Midwife or Dr? - Page 2

[mama2annabelle]

I'll be seeing a midwife this time around as well. I work as a midwife's assistant in a practice of 2 midwives and will be getting my care from them. I am so excited to be getting care from my friends.

FWIW, to others who have had previous high risk pregnancies...my last pregnancy was rough too with pre-term labor at 23 weeks and 3 months of bedrest. I continued my midwifery care throughout the pregnancy, although I did have to see an OB as well. Everything turned out well and I was able to have the homebirth of my dreams! This time around I am not expecting any complications, but if they do occur I will do the same thing. If you desire a midwife, go to one now. If complications arise, you can always switch.

[lucsmama]

i hope i don't offend anyone, but i had to get on here and comment. pre-eclampsia is not held off by being healthy and low risk. i was super low risk too, 25, ideal weight, healthy eater, exercised regularly. i was shocked when i ended up with hellp syndrome (a servere form of preeclampsia). it can and does happen to anyone at anytime. my point is to just make sure you are aware of the symptoms and to not assume because you are young and healthy things will be perfect. i wish that were true, i too had planned a homebirth with a midwife.

[mrsfatty]

Originally Posted by lucsmama

i hope i don't offend anyone, but i had to get on here and comment. pre-eclampsia is not held off by being healthy and low risk. i was super low risk too, 25, ideal weight, healthy eater, exercised regularly. i was shocked when i ended up with hellp syndrome (a servere form of preeclampsia). it can and does happen to anyone at anytime. my point is to just make sure you are aware of the symptoms and to not assume because you are young and healthy things will be perfect. i wish that were true, i too had planned a homebirth with a midwife.

:

Granted I didn't have HELLP...but I agree that it can just HAPPEN to anyone (you are not immune if you eat a healthy diet)...well said mama!

[tempestjewel]

I'm struggling with the same question myself.

My last pg was considered high risk on two accounts. I have an abnormal vascular mass in my brain that they were worried about the extra blood flow and the "pressure" of delivery possibly rupturing and causing a hemmorrage (which could cause a stroke or rarely death). Then, they *thought* I had low amniotic fluid so DD was slosely monitered the second half of my pregnancy although when my water broke the nurses commented on how I sure didn't seem like I had low fluid.

So, for now I'm going back to my old OBGYN, but when I go in for my 8 week appointment (next Friday, I'll be 8 weeks 5 days or so) I'm going to push for a referral to a neurologist because I want to talk to someone who really specializes in brain conditions to see just what the risks would be for me to have a normal, un-medicated, natural labor (I was given the choice with DD between a C-section and a spinal + vacuum extraction w/o pushing and I chose the later). My intuition says that the risk to me is lower then the risk of putting another baby through anesthesia and vacuum extraction, I just need to find people who agree with me!

But, its hard. I want a healthy baby and I want to be a healthy mama who is alive and able to care for my child. So, I'm just trying to seek out information and expertise from as many sources as possible so I can make a *truly* informed choice. With DD I just did what I was told, but this time if I end up with the same delivery I want to know that I did everything in my power to prevent it, kwim?

If I had no medical conditions myself I would elect for a home water birth. I'm holding out hope that I can find a birth center that will take me so I can at least go for a water birth...

[mrsfatty]

Not to beat a dead horse...but here's another thread about "Preventing" PIH/Preeclampsia

I really like pamamidwife's response:

I don't believe there is anything really we can do to prevent true pre-e. I'd like to think that the Brewer diet works in prevention, but I don't think it does (his sample size was really small and I think it had more to do with the overall caloric increase, not so much the protein as people like to focus on).

I wish there was something that we could be sure would "work". It's one of the things that scares so many pregnancy providers that if it was as easy as large amounts of protein, it would be done.

I usually just recommend keeping fluid levels up, not decreasing salt (sodium is necessary for an expanded blood volume) and making sure they're eating enough.

Pre-e is too often diagnosed at the end of pregnancy based on rising blood pressure alone. This is not correct. Too many providers include PIH (pregnancy-induced hypertension) with pre-e. They are different.

A rise in bp at the end of pregnancy (the last six weeks) shows that the body is meeting the growing needs of the placenta/baby by increasing the blood volume and pressure to it.

Swelling at the end of pregnancy is a GOOD sign of an expanded blood volume.

True pre-e shows with a contracted blood volume. This usually looks like someone who has the same iron levels mid-preg as they do at the beginning of preg. You should see a drop in the hemoglobin and hematocrit around 30 weeks, as this is the peak of blood volume expansion. This peak means there is more blood plasma, and the red blood cells (the iron level readings) haven't caught up yet.

If I suspected pre-e, I'd look at blood volume expansion numbers and liver enzymes. Any shift in these numbers should warrant closer observation.

[boscopup]

Not in your DDC, but wanted to say to the OP - Using a midwife and transferring to an OB *if* you become high risk should be an option for you, even in Canada.

