What if you and your client disagree on herb use?

[herbsgirl]

Ok, what if you are a midwife, and you dont encourage use of a herbal formula that your client wants to use?? LIke a labor prep formula with some blue cohosh in it? What if she(the client) knows you dont want her using it, but she feels pretty comfortable using it and thinks its pretty safe?? If thats her personal conviction and opinion, would you (or a midwife) be offended if your client didnt do as you wanted her to do and went ahead and took the labor prep herbs? Or what if she hid behind your back and took them?

I am considering using a labor prep formula (Gentle Birth from Mountainmeadow herbs) and I am not sure if I will have a doctor or midwife next time, but the midwife that lives closest to me, I dont think she approves of this formula, because it has blue cohosh in it. So what should I do? Take it behind her back? Or expect her to get mad at me, if I dont do exactly as she beleives? I know my doctor wouldnt support it, she doesnt have hardly any experience with herbs anyway.

Sometimes I just wish I could do the same as an "Unassisted prenatal care" and have the midwife/doctor help when I need them too. Really isnt that what its all about, as long as everythings like the CLIENT likes it, not neccesarily the midwive's or doctors beliefs?? I am a little confused, but I want to do things MY WAY the next time I get pregnant. MY hubby would never ever even consider an unassisted and it might be a miricle if I even get him to agree to a midwife, so I might need some pointers on what to do if My midwife/doctor and I dont agree...whether to tell her what I am doing and risk midwife/doctor getting mad OR do stuff behind their back???


PLEASE HELP !! Thank you!!

[herbsgirl]

Bumping this up...anybody???

[snugglebug14]

i would have an open conversation with your midwife about why she doesn't like the formula. what are her particular concerns? is there another formula you could use? some midwives belief that labor prep formulas are simply unecessary unless there is a specific known problem require some outside help (ie previous problems with an unripe cervix). although herbs are much more natural and in many ways safer, many midwives do still consider them an intervention which is something most midwives are looking to avoid. If her only concern is the cohosh, find out specifically what warrants her concern. Is it from personal experience? a study she read? word of mouth? pure precaution? do you feel very strongly about wanting the cohosh in particular? where did your information/reasoning come from? could you agree on another formula that would serve the purpose you are looking for but not cause concern for your midwife?
I would definately NOT go behind your midwife's back to take an herbal formula. It is unfair to the person providing your care if you aren't open and honest with them. I think that in most instances you would be able to either reach an agreement with this midwife you have in mind, or be able to find a midwife whose beliefs coincide with yours. In most instances midwife care is about what YOU want. However, they do need to operate within the limits of what they feel is safe.

[ckhagen]

I know that at the hospital here, if they find out you've taken a cohosh and for some reason you need an induction (ROM with no labor, pre-e), they will not induce you, rather go straight to a c-section because they are not comfortable mixing the two stimulants. So, sometimes there may be things like that going on in the background that you aren't aware of and fueling your mw's reasoning. I agree, have an open discussion about it.

[herbsgirl]

The last time I was induced, I induced myself with Labor balm and Rootbeer/castor oil. My doctor approved of both... Labor Balm has blue cohosh in it. But she did state that the bad thing(s) on cohosh where just ancedotes, not really any proven studies. I was able to get my labor started a little and she did give me one small dose of cytotec, It was my easiest labor yet, with the labor balm, tiny bit of cytotec, and castor oil/rootbeer.

I really do not have very much choice in doctors or midwives. #1 my husband does not want me to have to drive very far for prenatal checks, ect, #2 we have badgercare. So I basically dont have alot of options. My doctor is pretty workable, I suppose If I told Her I felt like the labor prep herbs I was taking were pretty safe, and no matter what she said It wouldnt sway me, she probably would just document in my records what I was doing and go on. I mean really, we ought to have stuff on our terms, not the doctors, as long as we RESEARCH OUR OWN REASONS AND ARE INFORMED, not just blindly doing something!

Thanks so much to the two poeple that replied!

