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Lots of questions, please help!

post #1 of 48
Thread Starter 
I am 34 weeks pregnant and am having a home birth with a traditional midwife. She advised me that I could skip the GBS test because the results could be positive one day and negative the next. Do you think this is smart? What if I have to transfer to a hospital?

She also said we don't need to do eye ointment after baby is born, she prefers colostrum. I'm fine with that. She said she doesn't do vitamin k injections but we could get the drops if we wanted to. Any advice on these? Should we use them and where can you find them?

She said I could do parallel care or use just her. She is not a Cnm but a traditional midwife. Up until week 32 I had been seeing midwives at our local hospital but they began to rub me the wrong way and I really wanted a homebirth so we hired our home birth midwife. Just wondering if I need both or if my midwife is fine. She does work with a partner and is very knowledgable.

Finally, she said we didn't need to take the baby to the pediatrician unless he was sick. We have always followed the pediatrician and their well baby schedule but she said it wasn't necessary unless we are vaccinating, which we are not. What are you doing regarding baby checks? My midwife will check baby at day 1 and 5 but then we are on our own.

This is my third child but I feel so lost! My first was a natural hospital birth and my second was an unplanned homebirth then we transferred to the hospital afterwards because we didnt know what we were doing. Thanks for any advice you can give me!

Robin
post #2 of 48

I didn't do the eye drops or Vitamin K with my son, but we chose to circumcise, and the pediatrician who performed it wouldn't let him do it without the Vitamin K shot, so we ended up getting it anyways when he was 9 days old. I did my research on the eye drops, and it definitely rubbed me the wrong way so we opted out of that with DS. 

We personally vaccinate and even if we didn't, I think we'd still go to the well baby checks. I like to see how my children are progressing, establish a relationship in the case my kids were ever really sick and we needed to go in, address any concerns out of my realm of knowledge, etc. 

post #3 of 48

Personally, I always do the GBS test, even for both of my home births. Testing at 36 or 37 weeks will usually tell you whether you're positive when you give birth. Yes, it's true that you might not be positive the next day, but generally speaking, being positive at 36 weeks means you'll be positive when you give birth. At any rate, I have tested because if you do have to transfer, if you haven't tested, they're going to want to treat you as if you are positive. If you have tested and are positive, well, things are the same. If you haven't tested and are negative, you won't know it and they'll treat you as if you're positive. So basically, as far as a hospital transfer is concerned, you're LESS likely to be treated as positive if you've tested, because then at least there's a chance you'll get a negative and be treated as such. As long as you don't test at all, they'll automatically treat you as if you're positive.

 

We opted to do vitamin K drops for both of our home births. If the births had been traumatic, we probably would've done the shot instead. Both of my home birth midwives have provided the drops themselves, so I don't know where you'd get them. Eye ointment is to prevent eye infections that can cause blindness from things like chlamydia and gonorrhea. If you've been tested and you're confident you haven't been exposed since then, it's highly unlikely your baby is going to get any serious eye infection. Other things can cause serious eye infections, but those other things just aren't likely to cause any serious problems. We don't do eye ointment for that reason. We DO see a pediatrician for WBVs, although not as many as recommended. We usually do 2, 4, 6, 12, 18, and 24 months. We don't do ALL of the recommended visits, but we definitely do enough to catch any problems there might be. Some things just don't cause a lot of symptoms until they're very serious, but can be detected by a pediatrician. I know there are some heart problems like that, but I'm not familiar with what they are or what other issues could be like this, as we've been extremely fortunate that our children have so far been healthy.

