Category Archives: homebirth

Transitioning from Home Birth to Hospital Birth – a Mental Journey

Midwife 1: Wow, 9lb and 11lb babies! We’ll definitely be inducing you around 39 weeks.

Midwife 2: Wow, 9lb and 11lb babies! We might want to induce you early but we’ll wait-and-see how thing are progressing when we get closer to your due date. 

Changing my Perspective
After my first visit to the new OB office I wasn’t completely sold on this whole hospital birth thing. However, Joe and I made a decision after delivering 2 large babies(9+lbs and 11lbs), both with shoulder dystocia, that a hospital birth for baby 3 is the wisest decision. So at this point it’s not a matter of weather or not we’ll go through with a hospital birth but how I will be able to change my expectations.


To be honest I’ve gone into each appointment with a defensive attitude. I feel like the doctors and midwives are going to be judgmental of my previous home births (they aren’t) and pressure me into doing something I’m not comfortable doing (so far they haven’t). During my first visit there was talk of inducing me early because I have large babies but my last visit the midwife was very, let’s-wait-and-see, which I appreciated. 

In a few weeks we have another check-up and our main ultrasound. I’m actually looking forward to this appointment because Joe will be joining me. I think the more familiar we become with the staff and the whole hospital birth process the more we’ll be able to get comfortable with the transition to a hospital birth. I don’t have anything against hospital births it’s just a completely different experience for me and the unknown can be scary no matter what.

I believe a lot of labor and delivery starts in your head, feeling confident and comfortable are key to letting go and letting your body take over. I also believe that I should take my pregnancy journey to prepare not only physically for labor but also mentally. I really don’t want the place or people attending my birth to be a hang-up. So I’m praying for peace and reminding myself that we are doing what’s best for this baby.

Planning My First Hospital Birth

Today is my first prenatal appointment for baby 3. I’m a bit anxious for obvious reasons, I hope the baby is developing fine and that both baby and I are healthy. But I’m also anxious for other reasons. Mainly because this will be my first hospital birth and my first of many prenatal visits at an obstetrician’s office. See we had both Jude and Noah at home with a midwife so this hospital thing is going to be a big change.

Joe and I decided to have a hospital birth with #3 for several different reasons and we feel like it’s the right decision but it’s so weird and foreign. I have no idea what to expect so there is a level of uncertainty that adds to my anxiety. Doctors and hospitals make me anxious to begin with, I don’t like the smells, the needles, the sick people at the hospital. It just makes me nervous. One of the main reasons we chose to have home births with the first 2 was to be in the comfort of our own home. So I’m a little concerned about how relaxed I’ll be able to be in the hospital. (Feeling safe and relaxed is a huge key in have a successful delivery.) Secondly, the thought of epidurals, c-sections and other drugs freak me out. I like to be in control of my body or in the case of childbirth, let my body be in control. I don’t react well to anesthesia and I really don’t want a c-section unless absolutely necessary. (It’s major surgery you know, with knives and needles and stitches… yuck.) I know that if the situation arises we will do what needs to be done to ensure we have a healthy delivery but I am fulling planning to do another natural birth.

It will be interesting to see how things differ from my previous experience. I’m not expecting a similar experience because with you can’t compare births anyway. I think the biggest adjustment will be the relationship with the doctors. When you use a midwife there is only 1 person you see on a regular basis, appointments can last up to an hour because their goal is to aid you in your birth not only physically but emotionally. You build a relationship with your midwife and when it’s time to have the baby you’re not only in the comfort of your own home but also in the presence of friends who make you feel safe. With a obstetrician, there are several different doctors I will see. I don’t think my appointments will be nearly as in depth or personalized, but we’ll see. And who know which doctor will be on-call when I go into labor. So that kind of makes me nervous.

This will be a new experience and while it will be very different from my other 2 births I’m confident that God is watching out for baby 3 and me.

Has anyone done both a home birth and a hospital birth?
How did they compare?
What differences can I expect?

Getting Insurance to Pay for a Home Birth: UPDATE, THEY PAID!

So yesterday we got a check in the mail for almost $3000 as reimbursement from our health insurance providers for Noah’s home birth. I was completely shocked since last time I spoke with a representative from our insurance they pretty much said, NO we will NOT be able to process your claim.

