24 Weeks and No Midwife

I haven't felt like a good example for BWB lately.  It's not that I am behaving recklessly or carelessly.  It's just that I have no professional caregiver right now, and I would never recommend that to any of my followers.  It's complicated.  Matt and I are keeping track of lots of things at home: blood pressure, blood sugar, oxygen, pulse, heart sounds, respiratory, fundal height, swelling (none at all), and urinalysis.  We can't hear Evangeline's heart rate on his stethoscope yet, and plan to get a fetoscope soon. Her movements get more frequent and stronger everyday, though. I need to do better on my diet and water intake as usual.  I eat so slowly and because there are so many other things pressing on me, I don't always eat as much as I should.  I'm working on it.  My weight gain is good.  I am 24 weeks along right now.

We've been in this position before.  When I was pregnant with Malakai, we were in a huge transition that was physically and emotionally stressful.  We ended up moving from CA to NY in my 3rd trimester, and decided on a midwife after we arrived.  Then, she couldn't help us with a home birth. So, I had to fight for the birth I wanted in the hospital.  It worked.  Malakai was the first water birth in that hospital, and it was nearly unattended (I say this as a good thing)!  It is good for me to reflect on that because it reminds me of how God has taken care of us in the past, and I can trust He will take care of us again this time.  That being said, I still firmly believe that his birth would've been handled better at home.  He had a meconium issue that you can see in the video below.  
At home, we would've suctioned and if he needed breaths, we have a warm tray (for a warm flat surface) ready right there so that he wouldn't have had to leave me at all and we wouldn't have had to cut his cord.  When a baby isn't breathing, he especially needs all the oxygen from his cord blood.  However, we were in the hospital.  So, they weren't set up to handle things like that.  I can't really complain as many many things were handled the way we wanted and they didn't give me much trouble at all.  We had zero separation, he slept with me and never in the crib thing, and when they were supposed to have him in the crib while we were being transported from delivery to recovery, they supported my decision to carry Malakai skin to skin inside my gown under blankets.  It's cold in the hospital!!  All things considered, we have a lot to be thankful for with our hospital birth experience.

A homebirth midwife such as a CPM (Certified Professional Midwife) is my preference of caregiver.  I personally believe that CPMs are better trained in the natural birthing process, and how to most effectively care for complications without the restraints of hospital protocols.  The care they provide prevents most complications in the first place.  On the other hand, they are skilled to know when things are not safe to stay home and when to transport to the nearest hospital.  They are passionate about what they do, and are not motivated by money or time (There are exceptions, of course.), but rather are motivated to provide customized care to mom and baby/babies.  Of course, I would never argue that CPMs are the only ones that provide this level of care.  I just feel like I have the best chance of getting the care I want, if I choose a midwife such as a CPM.

Because of the ridiculous legal situation with CPMs in our area, I can't share any of the details you may be wondering about.  I will say that I will continue to take care of myself, improve my diet and water intake, and we will plan Evangeline's bubble wrapped birth as soon as we can.  There are some options we are considering.  I hate that I can't just be open and share all the details with you.  Please just pray for wisdom in these decisions that need to be made very soon.  Please pray that the best midwife for this birth will be available and we will be able to relax and just enjoy the next few months before Evangeline's birth.

Thank you so much for your support.  I know that there are many BWB mamas who would make very different choices than I am right now.  I completely respect that, and I hope you can do the same for me in return. 

Home Birth, Midwives, and The Law

Silas in our herb bath still attached to his placenta (in a bowl next to him)

When you birth at home (assuming you have a great midwife), the focus is what is in the best interest of you and the baby, no strings attached.  At a hospital, even if you have excellent care, there are often hospital protocols and impatient medical personnel that you must choose to appease or fight.  I've had a great hospital birth, but even so, my midwife had to deal with a bunch of junk in the hallway to fight for my desires instead of just focusing on me and the baby.  There were things that happened to Malakai that we did not want, but had to because the hospital said so:  eye goop, vitamin k, ridiculous hearing test, not going home when we wanted to, etc.  At the hospital, the baby belongs to the hospital.  At home, we can just be a family.  Having a homebirth is not about having a fun or amazing birth experience for the mom.  It is a choice we make because we believe that is where our baby can have the safest most gentle birth without being cumbered about with much hospital protocols.  Yes, complications can arise, but they don't happen as much at home.  Unnecessary interventions (often because of hospital protocols or impatient medical personnel) CAUSE complications that require more interventions.  The most common are inductions, and timing labor and delivery to the extent that they do.  There are so many more, but most women don't even know they are wrong because they've never been taught otherwise.

Malakai on the scale after his pretty amazing hospital birth.
It makes me sad that all his beautiful vernix is gone here.
He was covered with it when he was born!

Certified professional midwives in states such as Indiana, practice "underground".  They must if they are going to help women who are having homebirths.  They can be extensively trained and certified, but the state simply does not allow them to obtain a license.  This legal situation is wrong, and those who act against it do so because they believe they are doing what is right in spite of the law.  This is much like how many people would respond to an anti-gun law.  I can tell you without a doubt that there would be countless people who would refuse to bend to that law and would not allow the government to disarm them.  Another example would be if it became illegal to carry a Bible or meet as a church.  Christians would then have to make a choice to obey the law or continue to follow their beliefs in spite of it.

In the case of Carol Velasquez, the deputy prosecutor claims that the issue is with illegally administering prescription drugs.  Those are the charges against Carol.  If Carol was carrying the drugs she is accused of carrying, she is in good company.  It would be very hard to find a midwife who doesn't carry Pitocin (for example). These midwives are simply arming themselves for any possible complication that may arise and the natural remedies are found to be insufficient.  Homebirth midwives should have the legal safety to care for their clients the best they can, but that is not the case at this time.  So, they give their clients the very best care while putting themselves on the line.

What needs to happen is that people need to speak up on the issue of homebirth freedom.  Midwives need to have the freedom to provide optimal care without the threat of the nightmare Carol Velasquez is going through right now.

Honestly, my husband put it in much better words than I did:

"Here is the thing, it is not a simple black and white issue. Is it technically illegal for a midwife to administer drugs such as Pitocin? I would have to answer yes. However, in order for midwives to be able to give excellent care to their clients and avoid certain complications they NEED to be able to use these drugs. The real problem is that it SHOULD be legal for CPMs to be able to use these drugs. By not allowing them to use them we are forcing midwives to either choose to compromise their clients care by forcing them to wait until they get to the hospital to receive treatment which in some cases may be too late when it could have been resolved easily at home by the midwife or take the risk because they are more concerned about the welfare of the baby and mother over the governing legislative body. Most midwives will choose the latter. It really is no different than a missionary going into another country where Christianity is outlawed, and under the pretense of being an English teacher, using that as a way to get into the country to teach them about Jesus. As Christians, we know it is TECHNICALLY illegal for them to teach Jesus and carry/distribute Bibles, but yet we encourage them, support them, pray for them, and fight for them if they get caught, because we believe it is the right thing regardless of what a governing body has declared. The same principle is true in this situation. The problem lies in the legislation, and I think some serious changes need to made at that level so midwives are not forced to make the sacrifices they do for the good of their clients."

