I know firsthand of the trouble pregnant women faced during the COVID19 pandemic. My first daughter was born April 2020 in Texas, shortly after COVID19 restrictions were implemented. It’s important for pregnant women to know their options and be comfortable with whatever decision they make.
I'm not your typical obstetrician-gynecologist (Ob Gyn). I have never had a cavity, never had surgery, never taken any antibiotics, and never even taken tylenol or ibuprofen. I relied primarily on chiropractic care (my dad) and prevention to maintain my health over the years. During part of my Ob Gyn residency training at the University of New Mexico, I worked alongside certified nurse midwives (CNMs) who practice evidence-based obstetrics in a hospital setting for low risk women. CNMs are nurses that have completed further training in graduate school in midwifery. This lay the foundation for my belief in normal physiologic birth and my desire to have a natural childbirth with a nurse midwife.
As an Ob Gyn, I realized early on the fears I have regarding birthing my own child. After all, my profession had exposed me to all the most severe and life threatening complications of pregnancy, labor and birth including abnormal pregnancy, miscarriage, ectopic pregnancy, hemorrhage, uterine rupture, shoulder dystocia, emergency cesarean sections, cord prolapse, preeclampsia, stillbirth... need I go on? The two years before I was pregnant with my first child, I worked as an Ob hospitalist at night. This involved taking care of all emergency room consults that were Ob Gyn related, and delivering patients on L&D (labor and delivery) as well as assisting other physicians with emergencies. There were many times in the labor room where I witnessed birth trauma. A study showing that 1 in 6 moms felt mistreated while laboring or after is not surprising to me. I was exposed to birth trauma regularly. I initially looked only at a hospital setting for my natural childbirth to have access to life saving blood transfusion and NICU support if necessary. The American College of Obstetricians and Gynecologists (ACOG) states that the safest places to labor and deliver are accredited birth centers and hospitals.
I realized early on though that I needed a “high touch, low intervention” support team to guide me through my pregnancy and sought out hospital-based CNMs. I used to joke that one Ob in the room (me!) is more than enough. I established care with a private CNM group but found the visits to be rushed 15 minute visits and impersonal. I needed continuity but instead was told I was going to meet everyone in the group at different visits, so I felt a disconnect from all the providers after meeting 5 different midwives. I wanted to check out other options, which we should be encouraged to do to find the right fit for us, so I visited an academic center that is staffed with CNMs. A lovely midwife at my visit told me that they are short staffed and there were times on L&D where no midwife would be available, and I would be delivered by the resident team. Additionally, I would see someone different at every visit, just like at the private group. I decided this was not going to provide the support I needed either so I set up another appointment to see the private CNM hospital group to give them a second chance. Upon arriving I was told I had my appointment cancelled last minute and was shuffled into the financial department office and was told 10 weeks prior to my estimated delivery that they would not let me see their midwife group unless I committed to delivering there and paid an upfront delivery fee copay. They were now requesting money months earlier than usual solely because they found out I was seeking other birth options. After having the appointment cancelled last minute, I lost all trust in this group to provide the support I needed during the remainder of my pregnancy and birth. I was displeased with my run into the "business" side of birthing in America. In addition to concerns about hospital birth trauma, I was also concerned about lack of privacy in the hospital. The average daily interruptions for a postpartum mother in the hospital is typically over 50. I decided to seek options out of the hospital setting.
My supportive hypnobirthing instructor emphasized how the way we think affects the way our birth will be and we worked on ways to calm my unfounded fears of childbirth. She knew of out of hospital birthing options in the area and recommended I check out birthing centers. On my first visit with an accredited birth center in the beginning of my third trimester, I felt supported and involved in the decision making process. The CNMs practice evidence based childbirth and even take care of the newborn for the first 28 days of life. I was not rushed through visits and was able to spend ample time building a relationship with the two midwives in the practice. My first visit was nearly 2 hours! The backup hospital was only two miles away, a four minute drive. There was a neonatal resuscitation setup similar to the hospital and an experienced L&D nurse that would be present with the CNM at the time of the birth. I finally found my birthing place. I got to know the two CNMs well over the remainder of my pregnancy and knew that one of them was always on call. As the COVID19 pandemic developed over the last several weeks of my pregnancy, I felt supportive and safe in the environment with my birth team.
On my daughters birthing day, at 41 weeks and 1 day, I felt nothing but support and love the entire time. My baby was monitored intermittently, which is a practice that is sometimes difficult for hospitals to implement even though data shows it to be an effective way of monitoring babies in low risk women. I was not tethered to an IV and was able to move around and labor in a deep and large tub. After laboring for several hours, I found myself asking for a break. I rested on their comfortable birthing room bed and went to sleep during my transition to complete. My RN hadn't seen anyone having a natural labor "labor down" and rest so peacefully so she was unsure what to make of it. The CNM came to see me and found that I was still contracting regularly and allowed me to rest where I was. When I was ready to push, I pushed on hands and knees position and progressed to deliver my 8 pound, 3 ounce baby girl, Anandi, in a waterbirth. My mother, sister and incredible Man-Doula (my husband) were able to be with me throughout the entire labor and delivery process. I felt that in that moment of birthing my firstborn, I finally completed my Ob Gyn training. There is only so much you can read about in a textbook and witness, but experiencing natural childbirth firsthand finally completed my training. My family cooked me a dinner in the birth center kitchen to eat right after birth. I was pampered with a herbal bath after the delivery by my CNM and then was discharged home 4 hours after my birth. My RN from my delivery then came to my home for a home visit a couple days later to check in on me and Anandi and make sure all was well.
They say that physicians make terrible patients. Perhaps this is true. Or perhaps we are just fed up with the current state of medicine and struggle to find a good fit that truly takes care of us. I would not have changed anything about my pregnancy, labor and birth. I am glad to have looked around my area for the best birthing place to start my family. Everything happens for a reason and I am so grateful for ending up at my accredited birth center and out of the hospital. I feel like I made the best decision for me. I had a patient, supportive, and competent nurse midwife catch my baby. Despite the COIVID19 pandemic, I had a supportive postpartum team of my CNM, an IBCLC that I worked alongside in my clinic, a perinatal chiropractor, and a pelvic floor PT.
I encourage everyone to find a delivery provider, midwife or Ob Gyn, that you feel safe with. Don’t be afraid to shop around to find the right provider for you.
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