My birth mindset

If it hasn't come through already in my posts to date, I'm really passionate about birth. I think it's just the coolest experience ever! That said, I'm not planning on becoming the next Michelle Duggar, so my personal birth experiences will be limited. But I love talking birth with other women who are passionate about it -- or, even better, with women who are interested but maybe not so passionate, and helping them understand that birth doesn't have to be what they see on "A Baby Story" or "16 and Pregnant."

Obviously, I started this blog to talk about homebirth specifically, which I particularly love discussing because it's so different from the "Baby Story" view of birth and because so few people have any direct experience with it. But I also have a lot of thoughts on birth in general. Since you've wandered onto this blog, I assume you have some sort of interest in birth :) So forgive me if I jump up on my soapbox every now and then, and talk about stuff that isn't specific to homebirth -- or even related to homebirth at all.

Starting... now :)

One of the places I love to hang out is The Bump's Natural Birth board, because it's full of women who are passionate about birth! A few weeks ago, a woman asked about the "mindset" going in to a planned natural birth. How do you truly commit to avoiding an epidural -- because from what I've seen, most women who go in saying "I'll try to avoid an epidural but I'll see what happens" end up getting one -- without feeling like a failure if you end up really needing one?

A lot of people liked my response, so here it is, slightly modified to make some pieces more clear.

About a year before I got pregnant with Littles, I did an Ironman triathlon. It's probably the experience in my life most analogous to labor, in a variety of ways. The morning of the race, my dad told me something along these lines: "You've done the hard part. All the training and preparation. Today is the easy part. All you have to do today is get out of the way, and let your body do what you've trained it to do."

That was precisely my mindset going into labor. I lined everything up... I did the classes, I did the exercises, I talked over my preferences with my doctor, I hired a doula. I did all that because I needed to know going in that I had done everything possible to achieve the birth I wanted. I didn't want to look back and think, "If only I had sprung for a doula..." That preparation meant that on the day of the birth, all that was left to do was get out of the way and let my body do what I had trained it to do.

As for changing my mind, well, I didn't line up at the Ironman start line thinking, "I'll try to finish, but we'll see." After nine long, hard months of training, there was no doubt in my mind that I was going to finish. But -- this is hard to explain -- ultimately, finishing wasn't the important thing. It was the journey to get there. On the bike, I watched a guy 10 feet in front of me fail to make a left turn and go crashing over a ledge. He probably didn't finish, but he also didn't "fail." Just getting to that start line took more guts, more hard work, than most people are willing to give. He might not have gotten a finisher's medal around his neck at the end, but he still got the really important things. The improved fitness level. The discipline it takes to train for an event like that. The knowledge that his body was capable of doing way more than he ever thought possible. Those things come from the journey, not from the race at the end.

Again, this was my mindset going into labor. There was no doubt in my mind that I would do it. But if the unexpected happened, I'd know that ultimately, avoiding an epidural wasn't the important thing. It was the journey -- preparing, learning about birth, learning about my options, and setting myself up to make the safest, most informed decisions for myself and my baby. In some labors, the safest, most informed decision is an epidural, or a c-section, and that's not a "failure." In fact, it's anything but.

So. That's my mindset.

Kids at appointments

With Littles
At the time, I didn't have any other kids, so this topic never came up!

With Noob
It was very important to me that Littles be included in Noob's birth, if she wanted, in a way that was completely comfortable and very meaningful. In my eyes, birth is a transformation for our entire family, and it would feel odd if a member of our family weren't there for that transformation.

But throughout the pregnancy, I opted not to include Littles in my midwife appointments, ultrasounds, etc. I wasn't sure that she would be welcome, or that the environment would be welcoming to her.

Finally, at my 34-week appointment, I figured it was now or never. My husband was able to come to that appointment, so I didn't have to worry about amusing Littles myself. I figured she could meet J, one of the two midwives who could possibly deliver Noob, so that she wouldn't be a stranger to Littles on the day of the birth. Afterwards, we could wander over to the hospital, which was right across the street from the midwives' office.