 ~Matt Reeves

Support Carol Velasquez CPM!

BWB family, I am posting this link hoping that some of you would be able to join me to support Carol Velasquez. Carol is a certified professional midwife who has over 20 years experience providing optimal care for women, babies, and families. She is a dear friend to me and my family. ~Sarah

PLEASE READ:

"On March 28th, 2013 Carol Velasquez, CPM was indicted by a grand jury for practicing midwifery during her time in Indianapolis. Carol is a Certified Professional Midwife with over 20 years experience attending births. The care that Carol provided her clients was unparalleled by the Obstetric community and hospitals in Indiana. The women she attended received prenatal care according to the same schedule and yet she spent an average of 700% more time with us! This was acheived by scheduling 2 hour long appointments (as opposed to the 15 minutes OB/GYN's allot for patients.) She provided women with detailed nutritional counseling, recommended supplements according to the individual needs of the mother, and practical as well as emotional support to women facing difficult circumstances (myself included). Because the State of Indiana refuses to license CPM's Carol put her freedom on the line for each of the families she helped. Let's show our support for this brave woman on Tuesday morning as she surrenders herself to the court!"

*I am going to try my best to be there. I may have all my children with me. If you are in or near Indianapolis and want to help, please meet me at the courthouse on Tuesday morning (4/2/13)! If you can't be there, please share this event in as many homebirth friendly circles as you can, and please please pray. ~Sarah

CLICK HERE TO VIEW THE EVENT ON FACEBOOK

Thank you all so much for reading this blog.  This is an unusual post calling you to action, but I wouldn't ask you if it wasn't important.

-----> PLEASE SEE UPDATED POST HERE!

A Simple Guide to "Bubble Wrapping" Your Birth:

We put bubble wrap around things that are special to us:  special Christmas decorations, fine china, crystal, figurines, and other treasures.  There is nothing more special than finding out you are carrying a new life inside your body.  You don't want anything to harm your most precious treasure of all: your baby.  "Bubble Wrapped Birth" means a birth planned with care to keep your baby safe through the birth process. 

But, how? 
Here are six key points to planning your own bubble wrapped birth:

1.  Be healthy. Making healthy choices and having a healthy diet is the foundation for a safe birth. This link is a good place to start.

2.  Know your body.  Understand your unique health facts:  birth history, factor level, bleeding history, etc.

3.  Know your baby.  Study fetal development.  Understand the impact that prenatal health, gestational weeks, and birth choices make on your baby.

4.  Understand birth.  Research the natural birth process, what things hinder the process, how to work with your body, how to safely deal with labor pains, and when interventions are truly necessary. Click here for an excellent resource to get you started!!

5.  Know your options in your area.  Is there a birth center available to you?  What options are offered at your local hospital:  midwives, water birth, doulas, competent NICU, etc.?  Are there good home birth options with competent care and medical backup such as support from your HTC with cord blood testing, etc.?  What policies will you have to work with at each birthing location?

6.  If you are unsatisfied with the options in your area, work to change them!!

Interview with Liz Purvis

Two weeks ago, Liz Purvis shared her heartbreaking story about the birth of her son, Ben (Tater).  She allowed me to ask her questions about her birth.  My hope is that this mom's message will touch your hearts and make you think.  If you are touched by her story in any way, please leave a comment for her below.  I know it would mean a lot to her to read that their family's suffering is not in vain, and she is helping others by sharing her story.

BWB:  Why is it so important to you to share your story and is it emotionally difficult to do so?
Liz:  It is important because I had no idea that I was pregnant with a son who had hemophilia. I feel like everything went wrong. I want to share my story with other moms who are in the same situation.  Hopefully, they will take away something from this and be prepared. It is very emotional. For 6 days I tried to bring him into the world safely, and it didn't happen.  It's hard to see all the beautiful and safe births, and ours went so wrong.

BWB:  Do you know why your water broke at 34 weeks?

Liz:  To this day, I have no idea. I remember telling some friends and the doctor that my belly had dropped.  I remember feeling the urge to clean the night before. My husband had literally just walked in the door from being out in the field for a week. I was starting a load of clothes, and it just happened.

3 months pregnant

BWB:  How was your nutrition and hydration during your pregnancy?

Liz:  Great. I only gained 20 pounds (though, I only made it 34 weeks! lol) I ate well, drank plenty, and took my vitamins.


BWB:  Do you think the progress of your labor was hindered in any way due to the care you recieved at the hospital?

Liz:  Yes.  I was on my back the entire time.  I wasn't allowed to eat.  I had fluids going in at 200 cc an hour.  I was forced to be in the bed all the time and use the bed pan.  I would get up and use the restroom when the nurses left because it seemed like I had to go every 15 minutes.   I wasn't allowed to walk.  I was allowed to be up for one hour a day when I would play cards with my husband.  I was very uncomfortable with different people in my room all the time.  I was very uncomfortable.  We had no clue what was going on.  We were away from home.  I was always taught (in school) that the baby needs to come out within 24-72 hours after water breaking.

BWB:  "failure to descend" - By any chance, were you on your back?

Liz:  Yes I was. I also had cervical cancer and had lots of biopsies done on my cervix and cancer removed.  So, I never thought I'd be able to delivery naturally with all the scar tissue.  No one listened.  I saw a different male OBGYN every visit, and I was transferred to a different hospital.

BWB:  What drugs were involved in your delivery?

Liz:  They hung pitocin after the contractions starting coming on their own. I was very upset with that. I didn't want that stuff at all. I said, "I waited for 6 days!  Now you can wait!", but they hung it anyway.  It was the worst thing ever.  I had an epidural that the doctor turned off while I was trying to push.  He said if I could feel the contractions maybe I could push him out.  I was also getting iv pain meds: Stadol, I think.

BWB:  Do you believe the Pitocin made your contractions too severe for Tater?

Liz:  I know it made it very hard on me.  So, I imagine they were too severe for him.


BWB:  Did the Pitocin make the contractions so severe that it made the epidural essential for you to endure the pain?

Liz:  Yes ma'am. The last thing I wanted was someone messing with my spinal fluid and putting a needle in my spine. 

BWB:  What is your opinion of them using an internal monitor on Tater?

Liz:  I was ok with the first one.  Tater kept moving around.  So, the external monitors couldn't read. 
*Liz went on to say that she was not ok with the second set that was put on Tater.  It made her very uncomfortable as a mom, and she questioned the medical staff about it being too much for him.


BWB:  How was your strength level when you were induced?

Liz:  I was tired, and recieving so much iv fluid that I was up and down every 15 minutes.  I couldn't sleep because of all the monitors on my belly.  I hadn't had a meal.  I was finally upped to a liquid diet after 2 days.


