I think I hate my midwives...

[jshannyn519]

I just got home from my MW appt and I am SO STINKING MAD!!! I'm seeing a group of hospital CNMs because my insurance doesn't cover CPMs so I'm severely limited in who I can see. That alone sucks.

So after waiting in the little room for 15 minutes or so the midwife came in. She's one that I haven't met yet, partly because I've only had one other appointment there (I'll be 23 weeks tomorrow).

She was asking me how I was feeling and I said that aside from the cold that won't die, I feel great. She asked me what I was taking and I stared at her blankly and said, "Taking? You mean like medicine? For the cold?" When she said yes, I listed all the stuff I've been taking: Vitamin D, Vitamin C, lots and lots of water, drinking peppermint tea with honey to soothe my throat, cough drops, more water, and sleeping. Oh, and I took a Tylenol one time for a headache that was excruciating. She then said, "Okay, well if you want anything just let me know and I'll write you a script."  What is she talking about? I have a cold! Antibiotics won't do anything for a cold, they just help build resistance against the antibiotics so that when I do really need them they won't work! My response was something along the lines of "Uhh..."

We got through the whole appointment and everything is fine. No sugar, leukocytes or ketones in my urine because I'm healthy. Duh. Baby's heartrate is 140, which is what it's been since 12 weeks. I'm measuring right on at 22/23 weeks where I'm supposed to be. I'm seriously the most boring pregnant woman alive because I am textbook all the time.

Then she said I would need to come back in 3 weeks instead of 4 because I'd need to do the GTT and I'd be almost 26 weeks in 3 weeks. I said that I wasn't doing it and she stopped, looked at me like I had grown another head, and asked why not. I told her that I wasn't at risk for gestational diabetes, that I've never had issues with it before and my babies have all been perfectly normal and healthy, and even a little on the small side. She asked how big they all were: 7#13, 7#2, 7#3. Not even close to GD sized!! Then she said that I could eat a big breakfast and come in to have my blood drawn. Fine. Whatever. I can do that.

And THEN she told me that I really needed to do the GTT one way or another because I'm "high risk" since I "want a trial of labor."

This is what really really made me mad.

1. What does the OGTT have to do with VBACing? Ummm... nothing.

2. I'm not doing a "trial of labor" I WILL BE VBACing!!!

3. Don't label me high risk because I want to have my baby the way God and Nature intended. That is hands down the most ridiculous thing I have ever heard in my entire life.

4. I'm measuring exactly on schedule, the baby and I are totally healthy, and my BP and urine are PERFECT. There is NO indication for further testing of any sort!

So now I have an appointment for the 28th so I can come in and be seen again and have my blood drawn for the GTT after eating a big sugary breakfast.

I'm so freaking irritated and ready to just drop the whole practice and go UP along with my planned UC. After today I don't feel confident at all that if I were to birth in the hospital that any of the MWs in the practice would truly advocate for me and my needs.

[amaayeh]

First, I am just so sorry!!!  It sounds like bad appointments are happening all around!  That would be very upsetting to me as well.  If you want to go back to have your blood drawn, do, but if you get her again, I would remind her that this is your birth and she is not being supportive.  It's so hard when you are in the moment, but she is obviously needing reminded of her role.  Hugs to you!

[imogenlily]

Hey, kind of a side note, but at my last MW appt., my midwife was telling me about studies that have shown that a GD diagnosis doesn't actually improve outcomes for women with GD. There's no sign that "treatment" (diet/exercise) actually makes mama or baby less at risk for complications. The increased anxiety from a GD diagnosis can actually make outcomes worse. I know there are obviously studies contradicting this, but it's interesting new data. I'd really like to read the articles about this, so I could pass it around. If anyone else knows where it is, please link!

Anyway, this in conjunction with the ludicrously high false positive rate is why I'm not doing the GTT. I am lucky in that my HCPs are on board with my decision, but if anyone gives you any flac, consider bringing up this point against the GTT.

Good luck to you!

[jshannyn519]

I just looked up GD on the NIH (National Institutes of Health) website since it's a reliable source that I can quote to my MWs if need be. Guess what? Only 5% of all pregnant women each year develop gestational diabetes. So, statistically I have a 95% chance of NOT having it. The screening tool that they use is stupid, one of the questions is "Are you over the age of 25?". Well, that's at least 50% of the pregnant population! Aside from that dumb question, the only risk factor that I have is being overweight and since I've never had GD before, or any other health problems for that matter, it really doesn't make sense.