Littles is normally outgoing, talkative, a lot of fun. But I don't think she said a single word the entire time we were in the midwives' office. It got even worse when we went over to the hospital. We were just in the waiting area, not even in one of the rooms with bright lights and funny machines -- but Littles turned to me and said, "I don't like it here. I want to go."

I thought, "Well, J is a stranger to her. Maybe that's why she was so quiet at the appointment. And maybe she was just tired and cranky by the time we got to the hospital."

We went straight home, as we had a meeting with another key component of our birth team: M, our fabulous doula.

Now, at the time, M was also a stranger to Littles; she had met her only once, about four months earlier, during our doula interview. But the difference in M's behavior was like night and day. The outgoing, talkative, fun little girl who had been missing all morning? She came out right away.

I had been thinking a little about homebirth prior to that day, but seeing the change in Littles' behavior made me think about it even more. I wanted her to be comfortable at the birth, and it was clear to me that her comfort level was tied to location, much more than to people. And, I mean, it made perfect sense. Of course a 2.5-year-old would be far more comfortable in her own home than in a strange hospital.

Furthermore, during our meeting with M, we discussed a lot of specifics about our birth preferences. A few things came up that would be more of a struggle in the hospital vs. at home. For example, M said that our hospital really liked all laboring women to at least have a hep lock. That's reasonable, but I was hoping to avoid one -- I had one during my labor with Littles, and the site hurt and itched for a few days afterwards. An absolute dealbreaker? Of course not, on its own. But all of those non-dealbreakers taken together, along with Littles' behavior at the midwives' office and the hospital, started making me think seriously about making the switch to homebirth.

That was the last appointment I had with my hospital-based midwives. By the time of my next appointment, at 36 weeks, I had officially made the switch.

I had four appointments with C prior to Noob's birth, and Littles came along to three of them. (I opted not to bring her to the very first appointment, as I knew we'd be doing a lot of talking and paperwork, which would be pretty boring for her.) Even though C was a new face and her office was a new place, Littles seemed instantly at ease with the entire situation. I knew I'd made the right choice.

She ended up being present for my entire labor, in a way that was very comfortable and meaningful. But I'll save that story for another post.

With Q

Littles at C's exam table

Since we didn't tell the kids about my pregnancy until after we heard the heartbeat at our first appointment with C, we couldn't exactly bring them along to any of the early appointments :)

But I did bring Littles along to my most recent appointment, at 14 weeks. Once again, she seemed instantly at ease.

It's even more fun having her along now that she's older and understands more of what's going on. For example, she was curious about the different colored squares on my "pee stick" (testing my urine for sugars, protein, etc.), so C patiently explained to her what they all meant. She loved hearing the heartbeat and was fascinated by a small model of a 12-week-old fetus that C showed her.

I think that the visit really helped "make it real" for her, too. Prior to that appointment, she knew I was pregnant, but didn't talk about it a whole lot. Now, she's constantly coming up to me and kissing my belly and saying hello to Q, she's picking out outfits for Q to wear, she's telling me how big my belly is :), etc. I can't wait for her to come to more appointments and learn even more.

I plan to do the same with Noob, but he is such a little tornado that I'm dreading it a little -- I worry that he's going to be into everything! But C sounded downright disappointed that he wasn't there last time, so I'll probably suck it up and bring him next time and hope he's not too much of a pain! At least I know he's welcome, and I know the environment is welcoming to him, and that is the important thing.

NT Scan

With Littles -- November 2006
Early in my pregnancy with Littles, my OB told me about what was then a relatively new test, known as the nuchal translucency (NT) scan. The non-invasive scan could detect Down syndrome (trisomy 21), as well as two lesser-known and more serious chromosomal disorders, trisomy 13 and trisomy 18. It was covered by insurance and it included an ultrasound :) So we decided to do it.

The NT scan requires high-powered ultrasound equipment that most OB offices don't have in-house. So on the appointed day, we went to the hospital where Littles would eventually be born. We first met with a genetic counselor, who went over a family history and explained the test in detail to us. Later that day, we had the ultrasound, and I also gave some blood for further testing. We got the results back within a week or so, which indicated that Littles was at low risk.

