Doing It at Home: Labor and Delivery in Your Bedroom

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When most of us think about the birth of our baby, we ask questions like Who do I want in the room? Which doctor/midwife do I want at the delivery? and Will I have a bowel movement while pushing (don’t stress if you do; it’s super common)? Until recently, very rarely did the question At home or in the hospital? cross our minds. However, over the past few years, home birth has gained some serious followers.

More and more women are opting to deliver their baby in their bedroom rather than in birth centers or hospitals. In fact, rates of home birth were up from .79% in 2004 to 1.3% in 2012. Fear of C-Sections and the medicalization of birth (monitors, medications, and modest autonomy) have collectively driven women out of hospitals and into their homes. While there are certainly benefits to home births (minus the cleanup factor—labor can be quite messy), there are some major downsides as well. Here’s what to consider if you are considering a home birth.

First, deciding to deliver at home is a BIG, BIG, BIG decision that should not be made alone. While we get that women have been delivering babies for centuries, things can still go wrong, very wrong and very fast. That’s why it’s super important that you speak with a medical practitioner (OB/GYN or midwife) to make sure that you are a good candidate for an at-home delivery. According to the ACOG, the following women are on the no-fly list when it comes to at-home births: a previous C-Section, babies who are not head down (medical term: fetal malpresentation), and multiple gestations (more than one baby in their uterus at one time). It is just way too risky.

Second, if you are good to go for it at home, make sure you are not alone. Seek out a midwife who is licensed and experienced in doing home births. You want to make sure that this is not their first rodeo. Knowing when to throw the towel in and trek over to the nearest hospital is essential.

Third, have a good idea of your surroundings. And while we aren’t referring to the nearest grocery store, we are referring to your local hospital. Being close to a medical facility can be the difference between a horrible and heroic outcome.

Why do we care so much? Well, we care about you and your baby’s safety—big time. And although most home births go off without a hitch, when compared to hospital deliveries, home births carry a significantly higher risk of bad outcomes. A large study that was recently published in the JAMA (the Bible of all good medical research) showed that death, neonatal seizures, and neurological impairment were nearly 2.5 times more likely to occur when babies were delivered at home as opposed to in the hospital. Additionally, mothers who delivered at home were more likely to need a blood transfusion. But to be fair, the data wasn’t all down on home births. Women who delivered in a hospital were way more likely to have their labor augmented (a.k.a. enhanced with drugs like Pitocin) and have a C-Section.

As doctors, we have opinions…lots of them. Most of these are rooted in research, data, and years of medical education and training. But despite our degrees, we are not dictators. We are, in many ways, nothing more than trusted advisors. Therefore, while we can give our advice and render an opinion, we can’t tell you what to do. That’s up to you. You take the information we give you and with it make an educated and informed decision.

But we’re not going to lie; on this issue, we side with the ACOG and truly believe that the safest place to deliver a baby is in the hospital or in an accredited birth center. In our opinion, the potential downsides of the at-home birth far outweigh the potential downsides of the hospital birth. And while bad things can happen anywhere, we would rather you go where they happen less.

We also get that the labor and delivery of a child is one of the most intimate experiences in one’s life. You want what you want. We know; we were patients, too. Our advice is to find a practitioner (OB or midwife) whose vision for labor and delivery is close to yours. While on D-Day what you expected while expecting and what happened may be very different, at least you are staring from a place of togetherness.

Labor is as unpredictable as the weather in the tropics. Things can change faster than you can imagine. Get ready to roll with whatever rolls in…it will allow you to weather the storm safely. Make sure you have a life jacket and safety net (a.k.a. good medical practitioner on your side) should the seas get rough.

Bad Moms

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The other night, amidst packing and paying bills, I stumbled upon the movie Bad Moms. And while I never had a strong desire to watch it, for a combination of comic relief and some much-needed mental respite, I decided to put it on. I was immediately hooked. As a mom who struggles with work and kids, family and career, there was something to this movie. And while I don’t think it will win an Oscar, the movie not only made me laugh, but I also came pretty darn close to crying (and not because I was laughing so hard).

My emotions went south because, from the title to the struggles that Mila K and her besties faced, I could relate. The being late to everything, the never having everything under control, and the constant feeling like you are doing a C job as a mom, a wife, and a professional resonated with me. Add to that the constant feeling that people are watching and judging you, and you really have yourself in a tailspin. It’s a wonder any of us can get out of bed in the morning! It seems that no matter how hard you try, crossing the threshold from “bad” to “good” feels impossible.

