It’s the 11th hour — I ache, I waddle. I watch my baby’s limbs slide across my abdomen and know that any second now she could start making her way into the world, and the details on how that will happen still aren’t 100% finalized.
You see, I currently live in North Carolina — where traditional midwifery is illegal. Had I stayed put in New Mexico, much of this wouldn’t have been a concern, but the baby’s father thought it best to take a job on the West coast to prepare us monetarily. It made sense, so I came to North Carolina to be with my family until his return.
I was living in the rural southwest for a variety of reasons, not least because I wanted to make an attempt at more, and more radical, self-reliance. Predictably, when I found myself pregnant at 36, I thought to myself, “Oh hey, natural process — we’ll do this at home!”
I was then totally surprised to find myself labeled “high risk” and of “advanced maternal age.” I might have been 36 when I got pregnant … but I was a wiry, energetic, and sun-leathered thirty-six, eating home-grown organic vegetables and deer meat shot on premises, living on the edge of a huge wilderness four miles from beautiful, natural hot springs that I visited as often as possible. Tests showed me as extremely low-risk for a variety of bad things, and my exceptional health and youthfulness were constantly remarked upon.
Still, none of that mattered when I arrived in North Carolina midway through my pregnancy. The town where my family resides isn’t like North Carolina’s more well-known vortexes like Chapel Hill and Asheville, where lay midwives are still very much part of the crunchy, alternative culture. In Greensboro, I wasn’t immediately able to find prenatal care that really vibed with the kind of person that I am, so I simply went for standard medical care that let me listen to her heartbeat on the Doppler every couple of weeks and checked my blood pressure.
Oh, but I heard there are some great birthing centers around, one of which is only 45 minutes away in Chapel Hill. It’s renowned, but the center and its midwives are booked through April 2011. But what about Women’s Hospital? They have great birthing rooms and Certified Nurse Midwives! But it’s still a hospital, which would require additional efforts in making sure my demands were met and some potential disagreements about, say, which kinds of vaccinations they’d shoot my kid up with before they’d let me leave. According to another Certified Nurse Midwive in Asheville, with me being 37, having never given birth before, and not having developed a serious relationship with any specific “care provider,” I was not a candidate for a home birth at all. They had, she said arrogantly, “an impeccable reputation” they needed to uphold. To jump in at the end and guide a strong, healthy woman through a natural process is just not how they go about things. Okay, then. Given the hell midwives have been put through in this state, I can understand the paranoia, but still…
How to find the perfect midwife or OBGYN for your birth
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Since when did pregnancy become such a complicated, delicate, and heavily-monitored matter for women in general?
Since when did pregnancy become such a complicated, delicate, and heavily-monitored matter for women in general? Yep, I still make my bi-weekly pee-in-a-cup-and-listen-with-the-Doppler visits, but they feel pointless. I’m well aware of this baby moving around inside my belly, and I’m also well aware that she’s getting ready to vacate the premises. They do that eventually. I also understand that something could go wrong — and that I could potentially wind up on my back in a hospital with a surgeon releasing my child from its uterine bonds at a designated time and hour. Either way, as long as the end result is a healthy, happy and whole baby girl, it’s all fine. I just want to give myself the chance to experience the process first — even if it means digging around underground for references to experienced midwives willing to assist and renting a cabin hours away in order to have some semblance of proximity to them.
Thankfully, at this 11th hour I’ve found someone who resonates with who I am and what I want out of my birth — a lot of advance education about the processes involved, minimal interference, a quiet, private labor with my lover, and some assistance, should I need it, when it’s really time to push. They’ve also got a relationship with the doctors at the nearest hospital, should I need them, because they reside in liberally-minded area where the idea that what they do is illegal seems as moronic to others as it does to me.
But for all the work involved to make this the most simple, natural (and still safe) experience it could be, I could have divested far less energy just doing it myself in the bathtub here at my family’s home. I’m still very much into the idea of unassisted birth, but I’d prefer that choice not be made out of desperation.
My first child was born at a water birth center with very hands off midwifes. My second child was born unassisted at home. The second experience was mind blowing. Though there is little possibility of a third baby I would love another chance to experience completely unhindered birth.
Congratulations on finding a care provider and experiencing the birth you wanted.
Hi, Dori! So great to hear your voice on OBM. Hopefully, we’ll be reading your birth story here soon too. I know the hassle and stress you went through to find a care provider. So glad it worked out for you. Blessings for an amazing birth experience. See you on the other side, mama!
I recently gave birth naturally at the birth center mentioned in this article and they were great. There is also 1 CNM in NC based in Carrboro. We loved her but since she would be out of network, we stayed with the birth center. Unfortunately, NC, like many states, is ASS backwards with birthing rights.
