Becoming disenchanted with birth center--help weighing other options...

[mum2sarah]

I'm 22 weeks along, and this will be my third time giving birth.  My previous experiences so far have been:

DD#1: Hospital birth with CNM from a practice of only 2 CNMs.  Prenatal care was very personal, and they were kind enough to take me at 33 weeks after I had decided an OB-attended birth was not how I wanted things to go.  Labor was extremely prolonged.  They had a labor pool available that I used in the LDR room, but the hosptial environment was still just so distracting.  I ended up on an IV, had my membranes ruptured, Pitocin and Nubain (no epidural, though), labored for a total of 27 hrs, pushed for almost 4 hrs semi-upright, and had an episiotomy when DDs shoulder was stuck.

DD#2: Unintenional UC with CPM arriving 20 minutes after DDs birth.  Prenatal care was wonderful.  I would go to her house and she'd even cook me a meal and we would chat for hours.  But she lived 1hr 30 min away and my labor was much quicker than I anticipated: 6 hrs total with 15 minutes or less of pushing.  Had a labor pool at home with the intention of maybe having a water birth but when I felt the urge to push, had an overwhelming need to exit water and pushed DD out on our bed on all fours--now-ex-husband caught her. CPM arrived in time to deliver placenta, cut cord, get us cleaned up, etc.  The whole birth experience was undescribably uninhibited!  I felt free to do whatever my body was telling me, and had very little pain and a much easier recovery compared to the first birth.  But I also had the reassurance of knowing the CPM was on the way, which was good because I lost what seemed like a lot of blood and was feeling woozy and cold by the time she got there.  She gave me some herbs, massaged my belly and gave me a warm compress on my chest.  I was grateful for her presence afterwards, but to be honest, I relished being alone up until that point.

So now, with DS-on-the-way, my situation is somewhat changed.  I have a different DH now, and our financial situation is now very poor.  In the Pittsburgh area, homebirth midwives have been driven out by a scandalous case of a midwife being jailed over a neonatal fatality a few years ago.  No CNMs will deliver at home, and the only CPMs doing homebirths are located in the surrounding countryside where they get a lot of Amish clients (the CPM I had with DD#2 is one of these).  Insurance doesn't cover CPMs so if we were to go that route, we'd have to pay out-of-pocket.  We do have some money saved but we were hoping to use that to help me stay at home longer with the baby.

Thus I initially thought the best compromise was a freestanding birth center run by CNMs that insurance would cover.  I have been going there for prenatal care.  But it is a large practice (5 CNMs), and I've been feeling lately like it is very impersonal.  To be blunt, my prenatal care has reminded me a lot of the large practice of OBs that I went to with DD#1 prior to switching to the CNMs.  It's always on me to make conversation, and if I cannot come up with any other questions, that's it, the visit is over.  I understand they are very busy but I just feel like it's so different from the CNMs and CPM I've had in the past where they really just take their time, don't rush you, and could chat for quite a while, even if it's unrelated conversation.  I mean, part of being able to give birth uninhibited by anxiety is knowing and trusting your attendant, right?  I feel like it's important to develop that trust and that relationship.... But I'm not feeling it at this practice of CNMs
.

Second problem is that their policy is to listen to the baby every 15 minutes with handheld doppler when you're in hard labor.  I know that sounds fairly unobtrusive, but after being completely free and on my own with my labor with DD#2, I feel that it is going to be sooooo distracting to me!  Truly, for most of the labor with DD#2, I didn't even want ex-husband around.  I just wanted to be alone and I really think a lot of how easy that birth was was due to listening to those instincts and not being bothered by anyone else.  Just the midwife's presence is going to be distracting, but I think I might lose it if they stick that stupid doppler thing on me every 15 minutes!

At first I told myself, well I'll just labor as long as I can at home and then only show up at the birth center at the last minute.  But I feel like that could be hard to estimate, and who wants to hop in a car during transition?  What if things go faster than I anticipate like they did with DD#2 and I end up having another unintentional UC but without the reassurance that the midwife is on the way???  I need to be honest with myself and I've come to realize that the fact of the matter is, while it's easy to talk about going to the birth center in principle, I think in practice, it's going to take a lot to get me in that car and go to the birth center during the actual labor.  And if I recognize that that is the case, I think I need to prepare myself better than I have been, and explore what other options I have.

