Opinions please!

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Renee_S's picture
Joined: 08/05/09
Posts: 39
Opinions please!

I just found out that I am pregnant with our second!
I was researching and planning for a home birth with this one. My last was an induction and although I had an amazing birth, I did end up with an epi because the pitocin was killing me. My body had a major overreaction to the pit and I had 3 contractions in a row with one minute between for 2 hours with no progress. I know I wasn't progressing because I was so tense, I just couldn't even catch my breath. The epi was wonderful, I dilated from 4 to complete in seven minutes and had complete control over my legs and everything. I even reached down and pulled DD out and onto my chest.
Anyway!!
I just found out that our insurance covers everything for a hospital birth and nothing for a home birth. The midwife my friends have used for home birth charges $2800 for prenatal, birth, and pp services. This seems pretty reasonable to me. However, my birth could be free.
What would you do in my shoes?

I don't have a problem insisting on what I want at the hospital, as far as no interventions, ect. But I do have a feeling that I will not end up with a NCB at the hospital. I had a great epi before and would probably cave and get one again because it'd always be an option in the back of my mind. Being at home where that's not an option would settle my mind and I know I'd have a great natural birth.

Also, has anyone had labor with pit and labor without? What was the difference in feeling? I was handling the pit contractions just fine until they started piling on top of each other without a break.
Thanks for your thoughts!

renee24's picture
Joined: 08/06/06
Posts: 1096

I'd say see how important it is to you to forgo an epi. Better yet if you want to keep it a free birth just make sure you have someone that can remind you that you don't want an epi if you do go that route. Around here a doula is around $500 and so you could always try that route. GL with your decision

kridda_88's picture
Joined: 01/28/08
Posts: 1798

I was induced with my first at 41 weeks, pit, epidural, all the fun stuff. With my second I went into labor naturally on my own at 39 weeks 2 days. Had a completely natural birth and was in labor in the hospital for 2 hours one of which was the observation hour. First labor was 14 hours and second was 4 hours. My natural labor was a breeze compared to my induced. My contractions never got closer than 2 minutes apart. I'm choosing a midwife, who is about $2000 with out insurance which I was more than willing to pay out of pocket. Our insurance covers 100% of the hospital birth and our midwife just recently got covered under our insurance but like I said I was more than willing to pay the out of pocket for a midwife. I feel it would be more than worth the money. BUT that being said you have to do what feels right to you and what you feel comfortable with. Good luck with your decision and you can have a natural birth at a hospital, my second was. Just labor at home as long as possible before going in, then you will be less likely to get an epi because you wont have time to. Wink

DitherDither's picture
Joined: 04/16/09
Posts: 152

I had pit with my first, and it was nearly unbearable, like your experience. I was about 5-6cm when they started the pit, and only labored with it for 5 hours. But...OMG the contractions were terrible. I was passing out in between them, as they were all on top of each other.

For my second, I was expecting them to be much the same, and they weren't at all. Even my midwife had warned me that "transition is transition, with or without pit." For me, the contractions without pit were, well, not so bad! Don't get me wrong, it was still tough, particularly the crowning, etc, but it was nothing like with my first. More comparable, IMO, to a really bad stomach bug.

Are there CNMs who deliver at your hospital? And the idea of a doula is a good one. With the right support system, having a great NCB in a hospital is definitely possible!

MrsMangoBabe's picture
Joined: 04/09/07
Posts: 2276

I had a pit induction with my first, but we did a very low dose. It was tough, but I did fine until they told me I wasn't progressing, so they were upping the dose, then I couldn't handle it mentally/emotionally anymore and we decided to do an epidural.

I had a spontaneous labor and natural hospital birth with my second--I stayed home for seven hours of labor until contractions were about 2 min. appart, and then we got in the car for the 25 min. drive to the hospital. When my OB checked me, I was 8cm, and at that point, I felt like I was pretty much past the point of no return--probably wouldn't be time for the tiny hospital I was birthing at to get me an epidural at that point. I was coping really well still at that point, anyway. I feel like there was a difference in the contraction patterns and how the strength of them chaged, though they were similar-feeling in general, but mostly the difference for me was mental--knowing my body was doing it on it's own made it easier for me. I was also more prepared the second time (did Hypnobabies), so it is hard to compare. I had a cervical lip, which sucked, and I think my OB told me to push before I really had the true urge. But, overall, it was a good birth.

