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September 24, 2003
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Joyful Inauguration.
I had anticipated that my first prenatal appointment with our midwife was going to be rather dull and boring; an uneventful initiation out of obligation into the otherwise exciting world of prenatal care. The monotonous chorus of medical history questions -- "no, yes, no, no, no, no, yes, yes, no, no, no..." -- perhaps an awkward but not unbearable pelvic exam, a standard "welcome to the practice" speech to outline appointment scheduling, expectations (theirs, probably not mine), To Do's and To Do Not's, and whatever else might be deemed necessary by the caregiver. Being a midwifery practice I would also expect room for my questions to be asked and answered, but this first appointment would certainly not an overly joyous event. These anticipations had been based out of experience and the memory of my first two "prenatal" appointments with a general practitioner before I had researched and been accepted into the midwifery practice we had care with during the remainder of my pregnancy, labour, delivery, and post partum period with Summer Lily, the same practice we have returned to for a second fabulous experience.
Those first two prenatal appointments with a GP were full of negativity, condescending attitude and a general and very obvious disdain for having made the choice to not only have a child while attending university full time, but for lacking proper morality and doing so outside of wedlock and not arranging a quick drive-through wedding upon receiving a confirmation of pregnancy. My very first appointment hardly qualifies as being thought of as a prenatal appointment -- more a chance for a self-assured morally and intellectually superior doctor and nurse to inform me that I couldn't possibly know that I was pregnant, despite the obvious symptoms and an at least 4 week late period, because I had failed to produce a "positive enough" urine sample. I enjoyed the awkward message she left days later confirming the positive test ("but you already knew that...") from the blood their lab assistant ruthlessly drew from my arm, not taking time to listen to my advice on how to handle my difficult veins until she had performed four jabs with no hit. I am sure that most married, graduated couples do not have to endure a small lecture on the option of abortion at their first prenatal appointment; these two "care" providers apparently could not simply understand that this pregnancy was wanted. I returned a few weeks later for a second appointment, starting with the incorrect assumption that we were there for relationship counselling, then truly beginning with endless questions of medical past and that of my extended family. There was an internal pelvic exam with cold jabbing fingers, me flat on my back on a cold, sterile metal table, legs spread and feeling overexposed and on display; it was made obvious Paul was expected to remain behind the partially drawn curtain. I suppose it would have been inappropriate for him to see my display, given our marital status. Or perhaps it was just assumed that any male would not want to be exposed to such a barbaric form of female torture, his testosterone and manliness unable to bear such a gruesome event. Not until the internal exam was underway did the less-than-loving doctor ask me if I needed a pap done; I was uncertain, I thought I had one performed the previous spring at a procedure I had needed then. Once the exam was over she took the time to ask further detail about the procedure, and then making it obvious I must not know anything she assured me no, they would not have performed a pap and then once establishing that I was completely to blame for now having to re-assume the undignified position she performed the pap (it was apparently her decision that it had to be done and not my choice) clarifying that if I had only been more careful to keep track of my paps that she wouldn't be wasting this time now to scraping my insides, it could have been done during the earlier exam. I guess she showed me. Any questions I might have asked during the appointment were met with that same condescending attitude and answered, barely, with a feeling of burden, as if my interest in my own prenatal care was a great inconvenience to her. Perhaps the only positive aspect of these appointments was the suggestion and encouragement towards midwifery care and a homebirth, after informing me that she could find me an OB (since I didn't already have my own -- how irresponsible!) although it would require a great deal of effort on her part since there was a drastic shortage of OBs in our area. Since Paul and I had been leaning towards midwifery care I had been impressed at the time that she had been supportive of this choice, but in retrospect I can't help but wonder if she didn't think that these two, unwed, irresponsible parents-to-be would be better off in the hands of alternative prenatal care, leaving the barely-available OBs free to care after the people who deserved them. Probably an unfounded thought on my part, but there it is, nonetheless.
