Category Archives: Army life

I’M NOT AN ANTI-HOSPITAL, NATURAL BIRTH NUT. IN FACT, I’M REALLY GOING TO MISS THE HOSPITAL HERE.

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First off, we are still on for Key West. T-minus eleven days until the movers arrive.

Today was my 28 week check-up and my last prenatal appointment here in Washington. I’m pretty sad about that. I’ve had such great experiences here and have come to know and love the midwives that I’ve seen with my three pregnancies. I’ve had the chance to speak to some of them about my concerns with giving birth in Key West and have received a few different opinions. One seems confident that with my knowledge and experience I should be fine  there, even in a “hostile” environment. Two others laughingly advised me to stay home as long as possible and advocated taking the path that would involve hanging out in the parking lot if necessary and coming in only when it was time to push. One of those midwives actually told me that she was working at the medical center in Hawaii during one of her pregnancies. She said that she didn’t want to have her baby there because of some of the hospital policies so she didn’t come in until she was ten centimeters. The one I saw today was pretty on board with my plan to go to a birth center in Miami. She was one of the first midwives at the hospital here and knows the difference between a hospital that promotes natural birth and one that doesn’t. She’s been part of a fight here to go from a hospital that mandated continuous monitoring to one that has a relatively large staff of midwives and a tub for laboring and for birth.

Today was a good visit. I felt like they were going to miss me as much as I’m going to miss them. The midwife today told me she was going to have to tell one of the others that she saw me for my last appointment here. I guess being at the same duty station for three pregnancies is not that common in the military!

Two more things came out of my appointment today. First, I am officially three for three. Meaning that each of the three midwives I went into detail about my concerns with giving birth in Key West confirmed that the 4th degree tear/episiotomy that I had with Madeline will definitely trigger many obstetricians to really push a C-section. I’ve heard enough about some of them trying to schedule a section for made-up reasons. The last thing I need is to hand them a reason on a silver platter.

Second, I am 28 weeks but measuring 27. Only one week “small” at this point, but who knows what will happen in the next twelve weeks. History has shown that I measure about three weeks “small” but still deliver average sized babies. However, a doctor looking for things to be concerned about will no doubt pounce on my measurements. I don’t need that stress…or the plethora of ultrasounds I’m sure will follow. Some of the doctors do them at every visit anyway, and I’m not okay with that. Pick up a doppler and listen. It’s not that hard. They aren’t much better at determining fetal size than a tape measure anyway.

As things stand now I am going with the birth center. Now I have to fight with our insurance and get them to pay for it. Florida actually has a law that says they have to pay for midwives and birth centers (and home births) because women should have the option to give with in the environment they want with the caregiver they want. Yay Florida. Finally a law from that state that I can support. However, TriCare apparently still gives you the run around about coverage. It might be as simple as getting the right people on the phone…or as easy as threatening to sue them. We’ll see. I really want to get permission ahead of time rather than pay out-of-pocket and then have to fight with them about getting reimbursed. All while wrangling a newborn, a toddler and a preschooler.

So that’s where we are. Twenty-eight weeks pregnant, Key West bound in less than two weeks, and a to-do list that is slowly shrinking.

THE DAY YOU GOT SMACKED IN THE FACE WITH A REMINDER THAT YOUR HUSBAND IS IN THE ARMY AND THE ARMY MAKES ALL THE RULES

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I’m not one to complain much about military life. Jay was in the Army when we met, and so it has always been a part of our relationship. I knew and know that he will have to go away for weeks or months, his life will be in danger, we will have to move, etc. However, there are certain realities of military life that I have not had to deal with much. The big one is a PCS or Permanent Change of Station move. We have only had to do one since we got married. It was just the two of us and our dog and we moved out of a one bedroom apartment. It took less than one full day for the movers to pack our stuff, load the truck and drive it away. We moved from North Carolina to Washington and have been here for close to five years. Five years is a pretty long time to spend at one duty station. We bought a house, added two cats and two children to our family and accumulated A LOT more stuff than would fit in our old apartment.

