Birth at home, prenatal with OB?

At a recent annual exam with my OB-GYN, I mentioned that I'd like to get pregnant in 2008, and that although I'd like to give birth at home with a certified nurse midwife, I'd like to continue to see my regular OB for prenatal care, in tandem with the CNM. My OB said that once I'd chosen a homebirth, her practice's insurance would no longer allow them to see me for prenatal care.

I guess it makes sense that people intending to give birth at home have their prenatal care with the midwife. Do the midwives handle routine ultrasounds, blood tests, glucose tests, all those standard tests I remember from my first pregnancy? I'd like a check-up that lasts longer than an OB, so a midwife would be cool that way, but I also appreciate the scientific expertise of the establishment!

I don't want anyone to tell me how to GIVE BIRTH, but I would still like to have my pregnancy monitored medically. I guess I'm afraid that a midwife check-up would be too touchy-feely or ineffective. Am I wrong? Any suggestions? Conflicted

Don't be afraid. Get a good CNM and enjoy your pregnancy. If all medical care were this good, I'm guessing we'd be a much healthier country. Laura

Then you once you do that you've got several options.

Option one is to stay with your OB and switch late in the pregnancy. The disadvantage of doing this, is that you don't get that time for bonding with your midwife that most homebirthers want.

Option two is called ''concurrent care'' meaning you stay officially with you OB, and pay your midwife out of pocket for prenatal care. DO NOT TELL YOUR OB you are doing this. With our first pregnancy our OB suggested that he would be happy to do concurrent care and have us change officially in the third trimester, then when his partners found, we were dimissed from the practice.

The third option is to pick a medically minded midwife, and they do exist. Certified Nurse Midwives are trained as nurses first, and are part of the medical establishment. If you ask around you will sometimes hear midwives described as ''medwives'' and those are the folks you probably want to talk to. I would seriously suggest that you talk to Amrit Khalsa, who worked originally as a Labor and Delivery Nurse, and I'm sure could accomodate you.

Whoever you interview, be honest about your concerns and if they are not supportive then they are not the right provider for you. In terms of what midwives do, it varies but almost everyone will check your blood pressure, your urine, measure you, and assess your overall health with more thoroughness than an OB will do, because they spend more time with you. I'm in midwife care, and I've chosen not to do most prenatal screening,(which I wouldn't do no matter who was caring for me) but I've had routine bloodwork, two ultrasounds (the nuchal screen and the level two test) and I have had a gestational diabetes test, and the option to do other testing, plus really excellent and thorough explanations of what the tests mean, and how they operate, not just ''everything looks good''.

It's definitely not an either/or decision, but a question of finding the practioner who meets your needs. Good luck. Doing it at home

-I WOULD pre-register with the hospital so that in case you do transfer to hospital during labor, they have a record of you.

-Homebirths cost between $4000.00 and $5000.00 and if you have a PPO, most all PPOs will cover about 70% of the cost (after deductibles). BUT, if you are going to continue doing OB prenatal care, the insurance company may wonder why you are in the care of two similar careproviders and will only reimburse one and not the other. For my 1st birth, I was lucky - my PPO reimbursed me for BOTH my OB's bills and my midwife's homebirth bills. But, for my 2nd birth, a different PPO took a year to reimburse me for my midwife's bills - and this was just the bill for the actual birth, since it had already reimbursed the OB practice for the prenatal visits. You have to be PERSISTENT with the insurance companies; they only reimbursed me after I hinted about seeing a lawyer regarding my legal and entitled reimbursement, this after a YEAR of calls and letters.

-Keep in mind that while homebirth midwives can do the glucose (gestational diabetes) test, other blood tests, the urinalysis, the vitamin K shot for baby, etc. they may not be able to get you an order for an ultrasound if you want/need one. It has gotten harder to do this but I think East Bay Prenatal in Oakland will still do them for homebirth midwives. This is why continuing prenatal with your OB/Hospital CNM is useful.

- You mentioned that you are thinking of doing a homebirth with a CNM. Why not switch OB practices and do concurrent care with a hospital CNM (Lindy Johnson or Hsiu Li?) and your homebirth CNM? You may still have to keep your homebirth plan to yourself, but you can ''feel her out'' and test the waters - say, mention homebirth and see what she thinks about them, etc. A hospital CNM will be able to order ultrasounds, etc. for you. Homestyle Midwifery used to do concurrent care for homebirth mothers; they were based at St. Luke's in SF but may have moved.

You CAN have your homebirth and still get some prenatal care from a hospital-based practice. You just have to think of all the logistics. Good luck, and congratulations! homebirth fan

Another reason for prenatal care with your midwife is that the midwifery model of care is qualitatively different than the medical model, which you will feel throughout your pregnancy. It makes a really big difference to have your questions answered with unbiased information from a practitioner who sees pregnancy & birth as natural processes rather than problems waiting to happen, and who respects you and honors your choices. As an example - when we told our midwives we had concerns about ultrasound and didn't know whether we wanted to do it, they gave us information about why people choose it, why people don't, when it is helpful and when information can be found through other means. I felt no pressure to choose one way or the other, and also knew that they were monitoring me in other ways and would recommend it if there were anything abnormal that needed closer examination.

As for routine procedures, yes, midwives perform many of them themselves (monitoring baby's heartbeat, blood tests, glucose, rhogam) and will refer you for others that they don't do (ultrasound or other invasive tests.) Interestingly, you'll find that midwives have greater expertise in non-technological methods - such as palpating baby to find position - than doctors usually have, and thus have more tricks up their sleeves to assist your labor without resorting to technological interventions. They actually have more experience with the many variations of normal birth than doctors do.

One distinction that you may want to be aware of - with this pregnancy I worked with Licensed Midwives (LMs) rather than CNMs. My first birth was with CNMs at a birth center, and while it was beautiful in many ways, I now see how my care in the birth center was less personal and more medicalized than it was with Homebirth LMs. Also, this may just be a quirk of my insurance company, but they say they will cover birth with LMs but not CPMs, which you may want to check out with your insurance.

