[kcparker]

I am sure this is a very individual question, but I am curious to know when people usually contact/interview/hire/start care with their HB midwife. Do you begin care with a FP doc/OB/hospital-based midwife, then transfer care at some point?

If you read a mainstream recommendation, it's always "call your doctor as soon as you discover you are pregnant," go in for a dating ultrasound, then a screening ultrasound, then a 20 week ultrasound to check for structural abnormalities, plus all the other tests - glucola challenge, endless pee dips, GBS testing, etc. etc. How does this factor into your decision about when to commence care with a HB midwife?

How do you weigh out what, if any, tests you would like to have done on you/the fetus? I am so newly pregnant that I don't even trust that it will stick at this point, but I am also thinking that I have a month or so before I really need to decide if I am going to get close enough to a doppler US to hear whether or not there's a heartbeat, have a NT screening ultrasound, or just fly blind on faith.

TIA.

 

[Daisie125]

I call right away. Some midwives fill up fast and you want to get that call in right away, IME. I usually make my first appt around 10 weeks.

I don't personally have any tests done other than looking for the HB with a doppler.

 

[GoldmanBaby09]

There is only one HB midwife in my area, and I pretty much called her as soon as I found out I was pregnant. Because my insurance doesn't cover hb or midwifery costs, I am also getting concurrent care from a CNM at an OB's office, which is paid for. I think with my next pregnancy, I would opt to see my hb midwife only. The ob office is really unorganized and I have had to wait long periods of time to see the CNM, even with an appointment. I didn't have an NT scan, but did do the AFP quad screen, which I now wish I had declined. My numbers came back slightly elevated for Spina Bifida, and we had to go see a perinatalogist, which was a whole different stressor. Our baby looked just fine but I have to go back when I am 32 weeks for a growth scan to make sure the afp elevation wasn't caused by something placental. I will end up with 4 ultrasounds by the time I am done, and that is waay more than I really wanted. I have declined the GTT. I think that screen is pretty ridiculous since I don't drink glucola for breakfast. My hb midwife is just going to have me do a finger stick after having a normal breakfast and monitor for a few days. I think I will be declining the GBS, as I am having a home birth and won't be on an IV antibiotic drip while in labor anyway. I am also not going to do eye goo on my newborn as I don't have either chlamydia or gonorrhea and no hospital strangers will be handling my child. I also won't do vit k unless the birth is traumatic or the baby looks bruised and will not be circumcising my son. I am going to stop seeing the CNM after I have that 32 week scan. All in all, I will stick to my guns next time and just go with the care my hb midwife provides. As long as the heartbeat sounds good on the doppler, and my fundal height is where it is supposed to be, I am just going to let nature take it's course.

 

[the_lissa]

I call my midwife as soon as I pee on a stick because they are in high demand, but the first appt isn't usually until 12 weeks or so.

 

[Full Heart]

I call right away but I usually don't have an appt till 10-12 weeks. I was first seen this time at 14 weeks. But I want to reserve my spot right away. If you are interviewing mws you need to start right away.

As far as testing goes. I researched each test, find out the risk/benefits and what I would do with the information it gives me. I don't do the quad screen or the nt scan. I don't do a dating u/s. But if you wanted a dating u/s you would want to get in asap, the earlier the better - before the end of the first tri. Since I don't want that I knew I could wait.

 

[Lynn08]

I started looking around the 12wk mark, but didn't actually find the one I used until about 5mo along. And although she was a CNM, we didn't do much in the way of tests (I think just a blood test for general health and a gbs). Inever had an u/s or any of the other fetal tests that are "necessary". We would listen to babe's heartbeat every visit, though. That was amazing

Good luck!

 

[Talula Fairie]

I call right away too. In this pregnancy I called at like 6 weeks and then I met with one at 8 weeks and another at 10 weeks. I chose the second and saw her for my first prenatal at 12 weeks.

 

[*MamaJen*]

I started doing the midwife interviews (well, in my case, single interview) at around six weeks or so. I wasn't quite sure how the process worked with a midwife and just wanted to get squared away with a provider.
I didn't do the date-establishing ultrasound because I knew exactly when I conceived (it was the night with all the bourbon in it, y'know). I did do the 20 week ultrasound, mostly because I wanted to know the gender. The midwife referred me to a local clinic for that.
As for all the other tests, the midwife can give you her preferred timeline. Stuff like the GD test and GBS test come way later in the pregnancy. The pee tests we did at the start of every visit -- she actually had the strips sitting above the toilet, and her patients did the dip themselves. There was a color chart on the bottle of strips, and you just compared your strip to the bottle and told her the results. She started listening for the fetal heartbeat at about 10 weeks.
So anyway, I'd start out prenatal care with the midwife. It's just easier and more streamlined that way, and you start building up that relationship early.

 

[Sk8ermaiden]

I started care with my midwife at 11 weeks. I picked that time because she really prefers that you establish care in the first tri.

