final chapter of the saga in post #108 (was "really conflicted about homebirth and need advice")

[mamahen2coop]

be forewarned, this might be long and scatter brained...  

I have two personalities- my L&D nurse/see what bad can sometimes happen/have medically oriented peers/ not totally into HB husband and my crunchy/no vaxing/ no circing/cloth diapering/homebirth wannabe side.  I come home and pour over Birthing From Within and forums like this and feel sure that I can do a hb if I could get DH on board.  Then I go to work and occasionally see the complications that can happen with even normal deliveries and makes me feel like I'd be more comfortable in the hospital.  How, OH HOW, do I choose!!!

Background- DS will be 23ish months when LO is born.  My labor with DS was 6 hrs only, delivered in the hospital, with epidural, not unpleasant but not amazing.  I was GBS positive and only got 1 dose because I was only there for 3 hrs before delivery.  I'm completely low risk, normal BMI, no complications whatsoever.  After DS was born I lamented about having the epidural for months because I really didn't want one but I think because I work there, they expected that I should know what I wanted.  I didn't tell anyone I didn't want an epidural because I didn't want to look like a failure if I ended up with one after saying I didn't want one.  I labored at home for 3 hrs, was 5cm/100% when I got there, was complete 2 hrs later then pushed for an hour.  This time, everyone will know that they will be strangled if they do anything but help me deliver without an epidural.  I'm not the kind of person to use a doula, I would need someone I know personally. 

anyway...  Im seeing my OB and I know this is totally chicken, but if I was able to talk DH into a homebirth, I think the way I would keep my work side from judging me (which Im scared of) would be to continue OB care as if I was going to deliver in the hospital and just pay a midwife out of pocket to do the home del then go to the hospital like it was an accident. 

I know it's totally gutless but it just all feels so complicated still.  I'm 17 weeks so I have some time to think about it.  I dont have a large pool of midwives to choose from so maybe I should try to start there and see if I can even find one that I like first. 

If you got this far, thank you for reading!  Any advice or guidance is very appreciated!!

PS how does one start to look for a midwife anyway?  the only one I know of that is also the closest, I'm not fond of. 

[Baby_Cakes]

Hmm.

This is just my two cents so take it with a HUGE grain of salt!!  From reading your post, I feel like you are still very focused on what other people are going to think.  The whole getting the epidural the first time b/c of what people would think if you needed one later, and now wanting to plan a hb in secret b/c of what others would think...it screams to me that you really need to think about what YOU want, and stop thinking about others!  I know easier said than done.  But here's the thing.  NOBODY is as invested in your labor and birth as you are.  Nobody.  Not your husband, not your OB, not your co-workers.  YOU.  What do you want?

I think in your heart you want to hb naturally, but are too afraid that if something goes awry and you end up transferring, people will think less of you.  But honestly, that is just not the case.  At the end of the day, you would have at least have had the chance of the experience you wanted.  If you never try, will you regret it?

Mostly people just want mom and baby happy and healthy.  If hens are going to cluck about "when she got the epi" or "did you hear she's having her baby at home!!??" they're going to cluck no matter what you do. You have to think about what YOU want and how you're going to feel after the fact, if you had the birth experience that you wanted.

HTH!!  Good luck making this decision.  Let us know what you decide!

[msmiranda]

I guess my question is, WHY do you want to homebirth?  Or, conversely, why do you NOT want to give birth in the hospital (but then go there afterwards?)?   I think drilling down on the specifics of these questions will help you decide what to do, and could also help the women on this forum give you advice. 

[carriebft]

Why not go for CNM care? you get your testing, ultrasound, GBS test, etc- everything the OB would give you. Present the information to your husband and show him how CNM care allows for the same things as OB care. Find a CNM that does in and out of hospital births and that gives you freedom of choice and will give you that peace of mind that comes with having OB back up, ease of transfer, and legal use of medications and equipment at home like pit and IVs, etc.  (is this an option in your area? maybe post in tribal area looking for a CNM)

[mamahen2coop]

Can I preface this by saying this is really helpful to me and I need all the honest, open discussion you all are engaging me in.  I have no friends, family, or aquaintences that I would be able to discuss this with so thank you for your time and thoughts!

(here comes long and free flow thought again, sorry!)

Carriebft-  I would love to see a CNM and be in a birth center since I think it would be a good compromise between HB and Hospital, but I would have to either drive over an hour to Tacoma or drive/sail (assuming the ferry was running right when I needed it) over an hour to Seattle.  So I dont think it would be feasible- what do you all think?

