[penstamon]

x-posted in July DDC

First off, I have no problems with my OB- she's great and the hospital is pretty laid back. But she is an OB and views birthing as a "medical" situation and of course hospitals are not exactly my favorite place. Our new doula is sooooo awesome and has finished her midwife training. She has been attending births for years and is full of good info and we just click. At our last visit she has fun showing us where the baby was lying in my belly (my OB never said anything when palpating) and we just had a good time. She lent us many birthing books and here's the problem:

Spiritual Midwifery has just solidified my desire to birth with a midwife, either at home or in a birthing center. Its not just that book, many many things (including many of you on MDC) have made me realize that I would just be more comfortable without the medical intervention environment. So after letting my desire slip to my doula, she has offered to take us as her clients under supervision of more senior midwives (who both come highly recommended). I have had no complications, no history of health problems, etc.

Problems: 1. DH not so into the idea of HB or switching providers
2. not covered by insurance, will cost around the same or much more than we would have paid for OB/hospital
3. Switching past 25 weeks? Our OB will be our pediatrician and I don't want weirdness between us.
4. Nearest hospital is 20 minutes away if there is a problem

What to do? It would work out either way but now I have this gut feeling that I will only have a few kids in life, why not have them the exact way I want? How do I start this process and get DH and OB on board?

 

[kcparker]

It's impossible to say what your total bill would be at the hospital. I had my son with midwives at a university hospital, totally uncomplicated, unmedicated birth, then a nurse in mama-baby noticed VERY MINOR flaring and retracting with my son's breathing...long story short, 1 week's worth of IV antibiotics and 7 nights of baby being held in the hospital for an "infection" that never manifested as more than this little breathing issue, we were in the hole $2000, so we might as well have stayed home, avoided the hospital germs, had a more comfy birth environment, and spent the same amount of money.

As for weirdness, I think you have to go with your gut, not with what your OB might think of you. They have PLENTY of other patients, and you are coming back for peds. care, so it's not like you hate the OB, just the environment. I LOVE the midwives at the hospital; I just don't like the hospital.

Most problems in labor don't crop up with NO warning, and likely you'd have time to make a decision to transfer. Talk with the MW about her plan if X,Y, or Z were to happen - when to call an ambulance, what does she have on hand for emergencies (drugs, O2, etc.), what is her training for various situations. If you had something terrible like a placental abruption, the baby could be gone by the time an you and an OR were prepped anyway, and that's such a rare event...

There are no do-overs, and your birth should happen in a location and with care providers that feel right to you. I use the analogy of marriage - big life event, lots of preparation goes into it, and everyone has an opinion on what you should do. Good luck talking it through with DH.

 

[GoldmanBaby09]

Well, that definitely is a huge decision, but if you have gotten to this point, and you know in your heart it doesn't feel right, I would listen to that intuition. It sounds like it would take a little work, but here are my suggestions. For your first problem, I would start educating DH asap! Make him watch The Business of Being Born with you, at least as a starting point. I would also make him read! My DH read Immaculate Deception and I'm going to have him read the Birth Partner by Penny Simkin. Just becuase you are the one in labor doesn't mean he doesn't need to know what is going on, regardless of where you deliver. You need to stress to him that this is very important to you, and have him sit down with your doula and the mws to answer any questions or concerns he might have. For number 2, we are in the same boat, not having our HB covered by insurance. But, depending on what is done to you in the hospital and what your coverage is like, you may find that it isn't any more expensive. Also, since it is so late into your pregnancy, I would talk to the mws about a sliding scale for payment. You have already recieved the bulk of your prenatal care already and they may be willing to negiotiate a lower rate for attending your birth. Number 3 I don't see as too much of a problem since you already have such a great rapport established with your doula who will be at your birth. The OB is another story. I can tell you that even at a "liberal" hospital, most OBs are NOT HB friendly, and I have know people who's OBs have dropped them as patients after finding out they are planning a HB. Why is your OB going to be your pedi as well? That seems kind of off. You can always run it past her and see if she is supportive, but I would be prepared to find an alternate pediatrician and I wouldn't count on her to be your back up. Number 4 seems like a non issue to me as well. Weren't you going to have to drive 20 minutes to get to the hospital when you are in labor anyway? What's the difference? If you have a complication in labor at home, it is generally known that you need to transport and rarely does that have to happen so suddenly. And even if it does, you call 911 and it is much faster to get to that hospital in an ambulance than if you are driving anyway. Good luck with your decision and I hope you find what is right for you and your baby.