BWB:  Had you been able to keep up your strength by eating and drinking for the 6 days you were in the hospital?

Liz:  No ma'am.

BWB: How long were you contracting before the c-section?
Liz: about 9 hours


BWB:  How do you feel things were handled after the cesarean?

Liz:  Horribly.  My stomach was growing, not going down.  I had horrible back spasms. My legs were swollen my ankles and feet were so swollen that I couldn't even wear a house shoe.  The pain was horrible.  They wouldn't tell me what was going on.  I had to climb from the surgery bed to my own bed.  They wouldn't even let Bubba help me transfer beds.  I wasn't allowed food or water.  I went to the ER after being discharged for 2 days.  They rushed me back.  I had high blood pressure.  I was so swollen.  They did ultrasounds of my thigh and leg because they thought it was a blood clot.  They stuck me over 6 times to try and get blood.  The amount of blood I had left was too low and they wanted to transfuse me.  When I was admitted back, they gave me iron pills and 3 doses of blood pressure meds, and discharged me again.


BWB: What caused his intercranial hemorrhage?
Liz: We really don't know if it was from all the trauma or if it was spontaneous.

BWB:  What have you learned from this experience?
Liz:  To not have another baby. I don't know how all these people were involved and let things go so wrong.

BWB:  What is your advice to pregnant women who are reading your story?

Liz:  Speak up! If you're not comfortable, talk with the staff and get comfortable.  Don't do anything you don't want to do.  Watch for signs of a brain bleed.

BWB:  What would you like others in the hemophilia community to learn from your story?

Liz:  My story is not normal.  Most people don't go through all of this.  Don't be scared.  Work with your hematologist.  Let your family and friends support you.  Make sure everything is ready just in case.

BWB:  As a nurse, how do you think the medical staff should've communicated with you during and after Tater's birth?

Liz:  They could have done much better.  The doctor was always too busy to talk with me.  The nurses just did what they were told.  The NICU staff was amazing.

_________________________________________________________________________________

Liz's story has made a huge impression on my life.  I am grateful to have had the honor of meeting her online and speaking to her over the phone.  I believe Liz's birth was stolen from her.  She had plans of a gentle birth.  She took care of herself during her pregnancy, and she and her husband were looking forward to having a large family.  For whatever reason, her water broke at 34 weeks.  Her birth was horribly mismanaged, and resulted in lifelong injuries for her sweet little boy.  Liz cares for Tater everyday with her whole heart.  She and Bubba want the very best for him.  Please comment below for Liz.  She will receive anything helpful and encouraging you can share. 

The Last Few Days / Weeks Before the Big Day

Everything is ready except for a few more towels that we are getting from Matt's mom.  The pool is blown up and cleaned.  The liner is on and cleaned.  A sheet is laying over the pool to keep it clean.  All the birth supplies are gathered and organized.  Our midwife and doula have both been to our home making sure they know the route well.  We have Silas's clothes washed up and in his drawer, the blankets washed up, and we have diapers ready for him.  The HTC sent the blue capped tubes for collecting the cord blood to be tested, and things are set up with the local hospital.  The carseat should arrive today. . .  Lets's see, anything else?

We are as prepared as we can be.  Now, we just wait.  This last bit of pregnancy always seems to be the longest, and it is very hard to focus on anything except for baby and birth.  However, I can't just neglect everything else.  I have a husband and four other children!  We homeschool, there are dishes and laundry to be done, and messes to clean up. 

The unknown is always aggravating to a certain extent.  I was just talking to another mom about her birth, and it has me puzzled.  Her baby's cord was wrapped around his neck twice close to the placenta.  Everytime she stood up, his heartrate dropped.  Pushing him out was strangling him.  I will talk to my midwife about this, and find out what is the best thing to do in a scenario like this.  One of my weaknesses is trying to figure everything out.  I want to understand what happened, and why, and how to best deal with it if it happens to me or someone else. 


Meanwhile, it's time for breakfast and everyone needs to get dressed.  We need to have a great school day and lots of housework is needing to be done.  I love my job.  It is not easy, but being a mom and devoting all of my time to taking care of my family is the best job I could have.

Silas will be here very soon!!  I'll be 39 weeks in just 4 days! 

I Have a Dream. . .

Well, it is very late, and I should be dreaming in my sleep.  Instead, here I write on this blog that holds so much of my heart.  We are officially 38 weeks now that it has hit midnight.  Birth is on my mind even more than usual.  Why do I do this?  Why did I even start Bubble Wrapped Birth?  Why bother?  I'll tell you why.  This is something I believe in with all my heart.  I learned about gently birthing my babies before I knew what the word hemophilia meant.  I want to get the attention of those who have a voice that can make a difference or be that voice myself.  There is a better way, a safer way to protect our little ones through the birth process.  I have a dream that someday our recommendations for delivery will include more than they do now.  Things like:  no pitocyn, avoiding epidurals, getting us up off of our backs, keeping the mom comfortable and making freedom of movement an essential priority, considering water birth, and no forceful pushing.  We can work with our bodies.  We do not need to fear birth.  God did create our bodies to do this.  We are strong.  Our babies are affected so much from birth.  Birth does matter!  Someday, my little girl may have the honor of motherhood, and she will need to choose what is the safest way to birth a possible hemophiliac.  I am doing this for me, for you, but mostly for her.  Goodnight, dear readers.  Sweet Dreams. . .

"Pushing" for a Gentle Birth

My husband and I have had 4 beautiful all natural water births, and are looking forward to our 5th in the next few weeks.  If you've read my birth plan, then you may have noticed #6: "I will not start pushing until my body starts pushing on its own. If I get an undesirable urge to push before then, my midwife will check to make sure I am fully dilated. Ideally, I will try not to ever push to make sure the baby comes out as easy as possible."  I want to use this BWB post to talk about my experiences with pushing.

Isaiah still in water seconds after his birth

With Isaiah, our first born, I pushed with every contraction as soon as I found out I was 10 cms dilated.  I felt like I was pushing against a brick wall.  Now, I know that I should've waited until my body started pushing on its own.  Of course, my midwife wasn't intending on my forced pushing.  She told me to push if it felt good.  I was pushing because I thought that my baby would get into my arms faster if I did.  Well, that pushing lasted for 4 hours.  Isaiah was fine.  Our midwife kept a close watch on his heartrate, and when he started crowning, she kept a close eye on his skin coloring.  The only issue he had was that the plates in his skull were very overlapped, and even caused the roof of his mouth to not be smooth which effected his ability to latch on well.  Isaiah does not have hemophilia, and I am so glad because I think all that time in the birth canal may have caused problems if he had hemophilia.  As it was, the overlapping issue was resolved in a few days, and he was just fine.

