Help me think this through: birth choices

[BrookValley.]

I've been a big, crying hormonal ball of mush (not my style, which just makes it worse) all morning agonizing over which of two practices to use for the upcoming birth of my baby. I'm hoping someone emotionally detached from the situation (that's all of you fine ladies :D) can help me see things more rationally.

 

Here's the deal, as succinctly put as I can manage right now:

 

This is my second pregnancy; my first birth ended in an unexpected c-section. I will be attempting a VBAC. My first c-section was not an emergency, there is no conclusive reason for why it happened (other than I just stopped progressing in labor), and all involved believe I am an excellent candidate for the VBAC.

 

So, on to the two different practices:

 

Practice 1: Two midwives (certified nurse midwives, have privileges to deliver at local hospital) working in an OB's office. Practice is somewhat separate; OBs are backup. Practice and hospital are app. 6 miles away from my home. One midwife is a lovely person whom I have known as a passing acquaintance for more than 10 years. She recently became a midwife a couple years ago. We are very much on the same page, birth-wise. She is well-respected at the hospital and I will be treated as normal unless I move off the path of normal during labor/birth. I am comfortable with her and trust her. The other midwife is nice and caring, but is much more medically-minded. I have been told with her that I will have to come into the hospital "very early" in my labor and also be attended by an OB. I will not be treated as normal at any point during my labor/birth. She is also rough physically (I am bruised and my skin is torn from her trying to find my baby on doppler yesterday). I am not comfortable with her. I have no choice who attends my birth; as would be expected/fair, midwives trade weeks off/on call. I will get whomever is on call.

 

Practice 2: Used for my first pregnancy/birth. Five certified nurse midwives work out of a free-standing birth center, but also have full hospital privileges at nearby hospital. Because I have had a previous c-section, I would have to give birth at the hospital, but my attendng midwife would be my primary caregiver unless care had to be transferred to OB for some sort of issue or c-section. I would also get whichever midwife is on call, but am comfortable with any and all of the midwives at this practice. I would be treated as normal unless I moved off the path of normal. However, the practice and hospital are 1 1/2 hours from my home.

 

What is most important to me right now is that I am set up for the best chance possible of having a VBAC. I want to be treated as normal (because, at this point, there is no reason to suspect my labor and birth will be anything but) unless I move off the path of normal. If I do move off the path of normal, well, that's why I'm in the hospital, and thank god for that. But unless that happens, I want to be able to labor as any normal woman. Right now, I do not feel that the second midwive at the first practice will support me in my choices. However, I LOVE the first midwife. Also, the difference in the drive time--10 minutes vs. 1 1/2 hours--is a big difference. Yes, I made that long drive for all my prenatal visits and then in active labor, and I'll do it again, but life is a little different now. I have a five-year old to make arrangements for and whatnot.

 

I just don't know what to do. I have been trying to call the second practice all day, just to ask them some questions, but I can't stop crying long enough to get it together to make the phone call. The thought of going into the labor and getting the second midwife at the first practice makes me insane. I do not want to have to stress over having to fight for my choices while I am in labor. I also plain don't trust her. But I would love the chance to stay close to home and have the other midwife attend my birth. I just don't know if I can risk the 50-50 chance. Then there's the other practice...I love them, and I would be comfortable with them and at their local hospital. But it's so far away. If I progress as quickly as I did with my first child, without the sudden halt in progress--I'll end up having a baby in the car on the side of the road.

 

:confused:

[JFSinIL]

Is it possible to use the first place with the caveat that if the first midwife is not available, you'd use the OB 9if they are experienced with v-bac) instead of the second midwife? You can but ask - they need to know how rough the second midwife is (bad enough to scare away a patient!)

[JenC3]

I would go with the midwife I loved. Now, I would also speak to this midwife and let her know you do not want to be cared for by her partner. No one should have bruises from a doppler!

[BrookValley.]

Is it possible to use the first place with the caveat that if the first midwife is not available, you'd use the OB 9if they are experienced with v-bac) instead of the second midwife? You can but ask - they need to know how rough the second midwife is (bad enough to scare away a patient!)

