Question for birth professionals - MW delivering by herself?

[MunchiesMom]

This is X posted on VBAC. I'm considering a MW who does not have a partner or backup. I plan on using a seasoned souls (who has 15 years of experience) but the I've MW concept still bothers me. Do most MWs attend home births alone? Is a very hands off, show up as K
late as possible approach appropriate for a VBAC?

TIA!

[babycatcher01]

I know alot of midwives who chose to work alone, good help is hard to find. If the type of care you are saying above is what type of practice she is running, are you comfortable with that? Is that how you want to be cared for? Some women like that, some want different kind of care. Tell her what you want or find someone who can give you what you want. Its all about your comfort. 

[DoulaAngie]

As an experienced doula, I don't like it. The last home birth I attended the mw's assistant couldn't make it. Then during the birth we had a seriously sticky shoulder issue and she needed another set of hands and I had to make a split second choice to either stay in my doula scope or step out of it and assist her with resolving the issue.

While it's not a deal breaker I'm not crazy about that type of situation.

[AlexisT]

Do you mean she comes alone to the birth? I don't like that at all. If something's wrong with mama AND something's wrong with baby, she won't be able to handle both at once.

Sole practice is common enough--but how can she guarantee she will always be available? Unless you take an extremely limited number of births, overlap is always possible. One woman goes a week late, another goes a week early... there you go.

[camprunner]

I accidentally had a midwife come alone. It wasn't planned but the backup midwife was sent and her assistant was occupied. My hhusband ended up having to hold a baby and a flash light as I was stitched for part of the time. I was in pain and had no one to advocate but dh was busy and the midwife had little sleep since she'd come from a previous birth. Based on my previous experiencee, I'd prefer to have someone else there but maybe a doula could fill that spot?

[DoulaAngie]

Originally Posted by camprunner 

I accidentally had a midwife come alone. It wasn't planned but the backup midwife was sent and her assistant was occupied. My hhusband ended up having to hold a baby and a flash light as I was stitched for part of the time. I was in pain and had no one to advocate but dh was busy and the midwife had little sleep since she'd come from a previous birth. Based on my previous experiencee, I'd prefer to have someone else there but maybe a doula could fill that spot?

It's really not fair to depend on a doula to fill that spot.  While she may not be needed to fill a clinical care role, if things go bad or get dicey it's outside of the accepted scope of practice for a doula to fill the clinical role.  Perhaps a monitrice, but I wouldn't ask a doula to be put in that situation.

[Katie8681]

I must say that would absolutely be a deal-breaker for me, VBAC or not.  You run the risk of having a)no midwife at all, b)having one midwife who hasn't slept in 72hrs, and c)having one midwife who needs to attend both to you and any problems you might have at the same time your baby needs care.  Not only that, but if the baby needed resuscitation, NRP is one hell of a lot easier with two people.  It's a sketchy situation.

[MeepyCat]

Originally Posted by AlexisT 

Do you mean she comes alone to the birth? I don't like that at all. If something's wrong with mama AND something's wrong with baby, she won't be able to handle both at once.

This.

[Charmie981]

So, as a midwife the unspoken rule is that you don't attend births alone and you always have backup.

The reality is that sometimes that's really hard to get.  I have never attended a birth alone except at the request of the mother, whose own mother (a homebirther herself) agreed beforehand to help me with anything I might need, so I did have a set of extra hands (albeit very inexperienced) if I need them.  So attending births alone is not really my thing.  I know some midwives choose that bcause they feel that having an assistant means their attention is divided and they are more likely to engage in idle chatter and not devote their attention to the mother.

Not having backup is a lot easier for me to understand.  While I now have two or three midwives that I could call if I absolutely have to, I spent a lot of my time as a new midwife with zero backup.  I was slow...only six births a year or so and I was only ever on call for one woman at a time.

So I guess my question to her would be "why do you work alone?"  and "what happens if you have another mother in labor at the same time?"  I would NOT be okay with an answer that means I have to go to the hospital for my birth or that implies that she works alone b/c of a strained relationship with other midwives in the area.

All in all, I think if there's another choice, you might want to consider it.

[tracymom1]

IDK, I guess I disagree. My midwife with my last home birth was (is) in solo practice and attends all births on her own. She only takes 2 births a month. In 20 years she has not had a problem with overlapping births or issues she couldn't handle on her own or with the help of whomever else is there. I think it really depends on the mother, her birth or family history and everyone's comfort level. I actually dropped my CNM that I was seeing at the beginning of this pregnancy largely because she brings an assistant (sometimes 2) and a student to all births. I do not like having an audience. That's just me, though, and every mama needs to decide what feels right to her

[kcparker]

So, I have a bias because I attend hospital births for the most part and have seen a number of situations that have made me say, "Oh, okay, so THIS is why such a thing gets labeled a risk for a homebirth..." Technically, VBAC is a risk factor sufficient to risk you out of a homebirth in the first place. For myself, I would be a little leery of a HB midwife who would take a VBAC and be willing to show up alone, at the last minute. Uterine rupture DOES happen, not often, but 1/200 is still frequent enough that it could happen to you (you being anybody VBACing). I think monitoring earlier in labor is appropriate and would be a requisite for me if I were VBACing at home.

[Peony]

 All of my MW's I have used work alone. They all had assistants but a partner MW, no. Back up MWs can be iffy and are pieced together only when the MW is out of town. And the assistants aren't always available. I prefer a solo MW, just the way I fly, the less people around the better for me personally. I have declined MWs in the past that had a requirement of having a partner or assistant there. I fully understand why, but I prefer not to and will find someone else. My last two MWs had no problem with it being just them. 

[JamieCatheryn]

My midwife attended DS2's birth alone, but my DH was there to help and the friend who was there to watch DS1 also, and DH and I were very well informed so if she needed extra helping hands she'd have them. With VBAC yeah I'd ask her to come early to keep an eye out, monitor intermittently and stay out of the way still though.

[homemademomma]

I would not be okay with a midwife who didn't have a partner or assistant who came to births with her. I would be fine with a solo midwife, but she absolutely needs to have an experienced assistant. I agree, it is not fair -or safe- to expect a doula to cover that role.

[Millicent]

@KCParker, check your research.  Uterine rupture is no more common than placental abruption or cord prolapse.  Most abruptions are a scar separation, not a catastrophic event.  If VBAC at home is too dangerous, then so is all birth.  BUT, with that being said, my midwife usually brings experienced homebirthers (previous clients) or sometimes nurses as assistants.  Only recently did she get a fully trained midwife to assist.  If she waited for another midwife to work with her (in rural areas), there would have been zero homebirths here for the last 10 years.  (By the way, her safety record is excellent.)

[JamieCatheryn]

Originally Posted by Millicent 

@KCParker, check your research.  Uterine rupture is no more common than placental abruption or cord prolapse.  Most abruptions are a scar separation, not a catastrophic event.  If VBAC at home is too dangerous, then so is all birth.  BUT, with that being said, my midwife usually brings experienced homebirthers (previous clients) or sometimes nurses as assistants.  Only recently did she get a fully trained midwife to assist.  If she waited for another midwife to work with her (in rural areas), there would have been zero homebirths here for the last 10 years.  (By the way, her safety record is excellent.)

Oh wow that's awesome to bring in mothers like that, way to build community! I love that idea. As long as they're all good at staying in the background unnoticed when not needed.