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#61 of 88 Old 09-29-2010, 10:50 PM - Thread Starter
 
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@homemade - I'm not sure if you mean financially or logistically it isn't a big deal, and beyond that...I'm going to leave the statement alone. For about a million other reasons, it would be a big deal for me to switch.

To respond to your question about the assistant, you're right, I didn't explain much. I thought there were a few. One, issues of trust. I didn't know her, didn't expect her to be there, and didn't know what she knew or didn't know about me, what she might ask, what she already thought. My MW had never discussed sharing my file with others, and as the assistant hadn't been present at any of our numerous previous meetings, I had mentally written her off as not being involved in my care.

Further, if she's meant to be labor support in the future...it would have been nice to see some sort of response indicating she recognized the situation was tense. A better reading of the room, so to speak. Done something supportive, even if it was just to support my discomfort and remove herself from the room. That's probably asking a lot, or shows that I don't understand what her role is supposed to be...but her sitting there mute and half-smiling didn't help her or help me. It seemed a lot like she was there to stare. She didn't speak to me, DP, or even the MW, at any point during the visit. It was intensely awkward, and I was in no mental state to pass the cookies and try to make nice.

If I'm misunderstanding what the role of an assistant/doula is supposed to be, I encourage posters here to enlighten me. Maybe a MW can chime in with what her assistants' roles are?

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#62 of 88 Old 09-30-2010, 12:15 AM
 
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[QUOTE=nashvillemidwife;15855461]When you first met with the midwife and told her you didn't like being touched, did you make it clear you meant any touch and that routine prenatal exams would be difficult for you? And that when you didn't want spectators, that means you were not comfortable with the assistant/doula which you say she told you about up front? I know you're hurting, but please remember that what you have been through is so far out of most peoples' experiences that you are going to have to be very, very specific about your needs.



But, recognize that you have your comfort level but the midwife will too. If you refuse all common care that a midwife needs to feel she has enough information to serve you, she may feel she can serve you. As far as the asst., you should have asked she leave at that appt. and then discuss her inclusion in the future with the midwife.

It sounds like you have not been clear enough with the midwife or your partner about your needs. Very few home birth midwives work completely alone these days. Most have a regular assistant or two they work with. Some have a list of ones you can interview and choose. You need to talk to her, but recognize that home birth is a relationship. Both you and the midwife have a need to feel comfortable with that relationship in order to trust and work together.

I am a birth asst. for a solo midwife practice, so I will try to tell you how we do our jobs. There are two assistants and one midwife. We all work hard to get to know our clients and their needs. We regularly have chart review to discuss clients who are coming due in the next couple months to make sure we are all on the same page. We all take turns seeing the client. "Seeing" means doing palpation and measurement of your belly, listening to the baby (by doppler or fetascope depending on your preference), blood pressure and asking how you have been feeling since last visit, any new issues, discomforts, questions. We do take blood if its time for a test (that you have not refused and signed a waiver for). If you have an infection going on you may get a speculum exam and swab taken to see if there is an infection, but typically we have you try natural remedies and wait one visit to retest urine before going there. Unless you are very symptomatic (in pain, itching, burning, contracting)...

We all have husbands, personal lives and children so there is a call schedule for the assistants. We alternate call so either of two main assts. and possibly a backup (who is rarely used) asst. could come out with your midwife. If the midwife is with someone else, you would get an asst. you know and the backup midwife for your birth. This is a hard life and everyone I know involved does the best they can to meet each individual clients needs. Maybe you can have a private, non-clinical meeting with the asst. to clear the air and get to know her. I am sure she was as confused as you were during that prenatal. I doubt anyone who has done birth work for that long would have missed the tension, she just didn't likely know where it was coming from and was looking to the midwife to take the lead in her first meeting with you.

I recently had our backup asst. shadowing me in the office. I had a mama come in that I know has certain anxieties and though I had been sharing the visits with her to that point, with this mama I asked her to just sit down and I would introduce her to this client, but handle the actual visit tasks myself. So maybe the mama I was with was a bit anxious, though she did not seem to be. I did not chance having the backup do any of the actual prenatal tasks that first time she saw her. The backup has been coming to the office in preparation for the other primary asst. taking a short leave of absence and we want the mamas from that month to get to know our backup.

In labor we set up the room, help the partner get tub ready, drinks, hot packs, trade off doing counter pressure if partner tires, whatever the need is. We do heart tones every half hour and a full set of vitals (temp, pulse, BP, heart tones) every four hours. Heart tones after every other contraction during pushing. We hand midwife things she needs at the time of birth. We do vitals on mama and baby four times in the first couple hours after birth. We help mama get up to bathroom and back to bed after. If she needs breastfeeding help the midwife or asst. may do it. We chart on the computer. We help tidy up the birthing room and pack the midwives bags back up and load up to go. We come back in the first 72 hours to do a check on mama and baby. I hope my description helps some.
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#63 of 88 Old 09-30-2010, 11:26 AM
 
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Did you speak with your midwife? Or just get that email?

If you liked the idea, did you bring up the possibility of the assistant staying out of the room unless needed, and not actually touching you unless there is an emergent situation?

Maybe the assistant was trying to be unobtrusive, I'm sure the mw spoke with her about your situation. Maybe she was trying to stay in the background to make more comfortable? If you set up a meeting with just her, do you think you can adequately explain the things you felt during the prenatal and have a dialog with her about your needs? If you are going to continue care with this practice, you'll want to get to know her anyway, right? You never know, maybe she will be more sensitive to your needs than your primary?

Did you midwife specify what would happen if you discontinued care? Most will charge you for the prenatals/tests you've gotten(and if there is one, a deposit). And you'll have those records to take with you. So you may get a partial refund. Even if money isn't a main concern, that's a nice thing.

