Boundaries and Communication: Me, MW, DP - Page 5

[Sijae]

Originally Posted by SquidMommy

I went and pouted a bit, and then got over myself I can completely understand how some of the PP's feel - I'm sure there are a lot of clients who get a little uncomfy during prenatals, and they're typically okay with plowing forward and getting through things. For a standard (oh, heck, I'll just say it - NORMAL) client, which I am not, I'm 100% positive it wouldn't have been a big deal. This is where I wish I was not such a mental train wreck.

For the record, though, I did say I didn't want her to use the doppler. I understand it's a normal/expected part of a prenatal, and I've thought the heart tones were pretty nifty when I heard them during my ultrasound. That gel stuff just sits WRONG with me, and I have a long pelvis. If the MW is going to use the doppler, that goop is going in my underwear because that's the only way she's going to get tones. Squiddo is sitting pretty low. It was just too much for me in that moment, and very unexpected. Now that I know it's something she wants to do, I can bring a change of underoos or something to make it less-gross.

ARG, I wish you did live somewhere near here. You really do sound like you can see where I'm coming from, even if parts of it are completely ridiculous. I completely understand, and will readily admit, I am probably a pain-in-the-buttcheeks client for my MW. I know the way my head works about some issues is completely batty, completely off-base, completely difficult and complicating. That's all the stuff I am trying really hard not to be, because I want this birth to be okay. Not spectacular, not life-altering, not monumental - it just has to be okay. Which I think I can get to - and the work is NOT all on my MW, a lot of it has to come from me.

I mentioned to my therapist the MW's suggestion that I get info from her "I work with triggered people" friend. After consideration, I probably got a little more rankled by my MW's actions than I needed to be. The PP's who said it wasn't the world's biggest deal were arguably right - she was acting as a professional and trying to help me have access to a resource. Though: I do want my therapy to come from my therapist, and not my MW. I don't want to blur the lines, or put more work on my MW's plate. Seems fair?

I'm going to schedule a face to face meeting with her in the coming week. Email is nice, but I want to be able to actually TALK to her and see how we interact. A lot of stuff has been aired out, and I feel like this next visit will be better.

I'm thinking of asking just to meet with the MW at first, and bring the assistant in at a different visit. Seem like a sage plan, or would it make more sense to incorporate the assistant sooner? To the PP who said I should work to build a relationship with the assistant - I'm going to give her another couple shakes and see how it goes. I don't want to force myself to put up with her, b/c my initial reaction was pretty 'enhhhh, no'. But I DO think I need to at least try, for my benefit and my MW's benefit. That way, I'll know I'm not making a knee-jerk or over emotional decision.

Again, thank you everyone, for your comments. I appreciate hearing from both POV's - the posters who have a less "touchy" approach to touch are helping me see what's normal or typical, so I know what I can work toward.

See, I still think this is being approached all wrong. If you were my client, I'd be fine with handling it however was most comfortable for you. Pregnancy isn't a disease nor is it an accident waiting to happen. Prenatal care is what you do for yourself every minute of the day and has very little to do with appointments. Nothing at your appointments is necessary to ensure a healthy baby. Your baby's heart will still beat even if she doesn't put a doppler on it (which by the way, she could easily use a fetoscope that is safer for baby and requires no gel), your baby will chose his/her position regardless of who is feeling for it, your baby's movements are the best indicator of health, your belly will grow if it's not being measured. And even if you consider some of those things important, your husband and yourself can learn to listen to the heartbeat, you can find the top of your uterus to reassure yourself that it is growing, you can have blood pressure take by a machine on your wrist, etc.

if you were my client, I would spend that hour teaching you about pregnancy and birth, about taking care of babies, about caring for yourself prenatally. I'd get to know you as a friend, I'd reassure you that no matter what, I was not going to do anything to you that you did not ask for; that I would not put my hands on you unexpectedly, bring out any unexpected equipment, bring anyone to the birth that you didn't authorize etc.

