Midwife or Dr?

[angel0123]

Which do you have? And why did you choose that?

---
I have been told I need to go to a dr this pg... I am considered higher than normal risk. I will be transfering to an ob/gyn soon.
I would love to have a mw. I love the idea of longer appts and some being with you the whole labor.
I feel like I am missing out b/c I have been told not to get a mw. :(

[meggles]

We're contacting midwives to interview now, and hope to decide on one within the next few weeks. We want a homebirth and believe pregnancy and birth are natural events that do not need to be medically managed. I'm healthy and in great shape, so I'm as low-risk as they get. :)

[swtpesq]

I saw a m/w for prenatal care during my last pregnancy (I loved her!), then saw the ob she works with when I had a m/c. I've since switched jobs, and my previous m/w is now too far away (plus I didn't love the ob). There are no other m/w's that do hospital births near where we live (DH insists on a hospital birth because of family history of c-sections, and I tend to agree with him), so I found the most "holistic", doula-friendly ob in my area that I could and that is who I'm going to see. Unfortunately she's getting out of ob (insurance costs too much!), but she will have a replacement who will hopefully be doula-friendly, non-interventive, etc. If not, then we'll be back to square 1!

[gribbit]

We are planning on having a home birth this time and so are seeing a midwife.. I really want to avoid the hospital this time.. More importantly, I want to avoid another c section which is what I ended up with last time.. We both feel that a home birth with a midwife is the way to go..

michelle

[mommy2boys]

I am having a midwife this time around. With my last pregnancy I had an OB and was so displeased with the level of care. I have received numerous recommendations for the midwife I have chosen, I hope she is as good as everyone says.

[Kierdan'sMom]

A midwife. Already picked out the m/w. Same as last pg. She rocks my world! :love

[Synchro246]

Which do you have? And why did you choose that?

---
I have been told I need to go to a dr this pg... I am considered higher than normal risk. I will be transfering to an ob/gyn soon.
I would love to have a mw. I love the idea of longer appts and some being with you the whole labor.
I feel like I am missing out b/c I have been told not to get a mw. :(

I'm not in your ddc, but I was wondering a few things:
1) what state do you live in?
2) who told you you need to go to a dr? and why the moderate/high risk status ?
3) Have you considered colaberative care? This is the midwife doing all the normal stuff (measurements, blood draws, pee sticks, etc) and when you need that "high risk care" you use the doc.

:)

[Thalia]

We are planning on a midwife. We want to have the baby in an alternative birthing center inside a hospital (in Illinois, freestanding birth centers are illegal, for now), and at the one we chose, midwifes are the ones who attend the births.

We decided to go with a midwife because everything seems to be normal with my pregancy so far, and we have a better chance of having an intervention free birth with a midwife. We also liked the fact that our midwife would stay with us the whole time (even if I had a c-section).

Finally, my sister, who is in her last year of an OB residency, said that if she were not an OB herself, she would have a midwife when she gives birth for the first time. She said, "you need an advocate during labor and delivery!". She's a pretty cool OB. :thumb

[angel0123]

1) what state do you live in? Canada

2) who told you you need to go to a dr? and why the moderate/high risk status ?
I was told by my dr... I bled threw my whole last pg with unexplained bleeding. My water leaked threw the last month needing lots of care to watch for my water level. I also had a very rough deleivery. My baby's heart rate dropped and they he was born with an apgar of 2 or 3 I believe.
I love my dr. She is very ap but doesn't like midwives. She told me with my history "if you go with a midwife you are being selfish considering how your last pg and delivery went". She isn't even the one who will deliver so its not like she would get paid for my delivery. kwim?

3) Have you considered colaberative care? This is the midwife doing all the normal stuff (measurements, blood draws, pee sticks, etc) and when you need that "high risk care" you use the doc.
In Ontario you have to choose a mw or a dr you can't have both. But I will look in to it thanks for the suggestion.

[Synchro246]

Now, although you may be at increased risk for developing the same pregnancy complications does not mean that you will develop them. As for the rough delivery it's hard to differentiate if that's something that would have been no matter what or if medical care contributed to the traumatic outcome.

Can you pick a midwife for now and then transfer to the care of a doctor if you become higher risk? It seems like a silly question since midwives take low risk women all the time and part of their practice is transfering care if the need arises.

