Provider Care

Mamas On Bedrest: How Did You Decide With Whom and Where to Deliver?

March 14th, 2014

Greetings Mamas,

I was just surfing around and came across a most disturbing webpage. Under the guise of wanting to “protect babies” this webpage’s content focused soley on disparaging midwives, lay midwives and Certified Professional Midwives in particular.

Now I am going to out myself right here and now and say that I have immense respect for midwives and the work that they do. I know both Certified Nurse Midwives-midwives who studied and trained at major universities here in the United States, as well as Midwives who were trained in other countries and chose to simply sit for the midwife exam rather than repeat their entire education (and pay the hefty educational costs) here in the US. I also know a few “lay midwives”, women who had such a passion for midwifery and childbearing that they have spent countless hours appreticining beside a midwife. All of these women are extremely dedicated to their clients and provide excellent care. Like all professionals, I do believe that they have all had some “untoward events”, i.e. births that have gone poorly. And like all professions, I believe that there are some really good midwives and some that aren’t so good.

The same can be said of physicians. We all know really excellent physicians and we also know physicians we wouldn’t let care for the neighborhood Alley cat! We must all remember that in every medical school, there are those students who graduate at the top of their class and those students who are amongst the bottom tier. Yet, We cannot (well, we should not) judge an entire profession based on the performance and habits of a few.

I was really disheartened to see this webpage really bashing midwives. There were a lot of sensational articles and posts, but little to no data to back up the claims. The moderator made very disparaging comments stating that laymidwives and Certified Professional Midwives had little more than highschool diplomas. It was shocking because most of the midwives that I know have sat for and passed national certifying examinations. I am all for having an opinion for or against something, but if you are going to make claims-and especially if those claims are disparaging or potentially impactful to those who may not be aware of all the facts-you must be able to back up what you are saying with hard evidence.

So that being said, Mamas on Bedrest, how did you decide with whom to deliver and where? If you are wondering how to figure this out, I’ll share with you how I made my decision.

1. Determine what type of practice and birth you want. I knew I wanted a midwife. I love the midwife model of care and I love that woman to woman interaction. I chose a practice that was all women. This is not to say that a practice that has men can’t be good or can’t be sympathetic. In my current area, the practices that are predominantly male were not as open to the less invasive, expectantly wait “midwifery”  model. But I do want to say, before I got married I had a wonderful OB/GYN that was a man, and only switched because I moved out of state.

2. Interview the practices. Now I have had many people gawk when I say this. But let’s be real. You interview contractors before you have work done on your house. You interview daycare providers before leaving your children. Heck, I interviewed vets before I ever took my beloved cats even near the door! Don’t you deserve at least as much? And when I say interview practices, I mean OB/GYN practices as well as Midwife practices. Your personalities have to mesh! Ask about call schedules, ask about meeting the other providers, ask about classes and how questions are answered and how soon phone calls are returned and how lab results are delivered. Make sure that you are able to have the level of communication and attention that suits you! Every practice is different and you must feel comfortable, heard and free to ask questions and get a reasonable response. If you feel put off, if things are more automated than you like, If you just don’t feel comfortable, try another practice.

3. Know your As/gynecologic history. I had a history of uterine fibroids and was over 35 conceiving, so I knew that I was at increased risk of having complications. While I wanted the back up of obstetricians, I also wanted a practice that would be as minimally invasive as possible. Be reasonable. If you have a history that is complicated, you may not be a candidate for a midwife. Don’t be mad and don’t berate her skills. If she tells you that she isn’t comfortable handling your case, you should thank her. She is putting your health and well-being first! Likewise, if you have a complicated history like I did and a midwife tells you, “No problem, you can totally deliver out of hospital!” Be wary. She may be operating beyond her scope of practice and potentially putting you and your baby at risk.

4. I wanted as much midwife interaction as possible. Almost immediately, my first pregnancy went high risk and my hopes of a midwife delivery went out the window. However, my OB worked closely with a midwife and so I was able to see the midwife for many of my OB visits. Additionally, after I gave birth to my daughter, I was able to have my follow up visits with the midwives. Go for what you want as much as possible. I was not a candidate for a midwife attended birth in a birthing center birth, but I was able to have a lot of education and interaction with midwives. For me, I got the best of both worlds.

5. Speak to friends, Get references. One of the best indicators of a practice is references and testimonials. There are a lot of websites where patients rate their experiences with doctors or doctor’s offices. This is a good place to start. Likewise, Midwives are also rated and referenced. But far and away the best information comes from other mamas. Try to connect with other mamas in your community to see what their experiences were like. Remember, every pregnancy and every birth will be different, and not all personalities mesh. But if you have a practice that everyone loves, you can be pretty sure that it’s a good practice. Likewise, if there is a provider that consistently gets poor reviews-be it OB or midwife-you may want to steer clear (or at the very least, do a thorough evaluation to see if this is the provider for you!). Also, the American Medical Association (AMA), the American Congress of Obstetricians and Gynecologists (ACOG), the American College of Nurse Midwives (ACNM),  and Midwives Alliance of North America (MANA) all have ways to find out about those in their profession, evaluate their performances, etc…

It all comes down to being a savvy consumer. Don’t be swayed by positive or negative advertising. Do your homework and get enough information so that you are making a wise and informed decision about who will provide health care to you.

