Should My Midwives Drop Me? (UPDATE #23)

[GinaRae]

I am about to lose my homebirth and I'm confused. On one hand I understand what she was saying and I should opt out for her sake and the sake of other homebirthers. But yet something doesn't seem right.

The MW at the last appointment said with all things considered, I may be a liability to them and she cannot take that chance because it's her family.

This is the first... every other appointment they have said that these things don't mean much yet. I have consistently bad urine, no matter what I do.

Here are some things about me:

-- I am 31 weeks
-- I am 31 years old and severely overweight
-- No GD with other pregnancies, no signs of it now
-- Iron is fine
-- I've had two good VBACs (c/s 12 years ago) and baby comes quickly when pushing
-- My boys were induced 2-3 weeks early and were 7.14, 7.2 and 7.2
-- Toxemia with first two boys, PIH with third
-- Currently having no swelling, no headaches, no spots. Usually I am on bedrest by now, so I think that's a great sign.
-- My BP has been perfect for me. (The bottom number hasn't gone over 74 to 84 (or was it 86?), which is good for me. No spikes.) I've never had BP problems during my deliveries, despite PIH and Toxemia. No meds for BP ever.
-- No bleeding, eclampsia or other problems postpartum
-- Protein 30+ in urine, sometimes maybe more
-- Leukocytes in urine the last 4 weeks, on and off
-- Bloodwork earlier in pregnancy for my liver showed my liver to not be coping perfectly with the demands, but I am cleansing with Milk Thistle
-- Latest bloodwork had shown liver was doing better but I had high white blood cells and low protein.
-- Despite the last bloodwork, my urine is now showing bilirubin a few weeks later
-- Urine is often concentrated looking, no matter how much I drink
-- I was SO sick a few weeks ago, but I believe it was due to egg allergy I'd never had before. Now eating no eggs and I feel much better.


I wonder if the midwives do not believe I am eating enough protein and drinking enough water even though I say I am.

I had terrible hyperemesis and I've only gained a total of 15 pounds now and I think they think I am not eating because I don't want to gain weight. One of the midwives asked me once if I am mad at myself so I am not eating

Informally, do you feel this information is enough to cause them to dump me as a homebirth client? I am freaked about a hospital birth - totally traumatized by the last one.

Thoughts?

[JunipersMom]

It's a hard call. As midwives we must use all the information and also our instincts while working with families. It seems they have been open with you about keeping an eye on your symptoms ~ and now it has gone beyond their comfort zone. But, you also have to use your momma instincts on where to go from here. You cant force a midwife to not risk you out of homebirth with them, but you can bring your chart to and check with other midwives for a second opinion - find a supportive doc for a second opinion and maybe care - labor at home and go to the hospital and take the OB on call when you feel its time - etc... you have options. Best of luck momma!

[homebirthing]

I think that it is also very normal for an overweight mother NOT to gain a lot of weight, if any.

[dewi]

My local ICAN president couldn’t find a homebirth midwife to attend her VBAC after they dropped her because she was very overweight and had some minor health issues. No other midwife would take her on and we have around ten homebirth midwives and that many birth center midwives.
She was spitting mad and going crazy looking for a homebirth!

She was then told to call all the different local doctors that did the back up for midwives in my area. She wound up with an amazing birth in a hosp with a doc, and in turn this doc turned into a great new resource for so many other VBAC women who are ruled out of the midwifery homebirth and birth center practices.

It was a really amazing turn of events for her to find a doc late in her pregnancy but she was so proud to have created a new resource for others to have physiologically normal birth wiouth meds with this doc in a hosp.


So stay positive and start making your calls. You will find the right person to be at your birth.
Keep us updated!

[soygurl]

I'm not much help, but have you ever read the site plus size pregnancy? It probably won't solve your problem, but may give you some good/new info in any case. Have you considered a UC if you do get dropped? It sounds like you really want to avoid the hospital, so maybe give it some thought... best of luck to you!

