Tag-Archive for » planning «

Sep
23
Quest Complete

Oh, well, I still have to turn it in, but we have completed our current quest to interview providers. (Yes, yes, blatant WoW reference. It just seemed appropriate.)

Today was the Puget Sound Midwifery and Birth Center, in Kirkland. They are two blocks away from Evergreen Hospital, which makes it even closer than the Eastside Birth Center is to their backup hospital. They operate three birthing rooms, shared by two sets of three midwives who work as a group. We had an interview with one of the three who would be in the group that I would be with, the Lake Washington Midwives. We saw Sunita, who is also a naturopathic doctor, so I’m not sure if she should have a Dr. in front of her name or not.

The facility was easy to get to, and inviting. They had a library of books on conception, pregnancy, childbirth, and early childhood/parenting in the waiting room – and I mean something like 15 (short) shelves of books. We did the ‘interview’ in one of the birthing suites, as they tend to do their prenatal appointments there. She had a very personable style, while answering questions, and went over most of the same stuff we’d been asking, sometimes answering questions before I even got to them. They have a low transfer rate, and most of their in-labor transfers are done for maternal exhaustion. They have a very low episiotomy rate, as well. She noted that they can do sterile water injections, but her experience is that they tend to be more irritating than painful, and she has been trained in TENS and uses it on occasion, but doesn’t use it often. Like the other birth center, when I asked about how they tend to manage coping with pain there, she pointed towards the tub (and they do birth in the tub as well). (Yes, “how do you, a birth center, manage pain and discomfort in labor” is a totally leading question trying to get at the mindset they have during the process, but that’s kind of the point of the interview.)

She was the first person who asked us, after she answered all of our questions, to tell her a little about ourselves. And she had a good hearty laugh (along with appropriate sarcastic response!) to Jason’s “Well, we tend to be pretty analytical people.” She even helped answer the “why are hospitals so anti-water birth”; her opinion being that it has a lot to do with provider convenience, since tub births are a little hard on them (hard tub sides and all) and there isn’t much in the way of visual access during one.

At the end of our visit, she showed us a little tour of the place. One of the birthing rooms was in use for a labor, and the other one was in use for an appointment, but the other provider (and patient) was fine with us checking in. Turned out to work perfectly, as the other midwife in the room was one of the other people on the team that I would see. And when we walked out into the hallway, I got to meet the third (who immediately said “wow, you look familiar” after I introduced myself). They all seemed quite friendly, and warm.

Really, that’s the impression I got from the whole place – a warm, inclusive welcome. Very homey, if not entirely in decoration (there’s only so much you can do with that who “homey hotely” setting), then very much in spirit.

This leaves me torn. I understand the “Oh! We have to be in a hospital because something could go horribly wrong and it’ll be awful if we’re not at a hospital” emotional reaction, but I also know that it is a primarily culturally ingrained irrational fear. There are certainly benefits to be had being in a hospital! But there are risks from every intervention, which is also closer at hand, and more likely to be used, in a hospital, not to mention just being able to be really comfortable and trusting of EVERYONE in the room.

I’m going to be sleeping on it, but I definitely have a preference in mind. 🙂

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Sep
16
Evergreen Complete

Last night, we toured Evergreen Hospital in Kirkland (~20 min away), and did a meet-and-greet with the nurse-midwives who practice there today. Let’s just say that making this decision won’t be easy.

The guide who did the tour of Evergreen was a short, older lady with… the most annoying habit of talking in short sentences, making the last two words sound crucial, and talking slowly. And the way she talked to the little two or three year old that was with us… UGH! It made it a little hard to focus on the tour, but as Jason said – over time, you kinda warmed to her, or at least uncooled towards her. It was the first maternity ward I liked the layout of, oddly enough. The rooms were nice enough, had a decent amount of space, various supplemental birthing supplies (ball, squat bar, jacuzzi tub, rocking chair, even birthing stool, I think). She talked a fair amount about the support for natural childbirths, one-on-one nursing (they try to keep you with one single nurse during each shift), their openness to avoiding interventions if not warranted, and even talked about the vaccination waiver process. (I’m not planning on not vaccinating this kid; don’t worry. I’m not so fond of giving a DPT, Hep B, and Hep A vaccine all at once withing 24 hours of the stress of birth. While I have much more research to do on this front, I’m of a mind to try to space the three out over the first month or so. We’ll see.)

