Anyone else h/bing with and "illegal" m/w?

[Pattyla]

I spent most of my first pg under the care of an ob and switched at 30 weeks to a h/b m/w. They are illegal where I live.

This time around I'm going to a h/b m/w from the begining and philosophically I'm great with that. But, I keep wondering what I'm going to do if anything unexpected comes up? All those things that the pg books say "talk to your Dr and they can run some test to find out if you are right. Well my m/w can't run any tests really.

I'm just nervous about the scenarios and if I can think it through I know I'll be fine. It doesn't hurt that I had a nightmare transfer with my dd's birth and I have no faith in the good will of hospitals when it comes to a mom who is obviously planning a h/b.

Like, what will I do if I go into preterm labor?

What if my baby stops moving and I'm scared he/she isn't ok?

What if I develop warning signs for pre-e?

I know how to recognize these sorts of things. I'm not confident about my ability to present myself as a rational woman in the ER in such a situation.

I have an appointment with my m/w in another week and I'll try to ask her these questions too.

I'm the kind of person who does better if I have prepared for the worst and it never happens. Too many what if's stress me out.

Anyone else? I'm sure there are other things I'm not thinking of right now that some of you who have been through this can help with.

[prancie]

I'm homebirthing with an "illegal" midwife (though by my rationalization I can birth where I want and have whoever I want there). If the midwife you have chosen is any good, then she should be able to deal with a lot of the issues you have stated. For other issues, you should establish a back-up OB. Preferably one who is homebirth friendly. Your midwife probably knows of docs in your area who would be happy to see you. You could even go for full prenatal care by an OB but go there for the birth.

I saw my OB once around 18 weeks. We talked and he told me to come back if I had any issues. That was it. No fuss. If I need any "medical" help during the pregnancy then I will go to him. If I need to transfer to the hospital during labor then we go to the nearest one.

Also, your midwife CAN run some tests. You should be getting a urinalysis done at each visit and she will probably check your iron levels a few times. She can also listen to the baby's heartbeat and keep track of your blood pressure and any warning signs of trouble.

[Pattyla]

Thanks for your reply. At my first visit we established that the people she usually uses for back up care aren't options for me for various reasons. Mostly my own bad experiences with those Dr's (one delivered my dd).

It is true that she is checking my urine and my iron and that she has a doppler to use as well.

[birthgreeter]

As you have planned, just talk with her, most problems are avoided with the routeen care she will provide for you. Also, a lot of issues are avoided with you living a healthy lifestyle...(not all but most)
Also read a lot...learn all you can...that will help you too.

[Nicole B]

I had lots of questions too that I got answered quickly just by emailing my m/w
Then I met her in person just yesterday and she pretty much laid all my fears to rest
Any medical needs that I may encounter during the pg I'll just go to the wonderful ob/nmw hb friendly clinic she referred me to
Like the pp have pointed out, your m/w may very well be able to direct you to a great hb frienly practice:

[LoveChild421]

you'll definately want to ask the midwife all your questions, but in my experience my midwife was more cautious because she of how our state views homebirth legally. If there is any sign of real trouble you will immediately transfer.

[SublimeBirthGirl]

Your midwife has had to deal with complications in the past. Definitely talk to her about your concerns.

Make sure you deal with your own fears as well. Your post comes across as very anxious. Birth is safe, and women left alone and not put under pressure, who are unafraid and ready to work with their bodies, are usually just fine. If you go to a mainstream board or watch Birth Day, it seems as though pregnancy and birth complications are almost guaranteed, but so many are iatrogenic. Really spend some time thinking about what you're afraid of, what you'll do if it happens, and get to where you have a plan of action you feel comfortable with. Then let it go.

[twilight girl]

I'm h/birthing with an illegal midwife. However, my OB is really pro-h/b so he will be the backup, and has done so for almost all of my m/w's clients.

