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Questions for the {already chosen but never met} midwife

post #1 of 16
Thread Starter 

Alright, so last pregnancy I had an OB and a forced hospital birth. This time around we got a midwife, and therefore should get our homebirth, or may choose the freestanding birth centre. Midwives here are in VERY high demand, as they are provincially funded. So you don't choose a midwife, you just get accepted into care and they assign your midwife. You can only change if there's a major conflict. 

 

So that said... with my midwife already 'chosen', what sort of things would you want to ask at your first appointment? I'll be 12 weeks. Hoping for a very hands off homebirth, laboring in water, undecided if I want to birth in the water yet. 

post #2 of 16

Where safety is obviously your number one concern, I'd ask a lot of direct questions about transferring, how many babies she's lost, what were some of her biggest learning experiences in her career, etc. If you don't feel safe in her hands, then you'll need to find another care provider.

 

Once safety is established, I think the most important thing is just to find out what births are typically like for her. Ask her lots of open ended questions, and let her talk. Even if she doesn't come out and say things directly, you'll get an idea of her philosophy. Then over the course of your pregnancy you'll be able to have more discussions about your personal preferences and concerns. 

post #3 of 16

:yeah  

post #4 of 16
Thread Starter 

Is it uber weird that I'm not as concerned about "safety" the way most people talk about? Our midwives here are all highly highly regulated. Beyond that- I feel comfortable with a UC (though my DH does not), and he is a trained paramedic... so i feel confident to deal with birth as it comes up, if that makes sense. I'm more concerned about the things she'll do to interrupt my birth lol! 

 

This is what I have so far... I'd love feedback! 

 

·         What circumstances would necessitate a transfer?

·         Under what circumstances would I be denied a homebirth (or birth centre birth)

·         What is the least amount of monitoring during labor you are comfortable with?

·         What is a typical homebirth like for you?

·         Are you comfortable letting me deliver the baby myself if I feel able to do so?

·         {complications} -- how to deal with, which could we stay home, how would she react. Need more thought on this one. 

·         How long after a homebirth do you typically stay?

·         When do you visit us again afterwards?

·         What supplies should we provide?

·         What sort of cleanup is provided after the birth, and what should we expect to have to do?

·         Have you ever lost a baby under your care?

·         What is your standard protocol if I go past 40 weeks?

·         Why did you become a midwife?

·         I felt very ill during and after the GD test last time. Are you comfortable with other methods?

·         Which backup midwives might we encounter?

·         What are the chances you will not attend our birth? What is the call schedule like?

·         What kind of equipment do you bring with you to a birth?

·         How do I reach you during the pregnancy if I need something? In emergencies? Labor?

·         How long are you comfortable letting me labor alone before coming to the house?

·         What is the frequencies of appts? Could I space them out?

·         I had a tear last time, what would you recommend to prevent that this time?

·         At what point would you transfer to a hospital to suture a tear?

post #5 of 16
Are you in Ontario? When I have my initial appt w/ my MW they give me a huge folder of info. The page that is most important to me lists the various complications, their risk category, and each category has a standard protocol for transfer of care or consult or discussion. Category 1 is discuss options w/ OB & MW & Patient, Category 2 is consult w/ OB remain in MW Care, and Category 3 is transfer of care to OB. DD was breech at 38.5 wk w/ a water leak, so that was a transfer of care, by my MW still delivered her after the OB did an external version, and induction. The OB was 'officially' in charge of my care, but from 1pm arrival at hospital to 6am departure fo rhome w/ 3hr babe, the midwives - 2 of them - never left the hospital, and only left my room to catch a nap for a couple hours while the induction wasn't doing anything. The OB left the hospital, and was paged back around midnight, and left soon after the birth.

