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Discussion Starter #1
Hi All!<br>
I have been looking through past threads and I see that many of you have delivered with Special Beginnings. I am a midwife at Bay Area Midwifery, and I just want to say that some of the info on here is not currently correct. I am so sorry if anyone has had a bad experience in our practice in the past. I have been with Bay Area since August 2005, and I do feel that our practice is much better today than it was then. I just want to say that our 2006 birth center transfer rate was 14%, and remained the same for 2007. We do not use stadol, or any IV pain medicine in the birth center, and the majority of transfers are for pain management and are requested by the mother. Financially a birth center remains viable by not transferring to the hospital. Our cesarean section rate last year was 12%, and that is not under reported. Our numbers, and stats are reviewed by NACC, and we recently were reaccredited with no citations. We offer waterbirth, hospital VBAC, and have new hospital backup, which has been a great change for our practice. Our Medical Director is Dr. Sweeney, a perinatologist that works closely with us. I will say that when I came our section rate was primarily from one particular midwife and she is not with us any longer. We have tried very hard to work on many of the issues I hear people discussing, and I just want to ask that you give us a chance. We are on the hospital campus, but it doesn't affect our transfer rate. If anyone would like to message me you are welcome to, and if you want to review your experience with me I welcome the opportunity to speak with you.<br>
Thank you<br>
Jennifer Caniglio CNM
 

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Hi Jennifer! It's nice to hear that the concerns of the birthing mothers are being taken seriously by your staff. I'm a big fan of Spec Beg and have no experience with Bay Area, except for what friends have told me. Sadly, they did not have good experiences there.<br>
Regardless, I'm glad you are here to represent Bay Area Midwifery and hope you will join our discussions. I'm sure only good can come from you conversing with the local mothers.
 

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I have many friends who have delivered with you and all highly reccomend it. I would love to use you, and I had planned to when we were still living in Howard County, but now that we live in north east Baltimore, I just can't fathom the hour drive to and from each appointment <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"> Oh how I wish there was a birth center in Baltimore....
 

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KatyLindy, Mary Knauer is working on opening one, but I am not sure when it will be done. She is very serious and has a good business plan and backup docs, so one day in the next couple years we will have a Balt. area birth center again. She is currently working at St. Joes and they have a good practice there to send women to.<br><br>
Jennifer, I am glad to hear you address concerns. I had long since stopped referring to Bay Area because of some of the concerns I was hearing/seeing with clients/students. I would love to have another birth center option I was comfortable referring too. Could you address the percentage of women risked out before labor ever begins and the stats of transfers for primips? I don't believe those two things were addressed in your previous post.
 

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Discussion Starter #5
I am back in the office on Tuesday, so I will pull those stats and post them here.<br><br>
To those who have delivered out of hopital, did the early discharge concern you? I find that we have a lot of clients that would do great in the birth center, in fact I had two this weekend, primips with 12 hour labors and easy pushing, less than an hour each, but both chose hospital because they didn't want to go home in 4 hours. So instead you have this great labor experience and other patients visitors congregating in the hall disturbing everyone. It is frustrating to see women choose hospital so they can stay two days. Any thoughts on this?<br>
Jen
 

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<div>Originally Posted by <strong>midwifemom3</strong> <a href="/community/forum/post/10340949"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I am back in the office on Tuesday, so I will pull those stats and post them here.<br><br>
To those who have delivered out of hopital, did the early discharge concern you? I find that we have a lot of clients that would do great in the birth center, in fact I had two this weekend, primips with 12 hour labors and easy pushing, less than an hour each, but both chose hospital because they didn't want to go home in 4 hours. So instead you have this great labor experience and other patients visitors congregating in the hall disturbing everyone. It is frustrating to see women choose hospital so they can stay two days. Any thoughts on this?<br>
Jen</div>
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Four hours is kind of quick compared to other BCs in the area where it is more like 6-8--longer if pp complication arise. Also, do you give them a home visit from nurse/birth assistant or midwife the next day? Like Special Beginnings or BirthCare? I think the reluctance to go home is mostly about the nervousness of new parents. With my doula clients once I explain the higher chance of formula pushers, baby getting jaundiced and kept after you get discharged (instead of getting it when you ped can order home phototherapy as mine did for my twins), nurses coming in and waking you up to mash your belly every few hours, really bad food, etc. then most of them are much more comfortable with the idea that home is really the better place to rest. I have had two births in hosp and one at home (this next one will be home in a few months as well) and I can say that I was much more rested and well cared for at home!!! Don't even get me started on the lousy and insensitive care I received in hospital when my youngest twin died at birth in the hosp. last time. Unreal!!!!!
 

