MW advice please (Ontario)!

[redvlagrl]

This is my second pregnancy with a MW. The first ended in a C section and my 2 MWs from that brith are now on leave. My clinic has placed me in the care of one of their new MWs, who has just joined the practice after a couple of years practicing elsewhere.

Because I'm in Ontario, I feel so lucky to even have a MW as so many people I know can't get one, so I feel like I shouldn't be too picky, but I feel like this MW doesn't really want to do an HBAC. We have discussed birth place in the past and when home has come up she has said "in Ontario we offer the mother a choice of birhtplace", but then gone on to say how serious a UR is and how it is a 5 min emergency C section (which I now know isn't entirely true).

We have decided we want to HBAC and I have an appt on Monday. I am going to tell her this and of course she will agree, but I am scared she will not really be into it and want to transfer when not necessary. She's fairly young and has been practicing for a couple of years and doesn't have kids. I don't know whether she has attended an HBAC before, though she has mentioned other VBACs.

Should I really push her to say if she is comfortable with it? Should I talk to the administrator and ask if I can see a different MW? Help, please!

Thanks!

[Pau]

Originally Posted by redvlagrl

This is my second pregnancy with a MW. The first ended in a C section and my 2 MWs from that brith are now on leave. My clinic has placed me in the care of one of their new MWs, who has just joined the practice after a couple of years practicing elsewhere.

Because I'm in Ontario, I feel so lucky to even have a MW as so many people I know can't get one, so I feel like I shouldn't be too picky, but I feel like this MW doesn't really want to do an HBAC. We have discussed birth place in the past and when home has come up she has said "in Ontario we offer the mother a choice of birhtplace", but then gone on to say how serious a UR is and how it is a 5 min emergency C section (which I now know isn't entirely true).

We have decided we want to HBAC and I have an appt on Monday. I am going to tell her this and of course she will agree, but I am scared she will not really be into it and want to transfer when not necessary. She's fairly young and has been practicing for a couple of years and doesn't have kids. I don't know whether she has attended an HBAC before, though she has mentioned other VBACs.

Should I really push her to say if she is comfortable with it? Should I talk to the administrator and ask if I can see a different MW? Help, please!

Thanks!

Having a RM as your HCP does not put you necessarily under true midwifery care, sad to say but true in many cases.
I would go deeper with her, asking the basic questions that are usually advised to ask to detect whether that person is truly supportive of VBAC and to get to know how much experience she has assisting HBAC.
For what you tell, probably she isn't a very experienced midwife, and that makes things even worse for a VBAC, not to mention a HBAC.
Probably she mentioned HBAC following her guidelines that she has to offer the choice of place to birth. But, something tells me she is not comfortable with that. Did she ask about the reasons that led you to the previous cesarean? Does she have room to discuss how you copped emotionally with that (if your cesarean made some kind of emotional impact on you)?
Now you still have time, but once you are approaching your due date, chances of getting a more supportive provider are more difficult. Women usually star to feel cornered and more vulnerable and that's the first step to end up again over the operating table.
I don't think it is good to feel guilty because "you are lucky to have a MW" but still have some inner uncomfortable sensation.
Why don't you contact the local people from ICAN? As far as I know, there are 2 chapter is Ontario.

[redvlagrl]

Thanks for your reply. There's no local to me ON chapter, unfortunately. I think that I could talk to the administrator at my clinic and perhaps she could arrange for me to change MWs within in the clinic. I was so happy with my last ones, even though it did take me a while to get used to one. I was hoping that this would be the case with my current one.

I think I will take your advice and push her a bit on Monday and try and assess what she really thinks about HBAC. I know she's totally VBAC supportive. I really don't want to go to the hospital because of the bad experience I had there last time.

[Tizzy]

I don't know about the practice you are with (although I can bet I know who your midwife is ) but mine has the option of requesting a different midwife. Particularly if it's early on, you can always ask.

The practice I go to has a policy for HBAC's where they discuss it amongst themselves and if everyone is okay with it, they will be fully supportive. I live 25min from the nearest hospital that could provide an emergency C/S (which my midwives don't even have privileges at) so I was considered a higher risk. But they never overly discouraged me from aiming for a HBAC (I ended up with a UBAC and am pregnant again). They explained the risks, I do have to sign a form that says I understand the risks, but they've never encouraged me to go to the hospital.

Long story short, I suggest you ask the administrator or "your" midwife if there is someone else available who is more comfortable with a HBAC since she doesn't seem to be herself. Any care provider is allowed to have their own comfort zones...

[Astraia]

I would ask now for another midwife.

When I had my first with an Ontario midwifery group, I was told at my first appointment that if I felt we weren't "clicking" then I should just ask for a different midwife and they'd make it work. They really emphasized that a good, trusting relationship with your midwife was very important.

If you're already not comfortable with her (and I wouldn't be either after that conversation- who knows what her motivations were for saying something like that, maybe she's a perfectly wonderful midwife with a great respect for HBAC) then there's no point trying to fix somethign that got off on the wrong foot unless there's no other option.

[redvlagrl]

Thanks for the advice. I don't really know what to do.

