Home Birth: Talking with My OB

When we first decided we wanted to give birth at home, one of our first concerns was how and when to tell our OB. She has been wonderful from the beginning, handling with compassion, tact and honesty what we all thought was going to result in a miscarriage. She's been very attentive and supportive and concerned throughout the pregnancy.

The anxiety I've experienced at the prospect of talking with my OB about the choice to birth at home has been a bit over the top. It's my choice, right? I'm never going to do this again, so I should go for the gusto and do it the way my husband and I are both now excited about doing it, right? The majority of folks I talked to suggested not telling her. This struck me as dishonest and even a little unkind, but I had been leaning toward doing just that--nothing. As much as I want to give birth at home and as excited as I am at the prospect of doing so, when folks start naysaying, I start feeling the pressure to placate and appease. I'm very suggestible that way.

I threw my anxiety to the wind today and talked with my OB. She was amazingly supportive, considering how worried I'd allowed myself to get over telling her. She said that, as an OB, she would obviously prefer that her patients deliver in hospital, but that life's short, and we should make this choice according to our convictions and preferences. She asked me to consider continuing to see her until 36 weeks (given my history of early preterm labor), but after that, we could be done.

I feel a bit foolish about how much time I've given to worrying about this. I was afraid she'd try to talk me out of it. I'm very glad I did talk with her. *Not* telling her was not sitting well with my conscience. It's a professional relationship that one has with her OB, but it inevitably turns personal. She's caring for me and my baby, and doing all that's necessary to ensure our health and safety, and if she's doing her job well, she really cares. I'm happy to have given her the benefit of my trust and vulnerability. I'd highly recommend her to anyone looking to give birth in hospital.

Home Birth: Interviewing a Midwife

This should be obvious to anyone in this process, but I didn't think about it until the last minute: Consider carefully what it is that you hope to accomplish as you interview a midwife. About five minutes before she arrived, I realized I had given *no* thought to deliberate organization of my thoughts and questions. This was a rather unfortunate mistake, redeemed only by the presence of my very level-headed husband, who asked all the right questions. I did come up with a few myself, mostly after he got the ball rolling.

Insurance and the Expense of Home Birth

We had read that home birth tends to cost more out of pocket than hospital birth, primarily because a great many insurance companies don't cover midwife services or home birth expenses. There's also the reality that, even if your insurance company *does* cover midwife services, your midwife may not accept your insurance. Insurance aside, we had read that home birth in the United States is *crazy* expensive, and I was gearing up to be disappointed by the reality that we simply couldn't afford to give birth at home.

My fears proved unfounded. There may indeed be places in the U.S. where home birth will cost you your first-born (pardon the expression), but at least in Kentucky, or perhaps just with the midwife we interviewed today, this is not the case. We, at least, will end up paying less out of pocket for a home birth than we would to give birth in a hospital. Unfortunately, we will need to maintain a relationship with our current OB in case I go into labor early again and need to deliver at the hospital (I delivered 12 weeks early with my first pregnancy), and this will mean a bit more expense over all. But if the midwife we choose has a fee as reasonable as the midwife that we interviewed today, this shouldn't be too much of a problem.

Husband as Primary Birthing Partner

My strongest desire regarding labor and delivery is that my husband be allowed to fill as active a roll in the process as we both desire and he can cope with. My husband is my best friend, hands down, and no one knows me as well as he does. Granted, there will be plenty of moments in labor and delivery when a trained professional will know better than my husband what my body needs, but it's not her face I'll be looking for in my moments of distress, and if it's my husband I want (and I foresee that it will be), everyone in the room had darn well be ready to get out of the way and let him through.

Unnecessary Interventions

I want very much to avoid unnecessary interventions--epidural, forceps, suction. This desire is near the top of my list of reasons for wanting a home birth. Specifically, I want to avoid an episiotomy. I'd rather tear naturally. I'd rather not tear at all. I know there are no guarantees, but I've read about (and observed) a great many techniques for avoiding tearing, and I wanted to know that the midwife we choose is versed in these techniques and ready to employ them.

Finding a Relational Fit

The one issue I *had* thought about was how my husband and I would mesh with each of the midwives we interview. What I have been told is that, with a home birth, it is absolutely essential that the midwife and laboring mother have a positive, trusting relationship--not simply a luke warm, I-guess-I-can-live-with-this-person kind of relationship. I assume that it's helpful if the midwife is also a good relational fit with my husband. In this respect, I feel I was very well prepared to interview. It doesn't take long to figure out if I can manage to mesh with someone. We got answers to important questions (most of which were brought up by my husband, God bless him), but I also talked with her about my first experience with labor and delivery, and was able to gauge her responses to my anxieties and desires for my next experience. I felt heard and affirmed, and I think this is one of the most important things (for me, anyway) that came out of the interview.

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These were some of our questions and anxieties--the information we considered key in our process of choosing someone to attend us in the birth of our baby. Your questions and concerns may differ from ours, but thinking through them ahead of time--even writing them down--will help you get the most out of your interviewing process.

Home Birth: Choosing a Midwife

The next step in this process, it seems, is choosing a midwife. I'm fortunate in that I have several friends who have chosen to give birth with a midwife. Only two of them, however, have chosen to give birth at home--not all midwives will attend home births. Both of my friends who are planning to deliver at home are using the same midwife. Therefore the word-of-mouth venue, at least within my immediate social sphere, yielded only one recommendation. But at least that's a start.

I searched the internet for midwives in my area. This yielded more results, but again, not all midwives attend home births. Most of the midwives I found work within medical practices with doctors and nurses, and my understanding from the websites of the practices for which they work is that they attend births in hospitals, but not in homes. I did find one home birth midwife. So I now had two names (with email addresses) on my list.

The third name on my list came from the friend of a friend. I was chatting with her on FB about my search for midwives whom I could interview, and she did a little digging, made a phone call, and got back to me with a name.

I've sent emails to these women explaining my history of early preterm labor. As of yet, I have received only one response, and we interviewed her this afternoon. I'll tell you more about that in my next post.

In the meantime, I'm very open to suggestions. If you know of midwives in my area (Lexington, KY) who are willing to attend home births, send me an email with names and contact numbers or emails.

Home Birth: Making the Choice

Last week, I talked with my husband for what I thought was the first time about the possibility of a home birth. Much to my surprise, he was very, very open to the idea. In retrospect, I'm not sure why I thought he wouldn't be. Regardless, I can clearly see that he is 100% behind me, and we're both looking forward to taking the reins in this experience and making it what we want it to be.

As we have begun to move through this process, the thought has crossed my mind that perhaps there are folks who could benefit from watching our decisions unfold. Also, I'm a bit of a verbal processor, so writing these things out is helpful to me as well. I hope others will find something in these posts leading up to our home birth that will help make these same sorts of decisions in their own lives feel a little less chaotic.