Friday, July 29, 2011

15 Weeks - Prenatal Visit and Plans

Midwife Ina May Gaskin at a prenatal visit.
I keep meaning to blog about my first prenatal visit, and it turns out I have more than that to talk about. Things are coming together, and I'm very excited.

I'll start about prenatal care.

I intentionally waited to schedule my first prenatal visit. Because of my two miscarriages I didn't want to try to find a heart rate at any point when being able to find one would be questionable. For instance, at 10 weeks with a doppler it's possible to get fetal heart tones, but it doesn't always happen. I didn't want to set my hopes up for something that might not work out even if things were still fine. If I hadn't been able to hear a heart beat at that point, it would have only caused more questions and doubts about the viability of my pregnancy, and I couldn't deal with any doubt. I was focusing on the positive and moving forward without fear. There were other factors in choosing to put off my first prenatal visit, but it was mostly that I felt things were OK and I didn't feel a need to have an official visit. I was already consulting with my midwife over the phone, and she had already helped me with some of my needs by offering advice, information, and alternatives I might not have considered myself. That shifted in my 14th week. Out of the blue I felt it was time to call my midwife and schedule a prenatal visit, so I did.

I took all my kids with me to Sherri's house, thinking they'd be happy to play there and that they could all gather around to hear the heart beat when it was time. Not so much. My toddler had just woken from a short nap and was grumpy. The other kids were fine, but the toddler refused to calm down. We didn't know where his pacifier was - I thought we'd left it at home - and he was MAD. Sherri and I were trying to start the prenatal visit and he just screamed at me. About halfway through the visit he found a Spiderman mask, and from that moment on he was Spiderman and he was happy. Phew! I had to laugh when Sherri's 5 year-old (her youngest) who owned the mask kept asking for it back and telling me how "crazy" my toddler was. Yes, welcome to my life.

On to the more important things. My weight was good, and exactly where I knew it was. I had bought a scale when I was thinking I'd have an unassisted pregnancy, so I'd been watching my weight. My blood pressure was nice and low (108/69 - normal for me), and the urinalysis was perfect! When I was pregnant with my youngest I had problems spilling ketones in my urine, meaning I wasn't getting enough nutrition, probably because I was still trying to breastfeed my fourth child at the time and it was such a struggle to meet my body's demands. My midwife counseled me endlessly during that pregnancy about eating more and eating healthier. I was so glad to have avoided that whole conversation this time!

She was able to find the baby's heart rate immediately, and it was 158 beats per minute.

Ina May Gaskin checking FHT with a fetoscope.
I don't remember everything we talked about. She asked if I was taking my nutritional supplements (yes) and how I was feeling. When I told her that I was still fatigued she asked about my sleep schedule and suggested more naps and going to bed earlier. 

Sherri was about to wrap things up and I said "Oh yeah, one more thing!" I told her about how I'd originally wanted to plan an unassisted birth for this baby, and how my husband hadn't felt comfortable about that and we'd decided to hire her again. I explained my reasons for wanting a UC and she listened and promised me that she would be as hands off as I want her to be. At the end of the visit she reminded me of her fees and asked me to talk with my husband and figure out how we would be able to pay her. I told her we would and thanked her, and we scheduled the next visit in 4 weeks. Then I gathered my kids and cleaned up the mess they'd made, and we went home.

I was happy about how the visit had gone, with the exception of the angry toddler. I was grateful for my midwife's support and felt very reassured that all was well with both me and the baby.

And here's where there's more.

About a week after the prenatal visit Sherri called me. She said she'd been thinking about what I told her about wanting an unassisted birth, and about our financial situation. She's a dear friend to us, and she knows our circumstances and has always been willing to work with us. She told me she thought that part of my motivation for wanting a UC was because of finances. She was right, but I had been afraid to admit that to myself until she pointed it out. She agreed that I have a lot of knowledge and understanding about pregnancy and birth and understood that I felt comfortable moving forward without outside support. She also pointed out that at my home birth there was a lot happening behind the scenes that I wasn't aware of. I had thought about that before and realized it was wonderful to just focus and be in labor la la land without worrying about setting up, cleaning up, and all the nitty gritty.

Sherri then offered an alternative plan.

She had talked with one of her midwife assistants and had made arrangements for this assistant to work with her in giving me 5 prenatal visits through my pregnancy, attend the birth, and provide one postpartum visit. They would also provide phone consultation throughout the pregnancy. She offered me this for a significantly lower cost than what my midwife normally charges.

The visits would be at the assistant midwife's home, which is closer to my home and a shorter drive than to Sherri's house. They would expect me to be responsible for my own prenatal care between visits, including tracking my own blood pressure and doing my own urinalysis. I was already comfortable with that, because I'd been considering doing it all myself to begin with. She suggested I get an automatic blood pressure cuff that would take the reading for me, since she wasn't sure if taking my own blood pressure would be accurate. She also told me where I could order the urinalysis strips from, and suggested I could also get my own doppler to use for fetal heart tones. She also asked that I commit to come to her monthly forum throughout the pregnancy, which was something I really enjoyed last time and was already planning on doing.

I'm very happy about this plan. I feel it shows trust in me to tune in to my body's needs and stay healthy and take care of myself, with minimal visits to the midwives themselves. I feel it's a really good compromise between an unassisted pregnancy and one with the full 13 prenatal visits that are typical. I feel very comfortable doing most of my prenatal care myself, and I love the idea of having my midwife and one of her assistants available as consultants. I feel this is a good way of utilizing them as valuable resources but not depending on them for everything. I'm really glad I spoke up and told my midwife about my desire to be unassisted, and that she really listened and seriously considered my wishes and my needs. It also takes some financial strain off by offering us a more affordable alternative.

No comments:

Post a Comment