At the time, the NT scan was considered optional for women like me, who had no risk factors for chromosomal disorders. (Risk factors include advanced maternal age or a family history of chromosomal disorders.) A few months later, ACOG started recommending NT scans for all pregnant women, regardless of risk level. That recommendation still stands today.

In the years since, I've talked to lots of other women about the NT scan, and have been surprised to hear that many of them skipped it, mostly based on misinformation. Some of the typical reasons I hear for not getting the NT scan:

• "It gives a lot of false positives, and I don't want to worry for nothing." One of the things the genetic counselor explained to us was that you cannot get a "false positive" on an NT scan, because it is not designed to conclusively state whether or not the baby has a chromosomal disorder. It simply states whether the baby is at "high risk" for one. To give an example, one of my friends' babies was deemed high risk and given 1 in 200 odds of having Downs. He was later born perfectly healthy. But this was not a "false positive." 1 in 200 odds meant that he had a 99.5% chance of being born healthy, and indeed, he was!
  
  Even the high risk designation is relatively uncommon. It's given to about 5% of babies. Hardly "a lot."
  
• "I'd never abort a baby with Downs, so why bother testing? It wouldn't change anything for me." I wouldn't abort a baby with Downs, either, but I'd sure want to be prepared! This has become increasingly important for me in my subsequent pregnancies, because not only would I want some extra time to prepare myself for a child with special needs, but I'd also want some extra time to prepare the older kids.
  
  Also, the NT scan doesn't just test for Downs. It also tests for trisomies 13 and 18, which are often fatal in utero or result in a short (<1 year) and very painful life. I might consider aborting for those, and if I didn't abort, I would definitely want some time to prepare emotionally for carrying a baby who might not stick around very long, if at all.

I've also heard many more stories that have convinced me of the importance of getting an NT scan:

• The anatomy scan (an ultrasound usually performed at around 18-20 weeks) looks for signs of the same disorders that the NT scan identifies. These are called "soft markers" because they are usually present in babies with chromosomal disorders, but many healthy babies have them as well. If I have a clean NT scan and then have soft markers identified at the anatomy scan, I can take comfort in the knowledge that the NT scan rarely comes back as low risk for a baby who truly does have a chromosomal disorder, so the soft markers are almost certainly "soft" in my case. If I don't have an NT scan and then have soft markers identified at the anatomy scan, I have no such reassurance.
• Since the NT scan includes an ultrasound on high-tech equipment, it affords the opportunity to identify other problems with the baby (besides chromosomal disorders) very early on. One woman's baby was diagnosed with spina bifida at her NT scan. They were able to operate on the baby in utero at 17 weeks. The problem likely would have been picked up at her anatomy scan, too, but that would have been later in the pregnancy and the operation might not have been as successful.
• Tragically, another woman skipped the NT scan and then was diagnosed with amniotic band syndrome at her anatomy scan. By that time, the condition was so far advanced that it was fatal. Had she had an NT scan, the condition could have been diagnosed early enough to take steps to address it, quite possibly saving the baby.

With Noob -- July 2009
Because I knew all of this, I was a little surprised when my midwives didn't talk about the NT scan early on in my pregnancy with Noob. So I asked about it at a regular appointment at 10 weeks. F seemed a little taken aback, but had no problem giving me a referral to a nearby perinatologist to get the screening done.

He did a great job with the ultrasound, taking his time to not only get a good nuchal fold measurement (the entire goal of the ultrasound -- the thicker the nuchal fold, the higher the risk of chromosomal disorders) but also to take a peek at the rest of Noob's body and give me some good pictures to show my husband, who couldn't make it to the ultrasound.

And once again, when the bloodwork results were final, I got the reassurance of being deemed low risk.

With Q -- December 2011
Since I was planning homebirth, I was particularly keen on getting the NT scan done. If there are any medical concerns that might affect our homebirth plans, I'd want to know that as soon as possible.

I assumed, correctly, that most of C's patients weren't interested in getting an NT scan. As a result, she had no existing relationship with a perinatologist or other facility capable of performing it. So I went back to Dr. C for a referral. Of course, she doesn't do these types of referrals often, either, so this ended up requiring quite a bit of back-and-forth, further delayed by the fact that this was right around the holidays and so there were some office closures in there as well. Since the NT scan must be done by 14 weeks, it came right down to the last minute, but I finally managed to get the referral and get in for an appointment on the next-to-last possible day.

