Today I met with one of the Midwives from the Midwife group at the Hospital and had a nice long chat with her. I brought a load of questions with me about how they typically do things, and she answered them all and gave me extra info to boot. Here’s my run-down:
There are 14 Midwives total, and 1 or 2 are always on call for labors. It could be any of the 14 that end up delivering me, but it will always be one of their Midwives (unless there are complications and they need an OB to step in). For office visits it’s up to me – I can choose to see the same one or two midwives for every visit and just “meet” and shake hands with the others… or I can have an appointment with a different Midwife every time. She said they really do work as a team, they have weekly meetings where they go over all their patients. She said she feels very confident that, no matter which Midwife is at the labor, they all follow the same proceedures.
They have a nurse who answers calls during the day, answering any questions I might have, and during the night/evening one of the Midwives takes the calls.
How often for appointments: once a month until 28 weeks. (I think it’s the same basic schedule as with my current practice.)
They do one ultrasound between 18 and 20 weeks for the biophysical profile, and no others. She said even if they can’t tell the sex at that ultrasound they do NOT do a second ultrasound. (I was like, “Umm, if I really really REALLY wanted to, could I get a second one anyways?” She said maybe, but they don’t recommend it.) I told her I’m all for the non-medical ways in everything else, but I want to know the gender, lol.
She said they do not do vaginal exams up to the due date like most practices do. She pointed out that if someone is 3cms dialated they could stay 3cms for weeks, so it really gives them no beneficial information. So they don’t do them.
They induce labor at 42 weeks pregnant – no sooner, unless there is a medical reason to get the baby out quickly. They highly believe in letting the body go into labor on its own time. After the due date they will do ultrasounds and listen to the baby’s heartbeat to make sure the baby is healthy, but if everything checks out okay they will let the pregnancy continue unimpeded.
If my water breaks but labor doesn’t start, they will not start pitocin right away (unlike most OBs). She said they usually tell the woman to go to sleep! She said labor more often than not starts within 12 hours of the water breaking, and the mother should get some rest while she can to prepare. Unless, of course, there are indications of fetal distress, etc.
When I first check in they will monitor the baby’s heartrate for about 20 minutes, then turn me loose. During labor they do intermittent external fetal monitoring every half an hour for about 5 minutes at a time. Just to make sure the baby’s doing fine, then they take off the monitors. She did say that sometimes the nurses do like to leave the monitors on (because they are used to more constant monitoring), but that I could ask them to remove it, and when the Midwife checks on me she will remove it, so I can remain mobile.
They highly recommend walking, using the birthing ball, using the shower or tub, and other relaxation techniques to deal with early labor.
They do not do routine IVs as soon as you’re admitted. She said they have a refreshment stand with water and juice, and encourage you to drink fluids by mouth! An IV will be started only if I am unable to keep down fluids for an extended period, or I need medication for any reason. Basically, they need a solid medical reason to do an IV… they don’t just do one as a matter of course. (Yippee!!!!)
They do not do routine episiotomies. She said less than 5% epi rate, and they only do it if the baby needs to come out and the skin is stretched tight. She said of the ones who don’t get epis, around 30% will need stitches for a tear – but she said they prefer to stitch up a tear for 30% of women, then do an epi and be guaranteed stitches!
She said about 50-55% of women in their practice do ask for epidurals – “Because that’s the societal expectation,” she said. Of the rest, about half get an IV for various reasons, half don’t.
How much time the Midwife spends with me during labor varies on what is going on… she said they may just check in with me from time to time, or they may end up spending the entire labor with me. She did say they like to leave women in early labor alone and not bother them too much.
During labor they do vaginal exams every 2 hours – unless the labor is progressing very rapidly, in which case it could be more often.
For delivery, she said they do have a preference that you give birth on the bed rather than, say, the toilet or the floor (which they have done, she said), but that they don’t care what position you choose to birth in. Whatever feels/works best. (No laying flat on my back for me!)
I mentioned birth plans and the Bradley method, and she said that the Bradley method has a lot of good about it, but that the downside is that it is very strict and some women come in thinking their labor is going to follow a specific, exact course and when something throws it off they get tense and, well, basically panic. Not helpful. So she said if we can take all the positives from the Bradley method and still be open to change and following the flow of the labor, then we’ll be in good shape. Same thing with birth plans, she said – that some women come in with this set view of their labor and birth and are too inflexible.
They have signs all over the office about how breastfeeding is best for the baby and how skin-to-skin contact is a wonderful, beneficial thing. They do have an LC on staff at the hospital, and they do offer prenatal breastfeeding classes which she recommends.
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So that’s it. It was kind of funny, because I walked in a few minutes late (stupid traffic) already feeling bummed about the half-hour drive just to get there every appointment. I then had to wait in the waiting room for half an hour, and I was feeling even more dismal about it. I got called back and sat in a room for a little bit when the Midwife – an older woman – walked in. Immediate first judgements, I thought, “Oh boy.”
But then when she started talking about the practice and their beliefs and procedures, I really felt so bouyed! I love it all. I honestly walked out of there feeling like I could now scrap my “birth plan” because they already did it all…. and there’s no need for me to specifically request something they do as a matter of course.
So it does look like I will be switching! I don’t know when… I may just have my 16 week appointment with my old Midwife and let her know that I did decide to switch (and possibly give her some info on the Midwife group she seemed interested), and book my big ultrasound. Then call the new practice and set up my 20 week appointment with them. Though I’m quite tempted to go ahead and cancel my old appointment and set up the 16 week with the new practice. Not that it would make a difference. The U/S will be scheduled for the same timeframe and at the same place, no matter which office I go through.
The only thing it has NOT cleared up for me is whether or not I want to hire a doula! A lot of the reasoning behind me wanting one was to be my advocate so that I get the things that I want in my birth preferences. But if I have the Midwife there, doing all that already… that take a huge weight off my shoulders! Den is still going to be my primary support. Quite possibly a doula isn’t necessary. I’m going to have to think on it for a while. I still don’t know how much one would cost… so that’s worrying me. I’m waiting for some to email me back. I only got one response so far and it was, “I’ll be happy to meet with you to discuss!” Yeah, well, I don’t want to meet 10 different doulas, I just want to know how much you charge and what you do. Grrrr. (And the one doula whose ad was written all in POORLY SPELLD CAPS LOCK didn’t even get an email. Seriously people. Don’t use all caps!! Ugh. Pet peeve.)
I hope I have enough time here to take a quick nap before work.