As regards, pre-term labor, your midwife probably won't take you for homebirth for pre-term labor anyway. I was just told that I have to make it to 38 weeks for her to attend me at home.

As to other things like pre-e, your midwife will monitor your blood pressure at regular pre-natal appointments, so just make sure that you are having your appointments regularly.

[noasima]

need to find an "underground" midwife

we are moving to albany new york and there are no homebirth midwives that are legal there. we have thought about my husband leaving work for two months so we can birth in austin where i homebirthed my first two babies. this would be both expensive and a bit too much moving around for my taste, but it is an option. (however, our midwife in austin is the BEST and we'd love to have her again) we have also thought about uc, but i still have to read more about this. we have looked into these other options because we may not be able to find an underground midwife in the albany area and secondly, how would we get the newborn infant screening performed. my midwife did this screening for us before and i can't figure out how we would get it done otherwise. there are so many questions. it is very frusterating as our first births were wonderful and stress free. this situation seems archaic at best. i think if we could just find an underground midwife many of my worries would dissipate. how did you all find yours?

[kbuglove]

I just move to an "illegal" midwife state after living in the very friendly homebirth area San Francisco. The politics make me very sad, and very motivated to try to change them here. But if I'm able to get insurance through my dh's new job, I'm going to go see a back up OB, although there are none very friendly of homebirth. I'm just NOT going to mention that I'll be homebirthing. I'll go a couple of times to try to establish a relationship and then play dumb about my plans for birthing. I guess if I have to transfer I hope they will be my backup and if not I'll come in during labor to the hospital saying I've done my own prenatal care. Which is what I have to say in order to get a birth certificate if I birth at home. Sounds pretty complicated but my midwife is awesome at advising me through the loopholes since she's had to work herself through them for over 20 years. Midwives not legally able to work or get certification in a state makes me furious, at the same time makes me feel even more rewarding that it's people the decide to hbirth that will keep spreading and and one day make change! That's how the states that became legal did so.
Good luck mama!!

[Pattyla]

Originally Posted by SublimeBirthGirl

Your midwife has had to deal with complications in the past. Definitely talk to her about your concerns.

Make sure you deal with your own fears as well. Your post comes across as very anxious. Birth is safe, and women left alone and not put under pressure, who are unafraid and ready to work with their bodies, are usually just fine. If you go to a mainstream board or watch Birth Day, it seems as though pregnancy and birth complications are almost guaranteed, but so many are iatrogenic. Really spend some time thinking about what you're afraid of, what you'll do if it happens, and get to where you have a plan of action you feel comfortable with. Then let it go.

I am most anxious about having to transfer for some reason. I had to transfer with my DD and it was hands down the worst experience of my life. I am terrified of doing that again. I know birth is safe. I mostly worry about how we will be treated by the hospital staff if we do transfer and how to help mitigate that to make it not quite the hell on earth that my dd's birth and first few days was.

I know that the likelyhood is that we will not have to transfer. That was true with my first birth too though. Ultimately we didn't have to transfer, it was a judgment call that turned out to be a false alarm but once we were there... The only local ob who will back up m/w's was the ob who delivered my dd. He was powerless to stop the hospital machine once it was in motion after my dd was born and her condition was lied about and she was taken away. If I have something happen I will be walking into a hostile situation. The hospital situation in our city is very hostile to home birth and natural birth. I'm just trying to figure out how to make it as unhostile as possible should I be faced with this again. The m/w who was supposed to catch dd has attended 1500+ births. She has had plenty of hospital transfers. Ours just went horribly wrong. The m/w I am using this time has attended 400+ births. Although I think she will do her best and use her judgment as to where to go etc should a transfer seem like a good idea I need to be prepared myself as well. I wasn't prepared for a transfer last time and it completely blind sided me. I couldn't answer the questions. I couldn't stand up for myself. I didn't know what to do because I wasn't prepared. (I had no trouble sending the epidural guy away more than once though. That I had already thought through )

I know me in labor. I can be easily pushed around, esp if I'm asked to figure out something I haven't thought through. That isn't me most of the time but it sure was me in labor, esp after 17 hours.

