Second guessing midwife practice... would this be a huge flag for you?

MrsPDX

I originally picked my midwife practice based on recommendations online, convenient location, hours, flexibility ect.. My first two appointments were awesome! I saw two different midwives and felt great about my decision. Tonight not so awesome...I waited for almost 40  minutes and the midwife I saw didn't really want to chat. She rushed through intros and checking the HB (literally listened for maybe 30 seconds). Then she basically was wrapping it up (after 5-10 minutes), when I pulled out some questions I had thought of. As a FTM I was a little bit overwhelmed with actually being pregnant the first trimester that I didn't ask these initially, so partially my fault these were brought up so late. Anyways her answers are really worrying me!

I asked if the midwife on-call would be with me through the whole labor. She said they "tried to be if you didn't want medication" and that they were of course a hospital based practice, so if more than one person was in labor than they would have to split their time. She recommended hiring someone to be there during labor for coaching. I always saw a midwife as helping me through labor... am I wrong? I kind of felt from what she said, that they would be there here and there, but it was up to your family, SO and a hired doula to get you through labor. Is this normal?

Next thing is I asked about a lactation specialist.  She said the "nurses were trained in helping with breastfeeding" and if after 24 hours of not being able to breastfeed then you could go to a specialist, but that they didn't come to your room. This worries me too...I always wanted a specialist right away to make sure that if I do have problems, that I can work those our right away and breastfeed from birth.

She also spoke in a weird tone regarding unmedicated births, which really concerned me! 

On the positive side, she did say they don't induce at 40 weeks, and let you get to 42. They are 100% for delayed cord clamping, supportive of placenta encapsulation and allow walking "unless medically you need to be hooked to an IV".

I am just really worried about not having midwife support during labor, or breastfeeding support after, and how much medical assistance they are going to push on me...(keeping in mind this is only one midwife and anyone could be at the birth). 

Do you think I should be concerned, and look for  a different practice and hospital? I really like that I can do group prenatal care here, which starts next month, and the rest of the midwives I have clicked with. Plus its a 10 minute walk from my house, which is so nice!

I really appreciate all opinions on this!

LimaD

What do you mean by her having a weird tone about non-medicated childbirths? I thought midwives were big supporters of that.  
I'd look at a midwife in a hospital setting as similar to any other OB.  I didn't use a midwife with DD, and my OB was not necessarily going to be the one delivering the baby, whoever was on call would do that.  The Dr. never came into the room until it was time to push--I had a nurse and my own support there with me. In my case it was DH and my mom (due to strange work circumstances DH couldn't be there for any of my natural birthing technique classes and I rarely saw him leading up to the birth, so my mom was there to go to the classes w/me and help out with making it through the contractions). 
I would take your SO with you for support and if you feel you need extra, hire a doula.  Like an OB, midwives can't be with all of their patients at the same time. I don't see any real red flags, but maybe you want to bring up any concerns at your  next appointment (assuming you'd be seeing someone else and not be rushed!) 

ETA: I guess the only real problem I have is that the lactation specialist wouldn't even come to your room after 24 hrs? Wouldn't you still be hospitalized? Where are you supposed to go if they won't come to you?
I had "lactation consultants" who came by to help and check in on how breastfeeding was going. I would consider that similar to what you mentioned about nurses "trained" to help for breastfeeding? I'd definitely ask more clarifying questions regarding the breastfeeding. GL!

fitnhealthy1

I have had two midwife assisted births and neither one was the midwife present for the duration of labor. My first I was in labor Dir maybe 12 hours and i was at the hospital for maybe 10. The MW checked on me maybe 3 times before it was time to push. With my 2nd birth, I labored almost entirely at home and I didn't get to the hospital until I was 10 cm and ready to push. They filled the birthing tub, and my MW was there but I was pushing my then lol. I think if you're looking for someone there throughout your labor, you should consider a doula or perhaps husband/partner coached childbirth might be a route to look into.

Snapdragon750

I jumped on the computer from mobile to respond to this.  I used a hospital/OB for my first two pregnancies and am using a birth center/midwifery (attached to a hospital) for my third, so that's my background.

It sounds like you're using midwives who work in a hospital, not a birth center.  Is that right?  First I'd like to mention that these are questions you should have asked right away, before choosing your practice, but hey what's done is done and you can still switch.  

