Talk to me about Midwives

[smerkin]

So I'm pregnant with my second child! Yippie!
Background: I had my first last year completely naturally at a great hospital in NY. My OB/GYN was practically like a midwife and I loved her but she was unfortunately out of town when I had the baby. So her back-up delivered the baby and he hardly did anything, just walked in the room, caught the baby and then pounded on my stomach until I delivered the placenta. I begged my amazing nurse not to call him because I wanted her to deliver the baby. So this time around I would way rather have someone who will be there with me the whole time I labored. Fortunately I had an amazing nurse who got me through my birth but obviously I won't have her this time and I don't want to take my chances. Also, the hospital was great and completely read my birth plan and did everything I wanted. And I won't be delivering there again obviously.
My husband is incredibly supportive but a bit nervous about me delivering at a birth center "just in case". I have an appointment at a great center with a highly recommended midwife here in DFW and he's coming with me so I'm sure he'll ask about every circumstance possible.
So I would like to ask y'all, I know a lot of you have had births in centers and at home. Home isn't really an option for us right now but we have several fabulous centers around us. There is also a good hospital where midwives deliver at but I really like the idea of a birthing center. I spent nearly my whole labor in the shower last time and I would love to be able to get in a big tub.
Anyway, please tell me how fabulous midwives are and if there are problems everything was just fine.
Thanks!!

[GoldmanBaby09]

I had my babe at home, so I am biased, but even if a BC was an option here (there aren't any in my area), I would still stay home!! Pretty much anything a BC has, a good hb midwife carries with her and the idea of driving somewhere in labor seems daunting and painful to me. To me, going to a bc seems like birthing in a well appointed hotel room and that isn't something I would want. I wanted my own sheets, my own bed, and no one to tell me what to do. Also depending on the BC, you could still be looking at a rotation of midwives and your specific midwife might not be there when you birth.

Anyway, I don't want to offend anyone who had a bc birth. I think they are a wonderful alternative to a hospital birth. I hope you find what will work for your family. I just know hb was what worked wonderfully for mine

[Turquesa]

The key is in the interview. The MWs we chose to work with let me come in twice to interview them--once and then again with some follow-up questions/concerns that I had.

The other key is to take your DH with you. MWs are used to getting grilled by skeptical fathers-to-be--including on all of the "what-if" situations-- and the experience *usually* helps put the guys more at ease with the prospect of out-of-hospital birth. Taking my DH along worked wonders for convincing him to support my choice! Good luck!

[ExuberantDaffodil]

I originally planned to birth at a birthing center, until I changed my mind midway through the prgnancy after I realized that the birthing center was literally a house, and my house was an option. (I'm glad I planned for a homebirth, in retrospect, because my labor was so extremely fast that I would have had to be driven to the birthing center in transition, and that would not have been fun.)

The midwives let me interview them as long as I wanted, asking every possible question I could dream up, and I liked that a lot. My hubby didn't go with me that time, but he did go over the answers I had written down, and he went to a subsequent prenatal appointment with me and asked all of his questions at that time. Even though he was iffy at first, he soon came around after watching the Business of Being Born with me and talking extensively with the midwives.

[Harmony96]

Just curious why you feel that a homebirth isn't an option this time?

Also, I'm in DFW as well (more D than FW though, lol).

[smerkin]

Thanks for all of your help!! Unfortunately I live in an apartment complex and I don't think that is an option right now. I also (I don't know if this is weird or not) don't want to have to deal with all of the mess that goes with birth. I would rather go somewhere else, have the baby, and then come home to my nice, clean, peaceful home. Just my preference, I guess. Maybe when we have our own home I'll feel differently. I've known several people who did HB and I would be open to it, just not now. DH is really not open to that right now tho.
DH is coming to the meeting and he will have plenty of questions to ask! I'm sure he'll try to think of every worst case scenerio possible. [= (lol my DD just typed that smilie)
I'm really excited about the thought of using a midwife so I'm hoping it works out. I had a very low-risk pregnancy last time so hoping this one is the same.
Thanks a lot! Anyone have any must-ask questions you would like to share?