I am planning a homebirth this time, but our insurance reimburses for homebirth. Do you have an HMO or a PPO insurance plan? If you have an HMO, they probably won't pay, but a PPO you might be able to get them to pay something, if you are using a midwife who is licensed in your state, you should be able to get them to pay at the out-of-network rate. I really want the personalized and gentle care of homebirth and to avoid the stress of the hospital this time.

Renee_S's picture
Joined: 08/05/09
Posts: 39

I did find a CNM that I can deliver with at the hospital. And our hospital offers a doula for free with every birth if you want one. I think I'm going to do a few appointments with the midwife plus a tour of the hospital (we moved so it's a new hospital), and then see how comfortable I feel. And if I'm not comfortable with the hospital DH said he will support the decision for a homebirth.

I'm glad to hear your stories about pit and then without. I labored for 7 hours on pit and even though the last 2 were torture once they started coming in threes with less than a minute before the next set, I really could have made it except they wanted to increase the dose because I wasn't progressing. That's when I decided on the epi and it was like heaven, especially because I was holding my baby just 30 minutes later. If I would have just been able to get a break between contrax on the pit I think I'd have been fine. My labor was only 9 hours total, and I feel like my second one might go very fast. My mom had a 2 hour labor for her second and my sister had 8 hours with her second.

We have a 40 min drive to the hospital, how did you ladies know when to go in? Getting there past the point of being able to get an epidural would be so ideal for me, but I'm afraid of waiting to long at home. Thinking of how my contractions felt and thinking about riding in the car for that long during them... ugh.

We have an HMO and they definitely won't cover anything for at home. I really want to have a home birth, but we plan to have a lot more children, so maybe next time I can save up beforehand knowing that our ins won't cover anything.
Brittany- I have the hypnobabies book, did you do the home course or take a class? I felt how you said with my first, mentally defeated because I wasn't progressing. If I got to the hospital when I was past 4cm I think I would be way more encouraged to keep going.

Starryblue702's picture
Joined: 04/06/11
Posts: 5454

I had my first baby naturally at the hospital with no drugs at all. Labor was very difficult (about 12 hours) and I had very terrible back labor. I ended up having an epesiotomy and tearing internally in two places. Recovery was very difficult, and with everything involved I regret very much not getting an epidural.

I was induced with pit with my second and third babies for different reasons, I actually found the labor to be somewhat tolerable. I never forgot how horribly painful my first was and because of that I caved with #2 & 3 and got an epidural, as I couldn't imagine going through what I did with baby #1 again. Please bear in mind that I had back labor, which not all women have, and it makes the pain much worse than having just normal contractions.

IMHO my labor with the pit was totally manageable, I held out as long as I could without the epi. As far as what I think you should do, do whatever you feel more comfortable with. If you can afford to birth at home, then go for it if it's what you want! But, don't go broke if you can't afford the midwife just to have a natural childbirth. Nurses in the hospital (at least at mine) are very attentive and as long as you give them your birthing plan stipulating that you do not want any drugs, they're really good about sticking to that. And you never know what kind of labor you might have (back?)... it's always better to be safe than sorry. Good luck to you!

MrsMangoBabe's picture
Joined: 04/09/07
Posts: 2276

I did the Hypnobabies home study (the one that comes with the set of 6 CDs) since there aren't any instructors in my area yet (I am actually in the process of becoming one!). It was also a good option for a second baby because you don't have to find childcare to attend the class. But there are a lot of benefits to doing a live course that you don't get with home study. But if the philosophy resonates with you, I recommend doing one of them.

boilermaker's picture
Joined: 08/21/02
Posts: 1984

I had pit with my first (horrible, terribly painful augmentation bc I wasn't progressing "fast enough"), and natural births for my last three. The last two were at home.

Check with your HMO directly. Are midwives licensed in your state? If so, you should be able to petition and have them covered as an "out of network provider", for which they will typically cover 70% or so, depending upon your plan. Check with your midwives directly and then the HMO. I was told mine wouldn't pay anything and in the end we got them to cover most of it (it is in their best interest to cover it, it is WAY cheaper than a hospital birth....) Just start making calls and pushing to get answers. Mine was covered by Anthem. Essentially they covered everything in the prenatal care and less of the actual "birth"-- every prenatal appointment, blood test, etc.....

Having had two hospital births and two home births, I, personally, would pay for the homebirth. For me (and my husband) we so preferred being at home. I felt safer there and better cared for there-- but only you can make that choice.

GL!