I think it can't hurt, to speak with other mw at this point if you are really feeling uncomfortable with the way things are progressing. You don't have to commit to anything. If you do other interviews, I would definitely talk about the things that happened in the prenatal that made things go south for you.

Was everything okay, before this one incident? You had other prenatals before this one, correct? How did it go with using the doppler and bp taking before this? Have you consistantly felt unheard and and uncomfortable during your prenatals? I think that's an important distinction. If this is a case of the "straw that broke the camel's back", so to say, or just a case of your anxiety increasing as you get closer (which is totally normal for a woman who does not have to carry what you have been through into birth, so I would think it must be that much more for you!) If it's the former, I worry that it's only going to get worse for you. You never have to stay the course just for the sake of ease, because really, is it going to be easy for you either way? If you think it's the latter then, yeah I get wanting to work through the difficulty and I truly hope you can get to a place in that relationship that allows you birth peacefully. Like pp's have said, you deserve to have the experience that want!

Just an afterthought- Have you tried a fetoscope instead of the doppler? Maybe it would be more pleasant for you?

Banana, doula wife to Papa Banana and mother to Banana One, Banana Two, Banana Three, Banana Four...

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#64 of 88 Old 09-30-2010, 12:10 PM - Thread Starter
 
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After review of the sentiments here, I'm beginning to think I should leave this alone. Many of you are saying I needed to do more to advocate for myself. I've tried to explain my difficulties with that, and my inability to do that in this specific situation. However, if the general sentiment is that I dropped the ball on this one, I need to step back and re-evaluate how I interact with people/professionals, and if I will continue to interact with this particular professional, which is probably best handled personally.

If the assistant's role is truly limited to the things listed by homewithtwins, I'm sure I can find a way to work with that, as it sounds like she would be a logistics-assistant. If she's more of a birth assistant, then no. Realistically, it won't work for me.

@Banana: That meeting was the first prenatal exam that had been done. This particular MW's practice doesn't rely on pelvics, etc, so this was the first physical exam that had been done, and wasn't pre-packaged as "Hey, next time you're here, we'd like to do blahblahblah." She hadn't done anything other than a urine dipstick and taking my weight. Once. So for me, this really was out of the blue. I know physicals are given; I figured she'd give me a little notice.

During the exam, she tried the fetoscope one time. I'm not sure how long it takes to locate a heartbeat using one; she tried for about 15-20 seconds, said it, "Wouldn't work," and moved directly to the doppler even though I said I didn't want it used. (Seriously. I hate the cold slimy stuff.)

Thank you, everyone, for your input.

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#65 of 88 Old 09-30-2010, 02:46 PM
 
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@homemade - I'm not sure if you mean financially or logistically it isn't a big deal, and beyond that...I'm going to leave the statement alone. For about a million other reasons, it would be a big deal for me to switch.
No, I meant logistically (records can be transferred, prenatal care can be resumed), etc. I understand that for trust and other reasons this would not be your choice. My point was (and I'm sorry I didn't make this clear enough) that if you don't trust the mw you have now, and you have the opportunity potentially to find a mw you trust more, you could still continue to interview mws that might be a better match.

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#66 of 88 Old 09-30-2010, 03:01 PM
 
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After review of the sentiments here, I'm beginning to think I should leave this alone. Many of you are saying I needed to do more to advocate for myself. I've tried to explain my difficulties with that, and my inability to do that in this specific situation. However, if the general sentiment is that I dropped the ball on this one, I need to step back and re-evaluate how I interact with people/professionals, and if I will continue to interact with this particular professional, which is probably best handled personally.
I don't think you needed to do more to advocate for yourself. I think it's pretty clear in the moment, you just couldn't. And I'm sorry your dp and your mw didn't pick up on that. I would be beyond annoyed if I was clearly uncomfortable and my mw said, "you're edgy" and just kept going. And I think she shouldn't have assumed your feelings (you're edgy) and assumed what comfort measures you would want (pillows under the knees). There should have been a lot more open-ended questions. "I'd like to do ____. It's important because of __________. How do you feel about that? How can I help you be more comfortable?" And so on. I don't think that's a lot to ask of a mw. I've had 4 in my time, and two I didn't love (but didn't have many options), but I didn't like them because of their condescending, maternalistic attitudes. The other two really made me feel like a partner in my care, giving me information, letting me make the choices I wanted. I really think that there might be another mw out there that might suit you better. Of course, she's going to want to do some things as part of your care, but another mw's approach might put you more at ease.

But even if you do stay with your current mw, maybe you can make email correspondence a bigger part of your care, so you can make your needs known before and after visits without all the pressure of a face to face confrontation in her office.

Whatever happens, I truly wish you all the best of luck!

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#67 of 88 Old 09-30-2010, 03:42 PM
 
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I don't think you dropped the ball at all. I am seriously not pleased with your midwife.

I am probably at the opposite of the spectrum from you, in terms of being super comfortable with strangers touching me in invasive ways. But I can understand perfectly what you are struggling with.

It seems most of us here can. I would guess the average person could too. And it is likely the assistant also could.

I don't think the problem is the assistant, specifically, but the midwife. She suddenly sprung a stranger on you, and didn't take any steps to inspire you two to click. It seems like they both knew you were uncomfortable, but the assistant was following the lead of the midwife because the midwife is the one who is supposed to know you already.

It is completely inappropriate that the midwife set up a situation where some stranger knows private things about you, and you don't even know which things, and you don't know a thing about her.

