What to ask midwife? (long)

I have had a chaotic week (my husband was injured at work and we've had a
lot of doctors office visits etc. to deal with in the last few days) and
have had no time to put together a list of things to ask when I interview
the birth center I hope to deliver this baby at. Did I mention , this
interview is tomorrow at 11am?

Background:

I have a 2.5 year old still nursing toddler. I had pre-term contractions
during my pg with her and went on full bedrest at 25 weeks. I went on to
deliver a healthy full-term baby at 40 weeks, but did end up with a
c-section, due to, I believe, too many interventions (epidural, pitocin, no
food or drink being given and exhaustion on my part). So, I hope to avoid
these things this time around which is why I am going the birth center
route. Ideally I would like a home birth but my DH is not keen, and I am
not sure that I am really brave enough or in tune enough with my own body to
do this.

Truthfully, the main reason I want a gentle birth this time around is for my
DD. She is VERY smart and remembers things for months and months after the
event. She can handle more than an average 2 year old, and I have no qualms
whatsoever about having her present at the birth. I know that after the
birth she is going to feel insecure and will need lots of attention and
reassurance. She wants to be held constantly as it is, so I can only
imagine what a new baby will bring. I have never left her overnight and
don't intend for this birth to be the first time. I can't imagine how she
would feel if I went away for 3 days, came back and couldn't pick her up (if
I have another c-section), but I could hold the new baby. She is very
sensitive and although she would probably understand if I explained
everything to her, she would still have a hard time with it.

So, I vacillate between, do I have a trial of labor, and possibly end up
with either a c-section anyway, or a tear/painful episiotomy, or do I just
schedule a repeat c-section and not be exhausted after the birth? I have
become so much more granola/crunchy since DD's birth and so that side of me
wants to do the whole natural thing, water birth, no drugs, etc etc etc.
The scared, cowardly side of me, doesn't want to go through labor again
(last one was looong) and STILL possibly end up with a c-section.

So, while I plan to explain all this to the people at the birth center, what
are some things that I should ask?

Things I can think of:
What's your policy on ultrasounds?
Monitoring of the baby during labor?
How long after birth do I have to stay?
Can I eat during labor?
VBAC success rate?

I am stumped for any others, and I KNOW this has been covered here before
but I am too exhausted to Google it and need to get to bed!

Any and all advice would be much appreciated!

Thx!

CY

Things I can think of:
What's your policy on ultrasounds?
Monitoring of the baby during labor?
How long after birth do I have to stay?
Can I eat during labor?
VBAC success rate?

those sound like very sensible questions, you might also want to ask about
vaginal exams, how often they like to do these, also do they have set amount
of progress they like you to make, say 1cm per hour. As you have laboured
before your cervix has had some practice at dilating and even though you
didn't deliver vaginally your first stage still should go a bit faster.
Induction and augmentation is a very bad thing, mainly because it is more
painful so many more women end up with epidurals. I'm presuming that at a
birth center they wouldn't do these things and you would have to transfer
anyway, which at least gives you a barrier.

In message 1097826787.9s/JYRiRZOwVbWG5Ca0sWw@teranews, Anne Rogers
writes

Things I can think of:
What's your policy on ultrasounds?
Monitoring of the baby during labor?
How long after birth do I have to stay?
Can I eat during labor?
VBAC success rate?

those sound like very sensible questions, you might also want to ask about
vaginal exams, how often they like to do these, also do they have set amount
of progress they like you to make, say 1cm per hour. As you have laboured
before your cervix has had some practice at dilating and even though you
didn't deliver vaginally your first stage still should go a bit faster.
Induction and augmentation is a very bad thing, mainly because it is more
painful so many more women end up with epidurals. I'm presuming that at a
birth center they wouldn't do these things and you would have to transfer
anyway, which at least gives you a barrier.

