The Business of Being Born

As I've written several times, there is much to be done in planning out the next 4 months. There will be a list shortly of the things that must be accomplished, but at the moment they make my head spin so I won't bother with that list in a post- not today anyway. They are all things that are doable- cleaning up the house and purging junk from our basement, figuring out which carseat works in small car, which diapers to get, who will care for the kid when I return to work and Rob is writing, which insurance to put the kid on, that sort of thing.

But one that I feel creeping up as a pressing issue is the labor and delivery part- or the actual having of the baby. I really, really wish there were more options involved. There are not. In Missouri, midwifery was just legalized last summer. There is one birth center, and it is a wonderful place from what I hear and from the information I read online. But it is 135 miles away, and if delivering there all prenatal visits are done there too. So this makes for a 270 mile roundtrip each visit. This is not a big problem for the first 6 months or so of pregnancy, when a woman with an uncomplicated pregnancy (which, thankfully, mine so far is) typically sees a doctor or midwife once a month. But the visits increase in frequency, to the final month or so when your doctor or midwife wants to see you once a week. This would be 1080 miles in just one month- and that is if nothing comes up in between routine visits. Then tack on the drive when you are actually in labor, or an extra one or two trips when you think you might be in labor as is apparently common for first time mothers-to-be.

So that is the first downer, and the second is that the birth center does not accept either my (out of network) insurance (or Medicaid), requiring full payment out of pocket. This is the same scenario if we were to consider a homebirth with a midwife. I have not done extensive research, but have learned that a homebirth would cost between $2500 and $4000, the birth center probably around $3000 not including fuel costs of all those road trips. This is just not feasible for us at this time. There are currently no midwives doing hospital births in St. Louis. Rob is also very uncomfortable with the homebirth idea.

This leaves unassisted homebirth (see the last sentence above and multiply that times 1000) or a hospital birth with an Obstetrician. I chose my OB/GYN carefully 5-6 years ago because of her progressive beliefs and practices. At the time, the progressive practices I valued in my new doctor involved being open to every kind of birth control and reproductive choice. I'd just experienced my longtime gynecologist first diagnosing me with some issues that could be resolved only with treatment that she refused to prescribe, offering no other options for relief. So I left her practice and found my new OB/GYN. (This is a long story that many of my friends know, feel free to ask for more detail. It is really quite appalling and is an hourlong blog post in and of itself!! I also happily also share her name as a doctor to avoid.)
I have been satisfied with my doctor selection since that time, and now am happily learning that the progressive practices of birth control and choice in this practice also extend to some progressive views on natural childbirth as well. This OB, Dr. T., offers VBACS (Vaginal Births After C-Section) when many OBs no longer do, is open to alternative pain relief measures in labor (like water submersion, walking around, sitting on a birth ball) when many OBs prefer and strongly recommend chemical pain relief and lying in a bed, and she even allows women in labor to rent her personal birthing tub for labor and, if you feel comfortable in the tub, a water delivery. This is the only OB in the St. Louis area who will allow this. She also encourages doulas and laboring at home as long as possible to minimize the chances of premature hospital interventions.
But Dr. T, awesome as she is, still only delivers in the hospital surrounded by an environment that is very open to and friendly to interventions. And she is still an obstetrician, not a midwife and practices a medical model of care, not the midwifery model of care. I really prefer the midwifery model of care.

So I, as an educated person who really would like to keep this whole labor and delivery business as natural and intervention-free as possible, have to have my ducks in a row and a good plan for making this natural birth happen.

This is not an easy task, and I hardly know where to begin even after having read extensively on the topic and assisting at around 10 births as a doula myself so far. Being in the birthing situation is very different, I am discovering, and puts one in a vulnerable spot. Who should help me/us during this time? How much"practicing" can one do to prepare for something you've never experienced? Can I REALLY, truly be prepared to handle the unexpected, and who should I/we trust if interventions are needed or recommended? Should I/we be taking classes on Bradley, Lamaze, Hypnobabies, Hypnobirthing, or just wing it with what I know and have read?

I feel like a confident outlook on my abilities to handle labor and birth, a healthy lifestyle in general, and a lack of fear are the biggest components of childbirth preparation, but is that enough? Am I strong, healthy, and confident enough? Would I know if I were not?