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