 

[njbeachgirl]

Follow your gut on this one!

The OB may never be on board but as you said you will only give birth a few times. It's up to you as the one giving birth. I have had a hospital birth and a homebirth (both with midwives) and I am really glad I decided to have a HB for #2. If your DH is not on board educate him till he is! Good luck!

:

p.s. Have you looked into getting an in network exception on your insurance? It took some legwork but I got my insurance to cover it 100%.

 

[2+twins]

In so many ways, your most important birth is your first one. It can make or break the way all future births go. Protecting the first time mom is a really big deal and is best done at home. Go with your gut on this! I'm convinced that if I had had my first baby in the hospital, I would have had a c-section which would have set me up for a repeat c-section with #2 and then for sure another with #3 & 4 - my twins. Instead I had all four of them peacefully at home and thankfully so.

 

[*MamaJen*]

Sounds like you know in your heart what you want to do! I say go for it.
Watching the Business of Being Born with your husband can be a good way to introduce him to the concept of homebirth. Also, most midwives are very familiar with the process of talking to nervous husbands.
I would be comfortable with a 20 minute transfer time.
I am so grateful for my wonderful homebirth, and would never in a million years swap it out for a hospital experience.

 

[Kirsten]

You don't have to get your OB on board. It is your pregnancy, your birth, your body, your baby. Will the OB be offended - yes. Is that a reason to put yourself through a hospital birth - no. Twenty years from now, do you want to look back and be happy you had the birth you wanted - or look back with regret about what happened to you and your baby, but it is sure good we didn't upset that OB!

Our third was a planned homebirth. Hospital is about 25 minutes away. I had had some pretty serious bleeding after dd1 was born (in hospital) but no issues with that at all with dd2 (birth center) or dd3 (homebirth). The midwives were equipped to deal with that if it occured, but it didn't.

I agree that your dp should watch The Business of Being Born, and also Born in the USA (which my midwife is in, and asked if we would allow our birth to be filmed for but I declined). When you come to a final decision, do not "ask" your OB or even put it up for discussion. He/she will likely say some scary/nasty things when they find out your change in plans. I would leave a voice mail stating that you are changing care providers and/or send a letter. No long list of reasons - just "I am changing care providers. Thank you for your care during the first part of my pregnancy." And I'd definitely find a different pediatrician. Your OB is also a pediatrician? I've never heard of that around here.

 

[Talula Fairie]

responding to your points:

1. It's your vagina, your choice! I know that sounds overly simplistic, but really, YOU should get the final say about this one. I do think it's important to take into account your husband's feelings, though. Nail him with the facts! Talk about how midwives are used as the main birth professionals in 80% of the cases in just about every other developed nation besides the US. Talk about our infant morality rate. That sort of thing. Rent The Business of Being Born (that should help a lot with his fears). Have him read all the books you read.

2. May cost more, probably depends on your insurance. For us, a homebirth is costing $4,000 and our co pay for the hospital would have been probably $100. Big difference. However, I have a friend who lives in Utah and her insurance has very high co pays. She paid $2,000 for her hospital birth. A midwife would have cost her about $3,000. Not as big of a difference, there. Ultimately though, as hard as it is to come up with the money, this is a decision that can impact the entire rest of your life. Most people describe the experience as priceless.

3. Again, your body, your baby, your birth. What your doctor thinks really shouldn't be a factor. It's more important to go with what YOU think and feel.

