Choosing HB w/ Midwife AFTER UC

[delicate_sunshine]

Has anyone here done this?  I UC'd my last baby and it was... beautiful wonderful amazing empowering spiritual; everything you hear that they are.  But this time around I just got a different vibe.  Part of the decision was prenatal care.  I didn't UP and don't want to and I hated prenatal care with my OB.  It always felt rushed and like I was just there to annoy him with all of my questions.  Another thing was I wanted to be free to just labor and not try to constantly analyze everything that was going on and wonder if it was normal. I like to be alone when I labor though.  I don't like feeling watched.  I've hired a midwife and she's okay with sitting in another room.  I guess I'm just wondering if there is anyone out there who has done this.  Also, I feel like so much preparation went into planning a UC that there just isn't anything left to do.  Does that make sense?  So, if you've been there what have you done to prepare?  

[Banana731]

Hi! I'm having my 3rd LO in March with a HB MW. My 2nd dd was a planned UC.

I really liked my UC, but had I been able to have a MW (I was living overseas) I would have done so. We decided to have a MW this time because we could. The idea of someone to listen to the HR, keep the pool warm, keep me company so dh can rest if he needs to, worry about where to put the chux pads, take care of the cord, clean up- those are appealing things to me! I am a little worried about having someone around to "interfere" because it was such an unhindered birth last time, but I really like my midwife and she's a person who I'd be happy to have at my birth if she were just a friend so I think it will be a good experience.

And yes, I so thoroughly prepared for my last birth that I am pretty much going with the flow on this one! I think it's kind of cool actually, no worries, you know?

[delicate_sunshine]

This is my 3rd as well!  I started the last pregnancy with wanting a MW, but the funds just weren't there.  I know they say you shouldn't UC b/c of finances and we didn't really.  But it sure did help push us in that direction.  I know what you mean about having someone there to listen to HR and keep the pool warm and stuff.  That's a lot of what I want too.  Someone to just take care of things for me so I can worry about laboring.  I really do think that my midwife will respect my wishes to "just labor" and not interfere.  We've talked about it a lot.  I really don't want her to suggest position changes and things like that.  I think it would be annoying.  But I do enjoy her company and she knows that I had a UC before and says that she understands that that says something about my desire for privacy during labor.  I'm glad to know that I'm not the only one out there who has done this.

[mylilmonkeys]

I have had two midwife attended HBs after our UC.  Our UC was great, but dh never thought to clean under the toilet seat (I birthed on the toilet), and really the last thing I want to do on birth day is clean the bathroom. LOL  He really was uncomfortable catching, though he did just fine, and I found that I really preferred having another knowledgeable opinion when ds was grunting a little longer than I thought was normal.  I met a midwife between pregnancies at a birth networking meeting and got to be very familiar and comfortable with her, and she has been wonderful.  She has been careful to listen and respect my desires, and frankly I just know now what I need to birth well and am not shy to say so.  She is miles apart from the other midwives I'd had, which drove me to UC in the first place.  So, with the right midwife, birth really can be as good as UC.  My births have gotten really fast, and the last one was almost a UC again, but at least she was on her way and would still help clean up! LOL

[birthgreeter]

From a midwife: in case you would wonder....

As a midwife, I am fine with a couple who wants to have me there 'just in case'. 

I just want you to be totally honest up front about what you are wanting.

 I have had a couple lie to me before about wanting this, and then have a problem at the birth-And once I was 'allowed' into the room- I had to do some things that I would have not had to do -if I could have assessed her/baby before the actual birth happening...(cant tell details here on a public forum)  But, it would have been handled different-over all.....  

So since then, I as a midwife, have certain boundaries/guidelines/comfort zones-- for couples who want a birth like this-more unassisted.

 I just want to be up front with the couple what I expect and will do and want you to be upfront with me.  

Then-

I would be willing to sit in a corner, knit and just do the basic of what you want- 

So to prepare?  I suggest that you talk about all of the 'what ifs' and what is considered to be 'normal' things she might do.... taking heart tones, checks, any monitoring-b/p all of that...etc...But all of these things can be talked about ahead of time so you could agree on everything each other is comfortable with-to be sure you could work together.

that is my opinion as  a midwife, but other MW's may feel different.

[Milkymommi]

Planning to do this as well... We previously UC'd and it was wonderful, marvelous and everything I ever wanted! However, my son was born still 2 yrs ago at full term ( found out prior to labor) and I feel the need for the close comfort of my midwife during late pregnancy and delivery. I ended up seeing a regular CNM/Dr's office for prenatals last time and it was quite unpleasant. Now that my fave MW is back from hiatus, I will see her and it will be fantastic. She is super like-minded.  I want to be able to give all my energy to birthing and being peaceful... that will be SOOOOOO much easier for me if she is there this time doing all the "stuff". LOL It will be reassuring as well. I am still a HUGE advocate of UC!

