Monday, October 17, 2005

Over the River? Or Not?

I want to begin this post with apologies and a heads up to my infertile and struggling friends. Inevitably, this blog has recently become more and more of a pregnancy blog, and I know that can be painful for people who so desperately want to be pregnant. This post in particular is about childbirth and choices, and I know we're very lucky to be getting to think about these choices. If you don't want to read this, please don't -- with our blessings -- but know that we've been so glad to have your love and support throughout our journey, and can't wait to return it to you however you find your children.






At a certain point in most pregnancies, prospective parents have to confront the array of birth choices available to them. Do they want to birth at a hospital or a birth center? Would they consider home birth? Do they want medication and/or technological interventions? Obstetrician or midwife? In the US, these choices are affected by geography, class, and access to insurance among other things. Not surprisingly, sexual orientation adds to the complexity of the choice.

Here in the DC area, Cait and I appear to be lucky in our choices. There are many hospitals of all scopes and sizes (major teaching hospitals, local community hospitals, facilities with and without religious affiliations, etc.), a variety of freestanding birth centers, and even licensed midwives who will oversee home births. Many families don't have this range of options in other parts of the country (hell, some women can't even find an OB in their state due to malpractice insurance rates).

Unfortunately, our menu of choices shrinks when you factor in things like insurance. We found out last week that our insurance does not participate with three out of the four area birth centers. This is a real challenge because we're leaning toward midwifery care at this point. We believe that unmedicated, low intervention births (when appropriate and wanted) are safe and beneficial for both the baby and mother(s). Most of the major obstetric practices in our area tends to be conservative in their practices, whereas midwives are open to a wider range of labor management techniques. Though they worked side by side in recent years, the OB/midwife divide is becoming more rigid in DC, and it's increasingly difficult to have a midwife in a hospital. There were several practices that delivered in hospitals but now it seems like they've all stopped delivering (one went out of business, one does only prenatal and well-woman care, etc.). So birth centers or homebirths are becoming the only option for having midwifes.

"But what about that fourth birth center?" you say. Weeeeell, that birth center is fantastic. Everyone we've ever talked to who has birthed there or toured the place raves about it. Unfortunately, it happens to be located in Virginia, and Virginia is not a gay-friendly state, to put it mildly. Last year at a discussion on protecting gay and lesbian families, one of the area's leading lawyers on queer family issues bluntly advised prospective families in Virginia thusly: "Move." And her caveat to pregnant lesbians in the greater DC area was, "Don't go across any bridges after your 7th month." Things have changed since then, and it is now possible to get a birth certificate reisssued showing the names of both parents (though, regardless of gender, one will be listed as "Mother" and the other "Father") but legal experts fear this will be contended and the courtroom fights for the sanctity and safety of GLBT families in VA will continue for years to come.

Our lawyer has said that it would be ok for us to give birth in Virginia, but not ideal. And frankly, I doubt that the birth certificate will be at the top of my list of concerns in labor. But I'm pretty good at coming up with stuff to worry about left to my own devices. The last thing I need is external sources of angst to subtly undermine my psyche during the birth process. And every option now open to us has some source of worry and frustration built in.

  1. The birth center in MD, if we choose to go out of network and pay for the privilege (fear factor: the added cost).
  2. The birth center in VA (fear factor: the future legal status of our family)
  3. Hospital birth with an OB who shares our belief in low-intervention births (fear factor: the doctor and hospital won't keep their word)
  4. Home birth (fear factor: something going wrong that could be prevented in another setting)
I know that we are lucky on so many levels to have this many choices when all is said and done. We have insurance after all, and won't bear the full cost of a delivery no matter what we do. We even have the financial resources to think about paying to get around the hurdles of the system. We are in an area with many doctors to choose from, so we probably could find one in tune with our beliefs about childbirth (though obstetrical practices in the DC area are greatly governed by fear of malpractice and open-minded doctors are often overruled by hospital bureacracy). As lesbians, we're lucky to HAVE a choice of jurisdictions, some of which discriminate less than others, in which to give birth. And, finally, so far I am healthy enough that all care settings are open to me.

But it infuriates me that the one choice that could meet all of our desires -- the birth center in Virginia -- is not totally safe for us, simply because we are two women creating a family together.

END NOTE: Before people start thinking that I am attacking them or their birth choices/experiences, let me say that I don't judge anyone else's decisions about where or how to birth, and I don't think that certain kinds of births are inherently bad. Having a healthy baby is the ultimate priority for us, and in some circumstances interventions are essential to the survival and health of the baby and mother. I also know that the birth and time immediately afterward is an eyeblink in comparison to the rest of our child's life and our life as a family, but it's an important eyeblink and one we want to approach thoughtfully and carefully.

