I have decided to have a natural birth in a birthing center, and No, I am NOT crazy.

As I type this from the comfort of my bed on a cold, rainy day, my computer barely lays flat in my lap anymore now that my tummy has grown so much. I've been meaning to get back to blogging for so long now, and I told myself I would WITHOUT QUESTION journal my way through my first pregnancy. It's now the 20th week of gestation, and this poor blog is quite sparse. But, better late than never, I suppose!

Seeing as my gauge of each of my feeling's worldly importance seems to have gone out the window along with so many other things, like my waist line and the ability to go on a three hour road trip- or even a thirty minute one- without having to stop to use the bathroom, it's become clear that the best place to unleash the cascade of emotion is some place that I can speak freely, and let go of it, and perhaps, garner a few supportive voices along the way.

In an effort to thoroughly explore the crevices of each emotional earthquake, I'll just start with the single most consuming thought on my mind lately, which is- How/Where/Who is going to deliver this baby?

Stepping out of my own birth experience dreams, it's clear to me that the short answer is that I will deliver this baby, one way or the other, with or without drugs. Hospital or no hospital. In the end, I will give birth, baby will be here, and what is most important is the safety of my dear baby, and that I will be a healthy mama.

I started this journey with my long time OB-GYN in Baltimore. She saw me through routine pap smears, birth control changes, and a few relationships, some good, some pretty bad. Sure, her staff was a little scatter brained, and I'd have to call a few times to get a hold of any test results, but she knew my body well, and she knew me considerably better than any other doctor I had been to. I left her care when my boyfriend and I came to a mutual decision that I would move home (to Texas) for the duration of my pregnancy, so that he could do some work on the house in preparation for baby's arrival.

When I got to Texas, setting up my health care was not as easy as I had hoped it would be, and was downright frustrating at times. But, in the end, I stayed on schedule and was just in time for my first second trimester appointment with a doctor I thought I had done adequate enough research about. Her doctor profile was wonderful. She attended medical school at Baylor, and was now practicing at a reputable hospital in Houston- Texas Women's Hospital. She had years and years of experience in obstetrics and gynecology. She even included a biography that highlighted her enthusiasm for the female anatomy and her wish to bring as much of her knowledge to her care practice as possible. I thought, "Alright! Here is a woman who cares!" Well, to be fair, I am not going to make a judgement with such gravity and say that she doesn't care about her patients at all, because what I realized is that we simply have different ideas about what "care" really means. Additionally, I think perhaps her schedule may not have been conducive to the care I was looking for. Our first appointment started off on a bad note when my previous OBGYN's office for some reason or no reason at all, had not forwarded any of my medical records as I requested. So my entire appointment time was spent playing phone/fax machine tag trying to get them to forward my records. Eventually, my doctor told me I would need to reschedule, or go to her other office which was considerably far away from me, for my appointment. When I told her that neither of those options worked for me, she squeezed me in for a quick 15 minute visit. There wasn't much for her to work with without my medical history, but she was able to listen to the baby's heart beat with a fetal doppler and do a quick exam of my pelvis, and declared, "Yes, your pelvis is fit to give birth." That was all for that visit. I walked away incredibly annoyed at my previous doctor for wasting my time and my doctor's time.

The next visit, I had an ultrasound. It was a little unique for me because I was used to having all of my ultrasounds done in- office with my last doctor. But with this one, I went to the hospital to have it done. I got to the hospital a little early to allow time for registration and paper-work. Naturally, things could not just go smoothly! Oh no, there had to be a glitch in the system! Evidently, I needed some sort of doctor authorization form before I could be seen by an ultrasound technician. So, I waited half an hour for my doctor's office to open, and then had them fax over an authorization form. The ultrasound itself was pretty routine, albeit far more in-depth this time, with a complete anatomical overview of the baby. I can't really complain. The technician was very nice, and took her time getting all the best angles of each organ that she could. I moved in a few different positions to see if baby would cooperate, but he was a little shy at times.

I left the ultrasound and went straight to my doctor's office. I was basically right on time and the transition was nearly seamless. I don't think I waited for more than five minutes. The nurse recorded my weight and all my vitals, and everything looked just as it should. I waited for a little bit in the exam room while the doctor got ready for me. She came in, and we essentially had exactly the same visit as the previous visit, minus the pelvic exam. In fact, I did not even undress this time. (Which I'm not particularly complaining about- though I did find it odd) The baby's heart rate was healthy. I asked my doctor how long into my pregnancy it would be safe for me to travel, and she told me rather impatiently, "As long as it's before 30 weeks. You may grab your things and head to the front to schedule your next appointment."

Umm? Thanks! I definitely didn't have ANY other questions for you about my continuously changing body?

I followed her into the hallway and sniffled into my sleeve, reminding me to ask about what I should do if I come down with the flu, since both of my parents were sick with it at the time. By this time, she had settled into her desk and was shuffling through a stack of papers, too busy to look up and give any sign of acknowledgement or concern. "Call us if you start to experience any symptoms, and we will get you some Tamiflu", she said. "Oh, okay. Great, thanks"

"Wait a minute", she said. "Have you had any blood work done? All I have here are labs from a Dr. Taylor regarding your TSH levels."

