What to do when you can't have a midwife?

[RayN]

I'm between 5 and 9 weeks pregnant, my first ultrasound isn't till July 11th. I really had my heart set on a midwife assisted birth, I didn't care where, in a hospital, birthing center or home. DH is really against a home birth, but that doesn't really matter anymore.

All the midwives in my area are 3+ hours away. I'v contacted the 2 closest ones and Both of them very nicely congratulated me and invited me for a consult at their centers, and welcomed me to birth at their centers. But neither one can come to me or my near by hospital. DH and I are both unsure about driving 3+ hours during labor, and not to mention all the gas for prenatal care.

I can't think of any other option that to go to the hospital, which is the very last thing I wanted. How do I make sure to have a natural birth and not get "assistance" pushed on me. This is our first child, and my family might not be here for the birth, and even DH might be deployed, we wont know for sure for another few months, but his name is up for deployment.

I'm just terrified and heat broken. Any info or advice is greatly appreciated.

[2littlebirds]

So is your heart more set on a natural birth or having a midwife? Do you feel like you can't have the birth you want without a midwife?

When I was pregnant with DD, I had my heart set on a homebirth. I saw a midwife until about 20 weeks. Our insurance changed then and it became cheaper for us to give birth at the hospital. DH was in the middle of switching jobs so we felt it was the best thing to do financially. I was still able to have a wonderful natural birth. You just have to be clear about what you want and know that it is your body and they can't force you to do anything.

I would start by interviewing your local obstetricians and tell them your desires for your birth. Go with the one who is most supportive. And you may gain more favor by compromising a bit. My OB with DD was the same one I had with DS and we have a great relationship. He is really supportive and I respect him a lot, so I allowed a couple things just to please him. For example, I was adamant about not having an IV and he said that was OK, but wanted me to have a hep-lock just in case. I didn't want it, but figured it wasn't a big deal and I didn't want to fight it and lose favor with him and the nurses, KWIM? Another thing was I didn't want continual monitoring, because I wanted to be able to move around, get in the tub, etc. Well, they had these cool monitors that were wireless and water proof, so I allowed that since they didn't strap me to the bed. My birth went great and I had a really nice nurse that encouraged me and never once asked me if I wanted meds. When you go in, just be really nice to your nurse and tell her what you want. If she isn't supportive, ask for a new one. After all, its YOUR birth!

Once you get settled with a good OB, I would suggest trying to find a doula. That way you have someone their promoting your needs and desires and not hosptial procedure. If there are no doulas, maybe one of the midwife's you spoke to would be interested in coming and being your doula. If that fails, read some support books (The Husband Coached Childbirth by Dr. Bradley is a good one) together with your DH and help prepare him to be your biggest supported. My husband was unexpectedly AMAZING during DD's birth. You can even ask your OB if there is a nurse trained in natural childbirth that you could have during your labor.  

Since this is your first birth, I suggest that you read, read, read everything you can get your hands on about natural birth. The thing that prepared me best was just reading birth stories online. They allowed me to get inside the laboring woman's head and gave me a much better idea of what to expect, especially feelings and thoughts during transition, which is usually when you hit a wall and want to give up, but by then its too late! :) The more you read and prepare yourself, not only will you be more confident in your ablilities, but you'll also be more adamant about not having interventions. That will help you so much. Another excellent book is The Thinking Woman's Guide to a Better Birth by Henci Goer. I read that a week before I had DD and it was a lifesaver. It was the final preparation I needed to know that interventions were not for me.

Good luck mama, and don't stress!

Edited by 2littlebirds - 6/26/11 at 10:46am

[cmarie]

I second a lot of what 2littlebirds said!

I had two natural births, one in a hospital and one at home. For the hospital birth, I had a doula and I highly recommend finding one that you mesh with and can support you. Especially if there is a chance your husband might be deployed! Having advocate during labor and birth really helped me!

And reading! Ina May Gaskin, Henci Goer, etc

[thebassomatic76]

Mostly the same as the posters above:

#1:  Get a doula.  Although there are lots of great doulas who are just starting out, in your situation I recommend trying to find one with at least a few births under her belt at the location you plan to deliver at.  She may be able to help you get the staff to be a little more flexible if they are famililar with her (and on good terms with her).  If they know her, and know she knows the policies, it's also less likely they can try to push you into something that's not really required but that they just wish you would do--and they will know this too.

