Tuesday, May 7, 2013

Your Opinions Wanted

First of all, thank you all for your comments on my last post. That definitely has been the scariest thing I've dealt with since...well, maybe ever? I don't know. It was just awful. Anyhow, everything seems to be better now and back to normal. We had our regular OB appt on Monday and she didn't seem concerned (more on that later) and baby looked great (lots of fist pumping).

But today I need to enlist all of you - yes ALL of you...even you lurkers!!! - to comment and give me your opinions. I am absolutely terrible at making decisions and now find myself faced with a big one. You see, last weekend, I finally watched The Business of Being Born and all four follow-up episodes. Yes, they really made four more after the original documentary. For those of you who don't know (I think most people do know?), The Business of Being Born was produced by Ricky Lake, a talk show host who somehow became an expert on natural childbirth after giving birth twice. You can tell she's an expert because her own birth video is part of the documentary and her expertise is clearly on display....as well as her enormous breasts, naked self walking around her kitchen while she moans desperately, and her placenta/afterbirth staining her bath water red. So yeah, I guess she's an expert?? Anyhow, the point of the documentary is to discuss the United States over-use of medical interventions in an effort to avoid pain, complications, and legal liability. However, the use of these medical interventions creates a cascading effect, resulting in a cyclical need for more interventions. That is "The Business" in a nutshell.

Now let me say, I am a research-driven, science-based woman, who happens to have been raised by free-spirited, hippie parents. Needless to say, the two sides of me often clash. Watching this documentary brought up both sides for me. Clearly I wanted to instantly decide to revamp my birth plan so I could have my baby in the most natural, healthy way for myself and my baby, including water birth under the stars....well, no, not quite, but you get the idea. But at the same time, I cringed at the clearly biased, one-sided documentary which did not present the positive side of modern medicine and the risks involved in home births and lack of good accreditation and management outside of hospitals in the U.S. My husband, on the other hand, did not seem conflicted at all. He literally LEAPT onto that bandwagon. He was all, "Yes! Totally! Doctors and hospitals are out to twist us into their little schemes! We can't let them take away your amazing, natural birth experience!!" Ok well, not really that bad, but you get the idea.

Meanwhile, after we watched the documentary, I had another appointment with my OB. Now, when I first went to visit her, I wrote in my blog that my doctor's office wasn't all that I'd hoped it to be. There were no pretty pictures on the wall, no nice interview sitting in my doctor's private office prior to the exam, no wind chimes...well you know. But I did say that I liked my OB because, and I quote myself, " The whole interview was filled with laughter. And, even though I could tell she was rushed, she felt present." Ok, well now, I don't know if I was just trying to hard too like her. I mean, I DO still like her, but she is ALWAYS rushed and I am always waiting. She always feels like she needs to be at the next appointment and our appointments only take about 15 minutes, tops. Is this normal? I feel like she puts the ultrasound machine on me, checks if the baby is alive, and then says, "See you next time." I was especially disappointed after having the bleeding when the appointment was a whole of three minutes just to make sure there was a heartbeat. I gave her the benefit of the doubt because I knew she squeezed me into her schedule and assumed we would talk about it at my regular appointment, just three days later. But no, she didn't seem interested in following up, even when I expressed how terrifying it had been and asked if it was normal. "Yep," she said, while squirting the gel on my belly. And that's about it. Then there is the fact that the first time I met her I had the sense that she would want me to go ahead with an epidural and wouldn't quite understand doing it "naturally." This time, we brought up the question of a doula (yes, probably spurred by our documentary-marathon). Her response? "Um, if you want. But I don't see the point." She also said, "Well I guess if you really want a natural birth, you should get a doula, because she could help you with that." Implying that no one else present would be supportive of that? I don't know...maybe I'm reading between the lines too much. Anyhow, STILL I was (am?) ok with her. She is knowledgeable, kind, smiles a lot, and I trust that she would deliver my baby safely. Everything was fine.

