Read the Backstory to Levi's Birth in Part 1 HERE.
The night after I hit 34 weeks pregnant, I couldn't sleep. At this point in the pregnancy game I was all too familiar with the plethora of potential nighttime discomforts, but this time was different. This time I couldn't place the blame on any of the regular sleep offenders.
My hands and feet were on fire with an itch I couldn't seem to quell no matter how vigorously I rubbed them against our sheets. After what felt like hours, I peered at the soles of my feet by the light of my cell phone, only to find my skin perfectly in tact without any hint of red, rash or bug bite.
When morning finally came, the strange itching subsided, and I tried to write it off as just one more weird ailment in a long list of potential pregnancy side effects.
But as night fell again, so did the prickling on my palms and soles. Desperate for an answer, I grabbed my phone and emailed my midwives from bed. It was 1am, and I had a response by sunrise that was devoid of their usual sweet check-ins: "We're going to have to order some blood work to rule out cholestasis."
Cholestasis? I'd never heard of it, but Google quickly filled me in. Obstetric cholestasis is essentially an unpredictable and unpreventable condition in which the normal flow of bile in the gallbladder is affected by the increased amounts of pregnancy hormones. It's essentially a liver disease that only happens in pregnancy, also called Intrahepatic Cholestasis of Pregnancy (ICP). Chilean women and women carrying twins are at a higher risk for cholestasis. I was neither. The main symptom though? Intense itching — hands and feet — usually at night — third trimester — no rash. Check, check, check, check, check.
Photo by http://jess-roy.com/
With cholestasis, the prognosis for the mother (other than really annoying itching) is good — things go back to normal once the baby is born. In contrast, ICP carries significant risk for the fetus. The main complications are prematurity, meconium-stained amniotic fluid, respiratory distress, and stillbirth. The chance of stillbirth rises significantly after 37 weeks and can increase the higher the mom's bile acid levels are as well.
Later that day I met up with one of my midwives to grab paperwork for the lab and discuss my options. The prognosis looked grim. If indeed I had cholestasis, it would mean I would need to be medically induced at the hospital at 37 weeks. This terrified me. Tears started to drop.
As a holistic nutritionist, I thought I had covered all my bases when it came to having the healthiest pregnancy possible. Preventative medicine always made the most sense to me. Do A so that B won't happen. Take A so that B will happen. And so forth. I viewed so much of my pregnancy through the lens of these preparatory equations.
Rub shea butter and Frankincense oil on your belly to prevent stretch marks. √
Take probiotics to avoid becoming Strep B positive. √
Lay off the sugar and increase healthy fats to avoid gestational diabetes. √ (I even completely 'nerded out' on this one and monitored my own blood sugar from home for a week instead of taking the glucose screening test.)
I had a whole list of ways to avoid nausea, and lo and behold, I never threw up. √
I even had a DIY oil concoction to prevent leg cramps and used it religiously in my third trimester with great success. √
I wouldn't call myself intrinsically Type A or a "super planner," but I've come to realize that I'm a bit of a preparation junkie. Proper preparation makes me feel safe and secure.
I had a plan, like so many of us do. And I had prepared for that plan to come to fruition. It was not my preparation that was lacking, but rather my willingness to be ready if my plan did not unfold according to my expectations. Preparedness is a skill; readiness is a condition. I only knew to focus on the former.
The rest of my 34th week was filled with questions. How could this happen despite my preparation? ...my commitment to my health? ...my dedication to doing ALL THE THINGS? We often feel entitled to "our best things"...the things that our in our wheelhouse. But sometimes our preparation and control can't actually maintain them, even if they are GOOD things.
I also spent that week doing as many gentle, pregnancy-friendly liver clearing things as I could, all midwife-approved. And then four days after the original itching, I had my blood drawn (a bile acids AND hepatic function panel). All that was left to do was wait for the results and pray it was all an itchy coincidence.
The night after I hit 35 weeks pregnant, the test results still hadn't come. I made my way to the bathroom at 4am, my sense of touch on high alert.
My weary mind was racing to notice each tactile sensation as it registered across different body parts: My fingers as they pried our bedroom door open. My feet as they padded across the cool, cement-colored bathroom tiles.
I was waiting for the creeping prick and pull of an itch. Expecting it, dreading it, and fearfully praying it away at the same time.
While my symptoms had improved (uncommon, but I'll take it!), my blood work had not. The official diagnosis came through later that day. [Actual blood work panels below for anyone curious or battling cholestasis themselves.]
I can't wait to share PART THREE with you all soon!
The fact that our son is almost 11 months old and I’m only now documenting his entrance into the world could be classified as avoidance coping. I fully understand that plenty of women never have the faintest interest in writing out their birth stories, but while I was pregnant, I binge-read birth stories like it was my job. However, in the days following Levi’s birth, tears would cloud my eyes when asked about the experience — and not magical, new mama tears. Although I did share the details of his birth with a handful of close friends and visitors in that first month, I didn’t enjoy sharing it — it felt like routine verbal processing.
