Birth Story Part 1: Why I Switched to a Midwife at 39 Weeks Pregnant

A while ago I put on Instagram (@nataliehodson1) that I was typing up my birth story so I could share it with my daughter someday and I was surprised to see how many people told me they would be interested in reading it!  I started thinking about sharing the story with everyone and at first I wasn’t sure if I was going to share this.  It made me feel a little vulnerable sharing this piece of my life.  But, I have always said I would always be honest with you guys here on this blog and in my Facebook posts, and this is an area I have a lot of passion talking about.  I will warn you….once I started typing I just didn’t stop!  The story ended up being really long, and if you just want to see a picture of a cute baby you can skip this whole blog post and scroll to the bottom of Birth Story: Part 2 (I will post it tomorrow) to see pictures of the cutest baby girl ever (hmmm….slightly biased?).

Part 1

While I was pregnant with our second baby I decided to switch from the OB/GYN I had been seeing my entire pregnancy to a midwife when I was 39 weeks pregnant. When I told people I was doing this, I got overwhelmed with questions about why I decided to make the change. I was able to talk to my friends and family about it, but I wasn’t able to respond to a lot of emails and comments I got about the topic. So, when I wrote up my birth story I decided to break it up into two parts. Part 1) Why I decided to switch and Part 2) what the birth at a birth center was like (and delivering a nearly 10-lb baby!)

I think this story deserves a little bit of background information to fully make sense. Let me back up a little bit and tell you about my history and experience with birth growing up and a little bit about the birth of my first son. I am the oldest of ten children, the youngest being 7-year old twin girls (I am 27). Our family is a little bit of “yours, mine, and ours” but my mom gave birth to seven children (three of my siblings are adopted). Growing up, pregnancy and childbirth was always viewed as a very positive thing in our household. I remember watching my mom enjoy being pregnant, breastfeed my siblings, etc. When I was in fifth grade, I was able to attend the labor of my younger brother.

Here is a picture of me right around that time (I’m the one with brown hair).

My mom had all her prior children drug-free and in the hospital. Here is a picture of my mom now, I can’t seem to find one of her back then:
This was her sixth child, and my parents decided to have a homebirth with a midwife. I didn’t know it at the time, but this would turn out to be a very positive experience for me that would later shape much of my attitude towards birth. I remember going on long walks with my mom while she tried to get labor going, I remember watching my mom labor without making a lot of noise, I remember my stepdad helping my mom in different squatting positions and supporting her during labor. My brother was born at home after multiple days of labor and was over 11 lbs! I remember thinking my mom was the strongest person I knew and I was so impressed at what our bodies were capable of doing. Later, when baby shows started becoming popular on tv channels like TLC, I remember watching a woman screaming in labor, lying on her back, and feeling confused because that was so different from the experience I had been a part of when I was younger at my brother’s home birth.

Here’s a picture of our family a few years after that birth.  My little brother on the bottom second-to-the-right was the birth I talked about above:

When I was pregnant with my first son, I knew I wanted a natural childbirth, mostly because of the exposure I had when I was younger. My best friend and many of my aunts and cousins had delivered their children at birthing centers and so I was very familiar with the midwifery model of care. As soon as I was pregnant I started looking into birth centers who worked with our insurance company. I knew we would be moving to Fairfax VA, when I was 30 weeks pregnant so when I was about 15 weeks along I started calling around to different birthing centers around the Washington DC area to see if they accepted our insurance (Kaiser Permanente). BirthCare in Alexandria, VA accepted Kaiser at the time, but unfortunately they were completely booked for the month I was due. They put me on a waiting list and I was discouraged because it was the only birthing center in the area that accepted Kaiser (we were on a HMO plan and so I had no out-of-network coverage). Luckily, I got a phone call about a month later that a spot had opened up and I could be a patient of theirs! I was thrilled! I explained to them that I wouldn’t be in the area until I was 30 weeks along (I was receiving prenatal care locally before 30 weeks), and we set up our first meeting.

