Question about Midwives :< « Back to Group Discussions

[hansigurumi]

Hello all, 

I have some uncertainties about my midwives, and I wanted to run them by you awesome, knowledgeable ladies to gauge whether I am merely being oversensitive.

First, this is a new practice that I started seeing about 4 weeks ago.  There are two midwives in this practice, both with about 6 years experience, as well as a student midwife.  I transferred into this practice from a university (teaching) hospital OB practice.

Here's the first 'red flag' (not sure if it is, but you be the gauge).  I have been going to a physical therapist since the 15th week or so of this pregnancy (I am now 30 weeks).  Earlier, the PT diagnosed me with a bad case of sciatica, did a lot of massage and gentle re-alignment, and gave me several strengthening exercises to do.  At this point, she checked to see if a pregnancy support belt would be appropriate, and when I found no relief upon wearing a couple, she concluded that the pelvic troubles that I was having weren't significantly SI joint or pubic symphysis related.  Fast-forwarding about 10 weeks to 26 weeks, the situation changed.  At this point, I needed some more intense physical therapy for pubic symphysis pain that was so bad that I was nearly unable to walk by the end of the day (serious 8/10, wanting to fall down and wail pain).  The PT worked on my adductors (which were sad and ropy and unresponsive from the developing diaphysis), gave me more core-strengthening exercises, and we began looking at benefits of wearing a belt again.  This time, I had enormous improvement with just a little bit of inward squeezing at the iliac crests, and we determined that the Mother-to-be belt would be a good option.  I wore the belt, and along with the exercises and manual therapy, the pain diminished within a couple of days.  Totally amazing.

Anyhow, when I went to my first midwife appointment, I was very happy about the belt (and the fact I could walk without significant pain).  Perhaps too happy?  Anyhow, I gushed about my wonderful physical therapist and the awesome belt, which allowed me to walk without intense pain.  The midwife and her student were both very interested in the belt, and asked me where I had purchased it, what it was called, etc.  I didn't think much of it, but at my next appointment (just this week), they asked me again about the belt and where I had purchased it.  Then, they said that they had been recommending the belt for all their clients complaining of any musculoskeletal pelvic pain (!?!).  And this is where I started to feel a little strange and uncomfortable.  Because it's one thing for friends to recommend things to each other, just based on 'anecdata', but aren't midwives supposed to advise their clients based on either 'evidence-based' or 'tradition-based' approaches?  I'm no medical professional; just because I can attest that the belt (along with manual therapy and exercises) worked for me doesn't mean that it's appropriate for anyone with back problems or a sore pelvis (as had been the case with me earlier in the pregnancy).  It seems that the reasonable thing would be to write a script for physical therapy (hopefully with a good therapist), and allow the PT to determine the cause of the pain and determine an appropriate course of treatment (involving manual therapy, exercises, etc).  At the very least, shouldn't they talk to the physical therapist about the kinds of musculoskeletal pelvic pain that would respond well to a belt, and not to one of their clients?  OK, so this totally rubbed me the wrong way.

Then, there's the subject of the GD test.  Basically, I was told that I didn't need to do it during the midwife 'interview' appointment (since I had no risk factors, etc), but was then strongly encouraged to get it done at the first appointment.  Also rubbed me the wrong way, as though they wanted to appear to give me more 'choice' than they were actually willing to give me in practice.

Finally, I am not happy with the way the appointments are structured.  The regular appointments are only half-an-hour, and my second appointment started 1/2 an hour late and only went on for about 20 minutes.  Honestly, appointments with my OB at the big teaching hospital felt more thorough than this latest appt.  During this 20 minutes, they spent the first 5 minutes advising me on my low blood pressure (nothing that I didn't already know, done by both the midwife and the student), the next five minutes giving me spiels on third trimester warning signs, and the last 10 minutes having the student take my vitals.  Anyhow, the student got some crazy low bump measurement (25 cm, when I should be nearly 30 cm), which worried me for a minute about intrauterine growth retardation and all those other scary things, until the midwife came over and corrected it (it was actually almost 30 cm).  Then, to add to the anxiety, they again did the palpation thing, and found baby's head was above my belly-button, meaning that my baby is breech at 30 weeks.  Which isn't awful (they can still easily turn at this point, and usually do turn), but for someone with high anxiety about breech presentations (my grandmother had a footling breech baby die during labor due to likely cord entanglement), I definitely needed a little more reassurance than 'Oh, you're baby's breech. She'll probably turn into vertex position in the next couple of weeks. See you next time!'  I understand that they were running late, but couldn't they offer a little more reassurance, or even an offer to call if I was feeling anxious?  

