CONFUSED!! Am I high risk now??

[LukesMum]

I recently moved away from my awesome "Water Birthin" CNM to a town where there is 1 hospital and everyone seems very "medically managed" -even the midwives. I went on a hospital tour and cried on the way home -it was awful. So, I found a lay midwife who I felt very comfortable with and was ready to commit to a home birth when....DH and I had some serious romance and both ended up covered in blood!! (I'm 24 weeks!!) After calls to my former midwife-(I had a cervical polyp) we decided over the phone that's what it was and to rest and see. Well, the bleeding stopped-I felt movement but went into the practice of a local CNM I had a consult with the next morning (this morning!) The CNM was out today so I saw on OB who said while homebirths scared the hell out of her--she would be willing to see me for prental care up until delivery if I wanted...but she didn't think i had a polyp-she thinks my cervix tore after the birth of my son (2 1/2 years ago) and I have kind of a Hemmoroid there. She is concerned re: bleeding during labor (I bleed alot after my last birth!) and felt that since I'm almost 37 I'm already "high risk". I just had an ultrasound at 19 weeks-but she recommended I get a "high risk" ultrasound (more detailed) next week--this not being related to the bleeding. She also said if it continued during sex-she will put me on "pelvic rest"...but for now just relax the baby seems strong!. so-now-I'm CONFUSED!! Not sure wether to try a homebirth ( $2200! out of pocket) with this "risk" or just work with the CNM (who I like). They both assured me I can have a natural birth at this hospital--I just am not sure I'd have the support I need ( they told me they get very few mamas like me!) What do you think????????

[Arduinna]

well, I would be concerned over the ob saying you are highrisk at 37 with no other medical reason. And why did this ob say they want you to have a level 2 ultrasound. Sounds like (unless he/she said otherwise) that it is only because of your age.

Did this ob tell you what they would do if you had bleeding from the "hemmoroid" during labor? It doesn't sound at all like they want to or are planning a natural birth.

[kama'aina mama]

RUN! Run away!

Sorry to be so dramatic, but there have been studies (I will try to find references for you later) showing that in many cases the biggest deciding factor in how aggressively (read medically) many issues during pregnancy and birth are addressed comes down to the risk label. Medicine is all about risk management and if you walk in with a label on you that says high risk and you don't manage to shed it (a tough thing to do!) it is really likely to affect your care. I would be very wary of this OB.

[LukesMum]

I'm not going to get the "high risk" more thorough ultrasound--made that decison easily. Wouldn't use this OB but maybe the midwife in her practice who was very nice and said not too worry-I could have the gentle birth I want in that hospital. BUT I guess my main question is--with this bleeding and stuff-would "YOU" still consider a homebirth?? I tend to be cautious with stuff like this--wish I had no complications..is this is complication??? I have tried to call the lay midwife I hve been considering back today but I think she's at a birth. I'm not concerned about the baby but I bleed a lot after my first birth and had to have pitocin to help me clamp down ...bleeding seems to be the concern during my births and I'm bleeding already. What would they do in the hospital if I was bleeding?? (pre birth?)

[sunmountain]

Talk all of this over with your CPM. If she's decent, she has dealt with this or knows someone who has. Whether to HB or not is not just your decision, it's hers, too. She may not feel comfortable attending your birth if this could be a big problem. I don't know if it is or not. Does she know about the pitocin with your first birth?
Do you live near a hospital? most serious problems are easily reconciled by a transfer.

Why do you not want the ultrasound? Is it invasive?

I wsh you a happy healthy gentle birth. I had two HBs, and I fully support your decision and wish you well.

[cottonwood]

Well, whether a hemmorhoid or a polyp, I don't see why that sort of bleeding would rule out a homebirth. Now if you are likely to hemorrhage, if it were me I would still have a homebirth but take certain precautions. Like having pitocin on hand, being not too far from the hospital, etc. I also think it's ridiculous that you are labeled "high risk" simply because of your age, and I personally wouldn't go for the level 2 ultrasound because that is inviting more intervention. But that is definitely a personal issue, and many people have ultrasounds (or not) for many different reasons.