I delivered my son with BirthCare at 41 weeks 5 days!  Here is a picture of me a few days before I went into labor with baby #1 in September 2009 – I get really big when I am pregnant!
I was in active labor (starting from the time contractions were at least every 4 minutes apart) for 37 hours and pushed for almost two hours. My son was born perfectly healthy at 10 lbs, 22 inches long! I know many people hear that and think I must have had a terrible experience, but truthfully, I have very fond memories of that birth. It was an extremely exhausting event, and it was very hard, but there were a lot of things that happened that I am so appreciative of. The same midwife (and her assistant) stayed with me the entire 37 hours! They never left or switched shifts with other midwives. For the most part, they allowed me to labor on my own (something I had asked for) with my husband and only interrupted to check the baby’s heart rate with a Doppler monitor. I was allowed to eat and drink the entire time. I know if I hadn’t been allowed to eat it would have been nearly impossible for my body to sustain its energy that entire time. Also, I wasn’t required to be hooked up to any machines. I was able to walk, labor in different positions, use the Jacuzzi bath tub for pain relief, etc. My son was born with an Apgar score of 9/10 at birth and 10/10 five minutes after birth. The midwives made sure the baby was put on my chest right away, did their initial assessments, made sure mom and baby were ok, and then stepped out of the room. They allowed us to spend the first 20 minutes of his life together as a family. That time will always feel cherished to me, and I will always be grateful they allowed that. We were able to go home about six hours after the baby was born and sleep in our own bed (we were all exhausted and looking forward to sleep!). The midwives made multiple visits to our house in the next week to check on me and baby. The entire experience, although very hard, was just so supportive of the natural process of birth, and I have very fond memories of the entire thing.

So, I think it is important to understand those two experiences when understanding my decision this time around. I found out I was pregnant this time with our second child when I was just 5 weeks along. Here is a picture taken right around that time:

I called BirthCare right away to schedule our first appointment and was devastated to find out that they no longer contract with Kaiser (their decision, not Kaiser’s). They told me that I could still deliver with them, but that I would have to pay out of pocket which was $4,500 plus the birth assistant fee of $500-$1,000 (different assistants have different fees). I was so sad because although my husband and I both have good paying jobs and we could afford to pay it, I just couldn’t justify paying $5,000+ for a birth that my insurance would cover 100% if I delivered with an in-network provider. With our insurance plan, we have no deductibles and no co-pays during pregnancy so the birth of my first son literally was free to us, but because it is an HMO plan you must go through an in-network provider or else you have zero coverage. I was so disappointed. I called Kaiser and they told us that they didn’t work with any other midwives or birthing centers in my area.

I decided to instead make my first appointment with one of the OB’s at the Kaiser facility. Here is a picture of me at 12 weeks right around the time of this first appointment.  My belly popped out SO much sooner with baby #2!  I started showing really quickly, but during the 2nd trimester my belly growth evened out.
I figured I would go to that first appointment just to make sure the baby was ok, and try to get a feel for the OB services through Kaiser. I went in with a really open mind and knew that if I liked them I would stay with them during my pregnancy. I figured since I had my first child naturally I knew what I was doing, and could manage a natural labor at the hospital. Unfortunately, the appointment didn’t go so well, and I ended up leaving in tears. I had a few questions I wanted to ask them, and I felt like the OB’s answers were completely opposite of my philosophy towards birth. For example, my first question was:

Me: “My first son was born 12 days past his due date, and we also have a family history of late babies (six of my mom’s seven kids were born late). What is your policy on delivering past your due date?”
OB: “You actually want to be pregnant for that long?!”
My thoughts: *oh crap. I started to feel my throat tightening up and I knew the tears would come soon. I was almost nervous to even ask the other questions after this.*

Me: My first son was 10 lbs, I didn’t have gestational diabetes, and we have a family history of big babies (on both sides). Are you ok with delivering a big baby with no interventions?
OB: Well, we will have to closely monitor you as you get closer to your due date. Big babies can have a much higher risk of problems and fetal death. I know you wouldn’t want your baby to die during labor, and so we would need to make sure you are highly monitored.

My thoughts: *What?! Even though I have already delivered a big baby perfectly fine with no drugs or interventions? I understand that there can be risks such as shoulder dystocia with larger babies, but come on…trying to make me afraid of the process by talking about the potential death of my child isn’t going to help.*

I asked a few other questions, but realized very quickly that we had very different philosophies and attitudes towards the birth process so finally just stopped asking questions about their practice. Even though she was a really nice lady, I knew I couldn’t deliver with a team of OB’s who had such different opinions as I did. I want to point out here that I am not anti-hospital or anti-OB/GYN. I know there are many, many OB/GYN’s who are very pro natural childbirth, and that you can have a good natural hospital birth experience. However, it is very important to research your pregnancy options and birth options and make sure the people you are working with are in line with your wants and have the same philosophies you do. I didn’t feel that way with this team of OB/GYN’s and just wasn’t comfortable delivering with them.