I recommend ''The Thinking Woman's Guide to a Better Birth'' by Henci Goer, and ''Ina May's Guide to Childbirth'' by Ina May Gaskin, both of which will give you a sense of the benefits of working with midwives. Also, the Bay Area Homebirth Collective holds monthly Birth Story Potlucks - where you can hear stories, meet homebirth midwives and families, and get your questions answered. FYI, I worked with Abigail Reagan & Sue Baelen, both a part of the BAHC, and recommend them wholeheartedly.

Throughout my pregnancy, birth & postpartum period, I have gotten better care, information and support from my midwives than I ever have from doctors. I have also been empowered to take complete responsibility for my experience and my choices in a way I have never experienced with doctors. For this reason I chose not to have concurrent care with a doctor, and was never disappointed with that decision. Annemarie

I had my first child in a hospital with a midwife/OB practice in SF. It went very smoothly and I felt supported for the most part by all the medical staff. There were moments when nurses tried to instill different plans (monitoring for monitoring sake) and encouraged an IV ''just in case,'' but that might impede my moving around. We were able to personalize the room a bit, but it was quite sterile. In between baby one and two, I had a miscarriage and some other medical issues. I was appreciative of the advantages of modern medicine, but also quite conscious of how de-personalized, sterile, and interventionist it can be too. When I got pregnant again, the last place I wanted to be was a hospital.

My second was at home with midwife Amrit Khalsa here in Berkeley. She has over 25years of experience delivering babies and has more ''scientific expertise of the establishment'' than many OBs. I loved it. I felt safer, more supported, much more informed throughout the prenatal process and coached in this amazing process. This cannot be emphasized enough - information in a useful way and true support and attention is so much more than ''touchy feely''. Because of my insurance (PPO) and my relationship with the OB/midwife practice of birth #1 (who were no longer doing deliveries), I was able to do some basic prenatal care through them that included ultrasound and various bloodtests. I did not feel like I needed anything from the OB, though, other than an office to run the tests through so insurance would cover it. Amrit read all the results and was more than proficient in appropriate protocol for dealing with any anomalies. She also paid attention to aspects of my ! health that few health care providers had ever asked about (diet, sleep, relationship, household cleaners, ...)

But this is a big choice - it's a significant philosophical difference in care, attention and personal responsibility. Be prepared for lots of opinions about how you should manage your health and that of your baby, and look inside for what will work best for you and your family. You'll know what to do and what is important for you. JV

to my knowledge i don't believe that most midwives will only see you for the birth and not participate in your prenatal care and i don't think that CNM's do homebirths, only lay and licensed midwives. i could be wrong, but this is my understanding. if you have any questions, please feel free to email me. best wishes, mazu

First - What is a Certified Professional Midwife (CPM)?

A Certified Professional Midwife (CPM) is an independent practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care. The NARM certification process recognizes multiple routes of entry into midwifery and includes verification of knowledge and skills and the successful completion of both a Written Examination and Skills Assessment. The CPM credential requires training in out-of-hospital settings.

-What is a Licensed Midwife (LM)?:

A ''licensed midwife'' is an individual who has been issued a license to practice midwifery by the Medical Board of California. Licensed midwives, who have achieved the required educational and clinical experience in midwifery or met the challenge requirements, must pass the North American Registry of Midwives' (NARM) comprehensive examination. After successful completion of this examination, prospective applicants are designated as a ''certified professional midwife'' and are eligible to submit an application for California midwifery licensure.

In other words, most non-CNM midwives will be NARM certified as a CPM, but only once they pass the State Board exam can they become Licensed Midwives, something one must be to legally practice in California.

- What is a Lay Midwife?:

The term ''Lay Midwife'' has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education (as was the fact before the Certified Professional Midwife credential was available).

-What is a Certified Nurse-Midwife (CNM)?:

A Certified Nurse-Midwife (CNM) is an individual educated in the two disciplines of nursing and midwifery, who possesses evidence of certification according to the requirements of the American College of Nurse-Midwives. And yes, many CNMs choose to provide homebirths, as some CNMS do in the east bay. It's just that more of them work in hospital settings than homebirth settings. There are also some LMs who work in hospital settings (there used to be some at SF General), but most provide homebirths.

Lastly, I noticed that the poster whose midwife was Judy Luce said that ''most of them (i.e. midwives) advise you not to tell your ob/gyn because of the reaction you got''. I'm not sure if this was her personal experience but I have to strongly disagree with this. I'm an apprentice midwife who works with a local licensed midwife here (AND I know Judy personally), and I'm sure most of the midwives in this area will NOT advise you to NOT tell your other care provider (e.g., OB) of your concurrent care or your planned homebirth - midwives, as medical professionals, will explain all of your options to you but they will leave it up to the mother to decide what is in her best interest. I would hate to get a homebirth midwife ''in trouble'' because of what this poster said, or to have other medical professionals who are part of BPN believe that midwives are giving this kind of advise to their clients. They're not. My midwife/preceptor, for one (and she is not alone), will give her clients extensive information on their many options - be it regarding a blood test or regarding the benefits/drawbacks of hospital or homebirth or concurrent care - and will leave the decision to the clients. Many homebirth clients often end up choosing to keep quite about their planned homebirths to their OB, but this is different from saying that the midwives are telling them to do this. 2-timer homebirther

Bureaucratic paperwork for a Homebirth

I'm planning a quite late switcheroo to a homebirth (32nd week) from Kaiser. I was hoping to get some advice about all the bureaucratic stuff that is typically done for a birth. I.e. the pregnancy disability paperwork, birth certificate, etc. I know at Kaiser, they usually help you with all this stuff. Is it more of a hassle when working with a midwife? Anyone with experience, I'd greatly appreciate your advice. Jina

We did have to fill out a couple Government forms ourselves. To get pregnancy-related disability, I had to fill out a claim form for State Disability Insurance (SDI) benefits. I sent it in the day I stopped working. Here's a link to SDI phone numbers: http://www.edd.ca.gov/direp/diloc.htm#Phone

Then for paid family leave, California state's EDD automatically sent me the form ''Claim for Paid Family Leave (PFL) Benefits - New Mother, DE 2501FP'' when my SDI claim was ending. I sent the form back with the documentation it asked for. They phoned me to verify the info was correct and they phoned the midwife to verify the birth. PFL kicked in when the SDI ended. My partner was able to claim PFL as well.

