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October 3, 2003
September 3rd-October 3rd: The Midwife Runaround
Suddenly my pregnancy is flying by, and I have this feeling I’m going to wake up one day and be in labor. With the house sucking up most of my brainpower, writing up all the pregnancy-related things that have occurred got put on the back burner. Hopefully, I’ll be able to get all of September explained so I won’t have to dig too far back into my sketchy memory next time.
Finally, the big birth decision
The night before we closed on the house, something went ‘ding’ in Dan’s head and he remarked at dinner “We really should have a homebirth, shouldn’t we?” Now, I’ve got to say that my heart has been set on homebirth since spring. I called a midwife before we were even ttc’ing. But once we got pregnant, Dan sort of freaked out at the prospect of homebirth. He’s been totally with me refusing all the testing and seeing how many episiotomies and C-sections occur in the CNM’s practice. But the finality of turning over my care to a homebirth midwife (CNM’s can’t attend homebirths in Minnesota) was too much for him until now. I think the short appointments and repeated refusals to the triple screen triggered in him the realization that the CNM wasn’t ever really going to know us. That he’d have to play the same role during labor, refusing Pit, or Demerol, or whatever. And he’d rather not do that. Some women make their prenatal decisions on their own and assume their partners will get used to the idea. I couldn’t do that. I needed to have Dan’s assent to feel like I could really start planning on a homebirth.
My only hesitations about homebirth were fearing paying out of pocket and not having a back-up doc if I needed to transfer care. I convinced myself long ago that homebirth is completely safe (if not more so than hospital birth), so long as I remain low risk. But since all the midwives we spoke with mentioned careful screening, I know that if I develop hypertension, or have a prolapsed cord, or a variety of other issues, I’ll end up in the hospital. And I’d rather not be meeting a physician for the first time that late in the game, especially if I don’t know whether he/she would treat me like an idiot for attempting a homebirth. Also, my insurance will cover every penny of a hospital birth without question, but it’s really chancy to assume that a homebirth would even be partially covered.
Once Dan made his declaration approving homebirth, I got the momentum I needed to call the midwives recommended to me. We’d met with J a month earlier (oh my goodness, I STILL haven’t gotten my sweater back from her), and I’d talked to K on the phone the week before. That night, I called a third midwife, G, that J had recommended. She seemed very nice, but told me right away that she was planning a vacation near the end of my pregnancy and the timing wasn’t going to work out. I tried calling K’s partner, but her phone kept cutting out mid-ring. Very mysterious. G had given me the phone number of a fifth midwife, JK, and I got ahold of her. JK and I didn’t talk much, but just set up a meeting at a neighborhood coffee shop for the next week.
The next day (we’re up to the closing date again, Sept 4th), I checked my messages and had messages from both K and her partner. I called K first, since I’d already talked with her, and if she’d decided to attend Feb/March births, that would affect the nature of my call to her partner. K, who I will call Kim from here on out, was going to return to her practice in time for my pregnancy—yippee! We arranged to meet the following Wednesday. She and her partner, Kathy (can’t have two people named K—just too confusing) would both meet us at her home, as they did for all their prenatals.
I decided that three midwife interviews were plenty and stopped calling people to arrange more. Ahhh. That gave us the time and energy to spend the weekend tearing up our new house, as I explained (in far too much detail, I’m sure) last entry.
Zooming forward to the interviews…
Our appointment with Kim and Kathy was over lunch on Wednesday the 10th. Dan picked me up from work downtown and we drove across the city to Kim’s house. She lives in a lovely older neighborhood, and her house is exactly how I’d like mine to be if we ever make all the improvements I’ve got swimming through my brain. A husband and toddler were waiting for their wife/mom and little one to finish. I saw the newest issue of Mothering, but before I could reach for it, the toddler asked if I’d read her a book. She climbed on my lap, and I had fun going through the story with her until her mom was finished. If the midwives always produce little ones as enchanting as she was, I’m in good shape.
The appointment itself was held in a cozily decorated bedroom. I’d brought a list of questions with me, but I was more interested in the vibe we got from them. Kim had told me over the phone that they kept statistics of their births. It turned out to be just a list of emergency transfers, which was interesting, but not as informative as I’d hoped. To me, the emergency transfers aren’t as important to know about as the non-emergency ones. Placental abruptions can’t be prevented, so if one midwife has been unlucky enough to experience a lot of them, as long as they did the right thing and transferred to a hospital immediately, there’s not too much I can learn about the midwives’ approach by hearing about them. If a midwife has lots of non-emergency transports however, that could mean that they don’t trust themselves enough to handle slight complications. So I was slightly comforted to know that they’d dealt with a variety of complications.