 

These are really all just personal decisions. It sounds like maybe you aren't really comfortable with this midwife. Is that the case, or am I reading too much into this? You have to do what YOU feel comfortable with. Everyone who answers will have a slightly different answer. I am personally uncomfortable with a midwife making these sorts of recommendations, so perhaps I'm reading more into it than there is because it makes ME uncomfortable.

post #4 of 48

I think there is value in GBS, personally, because I have seen kids really, really sick with GBS sepsis. Now, if you want to refuse eye drops and vitamin K, that's your call, but I wouldn't let yourself believe that colostrum is going to do anything to cure up any gonorrhea/chlamydia in your baby's eyes. Colostrum doesn't cure or even treat gonorrhea or chlamydia infections in infants eyes and I'm somewhat disturbed that your midwife would think that it does. That would really make me question her knowledge base, personally (but of course your choice of birth attendant is up to you). Vitamin K, I always cringe when I hear people refuse this before they even give birth. Vitamin K can be a very worthwhile "intervention", particularly if you've had a difficult second stage, your baby has a good deal of caput, facial bruising or even cephalohematoma (if you suspect cephalohematoma, that necessitates a pediatrician consult immediately). I might could see refusing it on babies who didn't have any caput or bruising, but on kids who have had these things, it really can help them- as that's what Vitamin K is there for. Finally, about a pediatrician, if you trust your midwife with your babies life- so much so that you believe that she is good enough to be able to diagnose all problems in the newborn period- from cardiac abnormalities, to musculoskeletal problems, to genetic disorders, to respiratory disorders, etc.- then I could see refusing a pediatricians well baby visits. But if you have any doubts about her abilities to accurately assess a newborn and catch whatever problems- even problems which may at first be subtle- with your baby, then I would take your baby in within a few days for a well baby visit. Pediatricians are not bad people. My pediatrician is actually quite wonderful- and your midwife should know one that she feels comfortable recommending to you. if not, ask around in the birth community where you live. There will be peds that are okay with selective/delayed vaxes, etc. 

post #5 of 48

I think I want your midwife. :)

 

But, these are all very personal decisions, and all based on your own comfort level.  If you do want any of the things she doesn't do (and she sounds like a typical mw to me), then you should continue parallel care so you have the option to go if you want, or anytime after the birth.  You can take your baby for a checkup and still not vax, but you don't have to (we don't).

 

I think the big thing that you need to decide is how much responsibility you personally want to bear.  My mws have never made decisions for me.  Those were mine to do.  They might offer some suggestions and advice, but mostly they would just support me in my choices.  The hospital is the other extreme (usually).  They have a protocol to follow, and everyone who comes is put through the paces. 

 

So, do you want to do the research, and be confident on your own, or would you rather have some one in a authority position to tell you what you should do?  There's not a right answer to that question, but the answer will tell you how much doctor support you want/need, and how comfortable you are with a homebirth and this mw.

post #6 of 48
Quote:
Originally Posted by holly6737 View Post

I think there is value in GBS, personally, because I have seen kids really, really sick with GBS sepsis.

 

But is also true that there are other risk factors...like prolonged rupture of waters, or fever in the mom. 

 

Now, if you want to refuse eye drops and vitamin K, that's your call, but I wouldn't let yourself believe that colostrum is going to do anything to cure up any gonorrhea/chlamydia in your baby's eyes. Colostrum doesn't cure or even treat gonorrhea or chlamydia infections in infants eyes and I'm somewhat disturbed that your midwife would think that it does.

 

One of the things I like about having a midwife is that she trusts me and my evaluation of my/my dh's sexual history.  If you don't have an STD, this is a non-issue.  If your baby develops an eye infection (or plugged tear duct causing goopy gunk), colostrum/breastmilk is quite effective.

 

That would really make me question her knowledge base, personally (but of course your choice of birth attendant is up to you). Vitamin K, I always cringe when I hear people refuse this before they even give birth. Vitamin K can be a very worthwhile "intervention", particularly if you've had a difficult second stage, your baby has a good deal of caput, facial bruising or even cephalohematoma (if you suspect cephalohematoma, that necessitates a pediatrician consult immediately). I might could see refusing it on babies who didn't have any caput or bruising, but on kids who have had these things, it really can help them- as that's what Vitamin K is there for.

