3rd: Pregnancy

- Overview - 

• Pregnancy # 3 (40 weeks and 3 days)

It was an over healthy pregnancy. I did not have any urinary tract infections (I had 2 urinary tract infections in my first pregnancy and was put on preventive medicine until 38 weeks, and I had 1 urinary tract infection during my second pregnancy but did not have preventive medicine). During the end of pregnancy, I was tested for pre-eclampsia via blood work (complete blood count) and 24-hour urine test. Thankfully, I was not diagnosed with pre-eclampsia. I had two health care providers team, my obstetrician, and two midwives. The obstetrician had one due date, and the midwives had another. The obstetrician went off my last menstrual period, and the midwives estimated due date was based off my 6-weeks dating ultrasound, the days were 4 days apart.  I passed both due dates before having my baby. I was 41 weeks according to the obstetrician's estimated due date and 40 weeks and 3 days for the midwives.

• Cervical Checks & Membrane Stripping

I was planning for a home birth and using midwives. My midwives did not do cervical checks or membrane sweeping and did not want me to allow the obstetrician  to do them either. They felt they were unnecessary. The information isn't going to tell me when baby is coming. Especially if I stay stuck at a certain number of cms for a few days or weeks. And some women can get frustrated with their bodies when they don't hear significant changes with how far they are dilated. Those were all the reasons and more that I heard. But the most important one was cervical checks introducing bacteria and possibly breaking my water, especially if its cervical checks and membrane sweeping. The membrane sweeping is also said not to work if the body isn't ready to go into labor. Better info in this video of why some midwives don't do cervical checks, here.


So for the first time, in my third pregnancy, I declined all cervical checks and membrane stripping from my obstetrician. I only had 1 cervical check for my entire pregnancy and 0 membrance sweeping. I did ask the midwives at 40 weeks for a cervical check and I was 2 cm dilated and 50% effaced. When I had abdominal pain on my left side and called my midwife at the end of my pregnancy, we did another cervical check, and I was 4 cm dilated and still, around 50% effaced. When my home birth became a hospital transfer, I did allow cervical checks since they needed to know if I had any dilation and effacement upon arrival and throughout the process of having some monitoring. After they had broken my water, I was around 5 cm. I know before, and after I had got into the labor tub, I was around 7-8 cm. I do know before pushing, I was 9 cm and 100% effaced. Because I was tired and becoming exhausted, they decided to have me push through the little amount of cervix left. In labor, I found the cervical checks overall helpful, except for the disappointment of hearing I did not dilate when I came out of the tub.

- Co-Care -

• 3rd Pregnancy 

This third pregnancy was done a little different than my other two. My other two pregnancies were with an obstetrician, and I had planned hospital births, the first a medicated birth with an epidural and the second unmedicated/natural, which actually resulted in the unplanned, unassisted birth in the waiting room of labor and delivery. This pregnancy I decided to receive collaborative care, also known as co-care from both a midwife and my obstetrician from my previous two pregnancies. 

• Why Co-Care?

I was told most women do not receive co-care unless there is a medical need. The midwife does not accept insurance, and I wanted my insurance to cover several medical related expenses, the obstetrician could easily provide, dating and anatomy ultrasound, prenatal blood work, gestational diabetes testing, Group B Strep testing and, Rhogam shot. I did not want to have to pay out of pocket for everything since I was already paying for the midwife's prenatal appointments and for her to attend my delivery. I knew I wanted to get the rhogam shot, which would be administered around 28 weeks from the obstetrician rather than pay for it out of pocket with the midwife. I figured if I was going to use the obstetrician for most of my pregnancy,  why not finish using him until the end? I did later learn, that the midwife can write referrals, but it seemed easier at the time to get all the medical related things the midwife did not offer from one place and have all my pregnancy related information in one file with the obstetrician. 

