please help me think through my options

[caedmyn]

I've had two homebirths and am planning a third. I am having some trouble finding a midwife I'm comfortable/entirely happy with this time though. Homebirth #1 was in a different state and the midwife I used with #2 has since moved out of state. There are 3 homebirth midwives here. One I would not hire under any circumstances...I just don't like her. One I have hired but am hoping to unhire soon for various reasons that I won't go into here. The third is an apprentice midwife who is close to being licensed but won't be in time for my birth. She would be accompanied by a CNM who is mentoring (or whatever the correct term is) her, who would only come to the birth to observe.

I like the appentice midwife and feel perfectly comfortable with BUT she doesn't feel comfortable doing a waterbirth and the CNM is absolutely against a waterbirth (says she's found that babies who are waterbirthed are more likely to need resuscitation). I told the apprentice that if I was in the birth pool and felt like pushing I wasn't going to be able to get out, and asked what would happen then. She said the CNM would basically tell me I needed to get out and ask DH to help get me out. Now DH isn't going to get me out if I don't want out (or let anyone else get me out) but that's not a drama I really want happening in the middle of my birth, KWIM? I could just have the midwives stay upstairs and if I feel like pushing in the birth tub downstairs, just do it and call them once baby's out (this is assuming it's another 5 min 2nd stage like my last baby). But then there's always the chance that someone would come down to check on me in the middle, or I might push for a while and want them...and then you end up with drama again or me being on land and never having a chance to get comfortable in a pushing position. I am NOT set on having a waterbirth one way or the other, but whatever happens I want to be comfortable with what I'm doing when I push, and transferring to land if I'm in the water won't do that. My 2nd was a waterbirth but I never could relax or find a good position because I was ready to push after only being in the water for 2 contractions.

I have two other options as I see it, and I don't know if either are the greatest. First is to look for a midwife 3 hours away (where the nearest homebirth midwives other than here are located). There's quite a few midwives there and I am sure I could find someone I feel compatible with, but three hours is a long way away (maybe 2.5 hrs if they drive a little faster than the speed limit). Both of my labors were 7.5 hours long. I was expecting a shorter labor with my second but I suspect he was slightly malpositioned (as I never had a consistent contraction pattern) and that caused a longer labor. I feel like with my history of shorter labors there is no guarantee that a three-hours-away midwife will make it for the birth.

The other option is to do a UC with a friend of mine who is an OB nurse present. DH is comfortable with a UC. I'm not sure I am. Not with the idea of a UC by itself, but with being responsible for recognizing any emergency or unusual situation and taking the appropriate action (DH would be calm but I am not sure he would be willing to research or learn how to handle situations so I would ultimately have to be in charge). On the one hand if I did UC with my friend there I would at least have someone there who can recognize an emergency and recommend a course of action. But it's not quite the same as a homebirth since 1) she won't necessarily have a HB persective on whether something is an emergency or not (though she's pretty natural birth minded in general), and 2) I won't have the option of pitocin or oxygen present in case a resuscitation is needed...that sort of thing.

Sorry for the novel...any suggestions or thoughts would be appreciated!

[Annoia]

Originally Posted by caedmyn

The third is an apprentice midwife who is close to being licensed but won't be in time for my birth. She would be accompanied by a CNM who is mentoring (or whatever the correct term is) her, who would only come to the birth to observe

I can't really comment on the waterbirth aspect - I'm not a waterbirth kinda person (I HATE pruning). But if it is an important aspect of the birth process for you, then you may want to consider other options. Since you said it's not, then maybe you can compromise on that issue?

Originally Posted by caedmyn

First is to look for a midwife 3 hours away (where the nearest homebirth midwives other than here are located). There's quite a few midwives there and I am sure I could find someone I feel compatible with, but three hours is a long way away (maybe 2.5 hrs if they drive a little faster than the speed limit). Both of my labors were 7.5 hours long.

With the time issue, I would be as concerned about labor as I would about prenatal appointments. I drive 2.5 hours for work (sometimes) and it gets REALLY OLD. And I only go maybe once a month. Imagine yourself driving once a week during the third trimester.

BUT it might be worth interviewing the midwives who are 3 hours away. You may find one that you really really love, that would make the drive worth it.

So I say:
1. At least interview some midwives who are 3 hours away
2. See if you click with any so well that the drive is worth it
3. If not, then consider compromising on the waterbirth

That's about all I could think of. But I bet there are many others on the board who have much better suggestions!!

[*MamaJen*]

The only useful advice I can think of would be to talk to the apprentice midwife and say, "I plan to have a waterbirth (or at least have the option of having a waterbirth). If you agree to take me as a client, I expect this to not be an issue."
You are a paying client, and you can make that a term of hiring her -- she's within her rights to not accept you as a client. But you can clearly state your terms and tell her that no waterbirth is a deal-breaker for you. You could also talk to the CNM and tell her that.
Maybe if you are confident and assertive, and show her research indicating the safety of waterbirth, you can negotiate something. That's what I would probably do.
I do kind of think that people, especially women, sometimes do too much asking for permission with healthcare providers, when they should be asserting themselves. Especially when its something like waterbirth that all the science-based research supports.