 

That might be possible, but the OB in question has the highest c-section rates in the area and is not VBAC freindly. She's also quite a mis-match for me, personality wise (and I am not hard to get along with). I think I'm more uncomfortable with the OB than the second midwife.

 

I would go with the midwife I loved. Now, I would also speak to this midwife and let her know you do not want to be cared for by her partner. No one should have bruises from a doppler!

 

Unfortunately, this is not an option. You get who is on call, period. I will be letting the first midwife know about my experience with the second, however!

[Soror]

In that situation I'd definitely go with option 2. It would be a HUGE stress for me to constantly wonder if I was going to get the "good" midwife or not. I'd also let her know that you are not using their practice specifically because of the rough and medically minded nature of her partner. I would bet that you are not the only one who has avoided the practice because of her.

[Carol in Cal.]

I'd go with the second choice. You have only a 50% chance of having a relaxed birth experience with the first one. It's too bad that your friend is part of that duo. But if she won't make an absolute commitment to be there for you, I would think you would be far better off with the second choice.

[Caitilin]

I'd choose the second practice. I am a 3VBA2C mom, and that's what I'd do. I'd not be able to feel comfortable about going into labor in fear of the other midwife at the first practice. Having a good caregiver is of incalculable value.

[Heatherwith4]

In that situation I'd definitely go with option 2. It would be a HUGE stress for me to constantly wonder if I was going to get the "good" midwife or not. I'd also let her know that you are not using their practice specifically because of the rough and medically minded nature of her partner. I would bet that you are not the only one who has avoided the practice because of her.

:iagree:

[MedicMom]

I would go with number 1 and just hope for the best. The reason is the distance...I was world's perfect candidate for a VBAC and was highly encouraged to VBAC by my OB. It just didn't feel right, so I scheduled a c section. I ended up going into labor right before the c section but was already at the hospital--85 minutes away from home--when I did. My c section was pushed off for a few hours due to an emergency, so I wound up laboring at thr hospital. And then my uterus ruptured. Had I been home we would have had a catastrophe...if I ever accidentally get pregnant again, we will be going with an OB much closer to home, even though I do not like the closer hospital or OB. It is a small price to pay for the safety of the baby and I.

[Catwoman]

Neither option sounds ideal. Is there a third option?

[BrookValley.]

I would go with number 1 and just hope for the best. The reason is the distance...I was world's perfect candidate for a VBAC and was highly encouraged to VBAC by my OB. It just didn't feel right, so I scheduled a c section. I ended up going into labor right before the c section but was already at the hospital--85 minutes away from home--when I did. My c section was pushed off for a few hours due to an emergency, so I wound up laboring at thr hospital. And then my uterus ruptured. Had I been home we would have had a catastrophe...if I ever accidentally get pregnant again, we will be going with an OB much closer to home, even though I do not like the closer hospital or OB. It is a small price to pay for the safety of the baby and I.

 

This is something I have considered, too. Though I have much smaller risk of uterine rupture than many of the other horrible things that could go wrong...I have less than a 1% chance of rupture, but there's at least a zillion other things that could happen, prior c-section or not.

 

Neither option sounds ideal. Is there a third option?

 

 

Not if I want to use a midwife, no. There's my local practice, and then the next closest practice is the one 1 1/2 hours away. There is another midwife practice about 45 minutes away that does homebirths, and I think they even ocasionally do VBAC homebirths, but I don't think that is an option for us.

[texasmama]

I would go with the one 1 1/2 hours away and plan to get there early or in the case of a "false alarm" having to make the trip multiple times.

 

Make back-up plans (several) for the care of the five year old, including taking her with you and having someone drive to get her if you are rushed. Pack a bag with necessities and leave it in the car. Be ready at any time to go, not stopping to shower, change clothes or pack a bag.

 

That option would likely not have worked for me because I deliver very quickly, but chances are it would work for many people. It is a chance, though.

[BrookValley.]

BTW, my husband's "vote" is for the practice further away. He says I will be more comfortable knowing I am ok with any one of those midwives and with that particular hospital. He is absolutely right, except I do really like the one local midwife and the distance concerns me.