If you want a midwife and don't have any high risk indicators for THIS pregnancy then I suggest selecting a midwife and being prepared to switch to a doctor if this pregnancy develops risks.

I don't think it's selfish at all to want the best care for yourself and your baby. I think it's overkill to go to a surgeon for a pregnancy just because your last pregnancy was abnormal. Many doctors don't know much about preventing complications they are proficient at dealing with them when they arrise. Midwives are great at keeping borderline women low risk through quality care and nutritional counseling (hence the long visits that you like).

If you post in Midwives, childbirth educators, and doulas about your previous antepartum complications you may get good responses about the liklihood of them developing again or how to prevent their development.

Good Luck with what you decide

[Synchro246]

I feel like I came off a little too pro-midwife in my previous post:o . It wasn't meant to be that way, although I am pro-midwife. I just felt like you really want a midwife and as of right now if your current pregnancy is progressing normally then you should go with what you want.

[velveeta]

Hi ladies! All the replies are interesting! We are going for our second homebirth, although I am actually kind of nervous about it because here in NC, homebirth does not enjoy the same legal status as it does in TX, where our first DS was born. :-(

Plus, we live in a much smaller house with a teeny tiny bathtub. But, my DS' birth was relatively quick (6 hrs), so maybe this one will be, too.

I sure loved my midwife in TX. She made it wonderful! :love

Jean

[gr8tfulmom]

We will be with the same midwives and family birth center we had for ds. When I called to schedule an initial appt. they said "you were just here!"

[PortraitPixie]

midwife/ homebirth this time around. :D

[mrsfatty]

In my previous pregnancy I was PIH/Preeclamptic. I interviewed a mw today...but I have this awful feeling I'm going to have to end up with a OBGYN anyway...

[Mamita Mala]

I just found out I'm pregnant with my second child and am going with a midwife this time. While my hospital experience with my daughter wasn't bad , I want something less medicalized, more natural. More than likely We'll be going with a birthing center since small nyc apartments don't make for great homebirthing places , plus I think my partner would freak.

[bobandjess99]

Which do you have? And why did you choose that?

---
I have been told I need to go to a dr this pg... I am considered higher than normal risk. I will be transfering to an ob/gyn soon.
I would love to have a mw. I love the idea of longer appts and some being with you the whole labor.
I feel like I am missing out b/c I have been told not to get a mw. :(

So what?
I am considered super high risk because of several factors, and had an unassisted homebirth.

It's your choice.

Do what you want.

If *you* truly feel you need the services of a surgeon to bring your baby into the world...then fine.
If you want, see a midwife, you're an adult, stop whining and act like one.

I SO HATE threads like this.

[mrsfatty]

So what?
I am considered super high risk because of several factors, and had an unassisted homebirth.

It's your choice.

Do what you want.

If *you* truly feel you need the services of a surgeon to bring your baby into the world...then fine.
If you want, see a midwife, you're an adult, stop whining and act like one.

I SO HATE threads like this.

Wow...your comment is highly innappropriate.:irked: It's not always about what a woman wants. An adult can be upset about knowing the services of a midwife will not be used for their pregnancy and labor and delivery because of their risk factor. If it upsets you to read it--then move on and don't comment--we weren't acting very "adult" when you were attacking that mama.

I can relate to that woman. I've interviewed a midwife. She said she *would* take me...but basically, wouldn't be able to care for me if I became high-risk--and it would be MY FAULT if I did develop PIH/Preeclampsia...and it's not a matter of choice--PIH/Preeclampsia is NOT preventable...it's ineveitable for some women...I don't need someone else blaming me for a condition I cannot control. That mama didn't need you blaming her for her conditions/situation either. Please be respectful...I hate to see this negativity here on this board.

[Synchro246]

Wow...your comment is highly innappropriate.:irked: It's not always about what a woman wants. An adult can be upset about knowing the services of a midwife will not be used for their pregnancy and labor and delivery because of their risk factor. If it upsets you to read it--then move on and don't comment--we weren't acting very "adult" when you were attacking that mama.

