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My assisted HB Questions...(long!)


Forum: Home Birth

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  #1  
May 1st, 2007, 11:06 AM
azchela's Avatar Mega Super Mommy
Join Date: Nov 2005
Location: Sunny AZ!
Posts: 1,448
Hey there -

I am considering homebirth for a multitude of reasons (was SO close to natural birth with DS - know I can do it myself without nurses and drs trying to drug me, comfort of home, etc).

Anyway, my doula, who is also a licensed midwife, is coming over this weekend to talk to DH and I about homebirth and answer our questions. Just thought i would run my list of questions by all you since there are so many HB vets on here:

THANKS -

How much does it cost?

Does insurance usually pay?

What medical supplies/instruments will be on hand?

What medical supplies will I need to buy? And where?

How do we make sure I stay hydrated during labor?

How do you recommend we handle Tyler (he will be 15/16 months) during active birth?

How often will cervical checks be done?

Where do most women end up delivering? (bed, floor, stool, tub, etc?) How do we prepare that place to avoid mess and horrible clean-up?

How many birth assistants (midwife/doula) will be on hand?

How do we handle the medical waste (placenta/cord, etc)?

How do we handle Vitamin K shot, baby weight?

How do we get a birth certificate?

At what point do we go to a hospital if we have to?

When does the midwife and doula leave?

How do we do the hearing test (can they do that at the pedís office)?

What about after care for me (giant maxis, pads for the bed)?

What if I tear? They said I had internal tears with Ty, and they did give me a couple of stitchs (which I can still feel).
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  #2  
May 1st, 2007, 12:00 PM
abigailsilva's Avatar Mega Super Mommy
Join Date: Jul 2006
Posts: 4,103
Quote:
Hey there -

I am considering homebirth for a multitude of reasons (was SO close to natural birth with DS - know I can do it myself without nurses and drs trying to drug me, comfort of home, etc).

Anyway, my doula, who is also a licensed midwife, is coming over this weekend to talk to DH and I about homebirth and answer our questions. Just thought i would run my list of questions by all you since there are so many HB vets on here:

THANKS -

How much does it cost?
$2500 is the norm

Does insurance usually pay?
No, but depends on the state
What medical supplies/instruments will be on hand?
She can answer that one, she'll prob bring various hemostats and scissors for clamping and the cord
What medical supplies will I need to buy? And where?
Probably just a birht kit, I got mine from Precious Arrows
How do we make sure I stay hydrated during labor?
Water, or juice, I chugged gatorade like it was going out of stule
How do you recommend we handle Tyler (he will be 15/16 months) during active birth?
If you don't want to send him away then have someone *likeminded* to come care for him while you labor and birth
How often will cervical checks be done?
Only as often as you feel are necessary, my MW only checked when I asked
Where do most women end up delivering? (bed, floor, stool, tub, etc?) How do we prepare that place to avoid mess and horrible clean-up? Lots of plastic sheets or shower curtains on the floor, there really isn't that much mess though the water breaking makes a mess, but it's not hard to clean. You deliver where you end up if you ask me, we spent 12 hours fililng my birth tub, and I had him in bed, go figure. Wherever you are most comfortable will be the place you gravitate to.

How many birth assistants (midwife/doula) will be on hand?


How do we handle the medical waste (placenta/cord, etc)?
Unless you want a lotus birht. Throw it away, or freeze it if you aren't going to use it within a few says, all the same rules apply as raw meat
How do we handle Vitamin K shot, baby weight?
You don't need the shot unless you really think it's necessary, MW will have a baby scale

How do we get a birth certificate?
Vital records will send you a form upon request

At what point do we go to a hospital if we have to?
Well, when you have to, if you have to. The only things I would personally transfer for are cord prolapse that would be better dealt with un a hospital, bhowever, I have faith in my MW to handle that at home, basically they are so fewer complications in home, that you don't have much to worry about.

When does the midwife and doula leave?
When everything is cleaned up

How do we do the hearing test (can they do that at the pedís office)?
yes, my MW had the machine and did it at my PP visit
What about after care for me (giant maxis, pads for the bed)?
Same as last time darlin, maxi pads, maybe keep some chux pads handy, i plastic sheeted my bed before the birrth
What if I tear? They said I had internal tears with Ty, and they did give me a couple of stitchs (which I can still feel). She can stitch you if you need it[/b]
You asked great questions, so I just thought I would answer them and maybe they will lead to more, hth!
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  #3  
May 1st, 2007, 01:21 PM
Frelle's Avatar Platinum Supermommy
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How much does it cost?
2000-5000 is the range I have heard.

Does insurance usually pay?
i would say not usually, but it depends on the state and on your insurance.

