Poll for midwives: Previous UC a reason to decline client?

[bobandjess99]

sorry..I apparently did not know the guiddelines clearly. sorry to offend.

[MidwifeErika]

Nope, I would not decline a client based on a previous UC.

[sevenkids]

Good god, no.

[triscuitsmom]

I'm still a student but certainly not... (but then I wouldn't decline someone who wanted me as a UC backup either so take that for what it's worth)

[Peppamint]

As long as they weren't planning to UC again. I'm perfectly fine with dads catching, moms catching own baby etc but I am not comfortable being the backup plan if UC plans aren't working out like mom intended.

[mamato3cherubs]

Originally Posted by triscuitsmom

I'm still a student but certainly not... (but then I wouldn't decline someone who wanted me as a UC backup either so take that for what it's worth)

:

[rebirth]

I'm also a student, and for me the reason they chose a UC would be important. I would NOT provide UC backup.

[mwherbs]

I wrote maybe- what is the reason they want an attendant this time- I don't want to be back up for another UC
secondly if mom is having feelings that something is not ok or is not going to be ok- perhaps the better referral is to someone with a hospital based practice- just speaking from experience here- women who were fine with their UC and are having some sort of intuition that they need help those women have frequently needed way more help than I could offer - like cord prolapsing in labor, or a baby with hydrocephalus, interuterine infection, heart defects, severe hemorrage
so maybe is the best answer for me

[MamaTaraX]

Originally Posted by mwherbs

I wrote maybe- what is the reason they want an attendant this time- I don't want to be back up for another UC
secondly if mom is having feelings that something is not ok or is not going to be ok- perhaps the better referral is to someone with a hospital based practice- just speaking from experience here- women who were fine with their UC and are having some sort of intuition that they need help those women have frequently needed way more help than I could offer - like cord prolapsing in labor, or a baby with hydrocephalus, interuterine infection, heart defects, severe hemorrage
so maybe is the best answer for me

This is my first post on here in gosh, probably years. Just wanted to say that before replying.
Now the reply: I found this incredibly interesting. I struggled for a long time deciding whether or not to hire a midwife this time around. I'd planned to be a UPin' freebirther but something early on said "no, you need help". It was a feeling that something was going to be "not okay" but I didn't know what. So I'm very fascinated with your assessment that you would defer them to a more hospital minded person. That truly fascinates me! I feel that my "not okay" is something post-partum however I don't necessarily feel that it will be a hemorrhage or anything like that, it could just be a need for postpartum support. Anyway, your reply caught my eye enough to make me jump up and write a post. Just wanted to thank you for your most interesting insight and thoughts!

[MsBlack]

I voted that I would not decline them, would treat them like any other client. But what mwherbs said really rings true for me.

I have been a UC mom myself, a few times. On the 4th attempt, I got pn care from an OB (my hb practice backup at one time). During that pregnancy, I ran into a CNM who has also backed up my practice--and she said she was available if I wanted to switch over to her. I told her in essence--this will be the first time I'm getting any sort of UC pn care or backup, because my feeling is that if I need any med help at all, it's going to be the whole 9yards.

That turned out to be my (probably necessary) csection. I transported during labor d/t mec and suspicious bleeding, labored in hosp for some hours prior to surgery which I myself asked for. There were definite indicators that in time, baby would have been in serious trouble (was already showing definite signs), and with a partial abruption I could have bled badly too, in time.

So yeah, I didn't think about it at first, but I do think that if a former UC mom came to me I'd want to know why she switched to mw care, and explore her feelings/intuitions about this baby/birth.

But I wouldn't have a prejudice against the family for UC, and I do provide UC backup now and then.

[zoebird]

i hope it doesn't defy the guidelines...

but would anyone be willing to assert why they would refuse back up and why they would allow for or support back up for UC care?

as a UCer, i would have loved to have had a back-up provider as a first time mum because of my understanding that many first-timers often just need support and reassurance, not full-on medical support. a midwife could do that well. and if we did need full-on medical support, she could assert this to us and we could utilize that as a good guage.

i'm curious, in general. thanks in advance.