I was thoroughly unimpressed by the perinatologist who did the scan. It was the shortest of the three NT scans that I've had. The perinatologist quickly measured the nuchal fold and told me that the measurement looked good. Then he said, "Do you want to know the sex of the baby?" as I could see him moving down Q's body towards his/her bottom. "No! I don't!" I told him quickly. We don't plan to find out the sex. "Well, then look away," he said. I closed my eyes and he poked around for a minute or so and then told me that the scan was complete.

When I relayed this story to C at my next appointment, she explained that many perinatologists are trying to get good at early guesses as to the baby's sex. When I was pregnant with Littles, most ultrasound techs were reluctant to take a guess as to the sex at 16 weeks, nevermind in the first trimester. Now, a lot of women do walk out of their NT scans with a guess. Which is insane to me, because at 12 or 13 weeks, male and female genitalia look almost identical. But anyway, C thought that the perinatologist was using Q to practice his skills at distinguishing between the two sexes that early on.

It all happened really fast, but after the fact, I was rather peeved. I feel that the perinatologist should have explained why he wanted to look -- whether it was for medical reasons or for his own "practice" -- and granted me the opportunity to give or refuse consent. Normally, looking at a child's genitals for no good reason without the parent's consent is not just rude but is grounds for persecution. Why should it be any different on an ultrasound?

Dating the pregnancy

"Dating" a pregnancy is the process of calculating the estimated date of delivery (EDD). Typically, the EDD is set at 40 weeks after the mother's last menstrual period (LMP). This assumes that all women have a standard 28-day cycle with ovulation on day 14.

In many cases, this assumption isn't valid, and then, the EDD should be determined by other means. Doctors like to use early ultrasounds to date pregnancies, since embryos grow at a very well-defined rate during the first few weeks of pregnancy.

In addition, women can "chart" their cycles and identify their personal ovulation date with a great degree of accuracy. I'm not going to get into a whole explanation of charting here, but if you're interested in learning more, I highly recommend the Fertility Friend site or the book Taking Charge of Your Fertility.

With Littles -- October 2007
My own cycles have always been on the long side, suggesting that I likely ovulate later than day 14. I explained this to the nurse at my first appointment after getting pregnant with Littles. I was not charting, but based on this and some other signs, I suspected that my actual EDD was about six days later than my EDD per LMP.

The nurse got me set up with an ultrasound, at what was 8 weeks 4 days per LMP, but 7 weeks 5 days per my suspicion. Littles measured 8 weeks 0 days -- so, closer to what I suspected based on my cycle history.

But Dr. K said that since Littles measured within a week of my EDD per LMP, she would not adjust my EDD. At the time, I thought this was great! Six fewer days of the miserable first trimester to put up with!

I came to regret it at the end of my pregnancy. My OBs would not let me go past 42 weeks gestation, because the risks to the baby increase past that point. Since my EDD had been set based on my LMP, this meant 42 weeks from my LMP.

I ended up having to be induced. Of course, if my suspected EDD was actually correct, I was really closer to 41 weeks at my induction date. We could have allowed Littles to keep baking for another six days before she got into the increased-risk territory.

As I've explained previously, I ended up having a very positive induction experience anyway. But I still felt a little deprived of the experience of spontaneous labor. I still believe that Littles would have come on her own had she had those extra days that she rightfully deserved.

With Noob -- June 2009
I started charting after my pregnancy with Littles, so when I got pregnant with Noob, I knew that I had ovulated nearly two full weeks later than "expected." This was another reason why I insisted on an early ultrasound (in addition to wanting some peace of mind after my previous miscarriage).

The ultrasound was at 8 weeks 2 days per LMP, but only 6 weeks 5 days per my chart. It came as no surprise to me that Noob measured 6 weeks 3 days. I didn't quibble over those two days, since I knew it gave him two more days to bake at the end!

