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Homebirthing Questions

716 views 14 replies 13 participants last post by  Nicole B 
#1 ·
I'm sorry, I probably should have posted this here first, instead of in my DDC. I hope it's ok for me to double post it as I couldn't figure out how to delete the other post. Anyhow...

I have some questions/concerns about home birth. I want to do a home water birth this time around and I am trying to figure out all the details.

Our insurance company said they would cover it 100% but only if it's with a midwife on our providor list. The closest midwives on our list are in Toledo Ohio and they all seem to be affiliated with/or work out of a hospital down there. Toledo is a good 30-40 min from us so I'm not sure if any of them will or are even able to come up to do a home delivery.

I guess the biggest thing I've had on my mind about the home birth is... the midwives do not do episiotomys right? Because I had one done with each of my last two and I REALLY do not want to tear. I would like to not have an episiotomy this time so the healing time is much faster after delivery and I don't have to take care of sutures but I deliver so fast I am certain there will not be time to stretch out. My doc told me that the recovery from tears, especially ones up by the clitoris area, is much more painful than taking care of the sutures from the cut. So would the midwives even be able to do one if it were necessary. Does that bascially rule me out completely for a water birth?

I don't remember right now what all other questions I had re: home birthing but as I remember them I will come back to this thread to ask. Thank you everyone, I appreciate your help and you sharing your wisdom and experience.
 
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#2 ·
Regarding distance: My midwife lives a good 30-40 minutes from me and got to my house real fast when I was in labor.

I've heard that tears heal better and faster than an episiotomy. But I could be wrong. I'd think you could still have a waterbirth.
 
#3 ·
Tears do heal faster than a cut. The chances of your really needing an episiotomy, esp in a situation where you're allowed to move around and birth in the position that feels best, are virtually zero. Birthing in the water helps your perineum stretch, and MWs typically know many techniques for supporting the peri during crowning.

I'm going to bet that these MWs on the list don't attend home births. I don't know how Ohio's MW law works, but here in NC CNMs (who usually work in hospitals) are the only ones allowed legally to attend HBs. There are, however, many amazing CPMs who do. We're using a CPM and just paying for it out of pocket--it's completely worth it (trust me) and actually isn't much more than our out-of-pocket maximum with insurance.

Ask around in the Ohio section of Finding Your Tribe--hopefully you'll get some useful recommendations for HB MWs.

ETA: oops--I see you're in Michigan. Replace "Ohio" with "Michigan" in my post and it still applies
 
#4 ·
I don't know about your area, but i do know many mws who will travel an hour or more for homebirth. You'd have to ask the mws in your area--surely someone will be wiling to come to you.

As for cut vs tear, your doc is not that well informed. Yes, SOME tears are more painful in healing that episiotomies, but not USUALLY. For one thing, with some preparation and your own participation in baby's emergence, you can have support for upper labia/clit region so that if any tearing does happen, it will happen lower down. Episiotomies most always tear further anyway, leaving you with a larger wound than simply tearing would have done. Also, while I know some women who had little to no pain or other issues with their stitches, I also know others who have both had epis./stitch and tear/natural healing---who said in no uncertain terms that healing naturally from a tear was way easier and less painful than stitches.

Good preparation prior to birth, and good support during birth, may be all you need to avoid a tear altogether. Besides, in every case where a mom had a prior episiotomy scar AND tore for next (home) birth, that tear was always along the line of the old episiotomy. Of course this must be considered anecdotal since I am only speaking of 4-5 cases....but still. And not every woman with a scar tore next time, by the way.

I suggest that during this pregnancy, you look further into ways to help prevent tearing both prior to, and during birth. Also get better informed on episiotomy vs tearing....there is some research available but I am on the wrong computer to share it just this moment.

I think docs in general have a really hard time believing that babies can be born without 'help'--and episiotomies are a very common kind of 'help' provided. But they are NOT an evidence based practice! In my practice I see very little tearing, and most often tears that do occur are minor and req no stitches, heal just fine.
 