This morning, we met with one of the five nurse-midwives at the Center for Women’s Health at Evergreen (not to be confused with the Evergreen Women’s Health Center, aside from the fact I confuse them every single time). She was an interesting combination of very patient (we were there for 40 minutes, asking questions, after all), and medically efficient. It’s a combination that I think I like. I was disappointed to hear they don’t do vaginal breech delivery, as I’m a little annoyed at the reduced care available because people aren’t trained. (Seriously, lack of training and experience is the biggest reason breeches aren’t delivered vaginally. In *some* breech presentations, it’s not more risky to do a vaginal birth, if the provider is trained. But, no one trains them anymore. Sigh!) But I was pleased about the discussion over various methods of version in the case of a breech. And I was pleased with her response to my question on episiotomies, which was somewhat vague in the “depends significantly on the woman” but she discussed the other methods they use to avoid them focusing on giving the baby’s head plenty of time to do the stretching naturally, and finished by saying that in her 15 years of midwifery practice, she’s probably done about that many ‘routine’ episiotomies.

As an final irony, the assistant at the chiropractor’s office I go to mentioned that she used to work in the birth center that we’ll be interviewing at next week, and she thinks I would really like two of the midwives in the group of three I’m interviewing with. She doesn’t know the third, because she left before the new midwife came in, who also happens to be the person we’ll be interviewing with. And, she knew the midwife at the birth center we already interviewed, and suspects I’ll take to the other midwives better. Definitely a small world!

So, this all leaves me very uncertain where I want to give birth and who I want for a provider. Evergreen falls into the “acceptable” category, and Jason does like the immediate proximity to emergency facilities (though I’d add that the other birth center is literally two blocks from the maternity center). The main differences are the environment – can I find myself just as relaxed in a hospital? – and only the birth centers offer water birth. And when it comes down to these two relatively small differences (as far as I know now, without having given birth, anyway), I suspect it will strongly come down to who do I mesh the best with.

The decision has gotten difficult!

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Sep
12
Hospital Tour #1

I admit, I went into the tour of Overlake with a significant bias – they don’t have CNM’s, they don’t always get the best reviews, and they just seemed unfriendly to a non-allopathic approach. I further admit, however, that my biases were not entirely met.

We got to see a labor room, and then a mom&baby room, though in the middle of our discussion in the labor room, a nurse came in to say they needed the room asap. 🙂 It was reasonably nice – the lights were adjustable (presumably during stage 1 labor, not so up-to-your-control during stage 2), the bed had lots of configurations (including being able to add a squat bar), they had birthing balls, and had telemetry on monitoring if necessary (but they do an awful lot of monitoring). But it was most definitely a hospital, with rooms that weren’t cramped but were definitely not spacious, a door in front of the tub (which was in the bathroom), and a bunch of machinery to watch you. I have to admit, the stack of twenty widescreens mounted to the wall displaying fetal monitors with two nurses behind the desk there to watch them… a little impersonal, and a little “metrics” heavy.

But they seemed open to all kinds of delivery choices (even non-medically necessary elective cesarean, which I might be of the opinion is a little too open minded), roomed mom and baby together, tried starting nursing immediately after birth, and other friendly options. They don’t limit both food and liquid after starting active labor, but do generally limit to liquids only, and definitely do limit to liquids only if induced.

So, all in all, not the place I would choose to deliver off hand, but I don’t feel worried about ending up there in an emergency transfer either.

Though, I have to admit, I felt really strange being the only woman not showing. I’m at seven weeks, and … well… don’t really look pregnant. Everyone else was at least 32 weeks. Weird!

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Sep
09
Food? No.

I’m still not particularly nauseated, but I still have pretty much zero interest in food. I haven’t felt this not-hungry since the last time I had the flu. Of course, I have to eat, or I feel shitty… GAH! At the moment, the only things I can count on are guava or mango juice, and avocados. I’m eating at least one avocado a day. ‘Cause I know that’ll not play funny with my stomach.