Until last night. My husband decided to sit down and have a heart to heart with his friend and friend's wife (who is 6-months-pregnant) about their experiences with their midwives at their Birth Center. He came home gushing with stories about how how their prenatal appointments are an hour long, how the midwives are caring and kind, how they check in about EVERYTHING that is going on with you physically/emotionally/spiritually, how the birth center is beautiful, relaxing and tranquil, and how amazingly happy both of them have been with their experiences.

So yeah, I was instantly jealous. It sounded like therapy for your soul as well as really good prenatal care at the same time. They stated that they instantly feel at peace when they step into their waiting room. Wow. But.....shit. That brought up two major problems for me. First of all, I have always wanted a hospital birth. The idea of a birthing center just sounds a bit like tempting fate to me. What if something goes wrong? Mostly, what if something goes wrong with the baby following the birth? Could we get to the hospital in time? Also, are these people qualified and able to do what an entire hospital of people can do for me? The part of me that has a PhD was screaming inside at the idea of the touchy-feely-unscientific side of all of this. But the part of me that has been exhausted, sick and scared, just wants a care provider who, well, cares and who will take a holistic approach to this pregnancy. Not to mention a provider who will not push me into interventions I don't want.

I mentioned two problems. The second may seem a little silly. But, well, I can't imagine "firing" my doctor. I mean, there are things about her that I wish I could change, but overall, I think she is good, capable, and probably better than most doctors out there. I am a person who is not very good at confrontation and likes everything to be "nice." So the idea of "firing" this doctor who has done nothing wrong sounds awful to me.

So what do I do?? Do I continue as planned, hope for a natural birth in the hospital and accept that the prenatal care isn't exactly what I dreamed of, but it is empirically valid and high quality care? Or do I go with the other side of me and sink into the beautiful birthing center that has candle-lit birthing rooms with beautiful decor and a team of midwives waiting to inquire into my overall health and well-being and give me the time and attention I so desperately am craving right now??

This is where I am at right now. I feel I want to decide as soon as possible, because the longer I wait, the harder a transition would be. Sooooo we scheduled a free "consultation" at the birthing center. Can I just tell you guys, when I called, the damn receptionist was so nice and caring that I wanted to cry? She gushed about my first pregnancy, consoled me about how hard the first trimester has been, and gave me hope that it could get better around 16 weeks. I wanted to make my decision right there. Oh, and the FREE consultation is an hour long, 1:1 with a midwife, followed by a meeting with their clinic director to discuss additional questions. Wow.

But now I need your opinions. Is a Birth Center (basically a home birth with a bit more structure and just a BIT more medical supplies) an absolutely crazy and maybe irresponsible thing to do? Am I throwing away my belief in science just because I've been so sick and tired and want a little coddling? Right now, I'm leaning toward trying to figure out a way to have the best of both worlds. Maybe I can have the midwives do prenatal care but somehow keep my doctor as a back up doctor? Meet with her occasionally or something? And decide later on if I want to do the hospital birth or not? According to their website, they are very open to "supplementing OB care," but I have a feeling my doctor may not be too keen on it... Anyhow, OPINIONS WANTED. Be honest and let me know what you think. Oh, and please don't try to introduce too many additional options, I really am overwhelmed enough as it is. Oh, and before you ask (because everyone does), LA does not seem to be good at the combo of alternative and standard care and doesn't offer options such as birthing centers within a hospital setting. I looked into UCLA Midwives program but that didn't work for logistical reasons, and that seemed to be the only option that combined the two. It seems to be one or the other. And here I am, trying to have the best of both worlds.

*insert huge sigh here*

Because what I really need is to create more stress for myself, right?

37 comments:

  1. By the way, here is an example of some literature from the birth center's website:

    "When you go to a doctor and you get standard obstetric care, you’re getting a very small slice of the pie. Your average appointment with an obstetrician is 7 minutes long. You’re waiting an hour for that appointment. You spend—real face time with the doctor—actually about 3-4 minutes. And there’s so little care that can be offered in that moment. There’s no relating, there’s no intimacy. Hardly any time to talk about how people are feeling, or what their concerns are, and it’s not built into that model.

