Letting go of plans for a midwife birth « Back to Group Discussions

[eleuthia]

The birth center called today and they are transferring my care to OB due to my succenturiate placenta/velamentous cord insertion. I was prepared to have one of the midwives attend my birth in the hospital (w/ doctors available if needed) instead of the birth center. I wasn't prepared to have to find a new provider at 32 weeks. They can refer me to their consulting OB practice - those docs deliver at the same hospital (which actually has 2 midwife practices that deliver there, so hopefully they are accustomed to natural birth). Or I can somehow choose from 4 urban hospitals/countless suburban hospitals and a bajillion doctors.

I'm pretty upset. I love the care I have been getting at the birth center - their hours are convenient, the midwives are almost always reassuring, I never have trouble with anyone getting back to me if I leave a message, and everyone who works in the office is pleasant. And I trust them. My experience with OB/GYN offices in the area has been pretty shitty - not so much the practitioners (many of whom I like) but the office staff. They are often incompetent and just plain RUDE and I end up getting rude right back and it stresses me out. So now I have to try to find a practice with a staff that won't give me hypertension AND I need to find a doctor who will actually listen to my wishes for as natural a birth as possible and who believes I should get to make decisions about my care AND I need to find a hospital with nurses who will treat me like a person rather than an inconvenience. 

I'm going to try to find a doula as soon as possible and hopefully she can give me some insight into my options for hospitals and doctors. It's too overwhelming for me to figure out on my own.

I totally trust the midwives' decision and I understand it and I might've chosen to transfer out on my own anyway, but I still feel like I got KICKED OUT for having a crappy placenta. Not a good day to be out of ice cream... though I can order cheesecake delivery (and I guess dinner too).

I know that pregnancy, birth & parenthood are pretty much a constant exercise in surrender. It sure isn't easy, especially when it comes to the things you think you get to hang on to! I'm really grateful to every mama I know who has prepared me for it just a bit by sharing stories of things not going as planned (& surviving to tell the tale). 

[Sol_y_Paz]

I am so sorry.  

[1stTimeMama4-4-10]

This is discouraging, I'm sorry that you are just dealing with this now.  Why didn't they make this decision sooner?  Did they just find out?  

Best of luck finding another provider - are the OBs connected to the midwifery group you use not a good option for you?  A doula (or group of doulas) or a really good childbirth educator would probably be able to help point you in the right direction to find another practice that will delivery you in a hospital but still be supportive of your wishes to the extent that they can medically.

[eleuthia]

The placenta/cord issue was just found on ultrasound on Tuesday. I had the ultrasound for unrelated bleeding (I have a cervical polyp and the u/s was just to rule out another source). I do think it's better that I know, but if I had declined the ultrasound or if I didn't have the (harmless) polyp... they wouldn't have reason to transfer my care and things would most likely have been fine! I am sure they deliver women with my placenta &/or cord issue without knowing it ahead of time. But I bet it is frightening when they discover it after delivery of the placenta or if it causes a complication during labor. 

I found a childbirth class we can attend next weekend and I am hoping to secure a doula very soon. I'm hoping they can help me choose a hospital and OB. I may end up going with the hospital where the midwives take transfers & with their consulting OB's, but I want to see what other options are out there as well. 

[ilovetchotchkes]

If your childbirthing class is something like bradley, ask your teacher for recs too. 


This stinks hon! I'm sorry this is happening to you. There ARE women who have fabulous natural births with OBs- (Check out the "Thoughtful thursday" on "My Ob said WHAT?!?!" ) it'll just be a bit more of a challenge because you're educated. That scares some docs, and impresses others. 

What area are you in? If its Chicago, I can recommend an amazing one who is VERY natural birth minded who i've heard from multiple people is amazing. - She's the back up for my midwives. My sister in law ended up having to have an emergency C-section (she had the same midwives as I do) and she said that despite losing her natural birth Dr B was incredibly kind to her and awesome. 

