Midwife opinion needed please

[Moukii]

I'd like feedback or opinions on the following thread I posted in the pregnancy section. Thanks for your time!

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A situation arose for me today that is really challenging my beliefs. I was raised with alternative medicine, rarely get sick, rarely go to a doctor, and believe strongly that birth is natural and should be done at home (in most cases). That said and done, I am not against medical philosophies and doctors, I believe there is a time and place for mainstream medicine.

So, the situation is: I have been low in iron (103 [120 is low side of normal]) which I have been working to get higher. I am 39 weeks and 3 days pregnant and planning a homebirth (waterbirth). I got new blood results back today and my hemoglobin has gone up to 108, but my platelet count had gone down significantly. I've been sick, after my 2 year old came down with croup. My platelets are now 136 where 150-400 is normal. With low hemoglobin and platelets there is a very high risk of hemmoraging post-partum. My midwife has strongly suggested I reconsider my homebirth desicion and birth at the hospital from the start of labour. I'm in Canada, and she can't force any desicion on me. IF, I did homebirth, she would have to legally call 911 and tell them she had a patient refusing to go to the hospital and they would have to come be present at the homebirth and there to take me to the hospital if need be. I have no problems with this, I don't care if they are there. I have not had any problems with bleeding in the past, and have a family history of low iron.

The thought of labouring and delivering in the hospital is very disturbing to me, and dissapointing. I don't think there is anything wrong with having a child in the hospital, but for ME I don't know, I just don't think I can do it voluntarily. It's a personal choice, and not a choice I would make.

I have agreed to getting oxytocin to stop bleeding as soon as the baby's head has crowned, whether or not there is hemmoraging.

I don't really know what else to say. Just any feedback would be appreciated. I can fill in more details if you need them, just thought I'd skip some for now. My minds just tired and fed up. I'm particularly interested in hearing from others who like me want a homebirth pretty much at all costs (not to be taken literally).

Thanks.

[jordmoder]

Hi Moukii-

I received my training and license in Washington State, so I'm speaking from that perspective, ok?

Wow, you're in a tough spot. Your midwife probably has either legal or "standards of care" criteria involved in your situation; that is, after a certain point is reached (in your case, your hemoglobin and platelet count)that is considered to be "high risk", a midwife is on very shaky ground attending someone in that category. On a philosophical level, is she willing to put her license on the line to accomodate your desires for a homebirth in the event something goes awry? You may not hold her accountable, but other people would.

I've seen comments on these boards to the effect that too much training raises the possibility of midwives not trusting women and or/birth - it's true, once you've experienced bad things you tend not to want them to happen again. And midwives can go too far in trusting technology and "science" etc. But unfortunately, in your case,
your anemia *does* put you at a greater risk of hemorrhage, and means for stopping hemorrage *are* more available in a setting (hospital) where they're used more, than at home. I don't know what you've been able to do in terms of iron therapy, or alfalfa tablets, or herbs to raise your counts. Have you been this anemic throughout your pregnancy?

I guess the bottom line is how willing are you to take responsibility for your life and the life of your child. This is not meant to be scary - there was a really wonderful thread about unassisted birth where the writer really really examined what that meant - and concluded that for her, that total responsibility was what she wanted and needed; any of us could be "hit by a bus" tomorrow - life is uncertain.

If you and your family decide that you truly accept the potential risk of massive ('cause that's the big concern) hemorrhage by not being at a location where help could be immediate, then that's *your choice*.

But again, if your midwife will attend you at home only by insisting (or being legally required to) call 911 at crowning, is that kind of potential circus atmosphere worth it to stay home for most everything? If it's possible to have the EMT's wait outside your house in case that's needed, I suppose that's the best case situation; but honestly, not that many EMT's are that respectful of women who choose to birth at home.

I personally had an unexpected bad outcome with the birth of my first child, that experience didn't change my trust and belief in the innate normality of birth, it did teach me that you can't control everything in the awesome process of giving life.

I think I've written a book here - sorry it's so long, but those are the issues that come up for me when thinking of being a midwife to someone "out of the range of normal"

Good luck! Please let me know how things go. Bottom line is, try to be in a place where you won't end up with "what ifs" - what if I had stayed home??? or what if I hadn't gone to the hospital??? that can really weigh you down.


Barbara

[temama]

I am not a mid-wife but I can tell you what my doctor told me. I also have low iron and low platelet count and tested positive for GBS. He said that wether you are at home or a hospital or birthing center. They take about 20 minutes to get you the help you need in an emergency at the hospital. If there are any problems at home and you are taken to an emergency room you will be seen immediately! You will have better care in the emergency room because they are more prepared to deal with emergencies. I would have my birth at home and have the EMTs waiting outside just in case. I wish you much luck...let us know what happens!

[Drewsmom]

I'm not a midwife and don't have much time to type but I did want to let you know that I had a great experience birthing my son in a hospital. Just to let you know some of the specifics, I toured it before hand and made sure that they had my birthing plan. They let me labor however and whereever I wanted to, I didn't have an IV or a EFM. They dimmed the lights, I was able to labor/deliver/recover all in the same room. I lived right next door to another hospital that was not as baby friendly so we had to drive a little further to get to the hospital where I delivered. I guess I just wanted you to know that I was nervous having ds there and afraid that they would make me do something that I didn't want to. Fortunately they were very respectful of my birthplan and my baby and honored everything that we wanted.

[temama]

If your mid-wife will respect your birthing plan, then great! No matter where you have it, unfortunately that is not always respected by the others "helping" at the hospital. Do what you feel is right for you and your baby!

[marymary]

I'm not sure about the figures translating-my iron count was 7 the day before I gave birth to my second son, the midwife's was 14. She came round to tell me that the hospital consultant had forbidden me to have a homebirth and to come and see him next morning. She said that if I wanted a homebirth she would support me but that I would have to do all the talking/fighting in the drs office. I went into labour that night at home and stayed at home and everything was fine. I did have a jab of something after the baby was born, perhaps to get the placenta out quickly or something but by that time It wasn't an issue. People have made some good points about midwives professional responsibilities, go with your gut feeling is all I can advise you, the last few days are always a bit mad but it will be worth it, take carexMM