Today was my 36-week midwife appointment (2 days early), and it seemed like all the restrictions came out of the shadows.

I’m most disappointed to learn that provincial policy applies an arbitrary time limit to cervical dilation. Once 3 cm dilation is reached, after 4 hours with no further progress, “consultation with a physician” (i.e. hospital transfer) is mandatory. Having read about homebirth (in the US context) as having the advantage of avoiding arbitrary hospital time limits, I am pretty disappointed to that this rule will be applied to me labouring at home, however unlikely the scenario.

The midwife’s response to my dismay was basically that if I had been labouring for 4 hours with no progress, I’d be asking to go to the hospital anyways. In certain contexts, that makes good sense. However, I can think of 3 births during which the mom’s body took a several-hour break at 6-8cm dilation to allow her to have a rest or nap before transition and pushing. So a pause in dilation isn’t necessarily pathological or even uncomfortable! The midwife also mentioned the purpose of this policy in limiting professional liability. Anyways, there is no point in arguing about it, because midwives are bound by these rules too. I’m still thinking about whether there’s anything I can do to try and protect myself, such as declining frequent cervical checks.

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St. Anne, a Catholic version of the crone goddess, and patron saint of childbirth. I love the idea of her, but do wonder why she is always so creepy looking in paintings. Also, why does the baby Jesus look like a balding miniature bodybuilder?

I also have an exciting new documented risk factor to contend with, because our baby is presumed giant. Oh, didn’t I tell you? Our last ultrasound at 34 weeks – which showed his kidneys are PERFECTLY FINE, fuck yeah – also resulted in a new diagnosis of “fetal macrosomia”. This means the kid is expected to be really big. Although guesses of fetal size are notoriously inaccurate, his head was estimated in the 99th percentile. Just what every mother wants to hear! We were offered another ultrasound to reassess his size, but have decided against it. Ultrasound exams look for trouble, and every ultrasound so far has brought a new diagnosis to cause stress and threaten required interventions. No, thank you.

Fetal macrosomia is a contra-indication for homebirth. It means that medical care providers will be extra vigilant about the speed of my progress, on the theory that big babies are at risk of cephalo-pelvic disproportion, meaning the head might not fit into the pelvis and therefore couldn’t apply proper dialating pressure to ye olde cervix. According to “Ina May’s Guide to Childbirth”, true cephalo-pelvic disproportion is pretty darn rare, but the concern is often raised with big babies, small women, and small women with big babies. (Hi!)

Another contra-indication for homebirth is my pet fibroid, which was also diagnosed during the last ultrasound. I couldn’t handle a discussion with the midwife today about how much it increases my risk of  postpartum hemmorhage, but will start researching.

Going post-dates would be another risk factor, and while there doesn’t appear to be a hard cut-off at three strikes, it’s clear that the more risk factors I have, the less support there will be for birthing with limited interventions. At an early appointment with a different midwife, I had already raised the question of going post-dates. At that point, with no other apparent risk factors, she had assured me there is no policy on induction or “risking out” of homebirth, but I could merrily go to 43 or 44 weeks. Because of the suspected big baby, however, I am finding myself encouraged to try and have this kid earlier, depending on which midwife at the practice I talk to about it. Hence, starting this weekend, I get more accupuncture, to try and line everything up for delivery. At 38 weeks, the midwives will offer stretch and sweeps, which I haven’t decided yet whether to accept.

The opportunity to birth at home (in the absence of good reasons to go to the hospital) is pretty important to me. The biggest reason is that I feel safer at home, with the fewest strangers around possible, and feeling safe helps mammals give birth. Mostly, that’s psychological, but it’s also partly based on a risk assessment. Despite my documented “risk factors”, I believe this is a low-risk pregnancy and birth, and going to a hospital (again, in the absence of a good medical reason) would actually increase our risk of infection and unnecessary interventions.

Overall, I am feeling relieved to still be clear for a homebirth, although wary and a little defensive about losing the opportunity. I’m also very glad to have an awesome doula lined up to provide non-medical support. I’m fortunate that Z is pretty sensible about all this stuff, although he does think I’m nuts to be upset about being on the clock for cervical dilation. Thank goodness we took a comprehensive childbirth class together, so he is reasonably well informed about best practices and options. One of the lessons from our childbirth classes were that the birth partner is the best advocate and spokesperson for the family. (I’ll be busy, and it’s not the doula’s role.) I still need to think about how to best prepare him to speak on my behalf about issues that might come up.

At 37 weeks (8 days and one midwife appointment from now) I will theoretically be clear for a homebirth at any time this baby feels like showing up. First babies do not tend to be early, and this one has shown absolutely no signs of being in a hurry to arrive, but he may find himself encouraged to depart earlier than he otherwise would have liked by evening primrose oil, acupuncture, and stretch and sweeps. As a general principle, I would prefer to leave my baby alone until he’s ready to be born, or at least until 42 weeks. However, given the risks presented either by actual macrosomia or by decreased support for a low-intervention birth due to presumed macrosomia (I don’t know which stresses me out more) I am feeling conflicted about hurrying him out. Baby, it would be really helpful if you could just be ready to be born on your own steam around 38.5 weeks, OK?

TL:DR – It’s very nearly time to start collecting waterproof sheets, Gravol and secondhand towels. Yay?

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