Choosing a Birth Location: What Would You Do?

[eatnobeef]

I am hoping to get some input from this community of women about my current conundrum: What would you do?

I am 31 weeks pregnant today and have all along planned for a homebirth. I am 36 years old and this is my first pregnancy. I have Kaiser HMO coverage and received all my early care at Kaiser until about 18 weeks or so when I transitioned my care to a private practice of homebirth midwives that came highly recommended in my community. Unfortunately, every time I visited the midwives for my regular visits, my blood pressure skyrocketed (white coat syndrome). Mind you, I've never had high BP EVER, not even white coat any where else, not during this pregnancy while getting my early care at Kaiser. My BP throughout this pregnancy has been about 120/70 pretty consistently, except with the MW's. At that first MW appointment it spiked to 140/88, that was back in August. The MW's reaction to this was one of panic and fluster with anxious requests for me to 'relax' and engage in deep breathing, which I did and my BP lowered immediately, not to their normal levels, but lower than the danger zone. This in turn totally freaked me out and I saw my visions of my peaceful birth vanishing. In response to this incident, I bought a home BP monitor and at home or work it never spiked over 138/79--even when I freaked myself out--which I started to do as my anxiety about this issue escalated and compounded. The MW's were concerned and requested my Kaiser records and saw that my BP has always been normal there. I gave them a copy of my home BP log as well to show them I've been keeping a close eye on it. We had some discussions about them possibly not being the right providers for me and they assured me they thought I was healthy and would stand by me and see me through this, even with the white coat syndrome. They promised they would trust my home BP readings and we would communicate about them and they promised to stopped taking my BP in their office. We agreed we would keep working together as I liked them and I guess on the surface felt comfortable with them.

Well, at every subsequent appointment they insisted on taking my BP, and of course it was sky high, like 148-150/90-100. At home, my BP continued to be normal. To me, this BP problem became a demon I could not wrestle down and left me feeling helpless and out of control--like maybe I really have a problem with my BP and this might be more than just white coat syndrome. I started dreading visits with the MW's. At this point I started exploring firing the MW's altogether to bring me some relief and thinking about a hospital birth just in case I might actually have a real health issue. My last appt. with the MW's was couple weeks ago and they 'cut me loose' and told me they think I should work with an OB because they personally have never seen BP readings that high (REALLY?!) and they think my white coat syndrome may mask pre-eclampsia and/or gestational hypertension and I essentially 'risked out' of their services. Note: I currently have very minimal swelling and have tested negative 2x during urine tests for protein. I have to say that I felt relieved by their decision, which was what I had also settled on before meeting with them. They thankfully reimbursed me most of my $$ (homebirths cost $5000 in my area) and we parted ways amicably.

Things have not been easy since that appt. My partner was really attached and committed to a homebirth and is crushed that I am considering birthing in a hospital. He feels afraid for me and afraid for our baby if we choose the hospital route. He's in a bit of denial that I might actually have a real health issue, which may or may not be true. We've gotten into some nasty fights over it and I am left feeling very unsupported by him. He is angry at them and blames them for reinforcing this problem with their negative reactions and breach in trust around taking my BP's when they promised they would not insist on it. I agree with those points, but also wonder if they are right in me truly needing care from an OB as a result of this. I am leaning toward hiring a doula and just biting the bullet and giving birth in a hospital. I cannot bear the thought of having to get to know more MW's only to have them cut me loose like the previous ones did b/c of this 'problem.' I am terrified my white coat syndrome will follow me to Kaiser and I'll be labeled high risk and forced to endure lots more tests when I really don't think I need them. If I decide to hire another midwife and pursue a homebirth, I am afraid of disclosing the experience about the previous MW's for fear that 1) they would also say no to caring for me during a homebirth 2) it is a small community and if those 'well-respected' previous MW's would not work with me, then why would any other MW's?

I am left feeling more vulnerable than I have ever felt as a result of this. I really don't think I am 'high risk' and feel like those other MW's broke my trust since the beginning and are more worried about liability than anything else.  I am committed to a natural childbirth and believe that it can happen in a hospital with the right support in place-and am very sad to imagine not birthing at home. If I need to be in a hospital, than fine, I can accept that. If I don't need to, I don't want to, but don't know if I should even attempt a homebirth with the BP issue and the anxiety around MW's I have developed. My partner is slowly coming around to supporting whatever decision I make, but it has been a painful journey with a lot of tears on my part. I have an appointment with Kaiser next week to see how things go there. I am trying to stay relaxed about it and am torn about whether I should even mention this experience with white coat syndrome to them or if it will cause more problems for me if I respond well to the BP reading at their office. Maybe I can start fresh there as ironically, I have felt totally comfortable there so far.

What is your take on the situation and what would you do? Thanks for reading!

[rnra]

What have your BP readings been at home the past few days/weeks?

[SamSarah]

I think your sense of relief at your midwives "cutting you loose"  is telling.   Choosing your birth place is about you feeling the most grounded and comfortable - your partner's job is to support you in this.  When I read your words, I hear you saying that you are relieved to not be working with the midwives, but your brain and partner think, perhaps, that you ought not to be.  I suggest you follow your gut.  Wishing you well.

