Midwife standards of practice

[nurseyface]

Hi, we are working with two midwives currently - having a homebirth in November. I am not feeling the extra attention that I keep hearing about with midwives nor just basic standards of practice. I fell today on an escalator, hurt my knee and foot only but thought I should probably let my midwife know. This is actually my second fall - I fell Saturday as well. I left her a voicemail at 6pm about my falls and still have not received a call back. am I being unreasonable for feeling a little frustrated about that? I am ok and I let her know that but I feel that she should call to assure herself of that and also to reassure me.

I'm not sure how to handle this. Thoughts?

[1love4ever]

Hmm, I would certainly think that she/they would be concerned and call you.  Maybe you should call again?  Sometimes with technology things get messed up.  Is this the reason that you say you are not feeling the extra attention?  Or in what other way are you not feeling the extra attention? 

I certainly do think that a midwife should act in a caring manner towards her patients.  Is she spending adequate time with you at your prenatals?  Does she take time to get to know you and answer all of your questions thoroughly, and explain things to you?  Does she or has she at least in the past, talked to you about nutrition(which most Drs do not do, but all the midwives I have ever heard of do because it is an extremely important part of your pregnancy)

These are a few things that I really feel are important and that my midwife does do.

What is your due date?  I am due November 2, and I am planning a home birth as well!

[Peony]

I wouldn't expect a call back right away over that. Ideally within 24 hours or so if you asked for her to call you back is a good response for nonemergency issues. If you called at 6pm at night, a MW might be spending time with her family and possibly would wait until the next day to return calls that don't require assistance right then. And it always could be longer if she is busy with a birth, etc... 

[nurseyface]

Peony, I don't agree.  It is part of her job as my practitioner to make sure that everything IS ok.  I am a nurse and know that if a patient is concerned about something and it is after hours, a patient can page a doctor oncall with their concerns so it can be handled appropriately and if needed, reassurance provided if it is not serious.  What if something were wrong with the baby and it was not immediately obvious? I don't think that spending time with you family is going to fly. Being at a birth could definitely be a hurdle but she has another midwife or two that she works with that could have called me back. I spent a lot of the night going back and forth about whether I felt the baby moving as much or not. It really stressed me out and I would have liked some reassurance from her.

This is also not the only example of her not seeming invested.  When I asked her about the glucose test for gestational diabetes, which would have been due at our next prenatal appt next week, she just said, if you don't have risk factors, most people opt out of it.  There was no discussion or information provided by her what the risk factors, are, just, basically, you can opt out if you want. I expect, based on the midwifery model of care, to be provided what the risk factors are and to have a discussion with her whether it's appropriate for me.  I just felt pushed aside.  

[dot1]

 My midwife has been very forthright with all kinds of information - she prefaces it with "this is the spiel that I give everyone..." (or something like that that acknowledges she realizes I also work in healthcare but she still feels it is her job to treat all clients equally and provide the same info regardless of their background knowledge).  I wonder if your mw is making assumptions that you need less reassurance b/c you're a nurse? (not an excuse but just curious...).

My mw has a pager system with room for a short message, and also has been very clear on expectations re calls back (e.g. examples of situations where she'd call right away versus wait for a better time).  When leaving a message, she has instructed me to clearly let her know first thing if it's urgent or not....that way she knows whether to interrupt what she's doing or not to call back right away.  She's in solo practice and I've found her to be extremely responsive and communicative.  She never causes me to feel rushed and encourages lots of questions.

It sounds like your mw hasn't been clear enough on communicating what you can expect as far as call backs, etc.  It can't hurt to ask her to clearly outline the policy on returning messages...and to also give her feedback that you want to be provided with more information to make it easier for your decisions to be truly "informed".  Instead of assuming, she can simply ask "Would you like me to outline what the risk factors of GD are?".

