having a midwife just to "catch" the baby? - Page 3

[onlyboys]

Nothing major, like changing from an OB to a midwife?

The OP certainly could find a midwife who would be comfortable with this arrangement, have a couple of appointments with her, and then catch her baby. It would mean the building of a midwife/client relationship with the woman, which is more work than just catching the baby, and yes, she should expect to pay the full fee. Again, one should pay for the service, even if you don't partake of each aspect of the service.

[olstep]

Originally Posted by Right of Passage

Midwifery and holistic care are about your whole being. She cares about more than your physical changes but your emotional changes. She's not only midwife she's a couselor, she's there to see that you are as healthy mentally as you are physically. If the state of your mental or physical health changes at any point she is there to help you back to normal (or refer you to those that can, severe pre-e or PPD) and support.

Why seek midwifery care if you don't want midwifery care?

I want to birth at home. UC is not an option as I may be able gain the knowledge through reading but will never have the experience to be prepared to deal with any complication.

Out of curiosity, what psychological education does an average midwife have?
And how often those mental changes would require a care from a MW or other specialist?

[Aka mommy]

I have to say that while I don't agree 100% with olsteps choice of wording, i think i understand her meaning.

Not ALL women need to be handheld through pregnancy and another woman (or 2) entering her most sacred of moments is TOO much for some. Some women can and do birth on their own and don't expect to have the intimate relationship with the mw that the mw may want to cultivate, but would like a professional who can spot a problem or hiccup. It is neither wrong nor crass IMO. It is a woman's right ultimately to choose the type of birth, care providers and environment SHE wants. If as a mw you have issues with this requested scenario, refuse care and refer her to another who is capable of providing it.

[olstep]

Originally Posted by onlyboys

Again, one should pay for the service, even if you don't partake of each aspect of the service.

But she has already paid OB for the prenatals! She would've seen the MW for the prenatals but 1.5 hour is a long drive for a pregnant woman. Why to make it financially difficult for her?

The OP doesn't even want those couple of visits with the MW which I included for MW peace of mind.

And she doesn't look for a relationship. Would it be acceptable for a MW to just provide the service of catching the baby at home?

How is possible to build the relationship you are talking about during a week or so? It is not like: work harder, dig deeper. Friendship and trust are delicate subjects that - let's be honest - take years to build up.

If it is not possible should the MW charge for it? Or am I to take that the charge is for the risk she may be taking in case a complications arise during the labor/ birth?

[TiredX2]

To me, the midwive's charge (one size fits all) is a type of insurance that works for every woman in her care.

You pay the same amount if you go 37 weeks and she is there for your one hour labor or if you go 42 weeks and she is there for 24 hours of labor. It enables every woman the midwife sees to know that she will be there for them and what they need, not what their individual pocketbook or insurance decides.

With DS' homebirth the midwife was there *maybe* 45 minutes before he was born. She didn't even stay two hours after (that I was a little disappointed with). But if she had shown up and it was another 6 hours til I gave birth I knew she would stay!

If you really want to find a midwife who will only see you at the birth and only charge for that, you can totally ask. But if they say, "I have one fee" they ARE telling you no. Your choice at that point is to pay their fee or look elsewhere. They are not hiding their needs behind a lie about your needs.

[dannic]

OP, I understand not wanting to drive so far for appts. Because of my birth choices, I've had to drive too. The first two were born out of town-3 hrs away with a bc mw because I only knew of one mw locally and I didn't jive with her. I drove there for all appts and stayed there before the birth--2 weeks for one and 5 days for the other--it wasn't my ideal at all, but it was my best option at that point.

With my last birth (and now this one) I found a mw 2 hs and 15 min away who is amazing. I go to her for all prenatals except two at the end and birth and postpartum. It is a financial hardship for us, and travelling isn't my favorite thing, but it has been well worth the sacrifice and effort.

Just saying, it can work out extremely well this way.

I hope you find a solution that you are comfortable with.

[MsBlack]

This thread has been so interesting to read.

Again I want to thank all of those who spoke up with respect for what a hb mw is, and does, for families.

