wonder(ing)land

It’s a lovely day in Brooklyn. The rumbling, all-nightly rain stopped for just long enough for my morning walk around the park which was perfect in every sense. It was still dark at 7am and the wetness of pavement combined with freshly shed leaves from neighborhood trees made for some heart-stopping prettiness.

When I got back, Chris and I had to scramble (again) to make our place a little more presentable. The occasion? Why, it was the midwife visit day, of course!

Every time I see her, I feel like I can fly. She makes me feel so confident and secure, it’s like she’s sprinkling faerie dust on me.

Things are well: belly is perfect 34.5 cm (corresponding to my 35 weeks), blood pressure 104/65 (I seem to have an even pattern here), baby’s little heart regular (she lets me and Chris listen on her stethoscope),  his head is down, his back turned toward my left side (optimal: chances for posterior labor are smaller), weight gain at 20lb (can go 5-10 more by the end).

We have 2 more weeks before I can stop worrying about preterm labor (and replace that with post-term worry :-), but even at 36 weeks (as early as next week!), she’s confident to assist me at giving birth at home.

Magical!

Cara was on vacation for a month, so I hadn’t seen her for what seemed like months (I did have another midwife check on me, however). We had a nice long visit today, after a week or so of postponement.  She had to push me to Friday because this week she attended 4 unexpected births. At least three of those, she surmises, could have potentially ended in a cesarean had they happen in a hospital or the birthing center. At the very least, the women would have been artificially induced for laboring too long; two of them labored for more than 2.5 days, water broken and all. Her mission in life, she said, is to do all that is in her power to prevent cesareans. (Apparently, her other mission is to protect woman’s perineum. On more than one occasion I heard her say: “First time mom, 10 pound baby, intact perineum.”)

I love asking her about the births she witnesses. I love, love how proud and satisfied she is with her work, how tireless and honest. She just let’s things happen naturally while monitoring for problems. That’s precious, rare, beautiful. It’s what I didn’t know I dreamed of.

So, because of her, I can report that we are doing fine over here. The boy’s head is wedged in my pelvis, his back is going along the left side of my belly (favorable), and what I thought was his head is actually his cutie-pie bum hitting my ribs. My belly measures 31 centimeters, which is exactly right at my 31 weeks (it should measure the number of weeks plus/minus 2). My weight gain is great, 15lb so far, it can be double that by the end. Blood sugar is good (the number is 120, should be under 140), as well as blood pressure (104/60). We’re so ok right now, I could dance.

We were recently asked a question (you might even say we were being interviewed) about our decision to have a home birth (aka homebirth). I mustered out an answer, tried to tell the story but was worried about being long-winded. Consequently, I didn’t do the greatest of jobs. To remedy that episode, and in the interest of not forgetting the long process this has been, I’ve been composing a write up.

This all got started sometime, I think, in 2003. I was working for a baby magazine (its online division) when a colleague, let’s call him Steve, announced that he and his wife just had their second child. At home. In a (kiddie?) pool of water. Just him, his wife and their older child. I remember that the whole office was surprised, emotions ranging from complete shock to astonished curiosity. Steve told me that he and his wife were so badly treated in the hospital during the birth of their first child that they wowed never to do that again.

I started reading.

Around that time, I worked close to Mid-Manhattan Library and there I went during my lunch breaks. I skimmed a whole lot of books on birth. I found out about midwives, history of birth, the need for mammals to be in quiet dark places while birthing, the way that endorphins help labor and pain, they way adrenalin stalls it. I read that a perfectly normal labor started in the comfort of one’s home can completely stop once moved to the hospital and its well lit, scary urgency. This sounded important, but we weren’t having kids so I put that pet project on hold.

Life went on. Bookclub was reading a book on mom who had a home birth. A friend birthed a child with midwives in Pittsburgh. A co-worker in New York had a c-section after being induced before her due date for having a large baby. She later told me not to let the doctors induce me, it wasn’t worth it, they did that so she wouldn’t have a c-section. “You’ll have a c-section anyways. It’s best if they don’t rush you,” she said.

Understanding that I would have to find a doctor who would be on my side, I started looking around. I found that many women recommended Eden Fromberg, a holistic doctor, who was definitely the person to go to for natural childbirth. But I couldn’t find her anywhere, she wasn’t working at the LICH anymore and there was no forwarding address. By the time I finally found her, sometime in 2005, I had probably one unnecessary gyn procedure under my belt. My insurance was accepted at her office (alas, it’s not anymore) and I thought I found my answer. However, at our first meeting I found out that no, she doesn’t deliver babies anymore and that, when I’m ready, she would recommend midwives for home birth. There it was again — this midwife/home birth thing! (At the time, Eden introduced me to natural family planning - fertility awareness, which shaped our lives in a way we wouldn’t have predicted. Though, and little did I know then, it would take almost 3 years of charting before we as a couple were finally ready to get pregnant.)