[IdentityCrisisMama]

Oh, mama!  What a difficult experience. I have a few thoughts on this...

• If possible, I would rethink the issues of trust with your MWs. If you need, perhaps they will help you work this out together. I think it's GOOD that they reevaluated their promise to not check your BP. I think it's good that they decided that your BP levels meant you were not a good candidate for a birth with them. It shows us that they know the scope of their practice and they aren't afraid to admit that you are beyond their area of expertise. This is what we want from our MWs. IMO, they have served you well. 
• Enough of the defense of your MW...because I don't think that's the most important thing - it's just the last thing that I read that I wanted to respond to...
• You can have a future HB, even this one (maybe) if you wish. Don't worry about future pregnancies right now if you can and only pursue a HB with this pregnancy if you feel that's a good choice for you. 
• Your DH needs to move on from his ideal birth. We have to do this as mothers in 99% of births. He needs to do this as well. Birth is rarely as we plan it. With mothers that are morning the loss of their ideal birth, we are sympathetic and give them time. I suppose we should give this to him too...but he also has another role to play here and he will not be able to play it if he is busy morning the loss of the birth you and he planned together. 
• I suggest you try to arrange your next prenatal with Kasier with your DH along side you. Be truthful about your experience with the MWs. I think it's important medical history. If you are there and your BP is fine, I am guessing you will feel that this is the better choice for where you should give birth. Let your DH see the relief you experience at having made a decision you feel is right. 
• If you are a do-er, focus on having an unmedicated birth in the hospital, get something like hypnobabies, take a lovely Bradley class together (sounds like your DH will like Bradley). Or, if you want to find another HB MW to give a try, do that together as well. 
• Mostly, try to practice acceptance of yourself and where you give birth. HB does not always happen even if we want it very much (my first was a hospital transfer). Birth is so unpredictable. I think if you start to really grapple with that now, it's better. You will go into it without so much attachment, which I think is better for birth.

And HUGS, mama, for a rough time and a late-term provider change. That's never easy.  And, continue to post here. I felt like a HB mama for 10 years before had actually had a HB because that's what I planned for my first birth. You are a HB family - your pregnancy is just not cooperating. 

[IdentityCrisisMama]

Back to the DH thing...

It's a difficult thing to talk about because we want equality in our parenting...and it does all balance out eventually but it simply isn't balanced now. You are carrying this baby. And you will give birth. And it's one of the most powerful life events you will ever have. It's simply not for him to influence beyond supporting you. I realize he is probably worried about you and the baby in the hospital setting. And that's GREAT...if he can channel that energy to learning what he needs to learn in order to support both of you in the hospital. 

For me (and I imagine a lot of women) birth is a very inward, independent thing. It would be nice to imagine it as being a bonding thing...similar to the thing that got the baby in the first place. But, it wasn't that way for me. It was very much about me, a personal struggle to relax and bring this baby into this word...even though I knew it would get a bit harder before it got easier. That's parenting, yk? 

Right now, you and your DH are doing very different roles and I know that may be hard for your DH but that's parenting too.  

Hugs to you both, mama & papa. 

[Adaline'sMama]

I'd get some other BP readings besides on your home monitor. Are drugstore, health department, etc readings possible for you? I wouldnt trust a home monitor to be the only thing I go by.

I think your partner needs to be more concerned for your health than his wish for how the birth goes, but that is JMO. 

[eatnobeef]

Thanks for your thoughtful responses! I have to say it felt really good to just type the whole thing out--it was cathartic, for sure. Yesterday morning DP embraced me and said he realized he needs to, above all else, be supportive of me no matter what. That was nice to hear from him.

I have an appointment scheduled at Kaiser next week and we'll see how it goes. I just don't think I have it in me to try to work with any midwives at this point. In my heart I don't think they handled the situation as well as they could have and I know I have some processing to do around the situation. I feel like *now* I need to focus on accepting of myself and my birth location which will most likely be the hospital, like IdentityCrisisMama suggested. I've been ready to change the script of this birth plan if need be--DP on the other hand has less of an understanding about this and has become surprisingly fanatical about the whole HB thing...but I feel he is coming around. I feel like I've created a HB monster!!! Hopefully by next week his strong feelings will have mellowed a bit. I agree that being flexible is really an important quality to have as a parent and this I think is our first tribulation with having to switch gears and go with it. For whatever reason my body was telling me that these MW's were not for me, so I think it is wise to follow that. Whether or not their bedside manner with me was on or off, in the end, they received the same message--that I am not comfortable with them.

And to clarify, I am not worried at all about any future pregnancies...maybe that got confusing in my original post...I am more worried about the here and now and if we were to go for hiring midwives for this birth and what are our chances of them actually working with me based on my history of white coat.