I left in tears, called my husband, calmed down, and decided to look for a new OB. I did a major internet search of all the doctors in the DC / Northern Virginia area who were advocates of natural childbirth. I kept seeing Dr. Tchabo’s name over and over. He delivers at Virginia Hospital Center and is one of the very few doctors who will deliver breech babies without c-section, promotes natural childbirth, etc. He was also the doctor I would have used with my first birth if a complication would have occurred and I would have needed to transfer to the hospital and he worked with our insurance company. I booked my first appointment with him (at about 20 weeks), and felt really good about my decision. Here is a picture of me right around 20 weeks pregnant when I first met Dr. Tchabo:
My first appointment was great! He walked into the room with a huge smile and said, “Hi mama! How you doing today?!” Dr. Tchabo is an older African man (lived in South Africa) but I think he is from Quebec originally and has a strong accent. He spent a lot of time with me in my initial appointment, and answered every single question I had (and I had a lot!). He said that I could eat and drink during labor, that as long as everything was fine with the baby he would mostly leave me alone to labor, that he knew I could deliver another big baby, and that he would allow me to go two weeks past my due date before he would want to induce me. I felt really comfortable with him, loved the fact that he had a midwife who worked with him in his office, and finally felt ok with everything.

As the weeks went on I had doctor appointments once a month and they all went really well. Dr. Tchabo was so friendly and so nice, and I felt great. Then at around 36 weeks I took a tour of the hospital and that’s when I started feeling some anxiety about this birth.

The maternity ward was very up-to-date, all the rooms were really nice and single rooms, but as the tour went on, I started to get a lot more questions. They nurse giving the tour kept saying how they were very pro-natural childbirth, and had beds that you could get in the squatting position on the end of the bed, etc, but they had some protocols that I didn’t feel totally comfortable with. When you got there you had to have a hep-lock put on (which I was ok with), you had to be hooked up to intermittent monitoring at least 20 minutes out of each hour (meaning you would need to lie still on the bed while the straps are on your stomach), you couldn’t request a Doppler monitor instead of the intermittent monitors, they didn’t have tubs that you could labor in (which helped me tremendously during my first labor – the water relieved so much of the pain), it is a teaching hospital so you may get checked by residents often (I wanted to limit cervical checks) and have many people in the delivery room, etc. Don’t get me wrong, there were a lot of things the hospital was doing right and that they did to encourage natural childbirth (also things afterwards I liked such as bringing baby to mom’s chest right away, encouraging that the baby stays with the mom the first night instead of the nursery, etc), but I still left discouraged. I started to get nervous that with the different interventions I was required to have in the hospital, it would make it more challenging for me to have the natural childbirth I wanted.  I felt like our bodies are designed to give birth, why was it required to turn this into such a medical procedure?

At my next prenatal appointment I talked to Dr. Tchabo about my concerns. He was really great about listening to what I said and addressing each area, but he said that the intermittent monitoring was required to make sure baby was doing ok (which I agree it is very important to monitor the baby’s heart rate, but can be done just as well with a Doppler, and there are no evidence-based studies that prove differently). There were some other issues we talked about, I also had some concern about his slightly higher episiotomy rate, especially since I knew this would be a big baby, and I would prefer tearing to an episiotomy if necessary. I went home just feeling really torn. I really liked Dr. Tchabo in general as a person and as a doctor, but I felt really uncomfortable and had a lot of anxiety about being in the actual hospital. Lastly, because Dr. Tchabo is a single-practice doctor, there was no guarantee he would be on call when I went into labor. There were other doctors that he said would be on-call, but I had never met them and I had no clue if they would have the same laid-back demeanor as Dr. Tchabo and if they would be as supportive of the natural childbirth I wanted.