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Discussion Starter #7
Our mom's can stay up to 12 hours if needed, but we try to get them home before they get tired and crash after the delivery. We recommend postpartum doulas so they can still get the pampered feeling when they leave. We don't use birth assistants like other centers, when we are getting close to delivery we call in the second call midwife, and then she stays to take care of mom until they are ready to go home. We don't do home visits, and haven't had anyone request one either. I am so sorry to hear you lost a twin. I can't imagine how awful that must of been. So you had two sets of twins?(looking at your signature) I also had twins but they were surrogate babies for a dear friend. It was the best pregnancy I ever had. God Bless you in your upcoming birth! I will be praying for you.
 

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<div>Originally Posted by <strong>midwifemom3</strong> <a href="/community/forum/post/10341933"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Our mom's can stay up to 12 hours if needed, but we try to get them home before they get tired and crash after the delivery.<br><br><span>See, I would rather see them have a chance to get tired and have a few hours sleep where they feel safe baby is being watched.</span><br><br>
We recommend postpartum doulas so they can still get the pampered feeling when they leave.<br><span><br>
Expensive and not covered by insurance! Also, none of the ones I know do the on call thing and would come out the same day/time mama went home.</span><br><br>
We don't use birth assistants like other centers, when we are getting close to delivery we call in the second call midwife, and then she stays to take care of mom until they are ready to go home. We don't do home visits, and haven't had anyone request one either.<br><br><span>Special Beginnings doesn't use birth assistants either, they use licensed nurses. The nurses most often do the home visit but sometimes its a midwife, but all my mamas have really appreciated having a breastfeeding knowledgeable nurse come out on the next day for reassurance and bfing help. Then I (if I am a labor doula for them) will come out on day two or three. If they are just a childbirth student I will check in by phone and have been known to jump in the car if mama seems to need help or seems nervous.</span><br><br>
I am so sorry to hear you lost a twin. I can't imagine how awful that must of been. So you had two sets of twins?(looking at your signature) I also had twins but they were surrogate babies for a dear friend. It was the best pregnancy I ever had. God Bless you in your upcoming birth! I will be praying for you.</div>
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<span>Yup, two sets of twins, 8 years apart. The first set were term and pregnancy was completely normal, then a home birth of one baby, then 31 week preterm birth of twins. Our daughter who died had complications of mosaic tetrasomy 12P-very rare and only lived about 3 hours. Her sister is fine now but spent 2 months in the NICU. You can read her NICU story on MDC at: <a href="http://www.mothering.com/articles/pregnancy_birth/birth_stories/crunchy-mama-nicu.html" target="_blank">http://www.mothering.com/articles/pr...mama-nicu.html</a><br><br></span><br><br><span><span>This pregnancy is going quite well (its one baby and amnio/20w US was clean) and is again a planned home birth. I think we have to stop now though. My pattern seems to be 2-1-2-1. We get pregnant again I might have twins AGAIN-EEK!</span></span>
 

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Discussion Starter #9
Birth assistants is a generic term, I know special beginnings uses LPN's, I did part of my clinical with special beginnings when I was a student midwife. We have continually discussed this with our director, and it alway's comes down to numbers, and it seems like it's hard to find nurses willing to be oncall for deliveries, when they can make a considerable higher salary in the hospital. I know I would prefer having birth assistants so that we are not constant utilizing the second call midwife. Having to do second call in birth center definetely contributes to midwife turnover and burnout. I was talking to Melissa Youssi at special beginnings before she left, and it's hard on your life. I know they use two cnm's when they dont have a nurse covering a particular day. If everyone doesn't know Melissa, left SP and took a job at Bay view (Pretty sure it was Bay View), They have a new midwife, Rachel I believe is her name, just met her at the hospital, very nice CNM.
 

