Midwife practices

[miztrezzlyn]

I am confused because I've made an appointment to see a midwife and got the appointment for Dec. 13th. I will about 6.5 weeks along and they informed me that they will be doing blood work (to confirm pregnancy I assume), cultures (not sure what this is for?) and a trans-vaginal ultrasound.

???? I thought that going to see a midwife would mean less of all this stuff and more just natural care. This is my 7th pregnancy (4 successful, 2 m/c, and this one) and I have NEVER had a trans-vaginal ultrasound.

What is this for? Why would they want to do it as a "standard" part of the first visit? What are the risks, if any?

I'm concerned about it. It just seems unnecessary to me and well, I'm just kind of flabbergasted right now.

What has been your experiences with midwives or even OB's who want to do these?

TIA

[amymaew]

All midwives are different. Are they hospital based or a homebirth practice? The ones I use take blood at the initial visit and then later around 28ish weeks, but that's it. They're fine with no u/s, not testing for GD or GBS, etc, but they're a homebirth practice. The midwives in my local hospital are pretty much OBs with different letters - they do u/s at every visit, test for GD, GBS, etc.... it just depends on their philosophy I've found.

[miztrezzlyn]

Originally Posted by amymaew

All midwives are different. Are they hospital based or a homebirth practice? The ones I use take blood at the initial visit and then later around 28ish weeks, but that's it. They're fine with no u/s, not testing for GD or GBS, etc, but they're a homebirth practice. The midwives in my local hospital are pretty much OBs with different letters - they do u/s at every visit, test for GD, GBS, etc.... it just depends on their philosophy I've found.

This midwife is in a practice with other OB's and it is a hospital based practice. I guess I just thought I would be able to have more natural care with a midwife than an OB, just by virtue of her being a midwife. I didn't know there was such a difference between midwives.

Well, I still wonder what everyone's opinion is about transvaginal ultrasound done as "routine". They don't know ANYTHING about my medical history with pregnancies so it really is just...routine.

I am nervous about it since this is one aspect of prenatal care that I have never experienced and I really know nothing about, like the risks and applications of doing it.

[Rivka5]

When midwives work inside an OB practice, typically the OBs are really the ones running the show and the midwives report to them. So you can wind up with more of an OB-style set of standards and procedures. Often people who see a hospital-based or OB-practice-based midwife are really looking for standard medicalized care, but with more personal support and attention.

Independent midwives are much different. My previous birth was with an independent practice of CNMs, who did hospital births but were never under the supervision of OBs or required to answer to OBs.

I had one ultrasound at 17 weeks, because of a family history of structural birth defects. That was completely up to me, though - they didn't require any procedures.

I did have a blood test and cultures at the first prenatal visit. The cultures were for STDs, which I think is required by state law here. (I didn't mind, because I know how possible it is to be carrying an STD and not know it, and the consequences for the baby can be severe.)

The blood test was for HIV, and for antibodies to two other viruses: CMV and toxoplasmosis. I'm not sure if everyone gets the CMV/toxo tests - they were personally relevant to me because I work in an HIV clinic and am regularly exposed to patients who may have those viruses. It was a real relief to learn that I already had antibodies to both viruses, because if I hadn't there could have been serious risks to my baby from in utero exposure. But obviously that doesn't apply to most people.

Remember that you have the right to refuse tests and procedures! It's your body, and your health care. I recommend using the first visit to talk to the midwife about her philosophy of birth and how flexible their standard routines are, and then decide whether or not you want to look for someone else.

[minsch1]

I've never seen a midwife, so I can't comment on the differences between an OB and a midwife. However, my OB also does a 6 week (or so) ultrasound as routine care. It has to be trans-vag because this early, that's the only way to see the baby. My OB does it for a couple reasons. First, to check for multiples. Second, you can usually see the heartbeat at around 6 weeks (a doppler usually doesn't pick it up until 10-12 weeks or so) which for me personally, is very reassuring. I think they also use it to "date" the pregnancy if the mother isn't 100% sure when she's "due". She prints me a couple pictures from the images they take, and for me, these are great to look at when I'm having a difficult pregnancy symptom day - tired, nauseous, ect.

I am not aware of any risk factors of the procedure, but I'm sure you could request to opt out of it if it bothers you. It certainly isn't absolutely necessary for good prenatal care. And seriously, if you do decide not to have it and your midwife freaks out because you are questioning this one small aspect of your care, it might be time to find a new care provider, ykwim?

[homebirthing]

You can decline anything you want. I don't see the point of an invasive ultrasound at all. You know your dates, and ultrasounds are not proven safe.

[amymaew]

If you're not comfortable I'd decline. They're good for confirming dates and seeing the heartbeat, but it's an ultrasound nonetheless, and they haven't been proven safe.

[amymaew]

Originally Posted by Rivka5

Remember that you have the right to refuse tests and procedures! It's your body, and your health care. I recommend using the first visit to talk to the midwife about her philosophy of birth and how flexible their standard routines are, and then decide whether or not you want to look for someone else.

: at least you're finding out their practices now instead of while you're in labor!