[wbg]

Originally Posted by zoebird

i hope it doesn't defy the guidelines...

but would anyone be willing to assert why they would refuse back up and why they would allow for or support back up for UC care?

as a UCer, i would have loved to have had a back-up provider as a first time mum because of my understanding that many first-timers often just need support and reassurance, not full-on medical support. a midwife could do that well. and if we did need full-on medical support, she could assert this to us and we could utilize that as a good guage.

i'm curious, in general. thanks in advance.

Me too...very curious. I posted in finding my tribe a while back about back up MWs for UC and discovered that it was frowned on and was very curious to know why.

[sevenkids]

Ok, to clarify as well, since my knee-jerk reaction was "good god, no!".

I would not automatically refuse them care based on having a previous UC. I do want to know why they want care this time around. I have taken care of women who chose to UC for a previous birth(s) and wanted a midwife for subsequent births. So far, none of them have told me that they felt something was not right, just that they felt like they wanted support and to have someone there. Basically, they thought their UC's were okay, but felt they would prefer having someone there, or that they missed the feeling of having a circle of caring women around them before, during and after birth.

I have provided prenatal care (not back-up) for a very, VERY select few UC families, women who I had taken care of previously, and with whom I had a very close and CLEAR understanding with. I would not provide UC back up for someone who wanted to call me when things got hairy or did not progress as planned, I am not willing to walk into a train wreck and put my license on the line for someone I have no relationship with. I am not an EMT or first responder, and I will not be used instead of a 911 call. What it boils down to is I am (un-ashamedly) covering my ass and my livelihood and my license.

[mwherbs]

Originally Posted by sevenkids

Ok, to clarify as well, since my knee-jerk reaction was "good god, no!".

I would not automatically refuse them care based on having a previous UC. I do want to know why they want care this time around. I have taken care of women who chose to UC for a previous birth(s) and wanted a midwife for subsequent births. So far, none of them have told me that they felt something was not right, just that they felt like they wanted support and to have someone there. Basically, they thought their UC's were okay, but felt they would prefer having someone there, or that they missed the feeling of having a circle of caring women around them before, during and after birth.

I have provided prenatal care (not back-up) for a very, VERY select few UC families, women who I had taken care of previously, and with whom I had a very close and CLEAR understanding with. I would not provide UC back up for someone who wanted to call me when things got hairy or did not progress as planned, I am not willing to walk into a train wreck and put my license on the line for someone I have no relationship with. I am not an EMT or first responder, and I will not be used instead of a 911 call. What it boils down to is I am (un-ashamedly) covering my ass and my livelihood and my license.

this is close enough to what I have to say that I don't really need to write many of my own comments- I also have some issues with trust, respect and safety - probably one of the more recent gals who had a "planned" unplanned oops had the baby before anyone could get here(via mom's choice of time to call rather than when she could have called) , when cleaning up after I asked if she wanted us to ... something any way before I got the whole sentence out of my mouth she had already sarcastically said well yes I have paid you alot of money to do the clean up- as if I were well beneath her and way over paid for the slave work I should be doing- and I could say more but the bottom line for me was a mom who lost a baby during a UC- someone I had only seen for a couple of appointments, and at the time I did not encourage her to have a UC - but the other midwife- who I was helping at the time was very very supportive and reassuring toward her doing it on her own- like this is not the infant mortality for UC is higher than attended birth.

[zoebird]

when i was going through the process myself (eg, pregnancy with planned UC), i was considering back up midwifery care. my feelings on the matter is that if i wanted the support when it came to it, then i would call and would receive it and so on. but if i did not, then i would not.

of course, for me, it would be imperative to be up front and honest with the midwife about my plans and how i would prefer to utlize her care. it would also be important for me to have a relationship with that person (both professional in terms of the level of prenatal care that we could agree upon, and also emotional, creating a trust relationship).

i also felt that if i required more care than the midwife could provide (legally or otherwise) during the birth, i wouldn't hesitate to call a first responder or go to the hospital on my own, but hopefully with the support of the midwife. would that count in her numbers as a transfer though? would that affect her license?

which aspects of UC would do that? i'm just curious. i think that i'm not just clear on what the risks to the license are.