After the insurance told us NO we were in the process of talking with Joe’s HR department when we got the check. We hadn’t filed an official claim with HR yet so I’m not sure if they actually intervened yet or not. I do know I talked with several different, very helpful, representatives with our insurance that were working on our behalf to get us paid. So maybe someone was able to work their magic. Either way we are extremely happy.

You can read the ongoing story of how we got Insurance to Pay for Our Home Birth here.

We have learned a lot through this process and I have a better idea of what to do next time around if needed. 
Here are a few tips on what to do if you are planning to have a home birth and file with insurance:

1. Do Your Research – Speak to insurance reps to confirm your policy coverage. Speak with the HR rep at your company to confirm what the insurance reps claim to be your policy. And if possible get it in writing.

2. Have a Plan – Pursue one route first and then have alternate routes to pursue if you reach a dead end. Not only do your research about your policy but do research about the laws in your state regarding insurance coverage of home births. Connect with local home birth advocacy groups to learn the best way to file your claim or file an appeal for a rejected claim. You may not have to use all of the information you obtain but it’s good to have a plan just in case.

3. Document – Keep every paper they give you regarding your claim. Write down every call reference number. Get the names of the representatives you talk with on the phone. If you have clear documentation you can make a solid claim.

4. Be Persistent – Know that no one actually WANTS to give you money so they may be vague and cryptic in their correspondence with you. Keep calling and asking for detail explanations and instructions. Don’t give up if you get a NO.

5. Be Nice – Kill them with Kindness. Being Ugly won’t get you very far. Understand that most of the reps you speak with don’t have the real power to change weather or not you get approved. Save your mean voice as a last resort.
I’m not 100% sure what happened that made our insurance change their minds and pay us. I think it was a combination of our persistence, willingness to work nicely with the representatives and their lack of written documentation to back up their claims. Either way I am extremely happy with the outcome. Yay Home Birth!

Insurance Paying for Home Birth: Update 2

Ok so here’s the latest on our Home Birth Insurance claim. I was told that my husband’s company policy only covers care from a Certified Nurse Midwife and not a Certified Professional Midwife, which is what we used. So now we are taking our case to his HR department since they specifically told him that midwifery care was covered but never stated there was a certain type of certification required. 

Has anyone dealt with a situation similar to this?
Can we write an appeal to the insurance company?

Update on Home Birth Insurance

So yesterday after talking with the nice rep who said she would resubmit our home birth insurance claim a few hours later Joe got a call from her. He was in a meeting so she left him a voice-mail that said our Midwife wasn’t certified. So I called her back and said that yes, our midwife was in fact certified. The rep said that Joe’s company will pay for CNM, Certified Nurse Midwives. Our Midwife is a CPM, Certified Professional Midwife. I told the rep and she said she would talk with her supervisor and explain that our midwife was certified. 
So now it looks like we may have to talk with the HR people at Joe’s work, who specifically told Joe that yes, Midwifery care was covered under our new insurance. It was never specified that only a certain certification was accepted. 
I guess the thing that frustrates me the most is that we did our homework, we asked both parties (HR and Insurance) before Noah was born if we could file a claim and they both said YES! Now, we are getting the run around and jumping through a million hoops to probably be denied.
Alas, I will continued to keep a positive attitude, pursue the reimbursement and be nice to everyone. (That last part is going to be the hardest)

Getting Insurance to Pay for a Home Birth

We had both of our boys at home with a Midwife. With Jude we didn’t even bother filing with insurance because we didn’t realize that was an option. We just paid the $3000 out of pocket and moved on. With Noah we decide to check all of our options and see what was covered under insurance. Joe’s work had pretty decent insurance at the time so I called and talked to a representative about our options and they said a midwife would be covered. So we went ahead with our plan to have another home birth with mid-wife.

However, mid-pregnancy Joe’s work underwent some changes and ended up switching insurance providers which have been super difficult to work with on all levels. We had to pay our midwife the total cost of her services upfront, $4000 so we figured we could submit a claim to our provider for reimbursement.  (Home births are significantly less expensive than hospital births so you would think they would love to pay out for home births since it’s saving them money.) I had Noah mid June and we are still going around and around with them about reimbursement.