Right after Ana's birth

Ana, our second, was another story!  I didn't mention in the previous paragraph that Isaiah was 9#8oz at birth!  Well, Ana was only 7#4oz.  That is a significant difference!  My midwife would not tell me when to push.  She said, I would let them know when it was time for me to push.  So, I waited.  It didn't take long at all until all of a sudden I was pushing with a contraction.  It just happened!  I wasn't trying to push or anything.  It was a natural response to my body's birthing process.  Within 6 minutes, she was born.  It was amazing!  Ana is a carrier of severe hemophilia A like I am, and did not have any issues at birth.

Elijah hours after delivery

Our third birth, Elijah was very different from Ana's birth.  If you read his story, you'll get a better idea.  One thing I did right was that I "tested" pushing with a few contractions, not a lot, just a very little start of a push.  It did not feel right.  So, I did not push.  I only started pushing when it felt right.  Which brings up the issue of epidurals.  Yes, they occasionally have their place, but they should be avoided for so many reasons.  Knowing when it feels right to push being one of those main reasons.  I learned in my first birth, that you can push too soon even after you're dilated to 10cms!  Ok, off the soapbox and back to Eli's birth.  When it did feel right to push, I quickly realized that this baby was BIG.  He wasn't coming out easy like Ana did, and I didn't want him to be in the birth canal as long as Isaiah was.  So, I P-U-S-H-E-D harder than I had ever pushed before!  When his head came out, my body rested as it always does.  It felt like forever!!  When I began pushing again and his shoulders and torso came out, I thought he was totally out, and went to scoop him into my arms.  "One more push! one more push!" my midwife and husband said.  I gave another little push, and that big 10#14oz bubba was in my arms!!  He was pink, and had no bruising at all.  If you read this blog, you know that Eli is our hemohiliac.  We didn't know until he was 4 months old that he had hemophilia.  I believe with all my heart that God's grace, the gentleness of his birth and my management of the pushing stage of his birth are credited with his safety.  It blows me away that our severe hemophiliac was the one that was almost 11#s at birth! 

Malakai just minutes after delivery

Malakai's birth was a breeze.  Like Ana, I didn't have to actually push at all.  My body just pushed him right out.  He was only 7#12oz.  He did have a meconium issue after his birth, and he was fine once they got it all suctioned out of him.  If you would like to see one of our births for yourself, we have a very non-graphic video of Malakai's birth on youtube.  His birth was the first one that we planned in the knowledge that our baby had a 50% chance of having hemophilia. 

All of our births have been water births.  I am a true believer in water birth.  I think it is a major cause of the gentleness of our births.  I have blogged about this before in:  Why I Love Water Birth:part 1 and Why I Love Water Birth: part 2.

The conclusions I draw from all my various pushing experiences are these:

1.  Don't push just because you are 10 cms.

2.  Focus on relaxing and staying "on top" of the intensity of your contractions.  If you are working with your body, your body will naturally start pushing on it's own, and you may not have to push at all.

3.  Only push when it feels right.  Sometimes, with very large babies, it may be necessary to push with your body.  I personally do not believe it is good for a hemophiliac to stay in the birth canal for a long time based on seeing what happened to Isaiah's head.  So, I do believe I did the right thing in pushing very hard with my body to get Eli out as soon as possible.

4.  Being as relaxed as possible, and in a position that allows gravity to help the process helps the pushing stage be much easier on mom and baby.

Thank you for your interest in Bubble Wrapped Birth.  As always, please don't just take my word for anything.  Do your own research.  Talk to your doctor or midwife.  This is what I believe and what I know works for me.  However, I do hope I have sparked some thoughts about the 2nd stage of labor that you may not have had before.  Thanks for reading!

Details, details, details!! (Of our hemo birth plan)

We put padding in our little hemo's clothes, use a helmet, and don't have a coffee table. We do these things to control our little hemo's surroundings to avoid bleeds in early life.  To the best of my ability, I need to control my baby's surroundings when it comes to birth.  Well, I am my baby's surroundings!  If I am tense, my muscles are tense and less flexible.  If I am lying on my back, my pelvis is up to 30% smaller, and my baby has to hit my tailbone and fight gravity to get out.  If I do not have freedom of movement in any way, I am compromising the ease of my baby's birth because I am not able to move with my baby's descent and delivery.  If I force pushing, I am potentially forcing my baby into the birth canal before he is ready and putting more pressure on his head.  If I am induced with Pitocin, my contractions are much more severe than natural contractions, making a lot more trauma for baby.  If I am drugged with an epidural, I am not as aware of my body throughout the birth and cannot respond to my body's cues (position, pushing, etc) In this light, we have designed a very careful birth plan with hemophilia in mind. 

Here's the details:

1.  I will be having a water birth.  Being in the warm water helps me fully relax and have full freedom of movement.  The warm water even helps me stretch more easily, preventing tearing.  It is also so pain relieving for me that it removes the need for an epidural (which usually leads to pitocin). 

2.  I will birth in an upright position: hands and knees, squatting, standing, or sitting on a birth stool.  The last two being out of the pool if I choose to get out.  The only exception would be laying on my side if for some reason I felt like laying down.  These positions let gravity help my baby and let my body open to the max!

3.  I will have intermittent monitoring as opposed to having a monitor strapped on my belly.  This also helps me have total freedom of movement.

4.  I have an IV available if needed, but I'm not planning on using it otherwise. This is also to help with freedom of movement.

5.  I will be eating and drinking through my labor, keeping my energy up and staying hydrated.

6.  I will not start pushing until my body starts pushing on its own.  If I get an undesirable urge to push before then, my midwife will check to make sure I am fully dilated. Ideally, I will try not to ever push to make sure the baby comes out as easy as possible.  This seems to be a small baby anyway.  So, there's a good chance he will be born without me pushing at all. 

7.  When Silas is born, we will not cut his cord.  We will allow him to receive all of his blood and stem cells.  We will wait until his cord is empty of blood, and his natural "Wharton's Jelly" has naturally sealed (clamped) his cord.  Then, we will cut the cord.  I believe that this approach will help him in many ways including reducing/eliminating bleeding from cord site if he has hemophilia.

8.  Our midwife will draw tubes of blood from the placenta to have his factor 8 level tested.  She has experience with this and I am confident that she knows what she is doing.  We have worked with her before and she is amazing!

9.  We are working with our HTC to arrange getting his blood tested right after his delivery.

10.  If Silas has any bruising or any sign of a bleed we will take him to the ER immediately to get him checked out. The hospital is less than a mile and a half away. Since we already have a hemophiliac, we do have factor on hand as well. 

11.  We've asked another hemo mom to attend the birth as our doula.  She is also a trained L&D nurse. 

12.  Also, I will be going to a chiropractor weekly until the birth to be sure my pelvis is in perfect alignment.  This will help the birth be easier on Silas as well.

Our approach is to do everything we can to give Silas the most gentle, non-traumatic birth possible to prevent a bleed in the first place.  We have hired a midwife who is highly skilled, and carries emergency equipment, drugs, and herbs.  I am pleased that we'll have another hemophilia mom attending the birth, and that she is a trained L&D nurse.  I am so excited and looking forward to an incredible birth!!