4. 20 minutes is fine. I'm about 25 minutes from the hospital and not that worried. Complications that require instant medical attention, ironically, are usually *caused* by the medical interventions! Things like cord prolapse are actually very rare in homebirths. You also mentioned you really loved Spiritual Midwifery. I'm not sure, but I'm fairly certain that The Farm is at least 20 minutes from the nearest hospital.

 

[penstamon]

All very supportive comments ladies- thanks!

I'm a little overwhelmed thinking about it but I think it may work out for the best. My doula/midwife has offered "at cost" services which would cost us a little less than the hospital (yay!) and we can birth at her house where they have done many births already. I don't know, it seems like I would rather do it at home, but if doing it at the midwives' house closer to the hospital would make DH happy, its no big deal.

You are right- I should not worry about the OB! She has been my dr. for years now and I do trust her. In our area many OBs are pediatricians/family practice. Unfortunately its a small area so it may be hard to find a new one if we have a falling out.

I have BBB in our netflix queue and will get DH to sit and watch it soon. He has been resistant to doing any research/reading and his excuses are pretty weak. It is frustrating! Our friends have birthed in the local hospital and all had good experiences so that plays a part too. I think people are generally so dependent on our medical culture to tell us what is right and wrong. The funny thing is DH has been anti-u/s and hates doctors himself. WTH???

Persistence and patience- that is my strategy.

 

[Jilian]

Good luck with your decision. I hope you are able to get your DH on board. Will there be another MW at your birth in addition to the doula/MW? Maybe that would make your DH feel better? Is it the MW's lack of experience that makes him nervous? If for whatever reason you decide that you cannot have a HB you can still use the MW as the doula and stay at home as long as possible and just show up at the hospital for the pushing part.

 

[momto4kids]

Quote:

Originally Posted by penstamon Persistence and patience- that is my strategy.

This worked wonders for me & we switched out @ around 24 wks

....my DH is now a HUGE homebirth advocate & tries to convince his coworkers to birth @ home

. Mind you we went from him not even considering it during my 4th pg at first!

dana

 

[penstamon]

Quote:

Originally Posted by Jilian Good luck with your decision. I hope you are able to get your DH on board. Will there be another MW at your birth in addition to the doula/MW? Maybe that would make your DH feel better? Is it the MW's lack of experience that makes him nervous? If for whatever reason you decide that you cannot have a HB you can still use the MW as the doula and stay at home as long as possible and just show up at the hospital for the pushing part.

Yes, the midwife/doula just finished training and she would have her preceptor there too (who is very well known and experienced). Basically she is only charging us $ to pay for the preceptor. There would be a chance that one more (very experienced) midwife would also attend. My DH lived with a midwife for a year as an exchange student in Europe, has cousins who are midwives, and was born at home himself. I think he may come around, but he is still very resistant to discussing so far. Oh well, this is still a new idea to him so I think we just need time to sort through this. I agree that if hospital is the choice, I will labor at home as long as possible with the doula/midwife here equipped with emergency HB supplies just in case...

 

[fairydoula]

Quote:

Originally Posted by penstamon All very supportive comments ladies- thanks! I'm a little overwhelmed thinking about it but I think it may work out for the best. My doula/midwife has offered "at cost" services which would cost us a little less than the hospital (yay!) and we can birth at her house where they have done many births already. I don't know, it seems like I would rather do it at home, but if doing it at the midwives' house closer to the hospital would make DH happy, its no big deal. You are right- I should not worry about the OB! She has been my dr. for years now and I do trust her. In our area many OBs are pediatricians/family practice. Unfortunately its a small area so it may be hard to find a new one if we have a falling out. I have BBB in our netflix queue and will get DH to sit and watch it soon. He has been resistant to doing any research/reading and his excuses are pretty weak. It is frustrating! Our friends have birthed in the local hospital and all had good experiences so that plays a part too. I think people are generally so dependent on our medical culture to tell us what is right and wrong. The funny thing is DH has been anti-u/s and hates doctors himself. WTH??? Persistence and patience- that is my strategy.