A couple points I want to address:

The legal, financial and social status of homebirth midwives has nothing whatever to do with me or any other mw. It is all about the legal, financial and social control willfully exerted by the Med System over all of health care. The greed and hegemony that has driven the AMA successfully to it's current status of control over health care and birth can only remain in effect as long as 'we, the people' stand for it. If someone has to drive a long way to get hb services, well maybe it is time for you to do some lobbying and promoting in your state so that more midwives are free to practice and there will end up being more of 'em in your area. Or if you're not going to do that then at least don't blame the mws, and don't complain about the situation that again, mws did not create and have been working so hard to change for 4 decades now (mostly with very little help from consumers who say they want a legal safe hb option but won't do much about it. But, to be clear, I add that SOME consumers have worked tirelessly and contributed unstintingly on behalf of safe, legal, universally available mw-care. But they are the minority).

As for those who wish to come late to care and get a discount, well I've seen it all. Mostly, these are very nice people who truly don't intend to rip me off, and many of whom I remain on friendly terms with--they just don't understand. Mostly, once they realize what I do offer by way of psych-emo-spiritual support, they are on the phone and email to me quite a lot even on top of what was supposed to be just a few visits (the few visits which are all they want to pay for because they are getting so-called 'prenatal care' from an OB via insurance). Now I don't mind really, because it does give us a chance to connect, gives me a chance to get to know the mom/family well and so, SERVE THEM BETTER as individuals (not as mere machines to whom I will apply science/tech skills impersonally). But giving so much of my time, energy and various holistic skills--well that is something I want to get paid for.

Not to mention that often, when a woman is seeing a med provider, there are at least a few if not many times when 'damage control' is needed--when she is being frightened needlessly by her provider and needs to be 'talked off the ledge'. This is something I'd rather not have to do--for my own sake as well as mom's/baby's--such stress is hard on pregnancy and birth (and is not much fun for me)! And this can most often be avoided if moms don't try to save money by getting what turns out to be highly inadequate 'prenatal care' in most cases *at best*, and highly stressful, potentially damaging care at worst.

Then there's the ones who *seem* cool enough--and who do not really avail themselves of phone/email, who really only want that 2-3 prenatals and then birth care plus maybe 1-2 early pp visits. Until you get to the birth and discover that maybe the dad is one of those super-controlling jerks who thinks HE can run the show....usually because 'God says he should' (!) which is a potentially deadly form of stress for mom and baby both. Hehehe--not to mention MY stress in a situation where I have to make nice when what I want to do is throttle him And then, I realize just why they didn't want more visits: because dad does not allow his wife to get personal support from anyone; does not trust his wife or trust anyone else to talk to his wife, thinks God and him have it all in hand (and he wanted a mw why? hard to say....).

As for 'holistic'--well, being a Whole Person, and being understood and individually cared for by a mw as a Whole Person, is about far more than 'nutrition and exercise'. Body, mind, feelings, spirit....relationships, money, homelife, work, stress....

Not everyone I serve really needs much of the psych-emo-spiritual support I offer. Some moms/families are truly happy and healthy, have plenty of fam/social support and healthy ways of coping with stress, etc...interesting thing is, these are most always the people who are happy to pay my modest fee in full--even though they do need me less than some others--because they value my presence at their birth and postpartum, they value that I *am* available in so many ways in case they should need me in those various ways.

As a very Trust-Birth, Hands-Off mw, and a 3x UC mom, it is kind of amusing to be accused (hmmm, not 'personally' but more generally as a member of the class of mws) of making too much of what I bring to birth. My clients will tell you that early and often I tell them that they are very unlikely to need my 'serious skills' because birth works so well! As one pp put it--yeah, I'm kind of like an insurance policy. But when it is you, or your baby who DOES need my 'serious skills', you will find it quite the bargain and many times my price!

Thanks again lovely ladies, you're GREAT!

[loveneverfails]

Olstep, have you ever participated in any kind of team sport, or seen how a ballet company performs? None of that happens the way it's supposed to without a significant amount of time learning how to function in relationship to eachother. Part of why I believe that home birth midwifery is safe is specifically because the *team* is more functional than just throwing random people together and expecting a good outcome, even when everyone involved is skilled. I mean, tons and tons of very successful companies invest a lot of money in team building exercises because if you have the team working well, your outcomes will be better. This is one case where how well the team functions is crucial. I mean, at least two people's lives and health are in the balance.