As to your first question (labor support), your midwife's answer sounds about right for a hospital setting.  This is still more hands-on support than you'd get from a doctor, who would not show up unless something were wrong or until you were ready to push (at least in my experience).  That said, I asked this question at both of the birth centers I toured, and they both said that they'd be as hands-on as you want and could be there the entire time.  THAT said, obviously this could not possibly apply if enough other women are in labor and there aren't enough midwives to go around!  I think this might be what your midwife was talking about.  It sounds like this is a large practice with a large number of patients (both of the birth centers I toured were pretty small), and she doesn't want to promise support that she might not be able to give.

Your second question (lactation consultant).  That would be a concern to me.  In the hospital and the birthing center that I've been to they have LCs available immediately, and I have no idea why they'd want to make you wait until you develop a problem before seeing one.  Wouldn't it be smarter to prevent a problem from occurring in the first place?  This answer is getting a HUGE side-eye from me, but it sounds like a hospital policy, so you'd have to go to a different hospital to find something different.

Also, it would be very strange to have a midwife who didn't support non-medicated birth.  I can't say what you mean by a "weird tone," but if nothing else it sounds as if you didn't click with this particular midwife.  I'm going to put this out there--if she was 40 minutes late and seemed a little "off" to you, she might have just gotten back from a birth...and it may have been a difficult outcome.  I don't think I would seek another practice just because you didn't click with one of the midwives, especially if there are others that you like and if it's not super likely that she'll be the only one attending your birth.

Still, the LC thing bugs me.

fitnhealthy1

I used the Bradley method of husband coached childbirth both times and it helped immensely.

gypsyheart85

For hospital based midwifes (not those at a birthing clinic- and even then they could have more than one woman in labor) it is normal that they can have more than one patient in labor, and yes that is what a doula is for- to be there exclusively for you.
As far as the lactation specialist this is really a hospital policy issue-
Ours has a LS that does come and see you within the first 12 hrs to help with any issues, as I said that's the hospital policy not my midwifes practice.

Also there are four midwifes at my clinic. I really don't care for one. I saw her once with my daughter and have never seen her again. You only have to see them all once at my practice then you can stick with who you prefer. Luckily my fave was on call and did deliver us. This time I am only seeing her and will be ok if any of the other three do deliver me bc I know they are all fully capable and honestly someone you don't like in office can surprise you in the clinical setting of birth. I wouldn't be too worried if I were you.

MrsPDX

Snapdragon750 yes its a midwife practice that solely delivers in a hospital. I guess I always envisioned OBs to be your typical birth at a hospital and midwives to have a much more personal take on the birthing process. From what I heard, these midwives stick to more the traditional route, which I wasn't expecting...

I know I should have done more research before, and now I am torn at what to do. 

I do think part of it is the fact that I did not click with this midwife, there was no connection..but what if she is the one who is there at labor? 

MrsPDX

Also there are 30 midwives, and I will only see maybe 4 during my pregnancy. The next appointment through my birth would all be the same midwife. So the chances are I won't know the midwife who delivers me... which is not as big of a problem for me as is not being their during labor. 

gypsyheart85

I promise you, you will see your midwife far more than you see would see a doc during labor. I know as a RN - a lot of docs literally show up just to catch baby. I've been present when mom was so ready to deliver that we almost delivered without the doc- and that does happen, rarely but it does!

Jillibean68

So, let me get this right, you basically want your midwife to function as a doula? That's what it sounds like. Please keep in mind that a MW is really not much different from an OB (except MWs can't perform surgery). My MW is a midwife/nurse practitioner, so maybe I'm spoiled, but she basically functions as a regular doctor. The only reason she was around while I was in active labor but not pushing was because the my L&D nurse was friends with her daughter and she called her over from her office.
You are not/won't be her only patient, and a MW job is to get you to the point of delivery. The reason there are LCs is to help with breastfeeding, while your MW can answer questions about it, she likely won't be there to help you in the hours after LO is born.
It really sounds like a doula would be a good fit for you, they can provide all the one on one support you need and will be able to focus only on you.
Please keep in mind, the L&D nurses will be coaching you through labor, it's the MW/OB job to show up and catch the baby. At least that's how it works out here in my part of the world.

sugarfingers

If you're talking about OHSU, I had my 2nd & 3rd babies there and I looooove them! The midwives were great, in my opinion. I didn't have "my" midwife for either delivery but still liked the ones I had a lot.

