Rethinking home birth midwives. Any thoughts?

[escher]

Hi Folks,

I'm 14 weeks pregnant with our first child, and we've chosen to work with some home birth midwives. We like them a lot, and feel like they are exactly the kind of people we would like to have around through the pregnancy and birth. There are lots of reasons why we are excited about having a home birth--not having to go anywhere during labor, not being in a germy hospital, not having a set date when they have to induce, being able to eat my own food, not having lots of people walking in and out during labor, etc.. However, two things recently have made me wonder if I really should just switch to a hospital birth.

1. Finances: After insurance pays their part, the home birth will end up costing us $2000-$2500, while the hospital birth would be covered 100% with no deductible.

2. Frustration with unpredictability of appointment times: Both of our appointments so far have had to be rescheduled due to things that came up with the midwives' schedules. The first was rescheduled for later the same day, the second has been rescheduled twice and still hasn't happened. I know this could happen with doctors, but people I know who have worked with doctors seem to generally have their appointments when they are scheduled.

Any thoughts? Thanks.

[seraf]

Is there another midwife group you could interview?  They do have things come up, but if they have too many births, will they be able to make it to yours? 

The money thing, well, they do cost more out of pocket...  You could have a great hospital experience or you could have one you wish you could have paid a couple grand to avoid.  Or, you could start at home and get tired and transfer. 

Good luck with whatever you decide.  I personally am very happy with choosing homebirth, but I have never had missed appointments.  The midwife group I used paired up in different teams so there was always at least 2 of the 3 midwives at all our appointments.

[asprague]

I had a poor hospital experience and a great homebirth with my second. Yep, the homebirth is more out of pocket, but the insurance that we had only covered 80% of the hospital birth, which ended in unnecessary cesarean (from inducing too early, hence the homebirth next time), this cost us $3000 out of pocket and I had a month of recovering. For me the money is a "I will make it work no matter what" type of thing.

As for the appointments being rescheduled, that is annoying. Definitely seek other midwives, as these ones may be over-booking. I always ask the question when I interview midwives (I have 3 different times) "How many births do you allow per month typically" 3-4 is alright, less is great, but when it climbs above 5, there are going to be issues if it is just a one woman show. Look for a practice with 2-3 midwives to schedule with, this may help.

Good luck with your decision, I hope that you still choose a homebirth, it is SO empowering to birth your own child and not be directed to do so by a doctor. The attitude is completely different, at home you are the boss, in the hospital the doc is the boss. Sorry, a lot of baggage there :)

[starling&diesel]

Hi escher! 

If you took the money out of the equation, what would you do?  If you'd still want a homebirth, then go ahead and have your homebirth and I promise you that the money situation will work out.  In my mind, all of your reasons to be at home are worth $2500.

As for the midwife unpredictability, I'm with the previous poster who suggested another midwife practice.

Our midwives work in a team of two or three, as do all the teams at the clinic.  Pregnant women are assigned or choose a team, and that's who they stay with for the duration of care.  So, any given day, one member of the team is doing clinical days (in-office visits) while the other one or two are on-call to attend births.  That way, there is always one of your midwives available.

Also, where are you?  Can midwives attend hospital births?  Ours can.  So we can decide at the last minute if we are going to stay home or go to the hospital. Just like with our dd, we will preregister at the hospital as well as plan for a homebirth this time.  Last time we had a hospital midwife-attended natural labour and birth after a natural induction due to pre-e.  You just can't guess what will need to happen or what you ultimately will want to have happen.  The more options you have, the better.

[camprunner]

Many times midwives have to reschedule appointments because they don't have anyone to take turns with being on call. I generally don't mind because when my turn comes, I want them to have that kind of focus on me too.  So far I think we've been rescheduled for a birth or two and one rally to legalize midwives. I felt both were excellent reasons.   However the appointments were rescheduled within a week.

[jeninejessica]

I would definately find out why they were rescheduling. It's different if it was for a birth, than if it was something personal, etc, you know? If it's for a birth, then I understand that. That one of the wonderful things about having a midwife, is that she's there for your whole labor and delivery, not just attending appts all day and then showing up for the finale, you know? But if they are being rescheduled because they're just too busy all around, or if it's because of bad planning, personal issues, etc-- then I would look elsewhere. 

[escher]

Thanks for sharing all your thoughts on this. It's good to be reminded that the money piece is just money, and perhaps not worth worrying about too much. I think it doesn't help that I just had a friend who had a fantastic (quick, easy) hospital birth, so hospital birth is seeming less unappealing than usual. But I know I have to remember that it is impossible to predict how it would go for me, and that in general home births seem much more appealing.

