Newborn screening plus Bending Hospital Policy to Your Will

[Lineymom]

I am trying to work things out with my hospital midwife. She was the midwife for my 2 DSs. This probably being my final pregnancy and learning from experience I want a more natural/ happy/peaceful labor/delivery/postpartum period. I want everything PERFECT as it can be. Ideally, I would have a homebirth, I have dreamed that if I had a 3rd it would be. I hoped to move to a different area that would have a closer midwife. The closest is 2.5 hrs away. She is willing, but I am only holding it as a last resort if things can't be resolved with my current midwife.

I had minimum intervention before. Heplock instead of IV (this time I will insist on nothing) I had no drugs, no potocin before or after delivery. Labored in tub but forced to get out for pushing. (She told me early in this pregnancy that even that was a NO this time, with no real explaination.) Nursed immediately, room in etc.

All that was pretty good but what I did not like:

I have large babies. She worries about it and as I am starting to push does a cathater to make extra room I guess (even after she sent me to the potty). I "had" to be in the stirrups. I had no real objections with the others, it seemed as comfortable way to push as any. I tore really bad, though. This time I want ideally to be in the water, but the runners up would be anything but stirrups!!!

I don't would the cord clamped until it stops pulsing this time. No vit K (plan on getting the oral, but need to research more) No eye stuff, no hepatitis B.
Because of the large babies, they were pricked over and over to test blood sugar and it was fine everytime. So no blood sugar tests this time. The baby was taken away for "monitoring" when they hook it up to the heartrate monitors or something. What is that? It was about 45 mins. I am not sure if I can live with that or not. At the time it felt like forever, but when I looked at the time stamped on the photos, it was less than 45 mins. I am mostly afraid that they would sneak in shots etc then. They would not let DH go back in the nursery for that or the bath. For the bath, they gave them baths in a strong smelling baby soap and lotion. With the 2nd, I told them not to, and gave them a scent-free wash... but it was another shift of nurses.

We left the hospital with 2nd right at 24 hours, but we were ready way before and had to wait and wait for the hearing screen gizmo to get fixed. I want early discharge this time, but don't know how it would work. I don't want to refuse the newborn screening, but looking back they were probably ineffective for my other babies because they were screened before 24 hours. I also wonder, my state now tests for all 29 conditions. How many pricks does it take? Surely the one prick they imply does not make 29 blots on the paper?

Anyway, I am due in Nov. I go for a visit next week at 21 weeks. Should I lay it all out to her the sooner the better? I get so emotional that I dread it. I want to discuss it all without erupting into tears!!!!

[notjustmamie]

Hi from another November mom!

You said she's been with you through your two previous births--did you make any changes to your requests from #1 to #2? It sounds, just from what you wrote, that she's gotten more strict with her birthing policies for this birth rather than less. I would seriously consider how much you're willing to give in order to stay with this midwife. Is she open/are you willing to fight while you are in labor? I'm thinking of things like the catheter and the stirrups, both of those seem to be way over the top for a natural birth to me. Will see be willing to just let those go, or do you think that she'll push for them while you're in labor? I would also find out just why she isn't willing to let you even labor in the tub this time.

Personally, based on what you've said, I'd be going with the homebirth mw, but then I really don't do well with feeling like someone else is in control of my birth.

I hope you find an answer that feels right to you and you're able to have as "perfect" as possible a third birth!

[amydiane]

: I am in a similar situation, though it isn't really feasible for me to switch at this point (yes, technically I could, but I think what I have currently is the least sucky option given my circumstances). I went over my birth plan with one of the 3 OBs the other day and some things that I expected resistance on were fine (she said she was totally willing to deliver in any position I'd like and apparently does it regularly), but she seemed pretty attached to the IV, for example. She didn't flat out say I had to have it, but she said something along the lines of, "Well, you're almost certainly going to have to have one at some point." I asked about a heplock instead and she said, "Well....maybe," which probably means she'll dig in her heels when it comes down to it but didn't want to argue now. But, at least I know the things she's not really agreeable to now and can plan accordingly. Anyway, I will fight if I have to, but I'd really rather not, so I'm also interested in any tips anyone has.

