Deep Thoughts - I need help/advice

JGY

<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

Warning: The below definitely falls into the category of “Pregnant Person Problems.”  I won’t be at all offended by those who choose not to read/respond.

That being said, this is something that is weighing very heavily on me right now.  I need some perspective that is not my own.  And I’m really interested in what other people would do in my situation.

Here’s the deal – I am struggling with choosing the medical and support team for my prenatal and birth care. 

A little background would be helpful … I have what I would call a “Close” relationship to my midwife.  I chose him for my annual (and eventual future baby-related) care way back in 2007 after I attended a birth where he was the on-call MW and I was impressed by him.  I was a Doula at that birth.  This MW was willing (offered, actually) to be on-call for my birth, coming in to the hospital when I went into labor and sending the on-call MW home.  He stayed at the hospital with us for the entire weekend, until G was finally born.  The birthing Mom at that 2007 birth was, in turn, our Doula for G.  There’s a whole lot of personal wrapped up in these relationships.  In some ways that makes me more comfortable, in some ways it makes me less comfortable.  In all ways it makes it difficult for me to consider changing care teams.

Next part of the story is G’s birth.  Acknowledging that the most important outcome is a healthy Mom and Baby, I think it’s critical to also acknowledge that the labor and birth experience can be very important and can have huge emotional ramifications.    G’s birth was FAR from a good experience for me.    Without rehashing my entire birth story for everyone, I can recap with the following – I desired an unmedicated, vaginal birth.  I ended up with Pitocin augmentation (after 24+ hours of labor), an epidural, 3 1/2 hours of pushing, a vacuum-extraction attempt, and an eventual c-section.  I was pretty devastated.  I still am.  I’m contemplating getting some professional help to work through it.

Now it’s important to note that I think the medical team made correct “Medical” decisions related to my care.  I know that my case was peer-reviewed by their entire practice, and all agreed that the steps taken and eventual outcome were appropriate.  But what I can’t get over is that there was very little done in the realm of “Non-medical” action.  And I had specifically tried to surround us with a team of people who specialized in that.  I have since swapped birth stories with friends who have described to me all of the different actions that their MWs and Doulas took during their labors to encourage movement by the baby and to help labor progress.  I’ve heard about the things they did as an alternative to Pitocin, and the successes that they had.  I know that the strong possibility exists that none of those things might have worked for me, but my issue is in that none of them were tried. 

There is the added complication that I can tend to speak with a lot of, what's the word, assurance maybe?  I tried to trust my body and tried to communicate what I thought my body was telling me to do.  Was my relationship with my caregivers TOO personal of a one where they didn't want to challenge/push me?  Was my incredibly qualified (way more qualified than I ever was) Doula in some way shy in stepping forward to make suggestions?  I just don't know.

So here I am now.  Pregnant again, given a second chance at an experience that I thought I’d only get to live once.  This time I’m even more AMA (I’ll be 41 when I deliver), and will be attempting a V-Bac.  I will be scrutinized even MORE closely from the medical perspective.  But I can’t shake the feeling that I want/need to try something different.

What do you guys think?  Is there more information that would be helpful in order for you to provide me your opinion?  Most importantly, if you DO think I should seek different care (MW and/or Doula), how does one “Break-up” from this type of relationship?

If you’ve made it this far, you deserve a treat (and a huge thank you).  Lemme know what you want and I’ll see what I can do.

ETA - Trying to fix weird font issues

CageyMack

Hey, JGY.

First, I think it is really strong and thoughtful for you to approach this now.  Way to go!  Putting genuine and patient thought into this now seems like the right beginning to a new, more positive birth experience.

Regarding the actual dilemma, I really feel for you.  I think we are so conditioned to believe that we can trust our bodies, and that things WILL go well. And, usually, they do.  Except when they don't--which is what happened for you.  Which I can see as a major shock--both your body not doing what "it should" and your caregivers inability to help your body when things were not going well.

If I were in your shoes?  I cannot say for certain, but I think I would find a new team of medical providers.  While your intellect knows that they are perfectly competent, your viscera has lost faith in them.  I believe it is that deep inner part of you that helps you feel safe and bold enough to have a baby in the actual labor moment, and I think you sense fear and distrust.  I think that will creep in during the critical moments and steal your resolve.

