So if I go with a mw this time, what happens?

[anotherpeanut]

So I had OBs last time and ended up with a c/section. i never labored at all and part of me wonders what would have happened had we given it a few more days and the other part of me remembers "knowing" that he wasn't in the correct position, he was off to the side sort of lodged in the side of my pelvis. i tried accupressure, massage, etc. to get things going and nothing helped.
so anyways i'm considering switching to a midwife this time around for several reasons. but what happens if at 40 weeks or 41 weeks the baby is in the same position (not full transverse, head down but shifted off to the side), mild unproductive contractions, nothing really going on. do they then send you to an ob? how does it work usually? i really don't want to end up with surgery from someone i don't even know! sorry this is probably a dumb question but i'm super early in my pregnancy and just beginning to consider my options. Thanks for any info.

[AlexisT]

If you need a section they will have to send you to an OB, yes (though I don't know about that particular scenario; they might try something else before saying it required a CS).

Some midwives (usually CNMs) will have you meet their backup OB at some point, so if you do need a section it won't be from a stranger.

That said, I've never considered this to be a point in favor of OB care, really. If you needed a scheduled section for a medical reason, you could arrange a consult beforehand, and in an emergency you are never guaranteed anyone. I was OB-led my entire 1st pregnancy and got a complete stranger for my section.

[prancie]

you can have parallel care with a doctor that you would trust to do the surgery if it became necessary.

[AlexisT]

Insurance may not pay for that, though.

[E-man's mama]

In Illinois, if you work with a CNM, they will have an OB who is their back-up who you will meet at least once. If you want to meet with him/her more, you could. But one of the nice things about seeing a midwife is that they may (mine did at least) give you helpful pointers about getting your baby in the right position and should help you in labor get your baby in the right position. Most OBs are very eager to say "not in right position, lets go to section" without trying position changes for you and helping you throughout your pregnancy. There is no guarantee that your baby will be in the right position, but it more than likely will be and many babies aren't right until just before they are born.

Even if I had ended up with a section, I was so happy to have mw care during my pregnancy. They were just much more caring and thought of birth as natural and gave me lots of "you can do its" as opposed to my previous OBs. I had an awesome VBAC birth and would never go back to OB without a medical condition. My first (section) baby was for posterior, but my VBAC babe was in the right position the whole time!

Good luck!

[anotherpeanut]

Thanks for the info. I'm actually in Illinois so that would apply to me. I feel like this time around I'm leaning more toward mw over ob for my primary care. I want to feel a bit more taken care of this time around. I didn't feel not taken care of the last time I just felt like another patient kind of...even though I was there so often. I was always nervous at appointments, I felt like my questions were given quick and convenient answers (although the woman i saw gave me a lengthy history and lesson on episiotomy that was quite interesting actually) and I just want someone to understand that having a c/s really sucks and avoiding another one is a high priority to me. Whatever i have to do throughout the pregnancy to help limit the chances of it, i'm willing to do it! Thanks for the responses! Now it's just convincing my mom the nurse that a CNM is an okay option for me!

[clicksab]

I used a hospital based mw practice with my DD and ended up needing an emergency c-section. I'd never met the backup OB, but heard a lot about him. To this day I'm not entirely sure who performed my C-sec, and I've never really thought about it. To me it was almost like when you go into the ER...I didn't really care who was doing it and was too busy being in pain to care! But I had such faith in my mw's and the hospital I chose, that I knew they would do a great job. And they did!

[Realrellim]

Originally Posted by anotherpeanut

Thanks for the info. I'm actually in Illinois so that would apply to me. I feel like this time around I'm leaning more toward mw over ob for my primary care. I want to feel a bit more taken care of this time around. I didn't feel not taken care of the last time I just felt like another patient kind of...even though I was there so often. I was always nervous at appointments, I felt like my questions were given quick and convenient answers (although the woman i saw gave me a lengthy history and lesson on episiotomy that was quite interesting actually) and I just want someone to understand that having a c/s really sucks and avoiding another one is a high priority to me. Whatever i have to do throughout the pregnancy to help limit the chances of it, i'm willing to do it! Thanks for the responses! Now it's just convincing my mom the nurse that a CNM is an okay option for me!

That's what I'm doing this time. I'm mostly going with the midwives b/c I felt like my OB practice treated me and most of the women as generic pregnant women even when that wasn't the case. (They also didn't do a great job of glancing at medical histories, as best I could tell, which is how they almost missed that I'd developed pre-e during my labor check.) My midwives seem to be more focused on each patient as an individual patient, and I feel more confident that if I end up with pre-e again and another atypical presentation no less, that they will catch it. I did my initial prenatal appt with the OB practice and they asked me questions that were all in my file: why I had the c-sec, etc (why they couldn't look at their own file, I have no idea), and didn't even bat an eye at DD's small-for-gestational-age issue as if that was perfectly normal. When I answered the same questions about her birth at the midwife practice, they looked at the notes they took and immediately said they wanted me to do a consult with the high-risk OBs down the hall (separate practice, so they just gave their opinion to the midwives) to see what might have been going on. I feel like I'm in much better hands.