I live in Burlington NC and am 7 weeks along. I had a miscarriage last year and had researched all the types of labor and delivery options I had. Basically, if I wanted insurance to cover me at all (prenatal is 100% covered) I had to do it in the hospital. Luckily, the practice I go to has two CNM. The only problem is there are 5 other doctors and whoever is on duty when I go into labor, will be the doctor or midwife. I have tried to request a midwife, but it is the luck of when my water breaks. I looked into home births or water births but I would have to go out to Raleigh to get anything like that. I’m pretty bummed about the whole situation but in the end, I just want a happy baby.
catherine – i have some resources for you if you are interested in a home birth. i know a really amazing CNM who accepts Medicaid – you’d still have to cover $2500 of her $4000 fee, but she’s incredible and she will come to you if you want to birth in your own home.
Hi Dori, I am moving to Greensboro and I feel like I’m afraid I won’t find a midwife like the one you described. Do you have any references for a midwife for a home birth? Much love, thanks xoxo
Generally what people do here in NC from my experience is say to the insurance company, “Oops! My labor was SO fast there was NO way I could make it to the hospital in time! Silly baby!”
I am a young, first-time [but i like to think, well-educated] mom-to-be living in Colorado Springs, Colorado. I love my city, and this state, but unfortunately the fact that my insurance is currently provided by the state, means that I have just about no other option than a hospital birth. I had really hoped for a quiet water birth, or at least something in a comfortable birthing center with a good midwife… But I just can’t get those things covered, and can’t afford to take the costs on myself. My doctor’s office also carries the rule of ‘whoever is on call when your water breaks is delivering your baby’, which I am supremely disappointed about. I would encourage anyone and everyone who can afford to or is able at all to go the extra length for the kind of birth you want, to do it! I feel like I’m absolutely being forced into a birth experience I don’t want and still struggle every day with the fear of unwanted or unnecessary interventions being pushed on me by a strange doctor or over-zealous hospital staff. I wish I felt like I had more power over my own pregnancy and birth. 🙁
Just gotta say- YAY Colorado!
Congratulations on finding a care provider and birth that you want! However, I would caution you (and others reading this story), that there are very real, very tangible medical risks for otherwise extremely healthy 35+ y.o. mamas having babies, especially for the first time. Mama may have absolutely 0 warning signs of certain conditions until things become complicated at the 11th hour. Do be careful and make sure you have all your bases covered! (As I’m sure you do.) BTW Chapel Hill and surrounds are a gorgeous part of the state.
Since when did pregnancy become such a complicated, delicate, and heavily-monitored matter for women in general?
Seriously. With all respect for anyone who has had a complicated pregnancy, and not to trivialize any number of real concerns that can come up…many many pregnancies are uncomplicated and even easy and it seems like no one talks about that. I was a perfectly healthy 26 year-old during my pregnancy and I was amazed at the level of straight-up paranoia that a lot of people have about birth. Babies happen! Everyone calm down!
I think youve written a wonderful article and there are many thing I can agree and sympathise on, and others I think are debatable for me. I hated being in a hospital when I had my son, I just wanted to be home. However I was a very healthy, active 21 year old having my first child, having had a wonderful uncomplicated pregnancy. The birth of my son was a different story, for the complications that arose at the last minute that couldnt have been predicted could have cost us both our lives, I am glad that we were in a hospital environment for that sake.
I think it’s very important to be comfortable with your idea of giving birth, and for me when I actually was in labour I couldnt care less where I was and who was or was not assisting, however I was no longer worried about the birthing process anymore as I was already in it, if that makes sense, all I cared was for a healthy bubba at the end, and we left with one. 🙂
I delivered in a foreign country where hospitals are minimally assisted for the most part, or hands-off midwives approach. They just monitored my sons movements every once in a while, other than that I was able to dance through my labor and walk all the way until transition labor. I began pushing when I felt like pushing and the midwife was just there to catch my son. People think its crazy that I delivered in the Italian hospital vs the American hospital here, but the healthcare overall was way better and the Italians had a 17% cesarean rate vs one American doctor’s 80% rate. (yikes!) I could hardly speak to any of my midwives, they could hardly speak to me. And while that scared the shit out of me before I delivered, it all worked out just fine. I ended up getting the birth I wanted, in a place I didn’t want but it was for the best.
My point is, that maybe its possible to have a minimal assisted birth in an American hospital? Maybe not, but good luck! Make the best of your birth, no matter how it happens and try to absorb every moment of it.
hey, neato – had no forewarning that this was up, lol – just an epilogue – we are actually birthing right here at home (old lady and parents notwithstanding) and have found an amazing CNM – not least do i love her because she mentioned “anarcho-libertarianism” and lives on a sustainable family farm (her husband teaches permaculture) but she’s also caught over 1200 babies and had NO judgements or hesitations whatsoever about stepping in at the last minute after viewing my records and talking with me.
as to the poster who hoped i had all my bases covered – i do appreciate your concern – it has been a scramble, but yep, got ’em covered… we’ve got backup plans behind the backup plans, just in case… i won’t be getting paranoid about any “last minute risks” simply because i’m over 35, however – last minute risks could happen to anyone and we’ll cross that bridge if we come to it. if ANY complications arise, well, it’s off to the hospital with my birth plan and demands in hand.
thanks for reading this, y’all!