So, those are my issues.  Not huge, but they still feel like red flags.  On the other hand, I know that I am very sensitive, and I hold my care providers to high standards.  Possibly too high standards.  I'm not sure.  

I know that this post is ridiculously long, but if anyone has any thoughts about this, I would love to hear it and would be eternally grateful.  I feel crazy for already thinking about switching providers again!  

~Hansi

[springmum]

Hey - I understand your anxiety and standards, I kind of feel the same way about my care providers (midwives this time too)

Regarding your first issue. This wouldn't throw up a huge red flag for me, but it may be b/c in our area it seems that anyone with pelvic pain is recommended the belt first and if that doesn't work there are no other options (based on speaking to 2 women, both seeing an OB though) Neither one was given the suggestion of chiro, specific moves etc. It if weren't for me recommending a chiro to one of the girls she would have never known that was an option. Maybe next time you go in you could also mention  that you know they were recommending the belt to others, but you want to share how important/great physical therapy has been to make the belt work properly?

GD test - wouldn't worry me terribly either. I declined as well and my midwife was clear in saying sometimes there are no other physical symptoms at this point to go on, and wanted to cover her bases to ensure I understood what I was declining (well I'm not actuall declining since I have access to a glucose monitor- which I told her and she was happy with) I think. Remember they don't always know that we know what are declining. They don't know if some friend just told us to decline it and we have no idea what it really is, so they need to do their job and cover their bases.

Appt length/structure - sounds like it would have rubbed me the wrong way too, but nothing I would be worried about in the long run. My appts are booked for 1/2 hour, but they never take that long - I just never have anything else to bring up and doing the vitals and basic talks seems to cover everything in less time (I'm happy to know I have more time if I need it though) I never feel rushed,

I think that b/c of your specific worries why not just tell them next time that you're having some specific anxieties about things? That way they know, and it gives them a chance to maybe change how they approach things. If they don't change or just brush it off then I would be a little more worried.

My midwives aren't perfect, there's a couple of things that have rubbed me the wrong way, but nothing I feel strongly about. I know that if I'm worried or anxious about something I really have to communicate that to them so they really understand and have a chance to support me. 

I totally see why your bothered by those things. Maybe go in with a plan to communicate some of the worries you have, get a better sense of how things are going to go and take it from there?

[pastrypuff]

Sorry you aren't feeling to confident in your midwives. This is something you need to address with them as soon as you can, perhaps bring it up at your next appointment. They are not perfect its true :)  But your birth team makes all the difference in the world!

Remember that you have options and can find another midwife if you have to. But bring your concerns up and see how they respond, if their responses don't agree with your gut, think about searching for a new midwife. You are trusting them with the birth and care of yourself and your unborn child, if your confidence in them is fading then it will present itself at the birth.

[hansigurumi]

Thanks so much for your responses, SpringMum and pastrypuff.