[eleuthia]

I heard back today from a doula who is going to help me with recommendations and hopefully meet with me soon for a consultation, so I'm feeling more confident that things will work out ok. I know there are good OBs out there - heck, even the perinatologist who did the consult and said he'd urge me to have a hospital birth also said he thought I'd go to term and definitely don't automatically need a c-section, and my questions engaged him rather than put him off (though if I'd known more about succenturiate placenta/velamentous cord insertion at the time, I would've asked a lot more). 

Unfortunately, I'm not in Chicago (it's probably where we'll move within a few years, since it's 3 hours away from my family instead of 12). I'm in Philadelphia, where there are a bunch of big teaching hospitals in the city and more small suburban hospitals than I even know about. And of course, tons of doctors. 

Yesterday was lots of tears and felt like dealing with a sudden breakup. Today is going to be spreadsheets and a thousand tabs open on my browser and research. 

[monkeyscience]

I don't have any good advice or anything, but I wanted to give you a virtual hug! I can see why you feel like you got dumped, and that is rough. I would feel upset to lose out on my birth center birth, too, even if I thought it was the best for my baby. (And who knows - I still could!) I'm glad you've got a doula to talk things over with, and hope you find an awesome OB - like you said, they are out there!

[Mama Chickadee]

Also, go to the "finding your tribe" section on MDC for your area - usually lots of good recommendations there.

[ithappened]

I'm sorry.. this sort of thing is really rough, its happened to me twice this pregnancy already. First I got booted when I the homebirth midwives found out I was having twins (none of them will do homebirths here for multiples) and the second time was just a few weeks ago by my OB. I was really upset when I found out I was going to have to give birth in this big state hospital with doctors/midwives/nurses I never met and who did not know me or even seem to care when I called their floor at the hospital.. it was really discouraging, esp when it happens at week 30 something.. anyhow- I'm sorry.. I wish I was there to give you a big hug.. it sucks I know.

I know that pregnancy, birth & parenthood are pretty much a constant exercise in surrender. It sure isn't easy, especially when it comes to the things you think you get to hang on to!

This is very very true. I also remember someone telling me how the birth is like a wedding, and how the marriage goes after the wedding is what really matters- the wedding is just a day, the marriage is the lifetime and I find this very true (at least for me). I remember being so focused on a home birth with DS1 and I thought the world was going to end when I found out I had to go to a birth center/hospital for his birth- I was upset the majority of my pregnancy but in the end, did it really matter how he came out? No. .. Did the birth go perfect? No. Was he and I more or less healthy/happy/etc once it was all said and done- Yes. . . and does how he came out or where really matter almost 3yrs later? Not really. All I remember about the birth was him coming out and being handed to me (that and really being hungry as soon as labor was over )- the music I brought, the way the lights were on or off or what my DH was doing I just don't remember much at all, and to think I put so much time into it beforehand.. .

I realize this is not the status quo on MDC and probably a lot of women do remember every detail- -  I just feel in the end, the things that matter the most- if its a homebirth or a csection or whatever is that you feel you are in control of the end result, that everyone comes out healthy, and that we remember that in the end we have a lifetime with these kids and all that will matter is how we treat them as families for the next 60-80 years.. the birth is one thing but the life is so much more important in the end..

[1stTimeMama4-4-10]

Originally Posted by ithappened 

All I remember about the birth was him coming out and being handed to me (that and really being hungry as soon as labor was over )- the music I brought, the way the lights were on or off or what my DH was doing I just don't remember much at all, and to think I put so much time into it beforehand.. .

I realize this is not the status quo on MDC and probably a lot of women do remember every detail- -  I just feel in the end, the things that matter the most- if its a homebirth or a csection or whatever is that you feel you are in control of the end result, that everyone comes out healthy, and that we remember that in the end we have a lifetime with these kids and all that will matter is how we treat them as families for the next 60-80 years.. the birth is one thing but the life is so much more important in the end..

