How many attended births make a midwife experienced enough for you?

[InchByInch]

Hey ladies,

I'm a staunch supporter of homebirthing, but have never gone that route myself-- my two kiddos were born in the hospital, with me on an epidural. I'm now pregnant again (yay!), and am finally considering a homebirth. We interviewed a midwife a few days ago, and she was really great-- we like her a lot. The one thing that worries me is that she's only attended 65 births. I'm fretting that if I have some kind of complication, she won't be experienced enough to catch it in time, and my baby or I will be injured or die.

I should also say that we're about 20-25 minutes away from the hospital, so if something does go wrong, we won't get there in time.

These fears are frightening enough that I'm considering going the hospital route again. I know that the vast majority of births are normal, and I myself am low-risk, but... the stakes are so high. If something does go wrong, I would never forgive myself.

Thoughts?

[LittleBirdy]

I know how you feel.  Number of births attended was actually a deciding factor in my selection of a midwife - there were two in our practice and between the two of them they'd attended over a thousand homebirths!

What else do you know about her training, education, and background?  Can you she give you a few references to talk to?  You could ask them if they experienced any complications and how they were handled - it might make you feel better.

And if you ultimately decide you feel safer in the hospital, go for it.  To me, feeling safe is a huge part of having a successful and satisfying birth!

[meesh933]

My midwife had attended 200+ when I first interviewed her. That was two years ago, and I'm on my second birth with her, so she's probably got close to 100 more under her belt. The midwife who assisted her at my DS' birth had 1000. Around here, midwives would have only been practicing for 8 months or so if they'd only attended 65 births. (My midwife and the midwife who she is assisting/is assisting her have 9 birth between the two of the month I am due.) I don't automatically think that number of births attended makes a better midwife, but a number that low would probably give me pause, too.

[patricegonzales]

Is that how many she has attended since practicing on her own? Depending on her training, she may have many more births under her belt as an apprentice as well as practicing under a senior midwife. 

I would find out more about her training. 

[starrlamia]

yeah ask about training, tbh i wouldnt feel comfortable without 2 midwives present but thats just my preference.
 

Originally Posted by patricegonzales 

Is that how many she has attended since practicing on her own? Depending on her training, she may have many more births under her belt as an apprentice as well as practicing under a senior midwife. 

I would find out more about her training. 

[Viriditas]

Originally Posted by LittleBirdy 

And if you ultimately decide you feel safer in the hospital, go for it.  To me, feeling safe is a huge part of having a successful and satisfying birth!

This, to me, is the bigger issue here.  If you need a midwife who's attended 400 births to feel safe, you need to find that midwife.  If you are going to feel unsafe at home no matter what, you shouldn't birth at home.  You need to have your baby wherever you feel the most secure.

I am in my third pregnancy.  My first was a UC, and I'm having a midwife present just because I want more support.  I'm extremely confident in my own intuition and knowledge.  I'm also very close to a hospital.  And I've had 2 complication-free births and recoveries.  If I clicked with a midwife who had only attended 65 births, I would be fine with that.  But that is my unique situation.

What really sticks out for me is this:

If something does go wrong, I would never forgive myself.

You need to be able to completely own your birth experience and be confident that you're making the best decisions for yourself and your baby.  This is important wherever you end up birthing, but it's especially important if you birth at home.  You simply cannot go into a home birth thinking, "Everything will probably be okay, but I will never forgive myself if it isn't."  Bad outcomes happen at home births, just like they do in the hospital.  But at home, there are a lot less people to blame it on.

Best of luck making your decision.  If you do decide to go to the hospital, give yourself the support you need to have the natural birth you want.  Find a natural-birth friendly provider and ask lots of questions!  Hire a doula!  Plenty of women have wonderful, natural, ecstatic births in a hospital.  If you decide to birth at home, just make sure you do it in a way that makes you feel totally safe and with a midwife that you don't have any reason to second-guess. 

[Turquesa]

Quantity of births is certainly important, but for extra comfort, I like to know about what types of situations a MW has personally dealt with--such as shoulder dystocia or the unanticipated breech baby.  What is her protocol?  How did she handle it when it did happen?

[lunarlady]

I had a traumatic HB with a MW who was fairly new to the practice. She had done only about 70 solo births before mine. My labor was terrible, fast, furious, and very painful. My MW was nervous. I'm a very sensitive person, and I could tell she was nervous. This made me more nervous and made my labor fearful for me. When I started to hemmorage after my birth, my MW panicked and did several things that were invasive, painful, and not helpful. This was terrible. I will never again birth with an inexperienced MW.

