Monday, May 24, 2010

Questions to Ask a Midwife

Matt got home unexpectedly early this evening, so we decided to trek to the Houston Arboretum for a free walk (with Hoss, of course) through the tree-lined paths. Heavenly!

Afterward, we decided to skip our yellow split-pea meal for the evening and instead head to one of our local restaurants.

Over dinner, I asked Matt if we could brainstorm some questions for our visit with the midwife next week. Occasionally, my thorough planning gets on his nerves (mainly when he's trying to do something else and I'm asking for his input), but tonight he was up for it.

Here's what we came up with:

  1. What are the things that can go wrong at birth?
  2. Which of these situations have you faced with your clients? How did you handle them?
  3. What is your hospital transfer rate?
  4. What equipment do you bring with you to a home birth?
  5. Are there certain pre-pregnancy exercises I should do to better prepare my body for the demands of pregnancy and birth?
  6. What do you consider the role of the doula to be?
  7. In your opinion, who do you think should be present at a birth?
  8. Do you provide any type of pain relief during labor?
  9. What are your thoughts about working full-time while pregnant?
  10. What should we say to the critics of home birth?
  11. What other questions should I be asking?

So that's what we've got so far. I would love, love, love for your feedback. Those of you who are critical of home birth, now's the time to make your arguments against it! Once we've made a decision, I really won't want to subject myself to antagonism and criticism. It's too stressful. I'm also going to e-mail my friend who is a pediatric neurologist to get her perspective.

I'd also love to hear your thoughts about other questions to add or things to think about. Thanks!

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Sara E. Cotner said...

Here's what my pediatric neurologist friend in Canada had to say:

"I'm very excited that you and Matt are considering extending your family! I'm not too keen on home births, because I've seen too many bad things that could have been averted by being close to proper medical attention. The majority of births do happen without any issues, but when something goes wrong, it usually happens very quickly and very disastrously. There is not enough time when you are at home, no matter how good your paramedic system is, they simply cannot get there fast enough, and also do not have the right expertise. In deliveries and with babies, seconds, let alone minutes, delay in resuscitation, can make a huge difference.

However, I think a midwife is a good idea because they can give you that individualized, personal touch which is sometimes lacking within our medical system, which makes some people feel depersonalized and devalued as human beings. I don't have much experience on how one should choose a midwife. But I would certainly inquire as to how they trained, where they trained, do they have any certification, how many births a year do they attend, how much time they will spend with you during the whole process, from pregnancy to delivery to afterwards. I would also ask how they intend to deliver you, some choose different positions, i.e. squatting, others will choose different location i.e. bathtub. The bathtub thing is a very bad idea, by the way, because the baby's first instinct is to gasp and breathe in. The worst thing is breathing in water, which alone would be bad enough, but is usually mixed with fecal matter expelled by the mother during labour and possibly meconium. This damages the lungs of the babies, and due to lack of oxygen causes severe brain damage, in what would otherwise have been a perfectly healthy baby. It breaks my heart when I see these cases. Of course that is the worst case scenario, but I see it as completely avoidable and unnecessary, thus tragic when it happens. I know many people who choose to have the "best of both worlds", which is to have a midwife, within a hospital setting that is inclusive of complementary health care. I know that most of our maternity hospitals in Canada are very welcoming of midwives at the delivery. If you go this route, you should "interview" hospitals and physicians too, and get a feel of what they are like and choose one that makes you feel comfortable, and one where you feel they really care. I would also make sure the midwife is also accepting of traditional Western medicine as well. Again, one that refuses to acknowledge the potential need for that, can be very dangerous. Hope all of this is helpful. Keep me up to date."

LauraC said...

Before I found out I was having twins, I went to a birth center. I am not sure if you have the equivalent in Canada. It is a home-like setting with midwives but they have full medical equipment and an OB on call in case anything goes wrong. I wasn't comfortable with 100% home birth and wasn't comfortable with hospital birth.