Unfortunately, this piece won’t offer you much in terms of advice. It doesn’t come with “10 Tips on How to Feel Better about Yourself as a Mom” or “5 Ways to Feel Good Rather Than Bad.” And that’s not because we wouldn’t share it if we knew (trust us, we give you all that we’ve got!), but because we also don’t really have the answers. We, too, just like many of you, struggle with the “bad mom” feelings on a daily basis. No matter how big our smiles are on Instagram or how color-coordinated our outfits are, we are far from perfect.

We are sharing these emotions, as well as our flaws, to bring unity amongst women. To help us all recognize our similarities rather than dissect our differences. At the end of the day, we pretty much all want the same things—health, happiness, and love. So, let’s promise each other that the next time you think about uttering the words “I am such a bad mom,” you stop yourself. Take a deep breath, and think about all that you have already accomplished today and all that you will do, both for yourself and for others.

Cut yourself some slack. Cut out the negative thoughts. And cut out the negative people who perpetuate those emotions. Although we didn’t learn it in medical school, we are pretty confident that a processed lunch with non-organic bread or an extra 30 minutes on the iPad is not the end of the world.

Give yourself a break: doctors’ orders!

The Seesaw of Hormonal Production: Why Your Periods Are Wilder Than the Old- School Wild, Wild West!

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When the arrival of your period becomes more erratic than airplanes during the holiday travel season, you know something is up, especially if before they were like clockwork. Why this is happening and what this all means can be confusing. It can also make deciding if you should wear white jeans very difficult! Most fingers point towards the ovaries and their dwindling supply of eggs and specific hormones: think inhibin, estrogen, and AMH.

As the ovaries start to run on empty, they shoot mixed messages to the brain. The brain, which is used to orderly and steady hormone levels from the ovaries, is thrown into a tailspin. Without adequate ovarian hormone production, the brain overproduces certain hormones. Think FSH and LH. There goes the regularity of your menses. In medicine, we refer to this period of confusion and “crazy” period timing as perimenopause. And to put it bluntly, this period (no pun intended) can be a big pain.

In terms of the brain-ovary relationship, think of a seesaw. As the ovaries (egg production and select hormones) go down, the brain’s hormone production goes up—and in some cases, way up. FSH levels can reach the high double digits. Ovarian hormones and hormones in the brain, specifically the pituitary gland, work in a negative feedback loop—high ovarian hormones keep the brain’s reproductive hormones low. So when you are nearing menopause and the ovarian production lays low, lower, and then lowest, the seesaw will remain lopsided. And while on this seesaw, the person left high won’t get hurt, it will have a major impact on how frequently you see your periods—as well as other things like your internal temperature gauge.

For most of our reproductive lives, the ovaries and the brain work as a team to prepare an egg, ovulate an egg, and maintain the corpus luteum (a.k.a. the structure that makes progesterone and helps maintain a pregnancy). There are some conditions where this system doesn’t run so smoothly—cue PCOS, thyroid disease, or hypothalamic amenorrhea. But for most of us, it is pretty well-oiled machine, that is, until we hit our mid-40s or so. Then the pendulum starts to swing erratically. Periods come closer together (about 20 days) and then farther apart and then close together AND farther apart. Not a pleasant combo.

Consistency becomes a thing of the past. While your mind may view pregnancy as a thing of the past, your ovaries haven’t quite given up. They are still working to prepare and ovulate an egg each month. Because of the diminished supply, they start to prepare the egg in the second half of the menstrual cycle the month BEFORE that egg will be ovulated. Simply stated, they are letting the horse out of the gate (a.k.a. the egg) long before the race goes off (a.k.a. the next menstrual cycle starts). As a result, the menstrual cycles will get shorter and shorter.

Although irregular menstrual cycles are quite common when we hit our 40s and beyond, when bleeding becomes excessive or all of the time, you need to speak to your OB/GYN. While it likely means nothing more than the ovarian reserve fuel tank is running on empty, you want to make sure there is nothing structural (a polyp, a fibroid, or even a cancer) that needs to come out. Don’t brush it off as another joy of aging!