[delicate_sunshine]

Originally Posted by Milkymommi 

  I want to be able to give all my energy to birthing and being peaceful... that will be SOOOOOO much easier for me if she is there this time doing all the "stuff". LOL It will be reassuring as well. I am still a HUGE advocate of UC!

This, exactly!!  
 

[delicate_sunshine]

Oh, and @birthgreeter  we have definitely been up front with her.  She knows about our UC and we have talked at length about our decision to have a midwife this time vs. having another UC.  I don't mind occasional checks and things of that nature, but we have definitely talked about how much I enjoyed laboring alone last time.  I did have some friends come doula for me and once they arrived I really felt "watched" and inhibited and we have talked about that too.  I'm a pretty private person and she seems more than willing to respect that so I can feel comfortable to labor.

[patricegonzales]

Originally Posted by birthgreeter 

From a midwife: in case you would wonder....

As a midwife, I am fine with a couple who wants to have me there 'just in case'. 

I just want you to be totally honest up front about what you are wanting.

 I have had a couple lie to me before about wanting this, and then have a problem at the birth-And once I was 'allowed' into the room- I had to do some things that I would have not had to do -if I could have assessed her/baby before the actual birth happening...(cant tell details here on a public forum)  But, it would have been handled different-over all.....  

So since then, I as a midwife, have certain boundaries/guidelines/comfort zones-- for couples who want a birth like this-more unassisted.

 I just want to be up front with the couple what I expect and will do and want you to be upfront with me.  

Then-

I would be willing to sit in a corner, knit and just do the basic of what you want- 

So to prepare?  I suggest that you talk about all of the 'what ifs' and what is considered to be 'normal' things she might do.... taking heart tones, checks, any monitoring-b/p all of that...etc...But all of these things can be talked about ahead of time so you could agree on everything each other is comfortable with-to be sure you could work together.

that is my opinion as  a midwife, but other MW's may feel different.

Birthgreeter,

This is very interesting to hear and gave me something else to think about. I am not sure if this is what you meant in your post, but It was eye opening to me-

If the mw is there 'just in case', and you call her into the birthing room b/c there is a problem that you feel you need her for, the situation (problem) will probably be handled differently than it would be had she been present for the entire labor/birth. Many problems that (can) occur in labor/birth show signs before they are "problems". MW look for these signs and offer help before they turn to a major problem. Not seeing the 'problem' unfold may call for more drastic measures from the midwife.

Birthgreeter, am I correct in this? If so, can you share some examples of 'problems' that are usually resolved if caught early (in labor/birth)?

Hmmm food for thought... For myself! as I had the exact same question as OP.

Thank you!

[Stayathomemommy]

Last birth was a UC, for that one i would have loved a midwife but in Arizona it was illegal for a lay midwife to attend a VBAC.  so we didnt have a choice, we did all prenatal care with a CNM and in the end just called her to let her know we had had the baby at home.  It wasnt all that nice but in our situation we couldnt really tell her our plans to stay at home or she might not have given us prenatal care AND our plan B was to call her and go into the hospital so we couldnt burn that bridge with her.

Now that we have had a UC we dont feel the need for a midwife at all.  My husband would prefer a UC actually.  but i was so excited to be able to see a naturopath/lay midwife for my pregnancy and at 36 weeks we had to decide if she was going to be on call for us for the birth.  Because she is so hands off and only wants to come in while i am birthing to listen to the baby every so often we figured we would have her here for the birth.  i worry i will depend on her for things that last time i just didnt worry about or just trusted my body to do.  I remember during the UC saying to my hubby, "i wonder how i'll know if i am 10 cm"  when i checked my self and found a head i looked up shocked and said, "I think its safe to say i am 10 cm!!"  it was just so cool.  with a midwife there i might have asked to be checked.  Luckily this midwife only does internals if asked and now i am sure i wont wonder.  There is some comfort knowing that if things get complicated she will be there and hopefully would be able to help so that there wouldn't be a need for a transfer.  My husband is convinced the benifits are that he gets to climb in bed with me and baby instead of having to do the clean up by himself.  And the fact that she will deal with the paperwork/birthcertificate and baby well visits so no going to vital records with in 7 days or a nasty pediatricians office.

[birthgreeter]

Originally Posted by patricegonzales 

Birthgreeter,

This is very interesting to hear and gave me something else to think about. I am not sure if this is what you meant in your post, but It was eye opening to me-

If the mw is there 'just in case', and you call her into the birthing room b/c there is a problem that you feel you need her for, the situation (problem) will probably be handled differently than it would be had she been present for the entire labor/birth. Many problems that (can) occur in labor/birth show signs before they are "problems". MW look for these signs and offer help before they turn to a major problem. Not seeing the 'problem' unfold may call for more drastic measures from the midwife.

