Would midwives accept me for a HB after a 3rd degree tear?

[*theophane*]

Hello there!

We are a French-Dutch family, currently living in the US but very probably relocating to the Hague/Scheveningen next year.
We spend each year several months there and love it and i am already thrilled to be able to give birth in a system different than the US, where pregnancy and birth are viewed as normal and safe.

Here is what worries me though: i was inflicted against my will an epsiotomy that extended to a 3rd degree tear. i recovered well in the sense that i have no incontinence. But I am afraid that this would rule me out for a home birth. I can't imagine lying about it to be admitted for a HB, as overcoming the memory of this tear will be a big part of my spiritual work and challenge for my next birth. And i can't imagine either having to deliver in a polikliniek just because of that antecedent!

So i looked in the Verloskundige Indicatie Lijst, the list of antecedents and complications based on which the midwives can accept or have to refuse patients for homebirth.

And perineum problems are on the list, and they are listed under "Tweedelijns verloskundige zorg" (midwife under supervision of an OBGYN in the hospital, or an OBGYN) or "Eerstelijns verloskundige zorg" (HB Midwife)-afhankelijk van de oorzaak, de operatie en het resultaat, ie, depending on how bad the damage was and how it evolved.

Does any of you homebirthers have feedback about that?
Did your midwife pay close attention to your perineum's antecedents?

Thanks so much in advance!!
Isabelle

[sarahmck]

Originally Posted by *theophane*

Did your midwife pay close attention to your perineum's antecedents?

I don't think so. I told her about my previous birth and I'm sure she asked about tearing, of which I didn't really have any, so it wasn't discussed further. I didn't have any physical exam prior to going into labor, so I certainly could have lied about if I'd wanted to.

If your history officially dictates that you can't give birth at home, I suggest that you try to find a midwife who isn't too worried about "the rules." I know that my midwife, for example, allows people to push longer than the guidelines allow and does VBACs at home and lets people go significantly past 42 weeks if she feels that everything is fine. She's here in the Amsterdam area, but if you'd like to contact her for a reference to someone like-minded nearer to you, I'd be glad to pass on her contact info.

[*theophane*]

Hello there!
Thanks so much for your reply! Sounds encouraging to read that there are midwives that are more relaxed about what fall into their scope of practice. Even VBAC, wow i am impressed! and glad!

The CNM i saw after the birth said i could very well have no tear next time with a more patient caregiver, and there was no pb for a future vaginal birth. I just was worried that the 3rd tear label would rule me out from the start.

Yes i would love your midwife's contact info. This is very much appreciated.
Isabelle

[clogmama]

I gave birth to my first born in the US, and I had a horrendous episiotomy and thrid degree tear. My second was born in the Netherlands at home, and I had no tears and an easy recovery. I cannot say enough wonderful things about my Dutch homebirth experience! My Dutch midwives thought the tear was a non-issue for my second birth. I honestly could not believe that it was possible to have such a different and wonderful birth experience until it actually happened. In the Netherlands, I also went to a few private prenatal yoga sessions which were helpful in mentally preparing myself for a new birth and to let go of the trauma of my first experience.

[*theophane*]

thank you so much for this very very encouraging reply!
i hope i'll have such a great birth!
is the specific yoga you mentionned called prenatal yoga or something like mensendiek?

anyways, many thanks for your heartwarming message!

[sarahmck]

Originally Posted by *theophane*

Yes i would love your midwife's contact info. This is very much appreciated.

http://www.onderwaterbevallen.nl/. Laura was my midwife.

[clogmama]

Hi!

is the specific yoga you mentioned called prenatal yoga or something like mensendiek?

The yoga was called zwangerschaps yoga (so, prenatal yoga). I actually phoned to register for a group yoga class, but it was full, and so the instructor offered a few private sessions at her home studio. She focused a lot on breathing techniques. She also encouraged me tell myself that I was going to have a new baby and a new birth.

