CurlTalk

CurlTalk (http://www.naturallycurly.com/curltalk/)
-   Pregnancy & Parenting (http://www.naturallycurly.com/curltalk/pregnancy-parenting/)
-   -   Choosing a practitioner (http://www.naturallycurly.com/curltalk/pregnancy-parenting/36586-choosing-practitioner.html)

iris427 01-15-2008 08:11 AM

Choosing a practitioner
 
Right now I am trying to find a practitioner for my pregnancy. As some of you know, I am very pro-natural childbirth and against the routine medicalization of pregnancy and birth.

Where I live, direct-entry midwifery is illegal. The closest freestanding birth center is 2.5 hours away. There are no CNMs in the area who do deliveries. There is one family practitioner (a DO) that does home deliveries that I have heard about. There are also underground midwives who practice illegally.

So I feel very limited in my options. I am going to talk to some experienced doulas I know about practitioners who are friendly to natural childbirth and maybe go to a La Leche League meeting and ask around there too.

I went to my first prenatal appointment yesterday at my gynecologist's office. I had an appt to see a "doctor," but it turned out the woman is a nurse practitioner who has a PhD. She told me she would handle my prenatal and postpartum care, but she does not attend deliveries. For my delivery, I would have whichever of 11 doctors is at the hospital at the time. I really don't like the idea of not meeting the doctor until I'm already in labor and having no idea what they are like and what their philosophy about birth is. And it does not seem feasible to try and meet with all 11 of them during my pregnancy.

I told her I wanted to do natural birth and she was very encouraging that I hire a doula and write up a birth plan, so I thought that was a good sign. However, she seemed put off when I asked about their c-section rate (26%) and episiotomies. I did not like her answer about episiotomies--she said they would do one if they thought I would tear into my rectum because it would save my rectum. Last I checked, 4th degree tears were more common with episiotomies. She seemed a little defensive and like she felt that she had to convince me that an episiotomy might save my rectum.

So I guess a smaller practice would be better. I know there is never a guarantee that the person you've been seeing will be the one to catch your baby, but if the practice is smaller, I could meet with the different doctors and get a better feel for the culture of the practice and how much they will support me in my hopes for a natural birth.

I'm going to make a couple more appointments with some other doctors I've heard are supportive of natural birth (one is the doctor my friend had a water birth with and had no IV or monitoring or anything). But I am feeling discouraged about my options.

marielle448 01-15-2008 08:23 AM

are you completely opposed to homebirth in your case? I know we have similar situations in that in NC it's illegal for the midwife to practice (except for one MW that was grandfathered into the law in 1983) but not illegal for the parents to have a homebirth. There's a thriving homebirth community here and even a formal organization called the NC Friends of Midwives. Also there are CPM (certified professional midwives) that have a professional certification and still practice in states where midwifery has been illegal for some time.

If it's not in the cards for your then I think you're doing the best thing by asking around from those "in the know" regarding recommendations. That's important because you may find a family doc that although not an OB would be more open to NCB and your needs as a birthing mom. Also some OBs talk the talk in the early shopping appointments then change their tune and show their true colors. By getting opinions from mothers who've given birth and more liberal childbirth educators you'll save yourself a bunch of heartache.

geeky 01-15-2008 08:25 AM

I'm sorry your choices are so limited.

I think asking doulas or people at La Leche is an excellent idea. There are OBs and other docs out there that are more supportive of natural childbirth and treat their patients with respect. Keep looking.

Like you, I prefer a small group practice where you can meet all the people that might be on call for delivery. Keep looking. You are at an advantage because you are educated and you can ask the hard questions right off the bat and get a feel for the practitioner.

Brown_Eyed_Girl 01-15-2008 09:05 AM

The LLL in my area has a yahoo group that they let me join and post to even though I haven't been to a meeting yet, so you might see if the group in your area has something similar. I found the leader's email address through the main LLL website, and she added me to the group.

The group flooded me with feedback, and that was how I found the midwife I'm using now.

PixieCurl 01-15-2008 11:18 AM

Quote:

Originally Posted by Brown_Eyed_Girl (Post 465235)
The LLL in my area has a yahoo group that they let me join and post to even though I haven't been to a meeting yet, so you might see if the group in your area has something similar. I found the leader's email address through the main LLL website, and she added me to the group.

The group flooded me with feedback, and that was how I found the midwife I'm using now.

I was going to suggest something like this. I belong to a Yahoo group with other local parents who practice attachment parenting, and I definitely plan to get their suggestions for my next pregnancy.

Amneris 01-15-2008 11:44 AM

Iris, you definitely can still have the natural birth you want even in a hospital with an O/B you never see before the delivery - I did! I think educating yourself and knowing your options (as you do) are more important than anything. I would just stay out of the hospital as long as possible so that there is a limited opportunity for monitoring and so on, and then just practise saying no! (easier said than done.) I got the same episiotomy answer - I think they have to say that - but I had pretty bad tearing and it was only second degree (no episiotomy.) I think fourth-degree tears are pretty rare.