To clarify that slightly, augmentation is a pretty dubious idea even if
you weren't induced (which I'm sure is what you meant, Anne - I just
wanted to clarify it). If everything's going OK with you and the baby,
it's doubtful whether there's any benefit in expecting you to stick to a
set timetable, and, as Anne has pointed out, there are certainly
disadvantages.

I'd also ask about their policy on skin-to-skin contact immediately
after birth (are they happy to let you hold the baby for the first hour
rather than whisking the two of you off seperately for clean-up and
medical procedures?) and about their breastfeeding policy - under what
circumstances do they give extra bottles, what breastfeeding training do
the midwives have, is there a b'feeding counsellor available to talk to
after or even before the birth?

Will they encourage you to move around and try different positions in
the different stages, rather than expecting you just to stay on the bed?

Do they like to break your waters early on or are they prepared to leave
that until it happens naturally, or at least until much later in the
labour?

What are their policies on pain relief? It can help to have a midwife
who'll encourage you to keep going when the going gets tough rather than
being in a hurry to ask you whether you want an injection.

Will you get the chance to try labouring in water as a form of pain
relief/getting things going if the labour seems to have slowed down?
(See http://bmj.bmjjournals.com/cgi/content/full/328/7435/314.)

One book I read suggested that a good all-purpose question was "If
everything seems to be going OK with both me and the baby, I'd like to
keep things as low-intervention as possible - how do you feel about this
philosophy?"

Incidentally, I found that when I was touring both the birth centre &
the hospital, a lot of this stuff I didn't even have to ask about,
because they volunteered the information - so it'll be interesting to
wait and see what they tell you first, then refer to your list of
questions for anything that hasn't been answered yet.

Can't think of anything else offhand, so I'd better post this if you're
going to have any chance of reading it before the interview. ;-)


All the best,

Sarah

--
"I once requested an urgent admission for a homeopath who had become depressed
and taken a massive underdose" - Phil Peverley

Dr. Sarah Vaughan advises asking birth attendants:

"Will they encourage you to move around and try different positions in
the different stages, rather than expecting you just to stay on the bed?"

PARTIAL TRANSLATION

In late second stage...

OBs and CNMwives generally keep the woman on the bed - semisitting or
dorsal - birth canal senselessly closed up to 30%.

OBs KEEP birth canals senselessly closed when oxytocin and Cytotec are used
to push and when hands, forceps or vacuums are used to pull.

Women shouldn't have to ask OBs and CNMwives - indirectly or otherwise - to
allow them to open their birth canals maximally - that's just the way it is.

Sincerely,

Todd

Dr. Gastaldo


PS Some OBs and CNMwives let women "try" alternative positions but move them
back to semisitting or dorsal (close their birth canals) for the actual
delivery...

So it might be good to clarify that you can use alternative positions for
the actual delivery.

"CY" writes:

deliver a healthy full-term baby at 40 weeks, but did end up with a
c-section, due to, I believe, too many interventions (epidural, pitocin, no
food or drink being given and exhaustion on my part). So, I hope to avoid
these things this time around which is why I am going the birth center
route.

One thing I'd want would be a midwife who had a great relationship with
the emergency backup ob/gyns, so that, if you absolutely did have to have
a c-section or other interventions, the interventions could be done in the
most sensitive way possible.

Example: I ended up having preeclampsia, and the doctors had me sitting in
a hospital bed when I had my trial of labor. I really, really wanted to be
standing. If I'd had a good midwife or a good ob/gyn rooting for me, I
wonder if maybe I could have been able to stand during labor.

Then, when I had my c-section, I had to sneak the baby on my breast after
the surgery to get nursing started. If I'd had a good midwife on my side,
maybe I could have gotten nursing started right away *and*, if there were
any contraindications, done so in a safer manner. (Example: I just had the
baby on my chest. Maybe that was actually idiotic and my husband should
have been supporting the baby's weight.)

MOM SNEAKS IMMUNIZATIONS TO BABY

See the end of this post...