    With a midwife, you spend an hour, you get to really go into the other issues that are lingering. It’s part therapy, part nutrition, personal coaching. We delve into all those other aspects of the human consciousness, of the human psyche. It’s called the human experience, to be able to unveil some of the fears and concerns and beliefs, so there’s more freedom and more opportunity to be a participant in your experience. We see ourselves as partners in the care versus we’re in control of it or we’re dictating how it’s going to go. It’s very much about individualizing based on uniqueness—what does one person need versus what does another person need."

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  2. Sorry, this is going to be long! Firstly, as a nurse I agree I find a lot of the 'natural' stuff a bit of challenge. Interventions save lives. I know litigation etc adds to the problem, but my friend is an OB and told me that 'you watch a mother or baby die once, then you do everything in your power to prevent seeing it ever again' Nothing to do with business or money, but a driving need to save her patients.

    BUT I agree the US is much more intervention focused than the UK, where midwives do 90% of all births. Because of that, I went with the midwives at Ucla first time. They were fine, but as soon as things looked bad, I was passed on to the oncall doctor, who was awful. My whole experience was horrific. Check what the back up plan is, who they refer you to etc because that ended up being the biggest issue for me. Of course you're totally unlikely to need it, but also check what they do if something goes wrong in delivery- they'll probably have a robust plan on place, ask to see it!

    Birth centre seems like a really good compromise for you both.

    I have actually found an amazing OB/gyn I adore now, and have had an amazing experience so far this time (almost 11 weeks, still a bit secret!) With appointments weekly lasting at least 40 minutes and weekly ultrasounds to ease my anxiety after the first time. I've been hospitalized with hyperemesis gravidarum and the care has been phenomenal. If you want to talk more about it, feel free to email me, I could talk all day about this! Laladiaries (at) gmail (dot) com

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    1. I am so happy for you , congratulations :) (and hope the hyperemesis gets better)

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    2. First of all, CONGRATULATIONS! I had no idea! I will definitely email you :) Also, so sorry you've been so sick... it puts my whining into perspective.

      Secondly, your comment has stuck with me all week, because really, it mirrors my own fears. How could I live with myself if something went wrong and not being at the hospital prevented my baby from getting the right care? But yes...I think that the U.S. doesn't really have the system down for how to provide the right kind of care for low-risk pregnancies and labors. There needs to be a better middle ground such that doctors (who are busy for a reason) can attend to higher-risk situations and then midwives can have more time to spend on the whole "pregnancy is not a disease" model of thinking.

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  3. I absolutely adore my OB! She only spends a few minutes with us each time but it's quality time and she puts me at ease. I don't really like doctors so I don't want to spend hours with one all the time.

    I also cannot imagine birth at home or a birthing center. First of all, I would not be comfortable because of all the things that can go wrong and secondly, I can't predict how my body will react to labor and I want drugs available just in case. I spent years planning how conception and pregnancy would go and watching it all fall apart. I don't want to decide how birth should be and then spend the first weeks and months of my child's life disappointed that it didn't go the way I wanted it to. So I'm going into it thinking that I would like to try for a natural birth but knowing that I may tap out and want the epidural ASAP.

    Finally, with my high BP it is almost necessary to have an OB. I need to be closely monitored and possibly induced if it gets too high. The risk of complications like pre-eclampsia is real and it can happen fast. I need to be able to feel secure and safe and my OB does that even with all the scary things that can happen.

    I think you should at least look into the birthing center. It may be just what you're looking for. But if you're looking for a hospital birth, than it's not impossible to acheive a natural birth there. I think what your OB meant about the doula was that it's good to have someone there to support you if you want a natural birth. It's difficult to do it alone. Whatever you decide I'm sure you'll make the right decision for yourself and your baby!

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    1. Yes, yes, and yes. I agree with everything you're saying. I'm terrified of the idea of something going wrong and the birthing center. Also terrified that I will want the drugs but not have that option. But I just can't totally throw it out of the window. But more and more, I am definitely leaning toward the doula at the hospital route.

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  4. So, of course I was going to suggest a combo setting... sorry that it's not an option for you.