RedCatWaves 01-15-2008 12:18 PM

I'd use a homebirth midwife, preferably a CPM. I don't feel the need for the state to sanction my homebirth or my birth attendant, any more than I need them to sanction when I have sex or take a crap. Really. Birth is a normal body process, and it's my body.

I had my homebirth in an a-legal/illegal state with a CPM. She was FAB-U-LOUS and I felt very safe in her care. I lived 10 minutes from a hospital, and if I had had to transfer, I felt I would get the same care as if I was seeing an OB all along. The OB's on staff for walk-ins are the same ones who take care of women on a private basis, so what's the difference really? It's not like you spend a whole lot of time getting to know a particular OB in a practice of 11 of them.

So, use a homebirth midwife, or don't. But don't use the excuse that there aren't any midwives in your area because they are "illegal". There are plenty of homebirth midwives in MO. It's up to you to decide if that's what you want, or not. Homebirth is about taking a lot of responsibility for yourself, no matter the legal status in a particular state.

webjockey 01-15-2008 12:51 PM

I definitely feel for you. In my search process it took some time to find a midwife that I meshed with, even though I had many options for home birth. For me, choosing a midwife that respected my partner's input and emotions as much as mine was key. Also, someone who understood that we do our own research and didn't take offense if I challenged her knowledge.

Something else to consider - what type of care do you want beyond the basic "I'll catch your baby". I personally appreciated having hour long pre-natal appointments and postnatal care that came to my home up to 6 weeks after the birth.

I also used a CPM.

Check out the mothering.com website. They may have some people in the area who have experienced your dilemma.

sarah42 01-15-2008 02:34 PM

Ditto what Amneris said. I think if you stay home during early labor and remain firm about what you want, it's definitely possible to have a natural delivery in a hospital. The hospital I delivered in has lactation consultants on staff and encourages 24-hour rooming in, and I had a good experience there. I bet LLL can direct you to doctors and hospitals that would likely share similar philosophies with you.

I had an IV and I received antibiotics for being GBS+, plus I did get an episiotomy. I don't think anyone particularly wants or plans for an episiotomy. I consented to it on my dr.'s recommendation, I didn't tear anymore beyond what he cut, and healing and recovery were very smooth and uncomplicated.

iris427 01-15-2008 03:01 PM

Thanks everyone

For those who used a CPM, what kind of certification/professional affiliation did your midwife have? Were they registered through NARM? I don't know a lot about CPMs and how that works. I know a CPM in Arizona so I guess I can bombard her with questions too. :)

RedCatWaves 01-15-2008 03:07 PM

Quote:

Originally Posted by iris427 (Post 465605)
Thanks everyone

For those who used a CPM, what kind of certification/professional affiliation did your midwife have? Were they registered through NARM? I don't know a lot about CPMs and how that works. I know a CPM in Arizona so I guess I can bombard her with questions too. :)


Yes, my midwife was a CPM with accredidation through NARM. She was apprentice trained. Some states recognize CPM and some don't. My state didn't...that made little difference to me because NARM is national and standarized.

webjockey 01-15-2008 03:28 PM

Quote:

Originally Posted by RedCatWaves (Post 465613)
Quote:

Originally Posted by iris427 (Post 465605)
Thanks everyone

For those who used a CPM, what kind of certification/professional affiliation did your midwife have? Were they registered through NARM? I don't know a lot about CPMs and how that works. I know a CPM in Arizona so I guess I can bombard her with questions too. :)


Yes, my midwife was a CPM with accredidation through NARM. She was apprentice trained. Some states recognize CPM and some don't. My state didn't...that made little difference to me because NARM is national and standarized.

Here's some info on how it works in Texas.

I orignally wanted a Certified Nurse Midwife, but here they are few and far between. I felt perfectly safe with my CPM, especially since she always travels with one or two assistants and has a fellow CPM as backup for all births. I also had a doula on hand (which in retrospect was a little overkill).

RedCatWaves 01-15-2008 05:27 PM

Quote:

I orignally wanted a Certified Nurse Midwife, but here they are few and far between. I felt perfectly safe with my CPM, especially since she always travels with one or two assistants and has a fellow CPM as backup for all births. I also had a doula on hand (which in retrospect was a little overkill).
I have found that CNM's have way too much pressure on them from the OB industry to be able to practice homebirth midwifery very often. They are under the thumb of the industry. Seriously. They can't move. They have so much baggage and so many rules they can hardly practice at all. If you do occasionally encounter a homebirth CNM, she's usually a rebel, or located in a very tolerant state. CPM's have much more freedom.

mad scientist 01-15-2008 06:15 PM

I would think with the knowledge and experience you have, you could totally hold your own and get the birth you want in a hospital setting.

To be honest, that's why I opted to deliver in a hospital with an OB. I was totally confident that with DH as my advocate (totally versed in the "medicine" of birth and neither of us at all intimidated by doctors or nurses). I got my natural delivery the second time around, and the first time around, I am confident that the interventions I had were necessary.


All times are GMT -6. The time now is 12:23 AM.

Powered by vBulletin® Version 3.8.7
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
Copyright 2011 NaturallyCurly.com