Msmiranda-  that's a good question!  those are the questions I need to be asking myself but haven't thought to ask.  I guess I've just been waiting for my gut to tell me what's right. 

I think one of the main reasons I dont want to birth in the hospital is the business of it.  Even though, if I asked her to, my OB would wait a few minutes to cut the cord, it's business.  She wants to get back to seeing patients, the nursery nurses want the baby to weigh and assess so they can do their routine and get back to business.  All the bustle is over within an hour but it's the first hour.  They dont NEED to weigh the baby right away except they want to so they can give report to the pediatrician who will give orders and they want to do it within the first hour because they want to give the vit K and erythromycin within the first hour. 

Which sort of leads me to why I would like to birth at home.  Although when I was at the hospital with DS it was comforting to know all the people involved in our care, knowing everyone might inhibit me from just laboring how I need to labor.  Same with just being there- they have to do monitoring, which I understand.  And they're just mostly used to what we normally see- early labor, epidural, easy to monitor, easy to manage.  We do get natural labor patients but 99% still birth in the bed lying down, because that's the comfort zone.  They can do intermittent monitoring as long as the FHR is reassuring so I could be on for 20 and off for 40mins.  I wasn't there long last time and am guessing I'd be there even shorter this time since my plan, unless I was GBS positive, would be to stay and home until the last minute.  I think they would inhibit me from freely choosing my favorite birthing position too.  What if I want to squat?  I'd have to use the squat bar (which are really dusty because NO ONE ever uses the squat bar) and squat over the bed.  Maybe once I get to that stage of labor I wont care what people think and I'll just be able to ask for one without thinking.  We have occasionally had someone deliver in the whirlpool tub, but it's not really meant for deliveries and aside from one instance, if you deliver in the tub, it was an accident. 

I want to be able to make normal birth sounds and feel free to roam about the cabin as I wish.  I want nature to just be able to do its thing and trust that my body and mind will be able to do it. 

BUT it's hard for me to turn off my medical training/background and forget about all the what-ifs.  I KNOW GBS sepsis is rare (although a local baby just died of it the other day, which puts it forefront in my mind and scary), but if it happened to me and I didn't get treated I would kill myself with guilt for ever and ever.  Same with other complications.  (I have this same inner battle with myself about vaccinations all the time- I'd feel SO guilty if I intentionally injected him with badness and he had a reaction but I'd also feel guilty if he was injured from a "vaccine preventable" disease- UGH parenting is hard if you dont just follow the herd!)

baby_cakes- it's so hard to put them aside!  No one at work yet knows I'm pregnant so any recent conversations about it have been hypothetical.  But we were chatting not long ago and I said I would totally contemplate home birth if we had a decent midwife around (which I haven't found yet, so if I cant find one then all this discussion is futile!) and the nurse I was talking to (who was a midwife in England before she came here), said why would you want to do that?  Why risk it?  Which I think is what a lot of people who haven't actually researched it would think.  They're extra biased because they dont have a good relationship with the local midwife so when ever they have contact with her it's negative (she recently transferred a pt to the hospital for extensive vaginal repair but the MD found no tear to repair)  
I think it would be easier for me to just live the lie and pretend I delivered at home on accident then go in than to face all their scrutiny and judgment (totally chicken of me I know!)  I'll be off work for 16 weeks after the birth so they would have done all their worst talking by then I'm sure.  And it's not them talking about it to each other that I'm worried about, it's more the backlash if something were to go wrong.  I would feel enough guilt as it was without them basically saying I told you so. 

This might be our last baby even though #3 isn't out of the question so I really want to have the delivery of my dreams even though I haven't quite dreamed it yet.  I just love watching homebirth videos online (I got teary watching this one this morning) and reading home birth stories.  I'm going to a conference next week that will be a room full of Doulas and childbirth educators, and one of the speakers is Pam England so I'm going to work that and try to get some info, ideas, or contacts there.  The only time I mentioned HB to DH he said no way, but he's pretty easy and I think if I can decide what I want, he'd be open to having a conversation about it.  And, like I said, I'm not sure I'll even be able to find a midwife I like in my area.  I also toyed with the idea of UC but since the guilt I'd feel if something went wrong is a big part of what would make me not want to HB, I think a planned UC is probably not a good idea. 

Like I said, I'm totally open and eager to hear brutally honest and insightful feedback.  and again, thanks for even having this discussion with me, I dont think I could have it alone.

[carriebft]

on the GBS thing- nurse midwives here in PA can do IV antibiotics for GBS at home; I am not sure of the laws/practices where you are, but you can be treated for GBS positive at home. I had a homebirth 2 weeks ago and took the IV antibiotics sitting on a birth ball in my room :)

[mamahen2coop]

If I can find a midwife that will actually come to my house I"ll for sure ask about it. 