[greenmagick]

Your above reasons are why I decided to have a OB as a back up. I see her for regular appts and am just planning on calling her to say oops, baby came quicker than we thought I dont want to have to worry about the details of a transfer if one was deemed necessary, I figure by that point I'll have plenty of other things to worry about.

I would say try to find the best "natural minded" ob you can, and just dont tell them about your homebirth plans. I really do like my OB, but she is not comfortable with homebirthing, so she will not be told (although I always sort of panick and wonder if she could possibly be an MDC member ) Anyways, it definitely is hard here isnt it

[sarahtdubb]

I'm using an "illegal" midwife as well, and my main concern was making sure that, in the case of a transfer, I wasn't going to have to go it alone. She promised me that if we need to transfer she will stay with me, and that she'll go with me to get the birth certificate, even if she's not technically certified here. I think a lot of it is about the relationships MWs have-- she has a good relationship with the birth certificate people in the city, because she's been working a long time, so she can go in with me without worrying about getting in trouble.

I think that even in situations where MWs might be in danger of getting in trouble, in taking you as a client they should make a promise to stick with you the whole way. So if I were you I would check with your midwife to make sure she'll go to the hospital with you and help stand up for you should that be necessary.

Good luck!

[AlexisT]

Originally Posted by noasima

we are moving to albany new york and there are no homebirth midwives that are legal there. we have thought about my husband leaving work for two months so we can birth in austin where i homebirthed my first two babies. this would be both expensive and a bit too much moving around for my taste, but it is an option. (however, our midwife in austin is the BEST and we'd love to have her again) we have also thought about uc, but i still have to read more about this. we have looked into these other options because we may not be able to find an underground midwife in the albany area and secondly, how would we get the newborn infant screening performed. my midwife did this screening for us before and i can't figure out how we would get it done otherwise. there are so many questions. it is very frusterating as our first births were wonderful and stress free. this situation seems archaic at best. i think if we could just find an underground midwife many of my worries would dissipate. how did you all find yours?

I would really double check... direct entry midwifery is not illegal in New York as far as I know, they just have to be certified (so yes, it does exclude some midwives, but it's not a blanket ban). I'm from downstate though and there's a decent number of midwives (hospital and homebirth). I know a fair few women who have had homebirths downstate.

A midwife from Vermont may be able to attend your birth. It isn't very far from Albany to Vermont at all. (Distances are short up there. )

Post in Find Your Tribe and see if anyone knows anyone!

[seekingtruth]

Great post, and you asked some questions I've also been thinking of a lot lately; also feeling anxious about a hospital transfer and what they would do to my dc. My first was born at home with a dr. attending, but he can't anymore due to new state malpractice laws. Knowing he was "legal" and would transfer with us if need be (it didn't) was comforting. So with this birth I'm using an illegal hb midwife (actually my dr's nurse, who's a DEM, but he can't know she's doing it for various reasons, so it's a touchy situation) who I'm completely confident in. One thing that made me feel better, and might help you as well, is that I asked her if she'd transfer with us if need be and act as our doula, which is not illegal (as if we were hbing unassisted), and she said she will. So in that case, it would be her job to do whatever she can (and she's pretty assertive!) to make sure our wishes were being followed (no separation, shots, vit k, circ, etc etc) in the event that dh or I were unable to speak up.

[mom3b1?]

Where I live MWs are semi legal. It's a misdemeanor crime to attend a birth without a license. There is currently no way for a DEM to get a liscense. So if a DEM without a liscense gets caught she can end up paying a fine. It's unusual for this to happen as it's not aggressively enforced, but some communities may vary.

In our state a liscensed CNM can legally attend homebirths but most of them are working only in hospitals, or are more into medically managing pregnancy than I'm comfortably. I know of one in our state who attends only home births and is not overly medical in her approach to birth. She also goes with patients if they transfer, which rarely happens in her practice.