I can relate to that woman. I've interviewed a midwife. She said she *would* take me...but basically, wouldn't be able to care for me if I became high-risk--and it would be MY FAULT if I did develop PIH/Preeclampsia...and it's not a matter of choice--PIH/Preeclampsia is NOT preventable...it's ineveitable for some women...I don't need someone else blaming me for a condition I cannot control. That mama didn't need you blaming her for her conditions/situation either. Please be respectful...I hate to see this negativity here on this board.

I totally agree that the above post is inappropriate. If a woman is having a hard time choosing her care provider it's OK and she deserves support and information.


I am a little confused about your post. Did the midwife say that PIH would be your fault? I do think that rates of preeclampsia can be reduced- ie SOME cases ARE preventable. However, I don't think it's a woman's fault if she develops it. If you are prone to preeclampsia please read about Dr.Brewer's work http://www.blueribbonbaby.org/ They argue that preeclampsia can be eliminated, and I don't know about all that, but I do assert that MANY cases can be prevented and severity lessened.

[mrsfatty]

I totally agree that the above post is inappropriate. If a woman is having a hard time choosing her care provider it's OK and she deserves support and information.


I am a little confused about your post. Did the midwife say that PIH would be your fault? I do think that rates of preeclampsia can be reduced- ie SOME cases ARE preventable. However, I don't think it's a woman's fault if she develops it. If you are prone to preeclampsia please read about Dr.Brewer's work http://www.blueribbonbaby.org/ They argue that preeclampsia can be eliminated, and I don't know about all that, but I do assert that MANY cases can be prevented and severity lessened.

Sorry to be confusing!!! :) Yes, the midwife said it would be my fault if I developed PIH/Preeclampsia...MOST women who get it would get it regardless of any "preventative" measures they may take (i.e. nutrition)...I agree that SOME cases PIH is caused by poor diet (PIH can lead to Preeclampsia)--but that was not the case with me...I've read about Dr. Brewer--his food concept is great for those who have no idea about nutrition...I've read many studies about Preeclampsia--and TRUE PIH/Preeclampsia cannot be prevented or cured (except with delivery)...

It's currently being suggested that those who have PIH/Preeclampsia may have an underlying disorder (like a clotting disorder or a hypertension issue or autoimmune disorders, etc.) that may cause Preeclampsia...but no one really knows...

...It's not guarenteed that I'll get it this time around (my third pregnancy--hopefully, my second full-term healthy baby)...but if I do develop it, I don't want to be under the care of someone who will blame me for it.

I will most likely end up with my OBGYN and pray I don't develop PIH/Preeclampsia...and I will get the birthing experience I desire!

Does that make more sense?

[mama2annabelle]

I'll be seeing a midwife this time around as well. I work as a midwife's assistant in a practice of 2 midwives and will be getting my care from them. I am so excited to be getting care from my friends.

FWIW, to others who have had previous high risk pregnancies...my last pregnancy was rough too with pre-term labor at 23 weeks and 3 months of bedrest. I continued my midwifery care throughout the pregnancy, although I did have to see an OB as well. Everything turned out well and I was able to have the homebirth of my dreams! This time around I am not expecting any complications, but if they do occur I will do the same thing. If you desire a midwife, go to one now. If complications arise, you can always switch. :)

[lucsmama]

i hope i don't offend anyone, but i had to get on here and comment. pre-eclampsia is not held off by being healthy and low risk. i was super low risk too, 25, ideal weight, healthy eater, exercised regularly. i was shocked when i ended up with hellp syndrome (a servere form of preeclampsia). it can and does happen to anyone at anytime. my point is to just make sure you are aware of the symptoms and to not assume because you are young and healthy things will be perfect. i wish that were true, i too had planned a homebirth with a midwife.

[mrsfatty]

i hope i don't offend anyone, but i had to get on here and comment. pre-eclampsia is not held off by being healthy and low risk. i was super low risk too, 25, ideal weight, healthy eater, exercised regularly. i was shocked when i ended up with hellp syndrome (a servere form of preeclampsia). it can and does happen to anyone at anytime. my point is to just make sure you are aware of the symptoms and to not assume because you are young and healthy things will be perfect. i wish that were true, i too had planned a homebirth with a midwife.
:yeah:

Granted I didn't have HELLP...but I agree that it can just HAPPEN to anyone (you are not immune if you eat a healthy diet)...well said mama!