Oh, and I do have a doula, which has been really helpful already, but of course she can't argue with the staff directly.

ETA: I want early discharge too (hospital policy is 48 hours minimum) and apparently that's more up to pediatrics - you can sign yourself out AMA without much trouble, but taking baby can get ugly. My doula recommended going to see one of the peds on staff (our regular one isn't at this hospital) ahead of time and getting them on board....otherwise it'll probably be harder to convince them if they don't know us.

[Lineymom]

I wish it were that easy to just go with the HB midwife. She is the only option and though I have never met her, on email I don't feel comfortable with her. She seems so eager to get her money. Speaking of money, we lost our insurance coverage and luckily I was able to get on medicaid, which covers hospital birth or homebirth with a CNM only. There are no CNMs anywere near my area that do HB. We would have real issue coming up with the $$$ for HB.

I am already driving past the c-section capital of the world to use my current midwife an hour and 15 min away. So these two are my only options.
I'm going to talk to her about it all at my appt friday. I really like her. Yes, there were things different with the 2nd than the first.

With both I had the heplock. With #1, she broke my water, but it wasn't something I was against at the time. I just wanted anything to speed up the terrible and slow labor, 2nd it broke with the urge to push while still in the tub.

With #1 I was shocked by a shot of pitocin after birth, but did not have it the 2nd time just as we had discussed. The nurse was actually going in for the shot and the midwife stopped her. She also stopped the nurse with only a strong glare when the nurse tried to move my hands when I reached down to help "catch" DS #2.

I really like her and do for the most part really trust her. She really put forth an effort to get it where I could labor in the hospital's unused physical therapy tub with #2. With #1 I was only allowed in the shower. So yes, there was more liberty with the 2nd not less, but she seemed with that one conversation to want less with this one.

BTW there were 2.5 yrs between my first 2 and now my youngest just turned 4. I think she gets caught up in the everyday humdrum of hospital medicine. As far as I know, I am the only person who has sought her out as a midwife. She works in a tiny rural hospital in an office with the only obgyn in the county, I think. It is easy for me to see how she losses the sense of what it is to be a midwife, you know. I guess it is my job to remind her! Wish me luck!

Sorry this is so long, Thanks for reading and for your imput.

[msmiranda]

Most of the stuff you are talking about with respect to the baby seems like it will have more to do with the nurses and the hospital than with your midwife. I would NOT be okay with the baby being out of my or my husband's sight for even two seconds, so I completely empathize. Unless you have been/are diagnosed with GD (and even then, it would only be needed if your GD was not well controlled), I don't understand why they are checking your babies' blood sugar so much after birth. You can decline that, you know. I don't know how much pushback they will give you, but you are the parent and can decline anything. Tell them you will sign a refusal form if they want. Also, you may want to talk to the head of the newborn nursery ahead of time -- this is what they suggested to me when I took the hospital tour this time when I asked about declining things. If they know in advance, they may be more willing to accommodate you even if they don't agree.

As for the stuff with your midwife, I am totally not getting the catheter and stirrups thing. I have never even heard of the catheter thing, it sounds old school. These are things you should definitely bring up as early as possible if they aren't okay with you.

I'm so sorry you're in such a predicament. You should be able to have the birth you want for your last child, and it sucks that there are so few choices out there. Hopefully your midwife will accommodate you; if not, seriously consider meeting with the HB midwife and trying to come up with the $ -- it might be worth it. Good luck with everything.

[Juvysen]

ugh, stirrups were my big "no" from the beginning. Luckily my hospital midwives said they almost never used them unless a mama had an epidural.

So sorry you're going through this. good luck!

[*MamaJen*]

I'm just shocked by the existence of a midwife who insists her clients deliver flat on their backs with their feet in stirrups. She must be seriously behind the times. That would be deal break city for me.

[Lineymom]

Originally Posted by *MamaJen*

I'm just shocked by the existence of a midwife who insists her clients deliver flat on their backs with their feet in stirrups. She must be seriously behind the times. That would be deal break city for me.