What medical supplies/instruments will be on hand?
your midwife will bring many of her own things, but she will also ask you to purchase a birth kit, probably. If you go to precious arrows, you can see what the birth kit contents are and if you want the basic one or a more fully stocked one. You can also get recommndations from other homebirth moms on what they found useful that was not in a usual, birth kit. Having 3 kids already, my afterpains are really really bad. I like the AfterEase tincture, taking more of that than Ibuprofen for afterpains. I got that on preciousarrows.com too.

What medical supplies will I need to buy? And where?
she will bring the medical supplies that arent in the birth kit.

How do we make sure I stay hydrated during labor?
make sure you have what you'd want around during labor, juices, water, sports drinks.. ice chips if that is something youd want, or even popsicles... and orange juice for after was recommended by my Bradley instructor.

How do you recommend we handle Tyler (he will be 15/16 months) during active birth?
You might ask your midwife to bring one of her own kids if she has an appropriate aged daughter (this is waht my midwife does for me), or like Abbey said, a likeminded friend that your son is comfortable with. Defeinitely try to hve childcare coverage, either in your house or out of your house. I prefer in my house.

How often will cervical checks be done?
none if you dont want them. At your weekly viists starting at 38 weeks if you do. I hve to request them if I want them from my midwife, she doesnt offer.

Where do most women end up delivering? (bed, floor, stool, tub, etc?) How do we prepare that place to avoid mess and horrible clean-up?
I would guess bed, but I have waterbirths. You'll want a few shower curtains, and some of the chux pads from your birth kit on the bed for after.

How many birth assistants (midwife/doula) will be on hand?
my midwife brings an assistant/apprentice, and I can have her bring a doula. If youre hiring a doula, its good to know if theyve worked together before or wish to, and are compatible, in my opinion.


How do we handle the medical waste (placenta/cord, etc)?
we froze ours, but some midwives will take it for you and bury it in their garden at home, depending on the season of the year.

How do we handle Vitamin K shot, baby weight?
no shot was administered at my house, she did do the PKU blood draw a week post partum after breastfeeding had bene established. She carries a baby scale, and your birth kit will likely come with a tape meausre for baby measuring.

How do we get a birth certificate?
vital records in your city/state. We have to bring proof of rpegnancy, proof of live birth (our baby), proof of address, mom and dad and our drivers license/identification.

At what point do we go to a hospital if we have to?
that will depend on what reason your transfer is for, if you have one.

When does the midwife and doula leave?
Mine leaves between 3 and 6 hours after the birth. Usually that depnds on how your blood pressure is doing, how functional you seem, and if you have others present to care for you and the baby.

How do we do the hearing test (can they do that at the pedís office)?
we have had a person from the health department come and do ours in the past, they are notified of homebirths after you apply for the birth certificate, and they and contacted us. But since Abbey and I have the same midwife, it looks like some midwives can do it themselves.


What about after care for me (giant maxis, pads for the bed)?
same as Abbey, have chux pads, large maxis, maybe some frozen maxi pads in the freezer for right after, a peri bottle and solution can be ordered in your birth kit also. And that AfterEase tincture I mentioned might come in handy. I like to hve someone at home in addition to my husband in the first few nights before my mom gets here. A friend who is willing to sleep over and get up with you in the night to help with diapers and feeding (depnds on how out of it you feel like you might be, or how many other kids you have that might be wakeful that your DH might have to be dealing with instead of helping you with baby).

What if I tear? They said I had internal tears with Ty, and they did give me a couple of stitchs (which I can still feel).
My midwife does the stitching. Im not sure if she would have you see anyone else if the tearing was really bad, mine have been minimal at 2 stitches apiece.
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  #4  
May 1st, 2007, 11:16 PM
LaLa's Avatar Platinum Supermommy
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The answer to most of these are "it depends" - and it depends on a great # of things... Ill answer the best i can too

How much does it cost?
This varies, and is sometimes negotiable, and most will let you spread out payments. Ours was around $1700, and we had to buy the birth kit (about $50)

Does insurance usually pay?
Some do some dont. ours would only pay for a licensed midwife, and then it applied the standard in network vs. out of network. But our midwife wasnt licensed (a lay midwife) so it wouldnt cover it. Had she been licensed, shed have been out of network, and they would have paid 60% - but b/c she was independent, likely we would have filed insurance after the birth and gotten reimbursed for that portion. Every situation is different, and even if most insurances SAY they wont pay - you can sometimes make an appeal & if you back yourself up with studies & statistics & show it benefits them and you if they cover it, then you may get them to

What medical supplies/instruments will be on hand?
Generally antyhign that woudl be in a hospital room/birthing center - but its sepcific to each mw - ours has oxygen, all the usual supplies for an emergency episiotomy, emergency pitocin, emergency stitches, etc.