 

I am against routine use of Vitamin K, but would concur that you should consider it if your baby experiences any of the above.

 

post #7 of 48

The way I would differ from your MW is on the pediatrician issue. Everyone does their own research and comes up with their own conclusions but from what I read at the time it was important for me to see a ped shortly after the care from my MW ended. I agree that they are largely unnecessary...but so are MW's. In most cases your birth will be fine, as will your baby in childhood. I like the safety net of seeing a care provider. 

 

In the end - it's up to you. I would prefer my MW let me know the options and let me decide with a bit less bias...but it doesn't matter. You just pick what's right for you, mama. 

post #8 of 48

OKay well I disagree with your MW about the GBS test. I mean, you have to do what you want to do...but for me (a person who does almost NO testing in pregnancy - seriously, I test for GBS and I do pee sticks at my MWs center. Period.) the GBS is just kind of a no-brainer. It takes two seconds to collect the material to be tested, just a quick swab that I have done myself all three times. Insurance pays for it. The results come quickly and will most likely be negative...at which point, you know that you are GBS negative and can simply not have to think of it again. Should the results come back positive, you are not then automatically forced into taking the IV antibiotics...most people I know who test positive do the Hibiclens when they go into labor and no one I know has had a problem. The Hibiclens is a totally harmless and non-invasive preventative measure...seriously, not a pain in the ass at all...I was told that you can even buy it on Amazon if you want to. I would see absolutely no reason not to do it on the off chance that you would end up being one of the cases of GBS that was transmitted and became a problem for your newborn....when GBS becomes a problem, it can be a really, really big problem. Why chance it if avoiding it for sure is as simple as, basically, a quick vaginal douching with a harmless cleanse? The Hibiclens has been shown to eliminate transmission at the same rate as IV antibiotics...so, what's the problem? Answer: There is no problem.

 

Any time I have been asked about a test, I take a look at whether the information I get from the test will help me, what sort of treatment I might be faced with, what the consequences of not treating could be...etc etc...I examine every facet. In a case where there is no solid way to tell if you have risk factors, the test is non-invasive, the treatment is non-invasive and the consequences for not knowing/not treating could be a big deal....why on earth wouldn't you take the two seconds to swab your vagina just to know? I mean, if you just don;t want to..I get that and that's a good enough answer for me, because it's not my business...but if you are torn about it, don't take your MWs word for it...just do it, you know? It's a piece of information that you don't have to do anything with if you don't want to...why not know?

 

 

I would do Vit K if I had a rough and/or very long labor/delivery and my baby was beat up in the process...but I haven't had that happen yet, so I have never consented to it. If I did it at all it would be the oral dose.


I don't do eye goop/drops because I know I am free of diseases that can cause problems. As far as colostrum in the eyes...Holly I think it's a bit ridiculous for you to assert that the OPs MW is suggesting she try and heal STDs in her infants eyes with breastmilk...she's not saying that. Many, many people who know they are free of diseases choose to forgo the ointment and many many of those people (in fact, many people around the world) do also choose to express colostrum into the eyes of their newborns as added protection against any infections or problems or just "new eyes in the world" irritation. Colostrum/breastmilk is wildly awesome and I use it for a ton of stuff, all the time. I've definitely cured pink eye with breastmilk in the past and prevented it from spreading to other in the household (I think, I'll never know for sure if we all would have come down with it, but I think I helped to stop its spreading).

OP....do the research yourself honey. No one can tell you what your comfort level should be. I do all my new baby checkups...but my doctor is a family friend and the family doctor for everyone in our family and extended family...so it's more like going to visit an uncle or something, we just love to visit with him! He is 100% supportive of our lifestyle and choices, so it's easy and wonderful to be around him and he loves our kids so much. I believe strongly in creating a strong relationship with the family doctor and take my kids for ALL the scheduled well baby visits. Also, we are 100% vax free in this house...and I see that as EVEN MORE reason to go to all those well baby visits. If some jerk ever decides to claim I'm medically neglecting my children by not vaxing them, I will happily point to the fact that my children were in the doctors office for EVERY recommended well baby check up...I know it seems silly, but that has happened to enough people I've known that it makes me feel better to have that.