"Al Bell" wrote in message
...
"CY" writes:

deliver a healthy full-term baby at 40 weeks, but did end up with a
c-section, due to, I believe, too many interventions (epidural, pitocin,
no
food or drink being given and exhaustion on my part). So, I hope to avoid
these things this time around which is why I am going the birth center
route.

One thing I'd want would be a midwife who had a great relationship with
the emergency backup ob/gyns, so that, if you absolutely did have to have
a c-section or other interventions, the interventions could be done in the
most sensitive way possible.


I'd want a culture where midwifery was the primary model - in hospital and
out - and obstetric surgeons simply did their jobs when called.

I know this making midwifery the primary model isn't going to happen real
soon - if ever - so I like Al Bell's idea - but then again CNMwifery is what
happened when OBs drove homebirth midwives underground and into hospitals to
become CNMwives. CNMwifery seems better than OBs in normal births - which
is most births - but CNMwifery is still too close to the medical model in my
view.(I still can't believe that Yale CNMwifery Prof. Helen Varney promoted
semisitting/closing the birth canal after I told her about the simple
biomechanics. I think CNMwifery is kissing OB butt - babies be damned.)

Example: I ended up having preeclampsia, and the doctors had me sitting in
a hospital bed when I had my trial of labor. I really, really wanted to be
standing. If I'd had a good midwife or a good ob/gyn rooting for me, I
wonder if maybe I could have been able to stand during labor.



Interesting PubMed abstract:

Obstet Gynecol. 2003 Jan;101(1):86-92. PubMed abstract


Severe preeclampsia and cerebral blood volume response to postural change.

Chipchase J, Peebles D, Rodeck C.

Department of Obstetrics and Gynaecology, University College London, London,
United Kingdom.

OBJECTIVE: To compare the cerebral blood volume response, measured by
near-infrared spectroscopy, to a change in maternal posture in pregnant
women with and without the hypertensive disorders of pregnancy. METHODS:
Normotensive (n = 13), chronic hypertensive (n = 7), pregnancy-induced
hypertensive (n = 9), and preeclamptic (n = 15) women were studied
cross-sectionally. The change in cerebral blood volume in response to a
change in maternal posture from the left lateral to sitting position was
quantified. RESULTS: In the normotensive, chronic hypertensive, and
pregnancy-induced hypertensive groups there was a fall in median
(interquartile range) cerebral blood volume of 0.18 (-0.21, -0.15), 0.11
(-0.26, -0.09), and 0.089 (-0.10, -0.049) mL/100 g, respectively.
Conversely, in the preeclamptic group there was a rise in median cerebral
blood volume of 0.13 (-0.20, 0.15) mL/100 g. Of these, six of the nine women
with a median rise in cerebral blood volume of 0.15 mL/100 g (0.13, 0.16)
required intravenous antihypertensive therapy, volume expansion, and
delivery by cesarean within 48 hours. Conversely, none of the preeclamptic
women (n = 6) with a median fall in cerebral blood volume of 0.22 mL/100 g
(-0.30, -0.18) required these emergency measures. CONCLUSION: The cerebral
blood volume response, measured noninvasively by near-infrared spectroscopy,
provides additional evidence of altered cerebral hemodynamics in women with
preeclampsia.


Then, when I had my c-section, I had to sneak the baby on my breast after
the surgery to get nursing started. If I'd had a good midwife on my side,
maybe I could have gotten nursing started right away *and*, if there were
any contraindications, done so in a safer manner. (Example: I just had the
baby on my chest. Maybe that was actually idiotic and my husband should
have been supporting the baby's weight.)

Sheesh - a mother having to sneak immunizations to her own baby.

What a bizarre culture we live in.

Todd

"Al Bell" wrote in message
...
"CY" writes:

deliver a healthy full-term baby at 40 weeks, but did end up with a
c-section, due to, I believe, too many interventions (epidural, pitocin,
no
food or drink being given and exhaustion on my part). So, I hope to avoid
these things this time around which is why I am going the birth center
route.