If I were you, I wouldn't count on the midwife to be particularly sensitive about this. I would take it upon myself to try to build a comfort level with the assistant. At this point, there aren't really any red flags that say you couldn't have a relationship with her, just an unfortunately uncomfortable start. What if you invite her to spend some time getting to know you? But definitely do it in a way that you feel like you are on your safe territory and fully in control of things. I have a feeling that by the time of the birth you'll end up feeling more secure and trusting with her than with the midwife.

As for the midwife, I think you should e-mail her before each appointment asking her for an itinerary of what will be done at that appointment. Then you could look at each item and e-mail back asking her if some of those things you could be taught to do for yourself, or if not perhaps they could be done in strict privacy with just you and her, if there is no particular benefit to having the assistant observe. (For example, while some posters said the midwife can't give you the same quality care without the assistant present, I don't see why it helps anyone to have the assistant observe the doppler use. You aren't going to get better data from the doppler by having more people in the room, and the assistant already knows about the doppler even if she misses observing it in use this time.)

In the mean time, you should also e-mail her asking her to clarify the role of the assistant, how hands-on you should expect her to be, and in what sort of circumstances her role could change. Having things sprung on you, and all the asymmetry of info that goes along with that, is a major part of the problem. If you can have an idea in advance of what to expect, it would remove the extra layer of stress.

Leigh, mama to Rostislav homeborn Aug 9 2007, and Oksana homeborn Feb 24 2011.
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#68 of 88 Old 09-30-2010, 05:17 PM
 
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I have been thinking about this situation a lot.

I think that you should leave the practice you are in.... that is what your intuition is telling you to do.

I don't think that the midwife did anything really wrong- I think you both made communication mistakes... but for you the damage is done and you need a new, clean situation.

It is totally normal, and in fact the standard, for providers to talk anonymously about their practice to other providers. It is a really helpful learning tool and one that helps hold all providers accountable. As mentioned, it is also the standard for an assistant to have some background on each client.

Maybe now with some experience you can go into a new situation better informed and more equipped to get your specific needs met.

I would graciously move on if I were you.

Mama to DD-9, DSS-11, happily married and living with 1dog, 1 cat, 7 chickens, and 2 ducks....expecting 03/11
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#69 of 88 Old 09-30-2010, 06:42 PM
 
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After review of the sentiments here, I'm beginning to think I should leave this alone. Many of you are saying I needed to do more to advocate for myself. I've tried to explain my difficulties with that, and my inability to do that in this specific situation. However, if the general sentiment is that I dropped the ball on this one, I need to step back and re-evaluate how I interact with people/professionals, and if I will continue to interact with this particular professional, which is probably best handled personally.

If the assistant's role is truly limited to the things listed by homewithtwins, I'm sure I can find a way to work with that, as it sounds like she would be a logistics-assistant. If she's more of a birth assistant, then no. Realistically, it won't work for me.

@Banana: That meeting was the first prenatal exam that had been done. This particular MW's practice doesn't rely on pelvics, etc, so this was the first physical exam that had been done, and wasn't pre-packaged as "Hey, next time you're here, we'd like to do blahblahblah." She hadn't done anything other than a urine dipstick and taking my weight. Once. So for me, this really was out of the blue. I know physicals are given; I figured she'd give me a little notice.

During the exam, she tried the fetoscope one time. I'm not sure how long it takes to locate a heartbeat using one; she tried for about 15-20 seconds, said it, "Wouldn't work," and moved directly to the doppler even though I said I didn't want it used. (Seriously. I hate the cold slimy stuff.)

Thank you, everyone, for your input.
I can't remember how many weeks you were but my MW cannot reliably hear with the fetoscope until 24+ weeks (and she is very skilled, it's just not loud enough). She will try from 20weeks, but as she says "i could maybe hear SOMEthing but i couldn't say if what i could hear was fine or worrying" (this turned out to be relevant in some ways for us because one episode of tachycardia heard with the doppler was the only indication we ever got of the true knot in her cord, which, luckily, turned out not to be a problem). Maybe she tried with the fetoscope to honour your wishes but knew she wouldn't hear well enough with it, if you're quite early on? (which does NOT sound like a good communication relationship right there!)

Another thing i would say is that while i understand how you felt at the time of the examination, and that you felt unable to advocate for yourself, but i wonder if the midwife feels very shocked at how it made you feel? If she isn't reading you very well, it could be that she had what she felt was a pretty normal appointment where the client was maybe a bit uncomfortable, and then got an email letting her know she had committed assault (which is certainly how you felt). Imagine you yourself hugged someone, or did their hair/nails (i'm scratching, but hopefully you get what i mean) and they seemed ok-if-quiet to you and later you found out they felt physically violated by you. It's probably hard for her to integrate that AND she is probably worrying if it will happen again and how she can avoid it and so on, afterall no-one becomes a midwife to hurt women.

I don't think it's an insurmountable problem, i don't think it's your fault, i just think sometimes it's how it goes. I have frozen in bed with loving partners and basically felt raped because i was unable to do anything but lie there and they didn't get what was going on. I would never compare that to the rapes committed out of intent i suffered, but it sure didn't feel great either. I have long since learned not to get into that situation with people who i cannot absolutely trust and am able to advocate for myself with.

I think that it is NOT a big deal to be able to ask your careprovider to check and double-check if you need it, that you are ok to continue, but i wonder if maybe you need a different MW to get that?

This is a tough situation for you but i really believe it can be ok, you will find what you need and have a magical birth. But don't settle, keep searching, find what you need, what you deserve. I get that you are perhaps second-guessing and thinking you should have done differently, but you didn't and she didn't and here we are. This isn't and should NOT BE about blame or fault. It's a problem to solve. If the peg don't fit the hole, no point shouting at either one! Be kind to yourself.
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#70 of 88 Old 10-01-2010, 10:59 AM
 
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Maybe I am just really sensitive, but I can't understand why the midwife didn't have little red flag warnings to be extra cautious and gentle with you regarding everything based on the history you gave her. I am shocked by the MW's inattentiveness and frankly, by the fact that so many people think you dropped the ball.