Birth is not just mechanical. It's not just "make sure the vitals are great, then hold out your hands and catch." A large part of home birth midwifery is determining normal vs abnormal, and pain is one of the most significant signs of that. For example, I have very very painless labors up until pushing as long as my babies are lined up well. So, if I'm in significant pain, my care provider needs to be more concerned about complications like placental abruption. However, to someone who does not *know* me and hasn't built that relationship, I'd probably just look like a drama queen. A nurse who has never met me can't effectively know what is normal for me versus abnormal, so she is not going to be as accurate in terms of picking up on a complication in the works.

And when we did encounter a very very serious complication with one of my births (3 minute dystocia with baby born not breathing and without a heartbeat) the team that had been formed between me, my husband, my midwife and the 3 apprentices and other midwives there was absolutely essential to getting us out of that situation safely. I needed to follow through some pretty complicated positions and start and stop pushing, so my midwife needed to know how best to direct me so that we could work together to get my daughter out safely. And we did it, as a team.

[MsBlack]

Originally Posted by loveneverfails

Olstep, have you ever participated in any kind of team sport, or seen how a ballet company performs? None of that happens the way it's supposed to without a significant amount of time learning how to function in relationship to eachother. Part of why I believe that home birth midwifery is safe is specifically because the *team* is more functional than just throwing random people together and expecting a good outcome, even when everyone involved is skilled. I mean, tons and tons of very successful companies invest a lot of money in team building exercises because if you have the team working well, your outcomes will be better. This is one case where how well the team functions is crucial.
I mean, at least two people's lives and health are in the balance.

Thanks for saying all that. Not as if I didn't already say plenty, but I meant to add a bit about birth being a life and death matter. I am happy to let people purchase SOME bits of my care--prenatal or postpartum visits or phone consults. But I don't sell 'just the catching', because it IS a life and death matter, and I want to feel that I am sufficiently in the know to step into it appropriately.

[Right of Passage]

MsBlack

I just got back to this thread and have nothing more to say MsBlack said it all! thank you, MsBlack, again for your sage words.

[MidwifeErika]

I do not offer a discount for "just the birth" nor would I want to show up for just the birth. Prenatals are also a way for me to screen women to know that I feel comfortable providing their care. I do take women who transfer late in care though, and honestly, there is a lot of catch-up work to do. There are forms that I need to have signed and tests I need to offer and I have to explain each and every one of these things.... part of informed consent. There is a list of topics for me to cover prior to the birth with each family and if someone comes into my care at 36 weeks or later, I am going to have to work quickly to get it all in. Not everyone transfers into care with a full understanding of all things related to pregnancy and birth. I have found these late-to-care prenatals take about twice as long as ones where women started care early and we covered everything spread out a bit more. No one really knows how much of my time they are going to need when they switch to my care either. No one knows how many questions they may end up calling for, how many "false-alarms" they may end up happening, how long the labor is, etc. I don't know these things about clients as they come to me either. So, flat rate it is.

I don't give discount for coming late-to-care because I also don't charge more for more services. I feel it would be unethical for me to charge a woman more because her baby had a shoulder dystocia or because she had a 40 hour labor or because she asked more questions than my other clients. So, if I don't ethically feel I can charge more for those who take more time and skill to deal with then how could I possibly charge less to anyone else?

I have a midwifery package that people pay for, clients can use as little or as much of it as they need. I offer sliding fee scale, bartering, and try to work with individuals on their financial situation as much as possible. I understand how difficult it is to drive for prenatals (around here, that is standard as there are very few of us in S. MN) and the fee can seem high. However, it is still less (by far) to pay the global for a midwife which covers all the care then it is to pay for only the birth potion of a hospital birth. Nobody is getting rich on homebirthing women.

[loveneverfails]

Originally Posted by MsBlack

Thanks for saying all that. Not as if I didn't already say plenty, but I meant to add a bit about birth being a life and death matter. I am happy to let people purchase SOME bits of my care--prenatal or postpartum visits or phone consults. But I don't sell 'just the catching', because it IS a life and death matter, and I want to feel that I am sufficiently in the know to step into it appropriately.