    I actually have been avoiding watching The Business of Being Born because I am afraid I am going to have the same reaction as you. As things stand already, I want to TRY for a natural birth, but it will be at a hospital where other options are available if necessary (which I am open to). I also worried about what if things go wrong and I am at a birthing center? I am very lucky that OBs at the hospital where I will be delivering are very "midwife-y" in their philosophy (their words, not mine). They actually encourage natural birth.

    The same hospital also has midwives. So if someone were getting care from the midwives in that setting, and something went wrong, there would be doctors available right there to intervene, so you wouldn't need to worry about being transferred elsewhere. It's unfortunate that this option doesn't seem to be available to you in LA.

    That said, I would recommend checking out the birthing center. They usually have connections with a hospital in case of emergencies. But generally, if you have a low risk pregnancy, this might be a good option for you, given how your birth plan doesn't seem to align with your doctor's point of view.

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    1. Ha! It cracks me up that you're deliberately avoiding watching the documentary, but you're right....look what happens! Although, I still think we would have been ok with our plan if not for hearing about our friends' marvelous experience with their midwives that contrasts so much with our experience with our OB. It sounds like your hospital and doctor is a good set up...a good middle ground.

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  5. After watching that movie I was high on natural birth, but because of my fibroid surgery it is not an option. I love the idea of a natural birth and most births do not need an OB. If I were you, I would go with a midwife- just being able to have more than 5 minutes with someone to ask questions would be really nice. If you remember during the movie there is always a backup plan if you do end up needing a dr.

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    1. Yes, there is definitely a back up plan. I will get specifics when I go in, but their website states that they avoid "emergency rushing to the hospital" at all costs but going in whenever they foresee a potential problem way down the road. Also, the hospital is probably a 5 minute drive away.

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  6. I can't really give you advice because I am Canadian. I can share my plans though (I have a lot of plans for someone who is not even close to being pregnant!) I am going to have an OBGYN and a midwife at the same time, and I will deliver in the hospital under the care of my midwife.

    I say go with your heart. Being a hippie, I'd probably lean towards the birth centre because when I lived in Mozambique I saw all the women getting together to care for a woman in labour and assisting in the birth, and it seemed like such an amazing experience I knew I wanted something as similar as possible. I'm sure if you have a low risk pregnancy you would be happy at the birth centre.

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    1. My friend was able to have a midwife do her delivery with an OB standing by. Now why can't I have that? Oh well. And yes, I agree that I would be very happy at the birthing center. It just "fits" with that part of my personality. But I have to overcome my own anxiety first...

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  7. Two of my girlfriends delivered at a birth center and couldn't say enough good things about their experience. Two of my girlfriends delivered in a hospital, one of whom had a great experience and the other of whom had a horrible experience (she was induced which slowed down her labor, then her epidural wore off and she had had no birth classes or anything to help her cope).

    It's a tough choice. I've thought about it a lot, and I'm personally leaning toward the birth center unless it looks like there are complications toward the end of my pregnancy. But I'm not even pregnant, so WHO KNOWS!

    Good luck with your choice!

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    1. Thanks for the words of support and good to know someone else is considering the birthing center. Also, most important, thanks for the luck with making my choice. I think once I've decided, I'll be happy either way. I'm just not good at decisions.

