Switching from OB to M/W - talk me down!

[doglver77]

Hi all. I used an OB for my birth w/my 1st child (DS). I don't really have any objections w/the OB himself, I thought he was actually really open & cool & I would totally go have a beer w/him. But, I saw him for about 10 minutes at the very end of my 30 hour, pitocin sponsored labor. However, I felt like the hospital I delivered at was verrrrrrrry pro-intervention, above & beyond the standard. My OB works in a group, & in speaking to one of the other OBs & going over my ideas for a birth plan, it became very clear to me that it was pretty much going to be The Hospital Policy Way at my upcoming delivery in April, as well.

That said, I've been looking into switching to  a m/w. I found a group that I really like, they deliver at a birthing center that's part of a hospital, & they take my insurance. I have to formally make the switch w/my insurance by 12/31. And now I'm starting to freak! I really have 2 concerns, & I was just hoping someone could talk me down!

1) I have ulcerative colitis (a digestive disorder). Mine has been "inactive" for years at this point, & I only take the maintenance dose of the meds. My OB has me going to see a MFM, even though no one can tell me what, if anything, makes me high risk at all. Last time they had me going in for monthly u/s, & weekly NSTs starting at about 34 weeks. Yes, sometimes people w/colitis can have absorption issues, but . . . there was no evidence I ever had any. So, I guess I'm just worried that well, what if I do develop some issue & it's not caught b/c I'm not getting monthly u/s & something bad happens? Also, since I have an HMO, what if I get "risked" out of the m/w care, & am now w/some random OB who might be a total hack?

2) my DH will in no way be supportive of this, & no, he does not want to talk about it. He's very much of the mindset of doctor = word of God, so the more monitoring, intervention, whatever, the better. My master plan is to just switch, & just let him know that hey, I want a water birth, & OB said that they don't provide that & he referred me here. I think he'd be ok w/that explanation, but I still feel all this guilt b/c what if something does happen then it will be all my fault b/c I made this unilateral decision. Am I nuts?

Thank you to anyone who read this whole monologue! Any advice & all perspectives are welcome! Thank you in advance!

[erigeron]

I think that if your midwives perceive you as low risk and are willing to assume your care, you should be okay. If you have a flare or other complication later on and it ends up getting you risked out, then you'll cross that bridge when you come to it ... the midwives may be able to recommend an OB who is less interventiony than others. It seems unlikely to me that you could have a problem develop that you wouldn't notice but for this barrage of ultrasounds, especially since you were okay with kid #1. It doesn't make sense to me that you could have no absorption issues for years, then, hypothetically, suddenly develop some and not notice anything is amiss. I would imagine if this does happen, you would notice--changes in bowel habits, feeling like you need to eat way more, or some such (surely your GI doc can add to this list).

Honestly, it sounds like a lot of this would be stuff to talk over with the midwives. Their practice likely has experience dealing with HMOs, determining who is low-risk, and so forth.

This is theoretical for me (first baby here, so have researched midwives but not a lot of field experience so far, and as a healthcare student I've studied UC but I don't have it myself).

[RoseRedHoofbeats]

You're in a birthing center attached to a hospital. You're safe as houses as far as "Well what if something goes wrong?" There's nothing really DIFFERENT as far as the AVAILABLE medical care or knowledge- they'll be right there if something happens, so your DH has nothing to worry about. It's just a much better environment for you to give birth in! So hang in there and don't worry. *hugs*

~Rose

[FoxintheSnow]

The birthing center may or may not even take you with a chronic health problem. Birth Centers have much stricter regulations about who they can and cant take than homebirth midwives. I was shocked when I saw the list at a birth center consultation I went to. It is true the most hospitals are really only set up for one type of birth, but that doesn't mean it has to be that way. Do your research and be your own advocate.

[lillymonster]

I just switched midwives (hospital based) at 38 weeks. My first midwife group was treating me as high risk because of my age - I will be 40 if baby is late, and I am a vbac. They midwife wanted me to get bi-weekly sonograms at 36 weeks, because of *possible* low fluid (keep in mind, I have no health issues and my 32 weeks u/s was fine) The high risk OB the midwife kept sending me for u/s kept asking why I was there. So I went to another (high risk) hospital that had a midwife group, and got a second opinion. So far they said I was not high risk and I switched to them.And I found out they are more natural birth friendly then the hospital I was at before - and they are like the hospital other places send patients too when it's beyond their scope!

You can get a second opinion at any time for anything....and you can switch at any time - I have no history of pre-term labor, so switching at 38 weeks was stressful, but I didn't worry about me going into labor. Ask if they can do a free consult because you want to switch and see what they say. I also believe in trusting your gut. I feel that you may know when things are going wrong or when things are fine - I knew things were fine with me. Nothing wrong with asking and meeting with the midwives to find out how they would deal with your situation.