I had PPROM at 29 weeks last time (delivered at 29w4d), so I'm slightly higher risk because it could happen again - we won't know until it does or until I go full term. I'm seeing an OB so that I have one when I go to the hospital (last time I was assigned the teaching group and never saw the OBs making the decisions - just saw the residents who had no authority). It wasn't a *horrible* experience, but it could have been better had I had an OB going in. So that's the only reason I'm seeing an OB at all this time around - I have one who is NCB-friendly and who is really cool about letting me refuse tests, etc. He's great to work with, and he knows all about my plans to use the midwife and have an out-of-hospital birth (not homebirth because it's illegal in my state to have a trained attendant at your birth... I'm crossing the state line just 15 minutes away). In my case, the midwife gets paid out-of-pocket anyway - insurance doesn't cover her. But we still have the midwife fee saved up from last time, which we ended up not needing, obviously.

Anyway, I'm seeing my midwife with every intention of birthing out-of-hospital. If PPROM happens to me again, then I become high risk, and I'll go to the hospital and see my OB, who will likely try to keep baby in longer. If I were to make it to 36 weeks, I'd probably go home, and when I go into labor, go see my midwife and have my originally planned birth.

[lucsmama]

thanks for the support katie! i guess i just get a little emotional about it when i read people who are as oblivious as i was. plus i still mourn the loss of my "ideal birth". pregnancy and birth is all about expecting the unexpected i guess

[maxmama]

Originally Posted by lucsmama

thanks for the support katie! i guess i just get a little emotional about it when i read people who are as oblivious as i was. plus i still mourn the loss of my "ideal birth". pregnancy and birth is all about expecting the unexpected i guess

It took three years for me to work through my issues around going from a planned home birth to an emergent section at 36 weeks (breech, platelets dropped to 80K and liver enzymes went all to hell -- for some reason, they don't let you home birth when you don't have a functioning liver or kidneys!). It's been very scary this time, but I figure if i make it to term I'm doing pretty well.

[mrsfatty]

Originally Posted by lucsmama

thanks for the support katie! i guess i just get a little emotional about it when i read people who are as oblivious as i was. plus i still mourn the loss of my "ideal birth". pregnancy and birth is all about expecting the unexpected i guess

No problem! It's just refreshing to have someone else who had the same (awful) experience...and knowing that they (or that I) didn't do anything wrong--that the condition just happened...

It's frustrating to suffer such conditions (especially during a time that's supposed to be such a memorable, life-changing experience)...but it's even more frustrating when you're constantly blamed...and told it's your fault you have your condition (even though it's been shown to not be preventable in MOST cases)...

I still mourn the loss of my "ideal pregnancy" and my "ideal birth"...I'm hoping this pregnancy and upcoming birth will heal that...I wish the same for you!

[lucsmama]

katie, that is my dream too that this pregnancy and birth will be very healing. what scares me is that it will be worse.

maxmama, it sounds like you had hellp syndrome as well. my son is almost three and it took me this long to feel okay with trying to go through this experience again. it is just not as fun too be pregnant and preparing for birth when you are sort of waiting for everything to go to hell.

[maxmama]

Originally Posted by lucsmama

katie, that is my dream too that this pregnancy and birth will be very healing. what scares me is that it will be worse.

maxmama, it sounds like you had hellp syndrome as well. my son is almost three and it took me this long to feel okay with trying to go through this experience again. it is just not as fun too be pregnant and preparing for birth when you are sort of waiting for everything to go to hell.

But you know what? This pregnancy, though high-risk (isoimmunization and history of HELLP/PIH/PE) has been a breeze. My BPs are lower than they've ever been pregnant (100s/50s), my labs are fine and my perinate and OB both think I'll make it to full-term. It's given me a lot of confidence back in what my body can do, instead of feeling like a "hostile uterine environment" (lovely phrase I found on my chart after last time).

[Synchro246]

Originally Posted by mrsfatty

No problem! It's just refreshing to have someone else who had the same (awful) experience...and knowing that they (or that I) didn't do anything wrong--that the condition just happened...

It's frustrating to suffer such conditions (especially during a time that's supposed to be such a memorable, life-changing experience)...but it's even more frustrating when you're constantly blamed...and told it's your fault you have your condition (even though it's been shown to not be preventable in MOST cases)...

I still mourn the loss of my "ideal pregnancy" and my "ideal birth"...I'm hoping this pregnancy and upcoming birth will heal that...I wish the same for you!

I just want to make sure that everyone here knows that I do not believe that it's anyone's FAULT. That would be rediculous. There are lots of factors that go into being at risk for hypertension related syndromes of pregnancy- most of those factors are out of a person's control.

I too lost my "ideal birth", and I know how hard it is to deal with accepting loads of intervention when I fully believe that most of the time intervention isn't necessisary. I hope to have dealt with my loss before my next pregnancy, but I don't know if I'll need the next birth to go smoothly in order to deal.

