When to call the midewife? - Mothering Forums
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#1 of 14 Old 01-24-2012, 07:00 AM - Thread Starter
 
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Hi ladies,

 

I am new to this forum (relatively). I am 34 weeks pregnant with baby #2 and planning a homebirth. Everything is going well for this pregnancy. My son was born in a hospital with an OB, he was posterior, wt almost 10 pounds...so long labor, but I still enjoyed it (before interventions started, but it was for the last 3 hrs of labor, out of 30!)

For my first birth, I wanted to wait as long as possible before going to the hospital, but ended up leaving after 14hrs of labor, wondering why my contractions didn't get closer then 5min (I didn't have a midwife then).

 

This time, I don't have to go anywhere. I like my midwives (I have 2, they are on call every other week, and one of them will be on call the day I go in labor) + a student midwife.

I wonder when I should call them?

I mean, they told me when they want to be called.....but I think I would want to wait longer.

I trust them, but at the same time, I know how intervention increases the longer a health professional is involved in labor. The main intervention is transfer in my case. ( I am biased, because I am a physician (not an OB), and I know that time has an influence on my decisions for my patients, if I am directly involved.....that's just human).

I think that I will have more risks of unneeded transfer if midwives arrive in early labor vs. if they arrive in early transition.

 

but I could be totally wrong, since I have no experience/knowledge in homebirth ( most of my close friends are physicians like me, none of them had homebirths).

 

Of course, I am more than happy to transfer when there is a real need (my midwives have privileges at the same hospital as I do, they have excellent relations with OBs (I know them all), and our EMS services have protocols for transfers for homebirths......they know they could be called for nothing: ex: meconium when pushing, if a midwife calls 911, the ambulance comes and waits at my door, if everything is OK, they leave, no bill, if baby is limp/distress and fails basic resuscitation, ambulance transport is already at my door)....I live 1 mile from the hospital.

 

I think that the main reason I am hesitant about when to call my midwives, is that I am much more relax then they seem to be. I was surprised, because during prenatal care, I found them more interventionist then me (for example, they suggested more tests then expected....but maid me comfortable to decide if I wanted them or not)

 

thank you for your advise!

when did you call your midwives?

 

 

 

 

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#2 of 14 Old 01-24-2012, 08:20 AM
 
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My midwives request that I call them as soon as I think something might be happening, but that does NOT mean that they come right away when I call.  They just want a heads up that hey, we may have a birth in the next day or two.  It helps them plan their life - most notably, I remember them saying if they get a call of someone in early labor the first thing they do is go take a nap so they'll have plenty of energy for the upcoming birth!  With my son, I called them on Wednesday afternoon when I started having contractions ~10 mins apart.  They didn't end up coming to my house until I went into active labor at 8:00 p.m. on Thursday night.

 

IMHO, calling them when they ask to be called is the respectful thing to do.


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#3 of 14 Old 01-24-2012, 08:52 AM
 
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I agree that you should call them when they want to be called.  It's not really fair to not give them advance notice of when you will need them or expect them to just drop everything and come over as soon as you call.   It's not like an OB office or when you go to the hospital and whoever happens to be on call or is there is the one you get.  Since, they have made a commitment to being there, giving them advance notice that you may need them in the next few hours to a day or so is only fair.


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#4 of 14 Old 01-24-2012, 11:05 AM
 
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Just because you call them doesn't mean they show up.  You call, you have a conversation, they determine from that whether you're in early or "advanced" labor (if you can talk through a contraction it's still early).  If you're in early labor, they're most likely not going to come out unless you ask them to, in which case it'll be 20 minutes of them checking heart tones, reassuring you that you're doing great and then they leave. 

 

I was in labor 5 days with my DS.  My MW came out a few times in the first few days, long enough to check heart tones and determine that I wasn't in danger of actually delivering any time soon (no cervical exams though), and then they left.  They were here for the last 20 hours of labor, when it became apparent (to them) that we were approaching the finish line. 

 

I would highly suggest having a conversation with your MW about what you want in labor.  That you don't want them to come out until you're "close".  Or that if they're at your house that you'd like them to give you your space unless necessary.  Most MWs are fine with that - they will inform you of any limitations they may need to place (like checking heart tones every 2 hours or whatever they need to do), but have no problem giving you space.  If they do have a problem with it, then it's time to really have a heart-to-heart about expectations for labor/delivery. 