The hour and a half we spent chatting with them flew by. They used dolls to explain baby positioning to us, gave us a packet of their reasons they’d transport or consult doctors, and generally made us feel very comfortable. They have an ob they trust when transfer of care becomes necessary, and they even have a provider number of some sort for my insurance company. The legislation passed to license midwives a few years ago was written in Kim’s living room. We did learn that licensed midwives (that they both are) are required to transfer care at 42 weeks, which was disappointing. When I asked about episiotomies, they declared themselves “Protectors of Perineums” who do everything possible to help women avoid tearing and cuts. They also explained that they felt very strongly that midwives should work in pairs so that there is always a trained professional available for both the mother and baby (for twins, they’d bring in a third midwife). As we left, I knew that I wanted these women to be my caregivers.
Thursday afternoon, we had our third midwife interview, with JK. I had been told she was the least experienced, which turned out to only be sort of true. She trained in Texas and spent a few years working at a birth center that worked mostly with moms who couldn’t afford to go anywhere else. She had been part of about 200 births, which is about the same as Kim and Kathy, although only about 100 of JK’s were homebirths. She seemed to have been quite lucky in avoiding emergency transfers—she had little to no experience with them. She works with an apprentice, and is a CPM but is not state licensed. We enjoyed talking with her, but felt we’d had more of a connection with Kim and Kathy.
A couple interesting tidbits—all the midwives we met looked younger than they were, by at least a decade. You’d think the odd hours wouldn’t help that. They’d also all had 3 or 4 children themselves, varying in age between grade school and mid-twenties. They were all very warm and easy to talk to, while making us feel like our opinions were important. Midwives seem like good people to have as friends!
We didn’t need to talk long to decide that we’d be calling Kim and Kathy back. It just seemed like the logical choice. Their licensed status might be just enough to convince our skeptical family and friends. The potential for insurance coverage was very alluring. And they were wonderful women to talk with—it was easy to envision myself returning for checkups with them.
I called JK and told her that we’d decided on other caregivers. I tried calling J, but got a busy signal and my preggo brain forgot to try again. Then a few days later, we realized we should tell Kim and Kathy, too :) When I called Kim, she mentioned that since she was originally planning to be on sabbatical through March/April, she might not be at my prenatals until January. Also, there was some fuzziness because Kathy had already planned a 10 day vacation in mid-February. Kim said they’d be looking into a back-up for when Kathy was gone, probably talking to J. That sounded fine to me, since J has more experience than any other midwife in the Twin Cities. I was sort of disappointed that Kim wouldn’t be at my early prenatals, but I realized there’d only be three before January anyway. Kim said Kathy would call me and arrange our first prenatal once she got home from a vacation around September 21st.
Last Visit to the HMO
September 16th, I went back to my CNM for my third prenatal (at 17 weeks, 3 days). We wanted to be honest with her that we wouldn’t be returning, but since we didn’t know how she’d react, we held off until the end to talk about it. Just like before, she didn’t have too much to say. She offered us the triple screen and the ultrasound again, and we said we were sure we didn’t want them. She commented that we’d be one of the few couples that were really surprised when the baby came. I thought that remark was over the top. It’s not like we’re the only people ever to not have an ultrasound. Secondly, plenty of people who do have ultrasounds choose not to find out the baby’s sex. Thirdly, we’d been told when we signed up with her that ultrasounds were not given as a matter of routine. Come on now, you cannot tell me that there was any indication that we needed one. How many times do we need to refuse the darn thing?
Once she let up on the testing stuff, I asked her about nutrition. I know my diet pretty much sucks, and unless someone whips me into shape, I’m never going to improve. So I asked if there were foods I should be making sure to eat, and she just told me to be balanced and do the best I could. I am really looking forward to getting better advice and more harassment from the CPM’s on food issues.
It was much easier to hear the baby’s heartbeat this time. This was probably the last time we’ll hear it on Doppler because the CPM’s all use fetoscopes instead. I’m not sure if I’ll be able to hear it then, or just the midwives. At the last appointment, the heartbeat sounded smaller. This time, it was fast (as it should be), but sounded more like an adult’s, going whoo-whoosh, whoo-whoosh, whoo-whoosh. So cool. She didn’t take the beats per minute, so I can’t determine where I fit in the old wives’ tale about gender.
As the appointment winded down, the CNM mentioned my returning in four weeks. I stammered a bit and finally choked out that we’d decided to switch to a homebirth practice. She wasn’t too phased—I think our all-natural, all the time stance kept it from being too shocking. She even offered to go make copies of all my records. I’d expected to discuss that with the receptionist, or maybe just call the office, so that part was easier than I’d hoped. She wished us well, and that was that. Another 20 minute appointment, and no hard feelings on either side. I sort of wished she was a little less nonchalant.