I understand that most women likely do not experience such disrespectful treatment from their doctors, but whatever the general trend or statistics of withholding one's own ethics and morals and treating your patient with dignity and compassion, the above experiences are mine, they are now part of me, and represent my reality of the medical community and prenatal care. The remainder of my pregnancy, cared for by a wonderful practice of midwives, was nothing but pleasant and filled with an air of equality and a focus on informed choice -- my choice. Despite the incredibly positive experiences I had with my first pregnancy, and knowing this first appointment would be like warm, inviting day to that dark, cold night of a doctor experience, I still expected dull, boring, routine. Not very exciting. Just barely a month and a half along, what more could there be -- nothing to talk about, nothing new, I was familiar with the mode of care, I was already well acquainted with our primary midwife Anita as she had been my primary and attended Summer Lily's birth. Instead of dull, boring, routine, there was a joyful inauguration to celebrate a new pregnancy, the creation of a new being. Congratulations were offered, there was no need to clarify that this was wanted and we were happy.
After I checked my own urine for glucose and protein levels, Anita greeted us in the reception room, warm, smiling, unbelieving of how big and beautiful Summer Lily was, even taking the time to ensure her name was Summer Lily, not just Summer. I was asked in an open fashion if it would be OK if Anita's student sat in at our appointment after clearly establishing that it was entirely my decision and I could change my mind at any point should I desire. Stacey is a third year midwifery student at McMaster, attending the same programme I plan to someday at the school both Paul and I graduated from; she was friendly and comfortable. Both Paul and Summer Lily were at the appointment. Summer Lily sat on the floor between Paul and I and played with "all deese toyz!" while the four of us sat around a round kitchen table. After some friendly catching-up on what had happened over the course of the past two years since we had last seen Anita, we were briefly introduced to Ontario's midwifery system and some changes within their practice. With Summer Lily we were assigned two midwives, a primary and secondary and told that it would be possible, although hopefully not probable, that we may end up with two midwives from the practice we hadn't met before for our birth. This time, we are assigned a care team of three midwives: a primary (Anita), a secondary (Andreia), and a back-up (Heather). I will continue to see Anita for several appointments still and then in my second trimester will start alternating appointments between Anita and Andreia, probably only meeting Heather once in my third trimester. We went over a folder full of pregnancy and birth information, pamphlets and printouts on a variety of topics, just glossing them over; "folic acid... OK... you know all about that, you've been taking it forever... ". Stacey showed me the information pamphlet on the MSS triple screen, her trying to explain what it was all about and me cutting her off to try to explain that I already knew. She started to comment on not knowing if I had it performed with... and I said no, we didn't think it was necessary or worth the potential months of worry. When she started to ask if I had done any reading, I quickly interjected and said "oh yes.. it was a, you know.. informed decision!" and we all laughed since our entire appointment had kept returning to the importance of informed decision. Informed decision. Means that your health care provider trusts you, listens to you, answers your questions, and ultimately respects the decision you make for your own body and baby. Informed decision means that when we were talking about what would happen at our next appointment, Anita asked (asked, didn't tell, asked) me if I would want a pap done, did I need one? Or would I rather wait until the 6 weeks post partum discharge visit to have one performed then? I raised my concerns with 6 weeks not being enough time for uterine cells to return to normal after their amazingly drastic changes during pregnancy, and the common false-positive results I'd rather not deal with. Anita nodded, agreed with 6 weeks being much too early for an accurate read, and it was decided upon, with my consent, that we would do a pap along with the internal exam at the next appointment.