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Just FYI, SB offers/requires the home visit on the third day, which is very useful IMO, but just to clarify it is not the next day. Also, it sounds like they have a similar policy as Bay Area re pp stay- they offer the oppty to leave after the 4 hr min stay. I was there for about 7 hours, and frankly felt a wee bit rushed, even though they said I could stay as long as I wanted. They told me the average was about 5 hrs. I might have liked the oppty to stay overnight, just to get a bit more rest, but at the same time it was nice to be home and not to have to worry about things like being separated from our older son, etc.<br><br>
As far as Bay Area, I had a friend who tried to use you guys and was shortly kicked out and told she was too high risk (possible GD, I think...) and no other midwives would take her - she ended up having a beautiful birth center birth at the DC Birth Center. Any thoughts on that or on risking out in general?
 

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Discussion Starter #11
We do risk out insulin dependent diabetes, but do allow diet controlled GDM to deliver in the birth center. We know work closely with Dr, Sweeney and Dr. Lantz to manage diabetics. I would need to see her chart/(have her name,) to see what the issue was.<br><br>
I did break the stats down, because the above numbers were not divided between primips and multips, so sorry for the delay.<br><br>
2006 Transfers from Birth Center<br>
Antepartum-13% of all transfers in 2006 and were all postdate pregnancies, beyond 42 weeks requiring induction and all were primips<br><br>
Pre-IP Transfer- Patient is in labor but not admitted to the birth center yet.<br>
Example- Patient calls with contractions and cervix is 1-2 cm, not active labor-33% of all transfers . Of those 40% were multips and 60% were primips.<br>
A typical scenario is a patient is having prolonged prodromal labor and requests pain relief, Many times this is after 3-4 days of latent labor. Also included in these are SROM with Thick Meconium at home, or breech presentation on arrival to birth center(not common).<br><br>
IP transfer- Admitted to the center in labor and then transfered- 54% OF ALL TRANSFERS. All of these were primips-<br><br>
Now number wise it breaks down like this.<br>
2006-15 people were transfered<br>
AP-2 people-primips >42 weeks<br>
PRE-IP- 5 people- 2 were multips, and 3 were primips<br>
IP- 8 in total- all primips-<br>
Of All the transfers only 3 had a c-section for failure to progress/Descend-with or without a non reassurring fetal tracing.<br><br>
The 2007 numbers are very similar<br>
AP trans-8-only 4 were primips<br>
Pre-IP-7-only 4 were primips, and one of those were breech<br>
IP-4 all primips<br>
Of these transfers 5 were sectioned- 2 breech, 3 failure to progress.<br><br>
Hope all of these numbers help.<br><br>
I will say that the majority of our clients choose hospital birth, for various reasons, and our goal right now is to increase birth center births over hospital birth, and to reduce the amount of clients going postdates, to reduce the need for induction. Because ultimately if your induction rates decline, the c-section rate also declines when looking at primips.<br><br>
Hope this helps
 