I know you didn't comment on anything I wrote in previous posts, but I still wanted to let you know that I think your message was quite clear. Even if the midwife has no experience with clients with this kind of past, she would have been doing you a big favor to look into it more and maybe set up a special appointment with you to discuss your comfort level for certain things.

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#71 of 88 Old 10-01-2010, 11:07 AM
 
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Maybe I am just really sensitive, but I can't understand why the midwife didn't have little red flag warnings to be extra cautious and gentle with you regarding everything based on the history you gave her. I am shocked by the MW's inattentiveness and frankly, by the fact that so many people think you dropped the ball.

I know you didn't comment on anything I wrote in previous posts, but I still wanted to let you know that I think your message was quite clear. Even if the midwife has no experience with clients with this kind of past, she would have been doing you a big favor to look into it more and maybe set up a special appointment with you to discuss your comfort level for certain things.
Unfortunately i think people who have no experience of abuse have a very linear imagination when it comes to how it might affect someone. Sexual abuse = sensitive about pelvic exams. Violence = sensitive about quick movements or overtly aggressive behaviour. Emotional abuse = sensitive about overt verbal bullying/belittling. People DO NOT GET that a trigger can be anything, and that unless you know intimately EXACTLY what went on there's no way to "guess" what will be hard for that person to bear. For me sex can be completely fine, but a word (non-sexual, not "obvious") or behaviour (quite common amongst couples) can make me more or less vomit on the spot. Without knowing me and being through those situations you can never know. People don't get that. I don't think it's AT ALL the OP's fault, but i don't think it's very surprising or rare for someone, even a MW, to miss such things given the average expectation of "what an abused person is like" that i encounter all the time.
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#72 of 88 Old 10-01-2010, 11:21 AM
 
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Unfortunately i think people who have no experience of abuse have a very linear imagination when it comes to how it might affect someone. Sexual abuse = sensitive about pelvic exams. Violence = sensitive about quick movements or overtly aggressive behaviour. Emotional abuse = sensitive about overt verbal bullying/belittling. People DO NOT GET that a trigger can be anything, and that unless you know intimately EXACTLY what went on there's no way to "guess" what will be hard for that person to bear. For me sex can be completely fine, but a word (non-sexual, not "obvious") or behaviour (quite common amongst couples) can make me more or less vomit on the spot. Without knowing me and being through those situations you can never know. People don't get that. I don't think it's AT ALL the OP's fault, but i don't think it's very surprising or rare for someone, even a MW, to miss such things given the average expectation of "what an abused person is like" that i encounter all the time.
Thanks for saying that- really. I have really been thinking about this a lot over the past few days and it has me feeling sort of sad/angry at the lack of empathy. I certainly have had patients who have been through some horrible things that I could never imagine, let alone know first hand, but I feel like it's better to err on the side of being overcautious. However, my Dh always says I was born with an abundance of intuition and empathy and not to expect others to understand or care the way I do. Maybe this is one of those times.

I hope OP and other abuse survivors can find ways to advocate for themselves, find caring providers, and know peace throughout their journey in motherhood.

Aimee wife to Matt Mama to Asher (4) and Ari (Due 11/6/10)
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#73 of 88 Old 10-01-2010, 11:53 AM
 
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I hope that things smooth out for you, Squidmommy. FWIW-when you're in labor, you are the one who decides when it's time to call the mw and no one's going to force you to do so until you are ready to have her in your birth space!

Peaceful birthing!

Banana, doula wife to Papa Banana and mother to Banana One, Banana Two, Banana Three, Banana Four...

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#74 of 88 Old 10-01-2010, 01:10 PM
 
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Maybe I am just really sensitive, but I can't understand why the midwife didn't have little red flag warnings to be extra cautious and gentle with you regarding everything based on the history you gave her. I am shocked by the MW's inattentiveness and frankly, by the fact that so many people think you dropped the ball.

I know you didn't comment on anything I wrote in previous posts, but I still wanted to let you know that I think your message was quite clear. Even if the midwife has no experience with clients with this kind of past, she would have been doing you a big favor to look into it more and maybe set up a special appointment with you to discuss your comfort level for certain things.
So I confess that I'm on the opposite side of the spectrum from you - I'm not very empathetic.

That being said, I'm honestly confused as to precisely what behavior you think would have been acceptable by the MW? I'm really curious as to what expectations are here.

As the OP wrote, she never said 'no'-- she just seemed uncomfortable. How is the MW to know that this "uncomfortableness" is something so severe that she should stop & not use the doppler, as opposed to "uncomfortableness" that is merely indicative of the OP getting used to the MW?
Or, to put it another way, is it really reasonable to expect the MW to never move forward if she senses any degree of "uncomfortableness' from the OP?

Obviously a MW shouldn't move forward when a mama says no, but if she just seems uncomfortable & doesn't say 'no'? Could it just be that the MW thought, "well, of course she's going to be a bit uncomfortable at first, it's going to take time for us to get comfortable with one another." -- like the uncomfortableness was a normal part of the adjustment period, NOT a sign that she needs to stop (again, in the absence of the word 'no'.)

& i think checking fetal HR with a doppler is pretty 'necessary' as part of a prenatal MW apt, (until it's possible to hear with a fetoscope, that is.) So I don't think, at least on a regular basis, that not doing it is really even an option (and, again, OP, admittedly, never said 'no'.)