Several months ago we found out that we would be moving to Key West, Florida. Initially I was a little bit (or a lot) stressed about the move. We would have to rent out our house here, figure out whether we would drive with all three pets or make other arrangements, get rid of a lot of our excess crap, figure out where I was going to deliver our third baby, etc., etc., etc. I was also hesitant to get myself too committed to the idea of Key West because I knew that things could change. Time went by, Jay received official orders to Key West, we contacted housing there and submitted paperwork to get on the waiting list for base housing, cleaned out our garage, met with companies to manage our house while we are gone, looked into options for boarding our cats and flying them to Florida after we arrive, decided to stay in Miami and have our baby at a birth center there… Things were getting accomplished and my to-do list was shrinking (and then growing again). With each thing that got checked off the list I was able to get a little more excited about the move. For months people would hear we were moving to Key West and the reaction was always the same, “That’s awesome!” “You are going to have so much fun!” “It will be a vacation!” It was hard for me to see it that way for a long time because there was so much that had to be done before the move. At this point I still don’t think it will be a vacation. To me a vacation would  involve staying somewhere without children and with daily housekeeping/meal preparation. However, I was really starting to get excited about the warm, sunny weather and the chance to be outside all of the time. I was planning on training for and doing my first triathlon there in December. Jay has always been excited about being near the beach and sharing that with the kids.

Two days ago I received paperwork for enrolling Madeline in preschool there in the fall. That same day I found and booked a great (and very affordable) place to stay near Miami around the time of my due date for baby #3. Yesterday I received an email back from the housing office telling me that they had us penciled in for a four bedroom house in the neighborhood we really wanted. Remember these houses from several posts back:

We should be getting an address with the week.

Then came the smack in the face I referenced above. Three weeks (to the day) from when we are scheduled to move out of here, I get a phone call from Jay. He is 99% sure he is going to get diverted to Ft. Bragg, North Carolina instead of Key West because some job needs to be filled there and it is more important than the job in Key West. Nothing is for sure yet, and I am trying (foolishly according to Jay) to be optimistic. Jay needs the “break” the job in Key West will provide. I need to know for sure where we are moving in a few weeks. There was a time that I would have been excited about North Carolina. It’s closer to my family and I have friends in Raleigh. But not now. Now I’m too excited about Key West. Now I want to live on that tiny island that’s three hours away from the nearest real mall. I want my husband to be in a job he can enjoy. I want him to have a little bit more time to spend with the kids and me. I want to live in hot, sunny Florida with the beach right there. I want to see the sunset on the Gulf everyday. I want friends and family to visit us there. I want to live in a house on the base and experience that community. I don’t want to start over finding a place to live in North Carolina. I don’t want to have to research options for having the baby there if the Medical Center on post is not as “natural birth friendly” as the one here.

If there’s one thing the Army doesn’t care about it is what I want. I have always known these things can happen, but I never expected it after we received orders and Jay was clearing from Ft. Lewis. I never expected it when we were three weeks away from starting our journey back to the east coast. Whatever happens I will get used to it. I will make the best of it and move forward. But for now I’m bummed and stressed and frustrated and anxious and kind of want to punch a hole in the wall (I won’t do that because then I would have to fix it and I’m not adding that to the list). Most of all I just want a definitive answer about where we are going. Is that too much to ask?