Birth is indeed a transformational experience, and I agree that it could be a time to help you feel powerful and safe again. But how can we say that is how it 'should' be for you. Maybe the healing part of this birth would be simply having someone on your side, giving you respect, and not pushing you to be anything that you aren't. Maybe you just want to have your baby and you don't want to be touched, maybe it's not time for you to face these issues. I don't think you should be pushed into a corner on this one. Midwifery is about "being with" women, not "doing to" women. Somehow, things have gotten off track and many modern midwives have embraced the obstetric mindset without even realizing it

[GoBecGo]

Sijae, respectfully, there are midwives in JAIL who did nothing "wrong" but were deemed to have failed in their duty of care. And the individual doesn't decide if that happened, if a baby is injured or dies the court decides. It might be completely ideal for the OP to find a midwife who could give the kind of care you would offer, but no midwives i know IRL would ever take such a massive risk. I'm in the UK where homebirth and independent midwifery are respectable and legal and even relatively commonplace in some areas, and there are midwives here who have lost their entire livelihoods (and in some cases their assets) because they failed to spot a breech ahead of time (said breech was delivered, badly, by an Ob after transfer but it was the MIDWIFE who got struck off because she was deemed to have been responsible for the emergent situation the Ob messed up so badly), they saved but damaged a shoulder dystocia baby (erbs palsy after a severe impacted dystocia which the midwife had to resolve alone as her back-up hadn't yet arrived), they missed signs of distress in a subsequently damaged baby (which could have been damaged any time in the last weeks of pregnancy)...i could go on. When a midwife takes on a client she also takes on responsibility for the worst possible outcomes, it is wonderful if you would have the courage to watch and wait and not need to document or quantify the health of the motherbabe, but most are simply unable to take that sort of risk.

[ARG2003]

Squid-

Forgive me for sounding condescending, but I feel proud of you for being able to step outside yourself and looking for ways to work on issues that are difficult. The easy way would be to run away fromit all, but facing it head-on seems like a really good step in your own mental health. Congratulations!

Aimee

[Lady Lilya]

GoBecGo, I am going to be halfway through my pregnancy before I see my midwife next, and she has never put her hands on me, measured me, or listened to the baby's heart beat.

[SquidMommy]

GoBec - Also respectfully - I believe there are many midwives who have a legitimate concern about legal interference in their practice, or unjust/unwarranted legal blame for a situation that may have been handled no better by an OB. I also know there's no way to really, truly KNOW how well a client has researched and understood the potential risks of homebirth, common and uncommon. That means each client may have to be handled, in some way and to some degree, as though something could go tragically wrong. Depending on the midwives' level of comfort and willingness to accept potential responsibility. I respect that all midwives practice differently based on what I said above.

That said, if there were a "No, I won't sue you, I understand the risk of what I'm doing," form I could sign, I would do it. I understand I don't have the "benefit" of constant fetal monitoring, and scalp monitoring, and hep-locks, and epidurals, and pitocin-controlled contractions...or even some or only one of those things. I know exactly what I chose when I chose homebirth, and I chose it precisely because I believed it would be less crisis-indulgent, less invasive, and less active in seeking fear and bad outcomes. I'm willing to accept whatever that brings me, because I know I don't have an OB, or an MD, or even an RN. I have a MW, who, despite all my carping, DOES have a lot of experience. I can promise you, for the purposes of the rest of this thread, I don't need to be approached as the "What if she sues because something went wrong" client, because I simply am not that person. Things can go wrong if I birth at home, at the best hospital in the state, or on Christmas at the Vatican. To sue would be to deny my own personal responsibility in the situation, and to potentially ruin a professional, personally and financially, because I felt some level or guilt, responsibility, or embarrassment at having had a hand in a less than successful outcome.

Like I've said before - this is not all entirely 100% on my midwife. I have to suck it up and accept my role and responsibility. I also don't think I'm he only "mom" out there who feels that way - homebirth is an informed choice, or at least it should be. I feel for the MW's who have to practice under such stress - it takes a lot of the joy out of the job, I imagine.

Sorry if that's completely incoherent and rant-y; I was in a car for eight hours today and my brain is toast made of pudding and jello. Ugh.