As always, I want to remind all my readers that I am sharing what we have decided for our family.  In no way do I think someone should use this as a blueprint for their own birth.  I only want to share what I've learned and spark thought.  If anything on this page interests you, look into it for yourself and discuss it with your doctor/s.  Thanks for reading!

33 1/2 weeks and planning a HOME birth!! :o)

The last time I wrote, I was unsure where we were going to be, or what kind of birth we would be planning for Silas.  We are now in IL.  We have hired a licensed midwife from out of state to attend our home birth.  We had this midwife for our firstborn, and love her very much.  She gives excellent care, and is extremely competent in handling emergency situations.  We have also hired a doula to attend.  This doula has nursing training and is a hemophilia mom herself.  We live 2 minutes away from the hospital, and we have a new hemotologist who has accepted and run cord blood from home births in the near past.  We are officially meeting with him in a few days, and do not anticipate an issue. 

I am so excited about this birth!!  Matt and I will be ordering the birthing pool and supplies this week.  My mom and Grandma plan on coming down for the birth.  All 4 of our children will be able to be there too.  Although, Isaiah, our oldest (7yrs), plans on playing video games through the whole thing!  ;o)  I love that we are receiving such excellent care.  I love that another hemophilia mom will be there too, and that she is a nurse.  I love that we can still get his cord blood tested from a home birth, and I love that we are so close to the hospital in case of any emergency. 

God has worked this out incredibly.  We are looking forward to another beautiful birth.  I want to live post/blog Silas's birth when the time comes if I can work it out.  All the pics posted will be "G" rated as I am not comfortable posting graphic pics of myself on the internet.  I would love for you all to be "with me" through our special day!

The Last 4 1/2 Weeks. . .

Four and a half weeks ago, we found out that the baby we are expecting is a boy.  As you probably know, this was significant news for us since I am a carrier of severe hemophilia A.  I've been off facebook a lot ever since. This was first because of a virus that hit our family right after finding out our little one is a boy, and second because we have a lot going on right now, and I have a lot to mentally and emotionally process.  I want to take some time and talk about that.

When I first saw that second pink line appear, I knew I was having a girl.  Of course I was having a girl!  I was so emotional, and we already had 3 boys and 1 girl.  Also, planning a birth for a girl is much less stressful for us than planning a birth for a boy, and I just knew that this time, we'd get a break.  This summer, we are moving, Matt will be going back to school in the Fall to pursue a nursing degree, and work full time on top of that.  It is very exciting, but also pretty stressful.  I was thinking that at least the birth planning would be a breeze.  We are hoping to move to MI where we already have a great midwife.  A girl would mean planning a simple homebirth with a midwife I already know and love.  Even though I said, "Oh, yeah, we could be having another boy!", I didn't really believe it.  I knew I was having a girl.  Then, it was time for our ultrasound. . .

The technician was so friendly and happy with us about our expecting our 5th.  She couldn't see anything revealing for what seemed like so long!  She was busy measuring all kinds of things, and then. . .

"Well, you've seen that before!" she said.

It was NOT the cord!  We saw very clearly that we were having another boy!  Matt and I just laughed.  4 boys and 1 girl?!  Wow!!  I was already very much in love with this tiny little guy, and now I knew that he was a HE.  We even knew his name:  Silas Martin Reeves. 

Even though we were very happy, we were in shock.  A boy meant a lot more work.  Yes, he could have severe hemophilia, but that wasn't what was weighing so heavily on me.  I was counting on having a break this time with birth planning, and having a simple homebirth.  With all the things we are dealing with right now, this was not going to be one of them. . . BUT now I knew it was. 

2 days later, our family was hit by a horrible stomach virus.  Eli was first.  He had a fever, and since he has a port, that meant 48 hours in the hospital.  It hit us all, and it was bad.  It lasted 5 days for each person, and it took 2 weeks total for us all to be well.

After we were well, I started thinking about Silas's birth, and things started hitting me.  Once again, I don't know where we are going to be for this baby's birth, and now, I have to plan for a severe bleeding disorder!  I still am not convinced that there is any danger for a severe hemophiliac with a gentle vaginal delivery unless drugs or interventions are involved (with the exception of breech, placenta previa, etc).  My main concern for planning a birth for a boy has always been getting his cord blood tested.  If we didn't get his cord blood tested, we would have to take him in for a blood draw which is traumatic for a baby. 

Our 4th, Malakai, was our first hospital birth.  His birth was awesome, but there were some things we didn't like especially afterwards:  the lack of rest, all the strangers (drs and nurses) coming in to touch the baby, the fact that the hospital pretty much owns the baby until they discharge you both, the ridiculous hearing test, the required vitamin K (although they did allow us to use oral instead of a shot), having to be separated for a few minutes from the baby so they could help him start breathing at birth (ended up being meconium, and they did a great job; but at home, we would've been set up right at the pool), our children couldn't be there at all due to a flu epidemic at the time (not to mention the fact that there was a flu epidemic at the time, and we were there with our newborn!), and the heel prick.  Malakai didn't have hemophilia, and we had an amazing hospital experience to say the least.  All the issues I just listed are nothing compared to what I've heard other people complain about, but still. . . I am a homebirther at heart.

I do not think that homebirth is the right choice in every situation, and maybe it's not the right choice for Silas.  I don't know yet, but I can't plan his birth until I know where we are going to be.  Matt has applied for so many jobs in MI, but has no leads.  He has started applying here in NY as well in case there is nothing in MI.  Soon, he will probably expand his search to other states as well.  We really can't afford to be picky right now!  Our income will end in just a month or two.  I decided that right now, I will just focus on keeping myself and Silas healthy, and when I know where we will be,  I will start planning his birth.  Before then, it's just too overwhelming for me. 

Even with all the birth planning stress and the possibility of more hemophilia in our family, I am SO excited about our new little guy!  Silas is a sweetie.  I am 21 1/2 weeks along now.  I feel him moving around more and more everyday.  My heart is full of love for him!  I know that everything will all work out, and when he is safely in my arms, I will look back on these days and smile.  God has always taken care of us.  We have been in more stressful situations that this, and everything is going to be ok. 

Thank you for your patience right now, and all your love, support, and prayers.

If I ever needed a c-section. . .

This is one of the most beautiful birth videos I've ever seen, and it's a c-section!  This hospital in the UK has made a great effort in making a cesarean birth as gentle and family oriented as possible.  The baby is handled so gently, they delay cord clamping/cutting, and there is no separation from mother until she has to be moved to the recovery bed.  Even then, there is no separation from father.  If I ever needed a c-section, I would insist it be handled like this one! 