I went home and talked to my husband about my concerns. He was very understanding about how I felt, but at the end of the day, it was just too hard to justify spending that much money out of pocket for a birth center birth when a hospital birth was free (to us) with our insurance. I felt so torn! I agreed with him, but just felt so sad that I wouldn’t have the same supportive environment I had with my first son. We discussed having a doula, but again, it was hard to justify spending a lot of money out of pocket for a birth that would otherwise be free to us. I kept reading my favorite natural childbirth books to prepare: Ina May’s Guide to Childbirth (a MUST have if you are expecting! Even if you don’t plan for a natural childbirth, it is one of the best books to prepare for childbirth out there – her breastfeeding book is great too), Natural Childbirth the Bradley Way by Susan McCutcheon, and Hypnobirthing by Marie F. Mongan. I read nearly all the stories on www.birthwithoutfearblog.com and watched as many YouTube videos about natural childbirth that I could find. I wanted to get rid of the anxiety I had towards this birth and just go into it as prepared and calm as possible.




Unfortunately, I just couldn’t shake the feelings of anxiety I had about the hospital, being forced to have interventions I didn’t want, etc. I get really bad pregnancy insomnia, and one night at 39 weeks pregnant I was up really late. I started thinking about all the different midwives in the area, and knew that there were about five independent midwives who had very strong reputations (I had heard their names either by other OB’s, other recommendations from the Birth Center, or positive reviews online). I was up really late and decided to email each one of them. I figured I would explain my situation, explain a little bit about my background, and see if any of them would be willing to work with me. Here was the email I sent:

Title: Accepting Moms at 39 Weeks?

Subject:
Hi!
I am writing to inquire about your midwifery services – however my circumstances are a little unique. I am currently 39 weeks pregnant with baby #2 (EDD 3/13/13). I have had a very low risk pregnancy thus far with no complications. My first son was delivered with BirthCare 3.5 years ago and we had a wonderful experience. Unfortunately, we have Kaiser insurance and BirthCare no longer contracts with Kaiser.

When I found out I was pregnant this time around I assumed that I would have to deliver in a hospital because I had heard that Kaiser didn’t cover any other birth center locations or midwifery care and I couldn’t justify paying $4500+ out of pocket when our insurance covered the majority of the birth at the hospital. I have been seeing Dr. Tchabo for my prenatal care, and although I appreciate Dr. Tchabo’s approach to natural childbirth, there are certain hospital protocols that have been giving me anxiety (intermittent fetal monitoring, no laboring in tub, hep-lock, higher episiotomy rates, etc). Also, my first son was 10 lbs and 13 days late (I have 35 days cycles which I believe caused a “late” baby) and I am nervous that if I have another bigger baby that may lead to a c-section in the hospital setting. I am the oldest of ten children (I am 27 and the youngest are 7 year old twin girls) and was actually able to attend a few of the births of my siblings (one being a homebirth – my brother was 11.5 lbs at that birth!). Those experiences when I was younger had a big impact on me as a pregnant mom. From a young age, the idea that birth is a normal and natural process was instilled in our family.

The reason I am writing is to see if you are willing to offer any type of discounted services for someone in their 39th week? We could pay in cash for services and basically would just be paying for the birth and delivery. I would love the opportunity to have a homebirth, but my husband isn’t totally on board because it seems to cost so much more than a hospital birth with our insurance coverage. I realize this is a long shot, but figured it couldn’t hurt to ask. I appreciate you taking the time to read through this email and look forward to hearing from you.

Thanks!
Natalie

I sent this email to all five midwives I felt comfortable with, and figured worst case scenario I wouldn’t hear back from any of them and then I was just in the same boat I was as I was writing the emails. I didn’t hear back from any of the midwives and was really disappointed. The next day, however, I got an email from Tierney Dovan, founder of Marshall Midwifery, and she had the sweetest response! She told me that her heart went out to me, but that it was a tough call. That the midwifery Model of Care is so much more than just helping you give birth, it’s a relationship built on trust, and that she would find it difficult to only help me have a baby. She told me that her fees are $3,750 typically and that she wanted to talk to me in person.

