Another guest post!

Today we have another guest post from my sister Eliza, who has shared snippets of her birth stories and many helpful resources for women who are researching OBs/midwives for their births. It is a bit on the longer side, but bookmark it if you don't have time to read it all, and you can reference the information later!

Thank you for this information, Eliza!

Knowing Doing


Have you ever met a "know-it-all" about birth? I have. And sometimes I am one. Which is funny, because I have had two kids and I’ve read a few books. Obviously I do not in fact “know it all.” I don’t think any woman does. Maybe if you have like 15 kids and you’ve tried every combination of birthing methods imaginable—the surgery and the pushing, and the pushing and the “breathing,” and the drugs and the hypnosis, and the cutting and the tearing, and the IVs and the Popsicles—plus you are an experienced midwife and obstetrician so you have helped 1,000 other women do it too, then you might know it all. But you are probably not reading this blog.

But since you are reading this blog, you probably have some experience or plan to have some experience with birth, and so I hope you will process this post in the context of what you have experienced in the past or what you hope to experience in the future with birth.

My first child, Theo, arrived via Cesarean section after two days of labor and two hours of pushing. Exhausted, I asked the doctor, “Can’t you just pull it out—or CUT it out!” So he did. And then he hurried off to his wife's birthday dinner, which he had mentioned that morning he needed to attend.

Two years later, my daughter, Ida, came right out all on her own after 12 hours of textbook contractions and 30 minutes of pushing. Okay, also there was some yelling involved--from both of us. My doctor (not the same one) gently lifted her cord from around her neck as she came out. He made sure she was fine, then he stood to the side and smiled.

But back to the Knowing of It All. Sometime early in life I decided that if I could read or talk about something enough, maybe eventually I would know it. This has always been my somewhat obsessive and certainly compulsive attempt to gain control over my world. So when I was pregnant with my son, I read everything I could find at the library and everything I could find in Google searches. I talked to everyone I knew and asked dozens of questions. I asked hundreds of questions. I planned to give birth to my child calmly and without fear.

One day, when I was feeling especially cumbersome (but calm…oh so calm), my mom called. “Have you thought about taking a childbirth class?” Ugh...she thinks I don't know what I'm doing....Practically before she even finished the sentence I hastily replied, “Sadly, I don’t have 300 bucks for a childbirth class.” “Well, maybe I could help you find—” “It’s cool, Mom. I’m doing HypnoBirthing." "I'm just a little worried that you--" "Have you heard of HypnoBirthing, Mom…well, I’m doing it…so don’t worry.”

Except I didn’t actually do HypnoBirthing. I read the book once, and I listened to the CD a total of about 10 times. I didn’t sign up for the class or any class. But I had it handled!

By now maybe you’ve thought of something I could have done differently during that first pregnancy. Maybe…change my attitude? That probably would have helped. Or maybe I could have taken an active part in what I consider the single most important aspect of pregnancy and birth besides eating and praying (side note: see this article about the role of prayer in childbirth preparation): finding and working with a care provider.

Do you know how I found my obstetrician for Theo's birth? I googled “Arlington Virginia obstetrician.” I read a few reviews online and people seemed happy with him, so I called the guy up. Appointment for August third. Done and done. I asked about natural birth. "Sure, you know you don't have to be a hero, but go ahead and try!" I asked about C-sections. "You most likely won't need a C-section."

So, fast-forward a few years. I was pregnant again and for the first time I really began to think about what I wanted to do differently. I have absolutely never blamed my doctor for my C-section, nor have I blamed myself, since no one knows whether the ultimate outcome could have been different. But I did know that I was unhappy with my relationship with my doctor and unhappy with my own level of preparedness that first time around.

This time, I knew I wanted a VBAC (vaginal birth after Cesarean). No longer was my goal quite so lofty as to march into the hospital, unafraid and unpracticed, and breathe my baby down while visualizing blue satin ribbons on a cloud of strawberry-colored mist. All I wanted this time was to push that baby out myself if it was at all humanly possible. But how on earth to go about finding someone who would help me with that goal?

This time, I attended a support group. I met people with similar ideals about birth and got names and numbers of doctors and midwives and doulas. I contemplated and researched home birth, since birth centers in my state do not accept VBAC patients. Then, having decided on a hospital birth, I interviewed six obstetricians at three OB-GYN practices. I timed these unofficial interviews to be my actual prenatal visits so as not to spend extra money on extra appointments. Finally at 24 weeks pregnant, after hours of discussion with my husband, I settled on a doctor. My husband and I prayed about it. Not long afterward, I found out that that particular doctor was no longer accepting new patients, essentially due to his popularity. I had barely slipped in under the wire.