I think I'm just going to call tomorrow, reschedule for the week after my current appointment and decline the blood draw. And have information with me on why I'm declining when I go in for my next appt because I'm sure they'll ask why I didn't do it.

[tracymom1]

Bah!! How annoying! Is there a full moon or something? What's with all these crappy providers lately?

Jenni, you know just as much about prenatal care as your midwives. Probably more, since you take the time to do research above and beyond what is considered the norm. I can understand why you want to continue care with the midwives - from here on out, though, just remember that you are simply playing their game and nothing they do can in any way diminish what you know about pregnancy and birth. It might just be easier to jump through their hoops for now and deal with whatever comes in the future. Are they the type to make you do a bunch of NST's and ultrasounds in the late 3rd tri? I think that's what I would be most concerned with, especially if none of it really mattered because you know you won't be induced or sectioned for any "routine" reason. Is the only reason they call you high risk is because of the VBAC?

I would never tell anyone to UP - that is such a personal and important decision, but what I will say is that I felt completely liberated and peaceful this afternoon on my walk home from the midwife's, knowing that this next part of my journey was completely on my own terms. Food for thought...

[Tumble Bumbles]

Ugh... well, I'm not going to come in and blow rainbows up anyone's rear because you know my situation

That stinks. Why, oh why can't people just trust women? Why oh why can't people make educated, well-researched, prayed upon (thought about, meditated on, whatever you particular belief system entails) choices they believe are in their best interests and in the best interest of their children without getting a bunch of HEAT and HASSLE about it? My goodness.  It shouldn't have to be an argument, a fight, stress, discussions, etc. It should be a low-stress, happy, delightful, exciting time for all of us and by golly, I am praying for that for all of us.

I love your calm and zen attitude about it Tracy :)

You need to do what you feel is best Jenni, we're all here to support you.

[Buddhamom]

I hear you on this.  My midwife talked to me about it at like week 13 and I told her I didn't want to do it and she said I was a risk and when I asked how she said my age only.  Just because I am 40.  I am definitely not or ever been over weight, no history of it in my family and my other babes were 7.12 and 8.1 and no GD either time so I do not see the risk factor for me. It will come up next eweek atmy 25 week appt. and I will hold my ground.  She will be bringing up the HIV test again too that I am holding a firm no on as well.

[nikie23]

Originally Posted by tracymom1 

Bah!! How annoying! Is there a full moon or something? What's with all these crappy providers lately?

This!

When I read the part about her offering you a script, it made me think maybe she was offering you something for your cough or possibly a runny nose or something.  But either way, her attitude towards what you were already doing was pretty dismissive.  Well, it sounds like she was dismissive the whole time, but that definitely didn't start things off on a high note. 

I'm so sorry you had such a frustrating visit!  Are the other CNMs in the group like this one?  Or have they been more open/less med-heavy?

[jshannyn519]

Originally Posted by nikie23 

I'm so sorry you had such a frustrating visit!  Are the other CNMs in the group like this one?  Or have they been more open/less med-heavy?

I honestly don't know. I've had one other appt at the office and it was with a CNM student, not one of the main midwives. I did talk to one of the midwives for about 2 minutes as I was standing at the desk making my next appointment. She said that I would need to come back in 2 weeks to do the quad screen, I told her I wasn't doing it, and she said, "Okay. We just have to offer it." and that was the end of it. My sister is friends with a couple of the other midwives, ones that I haven't met yet, and she said they're nice and that their philosophies line up with mine. However, my sister and I have never had a discussion about why I think the prenatal testing is completely useless (for the most part) so she doesn't know the full depth of my opinions on all of it.

The midwife that I saw yesterday was one of the newer ones, I think, so that may have been why she's that way. I think the older ones tend to be more hands off with everything.

I did look up the core competencies for basic midwifery practice yesterday (it's on the MANA website) and a couple of the items in the Guiding Principles of Practice REALLY stood out to me:

G. Midwives recognize that a woman is the only direct care provider for herself and her unborn baby; thus the most important determinant of a healthy pregnancy is the mother herself.

H. Midwives recognize the empowerment inherent in the childbearing experience and strive to support women to make informed decisions and take responsibility for their own well-being.

L. Midwives understand that the parameters of "normal" vary widely and recognize that each pregnancy and birth are unique.

These are the things, among many others, that all midwives are supposed to be basing their practice and client interactions on. I'm bringing the whole 4 page document with me. And I'm rescheduling for 4 weeks out and declining the GTT.

[amaayeh]

That's awesome!!  I would definitely take that with you...maybe have it put on a poster board for them. 

[astar326]

 i hope that your next apt. goes better. research and educating ourselves is very important.

