When there really aren't many homebirth options...

[Xiaohua]

then what? I realize there are two very simple answers - go with the hospital birth or UC. But so many decisions along the way!

If you've been there, how did you decide? And if you want to keep your options open, did/would you continue prenatal care with a provider/schedule of tests and interventions that you weren't really happy with?

I am in this situation now, and feeling rather bewildered. You'd think that this being my 7th pg (5 low risk, healthy babies and one early mc) that I'd have this figured out. There is only one OB practice available to me, and their standard of prenatal care is rather interventionist. I am afraid once I get into their cycle it will be hard to break out, or to at least opt out of the things I really don't want. (GTT and GBS screening are some things I don't want to get sucked into.) At the same time, I have no other option for prenatal care, and more importantly, I want to keep options open regardless of whether I decide to birth at home, as I would completely depend on this one hospital in case of problems or an emergency transfer.

I am only 12 weeks now, and just home from my second OB appt with this practice. They seemed just blown away that I knowingly declined the nuchal translucency screening at this visit. The (Australian) OB I saw today comes highly recommended for his "hands off" and "all natural" outlook, yet when he heard that my previous two were home births he made a big point of telling me (and maybe more aimed at dh, who accompanied) that I was a "grand multip" now and would totally risk out of a homebirth anywhere in the world now just based on the fact that this is my 7th pg. Huh? Say that again? (Yeah, we're Americans living abroad in Asia.)

It's early in the game, and I want to keep my options open. But I feel really stuck - how to find a balance between totally no prenatal care and UC birth (I *do* want some basic, midwife style prenatal care) and a follow the book, take no chances test everything pregnancy?

If you have been/are seeking a homebirth and midwifery model of care but find it not available, where did you go from there?
Would love to hear thoughts from those BTDT.


Serena

[MidwifeErika]

I went through that. We moved to a new place when I was 6 months pregnant with my last child. I couldn't find a midwife, so we decided we would UC. Then we ran into a few problems and it ended up being a hospital birth. I wish it would have been a homebirth, but we did the best we could with what we had at the time. So, it can be a pretty fluid choice, as things change everyday and every minute and you may choose to have a hospital birth and then at the last minute decide to stay home or vice versa. Another option you can always look at is bringing a midwife to you, there are some midwives who travel. I wish you luck with your choices!!!

[sunflowergrrl]

How close are you to the hospital? Are you close enough so you can labor mostly at home and go to the hospital at the very end so that they can't do anything to you except say "yep, go ahead and push"? I know it would suck driving to the hospital though.

As for the tests, just stand your ground and decline the tests you don't want. In the US you know it's not weird at all to decline the genetic tests.

[ExuberantDaffodil]

Having both a hospital birth and a homebirth, I honestly can't imagine going back to the hospital (if I can help it) if I ever am pregnant again.

Are there any "underground" midwives? Semi-retired CNM? Maybe you could post in your tribal area and see if there is more of a natural birth-friendly environment in your area than what you are finding.

And if your options really end up just being the OB you don't like and a hospital birth, I would go with the suggestion to labor as long as you can at home and then get to the hospital when you feel you need it.

[Astraia]

i found myself in the same situation. No midwives, the only OB I could find who would see me was touted as being very natural and hands off and midwife-friendly, but he wasn't at all. He was a passive-aggressive manipulator who never listened to anything I had to say, and when I finally said definitively NO he freaked out and told me not to come back because I was wasting his time.

Thankfully I found another doctor who is way better than this yahoo was - and is ACTUALLY natural birth and homebirth supportive, but for awhile that was my sitatuation.

I made appointments as far apart as possible (he'd say 4 weeks, I'd book an appointment in 6-7 weeks), I didn't ask questions or engage him in any way during my appointments, and if I didn't want to do something I'd do a little passive-aggressive dance so I wasn't ever actually saying "no" I was just making it clear I thought it was stupid and he'd back off. We ran into trouble when he started pressuring me to start routine cervical exams at 30 weeks. It's hard to be passive-aggressive when he's standing there telling me to take my pants off

I decided on UC a long time ago but am not comfortable with UP. You can sort of work within the system with a really horrible care provider, but it can be incredibly wearing. You need to build up your defenses and try hard not to discuss plans with your doctor.

Of course, I can't imagine intending to show up in the hospital and be attended by a dr like that. I would DEFINITELY be showing up pushing (or as close to pushing as possible) if that was my dr!

[*MamaJen*]

What location are you in? There might be someone here who knows a midwife who practices in your area?

[Natalie's Mama]

I'm a Canadian living in Asia so I know exactly what you mean when you say "hands off" and "all natural" when it comes to birth here. I'm doing a big combo of things for this pregnancy.
- I'm doing a lot of the simple weigh and measure things on my own. I have a doppler and blood pressure cuff so I've been doing exactly what they would do if I went to dr.
- I went to the hospital (where they do the prenatal care here) three times so far and am going once more. Once to register in case of transfer, once for a scan at 20 weeks, once to get clarification on placenta position and my only "normal" check there and I'm going once more for a second scan to make sure the placenta has moved.
- I've been to my regular GP twice and will go twice more.
- For the birth I'm flying a midwife in because I couldn't find anyone locally who would attend a home birth and UC is not something we are comfortable with.