 

Oh, as I was typing this he texted me the number to the further practice. Yep, he's trying to tell me something. :lol:

 

I am just trying to be thankful for even having the choice between two perfectly acceptable options. I am thankful, I think I'm just in the midst of a hormone-induced mini-mental-meltdown. Definitely file my pity party under "first world problems." Ugh. I'll probably kick myself for being shallow and petty later. Right now though, I think I'll go snuggle in bed with my 5-year old and zone out on some Sesame Street or something. :tongue_smilie:

[Veritaserum]

If the good midwife won't "special" you (come when you're in labor no matter what), option two sounds better. Since you've mentioned that you were acquaintances prior to using her as your midwife, I would approach her with your dilemma:

 

"I feel very comfortable and safe in your care and I would love to have you at my birth. However, I'm having major anxiety because I do not feel at all safe with your partner. I am not comfortable with risking going into labor when your partner is on call. Do you see a solution that would allow me to comfortably stay with your practice?"

 

See what she says. If she says no, there isn't a way, then you switch. (If there is any chance of the far away midwives getting too booked for your due date, I'd schedule an appointment with them and cancel it if your nice midwife says she'll be your sole midwife.)

[melbotoast]

I would go with the second choice so you don't have to stress about the horrible midwife. Good luck with your VBAC! I'm also a VBAC mom :)

[ktgrok]

Second practice, for a few reasons. First, there is no way you should have to put up with the second midwife at the first practice. taht is wrong. But, and this will sound awful, but you need a midwife with VBAC experience, and a lot of it. Your favorite midwife is just recently a midwife from what you said, so I doubt she has a lot of experience with VBAC patients. The reason experience is so important is it lets them relax. Midwives without VBAC experience, even GREAT midwives, tend to get nervous once a VBAC labor is actually underway. I've seen it again and again. You need to find out who in your area (and it might be a practice you haven't considered yet) has the best VBAC success rate. Contact your local ICAN chapter to get the dirt on the doctors/midwives in the area. I know my local chapter knows who has the best success rate, who has never had a succesful VBAC patient despite saying they are VBAC friendly, etc etc. Feel free to PM me with more questions. (and if you are in the Central Florida area I can give you local info, lol.) (oh, and I have had two VBACs. My c-section was failure to progress/Cephalopelvic disproportion, according to my chart, after 40 hours of labor. My first VBAC was 9 hours of labor, with a 9lb baby, and my second VBAC was 10 hours (about 3 of those were me fully dilated trying to avoid the pushing part, lol), with a 10lb 2oz baby. The baby that was the c-section was under 8lbs).

 

Oh, and both my VBACs were at home, with a midwife that has TONS of VBAC experience.

[ktgrok]

BTW, my husband's "vote" is for the practice further away. He says I will be more comfortable knowing I am ok with any one of those midwives and with that particular hospital. He is absolutely right, except I do really like the one local midwife and the distance concerns me.

 

Oh, as I was typing this he texted me the number to the further practice. Yep, he's trying to tell me something. :lol:

 

I am just trying to be thankful for even having the choice between two perfectly acceptable options. I am thankful, I think I'm just in the midst of a hormone-induced mini-mental-meltdown. Definitely file my pity party under "first world problems." Ugh. I'll probably kick myself for being shallow and petty later. Right now though, I think I'll go snuggle in bed with my 5-year old and zone out on some Sesame Street or something. :tongue_smilie:

 

WHOA! Hold up lady. You are NOT being petty and shallow to want a safe, normal birth. Protecting your bodily integrity is NOT shallow or petty. So stop beating yourself up! You have every right, if not a duty, to research and plan for the best birth situation for you and that little one. So give yourself a hug, eat some chocolate, and know that we get it, and that if things were as they should be you wouldn't have to research and worry over something as simple as finding someone to respect your wishes in labor.

[besroma]

BTW, my husband's "vote" is for the practice further away. He says I will be more comfortable knowing I am ok with any one of those midwives and with that particular hospital. He is absolutely right, except I do really like the one local midwife and the distance concerns me.

 

Oh, as I was typing this he texted me the number to the further practice. Yep, he's trying to tell me something. :lol:

 

I am just trying to be thankful for even having the choice between two perfectly acceptable options. I am thankful, I think I'm just in the midst of a hormone-induced mini-mental-meltdown. Definitely file my pity party under "first world problems." Ugh. I'll probably kick myself for being shallow and petty later. Right now though, I think I'll go snuggle in bed with my 5-year old and zone out on some Sesame Street or something. :tongue_smilie:

 

 

I agree with your DH.