And this is important even if you are in a small town or have limited options. I frequently get e-mail from mamas saying, “I can only go to this one practice because its the only one covered by my insurance.” Or “I have to go to this practice because its the only one in my town that serves high risk pregnancies.” No matter. You still need to do your homework. Get to know the providers and the staff. Get to know how the office works and who you need to contact if you need information. Establish as much open communication as possible so that you can voice your concerns and make your preferences heard.

Mamas, how did you choose with whom and where you will deliver your baby? Please share your experiences and any tips for other mamas in the comments section below.




Mamas on Bedrest: Using Technology to Improve Birth Outcomes

February 5th, 2014

It’s Video Wednesday!!! Today we’re talking about using technology to improve birth outcomes.

Advances in technology are making it easier and easier for medical professionals to connect with patients and eachother.  In this vlog I cite a study done via the University of Arkansas which shows that telemedicine, where one physician shares his case with other physicians via technology and receives input and expertise, is improving health outcomes. While most of us are on board with our smart phones, tablets, laptops and pc’s, the health care industry is lagging behind and just coming up to speed with electronic medical records, electronic communications with patients and now, telemedicine.  But even as the US healthcare system scampers to catch up, the benefits of technology in medicine are already glaringly apparent and will continue to shape how health care is delivered in this country.

Mamas on Bedrest: Who will attend your baby’s birth?

February 3rd, 2014

002_02Good Morning Mamas!

Have you considered having a midwife attend the birth of your baby? As a Mama on Bedrest, you most likely have been told that you are high risk and that you must have a your baby delivered in a hospital with a obstetrician. For many of us, this may be the case. But for women who go to term and in whom preterm labor, premature rupture of membranes, cervical insufficiency or other complications that become somewhat moot at term, having a midwife attend your birth is a viable option.

Why consider a midwife? If you are looking to minimize the amount of intervention you receive during your birth, then having a midwife attend your birth is the way to go! Certified Professional Midwives (CPM) and Certified Nurse Midwives (CNM) are highly trained and highly skilled health care professionals who have studied women’s health and the childbearing process in depth and have proficiency in providing care to the childbearing woman and her newborn baby. However, a midwife differs from an obstetrician in that she provides minimal intervention and is much more of an attendant to the process. A midwife is not a surgeon and does not bring surgical skills to the birth. However, CPM’s and CNM’s are trained in emergency procedures and are capable of managing a wide variety of birth complicatA midwife will allow a woman to birth her way; A woman may birth in bed, standing, squatting, on her hands and knees or in water (if she is an appropriate candidate for such a birth!). For women who are appropriate candidates and who choose to do so, some midwives will attend their births in their homes, in a comfortable environment, in the company of family and friends.

So who is not an appropriate candidate for having a midwife attend the birth of their baby? Any woman who has an unstable medical condition such as pregnancy induced hypertension, pre-eclampsia, Uncontrolled Gestational Diabetes, placenta previa or instability of the infant. These are major medical conditions and need to be addressed by medical doctors. Any condition that necessitates a cesarean section (specifically placenta previa and potentially pre-eclampsia with uncontrolled high blood pressure) these women should be attended by obstetricians. And a caveat for Mamas on Bedrest is that because of our histories, I do not recommend attempting home births. Even if a  Mama on Bedrest is attended by a midwife, I highly suggest that she be attended in a birthing center closely associated with a hospital or in a hospital where emergent medical care can be administered quickly if needed.

Why do I bring this discussion up? Because I want Mamas on Bedrest to explore all their options for their perinatal care. Unfortunately, many Mamas on Bedrest are told how they will birth their babies, told how their birth is going to go and are simply expected to show up and let the process happen to them. Having a baby is a very active process and it is my hope that all of you are as active participants as possible! This often doesn’t happen in the traditional hospital setting. There is little room for personalization, to have family members present, to be able to stand or walk during labor, to be able to deliver in a squatting position. But in a mama, these are all viable options and options that can make her labor and delivery easier, more comfortable and more memorable. As Mamas on Bedrest we have already lost so much of our pregnancy experiences because of bed rest. And while most of you would gladly do bed rest again if it means the safety and well being of your baby, whenever possible, my hope is that Mamas on Bedrest will be able to make informed health care decisions that will not only make for healthy and safe labors and deliveries for mamas and babies, but also make for memorable moments in the life of Mamas and babies.

If you have been considering having a midwife attend your birth, see what is available in your area. You may be able to deliver in a freestanding birth center or in a birth center attached or adjacent to a hospital. You may be able to have a combination of an OB and a midwife. There are as many possibilities as we can think of, but the first step is to have the desire and then to ask and see what is possible.

Who attend your baby’s birth? Share your story in the comments section below.