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.