Anyway one of the first things we discussed was birth classes they recommended. They gave us a list of suggested classes, and we ended up taking a Bradley class. I can not say enough good things about Bradley classes if you are considering a natural birth. It is 12 weeks and we had to practice a LOT of relaxation techniques.

I ended up having an emergency c-section but the relaxation practices were INVALUABLE as I was on bed rest for 3 months and regular real contractions for the last 6 weeks. At the end, they were 15 minutes apart all day. And I was in and out of the hospital being monitored.

I would say the Bradley class empowered us to make the right decisions for our pregnancy and childbirth experience.

Carrie said...

Sara-It just concerns me. I was healthy, had a great pregnancy, was in shape, prepared, etc. Labor did not go well. Never got past 6cm and needed a C-section in the end. A day later, Selwyn experienced very low blood sugar and oxygen de-sats. We would not have known about those things had he not been observed in the nursery (and NICU for 5 days), and I shudder to think about what might have happened without the medical care.

I like the idea of a birth center next door to a hospital or something of that sort so you can have a more laid back, less medical-feeling experience, but with the assurance that someone can high-tail it over there if anything does not go as planned.

Of course, I understand that it's a personal decision. Totally not worth the risks to my husband and me. But I support you! :)

Mallory said...

Have you looked into a birthing center at all? We have one here near Dallas and I have 2 friends who used it and loved it. It is right next door to the hospital but is a much more comfortable and holistic setting.

Sara said...

I love the fact that you are researching all of your possiblities. Just be aware that in pregnancy, birth and child rearing you cannot be prepared for everything. I too plan and plan for the plans but neither pregnancy went the way I would have planned.

First pregnancy went without any problems but the birth could have been a disaster. She had passed meconium and very well could have inhaled it. I know
that this is common so ask how they handle this situation. Ask about worst case senarios also, clearing the lungs, resusciation, and if needed how they get the baby to the NICU.

Second pregnancy was a disaster from the start. Twelve weeks in I had DVT in both legs. Twenty four weeks I got a pulmonary embolism and was on high powered blood thinners through the rest of the pregnancy. The delivery was scheduled due to the fact that the blood had to be controlled.

I had two hospital experiences that were completely diffrent. First was at Womens Hospital of Texas here in Houston. I had a wonderful experience with a wonderful doctor. The second was at a smaller hospital and it was a terrible experience.

I think ask questions, lots of questions. Don't assume anything. You will know what is right for you. I love to hear others points of view and hear of their experiences of this subject.

Stacy Marie said...

I had a long talk about this with my OB/GYN nurse practitioner. She actually trained to be a midwife for years, but she said that she would never recommend a birth outside of a hospital. She was the midwife at her daughter's birth and there was a problem with the placenta, and she ended up all happened really quickly, but another 3 minutes and she would've bled to death. Basically my nurse practitioner said that even the most healthy pregnancy can take a turn for the worst very quickly. Based on that conversation we're going to have a midwife, refuse hospital interventions (pitocin, etc) but still be in a hospital just in case. Best of luck with your decision!

Ms. Loaf said...

No offense to your friend, but what they said was just not true, and totally displays the biases that the medical community has against birth as a natural process. Water birth is totally safe and the baby is not going to breathe in water. I can't believe that myth is still around!

Most doctors aren't trained to understand and appreciate natural childbirth and they've usually never even seen a non-medicalized birth, so they often assume that every intervention is necessary. I'm sure your friend means well, but everything they're saying is in direct contrast to everything I know to be true through my training and experience as a doula.

Yes, sometimes bad things happen when you're giving birth, but it's rare and I hope the midwife is able to dispel these fears.

Birth is a natural process. Your body knows how to give birth. So many women have perfectly safe births at home. And midwives know when to transfer if necessary. There will already be a plan in place.

There is no reason you shouldn't be able to have a safe homebirth if that's what you want. Don't let the scare tactics.... well, scare you!

Hope the meeting goes well!

Annie said...

