Pregnancy insomnia has set in...

So here I am at midnight writing my birth plan.  This is the first draft.  If any of you have suggestions (especially you Tracie) feel free to comment!  Open the image in a new tab or window to make it bigger.

Doula

So I found a doula that is willing to travel to my area if I decide to have a hospital birth!  That makes me really happy because I like having options and it was starting to look like my only option was drive the hour/hour and a half to the birth center in Delaware or risk a lot of medical intervention with a hospital birth.  Now I don't feel quite as nervous at the prospect of delivering in the hospital if that's the choice we make.  Yay!

Purely amazing.

I'm fairly sure that I don't want a water birth, I might want to labor in the tub, but not actually give birth in it.  But this is one of the most beautiful things I've ever seen.

Questions for The Birth Center

*Updated*
We went for our tour and I was SUPER impressed.  I'm really excited about this place and I think it's going to work out for us.  I still have some time to collect more information before we make a final decision as I'm not yet pregnant, so if you think of anything else I should ask, let me know.

Q: Is the center licensed by the state?
A: Yes.

Q: Is the center accredited by the NACC?
A: Yes.

Q: Once I become pregnant, when should I schedule my first appointment?
A: Somewhere between the 6th and 10th week.

Q: With Tricare Prime, do I need a referral from my PCM to make my first appointment?
A: Not yet answered.

Q: Is the entire pregnancy covered by my insurance?  If not, what additional charges might I incur?
A: Not yet answered.

Q: Will I get to meet all of the midwives who may attend my birth?
A: Yes, you are scheduled with each of the 4 midwives at least once for prenatal visits.

Q: How long are prenatal visits?
A: The initial visit is 1 hour, all others are 30 minutes.

Q: Do you perform ultrasounds?  If so, how many?
A: Not routinely, but we will perform them as needed or by request.

Q: What is your C-Section rate?
A: 4% to 7%

Q: During pregnancy, what conditions would require me to transfer to the care of another provider?
A: High risk pregnancies.  i.e. pregnancy past 42 weeks, twins or other multiples, diabetes, placenta previa, preeclampsia, high-blood pressure, previous c-section, other pre-existing conditions.  We have about an 11% transfer rate.

Q: During labor, what situations would require me to be transferred to a hospital?
A: Breech delivery, baby in severe distress, mother in severe distress.

Q: If transfer becomes necessary, what is the backup hospital and who are the backup providers?  Can I arrange to tour the hospital and meet those providers?
A: The backup hospital is Christiana Hospital in Newark, DE.  It's a 20 minute drive from The Birth Center.  We also do transfers to St. Frances Hospital in extreme emergency situations which is 1 block away.

Q: What percentage of women who transfer have C-Sections?
A: Not yet answered.

Q: Would my midwife be able to remain active in my care if I need to be transferred to the hospital?
A: Possibly, but possibly not.  Because the midwife would not longer be your primary care, it would be up to the hospital whether or not the midwife would be allowed to stay with you.

Q: Under what circumstances would my baby need to be transferred to a hospital?
A: Not yet answered.

Q: Do you have any policies that limit the number of people I can have with me during labor and birth?
A: No, you can have as few or as many people as you would like in the room with you during labor and birth.

Q: Do the midwives here routinely provide continuous support during labor?  If not, do you have experience with trained labor support (doulas) during labor and birth?  Do you encourage the use of a doula?
A: Yes.  The midwife will remain with you for the duration of labor and delivery.  We do support the use of doulas, but they are not always necessary.

Q: Do you offer intermittent fetal monitoring (with a doppler)?
A: Yes.  We routinely use a doppler for intermittent fetal monitoring, but we do have a continuous monitoring system available if we need it.

Q: What are your usual policies and practices about:  IVs, freedom to be active and move about during labor, eating and drinking, positions during birth?
A: An I.V. is not standard during labor and delivery, if we need to give you antibiotics we will give you a heparin lock.  You are free to move about during labor, eat and drink whatever you like, and you can choose any position for birth that feels right.

Q: What is the usual care if labor is progressing slowly?
A: Natural methods of induction, castor oil, stripping of membranes, possibly breaking your water.

Q: Under what circumstances would you induce labor with Pitocin or other drugs?
A: None, if that were to need to happen, you would be transferred to the hospital.

Q: Is there a time limit on labor?
A: Only once your water has broken.  Once your water breaks, you have to be in active labor within 24 hours.

Q: Do you ever perform assisted deliveries with forceps or vacuum extractor?
A: Not yet answered.

Q: What is your episiotomy rate?
A: Less than 1%.

Q: Under what conditions would you perform an episiotomy?
A: To avoid the need to transfer you to a hospital in the event that the baby is in distress.  Only if absolutely medically necessary.

Q: What drug measures for pain relief are available?
A: We do offer I.V. pain medications.

Q: Do you use epidurals?
A: No, we do not perform epidurals as there is no anesthesiologist on staff.

Q: How long is the average stay after birth?
A: The minimum is 4 hours, you usually go home the same day.

Q: What follow up care and support would you provide after I go home?
A: The midwives will call for your and your baby's vitals the next day, the 3rd day will be a home visit, there is a one week check-up for the baby and a six week check up for the mom.

Q: Can I still have a home visit even though we live over an hour away?
A: Yes, the midwives will still come to your home.

Q: Do you provide information and support over the phone after I go home?
A: Yes.

Productive day!

I spent today cleaning out the bedroom that's going to be the nursery.  All that is in the room now is stuff that will be used in it once we have a baby.  I'm so happy because that room was FULL of all the stuff we I hadn't unpacked yet.  But, I'm excited to say that I'm finally finished "unpacking".  I haven't put everything away yet, but part of that is because I need some more storage to make up for the fact that we don't have a storage shed here like we did in Hawaii.  That's a little challenging.

Also, I reserved our spot for next Wednesday to tour The Birth Center in Wilmington.  I'm really excited about this place, so I'm really hoping it pans out.  I have a list of questions to ask them and I'm going to post it on here once I finish it.  Once I post it, if you think of anything you think I might want to add to it, let me know!

New Plan!

So, James and I may be looking into another option for where to have our baby.  I looked into the birthing center at Mainland Hospital and the C-Section rate for that hospital is a bit high.  I'm going to have to look into it more to see if that's just the regular labor and delivery ward or if that is the rate for the birth center alone.  We've found another birth center that is a freestanding birth center and is run by certified nurse midwives.  I'm so excited!  The only downside is that it's a little over an hour away in Wilmington, DE; which is not really a huge problem, but it would be a bit of a drive for pre-natal appointments.  But the C-Section rate is only 4-7% as opposed to almost 40% at the hospital that the other birth center was in.  That's a pretty big difference!  I think we're going to go tour both of them, but I'm definitely leaning toward Wilmington.