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<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
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<div>Originally Posted by <strong>midwifemom3</strong> <a href="/community/forum/post/10367044"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">We do risk out insulin dependent diabetes, but do allow diet controlled GDM to deliver in the birth center. We know work closely with Dr, Sweeney and Dr. Lantz to manage diabetics. I would need to see her chart/(have her name,) to see what the issue was.<br><br>
I did break the stats down, because the above numbers were not divided between primips and multips, so sorry for the delay.<br><br>
2006 Transfers from Birth Center<br>
Antepartum-13% of all transfers in 2006 and were all postdate pregnancies, beyond 42 weeks requiring induction and all were primips<br><br>
Pre-IP Transfer- Patient is in labor but not admitted to the birth center yet.<br>
Example- Patient calls with contractions and cervix is 1-2 cm, not active labor-33% of all transfers . Of those 40% were multips and 60% were primips.<br>
A typical scenario is a patient is having prolonged prodromal labor and requests pain relief, Many times this is after 3-4 days of latent labor. Also included in these are SROM with Thick Meconium at home, or breech presentation on arrival to birth center(not common).<br><br>
IP transfer- Admitted to the center in labor and then transfered- 54% OF ALL TRANSFERS. All of these were primips-<br><br>
Now number wise it breaks down like this.<br>
2006-15 people were transfered<br>
AP-2 people-primips >42 weeks<br>
PRE-IP- 5 people- 2 were multips, and 3 were primips<br>
IP- 8 in total- all primips-<br>
Of All the transfers only 3 had a c-section for failure to progress/Descend-with or without a non reassurring fetal tracing.<br><br>
The 2007 numbers are very similar<br>
AP trans-8-only 4 were primips<br>
Pre-IP-7-only 4 were primips, and one of those were breech<br>
IP-4 all primips<br>
Of these transfers 5 were sectioned- 2 breech, 3 failure to progress.<br><br>
Hope all of these numbers help.<br><br>
I will say that the majority of our clients choose hospital birth, for various reasons, and our goal right now is to increase birth center births over hospital birth, and to reduce the amount of clients going postdates, to reduce the need for induction. Because ultimately if your induction rates decline, the c-section rate also declines when looking at primips.<br><br>
Hope this helps</div>
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Just some suggestions for reducing inductions re: postdates. Evening primrose oil for all mothers at 36 weeks onward (Maternity center used to say 4500mg daily). My midwife adds two caps vaginally each night at 39 weeks as well. Actively encourage mamas to get those babies lined up using Optimal Fetal Positioning the last month of pregnancy and regular chiropractic (if you did some work at SB then you must know about Danielle Howard's practice). Accupuncture 1 x daily for three days in a row at 41 weeks. Charlyn Santiago was doing it for SB but got awfully conservative about doing accupuncture inductions in the last couple years so I send my clients to others. Also, I take my clients in during the second or third day of a prodromal for accupuncture to encourage her ability to rest and to give her more energy. I am blessed with a accup. practice near me who had given me an oncall schedule of their 8 practitioners so I can get someone on very little notice. Its been a godsend a number of times!<br><br>
As far as dating? Are these women being continually reevaluated for dates by US? Do you use the wheel or the Woods method? I like Woods for better accuracy. My own experience with US is that it is a poor predictor of due date compared to mama recollection for those that have any clue about LMP or conception date. I love when a hard core NFP mama gets told by and OB or US tech that their due date is X when she knows exactly what day she ovulated and got pregnant. And at the end of the pregnancy she is almost always the more reliable predictor!
 

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I went with Special Beginnings.<br><br>
When I first began researching alternatives to a hospital birth, Bay Area was one of the first places I called. I asked if I could speak to someone or make an appointment with a midwife to learn more about the center, but the woman who answered the phone immediately wanted to know how much I weighed pre-pregnancy. I told her about 180 lbs. I was then told that they could not help me, I would need to go elsewhere or to the hospital. That was it. I wasn't allowed to make an appointment, no offer of a return call by a midwife, no explanation as to why my weight immediately designated me as "high-risk" or otherwise "unacceptable" (this was the word used) for a birth-center birth.<br><br>
I understand that certain risk factors necessitate hospital births, but the fact that I was turned away without even speaking to a midwife was pretty ludicrous. I also think that being turned away because of my weight was pretty ludicrous. How can someone be considered high risk from one number, with no other factors considered? If I had said 400 lbs, I could see where I might automatically be considered "high risk." But 180? What if I were 6' tall? I'm not (I'm 5'7") but if I were, 180 could very well be my normal, healthy weight.<br><br>
I recieved excellent care at Special Beginnings, and none of the four midwives I saw there thought that my weight was any issue at all. Yes, I was overweight, but I have never been obese. I was very active and healthy pre-pregnancy, and I was very active and healthy throughout my pregnancy. My pregnancy was uncomplicated and normal. I never developed GD or anything else that would have put me into the high risk category.<br><br>
I would have contacted Bay Area in January of '07. I don't know if this "policy" has been changed since then.
 