I'm honestly not trying to be insensitive, I just really, truly, don't understand where the MW was insensitive. I don't understand how she should have behaved. Now, moving forward, as so many have said, they could do hand signals. But, again, the MW didn't know that prior to this meeting.

(All this being said, I think it would have been much better to forewarn OP that the Asst was going to be present, ask permission for her presence, & give them time to get comfortable with one another.)
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#75 of 88 Old 10-01-2010, 01:54 PM
 
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How would she know that uncomfortableness meant something more? Because she had patient history.

Squid said this:
Quote:
I detail my issues with depression, anxiety, weight/anorexia, and history of multi-flavored abuse. I explain my triggers. I make clear, in no uncertain terms, I do not like being touched.
but
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The topic of boundaries hasn't been revisited by my partner or MW since then.
No uncertain terms. This brave but scarred woman was ABUSED. People hurt her, infringed on her boundaries, took away her rights, her self-confidence, her self-respect, possibly. My guess is the depression and anxiety and anorexia came afterwards. Anxiety is a part of Squid's daily interaction with anyone new to her. Those feelings don't go away after she writes it on the intake form. It doesn't go away because she is pregnant. People (including herself) HURT this woman.

Upon reading the biographical information from the patient, I believe the midwife should have addressed this immediately. She should have spent time discussing what happens at visits ordinarily and ask Squid what modifications she would like to have made and discuss it.

At best she might offer some information and solutions, for instance, "We normally will want to listen to the baby by doppler. That involves some touch. First I squirt the aloe/gel on your belly and move the doppler on your belly. Being able to hear the heart rate can give us information about where the baby is positioned as well as health. When it comes time to do this, would you like to do it yourself or have your partner do it?"

At any instance from the beginning to the end when the MW needs/wants to touch Squid, she should say, "Is it ok if I ____?" or "At this point, I often do XYZ, would you or your partner prefer to do that?"

Certainly before sharing the OPs sensitive background with an assistant, she should have asked permission. That's true in any situation.

Homemadmama offered the same advice. Ask before doing: "Squid, I would like to invite my assistant to meet you so you can feel comfortable with her before the time of labor comes. Tell me how you feel about that."

When she noticed she was uncomfortable, why did the MW assume Squid needed a pillow? Weird. I would have said, "Let's take a break. Something isn't right. Can you help me do this in a better way?"

I can think of a thousand ways to have better approached it. I don't know if most people would call the MW INsensitive, but she certainly did not use all the tools available to her to help her client feel at ease.

Aimee wife to Matt Mama to Asher (4) and Ari (Due 11/6/10)
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#76 of 88 Old 10-01-2010, 02:02 PM
 
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Gladiola, I am not the most empathetic person either. Especially since I am so casual about being touched and stuff. But knowing that about myself, if I was working with someone who had this particular history, I would err on the side of caution. I would be checking and double checking each step of the way to make sure everything was going ok.

Leigh, mama to Rostislav homeborn Aug 9 2007, and Oksana homeborn Feb 24 2011.
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#77 of 88 Old 10-01-2010, 02:09 PM
 
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Arg, thank you so much for your kind words. They mean so much to me, especially now. DP and I have a tough decision to make.
Sorry, I didn't catch this update. Kind, but so true. I hate that you have to go through this. I truly hope the birth process is trans formative for you. I have heard that happens to so many women with similar histories.


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My MD and MW got together, talked, and my MW has said (I'm summarizing here, it was a NINE page email!) she's willing to try to work with me, BUT...

1) Picking a new assistant/doula will incur an additional fee.
2) She has other assistant/doulas available, but she said none of them have as much experience in "meeting mother's needs" as her current one.
3) Point #1 may be inevitable, as MW has said she will ask assistant/doula if she is still willing to work with me, because she was uncomfortable at the end of the last visit. (No kidding. Really? W-O-W. Me too!)

So...I will bring those issues to my therapist. We're at the point now where I have to evaluate if I can "work" with the assistant present, since it seems my MW will budge only marginally on the issue, and has said none of her backup choices are as "good" as her current helper.
I am "uncomfortable" with this response. It is not your place to make the doula feel comfortable. If this doula is so great at meeting the mother's needs, why is she unable to meet yours? I call Bull$hit on her statement that this woman is superior in the department of mother care. A really sensitive woman could meet the needs of any mama, no matter what her history. The doula is in a profession that requires her to be a sister to you, understanding and loving. This one isn't for you, IMO. (I wish I could be your doula, but as it is I don't know you, live far away probably, am untrained, and am having my own baby in 5 weeks, G-d willing).

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MW also, without asking me, brought my case to the attention of one of her friends who works with "triggered" persons. I appreciate the sentiment, but it smacks of her not really "hearing" me. I don't want my mental-garbage broadcast 'round the world, you know? I think I was presented as a "What if I had a patient who..." semi-hypothetical scenario, but I'm still annoyed.
This is a sign that the MW IS trying, but didn't quite get it. I appreciate the research she did, but maybe a more generalized search would have been better or at least ask your permission. I hate that the MW and MD talked without you. It would have been nice for you to have a chance to talk abotu this stuff with the MD as a mediator.

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Everything in me is saying, "This is stupid just SWITCH already" but I fear that with only four months left, I won't feel any more comfortable with anyone else, either, which isn't going to get me anywhere. And we're about $1200 paid off with my current MW. It's a complete waste of money. I feel so stuck it's a joke.
1. You might feel more comfortable with someone who is better skilled at dealing with "triggered" persons because they know how to approach you with respect and empathy.