For the birth certificate, our midwife gave us the number to call for birth certificates at the county health department. They set up an appointment for us to come in with the baby. At the appointment, the midwife met us there, so we could all sign the form and certificate at the same time, and it was all easy and friendly as they knew the midwife well. We were in and out in about 20 minutes--not a hassle for us. Much joy to you on your amazing journey. Homebirth Mom

the paperwork isn't that difficult.

SDI: midwife (hired when i was ~3mos along, and still with kaiser) filled out/signed the MD portion, i mailed it in. my PFL was automatically extended afterwards (ie forms sent to me by EDD when SDI was due to run out). when my husband applied for PFL, we didn't have the ''required'' paperwork for proof of birth yet (hospital D/C record, birth cert), so we sent in copies of the midwife's affadavit of pregnancy and the preliminary application for the birth certificate. no questions asked, checks started arriving.

birth cert: took midwife's affadavit of pregnancy, and the application forms she had given us to fill out, to alameda co. registrar (?1100 broadway). had to call for an appt, and there was supposed to be a lag time of several weeks, but when i explained we were going to need the birth cert in order to apply for PFL (which i later turned out not to actually need, but didn't know then), and were having $ difficulty waiting for PFL benefits, the registrar kindly fit us in that week. we had to take the baby to the appt (required, ?so people don't scam?), and since my huband and i (and our 3yo daughter) were the only witnesses to the birth, my husband signed as attendant/witness (where the midwife/OB would usually sign). the hardest part was getting out the door (with a 2 week old), and sitting in the registrar's office for an hour (with a restless/whining 3yo), while he filled out the computer fields. i can't recall his name, but he was very nice, and told us that he was born at home, too! he does all the birth/deaths in alameda co (mostly sent in by hospitals), except for some reason berkeley is separate.

have a great birth! signed :done it, it's not so bad.

Should we tell our OB we're having a homebirth?

My partner and I have started thinking that we'd like to try a home birth and use Alta Bates as our back-up but it seems that there are some complicatiins about that. Specifically, if we tell our ob-gyn, who we like a lot, that we're doing a home birth, then she and the other members of her practice no longer become who get called if we end up coming to the alta bates. Instead we would end up with whoever was working labor and delivery. If, on the other hand, we don't tell our OB but just end up coming in in a ''transport'' then this might make a few of the doctors in her practice very upst, and who wants to go through labor with a doctor who may be angry at you?! Still it seems wrong to give up the hope of a home birth because of these complications. And it's too late to switch to working with any of the Alta BAtes midwives. Has anyone else been through this? What did you do? Thank you!

Furthermore, having had three children, I feel that the birth process is not the main point in all of this. The main point is the child. I belive the extreme focus on the exact wishes of the mother at the time of giving birth are misplaced. They are a final attempt to hold onto control as you move into one of the most primal moments of your life. You will not have the control you have in other aspects of your life during the birthing process, nor will you ever have control of your life in the way you have had it before. So, perhaps you can give yourself over to this reality before the actual birth and accept that an in- hospital birth can be OK, or that a home birth backed up by whomever is on call is OK. The birth is one half of one day (more or less), and the child is for a lifetime. To start your child's life in the context of a deliberate deception of the very people who are committed to your care seems very inaspicious to me. Grateful to my OBGYN

In any case, it's not all that likely you will be treated by your OB if you give birth in a hospital anyway. I gave birth to both my children at Alta Bates and my OB wasn't at either of my children's births - nor were any of the 6 or 7 OBs in their practice! I asked one of the docs in the practice how many patients she treated that she actually delivered, she said about 30%. My advice: go for the home birth. anon

As to your question, though, about how to get your homebirth and your own ob/gyn back up just in case- I really think you need to decide what is negotiable and what is not. When in labor, especially if there is some danger or concern that would prompt a transport to the hospital, the last thing that I would want to deal with is keeping track of lies, omissions of truth, etc. At the end of the day, all we really have is our integrity, which for me is an alignment of my values and actions. Good luck! JV

Worried about sister's home birth plan

My sister is having her first baby. She announced to the rest of the family that she and her husband decided to have the baby at home. We are very concerned about it. She says that she has done a lot of ''research'' about it, which I think means that she's surfed the internet and found postings about how horrible hospitals are. She hasn't visited the hospital and is somewhat unwilling to hear other points of view. I did some basic internet searching and found that most of what is out there is very biased towards home births. Even statistics like ''40% of first time moms end up having to go to the hospital anyway because of slow progression'' are presented with a more positive slant. I have known lots of moms who have had successful home births for their second, third or fourth child. My main concern is that it is her first baby so no one knows how it will go. Another sister and I both have been able to have normal vaginal deliveries but we each had significant tearing and two of the four babies we have between us had some complications during delivery (umbilical cord around neck and one was a ''floppy baby'' and needed to be resuscitated).

Please be kind in your responses. I'm just looking to hear experiences, positive and negative and maybe some suggestions on where to find information that presents both options(hospital and home) in a non-biased way. anon

My pregnancy and birth progressed differently than my sister's; each woman and each birth is different. I got flack from my family for choosing home birth. I wish they had been supportive. I had a short birth with a healthy alert baby. Her cord was around her neck, but it was not an emergency that TV shows portray. Midwives have the training and equipment for handling minor complications. Those requiring additional care are transferred to a hospital, and how wonderful it is to have that resource when needed. Transfer to a hospital is rarely an emergency; usually evidence of midwives being cautious.

