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Looming problem with midwife



 
 
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  #1  
Old August 28th 03, 08:48 AM
Arthur Kludge
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Default Looming problem with midwife

We are in Texas, and my wife is due in December. We got the services
of what we thought was a good midwife in June, however during three
1-hour monthly appointments (June, July, and August) my wife began
piecing out a pattern that suggests this midwife is not right
for us...

- Will not do external versions for breeches at all
- "Wasn't sure" if she would attempt a home breech birth
- Doesn't know anything about herbs or other natural remedies
- Very hard to reach by phone and doesn't return her messages
- Complained about another client's comment about the phone tag problem
- Couldn't offer any advice about coping with headaches
- Takes clients to the hospital 18 hours after water break, no exception
- "Couldn't remember" her cesarean rate
- Never made an effort to discuss diet or nutritional counseling
- Condescending ("Sweetie", "We don't want...", etc) which often
deflects serious concerns my wife has (the midwife is only 40 yrs old)

Just a bit of info about her... the midwife claims about 500 births
over the past 10 years. The sessions have been at her suburban house;
she has five kids and her own home office room where she sees us.

Are midwifes usually ok with a partial refund at this point, or
should we be digging in for a fight? I am trying to provide
my wife with some support right now and figure out where we stand.
We can eat the money, but we'd rather not, of course.

She is already going to talk to another midwife on Friday, but
I'd like to give her some reassurance now.

Thanks,

Arthur
  #2  
Old August 28th 03, 03:56 PM
Em
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Default Looming problem with midwife

"Arthur Kludge" wrote in message
..com...
We are in Texas, and my wife is due in December. We got the services
of what we thought was a good midwife in June, however during three
1-hour monthly appointments (June, July, and August) my wife began
piecing out a pattern that suggests this midwife is not right
for us...

- Will not do external versions for breeches at all
- "Wasn't sure" if she would attempt a home breech birth


The doctor at my birth center won't do these either. She used to be have
admitting privileges at the hospital and could admit you and try a version
there. Now that she doesn't have privileges, she will refer people to one of
her hospital friends to have a version attempted. Also, according to her,
there is not a single doctor or midwife in my state (at least publically)
that will do a planned breech delivery at *all* (home or otherwise). It is
all about liability and insurance.

- Very hard to reach by phone and doesn't return her messages
- Complained about another client's comment about the phone tag problem


These seem worrisome.

- Takes clients to the hospital 18 hours after water break, no exception


You might ask her about her reasoning for this. There might be a legal one
in Texas.

- "Couldn't remember" her cesarean rate


Though I understand why someone wouldn't bother keeping track, this does
seem a bit odd considering that *lots* of expectant parents will ask about
it and it seems like one would want to have a better answer than, "I can't
remember." Doesn't seem that professional.

- Never made an effort to discuss diet or nutritional counseling


My observation is that most doctors don't discuss these things at all, but
that most midwives or doctors following a midwifery model, will at least
touch on them a little bit.

- Condescending ("Sweetie", "We don't want...", etc) which often
deflects serious concerns my wife has (the midwife is only 40 yrs old)


This I *really* wouldn't like at all.

Just a bit of info about her... the midwife claims about 500 births
over the past 10 years. The sessions have been at her suburban house;
she has five kids and her own home office room where she sees us.


Have you talked to any of her previous clients for opinions?

Are midwifes usually ok with a partial refund at this point, or
should we be digging in for a fight? I am trying to provide
my wife with some support right now and figure out where we stand.
We can eat the money, but we'd rather not, of course.


I'm not positive, but most care providers will charge you only for the
services you have already recieved. When I left my old OB practice, I was
billed for the visits and ultrasounds I had had up until 21 weeks only, even
though I had signed a financial agreement that included charges all the way
up through the delivery. At my birth center, if I had to transfer before I
am in labor, they would bill only for the visits I had to that point, *not*
for the delivery and would refund the rest. Once I am in in labor, there is
no refunds, even if I do end up transferring to the hospital.

She is already going to talk to another midwife on Friday, but
I'd like to give her some reassurance now.


I would say that you should go with your instincts and find a new person,
but be aware that the new person may have the exact same views about breech
deliveries and a few other things. Also, I feel reasonably confident that
you'll only have to pay for actual services rendered to this point.

--
Em
edd 9/23/03
(36 weeks)


  #3  
Old August 28th 03, 08:23 PM
Ericka Kammerer
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Default Looming problem with midwife

Arthur Kludge wrote:

We are in Texas, and my wife is due in December. We got the services
of what we thought was a good midwife in June, however during three
1-hour monthly appointments (June, July, and August) my wife began
piecing out a pattern that suggests this midwife is not right
for us...

