Kylie Orr
This week's word: Equanimity; ee-kwuh-NIM-uh-tee; (noun)
Meaning: evenness of mind especially under stress
I've had three babies. All different models of care and all individual experiences with varying outcomes. Well, they were all babies not assorted jungle creatures, so in that sense, the end product was the same.
Pregnancy #1
My first born was under a 'Continuity of Care' Midwife / GP model which was fully funded. I saw the same midwife for all appointments and had visits from the Obstetric GP at intervals during the pregnancy. It was a stock standard, low-risk pregnancy. My midwife was the one I called with any questions throughout the 38 weeks and the one I called when the inevitable rumblings in the belly started. She confirmed the contractions were not gas and met me at the hospital. It was the midwife who was there for the entire 12 hour labour, coaching me through. The Obstetric GP was called in towards the end as bubs got a little lost on his way and needed some further guidance with a massive vacuum cleaner hose followed by some salad forks to help him out.
Essential Baby blogger Kylie Orr
The birth was drug-free - not by choice but rather because pain makes me stupid.
All in all, it was a successful birth process and an outcome I was happy with. The midwife supported me through the first 6 weeks at home with on call advice and home visits which I completely credit for my ability to persist with breastfeeding despite a shaky start.
It was a fantastic program for which I was a strong advocate. Unfortunately the local hospital cut funding because they couldn't justify the one-on-one care. I'll get back to this later.
Pregnancy #2
Well, seeing as the first one had been relatively free from complication, and the original program had been canned, I decided to go with the birth centre at the hospital. Predominantly midwife care, not one-on-one rather seeing any of a possible 12 midwives on staff. As I was old hand at this pregnancy and birth thing, it suited me well.
I did find it a little irritating seeing a different midwife each appointment; building rapport was slow and having to explain myself and my current state each time was rather tedious. With no private health insurance, this was the best option at the time.
Fast forward to week 41. I was so swollen a friend laughed out loud when she saw me, my patience had worn wafer thin and my paramedic brother-in-law had offered to come round with the forceps and pull that baby out himself. In fact, I was ready to do a self-extraction, bare-handed, I was so over the whole thing.
An internal examination (got to love those) at a week overdue had the midwife exclaim "ooh, that's not a head." And then she left the room. All my sense of logic and reason evacuated with her and I was left panicking that my baby was in fact, headless. She returned with a 'senior' midwife who gloved-up and agreed, it was not a head. "What is it then?!" I asked in a complete state of terror. It was a bum. Then contractions started.
In a matter of minutes, I had gone from a low risk second pregnancy, to a woman now in labour with a baby in breech presentation. I was in tears. I rang my sister, hysterical, who thought something had happened to the baby and when she found out it was simply breech, she said "get the baby out, whichever way you have to!" My mother-in-law was called to mind the 2-year-old, and being the proud owner of a C-section scar times four encouragingly said, "stitches in your guts are much better than sitting on them, dear!"
Prior to that appointment, my biggest worry was the possibility of being induced. Now I was faced with whether I would be able to deliver this baby at all. I could no longer deliver in the birth centre but was told by the midwife "Don't be bullied into something you don't want to do." WHAT THE HELL DID THAT MEAN? I was in labour! The baby was ready to moon the world and no-one was giving me any clue as to how to get it out. The doctors across the hall in the labour ward were 'observing' me. After 5 hours of labour, I wanted to know what the plan of action was. Again, I was drug-free because I wanted to remain clear-headed to make intelligent and informed decisions. Brilliant idea. Instead I was delirious on panic and lack of information. My equanimity had deserted me.
Had anyone delivered a breech baby (vaginally) lately? Was it safe? I wanted to avoid a C-section but not at the cost of the baby's safety. Somebody? ANYBODY?
Finally the overseeing Obstetrician rocked up wearing a bowtie, which didn't incite much confidence in me, did an internal (yeeha - invite the whole freakin' suburb in please), a fundal height measurement, watched one contraction and proclaimed "this baby is too big to deliver vaginally. I recommend a C-section, you have 5 minutes to decide." Thanks. Thanks a lot. Is that what choice is about, is it? Give me limited information with limited options but leave the decision in my hands? My medically-untrained, in-full-blown-labour-hands? Then shove a form of 'consent' at me and expect me to read, absorb and sign? A nice way to dust the hands of any responsibility because ultimately it was me who made the decision, right?
My second son was 9lb 6oz and born by C-section approximately 30 minutes later. The midwife who stayed with me during the labour subsequently told me I was fully dilated on the operating table.
My recovery was slow and painful and with a toddler at home I was incredibly sore and limited in what I could do. In hindsight, I don't think delivering a big baby vaginally (for me) would have been a great option, but it was the poor management of the situation that had me resentful.
Pregnancy #3
So when it came to baby number three I went with my trusted Obstetric GP, exclusively. I was referred to an obstetrician to get 'authorisation' to attempt a VBAC (Vaginal Birth After Caesarean), and was given the obligatory fear campaign and associated risks. I believed that my body had laboured twice and was confident I had solid argument for a VBAC. I'd only pushed one baby out, but I was pretty sure my nether regions would remember and kick into action when the time came. That's if the baby chose to present head-first. I was not pig-headed about it and knew that if the baby's safety was truly in jeopardy then I'd invite a C-section.
My third was very cooperative. The labour was 3.5 hours and possibly the most painful one of the three (why was I not told about the 'ring of fire'?). But I did it. I managed a VBAC. Baby and mother were healthy and only the midwives on duty at the hospital and my husband were in attendance.
This is not a C-section versus Vaginal Birth debate. This is an question of informed choice. Informed consent. A question about who should be making the decisions. I understand that the situation with my C-section was effectively a last minute decision based on the circumstances that arose. It was, by definition, emergency rather than planned. And in those cases, it is not always possible to read up on the literature and make a clear decision. Being in hyena-pitched throes of labour didn't aid my decision.
But can someone please explain (Pauline Hanson perhaps?) how funding a one-on-one midwife program is more expensive than the seemingly increased rates of C-section? The amount of specialists it took to deliver my second son, plus the longer stay in hospital, compared to my third son who was delivered with one staff member (and a student) attending surely cannot be argument to ditch a program with clear benefits and positive outcomes. I cannot prove the correlation but I feel strongly that having 'too many fingers in the pot' during the second pregnancy meant that the breech was not picked up early enough. I will never know how it could have turned out if the baby's position was detected prior to labour but at least I would have been better prepared and better versed on my options rather than feeling like I had no choice but to have a C-section.
Whether you choose full private obstetrician care, midwife, shared care or a home birth, I believe the information should be available to you that presents a balanced view. One that does not panic you but lets you choose the option that is right for you. That being said, I also think the medical professional you are relying on should help you with your decision seeing as they are the ones who are trained in the field and can weigh up the risks and benefits. Being gung-ho when there are clear risks involved is irresponsible but being fed a campaign of fear and overstatement of negative outcomes doesn't benefit anyone but the insurers.
On the flip-side, "woman-lead birth options" is a great phrase but are we really experts in childbirth? Do we really know what's best for our body and our baby, particularly when things don't go to plan? Working in unison with the medical team is ideal but not always afforded to women.
What information should be standard for pregnant women? When does it become information overload? At what point (if any) should the decision be taken out of our hands and left up to the Medical Fraternity?