Perhaps you can tell them that you appreciate all they have done for you, that you don't have anything against them personally, but that they are bound up in the trauma of the whole experience.  You hope they can understand, but that you need a "clean slate" for the next birth experience.  It sounds like they are good people and should be able to get it. 

I completely understand being "too comfortable" with them.  If I were going to doula for DW, I know I couldn't do as good a job as if she were a stranger.  I'm too close, too intimately involved in her emotions to help her make good choices.

That's just a few thoughts.  Good luck!

doodah1013

I agree with what other people have said. I would start with a fresh group. The mind is really a very strong thing and if it tells you you aren't confident in those providers your body will probably respond accordingly.

We had a friend who had a very similar birth experience to your first one... She had midwives that she trusted... And had a very long labor and it ended in a c-section. For her second (and she was also AMA) she had a home birth, woke up in labor and had her perfect VBAC so fast the midwife barely made it! She said that the most important factor was her comfort level...

I am glad you are thinking about this now and hopefully you can get some positive decisions for your growing family!

trisholio

I agree with pp, be honest but do what is best for you.

Jazibel

@JGY - I think you are being really wise and proactive to start thinking about the birth of your second right away. I agree with PP in that I think switching to a new birth team is the best move. I would add that a change is likely a positive step for them as well.  If you were possibly too close before, after having gone through a less than ideal birth once it would take everyone doing a lot of footwork to overcome each individuals expectations and perceptions a second time around. Our midwife processed our first birth with EV and I several times prior to Owen's arrival, and Kaden's birth was fairly straight forward.  

I have the utmost confidence that you will be able to have the birth you want to have this time around. However the birth actually turns out, I hope that the team you put together, the preparation and communication during will leave you feeling empowered and at peace with the experience. 

Are you looking into a certain hospital or birthing center as well?

KH826

So much has already been said that I won't reiterate, but I definitely agree that pursuing a new care provider seems like the best option. You deserve to feel you are in the best hands possible and that your midwife/doula/OB is well aligned with your hopes and expectations for your birth experience. You are wise to be thinking of this early on. Not that I am surprised! I have no recommendations about handling the "break up" other than to be honest. Keep us posted & good luck!

ATXmommas

I've been thinking about this since you posted - it's been hard to respond since we're still at my family's house. From reading your post, it sounds to me that your desire is to switch teams, but the only think holding you back is your personal relationships with your previous MW and doula. I agree with everyone that I would switch if I were in your shoes. The fact is that your don't know for sure that the outcome of G's birth would have been any different with another team, but you also don't know for sure that it couldn't have been different. I think it would be very difficult for you to trust your team in the moment this next time around. You deserve to be surrounded by a team that you trust to provide your with an experience that most closely resembles what you desire. I wholeheartedly agree that while a healthy mom and baby are the most important thing, the birth matters too and every person giving birth deserves to feel empowered during their birthing experience.

As for "breaking up," I think PPs have offered great advice. One thing I know about you is that you are deliberate and thoughtful with your words and you will address it with delicacy and respect. I would hope that these individuals would understand and respect your feelings. Just remember that of they don't respond the way you hope or anticipate, that's not about you.

JGY

Wow, I made a major faux pas in posting and running.  I should have put an iota of thought into the timing of that and I apologize.

Thank you to all of you who read and all who posted, your words and thoughts are incredibly helpful.

To be totally honest, the reason why I'm thinking about all of this so early is because, well, I kind of have to. Because I'm AMA (I'll be 41 when I deliver), the genetic screening is really important to me. And while I can't remember the exact timing of when I need to have that done, I know it's going to come up on me faster than I'd like.  And I believe I need a referral from my OB/MW in order to get that appointment with Maternal Fetal Medicine.

As hard as it is for me to consider switching MW practices at all, I can't fathom beginning care at my old one for means of that referral, and then switching later on.  So there's extra pressure to get this figured out and soon.

