Wednesday, December 17, 2008

Home Birth Appt. #1

At first it was intense. Maria handed me a lot of forms. I have to sign a home birth consent form, a VBAC at home consent form and a lot of other paper work to look through and sign. I know that there is an increased risk of maternal or neonatal risk at home because there is not an operating room down the hall. But I have also read the Johnson and Daviss study, a summary on the home birth collective web site, which says that the rate of intrapartum and neonatal mortality was 1.7 deaths per 1000 births, similar to risks in other studies of low-risk home and hospital births in North America. I also know from experience that hospitals come with there own set of risks.

Maria didn't quote any study. She only said that she wouldn't be doing midwifery if she thought it was unsafe. "I really don't sugar coat any of it, because in reality, we could be dealing with some very hard scenarios at home that require guts and grit and trust in one another." I got the feeling that Maria expects her clients to be well informed when they walk in her door. In her office, she was not promoting the home birth cause or trying to convince me of a home birth. However, I do know from reading her blog that outside her office, she does do an enormous amount to help get the word out that home birth is a safe option for childbirth. Nonetheless, if I hadn't spent the last two years of my life researching birth, I think that those forms might have scared me away.

When I took my husband, Zack, to the informational interview, I had done a ton of research but Zack hadn't done any. I was hoping that she would give him a crash course in all things home birth. Instead, she only went over the risks. I left feeling like I would certainly never have a home birth now, but Zack didn't feel the same way and so here we are.

For me, the turning point was Maria's non-cavalier approach. If my birth is continuing normal, normal, normal, I can stay at home. The minute the baby's heart rate changes or my labor stalls or the birth has moved out of the normal spectrum, she takes me to the hospital. This approach makes sense to me, take me to the hospital only if there is something that doesn't seem quite right.

Then she presents the money forms. All prenatal, birth, and postpartum care is $4,000. If an ultra sound at 20 weeks shows that I have placenta previa, then the safest thing to do is to have my baby at a hospital and she will just charge me for my appointments up to that point. So, my whole birth plan could change in a couple weeks when I do my 20-week ultrasound. My insurance will cover 70% of the $4,000. Our expenses will be less than my total co-payments from my last birth.

She also provides a model of care that would transfer a woman to the hospital at 8 centimeters. So, I could do all the luxuriousness, hour-long prenatal appointments, labor at home with her monitoring me, and then go to the hospital. Then receive the postpartum appointments after the birth. So, it's like home birth care but with a hospital transfer at 8 centimeters. I thought this could be a lovely option for some, but if I make it to 8 centimeters at home and everything is looking good, no way do I want to get in a car and go to the hospital.

Next came the fun stuff and Maria took off her game face and I had the most enjoyable prenatal appointment. We listened to the baby's heart beat and marveled at its strength. She didn't tell me that I was still in the first trimester and a miscarriage was still possible even with an active baby and strong heart beat, which my last visit with an obstetrician told me. Midwifery care allows me to enjoy being pregnant. Let me worry only when there is something to worry about. Then, I had my blood drawn; I peed in a cup. All the usual stuff. Every few minutes a two-year old from the adjoining chiropractic office would peep his head under the curtain. Beautiful works of art about birth and pregnancy filled the walls. In a corner of the room, there is a place set-up for children to play with wood toys.

Read some of my other posts about my first child's birth here and here.

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