What home birth and midwifery model of care meant for us

From the day I realized I was pregnant when I didn’t get my period back in July I knew I wanted this baby to be born at home. My husband wasn’t so sure in the beginning. He felt there was no need to make any changes since our first birth was such a wonderful experience. “Why do you want to fix something when it’s not broken?”, he said. But I wanted more. I wanted peace, and no machines, I wanted dimmed lights, and no car ride. I wanted Kamar to greet his baby brother or sister right there and then. I wanted it to be intimate, no strangers around. Thankfully, it didn’t take much convincing – after seeing some documentaries and doing some research he quickly realized we were lucky the first time and hospital was the least safe place for a healthy mother and a healthy baby.

{health insurance}

Then I almost drowned in a health insurance mess and a search for a home birth midwife. I called several of them, met with a few and fell in love with one. I felt a strong connection with Jessica, our midwife. She’s the most modest, knowledgable, experienced and calming birthing professional I’ve met to this day. I knew instantly prenatal care was about to change in every aspect imaginable and I had such high expectations for our home birth. Not to mention she was the only midwife we met with that didn’t require any upfront payment (other midwives we met required a large upfront payment and we would get reimbursed once the insurance company pays for the services, Jessica simply waits for the health insurance to pay her). Frankly, I was worried about the whole coverage thing since home birth midwives are always considered to be “out-of-network” providers. But she was so awesome – she took care of this as well! She dealt with our insurance company directly and managed to get us approved for an “in-network exception”. This meant that her entire prenatal care, attendance during labor & birth and postpartum care were fully covered by our insurance at the in-network level.

{prenatal visits}

The prenatal visits were so easy and I always looked forward to them. Jessica came to our home EVERY. SINGLE. TIME. Not once did I have to take my pregnant self to her office. How awesome is that? I didn’t have to look for anyone to watch my 2-year old or drag him along with me to those boring OB/GYN offices. The number of prenatal visits was the same you would have with an OB/GYN – once a month in the first and second trimester, then every other week in the third trimester and every week in the last month before the due date. Jessica always arrived with a smile. She did all the things regular doctors do – she checked my urine, did blood tests (only once), checked my weight, measured my belly, checked my blood pressure and my pulse. Then she listened to the baby’s heart beat with a doppler or a stethoscope. Kamar loved this part – he thought we were making a phone call to his baby brother or sister and Jessica was so wonderful she let him play with the stethoscope which meant everything to him (and me). No vaginal checks as per my wish – loved this part! (Except for one vaginal check at 37th week to see if my cervix was dilated or effaced due to my fear of precipitous labor – it was – about 50% and 1-2 cm).

Usually, she spent about an hour with me during each prenatal visit. We had time to chat, she answered my questions, and we laughed together. I loved the bond with my midwife and knew I would never have this with anyone in a busy OB/GYN office. She went far beyond any OB/GYN would ever go. She asked me to write a detailed list of all the things I digest in one week and we talked about my diet and how to adjust it best to be healthy and to give myself and the baby inside of me the best nutrition possible. She understands herbs as well, which is wonderful. Every time I felt a little under the weather, I would just call or text her and she would respond right away. Not once did she advise me to take Tylenol. She prescribed garlic with honey for my very sore throat and it did wonders; lots of fluids, lots of protein and exercise for nausea and it worked. She was an incredible source of wisdom and gave me exactly what my hypochondriac brain needed – the sense of “everything’s going to be ok” and I was so grateful for that. I don’t want you to think she would underestimate things though. She never did. She was extremely cautious. If she noticed the slightest thing to be off, she acted fast to make sure the baby and mom were OK.

{ultrasounds + testing}

Once, towards the end of the first trimester, I went to the bathroom and there was blood in the toilet. No pinkish discharge. Bright red blood. I started crying in fear I was experiencing miscarriage which completely panicked my husband. We were so worried. I called Jessica and she asked several questions – what color, what amount, was I still feeling breast tenderness, was I feeling any cramping…? Though she tried to calm me down she did not take the situation lightly and we both agreed an ultrasound would be best to confirm everything was OK. I didn’t want to have many ultrasounds done but I couldn’t wait for this one. So there I was on the way to her backup OB/GYN in Morriston at 11 weeks to get my belly scanned. Everything was fine. My heart was lifted but I cried silent tears for so many women that hear the dreaded “I’m sorry…” instead. I was also assured I was not having twins and was offered a non-invasive Down Syndrome test. I smiled, took the envelope with the test kit and then threw it away later.

Another ultrasound was the 20-week ultrasound which was the only one I wanted to have done. Anatomy scan went well. Then the ultrasound tech mentioned it looked like there may be some fluid in my cervix. But after an internal sonogram she said that was not the case and I relaxed. Not for long. She proceeded to inform me that my placenta was very close to my cervix. I was barely able to breathe… “How close?(please please don’t be covering my cervix, please please please…). “One centimeter“, she replied. One centimeter – great! It’s not a previa. One centimeter – shit! My home birth plan is now in jeopardy. Sure enough, it was. To be allowed to have a home birth, my placenta would have to be at least 1 inch (2.5 cm) away from the cervix. I was told odds were in my favor, about 95% it will get past that point, and I was advised to have a confirming ultrasound done at 30 weeks. Although I didn’t get any bad news, I was crushed by this – the last thing I wanted was to deliver this baby in a hospital, and I didn’t even dare to think about the small possibility I might face a c-section. I panicked. Thank goodness for Jessica who calmed me down yet again – she told me to relax and believe it would move. We agreed to skip the 30-week ultrasound and do one at my 36-week check-up at the backup OB/GYN. This 36-week check-up is quite important as that’s when you get (or don’t get) the “OK” for the home birth. So basically, at the 36-week check-up everything must be great. The slightest thing that would be a little off would mean no home birth for me. So I just had to force this out of my mind and believe it would be OK.