This MW is obviously someone you trust.....this community of women (MDC) is obviously full of people and opinions you trust...but none of this trust you have for outside people and opinions can EVER be as important as what YOU KNOW as a mother. Get on the interwebs, get in the library...look up studies, locate the journals that these studies have been published in, seek out information that tries to debunk your current beliefs...really try and get to the heart of the body of evidence/information that is out there on these issues and make an informed choice for yourself! THAT is the only way to feel empowered in making these choices.

Sometimes life throws you curve balls...when it comes to your kids, you can't always see the future and how your decisions will play out. Please protect yourself from guilt and regret and make decisions that are based on truth, hard information and your own research....that way if something comes up that you were not expecting, at least you can tell yourself that you did absolutely everything in your power to make the best decisions based on a lot of hard work and time spent thinking about and collecting information about the issue in question. That has always helped me with my own kids and with EVERYTHING I make decisions about in our life. Don't take anybody's word for it...that feels easy to do now, but it's not as easy if something goes all sideways and you have to look at yourself in the mirror and feel like you sold your kid short because you didn't find out for yourself and took somebody's word for it, instead.

 

Good luck! I know how confusing and overwhelming all this stuff can be. <3<3<3

post #9 of 48

Hello OP! You have gotten lots of good advice here. I am just going to echo that if you are not feeling confident that it is important to do some research. Maybe you have, and are just looking for opinions, in which case here are mine:

I will be tested for GBS and choose alternative therapies or the hibiclens if I am positive. Seems simple and harmless to me. Why risk it ya know what I mean?

I will have Vit K drops on hand. You can find them on a lot of birth web sites. If you need a reference, I will come back.  Another thing that seems harmless. It is a little bothersome, that I have to pick these up, however I really like my midwives otherwise. 

Is going to the pediatrician necessary? No. However, it all depends on your comfort. Do you want to see how baby is growing? Do you want to establish a relationship with a doctor? Are you nervous that a baby could have something wrong undiagnosed by MW? If any of these are yes, then you should consider finding a doc. 

as for the eurythromycen (eye drops) they do temporarily blur baby's vision. It would surprise me if a midwife chose to use this as standard care. My guess is your MW knows you do not test positive for an STD. 

 

broodywoods, you always have great and encouraging advice. OP, read that over and over!

post #10 of 48

I think it's nice that your Midwife is letting you know that you don't have to do anything. Most women don't realize they can choose NOT to do thing that are routine.

Research what you want to do and make the decision that is right for your family.

post #11 of 48

I have to agree with all the other PP about how cool it is that your MW is letting you know you have choices.  I also agree that you need to be comfortable with YOUR choices.  Research!!

 

Here are my choices in regards to your questions:
GBS: I did this one, non-invasive, simple, not stress inducing (to me).

Vit K: I declined as my birth was not rough, baby was not 'beat up'.  We did not circ.  (I think that on average Vit K levels are higher after day 8, thus I think that is the average age for a jewish brisk?)

Eye Stuff: nope, declined as well.  No STDs over here either. 

Ped: We went once.  Because I knew that DS had 1 teste and I wanted it checked out.  Other then that, I saw no reason to take my healthy, growing, developing child to a Dr's office.  We don't vax and that is the normal schedule of WBV is also the vax schedule.

post #12 of 48

 "Why chance it if avoiding it for sure is as simple as, basically, a quick vaginal douching with a harmless cleanse? The Hibiclens has been shown to eliminate transmission at the same rate as IV antibiotics...so, what's the problem? Answer: There is no problem."

 

I am surprised to hear the claim that Hibiclens is as effective as IV antibotic (80% effective).  I thought the evidence on Hibiclens was, at the very best, mixed with a number of studies showing no preventative benefit at all.

post #13 of 48

I pretty much just do prenatals with my DEM- however I do go into the family dr for one appointment to confirm pregnancy for the birth certificate.

