Shortly after the post on homebirths, midwives and doulas (oh my!) many of you had follow up questions and emailed them in to us. To expand on the topic a little further here are two questions about high-risk pregnancy and who makes the call for a c-section (midwife? OB?) AND also how do you know if the midwife and/or clinic is a good choice for you? Read on mamas:
My husband and I are not expecting yet, but I have given my options a good bit of thought due to me being a high-risk case because of being Type 1 diabetic. As of now, I have chosen an ob-gyn practice that has midwives on staff, and they deliver across the street at a hospital for which I’ve heard great things about their birthing center. I obviously don’t want to end up having a C-section if it isn’t “necessary” Who makes that decision? Will it be my midwife if I have one? I know that a big part of that will be keeping a nice low A1C during the pregnancy to prevent the baby from growing too large. Thank you very much! :)
Thanks very much for your question, and good for you for taking your health concerns into consideration and looking into this before actually becoming pregnant. I think the OB practice with midwives on staff sounds like the best of both worlds. You sound like you have done your research and will be in excellent hands throughout your pregnancy.
I am not exactly sure if, because of your diabetes making you high-risk, you will be permitted to be under midwifery care or not. You definitely would not be eligible for a home birth, but you are happy with the birthing center anyway. I can’t see why you couldn’t be with a midwife if you keep a low A1C and maintain a healthy weight and lifestyle. (FYI: For those confused by A1C, Hemoglobin A1C is an average measure of your blood sugar maintenance over the past 3-month period.) However, you are right the size of your baby and the maintenance of your blood sugar throughout your pregnancy will ultimately determine how your pregnancy is managed. If you are able to keep your blood sugar nice and stable throughout, and your baby is growing at an appropriate rate, you will most likely go on to have a healthy vaginal birth without requiring a cesarean – and hopefully with a midwife! It will ultimately depend, though, on the rules and regulations midwives practice under in the area you live. A larger baby runs the risk of having shoulder dystocia, which is where due to the baby’s large size the shoulders get wedged behind mom’s pelvic bones, creating an emergency situation. Whichever form of care you are under, they will regularly measure the growth of your uterus and monitor the size of the baby, but I am not sure at what threshold they will make the decision for you to perform a C-section. That’s a question you would definitely want to ask in your initial visits with them.
You sound like you are very well educated and aware of the situation, so I have no doubt things will work out great for you! But once you do become pregnant, ensure you speak to both the midwives and OBs at the clinic near you to be sure you fully understand their individual scopes of practice, their stance on midwifery care with Type 1 Diabetes in pregnancy, C-sections, and under what circumstances a transfer of care may be required.
Hello Dr. Brown,
I just finished reading your latest post and I do have a few questions. I’m at the beginning of my pregnancy and I want to have an at home water birth. Â My first child was born at a hospital and I’d like to have something less drug-filled and pressuring than that this go around. I’m having a hard time thought trying to decide which midwifery clinic to go to. There are a couple big ones here in South Orange County, CA and I have visited one of them. But it’s hard to make a choice like that without a personal recommendation. What do you recommend I do? I’m all for doing the water birth at home. I just want to make sure I select the right place from the get go. Thank you so much!
Congratulations on your second pregnancy! And how exciting that you want to try for a water birth! Because you are aiming for midwifery care, which typically (but not always) involves a closer patient-practitioner relationship (longer visits, more individualized care, etc) than with an OB, it is crucial to your pregnancy and birth experience that you mesh well with your care provider! What I recommend is one of two things.
First, if anyone you know has been a patient at this particular midwife clinic, ask for referrals. Most often, throughout their pregnancy, a woman will have visits with more midwives in a clinic than just her primary midwife. Sometimes her primary is at a birth and is not available, sometimes you meet with your secondary midwife, sometimes other midwives will come into your visit for a consult, etc. So getting a referral from someone you know who was a part of that clinics clientele is a good way to find a midwife you’ll be happy with.
A second way to go about finding the right fit for you is to ask the reception staff at the clinic(s) you are interested in for a recommendation. They will have a good idea of the midwives different personalities, various styles of practice, and which midwives seem to have the best rapport with their patients. Alternatively, ask to meet a couple of midwives one-on-one. This may or may not be do-able, depending on how busy the clinic is, how many babies are due around that time, etc. But it never hurts to ask. And most of the time, the clinic will be happy to accommodate your request in order to ensure your satisfaction.
And finally, I am sure that if there ends up being a huge conflict in personality types between you and the midwife you end up with, a request to be transferred could always be made, and most likely approved.
Pss…Don’t miss the first post on everything you need to know about homebirth and choosing a midwife and/or doula!
Have a question for Dr. Corinne? Send her an email at firstname.lastname@example.org and your question will be answered here on Natural Mommie. These suggestions are not intended to provide diagnosis or substitute a private consultation with your healthcare practitioner.