Reading my records was fairly amusing. Aside from my blood pressure and weight readings (oh, I was at X + 7.5 this time around and 108/60 or so), most of my chart consisted of my repeated test refusals. The blood work was the most important thing for the midwives to see, since they don’t do labwork themselves. Yay, no HIV or syphilis for me!
So Everything’s Settled, Right?
Now, for the past three weeks, it seemed like everything was figured out. I was just waiting for Kathy to call and set up a prenatal. The 21st came and went, and finally this Wednesday (the 1st) I called her and left a message as I left work. 15 minutes later, she called me back from Kim’s house before even hearing her messages. I was excited to finally hear from her until she clarified that the reason for her call was to inform me that they’d decided they couldn’t take me after all. They’d decided that the timing was going to be too stressful for all of us, since she would be out of town in February and Kim was cutting short her sabbatical time. They’d had one mom go into labor before just as Kim came home from vacation, and it was a hard situation for everybody to deal with. They didn’t think it would be right to knowingly repeat that.
My take on it is that Kim’s the pushover of the two and would have done whatever she could to have me, even though it wasn’t her original plan, while Kathy was more hesitant to sign on with a mom when they couldn’t be sure they’d both be there.
I was on the bus when she called, and once I realized this was a decision they had made, and I wasn’t going to convince them otherwise, I pretty much lost it. Thank goodness only four other people were on the bus, because it was all I could do to keep from sobbing. I had tears streaming down my face, and I was trying to stay composed so I didn’t make Kathy feel completely terrible or make a fool of myself on the bus. But 19 week preggos are not known for their ability to keep emotions checked. I got off the bus as soon as I could (eight blocks early), and by then I’d realized that J, the more experienced, non-licensed midwife might make more sense for us in the long run.
Kathy asked if we’d talked to anyone else, and I told her the names of the two we had (and mentioned that we’d already told them that we were going with Kim and Kathy), and she said that J (who I will now refer to as Jeanne), works with the same person they do to convince insurance companies to cough up the money. She also said that Jeanne knows their backup ob, so I could still use her. Those two issues were the biggest reasons I wanted to go with Kim and Kathy, so hearing that they’d also be available with Jeanne was a relief.
I ended up walking the eight blocks home sobbing anyway. Now, I hadn’t even had one prenatal with these women, but I already felt like I could trust them, and I was just overwhelmed by the abandonment I felt. The worst part was that Dan had just gone to class and I couldn’t get ahold of him for three hours. I wanted to call someone to cry to, but there wasn’t anyone that made sense. My best friend, who lives in San Francisco, has a tendency to call and cry on me, but she is only tentatively accepting our homebirth decision and I didn’t want to jeopardize that. I certainly couldn’t call my mom, who I usually go to for this sort of thing. It just sucked.
The contrast between saying goodbye to the CNM and being turned away by the CPM’s I’d only met once really struck me. I already felt a strong connection to them that had never developed at all with the CNM.
The New Deal
That night, I couldn’t get rid of the sniffles, and when Dan got home, I broke down again explaining what had happened. I eventually fell asleep on the couch, where Dan let me stay until he went to bed at 1am.
Thursday morning, I had that lovely spent-too-much-time-crying worn out feeling, but by afternoon, I’d gotten myself together. After most people had left the office for the night, I called Jeanne. As soon as I said my name, she said that she’d talked to both Kim and Kathy since the previous day and that they’d worked out a possible solution if I was willing to take it.
I knew that Jeanne and Kathy had worked together quite a few times, but I did not know that Jeanne and Kim had assisted moms together twice before, too. Jeanne’s February schedule was pretty open, but she was nervous about my going late because her March was fairly booked. Her solution was that she could be my primary midwife, and Kim would be my secondary. Since Kim was planning to take a few months off, she might not attend my first few prenatals, but Jeanne would always be there. Then, if I’m in labor while one of her March moms is too, the other moms need to take priority because she agreed to assist them ages ago. If that happens, Kathy will come to be the backup midwife. Regardless of when I go into labor, two of them will be there.
Jeanne’s idea sounded good to me, and I called Kim this morning to tell her we would go ahead with the plan. Some of the logistics aren’t clear yet—which prenatals will Kim attend, where will they be, when will they be, etc. The two of them usually charge different amounts, so I don’t know how that will work. But they’ve promised to work out those things and call me within the next week to set up a prenatal. Jeanne mentioned possibly meeting every two or three weeks right from the start so we can get to know each other quicker.
I’m feeling confident that this will work out for all of us, and I’m so glad to be getting settled since I’m rapidly approaching the halfway mark (tomorrow!!) of this pregnancy. Now, as long as I hear from one of them in the next few days, I think everything will be alright.
TTM: Has anyone else taken this long to settle on a caregiver? Do you think I’m completely insane for taking the route I did?
I am really, really going to try to write another entry in the next few days. There are so many things going on that I want to share, but this entry needs to end here.
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