Edited by astar326 - 2/16/11 at 4:00pm

[msmiranda]

I will offer a slightly different perspective as someone with GD.  I don't think it's unreasonable for them to want the reassurance that you are not having any blood sugar issues, especially since they offered you the alternative of just eating a big breakfast and having a blood draw, which isn't as invasive/uncomortable (IMO) as drinking glucola.  You could also do some home monitoring if you were willing to and had access to a meter (maybe they have one you could borrow) -- every care provider I've talked to was fine with that as an alternative as well.  Yes, it's unlikely that you have GD, but why not know for sure?  I know from my own experience that it is a real condition with real physical effects, and although I strongly disagree with unnecessary interventions often pushed on GD moms, I also take the condition seriously and think that it is better for mom and baby's health to know about it and manage it (which most can do through diet and exercise). 

So, she could have been nicer in how she handled the conversation, but I'm not sure that what she said or their desire to know the GD status of the moms in their care warrants dropping them as care providers.  It sounds like the part that really upset you was being called "high risk" for being a VBAC.  That was not the best choice of words on her part, and you're right, VBAC is only very tenuously connected to GD status (e.g. maybe they think if you had uncontrolled/undetected GD and your baby grew larger than your past ones, you'd be less likely to be successful/more likely to rupture -- but that's a pretty circuitous argument).  But in general I think that some form of GD testing -- which does NOT have to mean the traditional GTT -- is not unreasonable.  It is your right to decline, of course, but if all they are asking is breakfast and a blood draw, that doesn't seem very burdensome/invasive. 

ETA:  I mean all this in a totally respectful and supportive way, just trying to offer a slightly different perspective from other posters.  FWIW, I have had GD in three pregnancies now, so my view is colored by my experience. 

[sharita]

Oh My Gosh!!!  I feel ya.  I would rather see an OB than a CNM anyday.  At least then you expect all their very "medicalized" and "interventive" methods and ways of thinking.  You get decieved when you hear the word "midwife" and think, "hands off, natural, etc".

I have noticed that most CNM's are nothing more than OB Nurses.  Half of them start out I think wanting to be a true midwife but are so bound by "hospital protocol" and having to answer to an OB or someone else that they have their hands tied for so long, they end up very medicalized and think just like OB's and OB nurses.  They too forget what a natural birth is and start looking for problems where their arent any.  There are a few (I have only met one) CNM"s who are kind of what I see a true midwife being but even the best ones are bound my policy of hospital and rules and regulations else they are held accountable.  It ends up not being worth it for them and they just go with the mainstream flow.

I see a cnm right now because my insurance pays for it (and wont cover my CPM, which I am also seeing and `who will be delivering the baby)  I am just going the CNM/OB route also so that I get to have the ultrasound to find out gender and the scripts if I need any such as antibiotics for my recurrent sinus issues and gallbladder infections.

I LOVE my CPM though.  She is a direct entry midwife who just now completed actual certification for it through school but has been at it for years.  She is so natural and hands off and I love it!  No vag exams (unless I ask for some reason), no rushing things, no tests for things I am not even at risk for, I mean heck, my water broke 36 hours before I had my first contraction  with last baby and she never batted an eye, just kept checking in, suggested things to get it moving, and had me monitor my temp and babys movements.  She is like one of the old school midwives who came to your house way back in the day and just was there to support you but didnt try to "deliver" the baby as only the mother can actually do that, she just is there to catch, unless you or hubby wants to, lol. Very "Let nature take it's course" but of course, not to the point where she would dismiss an emergency.

I had CNM's deliver two of my 5 kids (one never showed up till pushing time just like an OB) and the other just gave me funny looks everytime I asked about refusing unessesary interventions.  I had an OB next child and he was more hands off then the darn CNM"S  He let me refuse everything!  IV, AROM, Cervical checks, etc.  He didnt even bat an eye when I wanted to cut the cord instead of DH, lol.  Thats when I gave up on CNM's.

Ok, done with my rant, lol

This is why I am a midwife student but not taking the CNM course of study but apprenticing under my CPM!  I know beig a CNM would open up more options for me but I cant stand the idea of losing my passion for the birth process and the natural ability of the birthing mother because my hands were so tied and silly rules of a hospital than hinder instead of help the birth process.

Okay, NOW i am done!

[philomom]

Originally Posted by sharita 

I have noticed that most CNM's are nothing more than OB Nurses.  Half of them start out I think wanting to be a true midwife but are so bound by "hospital protocol" and having to answer to an OB or someone else that they have their hands tied for so long, they end up very medicalized and think just like OB's and OB nurses.  They too forget what a natural birth is and start looking for problems where their aren't any.  There are a few (I have only met one) CNM"s who are kind of what I see a true midwife being but even the best ones are bound my policy of hospital and rules and regulations else they are held accountable.  It ends up not being worth it for them and they just go with the mainstream flow.

