Homebirth midwife post partum visits really necessary?

[Rocketgal]

My midwife says she drives out to visit us one day after the birth, three days after, one week after and three weeks after... Does this sound insane to anyone else? She gets $100 for each of these visits too which is another reason I'd like to avoid them if at all possible- I'm being honest. ;-) I plan to bring baby to a GP, won't that suffice? I don't know. I'm 22 weeks right now and I'm still not settled on this midwife of mine, she is a very sweet and seemingly knowledgeable midwife- maybe it's just me. I have such a strong instinct for privacy (and I've never even had a baby before!) and I have told her I want an unassisted birth with her there just to basically babysit my husband lol (of course I didn't say that about babysitting my husband, I wouldn't want to be rude or demeaning to her). Anyway, thanks for any help. OH another thing- she is bringing an assistant midwife and an apprentice midwife. I really don't want one woman in my home when I'm giving birth, forget about three. I told her this and she kind of balked but said she would leave the apprentice home if I insisted. Should I insist? She says she'll keep them out of the room but can I believe her? *bites lip*

Let me just add that this woman is fabulous as far as no cervical checks during labor, no vitamin K shot, anything you would want to avoid she's okay with it. It's just... how can you trust someone with something so important especially since you are so vulnerable during labor!

At the hospital in my town (women and infants RI) you have the baby in the birthing center, and you literally go home two to four hours later. There is no 48 hour checking of the perineum, period. Unless you choose to stay another day, they leave it up to you.

[Peony]

I did one pp visit with my MW at 5 days and that was it. It wasn't necessary for me, the only thing we really did was fill out the birth certificate info.

I didn't want my MW's assistant or the back up MW there, I told her my wishes, and she respected them. I feel if they don't then it might be a sign of larger issues to come. I should say that the MW I birthed DD2 with, was not the MW I started out with. I switched at 30 wks after it became clear that the first MW was not really hearing what I wanted, very small things started to turn into battles, with is not something you want to happen during your birth.

[yoginisarah]

I think the ones right after birth are a good idea. I had plenty of questions (even though it was my second birth) and she may HAVE to do it for liability reasons. My midwife came the day after and 5 days after. She would also call me everyday to check in. After that, I went to her clinic at 2 weeks postpartum and in a couple weeks I'll go to her for my 6 week pp check. Maybe you could work out a different schedule with her?
My midwife did have her assistant there and she had also been at all my prenatal appointments. I really liked having her there though. It was great during delivery in the tub because my midwife was able to be up near my head reminding me how to breathe and not rush pushing baby out while the assistant was behind and able to catch. It was also nice postpartum becuase they were able to clean up more quickly....or one of them could clean up while the other was checking on me and baby. So, it was really helpful. However, your midwife should feel confident doing the birth by herself and should respect your wishes on what is going to make you feel most comfortable. And bringing 2 extra people does seem like a bit much to me.

[StacyL]

I think the one right after birth is the most necessary to catch any health problems in mom. Mine does them one day after, then at 2 weeks and 6 weeks. I don't think that is excessive. She also requires that the baby be taken to a ped within 72 hours, but I think that has to do with her CNM rules in the state. Not a big deal at any rate.

I don't object to a MW having an asst. Sometimes you need an extra set of hands - especially in an emergency. I'm sure she would leave the apprentice behind if you asked. You don't really need three people.

ETA: These visits are included in the MW's fee, as is true for most MW's.

[aprilsfools]

I am not paying extra for mine- it is part of the whole fee that we have already paid. I personally am grateful that mine will be returning so many times, because I am sure I will have lots of questions for her and I am glad that she is going to be keeping an eye on my mood, physical reaction to post pregnancy, BF, etc. Yes, I guess I could call my primary, but seeing as my MW is the one who has been with me through the pregnancy, it makes more sense to me that I would see her. Also, I feel a bond with my MW and am glad to have some time to get used to the idea that our relationship is at it's end.

Oh, and the care of the baby will go to our family doctor after the birth- at the request of my MW.

As for the day of the birth- my MW brings a team of 4 (including her). I am very happy about this because I know that everything that is not directly related to the birth (clean up, cooking, etc.) will be taken care of and DH won't be the one who has to do it. All he has to do is support me during labor and enjoy our baby afterwards.

GL!

[robynlyn80]

I also did not have to pay extra- it was included in the global. she came at 24 hours, 3 days, and then ds had a quick weight check at one week.

i dunno. I think those immediate ones are important, just to be sure there aren't any overlooked problems in mom and baby. The one week probably was unnecessary in our care (baby had gained over one pound- and he looked it).

I personally was glad to have had an extra set of hands at the delivery. DS had the cord around his neck twice and my midwife's assistant was useful. But, I also knew both of them very well. THe assistant didn't show up until I was pushing.