Seriously, and it's a life and death issue where the relationship established is extremely important. When my midwife was trying to determine how severely my hemorrhage was impacting me, she asked me questions about the undergraduate thesis I had just completed. Because she knew *me*, she could tell if I was giving a full answer, partial answer or was incoherent enough to require transfer.

Birth outside of the hospital does mean that you can't just quickly clean up a mess if you get it wrong. The cool tools are a drive away, not just in the next room. So yes... I want my midwife operating off of the *most* information possible, and that includes me because I'm the woman giving birth. I don't understand why you *wouldn't* want your midwife to know you well enough to be able to meaningfully gauge how you are doing. It doesn't have to mean that you're BFF4EVARRRRR, but having spent 20-30 hours before birth in eachother's company certainly isn't unreasonable for people who need to be able to work together.

[Bekka]

Originally Posted by olstep

Out of curiosity, what psychological education does an average midwife have?
And how often those mental changes would require a care from a MW or other specialist?

I am a new student midwife. I have had to read SEVERAL books dealing with difficult hard topics, including all details about abortion, sexual abuse, violence to spouses and children, rape, female genital mutilation, and many other HARD, HARD topics that I knew existed but things that in MY world have been minimal issues. I have gone without sleep, I have cried for unnamed women, I have had a psychological adjustment, and I am at the BEGINNING of my midwifery education. On the average, one in three women has had some kind of sexual abuse, rape, or abusive relationship that affects how they approach birth and their sexuality, and this information is very rarely offered at prenatals by the woman.

As a new student midwife, I'm also discovering how much of "scanning" the midwife does at those prenatals, teasing out of information. Hours of her education have gone toward learning how to be able to screen out needs that that 1/3 of her clients aren't going to tell her about.

I'm defensive for the HB midwife profession, but I've had 2 homebirths, 3 hospital births, and I had NO IDEA what went into my "fairly straightforward" prenatals without complications, etc. until I was the student. I don't know how much the MW *against her better judgment* still acquiesced to have me birth at home even though I was on the edge of her comfort for something. I'm not sure I would have done MY births if I were the midwife.

[olstep]

I thought going with a MW empowers a woman to take charge of her health care (in the opposite to an OB care where she has to play by OB's rules)
What if a woman wants to keep her life private? Should she be prepared that a MW - against her will - will want to check on her

Originally Posted by MsBlack

Body, mind, feelings, spirit....relationships, money, homelife, work, stress....

for a MW's comfort/ peace of mind?

If a woman does not want to turn the birth of her baby into a ballet show or a circus, as lovenerfails suggested, does she have no option but an UC???

Fortunately, it is not so. There are MWs out there who are able to provide quality professional service without turning you inside out to get to your guts. They will respect your privacy and won't go any further they are let to.
In midwife-client relationship, it is the client who is the boss and the midwife who is an employee. It doesn't diminish her skills nor disvalue her service.
I fully respect my midwife, her knowledge, skills, time. I do not bug her with phone calls at all. The few emails that I sent were about the organizational matters. She knows that I do not expect her to make friends with me and is perfectly fine with it. And I do not think I am an abnormal client.

For me, personally, money is not an issue. As I said, if needed we'd be able to pay it in full on the first prenatal (including what is covered by the insurance) without damaging our budget much.
My concern is about the women who are struggling to make the ends meet. One should not make them buy the package if they do not want/ need it. I understand that a MW would be more comfortable to provide service knowing more than just physical part of the woman she serves. But if the woman is not happy letting a stranger, who she knows for a couple of months, intrude in her personal life, so be it. This woman should not be left alone but let have her prenatals and/ or birth in the environment that is comfortable for her not a MW.

[loveneverfails]

Originally Posted by olstep

But if the woman is not happy letting a stranger, who she knows for a couple of months, intrude in her personal life, so be it. This woman should not be left alone but let have her prenatals and/ or birth in the environment that is comfortable for her not a MW.

