21-week visit

We had another routine doctor's appointment today, (they occur monthly for the first two trimesters or so) which included an extensive ultrasound to assess the baby's size, heart beat and organ function. Out of all appointments up to this point, this one, which usually occurs around 20 weeks is considered the "big one," and definitely the most exciting. The good news is that all looks a-okay - all organs and limbs are there and functioning properly, including two adorable little feet the ultrasound technician purposefully zoomed in on. I surprised myself by how awed I was over that final image and immediately popped my head up to catch a glimpse of Chris's reaction. He seemed equally enthralled. The technician guesses Baby P.C. weighs about one pound, but it's too big now for her to try to measure from head to heel. Based on on an estimate we read online, we assume it's probably just under a foot. The technician didn't see anything that concerned her, so she didn't feel the need to call the doctor in and instead will just pass along the selected images for her to review later.

The only uncomfortable part of the ultrasound is that you're supposed to drink about a liter of water shortly before the appointment. The full bladder allows for a better view of the lower part of the uterus and verification of the location of the placenta. While I think the ultrasound experience is really neat, at the same time, I couldn't wait for the first opportunity to go to the bathroom.

We had a special treat at the end when we got to see 3-D images of our baby. The images were rather amazing, because there was enough clarity for Baby P.C. to look like a real baby. As the technician zoomed in and out on different areas of the body, it was often difficult to tell what I was even looking at, except that she would conveniently type in "heart" or "brain" alongside the image. But when the first 3-D image popped up on the screen, all I could think was, "Wow!" We were given a few printouts and I'll let family members be the judge of whom Baby P.C. resembles.

The appointment concluded with meeting with the clinic's only midwife, who listened to the baby's heart beat and, for the first time, measured my stomach with a tape measure. The ever-bulging gut measures at 21 centimeters.

I like everyone I've met at the clinic, but I really liked the midwife. She asked me if I'd ever considered working with a midwife and thought that because of my health, low-risk pregnancy and my curiosity and desire to learn, (and the latter for Chris, as well) I'd be a good candidate. Hurray for being encouraged to ask a lot of questions! Despite all I've read and the many Pregtastic podcasts I've listened to, which have featured midwives on some episodes, I admitted I still wasn't quite sure what role a midwife would play in my prenatal care and during delivery.

A midwife is licensed and is an advanced nurse practitioner who, like an obstetrician, handles the care of expecting mothers before, during and after childbirth. Midwives and obstetricians are both autonomous practitioners, but can also provide complimentary care. Although midwives are medically trained to handle complications and emergency situations, they maintain working relationships with obstetricians, who can be called in at any point if a more advanced or invasive level of care is needed. Unlike the obstetrician who just pops in when the baby is ready to be delivered, but who has left all the hours of labor preceding to the care of nurses, (My mom, who had spent weeks in the hospital after open heart surgery, resolutely declared that it was the nurses who ran that place.) the midwife remains with the mother (and that team of nurses) throughout labor.

The biggest difference I saw was related to philosophy. Stereotypically, (and she really stressed that these are stereotypes and that if one approach works well for one woman it doesn't mean it works the best for all women) obstetricians are trained to manage labor, while midwives are trained to support labor as a natural process. While our understanding of medicine and how we have learned to manipulated labor has changed drastically over the decades, the labor process in itself has remained unchanged since the beginning of time. I imagine that before modern medicine, delivery practices (well-intentioned, even if not always the best of practices) were passed down from generation to generation. I've read that midwifery (pronounced mid-wiff-ery) as a profession, so to say, dates back to the 1300s. It's the holistic approach steeped in a long tradition of caring for women that I really go for. I liked that midwives are more likely going to encourage as natural of a process as possible, will actively include the support person and are sensitive to the cultural or personal wishes of the expectant mother.

I may not have looked into a midwife, because I knew I was comfortable with, and preferred, a hospital setting and the use of pain medication. I was under the misconception that midwives practice mostly natural (i.e. unmedicated) home or birth center births, while in fact, the majority of them work out of a hospital, as this midwife does. Since the obstetricians and one midwife at my clinic are on an on-call rotation, who actually delivers your baby would depend upon who is on call. She just recently started working for the practice and her goal is to be able to hire additional midwives, so that patients could choose one of two circles of care - from an obstetrician, or a midwife.

I was also assured that pain medication or an epidural are not frowned upon and she stressed again that midwives support choice. After just a short visit, I was growing increasingly convinced that a midwife in a hospital setting might be the perfect combination between a conventional and a natural labor. While I consider alternative medicine or practices legitimate, I would prefer to use them in conjunction with conventional medicine. I haven't grown up in a culture with an extensive practice of alternative medicine and I haven't been taking classes in natural birth, so I know I would be unprepared for a natural, unmedicated birth and the experience could easily be traumatic for me (and Chris!). But I am curious about seeing what works best for me and one of my biggest worries about labor is having decisions made for me. I respect a doctor's extensive medical knowledge and experience, but if it's not a life-or-death situation, I want someone with the patience to explain the alternatives and consequences and who is comfortable with allowing me to make decisions that are best for me. If there are two options and one procedure is easier for the medical team to perform, but the other offers better potential outcomes for me or the baby, I know which one I'm going to pick.

I was ready to sign on as this midwife's patient, but Chris and I are going to switch clinics so we can be closer to home. As appointments increase near the end of my pregnancy, it'll be more convenient for both Chris and me to be a short drive to the clinic, which is also in the hospital. But my conversation with the midwife at today's appointment made me more open to considering a midwife as an option and something to look into at the new clinic. Unfortunately, the new place also only has one midwife on staff, so I will most likely not be able to work exclusively with her.

And finally, for all those (okay, so I know there are only about seven of you reading) who've been eagerly waiting to find out the sex of the baby, well, all will be revealed in due time.