hadn’t we? It was about the same time that I started looking up tour times for the midwife group’s hospital that I went to Dr. R and realized that she never called me by my name. She would sweep in, answer my questions politely, and leave. I didn’t even have a shred of hope that she knew I went by Katie and not Katherine, as my chart must have told her. So much for having built something. So much for me having owed her anything at all. It hit me in the face that I was just another chart to Dr. R.

Switching turned out to be so easy, it was a non-event. I called the midwife group and scheduled my 32 week appointment. I called Dr. R’s office and asked the receptionist to fax my records to the midwife group. Done. Relief. At that point in my pregnancy I was going in so often that I ended up getting to see four of the fifteen midwives and as luck would have it every person that I interacted with in my birth had attended to me at some point prenatally except one (who was just as amazing as all the others anyway).

My decision to switch to this midwife group turned out to be so essential to the beautiful success of my birth not because I had the natural birth I had hoped for, but because I ended up with a medicalized one. The ugly face of high blood pressure reared its unexpected head at my 40-week appointment. I made them switch cuffs twice and take my BP by hand. None of it changed the fact that all signs pointed to pre-eclampsia. After 24 hours of monitoring and wallowing in my own denial, I finally started listening to the things they were saying to me. It was the doctors (who work closely with the midwife group) who were telling me to stay for monitoring, to stay for induction, to just have my baby since I’m here and full term. But it was the midwife that sat down and looked me in the eye and said that she would worry about my health and the health of my baby if I walked out of the hospital (which she reminded me was my choice, not theirs). She promised to start the induction with Cytotec instead of Pitocin. She explained why she felt okay about inducing labor for me and my baby. She promised that if it kicked my labor into gear that I could be taken off of constant monitoring and would be able to get into the tub. I agreed to this inducement I had dreaded for nine months because I trusted the person I had chosen to guide me in my birth.

I labored strong and hard without pitocin or any other drug for 17 hours. I moaned, I grooved, I threw up, I jammed out to my birthing mix, I cried. It was all natural and I felt every painful moment of it, but it was good. During that time I went from ½ of a centimeter to … wait for it… 1 ½ centimeters. I was crushed to realize that although the Cytotec slammed my body into powerful contractions, my baby just wasn’t along for the ride. I was exhausted and stricken. Unfortunately, I still also had very high blood pressure and my midwife was clear that Pitocin was a necessary next step to progress my labor. So I made it clear that if Pitocin was on the order, so was an Epidural. No one tried to talk me out of the epidural, but that was okay. It was 3 a.m. and I needed to rest and let my body do some work without me.

It took just four short hours for me to fully dilate, though I couldn’t really feel the pushing contractions for another 3 hours after that (probably due to the epidural). The most amazing part of my labor was pushing. Well, I guess I’d say the first two hours were pretty great… the third hour got a little old. Then I started needing oxygen and Miyagi’s heart rate started dropping frighteningly low. Not to mention my continuously high blood pressure. In the end the midwife called the doctors and they came in to give me an episiotomy. They also told me they were thinking of grabbing the vacuum extractor, but I assertively let out a forceful “No.” That decision was all it took and two pushes later I heard my husband weeping over my shoulder that it was a boy! My whole world exploded and imploded all in the same moment and everything was perfect. Yes, I had a doctor stitching up my bits, but my son was given a once-over APGAR of 7 and placed gently on my belly where his humongous blue eyes looked up at me in awe. He nursed immediately and the room cleared out to leave us in our bliss.

I feel comfortable with all of the medical twists and turns my labor took. At first I was sad for having missed out on the natural childbirth experience I had envisioned, but I knew I could trust the guidance I was given by the midwives. I knew that they were as centered in their quest for natural childbirth as I was, and that helped me let go of my anxieties when the cascade of interventions took over my labor. Had I stayed with the OB/GYN group, I might have fought harder at the difficult choices I had to make. It might have traumatized me for not having had anyone to trust. I realize that although my original inspiration for natural childbirth (all of my strong ancestral mother spirits) was a valid starting point, the stark reality is that before doctors and hospitals were around, women died in childbirth at a much higher rate. I could have been one of those women. I am so blessed to have my beautiful family, and I am looking forward to my next chance at natural childbirth with the midwives.