[RoseRedHoofbeats]

Originally Posted by FoxintheSnow 

The birthing center may or may not even take you with a chronic health problem. Birth Centers have much stricter regulations about who they can and cant take than homebirth midwives. I was shocked when I saw the list at a birth center consultation I went to. It is true the most hospitals are really only set up for one type of birth, but that doesn't mean it has to be that way. Do your research and be your own advocate.

Even a birth center attached to a hospital? I could see a free-standing one refusing to do so, but a birth center that's literally on hospital property and has just as much access to any machinery they might need shouldn't.

~Rose

[lillymonster]

Originally Posted by RoseRedHoofbeats 

Originally Posted by FoxintheSnow 

The birthing center may or may not even take you with a chronic health problem. Birth Centers have much stricter regulations about who they can and cant take than homebirth midwives. I was shocked when I saw the list at a birth center consultation I went to. It is true the most hospitals are really only set up for one type of birth, but that doesn't mean it has to be that way. Do your research and be your own advocate.

Even a birth center attached to a hospital? I could see a free-standing one refusing to do so, but a birth center that's literally on hospital property and has just as much access to any machinery they might need shouldn't.

~Rose

I think so, I had a midwife group in a hospital and they had restrictions on who they could see. So I think one attached could do the same.

[kriket]

Our MWs deliver *IN* the hospital, and if you are high risk they won't take you, you would have to be in the care of one of the OBs. But I'm sure it's different hospital to hospital, and MW to MW.

I don't know much about high risk, or your disease, but I DO know about husbands.

MWs ARE medical professionals. They have delivered hundreds of babies, can write RXs can do everything a DR can do except a csection. It's not like you are going to a voodoo princess who's going to have you drink swamp water to cure early labour. I know he's just concerned about your safety, but you are in a center attached to the hospital, you don't have to really go anywhere if there is a problem.

I would transfer in a heartbeat. I love the MWs we see, and they are very caring and supportive of my plans to have a baby the regular way!

[doglver77]

thanks ladies! This is exactly what I needed - rational people to counteract my irrationality! I had a consult w/the MWs, & they were comfortable taking me even w/colitis, since mine is well-managed. I also met with a (separate) homebirth MW, who also had no problem taking me w/colitis. I think I just need to chill & make the switch! After all, I keep telling myself that the likelihood of something unwanted (eg pit or a c/s) is far higher w/an interventiony OB than w/a MW, so it really is the best decision for me.

I know I will be referring back to this thread to ease my anxiety, so please, anyone else who wants to contribute, please do!

[Llyra]

I don't have much to contribute, but if you ever get any hard information about exactly what "they" think the risk with UC is, I'd love if it you could pass it on. I also have UC. I wasn't diagnosed until after my last birth, though-- I got sick four days after my twins were born. I don't know that I'd consider another pregnancy, but I am not totally saying we won't have another, either. My main issue is wondering how the UC would behave. I'm told it often flares immediately postpartum. But it's the risks of the drugs that concern me, mostly.

[doglver77]

I think the risk can be malabsorption of nutrients, or if your disease is active & you're having flares it can cause issues. You didn't ask this & I don't know how active your UC is, but it  some things I found super helpful w/getting it under control were: (1) probiotics and (2) I went on a very strict low-carb diet for a period of time & that greatly helped. I still try & keep my carb intake under control, but that's hard during the delicious holiday season, LOL! If you want more info, please send me a message!

[Italiamom]

Originally Posted by doglver77 

Hi all. I used an OB for my birth w/my 1st child (DS). I don't really have any objections w/the OB himself, I thought he was actually really open & cool & I would totally go have a beer w/him. But, I saw him for about 10 minutes at the very end of my 30 hour, pitocin sponsored labor. However, I felt like the hospital I delivered at was verrrrrrrry pro-intervention, above & beyond the standard. My OB works in a group, & in speaking to one of the other OBs & going over my ideas for a birth plan, it became very clear to me that it was pretty much going to be The Hospital Policy Way at my upcoming delivery in April, as well.

That said, I've been looking into switching to  a m/w. I found a group that I really like, they deliver at a birthing center that's part of a hospital, & they take my insurance. I have to formally make the switch w/my insurance by 12/31. And now I'm starting to freak! I really have 2 concerns, & I was just hoping someone could talk me down!

