The Birthing Center

18 weeks tomorrow and I cannot believe it is July 22! Where is summer going? My pregnancy is flying by and I am almost at the halfway point. My next, and likely last, OB appointment is Monday morning.

Sean and I have made the decision to switch to a midwifery group in our area. We came to this conclusion after examining several factors. First, my OB is 45 min away and delivers at a hospital 1 hr away. The midwives are 10min away and give you the option to deliver at their birthing center or at a hospital which is 15min away from our home. Second, I get the vibe from my OB practice that they would not 100% respect my plan for a natural birth. At our very first appt, I asked about their views and the doc told me, "It's your choice, but just know that epidurals were invented by women for women. If you want to be in pain, I don't really care." Not exactly the level of support I was hoping for. They also deliver at a hospital that has one of the highest C-section rates in our area and has the reputation of being the place to go if you are "too posh to push." Finally, while most of our appts have been ok, I just don't feel a level of personal care from the group. At the midwifery group, I feel like you become part of a family, which is what I loved so much about my RE's practice.

At this point, I feel like it is time for a disclaimer. Birthing a child is a very personal decision and people have very strong feelings regarding the process. I am simply sharing my experiences and impressions. I am by no means trying to preach to anyone or convince anyone that my choice is the better one or pass judgement on one birth choice over another. I respect your childbirth choices and hope that you will respect mine.

Ever since I was a young woman, I have always desired a natural birth experience. Going through invasive fertility treatments only strengthened my desire to do so. My mom had me naturally, I have a sister in law who had an amazing home birth, and I feel like I have been exposed to many positive birth stories that have further convinced me that this is what I want. Since starting my 2nd trimester I have begun to read and research my options regarding natural childbirth. I read Ina May Gaskin's Guide to Childbirth and although I found it a little difficult to relate to some of the birth stories in the beginning, the book really spoke to me and I learned a lot. In case you are wondering, my issue with some of the birth stories in the beginning is that I do not live on a commune and I didn't feel it was an accurate representation of how the modern woman in 2009 has a natural childbirth. Inspiring? Absolutely. In addition to the book, I joined a natural birth group online and began reading natural birth stories. All of this convinced me that I needed to explore options other than my OB's office, which led me to discover the midwives and their birthing center.

Sean & I toured the birthing center on Monday night and loved it. I wasn't sure how Sean felt going into it; I kinda thought he might just be humoring me, but in the end, he was 100% on board. There were 12 couples touring and that was exciting to me. One of the midwives spoke to us for over and hour and then opened the floor to questions before we toured the center. There are 3 midwives and an OB on staff and they are affiliated with our local hospital. Patients have a few options when they choose to become a patient of the practice. As long as you have a routine pregnancy, you can choose to deliver at the birthing center with the midwives. If it is more within your comfort level, you can deliver at the local hospital with the midwives. If you choose a hospital delivery, your midwife will stay by your side the entire time and work within hospital policies to accommodate your birth plan. The final possibility is if you are high risk in any way, you must deliver at the hospital. Again, your midwife will be at your side and help you achieve your goals and still have your high risk condition monitored in a hospital environment.

Ideally, as long as I continue to have a healthy, low risk pregnancy we would like to deliver at the birthing center, but I still have to sit down one on one with the midwives and make sure this is our best option.

Here are some highlights from our tour:

• There are 3 birthing suites that look just like a master bedroom.
• Each suite has a water birthing jacuzzi tub. YAY!
• There is a full kitchen and there are no restrictions on mom being able to eat or drink during labor.
• Mom is not required to have an IV during labor, but they are available in the event of dehydration.
  
