The Final Post (aka When Things Don't Go As Planned...)

My sweet baby J; 7 lbs 3 oz and perfect in every way!

 
"If I have a fever, or my water breaks too early, I may have to transport to the hospital.  But we'll cross that bridge when we come to it."

That's what I wrote in my last post about being beta strep positive.  And my water broke (9 days before my due date!).  And labor didn't start.  Until I got to the hospital.  Then, it was 45 minutes and my sweet baby J was here!

My water broke about midnight, and I called my midwife right away, not knowing if labor was going to kick in NOW or what.  Her and her assistant headed right over.  When labor didn't start immediately, they settled in for a night on my couch.  11 hours later, with labor still no where in sight, we started talking transport to the hospital because of my GBS+ status.  I felt like crap at this point.  I was throwing up (something that I've never had in labor before, but is common apparently) and felt completely drained.  Then my hubby brought me a Sprite and the barfing stopped.  I was able to regain my energy at this point, made myself a chocolate-cashew-date-banana shake, and started walking and trying to get labor to start.  We decided to give it a few more hours.

Finally, 14 hours after my water broke, we decided it was time to transport.  Why was I transporting? To get Pitocin so my labor would start, and antibiotics in an IV because that's what they would do because of my GBS+ status.  Turns out I got neither.  I felt contractions starting (I had had a few already, but nothing consistent), and, as I stood at the top of the stairs, hospital bag in hand, thought for a brief moment that maybe we should wait 30 more minutes. 

Hindsight is 20/20.  
Oh well.  

(And here's a tip for ya home birthers: have a hospital bag ready, just in case.  This wasn't an emergency situation, and I had the luxury of taking a few minutes to pack a bag.  But if there was an emergency, you'd want something ready for your hubby to grab for you.  I had NO idea what to bring- it's been 8 1/2 years since I last went to the hospital to birth- and my midwife's assistant had to tell me.)

Instead we went to the hospital, where I felt contractions getting stronger and stronger.  By the time I was sitting on the delivery table, I told the nurse this is going to happen fast- I guessed in 45 minutes we'd have a baby.  Turns out is was 43 minutes, my midwife later told me. So they got an IV in me and gave me one dose of antibiotics literally while I was pushing baby J out- so the antibiotics were useless for the whole GBS thing.  

And now I was stuck in the hospital.  'Cause here's the thing I HATE about hospitals: once you're in, you're not coming out 'till they say so.  You are their prisoner.

Okay, maybe that's being dramatic.  But it is kinda true.  A few nice surprises about this hospital stay though, was that right after J was born, they put her on me for skin-to-skin contact, the hospital staff really seemed to believe in that, which is cool, because so do midwives and homebirthers. They also asked if I wanted the baby bathed (I said no, I wanted the vernix- the waxy coating babies have on their skin when they're born- to absorb in her skin, and she'd have her first bath at home), they asked if I was taking the placenta home ("yes"- and no one batted an eyelash), and the food was actually REALLY good. ('Cause really, it's all about the food.) 

After the birth, the nurse brought us up to postpartum and told me that that was a really cool delivery to  see.  My midwife commented to me later that the doctor who delivered me (that's a generous term- she showed up and caught a baby.  I did the work, mind you!), had a resident with her and that resident got a unique experience- catching a baby with the mother on hands and knees position, a natural, unmedicated birth.  Apparently that's something hospital personnel don't get to see a whole lot of (us natural minded folk seem to be heading home more and more for our births- home birth is up 20% from previous years, though it is still a very small percentage of overall births).  So, that was cool to be part of someone else's education I guess.

But still, I am a little sad I didn't just stay home.  But at the same time, it's not the most important thing.  I have an adorable, healthy new baby girl- straight from heaven!- and that's what really matters.

My sweet baby J~ what it's all about

So let's step back and gain some perspective, people. 

 If you were to go into, say, a kindergarten class, you wouldn't be able to tell which kids were born at home, which by C-section, which were organically fed wheat grass for their first year, which were raised on chocolate.  You wouldn't be able to tell which ones were nursed, which were formula-fed, which ones had organic, free-range, farm-raised crib sheets.   
 What you would see is which ones were loved at home, which ones received positive discipline, which ones were spoiled, which ones were rude, which ones were considerate of others. 

The birth experience is important- it's important to me how I bring my children into the world. And it is special, powerful, and spiritual. But sometimes things don't go as planned.  And that's a-okay.  'Cause raising these little monkeys and showing love to them and teaching them how to be good people is WAY more important and frankly, way harder, than the way they are brought into the world. 

And besides, I still got to eat my placenta.