[MsBlack]

Mwherbs--I have to laugh a bit sardonically/bitterly at your story of being the 'clean-up mw' for UCers and the ugly comment. Oy. I do hear intended-UCers make just this sort of commentary amongst themselves and it's not fun. Not respectful--of themselves and babies, IMO, just as much as not-respectful of mws and what they offer.

I am happy to be that 'clean-up mw'--for anyone who wants the reassurance/insurance of my tools and skills, but might just have the baby without much of my help or even with me in the other room or on the way to their house. I'll cheerfully be that clean up mw IF the family is upfront and honest with me about their desires. And IF the family recognizes and respects the fact that I *do* have valuable skills among the humbler ones (and they *are* hiring me 'just in case' those serious skills might be needed, tho we all know that most of the time they won't be--right?), and to know that I *do* offer my skills as a career to provide for myself/kids among other important reasons for practicing. I want families to recognize also that I probably could have taken another client instead of them--I held a place in my calendar for them that I could have given to someone else, so it is not unfair or somehow wrong for me to get my full fee even if I mainly do clean up at the birth. Surely no one thinks that an independent hb mw makes so much $ that she could easily afford to forgo most of her fee for someone who might not actually utilize all of the services they paid for--?

Seems to me that if a family is recognizing the sacredness of their own birth, they will WANT to be honest and open with the mw, and promote some degree of intimacy and trust and friendliness with her--no matter WHAT she ultimately 'does' (or doesn't) do for them. What, you're going to invite someone to your birthing space (whether during or soon after) whom you don't much like or trust, towards whom you have some resentment for having to pay her? So, maybe you can't find or afford the 'backup mw' who feels like the perfect fit with you, and you have to hire a less-desired mw--well, it's not like most mws hide who they are along the way; if your backup mw is not your total cup of tea well, you are making this choice so make the best of it. Be nice, honor your mw's spirit if not her actual methods--for your OWN best experience under the circumstances you've created with whatever restrictions are imposed (as the I Ching says--'life is conditioned and unfree', but we are still free to choose how we manage and respond to the conditions)

I like what Zoebird said (Hi, Zoebird, how's NZ? ), and as mother and mw both, I think it is so true that some--even most--women really benefit from woman-to-woman support during pregnancy, birth, beyond. Some more than others--and some need support more at certain times than others (maybe not much birth support, but during pregnancy; maybe more at birth, or most of all for breastfeeding/newborn stuff, IYSWIM).

In short--I think UC is a fine and good choice for many women, one I've made myself and would again. With friendliness, honesty, mutual respect and clearly defined roles/boundaries/agreements, I'm happy to support some people in UC. I am also happy to provide prenatal/postpartum visits 'a la carte' for the cost of each visit only, and not be on call for the birth. Finally, I also reserve the right (as ever) to refuse UC backup to anyone who doesn't feel really really right to me as a fit, for any reason. I think there are many good ways to give birth, and the best thing is for women to find their own best way.

[zoebird]

i'm not in NZ yet, but hope to be soon. we're almost finished with our paperwork for our work visas! wow! can't wait though!

i think it's perfectly reasonable to charge the whole fee even if services aren't going to be used. i think pamamidwife asserted her fee schedule (a la carte) for UCers--there was a fee for holding a spot in her schedule for the client, and then if they used her service there was a birth fee in addition to that one, and if not, then no extra fee. but, i certainly can understand wanting the whole fee up front. i certainly don't think midwives are getting rich on their services.

in regards to post partum care, i think the most valuable skills are the ability to fix tears, the ability to check the newborn, and the nursing support.

i think that the cooking/cleaning/childcare aspect would be better handled by a doula. there are PP doulas--i'm thinking of becoming one myself. i would love to provide that kind of support to families.