I feel this way too.  With my first pregnancy, I was so desperate to protect my perfect birth that I contemplated some fairly dangerous things like stopping all prenatal care and signing myself out of the hospital against medical advice when I was at high risk for pre-eclampsia. At the time I was utterly convinced that I was fine and that the doctors were all overreacting (my BP started to spike when I was 41+3). They wanted to induce me and I just wanted to wait until I went into labor naturally.  Thankfully we were able to reach an agreement because my BP went down overnight while I stayed in the hospital (with a failed induction).  I did a 24 hour urine collection and my midwives let me go to 42 weeks before being induced because the urine collection showed no protein (I went into labor on my own at 41+6). 

But I wonder - would I really have listened if they told me I had to come back to the hospital after the 24 urine collection?  I think I would have, but I am not positive.  Then I ended up with a 36 hour labor and failure to progress even though I labored at home for 20 hours, labored at the birth center for 8 hours, and did everything right. After 28 hours, and 4 hours @ 8cm in transition, I couldn't do it anymore.  I transferred to the hospital and had an epidural and pitocin and an IV. All things I had been so deeply opposed to.    

Afterwards, I reflected on the experience trying to learn as much as I could from it. One of the things I learned was that the first lesson of parenting is that I'm not in control.  The second is that no matter how my daughter came into the world, she is here now and she is healthy and whole, and truly, that actually IS all that matters.  I didn't remember or care about anything that happened during labor except that we were both here and safe.  

I am in no way minimizing losing the birth you wanted - that is a loss and you have to grieve it.  But for me, the cliche about how all that matters is a healthy baby actually rings true now. It wasn't before I became a mother, but now that I have my daughter, I would have gladly gone through anything to get her here safely. 

At 18 weeks I was diagnosed with a single umbilical artery.  It looks like everything will be fine, but I have come to terms with the fact that if this baby struggles during labor AT ALL, I am not going to protest a c-section for one minute. It's not my first choice of course, but I am at peace with it.  I hope very much that you can make peace with your current situation - your feelings of loss are totally natural though, and you need to give yourself the opportunity to mourn for what you can no longer have.  It will all turn out fine when it's over, but for the next 6-10 weeks, be gentle with yourself.

[ithappened]

At 18 weeks I was diagnosed with a single umbilical artery.  It looks like everything will be fine, but I have come to terms with the fact that if this baby struggles during labor AT ALL, I am not going to protest a c-section for one minute. It's not my first choice of course, but I am at peace with it.

Yeap. I'm in a similar situation with my twins and realizing I will likely end up with a c-section due to baby A being in a really nasty transverse position still.. . I realize the c-s is not my first choice, its not even my second or third but given the circumstances it might be my only option and I have come to terms with that- and almost peace-- even if I feel some disappointment I realize it is in many ways not in my control.
 

[eleuthia]

Thank you so much for the support and for sharing your stories. It is really helpful to hear that having a healthy baby really is what matters. 

I think what I am struggling with is the sort of heavy-handed messaging that often comes from the natural birth community. A lot of it is really valid on a macro basis - c-section rates *should* be lower and the typical interventions are often not medically necessary & can do more harm than good. But on an individual level, hearing those things just really sucks when you are not low-risk and CAN'T choose to have no interventions. Like all of the talk about trusting birth and pregnancy not being a disease... how does that apply when something abnormal comes up? I'm not going to just trust my body & ignore medical evidence to the point where my baby is harmed.

And I think I am less attached to how this baby comes out than to what happens immediately afterward. I don't want to be separated unless there's a true medical need. I hear stories of women who don't get to see their babies for 3 hours or 12 hours or more than a day and I would have a really hard time with that. I think this is most likely to happen if I need a crash c-section with general anesthesia, and I don't know how likely that scenario is for me, but I sometimes think I would rather avoid the possibility by scheduling a c-section or at least having an epidural during labor so GA wouldn't be needed. I also think an epidural would be useful if there are problems with delivering the placenta and it needs to be manually removed (which pretty much involves a doctor's hand up in the uterus, and I can't imagine how awful that would be if I could feel it). I don't like the idea of having a vaginal delivery with an epidural by default, but maybe it is a good compromise. I might be much more relaxed if the worry of GA was removed. 