For tears, MW in ON can stitch 1st & 2nd, but require transfer for 3rd degree I believe. The appts are pretty standard to the schedule of my OB w/ my first birth, monthly to 34ish, every 2weeks to 38 or 40, weekly till birth. I'm not 100% certain beyond 38 weeks ... as I had DD before my last couple appts smile.gif
My first appt is usually an hour, subsequent ones are 1/2 hour - 45 min, but never rushed and I think they allow a full hour for each booking.
I had a hospital birth, didn't plan a home birth at all, but the PP visit schedule is the same either way, day 1/3/5 at the home, and then 2/4/6 week or so at the MW clinic. They are flexible if you are not recovering well and need them to come to you a bit more. At the 6 week check up they dischrage you from MW care, and babe sees your family doc or a pediatrician for their 2mth check up if you do the well baby/vax visits. I know at the hospital the MW stay for at least 3 hours, and that is the earliest you can be discharged. I'm sure they would stay at least the same time post-birth at home.
Our local practice has 2 teams of 3 midwives each, and when you are in labour, the MW on your team that is on call that week comes, and shortly after that the oncall MW from the other team comes. The other team MW is supporting your MW, and then does all the baby stuff after birth - measure weigh apgar etc, while your MW takes care of mom. In the event that both teams have births at the same time, they have otehr support staff, MW students, nurses on back up to call. You are guaranteed at this practice to have a MW from your own team at your birth, and see all 3 from your team for appts they are really good to schedule them so you get to know everyone.
I've only dealt with this one practice, but it's a similar model to the others I know of in the region from friends' experiences.
Edited by SynEpona - 11/25/13 at 4:35pm
post #6 of 16

Also wondering which province you are in? I am in Qc. I ended up having to hire an "underground" midwife last time after not being able to get in with the public birth centers. Same deal here, huge demand, not enough midwives/birth centres. There are 3 in Montreal, but 1 centre will only take people who live very close to the centre. So I totally understand that "switching" is not an option unless you want to go to the hospital. 

The things that I would add is to ask about her policies regarding a leak in your amniotic fluid or full premature rupture of membranes. What are their policies. Some midwives if they are still affiliated with a hospital, so not a free standing birth centre , will still have a 12 or 24hr limit with ruptured membranes before a transfer to the hospital for induction. Some midwives are fine to wait for labour to start, as long as certain precautions are followed to prevent any introduction of bacteria, no internal checks, no baths etc. 

Also find out what are their main reasons for transfer? emergency vs non emerg. (ex. tired mom who wanted to get an epidural/ induction) 

I was very relieved to find out that my midwives had almost  100% success rate in the past year before my birth. All Healthy homebirths, just 1 transfer (non emerg)

Let us know how it goes!

post #7 of 16
Thread Starter 

Thanks ladies. I've read through thoroughly the SOP for midwives here (I'm in Manitoba), so I know officially the reasons they're required to transfer/transport, but I also know that not all of the practicing midwives are comfortable with the same situations, so I'm hoping to gain some understanding of her and her comfort level, with the answers to some of the questions. SynEpona, your answers sound like most of what I understand our SOP are, just want to hear answers from her and see how she reacts to the questions too. 

 

Good idea about reasons for transfer. 

 

It's funny because with the OB, you just go in expecting to fight for everything. This time around, I guess I'm feeling like I want to know where we stand, and how much I'm going to fight for, and how much is going to be understood where I'm coming from. 

post #8 of 16

 I am just re-reading this list because I have my first appt with my midwife tomorrow. I luckily got a spot. How did your appt go?

post #9 of 16
Thread Starter 

Can't believe I forgot to update!  It was -fantastic-!  She is everything I could hope for. Literally the woman said if we wanted to go into the woods and birth our baby out there, she'd follow us.  She's totally ok with me declining any tests, with me or DH catching the baby, with staying out of the room for most of the labor, etc etc. The only thing I didn't love, was how often she said they monitor, but given her other answers, I'm totally confident I can talk her down on that one. 

 

Feeling really wonderful about the birth and our working together now. Just need to firmly decide that I want the homebirth and not birth centre, but either way, i know she's "on my side". 

 

fingers crossed for your appt tomorrow!

post #10 of 16

In Canada is there an advantage to a birth center over a homebirth? I know here, it's basically just a homebirth, but not at home.

post #11 of 16
Thread Starter 
Basically same thing with this one. It's a freestanding, so the only extra medical equipment they have is nitrous. The benefit is that you're less likely to get kicked to the hospital if there's no second midwife, since two midwives can bet here with two
Patients and it still count as being enough. Other than that though, it's really just the setup- an existing birthing tub, a very large open room, large bathroom with walkin shower and endless hot water. There's a soothing "garden room" to hang out in, etc etc. not having to clean up at home lol that's a tempting one.
post #12 of 16
Quote:
Originally Posted by Dandy Lion View Post
 

In Canada is there an advantage to a birth center over a homebirth? I know here, it's basically just a homebirth, but not at home.