24 Comments:

  • I'm SO psyched to follow your pregnancy, Jen, and I can't wait for more belly shots.

    Thank you for those kind words at the top, but no worries on my end.

    mucho smooshy love,
    Shell

    - How is Cait and the medicine saga by the by?

    I'd say go with the hospital, ask for a birthing room type situation, or do the home birt with ambulance on call kind of thing...

    there's my 2 cents!

    xoxox,
    S

    By Blogger Shelli, at 2:40 PM  

  • i, for one, really enjoy hearing what already-pregnant folks have to say about the matter. Think how informed we'll be when it finally works out for us! But thank you for your sensitivity, especially during a time when watching everyone else around you get pregnant is pretty darn frustrating.

    We are (truly) lucky to have a great gay-friendly birth center in our city. Tallahassee isn't known for it's community support or outreach, but this birth center hosts a midwife with incredible credentials and radiant energy and personality. All of her staff were friendly and accomodating at our initial consultation. Also, almost all insurance companies cover their services, including Medicaid for lower-income families. Some of our friends who birthed in the hospital here received less than 'caring concern' for their partners and their situations, so we're looking forward to this other option.
    Good luck making your decision...i think having a home birth would be a wonderful, comforting experience. :)

    By Blogger Amanda, at 2:47 PM  

  • Congrats on your pregnancy! I found your blog through Julie's big list. My best friend had a molar pregnancy last year so I have referred her as well. Your good news was a major boost to her as she waits and waits to be able to try again.

    The thing that struck me about your choices (and I'm sorry that they are unfairly limited by stupid Virginia laws) is that as safety goes I don't think there is really any difference between a home birth and a birthcenter birth. Unless the birthcenter is in an actual hospital there isn't anything that a birth center offers that a midwife couldn't provide in your home. The equipment and interventions available would be identical. Not that I don't understand why it might seem like a more comfortable choice if for no other reason than other people who judge homebirth don't seem to have the same reservations about birthcenters.

    Anway, it seems like the choice is really deciding if you are comfortable birthing outside of a hospital. Because once you take that leap (assuming you are within 20 minutes of a good hospital if you need to transfer) I don't think there is much, if any difference when it comes to safety and interventions available. Best of luck making a decision.

    -Amy

    By Anonymous Anonymous, at 2:48 PM  

  • I'm mostly a lurker here, but I am curious as to if you are out at work and how that goes over. When my husband and I started shacking up before marriage, my principal took me aside to tell me that it was "frowned upon" by the administration and school board and that I should probably keep that information to myself - especially around the students. I can't even begin to imagine how they would react if I had been a pregnant lesbian! (Although I'd have loved to see their faces if I were!) I'm sure geography plays a part in it (rural red state here unfortunately) but I'm just curious as to what kind of things you've had to deal with in regard to your relationship and pregnancy since you both are teachers.

    By Blogger Amy, at 3:13 PM  

  • I, like Amanda, was pretty happy to read this post. It's pretty frustrating to have that added stress when trying to figure out an already hard decision. Personally I am not sure at all what I am going to do. I have an ob/gyn who is a lesbian that I really like, but she practices out of the Catholic hospital. In and of itself this isn't a problem since I also identify with being Catholic, but I am worried about the friendliness of the staff there. I am also concerned about medical intervention in what I want to be a very natural thing.

    A friend of mine who birthed at the hospital made sure that she had copies of her birth plan to give to everyone attending to her. And she had a doula to make sure there was an extra voice/advocate there.

    I can't to hear more!

    By Blogger Katie (WannaBeMom), at 3:40 PM  

  • I didn't think too much about the birth because we had so many more important things to worry about, like her surgery after. Had we had the luxury, I would probably have chosen a hospital, just because I am so paranoid something would go wrong.

    Good luck on your choice! Wherever you are, the first time you meet that little person is INDESCRIBABLE.

    By Blogger R, at 4:48 PM  

  • I think your point is very valid that you don't want to be worrying in the least about these things while giving birth. I wouldn't and couldn't tell you which choice to make. My friends have done everything from home to hospital births, and most have had a good experience.
    I myself am with a very high-tech OB practice and internationally renowned hospital for my twins pregnancy. I really trust all 4 doctors in my practice and do believe that if I wanted a natural birth, a doula, the involvement of a midwife, or anything like that, that they would respect and work with that decision. I also notice that they have a very diverse patient clientele, in terms of ethnicity and sexual orientaion. As for the hospital, I know that it has doulas available on-site, midwives, lactation consultants, and they let the partners stay overnight.
    So my point is, after this looooooong message (sorry!), when looking into the hospital/OB option don't assume that you cannot have your wishes met. Make a list of your "demands" and see what they say. You may be surprised at what you find. The most important thing is that you trust and feel good with your group, whether it's doctors or midwives.