for my own part, i really did need support post partum and wished that i could go to a midwife. locally, the hbmws here refuse my care altogether because of the concern that i may UC again. i would be entirely upfront with them if that were the case, but at this point i am considering mw care for a second birth (though admittedly, i'm not really interested in birthing again).

my reasoning makes no sense to me whatsoever. i think it really might come down to not feeling so alone in the whole process--pregnancy, birth, and post partum. but for me, post partum was the hardest. i needed support that i didn't really get.

and i can't describe what that would look like per se. i needed a lactation consultant--i don't kow if a midwife could have helped there. i wanted someone to check and see if i'd torn (i didn't, but no one would check and recommended i go to the ER). i felt my newborn was fine until 24 hrs later when he still wouldn't latch. i was concerned for him.

pregnancy and birth, though, i don't know what support i might have needed then. i would need a very hands off midwife, no vaginal checks, etc. i don't know if she exists.

hard to say. i think i would prefer to have a midwife available if i want her, though.

[kimiij]

Originally Posted by sevenkids

I have provided prenatal care (not back-up) for a very, VERY select few UC families, women who I had taken care of previously, and with whom I had a very close and CLEAR understanding with. I would not provide UC back up for someone who wanted to call me when things got hairy or did not progress as planned, I am not willing to walk into a train wreck and put my license on the line for someone I have no relationship with. I am not an EMT or first responder, and I will not be used instead of a 911 call. What it boils down to is I am (un-ashamedly) covering my ass and my livelihood and my license.

How do you tell the difference? What if she didn't relay to you that something might have gone wrong? Once you get there and realize that things had gotten hairy, would you then call 911?

[MsBlack]

Originally Posted by kimiij

Once you get there and realize that things had gotten hairy, would you then call 911?

That's what I would do, yes. But I would certainly try to clarify things by phone before going over to someone's house. And I would not want a total stranger to call me for help at the drop of a hat.

Zoebird, it seems so extreme to me that the local mws wouldn't even let you have a la carte services after the birth--to check a tear, for instance. That is too bad. I wouldn't have any problem with that.

Yes, maybe you needed a lactation consultant. But I guess when I think of a mw's postpartum care, I think in part of breastfeeding support--which might include referring a mom to LLL or an LC, if there were issues beyond my ability to help. But also, checking in on various topics for mom and baby--amount of lochia and all associated matters such as pain, odor, etc; her mood and energy; helping to organize more pp help if it seems needed; being there to process the birth if wanted;--oh, various things. And for baby, apart from full nb exam there is listening to heart and lungs, checking in on diapers, cord stump, all nb behaviors (some of which is gained just by observing a baby in mom's arms during the hour or so of a visit).

By the way, I also adjust my fee for UC support. I have to make a certain amt each client, just to get through the month at 'break even' level--but like Pam I charge for services utilized (such as prenatal/pp visits), an 'on-call fee' to hold the space that month, and then a fee that will be added if I actually attend the birth. For full pn care and on call fee, it's about 2/3 of my full fee; they'd pay the other 1/3 if I'm present for the birth. But here we are at the lower end of the nat'l average for hb mw fees. Not sure how I'd charge for UC services if my total fee were twice what it is now--and twice my usual fee is about the middle of average US mw fees as far as I know.

And I really hear you about feeling too alone--IMO, a sense of isolation is one of the very worst stressors for a new mom to face. Also IMO, this is at the foundation of most PPD. It is a time when a woman (and her baby and partner) most need to feel belonging in community, and be able to draw upon the emotional support and wisdom of others.

[zoebird]

i think that is very true. i think that i do still have questions about the licensing issues that UCing brings to bear, though.

aside from this, i have so many questions about that time. in reading my journals and posts, and in what i remember, i remember mothering itself being easy.

what was surprising was how everyone around me seemed to go crazy. my husband became anxious and angry (i think he felt overwhelmed). my mother was baby-crazy (and sometimes manipulative). i didn't exist to my ILs.

i did have friends cooking for us, others who would come by and clean. they were great.

there is still a lot to process. i'm particularly working on family stuff, especially now that w eare preparing to leave.