Mar 9, 2009

Home Birth Manifesto III--Kiddo #2...

Part I; Part II; Part IV; Safety; Logistics

So to recap thus far, His Highness was born in a hospital, I went natural, and in the process I learned a few things that I wanted to do differently for subsequent kids. Boom; done.

Fast forward to August of '08, when we found we were expecting another baby. Yay us! The immediate issue was that we were no longer living in Massachusetts. We were in Lompoc CA at the time, but were rapidly approaching our relocation to lovely Cheyenne, so we needed to make some decisions as far as where to go for the maternity care.

Had we still been in Massachusetts, I actually would've been less likely to go with a homebirth. I had been happy enough with the results the first time through, and I was confident that I could go with the same docs & hospital and still make the changes I wanted. I haven't even mentioned the Cat Daddy in all of this yet, have I. He was with me the whole way, and entirely supportive & cool, and also very happy with our experiences with His Highness. For him staying with the same docs would've been a no-brainer.

But we weren't in Mass; we were headed to Cheyenne. So I started researching the options. I looked up OBs and midwives in the area, including Fort Collins, Greeley, etc. I called what is considered the main OB practice in Cheyenne, and talked to one of the triage nurses. I started out with something like "I'm very crunchy about the childbirth. How easy would it be for me to labor and birth naturally and not have to fight off unnecessary interventions?" Her immediate response was, "Wellll..." which told me everything I needed to know (and I appreciated her honesty). Boiling down her answers to all my other questions, it wouldn't have been a problem in theory, but I got the feeling I'd need to do a lot of self-advocacy, and quite possibly start kicking & swearing to fend off the needles. I also spoke with some ladies who had given birth in Cheyenne and the consensus was "If you really want to give birth naturally, don't give birth in Cheyenne." So that settled that.

By this point I had already broached the topic of home birth with the Cat Daddy. He wasn't really comfortable with the idea, so we talked about his concerns and reservations and all that. I pointed out the advantages for him. We'd have access to our own food, our own TV, internet, and even the PS3. He wouldn't have to go find a waiting room or cafeteria when he wanted a break, and could sleep in his own bed if things were going thru the night (the last time he snoozed on a thick floor pad the Rootses had very kindly brought for him). No driving back & forth to the hospital with His Highness, dinkin' around the hospital room, waiting until time to go home. While this all sounded good, he still preferred the hospital or even a birth center. Fair enough--I promised him I'd keep exploring the options, and he knew I would do the due diligence.

Over the course of the research, my options began to dwindle, and I began to feel nervous. The closest birth center is in Denver, about 2 hours away, and I preferred not to make that trek if I could avoid it. I had looked up hospital midwives and wasn't finding a whole lot of options. I really liked what I saw on the website for this one midwifery practice, but when I called they said they weren't taking any new maternity patients--rats! I was willing to travel the 45 min to Fort Collins, but had no idea what to expect from the practices in that area. Several OB practices include midwives, even the one I spoke with on the phone. But if the midwife isn't on call when you go into labor, you get the doctor on call, same as everyone else, and the doc may or may not be willing to acquiesce to the differences in approach. By this point I really, really wanted to strongly consider home birth.

I started putting out feelers for local home birth midwives. Wyoming has pretty strict midwifery laws. While homebirth isn't all-out illegal like in some states, only certified nurse midwives may legally attend births (as opposed to certified professional midwives or some other variant), and a home birth CNM can be hard to find.

I had also contacted my insurance company to see if they even covered home births, and it turns out they do, but only with a certified nurse midwife. So to have any hope of getting any sort of coverage or reimbursement, I had to go with a CNM anyway. I knew there would still be some finagling involved to get everything set up--that's just how it goes when you want to do something that's different from the norm. But I looked at it this way: I could fight with insurance on this end getting an approval, or anticipate fighting with medical personnel while I was trying to relax and get a baby out. The Cat Daddy was all too prepared to battle docs, and to have great fun doing it, but guess which one I prefer?

Long story short (relatively speaking), I found my certified nurse midwife, who is based in Denver but also has clients in Cheyenne. I contacted her and asked some cursory questions...yes, she'll come up to Cheyenne, yes she takes my insurance, yes she can give me the shots for my Rh-negative blood type, etc. She also referred me to two people: a rep from her billing company who could tell me how they'd dealt with my insurance in the past, and a fellow mil-wife who had recently been a client of hers, who could share with me how she navigated the insurance maze.

Next I asked the Cat Daddy if we could schedule an interview with her, so we could both ask all our questions and see if it was something we wanted to move forward with. His response was along the lines of "I can tell your mind is made up already, so we might as well." He was totally right, but I still give him high praise for being willing to consider it. It meant a lot to me.

So we met with the midwife, discussed her 25 years of experience in both hospital and home settings, asked all our "what-ifs," and talked about our experiences and all things childbirth. It was fabulous. Even the Cat Daddy seemed pretty comfortable with what he was hearing. After she left I asked him, in a very mature manner, "Please please please please please can we do this?!??!?!" and he said "go for it" while I did a little dance and tried to wipe the goofy grin off my face.

The insurance battle then commenced. You would think insurance companies would be all over home birth for normal, low-risk pregnancies, as it means much less overall cost, but that is not the case. In addition to politics and such, home birth is still unusual enough that they balk when people want to do something different, and furthermore want them to pay for it.

Oddly enough, it wasn't so much a battle with the insurance company as it was trying to convince the insurance office on base that they do in fact cover home birth, and to stop telling the doctor they didn't, so he would put in the dang referral for me. All told it took about a month, and was all I dreamed and more with the frustration, but it worked out in the end, mostly due to a very helpful lady who is a something-blah-blah liaison on base. She called on her people and helped me talk the doctor into submitting the referral.

Finally, it was approved. I'm still not sure we'll be reimbursed for the entirety of the cost. In fact I know we won't; there are some out-of-pocket costs we are not even going to attempt submitting because they would be all, "Why on earth do you need a kiddie pool and a garden hose to give birth??" (more on this later) With the referral, however, we know we'll get at least a good chunk of the midwife's fees back, and it's worth it (to me anyway) to pay the difference.

A great side benefit to all this was meeting the mil-wife and hitting it off pretty well. Through her I found the moms group I belong to, and a lady in the group told me about her wonderful experiences with an OB practice in Fort Collins, where they are much more receptive to the natural childbirth (and apparently they treat you like a rockstar in the hospital there. Sounds good to me). While I'd already made the home birth decision, it was good to find this out, because if I end up needing some non-emergent medical care, going there will be my first choice.

Which I believe brings us to the conclusion of how we got here in the way of decision-making. Next I'll talk about our experiences since...

1 comment:

imagyst said...

Good for you! Hope everything goes well!