[Paige, CPM]

Who & Where: One of my best buddies, and partner in practice before she moved, owes me 3 homebirths!

Why: Well, I believe if my body can create an amazing child that it should be able to complete the process just as successfully at a birth without unnatural interference.

If there are issues then I will consult with or transfer to an OB who has a very low (8%) c/s rate and know I am still in good hands.

My theory is if one starts with a good midwife who spends lots of time and goes over s/s and will do research with you and you need to consult or transfer you know that there is a really good reason...for me this situation is the best because I think it would make it easier for me to handle if things changed from our ideal. But I am hoping to not need any interventions or consults, just low key and normal.

Blessings to you all... Paige

[mrsfatty]

Originally Posted by Synchro246

I just want to make sure that everyone here knows that I do not believe that it's anyone's FAULT. That would be rediculous. There are lots of factors that go into being at risk for hypertension related syndromes of pregnancy- most of those factors are out of a person's control.

I too lost my "ideal birth", and I know how hard it is to deal with accepting loads of intervention when I fully believe that most of the time intervention isn't necessisary. I hope to have dealt with my loss before my next pregnancy, but I don't know if I'll need the next birth to go smoothly in order to deal.

Well, the midwife I interviewed said it basically would be my fault if I developed it--and therefore I could no longer be under her care at that point (I've since decided not using her)...

[a_work_in_progress]

I'm going to be seeing an OB/GYN, only because she is completely awesome, loves Mothering magazine, and encourages active participation in care. If I change my mind later, so be it. No biggie. I've had 2 unassisted pregnancies/childbirths, and I'm prepared to do that again. I have a few health concerns, which is why I'm seeing a doctor in the first place.

I'm going to have an unassisted home waterbirth. I want to be surrounded by family and friends, though.

[blissfish]

I'm hoping to find a CNM open to VBAC for this pregnancy. Probably in a hospital.

With my DS (11/03), we went from home water-labor to hospital c-section due to baby being COMPLETELY mummified in the cord. He descended and then there wasn't enough cord length for him to GO anywhere - SCARY! (Almost as scary as the mad drive through town in labor, baby nearly crowned, in the back of the midwife's station wagon). By the time they cut, I was so effaced (possibly because I'd had a 15" head stretching my cervix for 12 hours) that they had a difficult time making a "clean" cut. Subsequently, the attending surgeon gave me a Big Scary Speech about how I am NOT a good candidate for VBAC.

Humph, sez I! But DH was traumatized by the "bad" homebirth, and wants me to commit with him to hospital birth for #2.

I feel some loss around not attempting a home birth again, but recognize that there are more factors than my desire to have it the way I'd always visualized it.

[babysol]

I feel like I am pretty different than some of the other posters. I'm going with the same OB I had last time. I think a midwife would be nice, but I like the OB and know it will be a good experience. I don't need long appointments, or to have someone stay with me during the whole labor, other than my spouse. I also feel pretty comfortable advocating for myself and what I want. I guess in the end I just want a healthy baby, so I don't particularly care where I have him or her, or who I pay to foresee the process. My previous hospital birth was a good experience, so I'm going to do the same thing.

[haydensmom1]

I'm also going back to the same Dr. that handled my care during my first pregnancy. I had an easy pregnancy (very thankful). My bp spiked the day before he induced my labor (scheduled at my convenience). I ended up needing forceps to deliver and my Dr.'s quick decision/action probably saved my sons life. And the epidural was the route we chose.
Like babysol, I don't need anyone with me the entire time, except my husband. It's all about personal choice and what works best for you and your family.

[*~Danielle~*]

Hey Jess, maybe you consider yourself to be the homebirth guru and can't tollerate others exploring their thoughts openly, but this is a message board and I hate the attitude that came off in your post, it was b*tchy!:

[Synchro246]

Originally Posted by haydensmom1

I'm also going back to the same Dr. that handled my care during my first pregnancy. I had an easy pregnancy (very thankful). My bp spiked the day before he induced my labor (scheduled at my convenience). I ended up needing forceps to deliver and my Dr.'s quick decision/action probably saved my sons life. And the epidural was the route we chose.
Like babysol, I don't need anyone with me the entire time, except my husband. It's all about personal choice and what works best for you and your family.

I'm all about personal choices as long as hey are informed. Inductions often result in higher pain levels in labor and fetal distress. Many women get epi's when they have inductions or augmentations when they would have been quite capable of handeling the pain of natural labor. Epidurals statistically lead to more women 'needing' forceps or other asssisted deliveries. Perhaps you still would have needed your doc to save your baby w/o the induction, epi, or the forcepts, no one can know. I wonder though, how much your choices really "worked" for you. I am glad that you seem happy with your birth experience though, since that is important.