Pregnancy #2: Building our Birth Team

While we still haven't signed our contract with Miriam (we're waiting on a final financial answer from the insurance company on how much is covered) I can safely and confidently say, she's my midwife. So with Miriam on board, we also get her partner Sheila. So if one of them can't be there, we still have the other. But if both are free, we'll have two midwives present for the birth. Next we started researching and discussing a doula. I really believe my mom could be a doula if she wanted to be. So my first reaction was to say that a doula was an unnecessary expense. I'd rather have my husband and my mom and call it a day. But we don't even know for sure my mom will be able to be here for the birth and it's hard to truly be involved when you are 1400 miles away! Plus, lets be honest. Mom isn't really a doula. And if something scary happens, she might be too concerned for the safety of her daughter and grandchild to think clearly. So we scratched that idea.

What is a doula? A doula is a woman who is trained to assist another woman during childbirth and who may provide support to the family after the baby is born. After doing our research on doulas, we knew we needed to meet and interview a few to make some decisions. We'd also be in a need of childbirth classes - more involved and more "natural" than the hospital offered ones. And, while it does gross some people out, I definitely want to encapsulate my placenta. I know the thought is gross. I'm not gonna lie… when I first hear about this, I gagged. As I was researching it, I said I'd never do it. But I was so wrong. There are so many benefits to it, that I can't see NOT doing. The placenta contributes to mammary glands and preparing for lactation and increases milk production. It stabilizes postpartum bleeding and mood, stabilizes uterine cramping and decreases depression. It regulates the thyroid gland, boosts energy and helps support recovery. The placenta reduces inflammation and swelling and promotes healing. It replenishes iron to decrease anemia! There is so much more but that last one was the red flag for me. HELLO!! With all the battles I deal with when it comes to my iron levels, I would be so stupid to walk away from such a natural boost for my body! Miriam informed us that many doulas offered multiple services. While they were trained doulas they were also certified Childbirth instructors, or placenta encapsulators or prenatal yoga instructors, etc etc. So she gave us a list and directed us to two. I reached out to them both and spoke to one of them today.

It was an AMAZING telephone call. I had no idea what to really expect and with anything, my biggest worry was/is the dollar signs. The first thing out of her mouth was, "What is your budget? I don't care what we charge. I care what you have to work with so I can see how we can help you. We never want a momma deprived." I told her that in all honesty, that hadn't been discussed yet. We need to hear what the final outcome is with Miriam and the insurance contract and see where we are financially. I also had no idea what the average doula services were to even consider what it would be worth budgeting. She understood and so we continued to discuss what she offers. Here's some points we discussed:

• We receive two doulas, herself and her partner. Ideally they'd both be at the birth but we'd definitely meet them both so if someone got called away, we were still in the hands of at least one professional
• We'd receive unlimited prenatal visits at our home or where ever else we choose, such as a coffee shop
• We'd receive unlimited birth support. When labor starts, Miriam doesn't come until I'm in active labor but the doulas come in as soon as early labor starts. They'll help me work through all contractions, find my relaxation, etc and they'll be in constant contact with Miriam
• They will stay until the baby is a few hours old and make sure the baby latches correctly and is nursing well - they are both certified lactation consultants
• They offer (and is included in their fees) my placenta encapsulation both raw and warm/chinese methods and would discuss which is the best option for me/us (good, because I don't yet know the difference!) There are other placenta services they can offer as well
• It also includes a postpartum visit. They'll come by a week or so after birth to visit, check on me and the baby, discuss the birth (if I want to). They'll even help with light housework if it's needed (wash dishes, put up a load of laundry, put toys away from older siblings) AND they'll provide my family a meal.
• They do not offer childbirth classes though they do offer recommendations. However, if we didn't want a formal class, the can be a source of information for us on building our knowledge and will help us formulate a birth plan.
• We can meet and interview with them. Essentially a consultation prior to "hiring them" to make sure we're the right fit together.
• She books you as early as you're ready. The sooner the better since you get unlimited prenatal services you can take advantage of this and receive more benefits
• They will meet with you a minimum of two times before the birth. However, the more times you are available to meet and talk, the more they can be of help and offer their best services during the birth since they've had the time to meet with you and figure out what you want from your birth.
• If a hospital transfer were necessary, Miriam would go with me to "transfer me" to Dr. Spence and fill him in, but she would not stay. The doula would stay and still see us through the birth at the hospital, even if it were to end up in a csection.

The final dollar signs are negotiable. It's under $1,000 and that's a LOT of services for less than a $1,000! I am still not sure where it fits in our budget but I was pleasantly surprised with the "bang for your buck." I loved that she called me back within an hour of reaching out to her. Her phone personality was great. She put me at ease immediately. She spoke with me for 15 minutes and was patient, answering all my questions and assuring me that even if it wasn't her, a doula was such a necessary part of my experience. She also made sure I knew how special home birth was to her heart since she has an experience of her own, as does her partner. I'm really excited! I love the direction this process is taking and I love the possibilities playing out in building our team and formulating our plan. It makes this whole thing seem real and exciting! I will probably still speak with at least one or two others so I can compare services, prices and personalities but I'm excited that this was a great first start!