#5 ·
Thanks for the replies... I'm still nervous about it lol Keep the replies coming.. I'm getting there. I just wanted to post *cause I seem to be confusing ppl* Yes we live in Michigan SE lower michigan. Apparently for whatever reason, BCBS does not have a SINGLE one midwife on their provider list in Michigan. So when I search the book I have to look at Ohio midwives. The list coming up is all CNM's and I have this feeling the previous poster is right and they do not attend home births. I think they work out of smaller hospitals down there and you have to come to them. I understand midwives will drive half hour to and hour to be your midwife, only problem there is that more than likely they won't make it to me ontime. With my last delivery I woke up with the alarm clock (not because I was contracting) at pretty much 8cm dialated less than an hour before my son came out. Doc told me this time to remind him to be there with a catchers mitt on lol So, I'm concerned if our midwife is too far away we would just end up paying a midwife for an unassisted home birth lol

I am having this sinking feeling that what this is all coming down to is our insurance won't cover a home birth and therefore we would have to pay someone closer to us in MI, our of pocket, to do a home water birth.. which I have found two in our area that look good and I have heard good things and I would like to find out more however, hubby doesn't want to pay $2500+ out of pocket to do this when we are currently saving to buy a house before this baby comes and insurance will cover 100% of stupid hospital birth *sigh*

I'm getting sad. I'm not sure what to do at this point. I really love my OB/GYN and I wouldn't mind him delivering me again but like, he's only there for a half hour yanno? The rest of the time before and after its all different nurses and docs and staff and chaos and I machines and IV and confusion and where's my baby and when can I go home, etc. etc. You all know what I mean. I was just so looking forward to something calm and peaceful this time. Where hubby could deliver the baby not a doc and aI could have as many people who wanted to watch as can fit in my living room without getting in the way and I could have a photographer there if I wanted to take photos and I could snugggle in bed with hubby and baby and siblings right after. Grrrrrr.
 
#6 ·
Hi. Just wanted to post a few things. From my research, tears are almost always better than episiotomies. It's just easier for the skin to fuse back together along the jagged line (think like a puzzle piece) than a forced cut. I have very few scars from scraping my knee, but a few from being cut by things (not the same thing, but couldnt think of anything else). Plus, one of the things you get for your homebirthing kit is perineal massage oil, so that helps with stretching. The ACOG doesn't even recommend episiotomies anymore because it's not evidenced based medicine. This is from the acog's site

Quote:
Recent studies show that common indications for episiotomy were based on limited data. Additionally, there was a general underestimation of potential adverse consequences associated with the procedure, including extension to a third- or fourth-degree tear, anal sphincter dysfunction, and painful sex. Data suggest that women who have an episiotomy do not have significantly improved labor, delivery, and recovery compared with those who do not have one. Without sufficient data to develop evidence-based criteria for performing episiotomies, clinical judgment remains the best guide to determine when its use is warranted, according to ACOG.
Have you read Henci Goer's book "The Thinking Woman's Guide to a Better Birth"? It's really good, and tells alot about the hospital practices that are deemed necessary by doctors, but really don't improve (and often worsen) outcomes. Point out to your hubby that simply by walking into a hospital, you increase your odds of having unwanted (and harmful) interventions, a c-section, and the risk of injury (or worse) to mom and baby. I'd also netflix (or buy) "The Business of Being Born". It's a birth documentary produced by Rikki Lake. It's PHENOMENAL and shows how for a low risk woman, the hospital is REALLY not the place to be giving birth anyways. Another really good book to get is "Ina Mae's Guide to Childbirth" by Ina Mae Gaskins. Not only is it full of positive birth stories that take place out of the hospital, but its full of info on why that's better for most women anyways. Feel free to pm me if you need more info/resources/reading material. And if he still has doubts, you may want to inform him that the US spends the most on our pregnant women than any other country, but is tied for the worst birth outcomes as far as maternal and fetal death. The countries that have the best outcomes have 70% of their pregnancies handled by midwives and a high homebirth rate.

