When you're having prenatals every 2 weeks and MW is not able to keep up with appointments?

[IdentityCrisisMama]

I have a quick question.  

If you are at the point in your pregnancy where you are going to the MW every 2 weeks (after 32 weeks or something like that) what do you expect if your MW can not make appointments that meet that goal?  I know that most MW have a back up in the case that they can't make a birth but what about prenatal care during times of extended emergency leave or work/scheduling overload?  

I ask because in my DDC there are three HB mamas who are having scheduling issues with MWs kind of late in pregnancy and I'm just curious where opinions fall on this issue.  

Thanks for your thoughts.  

[firewoman]

I think homebirth midwives had better be keeping up with prenatal protocols and seeing their pregnant clients every two weeks or having their back-up see them.  I had the same midwife for three births and there were two times total during three pregnancies that I saw her back-up at a prenatal and one of those times my midwife was there.  The other time was at 28 weeks and my midwife was out of town visiting her sister so I saw her back-up and knew ahead of time that would be the case. 

Why are these midwives missing appointments?

[IdentityCrisisMama]

I feel the same way, FW, although I can see postponing one or two appointments a day or two and/or needing to reschedule to the following week once.  

I can't speak for the other mamas but I am one of the three and it was disheartening to hear that 3 women in our DDC were feeling a bit let down by their MW this late in pregnancy.  

In my case, I had my 36 week home visit scheduled.  We confirmed the day before and then my MW didn't show up. No one called.  When I called to find out what was happening no one answered and I my call was not returned until the next day.  I was told by the office manager that she had forgotten to call me, that something had come up (she was vague but I sensed it was something serious) and that she would call me to reschedule when she had the appointment book.  4 days later I have not heard from her.

I am a bit surprised by this uncharacteristic lack of communication and the office manager's assurance that they have a back-up MW for births got me wondering at which point a back-up MW for prenatals should be seen.  Also this gut feeling that something is going on for them is making my late-pregnancy mind a bit nuttty.  

BTW, the postponement of this particular prenatal is still within my comfort zone but I'm thinking ahead (nutty brain and all).  

Thanks for listening and for your opinions!  

Edited by IdentityCrisisMama - 3/23/11 at 6:38am

[firewoman]

I think regardless of what is happening with her she should figure out a way to get you seen by back-up and reschedule your home visit for SOON.  The home visit is an important appointment!  That is a long time to be out of touch IMO.  Hope you hear from her soon.  Let us know what happens.

[IdentityCrisisMama]

Anyone else care to weigh in?  How many days following a canceled 2 week appointment would you expect/want a make-up appointment?   As a client, would you  be ok waiting a week?   If you are a MW, what do you do if you get behind and have to cancel a 2 week appointment time for a mom?   Do you just move into the next week or do you try to make that up asap?  

I'm 37 weeks and it's been 3 weeks since my last prental and I still don't have an appointment for the next one (MW hasn't returned my call from yesterday morning).  

Am I being picky?  Tell me to chill out or fuel my fire.  ;-)   Mama needs some perspective...

[FillingMyQuiver]

I really think a lot of this has to do w/ your comfort level.  I'm 37wks today and I've seen my MW a grand total of 3 times this pregnancy.  BUT, I am a very busy homeschooling mama to 4 young children, this is my 4th homebirth w/ this MW, and my MW know that this is within my comfort zone.  This is how *we* work together.  But by no means do I think that my comfort level should apply to another pregnant mama who is NOT comfortable having a hands off pregnancy.

My MW operates alone, she has relationships w/ other MWs in our area as back ups JIC, but she is it for her practice.  If you're feeling like you NEED an appt, then I would call again and stress that to the office manager, MW, whomever it is you speak to.

[IdentityCrisisMama]

That does help FMQ.  I do agree that, to some extent, it is about individual preferences.  As it is my MW is a bit more hands off / "trust birth" than my previous HM MW.  So that's probably part of it -- my MWs protocol was already kind of the bare minimum of what I wanted as far as prenatal care so to have this happen put me over the edge faster than it may have another mother, yk?  

Also, when I think if it I've been waiting since last Thursday for a call back to reschedule.  It's making me anxious - both the lack of contact and the skipping of prenatal appointments.  

Urg...what to do?   

[Carson]

This happened to me.  We got to the end of my PG and just a bad string of events had me missing MW appts.  But I felt very in tune with the pregnancy and comfortable with the birth process - I think my previous appointments had laid the groundwork for that so I was okay with it. 

You are not okay with it, so hopefully can find a way to meet with your MW - even if it's via phone to answer any questions/concerns.  Maybe you can call her and ask her for some phone time at a minimum?  I can understand being anxious.