 

Also, you are *not* being petty or shallow.

[texasmama]

Not petty or shallow at all. The decisions and experiences women have around birth can be very empowering or traumatic or anything in between. As someone who came from a traumatic birth of one baby to have a more empowering experience with the next one, I completely understand your emphasis on and agonizing over the decision process.

[PentecostalMom]

Practice 2. After a m/c and unfeeling midwives at a practice 20 minutes from my home, I switched to one about an hour away. I moved five hours away about 1/2way through my pregnancy, and still drove the five hours for care and to deliver. It is a freestanding birth center.

[KidsHappen]

I have given birth in hospitals, at home, in birth centers attached to hospitals and a free standing birth center. I would go with option two.

[happypamama]

I do not think you're being petty or shallow, either -- there is no reason the MW should have been so rough. Bruised, with torn skin -- that does not sound at all right to me!

 

I'd discuss the situation with the first MW, but I think your best bet would be with the second practice. I agree with PP's who said to make multiple plans for caring for your 5yo and to go immediately when labor begins. If you're calm, chances are high that your 5yo will be just fine if you bring her along early in labor.

 

With my second baby, we were well over an hour from the MW because of traffic, and it wasn't fun, but it was worth it (though it was a homebirth, so I wasn't traveling in labor). Perhaps they will be comfortable with not doing every week at the end, so that you don't have to do the drive so often?

[kroe1]

What about a family physician who delivers? Or is there an OB practice without midwives? Why do you need a midwife specifically?

 

I don't like any of your present options either if your favorite midwife won't make the commitment to come in on her off week.

 

Mine were delivered by family physicians. Both babes were delivered right in the bed, no stirrups and no pushing. It was very relaxed (haha, relatively speaking). If I had needed a C-section the family doc could have done it. And when I went into labor with the last one, the family doc was at a party out of town. She immediately started driving back to meet me. We both flew into the hospital within 10 minutes of the delivery. But she was the funny one all dressed in evening wear.

 

Bottom line, whoever delivers the babe should give you a warm, fuzzy feeling. If anything went wrong, you'd never forgive yourself for being with a poor caregiver. I pray you find the perfect one.

 

:grouphug:

[LittleIzumi]

If the good midwife won't "special" you (come when you're in labor no matter what), option two sounds better. Since you've mentioned that you were acquaintances prior to using her as your midwife, I would approach her with your dilemma:

 

"I feel very comfortable and safe in your care and I would love to have you at my birth. However, I'm having major anxiety because I do not feel at all safe with your partner. I am not comfortable with risking going into labor when your partner is on call. Do you see a solution that would allow me to comfortably stay with your practice?"

 

See what she says. If she says no, there isn't a way, then you switch. (If there is any chance of the far away midwives getting too booked for your due date, I'd schedule an appointment with them and cancel it if your nice midwife says she'll be your sole midwife.)

 

:iagree:

[ktgrok]

Although I as a general rule prefer midwives vastly, I wouldn't rule out an OB. There are SOME that are very midwife like. In your situation I'd contact your local ICAN group ASAP to get the lay of the land. It may agree with what you already know, but may not.

[BrookValley.]

Thanks for all of your replies, everyone. I knew it would be helpful to get some outside opinions! And thanks for making feel a bit less down on myself about being so whiny. ;)

 

Well, I definitely am going to talk to the midwife I like, regardless. I don't think there will be any other options within that practice (i.e., that the midwife I like will agree to come in for me, regardless if it is her off week). But I also am going to talk to someone at the other practice, too, so they can give me their best advice for my specific situation. After I've had those conversations, I'll go ahead and make a decision.

[BrookValley.]

Although I as a general rule prefer midwives vastly, I wouldn't rule out an OB. There are SOME that are very midwife like. In your situation I'd contact your local ICAN group ASAP to get the lay of the land. It may agree with what you already know, but may not.

