Midwife versus OBGYN

Cathy Weeks wrote:
Lady Penelope Creighton-Ward wrote:
I am one of those rare 1% to give birth at home here in the Boston
area, attended by two direct-entry midwives. I faced a lot of
incredulous looks and comments about my irresponsibility when I would
tell people about my homebirth plans. Eventually I learned to just not
talk about it.

I also had a homebirth, but I was attended by two certified nurse
midwives. I got LOTS of comments, also but both my husband and I used
it as an opportunity to tell people that statistically it's safer for
an uncomplicated labor and birth to happen at home, and that if
complications occured, we'd simply go to the hospital, that in over
3000 births, my midwives had never lost a mother or baby.

I've no idea what the local % is, but I suspect it's very small. I
attempted a homebirth by a direct-entry midwife but unfortunately I'm
one of the 'homebirth gone bad' examples so now it's a bit harder to
use the stats argument when I'm already the exception.

prior to birth, I tried to avoid discussing it with people I knew would
not be supportive, but I did begin to share it and got some negative
feedback. I work in health, and so interact with medical doctors/nurses
from all area hospitals on a daily basis, as my belly grew the
inevitable question of "where are you delivering" became popular, esp.
as I was in a high profile position (giving lectures).

For those who would listen, I argued stats, but many in the medical
profession weren't even interested.

I'm really dreading next time around. I avoided too many negative
comments just by not bringing it up. Honestly, it wasn't worth the
fight. But now everyone knows we tried and will ask when the next one
happens. My skin is thick, but there's a limit!

I think a major point that hasn't been brought up is 3rd-party
insurance payers. Most insurance plans don't cover homebirth in the
U.S. Mine did, and I consider myself lucky. Although I would have
happily paid out-of-pocket, there are some women that cannot afford the
typical $3000-$4000 that a homebirth costs. It's a shame that you can
get insurance to cover a primary elective cesarean, but not to have a
safe (and much less costly) birth in your home with a skilled
attendant. My twin birth in a hospital would've easily cost $50,000.
I did it at home for $2700. You do the math.

Lisa

birth junkie wrote:
I think a major point that hasn't been brought up is 3rd-party
insurance payers. Most insurance plans don't cover homebirth in the
U.S. Mine did, and I consider myself lucky. Although I would have
happily paid out-of-pocket, there are some women that cannot afford the
typical $3000-$4000 that a homebirth costs. It's a shame that you can
get insurance to cover a primary elective cesarean, but not to have a
safe (and much less costly) birth in your home with a skilled
attendant. My twin birth in a hospital would've easily cost $50,000.
I did it at home for $2700. You do the math.

Oh yeah. Officially my insurance plan covers homebirth, IF the midwife
is 'in network', but since there are no midwives in network, and the
employer does not cover out of network services for midwifery *because*
they say they have HCPs (OBs) in network, effectively it's not covered.
My midwife has a cash price of $2500, so we paid that. If it was $5K we
probably would not have because we couldn't afford that much.

In the end, the hospital bills for DD amounted to more than $200K, of
which we paid $400 (and $10K for me, of which we paid $300). Insurance
paid most of that, but not all. I don't know how it works after that,
all I know is we don't have to pay more. So in the end we paid $3200.

We considered pushing the employer (DH's) on this , but were told by
our friends in HR that there was no chance.

That's just appalling! That there are so few natural births that he has
never seen one. I guess that's the American medical professional all over
then. If no woman is allowed to have a *natural* birth because of the
risks then of course, none of the medical staff have ever seen a natural
birth and this just re-enforces their prejudice that you cannot have a
*natural* birth! That's just insane! Urgh!

but it would be the same in a UK hospital, because doctors are not needed to
be present unless complications develop, so they are likely to see very few
natural births.

I had a natural 3rd stage and that was new to all involved, shocking in my
opinion, I had to tell them what to do, i.e. nothing, cord tugging could
have occurred otherwise.