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  8. I am using a midwife and birth center, and I'm actually extremely passionate about it. I have been reading and researching it for over a year and I am CONFIDENT that it is the choice for me. My miscarriage just confirmed it for me. My doctor's office treated me like absolute crap--the same office that my sister had a wonderful experience with. They didn't care about what I was going through. They didn't take the time to educate me about what to expect, and even worse they made me feel like a bother. NOT COOL. My midwife, on the other hand, had me come in for a last-minute appointment and spent over 30 minutes with us, answering every question we could have had and more. She was so calming, assuring and compassionate. 110% difference. She also educated us about things, asked me specific questions and ENCOURAGED me to trust my instincts.
    Another thing to consider is the idea that a lot of complications in labor are actually linked to the interventions and hospital environment. Gentle Birth, Gentle Mothering has a TON of information on this. Way more than I can give here, that's for sure!
    Yet ANOTHER thing is that hospitals have standards and policies and procedures to prevent them from getting sued. That makes them a lot less likely to take each woman as an individual or be open to natural birth, which can often take longer than the doctors like to see. You also won't be subject to nurses shift-changes during your labor and the liklihood that your doctor won't be there. Midwives are there caring for you from your first prenatal appointment and all through your labor, and honestly I would trust them FAR more to make medical decisions for me than a doctor who is in and out and seeing several other people at the same time.
    I would definitely look into it more. I HIGHLY suggest reading Gentle Birth, Gentle Mothering; anything by Ina May Gaskin; Your Best Birth (also by Ricki Lake!) and The Essential Homebirth Guide. I also suggest the website www.wellnessmama.com. She has a much more extensive list of books on there.
    Just my 0.02. =)

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    1. I will check out the books thanks! Also, thank you for sharing your story. I shared it with my husband as well. I think this really reflects what I am craving out of a midwife. I don't want to just have the doctor make sure I'm medically ok (as she did when I had the bleeding), but also have someone check in and listen and explain things to me. I'm glad you were able to have someone to do that for you when you really, really needed it.

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  9. I don't know when you started reading my blog but I had a hard time deciding where/with whom to birth. I have switched providers 3 times since I was 28 weeks (now 37!) so don't feel that you "can't" or feel badly because you want to switch. Pregnancy is an amazing time where we are very connected to our bodies and what doesn't feel right for us simply is not.

    Follow that mama gut-instinct. Wherever it takes you.

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    1. I love that you picked up on my irrational fear of "firing" my doctor. Thank you for telling me it's ok. Ironically, I just helped my sister transfer to a new GP today and she felt really guilty about it and I told her she was crazy. Somehow, with the OB, I just want the connection to be "there."

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  10. Hmmm....well...you would probably be fine at a birth center, so long as your pregnancy continues along smoothly. Tons of people do it that way. Is it close to a hospital in case that is necessary? Personally, I feel more comfortable giving birth in a hospital (plus I think with twins a birthing center probably isn't even a realistic option for me). However good your OB is at the medical side of her job she isn't giving you what you want and right now you need more than just a quick medical visit. It's your pregnancy and you have to do what makes you most comfortable. I think you should move on, whether it's a new OB or a midwife. You don't have to face her to do it, just call the office and request your records be transferred. Have you looked into other OB's that may be a little more "touchy-feely"? what hospital are you delivering at (I am in LA as well) I had a long list of doctors to consider and I narrowed it down by asking my acupuncturist (who also used to be a doula) who she thought was the best from working with so many of them. Coincidentally one of the 3 she picked also came highly recommended by a friend so we went with him. So far I haven't felt rushed with him and he answers all of our questions. I haven't felt like he is bothered with our questions, either. He certainly isn't at the level of personal care as a midwife, but I like that he will be my only doctor and he will be there for the delivery. I won't just get whoever is on call.
    this is a tough choice to make and obviously one only you and your husband can make. I think you could maybe have both - find a new OB who is a bit more caring but also get a doula who can help you through your pregnancy with the attention you need and also advocate for you at the hospital when you might have a hard time doing that. In the end you have to do what feels right to you.

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    1. Yeah...I wouldn't be considering this if I were pregnant with twins. (Stay in a hospital, girl!). I should say that I do like my OB, in terms of her personality and the fact that she would for sure be delivering my baby and not some other random doctor. I just feel like I am needing more right now. I am considering seeing if the midwives will provide "supplementary prenatal care" as it says on their website, but still stick with my doctor as well. We'll see.

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  11. Disclaimer: I'm a student midwife, pro-natural birth person, and pregnant with my 2nd child with midwifery care... I wouldn't say I'm biaised, because I've read about birth and pregnancy for years (8 I believe), including scientific studies, and I've seen both sides (appointments with doctors and midwives, hospital birth after laboring at the birth center). (and please disregard any mistake, English's my 2nd language...)