Toward the end of 2007, I read Tina Cassidy’s book Birth and, in early 2008, thanks to a friend’s website earthmother.org, I found out about the movie The Business of Being Born. Both the book and the movie, at this point in my education, were preaching to the converted. All that was left to do was assuring Chris that we should do home birth. This I’ve done gracelessly but he’s handled it with an open mind I can only strive to have. Now, we are in hands of one capable Cara Muhlhahn and we’re taking it one day at a time. I don’t know what is going to happen, but I do know that, should we end up in a hospital, it will be out of real necessity and not because someone arbitrarily decided that my baby is too big for my small pelvis or any other stock reason doctors give us for c-sections.

Back in March, when I was still daydreaming of giving birth at home, but we were looking at other options, I called my insurance, a company whose name starts with a neutered bull and ends in an American car, to inquire of their policy regarding home births. And, yes, the answer was a definite yes, they cover home births. Relieved, I put that beast on hold for the time being, while we took time for some soul-searching on our own home vs. hospital conundrum.

Fast forward some 4 months ahead: we made our decision and love our midwife. Coming up is another ultrasound exam and I thought I should call the insurance to see if I need some such silly thing as a referral. I’m part of a the Freedom Plan so, no, I don’t need a referral. Three ultrasounds are covered. Awesome. But, my midwife isn’t. Or, she will be, but at 70% of the “reasonable and customary charge” and only after I pay $2,000 “deductible.” Wha’!!! First off, and I don’t really want to get into it but here it is, this “reasonable and customary charge” is a black hole. There is no way of knowing that what you pay your doctor will be considered reasonable and customary by your insurance and, get this, it most likely IS NOT. Especially if you live in New York where things cost more.

If anyone has ever dealt with insurance deductibles (and this is the first year I am ’cause I got hooked on my out-of-network doctor), you pay your medical bill and then you submit the paperwork to insurance. So, say you paid $1,300 (with your credit card, of course) for 3 months of out-of-network exams. You submit your itemized bills thinking how you only have $700 more to pay before they’ll pick up the 70% and you can breathe a little easier. Eventually, you get a letter back with all those itemized prices that tells you how much of them will go towards this deductible. It’s something like $800 total. You see, at least 500 of those dollars were above the insurance-deemed reasonable amount. You get mad the first time, and you may even call and give them a piece of your mind. But then, you learn and start to expect it and I think they bank on that. You complain once and then you just roll over and take what’s dished out to you.

To get back to my home-birth midwife, she’s not in network. The insurance lady gives me her deductible-reasonable-customary spiel and is ready to get off the phone. Excuse me, I say, but I thought you covered home births. We do, she says. Well, is there anything else I can do to get this completely covered? Only then does she give me something I can work with. I need to call three different nurse-midwives that are in the insurance network and only after they can’t accommodate me, I can call the Medical Management office and ask for an “in-network exception.”

The very next day, I get on the phone again. I know my way around the automated system a little better today: Pressing 1 for English, then 1 again since I’m a member and I need to talk to a representative, 5 because I want to talk about benefits, 5 again because I don’t know what else to press here. I then enter my ID number including the *, I listen to some recorded message about who I am then finally I get to press 0 to speak to a representative and listen to some elevator music while waiting. Ten minutes into this, I’ finally conected to “Cathy.”

- Hi Cathy, I’m pregnant, baby’s due late November. I am planning a home birth but it turns out my midwife isn’t covered. Someone yesterday told me I need to call three nurse-midwives in the plan….
- Oh, you are trying to get in-network exception.
- Yes. - I want to kiss her over the phone.
- Ok, I’ll give you the names of nurse-midwives to call. Ready? The first one is Carol………..
- Hello, hello… hellooo - my phone got disconnected.

Man. I have to try again. Pressing 1 for English, 1 again since I’m a member, 5 for benefits, 5 again for the lack of better option, entering my number including the *,  listening to recorded message, finally pressing 0 to speak to a representative for more elevator music while waiting. Twelve minutes and I get “Trish.”

- Hi Trish, I’m pregnant, baby’s due late November. I am planning a home birth but it turns out my midwife isn’t covered. I just got disconnected with someone else…. She said I can request in-network exception.
- You know it’s really hard to get in-network exception. They are almost never given.
- I understand. I think what I need from you are names of nurse-midwives I can call.
- It’s just really hard to get an in-network exception. You have to make sure that no one around you within 20 mile radius or 20 minutes of travel isn’t providing a service you need.
- Yes, I understand. The rep earlier on the phone mentioned I needed to call three nurse-midwives and see if they would do a home birth. So, if you would, please let me have some names to call.
- Ok, but I just wanted to let you know that it’s hard…
- The names, please.