2. Your MW probably has a policy about refunds for transfer of care. Bringing up the possibility of a switch might let you understand if the MW is really wanting to keep you. She might feel ill-equipped or embarrassed by what happened. On the other hand, the MW might really want to make this work. Maybe the MW's friend who has experience has ideas that will help.

3. You are never really stuck. I think you deserve to either find a way to work with this MW so you feel very comfortable or research options that might be better for you.

- Aimee -

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#78 of 88 Old 10-02-2010, 12:54 AM - Thread Starter
 
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I went and pouted a bit, and then got over myself I can completely understand how some of the PP's feel - I'm sure there are a lot of clients who get a little uncomfy during prenatals, and they're typically okay with plowing forward and getting through things. For a standard (oh, heck, I'll just say it - NORMAL) client, which I am not, I'm 100% positive it wouldn't have been a big deal. This is where I wish I was not such a mental train wreck.

For the record, though, I did say I didn't want her to use the doppler. I understand it's a normal/expected part of a prenatal, and I've thought the heart tones were pretty nifty when I heard them during my ultrasound. That gel stuff just sits WRONG with me, and I have a long pelvis. If the MW is going to use the doppler, that goop is going in my underwear because that's the only way she's going to get tones. Squiddo is sitting pretty low. It was just too much for me in that moment, and very unexpected. Now that I know it's something she wants to do, I can bring a change of underoos or something to make it less-gross.

ARG, I wish you did live somewhere near here. You really do sound like you can see where I'm coming from, even if parts of it are completely ridiculous. I completely understand, and will readily admit, I am probably a pain-in-the-buttcheeks client for my MW. I know the way my head works about some issues is completely batty, completely off-base, completely difficult and complicating. That's all the stuff I am trying really hard not to be, because I want this birth to be okay. Not spectacular, not life-altering, not monumental - it just has to be okay. Which I think I can get to - and the work is NOT all on my MW, a lot of it has to come from me.

I mentioned to my therapist the MW's suggestion that I get info from her "I work with triggered people" friend. After consideration, I probably got a little more rankled by my MW's actions than I needed to be. The PP's who said it wasn't the world's biggest deal were arguably right - she was acting as a professional and trying to help me have access to a resource. Though: I do want my therapy to come from my therapist, and not my MW. I don't want to blur the lines, or put more work on my MW's plate. Seems fair?

I'm going to schedule a face to face meeting with her in the coming week. Email is nice, but I want to be able to actually TALK to her and see how we interact. A lot of stuff has been aired out, and I feel like this next visit will be better.

I'm thinking of asking just to meet with the MW at first, and bring the assistant in at a different visit. Seem like a sage plan, or would it make more sense to incorporate the assistant sooner? To the PP who said I should work to build a relationship with the assistant - I'm going to give her another couple shakes and see how it goes. I don't want to force myself to put up with her, b/c my initial reaction was pretty 'enhhhh, no'. But I DO think I need to at least try, for my benefit and my MW's benefit. That way, I'll know I'm not making a knee-jerk or over emotional decision.

Again, thank you everyone, for your comments. I appreciate hearing from both POV's - the posters who have a less "touchy" approach to touch are helping me see what's normal or typical, so I know what I can work toward.

Everything's perfect...
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#79 of 88 Old 10-02-2010, 03:39 PM
 
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Now that I know it's something she wants to do, I can bring a change of underoos or something to make it less-gross.
I take a wash cloth and fold it over the mom's waistbands (pants and panties) to keep the gel off her clothes.
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#80 of 88 Old 10-02-2010, 04:27 PM
 
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I want to recommend Penny Simkin's we site to you she has some good articles and tools- in particular look at the anxiety triggers works sheet, I would suggest using it now and sharing the sheet with your midwife for prenatal care as well as labor and birth

http://www.pennysimkin.com/articles.htm
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#81 of 88 Old 10-02-2010, 05:44 PM
 
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I went and pouted a bit, and then got over myself I can completely understand how some of the PP's feel - I'm sure there are a lot of clients who get a little uncomfy during prenatals, and they're typically okay with plowing forward and getting through things. For a standard (oh, heck, I'll just say it - NORMAL) client, which I am not, I'm 100% positive it wouldn't have been a big deal. This is where I wish I was not such a mental train wreck.

For the record, though, I did say I didn't want her to use the doppler. I understand it's a normal/expected part of a prenatal, and I've thought the heart tones were pretty nifty when I heard them during my ultrasound. That gel stuff just sits WRONG with me, and I have a long pelvis. If the MW is going to use the doppler, that goop is going in my underwear because that's the only way she's going to get tones. Squiddo is sitting pretty low. It was just too much for me in that moment, and very unexpected. Now that I know it's something she wants to do, I can bring a change of underoos or something to make it less-gross.

ARG, I wish you did live somewhere near here. You really do sound like you can see where I'm coming from, even if parts of it are completely ridiculous. I completely understand, and will readily admit, I am probably a pain-in-the-buttcheeks client for my MW. I know the way my head works about some issues is completely batty, completely off-base, completely difficult and complicating. That's all the stuff I am trying really hard not to be, because I want this birth to be okay. Not spectacular, not life-altering, not monumental - it just has to be okay. Which I think I can get to - and the work is NOT all on my MW, a lot of it has to come from me.

I mentioned to my therapist the MW's suggestion that I get info from her "I work with triggered people" friend. After consideration, I probably got a little more rankled by my MW's actions than I needed to be. The PP's who said it wasn't the world's biggest deal were arguably right - she was acting as a professional and trying to help me have access to a resource. Though: I do want my therapy to come from my therapist, and not my MW. I don't want to blur the lines, or put more work on my MW's plate. Seems fair?