Anne

In the end, the hospital bills for DD amounted to more than $200K, of
which we paid $400 (and $10K for me, of which we paid $300). Insurance
paid most of that, but not all. I don't know how it works after that,
all I know is we don't have to pay more. So in the end we paid $3200.

ok, so I understand the cost of your DD, but to charge 10k for you, that's
ridiculous, if you look at it this way, your DD's care was only 20 times
yours and with what she went though it would seem that her care should have
cost 100 times yours, or more, I reckon they make a large profit on
deliveries like yours.

Cheers

Anne

cjra wrote:

I've no idea what the local % is, but I suspect it's very small. I
attempted a homebirth by a direct-entry midwife but unfortunately I'm
one of the 'homebirth gone bad' examples so now it's a bit harder to
use the stats argument when I'm already the exception.

If I remember your story, you had a complication, transferred during
labor, and in the end, everything turned out all right, correct?

When I mention my story to people, I always emphasize the safety for
the _uncomplicated birth_. You aren't an exception, really, because
for you, the hospital *was* safer.

For those who would listen, I argued stats, but many in the medical
profession weren't even interested.

I have found that those in medicine, especially doctors, to be the most
inflexible in their opinions. Statistics seem to mean little to most of
them. The first doctor I mentioned my plans to ranted at me that I
didn't have a proven pelvis, and that it was dangerous! I hadn't even
gotten pregnant, yet. I was just in, to have a blood test to see if I
was immune to Toxoplasmosis and Rubella. She was of my favorite doctors
by the way. But she didn't do anything with OBGYN - she referred
patients to OBGYN stuff. One doctor in that same practice that I
talked to told me that she knew the statistics - that she understood
that it was a safe route to go, but that she had learned about too many
things that *can* go wrong in med school, to be comfortable doing it
herself. She also mentioned that her sister either did it at home, or
was considering it or something. I was very impressed with that
doctor, actually, but she spent too much of the next 2.5 years prior
to my move away, either pregnant or on materinity leave herself, for me
to develop much of a relationship with her.

I'm really dreading next time around. I avoided too many negative
comments just by not bringing it up. Honestly, it wasn't worth the
fight. But now everyone knows we tried and will ask when the next one
happens. My skin is thick, but there's a limit!

I wonder what the difference is between you and me? I think there is
something about me that brooks no argument from people. I had a few
people tell me *after* the fact that they had been pretty worried, and
were relieved that me and baby were safely delivered. I did tend to
look for questionable attitudes, and headed them off at the pass before
anyone got rude. But no one was ever really directly rude.

My husband got into the "what if" game with people a few times.

"We're planning a home birth".
"What if something happens?"
"Then we'll transfer to the hospital."
"What if there isn't time?"
"Then we'll deliver the baby in route, while in an ambulance".
"What if something goes wrong?"
"Well, statistically, this is VERY rare, but, if the baby dies, then we
probably won't choose to do a home birth the next time, now will we?"
[other person looks stricken]

What always seems wierd, is that babies do die in hospitals, and no one
ever questions their decision to do future births in hospitals.
Sigh...

Cathy Weeks

Cathy Weeks wrote:
cjra wrote:
I've no idea what the local % is, but I suspect it's very small. I
attempted a homebirth by a direct-entry midwife but unfortunately I'm
one of the 'homebirth gone bad' examples so now it's a bit harder to
use the stats argument when I'm already the exception.

If I remember your story, you had a complication, transferred during
labor, and in the end, everything turned out all right, correct?

When I mention my story to people, I always emphasize the safety for
the _uncomplicated birth_. You aren't an exception, really, because
for you, the hospital *was* safer.

Tsk tsk for *both* of you! ;-) That was a *successful*
homebirth! A successful homebirth is one that, though
excellent diagnostic and management skills, ends up with
a good outcome. Practically any old midwife can manage
a homebirth where nothing out of the ordinary happens, but
it takes a darned good one to give the right advice and
support when things aren't right out of a textbook. This
is *precisely* the *right* example to share with the
naysayers. Despite making this shocking choice, both
mother and baby weathered a significant complication
as well as could be expected. What would really be
upsetting is if somehow it wasn't possible to respond
to events, and choosing a homebirth meant that you were
locked into that choice regardless of what happened.
*That* would be a problem.