"Oh, I don't care what we're having, just as long as he/she is healthy. . . "

It's funny to hear this statement now that I know our baby has a 50% chance of inheriting my mutated gene, and either having or carrying severe hemophilia a.  I don't say the above statement anymore.  Now, it's like this, "I do care what we're having because knowing we are having a boy or a girl greatly effects our birth plans.  Matt and I choose to find out the gender to best plan the safest most appropriate birth.  I want a healthy birth, but I want the baby exactly how God hade him/her whether that means 'healthy' or 'hemophiliac' or any other genetic disorder.   As far as wanting a girl or boy more. . . no.  I want the baby we have to have the safest birth possible.  I wouldn't change a thing about him/her."  Although, I know I am thinking too much into the traditional statement for which this post is named, this was on my heart, and BWB is the best place for me to share it.  Now, off I go to eat a healthy breakfast for my sweet little one.  <3

Hemophilia Awareness Month Daily Facts (posted thoughout March on my facebook profile page)

1. Hemophilia is an X chromosome genetic mutation. That's why girls are carriers. We have another X to make up for the affected X. (There are exceptions, but it's complicated) Boys don't. So, a mom that carries the gene (ie: me!) has a 50% chance of passing on the gene with every pregnancy. Dads who have hemophilia will never pass it on to their sons since their sons get their Y chromosome. However, all their daughters will be carriers since they get his X chromosome, and the affected X is the only one he has to offer.

2. It is very nice for a hemophilia mom to spend the evening at the salon (via birthday money) after an exhausting day at clinic with all the children. . . ;o)

3. The most common hemophilia gene mutation is "22 inversion". All the right information is there, but inverted in a section of the X chromosome. Therefore, the information that is there cannot communicate to get the job done (in this case: make factor 8!). This is the gene mutation in our family.


4.  When you have a child with hemophilia, everyone is affected. We are not just a family of 7 with 2 hemophiliac boys. Our family has hemophilia. We may not all have it in our bodies, but we have it in our family, and we deal with it everyday. We are all in this together! :o)

5. When my Dad was a young boy in the 1940s and 1950s, most hemophiliacs didn't make it through their teen years because the only treatment was whole blood transfusions. Their was no preventative treatments. The few that did survive, suffered major bodily harm from their bleeds, and their bodies are mangled, but they're probably some of the strongest men you'll ever meet. The most impacting thing for me is to hear these men speak of the different life their grandsons have now that they have factor. (Based on the film,"An Unexpected Life. Living with Hemophilia." Presented by the Alta Bates Summit HTC)

6. To make a clot, our bodies make a platelet plug, then a fibrin clot to hold it all together. Hemophiliacs make the platelet plug, but not the fibrin clot. With little cuts and scrapes, the platelet plug is sufficient, but sometimes not when they are in the mouth. Saliva breaks down the platelet plug, and makes a lot of trouble! So, there is a liquid medicine called "Amicar" that is available to help. Amicar prevents the saliva from breaking up the platelet plug. Sometimes, this is so effective, factor is not needed! Yay for Amicar!!! :o)

7. What are the leading causes of bleeds for a little hemophiliac during childbirth? forceps, vacuum, internal monitor

8. How does factor work during a joint bleed? Blood starts entering the joint capsule. It fills up with blood. The factor helps the bleeding stop. Digestive enzymes eat away the blood, but also eat away at the cartilage and bone. Once a joint has had a bleed, it will always be more susceptible to getting more bleeds.

9. One of the greatest threats to hemophiliacs today is an inhibitor. An inhibitor is when their body starts rejecting the factor it needs so badly. When this happens to a factor 8 deficient person (hemophilia A), they are treated with factor 7 until the inhibitor is resolved. Clotting factors work like dominoes, and factor 7 is a good plan b for factor 8 deficient hemophiliacs because it allows clotting to skip a step. It is not easy. You have to infuse the factor 7 a lot more often than factor 8. Sometimes it takes a very long time for an inhibitor to go away.

10. Did you know that the worst position to give birth is lying on your back*? This position reduces the size of the pelvis by up to 30%!! This is especially dangerous for babies with hemophilia since that would threaten the use of vacuum or forceps if the baby appeared to be "stuck", and those interventions are the leading cause of headbleeds for newborns with hemophilia. Get off your backs, ladies! ♥
*There are exceptions to this.  Sometimes, a woman's pelvis is shaped in a way that consistently causes back labor, and lying on her back is the only way to get the baby to turn.

11. Carriers of hemophilia have varying factor levels. Sometimes their factor level is well within the normal range. Sometimes it is the low end of normal. Sometimes it is so low they qualify as mild hemophiliacs. Rarely, it is low enough to qualify them as severe hemophiliacs. I thought this wasn't possible until I met a girl with severe hemophilia. The explanation for this is in how the chromosomes split and multiply soon after conception. Another interesting fact is that carriers typically have elevated factor levels while nursing or pregnant. Since I have been nursing and/or pregnant for the last 8 years, I don't know what my regular factor level is. When I was tested while nursing Eli and again while pregnant with Malakai, it was 90% (within normal range). When I was in my 3rd trimester with Silas, it was 190% (high end of normal).  Ana was tested and her level was 44%.  Normal factor level is anywhere within 40%-200%.  I can tell you that I used to bruise a lot more than I do now!

12. When a person is having a bleed it feels like burning, swelling, sharp pain, or bubbles/tingling. Other descriptions include: "when a joint swells up with blood it is like having cement in there causing you not to be able to move"

13. It is super fun to launch caps off of empty syringes after prophy. . . ;o)

14. When you have a child with hemophilia, you no longer take it for granted when you actually can just "kiss it and make it all better" with a non hemo child or a minor injury with a hemo child. ♥

15.  "Hemophilia is a genetic bleeding disorder that prevents the blood from clotting normally. The main symptom is uncontrolled, often spontaneous bleeding. Internal bleeding into the joints can result in pain, swelling, and, if left untreated, can cause permanent damage.'  -Jennifer Grizzard Smith

Why I Love Water Birth: part 2

Before Ana could start walking, we were looking at two happy pink lines again!  We had been in IL for Isaiah's birth, MI for Ana's birth, and now we were in CA looking for a midwife.  We couldn't possibly have more than one baby in any state, could we?  We found the best midwife for us, and began planning another home water birth. 

I knew I was in labor at about 1:30am.  I labored in bed for a while on my side.  I got on my knees and leaned over a chair, all the time moaning through contractions.  By now, Isaiah was about 1 month from being 4, and Ana was about 2 months from being 2.  I had practiced these birth noises with them so they wouldn't be scared when the time came.  It worked.  They weren't scared at all.  I had nice breaks between contractions too, which really helped.  Isaiah wanted to help me so badly, but kept getting in people's way.  So, I asked him if he could hug me through my contractions.  He was my doula for this birth!   

The pushing stage for this birth was way more intense than it had been with Ana's birth.  For the first time during active labor, I called out to God, thanked Him for this baby, and that "I can do all things through Christ who strengthens me" (Phil 4:13).  When it was time to push, I pushed like I had never pushed before.  His head came out.  There was a small break before the next contraction (seemed like forever!).  Then, I was pushing again.  He was so huge that I thought he was completely out when he was only out to his waist!  Elijah was 10lbs 14oz!  I couldn't believe it!  His birth was so gentle, and he was a beautiful chubby newborn.  Four months later, we found out he had severe hemophilia.  I am so thankful that we had such a gentle birth for him.  I believe the water birth was a major reason why he was so big and did not have any bleeds or bruising, and I did not tear at all. 

