Advice? Maybe someone being in the same boat?

[alaskanmomma]

I'm seeing a midwife, and I like her, but I -really- am gravitating towards a UC, just what feels "right". My midwife won't continue care with someone planning an UC, so I'm kind of thinking of making it look like an "accident" and calling her afterwards so she can check me out. Regardless of her making it to the birth or not, she gets paid for the labor and delivery portion anyway so I'm not short changing her pay-wise.

I don't feel comfortable not getting prenatal care for the duration of my pregnancy or not being checked out afterwards to make sure all looks good, but really don't want anyone there besides me, kids, and DH for the birth part of it all..anyone been in this boat before?

[blessedwithboys]

Not that exact boat but one like it...

I was seeing CNMs with ds2 and instead of just smiling and nodding and then asserting myself in the hospital, I was more open about my VBAC birth plan desires.  They fired me.  I have wished every day since then that I had just kep my mouth shut.

So, in your case, I would do just what you described.  I'd have an accident.

[Voondrop]

You might ask some feeler questions to see how hands off the midwife is first. Has she attended any births where she just sat in the next room? There are some like that, though she'll likely want to listen to heart tones every 15 or 20 min. We're renting a doppler so we can do that ourselves. Or just call her late depending on how far away she is. I tend to vomit around transition so that's when I would call if I were wanting that kind of delayed back up/ post partum care.

I'm semi-comfortable w/ no prenatal care. This our 4th & for our home birth my midwives would have me pee on the strip, take blood pressure, weigh, & measure the fundus & spend a lot of time talking. Which was great! I really like them but it kind of felt like I was buying friends & I can do all of that myself. I've ordered a pack of the protein/ glucose strips, & the pharmacy has a blood pressure cuff. The 20% of prenatal care our insurance doesn't cover still amounts to $500.00, which is over half of our monthly income so we're doing it ourselves & should a complication arise, I guess it's off to the county health dept. I go. I've never had post-partum issues & should something life-threatening arise (ie. a fever, excessive bleeding) I'll go to the ER. A bigger tear & I'll call & see if my GP can handle it. She's one of the few female practitioners in the area & I am very much against being naked (even at my least attractive) in any sort of setting w/ a male if it's avoidable.

[queenrilly]

Definitely go with an "oopsie" or find a midwife you like that won't drop you.

I've thought about getting insurance back and going back to my Dr from last time because I love her. But I'm content with foregoing the prenatal care honestly. I think if you want prenatal care there should be no excuse for her not to give it to you, or someone not to, you know? I think it's selfish of her. Soemtimes it's a law thing too, they don't want to be sued by anybody, you or the state.

I don't like the idea of paying that lady for something she won't even be doing, but I'm really cheap lol.

[Peppamint]

As a midwife, I had a client who kind of wanted a UC so we agreed that I would hang out in the other room and listen to FHT periodically.  In the end, I was handed a video camera and took video while she caught her own baby.  I was more than okay with that, but I would not be okay with being deliberately left out of the loop.

If your midwife has made it clear she doesn't attend UC, it is not fair to intentionally plan one using her as your backup IMO.  Midwives are expected to meet certain expectations and I think the same can be said of the birthing mother.  

FWIW, I only posted in this forum because this came up in my Google Alerts.  Your midwife could be held accountable for the outcome and her licensure could be in jeopardy- which could mean she might not be able to serve the mothers who actually want her presence.  Let's not muddy the waters with intentional lies.

JMO

[prone_to_wander]

I agree with peppamint. I'm a student midwife and what you're suggesting would put the midwife in a precarious position legally and ethically.

Why not talk to your midwife about what kind of birth you would like. If you want her to be hands off, then I'd talk to her about that.

[salr]

Not in the same boat, but:  Have you looked around for someone who's more hands off/ UC friendly?  Maybe there's a midwife or doctor who would fit your needs better? It sounds like maybe you don't want even "hands off" but you want to have no outside presence there?  What is it you are hoping to gain from the prenatal care?

The only thing I can see that would put her in a tricky situation is if you waited a long time to call her and ended up calling her if something was wrong.  She may be afraid to have one foot on each side of the door, so to speak.  When it comes down to it though, I think the most important thing is for you to have your needs met.  I believe that is what will generally make things safer.

Have you personally talked with your midwife about UC and found out her policies/feelings on it?  If you have an oops after already talking about how UC makes her uncomfortable that seems kind of... awkward.

[lovebeingamomma]

I am hoping for, but not planning, a UC.  I will be calling my midwives towards the end of the labor, and when they show up they know I want them to be hands-off.  That's really the best you can hope for when hiring a midwife.  The question I would ask yourself is why you are not comfortable skipping pre-natal and postpartum care but you ARE comfortable with skipping birth care.  To me the birth is statistically the highest risk.  Personally I would rather skip pre and post care than birth care.  Things happen that require immediate attention, like true shoulder dystocia, severe hemorrage requiring the administration of pit or miso, or the baby requiring oxegyn right after the birth.  These are things you can't handle on your own (unless you were prepared for all these things, but that takes time, money, research, not to mention mental energy!) wouldn't it be nice to not worry about these things because you have a midwife there?  That's why I hired one.  If I have a true accidental oops however, that would be perfectly fine with me! 