As it turns out, he arrived two days "early" -- that is, precisely on his EDD per my chart. Of course, had we not accurately dated the pregnancy, he would have been considered 11 days "late." Many doctors would have induced him by that point... wrongly, because he was not at all overdue.

With Baby Q -- December 2011
I charted again, and so I know that I ovulated late again. But my midwife, C, does not routinely induce for being overdue. If I reach 42 weeks, as long as everything is fine with Q and me, we'll keep waiting. This is another reason why I didn't insist on an early ultrasound with this pregnancy: I'm less worried about accurately dating it, because I know there's no induction looming at the end.

(By the way, you might be curious as to why my OBs with Littles felt that it was too risky to continue past 42 weeks, but C is fine with it. I'll address that in another post, at some point.)

Also, unlike many doctors, C trusts my chart. When we went through the initial paperwork yesterday, she asked me not only what my LMP was (as all my previous providers have done), but also if I knew my ovulation date and my actual EDD -- both of which I do know, thanks to my chart. That's what we're using for dating purposes. Neither of my previous providers ever asked me about these two key pieces of data.

Houston, we have a heartbeat

I don't think any parent ever forgets the moment when they first hear their baby's heartbeat. It's truly magical.

With Littles -- October 2007
Our initial appointment was with a nurse, to do paperwork, go over do's/don'ts, etc. I wasn't entirely sure of my conception date, so the nurse got me set up with an early ultrasound at 8 weeks to date the pregnancy.

That was when we first met "Dr. K." And that's when we first saw and heard the heartbeat, beating away steadily in a small object that closely resembled a gummy bear. She took her time, explaining how she did the measurements, pointing out when Littles "moved" (it looked like a quick shudder), listening to the heartbeat and mapping it on the screen. My husband and I were just awestruck by the entire experience.

I happened to be wearing my Ironman finisher's shirt that day, and Dr. K noticed it and commented on it. We chatted a bit about it, and she thought it was very cool that I had done that.

I might get into my Ironman experience more in a future post, but for now, suffice it to say that it's the only experience in my life that even comes close to mimicking labor and childbirth.  To know that I've gone through that, and to comprehend what it means, is to understand a whole lot about me: When I put my mind to doing something, I do it. I'm not afraid of a little hard work -- or a lot of it. And my body is capable of some pretty amazing things.

All qualities that have served me very well at both my births.

Anyway, I really think that Dr. K "got" that, right from the start. I always felt really comfortable with her. Not so much with her partner, "Dr. S," who came highly recommended but whom I increasingly butted heads with over the course of my pregnancy.

We couldn't know it at the time, but nearly eight months later, Dr. K would be the one to catch Littles. I credit her for playing a huge part in making Littles' birth such a positive experience. And I really think it all started in that little room with that little beating heart.

With Noob -- June 2009
After a previous miscarriage, my midwife was happy to get me set up with an early ultrasound. We went in at 6 weeks.

I loved my midwives, but unfortunately, they could not do ultrasounds themselves (only the OBs in the practice could do so). And as it turns out, their ultrasound tech's bedside manner left something to be desired. At this ultrasound, she inserted the probe and a little blob appeared on the screen. Silently, she messed around with the image a bit.

Where's the heartbeat? My stomach sank.

Then she made a few comments and mumbled something about a heartbeat. Wait, what? "So there's a heartbeat?"

"Yes. 120 bpm." Which is great for 6 weeks.

It was a very different experience from our first ultrasound with Dr. K. But regardless -- Noob had a heartbeat. That was enough to put a big smile on my face.

We had to wait over five more weeks to actually hear the heartbeat for the first time, at a regular appointment with one of the midwives.

With Baby Q -- today! December 6, 2011
This was my first pregnancy where I didn't have an early ultrasound. I probably could have asked Dr. C to refer me at any one of my appointments with her, but I didn't feel like hassling with the referral process. Plus, it goes against my overall philosophy of minimizing interventions as much as possible. There have been concerns raised about the effects of ultrasounds on developing fetuses, and while I don't find any of the arguments to be particularly convincing, it does seem prudent to minimize ultrasound use to only what's medically necessary. And really, I had no medical reason to need an early ultrasound this time around.