[1love4ever]

I can understand how you feel!  Maybe you should talk to her about how you feel-explain that you would like to have more of her attention and your concerns addressed in a more timely manner, and tell her that you would like everything explained to you, and more information provided.  Obviously she probably should have done these things in the first place, but since she did not, maybe give her another chance.  If she is not respecting your wishes after she truely knows how you feel then maybe you should look for another midwife?

[RachaelsMommy]

I personally wouldn't be upset if she hadn't called back 3 hours later after I called to say I hurt my leg. Especially if she was at a birth. No offense, but if I'm the one giving birth, I don't want my midwife calling other people, and I have a feeling you would feel the same way. I personally don't expect my midwife to be on call 24/7 for non-emergencies. She is not a nurse or a doctor, and I'm not paying her what I would pay a nurse or doctor. I see the midwife as a birth professional and a doctor as a medical professional. I got in a wreck when I was 7 months preggo, and people thought I was nuts for not calling my midwife right away. I didn't see what my midwife could have done, if I had any problems, then I would need medical treatment from a doctor.

It does sound like you and your midwife have different philosophies. It seems like she is more laid-back and you are wanting somebody more hands-on. I think you need to discuss this with her ASAP and see if it's something that can be resolved or if you need to find another midwife who is a better fit.

[nurseyface]

Hi guys,  I spoke with her yesterday morning. I called her again about 10am yesterday and left a message just saying that I was a little disappointed I hadn't heard from her because I was nervous last night and could have used some reassurance even though I was pretty sure everything was fine. She called back soon after and said that she hadn't heard her messages until just then and she apologized. She was very sweet and concerned and understood why I wanted to speak with her. We discussed counting kicks to ensure the baby was ok and also discussed all of the cushioning in the uterus and that unless I really injury myself (my abdomen), I should be ok. It was really nice to discuss it with her because, the night it happened, and it may have been my nerves, but he seemed to be moving a lot less than he usually does.  

Anyhow, everything is ok. At our prenatal appt next week, my husband and I will probably discuss with her what our expectation and needs are to her. I can tell from her reaction to this situation that she'll be more than willing to offer the kind of care and attention we're looking for.

Just one last thing: I just wanted to say that I realize that she's not a doctor or a nurse and I certainly wasn't expecting her to triage my knee injury, but to reassure me about the baby since I squished him pretty good when I fell.

Thanks for all of your thoughts about this.  I appreciate it!

[Mulvah]

Originally Posted by nurseyface 

Hi guys,  I spoke with her yesterday morning. I called her again about 10am yesterday and left a message just saying that I was a little disappointed I hadn't heard from her because I was nervous last night and could have used some reassurance even though I was pretty sure everything was fine. She called back soon after and said that she hadn't heard her messages until just then and she apologized. She was very sweet and concerned and understood why I wanted to speak with her. We discussed counting kicks to ensure the baby was ok and also discussed all of the cushioning in the uterus and that unless I really injury myself (my abdomen), I should be ok. It was really nice to discuss it with her because, the night it happened, and it may have been my nerves, but he seemed to be moving a lot less than he usually does.  

Anyhow, everything is ok. At our prenatal appt next week, my husband and I will probably discuss with her what our expectation and needs are to her. I can tell from her reaction to this situation that she'll be more than willing to offer the kind of care and attention we're looking for.

Just one last thing: I just wanted to say that I realize that she's not a doctor or a nurse and I certainly wasn't expecting her to triage my knee injury, but to reassure me about the baby since I squished him pretty good when I fell.

Thanks for all of your thoughts about this.  I appreciate it!

Do you feel better after talking to her?  Or, do you think you'll feel better after having a more lengthy discussion with her?

I'm going through something similar with mine.  Part of me wants to talk to her and the other part of me wonders if I'm expecting too much, though I really don't think I am.

[nurseyface]

Originally Posted by Mulvah 

Do you feel better after talking to her?  Or, do you think you'll feel better after having a more lengthy discussion with her?