I work in rural communities in Ghana, West Africa; where women and babies commonly die in childbirth.
We have midwives and medical assistance because women and children can and do and CONTINUE to die in developing nations and in developed nations too.
Let’s not be paranoid or scared of childbirth but let’s not trivialize it either.
Childbirth CAN BE dangerous.
I also live near Greensboro, but I spend most of the year as a student in Chapel Hill. I can only imagine how difficult it must be to try to have a natural birth in this city–it’s why I want to move to a more progressive region before I have children of my own. Thank you for sharing your hardships in trying to have your own birth experience.
I too live in a backwards community, where midwifery isn’t illegal, but almost no one knows what a midwife or a doula is (and I get comments weekly about how crazy I a to not want an epidural). There simply are no midwives here, and the only choice for birth is in a hospital. Luckily I found a doula-in-training and a doctor who is OK with having a doula involved. We’ll see how the hospital birth goes….I’m a little worried I’m going to be pressured into having interventions I’d rather stay away from, but I’ve made my birth plan very clear about what I want and don’t want. I’m hoping that having it all on paper beforehand will keep me from having to fight with them while I’m in labour.
I am due in August 2011 and am also of “advanced maternal age” (with my first child) as I will have just turned 37 when he/she comes. I don’t understand what these last minute risks are supposed to be? I am very healthy… at least just as healthy as when I was younger. Maybe even healthier as I eat way better and exercise more now. I don’t get it. Age is just a number – it doesn’t really tell specifically how healthy a person is.
The “last minute risks” are things that pop up in the third trimester, no matter how old you are and how healthy you are– placenta previa, breech presentation, gestational diabetes, Strep B positive, and on and on and on, and the belief is that the older you are when you have your first child, the more likely you are to develop any of these complications, based on statistics, which is all that matters to the medical community, who sees your age as not just a number but a marker of risk.
I’m also a bit confused by that.
I know there are a lot more risks of the baby having certain disorders/conditions (eg down syndrome) in an older woman, but as far as the actual birth itself goes, I’m not sure what makes a home birth any more risky for a 35+yo than it is for a 20 year old?
Any nurses/doctors on here that can enlighten us?
A rare but extremely serious risk is that the cord can get caught being delivered before the baby or can get stuck between the baby’s head and mom’s birth canal. This causes the blood flow from he cord to be cut off. If the blood flow is cut off then baby has no air. We all know aprox how long a person can live without air. Not very long. If not caught and treated very efficiently the baby can die.
Mom will then have no continue to labor aware that her baby is dead or if contractions have stopped a c section may be considered. Sometimes the baby will live with severe brain damage. Fortunately Dr’s, midwives, nurses and paramedics(at least in Canada) are very good at recognizing this problem. Hospital treatment is necessary if this occurs.
Another problem that can happen to anyone is the cord getting stuck around the baby’s neck. Prolapsed uterus, severe post partum bleeding can also happen in otherwise completely healthy pregnancy.
The point is childbirth is almost always a wonderful, happy, natural experience but it’s good to have a backup plan to keep you and your little monkey safe. I wish everyone luck in finding the style of practitioner they like with the safety net they will hopefully never need.
Jess, while these are certainly risks of birth — are moms over 35 at higher risk for experiencing them?
Not that I am aware. These are just a few of the unexpected things to weigh when considering an unassisted birth.
Actually one of the only risk factors that I am aware of for specifically women age 35-40 who have had an otherwise healthy pregnancy and are in active labour(ignoring diabetes, hypertension etc) is placenta problems. Placentas can do crazy things like detach prematurely and cause mom to bleed. There are a few kinda strange things a rogue placenta can get up to. Women over 35 are at increased risk of this. I am not aware of too much else that is significant for a healthy 35 year old woman which is delivery specific.
Any other health care practitioners out there with more info?