Key West Birth Saga Continues…

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You may have read a recent post about limited options for having a baby in Key West, Florida. If not, you can catch-up here. Long story short, the hospital is big on technology and pretty silent about labor that doesn’t involve constant monitoring. I had hoped that my fears that this hospital was less than accomodating to women aiming for a natural birth were unwarranted, and contacted a couple of doulas to see if they could tell me I was wrong and they just forgot to mention their midwives and birthing tubs. Or maybe there is a birth center there that doesn’t show up on an internet search. Or maybe there is at least one midwife doing home births. Here’s what I learned from them:

  • There is no birth center. The closest one is in Miami (three hours away). There is no midwife for a home birth because none of the doctors there will back one up.
  • There is a birthing tub. There is one midwife in Key West and she has “rights” to the tub. If you want to use it, you have to be seeing her and the OB she works with and pay $1000 for a liner for the tub. The doctor she currently works with has the highest c-section rate.
  • You can labor in the tub but cannot have the baby in it. They will make you get out when you reach transition.
  • The midwife practices like a doctor and actually wants women on their back and in stirrups for delivery.
  • The only doctor that really worked with women to have their babies without pain medication and in any position is currently not practicing because she had an aneurysm.
  • One of the doctors has great bedside manner and patients seem to like him. However, he is notorious for using every reason under the sun to start pushing a c-section around 38 weeks (the baby is too big, you’re too small, fluid looks low, etc.). He promises to be at all of his patients’ births and does not use the on-call doctor on weekends like the other OBs. That sounded good at first until I was told of a story where a mom arrived at the hospital about 7 cm dilated. She was admitted and the doctor was called. He was about 45 minutes away, so he told the nurse to give the mom something in her IV to slow things down. Had mom not asked, the nurse would have injected the drug without consent. Apparently this doctor is better if you have a doula, but still wants you to have the baby in the lithotomy position.

Lithotomy Position - maybe the worst position for avoiding a tear. After having a 4th degree tear with Madeline, avoiding another one and the possible incontinence issues is of the utmost importance to me. Since a water birth is out, position is all I've got.

  • There is a doctor considered the “next best thing” now that the one is out with the aneurysm. However, he has been described as “crotchety” and reeks of cigarette smoke. I’ve heard good things from some  women I’ve communicated with, but they’ve all had c-sections.
  • Two different women that I have talked to were threatened by their doctor and hospital staff with calls to Child Protective Services because they refused to consent to certain interventions.  Here is one story I got after asking on a military wife forum if anyone had a baby naturally in Key West:

Well, I hate to be discouraging, but prepare yourself for a fight.

Unless things have drastically improved from six years ago, they will argue with you about every little thing that doesn’t fit their “plan to be bothered as little as possible and get you out of our hair as soon as we can.” I was forced to stay on a monitor and submit to regular checks, which meant that I couldn’t get up and walk normally. I was “required” to have a full IV, even though they acknowledged that I was drinking enough fluids. After a few hours (of normal progression), I was bullied into taking pitocin and it was just downhill from there.

They used threats (such as me killing my baby if I didn’t do what they said and how they would call CPS on me for ignoring medical advice.) If I hadn’t been in so much pain from the pitocin, I probably would have been able to stand up for myself. I knew I would have no trouble giving birth (DS1 was born naturally and he was almost 10lbs…this baby was only 7lbs), but the constant pushing and scare tactics made me give in. We won’t even go into the breastfeeding nightmare.

Like I said, I don’t like telling horror stories, but I do think people should know what happens there. They have pregnant women at a disadvantage because there is no where else to go to have a baby. And I am, by far, not the only one this has happened to…there are some here on CC that have been through even worse there.
  • Another doctor was described as “the worst of the bunch.” He has the highest c-section rate and usually works with high-risk patients. The impression is that he treats all patients as high-risk. He was the doctor involved in the other CPS story I heard.

We had been thinking about going to Miami to have the baby at a birth center there. Not wanting a three hour drive while in labor (on the one road going in and out, so you’re shit out of luck if there’s an accident or traffic or something) we decided to go there the week of my due date and bank on the baby being born right at 40 weeks like the other two. I was liking this idea because it meant no monitors, no checks, no IV, no epidural being offered, and best of all, a tub for delivery. I wasn’t fully committed because I don’t like the idea of trusting that the baby will be “on-time” and I would really rather be at home the last few days of my pregnancy.