In other news, Jason’s finished reading the Ina May Gaskin book I asked him to read, and I’m really glad he took the time to read it and think about why he initially preferred a hospital setting, as he is saying now that he’s just fine with a birth center. Not only was there the “why do I have faith in them doing a good job with labor when I don’t trust them to be intelligent for simpler things?” but he realized that all of the conditions I’m dealing with going into this (fibromyalgia, depression, restless leg, vulvar vestibultis, chronic migraines) – while everyone agrees do not put me at greater risk during the pregnancy or birth – are themselves best dealt with by relaxation, calm, warmth, and patience. And I’m not likely to find a great mix of all that in a hospital with different nurses and doctors coming and going, and bright lights and lots of directions.

Don’t get me wrong – we are going to be touring hospitals! All three in the area. If complications arise during the pregnancy, I want to not have to start over from scratch when evaluating places to go. There’s a small, but by no means close to zero, chance that even if we want to go for a birth center, I’ll end up in a hospital instead. If we get to make that decision before the birth, I want to go to a hospital I’m most comfortable with. (And if there’s an emergency transfer, just get me to the closest one!)

But I feel better about us at least being on the same page with what we’d like to work towards.

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Sep
08
Wake me up in two months…

Seriously… 10 hours of sleep, and I only get up because my body can’t sleep any more, despite it’s desires to do so. I’m ok with being mostly unproductive during these weeks, but the wanting to sleep and not being able to is annoying. Of course, so is the complete and total lack of appetite, despite the distinct need (via nausea and fatigue) to do exactly that. So… Summary of the first trimester so far? Distinct internal conflict.

I’ve always been sensitive to smell, and this has just increased that – as expected. Jason finished the steps for the car yesterday (as in finish/waterproof), and the garage REEKS of finish. Like, I can get so far as opening the door before pulling it shut. VILE! I’m happy food hasn’t smelled that bad, but the thought of some textures (mayonnaise, for instance) – BLECH!

And, today I started the search for a provider. Make that, “today I started banging my head against a dumber-than-usual brick wall”. Ok, ok – I’ll grant you that I have high expectations, and I’ll grant you that they may not be reasonable. But it doesn’t seem to me too hard to fathom that I might want to meet a potential provider and determine whether or not I feel comfortable with their philosophic approach to pregnancy and birth – BEFORE becoming their patient.

In a normal world, you want a new doctor, and you don’t generally interview. References from friends and family (maybe the internet) is standard, but you generally do a trial-by-fire type of evaluation, and dump them in favor of a new doctor if you don’t like their service. Well… It’s a little harder when you have about seven months to evaluate them, and less and less chance of being *able* to safely switch providers the longer you evaluate them. Not to mention that this person may (or may not!) play a vital role in one of the most important moments of your life. I want to know the person before I agree to a service agreement (essentially).

But NONE of the OB’s I tried calling, and only some of the CNM’s (certified nurse midwives) attached to hospitals do meet & greets. Both birthing centers threw an hour long (free) appointment at me, encouraging me to get a feel for the place first, and even suggesting a couple of hospital-attending CNM’s if their facilities end up not being a good fit for Jason and I. I REALLY want to try to be impartial, particularly as I know Jason has a preference for a hospital (and we have a tour set up for the first of three hospitals we’re going to check out), but the service levels and approaches are making it hard to remain free of too much bias.

The thing is – I’m a female. No matter what else I’ve done in my life, my body was bred for this purpose – to grow and birth another person. It’s what the human race does; we fuck, we birth. I am not in some sort of precarious medical condition that needs to be mitigated every step of the way. This is the job my body was supposed to do, and while I may need support and observation going through the process, I do not need to be managed. I’m not sick – I’m just pregnant.

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Aug
16
Off trail, in a meadow

This trip report, or at leas this portion of this trip report, is brought to you from the middle of a meadow field filled with wildflowers, fed my a meandering creek. (Which, I might add, is giving life to the mosquitoes buzzing around me, but no one else.)

It was a very long night – filled with sleep and only two pee breaks. A leisurely breakfast ensued, taking care of various packing and checking on a leaking ThermaRest. But two hours later, we were on the chilly trail, with overcast, puffy clouds occasionally letting the sun filter through.