One thing I'd want would be a midwife who had a great relationship with
the emergency backup ob/gyns, so that, if you absolutely did have to have
a c-section or other interventions, the interventions could be done in the
most sensitive way possible.

Example: I ended up having preeclampsia, and the doctors had me sitting in
a hospital bed when I had my trial of labor. I really, really wanted to be
standing. If I'd had a good midwife or a good ob/gyn rooting for me, I
wonder if maybe I could have been able to stand during labor.


No. Probably not. It would mostly depend on what your blood pressure did
when you were upright...

None of my clients with high blood pressure were allowed more than sitting
up, and that was iffy at best--and you can bet I was rooting for them. But
when someone's bloodpressure upright is 30 points higher than in bed, it's
hard to argue.

Now, in a different setting, there are other ways of mitigating high blood
pressure that don't involve sitting in a bed...


Jenrose

Background:

I have a 2.5 year old still nursing toddler. I had pre-term contractions
during my pg with her and went on full bedrest at 25 weeks. I went on to
deliver a healthy full-term baby at 40 weeks, but did end up with a
c-section, due to, I believe, too many interventions (epidural, pitocin, no
food or drink being given and exhaustion on my part). So, I hope to avoid
these things this time around which is why I am going the birth center
route. Ideally I would like a home birth but my DH is not keen, and I am
not sure that I am really brave enough or in tune enough with my own body to
do this.

One thing you'll need to ask your birth center and midwives is if
they'll even take you on as a patient since you've had a c-section but
no successful VBAC as of yet. For two pregnancies, I've had two birth
centers and two sets of midwives, because we moved in between the
pregnancies. I believe the first birth center won't take VBAC's at
all, and if they do, they require it to be at the hospital. That's
their case with twins and such -- they'll care for you during your
pregnancy, and one of the midwives will attend your birth, but at the
hospital instead of the birth center. The midwife will care for you
as much as possible while at the hospital, but if a c-section is
needed, she'll call for one of the backup OBs. They have an excellent
relationship with the set of OBs at their backup hospital, which is
across the street from the birth center. But a VBAC would not be
doable at the birth center, unless they've changed their policy.

My current midwives do birth center births and homebirths. Their site
says they limit VBACs to women who have already had one successful
VBAC, and even if you've already had one VBAC, IDK if they'd attend
your birth at home or if they'd require you to be at the birth center.
I've gotten the impression that they won't even care for a twin
pregnancy, that they'll make you transfer care to someone else, so I'm
thinking that they won't automatically plan to do a hospital birth
with a client. If a transfer is necessary during/after labor, that's
one thing, but I think they won't take you if you are automatically
going to have to have a hospital birth. So you definitely need to ask
the birth center if they'll even take you or not, and if they will,
but they require a hospital birth, you need to ask them if you will
automatically be required to have an overnight stay in the hospital,
even if you have a VBAC.

Things I can think of:
What's your policy on ultrasounds?

Both of my sets of midwives don't do routine ultrasounds. They'll
refer you for one if there is a need, but otherwise, no. When my
first baby was breech, the midwives would have referred us for an u/s
to see if I was a good candidate for an external version if she hadn't
turned. The current midwives referred me for an early u/s at 6w
because I was feeling more like 10 weeks; I was certain of the dates,
and they believed me, but they wanted to get an early, and more
accurate, picture in case they needed the confirmation later. Neither
has done a routine 20-week u/s; if I had wanted to peek at the gender,
they would have referred me for one, but I declined both times.

Monitoring of the baby during labor?

My first midwives did monitoring via hand-held doppler every 15
minutes during labor and every 5 during pushing. The current ones do
something similar, though I'm not quite sure of the frequency.

How long after birth do I have to stay?