Anita and I reminisced over Summer Lily's birth -- she even knew the exact date and time, all of the details, because July 29th had been a big day for her. She had attended three births in one day, all home births, mine being the last. We laughed over our gigantic pool (which had been filled with cool water out of good intention by Paul); Stacey was impressed by my short labour; everyone appreciated my recounting of meeting Helen for the first time, me round and huge, sprawled out completely naked on our couch and nearing transition, she warm and grandmotherly; and Anita filled Stacey in on "something unusual that happened at the end of Ashley's labour -- the baby's heart rate went up quite high instead of down like it's supposed to, indicating the possibility of fetal distress -- and I had to do something I really dislike doing. I had to give her a little episiotomy" and I assured her it had healed just fine when she inquired with slight embarrassment. In a moment of exchanged smiles and a sort of deeper, underlying understanding we looked at each other and agreed we'd do whatever we could this time to prevent another cut. I finally feel like I have closure and complete inner healing now on the event of the episiotomy; it was nice to finally hear from Anita that it was something she felt forced to do (and doesn't do often!) and for her to have raised the subject so early in my care.
With an hour long appointment, there is a lot of time to talk. Summer Lily requested a visit to the potty, and while they were gone we three women starting discussing the midwifery programme at McMaster, Stacey confessed it wasn't was she expected, hesitantly elaborating to say it was far more clinical than she had anticipated. Anita spoke about her midwifery days in Alberta were she did not have hospital privileges and clients had to pay out of pocket for care; her clientele was much more dedicated as a result, than here in Ontario where care is now covered by our health care system. We discussed the question of, is midwifery care too medicalized due to government regulation? and there wasn't much to discuss since the three of us had previously and independently arrived at the conclusion that government regulation still allowed for women to have pretty much all of the freedoms they want within their own birth experience while making midwifery care available to more women. Anita mentioned pregnant teens she helps, who would have been unable to pay out of pocket if care wasn't funded. Women from other cultures who want to see midwives for cultural reasons. It was interesting to hear a practicing midwife's perspective on the whole midwifery care system.
I was further impressed when Anita asked me how long Summer Lily had nursed for and I told her she still was, and I got a big, positive "all right!" with an enthusiastic thumbs-up. We later discussed our nursing relationship in a bit more detail when Stacey asked me if my cycles were regular 28 days long, but no, they vary from 24 to 35 days long. Anita inquired when my cycles had returned after birth and I explained that despite using no artificial nipples, nursing on cue all day long and all night long, and no supplementation at all, my cycles returned at approximately 3 months after delivery and were regular (as they get) right away (followed then with congratulations on being so stupendously fertile, from Anita). Why all this fuss and bother about nursing? Well, I suppose it wasn't fuss or bother, but just an attempt to figure out if we needed to change my estimated due date any, if nursing had thrown off my cycles. Not one mention of the w-word, no concerns about nursing being "bad" for pregnancy, and I wouldn't expect any less from wonderful, supportive, informed midwives. And in the end Anita explained she didn't feel that changing my date any was necessary, although if my cycles were consistency closer to 21 days or 35 days long, then they would adjust the estimated arrival date. Makes sense to me, and I'm content with leaving the estimated due date as is. Sometime in May, as far as I am concerned.
Anita gently breached the subject of my miscarriage in January; not dancing around and avoiding calling it was it really was, but speaking softly and with care; she knew because I had an appointment scheduled with her and then had to call to cancel. It was a sad event I wish hadn't happened, but I have come to terms with it because I know it happened for a reason, biological or spiritual, it makes no difference to me. That baby simply was not meant to be, and as I have once said before, I try to find comfort knowing that some karma has worked itself out of a knot somewhere, and perhaps that little person will find it's way back into my life someday. However, I was surprised at what relief I felt being able to discuss the event and my surrounding feelings, past and present with someone who obviously cared yet did not have an invested interest. Anita requested that if anything should happen again I be sure to call her so we could talk -- she couldn't promise to do anything to help, but at least would be there for emotional support, and she could help me assure everything was taking care of itself.
