If she is a CNM, it might be that her back up physician will not cover a twin birth at home, so she is unable to attend this and still keep her physician back up, which she legally needs in order to practice. Or it could be that she does not have much experience with twins, and therefore doesn't feel comfortable being a primary care giver in this situation.
Again, the overdue issue might be more an issue of what parameters her covering physician will allow her to perform. Most midwives are at the mercy of their overseeing physician, since ultimately, if something goes wrong, the overdeeing physician is as much liable as the midwife. Now, what do you mean by interfering? That she wants to do cytotec, or that she will discuss sex, nipple stim, herbs or caster oil? Our facility is accredited by NACC, and they require that we do not attend births that go before 37 weeks or after the end of the 43 week. Now, how many births actually go this long? We don't often have a mom that nears her 43 week...it is pretty rare. Most moms go about 1-2 weeks overdue, but hardly any go beyond that. Our physician has the right to waive these regulations, but then it is her butt (and our accreditation, which in turn affects our ability to be reimbursed by insurance) on the line if anything goes wrong. Nonetheless, if she feels that everything is okay, she will waive these rules.
Do you have an issue with weighing in? Weight in and of itself means nothing...but if a mom gains a bunch of weight in a week, and her blod pressure increases, that is something that alerts the midwife that, no, that blood pressure increase wasn't an isolated incident, it might be something more pathologic, we need to keep an eye on it. If you have issues with it, discuss is with the midwife. We require weigh-ins at our appointments, but if a mom doesn't want it, we certainly don't push it. We have moms weigh themselves and test their own urine, and then they either tell us or just write it in their chart themselves. In the entire 1 1/2 years that I have worked there, we have only had one mom that did not want to be weighed (previous eating disorder) and everyone was fine with that. It may be that all the things you have issue with would honestly be no big deal if you would just talk to the midwife about it.
Oh, regarding a complete physical...well, we do this too, including pap. For approximately 20% (it might be more) of our population, the only time they get a pap or a physical exam is when they are pregnant! dThe physical exam just tells us mom's physical health. It includes a pap and internal exam, a breast exam, and a discussion about mom's complete health history and lifestyle. It is a chance to sit down and talk for an hour or two, and really get to know one another. The pap and physical exam is usually done at the end of the visit, when mom is comfortable. The CNM tells mom everything she is doing, and usually offers her the opportunity to view her cervix and the exam with a mirror.
I find it more interesting that you don't want to have these things done. Why? Do you feel they are unnecessary, or are there other issues going on? In any case, these are things to discuss with your midwife. Why not ask her your exact questions...why does she need to do these things? What information is she looking for, and why does she need it? Why doesn't she attend twin births, or births before 37 weeks or after 42 weeks? What sort of interference does she advocate if you are way overdue?
And what sort of unassisted birth do you mean? That the midwife is there but doesn't do anything, just there to support you and dh, not there to catch baby, check VS, etc? Are you sure, in that case, you don't just want a doula instead? Or do you mean that you don't even want a midwife there, you just want her for the prenatal and postnatal care? If you don't even want her there, then it doesn't much matter whether she will *let* you go overdue or not.
I guess I see nothing wrong with most of what you say your midwife wants. I see more problems with the fact that you refer to such exams as being prodded and poked like a cow. I think the women who birth with us don't feel this way, but it is because of our interactions with them. If your midwife makes you feel like you are a cow (you know, that you are just a patient, not a friend), then it is time to find another midwife. If you just take issue with just some of the tests or restrictions, disucss them with her. no one can make you do anything, but you really do need to jive with your midwife, so that if a decision needs to be made quickly, you know that she will make decisions with your desires and health in her heart, not based on what the rules say. I think that if someone presented in our office and refused to have a physical exam, we certainly wouldn't refuse her care, but we would be much more concerned with WHY she didn't want the exam...past abuse issues, either from past care givers or from personal relationships? We would be very interestedin resolving those issues, rather than actually performing the exam, although I honestly feel that a pelvic exam is not an unnecessary part of a woman's health care.
I hope you are able to either work things out with your midwife (ie, have a great discussion with her and be satisfied with her answers and motivations) or that you are able to find another care provider with whom you really mesh, with whom you are very comfortable and who will be able to provide you what you need.
Good luck, and congratulations on your pregnancy!
I feel so lucky
I chose not to have the initial exam. Hello? I am a responsible person who gets a yearly physical and why on earth have someone start poking around if it's not necessary. Besides, I feel IMHO that it's an uncomfortable uneven way to begin a relationship; ie. my rel. w/my mw is one of support and guidance not medical intervention.