By the time we were expecting our fourth little one, we knew that I was a carrier of hemophilia.  I have written all these stories before, and have recently posted the story of "Our Journey".  Please read it to get the full story of how we began birth planning with the knowledge of hemophilia being a possiblility.  We moved from CA to NY when I was 6 months pregnant.  I found a midwife, and we started planning a homebirth with the goal of drawing cord blood and transporting the specimen from home to a lab.  That plan did not work out.  We had to consider a hospital birth.  I met with the perinataltologist.  I explained to her that water birth was the safest, most gentle way I knew how to birth, our large hemophiliac baby had been born in water at home with no problems at all, and I insisted that our fourth baby's birth was just as gentle.  Malakai was the first water birth ever for this hospital.  His birth was so gentle that his water never broke until his shoulders were born. 

I know I've shared all these stories in length before, but I wanted to give a fresh review to illustrate where I'm coming from with water birth.  Based on my experience, I love water birth because:

• It calms my pain and discomfort.
• It relaxes my body.
• It softens my perineum, and helps me not tear.
• Because I am so relaxed, I can get in the best possible position for my pelvis to be at maximum size.
• I can easily move to different positions at will.
• Because I am so relaxed, my whole body opens to birth my baby as gently as possible.
• It gives me my own space, and I feel safe. 
• Being in the water helps me feel covered, and I don't feel so exposed and vulnerable.

I am now 13 1/2 weeks pregnant with our fifth baby.  Malakai is 16 months old, Eli is 3, Ana is 5, and Isaiah is 7.  In about 5 weeks we will find out if this baby is a boy or a girl.  There is no question that we will be planning another water birth.  We hope to have a home birth, but if we must consider a hospital, we will plan a water birth there.  Hemophilia babies need a gentle birth even more than other babies do, and I am so thankful that we already practiced such a gentle way of birthing even before we knew hemophilia was a part of our lives.

Why I Love Water Birth: part 1

I first heard of water birth when I was a teenager.  My first thought was "That's crazy!  Won't the baby drown?!".  I really didn't think of it much more until I was married and we were expecting our firstborn.  The first midwife we interviewed told us that she almost exclusively did water births.  She told us that water birth was a lot gentler on both the baby and the mom.  "For the baby, the difference is like waking up at your own leisure on a Saturday morning vs. being woken up with an alarm clock on Monday morning."  The baby is born from warm fluid into warm fluid, and is gently lifted up to the air, and the baby is not stimulated to breathe until he/she comes in contact with the air.  The warm water helps mom relax, and her body opens up more.  The warm water is also great pain relief, and allows the mom to move to different positions effortlessly.  We were impressed with all the benefits she shared with us, and decided to go with a water birth.

Our first birth was at home.  My husband (Matt) and I were in the birth pool together.  Isaiah was crowning for an hour.  Our midwife kept close watch on his heart rate and skin color which was fine, and Matt played with his hair.  After 4 hours of pushing, Isaiah was born into his daddy's hands.  Matt passed him to me, and I lifted him up out of the water.  He was big!  9lbs 8oz, broad shoulders and big chest.  No wonder he took so long to come out!

Baby #2 was also born at home.  Things went a lot faster this time.  I knew I was in labor around 11:00pm and she was born at 1:30am.  My mom called our midwife, Matt got the pool ready, and I was laboring on the toilet, tailorsitting on the floor, hanging on people. . .  I couldn't wait for the pool to be ready!!  Finally, it was warm enough and full enough for me to get in.  Ahhhhhhhhh. . . .   instant relief!  My sister acted as my doula, and my sis-in-law was there to take care of Isaiah (then 2 years old).  Matt and I were in the pool.  My midwife would not tell me when to push.  She said I would tell them when it was time to push.  Suddenly, one contraction caused me to bear down!  I told my sis-in-law to wake up Isaiah.  He wanted us to wake him up for the birth.  She did.  She told him that the baby was coming.  He got up, unzipped his pajamas, and started taking off his diaper, and climbing in the pool!  My midwife said it was fine.  So, we let him in.  Within 6 minutes of the first pushing contraction, Ana was born into my own hands.  Matt was holding Isaiah, my sister was right outside the pool next to me.  With one hand on my sister's shoulder, and one hand on Ana's head, I told everyone when she was crowning, when her head was out, and brought her up out of the water when she was born.  She was pink and looked so little at 7lbs 4oz (2lbs less than her brother was!)

Our Journey

I was an avid natural birth advocate way before I knew what the word hemophilia meant.  After our third child was diagnosed with severe hemophilia and I found out I was a carrier, I began to ask people a lot of questions.  I asked other hemo moms, doctors, nurses, midwives, anyone!!  I wanted to know if my beautiful home birth days were over, and I wanted to know the real risks posed to baby hemophiliacs at birth.  It was then that my Bubble Wrapped Birth journey began. 

I have heard many stories, read the studies, looked at medical reports, and read our recommendations published in Hemaware magazine.  I have never once read a birth story where a baby had a gentle birth with no drugs or interventions of any kind, and ended up with a bleed.  In fact, all the birth bleed stories I've read have been births with drugs or interventions such as vacuum or forceps. 

I am committed to planning safe deliveries for each of my children.  I've learned a lot from other hemo families, midwives, and my own experience.  My husband and I have learned what works best for us and allows us to have the most gentle birth as possible.  We use water birth.  It allows me to fully relax, move effortlessly, and be in the greatest positions that open my pelvis to maximum size.  There are some situations that we have decided would mean the safest delivery would be a c-section.  These include placenta previa and a breech boy (maybe girl, not decided yet). 

The bottom line is this.  We believe that a gentle vaginal birth is most beneficial to our children unless one of the above complications become evident.  In this Bubble Wrapped Birth journey, I may come across other reasons for scheduling a c-section.  My concern is what is best for my babies.  Period.

As far as home birth, I birth at home when I believe the hospital situation threatens dangerous interventions and does not support our birth plan.  One hard thing we've come across is how to get the cord blood tested from a home birth.  It was for this reason our fourth child was born in the hospital. 

His birth was perfect, and just as gentle as a home birth.  After he was born, he had a meconium issue, and needed suction and breaths.  That was a first, and not fun.  He was ok, and I thought the staff did a fine job taking care of the situation.  If we had been home, we would've been set up right at the side of the pool.  He would've been able to be suctioned, and get breaths on a flat warm surface without cutting the cord or leaving me.  The baby care at the hospital was also something new for us.  Home is much gentler on the baby, and we are in full control of what happens with our baby.  In a hospital, we dealt with required procedures, sometimes dangerous for a baby with a bleeding disorder (ie:  rough personnel and the heel prick).  We were there for one reason, and that was the cord blood testing.  He did not have hemophilia.