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I told her about 180 lbs. I was then told that they could not help me, I would need to go elsewhere or to the hospital. That was it. I wasn't allowed to make an appointment, no offer of a return call by a midwife, no explanation as to why my weight immediately designated me as "high-risk" or otherwise "unacceptable" (this was the word used) for a birth-center birth.<br><br>
I understand that certain risk factors necessitate hospital births, but the fact that I was turned away without even speaking to a midwife was pretty ludicrous. I also think that being turned away because of my weight was pretty ludicrous. How can someone be considered high risk from one number, with no other factors considered? If I had said 400 lbs, I could see where I might automatically be considered "high risk." But 180? What if I were 6' tall? I'm not (I'm 5'7") but if I were, 180 could very well be my normal, healthy weight.<br><br>
I recieved excellent care at Special Beginnings, and none of the four midwives I saw there thought that my weight was any issue at all. Yes, I was overweight, but I have never been obese. I was very active and healthy pre-pregnancy, and I was very active and healthy throughout my pregnancy. My pregnancy was uncomplicated and normal. I never developed GD or anything else that would have put me into the high risk category.<br><br>
I would have contacted Bay Area in January of '07. I don't know if this "policy" has been changed since then.[/QUOTE]<br><br><br><span>Rightly or wrongly, this is basically part of the "bad rap" that I have been getting over the years about Bay Area. That the reason so few women are birthing at the birth center is that the protocols are so restrictive that few women qualify for being "allowed" (and oh how I hate that anyone would dare use that term with a pregnant mother) to give birth there. It makes zero sense to risk a woman out on her prepregnancy weight. I have taken care of mother's who didn't look a bit overweight or GD who ended up testing positive for it and had other clients who were HUGE and had perfectly normal testing. I am very willing to listen to reasons why the reputation might not be deserved, but I encourage you to really think about it and talk about it. The Maternity Center went under for a lot of reasons, but one of them was low census and I can tell you that their reputation for being over medical, unresponsive, and a bit on the "medwife" end of the spectrum contributed to why they were seeing previous clients and women who lived sometimes within a mile or two of them drive all the way to Arnold to see the Special Beginnings folks or to BirthCare in Alexandria where holistic, individualized midwifery care still seems to be in practice.<br><br>
I am not trying to beat up on you Jen, but one of the things that totally frustrated us who work in the area when Maternity Center closed is that the powers that be did not want to hear how some of their own practices had contributed to why they weren't able to keep the census up and make the birth center financially viable. Yes the insurance companies and malpractice costs factored in, but there were seriously fixable other reasons why a lot of area doulas and childbirth educators had taken TMC off their recommended practice lists.</span>
 

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Discussion Starter #15
Also, I take my clients in during the second or third day of a prodromal for accupuncture to encourage her ability to rest and to give her more energy. I am blessed with a accup. practice near me who had given me an oncall schedule of their 8 practitioners so I can get someone on very little notice. Its been a godsend a number of times!<br><br>
As far as dating? Are these women being continually reevaluated for dates by US? Do you use the wheel or the Woods method? I like Woods for better accuracy. My own experience with US is that it is a poor predictor of due date compared to mama recollection for those that have any clue about LMP or conception date.<br>
Most of our clients know their conception date, so we always use this first. We only use U/S when mom's are nursing and have had no cycles between pregnancies, and they have no way of knowing conception. If available we use a first trimester scan for dating if we need one, It is amazing how much the due date will change based on when the scan is done. We use primrose oil 1 pill with each meal starting at 36 weeks<br>
2 each meal at 37 and 3 each meal at 38 weeks and beyond. I think I am going to see if I can get it in bulk and hand it to them when they leave each week so they don't forget, that might help. Do you use borage oil, I have seen some posts on it, but have no experience with it. We also use caulyphylum, I like that it seems to work well when people are in prodromal labor. I am going to look around and see if we can set something up with an acupuncturist. I can't refer to Charlyn, because it doesn't look good to send a mom to another birth center for a service. lol, but I think there is a new wellness center that wil do it. Is that covered by insurance? Thank you for the info.<br>
Jennifer
 