[Harmony96]

Originally Posted by smerkin

Thanks for all of your help!! Unfortunately I live in an apartment complex and I don't think that is an option right now. I also (I don't know if this is weird or not) don't want to have to deal with all of the mess that goes with birth.

After I had DD, I felt like you did about the mess. Whenever I'd mention it on here, people would always assure me that the midwives take care of that end of things. We are in an apartment now and when we renewed our lease last spring, we got a free carpet cleaning for doing so. At a later office visit, I asked them if the cleaning could be after October b/c I was having the baby at home and they said that wouldn't be a problem.

But, it ended up not even being an issue. There was seriously no mess at all when they left. The chux pads went into a trash bag and the towels went into the washer (they started the load). A second set of sheets was on my birth-supplies list, and after the birth, they re-made the bed w/ the clean sheets (not that the others were even that dirty).

[laughingfox]

I second Harmony.

After my daughter was born, I walked into the bedroom and I was snuggling her and nursing her in bed, completely oblivious to the rest of the world. I expected to see a HUGE mess in the living room (where she was born) the next morning when I got out of bed, but it was cleaner than it was before she was born!
The mess wasn't in my trash cans, either; they took everything with them.

Homebirth professionals really know their stuff when it comes to preventing the mess from getting everywhere, and cleaning up whatever does get messy.

(For the record, though, I had a homebirthing MD, not technically a midwife.)

I was lucky in that my apartment was just in a two-apartment building (converted from a regular house), and the only other family living there included another homebirther. I was pretty loud.

[alton]

I'm not certain I fully understood your question so forgive me if I miss the point in my response!

"Active Management of Labour" is a system of obstetric-led birth management that was developed at the National Maternity Hospital in Dublin, Ireland in the 1960s and has since been copied all over the world. To give a very simplistic account of it, it is a highly medicalised approach to labour. Once active labour is established, the woman is expected to progress at a given rate (about 1cm dilation per hour) and if she is not progressing at this rate, pitocin would be administered to speed up the contractions. In theory it reduces the time of labour (which can be long in the case of first time mums) and reduces the rate of caesarean sections.
It is a system that has many admirers and has become a standard reference point in obstetic-led labour care. It also has its critics and I would suggest that you read some of these in order to understand what a midwife-led birth has to offer. There is a strong case to me made that a midwife-led, intervention-free birth is a safer option for both mother and baby in low-risk pregnancy.
You only have to google AML to get a wealth of viewpoints on this, but I'm enclosing one link to get you started.
http://www.birthinternational.com/ar.../wagner01.html
I think if you consider how a medicalised birth isn't always in the interests of mother and child, it makes it easier to understand what a midwife has to offer. But you'll find other articles on that site that might be of interest too!

Don't worry about your husband asking loads of questions about what might go wrong. I'm sure your birth centre is even more eager than you are to make sure that they have all eventualities covered! When we met with our midwive, she told my husband that they have an ambulance on stand-by reserved for me when I'm in labour. Bless him, but I think he'd imagining it parked outside our front gate and planning a ride in it while I'm huffing and puffing in the birth pool!!!!

[LaurenAnanas]

I gave birth to my daughter at a BC, and it was terrific. We considered it, but a homebirth did not feel right at the time. I liked going somewhere to deliver. I liked the fact that I was not at home. I liked the car-ride home a few hours after the birth, when we stopped for coffee and donuts.

Some of our reasons:

• the hospital closest to my home, in case of HB transfer, is not baby or mama friendly-unmedicated birth is almost unheard of, and they take ALL BABIES AWAY for the newborn exam (separation from the baby was my #1 fear)
• the hospital closest to the birth center, at which the BC midwives have privileges, is very baby/mama friendly
• my nosy and med-minded RN MIL lives next door
• our dog is not visitor-friendly

I do agree with PPs that a BC is just like home, safety-wise, but safety is not the only thing that matters in an uncomplicated delivery. The only thing the BC offered that a HB midwife might not have was a newborn transporter. But an ambulance would probably have that.

If we move and find a new home for our dog before #2 (both of which are likely), I'll probably go for a homebirth. But I was 100% happy with our BC experience and I'd absolutely do it again if the circumstances warranted.

