Aside from sheer exhaustion and pants that are getting a little harder to button, it’s almost easy to forget that I’m pregnant. We get so busy with our days that, unless my body reminds me to slow down, I don’t think too much about it. A large part of that is the “been there, done that” aspect of pregnancy the second time around. Initially, I was busy reading and watching everything pregnancy and birth related that I could get my hands on; I thought I knew how I wanted things to go and I was fairly confident in my ability to birth naturally and breastfeed exclusively, but not having experienced any of it before I still had a lot of questions and some degree of uncertainty. This time around, there isn’t any of that.
This time, I know what I’m doing and how I want things to go. I know that I won’t drink while pregnant, but I’m not going to stop eating delicious cheeses or an occasional under-cooked egg (I.e. brownie batter!). I know that I’m not going to do the glucose challenge or Down’s screening and that the only ultrasound we will have is at 20 weeks. I know that I won’t accept IV antibiotics even if I’m GBS+ (see this) or eye cream and vitamin K for the baby at birth, and I know that I’m not willing to be bullied into induction, even if I’m past that silly not-due-date. While I recognize that every baby and pregnancy is different, I also know now without question that I can manage childbirth pains and that breastfeeding will work out fine — no matter what I have to go through to reach those ends. Basically, I am 100% confident in my own judgement as a mother and I know exactly what I want and don’t want from my care provider.
The biggest (and really only) discussion Chris and I are having about the birth plan this time around is the “where.”
We discussed home birth while I was pregnant with Nora, but Chris wasn’t quite comfortable with it so we compromised on midwife care at a hospital birth center 45 minutes north of us and the agreement that if all went well, subsequent children would be born at home. If you’ve read Nora’s birth story, you know that we got a doula and stayed at home until transition, that I was pushing when I arrived at the birth center and that she was born not too long afterwards. I firmly believe that if one has to give birth at a hospital, staying home until the very end is the only way to do it and avoid unnecessary intervention. I left Nora’s birth feeling proud of myself for meeting my goals, for managing through some tough moments, and excited about my little girl. But, I also left it thinking how annoying it was to have to drive in the car while just wanting to push and how annoying it was to be at the hospital after the birth was over.
Now that we have Nora, home birth is even more important to both Chris and me. Not only do we want to avoid that annoying last minute drive and “settling in” period when I would much rather just be having a baby, but we also believe that it would be 100% better for Nora for us to stay home the whole time, where she has the option of participating in her sibling’s birth or not and still being in her safe, familiar environment; where there’s no possibility of Chris and me “disappearing” for a while and coming back with a baby. Whereas before I might have listed as the top reasons for wanting a homebirth my desire for a water birth (which is not allowed at Nantucket Cottage Hospital) or the fact that I don’t want to feel like I’m fighting with my care provider, now Nora is our number one reason for wanting to stay at home. When I think about my experience during Nora’s birth, my desires for this one, and the needs of our family, a home birth is a no-brainer…except for one thing: finances.
While the midwives I expected to use had we stayed in New York were certified nurse midwives (and thus covered by insurance) the homebirth midwife on Nantucket is a certified professional midwife (and thus not covered by insurance). While prenatal care and a birth in the hospital would cost our insurance company (and, honestly, Massachusetts taxpayers) thousands upon thousands of dollars, it would only cost us $250 out of pocket. A homebirth, which is cheaper many times over than a birth with one of the island’s MDs, would end up costing us well over $3000, because not a penny of it will be covered by insurance. So, just as next year’s expenses are increasing with preschool and the reality that we will probably outgrow our house by late fall, now Chris and I are facing a dilemma I never thought we would have: hospital vs. home.
Can we pay for a home birth? And more importantly, should we? Three to four thousand dollars is a lot of any family, but it is an especially large amount for us, and we aren’t sure yet that it’s the best long term financial decision for our family. What happens if we manage to scrape together that money, spend it on a home birth, and then can’t afford a larger rental by baby’s first birthday? We constantly talk about being people who care more about quality of life than material things; I know that we can live in this little house with another baby…but thinking about cramming in a toddler or preschooler is when quality of life and material things start to get muddled together. Neither Chris nor I want to deal with months of annoyance at each prenatal visit, nor do we want to give up our vision for a comfortable, simple birth. We aren’t the Duggars, it’s not like this experience is just one in a long line of births; this could be a once in a lifetime experience for our family. But I also don’t want some romantic idea to cloud my ability to choose the best long-term path for our family.
This discussion and this choice is so incredibly frustrating. Honestly, I completely understand why people free birth (don’t freak out, we aren’t going to do it…I just know why one would). I wish I lived somewhere where women could choose where and how to birth. Where birth was viewed as a natural process and naturally experiencing it was supported by the community as a whole. Where insurance would cover homebirth (which would be cheaper for everyone in the long run) or, at least, where money doesn’t have to be the deciding factor.