Hawaiian baby moon bump shot at 31 weeks
I knew I needed to change my perception of the experience in order to normalize it and take the fear away, so throughout the rest of his first year, I read more, shared more, prayed more and talked my therapist’s ear off. Some people tried to silver-line my birth experience with the classic, “...healthy mom, healthy baby!” line. But I didn’t want to sell my emotions short. It’s true, I gave birth to a perfectly healthy boy, so my pregnancy preparation wasn’t all for naught. But the path to get him into the world was far from any of the potential routes I had imagined.
By this point you’re probably wondering, Well what the heck happened then?!
Some backstory first. You already know I was a tad obsessed with all things “natural birth” in the years leading up to Levi. I read Ina May before we even tried to conceive and was hopped up on B vitamins well before we had “the conversation.”
When David and I decided we were ready for an addition to the family, I was consumed with excitement to finally apply all my research and knowledge to my own body in order to set myself up for the best possible pregnancy. And all things considered, I did have an amazing pregnancy. I conceived the first time we tried, and I felt like a textbook case following that first test.
For me, pregnancy felt like a purposeful season that was meant to be dedicated to proactive preparation: mentally, physically and emotionally. I could write chapters about the things I ate, drank, did, read and watched during those eight months, but this is a birth story, not a pregnancy story, so more on that later.
To officially confirm the pregnancy, I defaulted to the nurse practitioner I’d seen for an annual visit the year before. She confirmed the due date I had predicted — April 21, 2017 — and we heard the hummingbird heartbeat for the first time. It was a quick and clinical appointment, and many of the warnings and potential interventions she ushered our way didn’t line up with what I’d come to know about the beauty of natural birth.
Anything that disturbs a laboring woman’s sense of safety and privacy will disrupt the birth process. This definition covers most of modern obstetrics, which has created an entire industry around the observation and monitoring of pregnant and birthing women. Some of the techniques used are painful or uncomfortable, most involve some transgression of bodily or social boundaries, and almost all techniques are performed by people who are essentially strangers to the woman herself.
— Family physician Sarah J. Buckley writes in her popular book “Gentle Birth, Gentle Mothering”*
I have a deep respect for those who practice obstetrics in a clinical setting. I know people who desperately need their expertise to save their lives and the lives of their babies. I came to need their expertise at one point in my birth story (spoiler alert). But I also strongly believe that low-risk pregnancies should conclude in low-intervention births if at all possible. I highly recommend reading Chris Kresser’s short, sweet and science-based series on natural childbirth here.
Between weeks nine and 13, my husband and I had many conversations about what the birth of our baby could/should/would look like. A little context: Santa Barbara has one hospital** with a labor and delivery wing (OB/GYN’s only). The other birth option in Santa Barbara is to choose from a handful of private midwives who attend home births. It was only six years before Levi’s birth that a third option opened up to the families of Santa Barbara County — the perfect middle ground, as I kept calling it around my husband. The Santa Barbara Birth Center (SBBC) has two birth rooms and a dedicated group of midwives known as the Santa Barbara Midwifery. I looked at every photo and read every word on their website. I had already listened to hours of birth stories on The Birth Hour podcast, always gravitating toward the low-intervention, natural births at home or in birth centers. And lo and behold, there was a birth center in my hometown now! I was overjoyed.
The founding midwife of SBBC gave us a tour shortly after we had visited the hospital, and the differences were striking. We were impressed by the level of care offered by the midwives and the way the birth center was outfitted with oxygen and resuscitation equipment for mother and baby, as well as IV fluids for hydration, volume replacement and the administration of medications to control hemorrhage. These are the emergency moments many worry about when considering not giving birth in a hospital. And if a transfer did become necessary during labor, the hospital is only one mile away from the birth center.
Photo courtesy of sbbirthcenter.org
I was overcome by the warmth we felt as soon as we stepped through their doors (disclaimer: the jacuzzi tubs in each room were a big draw as well). My husband saw firsthand how affected I was by the level of support and continuity of care that the midwives offered. We filled out our paperwork that next week.
Each prenatal appointment was an hour long, allowing us to get to know each of the midwives and never feel rushed with any of our questions. They became like angels to me throughout my pregnancy, never making me feel insecure, small, or unimportant as a first-time mom. And they were always just an email away.
As a social experiment, I held onto my second OB/GYN appointment at the medical group I had previously been a part of. I literally left the birth center after one appointment and popped over to see a doctor for what should have been a very similar appointment. For fun, I timed each element. I waited 17 minutes past my appointment time, saw a doctor I had not planned to see, had my blood pressure taken in the waiting room, and then met with the doctor for a grand total of six minutes. I'm sure this must sound efficient and idyllic to someone reading this, but especially with my first pregnancy, I longed for so much more out of the experience.
*Buckley, Sarah J. Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. Celestial Arts, 2009. pp. 96
**We had toured our local hospital’s birth wing when I was just 11 weeks along, and it is a beautiful and newly remodeled facility, but I had several well-founded qualms about choosing to give birth there. It’s known for its high number of interventions surrounding low-risk pregnancies/births. As of 2014, its percentage of low-risk deliveries done by C-section was over 31%, when the federal target rate is 23.9%, with many hospitals in California as low as 12% (source). Area obstetricians have chosen to prohibit natural childbirth procedures for women who have had a Cesarean section previously (a.k.a. no VBAC’s). While they have recently made big strides toward becoming a Baby-Friendly facility, I still did not feel at ease when picturing the future birth of my baby there.
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