home birth

Birth Plans Second Time Around


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.

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9 responses

  1. Amber, I wish you the best in what you and Chris decide to do about your birth plans. As always, access to medical need at time of birth is most important. How exciting to welcome another child into your life!!! Enjoy your pregnancy and try to get plenty of rest. Have a wonderful day!! :):)

  2. Amber, we haven’t met yet but I feel like we know a lot of the same people. I went through a similar dilemma last year while I was pregnant with my son, our first child. We started prenatal care at the hospital but ultimately decided to go for the home birth. When it came down to it, I just knew in my heart that’s what I wanted and needed to do to feel safe and comfortable. That being said, the doctor I was seeing at first gave excellent care, better than I had expected. I had asked her about water birth in the hospital and she said it was possible and that it had happened once before. When I toured the maternity wing, I was appalled by the conditions of the laboring/possible birthing tub. It was in a closet sized room and was filthy, even the nurse seemed to be embarrassed by how dirty it was in there. That was the point where I knew it had to be home birth. It’s only a choice that you can ultimately make but I say follow your heart on this one! I don’t know if you’ve met with the midwife yet but she is very understanding of people’s financial situations and would probably work at a payment plan with you guys if that would help. I also have friends that had to be transferred to the hospital and although their births didn’t go as planned they were pleased with the quality of care provided by the staff there. If you have to give birth at a hospital this is probably one of the better ones to do so. Good luck with you decision and stay well!-Kaity

  3. Meg Glidden Avatar
    Meg Glidden

    Hi Amber, This is one of those irritations of American life. I taught Lamaze classes at NCH for 8 years and can tell you they were an excellent hospital for having babies in, before they were associated with Mass General. Ask for a copy of current intervention rates (I’ve been out of it for a while) to get the latest picture. That said, we had only one of our six babies in the hospital. I missed my husband too much. Spiritual and emotional values trumped financial for us. No matter how much or how little money you make it all gets spent in the end.

  4. Sarah M. Avatar
    Sarah M.

    home birth! Every time I teach a class I tell people that you had to transfer during transition. Don’t do that to yourself again! The money will come and you can find ways to make different housing work. Avoid the hospitol if you can. Maybe trade the midwife a web site for reduced rates? try that!

  5. Charity Avatar

    Just please choose your midwife carefully! I hate to scare you because I know lots of people who have had sucessful home births, but one of my friends had one that went terribly wrong, the oxygen didn’t work, the ambulance didn’t get there in time, and her son now has Cerebral Palsey because of oxygen deprivation. I hate to give the worst case scenario, but she says in hindsight she wishes she would have been where immediate emergency care was available. She just said it wasn’t worth it. I know you guys will decide what is best for your family, but do think carefully about the worst case scenario and have a good backup plan just in case of emergency. Sorry to be such a downer.

    1. Not a downer…I appreciate the thought. The home birth midwife on island is very experienced and highly recommended. Also, interestingly, our hospital is not one that always has an OR or the staff available for emergencies (which is why they don’t do VBACs, twin births, or other high risk pregnancies), so in theory, depending upon the time of day and what else is going on, they may not be able to respond instantly to an emergency. I think their time from emergency to OR is 20 minutes, sometimes less, but depending upon the circumstances that could be too long. So to some degree, safety could be compromised no matter where one births on island.

      1. And I should add, I’m a five minute walk from the hospital, so I don’t think we would bother to call 911 — we could drive faster. 🙂

  6. Charity O'Connell Avatar
    Charity O’Connell

    I totally understand your dilemma. We live in rural NC and although I do see a midwife, (2 actually) they practice out of an OBGYN’s office and contract through the hospital. They are also a 50 minute drive away. There are no midwives in my town and so I chose to drive. I also went through transition phase on the drive to the hospital and had to hold pushing until my midwife could get there. Very few hospitals in NC offer the option of water birth and the one that I delivered my daughter at was not one of them. I would love to have a home birth but it is not an option for me, sadly. Now, with #2 due in November, we are struggling with what to do with our daughter who will be 2 when our new baby comes. She has never stayed for more than a few hours without my husband or myself. She is still nursing and will be when the baby gets here. My mother is our only option to watch her but she doesn’t want to “miss” the birth, so is insisting on just keeping my daughter in the waiting room of the hospital while I deliver. I’m not trying to just take over your post by bringing in my own issues….just saying that I sympathize.

    Will the midwife allow you to pay her monthly even after the baby is born, so that it’s not such a huge burden all at once? Peace of mind is worth a lot, but so is money these days. You have a really tough decision on your hands. I have a large deductible with my insurance, so we are paying out $2,500 anyway to have a less than perfect birthing experience. My only consolation is that I love my midwives. They are both wonderful and will fight the hospital nurses for me, if needed, for non-intervention. I wish you luck with your decision.

  7. Sam Squailia Avatar
    Sam Squailia

    Nick and I had the EXACT same thoughts for niKi’s pending birth…although i have more options—i vistied a birthing center that was approx. 40 minutes from my home.
    It was incredible…water birthing tubs..midwives…a really nice home-like comfortable facility. BUT my insurance would not cover it =( and i seriously seriously SERIOUSLY considered spending the $4500+/- it was going to cost….but that was really just too much money. If there is a next time………that is what i want!!! or to be at home…with my Nicolette…like you said =)

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