[nikirj]

Originally Posted by alton

"Active Management of Labour" is a system of obstetric-led birth management that was developed at the National Maternity Hospital in Dublin, Ireland in the 1960s and has since been copied all over the world. To give a very simplistic account of it, it is a highly medicalised approach to labour. Once active labour is established, the woman is expected to progress at a given rate (about 1cm dilation per hour) and if she is not progressing at this rate, pitocin would be administered to speed up the contractions. In theory it reduces the time of labour (which can be long in the case of first time mums) and reduces the rate of caesarean sections.

It's kind of ridiculous how the pitocin was really readily embraced, but the Dublin model's one-on-one care throughout labor was totally ignored.

And IME, midwives love "what if" questions from partners because they are usually really easy to answer.

[Perdita_in_Ontario]

Love my midwives - love them! We had an all-woman OB team for my pregnancy with DD, and they were just fine. They were very hands-off, believed in nature taking its course, etc, etc. We were very lucky. But in the end, they weren't on-shift for DD's birth and we had the middle-aged male OB swanning in to catch the baby, take the honours, and leave again. Luckily for me we scored a magnificent L&D nurse too... so even though it was a hospital birth, we avoided much of the medicalisation.

But... I'm loving the midwives so much more. Hour-long appointments, lots of chatting, plenty of time to ask questions, and a lot of respect for my viewpoints. We have elected to have a BC birth (it's technically in a local rural hospital, but the birth wing is brand new and was developed with much input from the midwives, who do most of the births there). For me, a BC is preferable, not because of safety - I have no safety concerns - but because for me it just feels right - for some reason I just feel like my privacy is violated if I have people coming into my home while I'm in labour. I can't explain it, it just IS. So unless I end up having a super-fast labour, we'll be making the 15-minute drive to the BC. Given the choice between "transitioning" in the car, however, and a HB, I'll go for the HB

I can't say enough good things about our m/ws. DH came to the first appointment and had the standard male questions, which they answered very well, and he's a lot more comfortable now. I'd never choose to go back to an OB if these midwives were available and a pregnancy had no complications!

[alegna]

I've had both of my babies at home. I have done NONE of the clean up. Either baby would have been a section in the hospital here (long labors LONG pushing stages, ds had decels too)

Both were beautiful, uneventful homebirths.

-Angela

[CallMeMommy]

Midwives are AWESOME! If you have a great birth center near you, go for it! I had my last baby at home, and I urge you to look into that some more, but if in the end you're not comfortable with it, definitely do the birth center. With my midwife we had hour-long appointments, she came to my house for all of them (but again, I had a planned homebirth), she included my older son in the visits. I honestly cannot say enough about how much I love my midwife. I had a regular OB with my older son and a hospital birth and the difference is night and day.

[smerkin]

Gosh, thanks everyone!! I'm really excited about meeting with our potential MW on Wednesday! I think that a BC will be along the lines of what I want for my labor. My hospital birth was fine, no interventions or anything, but I just don't think it's necessary for a young, healthy woman to give birth in a hospital. Hopefully my DH will agree. I am looking forward to being able to go home a few hours post-birth. The donuts idea sounds great, Lauren!
I'm so glad that a HB worked out so well for many of you but it just won't work for us in our current situation. Plus, I'm thinking a BC will be a good compromise point for DH. Maybe sometime in the future when we have our own place.
Thanks again for all the input!

[Bluegoat]

We don't have birth centers here, but this is what I'd point out to your dh. Yes, there is always just in case. But these also apply to hospitals. In a hospital, for example, you are more likely to get a "bad" doctor, or be exposed to a resistant virus. Any location has its own risks, you just need to figure out which are most likely for your situation.

[mamakori]

I have had a hospital birth and a freestanding birth center birth, and am currently planning a homebirth with my third. My hospital birth was very typical (induction with Cytotec, AROM, and Pit, epidural, episiotomy, etc.) at a hospital with a very high c/s rate, and I completely lucked into having a vaginal birth.

I knew I wanted something different the second time around. My birth center birth was amazing. I ended up with the midwife I wanted for the actual birth, I had complete freedom of movement, and spent tons of time in the tub. My baby had meconium stained fluids and it was a non-issue. They handled everything very professionally while at the same time being as hands off as I wanted.