• No artificial means of induction (no pitocin, cytotec, cervadil etc...)
• They will not rupture membranes.
• Fetal monitoring only done with a doppler so Mom has full range of motion.
• No time limit on labor.
• Birthing chair, stool and ball available in each suite.
• Fully equipped for emergencies (resuscitation equipment, oxygen, anti-hemorrhage meds etc...)
• Right next to a fire station and an 8 min. ambulance ride to the hospital in the event of an emergency.
• C-section rate of 8%, compared to 49% in the local hospital.
• Episiotomies performed rarely - once or twice per year or less - compared to 79% of all vaginal deliveries at the local hospital.
• Cord is allowed to pulsate for 5 min. before cutting.
• Baby is not removed from Mom until Mom is ready - most babies bond with mom and dad for about 2 hours before they are removed in anyway.
• You can go home within 4hrs of delivery if you have showered, peed and eaten.
  
• No limit on the number of family and friends that can be present.
  
• You can change your mind and head to the hospital at any point.

Overall, we felt their philosophy matched up well with ours. Whether we deliver in the birthing center or at the hospital, I believe we will have an experience that we will be happy with. I am not naive enough to believe that complications cannot arise, but I feel 100% comfortable and confident that we will be in good hands.

If you have had a natural birth or a birthing center delivery, I would love to hear more about your experiences!

Decisions, Decisions...

After many tears, a great deal of soul searching, and many conversations with each other, friends and family, I *think* we have come to some conclusions about what our next steps might be.

We are very lucky to have 6 frozen embryos from our 1st two cycles. For whatever reason, our old clinic did things kind of backwards and if you had any good looking embryos on day 3, they froze them with the thinking that they can be grown to blast when they are thawed. Here is what we have in the freezer: (scale 1-4 with 4 being the best)

1 @ 10 cell grade 3+
1 @ 9 cell grade 3+
1 @ 8 cell grade 3+ - fragmented
1 @ 8 cell grade 3+
1 @ 7 cell grade 3+
1 @ 6 cell grade 3+

Not bad, right? So, we are going back to our old clinic where these embryos were created and have a consult on 12/17. Our ideal plan (which has been proposed by my docs before) is to thaw all 6, hopefully get a few to grow to blast and transfer the best ones. We have no guarantees that anything will make it to blast at all, but we feel strongly about giving these embryos a chance to grow and thrive. I feel great that some of these embies are from the batch that created a blast or two from the crappiest among them.I also learned they can be refrozen if they look good! FCOM's FET success rates for 2007 were 42%, which is certainly enough to be hopeful about!

Now, I know this plan is not perfect. I know we run the risk of wasting time, energy and resources on something that may never work, but isn't that true of all ART cycles? I am not convinced that there aren't possible immune issues, chromosome issues and maybe even a lab issue, but I am willing to give it a shot regardless. What if it is none of the above? What if it has just been bad luck? What if I am one of those people whose body hates stims, but does much better with an FET?

We feel committed to using these embryos that we created. If it works, not regrets, obviously. If it doesn't, no regrets then either because we will still have options and even more answers.

For now, phone consults with CCRM and SIRM have been postponed indefinitely. If this FET is a bust, we will take that step, but for now, we are trying to muster the energy to give this FET the best shot possible. Honestly, another fresh cycle with all the anxiety and stress that accompanies it, is not appealing to me at all right now. It is not easy and I am not ready for that. I wouldn't cycle again locally and traveling for one day work ups and for almost 2 weeks for stims and ER adds a whole other element of stress to the mix and I want to be 100% sure of my decisions before taking that on. I need to walk through this door first and see where it leads me...

I know I mentioned the possibility of FET with PGD and I think that is off the table for now, unless our dr. feels strongly about it. That is money we don't want to have to spend and would rather hold onto if CCRM or SIRM end up being in the cards. We also decided not to move the embryos to Shady Grove. We think that it is a little risky to move them and they were created at FCOM and did really well in their lab, so why take a chance. Besides missing my polyp, I was very happy with my care at FCOM and to be honest, if feels a little like coming home.

We are not in a big rush, it has been a long year. We may opt for January or February for an FET. We are going to *try* to enjoy the holidays as much as we can handle and try to rest and heal. I am still having a tough time, I am feeling very raw and emotional and broken. I do best when I have a plan though and we are well on our way to one!

In other news, you should head on over to my dear friend, Jill's blog , and celebrate with her! She FINALLY got a BFP on IVF #3! Go wish her congratulations.