For a first appointment that I expected to be dull, boring, and routine, I had a wonderful time. I am still breathing in the beautiful air of celebration and joy. We covered a wide variety of topics during our discussion and made a few decisions regarding future appointments and care. Birth plans so far include having the pool available so it is an option for me should I desire, and of course, avoiding that awful episiotomy again. I chose to schedule our next appointment for five weeks from the date of that first appointment because we should be able to detect the heartbeat by this time. Anita will also give me a physical, pap smear, internal exam, and draw my blood to check for levels since I don't take a full prenatal vitamin and would like to check my iron, haemoglobin levels and such. Oh, and I have to remember to ask Anita about taking alfalfa supplements and if this, combined with getting new babe to my breast right away, could possibly eliminate the need for a shot of Pitocin after delivery to help expel the placenta because of concerns of hemorrhaging due to such a short labour. And if increasing my vitamin K ingestion would have any affect on the need for a vitamin K shot for the babe after birth; we gave SL the intramuscular injection of vitamin K an hour or two after delivery and three days later when we did the PKU test her blood was clotting too quickly to get enough for the test and she had to be re-pricked several times. It was awful for both of us, and my secondary midwife performing the heel prick test told me that her quick-clotting blood was because of the vitamin K injection, and then tried to assure me that my new little baby wasn't screaming because it hurt, but because she was angry her heel was being restrained. Hrmph. All things considered, I need to make a decision that if this new baby is delivered gently and without complication, will I forgo the vitamin K injection; the answer might depend on any affect supplemental alfalfa might have during my pregnancy.
I can't talk about this pregnancy without mentioning current Summer Lily and her involvement. I haven't made a great effort in trying to create an understanding of what is going on and what it means that mama is having a new baby since we haven't told our family, friends, or co-workers yet and don't want them to hear it from Summer Lily before we are prepared to share the news. But on the morning of our appointment with Anita I felt I should try again to explain, at least so she would know where we were going and why. So I told my 27 month old daughter that we were going to drive to visit a woman named Anita who was going to help mama have the new baby when it was time, when the baby was finished growing. That mama was going to get Really Big first! That Anita was the same woman that was helping mama when Summer Lily was born. She seemed to accept all of this in stride and was content and happy during our time at the midwives', no doubt partially because of the cookie from the receptionist, and "all deese neat toyz". It wasn't until it was time to leave she started to fuss, sounding distressed and upset, repeating over and over "ohh noo! baby! baby, baby! ohh nooo!". Not until we were driving back home did I realize that Summer Lily thought we were getting our baby right that very morning during our visit with the midwives, and she was concerned that we had forgotten the baby there. Adorable, sweet, heartbreaking, enlightening, and reassuring all at the same time; my little girl didn't understand quite the same way I thought and hoped she did and she was at least interested and cared about this idea of a new baby enough to be upset that we had left it behind. Reassuring, because perhaps this means I can rely on Summer Lily to help me not forget our new baby anywhere when the time comes to actually be concerned of such things. I suppose though there is just as likely the possibility she will try to convince me to leave the baby on someone else's car, should she not think the baby is as wonderful as the idea of one is right now. Perhaps we'll have a few days of each. Taking extra care that afternoon to re-explain that it will be quite some time before the baby arrives, that we need to wait for Hallowe'en, and Christmas, and for all of the snow to come and go, and for mama to get Really Big! we awoke the next day from our afternoon nap to be talking about the baby again. Suddenly Summer Lily told me that we would need to borrow Grumpy Pa's drill because we needed to drill a hole in my belly button to get the baby out! I have full confidence that in couple of months when we will probably start looking for books about pregnancy and homebirth to share with Summer Lily that she will catch on more quickly and have a deeper understanding. I hope she enjoys hearing the baby's heartbeat at the next visit with our midwives, at the end of October.
So far my all day queasies are still hanging in, but I'm still hopeful they will up and leave sometime soon. I think though, that my morning sickness has become slightly worse as now the thought of eating certain foods, or the presence of certain smells makes me feel even sicker. I'm still eating and coping, things could be much worse. Still no other symptoms; barely fatigued any more than usual, no breast or nipple tenderness. I'm anticipating starting to feel more sensations in my uterus area, ligament stretching or some more fullness. And of course, movement, but I'm not expecting to feel anything like that until after my next appointment.
until next time,
in lovingkindness,
Ashley
& Summer Lily the Milkie Monster
& New Baby May, growing and on it's way!
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