Congrats on your recent delivery!  Enjoy your babymoon.

[Baby_Cakes]

I have to say this b/c it's relevant.  Some ppl just will not ever *get* homebirth.  These people can't be educated or debated with, or even brought around.  These kinds of ppl are the kind you don't need to share your birth plans with!  Even those of us who proudly plan homebirths know that some people aren't the right people to share that kind of information with.  You can totally be selective with who you tell.

Weird that your co-worker says why risk it when the risks for a healthy pregnant woman are so incredibly low.  What risk is she talking about?  To the mother?  To the baby?

[mamahen2coop]

Im not really sure what risks shes talking about but youre right.  Some people cant be or dont want to be educated or have an open discussion about certain things.  It was VERY helpful for me to spew my thoughts out earlier today (instead of cleaning house.  whoops).  But I can totally picture myself in our hottub outside in the summer just having a baby.  The hottub doesn't work so I figure I could use it like a pool.  Anyway, first I have to see if I can even find a midwife that will come to my house.  I dont have many to choose from.  I emailed a few today to see if they'll service my area.  I guess if I cant find one I'll just have to go by our original plan but I'm going to at least start trying to make it happen.

[labortrials]

Well, there's no way to get around the fact that your colleagues may "judge" you for your unorthodox birth choices.  You'll just have to weigh how important that is to you.

I'm sure you'll be able to sort out the complications that are genuine vs. the complications that are caused by the medicalized birth machine (cascade of interventions).  It sounds like you have every reason to assume that things would go well for you at home.  And think about what this could do for your nursing skills and for your patients - to know that their nurse had a baby w/o induction, augmentation, or an epi!

I think you'll figure it out!

[bird_verde]

I think you are on the right track in exploring your options.  Talk to any midwives that might take you on as a client - see if one of them clicks with you, get to know more about them and their practice/philosophies.  It may make all the difference.  Perhaps even take a birthing class (if they are offering one) from a midwife or HB doula - they are quite different than the hospital classes.  With more knowledge and research, you will gain more confidence in YOUR decision and other people's opinions won't matter as much.

FWIW, I had DD1 in a hospital and was perfectly comfortable with the idea of having DD2 with the same family practice doctor again at the hospital.  I didn't love my first birth but it wasn't terrible. It was just OK.  I didn't really think there would be a better way to birth.  However, we didn't have insurance and the financial reality of having dd2 in the hospital was astronomical and frightening when I started to concider the reality that interventions are so much more likely in the hospital and every intervention and every drug that they may give me would keep adding to the bill...  So I started exploring my options.  HB was the most economical choice and I wasn't opposed to it.  Once I finally found a midwife that would service my area (very rural), I met with her for a consultation for an hour. She was very professional and I liked what she had to say.  It took DH and me about three weeks of further research to finally feel comfortable with a HB. During those three weeks, I worried a lot about what others would say or think.  But once we were comfortable with OUR decision and confident in our midwife's abilities, other people's options didn't really matter anymore. I didn't exactly broadcast our HB decision to everyone as I wanted to avoid opinions and comments from those people that I knew had negative opinions on HB. With every appoinment with the midwife, I grew more confident in our choice - midwifery care is so different from standard OB care.  By the time I gave birth, I REALLY didn't care what others thought or would say about me (side note: we live in a very small community and are friends with many people on the hospital staff) even if we did have to transfer.  So glad we went with the homebirth - probably the best family-bonding expereincce we will ever have, very amazing!

[Marissamom]

going to Tacoma to the birth center could be an option, but I see two possible issues, first is that you have a shorter labor, an hour could be a long time, if you put off going at all you might end up having a car birth. second, an hour in the car in the middle of summer in the middle of labor could be really miserable. and I absolutely wouldn't count on the ferry schedule being timed perfectly for your labor. 

you may also be able to find a MW who will travel to you. I know my MWs will travel up to an hour, some will travel even farther. So I would look slightly outside of your community. (so if Tacoma is an hour away, I would call a few in Tacoma) 

I found this directory of WA state midwives http://www.washingtonmidwives.org/directory/index.shtml

and here's one of CNMs (though most don't do homebirth in WA state, there are a couple) http://www.midwivesofwa.org/find.html

[douladianne]

Hi Mamahen2coop ~ I've assisted a couple of midwives in many home births in the Puget Sound area and know at least four that will travel to Poulsbo. Feel free to PM me if you'd like some names and info :0)

