As I mentioned, we had a kind of crazy time last week when we went to get an ultrasound to try to figure out if our baby had flipped back breech (she hadn’t) and found a mysterious black circular structure that really had no business being inside of her.

Yesterday we went to get some higher-quality imaging and to see a specialist in birth defects. Up until last Thursday, we’d only ever seen our homebirth midwife. Now we were in a high-risk specialty unit in the hospital.

O frabjous day! Callooh! Callay!

And it was great news. Not only did the technician and the doctor speak to us this time (and respect my body as mine, which was very appreciated), but we found out that the cyst is probably nothing.

For anatomy geeks (me! me!), “probably nothing” translates to:

There are three options: it’s most likely a small fold in the retroperitoneum (sac of connective tissue separating some internal organs from others), in which case it probably won’t get any bigger and we can leave it alone. It might be attached to the spleen, in which case it could need surgery sometime in the future. And least likely is that it might be attached to the adrenal and would need surgery soon after birth.

It is almost definitely not: cancerous, a hole in the diaphragm, a hole in the intestine, affecting any other organs, or a sign there could be other problems. It isn’t solid, doesn’t have blood flow, and is well separated from the things around it. Good good good.

We will, however, go get her looked at again as soon as she’s born. That way they’re only looking through a few inches of skin instead of through me and all my internal organs as well. They should be able to see everything much better and also to measure it and know if it’s growing, shrinking, or staying the same.

(Much as I don’t relish the thought of possible surgery for my newborn if the cyst has grown, it sounds unlikely, so I’m going to focus my thoughts elsewhere.)

A girl!

Oh, and you know how we were certain it was a girl? We were right. God save me from any stores containing small pink things, because this could get ugly for my bank account quickly.

…

That was all the news. Now I’m going to talk about conflicting birth cultures. Continue if you’re interested.

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Birth Culture

Being at the hospital was a fascinating exercise in observing birth culture for me. I have most of a degree in the subject, so it’s something I think about a lot.

We got some rather pointed questions from the ultrasound technician. The baby’s measuring about a week ahead (that’s well within the bounds of normal), and has some fat rolls around her neck. The technician didn’t connect the dots, but she asked me if my midwife would schedule an induction and if I’d been tested for gestational diabetes.

I told her I had been tested, and it turns out my blood sugar is actually abnormally low, and that we probably wouldn’t induce. At which point she did exactly the right thing and didn’t say anything else about it.

(I didn’t go into why we wouldn’t induce, but it carries very real risks to both mother and baby, so I wouldn’t do it for something as spurious as “the baby looks a little big on the ultrasound,” especially given my family history of big babies and given ultrasounds’ poor ability to accurately estimate fetal size. Furthermore, induction needs to happen in a hospital.)

When the doctor was done (thoroughly and understandably) explaining the cyst to us, I asked him if a homebirth would still be possible. He was also very respectful and owning-of-his-stuff (that’s pretty much the highest compliment I give) despite big ideological differences with me.

He said that for him, homebirth is always inherently risky, and he doesn’t like risk. As someone who sees the worst cases of the worst on a regular basis, it doesn’t seem prudent to him to have a baby out of the hospital at all, much less when there is “an additional unknown, however small” because in a very small percentage of cases the incredibly quick interventions hospitals can perform (like a c-section in which the baby is out in under 5 minutes) will save lives. So he wouldn’t recommend it, but he also thought the additional risk from this cyst was quite small. And then he told us to talk it over with our midwife.

Can I explain how much I appreciate this? Here is a man who sees babies die on a regular basis. He knows we’re seeing a homebirth midwife, someone whose credentials he doesn’t know (and probably doesn’t much respect). He wants the best for us and our baby and at the same time is willing to acknowledge his biases and express trust that we’ll make the right decision. Many doctors I’ve known couldn’t do that.

Homebirth anyway

Now our midwife hasn’t seen the scan yet and she is incredibly well-informed and thorough (we get in long geeky discussions at my appointments trading research about things like bicornuate uteri), so I expect her to go over everything, including what a cyst that was affecting the adrenals might mean for the baby’s ability to stabilize after birth.

But barring further information, we’re going ahead with the homebirth, and this is why:

Hospitals have risks too. Physiological, psychological, and (I believe) spiritual. The physiological things include interventions like IVs, hospital beds, epidurals, and pitocin induction or augmentation – many of which are routinely used in situations where they’ve been shown, time and again, to do more harm than good. (Harm like: more mothers and babies die. That kind of harm.)

(Why that continues to be the case is the subject of many books. One short answer is “Americans’ trust of technology and fear of litigation.”)

But for my specific case, the other two categories of risk are more worrying.

Most importantly, I have a lot of trauma about the medical system. I have social anxiety. I have PTSD. I’m an introvert. I feel safest and calmest in my home with only a few people I know well around me.

If this were just a matter of my comfort, I would have the baby in the hospital anyway and be uncomfortable about it, but a mother’s psychological state is hugely important in birth (scientific studies have shown…). Labor stops when a woman doesn’t feel safe. And then you need interventions, all of which have real physical risks. So unless something bigger and scarier comes up, homebirth will be safer for me especially because I feel safest at home.

And because my home is 5-10 minutes (depending on traffic) from one of the best hospitals in the state. And a few blocks away from a fire station full of trained paramedics. And because my midwife is an incredible gem of experience and knowledge.

I’m grateful

Ultimately, I’m glad I have the knowledge I do. That I’ve read so many books and taken (and taught) so many* college classes in Biology and also Cultural Studies. That I’ve attended births at home, in birth centers, and in hospitals both here and even in Tajikistan. That I’ve known midwives, doulas, childbirth educators, and doctors and heard their opinions on diverse topics related to birth.

(*I only ever taught one college-level class.)

That I also know myself, which is the most important, and I know where and with what type of support I’m likely to do best, and what my options are if there’s some reason I need to go somewhere else. And I’m glad there are hospitals around, and high-tech ultrasounds and high-risk doctors.

My birth might go exactly as I’d like it to. It might go very differently. But I’m setting myself up in the way that’s right for me, and that’s important.

Comments

I’m open to anything that doesn’t become a war of ideologies. So focusing on your own experience and what it means for you… Or just congratulations and celebrations. Those are good too.