When pregnant with my past three children, I called my midwife early on to let her know I was expecting. When I was three months along, my monthly appointments with her began, with my midwife coming to my home each time. (For the midwife I used the two births before this, I went to her office every month.)
And now I’m far from my fantastic midwife and I very much feel caught between the medical system and what I want to do. What I want is regular prenatal care with the midwife who will be attending my birth. However, that midwife lives too far away for that to be an option. So that leaves two choices: go without any prenatal care, or go to the local heath clinic.
I had very mixed feelings about this; thank G-d I had healthy and uncomplicated pregnancies, but I don’t like the idea of having no prenatal care at all. It doesn’t seem responsible to me. I went into the local clinic to find out about making an appointment for prenatal care, which is taken care of by the nurses – you know, the basics like blood pressure, urine dipstick test, heartbeat, fundal measurement. They told me they can’t provide that for me until I see an obstetrician first, so it will be officially confirmed that I’m pregnant. (I was twenty weeks along by that point, and looked down at my midsection and was like, “Are you joking?”)
But I also wasn’t sure how to approach choosing a doctor here, since I need someone who will be willing to sign off on my homebirth paperwork (certifying that I’m pregnant and then after birth signing a form that I had a baby, which is needed to get a national identity number for the baby). I was procrastinating about making an appointment with an ob because of my concern about how to deal with this paperwork issue, especially after I was told that the health insurance rules are that I have to stick with this doctor (whom I’ve never met) for the entire pregnancy. I finally decided to go ahead and make an appointment with one of the obs on my health insurance plans, and hope for the best when it comes time to get the paperwork signed.
The doctor that I chose supposedly spoke English, which is why I chose her, but when I got there she told me she only reads English. Okay, whatever. I can communicate in Hebrew so it’s fine. Having been used to the initial intake meeting with the midwife, in which I was asked specifics about every single birth, I was a little surprised to only be asked, “How many children? Any miscarriages? Are you healthy? Date of last period? Any immediate family members with health issues?” Ehe noted my one word answers and that was the extent of the intake, except for clicking her tongue that I didn’t have prenatal care until now.
She asked if I want the detailed ultrasound that is usually done about twenty weeks and warned me that it’s almost too late in the pregnancy to have it done and get accurate feedback. And I was like, “oh, too bad, Pesach is this coming week and it seems like it will be too late for me to get it done afterward”. She agreed. Not that I would have had it done anyway, but I don’t see any reason to make an issue of everything if I don’t need to!
My midwife used a fetoscope, which is my preference, but this is a lost art and I assumed the ob would check the heartbeat today with a doppler. I was surprised that she actually had a mini ultrasound machine in the room to use. It was pretty quick and since proof of a fetal heartbeat is something the nurses said I need to have before I can go on to get prenatal care, not something I was going to argue about. Now I won’t have to have it done again until before birth, since my midwife said she needs confirmation that the baby is head down, and it seems doctors don’t know how to tell by externally palpation anymore (something else that is becoming a lost art).
I left with a few blood tests I’m supposed to get done; I told her I won’t do the gestational diabetes test that you have to drink a sugary drink for, but she said there’s a blood test for that, too. I don’t really think any of these tests are necessary, but you know why I’m doing them? It’s a proactive move to have it in my medical records, which will be helpful so I don’t look like a whacko woman who has refused everything when I need to get my homebirth paperwork signed. A blood test won’t do anything questionable to the to baby, and I don’t see any reason to make a stand about something that really doesn’t matter. You have to choose your battles!
Overall my visit today was a positive experience in that it wasn’t negative. No, it was nothing like the personal care and concern that I had with a midwife, but that was okay. I accept that I have to work within the constraints of the local medical system. It means making compromises but that’s life; you can’t always have what you want the way you want it. I consider myself fortunate for the prenatal care I’ve been able to have with fantastic midwives for my last five pregnancies. ‘m really grateful that for my last five births I have had what I wanted.
