This is how the appointment went…

OB: So, how’s it going? Any contractions or issues lately?
Me: No.
OB: Well what about the morning sickness?
Me: I haven’t thrown up in awhile. I think the last time was 30 weeks. I have had a lot of heartburn lately. I still had some Pepcid you prescribed, but that didn’t really work. Tums seems to be the only thing that helps.
OB: Well we could prescribe something else if you are having a lot of reflux. Probably Reglan would be what I’d recommend, but only if you think it is bad enough that it warrants a prescription.
Me: I think I’ll just stick with the Tums for now. I don’t want to take something more serious unless I have to.
OB: OK then I’ll leave that up to you. Any other questions for me?
Stephen: Well yes, actually there was something else we wanted to bring up with you. I don’t know, Lisa do you want to do the talking or do you want me?
Me: Well, I know I had told you before that we were thinking about this and you gave me ACOG’s stance which I was aware of already, but I wanted to let you know that we’ve decided we do want to go ahead and birth at home with a midwife unless there are some things specific to my case that would put me at a higher risk.
OB: Well, first there’s just the risk of homebirth in general. Death is a real risk in about 2-3 percent of homebirths. There have been cases where the midwife didn’t monitor things closely enough and when signs of distress occured they were ignored. There is also a higher risk of cerebral palsey if interventions do not happen when they need to.
Stephen: Right, well we are aware that there are risks with homebirth just like there are risks with hospital births and even driving in our cars. I’ve gone through all the information with her and we discussed with the midwife what the risks were, I was very concerned about that. Ultimately though I’m not the one having the baby, so it is her decision and I want to support her. What we want to know is if there are reasons specific to Lisa that would make a homebirth more risky for her.
OB: Well you have not had a low risk pregnancy by any means. You have to remember that you have had hyperemesis gravidarum and hyperthyroidism. The PTU that you are on does cross the placenta and could have an effect on the baby. She could have problems breathing, latching on and even have a goiter upon birth that would need to be treated seriously and right away. Plus the stress of labor could cause your thyroid to get out of control. It could increase your heart rate. With hyperthyroidism you are at an increased risk for eclampsia and pre-eclampsia.
Stephen: We also want you to know that this is by no means a statement against you or your abilities. We think you’ve done a fabulous job with Lisa’s care and we’re happy with you. It’s more about her and her being in a comfortable environment.
OB: Oh yeah, I know that. I’d never think anything like that. I completely understand you wanting to be someplace that you are accustomed to. Another concern I would have is the home conditions. Homes are not sterile and babies are very susceptable to viruses and other things. Now I’m not saying that you don’t clean your house, but with a home birth one of the things you have to be concerned with is e-coli, among other things. In a hospital everything is sterilized and the baby is welcomed into that environment.
Stephen: Well doesn’t that increase the chances of the baby being exposed to a super-bug like MRSA?
OB: Super-bugs happen when doctors and nurses don’t wash their hands. We’re very diligent about that around here.
Stephen: Well I know some of the things she was concerned about was being able to move around in labor and have that bonding moment with the baby right afterwards. How likely is that?
OB: Those are all fine. You have to remember to that I’m not your typical OB. I was actually trained by and have worked with many midwives over the years both in the Indian Medical Service and when I did my residency at KMC. I don’t do routine episiotomies, if you want to labor your own way I will let you. I encourage you to have as natural a birth as possible because the more interventions you add into the mix the higher the risk of complications. However, there are just too many times I have written high risk on your chart that I cannot from a medical standpoint endorse this decision. I wish it was different for you. I wish you were a low risk pregnancy.
Stephen: And what are our chances of us actually getting you as our doctor at the birth and you being the one on call?
OB: Let’s see your due date is Sept. 13, the chance is very good. Actually, I’ll even make sure that I don’t go out of town during that time and make myself available to you guys at nights and on weekends. So I’d say your chance is about 95% that I’ll be the one attending your birth.
Stephen: Well thank you for that offer. You’ve given us a lot of information to consider. I know the midwife also tries to rule out as many things as possible ahead of time and wouldn’t take us on as candidates if it was beyond her scope of abilities.
OB: Well you see that’s what baffles me. Does this midwife you’re seeing know about your hyperthyroidism?
Me: Yes. She said she consulted with the other midwives in town and her overseeing OB and they said that it doesn’t rule me out from having a homebirth.
OB: Hmm. I just don’t understand that or agree with that assessment at all.

I measured at 33cm and the baby’s HR was 156. My TSH levels from my last blood test were normal.

I just… I don’t know where to go from here. I feel like my dream of my perfect birth story is already been ripped to shreds. I came home and cried. I left a message for our midwife to see what she has to say, but she hasn’t called me back yet. And now I’m afraid I might have put her in a sticky situation because my OB asked who her backup OB was that told her it was OK for me to have a homebirth. They work at the same practice and my OB said he was going to consult with him about his advice to my midwife.

It just feels so ruined. I wanted this so badly after 8 months of crap. I feel like I’ve been placed in this giant dichotomy of life or death though and if I go with what I really want I’m chosing death.

I also feel like the biggest dork for crying over this and being so upset. I mean I’m lucky to have made it this far in the pregnancy. I’m lucky that I’m affluent enough that I can even make a choice between these two forms of care. I can hear the responses now, “Just remember that the most important thing is the health of you and the baby.” Or maybe even a few “I told you so” things like, “Duh, Lisa anyone who’s watched you go through this pregnancy or read your blog could have told you that you were high risk and this was a crazy decision.” Or maybe a few along the lines of, “We told you not to get your heart set on an elaborate birth plan. You can’t plan birth.”

It just sucks at this point. That’s all I have to say.

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