Tuesday, 17 May 2011

Guest Post: Mollie's path to pregnancy/birth (Part 2: Preparation)

In Part 1, our intrepid heroine learned the secrets of her reproductive cycle and was blown away by a showing of "The Business of Being Born". Check out the next installment on...

Mollie's path to pregnancy/birth: Part 2: Preparation

So now my world had been turned upside down and I was looking for answers. Where did I go? The internet of course!!! I began following the Public Heath Doula’s blog, as well as anyone SHE followed. Soon I had a nice little list of Natural Birthing bloggers: Birth Faith, Our Bodies Our Blog, Science and Sensibility, The Unnecesarean, the Midwife Next Door, Enjoy Birth, and many others. And I read and I read and I read. I couldn’t get enough of it. Sometimes they were a little out there and scary, with a “if you give birth in a hospital you WILL end up with a cesarean”, but most of the time they were informative, and over time I learned about Doulas, episiotomy rates, c-section rates (and the vast discrepancy among hospitals in New York City, which range from 16% to 48%!), and most importantly, the questions to ask your care provider BEFORE you agree to work with them:

Questions to ask
A few more question
And a few more

Around this same time I also attended a talk given by the head of Parent Family Education from St. Luke Roosevelt Hospital. My company often holds mini lectures on topics like getting your kid into private school or how to reduce your stress at work. This one was called “Preparing for Pregnancy and Childbirth”, and thank goodness it had listed as one of the talking points “preconception” (I learned later that the instructor did not know she was expected to talk about preconception, but obliged because there were a few of us non-pregnants who showed up). The talk was basically a quick and dirty intro childbirth ed course, with an emphasis on “This is a really big deal, so after this, you should sign up for a real course.” But the most important thing that came up was this: pick your birth location BEFORE you pick your provider.

I’m going to say that last part again.

Pick your birth location BEFORE you pick your provider.

“Um, are you on crack?”, you must be thinking. “That makes no sense.” It sounded strange to me at first too, but the more I learned, the more I realized that the difference between hospitals – even hospitals within a few miles of each other – could drastically change the type of birth I would have. For example: St. Luke’s Roosevelt Hospital has an in-hospital Birthing Center, where many of the standard Labor and Delivery rules do not apply (e.g. there are no restrictions on eating or drinking, and continuous electronic fetal monitoring is not required). Approximately six miles away, Elmhurst Hospital requires every laboring woman to be confined to bed, on her back, with continuous EFM regardless of her risk assessment. The rules of the hospital would DRASTICALLY change not only my overall experience, but the specific ways I could cope with pain (if I’m not allowed out of bed except to go to the bathroom, I’m certainly not going to be allowed to walk the halls or labor on a ball).

“Well, my provider would never force me to stay in bed, and she can just meet me at the good hospital.” She could, if she has privileges there. I happen to love my gynecologist, but because of recent insurance changes, she only has privileges at Jamaica Hospital – not only inconvenient for me, but Jamaica Hospital has a 41% cesarean rate (as of 2008), compared to Roosevelt’s 28% (Read the stats here). You may decide that you want to do a home birth, but I highly doubt your OB/GYN is going to be your provider. Also, if your provider has privileges at multiple hospitals, he may have you meet him at the hospital where his current mom is laboring, not necessarily the one closest to you or the one with the amenities or rules best-suited for your desired labor experience. Now, this point may be moot if you only have one hospital or birthing center in your area, but if you live in a metropolitan area with many choices, it makes sense to get to know the hospitals first, and then ask the hospital or your insurance company for a list of practitioners with privileges at your favorite.

Ok, so I had my reproductive system down, I knew I had some options for hospitals, and I knew more about episiotomies than any child-less person should know. Over the three “preconception” months, we went on three hospital tours – Roosevelt, Lenox Hill, and The Brooklyn Birthing Center. I liked Roosevelt the best, so I asked them to send me a list of practitioners who had privileges in the Birthing Center. I narrowed down the ones covered by my insurance company (oh, side note: I called my insurance company and it was the opposite of helpful – the guy on the phone told me that midwives were illegal in the state of New York so they don’t cover them . . . oh Aetna customer service . . .), and set up consultation appointments. Now, I had no issues going on hospital tours while not yet pregnant, since they didn’t ask (I have heard rumors that some hospitals won’t let you come unless you’re pregnant, hoping to weed out trainee doulas and paparazzi I guess, but in that case, I imagine you can just lie). I got a little bit more push-back from the receptionists at the doctor’s offices (“Wait, you’re not even pregnant?!”) though thankfully, not from the doctors themselves; they knew exactly why I was meeting them so early, and even seemed to appreciate it. One midwife office (the ones I ended up choosing) actually had an orientation night, where they sat for an hour or so and talked about their practice and their birth philosophy, and where anyone could come and ask questions. I ranked my favorites, and now I was ready for baby-making!!!