    For me, there was never any other option than giving birth at home or at a birthing center... In Canada, midwifery is very strictly regulated, all midwives need to be registered. To do so they need to go through a 4-year university program, and they only study pregnancy and birth, both normal and pathological. They only take care of healthy women and babies (that's logical, since the OB-GYN are qualified to take care of problem pregnancies). They don't do pathological unless there's an emergency, and they're very qualified to do so since they spend a lot of time studying that also. They have all the equipment that's required to respond to emergencies, such as hemorrhage, reanimation, etc. I feel very confident being in a midwife's hands.

    However, I know things are different in the US. Different people with different qualifications can be midwives: certified nurse-midwives, certified midwives, and another one, I'm not sure what they're called. Their background aren't equal, I'd suggest you get more info to make sure you're satisfied with their level of training.

    You know, midwifery IS an evidence-based science. I know a study has been published a few years ago stating that home births are as safe or even safer than hospital births for healthy women. I'm sure you can find it with Google. There are others too.

    Midwives just believe that too much (or even "any") interference in the birth process can make it go wrong, or less smooth. Birth implies many hormones that are blocked by too much noise, light, people entering the room, etc. So the less people interfer with you, the better the birth will go. However, you need to feel safe... if you don't feel safe in the birhing center, it's best you choose the hospital instead. That's why both options exist... so everyone can feel safe somewhere. I'm glad you get to have a free consultation! you can ask them any question you have and maybe get visit the center? I'm sure it will help you a lot.

    You doctor is absolutely right: if you don't have a doula with you, it'll be very difficult for you to have a natural birth. Studies have shown that having a doula significantly reduces the interventions during the birth (epidurals, episiotomies, forceps, c-sections, etc). That's a great idea... Because the doctor won't be there until it's time to push, and the nurses don't have much time to help everyone...

    I really hope you'll find what you need and want, it's so important to feel safe during pregnancy and labor... There's no unique answer, midwifery IS safe (and so are home births and birthing center births), but it's not for everybody. Good luck!!

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    1. Thank you for your thoughtful and helpful response! Also,thank you for checking me on the fact that midwivery IS an evidenced-based practice. I think that the problem comes in in the U.S. that it is not as regulated and there is a big range. If we could just embrace a different model of care for women and babies, it would become more regulated, as it appears to be in Canada. I will check into the qualifications of the midwives at the birthing center, just to be sure.

      The consultation is at the birthing center, so I will definitely get a tour and hope to get all of my questions answered. I think you're right though, it comes down to where I will feel the least anxious, as I've read studies (probably by nurse midwives?) linking the level of anxiety to level of pain during delivery. If I go to the hospital, I will surely be getting a doula.

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  12. Hmmm...sounds like you would feel much safer at a hospital. I love the concept of a water birth, personally, but my anxious and stressed-out self would never allow it. I think a good mix is the hospital + a doula...have you thought of that?

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    1. Yes, see my above response. I will definitely include a doula if I decide to go with the hospital. And I agree with you...not sure if MY anxious, stressed-out self is so cool with a non-hospital birth either. Ha.

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  13. Yes, that documentary is so one-sided! It was really interesting though. And weird to see Ricki Lake like that, LOL.
    I love my OB, but she is also in a hurry most of the time. My visits are very brief. It doesn't bother me though. I've heard that midwives can be a lot more attentive. It seems like people love them. I don't have a choice in the matter since I'm high risk, but I lean more towards sticking with an OB and a hospital anyway. Maybe it's because I work in the medical field. It's just my comfort zone. There's definitely nothing wrong with natural births at home or at a birthing center. I totally commend women who do that - very awesome! Can you have an OB and a doula or midwife at the same time? You should definitely do what makes you comfortable and happy :-)

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    1. Yes, I'm actually going to ask the midwives if they are available to act as doulas at the hospital. I don't know if that's something they are open to, but I know that if you were to have to be transferred, they would come along and be doulas for your birth. So it's a possibility? Then I could get the prenatal care and still have them present for the birth?