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That was unacceptable, we have fired a front desk girl in March 2007, and I am sure this is who you talked to. I am sorry. We do ask if people weigh more than 250, but we should still be able to evaluate someone. Because 250 and 6 feet tall is way different than 250 at 5 feet tall. We use that number because many moms put on 50 pounds, not so much the birth center patients, but many of our younger primips do, and there could be some concerns by NACC if we have people over 300 in the birth center. There are many times on that first visit that I have "adjusted the weights" on mom so thst the director doesn't see the real weight. I myself think its rediculous, but there are many times that our hands are tied by the director. It has been frustrating and something we are working on know. I feel a director shouldn't be risking people out by some standard rule, especially if they are not in the call schedule. I think it should be a decision made by the midwives who have a relationship with the client. We are trying to correct this also.<br>
I am sorry<br>
Jen<br>
I will pass this concern on to the front desk though.<br><br>
When I first began researching alternatives to a hospital birth, Bay Area was one of the first places I called. I asked if I could speak to someone or make an appointment with a midwife to learn more about the center, but the woman who answered the phone immediately wanted to know how much I weighed pre-pregnancy. I told her about 180 lbs.<br><br>
I understand that certain risk factors necessitate hospital births, but the fact that I was turned away without even speaking to a midwife was pretty ludicrous. I also think that being turned away because of my weight was pretty ludicrous. How can someone be considered high risk from one number, with no other factors considered? If I had said 400 lbs, I could see where I might automatically be considered "high risk." But 180? What if I were 6' tall? I'm not (I'm 5'7") but if I were, 180 could very well be my normal, healthy weight.<br><br>
I would have contacted Bay Area in January of '07. I don't know if this "policy" has been changed since then.[/QUOTE]
 

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Discussion Starter #17
I am very willing to listen to reasons why the reputation might not be deserved, but I encourage you to really think about it and talk about it. The Maternity Center went under for a lot of reasons, but one of them was low census and I can tell you that their reputation for being over medical, unresponsive, and a bit on the "medwife" end of the spectrum contributed to why they were seeing previous clients and women who lived sometimes within a mile or two of them drive all the way to Arnold to see the Special Beginnings folks or to BirthCare in Alexandria where holistic, individualized midwifery care still seems to be in practice.<br><br>
I hope this is coming out right I cant figure out how to get the quote thing in my post. I am going to print out all of these concerns and show them to the director, because I think she needs to see them.
 

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Wow, it is so nice to see you here Jennifer. I had my baby by Bay Area and I had a great experience. I have known other people who went there and had great experiences but I've always been disappointed by the negative comments here. It's great to see you here to clairify things.<br><br>
I know that if I had not had my baby with you guys it would have not been the wonderful experience it was (I honestly think I would have been forced into a C-section by an OB). I saw you through the first half of my labor, then delivered with Suz Brown. I know that when I was interviewing pediatricians, they all said they liked the midwives there.<br><br>
I want to have #2, and when it happens you can bet I'll come there! BTW, you were my DH's favorite midwife.
 

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Jen, thank you very much for responding (and for starting this thread). I appreciate it and I'm sure others do, too.<br><br>
As for the receptionist who took my phone call, she said the "cut-off" weight was 150. I'm sure you can see where I thought this was ridiculous--a "cut-off" of 150 lbs I'm sure would rule out a <i>lot</i> of people wishing to birth at Bay Area!! I suppose it's possible that she thought I said 280, and that I misheard as well and thought she said 150 when she said 250, but even if that were the case obviously I should have been allowed to speak with a <i>midwife</i> who would then have made the determination if I were high risk or not...the receptionist shouldn't have made that decision! <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/thumb.gif" style="border:0px solid;" title="thumbs up"><br><br>
It sounds like the midwives at Bay Area are serious about working out any past problems/issues that the center has had. I think that's awesome--more choices for women in the area (I actually drove from 1 1/2 hours away to use SB because of the lack of good choices in my own area). I personally will probably use SB again if I have any more children because I already have a relationship with the midwives there. But if I'm asked I wouldn't hestitate to tell others that there are 2 birth centers in the area--I think each individual should take both into consideration and make the choice for themselves. What works for me might not work for another.
 

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<div>Originally Posted by <strong>midwifemom3</strong> <a href="/community/forum/post/10373583"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">There are many times on that first visit that I have "adjusted the weights" on mom so thst the director doesn't see the real weight. I myself think its rediculous, but there are many times that our hands are tied by the director</div>
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Hi! I think this is a very interesting discussion and it is great to see a practicing midwife in the area talking on MDC. I feel like perhaps I should make the gentle reminder that was once made to me -- that this is, in effect, a public discussion board, not at all private. Please be cautious about making any comments you wouldn't want, well, anyone or everyone to hear or read. Did you know if you google "Jen Caniglio CNM bay area midwifery" your first hit is this discussion?<br><br>
OK, done being paranoid for the day.
 
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