Friday, November 4, 2011

Homebirth vs. Hospital Birth

Hubby and I are over the moon! We got to hear the baby's heartbeat for the first time yesterday. We were both so happy to hear that amazing sound. The baby had a good, strong heartbeat of 160 BPM. It is a great feeling to know everything is going ok.

A lot has happened since my 10 week pregnancy update and when I told you the story of how I almost got kicked out of my midwife's practice at my first visit. The background is we were planning a homebirth and found an amazing homebirth midwife that hubby and I loved. At my first appointment with her at 8 weeks along my blood pressure was high. My blood pressure isn't normally high so it was a bit surprising. It wasn't it a little high, it was through the roof high. I had to give up coffee and all caffeine, add supplements, add exercise, make diet changes, and add rest time into my day. I also started acupuncture and started monitoring my blood pressure daily.

At my 10 week appointment my blood pressure was still over the 130/90 maximum allowable under state law for homebirth so my homebirth midwife told me I had to transfer care. I was pretty bummed out but tried to keep a positive outlook on things. One thing about being a parent you quickly learn is a lot of things are out of your control. I while I was understandably disappointed that my plans for a homebirth were not going to work out I realized it was out of my control. I could either be really upset about it or accept it. My faith is a grounding factor in my life and I feel if something is meant to be it will happen and if it is not meant to be it won't happen. Maybe having a homebirth wasn't meant to be for me.

After getting the news that I had to transfer care then the stressful part started, I had to find a new care provider. Everything about homebirth sounded perfect for me and my family but incorporating some of those thoughts and philosophies into a hospital birth was going to be difficult. Hospitals are meant for saving lives and birth is a very natural process that women having been doing forever. In a normal birth there doesn't need to be tons of interventions and "life saving procedures" going on. During my first birth which took place at a hospital with an OB I loved I felt like I was forced or bullied into a lot of things I did not want to do. I felt like decisions were out of my hands and everything was "for the safety of the baby". The classic OB, surgeon approach is, "the only c-section you get sued for is the one you didn't do." The average U.S. c-section rate is 33%, the World Health Organization studies find the optimal c-section rate to be 5-10%, and my homebirth midwife has a 5% c-section rate. More isn't always better when it comes to interventions. These are just a few of the reasons I wanted a homebirth. Finding a new care provider who shared my philosophy about labor and delivery and it being a natural process that really needs little interference was going to be hard.

The first doctor we interviewed was the opposite of what we were looking for. My homebirth midwife recommend a family practice doctor. She said they are most similar to what a homebirth midwife can provide because they are not surgeons trained in complications of pregnancy, they provide care for mom and baby both, and generally are very supportive of natural, intervention free childbirth. I've only had female OB, midwife, and family practice doctors and much prefer female doctors over male doctors though I have seen a few specialists who were males that I liked working with. The first family practice doctor most highly recommended by the homebirth midwife was a male doctor in a 4 doctor, family practice group. Let me say, a lot can be said based upon scanning the practice's website, reading the doctor's bio, and looking at pictures. In fact, when I lived in Maryland I didn't go see the specialist my PCP suggested because they guy looked creepy in his picture. Instead I found someone else in the practice who has research experience in the area I was looking for and didn't look like a creep. He turned out to be an exceptional doctor and I was happy I chose him. I didn't think I'd like the family practice doctor based upon reading his bio and looking at his picture. He also looked creepy and something just told me I wouldn't like him. I scheduled a "meet the doctor visit" anyway and the visit was a train wreck from the beginning. We waited for over an hour past our scheduled appointment time. Hubby was furious and was ready to walk out before we even saw the doctor. The doctor's website talked about the work he did with low income patients and with the crisis pregnancy center and it suffices to say by the other clientele in the office we were not his typical patients. During the interview I felt he talked down to us and didn't listen to what we were saying. He couldn't provide me information about their c-section rates. He said they scheduled 15 minutes for prenatal visits compared to the 1 hour my homebirth midwife schedules for each visit. He then proceeded to tell me how dangerous birth is and that hospitals are for saving lives and that women should be giving birth there because women die in childbirth all the time (actual figure is 11 in 100,000 not all the time). Needless to say, I left his office very upset because if this was my best option I was completely screwed and was not going to find someone who shared my philosophy. I couldn't stand the guy so maybe moving to an OB who I at least  liked would be better than nothing. At this point I was even more upset than when the homebirth midwife told me I had to transfer care.

Hubby and I went home and regrouped and thought about what was important to us. For me having a female care provider who I liked was very important so I decided to eliminate male care providers from the short list my homebirth midwife provided. In our town there is a very large (20 OB) practice which almost anyone I asked had used to deliver their babies. People seem to love them and according to my homebirth midwife there are phenomenal OB's there who are low on interventions and there are OB's there that jump to interventions at every turn. Problem is they rotate call so you could see the fabulous OB your entire pregnancy and have c-section friendly OB overseeing your labor and delivery. That did not sound like it was for me. There was an all midwife practice that operated independent of any OB's in town but still delivered at the local hospital. I had considered them as an option before deciding on homebirth but was unsure with my high blood pressure if they'd be able to take my case. I decided I was running out of options. Suddenly being without a care provider at 10 weeks pregnant when you found the perfect one at 6 weeks was a little disheartening so I called the midwife only practice. The receptionist was extremely friendly and helpful and despite not being a patient she immediately put me on the phone with one of the midwives. The midwife spent 20 minutes talking to me on the phone about their practice and philosophy, specifics of my situation and medical history. She explained they handled all their high blood pressure cases in house and didn't refer out to an OB. She thought their office would be a good fit based upon what I was telling her and said of all the midwives in town that deliver at the hospital they were the most "crunchy, granola" which sounded like just what I was looking for.

Today was my first appointment with the new midwives and it definitely is not a homebirth. The practice is much more medicalized, my appointment was shorter, we didn't spend time talking about emotional well being, diet, exercise, family issues, like the homebirth midwife does. My homebirth midwife takes a very holistic approach and treats you as a whole person and all aspects of your life. We were able to hear the baby's heartbeat which was amazing but we spent most of the appointment talking about my medical history. The midwife did answer all my questions without rushing me and explained a little more about their office procedures. I got a ton more reading materials but interestingly enough almost none of it overlapped with what the homebirth midwife gave me. A different approach I suppose but she did assure me they would spend as much time with me in labor as I needed, I could eat and drink freely in labor, moving, walking, and changing positions is encouraged, routine IV is not mandatory but I can get a Hep lock instead, opting out of standard newborn procedures such as eye drops and Hep B shot are fine and all newborn procedures will happen right there with me, the babies cord is not cut until it has stopped pulsating (newborns who umbilical cords are cut right away lose up to 1/3 of their blood and have to make it up during those first few days after birth), and baby is immediately placed on my chest and encouraged to breastfeed. Would I still want a homebirth if it was an option for me, yes! Since it isn't an option though I think transferring care to a midwife only practice that delivers at the hospital is the next best thing. Next month I meet one of the other 4 midwives so I hope I like her as much as I liked the midwife today.

Pregnancy and parenting in general is an exercise in giving up control, something which I am not good with, but I'll make it through. Yesterday also marks the end of the first trimester, yay! Happy, healthy baby makes for a happy healthy mommy.



Gina said...

I had a VERY positive, healing experience in a hospital after my very negative first birth. I felt like I had the best of both worlds. Here's hoping you do, too!

Brittany Ann said...

I'm so glad you found something your comfortable with.

Question, though: Does state law eliminate a birth-center birth with your blood pressure, too?