[MsBlack]

You could always give the one you 'just don't like' a shot--interview her, get some references on her from former clients. Maybe you don't know her well enough to make a fair (fair mainly to yourself, in this case, but also to her) assessment of her personality. Sometimes I've heard this 'just don't like her' comment from homebirth families...about myself or another mw (if it's about me, I don't hear it from the family, but through the grapevine). Anyway--when discussing this with people (as it concerns other mws), sometimes the reasons given for not liking the mw are either based on gossip/rumor, on some small interaction upon which a large opinion gets based, or are well, kinda silly in the Grand Scheme of things. Of course, I have no idea why you don't like her, or how much interaction you've had with her.

Only other thing I can think of is that maybe you don't know about ALL the hb mws available in your area. Have you been asking around, asked on your Tribal Forum here, anything else to find another mw?

[caedmyn]

I have interviewed the midwife I don't like...that's why I don't like her, I just don't click with her as a person. It bugs me to even be around her...not sure why, just the way it is. There *might* be one other midwife here, someone said they think she moved here, but I googled her name and I think she's actually 3 hours away.

I kind of felt like I was telling the apprentice that if I'm in the water and feel like pushing, I'm not getting out. Kind of letting her know that's the way it would be. But maybe wording it as "won't be able to get out" (which was literally true at my last birth, I was just stuck) was a poor choice. But that's a good suggestion, to present some research and tell her flat out it's a condition of hiring her. I don't think she will balk at it but I do think the CNM will, and I don't think she's going to be negotiable on that.

It's not so much that a waterbirth is something I have to have. But I want to be able to labor in the water, and IF I feel like pushing in the water, I am not moving and I don't want that to be an issue. I don't think I will be able to get back in the right zone if I have to move once I feel like pushing.

[*MamaJen*]

That's really weird, I've never met a midwife who was against waterbirths. That would make me wonder what other issues she has. I would carefully interview the CNM and lay out a list of other procedures you don't consent to unless truly medically indicated, like membrane stripping, manually breaking your water, directed pushing, pushing flat on your back, manual placenta removal, premature cord cutting, that kind of thing.
The good thing is it's not like it's an entire hospital policy against waterbirths. That can be really difficult to fight against. It's just one midwife's personal preference. I do think that if you walk in assertively with your research and tell her that it's a condition of you hiring her, then you're probably good to go. I think it will also be a good learning experience for the apprentice midwife about informed consent and women taking control of their own healthcare decisions.
Keep us posted.

[caedmyn]

Originally Posted by *MamaJen*

That's really weird, I've never met a midwife who was against waterbirths. That would make me wonder what other issues she has. I would carefully interview the CNM and lay out a list of other procedures you don't consent to unless truly medically indicated, like membrane stripping, manually breaking your water, directed pushing, pushing flat on your back, manual placenta removal, premature cord cutting, that kind of thing.
The good thing is it's not like it's an entire hospital policy against waterbirths. That can be really difficult to fight against. It's just one midwife's personal preference. I do think that if you walk in assertively with your research and tell her that it's a condition of you hiring her, then you're probably good to go. I think it will also be a good learning experience for the apprentice midwife about informed consent and women taking control of their own healthcare decisions.
Keep us posted.

The thing is, I'm not hiring the CNM at all, just the apprentice. I don't even have to meet her before the birth (though actually I already know her and have attended a birth where she was the midwife). So I feel like that changes things...I'm quite certain she wouldn't consent to letting me (or anyone) do a waterbirth at her birth center, so it seems like she would be even less inclined to "allow" a homebirth waterbirth when I'm not even her client.

I guess I don't want to say flat out, "I'm not hiring you unless you agree that I can waterbirth" and then have her/them say no and then I'll be out of local options. I guess I need to do more research on waterbirths and present it to the apprentice, and see what she says (and also if the CNM actually has to be in the room when I birth if the apprentice is in there) and go from there...assuming of course that I can actually convince DH to unhire our current midwife that I'm not comfortable with.

[erin_brycesmom]

Wow, that's really tough! I think I would probably either UC or hire a MW that was 3 hours away. I think it would stress me out knowing that my providers were not ok with waterbirth and I would hate to think of someone trying to move me at the most intense part of my labor. I remember with my waterbirth, I decided to get out of the tub (not realizing that I was in transition) and then the next contraction hit and there was no way in the entire world that I could have possibly gotten out. Ds was born less than 4 minutes later. What happened in those 4 minutes was the main reason I chose homebirth in the first place (being able to follow my body's lead, unhindered, etc).