[tempestjewel]

I'm struggling with the same question myself.

My last pg was considered high risk on two accounts. I have an abnormal vascular mass in my brain that they were worried about the extra blood flow and the "pressure" of delivery possibly rupturing and causing a hemmorrage (which could cause a stroke or rarely death). Then, they *thought* I had low amniotic fluid so DD was slosely monitered the second half of my pregnancy although when my water broke the nurses commented on how I sure didn't seem like I had low fluid.

So, for now I'm going back to my old OBGYN, but when I go in for my 8 week appointment (next Friday, I'll be 8 weeks 5 days or so) I'm going to push for a referral to a neurologist because I want to talk to someone who really specializes in brain conditions to see just what the risks would be for me to have a normal, un-medicated, natural labor (I was given the choice with DD between a C-section and a spinal + vacuum extraction w/o pushing and I chose the later). My intuition says that the risk to me is lower then the risk of putting another baby through anesthesia and vacuum extraction, I just need to find people who agree with me!

But, its hard. I want a healthy baby and I want to be a healthy mama who is alive and able to care for my child. So, I'm just trying to seek out information and expertise from as many sources as possible so I can make a *truly* informed choice. With DD I just did what I was told, but this time if I end up with the same delivery I want to know that I did everything in my power to prevent it, kwim?

If I had no medical conditions myself I would elect for a home water birth. I'm holding out hope that I can find a birth center that will take me so I can at least go for a water birth...

[mrsfatty]

Not to beat a dead horse...but here's another thread about "Preventing" PIH/Preeclampsia (http://www.mothering.com/discussions/showthread.php?t=451559)

I really like pamamidwife's response:
I don't believe there is anything really we can do to prevent true pre-e. I'd like to think that the Brewer diet works in prevention, but I don't think it does (his sample size was really small and I think it had more to do with the overall caloric increase, not so much the protein as people like to focus on).

I wish there was something that we could be sure would "work". It's one of the things that scares so many pregnancy providers that if it was as easy as large amounts of protein, it would be done.

I usually just recommend keeping fluid levels up, not decreasing salt (sodium is necessary for an expanded blood volume) and making sure they're eating enough.

Pre-e is too often diagnosed at the end of pregnancy based on rising blood pressure alone. This is not correct. Too many providers include PIH (pregnancy-induced hypertension) with pre-e. They are different.

A rise in bp at the end of pregnancy (the last six weeks) shows that the body is meeting the growing needs of the placenta/baby by increasing the blood volume and pressure to it.

Swelling at the end of pregnancy is a GOOD sign of an expanded blood volume.

True pre-e shows with a contracted blood volume. This usually looks like someone who has the same iron levels mid-preg as they do at the beginning of preg. You should see a drop in the hemoglobin and hematocrit around 30 weeks, as this is the peak of blood volume expansion. This peak means there is more blood plasma, and the red blood cells (the iron level readings) haven't caught up yet.

If I suspected pre-e, I'd look at blood volume expansion numbers and liver enzymes. Any shift in these numbers should warrant closer observation.

[boscopup]

Not in your DDC, but wanted to say to the OP - Using a midwife and transferring to an OB *if* you become high risk should be an option for you, even in Canada. :)

I had PPROM at 29 weeks last time (delivered at 29w4d), so I'm slightly higher risk because it could happen again - we won't know until it does or until I go full term. I'm seeing an OB so that I have one when I go to the hospital (last time I was assigned the teaching group and never saw the OBs making the decisions - just saw the residents who had no authority). It wasn't a *horrible* experience, but it could have been better had I had an OB going in. So that's the only reason I'm seeing an OB at all this time around - I have one who is NCB-friendly and who is really cool about letting me refuse tests, etc. He's great to work with, and he knows all about my plans to use the midwife and have an out-of-hospital birth (not homebirth because it's illegal in my state to have a trained attendant at your birth... I'm crossing the state line just 15 minutes away). In my case, the midwife gets paid out-of-pocket anyway - insurance doesn't cover her. But we still have the midwife fee saved up from last time, which we ended up not needing, obviously.