Birthgreeter, am I correct in this? If so, can you share some examples of 'problems' that are usually resolved if caught early (in labor/birth)?

Hmmm food for thought... For myself! as I had the exact same question as OP.

Thank you!

Position of the baby is one.  If the baby is coming in a slight abnormal position (they sure turn even at the last few days of pregnancy before labor begins) so even if your midwife saw you on one day, and said the baby was in a great position, you could begin labor the next day and the baby could have turned a bit, or completely.  Not all moms are as aware of the position of their babies.  (I try to always educate them, and encourage them with how to understand what position their baby is in.  I love it when moms are so in tuned to their won bodies and babies and they often tell me before I even place my hands on their bellies!  But not all do.)

So that is one thing.  

A baby coming with its head slightly tilted to the side  or posterior for example will usually be a longer labor.

A baby who turned breech, or is face presentation, or a cord prolapse...those can not all be resolved but could have different outcomes if not noticed until the actual birth. 

[patricegonzales]

Birthgreeter,

Are there any issues that a midwife being there, observing the entire labor/birth, could prevent from turning into problems (emergency)? The examples that you gave dont seem to be issues that would have a different outcome if the midwife was present or not:

Originally Posted by birthgreeter 

Position of the baby is one.  If the baby is coming in a slight abnormal position (they sure turn even at the last few days of pregnancy before labor begins) so even if your midwife saw you on one day, and said the baby was in a great position, you could begin labor the next day and the baby could have turned a bit, or completely.  Not all moms are as aware of the position of their babies.  (I try to always educate them, and encourage them with how to understand what position their baby is in.  I love it when moms are so in tuned to their won bodies and babies and they often tell me before I even place my hands on their bellies!  But not all do.) --------------Why/how would it make a difference if a midwife was present for the labor? A midwife cant stop the labor for the baby to move to a more favorable position. I guess she could offer different positions for the mother to move into to encourage movement? I dont understand this example.--------------

So that is one thing.  

A baby coming with its head slightly tilted to the side  or posterior for example will usually be a longer labor. -----How is this a problem? How would the outcome be different with midwife present?

A baby who turned breech, or is face presentation, or a cord prolapse...those can not all be resolved but could have different outcomes if not noticed until the actual birth. -----Again, how can the presence of a midwife prevent these problems?

Thank you for taking the time to answer my questions, birthgreeter! I appreciate the insight and knowledge that you are sharing with me.

I hope I havent taken the OP topic too far off topic :)

[birthgreeter]

Would you (or any parents) recognize the position of the unborn baby?  Enough to tell if it is cephalic, breech, posterior, face, asynclitic, etc... Not all mothers can tell the exact position of their own baby...(from my personal experience).  Most do have the general idea,  knowing if their baby is head up or head down, but not be able to tell if the head is properly flexed or not-or if in breech, which breech position the baby is in.  (that is what I mean here-hard to tell if they are feeling a foot, arm leg etc--not saying anything negative about mothers here)

In witnessing about 2000 births -yes, the examples I gave I have seen a difference in having a trained provider available in early labor --and also for the birth with some of those.

 (due to HIPPA I can not provide you with exact examples as some on mothering know who I am-)

Example:  Face presentation-is the chin anterior or posterior?  If it is anterior there is most always room for the baby to flex its head-which allows it to move under the pubic bone, but in a posterior of chin, there is less room available,  a greater risk for brain and spinal injuries.  Babies can turn anterior at the last minute, but when in labor, is that something your willing (or your husband) is willing to monitor and assess?  A skilled attendant doing a vaginal exam in early labor would be able to tell a face presentation.  

If you do not know the position of your baby, to have a skilled care provider do an early assessment in labor will help you to tell the position of your baby. And yes, again, the baby can turn at the last moment..to a less favorable position. but after knowing the position of your baby-You then can make a informed decision as to continue to labor at home or not- 

Example:  Breech presentation-what breech presentation is the baby in? complete or incomplete?  Incomplete breech caries a greater risk of a cord prolapse and cord compression.  where are the arms, how flexed is the head or is it extended. Is it extended with a arm up around the head? 

Example:  Asynclitic-would you know if your baby is in this position?  What about being asynclitic and posterior?  Once in labor, and certain signs occur, yes you might, but again, from my personal experience-many mothers do not know. What specific things can you do to help this other than position changes? Early intervention doing some of these simple things, might help esp if the baby is not settled into the pelvis.  If the baby is settled into the pelvis, what things can you do to help this?  Most mothers if told that this can cause your labor to be longer, and often harder, will choose to do early 'intervention' things to help move the baby into a more favorable position.  (again, doing more than position changes of the mother-)

Example: Cord prolapse:  Would you recognize the signs (I am talking about a cord that is just outside of the cervix, not totally prolapsed down into the vagina.)  