Long story short, my previous doctor STILL hadn't sent my medical records!!! At this point, I was feeling frustrated, and PRETTY DUMB. What would I have to do to get through to the nurses in that office??! 

"Can we just order them all again? I'll do it right now."

"Alright", she said in some kind of tone. "Do them again."

And then she was gone.

Flash forward a couple days, when I call her about that Tamiflu she had talked about getting for me, because I was feeling sick, and, as it turned out, somehow, either I was crazy, lying, or completely misunderstood my doctor's implication when she said, "We will get you some Tamiflu".

"Dr. Robinson does not prescribe Tamiflu", they told me. LORD. I'm not even going to get into this story again because thankfully I did not actually end up with the flu, and I suppose it's a good thing I didn't take Tamiflu after all. But, I hung up the phone certain that I would not be returning for my next appointment. The miscommunication between my doctor and I, between the staff and I, and the staff and the doctor, completely put the entire experience into perspective. If I was going to stick with this doctor, in this office, I should be prepared for these sorts of incidents.

Being pregnant and all, I decided that accepting that low level of care was unacceptable, and that I would not be at ease the day my baby came into the world, under this sort of disorganized care.

I knew the moment I found out I was pregnant that I was at least interested in trying to have a natural birth. It was an experience I wanted to have. It wasn't until I began to dive deeply into the advantages and disadvantages of both medicated and un-medicated birth that I became sure that I was going to commit to an un-medicated birth to every degree possible.

Let me clearly say that I am not suggesting that every woman SHOULD have a natural birth. And, in fact, I will still need to prepare myself for the possibility that my baby could decide he wants to do things his own way. I don't think there is any room for any "should"-ing when it comes to child birth. I would never tell someone how they SHOULD live their life, and, in fact, my whole point is that we all have choices, and the important thing is to make the educated decision that is best for you, because what makes mama happy, makes baby happy too. I know some women prefer a medicated birth, and I think it's an immensely personal decision. I PERSONALLY am far more faithful and feel safer in the hands of nature than I do technology. I also just have always been really really anxious in medical environments. This is coming from the person who, when she was 6 years old and went to the ER because she had a chin that busted wide open from a kick to the face by a girl swinging from the monkey bars, demanded that my pediatrician explain every step of my stitching, AND provide a mirror so that I could watch. One might conclude I've been distrustful from the get-go. That said, who knows what state my chin would be in right now if I hadn't had my doctor there to do what she was medically trained to do. But, pregnancy and birth is not an illness, or an injury, in my perception, unless abnormalities and complications occur that warrant medical interference. In fact, even a complication can be nature's way of saying "Hey, I don't know if I can handle this all on my own. Please send help." Then, in that case, and this goes beyond birth, I am thankful that doctors exist, and that they can do what none of the rest of us are medically qualified to do.

After researching natural birth more in depth, I decided that I wanted to start seeing a midwife instead of an obstetrician. I learned that midwives not only lower your chances of unnecessary medical intervention and the likelihood of cesarean section, but they also establish a more personal, in-depth relationship with their patients. (Or clients- some midwives prefer this term, so as to eliminate the pathological mentality behind being a "patient".) I searched for midwives both in hospital and in birth centers. What I found is that it is very rare to find a midwife in a hospital. At least in the state of Texas. There are a few hospitals that do have them, however, and I was lucky enough to snag an appointment with a midwife that practices at a nearby hospital. The reviews and statistics I found regarding this particular hospital weren't particularly stellar, in fact, they were rather abysmal in every unit except for labor and delivery. I was stunned to find out that according to the last statistical hospital reports in the state of Texas, their cesarean rate was 16% in 2011 (still a percentage above the World Health Organization's recommended rate), compared to 46% at Texas Women's Hospital in 2011. It's probably realistic to say that those statistics have continued to go up since then, and that although this particular hospital's cesarean rate could very well be approaching 20% if it hasn't already, I felt a little better about it after I toured the hospital labor and delivery unit, and was able to talk to several nurses in depth about all the many questions that I had. They assured me that the midwives that practice there do everything they can to ensure a natural birth, and that as a patient, I have the right to refuse any interventions that I do not want. I left feeling better about the direction I was heading, and that everything would be okay. I thought I had made my decision when I went to bed that night. I felt relieved that I had been heard, received information directly from the source, and that my hopes for a natural birth were backed by a hope outside myself as well. I had been supported.

Still, I started to read more and more about natural hospital births. What are the best methods of pain relief? What if I labor for a long time and they say that I need intervention? What can I do to prevent these sorts of circumstances?