The main reasons I opted for a homebirth this time was to have the continuity of care with one midwife and to avoid having to transport for early PP checkups (I tore down the old episiotomy scar the second time, and my stitches came out with all the car transport in the days after the birth).

If homebirth wasn't an option for me, I wouldn't hesitate at all to have another birth center birth. With my hospital birth we felt like captives at the hospital after the birth and all we wanted to do was get home and be a family. My DH and I both *loved* that we were back home 6 hours after the birth, especially with having another child at home. We were only away from home for a total of 12 hours with the BC birth!

[Plummeting]

I had an awesome birth with a CNM at a hospital. I know it's not a birth center, but heck, if it can be great at a hospital that doesn't even have tubs, then it can be great anywhere! My midwife was caring, understanding and supportive. Obviously, at a birth center drugs for pain aren't even available, but to show how supportive my md was, she was totally there for me to make sure I didn't cave at the hospital where they are available.

I had a great nurse who was really supportive of natural birth and really acted almost as a doula throughout, for the times my mw had to leave to go check on another patient. But at one point when I was in transition and no one knew I was because I'd only been laboring for 3.5 hours and was only 4 cm dilated, I started freaking out. I didn't realize it was transition and I kept thinking I had 8 or 9 more hours to go of the hell that was transition, so I lost my confidence. The nurse then asked the md, "Should we ask her if she wants the epidural now?" and my midwife just said, "No, she'll tell us if she wants it." I was in the throes of a contraction and couldn't say anything at that point, but I heard it and appreciated it. Then a minute later I said, "I can't do this! I'm going to have to have something!" and rather than my mw rushing off to get drugs, she said that I could have some Demerol if I wanted, but that we'd wait until the contrax was over to talk about it. When it ended, she never brought it up again and didn't rush out to get drugs, so thanks to her, it was a near miss.

I know that drugs aren't even an option at a bc anyway, but I think that story says a lot about how much my mw respected my pre-labor commitment to do it naturally. She remembered what I wanted and helped it happen. She didn't give up on me when I was weak or scared. She knew what was happening and trusted that I could manage it, no matter what I said in the heat of the moment. lol

Also, we hadn't even talked about it beforehand, but once DD's shoulders were out she said, "Reach down and grab your baby." I'm soooo glad she did -I'm so glad I got to experience that feeling of pulling my own baby right from my body to my chest. I thought it was so cool that she thought to do that, even though we hadn't talked about it. I just felt like she really knew what I'd want. I'm still friends with her from several hundred miles and two states away, after 5 years. I love my midwife.

The only complaint I have is that once DD was born she wanted to give me pitocin to get the placenta out faster, which we hadn't discussed ahead of time. I don't even know if she gave it to me or not, because just as she said she was going to, out it came flying. It did upset me a little later, but honestly my experience overall was excellent.

[MegBoz]

Be sure to ask about "risk-out" options for the BC:
1. going beyond 42 weeks (You MUST deliver in hospital in this case, withour local BC)
2. breech
3. mec-stained fluid
4. "suspected fetal macrosomia" etc.

I'd also ask about protocols if they limit use of the tub (If you have PROM, can you use the tub?), etc. Whereas most HB MWs don't have such restrictions. You can make your own choices.

I once read a GREAT link to a HB MW site where she gave a detailed explanation on how the clean up works. Yes, tehy are very skilled at it! You will not have stained carpets or a mess to clean up!

However, if you think you'll feel inhibited in making noise b/c of neighbors, and/or not have space to set up a tub or move & walk, then yes, the BC might be best.

While you can set up a tub in your home, if the BC has big tubs with jets, that's another perk! In any case, I"m glad you have options. (I've heard all hospitals in Texas are pretty bad for birth.

[fruitful womb]

Chiming in,

#1 was born in a hospital.

#2, 3, 4, & 5 were all born at home with a Midwife.

I never went back to the hospital after #2 was born at home. That says a lot.

I have a lot of respect for Midwives. You have to choose a care provider who you're most comfortable with. Shop around if you can.