[meisterfrau]

Gina, let me ask you honestly...turn it around...do you even want to stay with these midwives at this point? It seems to me that they have done nothing but cause you stress throughout your entire pregnancy. From everything you've posted (as far as I can remember) they have not believed you the whole time about your food intake and have really not been terribly supportive. I'm not sure that all the negative energy they'd bring to your birth wouldn't be almost as bad as the hospital. I didn't post on your last thread about possibly losing your homebirth, but I was thinking this then too.

I'm sorry you're going through this. I hope you can find peace with whatever you decide.

Gina, I'm editing here because I just realized this was posted in "birth professionals" and not in our DDC...I must have seen it in new posts and seen your name, and not even realized! Then I went back to our DDC to see if there were any new posts in the thread and couldn't find it...guess that's why. Looks like you're getting pretty good advice here from actual professionals, which is what you wanted in the first place. Sorry!

[wumanh]

It sounds like you are doing a lot better than with your other pregnancies. I would look for an alternative health care practitioner to help you as well as talking to other birth practitioners.
I would look into also nourishing your kidneys as well as liver. Have they done a diet analysis with you?
Nettles- all around good for the urinary system, goldenrod (helps your body to bring the water to the kidneys for clearing), joy Pye Weed or Gravel root helps the kidneys work better at clearing.
I also agree checking with plus size pregnancy

[dewi]

Gina,
So to reframe the situation and give you back your power...
Have you decided to Drop your midwives?

[1stimestar]

Originally Posted by meisterfrau

Gina, I'm editing here because I just realized this was posted in "birth professionals" and not in our DDC...I must have seen it in new posts and seen your name, and not even realized! Then I went back to our DDC to see if there were any new posts in the thread and couldn't find it...guess that's why. Looks like you're getting pretty good advice here from actual professionals, which is what you wanted in the first place. Sorry!

It never hurts to know you have friends that care.

[1stimestar]

How much protein are you getting a day? Take a look at http://blueribbonbaby.org/ for some good information.

[MamaAllNatural]

No matter how much water I drank my urine would be concentrated and show I was dehydrated. I had some liver issues too. You need to take at least 3,000 mg of Ester-C daily (up to 5,000 if you need it) and that will help your liver function better which will not only actually hydrate you but will help the other issues as well. Add dandelion root for your liver as well as liquid cholorophyll. I'd also start some Progesterone Cream (Organic Excellence is the best brand). Buy fresh lemons and put those in all of your water that you drink (will also help your liver absorb it). No sugar. Only good fats. Lots of protein.

Issues do not mean you can't have a homebirth. I had all kinds of issues but I treated them naturally and birthed healthy babies at home. You deserve your HBAC mama!

ETA: If these midwives do drop you, find another one that has more faith in women and more knowledge of how to treat very treatable things.

[GinaRae]

The only other MW here has a high transfer rate and I doubt she will take me on.

So I decided to go ahead and get an OB consult and most likely I have lost my HB, my water birth and piece of mind. I'm going to be in for a fight, I am sure, but we're not waiting around for the MWs to decide my fate for us, we're moving on.

I love MWs but am so disappointed with my choices in this area. Even the OBs are male with high c/s and intervention rates and the "birth climate" is strained. I expect someone to look at me and call for an induction and/or a c/s. I can't be positive until someone gives me a reason to be - I see nothing but stress ahead.

I continue to work on my intake and my liver, thanks to a PP for more suggestions on how to do that.

Thanks, everyone!

[MamaAllNatural]

Mama, I promise you that the stuff I posted w/make a huge difference! Don't give up. If you don't mind, where exactly in N. CA are you (you can PM if you prefer). I can likely help you find a good midwife. The really good ones are usually having to stay under the radar because they actually trust women and their bodies and aren't scared of the birth process or "what ifs." Hang in there.

[1stimestar]

How about going to a family practitioner instead of directly to an OB? OBs are surgeons. Regular MDs have far lower c-section rates. I would also suggest a good doula, an experienced one. She can help you in getting what you want out of your birth.