The paperwork issue has been a source of tension for me, wondering how it will work out. There’s a very good chance that I’m the first person in this city who is having a homebirth with an unlicensed midwife, and that the doctors here have never seen this paper or know what it’s about. I’m going to stay positive about this doctor being willing to sign my paperwork. If she doesn’t agree to sign, the only option I’ll have to speak to the health insurance company, insist on having my ob changed, travel to see a doctor who has signed this paperwork for others in Jerusalem (three hour bus ride away), and then go back to this same doctor in Jerusalem within a couple of days of giving birth. I don’t mind traveling when pregnant, but traveling right after birth isn’t my idea of fun. So thinking positively is what I need to do!
Avivah
oh good luck! Having moved so many times in the states alone I dislike wading through all the wasky rules and regulations to get the prenatal care I want. I choose (for a long number of reasons) a UC last time, but this time I found a midwife. Honestly not really for much for my own health reasons (I can do what she can) but for my sanity and not having to deal with paperwork and procedures myself. Plus, I don’t look like that “wacko mom” that refuses everything.
Hi, Tzippity, welcome! It really can be a big effort to get the desired prenatal care, and I have to consciously think about what really matters and what doesn’t now that I’m in different situation.
If you want, I can put you in touch with my SIL in Tsfat, who has home-birthed twice. She can tell you which ob/gyn signed her papers, and how she dealt with it.
Thank you for the offer! I would love that!
Hatzlacha with all this! I agree re: the blood tests. I figure it’s minimally invasive and doesn’t put my baby at risk…GD test I do with grape juice and banana so no biggie there (except last time I scheduled it for the 9 days without thinking so I ended up drinking OJ which I hate). I refused GBS testing since I didn’t want to be tied down to protocol till the last time where my midwife was cool with hibiclens as an alternative if necessary (honestly I have a lot of issues with the current GBS testing and protocol)…
It’s very, very tough not to have autonomy and let your prenatal care go the way you believe (educated and informed) is the best way. I am grappling with the reality that my future births I might have to pay out of pocket and deal with a lot of hassles due to the lack of certified HB midwives (hopefully the bill to legalize homebirth in MD will pass though)…but I really can’t give up home births just because the gov’t makes it hard for me to. I in theory have no issues with a good CPM. Financially, it’s not easy though. 🙁
I have the same issue that you mentioned at the end of your comment, LN, that even though the government makes it difficult, I can’t give up having a homebirth. And the financial aspect is definitely an issue; the first two homebirths were covered by insurance but the last three weren’t and this one also will be out of pocket. When I think of the discrepancy between the huge sums the hospitals receive for every woman who births there and what a homebirth costs, I shake my head. But since people usuallly aren’t paying out of pocket for hospital births, it’s not like there are many people to complain.
Regarding that last trimester appointment to sign papers, you just have to do it any time in your last trimester; i’d try to get your local doc to sign it early in the last trimester, and that way if you need to go to a new doc, hopefully it’ll be a new riv’on somewhere in that trimester and you can go to a new doc, and/or not have to rush to a doc somewhere else…
I’ll have to call and find out when the quarter begins and ends. Or do you know?
My midwife actually suggested doing it later rather than earlier because her experience is that most doctors will refuse to sign before you do all of their medical testing, or something like that. But I like the approach of get it done earlier so I won’t be pressured about it, and to give myself time for another option if I need it.
Every 3 months is a new rivon. January 1, April 1, July 1, October 1st.
Good luck! Just a few things you may have misunderstood: 1. You do not need to have “proof of pregnancy” before going to Tipat Chalav. Many women go to TC well before going to the obstetrician, and that applies to all kupot cholim. Could you have misunderstood them? 2. You are stuck with your doctor only for 3 months. After that, you are free to switch to whoever you want on your kupah.
Hi, kw, welcome! I spoke to three different tipat chalav nurses because I couldn’t believe they wouldn’t do any prenatal care for someone, and they all said the same thing. Maybe it’s different somewhere else? Or all of them were equally misinformed?