I began to search for answers to these sorts of questions. As it turned out, much of what I learned encouraged women looking for a natural hospital birth to labor at home for as long as safely possible. The longer you are not taking up space in a hospital, the fewer your chances of intervention, and potentially a cesarean section. This initially made perfect sense to me. "Oh yeaaaaah!", I thought. "Duh!"

But this was quickly followed by a wonder and concern for the hours of unsupervised home labor, when my baby and I would not monitored by my midwife at all. "What happens if...?", I thought. 

Then I learned that the best method of pain relief of a natural hospital birth is... yeah... still waiting for an answer to that question. The best method of pain relief for a natural birth in general is quite a varying thing, because there are several options- from laying in a warm tub of water, to various techniques that all require movement and/or positioning that isn't the lithotic position (laying on your back with your legs up and feet in stirrups)

The hospital where my midwife was practicing has a policy that requires continuous fetal monitoring (some would even warrant this alone as intervention #1) This, unfortunately, means that I would be confined to the hospital bed, on my back, for however long I am in unmedicated natural labor.

I thought for a minute and thought this sounded like torture to me. And then I thought some more, and it still sounded like torture. And then I thought- how realistic is it for me to have a natural birth in a setting where the only pain relief alternative is medication? 

My comfort level began to dwindle the longer I thought of myself in a hospital bed writhing in pain when I could have done this naturally, and more comfortably, if only I had some options.

So, I looked into a nearby birthing center that was recommended to me by the renowned midwives at Texas Children's Hospital. Conveniently, it's only about a 15-20 minute drive, which certainly looked great next to the 30-60 minute drives of the other two hospitals I had considered. I scheduled a tour of the birth center and an interview with the owner/midwife, and my mom and I went together to check it out. It sits in a quieter side of town, in a nice wooded neighborhood. Already, it felt a little more homey. Inside, it was warm and welcoming. Not much different from a usual medical waiting area, but it had a sense of life in it. There was a Ziploc bag of cheez its left sitting on one of the chairs, and I don't know why, but it made me breathe easier seeing signs of family and humanness lingering around. I filled out some simple paper work, and waited for one of the birthing assistants to call me so we could begin the tour. We weren't kept waiting long, and the tour was pretty short and sweet. On one side, the office was your usual doctor's office. A few exam rooms with all your standard medical instruments, and a lab room for any blood work. On the other side was the birthing center, where there were two separate birthing rooms. Each had a full sized bed (or maybe even a queen- in any case- not your standard cot of a hospital bed) a whirlpool tub, a stool, a birthing ball, and a private bathroom. There was a separate communal kitchen/lounge area in case I get hungry during labor and want a snack, or if any of my family want to step out for a minute for a beverage, or just to get away from the stress of witnessing labor.

After the tour, the midwife, Bernadette, came to meet us in one of the birthing rooms. She was probably half my height, but scrappy. Not that I am anticipating that she would ever need to, but she could probably kick my ass if she wanted to. She shook my hand and greeted both my mother and I warmly. We talked for what felt like an hour but I'm sure it couldn't have been that long. I asked her my most pressing questions about giving birth in a birth center. Namely, what happens in the event of an emergency? What even IS an "emergency" by her definition? And how often does it happen?

She assured me that firstly, she delivers over 180 babies a year, and the chances of a need for emergency transfer is very slim- less than 5%. But, in the event that it should be necessary, she has a back up OB at a nearby hospital that she would send me to. She explained that she does her best to facilitate the needs of both the baby and the mother during an emergency, and has oxygen if the baby should need resuscitation for any reason, and in the rare event that I hemorrhage, she has pitocin drawn up to stop the bleeding. In addition, the very fact that we would be doing things naturally, dramatically decreases the likelihood of any of these instances from occurring. 

What really brought everything into perspective for me is when she told me that she will want to see me every two weeks, and then every week as we get closer to delivery time. She warned me that she would be inquiring about my diet on every visit, and that I would need to keep a thorough record of my diet and activity. These things, she assured me, would help to prevent the circumstances that can facilitate a breeding ground for complications, and thus, transfer. She informed me of all the various methods of birth she has experience in, and all of the classes that she teaches, for free. 

Never did I feel like she was trying to "sell" her advice or expertise. I explained to her my recent experiences with my OB's and my concerns about hospital birth, and she told me about her time as a labor and delivery nurse, where she realized that a nurse's and a doctor's hands are often tied in that setting, due to hospital protocols and liabilities. But, there are options, she assured me, and it's important to know what those are. 

I went home excited, but I knew I needed to discuss things with my boyfriend before making any decisions. After a few days of discussion and deliberation, we both agreed- A natural birth center birth is the right choice for us. 

Today, I cancelled my appointments with my former doctor and midwife, and made my first appointment with my new midwife, who I am certain I will establish a close bond with and will take great care of me, baby, and my whole family through this whole crazy, amazing time.

Now, I can breathe, and focus on taking care of baby and I, and prepare for his big debut. :)

On that note- It's the second to last episode of Parenthood tonight, and I need to prepare my hot chocolate before someone steals my favorite chair!

Adios for now :)