DEM-Direct Entry Midwife
CNM-Certified Nurse Midwife

Kiley

[[e-mail]]

Originally Posted by mom3b1?

Where I live MWs are semi legal. It's a misdemeanor crime to attend a birth without a license. There is currently no way for a DEM to get a liscense. So if a DEM without a liscense gets caught she can end up paying a fine. It's unusual for this to happen as it's not aggressively enforced, but some communities may vary. Kiley

In states without licensure for DEMs, they're practicing medicine and/or nursing/nurse midwifery without a license and are subject to criminal prosecution for doing so. In other words, they're illegal, not semi legal. In some states practicing medicine without a license is a misdemeanor, but in most it's a felony that includes prison time in addition to fines as part of the penalty for violating statutes requiring licensure as a physician, nurse or nurse midwife in order to provide the services that DEMs offer their clients.

And you're right that the level of enforcement varies among communities in any given state. One thing I would add is that all it takes is one home birth death or injury to change a climate from tolerant to hostile virtually overnight.

What state are you in? Is it West Virginia by any chance? I'm asking because it's one of the few states without a DEM licensing law where the statutes make it a misdemeanor to practice midwifery without a license (most state laws don't refer to "midwifery" at all, but instead define the acts associated with providing midwifery care as the practice of medicine and/or nursing/nurse midwifery). PA and NC have similar laws requiring you to be a CNM to practice "midwifery" legally, but in WV it's a misdemeanor as opposed to a felony.

Even so, violating the WV midwifery statute (which requires all midwives to be CNMs) still holds up to a year in prison as one of the potential punishments, in addition to a fine. I'm not aware of any state without DEM licensure in which violating the existing statutes on medicine/nursing/nurse midwifery involves only a fine, but if that's the case in your state, I would love to get more information.

And I need to stress that I'm only referring here to the legal status of DEMs in states that don't license the practice. In states that license DEMs, the unlicensed practice of midwifery is almost always a misdemeanor, as opposed to a felony. I'm not aware of any other states besides WV where DEMs who can't get licensed are subject only to misdemeanor charges (KY and DE are other possibilities the last time I did a thorough review, though each have their own quirks that don't quite let DEMs off the legal hook).

Katie Prown
Legislative Chair
Wisconsin Guild of Midwives

[ksera05]

The other thing to remember - if you present to the hospital with, say, severe pre-e, a peri or high risk ob there will be taking over your case anyway.

In the state I lived with my DD midwives were legal and I was going to have a homebirth. However, when I presented to the hospital at 24w4d with severe pre-e the admitting doctor called the perinatologist and they took on my case. The same would have happened if I was in pre-term labor, etc. The perinatologist ended up doing my emergency c/s, etc.

So really, if it's a severe enough situation, it'll be okay - they're not going to let you go without care.

[chantald]

I homebirth'd with an "illegal" MW.. We went over the "what ifs" in case i had to transfer. I completely understood how it would be handled.. that she would be unable to be at the hospital for me in a MW capacity but could stay as a "friend". I would not have asked her to do that. If I had needed a transfer, I had planned on only having DH attend with me and telling everyone else to skedattle once the ambulance arrived.
I didn't need this plan, but I had a plan in case.

I never felt that I was putting myself or my baby at risk by having a lay midwife. I trusted completely that I was under the care of a wonderful and competant midwife. She went over every reason there could be a transfer and also everything she could deal with without a transfer.

I had PIH with my first baby.. slightly elevated BP with my second.. My MW this time around kept close tabs on my BP and my diet and it all worked out fine.. I think I have white coat syndrome..

I know me in labor. I can be easily pushed around

What about having or hiring a Doula.. who can help you not "easily be pushed around" should you need to transfer?


hugs and good luck to you!!

[chantald]

Originally Posted by noasima

we are moving to albany new york

I know a few women who have had HBs near the Albany area...