Who do I choose with possibly PTL and need for an Ultrasound?

[lhowlett]

I've been considering a homebirth for our 3rd child which we are not currently pregnant with, but I need to decide where I'll deliver so I can see that provider through the pregnancy, obviously. Here are my 2 concerns.

I have a feeling I'll get pregnant before I get a period back (still bf) which will make dating a pregnancy difficult. That would mean an ultrasound, right? Did any of you not do an ultrasound to date a pregnancy you had no conception date on? Did you just go by belly measurments?

I was in PTL with my second pregnancy, but delivered at 39 weeks. So obviously I will most likely make it full term again, but if I don't, won't that mean I'll have to deliver in a hospital with a provider I don't know?

This last birth I delivered naturally in the hospital with a CNM I really like. I kind of feel an obligation to her, like I'll upset her if I don't go back (she hasn't made me feel this way, it's all me). So then if I end up in the hospital, I'll feel bad I didn't use her, but if I end up using her to be cautious and go full term I'll either not get my home birth, or have to leave her after basically a whole pregnancy for a midwife I don't know. Arg, help!

[BelgianSheepDog]

Why don't you see a homebirth midwife with the CNM you like as backup?

[mwherbs]

ok the birth is yours and not the midwife's and without knowing her I would still venture to guess that she will not care if you decide to do what you feel the most comfortable doing. here where I live we have birth center and hospital based midwives and any one of them will tell you that it is just not the same as a home birth and for the right people they themselves make the recommendation to check out doing a birth at home instead of coming to them.

the other things you can ask your midwife if you decide to go that way-- I know that we can refer women to get an early ultrasound for dating and I have also had women go solely on measure , listening for heart tones with a fetoscope as well as when tones are first heard with a doppler and movement --- beginning and ending of morning sickness , guesses as to when you have had sex or felt more sexually driven.. kwim date of first positive pregnancy test... all these details go into figuring out dates... take care

[boscopup]

Ditto to what BelgianSheepDog said.

I'm seeing an OB and a CPM at the same time. I had a preterm birth last time, so wanted to have the OB on hand in case it happens again (don't want to be randomly assigned in the hospital again, thankyouverymuch!). Also, because I have long cycles and grow biggish babies, I wanted the dating u/s to have something in my chart that hospital doctors would believe, as I think last time they "let" me deliver my DS earlier than they should have (PPROM at 29 weeks, and they let me deliver at 29w4d instead of keeping me preg to at least 32 weeks). DS was measuring 31 weeks on u/s at the time due to his size, and I think the doctors there didn't believe me on my dates, even though I chart and knew when I was really due. It was quite annoying. :

My plan is to birth out-of-hospital with my CPM if I make it to at least 36 weeks (when she can deliver). If I go early or have some kind of complication that requires a hospital delivery, I'll use my OB for the delivery.

Since you had a PTL issue last time, I would recommend the early dating u/s, as it can make a difference in whether they try to keep you pregnant longer or let you deliver, or if baby comes despite the drugs, the NICU will know how old baby is gestationally and know when to expect certain developmental things (like the ability to take oral feedings, etc.). Fundal height is not a great measurement of how far along you are. It can be useful if you haven't been able to get a dating u/s, but some women measure big or small for dates via fundal height and are perfectly healthy and normal. I'm measuring 1-2cm ahead in fundal height right now (and baby measured 2 weeks ahead via u/s at 20 weeks). I just have a big-for-gestation baby again, just like last time. But I have that dating u/s that picked a date only 2 days ahead of the date I gave them from charting, so it's pretty close. Of course, dating u/s can be wrong too, but if you get it early in the first trimester, it's got a good chance of being fairly accurate, give or take a few days.

Do you watch for fertility signs at all? I had noticeable fertile mucus when I ovulated before postpartum AF showed up. If you don't already monitor fertility signs, I highly recommend learning about it. That would help immensely if you saw when you were fertile and knew when you likely got pregnant. Do a search on NFP (Natural Family Planning) and you can find lots of info out there.