Take care ~ Dianne

[mamahen2coop]

I get really excited and confident that I want to do a homebirth and just talk DH into believing it'll be OK and saying to heck with my coworkers.  Then I go to work today and have to hear comments from some of the nurses I'm closer to and an MD (not mine) about how a patient does what she says not like those homebirthers that dont want you to do anything to them.  I know it should only strengthen my want for a homebirth but I just dont know if I'm strong enough to handle the criticism let alone bringing up the topic of breaking up with my OB.  I think I would HAVE to plan a homebirth with an attendant then go to the hospital and pretend I delivered at home alone on accident.  I am really not a weak person in most regards, but I admit I'm not good at conflict and the thought of telling my OB or my "work friends" that I'm backing out of regular care and having a home birth is almost nauseating- I'd rather shoot myself in the foot. 

Ive yet to hear back from any midwives so am still not even sure one will come to us, or be OK with being my little secret.  Time will tell I guess. 

Quote:

Originally Posted by Marissamom 

going to Tacoma to the birth center could be an option, but I see two possible issues, first is that you have a shorter labor, an hour could be a long time, if you put off going at all you might end up having a car birth. second, an hour in the car in the middle of summer in the middle of labor could be really miserable. and I absolutely wouldn't count on the ferry schedule being timed perfectly for your labor. 

you may also be able to find a MW who will travel to you. I know my MWs will travel up to an hour, some will travel even farther. So I would look slightly outside of your community. (so if Tacoma is an hour away, I would call a few in Tacoma) 

I found this directory of WA state midwives http://www.washingtonmidwives.org/directory/index.shtml

and here's one of CNMs (though most don't do homebirth in WA state, there are a couple) http://www.midwivesofwa.org/find.html

The 20 minute drive from here to the hospital when I was only 5cm was rough enough.  I think a whole hour in the car would be miserable and probably risky since I will definitely not be able to make myself leave the house until I"m SURE I'm in active labor and maybe this time it'll go faster.  I dont really need baby's birth announcement to be a piece in the blotter about delivering on the side of the freeway. 

I have contacted everyone listed in my area on the MAWS website and have no responses yet :(
I'll take your advice and start contacting some people in Tacoma also.  It's right around an hour but a straight shot up the highway.

[labortrials]

Originally Posted by mamahen2coop 

Then I go to work today and have to hear comments from some of the nurses I'm closer to and an MD (not mine) about how a patient does what she says not like those homebirthers that dont want you to do anything to them.  I know it should only strengthen my want for a homebirth but I just dont know if I'm strong enough to handle the criticism let alone bringing up the topic of breaking up with my OB. 

It makes me sad to read this - that you feel so conflicted.  I know how hard it is to go against the grain.  Probably the less you say about your plans the better.  In the meantime, can you "subtly" start questioning/challenging some of your colleagues on their attitudes?  Maybe ask them why might a woman NOT want to be messed with?  Or why someone who transfers might be scared?  Ya know, just your curiosity . . . and trying to improve your ability to help "those women."  Just a thought.
 

[CookAMH]

I just want to say that I sympathize with how hard it has to be for you to be in your work environment and to sort things out to make the right choice, when everything around you at work (and thus, all day when you work!) is so much against the idea of homebirth.  Most of us who choose homebirth are not in L&D where you are right in the middle of the maternity business with people who generally buy into all that is done (that's not a criticism of all L&D nurses, I know there are fabulous ones out there who love to help women through natural childbirth!). I really commend you for taking this decision head on, not just stuffing it to the back of your brain like I did for so long (and finally switched at 27 weeks).  I would completely understand you keeping it mum if you do choose to homebirth.  YOU know yourself, what your weaknesses are and what could sway you.  Another option is to keep it to yourself until you are near the end of your pregnancy then tell, but then maybe that would cause issues with your OB.

Some things my doula asked me as I considered homebirth was in the end, if you have a good birth in the hospital, will you wish you had stayed at home? At first, my answer was yes, then i realized, no, I would have really wished I'd just stayed at home! A lot of it were the little things that made up the whole environment of the birth that I truly desired and felt was best for me and my baby.

What helped my DH be on board for homebirth was talking to a couple homebirth midwives and learning how they handle emergencies, transfers, etc. A great thing about WA midwives is they have more with them to deal with potential emergencies than many midwives do in some other states. They can suture, treat for GBS, give pitocin or methergen for hemorrhaging and have O2. Not all midwives in other states have that.