I'm going to schedule a face to face meeting with her in the coming week. Email is nice, but I want to be able to actually TALK to her and see how we interact. A lot of stuff has been aired out, and I feel like this next visit will be better.

I'm thinking of asking just to meet with the MW at first, and bring the assistant in at a different visit. Seem like a sage plan, or would it make more sense to incorporate the assistant sooner? To the PP who said I should work to build a relationship with the assistant - I'm going to give her another couple shakes and see how it goes. I don't want to force myself to put up with her, b/c my initial reaction was pretty 'enhhhh, no'. But I DO think I need to at least try, for my benefit and my MW's benefit. That way, I'll know I'm not making a knee-jerk or over emotional decision.

Again, thank you everyone, for your comments. I appreciate hearing from both POV's - the posters who have a less "touchy" approach to touch are helping me see what's normal or typical, so I know what I can work toward.

See, I still think this is being approached all wrong. If you were my client, I'd be fine with handling it however was most comfortable for you. Pregnancy isn't a disease nor is it an accident waiting to happen. Prenatal care is what you do for yourself every minute of the day and has very little to do with appointments. Nothing at your appointments is necessary to ensure a healthy baby. Your baby's heart will still beat even if she doesn't put a doppler on it (which by the way, she could easily use a fetoscope that is safer for baby and requires no gel), your baby will chose his/her position regardless of who is feeling for it, your baby's movements are the best indicator of health, your belly will grow if it's not being measured. And even if you consider some of those things important, your husband and yourself can learn to listen to the heartbeat, you can find the top of your uterus to reassure yourself that it is growing, you can have blood pressure take by a machine on your wrist, etc.

if you were my client, I would spend that hour teaching you about pregnancy and birth, about taking care of babies, about caring for yourself prenatally. I'd get to know you as a friend, I'd reassure you that no matter what, I was not going to do anything to you that you did not ask for; that I would not put my hands on you unexpectedly, bring out any unexpected equipment, bring anyone to the birth that you didn't authorize etc.

Birth is indeed a transformational experience, and I agree that it could be a time to help you feel powerful and safe again. But how can we say that is how it 'should' be for you. Maybe the healing part of this birth would be simply having someone on your side, giving you respect, and not pushing you to be anything that you aren't. Maybe you just want to have your baby and you don't want to be touched, maybe it's not time for you to face these issues. I don't think you should be pushed into a corner on this one. Midwifery is about "being with" women, not "doing to" women. Somehow, things have gotten off track and many modern midwives have embraced the obstetric mindset without even realizing it

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#82 of 88 Old 10-02-2010, 07:04 PM
 
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Sijae, respectfully, there are midwives in JAIL who did nothing "wrong" but were deemed to have failed in their duty of care. And the individual doesn't decide if that happened, if a baby is injured or dies the court decides. It might be completely ideal for the OP to find a midwife who could give the kind of care you would offer, but no midwives i know IRL would ever take such a massive risk. I'm in the UK where homebirth and independent midwifery are respectable and legal and even relatively commonplace in some areas, and there are midwives here who have lost their entire livelihoods (and in some cases their assets) because they failed to spot a breech ahead of time (said breech was delivered, badly, by an Ob after transfer but it was the MIDWIFE who got struck off because she was deemed to have been responsible for the emergent situation the Ob messed up so badly), they saved but damaged a shoulder dystocia baby (erbs palsy after a severe impacted dystocia which the midwife had to resolve alone as her back-up hadn't yet arrived), they missed signs of distress in a subsequently damaged baby (which could have been damaged any time in the last weeks of pregnancy)...i could go on. When a midwife takes on a client she also takes on responsibility for the worst possible outcomes, it is wonderful if you would have the courage to watch and wait and not need to document or quantify the health of the motherbabe, but most are simply unable to take that sort of risk.
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#83 of 88 Old 10-02-2010, 08:06 PM
 
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Squid-

Forgive me for sounding condescending, but I feel proud of you for being able to step outside yourself and looking for ways to work on issues that are difficult. The easy way would be to run away fromit all, but facing it head-on seems like a really good step in your own mental health. Congratulations!

Aimee

Aimee wife to Matt Mama to Asher (4) and Ari (Due 11/6/10)
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#84 of 88 Old 10-02-2010, 09:21 PM
 
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GoBecGo, I am going to be halfway through my pregnancy before I see my midwife next, and she has never put her hands on me, measured me, or listened to the baby's heart beat.

Leigh, mama to Rostislav homeborn Aug 9 2007, and Oksana homeborn Feb 24 2011.
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#85 of 88 Old 10-02-2010, 11:42 PM - Thread Starter
 
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GoBec - Also respectfully - I believe there are many midwives who have a legitimate concern about legal interference in their practice, or unjust/unwarranted legal blame for a situation that may have been handled no better by an OB. I also know there's no way to really, truly KNOW how well a client has researched and understood the potential risks of homebirth, common and uncommon. That means each client may have to be handled, in some way and to some degree, as though something could go tragically wrong. Depending on the midwives' level of comfort and willingness to accept potential responsibility. I respect that all midwives practice differently based on what I said above.

That said, if there were a "No, I won't sue you, I understand the risk of what I'm doing," form I could sign, I would do it. I understand I don't have the "benefit" of constant fetal monitoring, and scalp monitoring, and hep-locks, and epidurals, and pitocin-controlled contractions...or even some or only one of those things. I know exactly what I chose when I chose homebirth, and I chose it precisely because I believed it would be less crisis-indulgent, less invasive, and less active in seeking fear and bad outcomes. I'm willing to accept whatever that brings me, because I know I don't have an OB, or an MD, or even an RN. I have a MW, who, despite all my carping, DOES have a lot of experience. I can promise you, for the purposes of the rest of this thread, I don't need to be approached as the "What if she sues because something went wrong" client, because I simply am not that person. Things can go wrong if I birth at home, at the best hospital in the state, or on Christmas at the Vatican. To sue would be to deny my own personal responsibility in the situation, and to potentially ruin a professional, personally and financially, because I felt some level or guilt, responsibility, or embarrassment at having had a hand in a less than successful outcome.