[lhowlett]

Thank you all. You know I hadn't even thought of having my CNM as my backup. That sounds good, but what about the fact that during my second birth she wouldn't have been able to attend the birth if it was before 36 weeks? So doesn't that leave me seeing an OB regardless?
How does insurance stuff work with seeing 2 providers? I hate that money factors into my birth decision, but it does.
MWHERBS: that's cool that your midwives suggest the homebirth option!
I don't do the whole BBT or anything like that although I know what it is. I do know about the cervical mucus thing although I haven't been super confident in recognizing it because it's been so long since I've had it! But I think maybe I've noticed it a couple times. What I've noticed wasn't as thick as prepregnancy, do you think it will be just the same? We're kind of at the point right now where we're not preventing a baby and not trying yet, just letting it happen if it happens. So I don't really want to get serious with NFP, but I guess maybe I should if I want to try to date my pregnancy.

[Isaac'sMa]

I would "get serious" about the NFP approach if you're worried about dating the pg. It's a bit more work on the front end temping and checking CM etc, but (depending on the provider you choose) could rule out having to get an ultrasound you don't want later on. Fertility Friend has tons of tips and forums you can look at- they are great!

I agree with pp about seeing the CNM as back up. Sorry, I don't know how it would work seeing two providers, but I guess that would depend on your insurance plan.

edited to say: By using NFP and knowing exact dates, you may also be able to avoid unwanted interventions at the end of your pregnancy...

[boscopup]

Originally Posted by lhowlett

Thank you all. You know I hadn't even thought of having my CNM as my backup. That sounds good, but what about the fact that during my second birth she wouldn't have been able to attend the birth if it was before 36 weeks? So doesn't that leave me seeing an OB regardless?

The way I'm doing it right now is that I see both providers (CPM and OB) for prenatals. If I make it to 36 weeks, I'll deliver with midwife and stop seeing OB. If I don't make it to 36 weeks, I'll deliver with OB. Midwife only gets paid for birth if I make it to 36 weeks and she goes "on call". Prior to that, I'm only paying for individual prenatal appts. My insurance doesn't cover midwives, so it's all out of pocket, but prenatal appts are only $30 anyway, so not a huge deal. And if you're seeing two providers, you can always space out your appts more with one or both providers.

It'd be nicer if I could use the midwife alone and just have OB as "backup", but the way insurance is done around here, you can't just go see an OB for one visit. You have to do the full round of prenatal care. And non-CNMs can't legally practice here, so there's no midwife/OB relationship to utilize (my CPM practices just across the state line where she is legal, but she still doesn't have an OB backup).

Originally Posted by lhowlett

I don't do the whole BBT or anything like that although I know what it is. I do know about the cervical mucus thing although I haven't been super confident in recognizing it because it's been so long since I've had it! But I think maybe I've noticed it a couple times. What I've noticed wasn't as thick as prepregnancy, do you think it will be just the same?

I never chart BBT... just CM (I use the Creighton Model of NFP, which is a CM-only method). I know what you mean about forgetting what it's like. I went 16 months before AF returned, and that's after being pregnant for 6.5 months... so 22.5 months of no cycles to chart. I did continue to have the "continuous mucus" that I had pre-pregnancy, and thankfully I had charted my CM pre-pregnancy and knew the difference between my non-fertile mucus and my fertile mucus. When AF did return, the ovulation that occurred before that had insanely stretchy (like 9"!) CM. It was very obviously fertile! You can have different cycles postpartum than you did pre-pregnancy, but I think what the fertile mucus looks like should be about the same. You might just have weird lengths of cycles or varying lengths of cycles, etc. My best friend is 4 months PP, and she has 20 day cycles right now. : (and yes, she is ebf'ing, but her DD *won't* paci-nurse... she only wants to nurse when hungry, which totally threw my friend for a loop since her first DD paci-nursed all the time!). My friend is likely anovulatory right now though - she's not really having much, if any fertile mucus during her cycles (she also uses the Creighton Model). PP cycles can be really wonky, especially while bf'ing! I just got lucky jumping into a regular 35 day cycle right away (and 16 months PP to boot - boy was that nice).