    By Blogger lagiulia, at 4:57 PM  

  • It sucks that you can't have your baby where you want to. If I was in your shoes, I'd be petrified to have a child in a state that could try to take away parenting rights. I'm sorry that you have to deal with that. I've campaigned for gay marriage here in CA and even though I'm pretty educated on the topic, I never realized the little things that can stand in gay parents' way.

    It also sucks that healthcare in this country is both ridiculously expensive and choices are mostly our of the patient's hands. I just got laid off and have a variety of minor yet expensive medical issues and am now in the sorry position of buying my own health insurance- and the most affordable plan doesn't take my doctors. It irks me that we pay so much for healthcare in this country and yet are still limited in our choices.

    By Blogger LJ, at 6:08 PM  

  • I, too, chose to read on, even though I'm one of those intermittantly jealous ones...but i was very interested in your dilemma (especially since i "originated" from the Balto-DC area and am now a physician in Montana where the choices are really scant)...

    I just have something to add about the notion that the choices are "out of our hands" as patients. That is true right now, but I would encourage anyone who is so inclined to become politically active about this issue. Many women don't have choices because of the malpractice crisis but that is a political issue. So is the fact that insurance companies run everything and the fact that OBs won't practice with midwives...etc etc. Lobby for legislation in your states to change these thing; write to your representatives...

    Good luck, Jen and Cait, with your decision. It's good to have choices but it's never fun to have a bunch of choices that don't quite meet your needs.

    By Anonymous Rebecca, at 9:27 PM  

  • PS- I'm sorry that I didn't acknowledge in my previous message that it's not as simple for you as feeling good with your group of drs. or midwives, when you have to deal with things like parents' rights! I didn't mean to come off as insensitive or unsympathetic. Some of these very issues are what have kept my sister and her partner out in CO from trying to conceive. They keep saying they're going wait until they move back East, but then the move gets put off and therefore so does their attempt at becoming parents. It's very frustrating indeed, and I'm sorry you have to deal with this during this otherwise very joyful time in your lives!!! Okay, I'm done now.

    By Blogger lagiulia, at 9:42 PM  

  • As an attorney, the cost and the heartache of the potential legal ramifications of Virgina worry me, but in the end, the two of you know what's best for each other and for your situation.

    Wishing you the best in your decision together.

    By Blogger April, at 11:43 PM  

  • You are much safer in virginia than many couples, simply because you used sperm from a bank. Part of the legal problems in VA for us are due to using a known donor.

    I hope that you guys find a solution that you feel comfortable and safe with. You have a lot more information to work with than many people, us included, because you have many friends with kids. Our queer friends with kiddos (who are non-military) have all given birth at the birth center in Anapolis and loved it - but I suppose that one would be a bit of a drive for you two.

    Good luck!

    By Anonymous jenny, at 9:11 AM  

  • I need to clarify the legal piece a bit. Since we live in DC, the only legal issue about giving birth in VA pertains to the birth certificate. All other legal matters regarding the baby would be determined based on our "state" of residence.

    When a baby is born in Virginia, only legal parents can be listed on the BC (this is true in most states). However, after we go through court proceedings in DC, Cait will legally become a parent to the child and we can request a revised birth certificate from VA. Until recently VA refused to issue revised BCs. They are doing so currently (though as I said, they still read "Mother" and "Father"). There is fear that the court decision will be overturned and we would not be able to get a new BC following the second parent adoption. However, Cait WILL STILL be a legal parent; we'll just have to use different documents to prove it. It's more of a slap in the face and a hassle than true legal peril.

    Jenny's right - couples who use known donors or want more complicated family structures with co-parenting have MUCH bigger legal hurdles in VA.

    This is what we mean, by the way, when we say equal rights, not special rights. We just want our families to be given the same protection as any other. Nothing more, nothing less.

    By Blogger Jen, at 9:19 AM  

  • I just posted you a long reply and blogger ate it.
    I'll condense it. Our midwife brought everything with her to a home birth. If we could get it in the BC, we could get it at home. This means a vacuum, forceps, scalpels, IV antibiotics and fluids, oxygen, a crash cart, sutures, lidocaine, etc etc etc. When the hospital 4 blocks from our BC closed the L&D ward, we moved it to a home birth since we had a major birthing hospital spitting distance from the house. Maybe not all midwives bring everything with them, but for ours, we were truly just as safe at home as we would be in a BC.