#2:  Interview the OBs in person.  First, you will get a feel for the office staff and the way the OB likes to operate just by making the appointment.  You will find out right away if they are happy to take your questions, or if they act like it's a huge pain in their rear for them to make time for you to talk to the doctor.  As a potential patient, they should be happy to answer your questions and discuss any concerns you have, not be annoyed by it.  Second, at an in person interview, you will get a distinct feel for how the OB really feels about things, even if he (or she) tries to pretend he's more flexible than he really is.  If you're asking for something and he warmly responds and assures you he can do that or work with you, it's great.  If he hems and haws and try to give you a neutral, fence riding answer, you will know that he really doesn't like that or deson't want to help you with it for some reason, no matter what he says.  And of course if he is openly hostile about anything, you can move on to someone else right away.

#3:  Keep an open mind.  Don't make the mistake I did and go into it assuming they will fight you on everything, or that it just won't be possible to have the birth you want because it's in the hospital with an OB.  Be optimistic--don't set yourself up for a self-fulfilling prophecy.  It's also possible there are some benefits that a larger facility like a hospital might be able to offer that could be really nice for you.  For example, there was a chance my DH was also going to be deployed for this birth.  I contacted the hospital in advance and asked about their policy on video during the birth and told them why (so my DH could at least watch the video if he couldn't be there).  They replied and told me that not only do they allow full video of deliveries, they were fully equipped with all the necessary equipment to provide live, real time internet video which he could watch from his deployed location (assuming that location had internet access) so that he could watch the birth as it occurred.  I hadn't even thought of that option, but I was glad to know it was there should we have needed it and that was definitely a big hospital "plus" for me.

#4:  READING.  Read everything you can get your hands on that's in support of natural birth.  I particularly LOVED Ina May's Guide to Childbirth.  I read it before I had DS, loaned it out and didn't get it back, and so bought a new one during this pregnancy and read it again.  She has such a practical, natural approach to childbirth and I felt very at ease and confident after reading her book, both times.

I have had one hospital birth that was completely unmedicated and with no interventions, although I did have to deal with some unprofessional attitude from the staff.  I am about to have my second birth any day now in a hospital and although it wasn't how I wanted to do it, I've made peace with my circumstances and am just happy to be meeting my baby soon.

Good luck to you and I sincerely hope you're able to have the birth you desire.

[cinderella08]

You have receveid some amazing tips and help!!!

I'd like to add - where are you located?  Are you sure you can't find a CPM closer to you?  Have you posted in Finding Your Tribe?  Definitely do that if you haven't?

Good luck, I know what it's like to want something so bad but fear it may not be possible ((hugs))

[mmaramba]

Are there Family Practice docs who will attend you at the local hospital?  From your OP, I'm guessing you might live in a rural area-- one of the advantages can be that more FPs deliver, and they are often more supportive of NCB than OBs, who are trained surgeons.

[RayN]

Thanks for all the responses. I am sure there are no Midwives nearer, I even contacted the ones in OKC to find out if they knew any closer, and they said even the ones in Texas are further away. We live on Altus AFB in Altus Oklahoma. 

I've been talking to hubby, and he says he's willing to reconsider home birth, I've done tons of research for him, but he's still really hesitant. He's also willing to drive to OKC and have a consult with a few of the midwives there.

I haven't posted int eh finding your tribe yet, I guess that will be my next stop.

Thanks for all the info, advice and support. <3

[BananaBreadGirl]

Good suggestions so far. I heard that Family Practice Doctors are often less likely to push c-sections and interventions. Mine "allowed" me to do hep-lock instead of automatic IV, but would not allow delayed cord clamping, and pushed (hard and not very nicely at times) me into scheduling an induction based on pretty weak, in my opinion, "medical reason" (fundal height measuring "too small"). I managed to narrowly avoid it by putting it off and then going into labor naturally, but it wasn't a fun last few weeks of pregnancy.

I'd say ask around to friends, acquaintences, local message boards, LLL, etc. Then interview the potential doctors. Find out who they are in rotation with too, because sometimes you don't get your actual doctor for delivery. My doctor told me his partner used episiotomies a little more frequently than he did, but if I put "no episiotomy" in my birth plan, then his partner would respect that.

You CAN have a beautiful and natural birth in the hospital, but you need to do your research and know your stuff!

[LiLStar]

There are traveling midwives who will actually come stay with you the last couple weeks of pregnancy until the birth

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[kltroy]

I just wanted to second the suggestion to look into Family Practice doctors.  I had a really great intervention-free VBAC with a family practice doc a few years ago.  FPs will generally practice with a midwifery model of care, and as they are not trained surgeons, they will generally do what they can to avoid cutting you or intervening unnecessarily.  If you decide to go this route, you should ask about the relationship that the FP doc has relative to the OBs they collaborate with (ie is it friendly, or do they feel as though the OBs have too much influence?)  Also, I suggest contacting your local ICAN chapter (or the nearest one, if there is no local chapter), because those ladies will know who the most mother-friendly doctors in the area are.