Like I've said before - this is not all entirely 100% on my midwife. I have to suck it up and accept my role and responsibility. I also don't think I'm he only "mom" out there who feels that way - homebirth is an informed choice, or at least it should be. I feel for the MW's who have to practice under such stress - it takes a lot of the joy out of the job, I imagine.

Sorry if that's completely incoherent and rant-y; I was in a car for eight hours today and my brain is toast made of pudding and jello. Ugh.

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#86 of 88 Old 10-03-2010, 01:37 AM
 
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i think midwives run the gamut in their practice and it depends on their experience and confidence. one of the things i love about mine is that she talks about all this stuff ahead of time and she really LISTENS! she knows me from my last homebirth and she knows what i am and am not comfortable with. i distinctly remember her asking for permission to touch me when i was in labor. not just once, but each time. and i have absolutely no touching issues, quite the opposite. but the fact that she was so respectful of my potentially changing needs and listened to me throughout my pregnancy is what makes her so very wonderful.
you'll get there with yours. it just sounds like she needs some time to re-hardwire herself too. it kinda reminds me of my school's special needs students. there are some teachers who are more comfortable with them in the classroom from day one and there are those that need to be trained to be in that mindset. it'll be good for her too, like professional development.

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#87 of 88 Old 10-05-2010, 12:55 AM
 
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Hi there
I read only the first page of threads so I hope it's okay to jump in.

I loved my midwife, she and I were kindred spirits. One day she mentions having an assistant here for the birth that would bring her baby. That immediately freaked me out. I have an immunosuppressed child and am very cautious who is around all of my family for that reason. I also knew that I would not be able to labor knowing some lady's baby was out in my family room. I know that's terrible but that's just how I felt.
After my MW left that day I tried to think about the best way to handle things. I called her and said "I hope this doesn't sound bitchy but I feel uncomfortable with the assistant you mentioned. I know having someone with a child here will make things harder for me." She was apologetic and said she understood. She asked if I wanted to meet one of her other assistants who also had a dh who retired from my dh's police dept. This felt much better for me. And I agreed to meeting her. When I met her I loved her as much as I loved my MW.
Funny enough on the day I went into labor the assistant could not be reached and my MW went it alone. She called my dh for help when she needed it.
One way I failed a bit in communication was that my dh was very specific with me that he didn't want to see the baby being born. I thought I was clear on that with my MW but for some reason she called to him and I said "I don't need him" but I should have explained in advance more I guess before that moment LOL. And then over I go on hands and knees, dh walks in to baby's head out and my rear in the air. I thought he was going to pass out. He tells me later he thought baby was dead and that I was going to die. He was freaked out for quite a while.

All this to say I think being as specific as possible is beneficial. If you have to put things in writing to your MW or DH then you might want to do so.
Maybe if it's even a list of "I like" or "I don't like" so it's not confrontational.
I don't think an assistant is a must have based on my HB. But I think it might be something your MW feels is a must for her, so may be worth talking over with her more.
I put things in writing to my dh that I knew I didn't want happening during labor so that he'd know in advance.

Also I am very shy and hate the internal exams etc. as well. But I've noticed during labor (all four of them) that feeling does go away for me. The focus is on other things. Not saying that would be the case for you. The birth I felt maybe most uncomfortable with at first was my HB but once I got into that "holy crap this freaking hurts" all I wanted was to get the baby out.

I wish you much luck.

~Melissa~ Policewife, Mom to 4 great kids. Organ donation has touched our lives.
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#88 of 88 Old 10-22-2010, 04:45 PM
 
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Upon reading the biographical information from the patient, I believe the midwife should have addressed this immediately. She should have spent time discussing what happens at visits ordinarily and ask Squid what modifications she would like to have made and discuss it.

At best she might offer some information and solutions...
Ah, thanks for this. I appreciate you typing this out - I get it now. That makes sense & I see the difference.

Ironically, my HB MW has been having her asst (a MW apprentice) do the blood pressure, pulse, fetal heart tones & fundal height at the 2 prenatals I've had thus far. Before every single action, she is asking, "Would it be OK if I did XYZ now?" "Could I do XYZ now?'

Honestly, it's a little annoying! I thought I was being petty in feeling irritated by it - but now that I think about it, I realize - it makes me uncomfortable! It makes me uncomfortable because it makes it like it is all A BIG DEAL. I'm used to the hospital-based CNMs I saw with my 1st PG where it was just implied, "OK, let's listen to baby now." No question asked. Just get up on the table, lay down, pull your shirt up & your pants down.

& while, technically, it could be considered "rude" to not ASK permission, the thing is, they already have my blanket permission for those basic things (fetal HT & fundal height at every prenatal.) I've already given my permission by walking into the exam room & having chosen them as my care providers. So asking permission again seems superfluous & unnecessary, but what's more, seems to add tension to the room for me.

The attitude of assumption the CNMs had strikes me as more casual, relaxed, laid-back, no big deal. Like "This is what we're here to do, we chat a bit first, once you have no other Qs, then this is what we do next, so let's go." It feels more relaxed to me that way, more comfortable.

So I'm going to tell them that next time - tell them "You have my blanket permission for checking BP, pulse, fundal height & FHT, so just go right on ahead, no biggie, it's cool."
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