[MomtoXane]

So I started planning a home birth for this baby before we conceived. Then hubby lost his job, then I lost my job. Money has been tight ever since. So just being able to afford a CPM is questionable. Thankfully we qualified for state health coverage. I've been struggling with hyperemesis, going in twice monthly for weight checks, urine tests, and med changes. Finally got my HG under control when I was hit with the Gestational Diabetes. Despite attempting diet control, I ended up on insulin and risked out of the hospital's midwifery practice. Also my 27wk preemie was a c/s due to severe pre-eclampsia. I found a home birth midwife who is comfortable delivering me while getting prenatal care from the OB. She is also willing to work out the fee.

I'm just not sure I can be comfortable having my baby at home. I'm not so concerned about the VBAC risks since I had a successful one already, but it's still in the back of my mind. I'm not really worried about the pre-eclampsia risk because I didn't have it in my last pregnancy and no signs/symptoms so far. However I am at higher risk for it this time due to increased age and GD status. It's the diabetic complications in the baby that have me completely freaked out. Not the "big baby" that everyone talks about being undeliverable, but the hypoglycemia, hypercalcemia, premature aging, and under developed respiratory system. Things that are difficult or impossible to determine at home. There is a reason midwives don't take high risk clients like me. I just don't know what I should do...

 

[Romana]

Quote:

Originally Posted by MomtoXane It's the diabetic complications in the baby that have me completely freaked out. Not the "big baby" that everyone talks about being undeliverable, but the hypoglycemia, hypercalcemia, premature aging, and under developed respiratory system. Things that are difficult or impossible to determine at home. There is a reason midwives don't take high risk clients like me. I just don't know what I should do...

I don't know much about the complications from GD so I can't speak to that on a scientific front. However, it sounds like you know deep down where you feel most comfortable, and it isn't at home. There IS a reason midwives don't take high-risk clients. I don't think anyone would argue that neonatal and maternal mortality would be the same for hospital and homebirth if you included high-risk patients.

Because I don't know enough about complications from GD to comment on that, I can't say for sure what I would do. But I would NOT go with a midwife who was willing to take me on despite complications that most midwives would risk out. Instead, I would focus on finding a supportive HCP at the hospital and making the hospital experience a good one (as good as possible). I personally wouldn't feel comfortable having a homebirth with risk factors that could be an issue at birth, unless for some reason I'd really, really researched it and on the basis of that research believed that the risk factor was inappropriately applied to me. For example, I had borderline elevated BP in the last months of both of my pregnancies, but no complications at birth and no pre-e. It seems to be a normal physiological BP elevation for me. I did a lot of research and talked with a friend of mine doing her OB residency to really understand the risks and my specific situation. Based on what I learned, it seemed pretty clear that I was not developing pre-e and was safe to deliver at home despite a few moderately elevated BP readings.

However, if I had had pre-e or thought I might be developing pre-e, I would have definitely not had a homebirth. Also, I should say that I'm somewhat risk-averse. For example, I don't think I would feel comfortable with HBAC, but that's partly due to knowing a woman who lost a baby due to UR during her HBAC (it was her 2nd VBAC, first was in a hospital).

I don't know if that helps very much, but I hope it helps a little.

You're in a tough situation.

 

[hapersmion]

Sorry things are round.

I don't know a lot about GD, but you probably do by now, or are in the process of finding out.

Only you can weigh your risks and decide whether or not you're comfortable with them. I think it's great that you have found a midwife who's willing to let you make the decision.

I think the good thing about homebirth is that you can change your mind if you need to. There's no need to set things in stone right now - if you start showing signs of pre-e or if you think things aren't going well with the GD as you get closer to birth, you can always head to the hospital. So I think what I would do, hypothetically, is just keep going on as you have been, with prenatal care from the OB and the midwife standing by if things go well. I always prefer not to assume the worst - as long as you and the baby are doing well right now, there's no reason to assume that bad things will happen later. You already have an OB - you can have him/her do all the testing you feel is necessary, and if the results are good, hopefully you'll be reassured for your homebirth.

Good luck with whatever you decide!