  

P.S. FYI, I still continue my postpartum care with my awesome midwife, by the way.  Once we got to the hospital, she has to legally take the role of doula and can't actively participate in my care.  But once I was home, it's back to being my midwife. She has already been to my house for two visits to check me and baby, will come once more to my house this week, and then I'll have my last appointment with her somewhere between 4 and 6 weeks postpartum. 

And I want to point out that she and her assistant were with me a total of 16 hours- 14 at my house, starting at midnight, then 2 more during transport/delivery/afterwards. That's pretty amazing prenatal care, people.  Find me an OB/GYN that will do that!

My baby started seeing my pediatrician today, and that continues as normal as it would for any baby, regardless of where he or she is born. She got her first PKU testing in the hospital (which would have happened at home anyway), and my midwife does the second PKU screening later this week.  And I know it's called Newborn Metabolic Screening now and not PKU screening, but it's just easier to say.  It actually tests for something like 35 metabolic disorders. Don't skip that test, people. In the end, I decided to go with the Vitamin K shot and antibiotic cream in her eyes.  But the cream only has to be on the eyes for a minute, so I wiped it off just in time for her to start looking around at us.  And no one at the hospital seemed to care that I was passing on the Hep vaccine that they like to give babies at birth.  I just explained she'd get it later at my pediatrician's office (which she will...in a few months).

And in other randomness, the placenta lady told me that out of the 184 placentas she's processed, mine was the largest! A person usually gets 95 large-capsule pills, I got 156.  Whoa! I have no idea why this would be, since I'm not a large person, and my baby was 7 lbs 3 oz- nothing crazy.  But a fun fact, nonetheless. 

P.P.S. And Good-bye! Now this blog will sit in cyberspace, waiting to be read by anyone contemplating a home birth or by their family members who are freaked out by the idea and want a little more info on how a home birth or having a midwife works.  Ciao!

Are these girls excited to meet their new sister or what??

 

GBS+ and Homebirth: Compatible

Well, my beta strep test came back positive.  I've never been positive with any of my pregnancies before, but, considering that beta strep is a bacterium that 30% of the adult population has at one time or another, it's not hugely surprising.

Beta strep is a bacteria that is part of the natural bacterial flora of your body, it's usually harmless to you.  But it can be passed to your baby during birth.  This can cause complications, some very serious.  The good news is that even for GBS+ moms, the odds of passing it to your baby are extraordinarily low.  Like, crazy low (see the previous post).  So I'm not stressing about it.  Basically, I and my midwife will be monitoring the baby's temperature every 4 hours for the first week of life to make sure she's alright.  After that, we're in the clear.  There is late-onset GBS infection that can affect babies until 3 months old, but that seems to be unrelated to having GBS at birth. 

I scoured PubMed for loads of studies on this, and the scientific literature isn't clear on what's best to do to minimize transport of beta strep from a mom to her baby.  In the hospital, standard practice is to give GBS+ moms antibiotics through an IV for a minimum of 4 hours before the baby is born.  If I was delivering in a hospital, that wouldn't work- there's no way I'd be there 4 hours before my baby is born.  It'd be more like 40 minutes.  In that case, they'd take a blood sample of the baby after he or she is born and test it for C-reactive protein, an indication of an infection.  If the baby's levels of C-reactive protein indicate infection, he or she will then be treated with antibiotics.

Reading the studies made it clear that the medical community itself is not united on this. 
Many studies showed that IV antibiotics didn't do anything to prevent GBS in babies, and in fact, left the baby more vulnerable to other infections and to antibiotic-resistant superbugs (now that's scary!).  Some studies did show an effect.  And again, late-onset GBS is completely unrelated to whether or not a mom gets an IV of antibiotics.  The studies WERE clear on that. 

Also, beta strep (GBS) is something that a woman (or man) can have one day, and gone the next.  So testing at 36 weeks is not necessarily indicative of whether or not I'll have it during my actual delivery.  I read a few things saying that Europe doesn't even screen for GBS (but I have to research that a bit more, that may be heresay).  Several studies- in peer-reviewed scientific journals, people, not Self Magazine- questioned the veracity of screening and treating mothers for GBS the way we do.  The antiobiotic-resistant strains of bacterium developing in recent years is causing many in the medical community to question the practice of pumping every GBS+ mom with antibiotics.

There are a few important signs that I will have to pay attention too, however, that will put my baby more at risk for having a GBS related problem.  If my water breaks too early (like 16 hours or something before labor starts), if I have a fever during labor, or if my midwife performs lots of cervical exams during labor I will be putting my baby more at risk to contract the bacteria.  

My midwife already agreed she wouldn't check me (I haven't been checked before or during labor in either of my last two pregnancies and deliveries, so no biggie).  If I have a fever, or my water breaks too early, I may have to transport to the hospital.  But we'll cross that bridge when we come to it.

