How can I get the limited care I want?

[gwen's mom]

I originally posted in another forum but then realized the folks that may be able to best answer my questions may be over here...


First a little background:
DD#1-Care provided by a family practitioner, uncomplicated pregnancy, did virtually every test, ultrasound, etc, according to schedule including NST every few days after 40 weeks. DD born at 42.5 weeks, 8 lbs,15 oz. unmediated birth after labor began on its own. Realized that the hospital provided me with nothing but headaches and I vowed to have next babe at home.

Between the two pregnancies I became a Bradley instructor and wrote my masters thesis on natural pregnancy and parenting

DD#2- Care provided by CMW, uncomplicated pregnancy, consented to routine blood and urine tests and prenatal visits on the MW’s pre-determined schedule. DD#2 born at home, 42 weeks, weighing 9 lbs, 2oz.. Birth was great but MW tugged on cord to extract placenta (18 minutes after birth) and I hemorrhaged and I was transferred into hospital hell.

I am now pregnant with #3, currently 13 weeks, and I have two midwife interviews set up for September. While both of these women seem incredible, I am struggling to meet with them. Admittedly there is a large part of me that would like to UC however we live in a very isolated area and our local hospital is basically a band-aid station. As much as I believe in home birth, I really think DH and I would have a hard time finding peace if we UC-ed and something went wrong.

I am having a really difficult time when I think about consenting to prenatal care. I just don’t really see the point. I have read almost every pregnancy and birth book out there and during my last pregnancy my MW would try to answer any of my questions but I had none. My MW appointments were more like a doctor’s visit where I would pee in a cup, step on the scale, get my fundal measurement and be on my way. I am also dreading the financial part of prenatals since a round trip visit is almost 180 miles and that means a lot of gas money.

To complicate things a bit more, live over an hour away from these midwives and our state has recently started witch hunting midwives so they will not cross the border for prenatals or the birth. Thus we are going to be birthing in someone else’s home or a hotel. Obviously this also means that I will have to travel during labor since our babes have come so late it is naïve to think that we could go down a week before (or even after) our due date and wait for the baby.

When it comes to birth, I want someone who is willing to stand by and just watch things happen. My DH caught both of our DDs and is eager to do so again. I just hate being hovered over and touched during labor and birth.

I am feeling like I am going to come off very cold and demanding then I meet with these two midwives if I state my “wants” during our interviews. Basically I want only a few pre-natal appointment (granted I will be over 20 weeks when I chose a midwife, but I just don’t see the point in bi-monthly or weekly appointments.) and no prenatal tests. I also want someone who will be extremely hands off during the birth-essentially just getting involved if and when we ask her to.

Are my “wants” too unrealistic? Am I being too medically risky? Would a midwife be willing to consent to these sort of requests? How can I state my needs without being too demanding?

[Lynnette]

I think that if you simply communicate to the potential midwife the ideas you did here, then you will probably get what you want. I am not into being a control freak as a midwife, but I do like good, honest communication. I am not sure why any midwife wouldn't be flexible to fill your needs. As a person, I don't like being manipulated or lied to, so I would not like that from a client either. So, state what you want simply and see what reaction you get.

The illegal state and the traveling to another place to birth is a hardship. We are dealing with some of that here. Unfortunately, we do have to think about our own families and our own choices as midwives. I think that there are reasonable solutions to the problem. We just had a nice one yesterday, so if you are in the area that I think you are in, then feel free to call me if you would like to talk more. I am not hard to find.

[momileigh]

I know prenatal care can seem pointless, but it is just like birth. On the very small chance that something goes wrong... that's why you have a midwife. Peeing in a cup seems pointless until we dipstick it and you are spilling protein, or you have an infection that may need treatment to prevent preterm labor. Measuring your tummy seems pointless until you have an IUGR baby. That said, many midwives will give you the dipsticks and you can test your urine yourself at home. You can get your bp checked locally, weigh yourself at home, do kick counts, measure your own fundus, and fax it all to her. She can chat w/ you on the phone about your diet, birth plans, etc. You could probably skip numerous prenatal visits in this fashion. I would just be honest w/ her and she may be very flexible with you.

[Reha]

Well, actually, I would like to point out that routine urine dips are NOT AT ALL an evidence based practice. http://findarticles.com/p/articles/m...n15863446/pg_1
(one article about that).

Like my preceptor says, I really think that the majority (like 98% maybe) of prenatal care is all about building a relationship with one another (midwife and client) so that the mother feels comfortable allowing the midwife into her birth space, and so the midwife has an idea about what that mother wants (or doesn't want).