As for tests. I decline anything I don't see a need for. I have done the pee sticks, the CBC blood draws, and 1 US at 20 weeks, the GD test (only because she does it a different way), and will do GBS (so I have a record if I end up at a hospital).

 

[kcparker]

Quote:

will do GBS (so I have a record if I end up at a hospital).

That is smart. I hadn't thought about that.

This is all really helpful for me. Thank you all so much.

I guess I am almost superstitious about going to a HCP of any sort "too early", just in case. I am also pretty darned sure about the conception date, not sure how I feel about blood or U/S screening for genetic abnormalities but leaning towards feeling that I'd like to know if we are in for anything out of the ordinary.

 

[laohaire]

A midwife can handle your care the whole way through. There is no need to start with a doctor.

 

[Talula Fairie]

Actually, there is a reason to start with a doctor. At least in my case. I'm having a homebirth with a midwife paid out of pocket, but I have insurance that only covers hospital birth and standard OB care, though they do have "midwives" obviously there is no birthing center or homebirths allowed. Anyway, I see them for all my tests which are not included in the midwife's fee. My routine prenatal bloodwork and 20 week u/s specifically (and earlier u/s to rule out ectopic pregnancy since I've had one in the past). I also use my OB for my Zofran prescription.

Also I wanted the pregnancy to be on file with Kaiser in case of transfer and so the baby can be easily added to the plan with a phone call, so I can get the PKU testing for the babe after it is born.

Lots of women have a "backup" OB just in case they transfer, or to use for testing.

 

[kcparker]

I would start with the hospital-based midwives. This seems really silly, but I would feel sorta disloyal to them if I started with them and then transferred care. I LOVE them, I just don't like the hospital as a birth setting, and I don't like the amount of CYAing that they have to do. Plus, I know that if I had to transfer care back to the hospital, it would be transferred to an OB anyway because it would obviously be for something that would risk me out of midwife care...

Plus, I feel like it is somehow 'cheating' or trying to have your cake and eat it too to say, "Well, I want this test and this test, but not these other ones." Probably, I should just get over it, decide what tests or lack of testing will make me feel comfortable and secure about this pregnancy, quit guessing (or caring) what other people will think of my choices, and go from there...

 

[JamieCatheryn]

My policy was call the midwives soon as the pee stick turned pink, interview and pick one by 10 weeks, first prenatal visit at 12 weeks or so.

 

[laohaire]

Quote:

Originally Posted by kcparker I would start with the hospital-based midwives. This seems really silly, but I would feel sorta disloyal to them if I started with them and then transferred care. I LOVE them, I just don't like the hospital as a birth setting, and I don't like the amount of CYAing that they have to do. Plus, I know that if I had to transfer care back to the hospital, it would be transferred to an OB anyway because it would obviously be for something that would risk me out of midwife care... Plus, I feel like it is somehow 'cheating' or trying to have your cake and eat it too to say, "Well, I want this test and this test, but not these other ones." Probably, I should just get over it, decide what tests or lack of testing will make me feel comfortable and secure about this pregnancy, quit guessing (or caring) what other people will think of my choices, and go from there...

YOU are the customer. You have every right to decide, switch, decline and so on.

I think loyalty does have a place in our world, but I would not sacrifice the safety and security of my pregnancy/birth for any feeling of loyalty toward anyone who was not providing the pregnancy/birth that I was working for.

 

[RubyOrganique]

I called as soon as I had a positive stick, but I didn't start care until around 12 weeks. I agree with the others; though we have about 10 hb midwives in our area, they are in huge demand right now. Better too early than to have the one you want booked up.

We only did dopplers to hear the heart beat and I never needed a sonagram. I think we did that at almost every visit.

Our care schedule was much less intensive than conventional OB care, but each visit was minimum 2 hours long and I received exceptionally personalized, attentive care. It was such luxury to have those appointments at home and not have to sit in a waiting room, be on cold exam tables, etc.

 

[2+twins]

My mw books up super fast so I call right away. First appt. has usually been around 14 weeks for me though.

 

[dogmom327]

I called right away. With DS I'd heard good MW's fill up fast and was living someplace at the time with limited HB MW's available. This time I called right away because I needed to tell someone and was excited to be able to tell our MW.

Calling right away allows you time to interview and book someone before they fill up. This doesn't mean visits will start right away though. Many won't see you until 10-12 weeks.

 

[scrapadoozer]

I contacted my MW at 9 weeks and had my first prenatal at 10 weeks. I am glad I didn't wait any longer as she was already almost filled up for April.

I've had BP, fundal height measurements, doppler, pee sticks, GD testing, GBS swab & one really quick position check ultrasound.

 

[munkeesmama]

I called my midwife right away and set up a consultation. We hired her on the spot. We had my first prenatal at 11 weeks I believe.