Each woman has to make her own decision. I think each of us will birth best wherever we feel safest. I can tell you love your sister and are worried about her, but challenging her first major parenting decision is not helpful in the long run. If she appears headstrong about it, I'd bet she's just bracing herself for the reaction she anticipates from family, not that she is uneducated. Buy her a copy of "Ina May's Guide to Childbirth" and tell her how excited you are for her. Heather

I have a graduate degree and I know how to do research, and I also know how to follow my gut. Home birth was absolutely the right choice for me. I would do it again in a heartbeat. If it's right for your sister, please find a way to be open to her perspective if you can. If you do some reading about the statistics of home birth in other developed countries you might be surprised to see how safe it is (particularly if an experienced midwife attends the birth). Good luck to you and to her. Happy to have had #1 at home

I asked my midwife LOTS of questions about what would happen if something went wrong, including worst-case scenarios i.e. what could happen that would cause the baby or me to die before we could get to the hospital? With that information, I felt that I could make a responsible and considered decision. I had a high degree of confidence in my midwife's expertise, including medical expertise (she had been a labor and delivery nurse, and a neo-natal ICU nurse)-- certainly, a highly-competent midwife is essential.

I guess it's hard to describe why giving birth at home is so important to some of us. My hospital birth experience wasn't horrible: unmedicated, no interventions, and of course the indescribable joy of a healthy baby. But, giving birth at home was...a truly spiritual experience, like a veil opened up in our house, an incredibly deep peace, even in the midst of strong labor.

Perhaps you could embark on your research project with a truly open-mind, with the intent of educating yourself instead of convincing your sister-in-law. Then, you might be able to share in the joy of her pregnancy, and truly support her. Happy and healthy at home

It turned out that 3 of 12 women in my Mom's group had successful home births.

It's true that no one knows what will happen with a first -or second, third or fourth birth. But home birth midwives are obligated to turn down women who have medical reasons not to give birth at home. That's why their morbidity and mortality statistics are better than doctors and midwives in hospitals. A 40% hospital transfer rate for first time births is much higher any I've seen, though it is true that some women go to the hospital. Remember that few of these women transfer because of medical emergencies and very few of these transfers result in poor outcomes for mother or baby.

Are there risks in home birth? Yes. There are also real risks in hospital births, resulting from the hospital setting. I wouldn't recommend home birth for anyone who has not chosen to learn about birth and pain management - you really need to train for it. It sounds as though you AND your sister could both learn more about the realities of home and hospital births. Maybe buy her the book ''Birthing from Within'', which has accurate information about preparing for hospital and home birth and is ''alternative-y'' enough that you may be able to slip it past your sister's defensiveness. For you I'd recommend reading Ina May Gaskin's most recent book about home birth - the back of the book has outcome statistics about thousands of home births.

You'll probably get a lot of responses to this question and I'm looking forward to reading all of them. Good luck, Would Do it Again Tomorrow

It will help you to be informed. I had a homebirth with my first and it was the best thing I've ever done. I hope you can come to support your sister and her decision--it is a great one for her and her baby, a safe choice (far safer than hospital births according to studies that have convinced European nations to advise homebirth for low-risk pregnancies to increase the safety of birth there...a little research will point you there (most of this is on my computer in .pdf form and you didn't leave your email address)).

If your sister is in the Bay Area, point her to the Bay Area Homebirth Collective for support. http://bayareahomebirth.org

I could go on and on about the upside of homebirth, but I will let others sing that song. Suffice it to say, the interventions regularly used in hospitals (induction, etc) inevitably lead to even more intervention (epidural, episiotomy, etc) and doctors will tell you this (if you have x, you are more likely to have y as well). As a doula, I have seen this up close.

Your belittling of your sisters research seems to indicate that you generally don't trust her; that seems like a bigger issue to me than her choice of venue for her birth and one better resolved directly rather than indirectly through dissuading her from a safe choice around her labor and delivery. Best wishes to your sister and her husband! proud and informed homebirther

You may also want to read this very recent study, published in the British Medical Journal regarding homebirths in North America. Most if not all of the homebirth midwives in our area were part of this study: http://www.bmj.com/cgi/content/full/330/7505/1416?ehom_

Lastly, no one knows whether a first time or a second time or a fourth time labor and birth will be ''normal''. But, licensed midwives, like certified nurse midwives (who mostly work in hospitals) are trained to screen out mothers who may have a high-risk pregnancy, so chances for a normal birth at home are optimal. And licensed midwives are trained in neonatal resuscitation, carry oxygen and other such medical devices. They also know how to suture most tears if that happens. Umbilical cord around the neck is actually not so rare and often OBs and midwives just take the cord off when the baby's head comes out - true umbilical cord wrapping that creates a serious problem is not as common. And yes, you're right - many first time mothers end up transporting to a hospital - but for NON- EMERGENCY reasons, the main one being for ''lack of progress'', meaning that labor may have stalled and the mother is exhausted. There are definitely times when a hospital birth is necessary or advised, and homebirth midwives know when this is so - they are not going to keep you at home just for the sake of a homebirth.

Unlike hospital births, homebirth midwives visit their mothers and babies the day after birth, three days after birth, 6 days after birth, 10 days after birth, 3 weeks after birth, and then 6 weeks after birth - and are on call 24 hours a day. They check on the mother AND the baby AT HOME. Care with a homebirth midwife is like being pampered, and rightly so as a new mother!

Like you would interview for an OB - which is HIGHLY RECOMMENDED - you should interview for a midwife. I hope your sister has done this. I think you would benefit from going to one of the BAHC potlucks.