I was thrilled that someone had at least responded to my email! I called Tierney and we had a great conversation that lasted almost an hour. She explained to me that her approach as a midwife isn’t just on delivering a baby as inexpensively as possible, but that her prenatal appointments are almost always at least an hour long, that she commits a lot of time to each of her clients, and that the majority of what she charges for is the birth and post-delivery care of mom and baby (she drives to your home and makes home visit checkups after baby is born and also does post-partum checkups as needed, not necessarily only at two and six weeks postpartum, and also checks on the baby, not just mom). We had a great conversation and I felt like I had just had an hour conversation with my favorite aunt! She was very warm and friendly, but also straight-to-the point and factual. I got off the phone with her and felt so strongly that I wanted to deliver with her at the birthing center she owned.

When my husband came home that night I told him about my conversation and he wasn’t thrilled or sold on the idea of paying anything out of pocket for this birth. I may have guilt tripped him a little bit, but it wasn’t on purpose! I started tearing up at the dinner table and once the waterworks started I couldn’t shut them off. I blame the pregnancy hormones! I had the ugly cry going on and I tried to explain to him how much it would mean to me to have the natural childbirth experience I knew I could have and wanted so badly. I tried to explain to him how childbirth is an experience that a woman holds on for her entire life, and I didn’t want this birth to be a bad experience for me. I told him it wasn’t fair. We both have very good paying jobs and could afford to do it! I knew it wasn’t in our plan or budget that we set up at the beginning of the year to hit our savings goals, but I told him I would cut out things like getting my hair done, and cut out any extra expenses each month to make up for it throughout the year. After a long entire-night conversation, he agreed with me, understood my perspective, and said if I wanted to switch to the birth center we could do it.

I was thrilled! I was so excited to have the birth experience I had dreamed about…now I just had to meet the midwife! I felt like I knew her already from our phone conversation but we hadn’t actually met. I remember talking with Tierney on the phone and she said, “You are going to have a crazy story to tell some day when you tell people you switched from an OB/GYN to a Midwife at 39 weeks 2 days, but let’s not make the story really crazy and make it so we haven’t even met yet.” I agreed! So, I drove out the next day to the birth center (about 50 minutes from where I live) for my first appointment with her.

I got to the birth center and immediately fell in love! When you walk in, the room is very warm and inviting, and feels like a living room. It had red couches, some small toys for toddlers to play with, books for older siblings, etc. Tierney greeted me at the front door and was just as I had pictured her on the phone. She has eight children of her own (three are adopted from China), and was so friendly, kind, confident, and adorable! She is a runner like me and has completed marathons all over the world. She has served as a nurse and midwife on mission trips to other countries, and has been involved in midwifery care for over 30 years. Our first appointment felt so comfortable. She brought me into the ‘blue room’ (there is also a ‘pink room’ (pictured above) – both are used during labor), and we sat down on the bed and talked. She wanted to know all about me. She wanted to know about my first birth, about other births in our family, about me in general, etc. I loved that she was so nice! She didn’t just have a clipboard full of medical questions to ask, she just sat down on the bed and I felt like she genuinely wanted to learn about me. That appointment was an hour and a half! I couldn’t believe that she was willing to spend so much time with me and was so excited that I felt so comfortable with her.

Because I went past my due date, I ended up having a few more appointments with her.

Finally at 40 weeks 5 days pregnant we talked about doing a cervical check (first one I had all pregnancy), and doing a membrane sweep at that appointment at 3pm. We both felt it was ok to do since I was almost 41 weeks along and ready to meet my baby (we hadn’t found out the gender yet!). I was dilated to a 2, but unable to stretch to a 3, effaced 30% and 0 position. The sweep was slightly uncomfortable, but not really painful.

Later that night I got a text from Tierney asking how I was feeling. I remember getting a huge smile on my face when I got that text and just feeling blown away that she would care enough to text me! I remember thinking that if my OB/GYN would have done a membrane sweep, there is no way I would have gotten a text later that day asking how I was doing. I went to bed that night (March 18th) feeling the same way I had all week, no changes with the baby, but so happy with my decision to switch to Tierney.  Little did I know we would have our baby girl in our arms just 24 hours later….

That is my (very long) story of why I made the decision to switch to a midwife so late in the game. Keep checking my blog tomorrow, I will put up the post (including a few (censored) videos) with my actual birth story, and you can read about the all-natural labor and delivery of my nearly 10-lb baby at a birth center.  Click here for that post (Part 2).

And since you took the time to read this very long story, I’ll share a picture with you of the cutest, little cross eyed (only when she tries to smile) six week old little girl 🙂 .  Hope you click here to read the rest of the story!