If the baby does develop a temperature in that first week of life, we'll take her into the hospital and she'll be treated with antibiotics.

I asked my midwife if she's ever had any other GBS+ moms, she said oh yes- lots.  Had any of them had GBS problems with their babies? No, she said.  In fact, she's only ever had one baby that had GBS, and that baby was a planned hospital birth to a mom who had tested negative.  See, it can be gone one day, and there the next.  My midwife's apprentice told me she had been GBS+.  So it's not unusual, and even though it CAN be serious, the likelihood of it being so are so slim, and the treatment options in the hospital not really being an option for a fast-birther like me, that I'm not stressing over it.  I also firmly believe that my baby is in God's hands, and faith plays a major role in my decision making process in all aspects of my life, including having my babies. 

p.s. Camping was awesome- I slept like a baby. Seriously, better than I have been at home! 
Also, I have almost 20 freezer meals prepped and in my freezer! AND I'm 38 weeks! SO CLOSE!!!!

36 Week Home Visit & Beta Strep Testing and.....Camping, anyone?

Well, I had my home visit yesterday!  My midwife and her apprentice came (and didn't have any problems finding my house- yeah!).  I gave them a tour of my house, told them where I was planning on birthing, got the info to order my birth kit, and did my beta-strep test.  So this is for real, folks.

Beta strep tests for the presence of a bacteria that, if present at birth, could not be so great for your baby.  It can cause sepsis, pneumonia or meningitis in your newborn. So if you're positive and delivering with a doctor, they will probably give you antibiotics every 4 hours or so during labor.  This isn't a sure-fire fix, either. A recent study said that antibiotics don't help protect the baby from beta strep, but other studies have said they do, and some antibiotics appear to be more effective than others. But some moms have had unpleasant reactions to these treatments.   So...do some research and definitely talk with your provider about your concerns and treatment options if you are positive.

If I am positive, then I will be treated with more natural options: oral garlic/Echinacea, and some others.  And, if transporting to the hospital becomes necessary, whether or not I am beta strep positive will be important for the hospital staff to know. I have never been positive before with any of my babies.  

Many women have beta strep present, some with symptoms themselves, some without, and the stats of it hurting your baby (even if you are positive) are mind-numbingly low, but because the effects on your newborn can be serious, it's important to be tested and develop a plan with your provider if that test is positive. Having a home birth does NOT mean that I (or my midwife) ignore all the amazing medical knowledge available today.  Beta-strep testing, PKU testing on baby, ultrasounds, thorough prenatal appointments....these things are important.  But they don't have to take place in a medical setting with the narrow medical viewpoint that many doctors have.  In other words, there's more than one way to skin a cat. (No, I would never skin a cat....I have one and I love him! It's just a saying, people!) 

Some Beta Strep Stats:

neonatal infection rate: 0.18% (that means 1.8 babies for every 1,000 live births)

neonatal infection rate of babies born to mothers who are asymptomatic, but are known to have beta strep: 0.68%

neonatal infection rate of babies born to mothers with beta strep and have symptoms:  4.68%

Even if you're negative, there's still a risk of you developing it between your test and delivery.  Newborn infection rate of mothers who tested negative is 0.05% (1 in 2,000)

So you can see that there's no magic bullet here for Beta Strep, not even for babies born in a hospital with an IV full of antibiotics being pumped into mom.  But the odds of your baby being harmed by it are very, very low, so don't let it keep you up at night. Your squished bladder and insomnia-causing hormones are doing that already.

Anyhoo, so I ordered my birth kit! The birth kit is a basically a box of supplies your midwife has put together that you order to have ready for the birth.  It includes things like disposable gloves, water tub liners for water births, peri bottles, etc.  It generally costs between $40 and $70.  Mine was $55.  Ordering the birth kit is super exciting for me-it's another reminder to how close I am!

So this weekend I am going camping. For 5 days.  I am not sure how this is going to go....sleeping is my main concern.  I figure that if I can't sleep, we'll just come home.  But I love camping, so I hope my cot, 5 pillows, and memory foam pad will get me through.  I've gone camping while pregnant before, but never this late in the game.....so I'll let you know how it goes!

Also, I've been freezing meals like crazy! This week I did 10!  I definitely feel the "nesting" instinct and feel like it's time to get ready for baby, and to prep my family to survive with a low-functioning mom for a few weeks (although, they would argue they are already doing that...).  Freezing meals will be a huge help in getting through what I call the "survival period"- those first 4-6 weeks.  My babies have all started sleeping through the night between 6 and 9 weeks, so I am excited to again have sweet slumber in my future!

See how my mind is just glazing over these last few weeks of pregnancy and the labor and delivery? I am just so ready to have my baby, hold her, and welcome her to our family!