I, like Ms. Loaf, cannot believe that the swallowing water myth still exists!

We had our daughter at home less than 3 months ago and it was an amazingly awesome and empowering experience. I understand that homebirth is not the right option for everyone, but that is why there are options and you just need to find the one that fits your family the best.

I'm sure that the midwife will be able to answer all of your questions and you'll get a sense of whether or not this is the right choice for you guys.

Good luck!!

EmilyAnn said...

I'm sorry if you've addressed this elsewhere, but is your midwife a lay midwife or a nurse midwife?

Nicole said...

(I hope that people talking about the "water myth" are noticing that the explanation above is from a pediatric neurologist - i.e. brain doctor for kids! - who has seen the aftermath and isn't just spreading lore)

Anyhow, my disclaimer is that I am a medical student - so from the medical side. But I also am planning on being a family doc and am interested in alternative med. So, that being said, as most people have said, when everything goes lovely as planned, I think a home birth could be a great thing. But things can go unexpectedly wrong at the last minute, and it would be horrible to have something go wrong just because you couldn't get to proper care in time. As much as I can understand the desire to not be in a hospital for the birth (hospitals are one of my least favorite places to be and I want to be a doctor!) they also have the kind of care that is needed in an emergency.

The best compromise, I think, would be to have a midwife at a hospital for the birth. When I did my ob/gyn rotation the midwives were my favorite to work with, and they were always lovely with the patients and helped them achieve the birth experience they wanted in the safety of a hospital.

And as my closing, I will add in the link to my other favorite blog, since they just had a beautiful baby and also a last minute totally unexpected emergency that would have been disastrous had they not been in a hospital:

To me, it's all about the worst case scenario. Could I live with something going horribly wrong at home and not being able to properly deal with it since I had made the decision not to be in a hospital? No.

Sara E. Cotner said...

Thanks for your input, everyone! You've given me a lot to think about.

@ EmilyAnn: She's a certified nurse midwife.

I'll let you know how the upcoming conversation goes...

Jennie said...

Hmmm... more questions I would ask:

-What type of birthing options are available (ex. water - some have big tubs they can set up in your house where even your spouse can get in with you)?

-What if I change my mind during labour and want to go to a hospital?

-What involvement does my spouse have in the birthing process?

-Are you able to attend to me if I choose to birth in a hospital setting, or do I then have to use a medical doctor?

-How long after the birth do you continue to be my care provider? Do you do follow up care/home visits for a certain amount of time after the birth?

-Are there any books you can suggest I read to prepare for a home birth?

EmilyAnn said...

I have to second everything that Nicole said. I am also a medical student, but I did a summer rotation with a Family Medicine center that is very pro-midwives and alternative birthing options. Still, I have also seen the terrible outcomes on my OB/GYN rotation where hospital care is necessary. And truthfully that is the root of the medical bias. In our training we see the worst case scenarios (that the non-medical public rarely sees) and our sole objective as physicians is to prevent them.

I personally plan to go to a family physician for my pregnancy care because they typically believe in less intervention than obstetricians and they will also take into consideration what is best for my baby.

Sara, I commend you for taking ownership of your birth experience, and also doing so reasonably by educating yourself and keeping an open mind. I would encourage you to continue to stay flexible. There are lots and lots of things that can change through the process, which I know will be challenging for a planner like you :)

Justine said...

I am a NICU nurse (neonatal intensive care unit--where premature and sick infants go).

Things to keep in mind:

The first pregnancy is generally the longest and one of the more difficult ones. Have you thought about going to a birthing center for your first child and then trying out a home delivery for future children?

If you are in a hospital/birthing center you can empower yourself to take charge of the delivery as long as you are knowledgeable and reasonable. The "dreaded c-section" for some folks could have been avoided if the parents-to-be knew more about their options and while not getting in the doctor's face about it, but asking for alternatives.

Lastly...though my experience is biased because I see the sickest of the sick babies, when things go wrong, they can go horribly wrong. When it's a home delivery gone wrong, my co-workers and I give each other the's so sad to see what could have been prevented as resulted in what has happened.