[GinaRae]

Originally Posted by MamaAllNatural

Mama, I promise you that the stuff I posted w/make a huge difference! Don't give up. If you don't mind, where exactly in N. CA are you (you can PM if you prefer). I can likely help you find a good midwife. The really good ones are usually having to stay under the radar because they actually trust women and their bodies and aren't scared of the birth process or "what ifs." Hang in there.

I am in Napa (Napa Valley).

[mclisa]

have you considered a doula? It would be a compromise since you can't have the homebirth? She could be the advocate of trying to push what you would have wanted to do at home.

[pamamidwife]

Originally Posted by GinaRae

Here are some things about me:

-- I am 31 weeks
-- I am 31 years old and severely overweight
I'm not sure this has anything to do with being risked out - is this something your midwives have used to risk you out? were they not aware of your weight to start with?
-- No GD with other pregnancies, no signs of it now
GD is pretty much an inaccurate diagnosis anyway. Even if you were diagnosed with "GD" I'd have a hard time believing that it will cause harm to you or your baby
-- Iron is fine
That's good - did you see a drop in your hemoglobin right about now from your early pregnancy labwork? This drop in hgb typically means you will NOT contract pre-eclampsia....A good expanded blood volume does not go hand-in-hand with pre-e
-- I've had two good VBACs (c/s 12 years ago) and baby comes quickly when pushing
Even if you had longer pushing phases, you're still good to go. And the success and safety of VBACs at home is something I'm sure you're aware of. Are your midwives concerned about this?
-- My boys were induced 2-3 weeks early and were 7.14, 7.2 and 7.2
Again, there is a myth that fat women create fat babies. This is a MYTH. Your babies were likely to have been 8lbs and maybe 8.5 pounds at term. Inducing early because of fatphobia (and the erroneous diagnosis of GD) doesn't help mothers any. You learned that with your first pregnancy, ending in cesarean.
-- Toxemia with first two boys, PIH with third
Toxemia is sometimes confused with gestational hypertension. Were your labs indicative of true pre-e?
-- Currently having no swelling, no headaches, no spots. Usually I am on bedrest by now, so I think that's a great sign.
Not that bedrest improves blood pressure (it often makes it worse), but this is all a good sign!
-- My BP has been perfect for me. (The bottom number hasn't gone over 74 to 84 (or was it 86?), which is good for me. No spikes.) I've never had BP problems during my deliveries, despite PIH and Toxemia. No meds for BP ever.
Awesome readings!
-- No bleeding, eclampsia or other problems postpartum
We don't expect it or see it for the majority of women at home
-- Protein 30+ in urine, sometimes maybe more
This is likely due to stress on the kidneys and/or dehydration, pretty normal. I would only worry if, in a 24 hour urine collection (NOT A DIPSTICK!), the protein levels were over 300.
-- Leukocytes in urine the last 4 weeks, on and off
Leukocytes are normal, mean nothing for nearly all women. White blood cells are present in normal vaginal discharge - women get juicy in the third trimester. (again, a reason why I don't use dipsticks)
-- Bloodwork earlier in pregnancy for my liver showed my liver to not be coping perfectly with the demands, but I am cleansing with Milk Thistle
Supporting your liver is good - you're doing the right things and you've gotten some awesome advice here from other mamas.
-- Latest bloodwork had shown liver was doing better but I had high white blood cells and low protein.
High white blood cell counts is not only normal in pregnancy - but it's to be expected. Low protein IS GOOD
-- Despite the last bloodwork, my urine is now showing bilirubin a few weeks later
I think this test on dipsticks is pretty erroneous. Are you jaundiced? I'd have it tested with a clean catch, not a dipstick.
-- Urine is often concentrated looking, no matter how much I drink
Again, it's about your kidneys - they're working hard to filter more blood. You got some solid advice re: supporting your kidneys.
-- I was SO sick a few weeks ago, but I believe it was due to egg allergy I'd never had before. Now eating no eggs and I feel much better.


I wonder if the midwives do not believe I am eating enough protein and drinking enough water even though I say I am.