I saw her again yesterday and told her that we wanted an HBAC. She seemed ok, but a bit uncomfortable. My guess is that she's never done an HBAC before. BUT how will she ever gain experience if I ditch her (and that's if I could)? She said it is fine but will have to bring it up at the practice meeting this week and let the backup mw know.

After we had talked about this, we talked about some other stuff, including my history of abuse. I told her that this one the main reason I didn't want to go to the hospital even without a transfer of care. Last time (after a transfer due to prolonged ROM) I felt very disempowered and there were many, many vag exams which I found fairly traumatic. I don't want to be in that situation again unless the need is really there.

I am going to contact my last midwife (who is on leave right now). We were fairly friendly - perhaps she might be able to shed some light on the issue...

[limette]

Ask for another midwife. I'm in Northern Ontario and we have two groups of midwives totaling 8 I think.

My first go around they were all (3 midwives) fine with homebirth. The attending midwife transferred me as soon as she got here with "baby feels really big, you won't be able to deliver without help."

Second time they were against hbac but said they would support my choice.

In the last two months there were a lot of underhanded comments. When I went into labor my doula arrived several hours before the attending midwife (a different one from the first) and we were doing great. 6cm dilated, painful (back labor) but still going good. Midwife arrives, slams her bag down and demands that I verbally agree (which I had done in the office) that proceeding at home was against medical advice, during a contraction. She continued to be extremely rude to me, the doula and her own student midwife. I stalled and she started making whispered but loud enough for me to hear comments about how I obviously was incapable of delivering naturally. She eventually convinced me to transfer at 9cm (i was completely incapable of thinking things through at that point )and I delivered at the hospital. After the delivery she told me that her opinion was that the safest place for me to give was at the hospital. I restrained myself from flipping her the bird.

She was the nicest one of my midwives but she sure showed her true colours at the birth.

If she's iffy now she'll be even iffier during the labor.

[Tizzy]

Limette - Wow! I am so sorry, that does not sound like a pleasant experience!

[limette]

Lesson learned. I'm going to go with the other group this time around. Apparently they didn't understand why the other team was against me doing an hbac in the first place.

[redvlagrl]

Thank you, limette, for your post. It leaves me so torn. I really don't know what to do. In the end, it's a VBAC that's the most importnat thing for me and I just feel like the HBAC would make it more likely to happen. But really, the thing is that I need to actually go into labour!

I have a lot of thinking to do....

[Surfacing]

[Pau]

Originally Posted by limette

Ask for another midwife. I'm in Northern Ontario and we have two groups of midwives totaling 8 I think.

My first go around they were all (3 midwives) fine with homebirth. The attending midwife transferred me as soon as she got here with "baby feels really big, you won't be able to deliver without help."

Second time they were against hbac but said they would support my choice.

In the last two months there were a lot of underhanded comments. When I went into labor my doula arrived several hours before the attending midwife (a different one from the first) and we were doing great. 6cm dilated, painful (back labor) but still going good. Midwife arrives, slams her bag down and demands that I verbally agree (which I had done in the office) that proceeding at home was against medical advice, during a contraction. She continued to be extremely rude to me, the doula and her own student midwife. I stalled and she started making whispered but loud enough for me to hear comments about how I obviously was incapable of delivering naturally. She eventually convinced me to transfer at 9cm (i was completely incapable of thinking things through at that point )and I delivered at the hospital. After the delivery she told me that her opinion was that the safest place for me to give was at the hospital. I restrained myself from flipping her the bird.

She was the nicest one of my midwives but she sure showed her true colours at the birth.

If she's iffy now she'll be even iffier during the labor.

Limmete’s experience is what I was talking about when saying that being under a RM does not mean being under TRUE midwifery care.
Unfortunately, we know more and more stories of that type. So sad, because our options are becoming more and more limited.
Yet having a story of abuse is something not every RM, probably trained under the medical model of care, has no idea how to deal with. There is a short but very interesting article in Midwifery Today about that issue. It’s at the bottom of the page:
http://www.midwiferytoday.com/enews/enews0327.asp
Though they are not in your area, I would contact the nearest ICAN chapter. They probably have better and honest advice and support to give you than your RM.

[redvlagrl]

Thank you for the link. I am still very confused. I know my mw is totally supportive of my VBAC, but I suspect it's the H part she is not into. In the end, I just want my baby to come out the proper way. Because I didn't go into labour last time, this is the scariest thing for me on my VBAC path. Perhaps it will be enough to labour at home until 5 or 6 cms? And the hospital wouldn't be that bad as long as I was still in mw care and not transferred.

The mw also mentioned that if there was a transfer from an HBAC, we would face a LOT of backlash from the nurses and OBs. She said most of it would be directed at her which she was fine with. I can definitely see this being the case as the community standard here is VBAC in a hospital with CEFM. Does anyone has experience with this?

[rlmueller]

You are not to be anyone's test case!!!!!

OMGOMGOMG. You are not required to provide anyone with their first experience when it comes to something this big. Do not let that be a rationalization for keeping her. If there is ever a time to go with your guts, it is during childbirth. If the opportunity is there to switch and your guts tell you to switch--than switch.

Don't feel bad she is new and needs experience.