 

But I have never met a MW who would force a transfer on a woman against her will (outside of a medical emergency).  If the MW thinks it's time to start discussing a transfer, it's usually for some very specific reasons, either something is concerning, or mom is exhausted.  If something is life-threatening, they're not going to discuss, they're going to start issuing orders, but that's why they're there.  Otherwise they're most likely going to follow your cues.  During my long labor (which never would have been allowed if I'd been seeing an OB), the only time the subject of the hospital came up was when *I* brought it up.  When I told my MW I wanted a C/S (after 5 days), she suggested I might be in transition and maybe she should check me before we got in the car. 

 

I know all your experience is medical, but you can't expect that your MWs are going to react the way your colleagues would.  The best way to sort this out is really to discuss it with them. 


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#5 of 14 Old 01-24-2012, 01:02 PM - Thread Starter
 
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thank you for your replies! They are really helpful and make me think.

 

I didn't see the fact that I inform my midwives about my labor only when I am comfortable as a disrespect to them!

rather, I think that I will be more comfortable to labor alone without ''time frame'' until I feel that I need support/supervision etc.

once they are here, I would like to rely completely on their judgment and experience, and if they say we transfer, I will do it, even if I am not sure it's a good idea, since later in labor, I am not very objective to take this kind of decisions. That's why I need midwives. So I don't have to think. I would like to have the luxury to just labor. No thinking. That's the main reason I didn't want another hospital birth....I spent a lot of time discussing and giving arguments against interventions with my OB the first time (an OB that was once my supervisor, that is super nice, but we view birth very differently)

 

the fact that some of you suggest that I need to think about my midwives comfort in labor instead of my own surprises me!

I really like my 2 midwives, have excellent relationship with them, but when labor comes, my own comfort comes before theirs. That's why they work in a group of 2, each of them is on call every other week.

 

If I feel like I would like their opinion, I would call them. But if I feel that everything is progressing smoothly in early labor, and knowing that nobody is counting time will make more relaxed and I will enjoy more my labor. So I think it is not disrespectful to call them only when I feel necessary.

I caught a good 50 babies myself , some vaginal breeches and some twins.....so I have a good idea of when I will need to call them (but I know that this doesn't compare with hombirth experiences).

 

I agree with you that most midwives would not worry about labor being too long (if everything else is fine), and I am sure mine wouldn't neither......it,s more in my head: I feel that I can surrender to labor more easily if I know that nobody is counting time. I will feel more relaxed.

 

what do you think?

 

thank you for sharing your opinion!

 

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#6 of 14 Old 01-24-2012, 01:10 PM - Thread Starter
 
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Oh, and just to add: we have discussed this issue...and I find them more ''stressed' then I am about the home birth. They said they would suggest transfer if labor progresses slowly once it started, because they are afraid that baby will be too big and are scared of shoulder dystocia.

I do not have GD, my first baby as big, and this one will probably be as big...or bigger. but my son was born vaginaly, despite posterior presentation, with ''only'' 1 hour pushing, no shoulder dystocia, no tears/episiotomy, no instrumental delivery. (despite pushing on my back with an epidural). so I am not really worried about things going wrong this time, since it is my second birth, and I will have the freedom to move around. I think that my body makes big babies and is also well made to deliver them.

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#7 of 14 Old 01-24-2012, 04:19 PM
 
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Quote:

 

the fact that some of you suggest that I need to think about my midwives comfort in labor instead of my own surprises me!

I really like my 2 midwives, have excellent relationship with them, but when labor comes, my own comfort comes before theirs. That's why they work in a group of 2, each of them is on call every other week.

 

If I feel like I would like their opinion, I would call them. But if I feel that everything is progressing smoothly in early labor, and knowing that nobody is counting time will make more rela

 

While, I understand what you are saying, I think what it comes down to....is it really fair to call them (with them having no prior warning that you are in labor) and say "hey, I need you here NOW" and they have to rush around and drive to your house (and they could be an hour or two away), maybe drop their children off someplace, maybe get something to eat first, etc.    While, if you were to call them in early labor, they could at least have some warning that they might be needed in the next few hours to days and arrange their lives accordingly (notify their childcare, stay closer to home, make sure to have things ready, cancel other appointments,  try to be well-rested, etc.).  Even just things like, maybe the midwife normally stays up to midnight, but if she knows she is likely to be called in the middle of the night, she may be more likely to go to bed earlier, so as to try to get some more sleep in. 