As far as homebirthing and midwives goes: I'm 19 weeks pregnant with twins (my firsts) and planning a homebirth. I actually got my insurance to agree to cover my homebirth midwife, and they say they'll cover any fees for anyone who has to come to my home. What i did was this: I called my insurance company and found out that they cover midwives the same as obgyns (they're covered at 100%). I asked for a listing of midwives in my area. They had NOT ONE. So I called a care cordinator and asked that they give me a "gap exception". That's what they give you when they cover a service, but have no one in network that performs that service. Every insurance company has them, so don't let them tell you they don't. This is how you get them to cover your out of network midwife. Say that you're going to such and such midwife (your hb midwife) for prenatal care because there are none in your network in your area. Granted, you would have to see them for your prenatal care, but you'd have to do that anyways for a homebirth. That's how i got them to cover my hb midwife for my prenatal care. I called back and spoke to a benefits person, and told THAT person (not the care cordinator) that my family has a history of very fast labors, and that i was concerned that i would not be able to make it to the hospital on time and wanted to see what my benefits would cover. It was at that point (AFTER recieving the gap exception) that i was told by benefits that if i had to call someone to my home because i was having a quick labor and/or couldn't make it to the hospital that their fees would be completely covered. Since you've got a history of quick labors, this is on your side. But only do that AFTER you have the gap exception. If you do it before, they may give you the standard "we don't cover homebirths" bs. Another option is to get your insurance company to cover her as an out-of-network provider. They don't cover as much for an out of network provider as they would an in network one, but it's better than nothing. I would only try that after i'd tried for a gap exception a FEW times though. Most insurance companies cover out of network providers at about 60%. Another option is to pay out of pocket and send it in to the insurance company for reimbursement. Some are willing to pay for a homebirth after the fact because it's much cheaper than a hospital birth. But i recommend that only as a last resort, because they could deny it because you didn't have prior approval. Even if they deny you for the gap exception, KEEP TRYING. Some insurance companies will deny you two or three times before they will accept the claim.
It's a common practice. Persistence pays off though! You may have to start seeing ONLY your hb midwife for prenatal care. That seems to make a difference. When i was doing dual care (with my hb midwife and a CNM), i was told they didn't cover homebirths, wouldn't cover my midwife etc etc. Once i stopped dual care and presented them with "this is the only care provider i'm seeing and you say you cover this but have none in network", then all of a sudden they cover them.
BE PERSISTENT!

Also, how far along are you?

ETA: I see it's your dh's first baby. Maybe you should suggest that he research homebirths and why they're much safer for the baby and mom. It really is a slippery slope of interventions just walking into a hospital, even things as "innocent" as an iv and external fetal monitering tend to make birth harder and put you closer to a c-section. Alot of the routine things they do in the hospital the acog has even admitted doesn't improve the maternal/fetal outcomes. You should have him read/research/look into these things. And watch "The Business of Being Born". That may help to get rid of his fears about having a homebirth. Alot of people are scared about homebirths until they realize that for low risk women, it really is the SAFER choice, for moms and babies. Just my .02
 
