Would you pay $1800 for this?

[mrsdocmartin]

DH says it is totally up to me, but here is the backstory. DS's birth was a hosptial birth that did not go as we envisioned. I was pressured into an induction (looking back it was unnecessary) at 42w1d. I had pitocin and it was awful. I was able to still go without pain meds, but the pain was really, really bad and the experience was traumatic. We decided to go with a hospital birth again because we thought we were more educated this time and could make better decisions and not be pressured.

Now that I am 39 weeks, I'm not so sure. I tested GBS+ and plan on refusing abx. Our midwife is supportive to a certain extent, but we are finding that she is a more medicalized midwife than we like. She is very pro abx, pro pitocin during 3rd stage of labor, etc.

I am hoping to birth at home as long as possible and go to the hospital just to have the baby. I don't want an induction and I don't want to be there long enough for them to pressure us into getting the abx. My fear is that when I'm in actual labor that DH and I will panic and go in too early and the same crap will happen again (not progressing, pressured into pitocin or other interventions, etc).

So, we looked into homebirth, but my current midwife really scared me about the possibility of GBS sepsis in the baby with me not getting the abx.

We spoke to some homebirth midwives in our area and did get this option, which sounds great to me, but is $1800. What do you think??

When we have served families in the past in the Montrice role, what is most common is a team/circle of support enabeling the family to labor at home as long as possible and then the family moving to the hospital with 1 or 2 of our assistants in order to birth and welcome their baby there. At home LeAnn and I and one of our assistants would offer you anybody/mind/spirit support and also give you information about how your labor was unfolding (monitoring your vital signs, listening to your baby, checking you internally as you desired for how your body is opening and how baby is moving down). We would be available to answer any questions or provide you with information and options. We would respond to what your desires call for in terms of hands on or hands off support. As birth drew near one of our assistants/or apprentices would then accompany you to the hospital. At the hospital your hospital provider assumes her role as your primary birth attendant. Our assistant is there at the hospital to continue to offer you whatever support is needed and to answer any questions and share information and options. We are also still available to you by phone and will also offer you information, options and answer any questions you have. We have also offered in home postpartum visits, (how the adjustment is going for the whole family, physical assessment of mom and baby, breastfeeding support, etc...)

[wake_up]

Sounds like basically a doula who does internal checks... Why would you be passed off to another midwife upon going to the hospital? I dunno, $1800 for labor and postnatal support - and you still have to pay the hospital and another midwife - sounds like a lot to me.

edit - I guess what I mean is, why not hire a doula if that's what you're wanting? Would be way cheaper and do most of those things.

[lyterae]

It sounds like they would taking the role of a doula?

[mrsdocmartin]

I would be passed off to another midwife because they aren't a part of the hospital and my midwife (or the one on call) would take over as the caregiver. I have no idea what doula services normally run.

[Quaniliaz]

I'm confused. You don't want to have a homebirth, because of the potential for GBS in your baby. But you are also planning on refusing abx during labor. Will you be treating your baby with antibiotics after it is born? Otherwise I fail to see why having a hospital birth is an advantage in this case (certainly there can be other reasons - just curious, since these are the ones you've laid out.) Regardless of where you have your baby, you can treat with antibiotics for GBS by taking the baby into the hospital after the birth. Furthermore, I'd be more concerned with GBS in a hospital because of all of the vaginal checks (just my personal opinion - and that would depend on your care givers in each location).

Consider using garlic internally (vaginally) for the GBS. And re-consider what you actually want for your birth.

[MegBoz]

To answer your Q, yes I think $1,800 is high for that. Sounds to me like doula support (labor support at home + in hospital) along with monitoring fetal HR + the option of internal checks. Well, my doula told me legally she can't monitor fetal HR, but she has her own doppler she's willing to lend us. She also told us she's skilled at monitoring labor "sign posts" (a term I know from Bradley training) to help us gauge when to go to the hospital so we don't leave too early.

I think I'd just go for a doula. Doula services are generally not that expensive. Also, if you've BFed before, & have supportive family, you may not want or need the post-partum visit. Not that a PP doula isn't a fantastic thing, but if you don't have the extra money for it, I'd like the option of hiring just just a labor doula for a much lower fee.

Originally Posted by Quaniliaz

I'm confused. You don't want to have a homebirth, because of the potential for GBS in your baby. But you are also planning on refusing abx during labor. Will you be treating your baby with antibiotics after it is born? Otherwise I fail to see why having a hospital birth is an advantage in this case (certainly there can be other reasons - just curious, since these are the ones you've laid out.) Regardless of where you have your baby, you can treat with antibiotics for GBS by taking the baby into the hospital after the birth. Furthermore, I'd be more concerned with GBS in a hospital because of all of the vaginal checks (just my personal opinion - and that would depend on your care givers in each location).