Just like any relationship, when one member of the team goes haywire, things can fall apart pretty quickly. If you are not in sync with your partner, the partnership falls apart. The brain and ovary alliance is no different. When one stops working, the other one tries to overwork or make up for the deficiencies, which leads to irregular and often frequent periods. Although there may be nothing you can do to mend or tame this wild relationship (once ovarian production goes down, it generally will remain down), just acknowledging it can bring you some peace.

And with that, you can go out and face the wild, wild west!

Acceptance

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Weather has a mind, a plan, and a path of its own. No matter how many times we open our weather app, if it’s going to rain, it will rain. We can’t will it away, wish it away, or watch it away (although you can go away and avoid it). It is the ultimate in uncontrollable. For all of us who have planned an outdoor wedding, an outdoor event, or have been derailed at an airport because of weather, you know what we’re talking about. To put it simply, battling uncontrollable elements sucks. Watching and waiting is beyond unnerving. But this is not a piece about the weather; we are for sure no meteorologists. It is about accepting the seemingly unacceptable, making peace with a fate you never dreamed, and learning to work through the discomfort to find a new calm.

On the surface, the connection may be hazy. However, that awful feeling of “I have no control” combined with “I have no idea what will happen” is not dissimilar to what you feel when trying to get pregnant, especially when it isn’t working. And while we are certainly not equating the weather to whether you’ll have a baby (we get how different they are), we are highlighting the similarities in the emotions we feel in situations that we can’t control.

When the pregnancy thing is not coming easily, the first emotion is usually shock. We have heard many a patient say, “I thought I just had sex and it happened. What is going on? Why is this not working?” The reality is that getting pregnant can be really hard. It can be really frustrating, exhausting, and frightening. In this situation, thoughts like “Will I ever be a mother?” run through one’s head on auto-repeat constantly throughout the day.

Additionally, our inabilities to will a baby into our belly can make us angry—angry with yourself, your partner, your friends (especially those that seem to get pregnant when they just look at their partner), and your doctor. These emotions are common and normal. Everything you feel, say, and want to scream is totally legit—for lack of better words, this sh-t sucks.

While we can give you a ton of advice about fertility, a lot of advice about GYN, and a good amount of advice on OB, what we can’t tell you is how to let the anger, frustration, and I-am-so-pissed-off-right-now emotions go. For each of us, it’s different. For some, it’s time. For others, it’s distance; for still others, it’s change. But whatever it is and for whatever amount of time it takes, when you finally arrive, it will be liberating. Acceptance of what previously may have seemed unacceptable will allow you to no longer stand still or move backwards but in fact take a leap forwards. The freedom to let it go is empowering and energizing—with this release, you have the strength to tackle your next steps.

Most women struggling with infertility probably never wanted to undergo fertility treatments, let alone talk to their GYN about why things were not working out. They never imagined doing IVF, let alone something like egg donation or a gestational carrier. The realization of where you are in relation to where you wanted to be can be mind-boggling.

And while we are certainly not minimizing your emotions or making light or your situation, we are hoping to push you forward. As your pacers, we know what awaits you at the finish line. We can see the end way sooner than you can because we have run this race alongside many other women many other times. We have some serious experience on this course and know its ins and outs, turns and curves. We want to guide you to the finish and achieve the dream of parenthood.

There may be no bigger control freaks than us at Truly, MD. Admittedly, we too are type A++++ women who like to check, double check, and then triple check. Gambling is not our thing, and we almost never leave anything up to chance. It’s just not our style. But through years of both professional and personal trials and tribulations, we have had to learn to let go—to give in to the unknown and to say okay to the previously unacceptable.

While we are certainly not recommending that you just go along for the ride on your fertility treatment merry-go-round (we want nothing more than to empower you to ask questions and participate actively in your treatment), we do want to help you close that weather app and accept what’s going on outside. You may not get pregnant on a bed of roses listening to Sade…it may be in an operating room with bright lights and a speculum. It doesn’t mean you failed or are any less of a woman. In fact, most would say you are even more of a warrior woman and will make an even better mom because of all you went through to become a parent.

Although the weather forecast may look bleak, remember, things can change as the days and time get closer. And even if it doesn’t, even if it rains or snows or hails in April, you can get through it. You may need to go to Plan B or Plan C, but at the end of the day, if you hang in there, you will be a parent. You will have a family, and you will reach the end of the fertility journey.
If you can find a way to accept your forecast, the skies will be bright on the other side; you may just get wet on the way.