Now, what remains for cjra to assess is whether
what happened last time puts her in a higher risk
category for *next* time, and to such a degree that
a homebirth is contraindicated. But that's an entirely
separate issue. No one argues that there aren't births
that shouldn't take place at home. It's just that the
unlikely possibility that something might happen in a
normal scenario isn't one of those valid reasons for
not having a homebirth, because as cjra's experience
indicates, it is possible to assess and deal with the
unexpected in an appropriate way.

Best wishes,
Ericka

What always seems wierd, is that babies do die in hospitals, and no one
ever questions their decision to do future births in hospitals.
Sigh...

hmm, well my baby didn't die, my complications were of a rather different
nature and could have been prevented by either scheduling a c-section (which
I requested), or going that route after about half an hour in 2nd stage.
During that birth, I dislocated my hip, almost ruptured my SP and did
significant damage to my SI joints, which left the whole lower back swollen
for several months. After that, there is no way I'd birth vaginally in a
hospital, if I hadn't had 2 precipitate labours that would leave me with
birthing at home with an experienced attendent and if at any stage things
didn't look good for vaginal birth go to hospital for c-section. With the
history of precipitate labour that probably isn't going to work, leaving me
in the situation that _if_ I have any more children, that I will almost
certainly have a c-section, even though it may not be necessary, because I
dare not labour in hospital with c-section as back up because that has
already left me with significant mobility problems once and if I do actually
manage to recover from that I'm not going to chance it happening again.

Babies dieing is now fairly rare, so there might be few people out there
who's babies died in hospital who then plan a homebirth, but there are
numerous who have had complications in hospital, possibly doctor caused, who
then go on to plan a homebirth, or birthcentre birth.

Cheers

Anne

Cathy Weeks wrote:
cjra wrote:

I've no idea what the local % is, but I suspect it's very small. I
attempted a homebirth by a direct-entry midwife but unfortunately I'm
one of the 'homebirth gone bad' examples so now it's a bit harder to
use the stats argument when I'm already the exception.

If I remember your story, you had a complication, transferred during
labor, and in the end, everything turned out all right, correct?

DD had a wonky heartbeat late in labor (pushing stage had just
started), then midwife saw meconium, so we went to hospital, she was
delivered there 2.5 hrs later with meconium aspiratation. She was
intubated within minutes. We have a healthy daughter *now*, so all
turned out all right, but she was in hospital for 17 days and for the
first few days her docs weren't sure she'd make it.

So, as Ericka says, we did everything right. My skilled and competent
midwife assessed the situation, recognised her limitations and
potential risks, and we went to hospital (which is 5 mins away). But
for those who use the 'what if" argument, I'm the 'what if' example.
It's no longer someone's sister's friend's boyfriend's cousin who had a
complication, it was *me*. So while *I* feel ok with doing a homebirth
again (as does DH, and we're all who matters), the naysayers emphasize
it's no longer 'what if" but what *was*.


When I mention my story to people, I always emphasize the safety for
the _uncomplicated birth_. You aren't an exception, really, because
for you, the hospital *was* safer.

In the end. Although I wouldn't change the homebirth for anything.
Laboring at home was excellent, and I feel like we listened to my
daughter and she found a way to tell us we needed to get her to
hospital.

For those who would listen, I argued stats, but many in the medical
profession weren't even interested.

I have found that those in medicine, especially doctors, to be the most
inflexible in their opinions. Statistics seem to mean little to most of
them. The first doctor I mentioned my plans to ranted at me that I
didn't have a proven pelvis, and that it was dangerous! I hadn't even
gotten pregnant, yet. I was just in, to have a blood test to see if I
was immune to Toxoplasmosis and Rubella. She was of my favorite doctors
by the way. But she didn't do anything with OBGYN - she referred
patients to OBGYN stuff.