One of the things that I didn't touch on at all in my original post, is how S feels about all of this.  We haven't really discussed it past a fleeting comment or two, but I know that we need to.  My impression is that S is VERY comfortable with our previous care team (and again, I too am exceedingly comfortable in their medical knowledge and choices, it's the non-medical stuff I'm looking for).  I think that G's birth was a frustrating experience for S but in the end she feels that what happened was exactly what was going to happen no matter what.  And maybe it was?

Anyway, S's feelings are an important factor in the decision making here and I respect her opinion and desires greatly.  Long story short ... we need to talk.

Other things that are going to factor in to this decision, and were mentioned above by PP, are hospital location and credentials, and insurance.  I need to do quite a bit of research on those two things before I do anything else so that I truly DO know what my options are.  While I would love to entertain the idea of a home birth, there are two strong things preventing that: 1) S is 100% not at all comfortable with the idea, and really that was her only request all along with G's birth - PLEASE not at home AND 2) With my history of previous uterine surgery, and then also a C-section, along with my AMA, I don't know any sane birth professional that would take me as a client for a home birth (and I think that's probably the right decision on their part).  In terms of hospitals, the one where we previously delivered is the only certified baby-friendly hospital in the cities.  It's also the closest hospital to us.  It's also within the care system that we utitlize for all of our other medical needs, so they share the same electronic medical record.  Because I now work in healthcare, I know how much of an advantage that can be.  If we want to deliver at that hospital again, they only work with 1 midwife practice and that's the one that we used with G.  In terms of insurance, well, I think I have a few more options there but again, I need to research.

In wading through all of the various options here, there's a particular one that I'm kind of avoiding, but it's likely the one that makes the most sense - keep my MW (at least the practice as a whole) and switch Doulas.  Ugh.  Not only does this one make that most sense, but it should also really be the easiest.  And yet it's not.  I'm friends with our Doula, both IRL and on Facebook.  She lives close to us and, as I stated earlier, is incredibly qualified.  The thought of having to approach her to explain that I needed a change in that relationship for this next birth makes my stomach hurt. 

Lastly, as a few PP very thoughtfully pointed out, staying with the same birth team will bring along with it the expectations and perceptions of those individuals as well as my own.  But there is this huge part of me that is drawn to the challenge of having failed (for lack of a better term) once as a team, and pulling together to overcome that failure and have success in the future.  Perhaps it's because I've spent the vast majority of my years on this earth as a part of a competitive team, but it's a mindset that I not only have difficulty escaping, but I also see real value in. 

Ugh, I'm screwed.

I'll definitely let you all know what we decide to do, though likely in a far less AW-ish way.    Again, thanks for letting me air my thoughts here and for always responding with such thoughtful and caring advice.  I really treasure you all.

 

2MamazInSeattle

Hey, I didn't get to weigh in before you responded, but I'm adding my two cents now.

First, I think you know I'm not a "healthy mom, healthy baby" person - I'm that, plus "a non-traumatic birth experience" person. While of course baby and mom are key; not having a lasting emotional chem trail is an ok thing to wish for/want.

So, first off, my first pregnancy I was with a MW and they executed the cell-free DNA genetic test - no problem. It was recommended b/c I was over 40, and done as a matter of course along with the nuchal fold u/s. These tests are done between 10w and 13w. Now, (you know what's coming) - I had a big, fat false positive. It is only a screening, and had the positive been for something more serious I'd have done the CVS or Amnio but as it was, this was nothing we were going to change the course of our pregnancy plan on so we didn't. So - my point - you don't need an MFM to do a blood test and a simple u/s. That said, I had MFM 'full care' with Simone and I could not have been happier! I did not need a referral either - if you're over 40, they'll just take you. You might do some research and see...

It's so hard with personal relationships but I really do think you have some pretty legitimate "outs" for wanting a whole different experience this time. While I loved the MFM at UW who oversaw my D&E after my loss, I did not want to go back there after that horrible experience. I switched just to have that clean slate and it was the best choice for me. I think you having this kind of stress isn't good for you or baby, and I think these people love and care about you and will understand. I doubt they will make it about them, and rather they will support your desire for a new team and a clean slate for G's little.