[Shantimama]

Is she bringing the assistant and the apprentice with her to the birth or to the PP visits as well? My MW did PP visits and I appreciated them. I would not have liked having extra people around for those, but it was okay with me for the birth. Where I live two midwives are required for homebirth in case of emergency - one to attend to the mother, one to attend to the baby. I had my prenatal care with both of them so I was comfortable with that arrangement.

As for having a student or apprentice, I think that is up to you. I was fine with it, provided that I could meet the person before going into labour. The only way to get more midwives is for them to be trained, and they cannot become midwives without attending births. I was fine to have a student at one of my births - at another I wasn't as comfortable with having her there so my midwife instructed her to stay out of my room and she was very respectful and was ore of a gopher for my midwife than an attendant at my birth.

[caedmyn]

I think it would be a good idea to have at least one of the early PP visits done (one day or three day). I personally like having all the extra visits after the birth, but we don't do well baby checks and the PP visits are included in the fee--I'd probably feel differently if they were an extra charge. As far as having her assistant & apprentice there, she shouldn't have a problem leaving the apprentice at home. If she doesn't feel comfortable without the assistant being there in case of emergency (which is understandable IMO), I would allow that, but tell her that the assistant needs to be in another part of the house at all times, or even out in the car. If the assistant comes in where you are during the labor or birth, you or your DH can always ask her to leave the room if you don't think the midwife will.

Most of the midwives in this state work alone (unless they happen to have an apprentice) because there are so few of them. I'm comfortable with that because I'm confident that DH would be able to do anything my midwife needed him to do, and because my DD's birth was quite fast at the end and there wasn't even time for the midwife to contact her partner so it was just her there for the birth. If my midwife happened to have an assistant working with her, I wouldn't have a problem with both being there in case of emergency (and I'm a very private person, one midwife plus DH is enough) but I would request that the assistant remain elsewhere in the house unless needed.

[janasmama]

As with the other posters, I agree that the immediate pp visit after 24 hours is necessary. My MW comes at 24 hours, 1 week and 6 weeks but if I've talked to her in the meantime and everything is fine she'll skip the 6 week. It's usually to check on the healing of the perineum.

I didn't want any assistants or otherwise at my birth. Some MW's will only work with an asst. though so they can help them prepare things and or for emergency. I just didn't like the asst. and she never came to my prenatals. If you are going to have the asst. I would ask that she attend some prenatals so you can get to know her.

[treespeak]

As a first-time mom giving birth at home, I found my midwife's post-partum care to be the single most important aspect of our time together--way more important to me than pre-natal visits or labor support. My midwife came to my home at one day post-partum, day four, and then we drove to her office for two more visits in the first six weeks. She also called me every day just to check in for the first two weeks. I felt really confident and prepared for giving birth, but was totally overwhelmed by being a new mom. My midwife "mothered" me in those visits and phone calls and really made a difference in my parenting journey. By the end of her care, I felt that I had internalized a bit of her wisdom, and didn't need outer reassurance for every concern that surfaced. I am also a very private person, and had only one or two visitors for the first two weeks after DS was born, but found the midwife's visits to be really helpful.

[GSMama]

I have to agree with everyone else, the first visits are important ones. IME the midwife isn't there just to check on the babe. You need some looking after too, not just from a physical respect but also mental/emotional. My mw's support post partum was really important to me....I needed another woman there helping me navigate the first days of motherhood that wasn't family.

As far as the back ups are concerned, we don't have a choice in Ontario. All midwives are required to operate as primary (stays with you through labour and birth) and a back up who is there for the delivery. Sometimes they need an extra set of hands and if your DH can't fill that role I'd be reluctant to say no to a backup. When it comes to students we can decline to have them participate in our care if we don't want one involved but I have been more than happy to allow them there. One of the best post-partum visits I had was from our student

[Miss Chris]

I also really appreciated the follow-up visits. We had one at 2 days when she filled in the birth certificate (she doesn't like to put in the name of the baby until that day in case we change our minds when we meet her, I thought that was sweet). It was useful to me to have her there to ask questions about the post partum bleeding, treatment of hemmroids and all the other questions of a first time mom. She also felt my abdomen to make sure my uterus was moving back and contracting and to check how far my muscles had separated. At the one week visit she took a peak at my perineum to make sure it was healing up from a little skid mark and generally kept an eye on me and the baby. At the six week visit she also chatted with me about my feelings about my birth and answered any questions I had. She reminded me that she also could do my well woman check-ups and encouraged me to contact her in the fall for an appointment. We also took a picture of her with Maggie at that visit for our memory book. I found the whole thing tremendously reassuring and helpful and considered it one of the benefits over midwifery care as opposed to care with an ob/gyn. In our case we didn't pay her on a per/visit basis. We had a single price that we paid all at once and that covered everything. I think it would have been worth it though even if we had to pay extra.

