So when I finally got around to seeing my OB after I got pregnant with Erik I was at 11+ weeks. I asked her what other hospitals she delivered at because for this birth I wanted a hospital with nurses trained in midwifery to better help with a natural childbirth. It turns out she had dropped all other hospitals except for the one at which I delivered Kat so after that appointment I decided to look into some other options. One of my friends delivered at St. Lukes with some nurse-midwives. I showed up about 8 minutes late for the tour (of course with Kat in tow and dealing with Medical Center traffic) and was told to come back another day. Now, here I was about 4 months pregnant, totally hormonal and I broke down in tears in the parking lot because I had it set in my mind that this was going to be my awesome solution: midwives at a hospital! Alas, it was not meant to be. I hate being in the Med Center anyway. My second idea was a birthing center. There is one in The Woodlands, so I went there one day after a client meeting I had in the area. I thought the birthing center was really great - a very home feeling but with all of the pre-natal care and emergency transport plans in place. But I stopped to think: if I was going to deliver there, I might as well be at home with those same plans in place. So, third time is a charm, and this time I met with a certified nurse-midwife named Kellie Moeller.
At this point I was really just trying to decide if this was something I wanted to do before running it by Charlie. We were in April now, and Kellie and I met the day our house was being moved (I was also going hoarse from a cold). Kellie must have thought I was crazy, especially when Charlie came in and was wondering who this woman in our house was. Long story short, we ultimately decided on doing a home birth, but before that decision was made we had to ponder some of the details of a home birth along with its rewards and risks. In the hopes of demystifying what happens prior and at a home birth, here are some of those things:
- Prenatal care. Kellie would take over doing my prenatal care. She came to my house for all of the visits and we met for about an hour each time (the first time was longer). What I found kind of liberating about this was how informative she was at explaining things like measuring where my uterus was, etc. I hadn't really gotten that with my OB. We talked a lot about nutrition and exercise; I had to keep a food log for the first few weeks so she could see what I was eating. Sugar was a no-no (despite my once in awhile indulgences) and she focused a lot on protein to prevent preeclampsia. Midwives also use doppler and ultrasound as little as possible as the effects of these on babies are not fully understood yet. It was really cool to use the fetoscope to listen to little Erik's heartbeat. We discussed the physiological changes going on, but also the emotional ones as well. I believe this kind of prenatal care really helped cultivate a closer relationship between me and my care provider.
- The risks. Ah yes, this was the hardest thing to overcome mentally. I, like most people, have a little uneasiness about "what ifs". I.e.: what if labor stalls? what if an emergency happens? What do we do??? First, there are risks of giving birth both at home and the hospital. In both cases, you just need to prepare for them and have the plan ready and in place. In our childbirth classes (which we actually had to take this time), we spent an entire session on complications (non-emergencies) and emergency situations. We put together a transport plan, identifying not just the closest hospital but also the one with things like an anesthesiologist onsite 24/7. We had a backup OB if we had or wanted to deliver at the hospital.
- Insurance. God, you have to love our health care system. I learned a lot about it because Kellie was not on my insurance's list of health care providers. In fact, they didn't have any certified nurse midwives in my area at all. This ended up being a blessing as with insurance companies you need to go with someone listed in their system unless you can prove your care provider provides some service that the others do not. I went through getting an exception for insurance claims for her which took time but was not that difficult. The cost of delivering at home was much less expensive both as a total cost and out of pocket expense through insurance than a hospital birth. You would think health insurance companies would be all over this, right?
- Choices. There are so many procedures done at a hospital that are done solely for the purpose of CYA. When I delivered Katherine they put an IV in me even though I did not want medication. I was hooked up to a fetal monitor the entire time. I had to deliver on the bed with my legs in stirrups. The baby was automatically given eye ointment for gonorrhea or chlamydia (regardless of the fact that neither I nor Charlie have it!), vitamin K shot, and the umbilical chord was clamped and cut almost immediately after the placenta was birthed. Part of my reason for wanting a home birth is so we could have choices around these things.
- Childbirth classes. For better or for worse we were required to take childbirth classes. I think we would have been into these much more had we not just gone through this process about 9 months earlier. The classes were where we learned and discussed things like the stages of labor, risks, etc. So in that regards they were a good thing. There were about 8 other couples in the class, some first time parents others on their fourth child, and a lot of different types of people as well. Some were really into the touchy-feely part of home birthing, and others wanted a home birth to avoid interventions. Ima May Gaskin was mentioned on more than one occasion, and I knew about her because I knew about The Farm (that's another story, but has to do with a hand me down tie-dye from Charlie). I'm showing my granola roots here, but you don't have to be a tree hugger to want a home birth is my point about different type of people on our class!
- Preparing for a home birth. This is a little more involved than just packing a bag for the hospital. Kellie provided a birthing kit that had things like chord clamp, blue bulb syringe, etc. but we had to get together other supplies: plastic sheets, trash bags, towels, receiving blankets, compresses, heating pad, hand held mirror, paper towels amongst other things....I had a large plastic box in our bedroom full of the supplies put together a few weeks before my due date so that when labor did start Kellie could just go to the box and get whatever was needed.
- Birth, postpartum and newborn care. Kellie would provide all of that (and I'll tell about them in Part 3).
Now with all of the above said, we ran into a few snags that almost derailed delivering at home. The first came literally two days after we had decided to take the plunge and do a home birth. I had my 20 week ultrasound prior to meeting with Kellie. My OB called when she got the results and told me that the ultrasound showed placenta previa, meaning my placenta was covering my cervix. What that meant was if it did not shift out of the way during the pregnancy I would need a C-section (obviously a baby can't go through a placenta!!). I was really upset about this because we had gone through the emotions of making a decision to deliver at home and then I was hit with this news that could have made that an impossibility. I was not very happy about it and was having real trouble dealing with that fact until one of my friends who had a natural childbirth with #1 and a C-section with #2 told me, "Christi, babies come how they are supposed to come. If it turns out you'll need a C-section then that's what was meant to be and you'll have a gorgeous, healthy baby regardless." Ah, thank you Heather for snapping me out of my funk! I was ready to accept anything now, but I was still really thrilled when I went for another ultrasound at 32 weeks to find my placenta out of the way from my cervix.
Another snag had to do with a backup OB. This isn't just anyone - you want to have a backup OB who respects your decision of having a natural childbirth at home but understands that sometimes there are non-emergency complications that mean you go to the hospital. The backup OBs with whom Kellie worked were not very close to our house and my OB had said no when asked to be my backup because she did not have another doctor in her practice who could back up for her if I labored when she was not on call. This worried Charlie a lot: if my OB wouldn't be the backup then if we went to a closer hospital without one, would I get the care I needed? Would I be treated with respect? If we couldn't get a backup at Memorial Hermann NW (close hospital/where I delivered Kat) then Charlie was going to be very uncomfortable delivering at home. I made him the deal that if we couldn't get one there, then I would forego the home birth and deliver at the hospital again no problems. So I got to work - I called one of the lactation consultants at the hospital and asked if she could recommend any doctor there to speak with about being a backup. She recommended one, and ironically that was one with whom Kellie had spoken briefly to a year or so ago. Kellie met with him and signed an agreement with him and all of his partners for being a backup to her patients. Problem solved and at this point we were at 37 weeks and ready!
Photo: Waiting on Erik - 38 weeks and huge!!