Exactly! Actually that's not just opinion - it's proven that more internal exams increase the risk of baby getting GBS infection (since the bacteria live near the outside of the vagina & the exam pushes it up into the cervix.) & I think it is quite fair to say that the average hospital birth has a lot more VEs than the average HB (sure, there are exceptions, but I think this is definitely a true statement.)
& that is to say nothing of how much more likely HCPs are to AROM in hospital vs. in HB. (Again, ROM is proven to increase likelihood of GBS in baby.)

I was GBS+ & freaked out about it too. My DH had the FANTASTIC idea to see how the manage it in other countries (knowing how vastly superior maternity care is in other areas but the US). Funny how babycenter.com and babycentre.co.uk had rather different things to say about it!

In the UK, they don't even routinely test for it. If they do & you're +, they only recommend ATBs if you have two or more risk factors and the + swab is only one risk factor. (others are:
-previous baby with GBS
-UTI with GBS
-ROM of 18+ hours pre-delivery
-maternal fever in labor
-preterm labor

You also can do a hibicleans wash which is proven effective!! Basically, I joke that IV ABTs for GBS is like taking a sledge hammer to kill an ant. Sure, it's gonna work - you're going to kill the bug you're intending to kill, it's a bit MORE firepower than you really need! ya know? You could kill that little bug without lots of collateral damage in other ways.
That's exactly the comparison of hibicleans wash to IV ABTs - the IV ABTs get through your whole system & into baby -- potentially causing other problems! Did you know the rate of side-effects is 10%?! That's insane! & some of those side effects could be crazy rashes (my doula itched from them for like 3 months!) & thrush - which could kill a BFing relationship. & that is saying nothing of ABT-resistant infections such as e.coli which can be fatal to baby. Whereas the hibicleans just kills the bacteria right there in the vagina instead of wreaking havoc on the entire bodies of mama & baby.

All that being said, if you chose no treatment at all, you just need to monitor baby's temp. LOW temp in a newborn can be a sign of infection. You'll have to take this responsibility on for yourself since you won't have nurses to do it every few hours, but, , Um, I don't think it's a stretch to say that's something you're capable of handling, ya know?

So, ok, That's my essay on why I wouldn't let GBS+ sway me against HB.

Oh, also, I wouldn't necessarily say your MW is medically-minded for being pro-ABTs for GBS & pro pit in 3rd stage. For one, the ABTs are a CDC recommendation, so she'd really put her career on the line if she were ever too overtly outspoken against the policy. & surprisingly, "active management" of 3rd stage (prophylactic pit) is actually a WHO recommendation!

I believe the rate of PPH is like 10% - of course we know that hospital practices such as cord traction, manual placenta extraction, & pit to augment/induce labor all increase the risk of PPH, so I'd be curious what the rate of PPH is for "pushed" (medicalized) births vs. those allowed to progress normally & naturally. But in any case, 10% isn't all that low AND the risks of pit in 3rd stage aren't high, so I wouldn't let that worry me too much. (Of course, you can refuse, I'm just saying it's not a big red flat IMO.)

If, however, my MW got up-in-arms about things like going past 42W, pushing in any position I liked without coaching, pushing for more than 1 hour, DH catching the baby, no IV fluids & not even a hep-lock, eating & drinking in labor, and only intermittent monitoring via. doppler or fetoscope (dont' make me get out of the tub!) then I'd be more worried.

[kcparker]

Originally Posted by mrsdocmartin

Now that I am 39 weeks, I'm not so sure. I tested GBS+ and plan on refusing abx. Our midwife is supportive to a certain extent, but we are finding that she is a more medicalized midwife than we like. She is very pro abx, pro pitocin during 3rd stage of labor, etc.

I am hoping to birth at home as long as possible and go to the hospital just to have the baby.

I detect a little Freudian slip there.

If you are GBS+ where I live, if YOU, mama, don't take the abx, they give them to baby after the birth as a prophylactic measure, and I'd rather that I got the needle stick than the baby.

You could look into this chlorhexidine/hibiclens for GBS protocol that Barb Herrera, CPM laid out - print this out, take it to your provider, and ask if this would be an acceptable alternative to the abx. I would do this rather than spend $1800 on a monitrice.

And you can refuse the pit. unless there is a medical indication for it, like you are bleeding excessively or your uterus is boggy and not contracting down well on its own.

[St. Margaret]

I would be doing the protocol of probiotics, grape seed oil, all that jazz. You can probably find it online, I bet navelgazing midwife has it on her blog? It would reduce your risk. But just having a positive swab indeed does not mean you NEEd antbx. I had a friend planning a HB who had a really bad true infection and she went to the hospital with her midwife and a great OB and that was good, but just a swab is only a borderline thing.

It does sound like having an actual midwife at home with you would not serve a real purpose. Internals would only raise risk. Is there something that could happen during early labor that a MW would be able to detect better? A doula around here (and I'm pretty sure we have the highest prices of anywhere!) is only $600. I think hiring a doula is a great idea; we felt much better having someone who could come to our home for early support and help us know when the right time to go was, and then support in the hospital, it was great b/c she got me what I needed, massaged me, etc, but if it had been a pressured environment, she would be good at stepping in, too. Maybe a good doula is all you need? OR maybe what you really want is to switch to HB! But I'm not sure a monitrice is what you need. It makes sense they charge more for their time; they are trained midwives. But I've never heard of them passing you off to an assistant; the MWs I know do go to the hospital. There might be a reason for that; maybe rules or just how the OBs react, they might know best about who to send, and an assistant can still be jsut as good... but again,a doula is really the same thing!