I'm sorry. I was not flat on my back, didn't mean to imply that. I was really in a sitting position with my feet outstretched into the stirups, but kinda grabbing my knees with feet out of the stirrups a lot of the time. Still, though, this position was not the best, from what I have read for deliverying big babies and it was not great for the bad tears I got (but neither is squatting.)

Thanks for the advice about talking to the head nursery nurse. I will definitely do that. Don't know why I haven't thought about it. I am sure it would help to get on a first name basis with her and bring her name up. "Well So-in-so said that...."

[mysticmomma]

"No thank you." <---- to whatever intervention you decline.
"but we have to, it's hospital policy."
"I do not give my consent for xyz. Do you need me to sign a waiver?"


I would flat out tell her not to cath you though... tha'ts outrageous.

[mysticmomma]

Also, you wouldn't let your 5 year old go in without you for an exam, so why would you let them take your newborn?

My child will not leave my sight. Exams can be done on your arms, or in your room.

[Ruthla]

A few thoughts:

UC (homebirth with no paid attendent) is always an option, and it's free. Many women choose to do this alongside a "hospital birth provider" and then claim 'oops, the birth went too fast". You could always bring the baby to the ped at 1 or 2 days old for the newborn screenings.

This midwife does NOT sound "midwife like" at all! You might want to check out what other birth providers in your area are covered by Medicaid. You just might get a more natural, gentle birth with an OB than with this particular CNM.

[Lineymom]

Originally Posted by Ruthla

A few thoughts:

UC (homebirth with no paid attendent) is always an option, and it's free. Many women choose to do this alongside a "hospital birth provider" and then claim 'oops, the birth went too fast". You could always bring the baby to the ped at 1 or 2 days old for the newborn screenings.

This midwife does NOT sound "midwife like" at all! You might want to check out what other birth providers in your area are covered by Medicaid. You just might get a more natural, gentle birth with an OB than with this particular CNM.

Believe me, I have given UC thought. I would definitely need DH's support. That is not happening. He is very squeamish. I could not rely on him to stay in control, even if he said he was willing. I also have other issues I worry about. My last DS had cord compression, had low heartrate while pushing, and truly needed oxygen. I also have large babies and the risk of shoulder dyscosia. For me personally, I need a professional there to feel secure because of these issues. Really if we had all the money in the world, this would be a big issue because of the distance of the HB midwife if she made it in time.

An OB in this area is NOT an option. The local hospital section rate is over 40%. I already drive over an hour to use the midwife.

I have high hopes that she will come around at my appt friday.

[jecombs]

Originally Posted by Lineymom

Anyway, I am due in Nov. I go for a visit next week at 21 weeks. Should I lay it all out to her the sooner the better? I get so emotional that I dread it. I want to discuss it all without erupting into tears!!!!

It sounds like you are kinda stuck with your MW. Have you posted this in Finding Your Tribe? Maybe some folks in your area can tell you who they have used for successful NCB.

I think the sooner you have this conversation with your MW, the better. I also have a problem with becoming very emotional and bursting into tears. Sometimes it does work in my favor though ! But I always hate losing emotional control in front of people, especially when I'm trying to rational and confident. : One strategy that works for me is trying to run the conversation like I would a meeting at work. I type up an agenda, I take notes. Does this look a little weird... yes. But it works!

Good luck! I hope you get the birth you want.

[Lineymom]

Originally Posted by jecombs

I think the sooner you have this conversation with your MW, the better. I also have a problem with becoming very emotional and bursting into tears. Sometimes it does work in my favor though ! But I always hate losing emotional control in front of people, especially when I'm trying to rational and confident. : One strategy that works for me is trying to run the conversation like I would a meeting at work. I type up an agenda, I take notes. Does this look a little weird... yes. But it works!

Good luck! I hope you get the birth you want.

I have been doing that! I have it all written out and been rehersing it in my mind. I plan on rehersing it outloud to DH, too. The plan is to get so used to saying it that I am not really "thinking" it on an emotional level!