 

I don't do the GBS- and I probably won't ever do it again either.  

 

You don't have to do eye ointment if you are STD free- and I don't think it has any other benefit for something like plugged tear ducts.  I don't do the ointment cause I don't need to- but DS3 did have plugged tear ducts that we just couldn't get worked out without going to the dr for drops....

 

Also- Vitamin K is raise the babies clotting abilities- so if it is a low stress birth then you really don't need it unless you are cutting off parts of your baby....  

 

WBVs- are in my opinion a waste of time and money.  We do go in for a visit at about 5-7 days old to get the baby checked out by a family dr- mostly because I need him to sign a form so I can get a birth certificate :)  I have no problem going in if we need to other than that- but it seems someone always gets sick when we go to the dr- and I see no reason to go into that germ environment and shell out extra money to have the dr tell me what I already know.

 

What I think you should consider though is a PKU- I have that done at that one visit.  I don't want to sound like we never ever go to the dr- but generally between our midwife (who does phone consults anytime) and our chiro we are pretty well covered.  

post #14 of 48

I don't think you have to have prenatals with anyone else. If the DEM is not legal in your state, you may want to. When I had an unlicensed midwife, I only did prenatals with her and all was fine. Next time, I'm getting shadow care because I think it would be easier should I need to transfer.

 

I don't think you need the GBS test.  I have tested positive in 2 out of 3 pregnancies (didn't get it in the other one) and babies were fine. On the other hand you can test negative and the baby can still come down with it.  Regardless, you will need to monitor the baby for symptoms in the first couple of days.

 

I haven't done eye oinment with my homebirths. I did vitaman k with my boy because my husband insisted on circ.  We did the drops though.

 

I would not take the baby to see ANY doctor for the first 28 days of his/her life unless you have a reason to. Midwives are usually qualified to check the baby out for the first 28 days.  At that point, I'd get a recommendation from your midwife about which doctors are homebirth friendly.

post #15 of 48

What I am concerned also about, as the OP describes it, is that the midwife has not done a good job in terms of providing the information needed so that the OP can give actual informed consent with regard to these issues.  

 

Its not enough for the midwife to say that "in her opinion" certain things are not needed.  

 

With all these several hour long appointments, one would think that the midwife in question could summarize why birth attendents generally in the US choose to test for GBS, what the state of the medical literature is on GBS, what are the OP's likelihood of having a child with GBS sepsis without ABX treatment and what is the death rate for babies who have GBS sepsis.  And then summarize her basis for why she believes testing is unnecessary.

 

The fact that the information provided appears to be relatively poor would suggest to me that perhaps keeping the shadow care and having a second opinion would not be a bad thing in this instance.

post #16 of 48
I'm slightly taken aback at you reply that any midwife at all would think colostrum will cure gonnorhea or chlamydia...I refused eye ointment with DD specifically because I know for a fact that I don't have either STD and neither does my husband. The OP wasn't even concerned about the eye ointment, I assume because she also doesn't have gonnorhea or chlamydia to worry about. Colostrum could be great to simply cleanse the eyes after passage through the birth canal, which makes much more sense than the scenario you put out there.

As for vitamin K, we initially signed a waiver to refuse it with DD, but since labor lasted 36 hours and she had bruising on her forehead and temples from my pubic bone and forceps respectively, and since they cut her cord right away we asked that they give her the shot and signed a new form. If her birth had been as gentle and uneventful as I had hoped we wouldn't have done the shot, and if it had been a boy we wouldn't have circumcised so it still wouldn't have mattered.

This time around we'll take the same approach...if the birth is gentle like I hope it will be, then no vitamin K. If there are complications at all, we'll either do the shot if we end up a the hospital or drops if we're at home.