This has not been my experience. My CNM was awesome. She did practice with another midwife that I avoided because she was more intervention-y in style.

To the Op.. is there not another midwife in the practice? One that might be more helpful to you?

[jshannyn519]

Originally Posted by philomom 

This has not been my experience. My CNM was awesome. She did practice with another midwife that I avoided because she was more intervention-y in style.

To the Op.. is there not another midwife in the practice? One that might be more helpful to you?

There are 6 midwives in the practice. I haven't seen all of them yet. We'll see who I get next time and how it all goes.

[jshannyn519]

Well, I'm feeling somewhat better about the whole thing now after talking to my sister. She asked me why I was so upset with them and I told my sister the story of what happened. She's an OB at one of the hospitals here in town, and one of the hospitals where my midwives do births. She said that I do "have to" do the GTT, but I don't have to drink the sugar stuff I can eat jelly beans or a big breakfast. I said that I had agreed to eat the big breakfast, but that I don't "have to" do anything that I don't want to. My sister asked who the MW was that told me I was high risk and I told her and her response made my day! She said, "The next time you see her, just tell her that she's been a MW for 5 minutes and she doesn't know what she's talking about. You are not high risk during pregnancy because you're VBACing." :D  However, she did go on to say that I'll be high risk at the hospital and they'll require CEFM because that's the only way to tell if my uterus ruptures. Then she said that if I'm going to refuse all kinds of stuff (like the CEFM) then I may as well not come in at all. And I have an 80% chance of having my VBAC at her hospital because they have a 20% c/s rate to begin with and really high VBAC rates.

Anyway, it was a pretty nice conversation and I feel like I was validated by an OB and that makes me super happy! My sister's not nearly as crunchy as I am, but she knows this stuff is really important to me. She was also raised by our mom who is probably even crunchier than I am so I know some of that rubbed off on my sister too. lol

So if I do end up needing to go to the hospital, or if I change m mind about UCing, it's nice to know that my chances of getting what I want are pretty good. It super sucks about the CEFM though. I guess that just means that if I do end up going in, I'll need to wait as long as humanly possible so I have more freedom before getting stuck to the machine. I know I can refuse it if I want to, or try to compromise with them, but that is information that is good to have ahead of time.

[amaayeh]

That's great!  How nice to have someone you can talk to that knows how important this all is to you. 

[MamaBanana]

 Just reading through this thread now - jshannyn I am glad for you that you seem to be more resolved about the whole thing.  In my most recent check-up with one of the midwives, she spent about 10 minutes with me, max.  I am not exagerating.  It was hilarious.  Listened to the heart, measured me, asked if I had any questions, told me to do my birth plan with the "original midwife" I met with for the first/intake appt and sped out of there.  Good grief.  So, sometimes I think of them more as risk management than my support for this process.  I do any of the non-invasive blood, urines, etc they want and take pride in it when all the tests come back normal.  Ha! on them for being so obsessive and needing to control.  I know I am healthy - even despite my "advanced maternal age" of 39!.  I educate myself as much as possible as you obviously do, too.  I love that you found the midwife competencies - that is awesome!  Continued good wishes for good health and collaboration from here on out. 

[BarefootinBrooklyn]

I wasn't in love with the last midwife I saw from my practice either (but the first one I met seemed awesome) so I'm going to see who I connect with the most and just basically "propose" to her, like "Hey, I know that whoever is on call when I go into labor will attend my birth, but I really feel comfortable with you so if there is any chance that you are available on that day, would it be possible to request you? It would mean the world to my birth and my family." 

A friend of mine had that happen, at her favorite midwife's request! She just really became friends with one midwife and she said, "Listen, here's my cell. Even if I'm not on call, call me and I'll be here for you." I'm really hoping I can cultivate the same relationship. I'm coming into my midwifery practice halfway through pregnancy (because we moved to a new state) so it's going to take me a little longer, but hopefully after I've met everyone I can just profess my love to my favorite and see if she is open to being MY midwife. Worth a shot!

[jshannyn519]

Barefoot, I like that plan of having "your" midwife. I'm sure that if I developed a good enough relationship with one of them, she would do that for me. It helps that a couple of them are really good friends with my sister. :)  Of course, that would mean that I'd be giving birth in the hospital which is not my 1st choice. But you just never know.