As for hospital vs. home -- if you can possibly afford the out of pocket cost of hiring the lay midwife (maybe she'll do barter?) then you should not look at cost as a factor. Go with what you feel most comfortable with. Sometimes, for some people, the hospital ends up being the better choice, and I don't mean for safety reasons. I have a friend whose homebirth midwives were intrusive, and a hospital birth where she was basically left to her own devices. She very much preferred the latter situation. Sometimes hospital personnel are too busy to bother you, and sometimes they are even respectful of your wishes. Sometimes homebirth midwives aren't. Being at home is no good if you're basically bringing the bad aspects of hospital birth into your home with you. SO I think knowing your caregivers is extremely important in making the choice. That said, if the hospital says they will support you in having a natural birth, don't take that at face value. They are probably defining "natural birth" VERY different from how you are! Good luck, I wish you confidence and clarity as you look at your options.

[joymum]

I could not agree more with Kama' aina Mama. Labels always seem to cause harm. I too recommend that you avoid using the term "high risk" for yourself and be wary of any caregiver that uses it or a comparable term to describe what has been a very healthy pregnancy. http://hug

[Charmie981]

well, it only makes sense that if homebirth scares the hell out of this OB, she's going to try to scare you out of it and it seems like she's doing just that. The concern is not if the OB thinks you're high risk, but if the lay midwife is willing to take you on. MWs are taught to handle normal pregnancy and birth and to realize when something isn't normal and pass the torch at that point. She'll know if she's comfortable being responsible for your care or not.

As far as using the CNM in the OB practice, I really think that wouldn't happen. CNMs are also only allowed to handle normal, low risk cases and if the CNM's supervising OB feels that you are a high risk case (which she obviously does) then she would require the CNM to refer you to an actual MD and then you'd be medicalized into all sorts of crazy things just b/c this OB decided today that you're "high risk."

It all sounds like part of a plan to "save" yet another mama and baby from that risky homebirth fad.

[RachelGS]

Absolutely. There is nothing in the literature to suggest that a 37-year-old woman with an otherwise healthy pregnancy would be high-risk at birth. I'm not sure about the bleeding, but I agree that it's worth seeking the opinion of someone who isn't scared of your choices in the first place. If a qualified midwife or hb-friendly doctor tells you it's risky to have a homebirth, that swings a lot more weight than getting that advice from somebody who thinks NOBODY should have a homebirth!

[lunarmomma]

I agree. When I was 37 and considering getting pregnant, I had a pre-conception interview. I went in and said I thought I was high risk for my age to have a homebirth. (I was not all that informed at that point). She set me straight by saying "we assume all pregnancies to be normal and healthy unless proven otherwise." I became pregnant two months later and had a wonderful homebirth. I am now 41 and would do the same if we decide to have another
In your case, it becomes a matter of who defines what the "unless proven otherwise means". I would try to get more information regarding the source of bleeding.. not just from the MD but from other sources. Then you will be equipped to make an informed decision if you are truly at risk or not...
good luck to you and keep us posted.

[LukesMum]

Thanks for all your infomred responses. I"M HAVING A HOMEBIRTH!! The bleeding was from the polyp-which is now gone or atleast flattened--I had the Level 2 ultrasound just for reassurance and I was told my baby and my placenta were "PERFECT< couldn't be anymore perfect!!" I spoke to my midwife from my last birth-who is too far for me to see...but she said "go for it!!" She is really excited for us and says I am an ideal homebirth mama !! So, all that worry--why are "they" so fear-based??? After my level @ ultrasound which was at a perinatology office ( ie; high risk pregnanacy) I had to sit thru a 30 min. presentation on my risks bor downs, spina bifida, cerebal palsy etc....how annoying-when she was done she said " I agree this has gone way too far" (re: all the stats they give people these days. So I said thank you and walked out--even more determined to have a gentle, spiritual experience with the birth of my daughter. Thanks again all!

[lunarmomma]

YIPPEE!!!
Wishing you the beautiful birth of your dreams....

[sunmountain]

Wonderful!

I wish you a gentle birth

[phathui5]

I'm so glad for you that everything turned out okay.

[Peppamint]

Best wishes on your homebirth!