Anyway, I'm seeing my midwife with every intention of birthing out-of-hospital. If PPROM happens to me again, then I become high risk, and I'll go to the hospital and see my OB, who will likely try to keep baby in longer. If I were to make it to 36 weeks, I'd probably go home, and when I go into labor, go see my midwife and have my originally planned birth. :D

[lucsmama]

thanks for the support katie! i guess i just get a little emotional about it when i read people who are as oblivious as i was. plus i still mourn the loss of my "ideal birth". pregnancy and birth is all about expecting the unexpected i guess :)

[maxmama]

thanks for the support katie! i guess i just get a little emotional about it when i read people who are as oblivious as i was. plus i still mourn the loss of my "ideal birth". pregnancy and birth is all about expecting the unexpected i guess :)

It took three years for me to work through my issues around going from a planned home birth to an emergent section at 36 weeks (breech, platelets dropped to 80K and liver enzymes went all to hell -- for some reason, they don't let you home birth when you don't have a functioning liver or kidneys!). It's been very scary this time, but I figure if i make it to term I'm doing pretty well.

[mrsfatty]

thanks for the support katie! i guess i just get a little emotional about it when i read people who are as oblivious as i was. plus i still mourn the loss of my "ideal birth". pregnancy and birth is all about expecting the unexpected i guess :)
No problem! It's just refreshing to have someone else who had the same (awful) experience...and knowing that they (or that I) didn't do anything wrong--that the condition just happened...

It's frustrating to suffer such conditions (especially during a time that's supposed to be such a memorable, life-changing experience)...but it's even more frustrating when you're constantly blamed...and told it's your fault you have your condition (even though it's been shown to not be preventable in MOST cases)...

I still mourn the loss of my "ideal pregnancy" and my "ideal birth"...I'm hoping this pregnancy and upcoming birth will heal that...I wish the same for you!

[lucsmama]

katie, that is my dream too that this pregnancy and birth will be very healing. what scares me is that it will be worse.

maxmama, it sounds like you had hellp syndrome as well. my son is almost three and it took me this long to feel okay with trying to go through this experience again. it is just not as fun too be pregnant and preparing for birth when you are sort of waiting for everything to go to hell.

[maxmama]

katie, that is my dream too that this pregnancy and birth will be very healing. what scares me is that it will be worse.

maxmama, it sounds like you had hellp syndrome as well. my son is almost three and it took me this long to feel okay with trying to go through this experience again. it is just not as fun too be pregnant and preparing for birth when you are sort of waiting for everything to go to hell.

But you know what? This pregnancy, though high-risk (isoimmunization and history of HELLP/PIH/PE) has been a breeze. My BPs are lower than they've ever been pregnant (100s/50s), my labs are fine and my perinate and OB both think I'll make it to full-term. It's given me a lot of confidence back in what my body can do, instead of feeling like a "hostile uterine environment" (lovely phrase I found on my chart after last time).

[Synchro246]

No problem! It's just refreshing to have someone else who had the same (awful) experience...and knowing that they (or that I) didn't do anything wrong--that the condition just happened...

It's frustrating to suffer such conditions (especially during a time that's supposed to be such a memorable, life-changing experience)...but it's even more frustrating when you're constantly blamed...and told it's your fault you have your condition (even though it's been shown to not be preventable in MOST cases)...

I still mourn the loss of my "ideal pregnancy" and my "ideal birth"...I'm hoping this pregnancy and upcoming birth will heal that...I wish the same for you!

I just want to make sure that everyone here knows that I do not believe that it's anyone's FAULT. That would be rediculous. There are lots of factors that go into being at risk for hypertension related syndromes of pregnancy- most of those factors are out of a person's control.

I too lost my "ideal birth", and I know how hard it is to deal with accepting loads of intervention when I fully believe that most of the time intervention isn't necessisary. I hope to have dealt with my loss before my next pregnancy, but I don't know if I'll need the next birth to go smoothly in order to deal.

[Paige, CPM]

Who & Where: One of my best buddies, and partner in practice before she moved, owes me 3 homebirths! :lol

Why: Well, I believe if my body can create an amazing child that it should be able to complete the process just as successfully at a birth without unnatural interference. :thumb

If there are issues then I will consult with or transfer to an OB who has a very low (8%) c/s rate and know I am still in good hands.