[thebassomatic76]

Originally Posted by kltroy 

 Also, I suggest contacting your local ICAN chapter (or the nearest one, if there is no local chapter), because those ladies will know who the most mother-friendly doctors in the area are.

Apologies to the OP, this is off topic, but:

Does this routinely work for women who are not VBAC moms?  I'm asking because I see it recommended from time to time and had it recommeded to me (I am not a VBAC mom).  I both contacted ICAN myself, and had a friend of mine who is a VBAC mom contact ICAN for me (because I was told they are familiar with mother friendly docs), and when it became clear I have not had a c-section, they stopped responding to me completely in any capacity.  Just wondering if I had bad luck or if they're not really willing to help out unless you're looking for a VBAC specifically.

[kltroy]

Originally Posted by thebassomatic76 

Does this routinely work for women who are not VBAC moms?  I'm asking because I see it recommended from time to time and had it recommeded to me (I am not a VBAC mom).  I both contacted ICAN myself, and had a friend of mine who is a VBAC mom contact ICAN for me (because I was told they are familiar with mother friendly docs), and when it became clear I have not had a c-section, they stopped responding to me completely in any capacity.  Just wondering if I had bad luck or if they're not really willing to help out unless you're looking for a VBAC specifically.

Ok I can only speak from my own experience as an ICAN chapter leader...  I'm very sorry to hear that you were given the cold shoulder by your local chapter.  Part of ICAN's mission is to *prevent* unnecessary cesareans and help women *advocate* for themselves. IMHO, that means helping first time moms, or any pregnant woman, regardless of her previous experiences, to identify a good care provider.  I agree that the ICAN group will certainly have VBAC-specific knowledge, but IME, most doctors and midwives who are VBAC friendly, also tend to be more mother-friendly, or at least, more evidence based. 

Our local chapter has welcomed a variety of women both onto our listserv and to our meetings.  I can recall at least one or two instances where women who were pregnant for the first time came to the meeting.  I actually think that was pretty smart of them, to learn from others' experiences and maybe get some ideas of how to avoid a cesarean before it happened!!
 

Another great organization is BirthNetworkNational.  Their mission is "mother friendly maternity care".  They don't have that many local chapters, but the idea is that care providers who self-identify as "mother friendly" can "buy in" to a directory that BNN produces and distributes to local moms. 

Anyway, I'm sorry that you didn't have good luck with your local chapter.  We're all volunteers and I suppose it's possible that your question simply wasn't specific enough, so it was too difficult to answer?  Another idea is to actually show up to a meeting in person - you'll probably get a lot more useful information that way.

[thebassomatic76]

Thanks kltroy.  I'm nearly done with this pregnancy but I will try attending a meeting in person in the future and see if that gets better results.  It's entirely possible that what I asked or how I phrased it left my contacts unsure of what I was looking for, so I'll try to keep that in mind too.  Thanks for the info on BirthNetworkNational also--I have never heard of that until you mentioned it.  Will definitely look into that one next time too. 

[OptimalBirth]

Hi ladies!

Read my article about what to do when you can't get a midwife here:  http://healthybirthchoices.com/our-classes/couldnt-get-a-midwife.html 

It is about how to have a beautiful natural birth in hospital!  You can also ready inspiring natural hospital birth stories on our website here!  www.healthybirthchoices.com - it HAS been done many many times and isn't all that hard to do with a little know how...  I agree with the other comments...doulas are great!  quality classes that prepare your partner are even better!  I think Daddy Doulas are the BEST...  read "natural" childbirth books.  (check out our recommended reading list on our website as well).  and be careful about what "negative" or disempowering movies, tv shows, or friends stories you listen to. 

I hope this helps!

Sue MacGregor, Childbirth Educator

[e-mail]

[lunabin]

I just wanted to add that I used Hypnobirthing with my first natural labor, and it was very helpful http://www.hypnobirthing.com/  - we took an ipod with speakers, and played relaxing meditative music the entire time.  Nurses and my midwife even commented that our birth was very serene when I was even 9+ cm...  While I had to have an IV (needed to be in antibiotics), I wasn't continuously monitored, and also got to soak in a tub for a couple of hours!  I think it's vital that you find someone to coach/support and advocate for you in case DH can't be there - family, friend, doula!  

It was also helpful for me to tour the hospital beforehand.  We were lucky that the nurses were familiar with our midwives, but it may be possible to ask the nursing manager or staff if it's at all common for women to have natural drug free births.  They may know of providers who particularly support it.  Certainly, they should have a list of providers with hospital privileges that may be a place to start.