Questions for CPM/HB?
I've been around here from time to time as we've had our babies. I'm not sure if anyone remembers me, but I recognize some of your names :)
I am about 6w with #4. Our first two were born at a birth center with a CNM 3 blocks from a major hospital. Great experiences! Our third was born in a hospital (birth center wasn't an option because we'd moved) with an OB. It was not a good experience, more because of the hospital staff than the OB, but that is a story for another time :(
We've since moved again. I'm not at all excited to birth in a hospital. A birth center isn't an option here. There aren't any CNMs in our area who will HB and it is illegal for CPMs to attend HB. However, there is a CPM that practices in our area with a supporting OB who knows what she does.
We're going to meet with her. I've never considered a HB before. What kinds of things do I want to talk to her about? What kinds of questions do we ask? The closest hospital is 30 mins and the OB's hospital (if we had to transfer to him) is 45 mins. Anything regarding distances we should discuss? I've had a lot of respect for women who HB but it never seemed like a viable option for us until now.
Thanks for the input!
Generally, if you're within 30 minutes of *any* hospital, then home birth is considered safe. If there's an emergency, she'll call the hospital to let them know you're on the way, and it's possible an ambulance can meet you along the way to get you there faster. The fact is that many of the things that go wrong in a hospital, go wrong because you're in the hospital, kwim? And a trained midwife knows how to deal with a lot of things without jumping to surgery. She should carry oxygen with a baby-sized mask, pitocin & methergin for bleeding, and supplies for suturing a minor tear.
I would ask about what things might risk you out of home birth, and what of those are negotiable -- can you see the OB more often or have regular NSTs or get sign-off from a specialist, etc. Also, if you risk out of home birth, remember that you don't *have* to stay with her backup OB unless you want to. She's probably going to ask how quickly your prior births went, and some of the details about why you weren't happy with the last one. You'll want to know where she lives and works, because she's the one coming to you when it's time. Does she have an assistant or apprentice or some other backup; what happens if she gets sick or has another birth at the same time? With this being your fourth, that shouldn't be a deal breaker because you could totally do this on your own if you had to, but it's good information to have. Ask about how many clients she takes each month, and about her transfer rate. It's OK if she has a slightly higher rate for FTMs; that's quite normal. Ask about the reasons for her last 3 or 4 transfers. What happens if you transfer, does she stay with you as labor support, does the OB come in & care for you, or does she just drop you off & go home? She should offer you at least three references who had births with her; also ask for one more reference who did not have a successful home birth. You want to hear about how she deals with things not going well.
Keep up posted! Fingers crossed that you love her & are blissfully happy with this option. If not, then could you move temporarily to be closer to a birth center around your due date? Stay with relatives or a good friend, or book a short-term rental or long-term hotel, etc. If a birth center is covered by your insurance, then the difference in what you'd pay an unlicensed midwife out of pocket could go toward rental costs. Just a thought if you're in a really bad birth area. Sad that those still exist....
I think Stacey covered it all! ;)
I'll add knowing your general area of the country might help us to find other options for you depending.
I promise I didn't fall off the face of the earth…the stomach bug hit our house for two weeks (ugh!) and then MS hit (double ugh!). I'm finally finding my way out of the chaos. Wow.
Thanks for the info and tips, Spacers! That's really helpful. We have our meeting with the CPM on Friday morning. Hubs is pretty excited, I feel really ambivalent at this point about where we birth. Honestly, even though this babe was planned, I've had a hard time getting excited -- we got preggers SUPER fast, and I just feel overwhelmed about pregnancy (MS, body changes), birthing this child and then caring for 4 small ones under 7 (and we homeschool). I'm hoping that meeting with her will help me process through some of that as we get to know her. I also have an appointment with her backup OB, who comes highly recommended in our area for natural birth, in another two weeks.
We currently live in Southern Illinois -- but as my second labor was precipitous, we live too far from KY, IN or MO to look at options there. As far as hospitals go, we're actually 5 mins from the county hospital, but the ER is awful; 30 mins from the closest hospital with L&D, 45 from our preferred hospital. If we decide not to use this CPM, her back-up recently hired a CNM. If he's as open to natural birth as I've heard, maybe she's not very medical-minded. I might meet with her as well.
Ah, just an update on me :) Thanks again for the insight! I'll give an update after our meeting with CPM on Friday!
If there's a real emergency, all you need is a ready-to-operating room with anesthesiologist, so the county hospital would suffice. Alternately, an ambulance could get you to your chosen hospital in half the time it would take you to drive. And it's possible that something non-emergency but that needs to be dealt with in a hospital, like a retained placenta or 3rd degree tear, your backup OB might be able to do in their ER; if not, the drive to another hospital won't be so bad after you're no longer in labor. You mentioned a few other states, what about Indiana? I know there is a hospital near Evansville that does VBAC so it can't be *that* bad, I'd think. At least there used to be a hospital that did VBAC, many many years ago someone here on pg.org was looking to VBAC and I remember the general area she said was Evansville.
Thats really interesting what you said about Evansville. A friend's sister is a doula there. I chatted with my friend this evening and, according to her sister, the local c-section rate there is astronomical (she said 60%, but that's almost unbelievable and second-hand). Glad someone in the area is supporting VBACs!
Our area isn't all that bad - I just have limited options for location to birth. But, I guess that's common for a rural location - we just lived in the city for seven years before moving here, so it's new to me! I think this back-up OB is pretty well recommended in the natural birth community.
I've been reading a recent peer-reviewed article on HB (New Studies Confirm Safety of Home Birth With Midwives in the U.S. | Midwives Alliance of North America) and I'm feeling more interested in HB :) looking forward to meeting the CPM tomorrow!