To those who say that the baby does not need to be taken from you, that they can do all the procedures in the L/D room:

My hospital takes them to the nursery for weighing and measuring. Are the scales generally portable? Could they bring them in the room with me? I always missed that exciting time and always had to hear the weight and length from someone sticking their head in the door

What about the "monitoring" that they do in the nursery when they hook the things to their chest and monitor the heart? If this could detect something important that can't be heard with a regular stethoscope, I am willing. I have never had a good explanation of it. If it doesn't really detect anything I don't want it done. I don't want the baby in the nursery were they could "sneak" and test her blood sugar or give the K shot, Hep B shot etc. They would not allow DH in the nursery before due to germs for the other babies. I don't have a clue how to get past that unless he scrubbed up maybe?

[MegBoz]

Originally Posted by Lineymom

They would not allow DH in the nursery before due to germs for the other babies. I don't have a clue how to get past that unless he scrubbed up maybe?

Completely & totally ridiculous!! I went to see my nephew who was born premie at 26 weeks gestation! Obviously he was in an incubator in the NICU & we all could go to see him. They only let 2 adults in at a time, there was a wash station where you had to wash your hands first. But they let us in. We could even reach into the incubator to touch him.

To say you can't go accompany your healthy child into the nursery is beyond absurd. It's idiotic. Say, "OK, I'll wash up, wear rubber gloves, a face mask & not touch ANYTHING. Whatever precautions you nurses do, I will do too."

I agree with others - just say no as Mysticmomma outlined. Talking to the head of the nursery in advance is a great idea. I also like how ppl say you wouldn't leave your 5 year old alone, why leave your infant? You could tell them of that analogy to make it sound like you feel bad for your poor DC to be alone without Mama & Daddy & THAT is why you want to accompany DC. (Implying that it has nothign whatsoever to do with your distrust of hospital staff.)

Fortunately, I would imagine it's easier to fight for your rights PP then during labor, so at least you don't have to fight with this MW in labor. GL!

[MegBoz]

Originally Posted by mysticmomma

I would flat out tell her not to cath you though... tha'ts outrageous.

ITA
I was thinking about this - you said she "sent you to the potty" - so I assume you WERE able to urinate on your own? I understand that with an epidural & the loss of sensation, women need a cath because they can't release the urethra sphincter in order to empty the bladder. I think I've also heard of swelling with NCB rarely causing problems too. But if you WERE able to release the urethra & empty your bladder, what on EARTH made her think that there was still some urine in there? Seriously, I'm so curious!

Why does she think that if you were capable of urinating on your own, you somehow did not elimiate ALL the urine from your bladder??? I don't get it.

[amydiane]

Originally Posted by MegBoz

Completely & totally ridiculous!! I went to see my nephew who was born premie at 26 weeks gestation! Obviously he was in an incubator in the NICU & we all could go to see him. They only let 2 adults in at a time, there was a wash station where you had to wash your hands first. But they let us in. We could even reach into the incubator to touch him.

To say you can't go accompany your healthy child into the nursery is beyond absurd. It's idiotic. Say, "OK, I'll wash up, wear rubber gloves, a face mask & not touch ANYTHING. Whatever precautions you nurses do, I will do too."

: This is pretty much exactly what I thought when I read this. My DS is a 25-week preemie and we had the same rules. Oh, and they didn't have private rooms or anything, so we were always fairly close to other babies.

[Lineymom]

Originally Posted by MegBoz

ITA
I was thinking about this - you said she "sent you to the potty" - so I assume you WERE able to urinate on your own? I understand that with an epidural & the loss of sensation, women need a cath because they can't release the urethra sphincter in order to empty the bladder. I think I've also heard of swelling with NCB rarely causing problems too. But if you WERE able to release the urethra & empty your bladder, what on EARTH made her think that there was still some urine in there? Seriously, I'm so curious!

Why does she think that if you were capable of urinating on your own, you somehow did not elimiate ALL the urine from your bladder??? I don't get it.

I was able to urinate. She asked me if I did and how much, when I said "a little" she did the cath and more came out, I could feel it. She said she doesn't like to do it but it was the big baby thing...

I posted about caths on the birth professional forum here if you want to see their responses:
http://www.mothering.com/discussions....php?t=1104064


As far as the dad not going into the nursery, I will definitely bring that up (about the premmies) when I talk to the head nurse. I don't think the midwife has any power over the nursery.