I really liked my OBGYN, whom I found when I was miscarrying the first
time (hated the previous one and had started with my midwife). Since at
6wks post-fetal death I still hadn't fully miscarried naturally, I
decided I needed medical intervention. She was fine when I told her I'd
had prenatal care thus far (12 weeks) with a midwife, that I'd planned
a homebirth. She had stopped doing the OB and just doing GYN so told me
when I got pg again, I could see her to start so we can make sure the
pg progressed ok, then go back to my midwife. But by the time I got pg
again, she was doing OB and was excited to deliver my baby. When I told
her I still planned a homebirth she was *not* happy. Kept saying she'd
seen too many where they wait too long to go to hospital, because this
was my first she worried I didnt' have a 'successful track record',
etc.

I'm really dreading next time around. I avoided too many negative
comments just by not bringing it up. Honestly, it wasn't worth the
fight. But now everyone knows we tried and will ask when the next one
happens. My skin is thick, but there's a limit!

I wonder what the difference is between you and me? I think there is
something about me that brooks no argument from people.

I have a
know-it-all-in-your-face-I'm-the-eldest-I-have-to-tell-you-what-to-do
sister who's also an MD ;-) and a huge family who also don't hold back
on their opinions. We're an opinionated bunch! (I love my sister
dearly, and do go to her for medical advice from time to time, so it's
not all bad) Well, quite a few *did* hold back, but they won't next
time (fortunately, there are others like my dad who are 100%
supportive). I also work in the healthcare field and literally interact
with 100s of doctors on a regular basis, and in a setting where frank
discussions are the norm. Normally I welcome that, but it does get old.
That's why I just avoided discussion as much as possible. My boss is a
former midwife and was my rock of support at work, but our director
who's a pediatrician was less so. He wasn't ever rude or negative, just
repeated his grave reminders that it was risky, be sure to have a back
up, etc. He was however a rock of support when DD was in hospital, and
for that I'm grateful.

OTOH, I've had quite a few medical professionals offer me their full
support, which has been great.


My husband got into the "what if" game with people a few times.

"We're planning a home birth".
"What if something happens?"
"Then we'll transfer to the hospital."
"What if there isn't time?"
"Then we'll deliver the baby in route, while in an ambulance".
"What if something goes wrong?"
"Well, statistically, this is VERY rare, but, if the baby dies, then we
probably won't choose to do a home birth the next time, now will we?"
[other person looks stricken]

Yes, that conversation was the most common, more than the rude
comments. My concern now is, it is not just 'what if.' It will be 'look
what happened last time, how can you risk that again?" I was so looking
forward to having my uncomplicated homebirth so I could use that as an
example to all for next time, but it didn't work out that way.

Ericka Kammerer wrote:
Cathy Weeks wrote:
cjra wrote:
I've no idea what the local % is, but I suspect it's very small. I
attempted a homebirth by a direct-entry midwife but unfortunately I'm
one of the 'homebirth gone bad' examples so now it's a bit harder to
use the stats argument when I'm already the exception.

If I remember your story, you had a complication, transferred during
labor, and in the end, everything turned out all right, correct?

When I mention my story to people, I always emphasize the safety for
the _uncomplicated birth_. You aren't an exception, really, because
for you, the hospital *was* safer.

Tsk tsk for *both* of you! ;-) That was a *successful*
homebirth! A successful homebirth is one that, though
excellent diagnostic and management skills, ends up with
a good outcome. Practically any old midwife can manage
a homebirth where nothing out of the ordinary happens, but
it takes a darned good one to give the right advice and
support when things aren't right out of a textbook. This
is *precisely* the *right* example to share with the
naysayers. Despite making this shocking choice, both
mother and baby weathered a significant complication
as well as could be expected.

You're right. And I need to keep repeating that to myself so I'm
prepared for next time

Now, what remains for cjra to assess is whether
what happened last time puts her in a higher risk
category for *next* time, and to such a degree that
a homebirth is contraindicated.

Ah, we're pretty set at this point on future homebirths, provided pg
doesn't reveal an complications. But, we do have a bit of time before
that's an issue, I'd like to wait til DD is just a bit older before we
try for # 2 ;-)