A good reason for me to take labor prep formula would be that I would like to go into my labor on my own BY or RIGHT AROUND my due date. (the Gentle BIrth formula I am talking about helps with not going overdue) I have never went into labor on my own. I have always been induced at 38 wks, 38 1/2 wks, and 38 wks ) , my prenatal checks and ultrasouds were perfect, and my baby's werent that big ( 8 lbs 3 oz, 8 lbs 6 oz, 6 lbs 15 oz) BUt I have had gest. diabetes twice, so I would really like to go right around my duedate, and not too late, if I went on my own. I beleive the formula I talked about would help with this.

[Midwife Kris]

Originally Posted by herbsgirl

A good reason for me to take labor prep formula would be that I would like to go into my labor on my own BY or RIGHT AROUND my due date. (the Gentle BIrth formula I am talking about helps with not going overdue) I have never went into labor on my own. I have always been induced at 38 wks, 38 1/2 wks, and 38 wks ) , my prenatal checks and ultrasouds were perfect, and my baby's werent that big ( 8 lbs 3 oz, 8 lbs 6 oz, 6 lbs 15 oz) BUt I have had gest. diabetes twice, so I would really like to go right around my duedate, and not too late, if I went on my own. I beleive the formula I talked about would help with this.

Have you considered that you haven't gone into labor on your own because you've always been induced, not the other way around? 38 weeks isn't "around your due date", it's 2 weeks before your due date and that's a significant chunk of time.

FWIW I had my babies with a midwife who strongly recommends a particular labor prep formula and everyone ends up taking nearly two bottles of it for the last four weeks of pregnancy to keep from going postdates and to reduce bleeding immediately postpartum (but bleeders always sneak through anyway). For the last four years I haven't had anyone do any labor prep herbs and get the *same* results... no postdates, no additional bleeding. I'm inclined to think they don't do much except make us think we're doing something positive.

[herbsgirl]

You could be right, maybe the ones that take the Labor prep all think positive?!!!

Yes I know all about induction...and its not the best for baby. After my last birth I had a horrible time. My baby was healthy as healthy can be, but did not want to suck right, could care less if he ate 75% of the time, and had a horrible case of Reflux. I think alot of it stems back from the birth being so early.

I would also like to hear, if everythings PERFECT with gest. diabetes mom, would you not induce her at all, even let her go 2 weeks overdue, so her body could go into labor when it was ready? That seems to make sense! Please tell me your opinion! Thanks!

[MsBlack]

I have a lot of clients who like Gentle Birth Formula and also 5W, I think it's caled. I do not like these formulas--blue cohosh is not the only thing in GBF that is not recommended for pregnancy, by the way. I tell them why I don't like these formulas--and then tell them that I will not stop them using it, unless I come to beleive that they are having problems that are or could be related to the herbs. Depending on the situation, discovering secret use of some herb/other could be grounds for firing a client--and I know other mws who feel this way as well.

Personally I think that those formulas are a bunch of hooey, there is simply no evidence that they work to prevent postdates or pph. I'm not as familiar with 5W, but I know that GBF has various 'opposite' herbs in it (blue cohosh to stimulate contrax, false unicorn to suppress, for instance) and that maybe they just cancel each other out...not sure, but I simply have not seen any of the results promised by these formulas. What I have seen are ladies who end up calling me repetitively in the last few weeks with what they believe is labor...but it's not. This I think could be related to the formulas. Last mom who did this, went to 42+3 by the way.

I'm a big fan of herbs--used appropriately. There are numerous herbs to boost nutritional status like yellow dock that helps greatly with iron absorption, and others that are high in calcium, other minerals. RRL is a good gentle utering toner--it acts directly on the uterine muscle cells to produce mild toning contrax, while Blue Cohosh actually stimulates pituitary to release oxytocin (which is why it is used as a labor stimulant, and pph helper). I am no fan at all of my clients using herbs to interfere where no interference is warranted--and 'natural induction' seems to be all the rage lately! No, 38-9wks is not 'term' for most....and if I were your mw I'd be more likely to suggest 2 things: one is ways to eat and exercise that will help keep your blood sugar level healthy. The other would be to try to persuade you that GD is not the threat that it's made out to be by the medical world--and that it's ok to grow a nice big baby for 40 or more weeks!

Anyway--I would rather know what my clients are doing than not. I give them my speech on herbs, interference, trusting nature and themselves, eating/etc right for pregnancy--and then I tell them I'll shut up unless I see problems. Then I do shut up.