[salr]

Those things the PP mentioned as far as risks go, are something to think about when deciding if UC is for you.  I won't encourage you to get a midwife for those reasons, OP.  I believe there can be significant benefits to just a straight up UC.  But I don't think the PP is incorrect in what she says and I respect her wishes and experiences as well as yours.  

I hope you get some BTDT advice.  Your problem has me thinking, but all I can come up with is that it sucks that you even have to deal with this and can't easily get what you want.

The only suggestion I have is to keep considering what your desire is for prenatal care.  If it's clinical stuff, a lot of that you can do yourself.  If it's emotional, a good friend or doula might be able to help.  It seems like doctors and midwives are way more in favor of just giving a newborn a checkup than they are giving a gal just prenatal care.  Maybe you could drop your midwife and she'd be cool with doing a newborn exam, or maybe there's another kind person who does that kind of thing.  It might make a difference if you wanted someone to check on the baby right after birth or if you just wanted to take the baby in someplace to get checked whenever you felt like leaving the house. 

If you know your midwife can be really hands-off and that sounds OK to you, that might be a really good solution for the birth! 

Good luck and best wishes!

[1babysmom]

I'm in your DDC so I may have mentioned this stuff before.

I was wondering, like the PP, what your reasons for wanting prenatal care from a "professional" are?  Just trying to get a feel for what you're looking for, specifically.

Something I realized after my first UC/mostly UP (I had a MW for several prenatals after 20-some weeks, but I still did most prenatal care myself) was that when I do my own prenatal care, I actually do a much more thorough job than the providers I've had.  I know my body better than any "outsider", and I am able to gauge changes more accurately and quicker than someone else would, plus I have the advantage of intuition without having to fight to be taken seriously. :)  I do my vitals, urinalysis, measurements, weight, BGL's, FHR, cervix checks late in the game (not out of necessity- but am able to if needed, but mostly because the process fascinates me and why would I want to miss out on that? ;) ), etc.  We schedule an ultrasound for about 33 weeks each time (so before baby is "too big" to get a fair look at everything) just to confirm things like placenta placement and such...kind of our "go ahead" for UC, which I know many don't feel necessary, but I enjoy it.  I do have to have my thyroid bloodwork done during this pregnancy (haven't in the past) but that is easy to accomplish.  I keep all paperwork from my labs and I do my own "charts" so that I have that all available if need be.

Granted, I don't have quite the same easy access to everything they have, but if needed, that can be achieved.  And I am ALWAYS praying about things and trying to be objective as possible about any changes in order to know if I need to seek care from a provider.  That hasn't happened yet. :)

But anyway, all that to say, if we are anything alike, sometimes I just want the reassurance that I've got a "professional" looking out for me and on my side, working to keep me and my baby safe. (especially after loss...who wants to take any chances?)  But I definitely feel like if I stay on top of things myself, and just take care of my body, I can achieve more with "prenatal appointments" in my own home, by myself, than I can going in and paying someone to just take a glance at me and a handful of routine results.  And like I said, if needed, I can always choose the other route and go in for care.

[1babysmom]

Oh and I forgot to add, I did have a MW who was okay with  me UC'ing with DD2.  I had just flat out asked her during our initial "interview" via email, and she said that she had actually had a couple UC's herself (though her mom assisted and had some training).  But we also moved during the time I was seeing her, making her 3 hours away, so the possibility of a UC was no longer just my hopeful idea...it became reality.

I did NOT want an unnecessary hospital birth this time (I started out seeing an OB) and had to play out the logistics of an "accident" UC, but I have too much fear of the repercussions.  I just don't trust the care providers around here, none of who think outside the box, and would hate to red-flag myself for any reason.  But that's just me...I'm a weenie. ;)  And then I tossed around midwife assistance, but there are few to no midwives in my area, and even then, I hated the idea of paying thousands of dollars for someone I didn't really want or feel like I needed.  *IF* I had access to a midwife I absolutely loved and wanted present at such an important event in my life, then that would solve the problem and I'd probably just have an assisted birth, despite my love for UC'ing based on my experiences.

[alaskanmomma]

Thanks for the advice, everyone! 

Peppamint, didn't think of the legal responsibilities she could face, but if it WAS an unplanned UC, how does that work? Would she still have been legally responsible?



I choose to seek prenatal and post partum care because it's what I'm comfortable with :) My insurance covers a midwife or OB 100% for prenatal care, so I figure why not? I'd have to pay out of pocket 20% if I went to a health clinic, and well, our free public clinics are not a place I'd want to go, I'd literally fear for my safety in the ones around my neck of the woods. I like to make sure baby is doing good, get u/s, hear the heartbeat, make sure I'm on track, etc. If there were any red flags I would like to be prepared firsthand, and well.. post partum care, if I do a UC and tear, I'd like to get stitched at home vs. going to the hospital, if I wanted to leave I would've had the baby there in the first place . I'm going to talk to DH about it more, maybe drop the midwife all together after I do the glucose test and Strep B/get the results back, that way she isn't expecting to be at my birth, and I don't have to have an "accident".
 

[1babysmom]

Wow, having things 100% paid for is definitely a plus!  For us it's all on our own until $2500 then we only do our 30% so that's definitely a drawback to it!

[Peppamint]

I don't know the current climate there- bit I have heard some things such as no VBAC etc so it sounds like they have a tough row to hoe.