Good luck and please keep an open mind and most importantly, support your sister in whatever decision she makes - she is already stressed about all of the decisions she has to make as a new mother. homebirth mama

i labored at home with the support of my husband and doula. i actually handled labor so well (walking the entire time, which probably progressed labor faster, and just riding each wave as it came) that i was ready to push when i was still in our bathroom. i was waiting for this horrible pain and experience to consume me. i figured it must be horrible if most people in our culture talk about labor so negatively and use drugs with little hesitation. but it wasn't that way at all. to my surprise, i was ready to push after only 4 1/2 hours of labor.

although i was ready to push, i felt going to the hospital was the ''responsible'' thing to do, so i held my daughter in for an hour until the nurses let me push at the hospital. HELLO!!! i held her in for an hour! we'll never know what caused what, but our daughter was EXTREMELY colicky and suffered from reflux for months. colic is still one of those baby mysteries (which some attribute to digestive issues), but in our experience it wasn't that cut and dry. we tried every remedy, between alternative medicine and conventional medicine, and nothing worked. to this day, we can't help but think the trauma of holding her inside of me for so long contributed, if not, caused our daughter's colic and reflux issues.

so all of that was a long way of saying that no one can predict (whether first-time or not) what will happen in labor. it's most important that the mother and partner choose a provider they're absolutely comfortable with and trust completely. complications usually present themselves with warning signs, so there's time to get to a hospital, if the provider knows what to look for.

to address a couple of other points you mentioned... tearing is less likely if the mother is unmedicated and pushes when she feels she's ready (not when she's ''coached'' to do so).

resources on this matter are never unbiased, especially if you ask my husband, who has come a long way in his views on childbirth. during pregnancy, i enjoyed reading _birthing from within_ by pam england and rob horowitz and especially _ina may's guide to childbirth_ by ina may gaskin. ina may's book is rich in information and is supplemented with inspiring stories about women who birthed in a home-like setting. lydia

While I was laboring at the hospital, the nurse on duty made me stay on my back with the monitor on for several hours because the baby's heartrate was dipping. I had a very strong urge to get onto my hands and knees, but they wouldn't let me. My labor slowed down. Once the shift changed, the new nurse put in an internal monitor which allowed me to change to hands and knees. As soon as I made that change, his heartrate was absolutely fine and my labor sped up again. When it was time for me to push - inexplicably - they made me go back to being on my back. As soon as they did that, his heartrate started dipping. They didn't let me change position - instead, they decided to use suction. He came out, and because of the suction, I tore considerably. Right after that, the doctor said that she regretted they'd used suction, because he came out pretty easily, he would have come out in time anyway, and the suction really made me tear. I had a very long recovery period (it was 3 months before I was walking right again) and some depression issues that I am fairly certain were related to that.

4 years later - my homebirth was entirely on my hands and knees, and that position worked so well for me that between when my contractions started to get strong and when he came out was about 20 minutes tops. Yeah, some of that had to do with the fact that it was a subsequent birth, but I really think that the atmosphere at home and the fact that I was really self- directed in my laboring made a huge difference in my experience.

Another thing that I want to say... midwives KNOW when there is a chance someone will have to be transported to the hospital. They are not waiting and hoping situations will improve - they transport right away if they think there is a need. They are also fully trained in resuscitation, handling hemorrhages, etc - all the common complications that can arise. The midwives I worked with had plenty of first-time parents as clients. When I asked them about transporting to the hospital, they said that they would not hesitate to do it at all, and that in 10 years of practice they had not had a single medical emergency at a home. So if your worry is that she will have a medical emergency and she or the baby will be harmed - look at the statistics about how often that happens at a homebirth vs. a hospital and I think that will ease your mind.

I also want to say that the quality of care given by midwives is really unbeatable. For this last pregnancy, I changed to a homebirth very late in the game (36 weeks) so I experienced Kaiser care vs. midwife care. I can't tell you how different it was. At Kaiser I didn't see the same person twice for my appointments, which were all of 5 minutes each, and no one paid any attention to my state of mind (which I was worried about because of previous PPD), my other child, my knowledge of caring for a newborn - they were only interested in the baby. After one or two weekly hour-long meetings with the midwives, I felt very different, and much better, about my pregnancy. I didn't realize before that how much the tone of the care you receive really influences how you think about yourself, your body, your baby.

Anyway - please don't take this as propaganda or dismiss this as biased. Actually, I AM biased but it is thoroughly based on my experience. I hope you can let her make her decision and stand behind her. experienced (again)

In my own birth experience, after a completely healthy, uneventful pregnancy and labor, my daughter got stuck in the last phases of pushing, and her heart rate was dropping with each contraction. It turns out her cord was also around the neck (very common). My ob suggested using forceps to get her out (and then gave me and my husband time alone to discuss it, btw) and if she hadn't, I don't know what would have happened.

To be more on the direct side, you could always use this approach: ''If your baby stopped breathing when it was one day old, would you insist (s)he be treated at home, or would you take them to a hospital?'' and then assuming she says she would go to the hospital, ''So what difference does that one day make?'' Sure, a lot of babies are born at home and MOST of them do okay, but do you want your baby (or yourself) to suffer what could be irreparable damage if something should go wrong?

And lastly, in the words of a (young) pediatrician I know.... ''My grandmother gave birth to all 10 of her children at home, and 8 of them lived'' If your sister does decide on home birth, I wish her all the luck in the world, she'll need it.

Expect the best, but prepare for the worst... Believe in the Boy Scout Motto

the reason for my story? i thought everything was going to be perfect with my birth. but the truth is, birth isn't perfect. if i hadn't gone in to the hospital, either i or the baby could have died. now, tons of women have successful home births, but i don't know if i would risk finding out that i am the one who will have a problem. that is why we wanted natural birth in the hospital in the first place. anon

I was one of 3 women in my childbirth preparation class who had successful homebirths, all of us first-timers. I did lots of research as well (including a research paper on homebirth vs. hospital birth in nursing school) and it all points to the fact that in the presence of a qualified practitioner, homebirth is as safe as hospital birth. I think she should go for it! As long as she is close to a hospital and has a good midwife, she will most likely be fine. She will most likely also have a much much more positive experience as well. Take care, an RN who chooses homebirth

i chose a homebirth for my next birth. i now know many women who've had first babies at home. it was like night and day how great the care of my midwives was. they came to my house, spent 1 to 1 1/2 hours with me each visit, gave me tons of info, and really dealt with finding out what i needed. i'm sure i would have had a great first labor with midwifery care. in fact, my 2nd labor was so easy (and quick, ~4hrs) that i had the baby shortly before the midwives got there, no active pushing, just the strength of the contractions doing their job. i felt so empowered by this experience because I myself delivered my baby. women's power is co-opted by the medical industry that distrusts our bodies, and thus we have insane C/S rates.