1) I have ulcerative colitis (a digestive disorder). Mine has been "inactive" for years at this point, & I only take the maintenance dose of the meds. My OB has me going to see a MFM, even though no one can tell me what, if anything, makes me high risk at all. Last time they had me going in for monthly u/s, & weekly NSTs starting at about 34 weeks. Yes, sometimes people w/colitis can have absorption issues, but . . . there was no evidence I ever had any. So, I guess I'm just worried that well, what if I do develop some issue & it's not caught b/c I'm not getting monthly u/s & something bad happens? Also, since I have an HMO, what if I get "risked" out of the m/w care, & am now w/some random OB who might be a total hack?

2) my DH will in no way be supportive of this, & no, he does not want to talk about it. He's very much of the mindset of doctor = word of God, so the more monitoring, intervention, whatever, the better. My master plan is to just switch, & just let him know that hey, I want a water birth, & OB said that they don't provide that & he referred me here. I think he'd be ok w/that explanation, but I still feel all this guilt b/c what if something does happen then it will be all my fault b/c I made this unilateral decision. Am I nuts?

Thank you to anyone who read this whole monologue! Any advice & all perspectives are welcome! Thank you in advance!

I wouldn't talk you down, I'd talk you up.  I was happy to read that you are indeed taking the step and switching!!

1.  When I first read some of your concerns about switching in relation to your UC, my first thought was "if the UC is really a risk, the midwives won't take her."  I think a BIG advantage to them taking you, is that if you end up back in the care of a physician due to your UC for whatever (unlikely) reason, you'll know that it's because you really NEEDED the care of an OB, yk?  More extensive or invasive care IS sometimes warranted in pregnancy.  BUT, by switching to the practice with the midwives, either A) everything will be fine, and intervention will justly be kept to a minimum (most likely), or B) you really need those extra interventions, in which case, you'll know that they were necessary, rather than just hospital policy and bureaucracy. 

2.  I don't see how a birth center that is attached to a hospital would carry any of the supposed "oh-noes-not-in-hospital-aaaaaah" risks.  I know that hospitals simply label birthing centers as such as more of a selling point, and generally these areas have more of a natural and relaxed attitude toward birth.  But just because it has a nice fancy label and slightly different policy, doesn't mean it isn't the hospital.  Your DH (and you!!) can rest assured that an emergency in one wing will have the same outcome as an emergency in any other.  It's not as though the birth center wing isn't going to have oxygen, or anti-hemmoratics, etc.  All the same life saving measures will be available in any part of any hospital, label or no.

Take a deep breath, it sounds like you're making a really positive step!  As mothers, those warning bells are there for a reason.  I know women who have worked with really wonderful OB practices, and who had natural, respectful hospital births.  But those women were comfortable from the beginning.  They didn't get warning bells!  It was the women who saw  warning signs but didn't listen to their inner mama lion that ended up regretting it later.

And if you have any problems with your DH, come back and bounce ideas off the mamas here.  I think there are quite a few ladies whose partners went from adamant "no," to huge supporters of midwives and natural birthing, simply because the experience is so different, yk?

[swimmingbean]

I'm in the "talking you up" category too!

We're due in March and we've been with midwives since the beginning. This is our first baby (after a very long 3.5 years of infertility and WAY too many docs thinking they're gods) and I had to do some fancy talking to get hubby on board, but even more so my MIL, Mom and Aunt who are all in conventional health care as nurses.  Trust me, I've heard every horror story they could come up with!

This was the big turn around for my husband: after experiencing first hand the complete god-complex that quite a lot of docs have after our infertility journey and then walking into the midwives office and the total, absolute calm that was felt, he was hooked.  We found out we were pregnant naturally (!!!) in July and had an ectopic scare so were getting tests up the ying-yang by my family doc before we could get into the midwives.  Beta counts, ultrasounds, etc.  It was so nice to walk into the midwives with all that information, proving I'm pregnant and all is well, and having them say "congrats.  Welcome to a NORMAL pregnancy.  Now we're going to back off the over-medicalized-information for a bit and you're going to realize that yes, pregnancy is a NORMAL condition of the human female."  Sigh...peace!

Getting our family on board was a whole other story. 

At first (ok, the first 4-5 months!) my mom and MIL were panicking.  Big time.  At one point I heard my mom mention "witch doctors"...oy. No one in my family has had a non-doctor attended birth since the late 1800's (mores the pity) and it really did take a lot of evidence backed facts to get them on our side. I even brought my MIL to a midwife appointment so she could see that yes, blood pressure was still being taken, and no, they didn't chant over my belly.  However, after that meeting she even said that she wished she had done the same!  Watching videos with them such as "orgasmic birth" and "the business of being born" helped a bunch too.  We're still debating over birth center (which isn't affiliated with the hospital but is close by) or a hospital birth but we'll take that as it comes.  I'd love a water birth but they sure don't allow that up here in the hospital!

