If At First You Don't Succeed...

That's right. It's time.

I'm still carrying an extra few lbs from my failed pregnancy last winter, and I don't have my thesis in hand yet, but you really can't put your best and most important part of your life on hold for a few pounds of insulation and the most miserable job you've ever had, can you?

There are a few things I want to do differently this time. I'm not talking about the last pregnancy -- obviously I don't want to miscarry again -- I'm thinking of Elsie's pregnancy.

This time, I am a little older and a LOT more knowledgeable than I was with Elsie. I won't read so voraciously. I won't share as many details, because they won't feel so noteworthy. This time, I want midwife care. This time, I want to stay out of the hospital if I possibly can.

I know how strange and alarming that is going to sound for a lot of my readers. I would have been transferred several times over during Elsie's childbirth, first for meconium, second, perhaps for pain/nausea relief, and third for hemorrhage. I'm sure I sound crazy to even mention it.

I've been doing my research and talking to experts. My new doctor (just a GP, not an OB) fully supports homebirth, so he's on board. I've been in touch with a midwife who tells me that she thinks I'm an excellent candidate for homebirth. She says that one hemorrhage makes me a little more likely to have another, but there were two really big risk markers in my first birth: a very long labor (~25 hrs), and the fact that my OB yanked the placenta out by the umbilical chord, as almost all OBs do. Long labor exhausts your uterus and makes it slower to heal, and yanking the placenta is more likely to leave pieces in or tear from the walls of the uterus. She thinks that with my next baby, it will likely be an entirely different experience with shorter labor, and if I let the placenta deliver naturally, that will help matters. Worst case scenario, remember the catheter, suppositories and pitocin? That's all int he midwife's tackle box. homebirth CNMs come equip with all the drugs and IVs and fluids needed to get a handle on bleeding in your living room while the ambulance is on the way.

Why so against the hospital? You might ask. Better safe than sorry! Yes, I see that. I just also have this strong memory of the way I felt when I got to the hospital. My contractions stayed the same frequency and length for hours and hours and hours, but upon walking into that delivery room, they got much, much harder for me to deal with. It was nerves. Hospitals make me nervous. They make me want to crawl out of my skin. Laboring at home was an entirely different experience. A far better experience.

Hub is not on board with the homebirth idea. He experienced my labor, delivery, and emergency quite differently than I did. He wants to come out of this with a healthy and intact family, and so do I. While I might feel great at home, he would not feel safe.

So we compromise. Midwife care is a must, so long as I don't risk out. I was so sick of obstetrics by the time I reached full term with Elsie. I liked my own OB, but was often shuffled into the hands of other less sensible OBs in the practice, for whom fear of litigation (rather than evidence-based medicine) drove health-care decisions. Expensive and invasive measures were often offered up before easier alternatives. Inaction was unthinkable. Everything was an "emergency." I don't feel safe or well-cared-for in hands like those.

We have a few good intermediate options around Boston: two birthing centers (Cambridge and North Shore), and one hospital that works with midwives (Mt. Auburn). I'm looking into the birthing centers.

It's a strange place to start your thinking about having a baby: with the birth itself. It's ages away. The only guarantee about childbirth is that it will be full of surprises. Why on earth would you start here? That is just the way we fly in America. First matter of business is to choose your care provider. That choice will determine how things go at the bitter end. Do you want to deliver in a hospital? Teaching hospital or not? City or suburb? Do you feel safe with your local options? Do you want to deliver at home? Birthing center? Natural hospital birth? Then there are those other questions: do you have insurance? What does it cover? What can you afford? Without insurance, homebirth might be your only affordable option. With it, in a bizarre contrast, hospital birth might be the only choice you can afford.

It's very overwhelming to the primip. I guess my only words of wisdom here are these: you can always change your mind. People do it all the time. Don't let decorum prevent you from getting a provider whom you can trust. And don't assume that a hospital is the best place to have a baby. It depends on the birth, it depends on the baby, it depends on the culture of the specific hospital, and it depends on the providers on duty that night. Living in Boston and being well-insured, I am lucky to have many good options. Not everyone does.

I remember feeling completely confused and alone when I tried to track down my OB during the most emotional period of Elsie's pregnancy. I'm a very different kind of patient now than I was then. Thank goodness!