so if you distrust the internet, read some books, anything by: sheila kitzinger: http://www.sheilakitzinger.com/BooksUSA.htm ina mae gaskin: http://www.salon.com/people/bc/1999/06/01/gaskin/ Michel Odent: http://www.michelodent.com/section.php?section=odent or contact the Bay Area Homebirth Collective for more resources.

please educate yourself to allay some of your fears, and allow your sister to make her choice without trying to scare her. as you read, ask yourself if some of the problems you and your other sister had were CAUSED by the hospital model. were you given freedom of choice in positioning? or did you deliver in stirrups for the convenience of the doctor, like i did, which is much more likely to cause tearing than any other position, such standing, all fours, sidelying (where i wanted to be), or squatting. were you monitored, and thus expected to stay still for the convenience of monitoring, then saw your labor slow? there's a lot to learn about birth, and most of what conventional OB's and ''birth classes'' teach is geared towards teaching women to be expectant and accepting of medical intervention. i hope you can learn to trust your sister's decision. biased: wish i'd homebirthed the first time

However, factors influencing one's decision to plan a homebirth differ for each individual. For example, does your sister have diabetes or high blood pressure? If there are things in her medical history that would make her pregnancy high risk, then a midwife could not work with her in a homebirth setting. Has she interviewed many midwives? To ease your mind, you could ask her to find out the midwife's history re: number of births attended, number of transfers to the hospital, how deliveries with high risks, wrapped cord, neonatal resuscitation and other complications are handled. My midwife had been trained to deal with those kinds of eventualities. I found her through the California Association of Midwives. http://californiamidwives.org/

One thing I tell people is that even if I had ended up being transfered to the hospital, the prenatal and postpartum care I received from my midwife was much more comprehensive than what I would have gotten from my OB. We formed a close relationship with her and her apprentice and backup midwife. Each prenatal visit was an hour or longer to include the exam, educational information, and question-and-answer sessions; she was on call 24 hours for me from the moment we hired her. I was able to call her anytime with questions, and when I suddenly started feeling an intense back pain at week 26, she even came over at 4am with her fetal heart monitor. The care during labor and postpartum was also of the highest quality, exceeding our expectations.

That's just my experience. Best of luck to you, and hope that eases your mind. Homebirth Mom

I know you're worried about her, especially as it's her first birth. But whether it's a first or a fourth birth, no one knows how it will go -- birth is always unpredictable. But reputable studies (not just Internet opinion) have shown that for uncomplicated births, homebirth is as safe (or safer) as hospital birth. So despite your sister's lack of experience, homebirths aren't any less safe for a first birth.

Unless she's planning an unattended homebirth, she'll have trained medical professionals monitoring her throughout her pregnancy, as well as at her side when she delivers -- if needed, they can deal with cords wrapped around necks, resuscitate the infant, stitch up tears, etc. And unless she lives way out in the middle of the woods, it's just a short journey to the hospital should anything more serious go wrong. (The Bay Area joke is that if a C-section is needed at a homebirth, it's ''decision to incision'' in 30 minutes, same as in the hospital.)

My family has a tradition of homebirth (one cousin had babies #1-3 at home, another cousin had #2 at home, and another cousin is planning #1 at home) and although the extended family was worried at first, now everyone thinks it's the way to go. I gave birth to my son in the hospital, barely -- I labored at home right through transition, then went to Alta Bates as I was pushing -- and I wish I had planned for a homebirth all along. It would have been much easier and more pleasant.

You asked for recommendations -- you might read ''Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First'' (UC Press, 2006) or ''The Thinking Woman's Guide to a Better Birth'' for two scientific, evidence-based examinations of the issue. Nicole R.

I think there are many problems which are caused directly or contributed to by hospitals which are then ''solved'' by them. For example, according to medical journal articles I've read, almost all severe tears (3rd and 4th degree) are associated with episiotomies. this may or may not jive with your personal experience, it certainly does with mine (no episiotomy, very small tear (one stitch).

Also consider that hospitals and much more germ-ridden than homes so not really the best place for a newborn in general. Of course hospitals are great places to be in case of an emergency but if a woman is healthy and has had an uncomplicated pregnancy there's no reason why she shouldn't be able to have it at home if she wants. My advise, support her in her wishes and have a wonderful, if different, birth experience. mom and nurse

Instead of grilling your sister, you can ask your questions of the "neutral" midwife, and if you can enter that meeting with an open mind, you should find all the answers you need. And then, the very best thing you can do is stand behind your sister's decision, and support her to her face, and to your family. She will have many people questioning her decision - she deserves to have the support of those closest to her. Homebirth Was One of the Best Decisions I Ever Made

Ob Gyn who is open to home births?

i am looking for an ob/gyn with pacificare hmo who is open to or at least tolerant of homebirth. i live in emeryville, so anyone in the general area would be ok. ideally, the dr would be willing to be a medical back-up if needed.

Home birth and medical insurance

I have a question about home birth and medical insurance. I met someone (with Aetna insurance, not a UC employee) who had had a home birth and said that her insurance covered it; she said they paid the midwife bills and didn't ask any questions about the fact that there were no hospital bills. Has anyone tried this? Do you think it would work better with a PPO? It seems to me getting the birth paid for would cover the excess cost of paying for the PPO for that year. I have looked at the archives on home birth, but if anyone can give me a name to get in touch with to ask this question that would be great. thanks for the help, Erika

We will go ahead and submit the bill anyway and see what happens. I will be very interested to hear if anyone has had any luck getting any money out of Aetna for a homebirth in recent months. Elizabeth

With a hospital birth you have two bills, the doctor's bill and the hospital bill. This adds up to much more than a home birth, but in the latter case the insurance company sees only the midwifes bill which is typically much higher than what a doctor charges (forget that the prenatal visits are in your home, much longer, more comprehensive, that the midwife will be there for a much greater amount of time at your birth and then do home postpartum visits).