What medical supplies will I need to buy? And where?
usually the MW will have you purchase a birth kit - some MWs stock their own others go through different websites. Shell let you know And shell either gve you a list or some websites allow MWs to create their own, then they give you like a code or whatever (thats what ours did).

How do we make sure I stay hydrated during labor?
Drink water

How do you recommend we handle Tyler (he will be 15/16 months) during active birth?
it depends on the child. I would always recommend having an extra person there just for the child - just in case you need extra attention, they need extra attention, etc.

How often will cervical checks be done?
Most MWs dont do them often, or they do them at your request - this will depend on your MW. My MW preferred not to do them - and shes had some births where she did none. Otherwise - she slaps on a pair of sterile glvoes & does them like anyone else would

Where do most women end up delivering? (bed, floor, stool, tub, etc?) How do we prepare that place to avoid mess and horrible clean-up?
I would say theres probably not a "normal". And theres far less mess than youd expect. Many women tend to migrate to the part of the house that theyre most comfortable in. Usually your MW will have her supplies on a tray so theyre portable & there will be a plastic sheet shell follow you around with we used a vinyl tablecloth (theyre cheaper & more durable than a normal plastic sheet).

How many birth assistants (midwife/doula) will be on hand? At least 1 in most situations

How do we handle the medical waste (placenta/cord, etc)?
Your MW will usually work that out with you. Most MWs will give you the placenta to do what you wish with (plant, etc). Some MWs will take it and dispose of it for you if you dont want it.

How do we handle Vitamin K shot, baby weight?
The MW will have a scale - and most MWs only admnister Vit K in an emergency situation or where there is a need (bruising, etc). Really & truly Vit K is rarely necessary.

How do we get a birth certificate?
Most MWs will coordinate this. We filed for our own at our local Vital Statistics office. We just went in, filled out a form, had the baby with us, and they mailed it to us.

At what point do we go to a hospital if we have to?
As soon as necessary. If all goes well, youll never go. Its a decision the MW will usually make with you.

When does the midwife and doula leave?
usually around 4 hours postpartum - give or take depending on the situation. As a doula I usually leave within 2 hours or ocne everyone is settled in. The MW will stay longer usually to clean up, make sure everything is ok, do some vitals on you & baby, etc.

How do we do the hearing test (can they do that at the pedís office)?
They will do that at the peds office, but its optional. We didnt do it.

What about after care for me (giant maxis, pads for the bed)?
this will usually be in your birth kit or in a birth supply list from the MW

What if I tear? They said I had internal tears with Ty, and they did give me a couple of stitchs (which I can still feel).
Well, keep in mind youll be less likely to tear - MWs generally do perineal massage & take a more mild approach - help you position better, prep things, encourage gentle pushing, etc. If you do tear, it willd epend on the tear. I had two VERY small tears, which we opted not to stitch. She will usually do the stitches if its enough to require it. One thing Ive noticed is hospitals stitch EVERYTHING wether it needs it or not. Seriously, you could have something the equivalent of a paper cut or scratch & the hospital will stitch it - just to bill for it. But I do know in my state, anything past a 3rd degree a MW cant do. But in 25 yrs, b/w two midwives, theyve only encountered one 3rd degree or higher tear.


Hope that clears things up

Lala...
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  #5  
May 2nd, 2007, 06:34 PM
jhmomofmany's Avatar Look! A Dancing Banana!
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How much does it cost?
My current midwife is charging us $800 for everything. The mw I saw in Alabama charged $1700.

Does insurance usually pay?
Mine won't this time, but her fee is so low that I'm okay with that.

What medical supplies/instruments will be on hand?

What medical supplies will I need to buy? And where?

Your m/w will typically have her own supply, and she will probably give you a list of supplies to have on hand.

How do we make sure I stay hydrated during labor?
You can drink whatever fluids you need during labor.

How do you recommend we handle Tyler (he will be 15/16 months) during active birth?
I would recommend you have somebody available to babysit, but he might sleep through it if you labor at night.

How often will cervical checks be done?
Cervical exams really are not necessary, but can be done or avoided at your request.

Where do most women end up delivering? (bed, floor, stool, tub, etc?) How do we prepare that place to avoid mess and horrible clean-up?
For my first homebirth I labored on the floor leaning against the bed with some Chux pads and a towel under me, and my water broke just before I was pushing him out. There was no mess to clean up other than the pads to throw away and the towel to toss in the wash. For my last delivery, my water broke while I was on the toilet, and I delivered her in the bathroom floor, again with a couple of towels under me. Again, no mess other than the towels.

How many birth assistants (midwife/doula) will be on hand?
Depends on your preference and what you arrange with the midwife.

How do we handle the medical waste (placenta/cord, etc)?
We buried ours; perhaps your midwife can dispose of it for you if that isn't an option.

How do we handle Vitamin K shot, baby weight?
Vitamin K shots are unnecessary for a healthy newborn; the midwife should have a scale handy for weighing the baby.