- Will not do external versions for breeches at all



This is common--in many states she could be in legal
jeopardy if she does so. I wouldn't take this as a bad
sign in and of itself.


- "Wasn't sure" if she would attempt a home breech birth



Ditto. And you sure don't want someone who's
not experienced and comfortable with vaginal breech
births doing yours.


- Doesn't know anything about herbs or other natural remedies



Not all midwives believe in herbs and other alternative
medicine treatments. Obviously, if you want this, she isn't
the midwife for you, but I wouldn't question her overall
competency on this point.


- Very hard to reach by phone and doesn't return her messages



This is definitely a bad sign.


- Complained about another client's comment about the phone tag problem



Also not good.


- Couldn't offer any advice about coping with headaches



Not sure here. Sometimes there aren't any great
suggestions beyond the obvious if you're trying to avoid
meds.


- Takes clients to the hospital 18 hours after water break, no exception



This is more conservative than many, but may also be
due to legal requirements in TX. (I.e., she may be unable
to retain backup or other good things if she doesn't have this
policy--don't know if that's true, but it would be something
to check out.)


- "Couldn't remember" her cesarean rate



I wouldn't worry about couldn't remember, but I'd worry
if she wasn't willing to find out at least an approximation.


- Never made an effort to discuss diet or nutritional counseling



Very worrisome.


- Condescending ("Sweetie", "We don't want...", etc) which often
deflects serious concerns my wife has (the midwife is only 40 yrs old)



Her age wouldn't worry me. There are plenty of fine
midwives under 40yo. But being condescending isn't a good
sign at all, nor is ignoring your wife's concerns.


Are midwifes usually ok with a partial refund at this point, or
should we be digging in for a fight? I am trying to provide
my wife with some support right now and figure out where we stand.
We can eat the money, but we'd rather not, of course.



What does it say in the contract you signed? Most
contracts I've seen specify precisely what you can expect
if you leave prior to the birth. If nothing is specified
(shame on both you and the midwife! ;-) then you ought to
be able to work out a partial refund.

Best wishees,
Ericka

  #4  
Old August 28th 03, 11:43 PM
Daye
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Default Looming problem with midwife

Hello Arthur,

Below are my opinions only. I have not had a home birth, but I deal
with midwives in my hospital. In Australia, we have a midwife system
with doctors and OBs. I lived in Texas for over 10 years.

On 28 Aug 2003 00:48:32 -0700, (Arthur
Kludge) wrote:

- Will not do external versions for breeches at all
- "Wasn't sure" if she would attempt a home breech birth


This could be a legal thing. I don't know many doctors that would
attempt a breech birth in hospital. I was told by a midwife at my
hospital that delivering breech babies vaginally is a dying art. Most
(if not all) end up with a c-section. The problem is that doctors
don't know how to deliver them. It is not something they are taught.

Someone told me that there is only one OB in my area that would
deliver a breech baby in hospital. I don't know about midwives, but
when I thought my baby was going to be breech, I was told to expect a
c-section.

- Doesn't know anything about herbs or other natural remedies


I am not sure that all of the midwives that I know would be able to
offer advice about these things. Most would recommend seeing a
Naturopath.

- Very hard to reach by phone and doesn't return her messages
- Complained about another client's comment about the phone tag problem


This is a warning flag to me. She needs to be able to be reached.
What happens if there is a problem or emergency?? Does she have a
pager or a cell phone for emergencies? How do you contact her in the
case of an emergency? Does she have a backup if she is unreachable?

- Couldn't offer any advice about coping with headaches


Nothing? Not even a tynelol or a hot bath? Some people don't know
how to deal with headaches. My own GP's advice is just pain meds. I
have been dealing with headaches for a long time. I know how to deal
with them with or without pain meds. However, it is something I have
had to learn because of my problems with them.

- Takes clients to the hospital 18 hours after water break, no exception


Someone else mentioned this: are you sure this isn't Texas law?

- "Couldn't remember" her cesarean rate


Don't know anything about this. Sorry.

- Never made an effort to discuss diet or nutritional counseling


Outside of a handout that I got at my hospital for my first prenatal
clinic, this has never really been discussed with me either. When I
was pregnant with my first, I brought it up with my doctor. He was
willing to talk about it, but he suggested a dietician. He could give
general advice, but a dietician is the specialist.

- Condescending ("Sweetie", "We don't want...", etc) which often
deflects serious concerns my wife has (the midwife is only 40 yrs old)


That would bug the HELL out of me, and that would be enough reason
right there to get another midwife. I don't take kindly to being
treated like a child or a moron. If she isn't answering my concerns,
then I will find someone who would.

