Pants on Fire

Last night I had my first "shadow care" appointment. Shadow care is when you seek additional prenatal care from more "traditional" sources so that your insurance company will pay for things like lab work and testing. We didn't have to do it last time because our PPO would pay for whatever the midwife ordered. We have an HMO now, and we're doubly concerned that, should we transfer to the hospital again, the insurance won't pay unless we've established care with an approved provider. *sigh* So, off to a hospital practice I went.

I chose a group of midwives that "deliver" (pet peeve, right there -- MOM delivers, duh) at the major university hospital where I had my son. This would be the most likely place for transfer again since that hospital is Baby Friendly and the least hostile to homebirth transfers.

It took over an hour for me to see the midwife. AN HOUR. I've never even waited a minute for a homebirth midwife. The nurse told me to strip down and put on a hospital gown. I told her that I would like to meet the midwife with my clothes on, thank you very much. I didn't need a pap and wasn't having any bleeding or pain, so there was no reason for anyone to be sticking their hands up anywhere. By this point, is it any wonder my white-coat hypertension set in?

The midwife herself was really great. She was encouraging and supportive. She definitely believes in VBAC and was very excited about my prospects. Except for not having a vaginal birth before, I met all the criteria for an ideal shot at a VBAC.

Here's the problem: the hospital. The hospital "allows" VBAC's, but only with some pretty severe restrictions. Mom has to be on the monitors the entire time and there are no telemetry units (those are the monitors that are wireless and allow some degree of freedom of movement). I'd have to have an IV the whole time -- no heplock (that's a "port" they put in your hand so they can get an IV in you quickly if needed, but doesn't have you tied to a pole the whole time). She said the IV was going to be necessary anyway since I wouldn't be allowed anything by mouth when I arrived, not even water.

I asked if I would be free to walk around, and was told I would be. But with the monitors, my range of motion would basically be as far as the wires from the belts to the machines. So that would leave me pacing back and forth in front of the machine. Fun! This also means no water -- not even a hot shower to help with the contractions, let alone a warm bath.

Labor has to progress rather briskly, a period of two hours without cervical changes is "arrest" -- and that means either augmentation with pitocin (which I would refuse because it greatly increases rupture risk) or surgery. Lovely.

Basically, the midwife is not happy with these restrictions and suggested I get a monotrice (a doula who's also a midwife) and labor at home until the absolute last moment. She would want me to come to the hospital pushing, basically. Doesn't THAT sound like a lovely car ride?

So, in all, I think there are more than enough reasons why I am NOT switching to hospital care. The differences between the birth environments are like night and day. In the hospital I'd be tied to a machine, hungry, thirsty, watching the clock, pacing back and forth in a range of about five feet, and only occasionally getting support from the staff (whether or not I get a VBAC-supportive nurse is entirely the luck of the draw). At home I will be free to move about, take a shower, get in the tub, eat when I'm hungry, drink when I'm thirsty, will have constant support from a team of women I know very well and who have been chosen for both their expertise and confidence in VBAC, and will be a very short drive to several hospitals in the small chance we need OB care.

Does anyone really think that's a hard choice?

The upside is I have my orders for my blood and urine tests, as well as the sonogram. I'll get these done and then tell the midwife we are going to transfer care to a homebirth midwife. I really don't think she'll be surprised after the discussion we had last night.

But yeah, I'm a big fat liar. Oh well. :-P

(We have a prenatal with the "REAL" midwife on Sunday and I can't wait!)