[nashvillemidwife]

If there are no issues I move them to the next week. Where is the evidence that they routinely need to be seen every 4/2/1 weeks?

Originally Posted by IdentityCrisisMama 

Anyone else care to weigh in?  How many days following a canceled 2 week appointment would you expect/want a make-up appointment?   As a client, would you  be ok waiting a week?   If you are a MW, what do you do if you get behind and have to cancel a 2 week appointment time for a mom?   Do you just move into the next week or do you try to make that up asap?  

[IdentityCrisisMama]

I got in touch with 2 members of the office and am feeling better.  I really appreciate all the perspectives I got on this thread - they helped me organize my thoughts.  It sounds like whatever happened was a unique situation, which is resolving.  I think they were just super unprepared and everyone thought the other was taking care of me.  That and they are a bit archaic when it comes to record / contact keeping.  Apparently it took the person who was supposed to care for me 4 days to get my phone number.  Thanks for the help!  

[FillingMyQuiver]

Originally Posted by nashvillemidwife 

If there are no issues I move them to the next week. Where is the evidence that they routinely need to be seen every 4/2/1 weeks?

I've often wondered this, too.  Is this just standard practice for some MWs b/c it's what OBs do?  In my first 2 pregnancies (the 2nd being a home birth), I just felt like a watched pot.
 

[MidwifeErika]

Originally Posted by nashvillemidwife 

If there are no issues I move them to the next week. Where is the evidence that they routinely need to be seen every 4/2/1 weeks?

Same here.

[kawa kamuri]

I personally can't stand to reach the milestone of appointments every two weeks/every week and would be pleased to wait a week or two. I have no history or ongoing problems, no questions and no real need to bond and chat. It makes me feel like a gestating moth pinned to cork - all urine in cup, fundal height and boredom. 

[BabyFireFly]

Our MW is a one woman show and I'm actually thankful for it, there is no dealing with office managers and other staff....just her. Like FMQ above, I have only seen her for a limited amount of appointments (compared to a "traditional" schedule) and I am perfectly comfortable with her, her skills and our relationship. So when something comes up and she or I need to reschedule its not a huge deal to me. The winter has been harsh in our area this year and both her and I agree that risking our safety driving in a blizzard is not worth it for a prenatal appt. The two of us have also had our share of "home issues" (our well pump went in January and her boiler went around the same time) and we had to change some of our appointments, but she was always available to me if I had a concern and wanted to call.

We are having our 36 week home visit this week and from then on we are down to the once a week visits. I understand the feeling of being a watched pot, but that comes more from friends and family than my MW. I don't mind peeing in a cup and being measured and getting to listen to the baby....I do mind hearing every 5 minutes that it looks like I am going to pop at any moment....again, from other people, not the MW.

It all comes down to what is right for you and your pregnancy. I don't feel the need to keep strict appointments and be poked and prodded the whole time along - which is why I chose a very "hands off," laid back MW who isn't going to make it an emergency if I have to extend the time between appointments. One of the reasons I choose to HB with a MW is because I want that relationship with one person - if I wanted to just have a set of appointments on little cards telling me when to show up but never knowing who was going to be seeing me, I would go to an OB's office. I'll never forget my first prenatal appointment with my first child....I went to an OB and was told right off the bat that there were 7 doctors and many more nurses, and I would not know who would see me until I was actually there at the office the day of the appt. I never went back.

[Greenlea]

With my hospital birth with a CNM I personally pushed the appts out farther than 2 weeks when it got to that point.  I didn't see the point in seeing my MW that often, especially since I had a very boring pregnancy.

With my 2nd birth I did a homebirth and I saw my MW only once a month, even up to the end and even though I was 11 days past my due date.  But I felt comfortable doing that.  I think its personal preference.

[IdentityCrisisMama]

I'll add my 2 cents as if I wasn't the OP. 

I think if i had read the first post I would say that I can totally understand wanting to stick to the schedule set by the MW if that's what the mom chooses.  First, I happen to enjoy and look forward to MW appointments.  I don't feel like a watched pot and I don't feel invaded at all.  BP, fundal height and baby heart beat is all I've had this pregnancy (other than a very early resus factor / iron blood check) and it's no big deal to me.  The checking in helps me focus a little on the passing of time and helps remind me just how fast time is going by.  In addition to enjoying the visits I would say that if the MW has chosen a prenatal routine that she feels is best I would wonder how much flexibility is built into the protocol before things don't feel like they're enough.  I suppose that's different for individual MWs and their relationship with individual clients.  