{barriers to home birth}

But as soon as I stopped worrying about the placenta, I started to worry about other things that can come between me and this home birth. Like pre-eclampsia, for instance. Or gestational diabetes. I didn’t have either. Then I worried about my baby being breech – he was breech at 32 weeks. Jessica suggested some positioning and thankfully she’s very proficient in external cephalic version (turning the baby externally from breech to vertex) should the baby stay head up. The baby turned. Then I worried about my GBS testing and already started researching my options in case it’s positive. It was negative. At 36 weeks I was given the “OK” for the home birth as everything with me and the baby was great and my placenta was no where near the cervix. At this point I worried about going to labor before week 37, which would also put me to the hospital. Once I passed my 37th week I felt like opening a bottle of champagne – I reached the mark!! Yay! I can have a home birth! I was so excited!! I was finally able to fully relax and embrace what was coming soon.

{the home birth}

On Wednesday, during my check-up at 39W1D Jessica mentioned my belly was really low and she could feel the baby all around, looked like my amniotic fluid decreased a little and she expected the labor to start that day or the next. We both hoped the little one would wait a day or two because she was with a laboring client and her labor was unfolding very slowly (so slowly, Jessica was able to quickly see me for a prenatal check-up while her assisting midwife stayed with the client). After Jessica left I took my son to the playground, we walked and I wanted to pee every 10 minutes, nothing unusual. But I did feel some strong pressure. Truth is, I have been experiencing some on-and-off cramping since Friday and have been also passing my mucous plug since the weekend. Nevertheless, I didn’t feel anything labor-like and was completely calm and guessed the little one would come later this week.

But he didn’t feel like waiting. My labor kicked in that night and I had my baby on Thursday morning. I was sad Jessica was stuck with another client, but her backup midwife, Kasey DiVine, was just as amazing and I was so thankful she made it and caught my son (home birth story coming soon). He was laying on my chest all covered in vernix and she examined his cord which had a true knot on it! She was amazed and sent a picture of it to Jessica who in her 15+ years of practice only saw this twice. OH. MY. GOD!! A true knot! Poor little guy! If it got tight at any point during my pregnancy, his oxygen flow would be restricted and the result would be catastrophic… Guess he knew and didn’t want to wait any longer, he sensed the danger and wanted to get out to mommy’s and daddy’s arms. The placenta came out, she did a full inspection and it was perfect, came out in one piece. She asked what we wanted to do with it and we asked her to bag it and put it into our freezer. She checked my perineum – not a single tear (she massaged my perineum with a hot towel during pushing and it did wonders). She let the three of us bond with our new family member and started cleaning up. It was much easier than I had thought – she just pulled down the top bed sheet with the protector and threw it into a big black bag and 95% of the mess was gone instantaneously (note – we prepped the bed when my labor started, so there was another, clean bed sheet underneath the protector). She checked on the little guy – he was nursing and his latch was wide and strong! When we were ready, she did the newborn check right there on our bed, next to me and my son who paid close attention to this new little person we called his baby brother. His lungs sounded great, his APGAR was also great and so were his measurements. When she was done she helped me to the shower and then made sure I had something to eat and drink. I was so well taken care off. And so happy. My husband was next to me and so was Kamar, all three of us were cuddling with our new baby. Then there was Kasey’s soft voice, caring touch and her understanding smile combined with the dimmed lights and the intimacy of the atmosphere – all that made the experience unforgettable and so special. It was exactly what I wanted. I felt complete and overjoyed, so high from the love hormone flowing all over my body. This was happiness.

{postpartum care}

Jessica came the next day to check on me and the baby. She also gave me some herbs to wash my perineum with for easier healing. She told me to lie down on my back every day, massage my belly with castor oil, then put a hot water bottle on top of my belly and stay like this for half an hour – this was wonderful for my uterus to shrink back and for me to really relax. We talked and hugged and although I was sad she couldn’t be there, I was very happy with my birth experience and was (and still am) forever grateful to Kasey for jumping into the car at 3:30 am and driving across the entire state to make our magic happen. Jessica then came for another check-up on day 5, then when Sebastián was 2 weeks, and then when he was 6 weeks. That day was so bitter-sweet. Actually, it was more bitter than sweet because it was our last time with Jessica and I knew our beautiful prenatal and postpartum visits were over. I cherish those moments we spent together forever in my heart as to me they are a part of Sebastián’s birth.

Thank you, Jessica and Kasey, for allowing me to experience the beauty of midwifery and its compassionate model of care. I felt spoiled in your hands and my biggest wish for all pregnant women is to feel the same way I did.

Kasey DiVine Home Birth Midwife Bamboola Baby Doula

Kasey measuring Sebastián’s head and listening to his heart and lungs.

Kamar carefully watching every single move she makes.

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