 

I wouldn't completely rule out an OB, either, and I may check into it again. When I was pregnant with my son there were a total of 2 local OBs that delivered at the local hospital, both of which are still there today, and neither of which is a good fit (one is the head of the practice that the two local CNMs fall under, and she is a) nasty, and b) has a very high c-section rate. I saw her for my first couple of prenatal visits before heading to the out-of-town midwife practice). However, maybe this has changed. Yes, it's that midwife "model of care" I'm really after, but bottom line is I want a safe birth with someone who will support my choices. If I get that with an OB, that's fine by me.

[Dinsfamily]

Although I as a general rule prefer midwives vastly, I wouldn't rule out an OB. There are SOME that are very midwife like. In your situation I'd contact your local ICAN group ASAP to get the lay of the land. It may agree with what you already know, but may not.

 

I wouldn't completely rule out an OB, either, and I may check into it again. When I was pregnant with my son there were a total of 2 local OBs that delivered at the local hospital, both of which are still there today, and neither of which is a good fit (one is the head of the practice that the two local CNMs fall under, and she is a) nasty, and b) has a very high c-section rate. I saw her for my first couple of prenatal visits before heading to the out-of-town midwife practice). However, maybe this has changed. Yes, it's that midwife "model of care" I'm really after, but bottom line is I want a safe birth with someone who will support my choices. If I get that with an OB, that's fine by me.

 

I've had rapid labors so driving 1.5 hrs to the hospital sounds a bit nerve-wracking to me. If that isn't an issue with you or dh, then the 2nd practice sounds better to me. You might also want to think about the possibility of false labor and what that could entail with a faraway hospital. However, you might explore the third option of finding an OB.

 

After having great CNM experiences with my first two, I was scared when I found out a CNM wasn't an option with my 3rd. However, I found an amazing OB and she delivered my last two boys. She seems more like a CNM with a medical degree :D. Can you ask around? I found mine through a recommendation at DH's work since we were new in town and now half of my church goes to her.

[Soror]

Although I as a general rule prefer midwives vastly, I wouldn't rule out an OB. There are SOME that are very midwife like. In your situation I'd contact your local ICAN group ASAP to get the lay of the land. It may agree with what you already know, but may not.

 

I know my back-up OB is pretty awesome and definitely attends v-bacs- he's the only one in a several county area that does. I haven't had a need for ICAN but I bet they would be a good resource for the OP.

[SweetandSimple]

90 minutes away from the hospital for a second birth is too much, IMO. Both my second and third babies would have been born in the car if we had to go that far!

 

I'm sorry that there aren't any wonderful options near your home! Good luck!

[Farrar]

Either way, get a doula who will fight for you tooth and nails if you end up facing the OB's.

[cjzimmer1]

In my experience, the OB's are only really there for the delivery unless there is problems during labor. I'm guessing what you like about the midwives is that they are with you during the laboring and offering assistance/encouragement as needed. However, if you have to drive an hour and half that's a pretty long time to go without support if you need it (not to mention I found it incredibly uncomfortable to be in a vehicle during labor).

 

I want to offer another suggestion, find an OB who is willing to let you try for a VBAC and higher a doula to help be your support during labor. My doula gave me many things to do before hand to help ensure baby was in proper position and then really help me manage pain during labor. She also was a great go between, when the to medical community want to push interventions on me (just because I had had 2 previous c-sections not because anything was wrong) and myself when I could barely think straight since it takes a fair amount of concentration to get through contractions. She understood the medical speak that my husband and I weren't so fluent on and help me makes decisions to get the outcome I wanted. I've had 3 VBAC's after 2 c-section and I'm planning a 4th in January. But I totally credit my doula with helping me get through that first one when I doubted myself whether or not I could do it.

Edited November 9, 2012 by cjzimmer1
fix typo

[happypamama]

I think that's a really good suggestion, too -- get a doula. I have personally not found one to be necessary (my DH is a very good partner, and our midwives, for the births where we've used a MW, have always been enough), but if I was planning a hospital birth, I probably would hire a doula. Especially if I wasn't terribly comfortable with the OB/MW -- that way, even if you got the MW that you didn't like, you'd still have someone to be the comforting presence that you want. Or if you opt for OB care, you'd have the doula to assist in navigating the hospital culture and helping you advocate for your VBAC.