Homebirth and traditional prenatal care?

[Galatea]

Normally I post in Natural Family Planning, but we have set a date to TTC#2, and I already have baby fever, and I need some advice.

DH and I are going to start TTC#2 in December (yay!). We went to a midwife center (certified professional nurse midwives with hospital privileges and OB to consult) with #1 and really liked them. We ended up delivering at the hospital (not the birth center) b/c I was induced with low fluid (and a true knot in the cord - scary). The birth was great and ds was fine, but I really want to do a homebirth the next time around.

Can I go to the midwife center for prenatal checkups and still have a homebirth with another midwife? They don't do homebirths. Or would I get all prenatal care from the homebirth midwife? I am asking b/c since ds had problems towards the end of my pregnancy, I would want access to regular ultrasounds and tests. I know DH would not be comfortable being at home unless we had lots of prenatal reassurance (esp. in the form of ultrasounds etc.) Would I offend either the CPNMs or the homebirth midwife by trying to use them both? Can I do that? Am I being naive?

I really want to learn and plan - thanks in advance for all the help!

[jecaly]

we're planning a homebirth with a cpm, but we're registered at the hospital with a cnm our midwife likes and trusts, for backup care (at our midwife's request). we get some of our lab work done at the hospital, and we'll see the cnm twice during the pregnancy. in the course of our backup care, we have the option of lots of tests, most of which, like ultrasound and afp, we're declining. but it's nice to have the option! this is my only experience with a homebirth midwife, but i imagine it's pretty common.

good luck with ttc #2!

*jennifer

[pamamidwife]

You can do care with both if you like, but your mw (homebirth mw) will be doing the same prenatal care - and what's more, she'll be focusing on creating a relationship with you and your partner to help you have the birth you want.

Many times, people that start off doing care with me and a hospital-based provider (or one that is more medically minded) eventually stop going to the other provider and end up doing all the care with me.

It's up to you, but it's something to discuss with the homebirth mw you decide to hire. Many homebirth mws can order ultrasounds, etc.

And, FWIW: most women will have low fluid at the end of pregnancy (it's a normal variation that has become the most overused scare tactic to induce, etc.) and I've seen many beautiful babies born at home with true knots in the cord. In fact, with a true knot, I'd much rather have a woman's body take it's own time and do what it needs to do rather than to induce or interfere with the process - many times these women will have contractions that are spaced farther apart all through labor or will have very straightforward labors.

[KariM]

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[Galatea]

Originally Posted by pamamidwife

And, FWIW: most women will have low fluid at the end of pregnancy (it's a normal variation that has become the most overused scare tactic to induce, etc.) and I've seen many beautiful babies born at home with true knots in the cord. In fact, with a true knot, I'd much rather have a woman's body take it's own time and do what it needs to do rather than to induce or interfere with the process - many times these women will have contractions that are spaced farther apart all through labor or will have very straightforward labors.

*I* know this about low fluid but the knot and the repeated NSTs and AFIs really scared DH. I said once that I would not go for any more late-term ultrasounds with future children b/c Maddox was obviously fine and just older than they thought. DH freaked out and did not agree at all. So I am trying to make him comfortable too.

About true knots - how come some babies die in the womb and some have no problems, like mine? The knot was so tight. [We watch "ER" on NBC and recently a baby died at 7 months b/c of a cord knot. It really upset both of us.]

Also - do any of you know the PA midwife regulations? Or where I can go to learn about them?

[Breathless Wonder]

http://www.mana.org/statechart.html

[cottonwood]

Babies do die because of cord issues. But if the baby has gotten to term, the likelihood of there being a cord issue at that point is much increased with a hospital birth, because of the interventions and environment that put extra stress on the process. If you look at the situation realistically, there are no guarantees. Each choice carries risks specific to it, and you just have to decide which risks are more likely in your specific situation, and which you are more comfortable taking.

[momsgotmilk4two]

Even if you had more medicalized care there would be no reason normally to do late term u/s and NST's. These are not normal protocols even with most OB's. With my first baby I had two u/s's, the last being at about 19 weeks. No NST's at all. With my second I did have two NST's because of high bp. This time I am in the care of a midwife who works out of a hospital and she does not plan to do NST's and u/s for high bp, although miraculously now that I trust my care provider not to fight me on every issue my bp is perfectly normal, just the same as it was at the first prenatal . A friend of mine who delivered in a hospital had a baby with a knot in his cord. They didn't know about the knot until she delivered and he was just fine. Even the doc was like, "Oh, yeah, look there, it's a knot" like it was no big deal.

[Galatea]

Originally Posted by momsgotmilk4two

Even if you had more medicalized care there would be no reason normally to do late term u/s and NST's. These are not normal protocols even with most OB's.

At 36 weeks I was paranoid that ds was sunny-side-up so I asked the midwife to really check his position. She said she was having a hard time telling what position he was in so I should go for an ultrasound. DH and I were so innocent and were just excited to get to see him again! So we go and the ultrasound tech was like, "I'll get the doctor," and he (director of maternal fetal medicine!) was all, "You have to have this baby today! Your fluid is too low!" We said, "Bullshit, we want to talk to the midwives," and the midwives let us go home and said to drink lots of water and come back in 3 days for another ultrasound and NST.

Well, the next ultrasound and NST were fine and the fluid level was back up. The doctor suddenly was like, "Oh, everything's fine, go home," but we had spent all weekend worrying and were really hyped. When we went the following week for another NST and ultrasound, the fluid level was low again and DH and I were still nervous. The midwife came to the hospital to talk to us and I guess they all thought that we were fishing for an induction b/c she said we should induce.

In the end I must have been almost ready b/c the induction succeeded and ds was born vaginally. He really looked full-term - not too much vernix, but not wrinkly at all, so maybe I was just further along than we all thought (I didn't chart then and had irregular cycles.) No one knew about the true knot until I delivered the placenta and the midwife showed us.

So can a knot that wasn't there before appear during a stressful labor, like blueviolet said? Isn't it too crowded in there?

Well, despite everyone's good advice and insight, I think DH will still want all the bells and whistles in terms of prenatal care. I researched PA homebirth midwives and told him that they can order tests. I hope that was true. But also I am sure we cannot afford a homebirth as I do not work and we live on DH's student loans. The website I found said around $2000-5000. Does that sound right?