By the way, you might be interested to know that false unicorn root is an endangered species...and there are other herbs that do the same job, that are not. I always try to persuade my clients that human over-harvesting along with habitat destruction is not exacty a 'natural' way to go about the job you want done. And I hope they will look toward The Bigger Picture....

[Lynnette]

As a midwife, I am going to have to agree with above midwives. I don't think the formulas help, all women have their babies, and I have even seen too much confidence placed in the formulas to get things going- then when they don't, the frustration level increases.

Use it if you need to, but I tell ladies to save their money!

[Midwife Kris]

Originally Posted by herbsgirl

You could be right, maybe the ones that take the Labor prep all think positive?!!!

I doubt it unless women who don't take herbs think negatively by default

Yes I know all about induction...and its not the best for baby. After my last birth I had a horrible time. My baby was healthy as healthy can be, but did not want to suck right, could care less if he ate 75% of the time, and had a horrible case of Reflux. I think alot of it stems back from the birth being so early.

Gosh, I would think you were your own perfect advisor for why not to encourage labor for a preterm baby. Healthy, yet without a mature suck reflex is sort of a contradiction.

I would also like to hear, if everythings PERFECT with gest. diabetes mom, would you not induce her at all, even let her go 2 weeks overdue, so her body could go into labor when it was ready? That seems to make sense! Please tell me your opinion! Thanks!

Do you have some counseling for your pregnancies to make adjustments and get control of your diagnosis? Perhaps with some extra counseling on the GD you could get that weight off your back and work on a normal end to your pregnancy. Do you take insulin or work on it through your diet?

[herbsgirl]

Metro midwife--I had a diabetic counseler in my last pregnancy--I had No insulin, all diet controlled. And my doctor would always say she felt more "COMFORTABLE" for anyone with Gestational diabetes to be delivered by 38 weeks, she made me scared kinda , like the baby would die from something if I went furthur than 38 weeks, so I went right along with her and helped induce myself!! Please tell me dont you think that her philosipy is riduclus? I need a midwife like you to deliver my next baby! And to top it all off, my many ultrasounds/fluid checks, and non stress tests were perfect!!!

[guestmama9908]

Originally Posted by herbsgirl

Metro midwife--I had a diabetic counseler in my last pregnancy--I had No insulin, all diet controlled. And my doctor would always say she felt more "COMFORTABLE" for anyone with Gestational diabetes to be delivered by 38 weeks, she made me scared kinda , like the baby would die from something if I went furthur than 38 weeks, so I went right along with her and helped induce myself!! Please tell me dont you think that her philosipy is riduclus? I need a midwife like you to deliver my next baby! And to top it all off, my many ultrasounds/fluid checks, and non stress tests were perfect!!!

I'm not a midwife. I am an RN though. I think your Dr's reasoning is flawed. She is attempting to avoid a macrosomic or "big" baby by inducing you early. By doing this she is opening not only you but your baby up to a whole other realm of possible complications and risks.

I have birthed two gestational diabetic babies. One was born at 40 weeks exactly and if it weren't for all of the interventions on the part of the hospital/OB he would have been born perfectly healthy. My second was born at 41 weeks. She was perfectly healthy as well. They were 6 pounds 1 ounce and 7 pounds 11 ounces respectively.

[Reha]

Originally Posted by herbsgirl

Metro midwife--I had a diabetic counseler in my last pregnancy--I had No insulin, all diet controlled. And my doctor would always say she felt more "COMFORTABLE" for anyone with Gestational diabetes to be delivered by 38 weeks, she made me scared kinda , like the baby would die from something if I went furthur than 38 weeks, so I went right along with her and helped induce myself!! Please tell me dont you think that her philosipy is riduclus? I need a midwife like you to deliver my next baby! And to top it all off, my many ultrasounds/fluid checks, and non stress tests were perfect!!!

The only real "risk" of gestational diabetes is a "macrosomic" (big) baby. And, there are many midwives who don't consider a big baby a problem (myself included). It is a common misconception that the same risks of type 1 or 2 diabetes are present with GD (like stillbirth)...but this is simply not true. :

I think that your baby should be allowed to come on her/his own time.