#7 ·
I skimmed the replies so I'm sorry if I'm repeating what others have said. First, since there is no homebirth midwife covered in your area under your insurance, see if they'll cover one outside of the network. I was told by BSBC (I think it was - we haven't had that insurance for awhile now) that they would have paid for a homebirth mw outside the network even though I only had the HMO coverage (not PPO where you can usually go outside the network) IF they didn't offer me a provider - does that make sense? So b/c they don't offer a provider in your area maybe you can push to get a provider covered even though they're not on the list. I also remember them saying something about having the OB write a recommendation for care for me to be seen by the mw. They said that would have made the difference (I assumed I'd have to pay out of pocket since my mw wasn't on their list so I just did it but then later tried to get reimbursed - it didn't work for me that way). Second, regarding the episiotomy issue - yes, mw can and sometimes do cut episiotomies BUT you'll find this is few & far between for most of them. Some never do. It's important to check with *any* provider what their episiotomy rate is and in what cases do they cut them. The mw at my first birth offered to cut one b/c of my long pushing stage - she said I could have the baby out in the next push or work a little longer. Thankfully I chose to work longer but it kind of horrified me that I was even offered! It's hard to be asked these things when you're laboring, kwim? Anyway, back to the cut vs. tear - yes, healing from a tear is typically far easier on you than from a cut. I hear women all.the.time complain about their painful epi recovery and scar - even years pp. I can't think of once I've heard the same complaints about a tear. Fwiw, I did tear with my first birth (could not have told you that it happened). I had 2 stitches that I did not notice once they were in and recovery was totally typical. My second birth was very fast - 90 minutes from the very first contrax to the baby out. She was born in the water - the mw wasn't even there yet - and I'm SO thankful for that! I think being in the water helped make the difference in potential tearing. I wasn't in the tub for long (maybe 30 min most?) but I'm sure it helped relax the tissues. I did feel like I was going to tear into my clitoris which was a terrifying feeling. At that time I had not even heard of such a thing happening, which added to the fear I felt in the moment. I ended up having what I think my mw termed a sideline tear (skid mark). Nothing worth suturing - it was more like a scrape. She didn't even notice it in the initial pp exam - I noticed it b/c it burned where I was scraped when I'd pee so I brought it up to her and she detected it then. Fast forward to my next 2 births (twins) - one was born in 41 minutes from the first contrax and the next was born 2 hours & 32 min later. So fast births by any account. I had 1 minor tear, not worth stitching. So see, fast does not always mean you tear. I think your comfort level and position during pushing is much more important. And with an epi you're guaranteed a wound. With a tear you're only risking a *potential* wound - and one that is likely to be far less severe than a surgical cut, which can extend even further into a tear anyway. I hope this helps. Don't give up. Personally I'd pay out of pocket to give myself & my baby the best possible care, but that's me. Do whatever is right by you.
 
#8 ·
I am in NY, so laws may be different here. But i have BCBS, too.

We found one CNM that does HB's (80 miles away) and she was not on the provider list...since there were no other HB CNM's on the provider list (the only legal hb choice in ny state is CNM) NY state law requires that my insurance pays for it as if she WERE on the provider list...so we have no co-pays, no deductible, etc...

They did try to get me to pay the co-pay, do the deductible thing by saying that i was "choosing" her to provide my services when there were other CMN's who could provide prenatal care...however, the whole HB thing became the deciding issue. Please check my previous posts...or my website (link in signature) to find my letters to the insurance company and how i handled it.
 
#9 ·
Quote:

Originally Posted by DoulaJulian View Post
I am in NY, so laws may be different here. But i have BCBS, too.

We found one CNM that does HB's (80 miles away) and she was not on the provider list...since there were no other HB CNM's on the provider list (the only legal hb choice in ny state is CNM) NY state law requires that my insurance pays for it as if she WERE on the provider list...so we have no co-pays, no deductible, etc...

They did try to get me to pay the co-pay, do the deductible thing by saying that i was "choosing" her to provide my services when there were other CMN's who could provide prenatal care...however, the whole HB thing became the deciding issue. Please check my previous posts...or my website (link in signature) to find my letters to the insurance company and how i handled it.
This is what i was going to mention. Many states have an allowance for how far you have to travel for care. In my state it's something like 30 miles or the insurance company has to allow for a closer out-of networkv provider using in-network rates.
 
#10 ·
You should look into the insurance code/laws in MI. Here in CA all insurance companies MUST provide coverage for OB and midwifery care (they recognize each as a legitimate and different path for the consumer). If the insurance company doesn't have any midwives within a certain geographical area (30 miles from your home, I think), they have to pay for a midwife in your area *as if she were in-network.* The insurance company cannot disallow LMs if they allow CNMs to attend.

Remember, insurance company = evil bloodsucker. Even though a homebirth would be MUCH cheaper for them, they try to get out of paying for just about everything. I know what I know because we fought with our insurance company (Cigna) for months, but finally got reimbursed 100%. The insurance companies are not to be trusted to give you accurate information over the phone. Do your own research and have a homebirth if you want one!
 