So this morning, after reading about the CPS threat I shared above, I decided that maybe I would rather beat them at their own game. I will do more research that I did during either of my other pregnancies. I will read up on patient rights and seek legal counsel regarding what happens when a patient’s (particularly a pregnant patient) desires are in direct conflict with hospital or doctor policy. I will speak to CPS myself when I arrive to find out if they had ever been called and what their take on this kind of situation would be. I will let them see me in a professional setting rather than risk meeting them for the first time at the hospital and pissed off. I will arrive at the hospital as far into labor as possible, preferably holding the head in as I waddle into the ER. I will arrive with a detailed birth plan and binder full of my research that will include documentation on patient rights, copies of business cards from my lawyer and whoever I speak to at CPS, and a copy of the Hippocratic Oath in case someone forgets it. Just for fun I might write up a legal memorandum summarizing the law as it pertains to informed consent and the right to refuse consent during childbirth. I will be super nice to my doctor at all prenatal appointments so that he has no idea what a true pain in the ass I will be if they don’t work with me to have the birth I want.

I’m also going to make sure Jay is wearing something Special Forces related…maybe one of his t-shirts with a picture of a skull with a knife going through it.

I’m not sure what showing up for a war will do for my psychological preparedness for childbirth, but I’m hoping that being over-prepared for the worst will make me confident that I can win a battle of wills with the hospital should it become necessary.

And it goes without saying (at least it should) that I have no problem consenting to interventions that are medically indicated. I don’t want constant monitoring, but if I need it, fine. I don’t want a c-section, but if there is a real emergency, I’ll sign the paper. I’m not an idiot. I’m an advocate for natural childbirth, not a crazy fanatic about it.

For anyone who thinks that I’m being crazy and no one can force me to do anything, let me leave you with a story I first read about in the book Pushed: The Painful Truth About Childbirth and Modern Maternity Care and read again while researching forced interventions this morning:

When a pregnant woman refuses an intervention that doctors judge provides a substantial benefit to her fetus, is overriding her refusal ever ethically justified? It is typically a sacrosanct principle in medical ethics that patients have an absolute right to refuse medical interventions, including life-saving interventions, if they make an autonomous, informed, competent choice to do so. However, in the case of pregnant women, this principle has been questioned and sometimes violated by force in the name of protecting the fetus. Examples have included forced cesarean deliveries, mandatory HIV testing, and life-saving blood transfusions performed despite religious objections.
The 1987 case of Angela Carder, a 27-year-old woman who had cancer that had gone into remission but recurred during her pregnancy, brought these issues to a head. Fully competent, Carder made clear that she wanted everything possible done to save her life. However, during the 25th week of gestation, it became clear that Carder was dying. George Washington University Medical Center, where she was a patient, tried to insist upon an early cesarean section delivery in order to save her fetus. She refused the intervention, which was nearly certain to kill her, with the support of her family, husband, and doctors, but the hospital obtained a court order and forced the delivery. Both Carder and her extremely premature baby survived the operation only very briefly. In 1990, the D.C. Court of Appeals posthumously vacated the court-ordered cesarean section, holding that Carder had the right to make health care decisions for herself and her fetus, and that only in the most exceptional circumstances should a pregnant woman’s right to refuse interventions be called into question 
Stay tuned…

Anybody know a good midwife in Key West, Florida? I fear my birthing options there are going to be severely limited.

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We are moving to Key West and it looks like it will be before baby #3 arrives. This is probably better than trying to move two weeks or so after the baby is born, but still has me a little stressed out. That’s because I will have to figure out where I will have this baby and start prenatal care with a new provider just 1-2 months before I am due.

Last night I started looking into my options. There is no full-service military hospital in Key West, so if I go the hospital route it will be in a “civilian” hospital. No big deal. I went to the website for the Lower Keys Medical Center to read about their Labor and Delivery services. I was hoping to read that they have a team of midwives who work at the hospital like we have here. Unfortunately I did not see the word “midwife” once. This is what I read instead:

A complete renovation of the birthing suites and nursery has just been completed which includes new nursing station, furniture, hardwood look flooring, paint, ceilings, window coverings, wall décor, 42” flat-screen TVs and luminescent lighting that is less harsh for mom’s and babies. 