I think our bodies have deep wisdom that is sometimes hard to intellectually figure out. I have been trying to convey this to DP, but he says I am taking on the anxiety of the MW's and that I did not have a problem w/ BP before I started with them...eh, I don't know about that. I think my body's ability to regulate BP while under stress has been compromised by pregnancy. Yes, now I want him to focus on how he can be the best, strongest support to me that he can be, and for him to have faith that we can have the birth we want, even in the hospital. The negative talk about the hospital is NOT helping and is creating MORE stress, which is exactly the opposite of what I need and what our baby needs. I need him to move forward swiftly with me as we are too late in the game to feel sorry for ourselves. That is what I need from him the most right now :-)

[IdentityCrisisMama]

I think our bodies have deep wisdom that is sometimes hard to intellectually figure out. I have been trying to convey this to DP, but he says I am taking on the anxiety of the MW's and that I did not have a problem w/ BP before I started with them...eh, I don't know about that. I think my body's ability to regulate BP while under stress has been compromised by pregnancy. Yes, now I want him to focus on how he can be the best, strongest support to me that he can be, and for him to have faith that we can have the birth we want, even in the hospital. The negative talk about the hospital is NOT helping and is creating MORE stress, which is exactly the opposite of what I need and what our baby needs. I need him to move forward swiftly with me as we are too late in the game to feel sorry for ourselves. That is what I need from him the most right now :-)

I totally agree. I think your body could be telling you something, or you may have some signs of pre-e but either way you are listening to your body and following its lead about where you should give birth. This, to me, is the very premise of HB. NONE of us....not a single one, think that all births should be at home or that all pregnancies indicate a good outcome for homebirth. It's sad when a mama finds herself in that place (and that line IS different for all women) but this is where you are. And the reality is that HB is a lovely choice for the right pregnancy but its a terrible choice for the wrong pregnancy. You are making the right choice, mama!  Let your DH see this thread (if you'd be Ok with that) or have him post here to get some feedback. I agree that coming around swiftly is what he needs to do. He's about to have a baby...this is just one of a long series of things that doesn't go as expected. There is a time to focus on the loss of your hombirth but this is not the time for your DH. 

Have the two of you taken a birth/parenting class together? Have you heard of Bradley - it's a real "dad as labor coach" centric program that would be a good fit for you. You will likely meet lots of thoughtful folks who planned a hospital birth. And, there are so, so many people who thoughtfully choose hospital birth. In planning a HB maybe we get a bit tunnel visioned about the choice...all the reading and etc., but the choice to birth in the hospital is not without merit. Thus the popularity. ;-)  Maybe have a look at the positives? 

[Buzzbuzz]

There was an episode on "Call the Midwife" on PBS where the mother has undiagnosed eclampsia. 

While I certainly wouldn't recommend you watch it, maybe seeing something like that would help your DH put the issues at stake in their appropriate focus?

[salr]

I think the PPs have said a lot of really good things.

It sounds to me like you are saying that you want to have a hospital birth.  When I read your story, I think that if it were me in that position, I would want to contact other homebirth midwives.  And you do not feel that way.  So that says to me that it's not just that you want to move on...because you could move on to completely new care providers while having a home birth.  It sounds like you are really more comfortable giving birth in the hospital.  Does that sound right?

I think one of the most important things is for a woman to give birth where she is comfortable.  You're more likely to have the experience you want.  That being said, if you were looking for advice about your particular situation, I'd want to know what the hospital in question was like.  If it's fairly natural birth/mom/baby friendly, then that sounds great.  If it will be a big fight giving birth there, then I would recommend looking into your thoughts/feelings more, and contacting other midwives and reconsider birthing at home.  Of course if you just think it's your intuition telling you to go to the hospital no matter what- then that's the voice to listen to. 

All I'm saying about the hospital thing is that there are some hospitals where it is near impossible to have a natural birth at all, or some where your or your baby will not be treated well or have the safest birth possible. If your hospital isn't one of those, or if you are OK with whatever the hospital has to offer- then maybe that's where you all will do best. 

I'm glad you're husband is coming around to supporting your decision and moving forward.  I'd love to hear how your visit at the hospital goes, and I hope it goes really well. 

p.s.  I really recommend Hypnobabies.

[phathui5]

I think it's important for women to birth where and with whom they feel the most comfortable. If Kaiser is where you feel comfortable, maybe they're the caregivers you should be seeing.

[silversparrow]

Just a note about BP measurement: manual mercury ones are the gold standard. Some MWs and OBs I've met outright refuse to use the automatic ones because they can be so unreliable. All the major guidelines on hypertension say borderline or high readings should be followed up by manual one for accuracy. If you do go with new midwives, ask them to come check it at home once or twice, just to see, or bring your auto one to the office to compare its reading there.

Also be on the look out for severe frontal headache and blurry vision or lights/spots in front of your eyes.

[Ratchet]

Your BP wasn't sky high but it was high.  High BP is not preeclampsia.  There are some standard preeclampsia labs (bloodwork, 24 hour urine test) that could be done now to serve as your 'baseline' and rechecked if there was concern to you developing pre-eclampsia.  This could be done by your OB  (probably would be, in fact) and a midwife could probably order it too, but IMO you deserve to have someone look at your BPs and say "we will work together to keep you healthy and here's what I suggest we do" and not act freaked out, because it's tough to have faith in yourself or your body if you don't have someone to guide you through the process.  When you find that person and click, whether it's an OB, a CNM, a doula, etc, you will be in the right place.  Best wishes!