Midwives and such
To answer the questions/suggestions on the whole OB/Midwife/Doula thing, here’s my situation:
I currently am at a practice that has a midwife and two OBs on staff. I’m not certain one of the OBs delivers, however. But last time I went in I asked the midwife about what would happen were I to use them for labor and delivery. Basically she or the OB would be on call, and who delivered would depend on who was on call at the time. This made me sad, because I really like her (the midwife) and I had really hoped it wouldn’t be a “maybe” situation. I really do want a midwife-attended birth, for personal reasons.
There is a large midwife-only group that practices out of the hospital I’m going to give birth at, so I looked into them. They will accept me as a patient. However, it would be a similar situation, in that even if I really love one of the midwives, they still have one designated on-call person. The difference would be that it would for sure be a midwife, not an OB.
The problem is that I am staying on my anti-depressant during my pregnancy (during breastfeeding is to be determined). It’s not really a big deal to me – I’ve talked it over with one of the OBs at my practice, who okayed it, and I’ve done a lot of research so I feel comfortable with the decision. The problem is that my general practice doctor – who has been proscribing my medication – has said he will request that my OB take over writing my prescription during pregnancy (ostensibly to avoid lawsuits – GP doctors just do not like doing anything with a pregnant woman). And therein lies the problem: I need an OB to write my script. I don’t think midwives can.
So my plan at this point is to stay with my current practice, as long as I like the other OB and their answers to my interview. I already know I love the midwife, I just want to make sure the OB feels the same way about things. If not, I’ll look into switching to the midwife practice and deal with the medication issue then.
But I still want a doula there. Mainly because I don’t want a “traditional” labor… if I was planning on just doing the normal thing in a hospital bed with an epidural I wouldn’t really have a need for one. However, there are several things that I’m really hoping for, and I don’t know how receptive the nurses on staff are going to be. I don’t really think I’m going to be in a position to argue anything while I’m having contractions, so I want someone there to be my advocate. Den could possibly do it, but I need him to be at my side, helping me through.
Don’t get me wrong, I have every faith in doctors in a medical emergency. I just think that sometimes the nurses and doctors over-medicalize birth. If I have a low-risk situation I would like to labor however I want to and not be chastized for not doing it the “traditional” way. (Ie, moving around, taking a bath, etc. Even birthing wherever I feel best pushing, not flat on my back on a bed.)
If the need arises my plans can and will change on the fly. I will be giving birth in a very large hospital that has a level-III nursery, and Den even knows (and greatly respects) one of the head doctors who takes care of all the emergency, extremely-high-risk situations.
I’m really trying to get the best of both worlds. I want the freedom to do what I want in a very natural, non-medical way, with the safety net right there if something goes wrong.
I don’t want to be too pessimistic, but it is very difficult to achieve what you are describing in a hospital setting. There is an entire institutional apparatus that will align itself in favor of institutional efficiency that may not suit your wishes. They may also scare you into conforming with what they want. . . doulas may or may be able to “advocate” as much as you think because their continued access to labor and delivery patients depends on their towing the line to some degree as well. I was going to have my baby in an in-hospital birth center with a wonderful group of midwives but as my pregnancy progressed, I realized that there were so many “disqualifying” rules (can’t go past 40 weeks, can’t have a baby over 9 lbs etc etc) that there was a good chance that I’d get booted to the L & D anyway. I don’t want to need an advocate during labor. I want everyone involved in my birth to be my advocate, not my adversary, so I choose a wonderful out of hospital birth center and switched in my seventh month. In this setting a birth plan is superfluous, as we all understand that the objective is a safe, natural birth. If my midwife says that I must be transferrred to the hospital for any reason, I won’t argue because I am convinced that she will not recommend any interventions that are for “convience” or “policy” but rather out of true necessity. Incidentally, at least here in NYC, midwives have full prescription writing priviledges so I am surprised that your midwife group does not. Also, you can always look for another GP who will write your script. There’s always more than one way to skin a cat. Good luck in attaining the birth you want!
That is all so true, and a lot of what goes through my mind… unfortunately it’s one of the situations I need to deal with, because it’s the one thing my husband insists on: a hospital birth. It’s a nice L&D wing, and they do have certain accomodations (labor tubs in some rooms, birthing balls, showers). Even the midwife group delivers there. :/ So unfortunately I think I’m stuck with this, at least for the first baby. Maybe Den will look into alternatives for our second, if we ever get that far.
And I know I’ll just have to see what kind of policies are in place.
Just a note from a veteran (don’t rule out the epidural. It is a WONDERFUL thing. You will feel plenty of pain afterwards – promise)
hugs
well, i don’t see why you can’t see one of the ob’s for your script and then the midwife for your main visits. i bet they would not have a prob doing that. (if the midwife can’t write the script)
Certified nurse midwives can write prescriptions in all states in the US (except for PA – PA just passed a bill in the House to allow CNM’s prescriptive authority).
I work as an RN in L&D, and I wish I had more natural births. Unfortunately, due to the high malpractice arena for OB’s and hospital based midwives, we (RN’s, CNM’s and MD’s) all have “standards” we have to follow.
I hate all of the technology that we are required to use in a low risk birth. Luckily, I am very pro-natural birth, and low intervention, so when I do get a woman who wants something along those lines, I LOVE taking care of her – I will be her biggest advocate and will speak up to her MD about what SHE wants. *screw the system!*
If you do indeed want and are a candidate for a low risk birth, try a birthing center, or a homebirth.
If you feel the need to go to a hospital for your birth, then make sure you check out the policies and procedures ahead of time, so you’re not surprised. (external fetal monitoring, IV or hepwell, ambulation, use of tub to labor or birth in, etc)