One midwife I spoke to said she had a client who was a lawyer and challenged the ''customary'' amount that his bill had been reduced to by surveying all the home birth midwives and showing that they all charged much more. He lost. Most midwives use a billing agency that knows how to work the codes and most folks on a PPO plan get a half to three quarters of their money back.

To the person using Aetna, they are not above the law. Many of the folks you speak to at insurance companies don't know that homebirths are indeed covered. Call again and instead of using the word ''homebirth'', talk about a bill from a Licences Midwife. Checked It Out

VBAC at home?

Hi, Baby two is due March 2006 and it will be a VBAC. First baby was an attempted home birth. I am new in the East Bay (Piedmont) and still trying to find my way around. My question is: does anybody know of any midwives that have experience with home VBACs? Are there any birth centers around here, attended by midwives, that do VBACs (with or with out physician back-up)? I would prefer not to give birth in a hospital and am exploring home vs. birth center births. Thanks! Thanks. Iris

You may or may not be able to convince a midwife to attend you at home; there have been successful lawsuits against VBAC homebirth midwives in recent years, so this option is also closing. I am not aware (and this is after some research, believe me) of any Bay Area OBs who will provide homebirth backup for a VBAC. This means that if your home VBAC does not go well, for whatever reason, you are likely to be at the mercy of whatever OB you find on call at the emergency room that day. Given the enthusiasm most MDs seem to have for repeat Cs, I would not think your chances of getting out without getting cut are very good in that circumstance.

After giving all this some consideration, I've elected to plan a hospital VBAC for our next kid. Alta Bates is still accepting VBAC patients. Sara

Creating a homebirth-like setting in a hospital

Hi, I am new mom to be (currently 5 months into healthy pregnancy). I have a good OB, but I am feeling concerned about the prospect of giving birth in a hospital, where the tendency is to medicalize the process, and where I may or may not be attended by my OB, if he is not on call at that time. So: I am looking for a way to have a hospital birth (probably at Alta Bates, but I'm open to other facilities nearby) that as closely as possible replicates the benefits of homebirths (e.g. known/trusted attendant, minimal interventions, birth positions according to how I feel, birth as natural process, etc.) Any advice or recommendations are much appreciated, particularly for how to create that kind of atmosphere in a hospital setting, plus any recommendations about OB's or midwives that are committed to being the one who delivers their patients. Thanks! Erica New Mom to Be

1. Get a doula. She can be with you at home---where you want to stay as long as possible---and go with you to the hospital. She can be your advocate for your desires.

2. Resist the medicalization. If you get an epidural, then they have to monitor you and your baby and your dreams of an unmedicalized birth are over. If you are exhausted that may not be so bad! But you will then have a necessarily medicalized birth.

3. Your doula has to be really upfront about what you want. For instance, I asked both of my midwives (in the office at appointments) to delay cord cutting for a few minutes and both times that clamp was on the cord before you could say umbilical. If you want or don't want something, like cord cutting or an episiotomy, you have to remind them just before the birth, because most often they don't remember and don't ask. They just do what they are used to doing.

4. The hardest thing about the hospital is that there are no distractions. The only reason you are there is to have a baby. When things get long or slow down for a bit, everyone wants to keep that freight train rolling. At home you can just relax and put on a movie if your contractions space out. At the hospital they are hovering and always wanting things to speed up. So, stay at home until you can't smile between the contractions. At that point things are really happening. You'll hate the drive, but your birth will be better. Oh, and don't take your labor seriously too early. Use distraction and putter about for as long as possible. First labors can be long and if you start doing breathing and deep relaxation from the getgo you can get bored and exhausted and be so discouraged if you arrive at the hospital and find you are 3cm or less. A doula can really help you to m! anage your labor well. Congratulations and good luck! susan

My advice -- get a doula! They are not as expensive as you think. There are many who do sliding-scale or even free births, especially those who are just starting out. Mine was just starting but she was wonderful. I labored at home for 15 hours before going to the hospital -- I felt like between what I knew and her help I KNEW I had done everything possible at home to stall the interventions and control the process. I wouldn't have felt this confidence had it not been for the doula and my preparation.

When I got to the hospital it was pretty medicalized. I had pretty much every intervention that I'd feared. But it was ok! I was in so much pain that it a great relief. It was good to have this acceptance rather than dispise the medical establishment that I'd rallied so much anger towards. And I was able to have low lights, my music, my family, and all the comforts that I wanted in my little room. I felt like my knowledge allowed me to understand everything they wanted to do. I was also tremendously grateful to my doula who helped me understand everything and who in the end agreed that the c-section was necessary and that it wasn't just the industry wanting to cut me up and make more money. I felt in control of the whole birth and by the end, I felt like a lot of my fear and anger at the hospitalization/medicalization of birth had disipated. I really learned that the pr! ocess of birth (and now motherhood) is so much about letting GO. And I coudl do that because of the knowledge I had. If I hadn't had the knowledge and preparation then I could have felt like it was forced as opposed to me letting go. So you can prepare a lot. You can get a midwife, which USUALLY ensures a much higher possibility that the woman who has seen you and known you for all those months will deliver the baby. There are some great midwives out there. Lindy Johnson has a great reputation, as well as Sho Li (that's not how you spell her name, that's phonetic.) They are recommended in the archives here. I would definitely try for a midwife If I have another baby -- I really didn't like the on-call OB who I had to deal with at Summit.

Most Bay Area hospitals are so open to letting you deliver any way you want -- in the dark on your hands and knees with your whole family in the room. Stay at home and labor as long as possible -- and be prepared for that. Labor was 1000 times harder than I expected! But take classes, take prenatal yoga (check out Cynthea Denise at Piedmont!) get a doula, learn relaxation techniques, and you'll be ok. The later you go to the hospital the better. Good luck! It's a wonderful, liberating journey you've embarked on..birth is only the beginning. happy new mama too

When it's time to deliver, go to the hospital as late as you safely can. The earlier you go, the more likely there will be an intervention.

