MW post-date hypervigilance

[fiddlefern]

Looking for advice and/or momma-strength vibes.

(Warning- this is rant-ish)

OK, I'm not even post-date yet, but one of my midwives is already making me feel like I've got a problem that I don't think I have.

At one point my due date was today, but that was totally a guess because I'm extremely irregular and have no idea when I conceived. SO, based on the 18 week ultrasound, one of my midwives (he's a guy) moved my due date up to the 12th. Great- I thought. Less hassle at the end. Wrong.

So this guy feels that woman should start having non-stress tests and having their amniotic fluid monitored starting at 41 weeks, which I hear is common in this practice. But he wants to start using the OLD due date, even though HE's the one that changed it in the first place.

I let myself be talked into making appointments for a NST on the 14th, 17th, and 21st. But that's nuts. I'm not even due till the 12th, and all the babies in my family come about a week late. So I've agreed to have two tests before I even think Luke should be coming.

My next two appts are with the female midwife I've seen the most. I hope I have the strength to advocate for myself and at least cancel those first two appointments.

Also, what do you gals think about membrane stripping? Male MW wants me to tell female MW to do it at my next appt. Should I go for it just so this baby (may) come sooner, to make the medical team happy, or should I just allow baby to go post-term like I think he wants to, and be prepared to stand my ground against an onslaught of provider concern?



Thanks for letting me vent, anyhow.
fiddlefern

[Quirky]

I'm not in the club, can I post anyway? Also, I'd post on the Midwives or Birth boards - I think pamamidwife, blueviolet, defenestrator, lorijds, and other professional types might have some really good advice for you.

Well, from what I understand (I'm not a professional), ultrasounds are more accurate for dating when they're earlier, so I'm unclear on how accurate an 18 week ultrasound would be for dating anyway.

I would stand your ground. First-time moms go an average of 8 days over their due date (which tells you a lot about how meaningful the due date is, huh? ) Keep in mind that in Europe they don't even consider it term until 41 weeks; there's nothing set in stone (or even all that accurate) about the 40 week that's the standard here.

Again, this is just my lay understanding, but isn't it true that measuring amniotic fluid (like measuring the size of the baby) is a fairly inaccurate science? I wouldn't mind doing NSTs, all they do is hook you up to a fetal monitor, no biggie, but I'd be concerned about what they'd say if they thought the fluid levels were low. I'd want to know what the margin of error is, what would happen if I drank a lot of fluid, etc.

Having had my membranes stripped, I wouldn't do it again. I was at almost 42 weeks (with accurate dates) and I was about to be kicked out of the birth center and into the hospital for an induction, so I consented to it, but I don't think it was the right choice. It worked for me the third time it was done (each was progressively more vigorous and painful) but given that I was GBS positive I think it would have been better in hindsight to refuse all internal exams and/or stripping and just wait for baby to come on his own.

There is a risk in stripping of rupturing membranes and then you're on the clock to deliver, ready or not. I also just think it's something for medwives/OBs to do to make things happen on the schedule they're happy with, rather than on the mother's and baby's schedule. :

[anothermama]

Ergh. How frustrating!

I'll send some strength your way...........I always say the same ol' thing.....if nothings wrong, why mess with it?

As far as membrane stripping goes, lots of mamas here are opposed (from what I've seen) because it's basically a more natural way to induce labor early, you know? And, if the baby is ok and theres no reason to go early, then why do it. Maybe someone else can lend info?

I do know that I had it done with my daughter. I was with a somewhat high intervention/medically orriented midwife and she did it when I was 42 weeks. It didn't hurt me any more than a regular cervical check, it took about 2 minutes, and I went into active labor and had my daughter the next day. I don't really know the down sides of it other than inducing labor too early, and I'd probably be ok with it again at 42+ weeks, but only at that point. If you aren't even sure of your dates, I *personally* would err on the side of the later date and do it at *that* point.

