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:

Hi,

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! :)

Beth

 

Hi Beth,

 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.

Good luck!

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.  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!

~ Andrea.

Hi Andrea,

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 clinic’s 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.

Good luck!

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 drcorinne@naturalmommie.com 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.

Most moms, especially natural mommies have heard of Midwives and Doulas and a portion of you have even used them! But just in case there’s one or two who are unclear, I thought it was a good idea to reiterate their roles, how they’re different, and their individual benefits to childbirth. Being a Doula myself, being over seven months pregnant {yay!}, and planning to have both a Doula and a Midwife attend my birth, I have encountered many varied reactions {fear, shock, ignorance, judgment} on the subject from friends, family, and even some complete strangers. So let’s clear the air!

What’s a Doula?

The Greek word “Doula” roughly translates into “woman who serves”. A Doula is a labor coach; her only role is to help mom labor. She provides physical support, emotional support, partner support, pain relief, and most often education. It usually comes very naturally to women to nurture and encourage other women throughout labor and birth. In terms of the birthing mom, I always say, “the Doula takes the top half”, meaning the Doula is concerned with mom’s emotional state, her well being, her overall birth experience. Sometimes, a Doula can take the form of a mom, sister, friend, or an incredibly supportive husband or partner. Anyone can be a Doula so long as they are committed to mom’s wellbeing; being a Doula is more about instinct, encouragement, and love rather than education. That being said, any couple who has had a trained and/or certified Doula attend their birth – in addition to supportive friends, family, and partner – will tell you they found her indispensable.

With a trained Doula, you can be assured a standard level of education and experience, tricks of the trade to help mom manage contractions in a powerful and empowering way, and an individual who finds true joy and pleasure in helping women labor. A Doula can absolutely be used with or without a Midwife, with or without a home birth, and with or without a partner. Current research is exploding with the benefits to both mom and baby of having continuous, dedicated labor support, which reiterates the importance of having a Doula present throughout labor and birth:

1) Continuous labor support throughout and between contractions – help mom to focus, pain management, and emotional encouragement.

2) Relief for partner – tag in/out for mom’s support. Both Doula and partner need to eat, pee, get coffee, so this way she never goes without support.

3) Statistically, the difference a Doula can make on a woman’s birth experience is significant:

- 26% less likely to give birth by cesarean section

- 41% less likely to give birth with vacuum extraction or forceps

- 28% less likely to use any analgesia or anesthesia

- 33% less likely to be dissatisfied with or negatively rate their birth experience

4) Someone dedicated to advocating for your wishes and birth plan so you/your partner can focus on the birth

5) Overall more positive birth experience for the mom

 What’s a Midwife?

Compare that with the Midwife, who “takes the bottom half”. The Midwife is essentially the physician, the one who has undergone years of intense education to make all the real decisions, and catches the baby. A Midwife is essentially a naturopathic obstetrician – an alternative highly qualified, educated, regulated practitioner who is trained in delivering babies. So why choose a Midwife over an OB? Midwives view pregnancy of a healthy pregnant woman as a normal physiological process. They trust that body of a healthy pregnant woman knows to do what it has done for centuries, and as a result, medical interventions {pitocin, epidural, vacuum/forceps, cesarean} are significantly lower than in obstetrician-attended births. A Midwife offers patients all standard medical testing throughout pregnancy and birth, but gives the patient “informed choice”, the option to comply or deny, essentially allowing the parents to take more control over their prenatal care, labor and birth. The postpartum care with a midwife is exceptional as well – she will visit your house (you don’t even have to get out of bed!) on day 1, 3, 5, 7, and 10 to weigh the baby, assess mom’s recovery, ensure proper breastfeeding latch, etc. Then the 2-and-3 week appointments you go to the clinic. Midwives were the way women delivered babies years ago before doctors and drugs and technology was invented. We made it this far, so they must have been doing something right!

Midwives do have hospital privileges to deliver babies in a medical setting if that’s where mom is more comfortable. However, because they do not see the woman as “sick” or birth as “dangerous”, they are also very comfortable delivering babies in a home setting. The birthing woman and her partner are given the option to choose their birth location – some couples don’t even know they have a choice! A Midwife is not an anesthesiologist, though, and so a homebirth would also include no epidural – a true ‘natural’ birth. However midwives have faith in the female body and in women’s inborn, innate, instinctive ability to birth without medication. In a healthy, low-risk pregnancy, statistically, there are rarely complications and a homebirth is a very safe {some would argue safer} and comfortable option for those women. Of course, because Midwifery is a government-regulated profession, there are strict safety standards which must be upheld, and mom and baby’s safety is always of the utmost importance. Midwives never hesitate to transfer moms from home to hospital {in a car, not an ambulance} the moment any aspect of birth becomes non-normal {blood pressure increases, fever, etc, which is usually long before it is considered an emergency or mom or baby’s health is compromised in any way.

I highly recommend all you moms out there who are curious about your options for your next birth to explore the idea of a Doula, Midwife, or both! I am currently reading the book “Birthing From Within” by Pam England, which is – of all the pregnancy and birthing books I have read {a lot} – already my absolute favorite and I’m only halfway through. I highly recommend it, it is very informative and interesting and the information is all very clear and well researched. Another great thing about this book: most chapters are only 2-3 pages! So if you have kids running around or dinner to make or whatever the case may be, you can feel like you’ve accomplished a chapter or two whenever you can grab a free minute. {So far I have found sections I and III most informative and helpful, so if you’re short on time, maybe skip section II and come back to it later.}

Even if you are not considering a Doula or Midwife for your next birth and have decided to have an OB-attended birth in a hospital, I still highly recommend reading this book. Labor and birth are something all women should be educated in, perhaps especially if having a hospital birth, where oftentimes informed choice is not offered and women agree to doctors’ decisions out of fear, pressure, or simply because they don’t know. In these situations, women find it empowering to have information in their back pocket which can give them comfort and confidence in their bodies and the process of birth, allowing them to make sound, informed decisions about their birth.

I feel like I could talk about labor and birth all day long! If any of you have any other questions on this topic – or any naturopathic topic! – please don’t hesitate to drop me a line at drcorinne@naturalmommie.com or visit my website at www.brownrootswellness.com.

Did you have a midwife?  A homebirth? A doula? Please share your experience!!!

- ask the doctor: dr. corinne brown, ND -