The one I am going to is a little different (US->Mass) It is setup like a home (with a HUGE birthing tub) but they do have some equipment. They also have a few exam rooms. But there is a shared living area, kitchen and porch. They have two bedrooms each with their own bathroom and birthing tub. The midwives are also employed by the hospital and have to report into an OB with progress and collaborate with an OB during the entire pregnancy. You are required to wear a heartbeat monitor periodically during the birth. They are across the "hospital" street.... so it's a very quick transfer if needed. After you give birth you get transferred to the hospital 2-12 hours later (you have the option to go home but only if everything is OK..and then you need to see a pedi within 24 hours..).

 

So I'd say it's in between a home birth and a hospital birth. Interventions are not standard and they are very pro natural birthing.

post #13 of 16
Quote:
Originally Posted by onetwoten View Post

Basically same thing with this one. It's a freestanding, so the only extra medical equipment they have is nitrous. The benefit is that you're less likely to get kicked to the hospital if there's no second midwife, since two midwives can bet here with two
Patients and it still count as being enough. Other than that though, it's really just the setup- an existing birthing tub, a very large open room, large bathroom with walkin shower and endless hot water. There's a soothing "garden room" to hang out in, etc etc. not having to clean up at home lol that's a tempting one.

After reading your birth story, I'm going to suggest you seriously consider homebirthing. Your story talks so much about you not feeling comfortable in your environment, and when you're at home, you have complete control over your environment. It's so nice not to have to leave the house or worry about when it's a good time to go. And it's great to just climb in bed with your baby afterwards, and not have to worry about going anywhere. I think it's pretty typical for midwives to clean everything up afterwards too, but that could just be here in the states. 

 

What types of situations would they allow you to stay at the birth center, but not at home (what are two midwife situations vs. hospital situations?)

post #14 of 16
Thread Starter 

Oh yes, definitely! For me personally, the only -real- factor that makes me want the birth centre birth is the unlimited water. I know that sounds ridiculous, but I get -such- relief and centering from a running shower, and knowing that my water will run out after 30 minutes really sucks. But- I do have access to a birthing tub to use at home, I've just never used one in labor, so I don't know if I'll get the same relief from it. But yeah... for all the many many benefits to the homebirth, that seems like such a small reason to use the birthing centre. 

 

In our province, midwives are required to have two midwives at each birth- if they *know* in advance a second midwife will not be able to attend (due to just coming off a birth, or another birth happening, severe illness, etc), they are to send us to the hospital, and we will have the baby there. No option for planned homebirth in that scenerio. If during the birth they call the second, and the second can't come, they're required to call 911. If we were at the birthing centre, then if two midwives have a patient each, they can both attend each mamas birth, and act as each others second. But obviously if those mamas were both laboring at home, there's a chance a second can't come to them- and the other midwife couldn't leave her client to come be a second at the first's birth, kwim? That's really the only scenerio where being at the birth centre would save me from being booted to the hospital and in a homebirth scenerio I would still have to go. 

 

It sounds like it shouldn't happen often, but I know a few people in my moms group that -have- had it happen, where they've called the midwife when they've gone in to labor, only to be told "ok, well for X reason, I don't have a second, so you need to go to the hospital and I'll meet you there." That terrifies me! I think honestly I would elect to say home, hope the mw still attended me, but go UC otherwise. Not sure my DH would be on board with that though. 

 

We -did- joke/mention to her that we have friends who are paramedics, who would attend for us as a second if needed. She kind of laughed and was like "oh good, we'll know who to call..." but I couldn't tell if she was totally shrugging it off (like most people would), or if she would consider doing it in that scenerio. 

 

My guess is that if I went into labor and was told we couldn't birth at home, IF there was someone already laboring at the birth centre, then they would give that option, but I'm honestly not sure. I'll have to ask her next appt. 

post #15 of 16
Does your birth center only have one room? We had a home birth last time( with an underground midwife) but since we got a spot in the birth center I am considering going there for the birth. Not decided. I like the fact that I wouldn't have to prepare my house and so many things for the birth. But I do worry that my labor would stop when I change from home to the
B.C. I had problems with that in my 1st labour but I wasn't really in active labour yet and I really wasn't relaxed at the clinic so that probably had a lot to do with it. The set up and the rooms at the birth center is really nice so it is tempting!
post #16 of 16
Thread Starter 

There are four birthing rooms plus the family lounge and kitchen, the indoor zen garden/outside area, and then obviously the hallways to walk. There's not usually more than one or two people laboring at the same time though, from what I understand. 

 

It is tempting, with the whole not having to set up/ cleanup. But I've always always really wanted a homebirth. So... yeah. 

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