This might be a minor point, but aren't you saying that your DOCTOR is a FAMILY Practice Physician?
Because it is VERY rare for a board certified OB to also be a board certified Pediatrician.
BUT
it's very COMMON for a Family Practice Physician to both deliver babies and be their PCP (primary care physician) as well.
Just curious.
- Jen

 

[ShwarmaQueen]

I REALLY regret not listening to my inner-voice telling me to go w/ a MW.

I think we're all a little naive on our first birth (at least I was, BIG TIME) and it's easy to feel loyalty towards the "status quo"- but just bear in mind that our c/s rates and infant mortatlity rates are nothing short of atrocious, as a result of that status quo!

:

 

[BethandLC]

I am in a similar boat as you. First I hired a doula around 22 weeks, then educated myself further and just last week at 30 weeks have made the decision to hb. My doula is an apprenctice MW and I chose her MW as mine.

As for your concerns:
Problems:
1. DH not so into the idea of HB or switching providers
Have him meet with the midwives you interview - that was a huge thing for my DH. Plus he knows that I am the one birthing this baby - enough said.

2. not covered by insurance, will cost around the same or much more than we would have paid for OB/hospital
We have no coverage for HB here as our state does not recognize CPM and no CNMs do homebirths due to back up issues. So we're out of pocket. Its going to cost us more than our portion of a hospital birth - but people spend thousands on cars - this is my child and my birth. We never know if we would get to do it again. Further, if a hospital birth went really bad for me, I think I would regret not spending this money.

3. Switching past 25 weeks? Our OB will be our pediatrician and I don't want weirdness between us. Is there someone else you can use as a pedi? Is your OB a family practice doctor?

4. Nearest hospital is 20 minutes away if there is a problem
Talk with the midwives and see how they feel about proximity. We're 15 minutes so we feel ok with it all.

Good Luck! Since making this decision last week I feel so much more in charge and part of MY birth - so empowering!

 

[penstamon]

Quote:

Originally Posted by fairydoula This might be a minor point, but aren't you saying that your DOCTOR is a FAMILY Practice Physician? Because it is VERY rare for a board certified OB to also be a board certified Pediatrician. BUT it's very COMMON for a Family Practice Physician to both deliver babies and be their PCP (primary care physician) as well. Just curious. - Jen

Good question. Her website says she specializes in obstetrics, pediatrics, and family practice. I never asked her to be more specific. There are so few good docs in the area for OB and ped care and she is great so I would hate to have to get on a waiting list for however long to find a new one.

ShwarmaQueen- Yes! I am feeling very naive and vulnerable! My gut tells me that HB is the right thing but stupid inhibitions instilled by our medical society make me nervous. I dont feel like I would even share the news of the HB with family until after the birth.

I need to be stronger...

BethandLC- It is funny and wonderful to hear from someone who just went through the same thing. Congrats on your choice!!

You make all valid points and I think DH is the main obstacle. I am slowly getting him to open up but right now is soooo stressed with work and home remodeling that I just have to sit back, do my homework, and wait. And interject little comments/facts now and again when appropriate. We only have the midwife duo to choose from, so DH would have to like them or back to the OB.

I have a prenatal Monday with my OB and I think I may test the waters with her. I may not actually tell her of my thoughts to switch but I would like to keep her as my doctor. That may change though

 

[MommyMichele]

My first two were born in hospital births as natural as hospital births can be and those experiences were not bad (except I didn't like being scared into inducing at the end of pregnancy #2 just for being 41 weeks).

Still, when Baby #3 surprised us, I decided it must be an opportunity to have the homebirth I dreamed of. My husband needed a lot of convincing and it was hard, but I decided it was worth it.

It is so wonderful being already home after giving birth! You won't regret it.