I had a UP (unassisted pregnancy....I didn't see a professional for prenatal care). I did measure my belly and listen to my little one with a fetoscope, but that was mainly for fun.

To the OP, I don't think you are being too medically risky. I would be willing to be your midwife if we hit it off (I think that is the most important thing) and would be fine with just a few prenatals and a very hands-off approach at your birth. Good luck in finding what you want in a midwife near you! I think just being open and honest is the best way to state your needs to a potential midwife, emphasizing why you want what you want.

[momileigh]

Very interesting... but now I am confused, because I was taught that pre-e was declared with any "two out of three" of the symptoms, but that article said it had to be elevated bp plus one other symptom. (So many women have some swelling, it seems that if it was any two out of three you'd almost have to do some testing for all women with swelling.) I'm going to have to look that up.

So, does not everyone dipstick for leukocytes? I know we've caught some serious, symptomless UTI's with routine dipping for leukocytes. (Serious as in we sent it to the lab and she's got tons of e-coli in there.)

[bryonyvaughn]

Originally Posted by gwen's mom

...Are my “wants” too unrealistic? Am I being too medically risky? Would a midwife be willing to consent to these sort of requests? How can I state my needs without being too demanding?

As a UCer I don't think your wants are unrealistic at all and you haven't mentioned a single medical risk.

Some MWs are suportive of UC. We used to have a CNM practice about 45 min away that would back up HBers and UCers. There's a DEM about the same distance in another direction who when folks want to UC but are nervous about completely flying alone, will do a few prenatals and then come to the laboring woman's house and sit downstairs or in her car until her presence is requested. She's definitely outside the mainstream though.\

~BV

[mwherbs]

that article covered routine glucose and protein dips-- if you don't run routine UAs then yes the multi-sticks that screen for UTI can make a difference-and even with a UA I have found the dips sticks to be a quick way to have some info while waiting-- there are other things as well like pH and specific gravity that point to if mom is getting enough fluids and if she is at risk for developing an infection- and ketones really say something to the women who have food aversions-- in any case beyond urine dips there is weighing and measuring and bp checking- getting to know each other plays a big part-- also there are things like just what does someone look like and act like when normal/healthy compared to when they are not well-- a mw I know recently caught a devloping case of PE/HELP by very few symptoms (not BP initally) but pain in the upper right quadrant and mom looking not her usual self, first time she has transferred for a reason like this but as she said things were just not right and it took the hosptial a while to figure it out as wel--- when things are fine it seems like why are we doing this-- but when they are not fine it is clear---
I think it is possible to find a midwife who will follow your wishes - and I think it is important to be clear about your wants and needs- I would say that there are only a few things that I want to do at a birth- one is to be able to listen to baby and things like if I have noticed that she hasn't emptied her bladder in quite a while-- or has not drank anything.. stuff that would help to keep mom well if she is pre occupied not doing that for herself -- I can think of one client in particular who came saying do not make me drink or eat if I don't want to so we didn't say anything about fluids but after many hours we said maybe you might want a drink of water or juice-- her husband spoke very sharply and curtly that no! we should know better! --- well maybe 1/2 hr later we could smell ketones on her breath- and instead of saying something about food or fluids I just said my observation ( she was also seeming to be wearing out at this point, which I didn't say) and she knew what ketone breath meant and said ok get me some recharge-- also I can think of one gal who had a baby near crowning for about 2 hrs and you could see that the baby's head was sideways a bit and she was holding the same position for about 4 hrs, so it had worked to move the baby down to a point but-- well she was basically stuck in that position sort of like when your leg falls asleep or when your hip feels like if you move it ,it is going to pop- well it took some doing to get her up - actually some physical support- normally a mom doesn't need much physical assistance but there are occasions - and there are moms who prefer some massage or back pressure but what ever she wants including standing on her head - fine with me-- and I have talked to other midwives with similar approaches so it is possible to find and get what you want-- and given your story I would be talking about NO CORD TRACTION!!! once I see a gush and mom usually feels some discomfort or just a need to push the placenta out then I will use the cord to help guide the placenta out many times everything just plops out--sometimes it is a good idea to turn the placenta a bit to consolidate the trailing membranes so they come out rather than bits ending up retained--

[SublimeBirthGirl]

There are midwives where I live who are fine with mothers setting the prenatal schedule. I guess it just depends on the midwives. In the end, I went for a UC. The idea of the prenatal care and birth attendants was just stressing me out. Part of it, of course, was making peace with the knowledge that every once in awhile, something goes terribly wrong, and facing that head on to see how we would deal with it. If you really feel you couldn't then obviously it's not the best choice, however unlikely it is that anything will go wrong. I hope you're able to find a midwife who will work with you!