Anyway. Waiting also meant that we'd get to hear the heartbeat for the first time with our friendly homebirth midwife "C," rather than some random ultrasound tech.

Unlike my previous providers, C gave me the option to come in for my first appointment whenever I wanted. I opted to wait until 10 weeks, because I figured there wasn't much point in coming any earlier. C has no ultrasound equipment, and the heartbeat isn't usually audible on the doppler until around 10 weeks. Paperwork can be filled out anytime. I knew I could contact C via phone or email if I had any questions in the meantime.

Finally, 10 weeks rolled around, and I headed over to C's office. When it was time to listen for the heartbeat, C showed us a model of a 12-week old fetus and warned us that it can take some time to find the heartbeat of such a little being. Indeed, she had to poke around some, but finally she moved the wand a bit to my right side and there it was. Clip-clop. Clip-clop. Clip-clop. The unmistakable sound of a tiny heart beating away.

We all got big smiles on our faces. That sound was well worth the wait.

The role of my primary care physician (PCP)

With Littles -- 2006-2007
When I said that I chose the OB closest to my house... well, that wasn't entirely accurate. I actually chose the OBs who worked out of the same medical foundation as my primary care physician. (I had chosen my PCP years before because she was the doctor closest to my house :) It was a large office with doctors covering many different specialties. Littles' first pediatricians were out of the same group, as a matter of fact.

Due to the proximity, the OBs had a unique setup where patients who had a PCP in the same group alternated appointments between the OBs and the PCP, at least until the third trimester. So, I think I had three regular prenatal appointments with my PCP, at 12 weeks, 20 weeks, and 28 weeks, with OB appointments in between. I also saw her for an unscheduled appointment after a bad fall, when I wanted some reassurance that the baby was OK.

At the time, I appreciated that it was much easier to get appointments with my PCP, as compared with my OBs, and that PCP visits usually involved a lot less waiting time prior to seeing the doctor. I'm sure it was nice for the OBs too, as it allowed them to offload appointments that, frankly, do not demand the skills of a trained surgeon.

Looking back, I think it was also nice to have my PCP involved in that major transformation in my life. As it turns out, it didn't really matter, because we ended up moving twice in Littles' first year, so I never saw my PCP after that 28-week appointment. But had we stayed in the area, my PCP, not my OB, would have been responsible for my long-term health. (In that medical group, PCPs were responsible for all regular well-woman care. Aside from childbirth, I would have only seen my OB again if I had some sort of gynecological complication.) It just made sense for her to be involved in an event that changed me in so many ways, including ways that have had a direct impact on my long-term health.

With baby #2 and Noob -- 2009
After our move, one of our first priorities was finding a pediatrician for Littles. We got a recommendation for one, "Dr. C," who actually turned out to be a family practice doctor. By this time, my husband and I had both been without a PCP for over a year, so we figured we'd start seeing Dr. C as well.

By the time I got pregnant with baby #2, I had had a physical with Dr. C, and had met her a few other times at Littles' well-child checkups. Yet it never occurred to me to contact her during my miscarriage, even after I found out I couldn't talk to my midwives about it. I guess I just figured that pregnancy stuff was the exclusive realm of OBs and midwives. Same thing after I got pregnant with Noob.

She was aware of the miscarriage (the subject came up during one of my regular visits) and, of course, of my pregnancy with Noob (through Littles' well-child visits and because we eventually talked to her about adding Noob as a patient). But that was the extent of her involvement.

With Baby Q -- October-November 2011
As I mentioned previously, as soon as I found out I was pregnant, I knew I needed to get my progesterone tested, as I had done with Noob. My homebirth midwife was unable to do this testing, and I didn't particularly want to see a random OB just to get it done, so I tried Dr. C first.

At first, I considered this to be a disadvantage of choosing homebirth. I had to convince Dr. C's staffers (who surely don't deal with newly pregnant women that often and didn't seem to comprehend the importance and urgency of my request) to find a spot for me that week, in her always-jam-packed schedule. It sure was a lot easier with Noob, where all I had to do was call my midwife's office and I had an appointment for testing a few hours later.

But since I got that spot, the care I've received has been nothing short of exceptional.