 

I realize the midwife is on call, but there are still things she may need to do before she can get to you, and giving her some warning can only make things easier for her, and help you have a less stressed and more relaxed midwife, which in turn would help you.   Especially if they are expecting to be called in early labor. Being on call doesn't mean she just sits by the phone, ready to jump up at a moment's notice, yk.

 

I'm sure homebirth midwifes are very used to prodermal labor and labors that start and stop and aren't going to put you on a clock or count time, the way a hospital would.   If that is a concern of your, you should discuss it with them.


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#8 of 14 Old 01-25-2012, 04:44 AM
 
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I have to chime in here.  I'm a home birth midwife that has missed many births because I arrived too late.  I remember the first time it happened.  I called my fellow midwife, an old experienced midwife, and told her I missed my first birth.  She replied, "Was it her second baby?"  I said, "Yes."  She said, "It's always the second baby."  Now 12 years of experience behind me, I agree, it's always the second baby. Second babies usually come much faster than first babies. All that being said, it does sound like your midwives are a little on the nervous side.  I can't relate to that, but have known many midwives like that.  I actually agree with your plan to labor as long without them as possible.  I attend Mennonite and Amish women who prefer to labor alone as much as possible (which probably explains why I miss so many births).  I no longer put a time on when to call me.  I missed a birth when a woman called me with contractions every 10 minutes.  Now I tell them, "You will notice there will be that one contraction that feels different.  This one feels like it means business.  That's when to call."  I think there is a happy medium about abiding by your midwife's instructions.  You shouldn't have to call with the very first contraction and you probably shouldn't call when the baby is close to coming.  Call when it's active labor.  I've cared for women who have had 5 or more babies and still aren't sure when to call.  Your comfort is the primary concern as well as the concern for the health of your baby.  A watched pot never boils. Some women like a group of people watching them in labor and others prefer privacy.  I've often noticed how labor slows when I arrive if the woman isn't in active labor yet.  Women intuitively know what they need.

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#9 of 14 Old 01-25-2012, 09:57 AM
 
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Hi :) I can identify with your feelings, I think. I'm a CNM and I had my first baby 6 months ago, hospital with a CNM. I was at home for the majority of my labor. Like you, I was very aware that the earlier you are with the professionals, the more you can be "messed with". Probably my top concern was going in too early and being put on a clock, because although I fully trusted my midwife, I knew that the hospital has its protocols and who knows what the nursing staff would be like. What I did was hire an experienced doula and explained that I wanted to be as sure as possible that I was going to the hospital in _active_ labor, but not so active that I was pushing in the parking lot :) Obviously doulas don't have medical responsibilities, but I trusted her qualitative judgment on labor progress- looking for "turning within", etc. I didn't want to be trying to figure out how dilated I was, or even how far apart the contractions were; I wanted to turn that part of my brain off so I could get out of my body's way. My husband is a doc (not an OB) and I wanted him to just be able to be a daddy, not clinical. So I called the doula once I felt like I was having to work with contractions and after I'd had some bloody show, and she came over and just hung out with us. She had a way about her that put me at ease and let me just do my thing in labor.  When she suggested it was time to go in I did, and ta-da, 5cm (which made me go D: ), which 3 hours later was fully and pushing :)

 

Long story short... doula?  :)

 

ETA: You totally shouldn't be concerned with your midwives' comfort while you are laboring. I agree. BUT: being on 24/7 call is a big deal. Yes, it's part of the job, but it's a really hard part of the job. A simple heads up of: I'm having some bloody show, or: having some uncomfortable contractions, might be such a huge help to make sure they are ready to drop everything and go to you. You don't have to time contractions or rate your pain on a scale of 1-10 or any of that crap. 


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#10 of 14 Old 01-25-2012, 11:54 PM - Thread Starter
 
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thank you for your posts!

I have no one to talk to about homebirth....I am happy there is this forum.

I just realized today how far my everyday work is from homebirth. I was just supervising an anesthesia resident today ( I am an ER physician), and he was asking me if <<I have a date scheduled for birth>>....when I said no, it will just come when it,s time, he looked very surprised. nut.gif

it,s sad!.....

 

back to the main topic: I read your posts 3 times and kept thinking about them.

 

I think that the <<problem>> is not rational. It,s not logical. it,s just that I would feel much more relaxed and intimate if I can labor without professional involvement for the first hours. (even if nobody is at my house, but midwives are aware, it changes a lot for me: <<performance anxiety>> maybe, also feeling less responsible for my birth when midwives are already aware, loss of control....I am not sure).