Should I suck it up and pay for my CPM to attend this as a homebirth?  Should I educate myself and just plan to UC?  Should I plan to birth at the birth center, but make sure I have some supplies on hand "in case" I end up UCing? I'm so unsure what the right thing is to do!   (Oh and FWIW, my CPM might actually be slightly closer now that we have moved, but still likely over an hour away).

[Graceie]

I would do the CPM  and ask to barter or lower her price ? or pay over time posibley see the group your insurance covers for test and such so they will be covered if you do ultrasounds and what not

but this is comeing from the gal who is pulling 2000$ + barter out of her a** to pay a cpm and totaly fine with it

[rachieface]

I agree with the PP.  I understand money and insurance issues, but I honestly feel that having the type of birth you want trumps financial concerns.  Ask about a payment plan, a discount, or bartering services.  It sounds like you know what works best for you, and your peace of mind may have contributed to the shorter labor you had last time!

[mum2sarah]

Yeah, I really think my heart really wants another homebirth with the CPM I had before.  DH's only objection, really, is financial.  So I think I will call her and make sure she's still attending homebirths (since it has been 7 years...) and would take me at this point, and explore what payment options we might have.  In the meantime, I'll still go to the CNMs for prenatal care and ask them some pointed questions about my concerns to see if any of my worries could be addressed... That way I'll be in a position to make the most informed choice...

[poorlittlefish]

I personally would rather go to the birth center and use the money to stay home with the baby longer, if that is where that money will go.

[lookingforaname]

This is such a person to person type situation. 

I am the kind of person who would weigh and say that a safe situation that isn't ideal, but is *free* or cheaper - is better than one that would be ideal.  I mean, if I had $2000 to spare, I think I'd personally prefer to go on a long weekend trip to a spa or beach with my dh than to pay for a specific birthing environment - but that's a personal type of financial choice.  Also, financially, there is the question of what happens if you use the CPM and then have to transfer - does insurance cover your hospital bills still?  Does she have a good relationship with an OB or hospital in your area?

My way of thinking through the birth center group:  even if you feel emotional distance from this midwife group, do you feel like you TRUST them in terms of medical decisions.  Do you trust their expertise to navigate any issues during delivery that will favor a safe, natural birth and help you avoid unnecessary interventions?  Will you trust them if they DO make a judgment that would lead to a hospital transfer or c-section?  

With my first two, I used a midwife group similar to the one you are talking about, and actually really grew to love a few of the midwives.  They were on a call-base system for labor, so I couldn't count on having them during my actual birth, but I made it a point to try to schedule my prenatals with just these two.  I didn't begrudge them their call rotation because one of my fave mid-wives explained it as just something she personally needed in order to prioritize time with her own family and children - said that the burden of having to dash out of a son's baseball game, or reneg on a special dinner promise wasn't worth the trade off.  Something clicked, and I totally got and respected why they ran the office the way they did.   Even though there was a trade off on personal connection with their patients, they were providing safe and natural birthing situations for more people, in a way that didn't mean they had to sacrifice their own lives. 

Anyhow, that might be tangental.  Good luck with your decision making!!!

[Amatullah0]

How far is the birth center from your house? Would you be comfortable "oopsing" at home, and then going to the birth center later? Not like there would be much point by that time though, but if the birth center is only 5-15 min away, it might be worth it, since it seems like postpartum and hemorrhaging is what you are worried about. 

But, no matter what you choose to do, you SHOULD be prepared for an accidental UC, including what to do if you hemorrhage again (and what to have on hand).

Honestly, if my DH was comfortable with UC, I would just UC. Keep doing prenatals with the birth center, if you'd like, then if you change you mind in labor, you can go to the birth center. You need to do what you feel comfortable with -- that is the safest option.