Bikers, of all Kinds, at the Top of Horse Head Pass

We went up over Horse Head pass, meeting a few motorcyclists at the top. It was definitely a slog to get there, but not a terribly long one. As we chatted with the motorcyclists, two mountain bikers came to join us and took a short break as well, and we watched as they and the motorcyclists took off.

Posing Marmot

Posing Marmot

And so we headed down towards Boiling Lake, down the other side of the pass, with yet more zigzagging. A few turns later, we had a powwow to figure out what path we were going to be taking towards Angel’s Staircase, either around the lake in a longer, more level path, or a reopened sheep’s trail over another saddle. All along that section of decent towards Boiling Lake there were a bevy of
marmots, some looking for food and checking us out, and others mating.

A Rare Picnic Table

A Rare Picnic Table

After finding the path to the saddle, we found a fabulous horse camp, complete with extremely wobbly picnic table, and had a leisurely lunch with the sun breaking through just as we finished. (The sun was not to last long.). That particular ascent up the sheep path was definitely a steady climb, mostly right up the hill, but the saddle we were heading towards was visible the whole way.

Gorgeous Meadows Deserve a Admiration Pause

Gorgeous Meadows Deserve a Admiration Pause

Babbling Brook in a Field of Wildflowers

Babbling Brook in a Field of Wildflowers

We found the gorgeous meadows on the other side of the saddle, fields of flowers just before the minor path met back up with the major ones. A babbling brook, which really looks and sounds just like a babbling brook should, comes though much of this meadow. Another bevy of marmots was wandering through this field, some posing, some galloping through the field.

A Break on the Meadow

A Break on the Meadow

We had another powwow about where to camp, with many options available to us, and the majority of the group wanting to camp on the meadow overlooking the North Cascades. The water, and the possibility of climbing Martins Peak, seemed to settle this issue. Of course, the inertia of already being on the ground helped. There has been enough inertia at this point that the peak isn’t going to happen, and instead we’re setting up tents, in case of weather. Thus ends the 3:20pm update, frozen fingers causing significant typos.

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Jul
29
All good plans…

At some point, even the best planner makes a mistake, and heavens know I am a far cry from the best planner. So it is with poor planning that I find out, three days from my expected departure, that the Olympic National Forest Sol Duc/Seven Lakes/High Divide area has limits on camping permits. And, naturally, they’re out of them. Sigh.

With only one other person on the trip, whose schedule is flexible, at least I have the luxury of replanning. It’s always tough to replan, atthe last minute, when the original plans are exactly where you wanted to go, but it’s not like there’s a dirth of options!

I just must remember to check on these things earlier.

I have, however, been doing a great jobs preparing all my dehydrated foods. The trip might not happen as planned, but there will be food!

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Jul
14
Maps Make Things Look Too Small

I’ve got my backpacking trips all planned out. Every single weekend, I’ll be sleeping under the stars. (Ok, ok. Under a tent. I do really hate mosquitoes.) I’ve yet to plan the day trips, and it’s made worse by seeing the special achievement awards – ‘most state parks visited’? ‘most miles in a day’? ‘most trails hiked’? ‘best hike-a-thon blog’? They all speak a little competitive voice in my head.

Only I still feel undertrained. And I have… an insane amount of ambition about this thing. When I look at the mileage on a map… it just doesn’t seem all that bad. Eh, what’s a couple of 9 mile days in a row? Eh, what’s a 24 mile day trip?

I think I may be in trouble. 😛

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Jul
11
Hike-a-thon: The Planning

Hike-a-thon is three weeks away, and I am woefully under-prepared.

I don’t have my hikes all planned out. I haven’t been training for three months. I don’t even have backpacking food drying out in the dehydrator! (Ok, ok… perhaps I’m being a bit silly.)

But, plans are starting to come together.

At least two backpacking trips are on the table: 1) Deception Pass (the one in the Central Cascades, not on Whidbey Island) and 2) Dutch Miller Gap (a repeat, but that was an awesome trip!). Ptarmagin Ridge is in the plans as well, and maybe Lake Elenor (Mt. Rainier).

And then the day trips. I think gas costs will keep me close to home, but that’s ok. Perhaps this is the year I’ll do the whole traverse of Tiger Mountain – something like 30 miles, if I remember correctly.

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