Most medical insurance has no idea how to handle such a situation so I’ve had to call and explain stuff and get my midwife to submit all of my medical records. Also, because I’m Rh- I needed a RhoGam shot after Noah’s birth which was another $151 out of our pocket. So we included the receipt for the shot with our birth claim. Well yesterday we received a check for $60 as a pay out for the Rhogam shot. They said the $4000 claim for the birth was from an “Ineligible Provider”.

So I called today and talking to a very nice representative that said she was going to resubmit our claim because midwifery IS covered under our policy. So we play the waiting game again. I highly doubt it will be a simple yes they give us. But I plan on pursuing them until they finally cave and give us some sort of reimbursement. I’m not expecting 100% returned but I do think having a baby should be covered under medical insurance.

To Be Continued….

Home Birth Insurance Update 1

Noah’s Birth Story

Noah Asher Lieb
Born: 6/18/11
At Home with a Midwife
At 3:35 am
11lb and 22in
 
Not really sure where to start this story since I kind of felt like I was in labor for months but I’ll start with the real action.
 
After almost 2 months of mild-medium contractions every day (no seriously EVERY DAY) and at exactly 2 weeks past my due date Noah Asher Lieb was finally born. Whew!
The real action started on Friday, June 17th. After visiting the midwife I was instructed to go ahead and take a tiny dose of castor oil and see if anything happened. If I was ready it would work and if not I’d have some clean bowels. So around 2pm I took the castor oil then laid down for a nap. (Joe’s parents were in town and took Jude to Monkey Joes) For a couple of hours I felt nothing. I was slightly tempted to take another tiny dose but decided to wait until after we got home from dinner. While at dinner I started having some contractions about 5 min apart. Nothing too bad just noticeable and pretty consistent. 
 
After we got home the contraction started to get irregular so I just figured it was my regular night contractions and we’d go about our evening. We put Jude to bed and sat down to watch an episode of Psych with Joe’s parents and eat some ice cream. During the episode the contractions came back and were getting uncomfortable. It was about 10:30 so I decided to go lay down and time them. They stay pretty consistent for about 30 min (5 min apart). Joe and I got ready for bed and I asked him to time them for me. As soon as he started timing they started to slow down. So he put away his phone, we cuddled in bed and he opened his book to read. Two seconds later I heard a pop and felt a thump in my lower uterus. I asked Joe if her heard that and I popped up and thought, oh boy… I think I know what just happened. I stood up and began to feel the water flow from my body. I rushed to the bathroom and made it mostly in time to the toilet. I told Joe, my water just broke and to call Stacy. Joe said it sounded like someone was pouring a 16oz drink into the toilet. I was a little surprised it didn’t just gush out but it continued on and off for about 30 min. After Joe hung up the phone with Stacy he did a little dance of excitement since he was finally about to meet his second son. To be honest I think we were both pretty happy that I was FINALLY in labor.
between a contraction before the midwives arrived
 
As soon as my water broke (at 11:50 pm) my contractions moved to 4 min apart. While we waited for the midwives to show up Joe worked on filling up the pool and I paced out the contractions, stopping to hold the dresser and moan and try to go with the flow. About an hour later (1am) the midwives arrived. I was still pretty coherent and we decided to move to the pool. (The pool was set up in the nursery) It was relaxing to be in the pool but I only stayed there for about 45 min – 1 hr. While in the pool the contractions intensified, I threw-up and Audrey instructed me to push with the contractions because it would feel good. And it did, what relief. However, my hips started to hurt like HELL. That was Noah making his way down. So Joe and Stacy applied counter pressure to my hips and that helped a lot. Finally I got sick of the pool and we moved to the bed where I actually started pushing. (I’m not exactly sure what time it was… I was a little busy)
 