I'm going through something similar with mine.  Part of me wants to talk to her and the other part of me wonders if I'm expecting too much, though I really don't think I am.

Hi Mulvah, I did feel better but I think we need to tell her our expectations to avoid future issues like this. Like I mentioned, this isn't the first time I've felt this way with her so I think it will be better to discuss it because she certainly can't read my mind!

What's going on with your situation?
 

[Mulvah]

Originally Posted by nurseyface 

Hi Mulvah, I did feel better but I think we need to tell her our expectations to avoid future issues like this. Like I mentioned, this isn't the first time I've felt this way with her so I think it will be better to discuss it because she certainly can't read my mind!

What's going on with your situation?
 

I'm glad you feel better after speaking with her.  My partner mentioned the same thing - talking to her so she is aware of how I feel.  I almost feel needy to do so, though.  

My main issue stemmed from something very recent.  I started spotting.  The bleeding was fairly steady and obviously red.  I called my midwife to see what she had to say and she said I could either wait it out or get an ultrasound.  After it didn't stop, I opted for an ultrasound.  She was fully supportive and told me she would contact me after the ultrasound.  The baby looked great.  I never got a call from my midwife saying...anything.  I know the baby is fine, but beyond that, I don't know if they found anything to explain the spotting (the radiologist said my midwife would be in touch with me and that the pregnancy was healthy).  Now, it's very possible she didn't get the results or that there was no known reason for the spotting.  However, I would think she would at least call to check in with me.  My main issue is that when you say you're going to call, call.  She did the same thing at my last appointment when she said she would call with the results of my lab work.  She never called.  Now, I don't expect a call if everything is normal, but don't say you're going to call and not call.

Reading what I typed makes me wonder if I am needy.  

[nurseyface]

Originally Posted by Mulvah 

I'm glad you feel better after speaking with her.  My partner mentioned the same thing - talking to her so she is aware of how I feel.  I almost feel needy to do so, though.  

My main issue stemmed from something very recent.  I started spotting.  The bleeding was fairly steady and obviously red.  I called my midwife to see what she had to say and she said I could either wait it out or get an ultrasound.  After it didn't stop, I opted for an ultrasound.  She was fully supportive and told me she would contact me after the ultrasound.  The baby looked great.  I never got a call from my midwife saying...anything.  I know the baby is fine, but beyond that, I don't know if they found anything to explain the spotting (the radiologist said my midwife would be in touch with me and that the pregnancy was healthy).  Now, it's very possible she didn't get the results or that there was no known reason for the spotting.  However, I would think she would at least call to check in with me.  My main issue is that when you say you're going to call, call.  She did the same thing at my last appointment when she said she would call with the results of my lab work.  She never called.  Now, I don't expect a call if everything is normal, but don't say you're going to call and not call.

Reading what I typed makes me wonder if I am needy.  

Mulva, I 100% agree with you . . . I know you said that everything looks fine and the baby is fine BUT you want to feel that she is checking in because it makes you feel like she is invested in you and thinking about you.   Spotting is scary and obviously can be serious so it's not something that should just fall through the cracks.  It sounds like you worry about her dependability, which is also valid.  If you say you're going to call, call.  With any provider, this is important. 

Are you having a homebirth?  

[Mulvah]

Originally Posted by nurseyface 

Mulva, I 100% agree with you . . . I know you said that everything looks fine and the baby is fine BUT you want to feel that she is checking in because it makes you feel like she is invested in you and thinking about you.   Spotting is scary and obviously can be serious so it's not something that should just fall through the cracks.  It sounds like you worry about her dependability, which is also valid.  If you say you're going to call, call.  With any provider, this is important. 

Are you having a homebirth?  

Yes, my main concern is her dependability.  My partner still feels that we should talk with her at the next appointment and admittedly, I'm glad you feel better after speaking with your midwife.    I may have a chat with her.

I'm leaning towards birthing at the free-standing birth center, but all of the midwives at the practice do homebirths as well.