HTH

[AngelBee]

My midwife would come as much or as little as needed. There was no seperate fees. I just paid $2000.00 for the birth which included everything I "chose".

[mommathea]

My midwife will call at 24hrs pp, visit 3days, 1 wk, 3wks, 6wks. All this is covered in the 2,500 that we pay for her services. For her to charge extra for each visit seems a little strange to me.
She also brings her midwife in training with her, but she is not to be involved in the birth or in the birth room at all, until or unless there is a problem and the midwife would need an extra pair of hands, and to get things for the midwife so the husband can devote himself to his wife and not running around for anything.

[Rocketgal]

Ultimately, I'm going to ixnay on the postpartum visits. I mean if you had a baby in a hospital they wouldn't ask you to go back the next day to get your perineum checked out! lol. They would just check it at the six week visit. I'm going to have a lot of help with this baby and just don't think the midwife visits are a necessary item. I'm going to tell her that if I am feeling like I need her I'll let her know. I'm also going to tell her I don't want the assistant there.

[wendy1221]

My midwife came at day 4 to do the heel prick and send it in for the genetics testing. SHe usually comes the day after birth and at 1 week, but didn't w/ me. She called and my sister was still here. SHe asked me how I was feeling and bleeding, asked if I wanted her to come, then had me put my sister on the phone to make sure I was fine, and thre was no reason to come over.

[StacyL]

Originally Posted by Rocketgal

I mean if you had a baby in a hospital they wouldn't ask you to go back the next day to get your perineum checked out! lol. They would just check it at the six week visit.

Not true.

I had a hospital birth (emergency transer/failed UC) with my first, and they check your perineum each day you are there - I was there 48 hours (which is standard).

They also have you come back at 2 weeks and six weeks under standard OB care.

[teachinmaof3]

If you are already questioning her so much maybe it's a good idea to start looking for another midwife??

[robynlyn80]

Ultimately, I'm going to ixnay on the postpartum visits. I mean if you had a baby in a hospital they wouldn't ask you to go back the next day to get your perineum checked out!

If you don't want to do them, thats fine. Especially since they cost more (which I honestly think is really strange- the MW is charging extra to do her job IMO).

But don't think that you woudln't get checked out in a hospital if you were there. Most people stay in the hospital for 48 hours after a vag delivery. I guarantee they get poked and prodded a lot more than you will by your mw.

I know my mw once sent a babe into the hospital at either the one or three day visit. I don't know the whole story, but I know the babe was having quick respirations and the mw decided was unusual. Sure enough, the babe had a tiny bit of mec in his lungs. When I'm still spinning 24 hours after birth, I like the piece of mind that someone else has their eyes on my babe (and me too )

[Nan'sMom]

Originally Posted by Rocketgal

My midwife says she drives out to visit us one day after the birth, three days after, one week after and three weeks after... Does this sound insane to anyone else? She gets $100 for each of these visits too which is another reason I'd like to avoid them if at all possible- I'm being honest. ;-) I plan to bring baby to a GP, won't that suffice? I don't know. I'm 22 weeks right now and I'm still not settled on this midwife of mine, she is a very sweet and seemingly knowledgeable midwife- maybe it's just me. I have such a strong instinct for privacy (and I've never even had a baby before!) and I have told her I want an unassisted birth with her there just to basically babysit my husband lol (of course I didn't say that about babysitting my husband, I wouldn't want to be rude or demeaning to her). Anyway, thanks for any help. OH another thing- she is bringing an assistant midwife and an apprentice midwife. I really don't want one woman in my home when I'm giving birth, forget about three. I told her this and she kind of balked but said she would leave the apprentice home if I insisted. Should I insist? She says she'll keep them out of the room but can I believe her? *bites lip*

If you don't want her extra people definitely insist on just her. If she'll only do it with her assistant then make sure you have ample time to meet and get to know the assistant. Wow, three attendants seems like way too many to me. Some people are cool with lots of people around and find it helpful, some not, so go with what feels best to you. And if they're supposed to be out of the room, what is the point of having them there? Ask her specifically what they do. Ask lots of hard questions, make do and don't lists and see how she reacts. Better to go through this now than in labor.

In terms of post birth visits do what feels best to you. For me a midwife visit was far better than driving out to a ped, as my babies hate car seats and I'm not keen on them being in public at very young ages. But that's just my take--it'll be your own baby so your instincts will need to rule it.

One more thought--make sure "in the next room"includes during crowning, birthing the body and birth of placenta. Seems obvious but some mws are silly about stuff like this--I know mine treated crowning like a spectator sport.