Spacers's picture
Joined: 12/29/03
Posts: 4100

Your labor was 7 hours total & they said you weren't progressing fast enough? :eek: That's ridiculous. You probably could have handled it if they hadn't raised the pit, or even turned it off once your labor was well-established. You definitely need someone else there to help you think about these things when you're in the moment. I doubt I'd trust a hospital-provided doula, though. I'd be concerned that they wouldn't be impartial and truly on my side. At the very least, spring the $500 for an independent doula.

I know the lure of "free" birth is great, but having a great birth is priceless. Blum 3 Start setting aside money now, that's about $300 per month. After the first of the year, start rolling pre-tax money into a medical spending account. Many midwives are creative in working out payment plans; ask if she will write a contract allowing a very minimal payment per month with the bulk due after the first of the year so you can pay her with the medical spending account money. And then consider the HMO as no-cost backup in case you or the baby need it.

Also, Boilermaker mentioned seeing if your HMO will pay the midwife. In some states, that works. In California, it probably won't if you have Kaiser, but the others it might because they aren't true "we provide everything in one place" HMOs. You'll have to pay your midwife up front and bill the HMO, but I know people IRL who have gotten Blue Shield HMO to pay for some of their home birth costs as an out-of-network provider. The argument is that the insurance pays for the person providing the service, not the place where it takes place. That said, I chose to do dual care with my HMO since it was free. I got prenatal bloodwork done there, ultrasounds, fetal monitoring when I went overdue, etc. When I did end up in the hospital, it was nice to know they had complete records for me. Especially with Tiven, things happened so quickly that my midwife didn't arrive until after she was born.

MrsMangoBabe's picture
Joined: 04/09/07
Posts: 2276

As for when to go to the hospital--I'd say trust your intuition to let you know and learn to recognize the signs, other than cervical dilation, of active labor and transition (or have someone with you who knows these--a doula that can come to your house can be good for this). You can also check your own cervix if your water hasn't broken--I did this in labor with DS--since I could still feel cervix, but it was open, I knew I was in labor but still had time. You may also want to find some positive accidental homebirth stories to read, so you can recognize that as a possibility--they usually go well.

sweetsriracha's picture
Joined: 03/29/11
Posts: 1318

I agree that this is a very personal choice... I was unfortunately insured with Kaiser at the beginning of pregnancy. No options for homebirth and a local C-section rate much higher than the national average. We've made some huge adjustments, including a small gap in insurance coverage for me, and we're definitely paying a lot for a birth center birth with a certified midwife -- and I'm happy in this decision!

Renee_S's picture
Joined: 08/05/09
Posts: 39

Thanks for all the input.

I'm meeting with the hospital midwife on monday to see how I feel about her. We are also going to meet with the homebirth midwife sometime this month or next month. I'm just going to keep my options open for a little while.

Thanks for the info on insurance, I will be giving ours a call. Honestly, I don't mind paying for the homebirth, and DH would rather not, but is supportive of what I want. But, if I can have a good NCB at the hospital I'm ok with that too. I'd like to just take the money out of our tax return next year and set it aside for our next birth and plan a homebirth from the beginning if we don't do it this time. I really, really want at least one homebirth.

Spacers- It does sound ridiculous now. The first 6.5 hours hours on pit I went from a 3.5 to a 4. They shut off the pit at 6.5 hours once the contractions were out of control, and I stayed at a 4 for the next hour so they wanted to turn it back on. That was the end for me, and the second I had the epi in I went from 4 to complete in seconds. I literally felt the baby sliding all the way down. Looking back, I would have changed things, but after six and a half hours of almost no change, I didn't bother arguing with turning the pit back on. This time, I plan on refusing it regardless of what they say. Also, I was in for an induction in the first place last time. I had 3 weeks of prodermal labor, wasn't sleeping, and was losing weight and having bp issues. This time, that's not going to be a good enough reason for an induction.

Brittany- I'm looking forward to getting the hypnobabies material. Did you have doubts about it working? I want it to work ,and I believe the stories, but I still have doubts it will actually work.

MrsMangoBabe's picture
Joined: 04/09/07
Posts: 2276

I did have doubts about Hypnobabies. I think that it is very normal to doubt that it is possible to have a comfortable birth when you have experienced pain in birth before. One thing that I think is important to recognize about Hypnobabies is that it doesn't guarantee a painless birth--there are too many variables in individual births for them all to be completely comfortable. What Hypnobabies provides is an unparallelled (IMO) system for automatic relaxation and teaches you how to increase your body's endorphins. You will still feel contractions, but you learn to interpret the sensation as not painful. My son's birth was not 100% painless, but the tools I learned in Hypnobabies helped me A LOT to enjoy the birth and meet my goal of having a natural birth.