For example, when we discovered that my progesterone levels were dangerously low, Dr. C immediately prescribed Prometrium (progesterone supplements), just as my previous midwives did during my pregnancy with Noob. Unfortunately, I soon discovered that Prometrium contains peanut oil. Noob is allergic to peanuts, so I've been peanut-free since his diagnosis earlier this year, because he is still nursing. Some doctors might have told me, "The kid is almost two years old. He doesn't need to breastfeed anymore. Deal with the peanut oil, or wean him." But Dr. C responded by giving me a prescription to a compounding pharmacy, who could make the medication without peanut oil. She is very supportive of extended nursing, and has a vested interest in seeing Noob stay healthy and happy -- because he's her patient, too!

It's funny. I started off thinking that having to involve Dr. C was a disadvantage of homebirth. Now, my thinking has flipped completely, and I consider it a wonderful advantage. She'll be Baby Q's doctor after the birth, and hopefully for many years to come -- so I love that she's been involved in his/her life practically from the start! And as with my PCP during my pregnancy with Littles, Dr. C is ultimately responsible for my own long-term health (she does my yearly physicals and well-woman care), so I'm glad she's been involved in this major event in my life.

When we found Dr. C, we weren't specifically looking for a family practice doctor, but now that I've experienced this model of care, I can't imagine ever going back to having separate doctors for us and the kids. I hope we'll all be with Dr. C for a long time, but if we ever do need to find a new practice, I'll definitely look for a family practice doctor again.

The nervous early weeks

With Littles -- October 2006
The early weeks weren't all that nervous. I was aware of how common miscarriage was, but just hoped for the best, and had no issues.

With baby #2 -- February 2009
My first appointment with the hospital-based midwives I had selected was scheduled for 8 weeks. But late one Friday night, when I was about five weeks along, a few hours after my husband and Littles left on a weekend trip, I started cramping and bleeding. I immediately called the midwives' office and was told that I could not speak with a midwife or with any of the OBs in the practice, because I was not "officially" a patient yet.

It was probably the worst experience I've ever had with the medical profession. I understood the liability concerns driving it, and I didn't blame the midwives themselves. But still, I was losing my baby, I was terrified, and I was completely alone.

With Noob -- May/June 2009
I did end up seeing one of the midwives the Monday after the miscarriage started, so after that, I was officially a patient.

I started having concerns about my progesterone levels -- along with the early miscarriage, I was charting my cycles and saw symptoms of low progesterone in my charts. So I talked to my midwife about it and she agreed to do some testing.

I was really happy that she took my concerns seriously. Many doctors won't agree to testing until a woman has had three miscarriages. I think that's ridiculous. After suffering through the heartbreak of one miscarriage, my goal was to not have two more.

As it happens, the cycle when we started testing was the cycle that I got pregnant with Noob. After receiving a positive pregnancy test at home, I requested beta HCG counts and another round of progesterone testing. My midwife complied, and prescribed progesterone supplements for me when my progesterone levels did indeed come back low. My HCG counts looked great, which was a huge reassurance.

Then I requested an early ultrasound (technically to date the pregnancy, but my midwife and I both knew it was more for reassurance) and an early first appointment. Again, my midwife happily complied.

That support helped make those early weeks a little less nervous.

With Baby Q -- October/November 2011
As soon as I found out I was pregnant, I started working on getting my progesterone levels tested again. Unfortunately, my homebirth midwife is unable to write lab orders for that testing or prescribe supplements to address low progesterone. So I had to go elsewhere.

At first, I was worried that I'd have to go back to my old midwives, or find a random OB to do the testing. I wasn't really looking forward to that, because I didn't want to get into the history of my previous births (specifically Noob's place of birth) or my plans for this one with someone who might not be supportive of homebirth.

Luckily, my primary care doctor was happy to order up the tests, and to prescribe supplements when my progesterone turned out to be low again. She is truly amazing -- she's family practice, so she sees our entire family, including the kids, and she has the most wonderful personality. She always makes me feel like I'm in good hands, and this was no exception. It is still very early and I'm still very nervous about everything, but as with Noob's pregnancy, having great support helps tremendously.