    By Blogger Estelle, at 10:23 AM  

  • We have three options: hospital #1, hospital #2, and a homebirth. We're going with hospital #1, making a birth plan, and bringing along a doula. We're also counting on my ability to be very firm and convincing when under stress.

    By Blogger Emilin, at 11:26 AM  

  • Can't even tell you how helpful it is to see you walk through this before us! We have a few different legal and medical issues of course, but still... It's amazing that the birth choices that actually cost less are increasingly difficult to access unless you pay out of pocket. We feel amazingly fortunate that our biggest "legal" challenge up here is that the original birth certificate will have hand-written modifications on it - thus able to be called into question for the remainder of the child's life! But, both names from day 1 - seems SOOOO simple!

    By Anonymous cathy, at 3:09 PM  

  • Is Sibley in your plan, Jen? We were there, and there were two lesbian couples on our wing, one of whom needed a whole lot of extra help due to allergies, and the nurses were supportive. I think there is/was a Takoma midwives group that works with them, too (not sure if they do birth centers or home births, but at least it would be midwife care). But now that I'm thinking more, you've probably already looked at all and any Takoma midwives who deliver in any way covered by your plan. Good luck in whatever you choose.

    By Anonymous Andrea, at 7:08 PM  

  • I'm so happy that you are in a position to be considering childbirth questions :-)

    This is a hard decision to make. There are no birth centers within 30 miles of us, and the only group of midwives within 50 miles who will deliver are lay midwives who do homebirths (there are other midwives, but they don't deliver). The hospitals are a pain and rarely listen, there is only one good one.

    I hope you find a SAFE choice for your family, whatever that may be!

    By Blogger Hostile in Ohio, at 7:41 PM  

  • We were excited about the Takoma midwives at Sibley (it seemed like the best of both worlds) but they are the practice that no longer delivers. They only do prenatal and well-woman care. We are still looking at Sibley to see what we think even if it would be without midwifes.

    By Blogger Jen, at 7:51 PM  

  • Nor do they take our insurance, for that matter....

    By Blogger Jen, at 8:44 PM  

  • How IS Cait's medicine saga going? I live in VA (hetero, three kids), and I knew we were backward here, but I'm horrified to see that our state laws are actually influencing a decision like this for you guys. Is there anywhere you know of that I could write or email to raise hell about it? If we spent half as much on our public schools as we do on asinine legislation in this state...don't get me started.

    By Anonymous RachelH, at 11:28 AM  

  • Hey, Jen:

    Thanks for being so kindhearted toward those of us still playing the IF waiting game. =) However, despite my own issues, I LOVE hearing all the good PG news from other girls. It gives me lots of hope, and I'm trying to store up all that wisdom for future reference, so keep it coming!

    The choice you have to make is definitely a tough one. I don't have any insight from experience, but I can say that one of my closest friends used to work at Sibley's L&D ward, and she said they were very uderstanding of the unique birthing experience. Women from many different cultures and backgrounds would give birth there and they tried to accomodate everyone as best they could. I know she said they were very welcoming of doulas, in particular. My friend just left Sibley a few months ago, but I can check in with her if you have any questions you wanna ask. Just let me know!

    By Blogger deanna, at 6:50 PM  

  • Hi. I noticed you never responded to my question about your work environment, and I just wanted to add that I hope what I said wasn't offensive in any way. As a fellow teacher (currently a stay-at-home mom but I'll go back when the kids are older) I'm very curious to how your colleagues and administration handle this type of situation, since just living together before marriage was such a scandal in these parts. (Actually, one of my friends had a parent call the principal and complain because of her Henna tattoo - talk about uptight.)

    Anyway, you don't have to answer it, I just wanted you to know that I didn't mean any offense by it and I'm totally psyched for you guys and Harpo.

    By Blogger Amy, at 3:56 PM  

  • I don't want people to think I am mean and ignore questions like Amy's! I just answered her in a VERY long e-mail that's way too long to put here, so I will summarize:

    We are lucky and live and work in a progressive part of the country. My school system and Cait's school (a charter school) both have non-discrimination clauses, offer domestic partnership benefits, and have generally been very supportive of us. Coming out to students and parents is still a bit scary but it's something we plan to do (it will be kind of impossible not to once we have a kid).

    I imagine we'll write more on this as the time comes.

    By Blogger Jen, at 4:24 PM  

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