Interestingly enough (because I get the vibe some that midwifery is the "anti-OB" choice) - I've never been to an OB (well, I have had a hospital transfer but that's a slightly different issue).  My last doctor was my pediatrician.  I don't have a framework to compare midwifery to OB care.  I guess I mean that I'm not looking for care that's unlike an OB - I'm just looking for care that's right for me.  I did not choose midwifery because I hate OBs anymore than because I wanted "hands off care".  I want thorough, thoughtful, professional care.  I don't know why HB MW follow the 4/2 week protocol but mine did/does...I expect that my MWs chose protocols that they felt were best for mom and baby...and MW.  At least that's what I would hope were their reasons.  I can't imagine any of them doing things that have little value just because that's the way it's always been done.  

Of course I would also say that a MW is going to miss visits from time to time and it's completely unreasonable to expect that every meeting will happen as planned.  I would even say that the occasional "no show" is par for the course.  BUT, I would also say that I think that should be rare and if it happens it's reasonable to expect a bit of extra attention to follow up.  A 4 day delay in getting back to a mama following a no show is not ideal and I wouldn't expect any mom to be totally relaxed about that.  

I do appreciate hearing from those of you who don't really want or feel you need as frequent prenatal visits as well as hearing the perspective from some MWs about what you do when you need to cancel a visit.  I do think it's 100% reasonable to not want to go as often and I also think postponing till the following week if a MW needs to cancel is a reasonable soluton.   

Edited by IdentityCrisisMama - 3/24/11 at 1:02pm

[nashvillemidwife]

If midwifery is regulated in your state, then your midwife may not have been the one to set her own protocols. That may be a part of her state's rule and regulations (that's the case here in Tennessee). I am supposed to see my clients on that schedule whether I like it or not.

[IdentityCrisisMama]

Oh, I see how that could be - my CA midwife did seem to do a few things because she had to, which I thought was unfortunate for both her and her clients.  My current MW is a CPM in a state that does not recognize that credential (or something like that).  She seems like the type to do what she thinks is best with less regard for the norms but perhaps I am wrong about that.  Bummer all around that anyone feels they must offer a standard of care that they don't believe in.  That's certainly a subject I would want to be aware of as a client.  

[Sijae]

I have no problems with spacing out the appts. I think the schedule is very arbitrary and does have little do do with evidence or need. You would be surprised how many things are done by midwives "just because" it is the standard of practice, or it has always been done that way. As a client, I would not mind spacing out appointments, but as a midwife I would try to re-schedule for a day as soon as possible unless my client indicated that they would prefer to wait for the next appointment. However, to answer your question I think unless the midwife is in a group practice, it would be very rare for a midwife to call in a back-up for prenatals unless she was in an accident or something that would have her unavailable for an extended period of time.

If she is in a group practice, then you should have received a phone call from the other midwife if your midwife was not available, or the office manager to re-schedule. Also, she should have all client numbers on her person at all times and be prepared to call them or have her manager call them.

Not calling for 4 days is not only rude but it doesn't instill confidence. As a client I would wonder if she was really going to show for my birth, and if I would even have a back-up midwife if she didn't. I think all client contacts should be returned within 24 hours for non-urgent issues, definitely 2 days at the most. It sounds like maybe something serious happened that was unusual, but you should have received a pone call explaining the situation from someone - office manager, other midwife, midwife herself, even her husband. I think 4 days is just too long for a midwife to disappear.

[PunkElmo]

Originally Posted by Sijae 
Not calling for 4 days is not only rude but it doesn't instill confidence. As a client I would wonder if she was really going to show for my birth, and if I would even have a back-up midwife if she didn't. I think all client contacts should be returned within 24 hours for non-urgent issues, definitely 2 days at the most. It sounds like maybe something serious happened that was unusual, but you should have received a pone call explaining the situation from someone - office manager, other midwife, midwife herself, even her husband. I think 4 days is just too long for a midwife to disappear.
 

  My midwife has a cell phone, computer AND iPad on her at almost all times... when I call and don't get her, she gets back to me ASAP, usually immediately, ALWAYS within an hour or two.  I've seen her phone vibrate/light up during our appointment, and she'll ask me if it's okay to take the call if it's a mama that's due or other call she's been waiting for, otherwise, she'll call them back when our appointment is over.  (conversely, there was a midwife we decided NOT to use - one of the turn-offs was that in the middle of our consultation/interview, she answered her phone without even saying "excuse me")

I mean, geez, what if you were in LABOR and she didn't get back to you for 4 days?! what would you be paying her for?!
 

The only exception is the silly little questions I ask via e-mail (like "did you mean this Bradley book or THIS one? How many cups of RRL? Where do I buy xyz" etc.), and those are usually the type of thing that can wait, anyway.