My theory is if one starts with a good midwife who spends lots of time and goes over s/s and will do research with you and you need to consult or transfer you know that there is a really good reason...for me this situation is the best because I think it would make it easier for me to handle if things changed from our ideal. But I am hoping to not need any interventions or consults, just low key and normal.

Blessings to you all... Paige

[mrsfatty]

I just want to make sure that everyone here knows that I do not believe that it's anyone's FAULT. That would be rediculous. There are lots of factors that go into being at risk for hypertension related syndromes of pregnancy- most of those factors are out of a person's control.

I too lost my "ideal birth", and I know how hard it is to deal with accepting loads of intervention when I fully believe that most of the time intervention isn't necessisary. I hope to have dealt with my loss before my next pregnancy, but I don't know if I'll need the next birth to go smoothly in order to deal.

Well, the midwife I interviewed said it basically would be my fault if I developed it--and therefore I could no longer be under her care at that point (I've since decided not using her)...:(

[a_work_in_progress]

I'm going to be seeing an OB/GYN, only because she is completely awesome, loves Mothering magazine, and encourages active participation in care. If I change my mind later, so be it. No biggie. I've had 2 unassisted pregnancies/childbirths, and I'm prepared to do that again. I have a few health concerns, which is why I'm seeing a doctor in the first place.

I'm going to have an unassisted home waterbirth. I want to be surrounded by family and friends, though.

[blissfish]

I'm hoping to find a CNM open to VBAC for this pregnancy. Probably in a hospital.

With my DS (11/03), we went from home water-labor to hospital c-section due to baby being COMPLETELY mummified in the cord. He descended and then there wasn't enough cord length for him to GO anywhere - SCARY! (Almost as scary as the mad drive through town in labor, baby nearly crowned, in the back of the midwife's station wagon). By the time they cut, I was so effaced (possibly because I'd had a 15" head stretching my cervix for 12 hours) that they had a difficult time making a "clean" cut. Subsequently, the attending surgeon gave me a Big Scary Speech about how I am NOT a good candidate for VBAC.

Humph, sez I! But DH was traumatized by the "bad" homebirth, and wants me to commit with him to hospital birth for #2.

I feel some loss around not attempting a home birth again, but recognize that there are more factors than my desire to have it the way I'd always visualized it.

[babysol]

I feel like I am pretty different than some of the other posters. I'm going with the same OB I had last time. I think a midwife would be nice, but I like the OB and know it will be a good experience. I don't need long appointments, or to have someone stay with me during the whole labor, other than my spouse. I also feel pretty comfortable advocating for myself and what I want. I guess in the end I just want a healthy baby, so I don't particularly care where I have him or her, or who I pay to foresee the process. My previous hospital birth was a good experience, so I'm going to do the same thing.

[haydensmom1]

I'm also going back to the same Dr. that handled my care during my first pregnancy. I had an easy pregnancy (very thankful). My bp spiked the day before he induced my labor (scheduled at my convenience). I ended up needing forceps to deliver and my Dr.'s quick decision/action probably saved my sons life. And the epidural was the route we chose.
Like babysol, I don't need anyone with me the entire time, except my husband. It's all about personal choice and what works best for you and your family.

[*~Danielle~*]

Hey Jess, maybe you consider yourself to be the homebirth guru and can't tollerate others exploring their thoughts openly, but this is a message board and I hate the attitude that came off in your post, it was b*tchy!:irked:

[Synchro246]

I'm also going back to the same Dr. that handled my care during my first pregnancy. I had an easy pregnancy (very thankful). My bp spiked the day before he induced my labor (scheduled at my convenience). I ended up needing forceps to deliver and my Dr.'s quick decision/action probably saved my sons life. And the epidural was the route we chose.
Like babysol, I don't need anyone with me the entire time, except my husband. It's all about personal choice and what works best for you and your family.

I'm all about personal choices as long as hey are informed. Inductions often result in higher pain levels in labor and fetal distress. Many women get epi's when they have inductions or augmentations when they would have been quite capable of handeling the pain of natural labor. Epidurals statistically lead to more women 'needing' forceps or other asssisted deliveries. Perhaps you still would have needed your doc to save your baby w/o the induction, epi, or the forcepts, no one can know. I wonder though, how much your choices really "worked" for you. I am glad that you seem happy with your birth experience though, since that is important.