SpringMum - Thanks for addressing each one of my worries.  Thanks for letting me know that the belt thing is pretty standard.  I had no idea; I thought you were supposed to get assessed by a PT before going with the belt.  To me, it seems that the belt is just *one* part of helping someone with their pain, and to just recommend it without recommending anything else seems like cutting corners.  But since you say this, it does make sense, and seems OK.  Or at least it seems pretty standard (though somewhat unsatisfying).  (My DH said the same thing as you when I mentioned this issue to him!)  And the GD thing - yes, I'm sensitive about this ridiculous test.  Yesterday, I had to wake up at 6 am to go to the clinic at 7 am to do a 3-hour blood test (fasting, then glucola, then three more draws).  It was pretty awful, especially because I tend to have very low blood pressure in the morning, and drinking that awful glucola made me feel really nauseous and light-headed.  At least it's done with, and if I need to have a hospital transfer (heaven forbid), they will be reassured that I haven't grown a huge baby.  And finally, the structure of the appointments issue - I will definitely talk to them about that.  I hear you that this is probably the only *real* issue, and that it is an issue that can be addressed.  Actually, I am going to go ahead and e-mail the mws about my concerns and let them know that this structure does not work for me. I'd rather begin with the vitals, and if there's anything to be concerned about, I'll have my allotted time to ask questions and talk through my worries.  Sending you virtual {{hugs}} for your reply!  Thanks so much.  And it's good to know that having a *few* concerns is OK, as no one is perfect, and issues will come up.  I think I expect my caregivers to be perfect, which is (of course) too much to expect.

pastrypuff - Yes, I will go ahead and voice some of my concerns, particularly about the appointment structure issue.  The biggest worry for me here is the fact that the appointments are so short, and since I have just started with this practice, the appointments don't give me enough time to get all my questions answered.  And, of course, the weird format of doing all the measurements at the very end, so that I don't have any time to ask questions about anything seemingly 'abnormal' is just strange to me.  I would also like to ask them about their full protocol for what approach they take to breech presentations at 30w, 32w, 34w, 36w, and at term.  Obviously, the 30w answer is 'nothing' (no mention of spinning babies, etc., even though a smaller baby is easier to turn than a larger one).  Honestly, I don't want to end up being dumped at the hospital at 38w with a breech baby, where the policy will be mandatory c-section, no possibility of a trial of vaginal birth.  I would like to get my cards in order, earlier, if I have to.  There's a hospital a couple of hours from here where there's an OB that has experience in vaginal breech births, as well as a few midwives who have some breech experience.  I want to make sure that they will be referring me to the right people and places, if it comes to that.  

[hansigurumi]

Just an update.  Here is the message that I sent.  Hopefully, I've written it well and it's not too bitchy.  And hopefully it will help!

Hi ___,

Hope you are well.  I have a couple of concerns from my last visit with you this Tuesday that I'd like to air.  

First, I would really prefer that we take the weight/belly/BP measurements and position assessment at the beginning of the visit, rather than at the end.  That way, if there are any concerns that come up (as did last time), there will be a good 20 to 25 minutes to talk about them.  During this past visit, I honestly felt like there wasn't enough time to have my worries about my baby's position (possibly breech) adequately addressed during the visit.

Second, I would prefer that either you or ___ [the other midwife] take the belly measurements before the student midwife.  Last time, it was very anxiety-provoking for me to hear that my uterus hadn't grown since my last visit, as assessed by the student midwife.  I appreciate that this assessment was corrected, but I would prefer not to have to go through this type of stress.  I have enough stress in my daily life!  

Third, I would like to know what your policies are regarding breech presentations at 32w, 34w, 36w, and term.  I would like to know what treatments/practices you would recommend (if any) at each of these times to encourage baby to turn to a vertex presentation.  I would also like to know if you have any specific practitioners to whom you would refer me if my baby refused to turn by 38w.  If you have no other recommendations other than UW hospital for a term breech (where the policy on breech is mandatory C-section), I will know that I'll have to do my own sleuthing to find practitioners elsewhere experienced in vaginal breech births.  This is sleuthing that I'd rather start now than when I am term.

Finally, would you be able to send me a quick text to let me know when you are running half-an-hour late in clinic, as you were this past time?  I would also appreciate having a full half-an-hour appointment, rather than the abbreviated 20-minute appointment we had last time.  If you need to re-schedule me, that is fine.

One more thing - I would prefer to be seen every 2 weeks (rather than every 3) in the third trimester (as is customary for most forms of prenatal care).  Particularly with my worries about a possible breech presentation, as well the fact that I have just recently transferred into this practice and will likely be giving birth in 2 months, I would prefer to be on the 2 week schedule.  

