Wednesday, October 29, 2008

Meet the midwife

Last Friday we had our first consult with our probable home-birth midwife. She was the "second" midwife at Leigh's birth, and provided a much needed calming influence during that rather arduous journey. Leigh's birth story merits it's own post (or two or three), but the very simplified story is that after planning for a home birth, two solid nights of beautiful but grueling labor for Gail at home, we transferred to the back-up hospital and Leigh was able to make her appearance with intervention but without surgery. It was both astounding and frightening. This particular midwife had a great way of supporting me as I was supporting Gail. She was supporting Gail also of course, but her presence was what kept me hanging on and able to be present for Gail during that long second night of labor. I'm not always a particularly easy person to support, and am extremely sensitive to the moods and emotions of other folks, for good or ill, so we consider this a pretty good indication that I might actually listen and respond to her during a labor, and that she would calm me down instead of ratcheting me up.

The consult contained both good news and bad news.

Good news:
1) She'd be thrilled to work with us.

2) We can afford her.

3) She has office hours close by our home (important, since we don't drive).

4) We'll probably get some insurance coverage (never guaranteed with a home birth, but probable and she's had some success with my insurer).

Bad news:

1) She has plans to be out of town (on the OTHER coast) for 2-3 days just after the due date. We're thinking we may try to meet the probable back-up midwife to make sure we feel comfortable with her. The back-up midwife will also probably be our "second" midwife at the birth if preferred midwife is in town, so we'll be meeting her anyway, and we know she and our midwife have compatible styles. But we do still need to think on it.

2) The medical back-up situation for local home birth midwives has seriously gone south since Leigh's birth. For Leigh, we were able to have all labs done at a local hospital/birth center, and to transfer directly into labor and delivery where they knew our situation and had access to our records. It was overall fairly smooth, the hospital treated us well, and we were able to receive hospital midwife care as opposed to whatever random OB was on call (which is what happens if you transfer through an emergency room without a pre-existing back up relationship). Things have changed dramatically though in the last few years, and at the moment, the only practice willing to provide official back-up is over an hours drive south, which is obviously too far for an emergency transfer (but isn't too far for going way post-date, say, and needing a ultrasound, or induction). This practice has something like a 7% C-section rate, so it would be worth the (rental car) drive, particularly if we end up needing induction. Otherwise, for labs or a last minute emergency transfer (like we had with Leigh), we need to cobble things together. I'll be consulting with an OB who I've heard is sometimes supportive of home birth at the most probable emergency transfer hospital. If she was willing to do some labs and minimal OB care, at least the hospital would have my records. If that fails, I may go through my family doc for labs (who is affiliated with a different hospital) and either have labs transferred or just hand carry them if we transfer. In any case, any emergency transfer will be through an emergency room to whichever OB is on call, but that seems to just be the lay of the land these days. I hadn't realized how spoiled we were last time.

There is also a "big meeting" with one of the most wonderful miwife-supportive OBs in the area who is apparently lobbying her hospital to be able to provide back-up in November, so maybe the situation will change. Who knows. We have close midwife friends, and have been peripheral to this world for long enough to pick up that back-up situations change, based on all kinds of things you can't predict. Even with this less than ideal situation, I'd still feel safer starting at home (for both me, the baby, Gail and Leigh for that matter) than setting foot initially in any hospital or birth center, given our state's 33.3% C-section rate, not to mention my (admittedly slightly unreasonable) discomfort with medical situations.


Anonymous said...

Sounds like a lot of good news! That's great! The rest of it will shake out.

Anonymous said...

i'm so thrilled to read about you process for a hopeful homebirth. we are putting the idea in the mix if we have a second baby. i had a great hospital birth, and now feel more confident to try a wife, well she's working on being ok with it...

Lyn said...

TMABTO--Not sure how Mr. E's birth felt for A, but I certainly felt much more capable caring for Gail at home than at the hospital where 50,000 things were happening, and I got lost in the shuffle. Our midwife was still there to help us parse things, but she was also quite spent. Thankfully, we lucked out and got an excellent labor and delivery nurse who advocated for us beautifully.