Good luck! You can do it! Hopefully the second time around your body will start things a tad sooner and progress a bit faster and you won't have to worry about the timing and pressure anyway

[mrsdocmartin]

Thanks for all of the input. I don't really know what to do. I have been following a GBS protocol, with tons of probiotics and other supplements, garlic orally and vaginally. I did retest and was still positive, but had only been taking supplements for a week and hadn't started the garlic at that point. At our hospital, the protocol they follow is that if mom does not get the antibiotics, then they take a cord blood sample and run an I:T ratio. I guess that is to check for an elevation of a certain type of white blood cell. If that is elevated, then they give the baby antibiotics. So, they don't just give the antibiotics to the baby unless that score is elevated. I haven't been able to find much research as to risks of false positives of this test. DH will probably have to do some digging.


I guess I'm just afraid that I'm being irresponsible if I have a homebirth knowing that there is this risk. Maybe that's silly. Also, financially, a hospital birth would be a lot easier on us. Again, maybe not the best reason.

My CNM is really great and has agreed to no pit during 3rd stage of labor unless the need arises which I am fine with. She understands that we want very few interventions, checks, etc. But, we had her last time and it didn't go well.

[MegBoz]

Originally Posted by mrsdocmartin

I guess I'm just afraid that I'm being irresponsible if I have a homebirth knowing that there is this risk. Maybe that's silly. Also, financially, a hospital birth would be a lot easier on us.

Well, actually you can get the IV ABTs at home if you really want! A friend of mine did with her HB with a CNM.

Besides, you can say that about any issue. Personally I'd feel just as worried birthing in a hospital and accepting ABTs (in either location) if baby or I ended up with bacteria-resistant e.coli, thrush which killed BFing, or went to the hospital & ended up with MRSA, unnecessary CS, etc.

My point is that birth is never 100% safe & there are risks either way. You have to weigh all the options, all the risks/benefits, all the pros/cons (including money, which is NOT a silly thing to consider, IMO!) & make your own decision. But, ya know there are still risks wherever you are.

Originally Posted by mrsdocmartin

But, we had her last time and it didn't go well.

Aaaah, maybe I missed that the first go round! Hm, that changes things.

[mrsdocmartin]

No, I'm NOT getting the antibiotics either way. We feel the risks outweigh the benefits. I'm more concerned that if the baby does end up with problems, that I'd feel better about being in the hospital.

But, the likelihood of that happening is small and I don't want a million unnecessary interventions, kwim?

[fruitfulmomma]

A competent midwife should know the signs of complications from gbs in your baby and advise you to take the baby to the hospital if they arise, but clearly it is up to you whether or not you feel comfortable in that situation.

In my state I would be risked out of homebirth care if I tested gbs+ so I always decline but my midwife has stated that it can be positive one day and not the next. She advises me to take probiotics as a precaution. There are other ways to help get it under control before the birth as well.

Back to your original question... it does look like they are doing more than just doula work with regards to ve's and other monitoring, which may or may not be worth it. The doulas around here seem to charge $500 to $800 so I'd expect to pay more for monitrice services. If money is an issue I think I would personally hire a doula for a lot less and then learn how to do ve's myself or have my husband do them. As a pp said earlier, a doula should be able to look for other signs that it is time to head out and would be a lot of help to you once you arrive at the hospital.

[loveneverfails]

OP, if you had a baby who did get GBS, they would be symptomatic and then you transfer. It's not as if GBS results in a baby crashing out of nowhere. You would have time for a timely transfer if your baby started showing signs of GBS. GBS is an infection. It's not a traumatic injury. Infections take time to develop.

Also, please remember that there are hospital based infections. I was GBS positive with my 2nd birth, took the antibiotics and I came home with MRSA from that stay. I don't think you will get the benefit that you're looking for from being on site at the hospital, and you could still get sick (and your baby can still get GBS! Late onset GBS is largely hospital acquired...)

[mrsdocmartin]

Originally Posted by loveneverfails

OP, if you had a baby who did get GBS, they would be symptomatic and then you transfer. It's not as if GBS results in a baby crashing out of nowhere. You would have time for a timely transfer if your baby started showing signs of GBS. GBS is an infection. It's not a traumatic injury. Infections take time to develop.

Also, please remember that there are hospital based infections. I was GBS positive with my 2nd birth, took the antibiotics and I came home with MRSA from that stay. I don't think you will get the benefit that you're looking for from being on site at the hospital, and you could still get sick (and your baby can still get GBS! Late onset GBS is largely hospital acquired...)

This gives me a lot to think about. Thanks to you and everyone. I just really want to make the best decision for my family and don't know what that is.