[KristyDi]

I just wanted to offer some empathy.  Totally different situation, but I'm changing providers at 32 wks too (we're moving) and it's really overwhelming and a bit scary.  Here's wishing us both a smooth transfer and peaceful birth.

[Ninetales]

Oh, that does suck.  :(

I'm very much set on doing everything I can to make a VBAC happen, but I'm trying to keep my mind open to the possibility that I may have to ask for a c-section if things go the way they did with Elsa.  I so hear you on the heavy handedness of the natural birth community.  If I hear "oh, don't worry, your body won't grow a baby so big it can't birth it!" I'm going to scream.  Sure, that's true the majority of the time, but it HAS happened to me.  And I'm not committing to natural birth no matter what just because of trust in my body.  When you're talking about a baby that is 12+ lbs I feel that is a lot to ask.

Your perspective is very good, and I'm sure with enough research you'll find someone who will work well with you to get the best, most positive birth you can get.  :)

[1stTimeMama4-4-10]

Originally Posted by Ninetales 

I so hear you on the heavy handedness of the natural birth community.  If I hear "oh, don't worry, your body won't grow a baby so big it can't birth it!" I'm going to scream.  

I wish this weren't the case, but it totally is.  I still feel some shame when I talk to my friends who had totally natural births.  One had a homebirth in the birthing pool that was PERFECT, another had an UC that was also perfect. When I talk about my experiences and how it came to be that I willingly transferred to the hospital for pain relief, it feels as though they silently disapprove.  They have never said anything to make me actually think that, but the whole natural birth community - including all the books and articles I read prior to labor - has a big blind spot when it comes to necessary interventions. It makes it that much harder on the moms who WANTED a natural birth, and worked as hard as they possibly could to achieve it, but for one reason or another were unable to have a natural, intervention free birth. I know that I need to overcome this and be proud of how far I went on my own (28 hours of double and triple peak contractions without any pain relief, all on only 2 hours of sleep in 42 hours), it's hard when I feel like I still came up short. 

The thing is, it's not about what anyone thinks of you. The primary reason to have a natural birth, at least in my opinion, is to bring your child into the world in the way that is safest and easiest to recover from for BOTH mother and child. The reason I want to avoid interventions is that I am fearful of the cascade that can end in an unnecessary, avoidable C-section.  But when it is a c-section is NECESSARY and will legitimately be the safest way to bring your child into the world, there is nothing to feel bad about. I think this is a major failing in the natural birth community.  

[rebecca10]

Eleuthia--I'm so sorry to hear this.  That's tough. But it does sound like you have a really great attitude about it.  And as tough as it was to hear from your midwives, it seems like having people who aren't comfortable with the situation deliver your baby would not be good at all, so I'm sure it came from the best intentions to tell you up front.   

I totally hear you on the natural birthing community. I'm all for natural birth, but sometimes I think people lose sight of the fact of that modern medicine has done amazing things in terms of decreasing infant and maternal mortality, and the fact that we have it there when things do go wrong is a huge, huge blessing of living when and where we do.  With my first, she was transverse until 39 1/2 weeks, so I had to do a lot of coming to terms with the fact that I would probably need a c-section (in the end she turned, so I did have a vaginal birth).  I definitely mourned the loss of the birth I wanted, but I also did eventually get to a place of appreciating how lucky I was that if she stayed transverse I could have a c-section, since the alternative might so easily be tragic.  And in the end, when I got the vaginal birth I wanted, it felt absolutlely perfect, even though I did end up with some interventions, most notably pitocin. I think the trick, like I think a pp mentioned, is to feel in control and empowered, so that you are the one making the final decision about what is right for you (with of course the advice of doctors, midwifes, etc).  If you do that, I think you can have a really positive birthing experience no matter what interventions you end up with.  And I think you are totally right that you need to think about what is right for you, not just in the abstract about what might be best for someone else, and if that is an epidural to avoid the risk of GE, than, that is a perfectly valid choice. 