4 to 12 hours is typical. Will depend on when the baby is born and
how tired you and your DH are, whether you want to nap for a bit at
the birth center or head home to rest, whether there are any minor
complications with you or the baby (ie with my first baby, they
thought I had a cervical tear, so they called one of the OBs to come
over and confirm that there was no tear at all, but we had to wait a
bit for the OB to have chance to come over; beat going to the hospital
myself though), what all you want to do (ie we were really hungry, so
we ordered dinner at the birth center rather than waiting until we got
home, and after dinner DH and the baby fell asleep together while I
showered), how quickly they get your discharge paperwork and such
together, etc.

Can I eat during labor?

Both of my sets of midwives allow and encourage eating during labor.
I wasn't up to eating during my first labor, but they strongly
encouraged me to drink water and juice, which I did, and that helped
keep my strength up.

-Sara
Mommy to a Toddler DD (31 months), and a New Baby due in February

"Jenrose" wrote in message
news:1098004932.2yRGEk2/9XTMQ/aZWMDZOA@teranews...

"Al Bell" wrote in message
...
"CY" writes:

deliver a healthy full-term baby at 40 weeks, but did end up with a
c-section, due to, I believe, too many interventions (epidural, pitocin,
no
food or drink being given and exhaustion on my part). So, I hope to
avoid
these things this time around which is why I am going the birth center
route.

One thing I'd want would be a midwife who had a great relationship with
the emergency backup ob/gyns, so that, if you absolutely did have to
have
a c-section or other interventions, the interventions could be done in
the
most sensitive way possible.

Example: I ended up having preeclampsia, and the doctors had me sitting
in
a hospital bed when I had my trial of labor. I really, really wanted to
be
standing. If I'd had a good midwife or a good ob/gyn rooting for me, I
wonder if maybe I could have been able to stand during labor.


No. Probably not. It would mostly depend on what your blood pressure did
when you were upright...

None of my clients with high blood pressure were allowed more than sitting
up, and that was iffy at best--and you can bet I was rooting for them. But
when someone's bloodpressure upright is 30 points higher than in bed,
it's
hard to argue.

Now, in a different setting, there are other ways of mitigating high blood
pressure that don't involve sitting in a bed...

In addition, if you were on magnesium sulfate, it's not surprising that
inductions fail, because while mag is effective at preventing eclamptic
seizures and often keeps PE from getting worse, it is also effective against
stopping pre-term labor, so unless your body was ready for labor, the trial
of labor serves more to let the body know that the baby is coming then to be
effective at actually delivering the baby. I know that for me, as soon as I
went into labor both the PE and HELLP symptoms stopped getting worse, but in
20/20 hindsight, had I known what the failure rate on 2nd trimester
inductions on mag sulfate was, I would have stopped him after the first
round of attempts and just gone to a C-section, instead of going through
every induction method out there and still ending up with a C-section. 72
hours of induced labor followed by a C-section is just too much.

FWIW, I couldn't even sit up-just moving while lying down sent my BP into
the range where stroke was a possiblility, so I did all the labor on my left
side.



Jenrose

On Sun, 17 Oct 2004 04:09:26 GMT, "Todd Gastaldo"
wrote:

I'd want a culture where midwifery was the primary model - in hospital and
out - and obstetric surgeons simply did their jobs when called.

In many hospitals in Australia, this is the model. Doctors check on
the mothers, but the midwives are the support to the mothers through
the entire laboring process. Basically with a straightforward labor,
it is the midwife who is in charge. The doctors only come in when
something goes wrong. Midwives do the follow up care in hospital, and
they home visit once the mother and baby go home.

I have severe pre-eclampsia with #1. A doctor was there and checking
me regularly through out the entire ordeal. The midwives supported me
through out the night and helped me in any way they could. I had a
very lovely OB who only told me the truth. She would answer questions
with words like, "Although it hasn't been prove, we believe that..."
or "The thinking behind this is.... although it hasn't been proven."
She performed my c-section, and I delivered a healthy baby girl.

I wished that I had a normal childbirth without meds of any sort.
Though when I truly needed a doctor (because of the PE), I am glad
that I had that at my disposal.

--
Daye