How do we get a birth certificate?
This varies according to where you life; contact your state Vital Statistics office or the county registrar.

At what point do we go to a hospital if we have to?
This completely depends on why you would need/choose to go.

When does the midwife and doula leave?
My midwife left about an hour after the delivery.

How do we do the hearing test (can they do that at the pedís office)?
I should think the pediatrician would be able to do that for you. I've never known of hearing tests for newborns to be routine.

What about after care for me (giant maxis, pads for the bed)?
Yes, you will want lots of maxis and pads for the bed; similar to what you would need after coming home from the hospital.

What if I tear? They said I had internal tears with Ty, and they did give me a couple of stitchs (which I can still feel).
Your midwife can treat most tears. Even better, though, she can help you to deliver in such a way that tearing is probably going to be prevented. After "needing" an episiotomy for my first four babies (all born in the typical hospital fashion with me lying flat on my back pushing as hard as I could with a nurse yelling at me) my two home babies came without any tearing at all. The difference is I was upright, and I wasn't rushed into pushing too soon, too long, or too hard.
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  #6  
May 3rd, 2007, 06:21 PM
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GREAT questions!!

How much does it cost? TOTALLY depends on geographic area. In our city, it's $1500-2500. I found a lay midwife just outside the city who charges $1000 for all prenatal, birth, and 3 ppd checks. Some places, you can't find a mw for less than $4000. If you're near the edge of a city, I recommend looking in a more rural area for lower cost.

Does insurance usually pay? Nope, not for us! If we had a CNM, it might have been different. I LOVED our mw though and wouldn't have had anyone else.

What medical supplies/instruments will be on hand? I'm not sure. We had a doppler, oxygen tank, and a couple of cases of medical supplies left here a couple of wks before the birth. I'm not sure what all was there. The doppler came in handy when my water broke with fairly heavy meconium. We made sure the baby was not in distress before the mw could even get here.

What medical supplies will I need to buy? And where? I bought bits and pieces (shoelaces to clamp cord, etc). Some companies like Cascade sell birth kits. Our mw gave us a list of supplies we needed to provide and how to sterilize them.

How do we make sure I stay hydrated during labor? DRINK!

How do you recommend we handle Tyler (he will be 15/16 months) during active birth? I read a book called Children at Birth a few yrs ago. It suggested having an adult available to focus on the child. If you want to give him the option of being present, try to prepare him with videos and discussions of what will happen (esp noises you may make or the sight of blood). He should be able to leave at any point that he feels overwhelmed which means that the person watching him needs to realize that they may not be present at the time of the actual birth.

How often will cervical checks be done? It's up to you. You always have the right to request it or refuse it wherever you birth.

Where do most women end up delivering? (bed, floor, stool, tub, etc?) How do we prepare that place to avoid mess and horrible clean-up? I did not plan to have ds in bed but did just that. I always pictured myself giving birth on the toilet, in the tub, or on the living room floor. I guess I wasn't worried about mess b/c I had like 10 people here so they could always run in front of me with plastic if needed. We used dollar store shower curtains and painting tarps under the bed sheets and available for the floor or wherever.

How many birth assistants (midwife/doula) will be on hand? I just had the mw. She sometimes works with an apprentice but not for my birth. You can hire a separate doula if you want, but my mw really served both purposes.

How do we handle the medical waste (placenta/cord, etc)? We threw it in the trash.

How do we handle Vitamin K shot, baby weight? The mw had a fish scale that she used to weigh the baby. We didn't get the vit K shot.

How do we get a birth certificate? Depends on the state. We just went to the county health dept and filled out a form. DH was listed as the birth attendant because of a gray area in the law about lay midwives.

At what point do we go to a hospital if we have to? Ask the mw. Some of the ones I spoke with transferred more than 50% of their clts. Our mw didn't feel it was necessary even with meconium in the water (I totally agreed with her). Some transfer for slow labors, others just for med emergencies, etc. If at any point, YOU want to go, you always have that option.

When does the midwife and doula leave? Our mw left about 5-6 hrs after the birth. It took a while to wrap everything up. She returned for a 24 hr check up.

How do we do the hearing test (can they do that at the pedís office)? I would think you could get it at any pediatrician's office. Ds never had one.

What about after care for me (giant maxis, pads for the bed)? I recommend putting some chux or towels on the bed to preserve the mattress. I had some disposable undie type things (maybe designed for leaky bladders??) that were great for the first couple of days. Expect a very heavy menstrual flow.

What if I tear? They said I had internal tears with Ty, and they did give me a couple of stitchs (which I can still feel). My mw gave me one stitch. Some do stitches and some don't. You'll want to talk to the mw to see how she handles it.

HTH! Let us know what you decide!
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