      And yes, it is hilarious to see Ricki Lake like that ;)

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  14. I would like to start by speaking about my experience:

    I had an OB/GYN when I was pregnant with Little K. He was my GYN prior to pregnancy and I already felt I had a good relationship with him, so it was easy for me to continue care with him once I was pregnant. I planned on an epidural, so I didn't even ask questions about natural birth with him. Although I always had to wait an hour for appointments, he was wonderfully thorough, allowing me to ask questions and giving me detailed answers. I felt like I learned a lot while I was with him. Our local children's hospital was one of the top in the country and I had a lot of confidence in the care I would receive. Although my doc did not delivery me, I had a very good experience.

    That being said! If TTC works out for us this time, I want to try natural birth (using Hypno.Babies). I've already researched birth centers and midwife practices in our area. I would very much like to work with a birth center but, because R feels very strongly about wanting me to give birth in a hospital, we ended up deciding on a small country hospital near us where a midwife practice I like has delivery rights. We feel like we would receive the least amount of interference with a natural birth plan at this facility.

    However. If our IUI were to result in a twin pregnancy or if I were to experience any serious complications during pregnancy, we would most likely change our care plans and work with an OB at one of the major hospitals in the area.

    IMO, if a midwife with delivery rights at a hospital is not an option, and if your pregnancy were to continue without complications, a birth center sounds very appealing. Just be sure to Google, do board/license research, etc. the heck out of the midwives there.

    Nothing is hurt by attending the free consultation!

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    1. Oh! Absolutely get a doula if you will be in a hospital without a midwife. And, if you OB isn't engaging in your appointments or knowledgeable/supportive of natural birth, find a new doc! Pregnancy is such an emotional rollercoaster; you deserve a doc that takes care of your body AND mind.

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    2. What I meant was: If your OB isn't supportive of your birth plan - WHATEVER that plan may be - get a new one. Honestly, this isn't natural vs. intervention. If you and your doc aren't on the same page, get a new doc.

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    3. Thank you! Your thoughts are really helpful, especially since you've been through it. It's funny, I always thought I'd do a more traditional route for the first baby and then the birthing center for a second baby. Leave it to my husband to push my comfort level! But yes, you're right, I mean, I LIKE my doctor, but natural birth clearly doesn't seem to be her thing. I don't want it to be confrontational between us or a point of contention.

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  15. I was just going to say what the other commenter above said: "In Canada, midwifery is very strictly regulated, all midwives need to be registered. To do so they need to go through a 4-year university program" and in the U.S. it's VERY different -- you really need to look into the qualifications of your midwives and whether or not they're nurses or actually have post-graduate degrees in this stuff or what. Once you've become satisfied with their expertise, THEN make a call on which care provider you prefer.

    I would also say that, regardless of these people saying doctors push drugs on you at the hospital, they ultimately will not do anything without your consent -- unless the baby's life (or yours) is at serious risk. So you CAN tell them you don't want an epidural, or pitocin, or whatever. That's up to YOU. If you have a doula on hand, that's just an added bonus because she can help explain things and coach you.

    Personally, I think you need to consider whether you care most about the care you receive during pregnancy or the delivery itself. Midwives definitely excel in the pregnancy department because they can offer a lot of hand-holding, and as long as you're low-risk, they can be great at the delivery, too. But if you DO have any serious complications, are you comfortable with being in the hands of an OB who doesn't know you? Some feel that it's important to actually be the official patient of their OB because then the OB takes a greater sense of responsibility with you. But who knows, really...

    Honestly, do what feels right. And know that BOTH choices here are absolutely fine for your baby!

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    1. You're right that they can't do anything without my consent and I think having a doula along plus being an educated, articulate person should help me to make my opinions and needs known. But I don't want to have to be "that bitchy lady" who disagrees with the nurses. They are just trying to do their jobs. And who am I to tell them what intervention I need or don't need? It's a slippery slope.

      I also agree that I don't like the idea of having some random OB do the delivery (worst-case scenario). I am still trying to figure out if there's a way to still have my OB as a back-up doctor, or something like that.