#11 ·
Something that my MW is having me do is rub a little Vitamin E oil down there. If I have any scars from the stiches I had with my DS the oil will help soften the tissue. The scar tissue is strong, but the tissue on either side of it may tear. The oil will help prevent that. Just start using it daily once you're a few weeks away.
 
#12 ·
Quote:

Originally Posted by Angey View Post
. Apparently for whatever reason, BCBS does not have a SINGLE one midwife on their provider list in Michigan.
Hey Angey --

I wanted to comment on this -- this is a peculiarity of Michigan and the way that CNMs have historically billed here. Most CNMs in MI bill through the doctors that they work for, so they don't show up on their own on the provider lists that BCBS issues. If you are interested in a hospital-based midwife, the best way is to go to the acnm website, look for providers in your area and then call the offices themselves to see if they take your insurance and whether they are in-network or out of network.

I gotta say, though, as a midwife and a doula and a birthing mom, there is no comparison between a homebirth and a hospital birth. For low-risk moms, homebirth is sooo much better, for a lot of the reasons you mentioned. Many homebirth midwives are flexible with payment, depending on your insurance, some may be able to get reimbursement from the insurance company too.

Oh, and regarding the episiotomy -- I have never felt the need to cut one. Of the women who trained me and the women who trained them, I think there is one episiotomy in something like a 15 year history. Our way of handling pushing and protecting the perineum and helping babies come out is different in so many ways -- we do have bad tears occasionally, but they are pretty rare. I have never had the women I care for, though, report pain at nearly the level postpartum as the women I have worked with as a doula who are healing from episiotomies.

If you were the first, though, who seemed to need it, I would just ask you to get out of the tub. If the baby isn't coming out, then there is time to move. Usually I prepare an area near the tub in case mama decides to get out or we need her out in an emergency -- you would just move to that area. Sounds difficult, but I have never had trouble with mamas moving the way I need them to in times of difficulty.

Good luck! I hope you find someone great to help you and get the birth you want.
 
#13 ·
Thank you for the responses everyone. It has really helped me hash a few things out in my own head.

First of all I have decided to fight it out with the insurance company for my home water birth. I am only 11 weeks give or take so I have some time to try and make it work. If they won't cover who I want to use 100% then perhaps they will cover them out of network which should be like 90% for us. I told hubby today that I really wanted to just pay for the midwife if insurance absolutely refused to pay any of it in any way shape or form. So that's that!

I have also decided, based on what I have heard/read over the last week or so.. to contact Trillium first. I like what I see on their website. I like what I hear from other people. They are right about 30 min away from us. So I emailed them tonight and hopefully they will get back to us before too long about setting up a meeting where we can go get some further information.

Thank you for the information about the books and the movie. We don't have netflix but I will get ahold of the video one way or another and watch it with hubby. I also plan to pick up the books this weekend and both read them myself and have hubby read them.

I feel really positive about this.. I really hope everything works out for us. I thank you all so much for your help and guidance. You have no idea how valuable it is when people come in here not knowing anything, like me
 
#14 ·
Hi angey! I have been lurking your threads on homebirth. I am not pregnant yet, but hope to be soon and am in a very similar situation. I have bcbs too, and I really want a homebirth when the time comes. Please keep us posted on your progress with the midwife hunt and with the insurance co.
Oh, Welcome to MDC and CONGRATULATIONS!!!
 
#15 ·
Hi! Congrats on your pg!

I just wanted to chirp in and say that an eppesiotomy should be last on your worry list for a hb

I havn't had a hb YET
but did have a different OB for both births and at my first birth (6 lb 10oz) the dr felt the need to cut me cause I guess the pushing part was getting too long for him
: (1/2 hr
)
Second birth I had a great dr who believed in supporting the perineum instead of cutting it and I delivered a 7 lb 4oz baby with barely a "skid mark"

In my case the old eppesiotomy scar did not hinder things at all
 
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