Thursday, November 18, 2010

Getting the birth you want

This is something people with a lot of kids have to deal with frequently. For most couples this might happen twice in their lifetimes.  However for us that means every year or every other year we have to plan a birth.  I know lots of women wonder what could possibly be so hard.  You pick a dr, you go to prenatals, you show up at the hospital for the birth and then you go home.  Whats there to plan?  For women like me who choose a homebirth or a birth center birth this can be much more involved and difficult.  Everything from getting insurance to pay for it to gathering birth supplies, home births and birth center births are rarely easily planned. 

For most women who plan a homebirth or a hospital birth the main problem is paying for the birth.  Rural Midwife addressed this topic recently but I found even as an experienced homebirth midwife she was missing key points to how and why women might not choose a homebirth.  For starters I have gotten to know lots of homebirth midwives personally.  Even when you choose a midwife for your homebirth it is not the same type of relationship you have with your dr.  But I have had the chance to go beyond that and really get to know a few midwives.  While they are more than willing, generally speaking, to work with you for payment or barter this is not something I would now ask a midwife to do.  From what I have seen those midwives who are willing to work out a payment plan or barter often end up with the short end of the stick.  Pretty soon their whole clientele is women who can't pay.  Midwives are left with begging for payment or turning women away because they, the midwife, can't afford to take them on.  Very few insurance companies will pay for homebirths or birth center births.  Companies like Aetna cite ACOG's statement for homebirth as why they won't.  Writing letters, threatening to go somewhere else, does little when a huge force like the ACOG is dictating policy. 

Secondly, paying by working, say by starting a small side business, trying to pick up work here or there to raise money for the birth you want, or asking people instead of gifts to help pay for the birth are also not feasible for many women.  It sounds great in theory and I have done it before, but realistically its not something most women could do.  Alternative births are not an accepted practice in this country with only 1% of births being planned homebirths.  Many people would not feel comfortable giving money knowing it is going to pay for a birth they would not otherwise support.  Opening a store is a great idea if not for the inital outlay it requires.  I have spend literally hundreds of dollars in supplies for my store.  Some women really have very little money, to the point where they can't pay their bills.  Life happens, even to the most well prepared.  I would never expect a woman who can't pay her electric bill to spend even $5 in supplies in the hopes of selling it for $30.  Thats called a gamble and when you are looking at no utilities for you and your family often the gamble is not worth it.  Further, scrimping and saving for a birth a few times is one thing, but doing it 10 times or so is something totally different. You are basically scrimping and saving for years and years, often forgoing other important items that your family needs.  At what point does the birth become more important than a family car?  Thats a decision every family has to make and it can be very difficult and not as simple as "If its important to you you can make it happen." 

I am coming at this from a homebirthers point of view.  I have had 6 homebirths, none of which insurance paid for.  We scrimped and saved for each one.  I have bartered for services, been on payment plans, gotten reduced fees, and yet I know there are times finances really do dictate how you give birth.  However, that does not mean you give up all hope for the birth that you want.  Even if that means you want a hospital birth or have to have a hospital birth but wanted a homebirth.  There are ways to compromise and get what you need and want. 

This is not for women who are simply looking for the cheapest way out.  If you can afford, even if it means juggling your finances and it wouldn't be a burden, the birth you want don't take the cheapest way out. You get what you pay for.  If you can afford the birth you want, then do it.  You will probably end up regretting it if you didn't.  But for those women, like myself, who really have hard choices to make there are ways around it. 

If you can get a free hospital birth because of insurance of some sort and simply can not afford the birth you want outside a hospital don't despair.  You can get close to a home birth if you educate yourself and plan.  We all know that nothing is set in stone, and everything you plan is subject to life happening.  But you can avoid some of the things that make hospital birth so unappealing to some.  #1 - get a doula.  Doulas have to attend a certain number of births before they can get their certificate.  These are typically done for free.  Some hospitals also provide them free of charge.  If you have access to one, use it.  Doulas are proven to reduce interventions.  This is not one of those things where you are asking a woman to take a hit on her finances for the sake of yours.  They really do need to have the births under their belt, and I would have been more than honored had someone asked me to doula for them so I could get my certificate.  Contact your local doula trainer for a list of names.  DONA is another good resource.  #2 read everything you can.  Libraries are free.  The more you educate yourself the better your chances will be of a good outcome.  Knowing you can wait a little at home before going to the hospital just because your contractions have a good pattern can save you from interventions like AROM.  No one is gonna take care of your body like you, learn everything you can about it.  #3 find a dr that supports your ideas of birth.  This is not as simple as walking into a dr office and asking if they support natural birth.  Most drs will say yes every time.  Best thing you can do is ask for recommendations from other women who you know had natural hospital births.  There are several online communities where you can ask for referrals, there are sites you can read reviews about drs.  And there are questions to ask that will tell you a lot more than the standard questions would.  Questions like, "How many births have you attened with the mother kneeling? squatting? in water?" will tell you how often they attend natural births and if those women are free to move around during labor.  If they have never attended a birth where the mother wasn't reclining you should probably look somewhere else.  Look for key words like "allow or let", "trial of labor", and if they throw out words like induction and c/s because of some precieved problem like your weight; that tells you the dr probably isn't on the same page as you.  The same is true if you want to have a scheduled c/s.  Some drs will tell you what you want to hear only to change it later on.  Choose your words carefully, ask questions that actually require an answer other than yes or no.  #4 - apply for exemptions from your insurance company.  This costs nothing and can get you the birth you want.  Google can be your friend in this.  There are women who have successfully done this, finding out how can help you with yours. 

Still, after all this, you can end up with a birth you did not want.  You can ask all the right questions, do your research and do everything in your power to get the birth you want only to end up disappointed.  But at least you can say you tried your best.  Regret is an awful feeling, and there is nothing worse than doubt.  Wondering if you had only done this or that, things that would have been free and easy, is not what you want to be doing after you give birth. 

After the birth of my second, which ended in a hospital birth with an epidural and pit after a planned homebirth, I did a lot of questioning.  What all the answers came back to was that it was an experience I needed to go through, things happened that I needed to learn first hand.  I wouldn't want to repeat the experience but I am glad I had the opprotunity to go through it and come out the way I did.  Which is how I got to this post today.  At one point it was me saying "If you want the birth you can make it happen" and "Don't like finances get in the way of the birth you want, nothing is more important."  And I am sad now for the women I said those things too.  Nothing is black and white.  I couldn't see all the extenuating circumstances that some women might have in their lives, but I do now.  I see them because I have lived them.  But at the same time I can't tell women to just do what they have to do.  I have to give them hope that they can have their homebirth, their birth center birth, their hospital birth the way they want to.  You can beat those finances if you just know where to look. 

Birth centers and Hospitals births are a bit more tricky.  Most hospitals will reduce fees if they know you are paying cash, some have already set up payment plans for self payers.  But they will most likely not accept any form of barter or try to work with you further. They are a business first and foremost where as midwives will often say it is their calling.  However, there are hospital that have charities connected to them that can help you pay for your birth if you can't.  I know this because I gave birth at such a hospital and they would have helped pay for our birth, even the whole amount, if we qualified.  Choose your hospital carefully, especially if you live in a city where you have that option.  Birth Centers often operate like midwives but have much higher over head.  So your chances of getting a reduced fee birth at one is not likely.  But some insurance companies will make exemptions for them, especially if you live in places where state law dictates they have to.  So know your laws, it could save you money. 

In the end, don't let other people make you feel guilty for having the birth that you had.  It was your choice to make and had they been in your shoes they might have made the same choices .

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