What worked for me? Why did I click with this doctor? For starters, VBAC was listed on the hospital Web site as one of his specialties. Next, I knew from talking with other patients of his that his approach tended to be organic, working with mothers to find out what they wanted, and helping them achieve it. Finally, I just felt good when I visited him, and not only because he said what I wanted to hear. He told me that I had excellent chances of achieving VBAC, and he gave me reasons—my health and determination, the circumstances of my first birth, statistics of other births, his approach and his history after being in obstetrics for several decades. He also told me about risks associated with VBAC and with C-section, as well as circumstances in which he would not recommend VBAC. But the testimonials from other patients were the biggest deal-sealers.

By the way, I don’t exactly mean for this to be a cautionary tale about C-sections. That is another kettle of fish (and a fine one, might I add). It is instead a prescription for finding a care provider who will approach pregnancy and birth in the best way for you and for your baby.

Who is the best care provider for you? We all have different preferences, so the specifics will vary, but a few things will be constant. I'll say "she" because a "she" can be an OB or a midwife, but I do mean "he or she":

• She will possess the level of experience and education that you expect.
• She will answer your questions frankly and quote evidence of her practices rather than just ideals.
• She will not allow you to feel rushed at your appointments.
• She will not roll her eyes when you ask to discuss a birth plan.
• If asked, she will sign your birth plan for you, to signal to the hospital staff that she agrees with your requests.
• If she needs to vary from what you've agreed upon, she will give you the facts about why.
• And you will feel comfortable in her presence.

Are you a BYU student or otherwise a Utah county resident and love your OB or midwife? Do tell in the comments! For the rest of us, here are a few suggestions to get started on finding as near a perfect match as you can get. Forgive me if I list things you already know, because I probably will. But I hope you find something new, both in this post and in the comments. And if nothing else I hope that what you read here motivates you to stay on top of your own health care. No provider is perfect, or even perfect for you. But remember: you are paying her! (Or him.)

Ideas for choosing a midwife or obstetrician
A Google search: ridiculously basic, I know. But doing starts with knowing. Clicking here or there on this sample search might get your ideas coming, or help you determine what it is you want and why. You may want to think of this in terms of a birth plan which you will ultimately discuss with the provider you choose. An OB nurse told me once that to some nurses, a 4-page birth plan immediately signals "probable C-section." In other words, having too many "wants" can help you lose focus on the end goal, if, for instance, your goal is a vaginal birth.

During my second pregnancy, a doula helped me focus using this simple exercise: Make a list of 20 or so things that you hope to be part of your birth experience. What matters to you? Examples on either end of the spectrum might be: epidural/no epidural; IV/no IV; hospital gown/wear my own clothes; episiotomy/allow to tear if necessary; Pitocin/no Pitocin; etc. Once you've written down every possible wish you can think of, start crossing items off. Eliminate them one at a time until you have identified your #1 goal, the one item or procedure or atmosphere that you can't live without. Structure your birth plan around that, and keep it less than a page.

Ideas about what to ask a midwife or obstetrician
You can ask these or questions like these at any point in your pregnancy, but it's good to get them out of the way first. If you have strong feelings about certain procedures (e.g., you definitely want an epidural or you definitely want to go into labor on your own), I suggest framing your questions objectively--"When do you suggest inducing?" rather than "Can I go past 40 weeks?" or "Can I be induced before 40 weeks?"--so that you will get the provider's true opinion, not slanted toward you as a customer.

BYU Health Insurance: Maternity FAQ
Answers to some basic questions about how to proceed if your pregnancy is covered by BYU Health Insurance.

BYU Health Insurance: Maternity Benefits
Specifics about what's covered and what's not under your health plan at BYU.

BYU Health Insurance: Find a Provider
When filling this out to find a current list of providers, note the following: under Hospitals, Surgical Centers, and other Specialists, you may select Certified Nurse Midwife (CNM) or Obstetrics and Gynecology (OB-GYN). CNMs and OB-GYNs are not listed together. As of April 2009, both lists are rather short: 12 CNMs and 34 OB-GYNs in Utah County are approved for BYU Health Insurance subscribers. One piece of advice I found helpful when searching for a provider was to call the hospital or birth center associated with the care provider and ask to talk with a labor and delivery nurse; then quiz her about that particular provider's methods and demeanor. I have also chatted up other ladies in the waiting room before my appointments.

Utah Valley Resources for Birth at Simple Birth
A great list of resources for childbirth preparation and education, labor and postpartum support, and finding a care provider who meets your needs.

Utah Valley Childbirth Professionals
Scroll down to "Utah" to find contact info for local childbirth professionals, including childbirth educators, doulas, and midwives. Reviews are not included, so you will want to try a few Google searches and ask around.

I think that more than anything, when we as mothers seek our "dream" doctor or midwife, we are yearning for an experience that we will not regret and that we know will be the right thing for our baby and our family. I think that can happen no matter what, vaginal or C-section, home or hospital, epidural or "organic," as long as a mom and her husband are prepared and prayerful and their health care provider is skilled and competent.

Once you've done the appropriate amount of research and you know what you should know, then take action. You can take charge of your health care by selecting a provider who knows your wishes and will do his or her best to follow them while maintaining the health of you and your baby.

Image credit: Mother and Child (Detail) by Gustav Klimt