[KKmama]

Oh, I'm really sorry. I know how frustrating it can be to be a watched pot . My ds was 2 1/2 wks late. I had 2 NSTs a week I think from ~41 wks onward, and they totally stressed me out, and looking back, I wish I hadn't let them get to me. Unfortunately, sometimes, it's what you have to do to reassure *them* to not be handed over to an OB (I know that's not a great reason, but it's kinda true).

Do you think you can exchange daily or twice daily kick counts (even called in to the office) for your 1st 2 NSTs?

You still have plenty of time to decide on the membrane stripping, but maybe you can say you'll *consider* it *if* you are still pg on the 21st? I think that's a reasonable thing to say ("I'll consider it" does not equal "I'll do it", either).

FWIW... I have a NST scheduled for this Thursday. I'll be not quite 41 wks (if I make it to Thursday). My ob practice starts them at 41 wks (but their u/s tech doesn't work Fridays). I'm willing to do mine because I feel like in my case, I'll definitely "pass" and it's something I can use to prevent them from pushing for a repeat C (we're obviously in very different situations, so don't extrapolate from me!).

Y'know, I'll bet this other MW will have a different opinion. Please don't get yourself all upset because of what the guy said... it's not worth it. I'm hoping you don't have to see him again and that you get only the good one(s) from here on out (and at the birth, of course!).

[Marco Esquandolas]

Here are my thoughts-membrane stripping: I'm one who believes that membrane stripping doesn't work unless you were really ripe and ready to begin with. That is just my opinion and could be totally wrong, though. I thought with both boys that I wanted to do this and that to help them along, but in the end, I did nothing other than walking and sex, lol.

NST's: once you are over about a week beyond your edd, IF you have something like pre-e or gd or lack of fetal movement, like a marked lack. Both my boys went over and I had pre-e the worst with my first and I did have *I think* two nst's with him. He was definitely well cooked, as evidenced at delivery (meconium stained fluid, only 2 small pockets of fluid left, shoulders bigger than head, long fingernails and so on and so forth). For ds#2, he was 8 days beyond and we were basically as sure as you can get about his due date being accurate and his nst was for marked lack of fetal movement. I was really scared with him. If I were you, I'd probably cancel at least the first nst and wait and see about the other ones. The medically minded folks do tend to like to err on the side of caution and do the most they can, even when it is seemingly unneccesary. If it isn't medically necessary, then it is your call, imo.

[Defenestrator]

As I see it, you have four steps here to take.

1 -- find out what will happen if you "fail" a NST. Will there be a recommendation to induce right away? A bio-physical profile? How do you feel about those possible consequences?

2 -- Decide when you want the first NST to be, if you want to do them at all. Ask why it is that an NST has been recommended just days after your due date. The ACOG recommends testing after 42 weeks. Why is a midwifery practice which likely prides itself in being non-interventive choosing to be so much more conservative than the national standards for doctors?

3-- Decide whether or not you want to do an induction without evidence that the baby is compromised. This is essentially what a membrane stripping is.

4 -- If the baby is showing signs of postmaturity, decide whether or not you feel an induction is warranted and whether or not you believe that membrane stripping is the right choice.

I am not saying that there is never a reason to strip membranes, nor that it is never appropriate to try and stimulate labor in the absence of signs of a baby in trouble. But, it sounds to me like your providers are afraid of something happening and trying to induce you to avoid whatever it is that they fear. However, it also sounds like they are entertaining those fears in the absence of medical evidence.

I think that the best advice I can give you is to discuss what will happen if you get a poor result for a test BEFORE you take it. At the moment you are hooked up to the monitors and hear "hmm, baby looks compromised," it is really hard to think clearly about your options.

Good luck. I hope that you have a good meeting with your other midwife and get your questions answered.

[fiddlefern]

Just got back from a movie with dh, and checked in.

It's SO nice to know I'm not some wierd crazy person for not wanting interventions. That's how I feel sometimes when I go in for an appointment. I feel like I have to come armed with studies, and that I have to remember everything IN those studies, to justify my opinions.

Now, I have a B.S. in Biology, and I can talk sample size, and chi tests and t-tests for significant difference, and margin of error with the best of 'em, but not when I feel emotionally threatened, which is how I feel when I have to defend my parenting choices. Grrr.