[Jane]

There are more risks of gestational diabetes than just a "big baby". There is a risk of polyhydramnio, and it's risk of abruption and cord prolapse. There is a risk of hypoglycemia in the newborn. Wrapped into the risk of GDM are those women that have plain old diabetes, that showed up in pregnancy or was undiagnosed previously. There's no way to separate them - they fail their GTT just like women with "just" gestational diabetes. So yes, I feel that the risks of Type 1 or 2 can apply unless the woman knew her blood sugars were good prior to pregnancy.
I will admit that I have a bias because I see many women that have several additional risk factors for diabetes b/c they are Native or Islander + another risk factor. If all real estate is local, perhaps all midwifery is personal?

I don't consider glorious big babies to be troublesome, but they are different than those babies with 17" chest and 14" head. Those babies trouble me. I do not think they grew on their own plan sometimes.

I dislike any marketing plan that fosters a dependence on medicines to help that which has shown no need for help.

On the OP, if we couldn't come to an agreement after a discussion or three, I'd strongly suggest the mama find a new midwife for her. I think there might be other issues that come up with her when there is no time for her to change midwives. I wouldn't want the argument to repeat at 41 weeks, when the mother should have switched at 14 weeks. That's not clear...let me try again...At 14 weeks, I can have a wide reaching discussion and it shouldn't feel coersive. We just met...she could find another midwife - I'd recommend midwives if I could. We both have time to research things and change our mind. At 41 weeks, my discussion can become coersive solely because her time to research or change provider is limited.

[wumanh]

communication is key!

I have replied after sections of your message.

Originally Posted by herbsgirl

Ok, what if you are a midwife, and you dont encourage use of a herbal formula that your client wants to use?? LIke a labor prep formula with some blue cohosh in it? What if she(the client) knows you dont want her using it, but she feels pretty comfortable using it and thinks its pretty safe?? If thats her personal conviction and opinion, would you (or a midwife) be offended if your client didnt do as you wanted her to do and went ahead and took the labor prep herbs? Or what if she hid behind your back and took them?

What is in this formula? There may be a reason she might not like it. There are many products on the store shelves that make no sense in how they are formulated.
My first thing to do with women is do a thorough diet recall. Having excellent nutrition avoids so many problems. I have them do nutritional herbal infusions which make a big difference in how they feel. Please get info on eating a whole foods diet and make the effort as you will see a difference in blood sugar levels. Being active- as in taking a walk every day, at least- will also help your body burn sugar more efficiently.
I would find a midwife who is compatible with you as far as being comfortable and knowledgeable about herb use. That way you can ask her opinion and have a degree of confidence. That she is not just saying no to something because she doesn't know about it.
I don't think going behind your caregiver's back is good. This would indicate to me there is not open communication and trust which is not a good client/caregiver relationship.

I am considering using a labor prep formula (Gentle Birth from Mountainmeadow herbs) and I am not sure if I will have a doctor or midwife next time, but the midwife that lives closest to me, I dont think she approves of this formula, because it has blue cohosh in it. So what should I do? Take it behind her back? Or expect her to get mad at me, if I dont do exactly as she beleives? I know my doctor wouldnt support it, she doesnt have hardly any experience with herbs anyway.

Perhaps you can also work with a knowledgeable herbalist who can communicate with the midwife.
As said above- the first step is nourishing your body so it can do what it naturally does as well as it can.
You can also work with someone between pregnancies to improve your health, toning your reproductive system before you conceive. Then I feel you don't need any special formula during pregnancy.

Sometimes I just wish I could do the same as an "Unassisted prenatal care" and have the midwife/doctor help when I need them too. Really isnt that what its all about, as long as everythings like the CLIENT likes it, not neccesarily the midwive's or doctors beliefs?? I am a little confused, but I want to do things MY WAY the next time I get pregnant. MY hubby would never ever even consider an unassisted and it might be a miricle if I even get him to agree to a midwife, so I might need some pointers on what to do if My midwife/doctor and I dont agree...whether to tell her what I am doing and risk midwife/doctor getting mad OR do stuff behind their back???

I feel the relationship between client and practitioner is important. It should be open and honest with both feeling they can say what they need to and be respected and heard. Each has the right to terminate the relationship if they feel they cannot work together.
It is not an adversarial "your way or my way". It is a partnership with both sharing knowledge, opinion, etc. and coming to agreement on the plan. In an emergency you will have to trust your caregiver's experience and judgement.