I know of someone who came from Bainbridge to Seattle to a midwife's home to "homebirth". I hope you hear back from some of them! I strongly believe that actually meeting with and talking to one or two, to start, will really help. You both need to be there too. Ask hard questions. You know of complications that can occur, ask how they'd handle examples, if they have before, and consider whether being in the hospital could actually make that complication worse (for example meconium is often overhandled and hospital protocol doesn't improve outcomes), would a transfer still give the appropriate care with a great outcome. Keep us posted.  Remember this is your (and I also believe, DH's) decision, and the pressure around you is STRONG. Keep focused on what you want for the birth, NOT what others will think.  It's enhanced for you b/c of where you work, but we all are dealing with that on some level and can support you.

[mamahen2coop]

**UPDATE**

So here's my story now...

I did eventually find a couple midwives that would service my area.  I didn't end up talking with either of them because I wanted to talk to DH first to see if I could even get him on board.  So I brought it up today and his first reaction was surprise.  He asked the common questions like who will clean it up and what happens if something happens.  I told him the midwife would take care of everything, that she would be able to bring medications and equipment to help deal with any emergencies.  He asked lots more questions then said, you know, it sounds like it would be safe enough but I think I would just be really uncomfortable with it.  I was actually really glad for his honesty because he's not the kind of guy who is super in touch with his feelings and has never been good about just coming out and saying what HE feels.  I inadvertently picked the VERY wrong color of paint once and he painted the whole bathroom Mexican restaurant orange because he thought it's what I wanted- I came home and about died!  He also let me get most of the way done planning our wedding before he finally said he wouldn't be comfortable standing there in front of all those people and that he'd rather it be really small- We then scrapped it and got married in Hawaii with 11 people.

Anyway, knowing that he would be uncomfortable the whole time and be worried would make me worried and uncomfortable so I think we'll just go ahead as planned.  Labor at home and go to the hossy for delivery.  I'm OK with it too.  I was so on the fence.  But going through this thought process will make me more vocal about my wants to my OB and to the nurses so they support that instead of what happened last time.  They were supportive but assumed I would be able to know what I was doing since I know the process so well.  now I just have to grow a baby for another 22 weeks

[CookAMH]

Thanks for the update! I'm glad you've been able to make a decision and have an open conversation with your DH. That's really important.

I wish you the best with your birth!

[ocelotmom]

I don't have any good advice, just sorta-BTDT sympathy!

I'm also a nurse. We moved to a new area while I was pregnant, and I'm looking for a job. Part of the reason I chose homebirth was because I didn't want to go into an interview and have someone remember me as the crazy pain-in-the-neck natural birthing patient who refused to follow hospital policy, and there isn't another hospital within reasonable distance. 

It's an awkward situation to be in.

Can you plan a homebirth, and give the impression at work that you'll be delivering at a different hospital because you're uncomfortable with mixing personal and professional boundaries or something like that? Then they wouldn't question it if you had the baby and didn't show up at the hospital. If they question the distance to a different hospital, you could say that you'll come to the closer hospital if things appear to be progressing too quickly.

[mamahen2coop]

Originally Posted by ocelotmom 

I don't have any good advice, just sorta-BTDT sympathy!

I'm also a nurse. We moved to a new area while I was pregnant, and I'm looking for a job. Part of the reason I chose homebirth was because I didn't want to go into an interview and have someone remember me as the crazy pain-in-the-neck natural birthing patient who refused to follow hospital policy, and there isn't another hospital within reasonable distance. 

It's an awkward situation to be in.

Can you plan a homebirth, and give the impression at work that you'll be delivering at a different hospital because you're uncomfortable with mixing personal and professional boundaries or something like that? Then they wouldn't question it if you had the baby and didn't show up at the hospital. If they question the distance to a different hospital, you could say that you'll come to the closer hospital if things appear to be progressing too quickly.

I probably could have.  And if DH would get on board then I think I could get around it OK.  But since DH is uncomfortable with it I think I have to be too.  Yea, I'm doing all the work, but it's his birth too.  I'll probably bring it up again in a couple weeks if it continues to dominate all other thoughts in my mind like it had been.  Id wake up thinking about it in the middle of the night and put off studying for ACLS until the morning of because I couldn't stop reading Birthing from Within.  But since DH and I talked about it and he said he would feel uncomfortable, I haven't really thought about it at all.  If he would have said, sure, what ever you want I'll do, I would have found a way to either buck up and hb proudly or somehow hb in secret.  We'll see.  Maybe i"ll go so fast that I"ll UC on accident.  I"m going to have some equipment on hand just in case.  I plan to stay home until it gets bad, which with DS was 3 hrs before he was born so with this one maybe it'll go faster.