Pregnancy #2: WE HAVE COVERAGE!!!!

I want to scream from the rooftops but this involves a post of it's own! After a LOT of hard work, my insurance company FINALLY approved my exemption for my midwife!!!! I still don't know EXACTLY what and/or how much they'll cover. They just gave me an authorization code and Miriam has to call them with that code and work out the contract between them. So we wait again. But at least there is progress in the right direction and cause for CELEBRATION for my heart today. One more baby step to show me that God is in control! 

Pregnancy #2: The Process of Getting Coverage

So begins our process of getting the insurance covered! As promised, Miriam called the insurance company and they informed her that we need to file for a GAP exemption. Basically the two midwives they offer in Miami-Dade County, one is ill in the hospital until further notice and the other only offers prenatal care and no longer delivers. So I needed to request Miriam to be covered. I called multiple times a day for three days to never get anywhere. So yesterday, we went to their offices. We were in and out in no time and while we didn't get an immediate answer, we found help. The lady who we spoke with informed us that the request needed to come from my PCP. My appointment with him was scheduled for Friday the 13th. However, I didn't want to wait that long. So I called and was able to get an appointment today from someone else's cancellation (thank you God!). I saw him earlier and he's such a gem. Honestly, I haven't had such a positive and proactive doctor in so long! His first concern was my iron levels and we discussed the midwife. He said basically that it's my pregnancy and he will do whatever I want but he legally has to go on record and state that he doesn't recommend it. He said unfortunately home births are either positive or negative and there is not much in between. He said he believes I'm strong willed enough to make this happen but he would hate to see a "what if" happen to me. With that, he had his assistant file the request with my insurance company. I also requested if I could have two more venofer IVs of 200 mg versus four more of 100 mg. It's a hassle to go and costs me a $50 co pay each time. Obviously I want to do what's best for me and the baby but I didn't see how it would make a difference. He immediately sent me to the lab for a CBC to check my hemoglobin just to make sure we were going in the right direction. The best news I received today? My hemoglobin is up to a 10! While it's not great (recommended to be a 12 before getting pregnant), it's a huge step in the right direction. It's also only 1/2 an answer since ferritin wasn't tested. However!!!!! He said that he feels much more confident and supportive of me working with a midwife knowing that my number is going up! He also gave me the prescription to receive 200 mg next week and 200 mg in a month (in March) and then come first week in April to check bloodwork again. At that time I will request he also checks my ferritin. It's also positive because we have to get my hemoglobin to an 11 and MAINTAIN it at an 11 for a home birth to be an option. So we're getting closer to reaching that! However, it WILL drop again between 25-27 weeks of pregnancy so we will all have to stay on top of my levels. I'm pretty sure I'll be receiving even more infusions throughout this pregnancy. BUUTTT if it's going to continue to rise and help me maintain I'm all for it. I know it will have a huge effect on me after birth too. My low iron was such a huge reason that I was so miserable after the twins!!!

For those of you who don't know, here's a simple answer on the differences between ferritin, iron and hemoglobin:

IRON: aka ferrum. Essential ingredient for hemoglobin among other biological functions

HEMOGLOBIN: Protein that is responsible for transporting oxygen. Contains a "heme" group which has iron in it. Hence the name, hemoglobin. 

FERRITIN: Protein that stores and carries iron around to wherever it's needed.

So we really need both ferritin and hemoglobin to rise to know we're having a long term impact on my body and my baby. You have to keep in mind too that I had gastric bypass surgery 7 1/2 years ago so rules are slightly different for me than a normal pregnancy. My pre-pregnant ferritin should have been at least 70 before getting pregnant. While pregnant my iron stores are being diluted to half their value until my bone marrow catches up to the demand to create blood for me and the unborn baby. It will take 6-7 months for my bone marrow to meet this demand. Iron deficiency is the single largest cause of prenatal anemia (close to 70%)…. Prenatal iron deficiency leads to low birth weight and premature delivery. It also leaves me at an increased risk of post partum hemorrhage. Infants born to iron deficient moms are themselves at a higher risk of iron deficiency which may result in cognitive damage. 

Obviously a lot of what's out there sounds SCARY and it isn't always the case but it falls in with those "what ifs." Sadly I believe my iron & ferritin were this low, if not lower with the twins pregnancy. However I didn't have a proactive doctor and I was educated enough nor advocating for myself. This time around, I'm doing the legwork. With knowledge comes more responsibility but I believe and will continue to believe that God is overseeing this whole process. He will take care of me and this unborn baby and keep us in all the right hands and I will have an amazing testimony that is formed! 

I will follow up with the insurance company next week and hopefully get some more answers. Until then, I'm here to answer any questions and help anyone else's process however I can and I'm continuing my own research and care! Enjoy your weekend!