[eleuthia]

So I'm 34 weeks and still don't have a doctor or know where I'll be giving birth. I have a doula and she gave me suggestions/advice on this, but the problem I am running into is that no one around here wants to take a late transfer. I've had people imply that I should just show up at the hospital in labor. Well, that's great, but I need OB care in the meantime! And it's possible that the safest thing would be an early induction or c-section, but I won't know that until I can talk to a doctor. It is making me pretty angry that my health & safety and that of my baby seem to be of little concern to these doctors, I assume because caring for me & *preventing* a tragedy puts them at risk of being involved in something tragic due to my diagnosis. Like, one maternal fetal medicine practice doesn't take transfers after 30 weeks - and they are high-risk specialists! I still have more practices to call and follow up on, but... I work full-time during business hours and have 0 privacy to make phone calls, so it's taking me a long time to even get ahold of anyone. 

I am still seeing my birth center midwives until I find a doctor, and things seem to be fine, but they do not have the expertise to manage my condition, sooooo... I do not feel like I'm getting the level of care I need. And that scares the crap out of me. 

The OB practice the birth center works with does have to take me, but they are far from home and aren't going to have late appointments like the birth center, so without a car that could mean taking a significant amount of time off work. Time that I want to spend with my baby! And the hospital is also far (1/2 hour driving without traffic, could be more than twice that in rush hour, plus the time to find a cab who will take me if I go before my sister gets here with her car) which seems risky given my situation and how quickly things can start to go wrong. And if I had to go separately from my partner, it's possible he could not make it there in time. Plus it would be a hassle if the baby or I needed to stay for an extended time. And apparently the nurses there are shitty and some of the doctors in the practice are not great and it's going to be more difficult for me to have the kind of post-birth experience that I want. Knowing all this, I really don't want to give birth there; I think it will just put me in a state of stress which isn't going to help at all. But I may have 0 choice about it. And that just sucks. 

I feel like I am worrying almost constantly about the worst case scenarios or having hospital staff do things to the baby (or me) that I don't want (like giving bottles/formula, not helping with breastfeeding, separating us for routine reasons, etc.). I already have potential breastfeeding challenges (flat/inverted nipples & PCOS so supply concerns) and I'm really anxious about having to also work *against* the nurses to make sure they don't make things more difficult. I don't know how to prepare for that really. 

[1stTimeMama4-4-10]

I would go in late to work one day and call every practice in your area. And I would do it this week. It sounds like you really need a new practice.

[eleuthia]

I left work early last Monday to do that and only got in touch with two practices. And then didn't hear back from them, so I called one on Friday on lunch (and then had to take their return call from my desk, which I'm not supposed to do) to be told "nope". So far I've had to get my records sent to the practices that would consider me, which means calling the birth center to send the records and then waiting til they've reviewed them. So I really can't just get it done in a morning. And I only have a limited number of vacation days left, which I am going to need for appointments (and heaven forbid if I get sick after I return from leave). Also, since this is a holiday week and people are already on vacation, I will not be allowed to even take vacation time without penalty.  I feel kind of screwed.