I'm not sure which way the "weird" tone was...both my labor and deliveries were completely med-free and no one pushed anything on me. I felt it was so relaxing and supportive!

MrsPDX

@sugarfiingers no I am talking about Women's Healthcare Associates at St. Vincent's. I am thinking about switching to OSU.. If I did switch that is where I would go. 

But, (ok this is going to sound idiotic), but I hate driving to OHSU! The parking is terrible, and its a long distance from my house. Which is why I was at first reluctant to go there, even though I think their midwife program sounds closest to what I am looking for. 

sugarfingers

Oh I like I said, I can't say enough good things about it! I live in a different state & drive a solid hour to get there! Lol that's how much I love it! Take the tram! :-) (I've never been to the one you're going to so I can't compare.) Anyway, good luck deciding!

chailife34

Maybe consider what other midwiferies offer. I'm really impressed with Andaluz in Portland/Tualatin, as they support you with three dedicated midwives, one of which is guaranteed to be at delivery. It's a natural/water birth center not attached to a hospital (but they are close by just in case of an emergency). They don't do epidurals or medical inducements but rather they empower women to find their own strength with their guidance. They also have a lactation specialist that will even follow up with you in the weeks after. I'm super impressed and love that I have been able to call "my" MWs and get an answer right away. Couldn't pay me to go to a hospital setting!

Snapdragon750

MrsPDX said:

Also there are 30 midwives, and I will only see maybe 4 during my pregnancy. The next appointment through my birth would all be the same midwife. So the chances are I won't know the midwife who delivers me... which is not as big of a problem for me as is not being their during labor. 

If there are 30 MWs then I wouldn't even think of leaving mostly because you didn't click with one!!

Alliinwonderland

I'm a RN in a maternity unit. All of this is quite typical of a hospital. A nurse will be at your side for the entire labor. A midwife will be there for as long as she can but she may have other patients as well and it would be impossible for her to be on call and see only one patient.
As for lactation specialists versus nurse assistance- your nurse will be well trained/certified for lactation education and will be with you for a full 12 hours, a lactation specialist normally provides no more than 20 minutes of her time per day before moving onto the next case.. You can't expect your baby to be ready when she's ready...especially within the first 24 hours

MrsPDX

chailife34 said:

Maybe consider what other midwiferies offer. I'm really impressed with Andaluz in Portland/Tualatin, as they support you with three dedicated midwives, one of which is guaranteed to be at delivery. It's a natural/water birth center not attached to a hospital (but they are close by just in case of an emergency). They don't do epidurals or medical inducements but rather they empower women to find their own strength with their guidance. They also have a lactation specialist that will even follow up with you in the weeks after. I'm super impressed and love that I have been able to call "my" MWs and get an answer right away. Couldn't pay me to go to a hospital setting!

Did you insurance cover your births there? I am definitely willing to look at a birthing center, just worried maybe it wouldn't be covered like a hospital is.

chailife34

My insurance (United) covers it completely. All tests, the labor, all of the follow up care, even if you elect to do a home birth. It's amazing! I love it!

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beaseg

I think you should hire a doula. She (or he) will be the one with you supporting you throughout your entire labor and delivery. The doula is your champion and your rock. Your midwife is more medical, and while it's SO great to have their presence, in a hospital based practice- it might be a little unrealistic to expect them there all the time, unfortunately. But I really really encourage you to find a doula. They've attended tons of births and know all the best massage tricks, positions to encourage you to get it, etc. 

Also, a doula fully supports medicated and non-medicated births. They're your advocate. So they are cheering for whatever YOU want. A doulas job is to make sure you walk away from your birth with a positive experience. I can't speak highly enough.

About the breastfeeding- I worked with a LC from the hospital. They had one on staff every day, and she stopped by once a day to work with me. She was great. I also could call that line any time I wanted, even 2 years later when I developed mastitis! Someone in your hospital will help you. But, if you have a supportive partner- that's probably where most of your help will come from. My husband watched carefully, took pictures and recorded video of the LC helping me in the hospital, and would help me re-create the positions at home. When my nipple was too slippery from milk and would keep sliding out of the baby's tiny mouth, he helped me by actually inserting the nipple into my baby's mouth. It's crazy. Breastfeeding is a challenge in the beginning! You'll need lots of help from lots of people. But it's the best! I'm still nursing my daughter 2.5 years later!

