Swimming Upstream

Archived User

Swimming Upstream

I'm 40, 12.5 weeks along now, and my only child just turned 4.  She was delivered by Cesarean after our homebirth didn't go the way we'd planned.  Now as a hopeful HBAC in Alaska, I'm finding very few options for a normal pregnancy and birth... especially since I believe I am carrying two babies. 

I don't feel that early or routine ultrasound is safe, and will continue to deny this intervention until 20 weeks.

I was upfront with my prospective traditional midwives and they directed me to the local VBAC friendly OB.  He's nice and supportive and believes in birth, but he's still a surgeon who delivers babies in a hospital setting.  My whole heart and soul believes that babies should be born at home.

Most of the experienced midwives that I have talked to are encouraging me to plan a hospital birth.  So considering that my intuition is correct, and there are two babies, and we plan a hospital birth... how do I retain the dignity of a normal pregnancy and birth?

I don't want ultrasounds every two or three weeks... I don't even really want a doppler.  I don't want to spend my entire labor in a hospital and I don't want someone else to catch my babies.  But what I do want is a normal, hands off pregnancy where I am allowed to connect with my babies... a waterbirth with darkness and privacy and only the people around me that I choose.  And of course, I want us all to be safe and well.

How do I balance all of this?  If I go in for an ultrasound at 36 weeks, and everything looks great for a homebirth, and I can miraculously find an experienced midwife who will assist me at home (or at my friends home, 8 minutes from the hospital where this OB that ultimately I do trust works) and we get into labor and everything progresses normally... is it foolish to stay home and let things unfold naturally? 

Or, do you think that a twin VBAC should be continuously monitored in a hospital setting for everyone's safety?

Thanks so much for reading.  It's great to get this on paper.  I know that there are unknowns here because I'm denying early ultrasound for diagnosis, but perhaps you can speak more to the broader questions instead of my particular situation.


Henci Goer

RE: Swimming Upstream
(in response to Archived User)

So, as I understand your concern, you want the best outcome with the least possible medical intervention given your individual circumstances, a concept the American College of Nurse-Midwives has developed under the title "optimal birth," and you are trying to figure out how to obtain that. Fortunately, you seem to be in the enviable position of working with care providers who essentially have the same philosophy, which puts you way ahead of most women in the U.S. 

The key point is making informed decisions based on complete and objective information about your options, including doing nothing. An acryonym, BRAIN, can help:

B enefits
R isks
A lternatives
I ntuition
N o or not now

Childbirth Connection has a webpage with additional information on decision making. If you are working with practitioners who are prepared to respect your point of view, make decisions collaboratively with you and each other, and compromise, then it doesn't matter that one may be more inclined to see things from a medicalized point of view or, for that matter, the other may be more inclined to dismiss concerns about risks.  

You may also wish to preplan a family-centered cesarean so that if cesarean becomes your optimal choice, you have already thought about and gotten agreement ahead of time. The International Cesarean Awareness Network (ICAN) has helpful information on that topic  here

It seems to me, though, that a great deal hinges on whether you are carrying twins. If it's twins, you then have a set of decisions to make about place of birth and care in labor whereas if it isn't, given your preferences, the path ahead is much clearer--at least for the present; life can always pitch you a curve ball. You may wish to agree to a brief scan to establish this one way or the other. 

~ Henci

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