I'm kind of disappointed that the birth center isn't doing more to get this done; they are happy to send records when I ask, but I think more practices would consider me if they were getting a call from a midwife versus some random pregnant lady. They seemed surprised that I'm having trouble finding anyone to take me. Maybe most women just go with their doctors? But it really just doesn't seem like the safest/best option for my situation. And the clinical director seemed kind of annoyed that I decided to look for a different provider after I'd said I would like to be referred to their doc - and this was after it took me calling back a week later to even set that up because she was too busy to call me when I left a message?? This really shouldn't be taking this long, and I'd think if they really can't  be responsible for my care, they would have some sense of urgency about getting me transferred, especially if my chances go down the farther along I get. But I guess if they are only obligated to transfer me to their OB, then... why would they do any extra work to help me find someone else? Again, I feel like no one who can do anything about it gives a shit about what happens to me and my baby as long as they're not liable for it. 

[midstreammama]

Originally Posted by eleuthia 

I left work early last Monday to do that and only got in touch with two practices. And then didn't hear back from them, so I called one on Friday on lunch (and then had to take their return call from my desk, which I'm not supposed to do) to be told "nope". So far I've had to get my records sent to the practices that would consider me, which means calling the birth center to send the records and then waiting til they've reviewed them. So I really can't just get it done in a morning. And I only have a limited number of vacation days left, which I am going to need for appointments (and heaven forbid if I get sick after I return from leave). Also, since this is a holiday week and people are already on vacation, I will not be allowed to even take vacation time without penalty.  I feel kind of screwed.

I'm kind of disappointed that the birth center isn't doing more to get this done; they are happy to send records when I ask, but I think more practices would consider me if they were getting a call from a midwife versus some random pregnant lady. They seemed surprised that I'm having trouble finding anyone to take me. Maybe most women just go with their doctors? But it really just doesn't seem like the safest/best option for my situation. And the clinical director seemed kind of annoyed that I decided to look for a different provider after I'd said I would like to be referred to their doc - and this was after it took me calling back a week later to even set that up because she was too busy to call me when I left a message?? This really shouldn't be taking this long, and I'd think if they really can't  be responsible for my care, they would have some sense of urgency about getting me transferred, especially if my chances go down the farther along I get. But I guess if they are only obligated to transfer me to their OB, then... why would they do any extra work to help me find someone else? Again, I feel like no one who can do anything about it gives a shit about what happens to me and my baby as long as they're not liable for it. 

Eleuthia- I don't think I'd ever met anyone in a similar situation as mine. I can completely commiserate with you.

When I was 9 weeks I made an appointment with the birth center. Went to the first appt, told I needed to transfer to one of their ob practices because of my medical history within the past year or so.

Well, my very first birth was a very traumatic birth for me, in a hospital. So it took me 10 weeks or so to get up the courage and guts to make the call with out feeling like I was going to pass out. I called the first practice and was told that because I didn't have prenatal care consistently, I couldn't transfer there...this makes no sense to me. Couldn't I just submit to their bloodwork and tests and junk and if anything came up wonky then they would transfer me to material fetal medicine? Idk. As it is, the mfm department at this particular place is the one that traumatized me so bad before, I won't go back there.

The second practice, I thought would take me..but when I explained my situation the nurse on the phone said that he pebbly wouldn't take me because I would "question his judgement" and that they have had problems with us "birth center transfers" before..ummm, yes, I will question your judgemeNt..and every other doctors for that matter, ob, midwife or not. That is just my nature...bite me.

I began asking my chiro to at least set eyes on me once a month and he attempted to get two or three practices to at least see me once..all declined. So, I decided if I felt like it I would go to planned parenthood and just get an ultrasound to make sure baby is head down..

I feel so stuck. The only place anyone wants to send me is the one place I refuse to go. It was just too crazy. I feel like, and I have articulated this many times, more healthy this pg than any of the other three. I have less swelling this time I'm eating better, exercising more..generally taking care of myself better. I am at peace if I just so happen to deliver at home..I'll be prepared for that.

I just can't believe that these drs are so , idk the word. Like you said,.if they were so concerned because every time I call I get oh my you need to be seen, but, oh no not here, somewhere else...you would think they would take me with a drs referral. I guess not.

I'm also pretty darn close to you geographically, I wonder if it has anything to mdo with this area or if it would be like this everywhere.