I could care less about wall decor, window coverings, flooring, etc. I couldn’t tell you what color anything was in my room when I labored with either of my kids. A 42″ television in the room I went to after the birth would have been nice, but when you’re aiming for a natural delivery the size of the television is pretty irrelevant. I kept reading:

Our goal was to create an environment that will provide total comfort and promote bonding between mother and baby. New mothers also won’t have to worry about their doctors knowing how they’re progressing once they’re admitted for delivery with our NEW TECHNOLOGY (emphasis added). 

I am completely against technology being how my provider knows I’m progressing. I understand why hospitals use it, even though I am confident 90+% of women and babies don’t need it.  It was becoming clear to me at this point that this hospital (the only medical facility in the Florida Keys delivering babies) places a heavy emphasis on technology. It got worse:

The Philips OB Trace Vue fetal monitoring and surveillance system has recently been installed and allows doctors to log on from their computers or even their PDA (personal digital assistant) devices, such as a Blackberry, to check on a patient’s vital signs or a baby’s heart rate in real time.

And that is when I wanted to cry. Really? The doctors can track progress via computer or Blackberry???? Probably while they’re out on their boats, waiting to stroll in at the last minute to take a seat on a stool in front of my crotch and pull my baby out. The only way the docs can keep tabs on things that way is if I am hooked up to numerous monitors. And that means I’m not moving around much or hanging out in the tub. After my experience a year ago with my son I refuse to labor without a tub…even if it has to be the one in my own bathroom.

This hospital sounds like the last place I want to have a baby. I could be wrong and they forgot to brag about their awesome midwives and birthing tubs, but I’m not optimistic.

We decided to look into homebirth midwives, skipping the birth center option because I can’t find one close enough. I haven’t found anyone serving Key West yet, but I sent e-mails to two doulas I found hoping they can put me in touch with someone, or tell me the hospital is actually very friendly to women seeking a natural birth.

I don’t think all OBs are unsupportive of natural birth, but some hospitals are more focused on doing things their way and the number of interventions you might encounter is about 100% higher than birthing at home or in a birth center. I’m so glad that the hospital I had my first two children in has a great team of midwives and everyone there supports women and the way they want their birth to go.

A friend posted a link on Facebook to a birth story written by an OB who had her baby at home. She actually lied to her colleagues about her choice because they made fun of women choosing birth centers. Nice attitude. I recommend reading her story and the follow-up interview by the blogger who shared her story, especially if you have reservations about having a baby anywhere except a hospital.

Story:  An OB Pushing Her Baby Out at Home? Say it Ain’t So!

Interview: A Home Birthing OB Speaks Out

Key lime pie anyone?

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We just found out that we are moving to Key West, Florida next summer. From the northwest corner of the U.S. to the southernmost point in the country. Mommy wanted sunshine and what mommy wants, mommy gets. However, it does not come without a price: hurricanes, ridiculous cancer causing UV rays, and no Target, TJ Maxx, Marshalls, etc. that I have become accustomed to.

But I’m not here to complain. With the Army life comes the PCS (Permanent Change of Station) move and my job is to make the best of it. How hard can that be when the sun will be shining, the ocean water warm and inviting, and the palm trees swaying in the breeze.

Now this is a beach. Give me a chair and a bucket of sunscreen and I'm good.

Cannon Beach, Oregon. Beautiful, but not exactly white sand and palm trees.

To be fair, the sun does come out here in Washington. However this picture was taken in July and we are in long sleeves. Jay needs to wear a full wetsuit with a hood to surf in the middle of summer.

