That's a rhetorical question, by the way. I don't actually care if you think home birth is safe or not, so save your opinions for someone who wants to discuss that.

I want to talk about guilt. I can't give my baby a story like mine. In fact, my "birth story" will likely involve my baby having a pretty rough first couple of days. My medication travels through my blood stream, which I will share with a fetus until that umbilical cord is cut. Once that cord is cut, the medication in my blood will obviously no longer go to my baby, who will then probably experience withdrawal. I have felt withdrawal when I couldn't take my meds on time, and it is really awful. [I will explain later why breastfeeding would probably not help with withdrawal and might actually make it worse.] I hate that this could happen. It might not, but I feel like I should be able to protect my baby from it. But, I have to either risk withdrawal for the baby or risk anxiety attacks sending me into preterm labor. I'm pretty sure that being born fully developed is better than being uncomfortable and upset. All of this means that I will be having my baby in a hospital so that doctors can immediately treat any problems caused by the meds. I know that this is the responsible choice, but I hate it.

I hate hospitals in general (who likes them?) but I become really panicky when doctors bustle around making decisions without telling me. I was once an inpatient in a psych ward; it was an excellent program and helped me a great deal. My first reaction on entering a hospital, however, is to panic that someone is about to take away all of my power. When I entered the psych ward via the emergency room, doctors I had never even met tripled my dose of Zoloft, and they didn't even tell me. I was told to go get meds, and I looked down to find capsules with scary numbers on them. Even my psychiatrist was angry, and even he had no control over it. 

I feel anxious that they will force me to be hooked up to all kinds of machines, and I am particularly afraid of the fetal heart monitor. I want a midwife with a doppler or whatever they use checking on my baby during labor. I want to move around during labor, because being stuck in a hospital bed makes me feel helpless. A woman in labor who feels helpless is not a good thing. Feeling helpless means that you are less likely to, you know, push the baby out.

I will have midwives at my birth. I will have a doula. I will have my mother and mother-in-law and anyone else who can advocate for me. I will do everything in my power to make sure that if something scary happens, a midwife will look me in the eyes and tell me about it. I do not want a doctor yelling out jargon and then demanding that I allow an intervention. That's not the same thing as deciding in advance to refuse every possible intervention; I want to make an informed decision after I understand the situation as best I can. That's all. My husband feels strongly about this, too; he will not let me make any decisions in a panic. He will bring me back to reality like he always does. I know all of this, but a hospital birth is just not what I pictured. It's not what I want. As I write this, I feel like stomping my feet. If I stop the medication, I will panic throughout my pregnancy. If I take it, the only responsible birth option is to go to a place that makes me feel panicky. I'm taking the stupid pills, because it really is the responsible choice. But here is my deep dark fear: if I can't get the first day "right" how am I going to get anything right as a mother?

I feel pretty strongly that once this is all over and done with, after I'm actually in labor, after I've actually had a baby, my mothering skills will rock. I will know that. I am so good with babies that strangers just hired me to take care of their eight-weeks-old infant while they go to work every day. I love it. I'm comfortable. I'm relaxed. And yet... the guilt...

I will not be breastfeeding.

Let me repeat that we are not here today to discuss the relative risks and benefits of any of my decisions. I've done that. Ad nauseum. Again, what I want to talk about is the Catch-22 that has come with my perinatal treatment plan. I need the medication in order to function as a mother, but taking it makes breastfeeding, a basic "mom task," risky. Guilt, no matter what I do. It's risky to breastfeed in my case because the two medications that I take at the specific doses I need in order for them to work properly both sometimes make people sleepy, and my doctors have no way of knowing whether my breast milk will include too much of the drug and sedate the baby. [The amounts of the medicines that might show up in breast milk are unpredictable because the drugs are designed to travel through blood, not fat-filled milk. It's different for every woman.] 

A sleepy baby sounds good, though, right? Who doesn't want a baby to sleep through the night? No. In this case, a sleepy baby is dangerous. The higher the dose, the greater the danger. An overly sedated infant might be too sleepy to eat. In some cases, too sleepy to breath. You know what sounds really terrible? Feeling increased anxiety about what my anti-anxiety meds might be doing to my baby, increasing the dose, feeling more worried, checking on the baby's breathing all night long, even when he or she is asleep, getting no sleep, feeling more anxious because I haven't slept... Do you see where I'm going with this? You go ahead and read the page I just linked to; it's short, I'll wait here. I'll be shocked if reading that doesn't make you feel anxious about breast milk laced with clonazepam, the benzodiazepine I take. And guess what? I also take Effexor. Even though the research does not prove that Effexor or Klonopin harm breastfed babies whose mothers take these drugs, no one has done any kind of study about the combination, let alone at the (relatively high) doses I need.

I know that formula feeding is perfectly fine. I even have breast milk donors lined up. In fact, the very day that I found out I would not be breastfeeding was the same day my close friend told me that she was pregnant. She can freeze extra milk, and as long as it stays frozen (we're going to get them a freezer for just this purpose to be extra safe), it will last up to a year. Don't worry, she'll have blood tests done for infectious diseases. Yes, she has already had one child, and yes, her milk supply was great last time. Barring anything truly strange happening, she'll be able to pump plenty of milk to give to my baby. So you can see that I will be feeding my baby breast milk from a woman who takes excellent care of herself and most definitely eats better than I do. 

My guilt about this is similar to my guilt about my limited birthing options--I will not be able to perform an extremely basic mothering task. Do I think this will cause any harm to my baby? No. Do I think it's awesome that my husband will share the feeding responsibilities? Yes! He's excited to share that job, by the way. It's all going to be great, really. But, just like the hospital birth, this is not what I wanted. Can you hear me stamping my feet?