Get a doula or someone who has gone through the experience to support you through the delivery. While the hospital staff is there for you, their interests and motivations are not necessarily aligned with yours. Having a doula or someone there giving you support and looking out for your interests is great since you'll be focused on delivering a baby. And for postions, you do what you want. The postion that felt comfortable was squating on the bed using the ''lean'' bar. I wanted to stand up on the bed between contractions, the nurse kind of freaked out a bit over that, but ended up saying ''okay, whatever''.

Supporting out-of-state sister's homebirth

My sister has decided to have a home birth which I fully support. She moved last year to New York though, and has no close friends or family who can be there during it. I am looking for advice from moms who have had home births about some things I could mail to her that would really show her how much I love and support her even though I can't be there. I guess I want to try to give her things that will make the whole process easier. Any suggestions?

It is a common practice at a ''blessing way'' for each person to string their bead and state their wish, however, my friends and family being mostly far away, sent the beads with the wishes written down. I still have the wishes so I can never forget AND, a beader-friend put the necklace together very nicely and she added many beads to make it absolutely BEAUTIFUL! It meant the world to me, really, and still does.......

Also, I sent candles with little heart candle holders. I asked each person with one of these candles to light it when they heard we were laboring and to let it burn until it went out. There was a lot of love and light around us. We felt it and had a wonderful (albeit 50 hours of labor!) birthing experience! LogicalMama

Arrange for a postpartum doula. These wonderful women can do it all---dishes, laundry, meal prep, baby cuddling, and most importantly, they offer understanding of the physical and emotional rollercoaster that your sister might be on after the birth of her little one. Having a doula come once or twice a week can also help your sister catch up on her sleep, which she will likely need. Your sister's midwife certainly knows many to recommend.

Ready-to-go meals. While you're not there to cook for her, you can talk to her midwife and find out if there's a casserole circle you could tap into for your sister, so folks bring a wholesome prepared meal every other day or so. I bet she could hook you up. There are often services that provide food especially for postpartum women, keeping in mind their special nutritional needs. The midwife could also tell you about any of these in your sister's area.

Diaper service. If your sister's planning to use cloth diapers and hasn't set one up for herself, this is a thoughtful gift.

Grocery delivery. Is there any in your sister's area? Your sister's partner or doula could give you an idea of what they need and you could set it up.

An available ear. For me it was helpful just to have someone listen when I needed to gush, cry, complain, etc etc. Your sister is lucky indeed to already have a sister who wants to support her. She'd surely appreciate hearing that you're open to hear whatever she needs to share with you

Those are just a few thoughts. I'm sure you'll get many terrific suggestions. Congratulations on your impending aunt-hood! Best, dleto

Homebirth - any regrets?

Hi everyone, I'm interested in possibly pursuing a homebirth for my next pregnancy. I have heard and read about so many people raving about their own homebirths, and have never heard of anyone having a homebirth and then opting for the hospital for the next one (except for medical necessity). But there have got to be some people out there who didn't enjoy the homebirth experience and wouldn't do it that way again. Am I right? I'd like to know if these moms exist and I'd like to hear why they now believe that homebirth isn't right for them. Thanks so much. Homebirth Hopeful

Want homebirth but hospital birth is cheaper

We are planning our second child and considering birth options and I am confronting a dilemma. My husband and I have agreed that we would like to have a homebirth, but we are also really broke and the cost of doing it at home rather than taking the insured-hospital option makes a meaningful difference to us. I am looking for advice to help me weigh the costs and benefits of choosing a homebirth or a hospital birth.

Here are several factors entering into my decision:
(1) the labor with my first child was relatively short and uncomplicated; since second children are routinely born in half the time, my next labor is likely to be about four hours. Is it really worth several thousand dollars to have those hours at home vs. the hospital? Or should I be looking at this dilemma over a longer span -- i.e. comparing prenatal care styles.
(2) my husband and I are both strong-willed people and I feel confident that we can stand up for our interests in the hospital environment.
(3) The homebirth option is attractive because you don't have to stay in the hospital, but considering that we have a two year old, might not a night at the hospital actually give me an opportunity to have one-on-one time with the new baby?
(4) The cost of using a doula and midwife at the hospital would be almost as much as a homebirth, so if I took the hospital route it might make sense to go cheap and use an OB and no doula.

I guess the question that is nagging me is, why spend so much money and make such a big fuss when the next baby is likely to be born quickly. Maybe it would be better to go the cheapest route and use the ''saved'' money to hire someone to clean the house during the first couple months. Or maybe having a home birth will be special wonderful and invaluable? Help! I can't make up my mind.
wannabe homebirther

On the other hand, it may be nice for you to stay overnight at hospital; if you were to use Alta Bates, bear in mind that you will have to pay out of pocket (somewhere less than $300.00) for a private room. If you don't choose a private room, you may have to put up with a noisy neighbor.

You mentioned that the costs of a doula and midwife in hospital would cost as much as a homebirth. I don't know about this, as it may depend on your insurance. I thought that if you went the hospital route, it wouldn't matter cost-wise whether you used a CNM or an OB. The Doula may be extra, as not all hospitals provide doulas. It doesn't sound like you're particular on which OB or CNM would help you deliver, but just remember that at hospital, there is no real guarantee that the one you want will be the one assisting you on that day.

Also, bear in mind that just because you had a quick and easy labor/delivery the first time, it doesn't really guarantee an as quick and easy or easier labor/delivery the second time around. So, where would you rather be - in hospital or at home, if your labor were long? (Most complications, other than long labor which isn't really a complication, can be diagnosed prior to labor. So if you had true complications, your midwife would send you to hospital anyway).

You sound like you are just thinking out loud for now and not really hedging one way or the other. Good luck with whichever decision you choose. doing it at home