I can really relate to the struggle of navigating the ‘birthing world’ the first time you have a little one. After much thought and going through a very similar process as yourself, I decided to go with a CNM in a hospital setting for both of my kids. For myself, doing this was a great choice, because I wanted the comfort of knowing that the hospital resources were right there if I needed them, but that the timeless experience and wisdom of midwifery was at my side during the process. I saw it as the best of both worlds. It did prove to be this for me, because by hospital policy I would have probably had two C-sections by delivering in the hospital with a doctor. However, the CNM monitored my heart rate and the baby’s vital signs (with my first labor) when a complication arose at the end of my labor, and said that I just needed to focus on pushing and stay calm. Eventually a female doctor was called in to rotate my son, who was over nine pounds, and then I pushed him right out. My daughter was more of an unmedicated birth in this same setting with a nurse midwife. The experiences were not ‘perfect’, but they were pretty darned good, and I was able to have two minimally-invasive vaginal births with big babies.
oh lord, and the saga continues…
as of this morning, this midwife didn’t work out either. all i want out of a midwife is for her to coach and catch, or call the hospital if need be – but i unfortunately can’t find one who is willing to do this without imposing her own ideas on how my birth should be, and that was my entire point for trying to birth at home with a midwife in the first place – so i could at least ATTEMPT to birth the way i want. it ain’t gonna happen in greensboro unless i step back to square one… that being said, i’ll be back here with a birth story and only god/dess can predict what it will be, but i am not afraid. 🙂
Good because there is no reason to be afraid Mama! You’ll have your beautiful little girl here in no time! And once she is here, the details of how she got here will fall by the wayside. And again, Good luck!
I am currently trying to get pregnant–I’m a 36 year old mom of 2, 1 by birth, 1 by choice. I gave birth to my daughter at 33 and was already hearing the comments about my age. It’s so hard to find a care provider that you click with sometimes. My first birth was awesome, amazing–but still far more medical than I would have liked. My midwife pressured me into a stadol shot, and also pushed me more than once to get out of the tub so she could check me.
My husband has gone back and forth on the idea of an unassisted birth–he’s fine with a homebirth, but we live on a military base and they will not allow the midwives to deliver babies here, so it’s unassisted or birthing center, most likely. I’ve considered renting a hotel room off base too. Whatever we do will not be covered by TriCare, so it will all be out of pocket–and regardless of when I deliver, my husband will not be here–he’s going to be gone for almost 16 months, with 2 2-week breaks to come home. I definitely feel capable of UCing, but I hate the idea that my choice is not because I felt led to it, but because financial constraints and base rules are pushing me to it.
Sending you positive thoughts and happy labor dust, Dori
Dani,
As someone who has lived with the military medical system my whole life (Army brat, Army veteran and Army wife), I understand and sympathize with you about how difficult Tricare can be when the type of care you want doesn’t mesh with what THEY want. However, I wanted to make sure you were aware that Tricare Prime isn’t your only choice! (I’m just guessing that you have Prime based on your comment.)
Tricare Standard/Extra is something I myself am looking into switching to because it will allow me more freedom in the care I receive, albeit at an increased cost to the nothing I would pay under Prime. However, while I don’t know your personal situation, the price to choose your medical provider may be worth it to you.
Again, I just wanted you to know there are other options out there, as it sounded like you felt “trapped” (as I do) under Prime.
Good luck!
-Heather
P.S. And Good luck to you, too, Dori!
Dani, Heather,
Definitely DON’T let Tricare pressure you. They told me that if we didn’t command sponsor here I could not have Prime insurance and everything over the 1K cap would be out of pocket… they NEVER could give me an answer as to how much delivering off base would be. So since Italians pay with the Euro, we figured we would be screwed by opting out of Prime. – My husband had to extend his enlistment a year to keep insurance on us (I’m a veteran, I separated from this base) – We got the bill in the last few weeks from Tricare, informing us on how much my birth was… about $1200. So only 200 would have been out of pocket… Tricare scared us into extending for $200. Assholes.
I am a father to two lovely born at home daughters, our first was born with Homebirth Midwives in attendance and our second was completely unassisted. I know that both for my partner (she being the important person actually birthing our baby) and for myself the unassisted birth was a fantastic and empowering experience. Good on you for trying to have the birth that you want, you should not have to compromise your ideal of birth for anyone else or their ill informed preconceptions. I hope that everything works out for you and that somehow you are able to birth your way, unhindered by the stupidty of others.
my uncomplicated birth could have been complicated by strep b. which i tested positive for. the midwives demanded i take an antibiotic in labour. i am extremely allergic to penicillian so they gave me a prescription to another one. forgot the name. my sister is actually very allergic to it and penicillian. well, i didnt take it. i laboured at home arrived at the birthcenter at 9 cm, much to my surprise, my water broke after five minutes and i pushed for five. yay no antibiotic iv!! and no possible reaction to something i had never taken before!
Re: the “Why did they think I was high-risk” comment, I think that has more to do with the fact that after 36 years, the eggs stored in a woman’s body are not all as stable as they were when she is (say) 20 years old. You only get one set of eggs for your entire life, so they age with you. The “high-risk” factor has nothing to do with you eating healthy or not.
(Though obviously it’s better to be healthy, and I’m certainly Not advocating everyone becoming parents at 20 years old).
I have a friend who had her first of three at age 39. She had all three at home, uneventfully, the last two unassisted. Just an anecdote, but an encouraging one.