Now for the details I need to think about. First of all there is housing. We need to find a renter for our house in Washington, but that’s a ball of stress for a different post. We also will need to find a place to live in Key West. Since Key West is basically a vacation destination for most people, the most economical option will be for us to live on the Navy base there. They just built a new housing development that I am intent on being assigned. How am I going to make that happen, you ask? No idea. But I will not rest until I have played every card in the deck.

This needs to be where I live next. According to my two year old daughter, the line between want and need is a thin one. I'm taking a page out of her book when I say I need this house.

The photo below is also government housing that we could be assigned. No thanks. Not when there is something like the houses above.  A lot of this just depends on timing and when we get orders so that we can be put on the housing list and when people move out of the houses I want…there’s a whole lot out of my control and that’s something I am not a huge fan of. When where you live is dependent on your husband’s job and you are essentially along for the ride, you want to be able to take some things into your own hands. Attempting to control where we live in Key West is my project for the next several months.

No, thank you.

The next issue is my wardrobe. As I stood in my closet yesterday picking out a sweater to wear to the pumpkin patch, I thought to myself, “this just won’t do when the average high in January is 75 degrees.” While shopping for a new wardrobe is not exactly a chore, it’s also not free.

I see a lot less of these:

and a lot more of these in my future. Also not really a bad thing, but I do love my Uggs.

Speaking of the pumpkin patch, I don’t think those abound in Key West. I did a little google search and there is a place to buy pumpkins, but not the fall festival that we’ve gotten used to here. I’m pretty sure we won’t be cutting down our own Christmas tree while we live there, unless we plan on stringing lights on a palm tree.  So, while we won’t be strolling pumpkin patches or snowboarding in our next home, there are some new hobbies we can pursue:

Something that you can do here in Washington, but without the same view and with a lot more skin covered.

Also something that can be done in Washington, if you don't mind being cold. I prefer water sports in warm weather.

And now for the big one: sunscreen. I might as well buy stock in Coppertone right now because that stuff is getting sprayed on my kids until it forms an impenetrable armor on their skin. If someone can recommend a great all natural sunscreen that doesn’t cost twice as much as the other kinds (considering I’ll probably be using a bottle a day between the three of us), I’d appreciate the heads up.  My children and I are about one shade away from being invisible we are so pale. We went to San Diego in May and I was a maniac. Madeline got a little sunburn on her nose and I felt so guilty about it. The sun is at full strength so infrequently around here and we are so far north that after the middle of the day your risk of a burn is minimal. Did I mention Key West is as far south as you can get?

So far those are my thoughts on this move. I hesitate to even post this because I am talking about the Army. The past few months I have heard that we could possibly be moving to North Carolina, Hawaii, Korea, the Philipines, etc. When it comes to the military definitely means maybe, maybe means no, no means no…you get the idea. Your husband is definitely deploying in June. No wait, maybe it will be September. Nope, it’s going to be June and he’ll be back in February.  Just kidding, he’ll be back in April. Oh, you want your husband to be able to come home when you give birth to your son? Absolutely. Without a doubt. No soldier will miss that important event. Oh wait, we’re not doing that anymore. No, we’re not sending him home.

As of right now we are going to Florida. I have been told this is a sure thing, but until I see orders I will be a little wary. But I will start to mentally prepare, because that’s what I do. And I will try to get that house.

One Countdown is Over!

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Daddy is home! We picked him up the other night and I am happy to report that despite being gone for nine months, our daughter is all about her Daddy. I was definitely nervous that she might not take to him since he’s been gone for so long and she is so young, but they have been getting along great. They went to the dog park yesterday and are outside playing right now. It’s even better because it means that I can actually do some things that I want to do while the baby sleeps without worrying about whether she is getting herself into trouble. If only he could always stay home and did not have to work during the day :) But we’ll get him in the evening and on the weekends and that is great!
He also got to meet his son for the first time. Daddy has been getting some smiles and has been able to hold him a little bit, but he is Mommy’s little boy right now and is only minimally tolerant of anyone else holding him. The good thing is they have lots of time to bond now.