Snapdragon750

MrsPDX said:

chailife34 said:

Maybe consider what other midwiferies offer. I'm really impressed with Andaluz in Portland/Tualatin, as they support you with three dedicated midwives, one of which is guaranteed to be at delivery. It's a natural/water birth center not attached to a hospital (but they are close by just in case of an emergency). They don't do epidurals or medical inducements but rather they empower women to find their own strength with their guidance. They also have a lactation specialist that will even follow up with you in the weeks after. I'm super impressed and love that I have been able to call "my" MWs and get an answer right away. Couldn't pay me to go to a hospital setting!

Did you insurance cover your births there? I am definitely willing to look at a birthing center, just worried maybe it wouldn't be covered like a hospital is.

My insurance also covers birth centers. I just had to make sure it was in network.

mpiemont

My midwife (DS1) and OB (DS2) were not there for most of my labor. I labored at home for a long time and was only at the hospital 3 hrs/2hrs before each of my babies were born. Having my H and a doula both times was invaluable for me.

I don't think them staying with you the whole time is ever going to happen. You will have an L&D nurse that is pretty much there the whole time. So I wouldn't let that part of it bother me. I'd be more excited they are on board with delayed cord clamp, placenta encapsulation, etc.

The lactation consultant thing is a bit concerning but often times the nurses are just as helpful.

As for an unmedicated birth- they cannot force you to have anything you don't want. They can use fear tactics or "bullying" but it's your body. If you truly want a med free birth, you need to educate yourself- read read read. Attend a natural birth class if you want. Have a support system in place- this is the most important- your H, your mom, a doula, etc.

I wouldn't find a new practice based on what you posted here.

rels09

I don't think it's weird for midwives not to provide continuous labor support at ALL. My last pregnancy, I was with midwives in a free-standing birth center (non-hospital), and they actually required that you hired a birth assistant (like a doula). Midwives do provide more support than OBs, but ultimately, they are focused on medical monitoring, not emotional support.

rels09

MrsPDX said:

Snapdragon750 yes its a midwife practice that solely delivers in a hospital. I guess I always envisioned OBs to be your typical birth at a hospital and midwives to have a much more personal take on the birthing process. From what I heard, these midwives stick to more the traditional route, which I wasn't expecting...

I know I should have done more research before, and now I am torn at what to do. 

I do think part of it is the fact that I did not click with this midwife, there was no connection..but what if she is the one who is there at labor? 

My (limited) experience is that midwives are completely different when you're in labor than they are at a routine appointment. I wouldn't read too much into one appointment. 

Hawk&Eye

I'll just chime in on the "doula" part. Mine was excellent. Stayed with me through a long labor and helped with nursing immediately after delivery. Do your research and you'll probably find one that is an LC or at least very experienced. A good doula is coach, friend, advocate, and a great help with nursing all in one. Totally worth the money!

jesslfar

My understanding of the midwives is that if you are using the hospital based ones they are more like a nurse.  They will not be with you the whole labor, but will be in and out dealing with multiple patients depending on who needs them most.  If you are having your child at a slow time you might have more 1 on 1.  The midwives who come to your home or who work at the birthing center do stay with you for most of the delivery.  I think what you are describing wanting is more of a doula.  I haven't had a baby at St Vincents, I had 1 at Emmanuel and 1 at Meridian Park, both with different Women's Health Care offices.  The way the hospitals here work is there is a lactation consultant who works at the hospital.  I believe Sunday was the only day they were not there.  The nurses are trained to help, but they are not quite the same.  If you ask for a pacifier or a bottle of formula and stated you want to breast feed it is an automatic visit from the lactation consultant.  Your visits with the LC at the hospital are minimal.  They call to check up on your if you are breastfeeding, but the support is not great.  I would sign up for a breast feeding class and find a good LC on your own.

smurf605

The LC's availability is going to be a hospital controlled thing, not controlled by your midwife. Commonly they are only available during certain shifts and they give you about 20min window for advice. Certainly request one, they provide a different perspective then the RN that also has significant lactation experience. However, I do not think it is necessary to see on even on the first day that baby is born. At both hospitals I delivered at the nurses were very helpful and the LC just provided supplemental help. I also wouldn't expect a midwife to be with you throughout the entire labor or even most of the labor. I had an OB, and he/she probably checked in on me once or twice and then was there for the end of the pushing. I would imagine a midwife to be more present, but certainly not for the entire labor (or even close). If you wanted added support, a doula as suggested, is a good idea.