Share what you are learning about birth and how you feel with your husband. Listen to his thoughts and feelings and see if you can come to some understanding. He may have some fears that you can show him research about or make a plan to address so that everyone is happy. It is not about coercing or convincing but understanding.



PLEASE HELP !! Thank you!!

[herbsgirl]

Thank you to all who replied, I am not pregnant at this time, as some maybe thought, but would like to be prepared and knowledgable the next time it comes time for me to make these descions. I have had 3 inductions and would truly like to avoid this in the future! Thanks to the person who replied that had GD births at 40 and 41 weeks--encouraging to hear!! My doctor made it plain to me she was not worried at all about me delivering a HUGE baby, she thought I could do it no problem, so That wasnt a factor, I dont think.

As far as the other risks with the fluid, she was doing fluid checks once a week by ultrasound, so they would have caught that right away. Non stress tests were done once a week also, so they were keeping close tabs on me. The problem is if I dont go with a midwife next time, I really like my doctor other than a few points (herbs and inductions) she is a really sweet woman and will work with me usually. I had contacted a midwife and asked her if she would do my next birth with GD and she said yes, and that she would let me go into labor spontanously!! SO now I just have to convince DH to have a home birth.

I am really feeling like your probably right about going behind the caregivers back. I would feel guilty ect, not to mention not having a good relationship. I guess if the doctor/midwife did nt agree or want to let me take what I thought I wanted after I shared what I was going to take, then I could always change caregivers to a certain point.

I have dreamed of becoming a midwife..maybe I will after kids get older. I love birth ...I always have. Maybe I could be an assistant. I dont know if I could ever be a midwife on my own!

[BirthFree]

I would be honest about it - (if I chose to take it) - but it would probably depend on how open the MW was about herbs as to how I would take their feedback in the first place. Do they know something about herbs or are they freaked about using them (I know both types of HBMWs) and would rather use drugs made in a lab.

I'm an herb girl, but I tend to be a bit conservative ESP. in re: to the cohoshs... man those are not really for playing with at all in my opinion. So I'd weigh in on why I want to (or don't want to) take it and make a choice based on a combination of those and my provider's opinion (if I trust them).

I don't go over my due date (or have never even been 39 1/2w according to my EDD) so some of this is from that perspective, but I have to sit on my hands at the end of pg and wait it out... they come when they are meant to and I have a lot of faith that that is true. I'd probably start to feel anxious at 43w, but prior to that I'd feel safe unless my inner heart said something different.

That doesn't contribute a ton, but this was an interesting threat to read... thanks for bringing it up herbsgirl

[wumanh]

Everyone should check out what Anne Frye has to say on gestational diabetes! Basically it's a diagnosis not based on any good scientific knowledge.

[Reha]

Originally Posted by wumanh

Everyone should check out what Anne Frye has to say on gestational diabetes! Basically it's a diagnosis not based on any good scientific knowledge.

:

'a diagnosis still looking for a disease'

Also , check out Henci Goer's articles on it:
here is one

[pamamidwife]

Originally Posted by Apricot

There are more risks of gestational diabetes than just a "big baby". There is a risk of polyhydramnio, and it's risk of abruption and cord prolapse. There is a risk of hypoglycemia in the newborn. Wrapped into the risk of GDM are those women that have plain old diabetes, that showed up in pregnancy or was undiagnosed previously. There's no way to separate them - they fail their GTT just like women with "just" gestational diabetes. So yes, I feel that the risks of Type 1 or 2 can apply unless the woman knew her blood sugars were good prior to pregnancy.
I will admit that I have a bias because I see many women that have several additional risk factors for diabetes b/c they are Native or Islander + another risk factor. If all real estate is local, perhaps all midwifery is personal?

I'd like to see solid research on this. Hypoglycemia in the newborn? Perhaps due to long inductions with no food stores in the mother? Risk of abruption? Cord prolapse? Where are the solid studies on this? Polyhydramnios? What??

I think I'm missing a big piece here - are we talking about women who honestly NEED insulin in pregnancy because of the hormone shift that throws them into true Type II diabetes or women who are just diagnosed from the horribly faulty GTT??