The rescheduled appointment piece is a bit harder for me to figure out. I am working with a team of two midwives, and I definitely appreciate that they are doing their best to meet everyone's needs. The first appointment was rescheduled (and switched to the other midwife) because the first midwife was with someone who was having a pregnancy complication. The second appointment (last Saturday) was rescheduled due to an issue with the midwife's schedule that was not related to being a midwife, then it was cancelled due to a birth. The midwife said she would call me after the birth to reschedule, so I imagine I'll hear from her sometime soon.

So in general I think that they are cancelling/rescheduling for valid reasons, and like some of you said I appreciate that this means they would be there for me if I were having a complication or when I was giving birth. But I'm sorry to have to admit that I was counting down the days and then the hours until I would be able to hear the heartbeat again and hopefully be reassured that everything is going ok, and it was/is hard to have that repeatedly put off. I don't think these midwives are doing anything wrong, but I just wonder if I'm not the right candidate for prenatal care that requires this much flexibility in scheduling.

I guess I should check around and see what my other options are. There is one hospital-based midwife practice in my area (there unfortunately aren't any midwives around here who do homebirths and who have hospital privileges), so I've left a message for them seeing if they still have room in their schedule for a late October birth. I could check with other homebirth midwives in the area, but it seems like I might run into the same scheduling challenge with them. Or I guess I could consider an OB.

I appreciate all your advice. Thank you!

[jeninejessica]

If you're meshing really well with them do you think you would feel comfortable trying to explain how you feel? Just saying something like how you understand that they have other patients who have had complications etc, but that with this being your first baby, you're needing a little bit of extra reassurance and guidance, and that the cancelled/rescheduled appts do have you feeling a little nervous. Maybe they just don't realize how big of a deal it is, and would be able to be a bit more flexible if they realized it was worrying you (ie booking a quick late appt that day on the way home from a birth, say 9pm, when they wouldn't normally book an appt). You may find they were just trying to be less of a hassle, but for your personally, it's more of a hassle? 

I'm having trouble finding a caregiver at the moment, so hearing you say that you get along with them so well and they're exactly what you want for the birth, I just have a hard time in my head wanting to give that up, you know? I'd be sticking to it like glue. But that said, I do understand the need for comfort and reassurance, and if you aren't getting that from them, then it is an issue. 

[cinderella08]

I'm a midwife apprentice, and here are a few thoughts I have as I've gleaned from my experience thus far.  I put my words in red.

Originally Posted by escher12 

Hi Folks,

I'm 14 weeks pregnant with our first child, and we've chosen to work with some home birth midwives. We like them a lot, and feel like they are exactly the kind of people we would like to have around through the pregnancy and birth. There are lots of reasons why we are excited about having a home birth--not having to go anywhere during labor, not being in a germy hospital, not having a set date when they have to induce, being able to eat my own food, not having lots of people walking in and out during labor, etc.. However, two things recently have made me wonder if I really should just switch to a hospital birth.

 

All excellent, excellent reasons to birth in your own environment.  Having a good "vibe" from your caregiver is very, very important.  You need to feel 110% comfortable discussing your feelings.

1. Finances: After insurance pays their part, the home birth will end up costing us $2000-$2500, while the hospital birth would be covered 100% with no deductible.

 

Discuss finances with your midwife.  Most, if not all, will consider payment plans.  Also - many midwives work with a sliding scale that reduces the cost depending on your income.  This may be an option as well. 

2. Frustration with unpredictability of appointment times: Both of our appointments so far have had to be rescheduled due to things that came up with the midwives' schedules. The first was rescheduled for later the same day, the second has been rescheduled twice and still hasn't happened. I know this could happen with doctors, but people I know who have worked with doctors seem to generally have their appointments when they are scheduled.

 

This is just slightly worrisome to me.  I'm very well aware that things come up  - women go into labor and you are unable to make it to a scheduled prenatal or consultation.  However,  repeated rescheduling may send up a slight red flag to me.  I would sit down with the midwife and let her know you are a little concerned about the lack of availibility and let her see if she can ease your fears.  I have a feeling you'll either walk away from the appointment feeling 100% better, or 100% worse.

Any thoughts? Thanks.

 

And lastly, don't be afraid to simply interview another midwife or two!

[willsmomm]

Yeah, doctors are definitely better at scheduling their deliveries to not encroach on their office hours. ;) Really, my midwife is pretty strangely reliable so far. Is there someone else you could see? Good luck!

[bubblebrook]

I am really excited about using my midwife.She has delivered over 250 babies. I have also worked close with her in her birth center.She always shows great care and all her lients seem very pleased and come back to deliver more babies. Amber Riedel is awesome at The Family Birth Center in New Braunfels,Texas.I am hoping for a great experience with my first baby.