The first thing she asked was "Do you have any questions?" This is one of the biggest differences between a midwife and doctor. Midwives encourage you to ask questions, are fine with you wondering why they are doing this or that, and want you to feel comfortable. Personally, it makes me feel more in charge, more empowered, and I learn a lot too. Typically the reverse is true for doctors- you do what they say and they are the boss. You are a doctor's 'patient', but a midwife's 'client'. There is a difference. We talk about my previous homebirth experiences, and she asks who my midwife in Las Vegas was. I tell her it was Marvelys Lopez. Oh, I know her, she says. Sherry and other midwives go down to Vegas to re-certify and train in neonatal resuscitation, and they know the Vegas midwives. Midwifery is a small world.
Next, this being the first appointment, there's paperwork. I fill out papers about my previous medical history, pregnancies, and sign a contract. She copies my insurance card. Many insurances reimburse you for home births. I'll do a separate post on cost later on and I'll talk more about that. You sign other papers acknowledging things like the fact that midwives don't carry malpractice insurance, etc. Basically the same stuff you sign at a doctor's office pertaining to liability. Then you write a check- the initial partial payment of her fee.
Now it's down to business. I go in the bathroom and pee in a cup, the apprentice tells me she'll test it, I don't need to. There is strip they use to test it for all the same things doctors do. Most midwives let you test it yourself, which is kinda fun and adds to the empowerment feeling. But the apprentice is learning, so she does it this time.
Then the apprentice takes my blood pressure and pulse (which is always low and just gets lower when I'm pregnant. We joke in my family that we're all half-dead, we all have pretty low blood pressure). Then she asks my prenatal weight, and then it's time to try to find the heartbeat of my little kumquat-sized baby. I lay on the couch and get a squirt of the cold jelly, then the apprentice tries to find it with the Doppler. She can't, so Sherry takes over. Sherry gets a beat or two here or there but can't get a consistent reading. That's not unusual at 11 weeks (it's happened to me before), and I'm not freaking out about it. We'll probably get a reading at the next appointment, which is in 4 weeks.
All this happened in Sherry's living room. This might seem too casual for some people, but it's fine for me. The first time I had a midwife, with my third baby, my midwife, Marvelys, came to my home for appointments. She had a suitcase she'd bring with her with all her gear, and our appointments were in my living room. My older kids got to help with putting the "jelly on my belly" and listening to the heartbeat. By the time I had baby #4, Marvelys was busier, and no longer did home appointments. So I went to her home office. Her home office was set up very similar to a doctor's office (she had previously been a family doctor, after all)- the same kind of exam table, etc. So each midwife operates differently. If it's important to you to have your midwife operate a certain way- home visits, a professional-ish office, or whatever, add that to your list of questions.
Next Sherry tells me where to go to get my lab work done for a prenatal blood panel. In Las Vegas, Marvelys drew my blood in her home office and had a lab-pick up service. That was pretty awesome, because it didn't entail going anywhere else. But here, with homebirth being a little more "underground" and obscure, I have to go to a lab to get my blood drawn. So on the way home I stop at the place and get it done. I had forgotten how many vials of blood they fill up - like 6 or 7! I'm feeling pretty cool, though, because I'm watching the vials fill up and not even looking away. Apparently it doesn't take much for me to feel cool. =)
My appointment at Sherry's is about 45 minutes, which is typical. Each prenatal appointment will be 45 minutes to an hour. This fact, independently, reduces the risks of a negative outcome for me and my baby. Studies have shown that the better prenatal care you get, the more likely you are to have everything go right. When you have a doctor that sees you for ten minutes and doesn't address things like nutrition, exercise, concerns, or questions, quality prenatal care is harder to get. (And I don't mean to imply that all doctors are like that- mine were, but I've talked to lots of people who got great prenatal care from their OB's. So no matter what route you go, be an active participant in your prenatal care and you'll increase your odds of having everything turn out happy).
So that's the run-down. Do I miss my Vegas midwife's more professional set-up? Yes, a little. Plus, I connected with her more than I think I'm going to with Sherry. But...it's okay. Do I think Sherry is smart and capable and will be able to deliver my baby? Yes, definitely. Las Vegas was a home birth mecca- at one time, I had 5 friends all having homebirths, plus myself, and there were 4 different midwives between us. Midwives had more of a foot in the door in the medical world down there. Up here it's different, and that's okay. Appointments are in living rooms. Blood work is an extra car trip. But those are things that are cosmetic- the level of care I'm getting is every bit as awesome as I've gotten previously. If you live in a home birth mecca (like say, in Oregon), you'll probably find more of a professional feel in the world of midwifery. If you don't, your experiences will probably be a little more low-key. And that's okay.
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How much does all this cost?
I'm enjoying reading your home birth journey! Was Abby your first home birth?
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