So far we've had four midwife homevisits (not counting the first 'orientation' one before we had made up our mind).
Last one, a few days ago, I asked the visiting midwife for more details regarding going overtime (past 42 weeks) here in Tromsø. I am fascinated with 'standard procedures' here, loving that I get to compare them to those in Taiwan, not to see which ones are better, but just getting a deeper understanding of the similarities and differences in what I now consider my two home countries.
A little run-down/back-ground:
Last Tuesday I went on my final midwife check in town - I have continued to go to these even after deciding on a home birth because these checks are 'in the system' and the homebirth midwives prefer you continue to do them - the home visits are more us getting to know eachother and discuss birth-stuff. I was 40+4 at that visit, and so two days post EDD, so an overtime-control was scheduled for Monday (41+3).
[Sidenote: A difference between here and Taiwan is that at first the checks are every 4 weeks, and then towards the end of pregnancy the checks become first bi-weekly then weekly in Taiwan, whereas here because of my midwife's schedule and some double-bookings, I've gone 6 weeks between a check, and now towards the end the last three checks were 3 weeks apart, not weekly...no complaints on my end!]
At the OT-control we will get a high level ultrasound done by a doctor that specializes in this, rather than an ultrasound technician, because he is going to have to check some aspects that need special training and practice: Amniotic fluid levels, health of the placenta, and blood flow in the umbilical cord being the most important ones - and of course general stress levels of the baby (based on heart-rate I believe). I will also be discussing with the doctor our plan for home-birth, and asking when the deadline is for it being advisable from the hospital's perspective.
With 'advisable' or perhaps allowable or preferred, I mean is that during the first homebirth orientation meeting the midwife had mentioned that if I go past 42 weeks the hospital wants me to give birth there, and the homebirth midwives prefer this as well. If I did decide I still wanted to have a home birth they would come of course, but because home births are no longer the 'norm' here in Norway, it is important to uphold good relations with 'the system' in order to ensure continued support for it, and that is something I am fully on board with. So if we do reach the deadline I get from the doctor, we will go on to plan B - a hospital birth. Not a bad alternative due to the SOPs here being pretty darn good imo - and flexible enough to accomodate my wished alterations to the SOP, plus there is the possibility for a water birth.
Tomorrow (OT-control) I will also have to tell the doctor I do not wish to have an internal exam (I am so of the school-of-thought that internal exams just give you info on where you are right now, and say nothing about when or how soon you will give birth), and definitely no stripping of the membrains (which would require an internal exam anyways). My midwife mentioned it was important I explicitly state this, as the doctor very well could just strip the membrains during an internal exam, without discussing/asking first. This I am not a fan of, obviously, and so am very happy to have midwives that understand - and fully agree with - my thoughts around birth, so they know what kind of information to arm me with when I head into The System.
Anyhow, if at the first OT-control all seems well, another OT-control will be scheduled for a few days later (before 42w roll around) to check the same stats. At that control I believe is when a potential date for induction will be set. Potential date means potential in two forms, one of course being I could give birth spontaneously before it, another being if they end up being too busy in the birth-floor that day, I would just get checked once more and then asked to come back the next day or two when they had better time.
I will be discussing with the doctor this whole induction-after-42-weeks issue as well. I prefer, if everything looks ok in the OT-controls, to rather wait until birth starts naturally...but at the same time I don't have a strong need to go too far over 42 weeks. It's not that I have a strong faith in my estimated due date (EDD) actually being 'accurate', because it was set with the ultrasound done in week 18 which means it could be measured off by about a week, based on my own calculations I believe it ended up being a bit earlier than it should be. PLUS EDDs don't mean that if even accurate, babies would be born that day, as all babies have different needs and schedules in the tummy. I fully believe a baby will come when she is ready...and am against interventions or inductions that are not medically necessary, but at the same time...I don't know, risks do increase by 42-43 weeks.
Anyhow, I am hoping we just won't have to face that issue.
In Taiwan it was very different. After my 40w check-up I went down to the front desk and asked her to schedule my next check-up, and she was super surprised because there are basically no more check-ups after that, just scheduled inductions/c-sections.
Speaking of inductions and c-sections, out of curiosity I asked about how they approach requests, and was pretty happy about the answer. Basically, I cannot get a c-section or be induced just because I want to, there does actually have to be a medical reason for it. If I am insistant, I would have to talk with the doctors several times, and they would see if, for example, it is because of a mental reason (i.e., if I had had a very traumatic last birth and am now terrified, etc.) they would try to first address these mentally through therapy/talking. So basically, being induced or c-sectioned for 'social' reasons doesn't happen often or easily.
Of course, the whole 'going over 42 weeks' being a medical reason can be debated, I'll give you that.
Another interesting tidbit is that many midwives here are trained in accupuncture - accupuncture is in fact considered mainstream in Norway, not alternative medicine. So one can ask for 'maturation' accupuncture (not considered a form of induction, but to help your body move towards birth, encouraging thinning of the cervix type of stuff), and can ask for accupuncture during the birthing process as well.
One of my homebirth midwives does it, but...I'm fully aware of certain dangers with accupuncture as well - not saying I doubt her skills in it, but just...yeah, if it isn't necessary then I am of the stance that one shouldn't mess with things. So, I think I may not end up taking advantage of the opportunity. However, last visit she showed me some points I could do self-accupressure, which I am down with. One for mental stimulation (help with when I'm not as chipper as I'd like) on the top of the head, and then also a few for uterus strengthening/stimulation.
So now we are just playing the waiting game.
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