What was that all about? Did she just enjoy the pleasure of torturing me with the impossibility of the coveted in-network exception? She finally let me have the names and numbers of three midwives, two of which were in the same practice. And no, none of them do home births. One of the receptionists even chuckled in disbelief when I asked her. I chuckled to myself at the same time. Goody. It looks like the “providers” insurance supplied me aren’t really offering the service I need.

Dial again. One, 1 again, 5, 5 again, ID number including the *, pause for recorded message, 0, elevator music while waiting. Fifteen minutes and I get “Rhonda.”

- Hi, Rhonda. I need to speak with Medical Management Department about in-network exceptions.
- Right away, hon.

Thirteen minutes of elevator music. Quick talk to “Sandy”, ten more minutes of being on hold:

- Thanks for waiting. This is now being processed, we’ll let you know in two days. Keep your reference number handy.

[Oh,  Canada....]

TO BE CONTINUED

This Tuesday, my midwife Cara and her assistant Kate (Cate?) came over to our house for my first checkup. Chris and I scrambled to make at least one room comfortable for us to meet. (Incidentally, we’ve been trying to make our apartment liveable: The Accumulation of Stuff had reached a tipping point sometime last month. Plus we’d been re-shuffling the rooms. More on all of that later — maybe from Chris.)

Had I (and I hadn’t) even the slightest doubt that I should have a home birth with Cara, this meeting would have completely obliterated it. As it were, my buckets of faith have just gotten bigger to accommodate how much I believe in this.

So, get this: they were late for our 11am. While waiting for hours or even minutes for the doctor in her office can take all the steam out of you (not to mention traveling there or the fact that you’ll only see her for 15 minutes at best), imagine waiting in your own home. You’re straightening the cover on the bed, catching up on email, eating left-over ratatouille, gathering up any data you can think of to share while your husband is maybe vacuuming the hallway or cleaning the latest cat damage in the box. We loved the extra half hour of anticipation.

When the buzzer rang, we both ran downstairs and hugged our midwife. We climbed up to our apartment and settled in our cute little railroad room. Then we started talking: birth in general, home birth specifics, her methods of handing difficult baby presentations (oh, do I love her), protein needs (80 -100 grams per day!), mercury in fish (eat small ones), sugar (don’t eat: makes big babies), labor positions, shape of pelvic bones… We went over my medical history and looked at the stack of fertility charts I’ve been keeping for 30 months. She answered my questions and in general made me feel warm and fuzzy. Kate chimed in about her experiences working elsewhere as a nurse-midwife and assured me I’ll be getting the best care possible.

For the actual exam, I laid on our bed in our awesome sunny bedroom and she took my blood pressure, measured my belly and, the best part of all, gave me her stethoscope so I can listen to the baby’s heart beat (with my eyes closed… it went tic.tic.tic.tic.tic.tic.tic for every tic of my own)! It was lovely.

I think I’m in love. To celebrate, I went to Prospect Park and took lots of pictures.

I spent the week worrying whether come Monday I will have my midwife of choice. I get a call yesterday from her office: they can’t make a decision until Wednesday, and it’s really looking like my chances are slim. A big part of this was completely my fault. I had delayed a little (again) although she knew about it and assured me she can wait a week. Well, it didn’t exactly work out. So right now, we don’t have a midwife. Chris pointed out (again) that in New York, you don’t just show at the theater for an opening night and hope to get the birth you want. “Fool me once” he said “shame on you. Fool me twice … you can’t get fooled again.” I told him we’d just have to get a book on birth and try it ourselves. Here’s his scenario:

CKAB do Birth

Chris, reading Do It Yourself: Birth. Points at parts of Alisa’s body.
- Ok, we have two breasts, one belly, two legs. Right. Here are the pelvic bones, right. I think if I peek with this flashlight, I can see the cervix… which looks like… oh, eek….. ok, hope I don’t have to do that again… So, yes, I think we have all the parts.
Alisa, breathing through contraction.
- Hmmmmm, haah, hah. haaaah, Ok. What’s next.
- Ok, says here, we need boiling water (I’ll go put that on), scissors, bath towels…darn didn’t get those. I’ll run out to Bargain Land. I’ll bring my cellphone. Call me if you can think of anything else.
She’s doubled over in pain. He’s walking out the door. As contraction is ending, she yells out
- Don’t forget the shower curtain.