      Finally, I WILL check into their backgrounds. I would prefer a nurse-midwife, but I'm thinking these may be the level one below that training (I think there are three levels?). Anyhow, clearly I need to do more research on that. I wish that it were as regulated here in the U.S. The lack of regulation and clear training guidelines reflects poorly on our system.

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  16. You already have been given a lot of great advice (and I haven't even read all the comments) I apologize if I'm just reiterating what others have said. I had a hospital birth with a doula. It was everything I hoped for but then again I didn't have super high hopes, seeing as I had to have a hospital birth. (Our HMO only covers births at their hospital and we couldn't afford a birthing center, though I would have seriously considered one if given the chance). I would take your questions and concerns to that free consultation and see what they have to say. What do they do if a baby or mother ends up in distress? What do they have available at the center? How quickly can they transport to the hospital? Voice your concerns. If you feel heard and like their responses, go with them. The 15 minute OB appointment sucks (and is TOTALLY normal). If you can get the care you want elsewhere, and you can afford it, I say go for it if it feels right.


    Good luck!

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    1. I think we could make it work financially, especially since there is a possibility our PPO could cover some or part of it. Which would be amazing. You can bet I am going to be asking a million questions at our consultation this Friday!

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  17. I feel pretty much the way you feel. I would, ideally, as in, if able to choose, prefer a natural birth, in a swimming pool, under the stars, like you described. (Seriously, I read about birthing in water and it sounded like something I might want). But as a medical professional I know that complications (like bleeding, eclampsia...) while relatively rare, do happen, that you can be the 1 % (says someone dealing with infertility), and based on that I know I WANT medical professionals around me.
    In The Netherlands the views on childbirth seems to be quite the contrary to the overmedicalization you describe. If you want doctors, painkillers or a hospital birth you are viewed like a crazy, weird person. What they say is that "Pregnancy is not a "disease" " ( so you get very minimal monitoring) and giving birth is just a "normal" process so most women do it at home, in their own bedroom. I know, from getting bad menstrual cramps, that I will want painkillers, but for the rest I would, if possible, have it be as natural as possible, while staying open to whatever the doctors decide is best. I want to be able to trust my doctors.
    I also know that most births go on without any complications. That, as a doctor, the cases that need intervention are minimal. But, but, I am not going to pretend birthing did not use to be one of the main causes of death of women, before modern medicine, and so, yes, I know I want the doctors.
    Those intermediate options, sound ideal.
    I would say, and it's just my opinion, you could get the midwife for prenatal care / appointments and give birth at the hospital. Maybe your doula / midwife can be with you until the end, or even be allowed at the hospital? Is that an option at all?
    As a sidenote, regarding doctors, as much as I would like them to be nice, caring and have that human touch, what I want of them is to be good, accurate, knowledgeable. At our clinic there is a doctor who is super nice and kind, but it is the doctor that confused a corpus luteum with a growing follicle, and on another cycle missed my ovulation. Whereas there are other doctors, that are more "to business" and are just with you 15 minutes, but you can tell they know what they are doing. I think I prefer that... all these mistakes are just making our wait longer, for nothing.

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    1. "Maybe your doula / midwife can be with you until the end, or even be allowed at the hospital?" Yes, in response to an earlier comment, I stated that I want to see if the midwife can actually BE the doula. That would be truly ideal. If not, the hospital (and my current OB) will definitely allow a doula present for the entire labor and delivery, so that's a definite for me.

      I think that, even though I don't technically work in the medical field, I do have a doctorate and work in a hospital, and so I feel really strongly about the science behind medicine as well. It seems a bit careless to eschew everything we know and through it out the window, saying "Oh don't worry, I won't need that." Even the Business of Being Born admits that labor is 98% boring and 2% sheer terror for medical doctors. The 2% sheer terror can come out of nowhere!

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  18. I am way late to the party here but just wanted to say thanks for raising this. I have a high risk OB right now - because of my Crohn's disease I've been told I don't totally have a choice in this regard - however I've been seriously contemplating if/how to supplement my care with either a midwife or a doula. Please keep us posted on your experience and thanks for getting the conversation going!

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