Wow, it sounds like a relationship I wouldn't want to continue - especially if they're not trusting you.

I had terrible hyperemesis and I've only gained a total of 15 pounds now and I think they think I am not eating because I don't want to gain weight. One of the midwives asked me once if I am mad at myself so I am not eating

This is really, really sad. The idea of emotional components in relationship to illnesses and disease is one that should not be approached in situations like this. Because it's not always likely the cause. To turn the blame on the woman is something that keeps her from trusting her provider.

Informally, do you feel this information is enough to cause them to dump me as a homebirth client? I am freaked about a hospital birth - totally traumatized by the last one.

Egads...they obviously need to read Anne Frye's "Understanding Diagnostic Tests" and her "Holistic Midwifery, Vol I". I'm not sure where your midwives are getting their information. I feel like they're using a bunch of excuses to risk you out.

Frankly, I think you should risk yourself out of their care. They're much too high risk for you!

Originally Posted by DoulaSarah

I think that it is also very normal for an overweight mother NOT to gain a lot of weight, if any.

YES!

Originally Posted by dewi

Gina,
So to reframe the situation and give you back your power...
Have you decided to Drop your midwives?

This is the real question: even if you feel they are your only hope for an attended homebirth, what do you have to sacrifice and endure to get there? And will you trust them at your birth?

Originally Posted by 1stimestar

How about going to a family practitioner instead of directly to an OB? OBs are surgeons. Regular MDs have far lower c-section rates. I would also suggest a good doula, an experienced one. She can help you in getting what you want out of your birth.

I agree wholeheartedly. I recommend FP docs over surgeons any day for normal pregnancies. And that is what you have - a normal pregnancy.

Originally Posted by mclisa

have you considered a doula? It would be a compromise since you can't have the homebirth? She could be the advocate of trying to push what you would have wanted to do at home.

I think there is a fine line with doulas between advocating and offering information. A doula should never be the advocate - only the woman and her partner. A doula can provide physical and emotional support, but she ultimately cannot change hospital or doctor policy nor the measures by which both get their way. I don't agree that doulas should push for a woman's needs. To do that takes power away from the mother.

[1stimestar]

Originally Posted by pamamidwife

YES!
I think there is a fine line with doulas between advocating and offering information. A doula should never be the advocate - only the woman and her partner. A doula can provide physical and emotional support, but she ultimately cannot change hospital or doctor policy nor the measures by which both get their way. I don't agree that doulas should push for a woman's needs. To do that takes power away from the mother.

A doulas best advocating tool is to help the parents gather the information they need to make their own choices. Advocating does not mean speaking for the woman. We are not there to tell them to do X or don't do X or to tell the doctor they will or wont do X. I can help them to find the research about any situation they have concerns over. They can then bring this to their care provider for discussion. There may be a reason doc doesn't want to do X or does want to do X against what the research says and the mother wants. If they can have open discussion about the reason, either the doctor will change his protocol for client, the client will realize why the doctor wants X and will be comfortable with that choice now that she is informed about his reasons, or the client will be uncomfortable with that choice and go to Plan B.

I also offer a lot of negotiating tools for my clients to use that have been pretty successful. My clients might have to do more leg work then mainstream moms (if they are not mainstream moms themselves) but they generally get what they want as far as it is in anyones power. If I were to do these things for them, that would imply that they are unable to do it themselves. That takes away their power, something I am not in the habit of doing.

[MsBlack]

As a midwife, I just want to give a big, hearty SECOND to all that Pam said--and also to reiterate that you've gotten good advice from many of the pps on this thread.

And yes, THEY (the mws you've been seeing) are too high risk for YOU.

It may seem that you are drinking a lot--but drink more, pregnancy takes a lot of fluid!

Finally, if you are really concerned about protein in your urine, then you should get a 24hr catch, and have a lab look at it. Dipsticks are simply not reliable.

All the best to you and your baby...

[pamamidwife]

1stimestar, I think we are basically agreeing.