But you're essentially demanding that the home birth midwife take on professional risks without sufficient knowledge to judge that the client she is taking on is appropriate for her scope of practice. That's absurd and demeaning, especially given the professional and personal risks involved in home birth midwifery in the US compared to other countries.

No midwife (at least no decent one) forces disclosures from her clients. Some people are more open and some people are more private, but unless she's had enough opportunities to observe and interact with the mom, how can she possibly know the difference between a mom who is normally more private and carefully guards her person life and someone who is being abused but can't ask for help from the midwife who she saw at 2 prenatal visits with the abusive partner present both times.

The midwife doesn't need to know your entire life history, but she does need to know you well enough to work with you, and that requires time. Home birth is medically appropriate for low risk, healthy families only. That's the midwife's proper scope of practice, and as a practitioner she needs to be confident that the family seeking her care is within her scope of practice. Health care providers are people too, and they have the right to protect their practices and to provide services only within their own level of comfort. Not for anything, but why on earth would anyone want a care provider who was not comfortable and confident in their ability to care for you?

Home birth isn't safe because that's where the super special birth fairies live. It's safe because of careful monitoring and continuous risk assessment, and because the home birth team works well together. And it's a partnership on equal footing because the mother is the one who does the work of birth while the midwife has the expertise to identify and help resolve issues so that the mother can do her work. Partnerships work best when the people working together *know eachother.*

I feel like I'm talking in circles, but I am completely confused and bewildered by the level of hostility towards home birth midwives. I really, truly don't get it.

[olstep]

Some people can hear only what they want to hear.

I do not ask a MW to provide a service when she is not comfortable to do so. I do not say that home birth is safe for every woman. Like one of pp said that if she were a midwife would have not attend her own homebirth. Does it speak bad about the midwife who decided to attend that homebirth? Or does it say that different MWs have different comfort level of what that can and cannot do? Due to their past experience, lack of experience or many other things that may come into play when a MW decided to take or not to take a client.

I am asking not push that psychological part of MW service when it is asked not to. Maybe I am wrong, but I doubt that provided A MW have all the necessary labs available and a chance to meet with her client at least one time, she is put into risk when she decides to take this client. It is should not be hard for a MW with an experience of dealing with many different women to make a good judgement whether or not serving a client is within her level of comfort.

Practically, how would it work? A MW see a woman a week or two before her due date. Is she going to see her every other day to make up for the missed appointments or move in with her to learn more about the woman's life?
If the reason she would want the full fee is a possible risk she taking, then fine. Fair enough. Just say so. I do not understand why to make up a story about catching up to justify the fee.

[MsBlack]

Yeah, I hear hostility, too, and really wonder why. I also wonder why there is not more real listening going on--each of us who post certainly wants to say our piece, and be heard. Is not only common respect and 'turnabout is fair play', to accord other posters the same attention to our words and meaning that we each hope for, when we post our own words and meanings?

I think you have done a marvellous job of it, loveneverfails! Thanks a bunch for investing so much of your time and thought and love into this thread (and some of your others deserve similar hugs or appreciation). A really marvellous job---and the only reason you feel you've had to say so much and go in circles is because sometimes, some people not really interested in what anyone else has to say....only in their own point of view, which for them is the One and Only Valid Point of View.

See, thing is, sometimes more words help people reach agreement, because using more words helps understanding occur for all parties at last. But sometimes more words are useless--because it is not a lack of understanding that is going on. It is either a simple but deeply rooted difference of needs and values, OR, participation by some who do not care to understand.

Well, Olstep--different strokes for different folks. If you have found a mw whose terms agree quite a lot with yours, great! I think that is what we are all hoping for, mws and families alike--to work with others whose terms/needs agree sufficiently with our own for that teamwork, that ballet, or whatever you care to call it, to occur safely and happily.