My aunt was a lot easier to get on our side.  She's a public heath nurse who does the home visits to new mums and she saw just how good of care those who had midwives experienced vs. those that have been pushed through the hospital system.  She did a lot to help convince my mom too!

All that being said, I agree with Italiamom...the midwives won't take you on if you go into the pregnancy with anything remotely high risk.  So if they've approved you, Congrats!!!  You're good to go!  I'm not sure where you live but up here our midwives have full clearance in hospitals as well as being able to provide birth center and home births, so maybe hubs would be ok with a midwife attended hospital birth?

Honestly, there is no way I'd ever go to an OB if I could stay with midwives for the rest of my fertile years.  Yes, you won't get ultrasounds to confirm every little thing, and you'll have to do a bunch of research on your own (guided by the midwives) in the name of being informed and able to make choices regarding your care and birth, but that's not  a bad thing.  So many of my friends who have gone the OB/conventional route had NO clue about what was being done to them or how decisions got made and I'm pretty happy to say that both my husband and I are much more informed than they were about our care.  These women are genuine, caring, TRAINED, thinking midwives and nurses and they are truly the experts at normal birth. 

Whichever your decision, good luck!  Once that baby is in your arms I've heard there are no regrets!

[Eresh]

If you're anything like me you tend to really obsess over big decisions and work yourself up over it to the point where its a lot bigger than it needs to be.  I did that with switching from an OB to a MW with my first son.  I ended up delaying it until 30 weeks.  After I finally made the switch it was such a big relief.  I've since had two homebirths and am so glad I made the decision I did.

One thing you've touched on is the level of care from a MW is sooo much better than with an OB.  They spend an hour or so with you at your prenatals and they're there with you while you labor.  I don't know why everyone thinks OB care is so much safer in labor.  They're not actually there!  You're actually under nurse care and depending on them to notice if anything is heading south.  I'd rather have a MW there! 

Good luck :)

[doglver77]

Awwww, you all are seriously the BEST!! I am so thankful that I found this forum! I really think I'm going to print this thread out & carry it around w/me. Yes, I am an Obsesser. Thank you thank you thank you all!!

[lillymonster]

Originally Posted by Eresh 

One thing you've touched on is the level of care from a MW is sooo much better than with an OB.  They spend an hour or so with you at your prenatals and they're there with you while you labor.  I don't know why everyone thinks OB care is so much safer in labor.  They're not actually there!  You're actually under nurse care and depending on them to notice if anything is heading south.  I'd rather have a MW there! 

Also in my case, the OB was "busy" she had like 3 scheduled inductions and then, wow surprise a few patients went into labor naturally. Well, guess what - when I felt the urge to push, the nurses told me NOT TO! I was told they could not help me if anything went wrong, they can't stop me, but they can't advise me or help me so if something happened it was on my head. Yes a nurse told me that! Being panicked and scared, I just kind of rolled around in pain and they said to press the button for more pain relief. I really believe that urge and stopping it caused my baby to turn OP. A few hours later the OB came in and told me to push. By that time it was too late, DD was wedged and wouldn't come out. I really didn't even see the OB much, and then I saw a back up who I never met before (she was in sole practice)

My mother said to me "your going to a midwife, OBs have been trying to push them out of practicing for years and now they are coming back" she's a little nutty...she worked in a GYN office and thinks she knows everything about medical care. But I have been happy with midwifery care so far, and probably won't ever go back to an OB again.

[doglver77]

Just wanted to update & let all of you lovely ladies know that I did it!! I made the switch yesterday!! I am officially under MW care!! Woot woot! I even talked to my DH & he was like, meh, whatever you want to do. Yay!!

I can not thank you all enough!! Your responses really helped me take that step & make the change. So happy to be in this forum!!

[Italiamom]

Originally Posted by doglver77 

Just wanted to update & let all of you lovely ladies know that I did it!! I made the switch yesterday!! I am officially under MW care!! Woot woot! I even talked to my DH & he was like, meh, whatever you want to do. Yay!!

[Eresh]

Originally Posted by doglver77 

Just wanted to update & let all of you lovely ladies know that I did it!! I made the switch yesterday!! I am officially under MW care!! Woot woot! I even talked to my DH & he was like, meh, whatever you want to do. Yay!!

I can not thank you all enough!! Your responses really helped me take that step & make the change. So happy to be in this forum!!

Yay!  I'm so happy for you!

[georgia]

How exciting! I think you will find the midwifery model to be a much better fit. Congratulations on being proactive!