I’m not really sure how I ended up in the position but it’s what felt best. Joe was behind me, I was leaning on him and somehow he was hold me upright. I had my feet pressed into Audrey and Stacy on either side of me. This is the part where I did a lot of pushing. I would start of the contractions with a big NO and finish with a LETS DO THIS. I remember thinking how crazy I must sound going from I want to quit to I can totally do this. I don’t remember pushing that hard with Jude. I pushed with every inch of my body and still felt like I wasn’t giving enough. Audrey instructed me to put my chin to my chest, hold my breath and grunt. I would give a few big pushes with contractions but didn’t really follow through long enough. I was so glad to have support that called me out on not following through even though I wanted to fake my way through labor. (btw You can’t fake your way through labor)
 
This next part gets a bit hazy but here’s what I remember. I finally started to give some huge pushes and his head started to crown. The stretching of the skin burn and I reached down to feel his head and to help stretch the skin. (I didn’t do that with Jude, I was a little nervous about looking or feeling what was actually going on.) Finally his head came out and they said oh one more push and you’re done. But then I wasn’t done. He was stuck. Immediately, they flipped me onto hands and knees (Thank you Ina May Gaskins!) and Audrey reached in to help get the cord out from around his neck and to remove both of his stuck shoulders. I’m not sure the order of things but I remember hearing that both of his shoulders were stuck, then his hips need a little extra tug and there was some major pulling going on. Finally 4 min after his head crowned Noah was born. (At 3:35 am)
 
I couldn’t see him because of my position but a few seconds later I was able to turn around and see them resuscitating him. He was breathing on his own and already had a pink color to him but his breaths were shallow so they had the bag on him and were timing his breaths. I don’t really remember all of what happened next but I knew when I saw him start to cry he would be OK. They instructed me to hold him and touch him and talk to him. Right after he was delivered he had a huge bowel movement and probably lost about 2oz of meconium. (A stress induced poop)
First picture (Yes I do look a little like a zombie)
 
The Placenta
(With Jude I had a horrible time delivering my placenta. It was manually removed and caused me to hemorrhage. There was a duration of 2.5 hour between when Jude was born and when the placenta was delivered. This time we made sure it was different.)
 
I had a great deal of blood loss with the birth so they gave me a small dose of pitocin to stop the bleeding which also helped keep the contractions going which helped the placenta to be delivered very quickly and easily. (I’m not sure how long it was but probably less than 30 min)
 
After that was all done I was  shaking uncontrollably for at least an hour. It was mostly due to the intensity of the situation and maybe a little to the large blood loss I experienced. After some food, hydration, relaxation herbs and techniques I was pretty good. They stitched up my 1st degree tear which was not fun but thankfully they numbed the area and gave me plenty of distractions so I didn’t really know what was going on.
Me and Mr. Noah
Brothers
After making sure everyone was OK, cleaning us up, cleaning up the house and taking a little breather the midwives left around 7am. Shortly thereafter Jude woke up. (he’d been asleep the whole time in the room next door…. so were Joe’s parents). When Joe’s mom got Jude he held his hands to his ears and told her he heard cats in his house and headed toward the kitchen to find him. She told him there were no cats and what he heard was a baby crying. Immediately he knew it was his baby brother and came running in the room to meet Noah. I was surprised and excited that it took him no time at all to put 2 and 2 together and happily greeted his new little brother.
Jude meeting his baby brother for the 1st time.
4 days later and we are all happy and health (aside from some breastfeeding issues which I will share about later.) I’m loving our new family of 4. It’s been kind of crazy around here the past few days and I’m looking forward to it slowing down a bit. (Joe’s parents are still here helping, which is great but adds a bit of excitement to Jude). I know eventually all the pieces will fall into place and our family will just be awesome. I love all my boys so much!

Ways to Induce Labor: 3 HOTS

Baby 2 was due last week. Today the midwife said things look great and it could happen any day now…. or it could be another week. You know since due dates are pretty much guesses anyway. So until then we are going to employ the 3 HOT ways to induce labor rules that my midwife shared with me.

1. HOT Bath
Not only is it nice to take a hot bath, it reduces swelling and helps you relax.

2. HOT Foods (spicy)
I’ve heard many people say that spicy foods induce labor. I can handle spicy foods OK but I may have to bite the bullet and just get something crazy hot to help get this boy out.

3. HOT Sex
Like a true home birth dad Joe has offered on many occasions to help me soften my cervix. hehe

So now that everyone knows my plans for the evening. I will be taking suggestions on some yummy but spicy food options.