GBS testing is no big deal, we'll at least do it and find out. I was negative last time, so I assume it will be fine against is time.
post #17 of 48
Quote:
Originally Posted by Buzzbuzz View Post

With all these several hour long appointments, one would think that the midwife in question could summarize why birth attendents generally in the US choose to test for GBS, what the state of the medical literature is on GBS, what are the OP's likelihood of having a child with GBS sepsis without ABX treatment and what is the death rate for babies who have GBS sepsis.  And then summarize her basis for why she believes testing is unnecessary.

It isn't even possible to determine that until the woman is in labor. A general, "X number of babies develop GBS sepsis without ABX" is way too general, since the breakdown is so vastly different for women with different risk factors. A 40 week pregnancy ending in a 60 minute labor, in which the water breaks 2 minutes before the baby is born, with no fever or other symptoms of infection, will have a LOT less risk of GBS sepsis than a 37 week pregnancy ending in a 23 hour labor, in which the water breaks 35 hours before the baby is born, with fever in the mother. There is just much more to it than the oversimplified, GBS For Dummies version you're suggesting her midwife should share with her. I also believe there's a lot more to it than what her midwife is telling her, but the solution is not to take it to the opposite extreme. You're BOTH wrong. No one yet knows the OP's likelihood of having a child with GBS sepsis without ABX treatment. 

post #18 of 48
Quote:
Originally Posted by Buzzbuzz View Post

What I am concerned also about, as the OP describes it, is that the midwife has not done a good job in terms of providing the information needed so that the OP can give actual informed consent with regard to these issues.  

Its not enough for the midwife to say that "in her opinion" certain things are not needed.  

With all these several hour long appointments, one would think that the midwife in question could summarize why birth attendents generally in the US choose to test for GBS, what the state of the medical literature is on GBS, what are the OP's likelihood of having a child with GBS sepsis without ABX treatment and what is the death rate for babies who have GBS sepsis.  And then summarize her basis for why she believes testing is unnecessary.

The fact that the information provided appears to be relatively poor would suggest to me that perhaps keeping the shadow care and having a second opinion would not be a bad thing in this instance.

I don't disagree that the OP may not have been given enough information to give informed consent. However, just to be clear, OBs and hospital CNMs rarely or never discuss the kind of information in detail that you feel this midwife should be providing. When they do routine GBS testing, they certainly do NOT go over rates of sepsis with or without prophylactic ABX administration and let the patient make an informed decision. They say, here's the test - if you're positive, you'll need IV ABX during birth. End of story. If these providers are not providing the the patient with an explaination of basis of their belief that testing/treatment IS necessary, and they are not provoking suspicion, why would it be questionable for this midwife to behave similarly but hold a different medical opinion?

In all cases, patient informed consent will require the patient themselves seeking out this information and verifying what the provider says. Which it seems the OP is doing, and more power to her. Good luck, OP.
post #19 of 48

Every profession establishes best practices.  Over time, as the result of experience, outcomes, thought, studies, etc. a consensus emerges as how to handle certain issues.

 

So, if a large consensus of specialists in a particular field, most of whom are highly educated and trained say that "X" is a best practice, I think it is further incumbent upon those who take a differing point of view to explain their rationale.

 

I think it is fair to say that a consensus has been reached among birth care providers in the United States that GBS testing should be done and if positive, should be treated with IV anti-biotics.  While I think most medical providers can do a better job with informed consent, I think if a provider is recommending against the generally held best practice they have a higher bar to meet in terms of informing and educating their patient.

 

 "In all cases, patient informed consent will require the patient themselves seeking out this information and verifying what the provider says. Which it seems the OP is doing, and more power to her."

 

As long as this thread doesn't count for the extra information purposes....

post #20 of 48

Hmmm, lurking on HB forum waiting for a thread to sink her teeth into so she can turn it into a big long stupid fight just because she hates MWs and HB and anything that isn't rubber gloved and "peer reviewed".

 

Why is anyone even biting at this point? nut.gif
 

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