• Obstetrician Onboard

To my surprise, my obstetrician is perfectly fine with me breastfeeding during pregnancy (I learned that during my 2nd pregnancy) and is not encouraging me to wean my children from breastfeeding. Also, he would rather have me come for prenatal care then just disappear and use the midwife for my third labor and delivery. I was actually bracing myself for a fight. He was very supportive that if I wanted to have a home birth. We agreed I should, at least, continue prenatal care in case I changed my mind or something came up in the pregnancy that meant I could no longer safely have a home birth. Or I attempted the home birth, and things didn't go according to plan, that I could go to the hospital and have him paged. He also accepted me declining a cervical check at 36 weeks and my decision for this 3rd pregnancy to not have the membranes stripped. Another shining moment for my obstetrician was when my midwife wanted to save me money by seeing if they obstetrician would order the rhogam shot for me and if I could go to the OBGYN office or hospital within 1-3 days post delivery in case I needed it. My obstetrician gave me a second rhogam shot at 36 weeks, stating it lasted about 12 weeks and would cover me so I would not need one after birth. My midwife team was pleased with this decision.

• Challenges

One thing is my midwife and her birth team, and the obstetrician does not work together.  They both have a separate business, policies, and philosophies for birth. An example of this is, my obstetrician begins cervical checks around 36 weeks as a standard routine. My midwife and her birth team do not do cervical checks unless the woman requests or it is necessary to know if and how far along a woman is in labor. This pregnancy, I declined the cervical checks and membrane stripping I had previously allowed my obstetrician to do with my first two pregnancies. I admit it was a little stressful telling my obstetrician, I would like to use you for prenatal and postpartum care only. I also would like to have a home birth which I know would require me to use another medical professional. And I would like to decline all cervical checks and membrane stripping because it's a different care than he usually provides. Did I mention, I also have two estimated due dates. My obstetrician is going off the one based on my last menstrual cycle, and my midwife is going off the one based on the 6 weeks dating ultrasound. Thankfully it's only a 4-day difference, and once I hit 39 weeks for both the estimated due dates, it was a relief because I was considered full term according to the March of Dimes definition and by both dates.

- Differences from My Previous Pregnancies -

• Longest Pregnancy

Another difference was this pregnancy was the longest I have carried, 40 weeks and 3 days. My first baby, I carried to 40 weeks and 2 days. My second baby was 39 weeks and 2 days. 

• Biggest Bump & Most Weight Gain

Another difference is my bump has gotten bigger with each pregnancy. My bump last measured at 39 weeks with my midwives as 44 cm, and I had gained a total of 50 lbs. My first pregnancy I had gained 41 lbs and my second pregnancy 31 pounds.

• Posterior Baby & Anterior Placenta

I had an anterior placenta and posterior baby this third pregnancy. From my previous labor and delivery experiences with how quick baby came out and baby being engaged, this is probably the first time I've experienced an anterior placenta and posterior baby. I feel this made for a longer and more challenging labor than any of my others. My midwives said the baby was in the right occiput transverse position (considered a posterior position), his head was transverse. 

• Unusual Labor Pains

One of the biggest differences was how I felt in the early stages of labor. I felt abdominal pain on my left side, and a little in my back as my body was in pre-labor. I actually felt that pain more on my side, then the pain in my back or any contractions. It was not due to any known reasons my hospital team in labor and delivery could find, they checked my urine for a urinary tract infection, as well as protein, glucose, and so forth. The on call doctor also broke my water to check it for meconium staining, blood or any other indicators of infection and there was none. The only conclusion I can draw is it had to do with baby's position and being posterior. I've never felt labor like that before because I would describe labor as waves that come and go. After my water broke and I continued to progress, I began to eventually feel contractions similar to my previous labors. The pain in my side lasted a long time. However, when I began active labor is when the pain felt more like what I would consider normal contractions I did not have any more pain after the baby was delivered.

• Longest Hospital Stay

With my first pregnancy, I did 2 hours of pre-labor at home and then went to the hospital where I started active labor. I stayed 24 hours in the hospital post delivery. With my second baby, I had a quick labor and delivery and had my son in the waiting room, I stayed for 18 hours. This third labor and childbirth were 7 hours and 10 mins after my water was broken. I spent 26 hours at the hospital post delivery.