So reading all of your posts has made me feel way better. I'm not a freak. There are other people out there who think my choices are reasonable. I'm a perfectly healthy momma with a baby who seems perfectly healthy, and a family history of late-ish babies.

Thanks, everyone.

[pamamidwife]

You need to get Henci Goer's Thinking WOman's Guide to a Better Birth. I mean, you're planning a hospital birth - you NEED to have this evidence-based info!

But, evidence-based aside, fewer women are actually seeing their due date because of practice policies to induce on the due date or before. Those with providers that "allow" them to go over often will face serious threats around 41 weeks.

All that due date shifting is crazy. I don't know what to tell you except stick to your guns. NSTs are fine, but often staff is like "see? see? the baby's not doing well!" and, well, how are you going to argue? Biophysical profiles are notoriously subjective - and it's the "low amniotic fluid" that gets 'em every time.

I'm not sure what to tell you. Really, in a city like Portland, with so many amazing birth center and homebirth midwives, you could switch gears if you really want the birth you want. Or, just tell Male MW to stick his fingers up inside his own darn self.

What do I know? I've had clients that went four and five weeks over their "due" date. You're not a carton of milk - you won't expire! Do you have a doula? Put your boxing gloves on and stand up for the birth you want! Yeah! You can do it! you GO GIRL!

[TurboClaudia]

fiddlefern: What hospital in Portlandare you planning on birthing at? Just curious...

warmly,
claudia

[mittendrin]

you've gotten some good advice here already. i've never been in your situation, so i don't know what i would do, honestly. i know i don't want any interventions, but it's easy to say when you're 2 weeks away from your edd and expect to have it all go natural, kwim...
your guy-mw seems to be a jerk, though. sorry. i hope you'll have the strength to stand up for yourself. even a strongwilled person will cave when "professionals" put a knife to her chest, so don't feel bad about scheduling a few appts. you can cancel them. or just don't show up. read this thread again on monday and make a big sign "THIS IS MY BABY! I MAKE THE DECISIONS AROUND HERE! SCREW YOU!!!"...or something along those lines, you get the idea. then call them and cancel for the 14th.
oh, btw, i'll send a few labor vibes along, maybe you've gotten so stressed out over the whole thing, that your baby decides to come out tonight...then you can say: IN YOUR FACE!!!!
happy mother's day, have a glass of wine!

[fiddlefern]

Hey, everyone

Somehow I wasn't subscribed to my own thread, so I didn't realize there had been new posts.

Here's the update: on Wednesday I went to see the "good" MW. I came armed with all kinds of info from the ACOG, etc, etc. Also, I came with my original data about when I _might_ have conceived.

Well, I didn't need half of the info, and I didn't need to fight, because the MW was actually working _with_ me. (relieved sigh). I showed her the dates I'd had a negative and then a positive pregnancy test. We looked at the ultrasound data again. And we changed my due date to the 14th- yesterday.

Hooray!

She agreed that I could cancel the first 2 NST's, and start with one at 41 weeks (on the 21st).

Well, then we moved on in the exam, and she did have some concerns about how my fundus hadn't changed for 4 weeks. She said it could be due to baby dropping, but then with the vaginal exam (she agreed to no stripping membranes ) she said I hadn't dropped much, so that didn't really explain the lack of fundus growth. She said she wasn't really worried, I probably just had a smallish baby, but how would I feel about an NST just to make sure. I really felt she was waiting for my _opinion_ and so I felt fine about agreeing to it.

The NST technician was awesome and said everything looks great. So- I feel like I have the go-ahead from my providers for baby to do what he needs to. This is good, because I'm going to let baby do what he needs to anyhow, and am glad not to feel tons of pressure for baby to come when THEY want him to.

Your fellow mamma-warrior,

fiddlefern

[fiddlefern]

Oh- and Claudia-

I'm having him at Sunnyside- Kaiser.

My doula has been great through all of this, encouraging me and telling me that I'm the momma and I get to make decisions about what's best for my baby.