I am not planning on calling them at the last minute, and when I do call them, I am not expecting them to come right away.  I just feel that I will feel pressure if I tell them very early in labor. It sounds stupid, I am not sure why I think this way.

 

For the Doula suggestion, I have thought a lot about it, and haven't really decided....but I don't think I will have one. I can not ignore the research/evidence, Cochrane review that show they make a big difference. but.....

I will have my DH with me, and a very close friend (who was at my first birth, and was very helpful....she happens to be a physician, but of course, she will not be there as one, just as a close intimate female friend. I was at her daughters birth too). If everything goes well, my massage therapist will drop by for 2-3 hours during labor, mostly early (to help me relax, prepare, and show some good techniques to my friend and my DH). I feel comfortable with this arrangement, since none of the 3 supporters are birth specialists, so I feel free to labor at my rhythm.

Once I feel that things are more serious/active labor, I will call my midwife + student. So I will have 3 more people at my house. I think with all this team, I should be fine (considering I am pretty private and like to do things alone).

 

 

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#11 of 14 Old 01-28-2012, 09:51 AM
 
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Just a comment on letting a midwife know in early labour....When I started as a midwife I used to ask people to give me a head's up but I've stopped doing that.  Because early labour is ubiquitos it can start and stop, it can go on for a very long time.  I can lose sleep wondering about what's going on with my client in early labour, I can cancel plans because of it and then not be called again until two or more days later.  If someone needs to talk to me in early labour (or anytime) that is totally fine and I am here for them but I don't need to know for my sake.

 

I hope your birth is everything you desire.


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#12 of 14 Old 01-28-2012, 10:40 AM
 
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Here's what I've done the last two times. I call or text them when labor starts to give them a heads up. Even when they are on call, the reality is that they have lives and with DD's MW (same one for this pregnancy) she has a young son so I want to be sure she has plenty of notice to get him where he needs to be, etc.

 

BUT, I am very clear with them that I don't want them around until I am ready for them and they are fine with that. So I call as a courtesy, not as any sort of "please come" type deal. Then I labor until I feel like I need them (about the time I start to panic...hello transition!) and then DH or I call them to come. This has worked out great so far. With DS, the MW got there and I was 10 cm and starting to feel pushy. DS was born less than 2 hours later (long pushing phase). With DD I was only 6cm (man was I pissed!) but I was fully in transition and started pushing about an hour later and she was born maybe 2 hours after the MW arrived. It was perfect.

 

With this being my third baby my MW has gently suggested that maybe if I'm comfortable with it, I could call her just a bit sooner in the process to come, particularly if it's a time of day when there is traffic. It's quite possible with a third baby to have it go much faster and I know she'd rather not miss it unless that's what I want (she's awesome...totally down with sitting in the other room if I want a UC of sorts, it's totally up to me at that moment). I think I will go with that though partially because we are currently renting an extremely large house with basically an apartment downstairs where she could hang out if needed. The thought of having them all hang out for hours freaks me out.


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#13 of 14 Old 01-29-2012, 06:08 AM - Thread Starter
 
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sweetsadie77: your post is helpful at making me feel less guilty Sheepish.gif

I think I will try to have a good honest discussion about this with the midwives.

the hard part, since I only see one of them every prenatal visit, and the other one on the next visit, I feel like having a good indepth discussion about this could be useless, since there is only 50% chance that the particular midwife I talked to will be my birth attendant.

 

dogmom327: I like your approach! I think we will do the same.

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#14 of 14 Old 02-07-2012, 03:30 PM - Thread Starter
 
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So, I had my 36 weeks home visit today by one of my midwifes.

I talked honestly to her, and I am so happy that I did!

 

First, she assured me that they can be more relaxed about need for transfer, if I am OK with it and understand the risks/benefits.

like pp, she said that obviously, she would prefer to know earlier rather then later, since she has to rearrange her day and be close.

She expects this labor to be much faster the the fist one (DS was posterior).

she doesn't think that my baby is that big.

 

at the end, she is completely OK with a very long/slow labor. What she doesn't like, is when the pattern suddenly changes: like cervix going to 8-9 cm quickly, and then stop there for hours. But she will work with positions etc if FHT/amniotique fluids are OK.

 

at the end, she said if I end up calling her late, and she has to rush through the traffic etc, she will not be upset, she understands.

she also said that she was much worse then me as a patient, when she was pregnant. biglaugh.gif

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