For the last few months I've been musing on the difficulties of finding good maternity care. My journey with this began even before I was pregnant, when I called our new insurance here in Jersey to figure out what the coverage was like. I was practically ecstatic: a $10 copay for the first office visit, and then 100% insurance coverage of all care, including labor and delivery. Given that we were still paying off Eva's delivery when we moved here (at 10% coinsurance, plus the day in a children's hospital for jaundice, we ended up owing about $1600 for her - and that's with a natural delivery.), it just seemed amazing that we would only have to pay $10 for our next. More good news: our new insurance covers birth centers, midwives, hospitals, etc. It appeared to have a lot of options.
It seemed fantastic, and I was already joking with people about wanting to get pregnant as soon as possible (of course, I wasn't actually fertile when I was joking about it...). Then, I got pregnant, and I had to make the next move of selecting my care providers. Since my sister is a midwife, I'm prejudiced toward midwifery care, so first I did a midwife search, and I was pretty astonished at the lack of midwifery care available. Most midwives here work in OB practices, rather than midwifery practices. So basically I would end up with four OBs and one midwife, which was not what I was looking for. There was one midwifery practice that came up on my insurance website, but it looked to be at least a thirty minute drive. Out here in Jersey, no one thinks twice about driving thirty minutes for anything (especially if they can do it every day). But as someone from a non-commuting small town in Iowa, an hour in the car just wasn't appealing to me. Not to mention that particluar practice wasn't in a very safe area.
I also called the insurance to identify where the birth centers were, since I'm covered for them. As it turns out, there aren't any within a 75 mile radius of where I live, for which I'm covered. Hmph.
Who would have guessed that in such a highly populated area there would be so few birthing options? It was actually much more limited than in Ohio.
My next object was to see if I could get a homebirth covered by insurance. This was kind of our first choice all along. But to make a long story short, the answer was no on the homebirth. It took a few weeks of arguing on this to ascertain that homebirth was not an option, unless I wanted to pay $6,000 out of pocket for my care and delivery (this was for a CNM, not an LPM, which would be about $3,000 out of pocket). My husband was willing to do it, but, my inner utilitarian could just think of a lot of ways I'd rather spend $6,000 than on a delivery I could have for free.
Finally, I started asking around to get some names of potential caregivers. The first three friends I asked had all had C-sections (two for very weak, i.e. not medically indicated, reasons). I didn't really want to go to their providers. The fourth person I asked had had two vaginal deliveries and really liked her doctors, and the office was closeby, and they had a midwife on staff.
Of course, by this time, I was already 10 weeks along, and when I called to make my appointment, they insisted that I come in that same week. The only appointment was for a Wednesday morning, so I told them I'd have to bring my kids. They said it was no problem. But when I showed up on Wednesday with Maia and Eva, they told me I needed to have a stroller for Eva. So I went out to the car and brought the stroller in. Then, after taking my blood pressure and weight, they informed me that they just really couldn't do the appointment with children present and they'd like me to reschedule. This was immediately a red flag for me, but I agreed to come in later that day. Jeff had to leave work early and take Maia to gymnastics.
Within about five minutes of meeting with the midwife that evening, she informed me that I would not be happy with their practice because they are so medicalized. She went through all the details - things like continuous fetal monitoring, a clear liquid diet during labor, no waterbirths, etc. In other words, all things that have NOT been shown to improve birth outcomes, but which, nonetheless, the OB community seems wedded to.
So I transfered care to the midwifery practice she recommended, which, of course, is a good forty minute drive from where I live. On the day of my first appointment there, my kids spent about an hour and a half in a car and an hour at an appointment. That'll wipe out an afternoon for you. It also almost wiped out our lives. There's no time that I have such a keen sense of my mortality as when I'm in the car on the road, especially here in Jersey. This time, we escaped in tact, and possibly the drive will seem easier when I'm more familiar with the route. Until then, our four guardian angels will have to be working overtime to ensure our safety in the car.
Now I will be delivering in a hospital that is about forty minutes away, as well. Because, it's oh, so much fun to be in heavy labor and immobilized by a seatbelt for forty minutes, let me tell you (I did this with my first delivery, actually). But, this place does have waterbirths, my midwives seem nice, and it probably will be a better birth experience. And, hey, it's free.
God bless America's healthcare, where you can get the expensive ($15,000+ for a C-section), interventional hospital delivery for free, but you can't get a homebirth without going into debt. Or in other words, see my sister's earlier insight on this.