23 Weeks Pregnant – Options for Birth

Yesterday, a glorious thing happened. I had my first appointment at my home with my homebirth midwife. I made the switch from my OBGYN CPM to my homebirth midwife. Truly, a wonderful thing.

Options for Birth

23 weeks pregnant. Photo credit: My three year old.

I haven’t been that forthcoming (to you or anybody who has asked me in person) in regards to who my care provider is/will be/and if I’ll be having a homebirth or a hospital birth. I was never completely sure where I’d end up, and even though I had a good idea I would be able to have a homebirth I didn’t want to count my chickens before they hatched. However, all along I have been making plans with my homebirth midwife to switch back to her.

I Was Determined

Frankly, I was determined from the beginning to have a homebirth unless I was personally convinced that it wasn’t a good idea. Before I was pregnant, I started my hunt for information. Many doctors, midwives and (of course) the internet failed to convince me that if a person has MTHFR (and no other risk factors) that she should be risked out of a homebirth and have a hospital birth. Doctors and midwives would ALL tell me that, “No, you should have your baby in a hospital” or “No, that would risk you out” but nobody ever gave me a good reason as to WHY.

How Would Hospital Birth Be Helpful?

How exactly would birthing in a hospital be beneficial to someone like me with MTHFR? I came up with no answers, and so I kept asking questions. I was determined to figure it out and to not accept no for an answer unless the no came packaged with other information as to WHY that made sense. At one point, I started thinking about how I would cope if I had to have my baby in a hospital. I tried to justify it and think of ways it would be helpful, but I started having a lot of anxiety about it… mainly because I just KNEW (at least at that point in my pregnancy) that I didn’t need to give birth in the hospital. For me, hospitals are the place to be for when something is wrong. I knew there was nothing wrong.

Advocate for Options for Birth

Ladies, I have learned a great deal about advocating for myself. It has truly been eye opening. Because really, if I hadn’t kept asking questions and DIGGING and DIGGING I would not have had an appointment yesterday with a homebirth midwife. If I didn’t value my opinions and ideas, nor my values about pregnancy and birth and accepted others’ opinions over my own, I would not have spent 90 minutes in my living room yesterday, talking to my midwife while my 3 year old showed her his toys.

MTHFR Risks

23 weeks pregnant belly

The risks of MTHFR/thrombophilia are all prenatally and postpartum.  I am at a higher risk for miscarriage, still birth, intrauterine growth restriction (IUGR), pre-eclampsia, and postpartum blood clots/stroke. No matter where I am getting my prenatal care – at an OB office or if I use a homebirth midwife – I am still having parallel care with a perinatologist. Because of that, really, there is no reason why I shouldn’t use a homebirth midwife for my prenatal care. If anything, homebirth midwives give more one-on-one attention, are more accessible, more interested in my whole well being and are proactive in care rather than reactive as my OB office has been.

Determining My Risk

So far, I have had two ultrasounds at my perinatologist’s office. The first ultrasound was part of my first trimester screening where I was screened for down syndrome and trisomy 21 & 18. My results came back and was told I have a 1 in 10,000 chance of having a baby with one of those issues. According to my perinatologist, that test and those results decreased the risk of MTHFR/adverse pregnancy outcomes. Next, came my 20 week anatomy scan. The same perinatologist said that if everything looked good, my risk for complications with MTHFR became even lower. The scan went very well. Throughout my entire care with the perinatologist, he has told me that since I am taking the supplements that I am (prenatal vitamin, folic acid, b complex, baby aspirin), am generally a low risk individual (weight is good, good diet, don’t smoke, no health complications, etc.) that I am considered just as low risk as others and maybe even better. AND he also said that if I wanted I should have an out of hospital birth just like my first because a) I am low risk and b) it’s my decision. Holy crap. Did you ladies read that? A FREAKING PERINATOLOGIST ENCOURAGED ME TO HAVE AN OUT OF HOSPITAL BIRTH. I almost wanted to record him on my phone saying that so people would believe me.

MTHFR By Itself Isn’t High Risk

Click on this to read the letter.

After he told me this I told him I needed that in writing so that I could show that to my care providers and future care providers to convince them otherwise of what they think they know already. He wrote me a very detailed letter doing just that. He wrote up our care plan, and even stated at the bottom of said letter that where I have my baby is my choice. He also suggested that “early ambulation” (not staying at a hospital postpartum) would be helpful to prevent against blood clots. I should tell you that the other perinatologist in that practice would not have given the same advice as far as where I deliver my baby. Remember ladies, DIG! If you don’t get the answers you want, keep digging, keep asking questions, ask many people, get second opinions, search the internet but don’t give up until you are satisfied and agree with decisions that impact you, your body, your birth, your baby, your children, etc. You are your own advocate and nobody else is. Nobody will stand up for you like YOU can and should. Believe in yourself, your instincts and question everything. So, now what? Well, my plan as of right now is to continue with my homebirth midwife, have another ultrasound at 30/32 weeks to check for proper growth, and if everything continues to look good I have the green light to proceed as planned. I’m so freaking stoked.