How do I break up with my midwife?

[Cassaba]

DH and I have been seeing a hospital-based CNM for 1-1/2 years. I am 42 years old and this will be our first birth. Our midwife has seen us through 2 pregnancy losses, surgery to remove an ovarian cyst, and now a 3rd pregnancy where we are at 29 weeks. She is very invested in our pregnancy, especially after the 2 losses. We like her a lot, but she works for a large health system and although she is supportive of our birth plan, we are concerned that she/we will be subject to the hospital's expectations and procedures. She has made it obvious that she is subject to the OBs' oversight, and she said some of them like to "watch the monitors." We were not comfortable when we toured the hospital's birthing unit. During the tour, they were also sure to show us the NICU, since they are the region's only Level 3 NICU. So, it seems like a high-risk, interventionist atmosphere. Also, our midwife has recently told us that she wants me to do NST and ultrasounds beginning at 36 weeks due only to my advanced maternal age. I have no other risk factors. As a result, we started exploring options and interviewed a hospital-based CNM who works in a smaller, lower-tech hospital. We also toured the birthing unit and talked extensively to a L&D nurse. We feel like we are likely to have a better experience in this setting. SO, my question is: how do I let my current midwife know? I really don't want to hurt her feelings, but I have to do what is best for us. I was thinking of writing her a letter and focusing on a couple things that the new hospital provides that hers doesn't: (1) they have a labor tub, whereas hers only has showers, (2) I would have a 50%+ chance that my actual midwife would attend my birth, whereas she works with 5 other midwives and there would only be a 20% chance of her attending my birth. What do you think? I really like her and think she'll be disappointed that we are leaving.

[homemademom]

That's hard. I would probably do what you're doing and focus on the hospital situation. I think you're reasons are really good and valid. Maybe you could even add, "This other hospital is where we have decided to deliver, and we would love for you to be the one to attend if you have privileges there, but if not, we'll need to change care providers." If you intend to keep her for your well-woman care, let her know that, too. Best of luck!

[Naomismom]

Perhaps instead of "breaking up" you could write her a thank you card expressing gratitude for everything she has done for you guys and how much you like her. You could quickly explain why you are leaving. From what you wrote, it seems completely understandable that you would want to go with the other hospital and practice. I don't think she'd be terribly hurt.

[momasana]

You need to do what is best for your and your birth experience. As the other posts have mentioned, just be honest with her about the reasons you are leaving. She should understand.

[Cassaba]

Thanks everyone. I have written her a letter thanking her for her care, telling her my reasons for changing, and also letting her know that I would like to keep her for my well-woman care. I can't get in to see my new midwife until October 5th, so I am going to hold off on sending it for a couple weeks in case anything comes up between now and then.