Example: Some bleeding in early labor-would you know if it is normal or not?  What about placenta abruption? What are the signs?  

These are some of the things that a early assessment of a midwife might help to rule out for you. 

Now-I want to say, I personally believe that all babies should be born with the care of a midwife or unattended-with the parents.  That is my personal belief.  I think those who are high risk, or have a problem should seek medical care.

 So I am not trying to say that you should not have an unattended birth, I am just saying from personal experience with the above examples, there could have been a different outcome with some of the examples above-had the coupled not had a skilled attendant assess them in the beginning of the labor--as the couples had no idea or did not recognize what was happening. Does that mean that unattended couples should always have a midwife or someone present-that is their decision.  Not mine.  

 After an early assessment and after the couples are given true informed consent-about possible outcomes, the decision to stay at home or to go into the hospital for medical care ---is their decision.

Hope that helps.

Originally Posted by patricegonzales 

Birthgreeter,

Are there any issues that a midwife being there, observing the entire labor/birth, could prevent from turning into problems (emergency)? The examples that you gave dont seem to be issues that would have a different outcome if the midwife was present or not:

Originally Posted by birthgreeter 

Position of the baby is one.  If the baby is coming in a slight abnormal position (they sure turn even at the last few days of pregnancy before labor begins) so even if your midwife saw you on one day, and said the baby was in a great position, you could begin labor the next day and the baby could have turned a bit, or completely.  Not all moms are as aware of the position of their babies.  (I try to always educate them, and encourage them with how to understand what position their baby is in.  I love it when moms are so in tuned to their won bodies and babies and they often tell me before I even place my hands on their bellies!  But not all do.) --------------Why/how would it make a difference if a midwife was present for the labor? A midwife cant stop the labor for the baby to move to a more favorable position. I guess she could offer different positions for the mother to move into to encourage movement? I dont understand this example.--------------

So that is one thing.  

A baby coming with its head slightly tilted to the side  or posterior for example will usually be a longer labor. -----How is this a problem? How would the outcome be different with midwife present?

A baby who turned breech, or is face presentation, or a cord prolapse...those can not all be resolved but could have different outcomes if not noticed until the actual birth. -----Again, how can the presence of a midwife prevent these problems?

Thank you for taking the time to answer my questions, birthgreeter! I appreciate the insight and knowledge that you are sharing with me.

I hope I havent taken the OP topic too far off topic :)

[patricegonzales]

Birthgreeter,

I understand that you feel these interventions are needed in order to provide the best outcome for the mother/baby, but, we will have to agree to disagree.

To me,  "A skilled attendant doing a vaginal exam in early labor " is unnecessary, invasive, and potentially harmful. 

Anyway, I am having a hard time understanding your replies. I think this conversation would be better suited for face to face dialog, but since we are in cyber-land......  :)

Take care,

Patrice

[Peony]

I guess I am choosing a MW after a UC as well. I've always been low key about prenatals. I did do the regular ones with a CNM with #1, #2 was 3-4 with another CNM and then she came for the birth. Slept on my couch until I was pushing, hung out in the doorway watching while I birthed and then left shortly after. It was exactly what I wanted then. For #3 I wanted a UC, DH did not so we settled and hired a MW for the birth alone. The deal was she would hang out downstairs and if I needed her she was there, if not then I didn't have to see her. There always was a good chance she wouldn't actually make it due to various other things. She ended up not making it.  So this time I will use her again but I guess try to get here sooner. It was not her fault she didn't make it, quick labor, much quicker then my others, and I did let her know I was laboring and would call when it picked up. Only labor was all over the place so I called and he was born 10 minutes later.  I got my UC because we did everything ourselves since that was the arrangement and will be this time as well. Frankly, I have no desire to deal with DH and a UC again, he just turns into a basket case during any birth, a UC was so much worse. I will gladly have her come over at the first sign of something this time (even though I don't like people in my house till the end) if it means someone else will get to handle him so I can labor alone in peace!

[Kokopelli-mana]

I'm pg with my 3rd and have decided on a homebirth with a MW in the home.  I had a wonderful planned UC with my 2nd.  This time around, I like the idea of having someone there in case I need her, but if all goes along like last time, she will merely be in another room twiddling her fingers.

I, too, will not be examined vaginally, and I know from experience that I deal best with labor pain by being left alone.  I need to focus on the task at hand!  But I will also have the security net there in case there is any bleeding, prolonged labor, etc.  My main concern is to avoid going to the hospital (and the resultant interventions, no matter how hard one tries to avoid them) at all costs. 

I have a really good feeling about this birth. :)