R-E-S-P-E-C-T. It does mean a lot.

As some of you know, I decided to switch from a nurse midwife-run birth center to a direct entry midwife home birth last month, because the birth center wasn’t able to accommodate my special needs regarding vaginismus and frequency of vaginal exams. This decision was made after two of the six midwives at the center told Martin and I quite clearly that they were not going to waive their policy of, at a minimum, three exams - one at admission, one when my water breaks and one when I feel the urge to push. Plus any others they wanted. They both had said, in separate individual appointments, “if you can’t handle the pain of the exam we will send you to the hospital for an epidural so you can have the exam without pain” and one of them had told me that there was no way to assess whether a woman was in active labour without a vaginal exam. (This midwife clearly had a lot of preconceptions, including something about "midwives who don't believe in doing regular vaginal exams also don't believe in things like diabetes" which came completely out of left field.)

Yesterday I had my final appointment at the birth center; I had already made my decision to leave but felt it was morally right to go back one last time to let them know. Also at my previous appointment a month ago I had presented the midwives with a three page letter stating my reasons for not wanting unnecessary exams, and I felt it was only polite to go back to hear what they had to say. This time, I saw a third midwife whom I had not met before. (I intentionally scheduled to see someone new as there was no point in revisiting the closed minded ones.) This midwife was older than the other two and had had a homebirth herself. She said she had read my letter. I explained that since writing it I had been exploring alternate arrangements that might be better suited for me, and that I had found a licensed midwife in town who would be willing to do as few exams as possible. I explained that that midwife had said if she felt the need for an exam, she would tell me, and tell me why she wanted to do one, what she hoped to learn and how her care would change depending on the results of the exam. At that point I would have the option to consent or decline the exam.

The nurse midwife at the appointment yesterday then told me that she had great respect for me. She said it was obvious that I had done careful and extensive research about the issues involved. She asked who the midwife was whom I had chosen, recognised the name and said that it was a good choice. She told me that her own policy on vaginal examinations was about the same as that midwife’s. I said I had hoped that a few of the birth center midwives would feel the same way but that I couldn’t go comfortably into labour with a one-in-six or two-in-six chance of having a significantly less stressful experience, and she said she understood that. I think she had been worried that I wanted someone to say “I promise never to do a vag exam on you” before labour even started, but that’s not what I wanted. I want what’s best for the baby without unnecessary vaginal pain for me, done for the sake of a routine.

She then took my hands and said she felt that home birth is usually very safe and she had one herself, and said that she thinks I am making the right decision for my birth, and said again that she respected me for making the decision.

I really liked her, and if I could guarantee that she would be at my labour I might have stayed with the birth center. I told her I would bring the baby in to meet her after the birth and she got all excited and made me promise to do so, hehe.

And she said I taught her something! In my letter I listed 11 signs of progressing labour that can be assessed externally. One of them is called “the bottom line” which is a purple line which develops between the mother’s buttocks in the last stages of pushing. She had heard of it but not seen it, and had a vague impression that it would be a horizontal line across the buttocks. In the past month, she was attending a birth and decided to look for the line, and saw it! (A second birth she was at recently didn’t display it, so it doesn’t always show.) She got all excited and said later she ran to the other midwives and said “I saw the bottom line!” It turned out that one of the other midwives had seen it before but not recognized it for what it represented. I wonder how often that happens with the other visible signs of progressing labour.

Same practice, but completely opposite viewpoints concerning the needs of the patient vs the “routine procedures”. It was SUCH a nice experience, especially compared to the last two visits where I left shaking and in tears.

We also talked a little bit about my losses, spurred by the opening conversation:

Midwife: So are you feeling the baby moving?

Me: Yes, and it's really reassuring, but I've still got my home doppler that I can use to check if I get worried.

Midwife: Do you get worried about this baby?

Me: Of course! I lost my first two.

Toward the end of the conversation I wanted to show her the inside of my locket, so I did. She's the only other person besides Martin that I've opened it for in person so far (there is a photo on this blog of it open). She didn't recoil at the sight of the photo of Quinn's hand, which meant a lot to me too.