Ironically, my first HB was wonderful, and was attended by a STUDENT MW. Yes, she didn't even have the 100 proctored births required by the state to practice on her own. The difference was that she had gone on a year long MW mission to Africa, and spent six months as a MW among the Amish. The state didn't count those. But in both situations she was it. There was no hospital for back up. So she had dealt with all sorts of unexpected and deadly emergencies before my labor. As she said, once you've delt with unexpected twins, transverse lies, breech births and PPH in a population of women that had poor nutrition, stunted growth, zero prenatal care, and no hospital for backup, dealing with the emergencies a healthy American woman might experience just seems easier. With her, we had a shoulder dysocia that resolved with her calmly changing my position, and a blue baby who needed a little help getting started. But she handled it with such a calm presence that the whole experience seems wonderful in my mind.

If I were you I would keep looking. Kicking yourself after the fact for choosing the wrong MW is awful.

[PseudoDiva]

I'd keep looking.  With my first I had a MW who'd delivered around 160.  We received great prenatal care, but this time I am going with a veteran MW who's probably delivered around 2,000.  She's been at it for 35 years.  That's just me.  

[Alenushka]

The OBs and CNMs who attended you in the hospital seen thousands of birth. They deliver every day. So, yes, they have seen all possibale complications. 30 minutes is very far from the hospital. Yes, most of the time things are well and normal...but when things for wrong, you have 5-7 minutes to get baby out via C-section to prevent brain damage.

I have friend who have lovely natural birth in the hospital. no one was pushing anything on them.  No one was pushing anything on me either.

65 birth is nothing, in my opinion.

Originally Posted by InchByInch 

Hey ladies,

I'm a staunch supporter of homebirthing, but have never gone that route myself-- my two kiddos were born in the hospital, with me on an epidural. I'm now pregnant again (yay!), and am finally considering a homebirth. We interviewed a midwife a few days ago, and she was really great-- we like her a lot. The one thing that worries me is that she's only attended 65 births. I'm fretting that if I have some kind of complication, she won't be experienced enough to catch it in time, and my baby or I will be injured or die.

I should also say that we're about 20-25 minutes away from the hospital, so if something does go wrong, we won't get there in time.

These fears are frightening enough that I'm considering going the hospital route again. I know that the vast majority of births are normal, and I myself am low-risk, but... the stakes are so high. If something does go wrong, I would never forgive myself.

Thoughts?

[starrlamia]

Obs also are rarely in the room with you unless there is a complication or you are about to deliver, they also have no training in normal birth. You also arent guarenteed to be seen by Your OB and could be seen by a student or newer doctor who havent seen thousands of births. And the time needed to deliver by c-section varies dependant on the complication, and it generally takes more then 5 minutes to anesthetize the mother and start the operation. In fact the standard procedure is to have the cesearan started within 30 minutes of the decision though they are expected to do it ASAP.

http://www.abclawcenters.com/pdf/Emergency%20C-Section%20Article.PDF

 

Originally Posted by Alenushka 

The OBs and CNMs who attended you in the hospital seen thousands of birth. They deliver every day. So, yes, they have seen all possibale complications. 30 minutes is very far from the hospital. Yes, most of the time things are well and normal...but when things for wrong, you have 5-7 minutes to get baby out via C-section to prevent brain damage.

I have friend who have lovely natural birth in the hospital. no one was pushing anything on them.  No one was pushing anything on me either.

65 birth is nothing, in my opinion.

[Alenushka]

Have you been in the hospital lately? There is OB on the unit.  Maybe not my OB but a hospital one.

Yes, they are absolutely trained to do C-sections in 5-10 mins if needed. There do regular drills.  It is like f-g Russian ballet the way it is done.

Yes, doctors see normal births all the time.  There plenty of sweet natural births in hospitals now.  It is not the 50s anymore.

I do not need anyone if all goes well. Just like I do not need a seat belt if I am not in an accident.  The problem  the birth is the same problem as with  driving....I do not know when things will go wrong. So I wear a seat belt and birth in the hospital.

[starrlamia]

your seat belt analogy is tiring, as there really is no comparison. You have roughly a 30% chance of being in a serious car accident and you are subject to other peoples actions and not just your own. That is 3 times higher then having a complication during labour (keeping in mind the high incidence of false fetal distress due to EFM and "failure to progress").

Doctors dont see a whole ton of normal births, the majority of births in hospitals have been subject to a whole slew of different interventions. NVM when a doctor sees a normal birth generally they view it as dodging a bullet and having a birth that had no pathologies. They are trained to view birth as normal only afterwards and not inherently.

 

Originally Posted by Alenushka 

Have you been in the hospital lately? There is OB on the unit.  Maybe not my OB but a hospital one.

Yes, they are absolutely trained to do C-sections in 5-10 mins if needed. There do regular drills.  It is like f-g Russian ballet the way it is done.

Yes, doctors see normal births all the time.  There plenty of sweet natural births in hospitals now.  It is not the 50s anymore.