Thanks for listening to my concerns.  I hope that we can come to a mutual understanding about these issues that is agreeable, and that allows for a strong, continuing patient-care provider relationship.  

Sincerely,

~h

[JoyofBirth]

I'm posting without reading other responses to give my personal opinion. Sorry if I missed info or repeated what others said. I was a student midwife before having kiddos. So this comes from being on the other side. First of all, I want to say if you are uncomfortable with the midwives then it really doesn't matter if the "red flags" are really red flags or what anyone else thinks. What really matters is that you feel comfortable with your care providers. If you need to switch 12 more times before October to find that, then so be it.

With regards to the glucose test, be up front. Say you told me a at the interview and now you are telling me b, why did this change? Keep asking questions until you feel better. I remember my midwife and I sitting with a client for a half hour explaining one thing over and over because she didn't understand. A good midwife isn't bothered by this and wants her clients to understand. Also, I have had clients ask that I not be present. It didn't hurt my feelings because I'm not important, that mama is and I understand that not everyone will feel comfortable with me. So if you feel uncomfortable with the student performing vitals or even just being there, don't hesitate to express that.

With regards to a breech baby at 30 weeks, it's very common. And baby's usually change positions a lot until they settle in. Did you express your concern over baby being breech? And perhaps add the why? What was the reaction there? To a midwife, a breech baby, even at full term, is not necessarily cause for panic. We have several around here who will do a vaginal breech delivery. We have at least one doctor that will do a vaginal breech, though it is becoming very rare and unheard of.  Did you express that you needed more time? With midwifery care, it is very different. The client is responsible for their care, which is why most people choose it. Please be assertive and make your needs known.

As to the recommendation of the belt, it's a little odd that they're recommending it on one referral, but not too far. It's not a medication or herb, so it's not likely to cause harm. I really wouldn't have a problem with my midwife or even dr  telling me about a product that I could buy on my own that worked great for another client. That's how a lot of products become known. And it is possible that they researched it online some and decided it was worth recommending. Also, unless this midwife is a CNM, then they can't refer to a PT, so they have to come up with alternative methods, such as a belt.

[hansigurumi]

Thanks so much for your reply, JoyOfBirth.  I really appreciate having your perspective.  I spoke to the mw after sending the e-mail message (see below).  However, I *really* like your idea of making requests regarding the student mw's participation in the appointments.  During my pregnancy with DS 6 years ago, the mws had a student assistant, but the appointments were very long (1 hour), so there was plenty of time for the student to be poking and fumbling around (not to mention that I was a naive first-time mama then, without the same history of loss that I have now); plus, that student was really quite exceptional, and I really liked her and her manner (she is, in fact, one of the mws in this current practice that I'm in!); now, with these shorter appointments, I would prefer that the mw conduct the care, not the student, particularly when the student is fumbling around.  Perhaps I can request that the student just observe the appointment, rather than actually participate.  I think I will send a second e-mail message to request this.

Update, 7/28: Had a phone call with the mw yesterday, and she was able to agree to all my requests, and to describe their position on breech births.  Apparently there are two CNMs in the area that do perform vaginal breech births, and to whom they would refer my care if my baby hasn't turned by 37 weeks.  So, I don't feel like I'll be totally abandoned if my baby ends up breech.  All in all, good communication, which resulted in a good outcome.  Thanks so much to all who responded for helping me decide to communicate, rather than abandon ship!

[JoyofBirth]

I also wanted to add that I hear a lot of fear in your posts. I had a loss at 22 weeks with my first pregnancy, so I completely understand this. I read this book Birthing From Within and did some of the exercises they recommended and it helped tremendously. I'm thinking about going through it again as I have some fears with this birth associated with my last birth. It's very helpful in dealing with past issues so you don't carry them into this birth. You might look into it. And I'm not saying that anything you've said here isn't valid or anything like that. Just that I am sensing some fear that you might want to release.