[*theophane*]

sarahmck, thank you! sounds great!
this is so reassuring to me, i felt looking at the website, "ah they look like REAL midwives!!"
I mean that they do look like comitted, activist midwives. A little like midwives i know here in the US. i do have to say that i got the impression that some midwives in NL, especially in big practices were less comitted to HB or really individualized care, hence my concerns about being ruled out on rules that are not applied in an individual matter.
I did come around a pretty large practice in the Hague. I got the feeling that their way of practicing was more standardized, administrative, mainstreamed, i don't know how to express that and i don't know if you see what i mean? For instance they work in shifts, so you don't know who you get when in labor, and some women told me that they come only late during the labor, close to the birth only. The whole length of the labor ?? is it for the partner? the Kraamverzorgster??

clogmama,
Thanks i will keep this idea!
I will definitely need some healing to ovecome this first birth and I can see how yoga could help me with that!

thank you girls!

[sarahmck]

Originally Posted by *theophane*

sarahmck, thank you! sounds great!
this is so reassuring to me, i felt looking at the website, "ah they look like REAL midwives!!"
I mean that they do look like comitted, activist midwives. A little like midwives i know here in the US. i do have to say that i got the impression that some midwives in NL, especially in big practices were less comitted to HB or really individualized care, hence my concerns about being ruled out on rules that are not applied in an individual matter.
I did come around a pretty large practice in the Hague. I got the feeling that their way of practicing was more standardized, administrative, mainstreamed, i don't know how to express that and i don't know if you see what i mean? For instance they work in shifts, so you don't know who you get when in labor, and some women told me that they come only late during the labor, close to the birth only. The whole length of the labor ?? is it for the partner? the Kraamverzorgster??

Your description sounds like how the majority of midwives work here. You have to keep in mind that homebirth is the norm here, so the midwives don't have to be activists and don't have to be driven to midwifery as their life's passion in the same way that they do in the US, where homebirth is a freakish thing to do. I say this from the perspective of someone who had her first baby at home in America. When I was looking for a midwife here, I wanted what I had in the US too: a dedicated midwife who would virtually certainly be the one to deliver my baby, who felt strongly about homebirth, who was committed to keeping me at home, etc. Since homebirth is normal here, I think it's better to think of midwives like doctors or nurses in America: some are wonderful and special and committed, and some just chose it as a job that appealed to them.

Midwives generally do come at the end of labor here, for transition and pushing. They are vastly overworked and couldn't possibly attend all their births from beginning to end. I recently heard a statistic about how many births the average midwife attends (along with the associated prenatal care and post-birth follow-up) in a year. I think it was 100 or 120 or something insane like that. For full labor support, I strongly recommend getting a doula. I know several here in the Amsterdam area. Perhaps when the time comes one of those could give you a lead in the Hague.

[*theophane*]

thanks for your detailled answer!

so even the most comitted MW cannot stay for the whole birth, or just the 'typical' MW? if so, i will definitely need a doula.
i also hear that (some) kraamverzorgsters are at the birth earlier in labor - do you have to have one during labor? how really familiar are they with the needs of labouring women (psychologically, spiritually)? i can see how the MW needs everything set up when things pick up, but what's the point of having someone who is not a doula?
i went to the Dutch doulas website and i found a few women who are both doula and kraamverzorgsters, maybe a nice solution??

one last question, can you choose your Midwife completely freely? have you met several before choosing one?
i mentionned this 'practitionner shopping before choosing one' to our Dutch family as i would intend to do that when searching for a GP that suits us, too, and they said you can't. You go to one and then you stay with him/her and you need a whole procedure to switch to someone else.

thank you, again!!

[sarahmck]

Originally Posted by *theophane*

so even the most comitted MW cannot stay for the whole birth, or just the 'typical' MW? if so, i will definitely need a doula.