[emc03]

i think midwives run the gamut in their practice and it depends on their experience and confidence. one of the things i love about mine is that she talks about all this stuff ahead of time and she really LISTENS! she knows me from my last homebirth and she knows what i am and am not comfortable with. i distinctly remember her asking for permission to touch me when i was in labor. not just once, but each time. and i have absolutely no touching issues, quite the opposite. but the fact that she was so respectful of my potentially changing needs and listened to me throughout my pregnancy is what makes her so very wonderful.
you'll get there with yours. it just sounds like she needs some time to re-hardwire herself too. it kinda reminds me of my school's special needs students. there are some teachers who are more comfortable with them in the classroom from day one and there are those that need to be trained to be in that mindset. it'll be good for her too, like professional development.

[Overthemoon]

Hi there
I read only the first page of threads so I hope it's okay to jump in.

I loved my midwife, she and I were kindred spirits. One day she mentions having an assistant here for the birth that would bring her baby. That immediately freaked me out. I have an immunosuppressed child and am very cautious who is around all of my family for that reason. I also knew that I would not be able to labor knowing some lady's baby was out in my family room. I know that's terrible but that's just how I felt.
After my MW left that day I tried to think about the best way to handle things. I called her and said "I hope this doesn't sound bitchy but I feel uncomfortable with the assistant you mentioned. I know having someone with a child here will make things harder for me." She was apologetic and said she understood. She asked if I wanted to meet one of her other assistants who also had a dh who retired from my dh's police dept. This felt much better for me. And I agreed to meeting her. When I met her I loved her as much as I loved my MW.
Funny enough on the day I went into labor the assistant could not be reached and my MW went it alone. She called my dh for help when she needed it.
One way I failed a bit in communication was that my dh was very specific with me that he didn't want to see the baby being born. I thought I was clear on that with my MW but for some reason she called to him and I said "I don't need him" but I should have explained in advance more I guess before that moment LOL. And then over I go on hands and knees, dh walks in to baby's head out and my rear in the air. I thought he was going to pass out. He tells me later he thought baby was dead and that I was going to die. He was freaked out for quite a while.

All this to say I think being as specific as possible is beneficial. If you have to put things in writing to your MW or DH then you might want to do so.
Maybe if it's even a list of "I like" or "I don't like" so it's not confrontational.
I don't think an assistant is a must have based on my HB. But I think it might be something your MW feels is a must for her, so may be worth talking over with her more.
I put things in writing to my dh that I knew I didn't want happening during labor so that he'd know in advance.

Also I am very shy and hate the internal exams etc. as well. But I've noticed during labor (all four of them) that feeling does go away for me. The focus is on other things. Not saying that would be the case for you. The birth I felt maybe most uncomfortable with at first was my HB but once I got into that "holy crap this freaking hurts" all I wanted was to get the baby out.

I wish you much luck.

[Gladiola]

Originally Posted by ARG2003

Upon reading the biographical information from the patient, I believe the midwife should have addressed this immediately. She should have spent time discussing what happens at visits ordinarily and ask Squid what modifications she would like to have made and discuss it.

At best she might offer some information and solutions...

Ah, thanks for this. I appreciate you typing this out - I get it now. That makes sense & I see the difference.

Ironically, my HB MW has been having her asst (a MW apprentice) do the blood pressure, pulse, fetal heart tones & fundal height at the 2 prenatals I've had thus far. Before every single action, she is asking, "Would it be OK if I did XYZ now?" "Could I do XYZ now?'

Honestly, it's a little annoying! I thought I was being petty in feeling irritated by it - but now that I think about it, I realize - it makes me uncomfortable! It makes me uncomfortable because it makes it like it is all A BIG DEAL. I'm used to the hospital-based CNMs I saw with my 1st PG where it was just implied, "OK, let's listen to baby now." No question asked. Just get up on the table, lay down, pull your shirt up & your pants down.

& while, technically, it could be considered "rude" to not ASK permission, the thing is, they already have my blanket permission for those basic things (fetal HT & fundal height at every prenatal.) I've already given my permission by walking into the exam room & having chosen them as my care providers. So asking permission again seems superfluous & unnecessary, but what's more, seems to add tension to the room for me.

The attitude of assumption the CNMs had strikes me as more casual, relaxed, laid-back, no big deal. Like "This is what we're here to do, we chat a bit first, once you have no other Qs, then this is what we do next, so let's go." It feels more relaxed to me that way, more comfortable.

So I'm going to tell them that next time - tell them "You have my blanket permission for checking BP, pulse, fundal height & FHT, so just go right on ahead, no biggie, it's cool."