[mezzaluna]

with baby #1 i chose care with OBs because i have a couple conditions that require extra monitoring during pg and possibly could have complicated delivery... however, in the end, the problems were all confined to pregnancy, and had nothing to do with my labor. my labor was about as natural as possible in a hospital setting, doula attending, ob only coming in to screw things up in the last 15 or 20 minutes...

so... this time i really want to do whatever it takes to have a homebirth, but i'm not clear how it works with a "high risk" pregnancy... do hb midwives have regulations about who they can take on?

i'm in massachusetts, and my conditions are hypothyroid (i see an endocrinologist) and a tendency to hormonally induced high blood pressure, family history of pre-e, and high blood pressure in the first tri last time and from 37-39 weeks (went down with bedrest, increased protein intake, and BP was totally normal during and after l&d).

 

[BelgianSheepDog]

Laws vary by state, but from what I recall, you could be seen by a CPM/LM in my state, so long as you were able to avoid developing preeclampsia or another serious blood pressure condition. Midwives have all kinds of tips for preventing that, first and foremost a high-protein diet. So it might be worthwhile to call a midwife and schedule an interview and find out more.

The hypothyroidism I am not sure about, but I am pretty sure if it's controlled it's not considered high risk. I am just guessing based on my glance at the sheet I got for when I could be risked out from my homebirth midwives, though, so YMMV.

 

[mezzaluna]

thanks

now that i think about it the ob had very little to do with my thyroid condition - the endo handled that all, so it shouldn't be any different for a m/w.

i guess i'm just worried that a hb m/w wouldn't take me because they couldn't do my pg care, when i think i have very good odds of a normal straightforward labor.

 

[Hayes]

My MW monitors my BP. I am sure she would check you more often iof you needed it. I think continuing to see the endo for the thyroid stuff and an attentive HB MW would be sufficient unless a problem arises.

 

[alegna]

If you're seeing other drs for your other conditions sounds like a midwife is perfect!

-Angela

 

[boscopup]

I too don't think you should be risked out of homebirth as long as things are under control. Obviously if you *do* develop pre-e, then at that point, you need to transfer care to an OB/hospital. But as long as you're doing ok in that department, your midwife can handle it. As others said, she'll check your bp at every visit, just like the OB does. You can continue seeing your endo for your thyroid issues, and just keep your midwife uptodate on how you're doing there.

I'm seeing an OB and a HB MW this time around due to preterm birth last pregnancy (if it happens again, I want this OB in the hospital - not just whoever I'm assigned to). I've noticed that the midwife and OB do the exact same things during prenatal visits - have me pee in a cup, check blood pressure, check weight, check baby's heartbeat, check fundal height (at the appropriate time to start that). The OB throws in u/s at 8 weeks and 20 weeks (those can both be refused, of course), and a GTT at 28 weeks (I'm refusing that - no big deal). The midwife talks more about my nutrition and making sure I'm getting enough protein, etc. Last preg, she had me bring in a diet sheet at each visit. This preg, she hasn't asked for that, but we still talk about my diet each time. She basically recommends the Brewer diet (and since a high protein diet seemed to help your bp issues last time, it sounds like Brewer diet is what you need to be doing throughout pregnancy anyway).

Good luck! I hope your bp stays normal and you can have a beautiful homebirth!!!

 

[Emilie]

I am hyperthyroid and i had a hb. i was in remission long eniough to get pg and have the baby!

i think you should be fine with it. totally fine.
a mw will concentrate more on your nutrition and overall health rather than an ob who will just fix problems after they arise rather than preventing them.

 

[~Megan~]

I can't see why you couldn't still have a midwife and homebirth. I'm sure you will get even better care than you did with an OB. You may do more self monitoring, which makes more sense anyway because you can do it more often.

 

[Paige CPM]

Hi Mezzaluna,

I am a midwife in MA. We are unlicensed and independent, and therefore do not have regulations. We self regulate and that has worked very well for us and out clients (being able to offer informed VBAC, breech and twins under good conditions).

I have dealt with two clients in my practice with thyroid issues. One we had little to do with her care and meds as her endo covered all this, we just kept making sure she was getting tested regularly by an endo, which she was. We also kept a close eye pp for post partum depression too. The other client I worked with did not have health insurance so I had to learn a lot about hypothyroidism (which was very interesting) and talked to a CNM, OB and Maternal Fetal Specialist. In the end I did all her lab work and consulted with the MFS on meds. The MFS was willing to write scrips for her based on lab results I faxed to him. He was a really nice man, very understanding of her insurance situation.

Suffice to say, it should not be a problem if you are seeing an endo. I would focus on protein intake from the beginning. There are different things that you can do to help bp issues that a midwife can also help you with.

Bottom line is that midwives, incl CPMs, do offer the same regular testing an OB or CNM does. (We don't have u/s on site be we can help you to arrange for one, or you can arrange for one through a pcp) What makes us even better is that we offer all the other care ....great counseling and time spent just checking in and developing a relationship which is integral to safe and wonderful birthing. If there are complications that are outside of our scope then we will definitely refer to the best Dr to deal with the issue and can still be there for you.

Good luck with your decisions and your pregnancy and birth...I hope it is everything you want! Paige

 

[pigpokey]

Hypothyroidism, as others have pointed out, does not rule out home birth or direct entry midwife care. My first preg. I got regular blood testing and dose adjustment, but I noticed that I could tell when I needed an increase and just handled it myself in my second pregnancy UP/UC.

I think the risk of pre-e is dramatically lower after the first baby w/o pre-e -- am I remembering this right? Sounds like you are pretty normal to me

 

[mezzaluna]

thanks everyone! especially paige for the MA angle

last time i had protein aversions in the 1st tri, ate mostly carbs, and my BP was high. i saw a perinatologist, then transferred to a regular OB at 14 weeks. 2nd trimester my aversion went away and my diet was more balanced and my BP was fine. 3rd trimester i stuck to the brewer diet most of the time, and was doing well, but i think i slacked off at the end and my BP did go up around 37, 38 weeks and they started seeing signs of protein in my urine and blood tests not enough to rush me to an induction, but they were concerned. i went on partial bed rest, upped the protein intake and everything went back to normal by 39 weeks. i delivered spontaneously at 41w1d, no problems with BP in the delivery either.

thyroid really wasn't an issue at all - i didn't even have to change dosages, just had to get checked a few times. it's just another factor that i worry would end up discouraging a m/w from taking me on. good to know it sounds like overall i should be able to work with a m/w!

now to find one.....

 

[Paige CPM]

www.massmidwives.org This list is more concentrated in eastern, some in central MA.

If you want to talk to someone about midwives in western MA then you can email Rebecca Beck (she is lovely, when she lived closer, we were midwifery partners, she will deliver my baby!) and she can tell you who is out there. [email protected]

Good luck with your search! Paige

 

[mezzaluna]

western, thanks! i have been trying to reach my LLL leader who is an apprentice hb midwife, but i think she may be out of town, so thanks for the lead! i've done some web searches, and i just can't find a good directory for hb midwives, at least for massachusetts.