Now, we are 12 weeks along with baby #5.  We will find out around Easter time if baby is a boy or a girl.  Plan A is a home birth with cord blood testing and a trained professional with emergency equipment.  Plan B is a gentle water birth in a hospital with a midwife where our birth plan is respected and we can get the cord blood tested for factor 8 level.  We will continue to grow and learn, and we will never compromise our baby's safety.  If we are having a girl, we will probably plan a home birth. 

Bubble Wrapped Birth is a passion of my heart.  Thank you for joining me on this amazing and precious journey!

Back Labor

So, today we were talking about back labor on facebook.  Well, it didn't start out about back labor.  I started by making this statement: 

"The worst position to give birth is lying on your back. This position reduces the size of the pelvis by up to 30%! This is especially dangerous for babies with hemophilia since that would threaten the use of vacuum or forceps if the baby appeared to be stuck, and those interventions are the leading cause of headbleeds for newborns with hemophilia. Get off your backs, ladies!"

One mom commented that she strongly disagreed, and said that she had suffered terrible back labor for all 4 of her births, and the only position that worked for her was on her back, pulling her feet up (in a frog position).  She said that pulling her legs up also allowed her tailbone to move.  I asked my BWB fb page readers if any of them had a similar experience with back labor.  One mom agreed and said that this position was also the only one that worked for her.  However, it seems that it only worked for the pain because her baby got stuck, and they used a vacuum on her. 

So, my question is:  What is the safest way to deal with back labor?  I've never had back labor, but I want to know what I could do if I ever were dealing with the pain of back labor.  Another mom commented and said that her husband pushed his fists into her lower back as hard as he could for counter pressure while she squatted or leaned forward.  To me, that seems like the ideal choice.   Although, it may not be feasable for all back laborers, it is currently my plan A if I were ever in that situation.

My Bubble Wrapped Birth

If I were putting together a birth plan for another baby, I would look at my options and decide where my baby would be the safest.  That is simple enough, but what is "safest" to me?  I choose water birth with a midwife nearby who is trained in newborn and adult emergency response.  I would choose to be in a place that does not interfere with my natural birth process.   If you have read my birth stories, you know that I have had 3 home water births, and one hospital water birth.  I prefer home because there are no hospital protocols to deal with.  Some could even cause a bleed.  I want to have the cord blood tested immediately after birth as opposed to getting it drawn a few days later.  That's rough.  My motivation is my baby's safety.  So, I would draw from my experience, assess my options, and choose the birth plan that keeps my baby the safest.  The purpose of this blog is to gather and discuss information that would help make this careful decision.

I consider water birth a huge asset to hemophilia carrier moms who want to avoid a c-section. Most hemophilia "experts" recommend that we have scheduled c-sections. Yet, I have searched and searched on this subject and cannot find any proof that a normal, calm, un-intervened birth has ever caused a bleed in a severe hemophiliac. All bleeds I have read about are caused by interventions during labor and delivery. Water birth has so many benefits to mom and baby, but the most important is that the mother is more comfortable. This relaxes her muscles. The warm water makes her stretch much better. The buoyancy of the water makes it much easier to move anywhere at will weightlessly. You naturally ease your baby out. These facts make the birth more gentle on the baby, and isn't that always the goal with a hemophiliac?

Our Fourth Birth - Malakai (part 1 - pregnancy and planning)

I didn't realize how emotional it would be to revisit my pregnancy with Malakai.  I've shared my birth story with so many, but his story begins a few months before he was created. . .

One month before Elijah was a year old, I got the news that I was indeed a carrier of severe hemophilia A.  (For those who aren't as familiar with hemophilia:  It is possible that a hemophiliac is the result of a spontaneous mutation, and did not inherit the gene from a parent.)  That was November 2008.  In March 2009, we found out that we were expecting #4.  Within the next month or two after that, my husband learned that he was losing a huge part of his job that would make it impossible for us to stay in CA.  This was a very personal thing, and not just a business downsize.  Also, Elijah was one week from his port surgery.  I was under extreme stress, and had to choose where my energy would be spent.  That was not a hard choice.  I had to take care of my family.  My husband needed a lot of support, I was growing a baby that needed me, and I was gearing up to hand off my older baby to surgeons.  There was no room for anything else.  But, still, it didn't make all the other pressure go away.  On top of all that, I had to start planning my upcoming birth.  We got an ultrasound to determine the sex of the baby.  It was a boy!  I started doing extensive research on hemophilia and childbirth, and was not satisfied with what I found. I'll get into that in another post. 

Several facts were in the mix: 

1. Our baby had a 50% chance of having severe hemophilia. 

2. I had to plan my birth with wisdom in the new knowledge that I may have passed on this gene. 

3. I could not base my decision on the success of Elijah's birth, although that did play a part in the decision.  All hemophiliacs are not the same, and have different bleeding patterns. 

4. Until my third trimester, I did not have any idea where we would be for the birth. 

5. We needed to have his blood tested right after his birth.


6. Our son's hematologist recommended that I schedule a c-section.  Then, when she could see that I was not welcoming that idea, she recommended a plan B:  Have my birth as natural as possible in a hospital where they can do an emergency c-section if needed.


Near the end of my second trimester, my husband was offered a job in NY.  He accepted the position, and we had to pack up our house in a week.  We decided to drive.  After all, when would we ever get the opportunity to drive from CA to NY again?!  So, Matt drove the big truck, and I drove the van.  Yeah, it was pretty crazy!  It was fun though.  We made lots of memories.   I met with the only licensed midwife in the Buffalo area a couple weeks later.  We were planning a homebirth, hoping the local hospital would support running the labs for us (Matt would take the blood to the hospital immediately).  In some cases, this does work. However, this time, it did not.  Our new pediatric hematologist tried to work out the labs for us, and even an on call emergency transport.  However, the hospital would not support this plan.  Our midwife, who we loved, could not help us with a homebirth.  She was under fire from the hospital, and could only offer to help us with a hospital birth.  I was devastated.  We met with another midwife, but we couldn't work out the labs.  I met with the nurse manager at the hospital.  I told her that I wanted a waterbirth.  She told me that they did not offer waterbirth, and the room was so small that it just wouldn't work.  I was determined to have the most relaxed non-traumatic birth possible even if that meant having my baby at home and compromising the immediate lab work.  I was trying to avoid causing my baby a bleed.  I would keep him safe!!  I met with the perinatologist who asked me about my birth history and what I wanted for this birth.  When she heard my reasoning and that my only concern was the safety of my baby, she told me that I should get exact measurements of the birth pool, and get them to the nurse manager.  I did, but the NM said there was simply no room.  I asked her if we could make room for the pool by moving the bed to the hallway.  She said I shouldn't hope for this to be approved, but she would speak to "the powers that be", and get back to me.  I again shared my heart for my baby's safety with her.  The next morning,   I wept tears of joy when the NM called me and told me to order the pool!! 

*All pictures are from our trip from California to New York in August 2009*