I didn’t know that you could change doctors after a few months; when I asked the representative on the phone about this, she said that for pregnancy I have to use the same person the entire time. But that if I had a good reason to be unhappy, I could call them and they’d try to work with me. It was a bit nonreassuring since it sounded dependent on the person who answered the phone feeling like being helpful that day; your information is much more reassuring!
Not all Tipat Chalav clinics provide prenatal care…I know mine doesn’t either. I believe in most places it is now provided by the kupah nurses.
I made a home birth with my two children.my first i started with a doctor whom I didn’t care much for but when I asked for forms for the doctor to sign she talked very mean to me, people aren’t used to hearing home birth as an option they if thought I was crazy for doing it. I have no regrets doing it and loved the experience every minute of labor. my midwife did check the position of the baby with her hand and estimated the size too!
Yeah, I made the mistake last week of enquiring at the kupah regarding a pediatrician to check the baby afterwards, and how it works (because my ped didn’t know) and the argument I had about it afterwards was incredible! By some miracle, however, there was another woman there in the next line over who overheard and came over to tell the secretary/receptionist that I’m not out of my mind, that for some women home is much safer than the hospital, and it’s not for the kupah to decide who is better off where!
Do you know Rachel Gurevich? She’s navigated the medical system a few years ago with her twins. Write to me if you have forgotten her email address,
I think I can find her address, and my neighbor told me she is a friend of hers so I can always reach her via that person. But since she had a hospital birth with twins, I’m not sure specifically what she would have experience with as it relates to my situation? (I only look like I’m having twins, lol, just one baby in there, though!)
She could help you navigate the medical system, and possibly support you through homebirthing. I think she had a negative experience at the hospital, because her babies were separated from her longer than necessary.
Avivah, if you find Rachel Gurevich, please privately email her info, as I have lost touch with her. She used to live in Baltimore….and she has written a book on doulas, as well as lots of other stuff. Definitely, somebody worth connecting with…I believe she lives in RBS now.
Sent you info privately.
Actually, she has moved away from RBS. But she’s still in the Holy Land. Hi Rena!
Just saw this link that may be helpful: http://www.gaianaturopathic.com/resources_links_natural_birth.html
Also, if you attend a La Lache League meeting, sometimes the leaders or even other mothers can suggest a pro home birth type of doc that they may know or have used in your area.
Here is a link with contacts for LLL in your area: http://www.lllisrael.org.il/98302/%D7%A7%D7%91%D7%95%D7%A6%D7%95%D7%AA-%D7%91%D7%A6%D7%A4%D7%95%D7%9F-1
Chag Sameach!
Thanks so much for the links, Dahlia – it was very thoughtful of you to look this up for me! It looks like LLL has a regular meeting in Karmiel, which is nice to know, and I’ll give the leader a call sometime in the near future to see if she has suggestions for me.
The leader in Carmiel is a lovely women from the Garin Torani. I used to go the meetings before I started working. She homebirthed with Dr. Shiftan about 2 years ago.
We really should meet in person!
That’s nice feedback to hear! I hope I’ll be able to get to the coming meeting and meet her at this coming meeting. If you’re in the area, please contact me – I’d love to meet!
Not ALL OB’s in Israel can’t manage to place a baby without a US, by the way! My OB is great, can totally feel where the baby is, how engaged, and can use a fetoscope (although he prefers doppler for heartrate count because he says he loses count in his head, lol!). If you want to change OB, you ABSOLUTELY can, you just have to think Israeli about it and complain. Basically, if you’re not the squeaky wheel here, they think you’re not really serious, especially with medical stuff. You need an IShur from your kupah, and you might have to go to a main clinic to get it, but I had mine in 2 minutes flat after my previous OB told me outright that he thought “there is nothing you can do to prevent a c-section”. My new OB is very supportive of VBAC and even told me to skip certain test to keep me in the low risk category so they will let me go ahead with TOL at the hospital.
Amanda, it sounds like your ob is a gem! How wonderful that you’ve found someone so supportive of your needs! I hope your birth goes smoothly and well.