I do not need anyone if all goes well. Just like I do not need a seat belt if I am not in an accident.  The problem  the birth is the same problem as with  driving....I do not know when things will go wrong. So I wear a seat belt and birth in the hospital.

[Devaskyla]

Here, midwives are limited to attending 40 births a year, so a midwife who has attended 65 births would have been in practice for about a year and a half. Depending on her experiences during training (does that 65 include her births while supervised or just her solo births?) I'd be ok with a midwife at that level, but I only live about 8 blocks from a hospital & I'm more of a UC type.

[PseudoDiva]

Originally Posted by starrlamia 

Doctors dont see a whole ton of normal births, the majority of births in hospitals have been subject to a whole slew of different interventions. NVM when a doctor sees a normal birth generally they view it as dodging a bullet and having a birth that had no pathologies. They are trained to view birth as normal only afterwards and not inherently.

As someone who attempted a HB with a wildly underqualified support team and ended up in the hospital for the delivery, I can second this.  I arrived just in time to push and my son was born about 1.5 hours later.  The midwife actually said: "I hardly ever get to see births like this."  
 

[PseudoDiva]

The CNM on call, I mean, not the HB midwife...And this hospital is considered progressive!

[jenrose]

"Sweet natural births" are passing rare at most hospitals. I've been involved in 16 hospital births in my life, and while most were unmedicated, not one of them was really what I'd call "natural". There's nothing natural about people yelling at you to push, forcing you into a position you don't want to be in, or cutting the cord the second the baby is out. It's not the 50's... but it's a highly litigious environment with a whole lot of CYA and opinion-based medicine.

As for # of births attended... it isn't high on my list of first questions to ask. There are midwives who do the job better at 50 births than some who've been to thousands. I want to know if they're going to listen to me, if they're comfortable with my asking for help when I need it, even if that help is more than they can give (requiring consult or transport), or less than their training says they ought. I want them to be honest with me about what their comfort zone is. Most of the midwives I've worked with have spent time in third world countries catching babies in high-volume environments as a part of their training. And most of what I want them for is to help me figure out if things are still "normal". 

I've never seen a c-section, not even a nominal "emergency" section, get the baby out in less than 20 minutes from the time the section was called. In most cases, the call-to-cut time was closer to 30-45 minutes. And that's for births that start in the hospital. They are actually faster with people coming in on a homebirth or emergency transport in many cases. 

[seafox]

Originally Posted by lunarlady 

I had a traumatic HB with a MW who was fairly new to the practice. She had done only about 70 solo births before mine. My labor was terrible, fast, furious, and very painful. My MW was nervous. I'm a very sensitive person, and I could tell she was nervous. This made me more nervous and made my labor fearful for me. When I started to hemmorage after my birth, my MW panicked and did several things that were invasive, painful, and not helpful. This was terrible. I will never again birth with an inexperienced MW.

Ironically, my first HB was wonderful, and was attended by a STUDENT MW. Yes, she didn't even have the 100 proctored births required by the state to practice on her own. The difference was that she had gone on a year long MW mission to Africa, and spent six months as a MW among the Amish. The state didn't count those. But in both situations she was it. There was no hospital for back up. So she had dealt with all sorts of unexpected and deadly emergencies before my labor. As she said, once you've delt with unexpected twins, transverse lies, breech births and PPH in a population of women that had poor nutrition, stunted growth, zero prenatal care, and no hospital for backup, dealing with the emergencies a healthy American woman might experience just seems easier. With her, we had a shoulder dysocia that resolved with her calmly changing my position, and a blue baby who needed a little help getting started. But she handled it with such a calm presence that the whole experience seems wonderful in my mind.

that is awesome! that was one reason I went w/ the ob/gyn I did - she did yearly treks to Nepal and would stay there for a month or so and help the women there with birth and anything else she could. No hospitals nearby, etc. She was an incredible calming influence for me throughout my whole pregnancy, with her combination of science background and hands-on experience and seeing scary situations, etc.

with both they let my husband cut the cord, did skin to skin right after delivery, bfing right away also (they'd do a quick check and wrap them up and give them back to me), etc. But I live in a pretty natural-birth-friendly area.
Edited by seafox - 10/6/11 at 7:13am

[starrlamia]

your ob sounds amazing!

[seafox]

Originally Posted by starrlamia 

your ob sounds amazing!

I *really* loved her - she was pretty crunchy (breastfed both kids until 2-3, supported me bfing through my second pregnancy, tandeming, pro-cosleeping, etc) she took lots of time w/ each appt I had and was just great. I am so sad she isn't practicing anymore! She stopped right after my last babe - she's moving into public health which is cool also but too bad since she's so great. Although I did see many of the other ob's on the rotation (since I was there so long for #1, I saw 4 of the 7 docs!) and they were all really awesome.

I knew I'd like her when I saw all the tibetan prayer flags hanging in her office