If I end up needing a c-sec, I'm sure they'll pull one of the OBs that also practices at the hospital where I'll be delivering. It's a good hospital so I'm sure they'll do a good job if that's the case.

Good luck with your mom! Mine was rather annoying about it. I think I finally said something along the lines of "mother, I am 35 years old, this is my second child, I didn't receive great care from my OBs, I'll be delivering at the best research hospital in the state, and midwives are *highly trained medical professionals* so I"m in good hands." She probably still has her (unfounded) worries, but she's keeping them to herself, thankfully!

[jess152]

I'm 35 weeks and baby has been consistently head down for the last 6 weeks or so. Prior to that, he was breech and I was so worried about what my m/w would do if he didn't move. At that time she did a version and turned him. She very matter-of-factly told me that she'd just turn him again if the need arose. I know he could still flip to breech between now and then, but I'm confident that she'll get him in the right spot if that happens.

Good luck! Having a m/w this time around has been so much nicer than a dr.

[DocsNemesis]

I agree that midwives would be more likely to help you reposition babe, as well as allowing more time for baby to move on its own-which happens most of the time.

Do keep in mind that you can do things as well though. I never asked my midwives, I'd assume they would've gave me some ideas, but instead I decided to try for myself to get my 3rd into a decent position. She was off to the side (sounds sort of similar to yours) and wouldn't get into my pelvis. So, I got on my hands and knees and relaxed as much as I could, letting her sort of hang there. Then I started pushing around on the lower half of my belly, trying to get her head over away from my hip more. I wasn't forcefull or anything-just gently moving my belly a bit. Then I stood up and walked around for a bit. It took a few times before I felt that she had moved into a good position but it was worth it.

Again though, I never asked for help; I'm sure if I had, they would've helped me with this. Honestly just getting on your hands and knees for a few minutes might help a bit, since it allows the baby to move off of whatever they are on/stuck on, and reposition themselves.

[anotherpeanut]

yeah i can't help but think looking back that a different perspective may have produced a completely different outcome (which wouldn't have included major surgery)! anyways i'm over it for the most part and just trying to look forward and focus on getting this next baby positioned correctly and out safely. my family thinks i'm totally nuts for even considering switching to a mw so it's making the decision even more challenging. my mom is a nurse and keeps telling me that i was 3 days past due and he was stuck and if they tried to let me labor #1 it may have ended in a section anyway or the baby could have been deprived of oxygen because i waited too long. and while i don't doubt he was stuck i do doubt that there wasn't anything that could've been done or attempted at least for a day or 2 before going to c/section.

[courtenay_e]

If she is a nurse, have HER look into the training a CNM receives...which worked well for my in-laws (Paramedics, trauma surgeons, and nurses). Basically a CNM has all the rotations/training an OB has, except for surgery...so they are "as qualified" as the OBs when it comes to maternity care. Telling your nurse mother that, in fact, midwives are MORE qualified than OBs to take care of normal, healthy women (a cesarean scar that has been cut for only one child has the same chance of rupture with a double suture as a primip with no surgical scars), as that is what they are trained to do. OBs are surgeons who are trained in HIGH RISK, in the PATHOLOGY of pregnancy, labor, and birth...they are trained to look for and cut out what is wrong. Since you are a normal healthy woman having a normal healthy pregnancy, and assuming a normal healthy labor and birth...you would be better off with the professional trained in caring for your situation! Everywhere else in the world, the midwives take care of all but the highest risk woman (in Great Britain they have published studies showing that even high risk women have better outcomes with CNMs even in HOME BIRTH than with OBs...).

Just some ammo for you!

Another thought, whether you go OB or midwife, you would do well to see a chiropractor through this pregnancy, specifically one who is very practiced at performing the Webster technique. It would go a long way toward helping you have a baby in a good position.

[jess152]

Not related to your original post, but worth mentioning:
It seems kind of alarmist, your mom pointing out your baby being 3 days overdue! 3 days? If you have a longer cycle, or weren't positive when you ovulated or conceived, 3 days late could be 2 weeks early. I was obsessively charting my temps and knew when I ovulated, but for women going by LMP, things aren't so cut and dried. To avoid that pressure this pregnancy (because I got it last time, my c/s due to post dates, dried up placenta, dwindling amniotic fluid and increased risk of stillborn), I've told no one my due date. My midwife knows roughly when the baby will come, everyone else has been told 'late Nov, early Dec'. /end of rant!