Sunday, June 27, 2010

Getting closer to a decision

I have had so much stress and anxiety about making a decision about what I want for my next birth. I don't want an overly medicalized birth that generally happens in the hospital, but I don't feel comfortable enough to birth at home. I kept looking for a happy medium. I needed the right mix of comfortable personalized and unmedicated care and the safety-net of the hospital for that dreaded "what-if" factor. (I know there are lots of people who believe that it is more dangerous to give birth in a hospital, and to them I say, you're right. I have read the research and I believe that to be true, but I still feel more comfortable in a hospital. Who knows? Maybe I will change my mind by the time I am actually pregnant.)

I have been hoping that going to a Certified Nurse Midwife (CNM or hospital midwife) would be the middle ground I was looking for. I was told not to expect much. I was told they are only as good as the OB's that control them and that they have to transfer patients to the OB's for nearly everything. I started to doubt that a middle ground even existed. Then, after lots of phone calls I realized that much of what I had been told was true, but not all of it. I realized that, just like any medical professional there are good and bad providers. I felt like I just needed to find the right CNM, and I think I did. :)

Today I met with a CNM named Lindsay. The clinic where she works is in a large hospital. This clinic says (on their website and reitorated in person) they are intentionally small in order to provide personalized care. They have only 1 OB and 2 midwives, including Lindsay. The OB is the doctor who delivered all 3 of my boss' children. She wanted an unmedicalized birth with her second and third children and he was very supportive of that. I considered going to him, but I really just don't like the idea of choosing a surgeon to help me with something that doesn't and should only in rare instances require surgery. I was thrilled to hear he had CNM's working in his office.

I talked to Lindsay for over an hour! She never seemed rushed or irritated by the questions I had. She asked me a lot of questions too. She wanted to hear about my husband and family and how long we had been married. She asked me to tell her about my first birth and my experience with the OB and the hospital and nursing staff. We talked as though we were friends instead of a doctor-patient relationship. I felt so comfortable with her.

I told her about my episiotomy and she told me that she never does those. (Exactly what I wanted to hear!) I told her about how I was induced because my baby was big. She told me that big babies are not an medical reason for induction and she doesn't do elective induction. (Exactly what I was hoping she would say.) I asked her about which circumstances required her to transfer my care to an OB and she told me only if I have gestational diabetes that requires insulin, or severe preeclampsia. I asked her if I had to transfer to an OB if I was overdue and she told me only if I was 43 weeks. She could deliver my baby up til 42 weeks 6 days. I was concerned about that so I felt relieved. I asked her about autonomy during labor and she told me she encourages intermittant fetal monitoring and no iv. She said her patients usually labor in the jacuzzi or walk around. She told me she delivered a baby yesterday while mom was standing up. (Awesome!)

I then asked her about hospital policy on several things. Since she was a labor and delivery nurse at that hospital she was familiar with the staff and policies. I wanted skin to skin and to breastfeed immediately after birth. I also felt strongly about delayed cord clamping and waiting for established breastfeeding and bonding before bathing the baby. She told me all these things were no problem at the hospital so long as baby was breathing. Baby always rooms in (unless medically required to be elsewhere but I don't even want to think about NICU) and won't come in to weigh or check baby until an hour or more after birth. They encourage bonding and breastfeeding. I am sure I will have to make a request for these things, as I doubt that is standard procedure, but I am glad my CNM will back me up. She told me I wouldn't need an iv unless I tested positive for group b and even then it would be a hep lock that could be removed so I could walk around and not be stuck to the pole.

Anyway, I felt really comfortable with Lindsay and I feel comfortable with my decision to have a hospital birth with a CNM. I am open to change and will continue exploring other options, but I feel relieved to have made some progress. I still need to get pregnant first! I am still open to other options, so it's likely I could change my mind and skip the hospital altogether. My next plan is to gather the required paperwork from the hospital and go over the details. That may help me decide if a hospital is really where I'd like to give birth.


  1. I'm glad you found someone wonderful :) Most CNM's induce at 41'6" since it is a part of their certification and keeping it. I am so glad she has an OB that will back her until true overdue, and not just impatience.

    I think we all forget sometimes that there are good ones out there. Good OBs, good CNMs, good CPMs, and good DEMs. The key is knowing what YOU want and finding the provider that fits with that mentality. One that will support you in YOUR choices. You are paying them. They offer a service. If you aren't happy with the service, send it back or move on. It is your body and your choices :)

    I can't wait until you have the birth you want with your next (whenever that may be). It is going to be wonderful.

  2. Oh, one last thing (since you said I could haha) let me know how easy it is to get your hospital documents. Ours won't give them out anymore. The only way to get them is to be IN labor and checking in. As if they have something to hide. Ugh, so ridiculous.

    And, okay, one more - with positive group b strep, do they make you get the antibiotics regardless of whether your water is broken or not? The studies and research for it are all conclusive and say antibiotics only help or should be used if your water has been broken for 18+ hours, if you go into labor before 37 weeks, or you get a fever in labor. Every other time it is shown to not help against the spread of group b strep from mother to baby. Also, if you do test positive, the best way to get rid of the infection is 7 days of garlic vaginally. Can be done right after you get your positive test back. It will completely kill the bad bacteria while keeping the good, and you can avoid antibiotics completely, thus avoiding the IV or heplock.

    Okay, I promise I am done.... Well, until I think of something else lol

  3. Thanks! I will have to look into both the documents and more info on the group b strep thing. I am not sure on either. I sort of have an "in" at the hospital, so maybe I can get a hold of the documents even if they don't give them out. (DH is doing rotations there and I know a NICU nurse at that hospital.)

  4. Oh lucky!! Our nurses aren't allowed to give out documents without a doctor's permission, and none like to give it. They even stopped the practice they used to have that at about 38 weeks they sent you home with the documents so you could sign them and bring them when you were in labor. I really just think they don't want anyone to see them here.

    And group b strep is so much less scary than they make it sound. If you are left on your own, not being checked every two hours, well, barely checked at all, the infection won't travel anywhere. The good bacteria trump the bad. Labor is so awesome with how it works haha.

    Oy, I need to stop being a bother lol