Most people here thing that home birth is illegal so I've only told a few people of our plans. I did mention it to my doctor and explained it wasn't illegal and she basically took the don't ask don't tell route which is fine with me. I'll take the baby to her a day or two after the birth so it is on record that I was seeking care.

The biggest obstacle I think we are going to face is registering the birth. We've heard all kinds of crazy things (like you have to call 999 or you go to jail for having the baby at home) so I'm prepared for a bit of a fight. I'll have photos etc of me pregnant and in labour as well as some with the cord still attached with me when I go to "prove" the baby is mine if I need to.

Other things we looked at was going to a more birth friendly country nearby or even back home but this option is perfect for us.

Good luck and let me know if I can be of anymore help.

[Xiaohua]

Hi Natalie's mama, where in Asia are you? Good for you to fly a midwife in! Sure beats flying you away from home, right? Do you mind if I ask where your midwife will be travelling from?

I have actually had 2 UC's here (China) but it's not my first choice for this birth. But I do have experience (as an American, not Candadian) registering the birth with the Embassy. I do not have a local (Chinese) birth certificate for either of my UC babies (2003 and 2007) and ran into some roadblocks when I tried to inform the Embassy and apply for a passport. At first they wanted DNA testing to prove the baby was ours and we didn't just find him on the street and were trying to pass him off as an unattended birth.
But I just showed up at the Embassy with all of my pre-natal and post-natal records and they said that was enough. With the second UC birth we had a witness swear to the consular officials that the baby was indeed ours. (This was our midwife, who did not make the actual birth but we left that little detail out! ) I can't speak for Canadian officials, but your plan sounds like more than enough and should be satisfactory.

I am also told that home birth is illegal, but have no actual evidence that this is true. I do know that there was a hospital here that was sending doctors out to attend homebirths (somewhat secretly; they weren't exactly advertising it) and they have gotten fined by the health bureau the last two times they did. So maybe there is some regulation somewhere...


Anyway, I am seeing the OB practice at a local international hospital now. I am very unhappy with the standard of care and the threats and bullying to get me to conform to their standards. I would like to go intermittantly during the pregnancy, but am really afraid they'll drop me for care if I don't cooperate fully. It is really important for me to keep this option open for backup in case I do home birth and need a transfer, or on the slim chance that I decide to have a hospital birth. So I'm kind of stuck with them for now.

I hate that my only two options are the fully medicalized model or the totally unassisted model. Women should not be forced into these situations!

I keep hoping there's a midwife in hiding here somewhere, and any day she's going to pop up and say "Here I am!" . But I have to be realistic; it's probably not going to happen. Having had two UC's I am obviously pro-UC, but I don't think UC should ever be a "last resort" "no other option" kind of thing. And just because I've done it twice doesn't mean it's going to be right for me this time.


And to the OP who suggested staying home till the last minute - that is our other option. Just sounds so stressful, and what if things go faster than you plan and the baby is born in the car? If you forgo all the mid-labor monitoring etc, why bother going at all? Or the opposite - the last time I had a hospital birth everything just stopped and stalled out once I got there... led to all kinds of nasty interventions.

Still go a lot of thinking to do!

[MegBoz]

Originally Posted by Xiaohua

And to the OP who suggested staying home till the last minute - that is our other option. Just sounds so stressful, and what if things go faster than you plan and the baby is born in the car? If you forgo all the mid-labor monitoring etc, why bother going at all?

Well, one thing I can think of is that if you go push the baby out at the hospital, you'll be there in case you need treatment for post-postpartum hemorrhage, or if baby needs treatment like resussictation, or if you have a shoulder dystocia.

So I can see some value in treatment for 2nd & 3rd stage, but no monitoring for 1st stage.

But yeah, i totally agree with you that it's awful to have no options but fully medical or UC.

[Natalie's Mama]

We're in Hong Kong xiaohua. Where abouts are you? The government prenatal care is such a headache that I have no idea how anyone does it on the "proper" schedule. When you do deliver your partner is not allowed to be with you when you labour which is the silliest thing I have ever heard! They recently are allowed in during delivery but you do the rest alone. That in an of itself made me want to stay the heck out of the hospital if I could help it. I'm really happy to have found a way that seems to be satisfying everyone's needs but it took some work that is for sure.

Our midwife is coming from Belize. Not a short haul by any means! I was hoping to find someone here but like you said no one was jumping out saying "oh I'm a midwife!" so when I found this lady I jumped on it.

I hope you can find something that works for you. I agree UC shouldn't be your only alternative. It seems to me like over here the more machines, tests and restrictions the better everyone thinks the care is. Reminds me of that Monty Python sketch actually. I was worried about my OB's dropping care when I didn't go, but they seemed happy to hear that I was seeing a GP. I never mentioned how much, just that I was going. Maybe that is an option for you?

Thanks for the info on the passport. I've talked to a few people that have done it and they all say it is in who you manage to get on the other side of the window. I have my ultrasound report etc so hopefully that is all I need to prove I was pregnant.