She is already going to talk to another midwife on Friday, but
I'd like to give her some reassurance now.


Good luck to both you and your wife, Arthur!

--
Daye
Momma to Jayan
"Boy" EDD 11 Jan 2004
  #5  
Old August 29th 03, 08:10 PM
aps
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Default Looming problem with midwife

In article , Arthur
Kludge wrote:

We are in Texas, and my wife is due in December. We got the services
of what we thought was a good midwife in June, however during three
1-hour monthly appointments (June, July, and August) my wife began
piecing out a pattern that suggests this midwife is not right
for us...

- Doesn't know anything about herbs or other natural remedies


It sounds like you had a pretty clear idea of who your ideal midwife
would be, and she's really not turning out to be it.

- Couldn't offer any advice about coping with headaches


We had lots of specific questions (what's your opinion of ____) for our
midwives based on what we'd read and found that really helpful. When we
just had an open-ended question, we didn't get much more than you seem
to have gotten.

- Never made an effort to discuss diet or nutritional counseling


Actually this would be my red flag--it just seems that a midwife who
ideally is willing to take on risky situations in home birthing would
want to ensure that her client has taken steps to be in the best shape
for it.

- Condescending ("Sweetie", "We don't want...", etc) which often
deflects serious concerns my wife has (the midwife is only 40 yrs old)


How long have you lived in Texas? I grew up in Louisiana, and seriously
it's kind of expected from people with expertise. Or at least it's one
of the prevailing "dialects" for getting on socially. Being used to it,
I'd prefer it over the brutal honesty one gets in the upper midwest.
But if you want a close relationship with her, it could be reason to
shop around.

She is already going to talk to another midwife on Friday, but
I'd like to give her some reassurance now.


Ask the other midwife what's the ordinary way to handle this situation.
Who knows-she may want out of the deal too.

APS
  #6  
Old August 29th 03, 11:09 PM
Jenrose
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Default Looming problem with midwife


"Arthur Kludge" wrote in message
om...
- Doesn't know anything about herbs or other natural remedies
- Very hard to reach by phone and doesn't return her messages
- Complained about another client's comment about the phone tag problem
- Couldn't offer any advice about coping with headaches
- Takes clients to the hospital 18 hours after water break, no exception
- Never made an effort to discuss diet or nutritional counseling


Okay, so she's not willing to be flexible, doesn't make herself available,
bitches inappropriately about other clients to you, has rigid policies and
doesn't know much about basic comfort measures for pregnancy? So what IS her
transfer rate, anyway? And the diet thing... ya gotta at least ask.

I'd run screaming.

Jenrose


  #7  
Old August 29th 03, 11:35 PM
Dagny
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Default Looming problem with midwife


I've seem pictures of "dangling" the baby -- the body is out, face down;
body is allowed to dangle, which helps with the angle of the head. I can't
remember if the body is partly supported or not, but I think so.

Won't many more doctors do breech vaginals on multips than primips? That
was my impression.

Breech vaginal deliveries may be a dying art, or possibly a profitable new
subspecialty. Hint to obstetricians reading this...


"Liz S. Reynolds" wrote in message
...
In article ,
Daye wrote:
I was told by a midwife at my
hospital that delivering breech babies vaginally is a dying art. Most
(if not all) end up with a c-section. The problem is that doctors
don't know how to deliver them. It is not something they are taught.


Does anyone know what the trick is? Besides doing a version so it's not
breech anymore? As I understand it the problem is the head getting stuck
because the behind is a little smaller than the head and doesn't open the
cervix so much. Plus I guess at that point the cord is alongside the head
and getting compressed. What sorts of things can be done at that point?

-Liz



  #8  
Old August 30th 03, 04:51 PM
Ericka Kammerer
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Default Looming problem with midwife

Dagny wrote:


Won't many more doctors do breech vaginals on multips than primips? That
was my impression.



I'm not sure what the situation is in your neck of the
woods, but around here you'd be hard put to say "many more."
When Genevieve was breech and I was investigating my options
should version fail, I found that very few OBs did versions
(no midwives) and only one (in a very large metro area) would
even *consider* a planned vaginal breech delivery The difference
between 0 and 1 isn't much ;-)


Breech vaginal deliveries may be a dying art, or possibly a profitable new
subspecialty. Hint to obstetricians reading this...



I don't think it would happen in the US. The feelings
are so strong that it's unacceptably risky (despite evidence
suggesting that in some cases the risks are no more than
with some other things are people are allowed choice over)
that the legal exposure is likely way too high for it to
make a resurgence in popularity. So we'll continue to
have a situation that provides little experience in handling
vaginal breech births, which *does* up the risks (who wants
to be a guinea pig?).

Best wishes,
Ericka

 




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