The vast majority of midwives don't stay until you're close to pushing. They may come and check you a few times, but they'll generally leave again if you're not getting towards transition. I personally think a doula is essential, even if the midwife does stay, but that's just my own bias towards thinking that doulas are worth their weight in gold.

i also hear that (some) kraamverzorgsters are at the birth earlier in labor - do you have to have one during labor? how really familiar are they with the needs of labouring women (psychologically, spiritually)? i can see how the MW needs everything set up when things pick up, but what's the point of having someone who is not a doula?

I know that my kraamverzorgster wanted to be here for the birth. She wanted to be called as soon as I went into labor so that she could be getting herself in order and could come as soon as they called to say that it was looking imminent. Then she would have come to witness the birth. We didn't call her like that, though, because I had my husband and my midwife and my doula and we just didn't need her, so although she wanted to be there for her own spiritual connection to our baby, we decided that it was a bit much. This was also influenced by our knowledge that she feels a bit bitter about doulas (like they're muscling in on her territory), and we didn't really want those feelings in the room during pushing, which is very hard for me.

That said, I think that the standard kraamverzorgster does not want to be there for the birth, per se, particularly if it isn't occurring in normal business hours (because they only come straight out after the birth at certain hours). Most people go with an agency who may send different women on the different days of the kraamperiod. We chose a private kraamverzorgster where we knew that we'd get her and only her, so it was a bit different.

i went to the Dutch doulas website and i found a few women who are both doula and kraamverzorgsters, maybe a nice solution??

Yes, that sounds nice.

one last question, can you choose your Midwife completely freely? have you met several before choosing one?
i mentionned this 'practitionner shopping before choosing one' to our Dutch family as i would intend to do that when searching for a GP that suits us, too, and they said you can't. You go to one and then you stay with him/her and you need a whole procedure to switch to someone else.

I only met my one midwife before choosing her, but I had seen her speak at an attachment parenting event, so I was already quite sure that she was who I wanted. We did go for a first visit after which we said that we wanted to go with her, so clearly we could have said that we didn't want to. So my answer is yes, you can meet them first. Most people don't, which could explain the answer you're getting from your (reasonably mainstream?) family. Lots of times people assume that if something isn't commonly done, that means it can't be done.

As for the huisarts, the same story holds. Yes, most people choose the one located closest to them and stick forever. We wanted a homeopath, so we found a huisarts who is both a homeopath and a physician and we went and talked to him to gauge his feelings about our choice not to vaccinate and to avoid allopathic medical treatment whenever possible. He was very supportive (despite vaxing his own kids) so we registered with him. He was even officially full at the time, but he told us that "he always had room for motivated patients." So clearly the interview and decide approach works there, too.

I believe there may be some truth to the idea that some paperwork is involved in switching between huisartsen, but it's certainly not prohibitive. I know quite a few people who have done that, probably mostly because I know lots of ex-pats who are looking for an American experience and have to shop around a bit to find someone sufficiently willing to prescribe.

[clogmama]

I think this is a nice Mothering article, titled "Homebirth in Holland":
http://www.mothering.com/articles/pr...n-holland.html
I used the same group of midwives, and had a very similar experience. The midwifery group was simply the neighborhood practice, and was well regarded by the local mothers. The yoga teacher I had knew of other midwifery options, including one midwife who only performed home water births.

In the US, I had a traumatic birth even though my midwife stayed with me for 9 hours and gave me lots of wonderful support during labor! I agree with Sarahmck in that a doula would be a good option for labor support in the NL. When my Dutch midwife arrived she told me that I wasn't very far along and to take a shower and eat crackers, and then she left! I did what she suggested, and my labor progressed quickly after she left. The midwife was called again in 1.5 hours and 30 minutes after she arrived the second time my baby was born. The kraamversorgster did not arrive in time for the birth, but she was very helpful to the midwife soon after the birth. She also prepared food for me right away, which was great!

[*theophane*]

Thank you girls!
I really really appreciate your info!

We're hesitating between TTC this next baby very soon in the US, or waiting until we're in the NL and the birth choices are an important part of the decision.
Your replies are so precious in that sense!
thanks!!