[jljeppson]

Originally Posted by MsBlack

Yeah, I hear hostility, too, and really wonder why. I also wonder why there is not more real listening going on--each of us who post certainly wants to say our piece, and be heard. Is not only common respect and 'turnabout is fair play', to accord other posters the same attention to our words and meaning that we each hope for, when we post our own words and meanings?
See, thing is, sometimes more words help people reach agreement, because using more words helps understanding occur for all parties at last. But sometimes more words are useless--because it is not a lack of understanding that is going on. It is either a simple but deeply rooted difference of needs and values, OR, participation by some who do not care to understand.
Well, Olstep--different strokes for different folks. If you have found a mw whose terms agree quite a lot with yours, great! I think that is what we are all hoping for, mws and families alike--to work with others whose terms/needs agree sufficiently with our own for that teamwork, that ballet, or whatever you care to call it, to occur safely and happily.

Thank you Ms. Black, this is exactly what I was going to post. On MDC we tend to be strong, and strongly opinionated, women and that doesn't always lead to an open discussion. Unfortunately, I think this thread has gotten to a point where there is no longer an open discussion. What I truly hope and pray for is that one day the original topic of this thread, which boils down to a woman who can't find a caregiver within a reasonable distance of her home, will be a moot point. May we all work together to ensure every woman receives the maternity care she desires, whatever that may be!

[thismama]

Just catching up here... to me it's not even about emotional or psychological support or getting to know you. It's that you could go into labour any time between 37 and 42 weeks, or outside that time, and your midwife will drop everything to attend you from 4cm (or earlier, especially if water breaks) onward, through a short or long labour, starting during the day or middle of the night, etc. She assumes legal liability for the outcome of the birth, will provide postpartum and newborn care, etc. It's a heavy responsibility and a heavy work burden.

Add to that that she must catch up on your clinical history, get records, order any necessary tests that have not been performed... these things she needs to know what is going on before the birth, even if you don't care that she has them, from her perspective to provide good care, and to feel comfortable with the liability aspect, she needs these things. And they are not her problem because she needs them, as they are necessary to the service she provides you.

I don't know, loose analogy, say you are having your house painted professionally but it needs to be entirely primed first. You don't care if it is primed, you won't be looking at the primer, but the layer of primer is necessary to get the job done properly. The painters are not going to come prime your house on their own time, kwim? This will be built into the fee structure. It's the same thing to lay the groundwork for good care at your birth with a midwife.

[BirthIsAwesome]

Olstep, here is the key: you have already revealed to us that you admit ignorance as to what a midwife's job entails; until you are a midwife (or ask questions of a midwife and actually listen to her...you will not know.

You are basically asking a midwife to put her license/certification/professional standing on the line in order to fulfill your wishes for no-relationship care. SOOOOOOOO many problems can be picked up prenatally that give the midwife clues about how your birth will go. MOST of these are not revealed by labs/medical diagnostic services. And will DEFINITELY not be noticed by an OB. Do you realize that? Do you realize that you are putting her in the position of basically walking into your birth blindly, not knowing what might/could happen, what specific risks you could be vulnerable to, what your personality is, how best to relate to you and your partner? One of the pp's mentioned the scenario about closet smoking and the various complications associated with that risk factor. If midwife had regular prenatal care over time, she would pick up signs that would indicate closet smoking---mom would not disclose this in one visit if she were intentionally trying to hide it.

I'm not talking about being best friends; I'm talking about a professional relationship that allows the midwife to obtain the information to do her job competently. Personally, I wouldn't expect my full fee for a woman that transfers in at later than 35 weeks, I just wouldn't take her period (I'm talking about once I finish my training and become a CPM)! I wouldn't be comfortable not knowing my client. It's not respectful or right for you to expect her to do her job with much less information than she normally would have obtained over 20 or more weeks of prenatals, and then expect her to give you a discount on top of that!

Not to mention the fact that you're not just paying for the one day she comes to your birth; you're paying for her to block out 6 weeks of being on-call, from 37-43 weeks. This basically means she will not leave town, she will not schedule activities that she can't cancel on a minute's notice, she will not consume alcohol, and she will be prepared at any moment of the day or night to drop her whole life and come running for an undetermined length of time (possibly a couple days!).

The point is, you can't expect a midwife to just swoop in and catch the baby. There is so much risk and liability that she takes to be your midwife; to ask her to do that is cheating yourself out of safe and informed care, and putting her at risk for losing her license/certification/reputation because of an avoidable complication. It is also disrespecting her skill and role in your care as a Primary Healthcare Provider.