Kristen said...

Wow - I found this post and all of the comments extremely enlightening. I am right smack dab in the middle of my child bearing years (don't know if I am going to have them or not), and we are surrounded by friends who are having babies. Many of them have done it at home or are planning to do it at home, so I thought that was the new way to go these days.

But, after reading the first post, I realized I hadn't really researched the subject too much. Our good friend used to be a NICU nurse, and I mentioned this blog and brought up the topic with her to get her thoughts. She felt very much the same way that the pediatric neurologist felt.

She said that as a nicu nurse, the funniest thing she has ever heard of is a "birth plan", and that having a plan for the birth is like having a plan for the weather, because anything can happen and you can't predict it. That's why she is in favor of hospital or birthing center births, because usually everything goes great, but when it doesn't, you might have a brain damaged child on your hands that could have been prevented. That's pretty heavy stuff. The other thing she mentioned is that you can get in and out of the hospital pretty quickly these days - like 24 hours. One of her points was that you are going to have the whole rest of your life to spend with the baby - why not do the first 24 hours (some very critical hours) in a place where you have everything you might need in case something goes wrong. Then you get the rest of your life to be with the baby in a non-hospital environment.

I would love to hear more comments from people that have chosen to have babies at home and their thoughts on the risks and benefits of at home births to hear more of the other side of the story. And I wish you the best with your decision Sara!


Megan said...

I love Raising Baby Green by Dr. Greene. He has an informative, if brief, section on this topic. I think he falls in favor of being in a hospital with a birth plan and a doula. He mentions that having an advocate like a doula in the room with you to remind the hospital staff about your wishes leads to less medical intervention and assurances that you and your baby are treated the way you planned--that is, if everything goes according to the plan. If not, you are where you and the baby will get the best care. He brings up things I've never thought of like asking staff to wash your baby with only water or a natural wash that you provide (he even gives product suggestions) and using organic cotton, etc. Me and my husband are on a similar timeline and I am hoping to get pregnant in July :)

cypress sun said...

Most of my friends have had amazingly wonderful homebirths.

I didn't, but it wasn't for lack of trying. Our midwife (the most reputable in the area) ditched us at that hospital on the big day!

Do your research & trust your intuition.

Johannah said...

I recently read two books I really enjoyed that were somewhat on this topic. If you're very much into having a natural birth and want some good questions, "Your Best Birth" by Rikki Lake and Abby something was wonderful. They had very specific questions for midwives and suggestions that were very helpful, as well as personal stories.

You and Matt might also enjoy (and have probably already read) Free-Range Kids by Lenora S--- something. I love that you're such a planner, and how prepared you are getting yourself mentally and physically.

Ingenue said...

I am the oldest of 4 children. We were all born safely and healthy at home with a midwife. At the age of 4 I sat on my aunts lap and watched my sistr's birth - it is still one of the most pwerful and memorable experiences of my life.

I am now 30 years old and my fiance and I are hoping to concieve early next year. I think homebirth just makes sense. Like others have said, our bodies are MADE to have babies. Much like the "wedding industrial complex" the "medical birthing complex" thinks we're suppossed to be afraid of giving birth. Don't be afraid - you are strong, healthy, educated and powerful. And at the end of the day, you just have to decide where you'll be the most comfortable. If you're in an uncomfortable place it will definitely have an adverse affect on your labor.

I highly recommend watching home birth and hospital births on youtube (there are a gillion of both). The stark difference between a home birth and a hospital birth is super obvious in all of them. Watch "The Business of Being Born" (Ricky Lake and Abby somebody's documentary on birth in America), it is jam packed with facts, testimonials and leaves you feeling like you really learned something. Also, the book "Baby Catcher" by Peggy Vincent is a fabulous memoir covering the author's 30+ years as a midwife both in and out of hospitals.

Good Luck! No matter what you decided, just make sure you do what YOU think is best for YOU!

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