Switching from MW to Doctor, bad idea? (super long)

pc150805

I'm having a really hard time here making a decision and it's causing me a lot of anxiety. Thank you for reading! So here's the story:

I've had 6 miscarriages and it took them forever to figure out what was causing my body to reject baby. It turns out to be a blood clotting disorder and extremely low progesterone levels. So when I got pregnant this time they started me on meds right away. It worked (clearly)! This is the longest I've ever been pregnant and baby seems to be doing great. 

I started out a an RE's office, they got me started on the meds. Then I was released to a high risk OB. At my first appointment with her, she told me that since things seemed to be under control,  I could go to a midwife if I wanted. Well at that point I really thought that was going to be best.

At my first midwife appointment I became really concerned, I asked her about the medication I was on and when I should stop taking it. She didn't know the answer and she never followed up. I ended up having to call my previous two doctors to find out.  I also had my NT scan and while my DS results were great, they found two problems (minor but still) and I never got a phone call about it. I ended up calling in a panic because I didn't know what the results meant. This is a group of midwives so I'll see others, but she also said she and another woman do most of the deliveries. Now I feel like I can't trust her because it sounds like she has no idea what she's doing and not willing to ask the doctors for information. What if I end up having her at the delivery?! I have the option of going back to the high risk OBGYN and I really liked her. I'm just soo conflicted!

All I really know is that I was a natural hospital birth.

couliegirl

If you feel more comfortable with your OB, talk to her about her stance on natural birth. Then do some research on her C-section or intervention rates, so you know if she's telling you the truth.

You could always talk to another MW and if you find one that you like, see if you can get them to commit to being at your delivery.

pc150805

Thanks! I know she's all for natural birth, but she's also part of a group so I don't know what the entire group's stance is. Her/their c-section rate is high because they are all high risk OBs so they deal with a lot of emergency situations/GD/multiples. I just feel like we've struggled so much I don't want to screw it up now. I'd be totally fine with the MW if she didn't seem so clueless/unwilling to ask. What if something comes up during birth and she's unwilling to ask the opinion of a doctor? Can I request a doctor to be present as well at the birth? Can I have both an OB and MW? I'm freaking out...

julyjennifer

Sorry to hear of your previous losses.  I'm only guessing, but I suspect that the midwife practice does not deal with many high-risk women, so they may not be used to someone whose previous experiences with pregnancy makes them feel more anxious about the whole thing in general.  It sounds like you might feel more comfortable with an OB who has more experience with high-risk patients.  Although you may not be high-risk anymore, your brain may not have caught up with what that means for you and your pregnancy. 

From my limited experience with low-risk pregnancy, I've found that there are long periods between visits with providers (e.g., 1 visit per month during the first half of pg) where you just have to assume that things are still going well with the baby, and that can be hard when you are feeling anxious and worried about potential problems. 

Being with a provider who you feel comfortable with, whatever that means for you, is a big factor in your body being able to do its work unhindered during labor and birth.  If I were you and I just couldn't get comfortable with the midwife practice for whatever reason, I might look around for an OB who you feel comfortable with, have confidence in, and who has experience with normal natural birth and who is supportive of it, and then also hire a doula (maybe someone with experience with clients who have experienced losses).  

julyjennifer

pc150805:

At my first midwife appointment I became really concerned, I asked her about the medication I was on and when I should stop taking it. She didn't know the answer and she never followed up. I ended up having to call my previous two doctors to find out.  I also had my NT scan and while my DS results were great, they found two problems (minor but still) and I never got a phone call about it. I ended up calling in a panic because I didn't know what the results meant. This is a group of midwives so I'll see others, but she also said she and another woman do most of the deliveries. Now I feel like I can't trust her because it sounds like she has no idea what she's doing and not willing to ask the doctors for information. What if I end up having her at the delivery?!

All I really know is that I was a natural hospital birth.

I would also consider calling the midwife practice and explaining your concerns like you did above.  Maybe they'll respond in a way that genuinely makes you feel a whole lot better about the situation.

CurbsideProphet

Have you met any of the other midwives? Is there another midwife/group of midwives you can use, maybe ones that work with OBs regularly?

drpayne

First, a million hugs for all you've been though.  I can't even imagine.

I don't blame you.  I saw a group of midwives at a birthing center.  This is the only place I have personal experience with but I know they really screen possible patients and only take the ones who are low risk.  Maybe not all places are that discriminating? I think midwives are great but I think specialists exist for a reason.  They see the "rare" stuff on a regular basis.  Also, I think part of being a good doctor (or midwife in this case) is sometimes saying "I don't know but let me refer you to someone who specializes in this sort of thing."  It sounds like your MW kind of left you hanging.  The other thing is that maybe it's best to see one person who is very familiar with your case consistently, which wouldn't be the case if you rotate between different MWs.  I think you made a good decision.

pepomntpat

Go with the provider that makes you feel most comfortable.

flyer23

I wouldn't freak out based on one appointment.

re: medication, I'm not surprised that your MW didn't know about when/how to stop the medication if she didn't prescribe it. If it's progesterone supplements, I'm on them right now, prescribed by my primary care doc because my homebirth midwife can't. I've only seen my primary care doc so far, but I'll transfer over to my HB midwife around 12 weeks, right when I should start weaning off the supplements. I honestly don't know if my HB midwife will know that, because I doubt she has much experience with them. Which is fine by me. I'm hiring her to deliver my baby, not to help me wean off a medication she didn't prescribe In other words, I wouldn't take that as a sign that your midwife "has no idea what she's doing."

re: not following up about the medication, did she SAY that she would ask and follow up with you? If so, she should have. But I've had plenty of times where I've had to talk to a doctor more than once to get some piece of information that I need. Again, not a sign of incompetence (in a medical sense), usually just of being busy.

re: the NT scan, both times I've had NT scans, I've been referred outside my normal provider's office. It's been the OTHER office that has been responsible for calling me and giving me the results. So I'm not surprised that your midwife didn't call you. It probably wasn't her job. ESPECIALLY if there were any problems -- the person who did the analysis should be the one to call and discuss problems, not your regular provider (OB *or* midwife), since they just get a copy of the report.

I would give it at least one or two more appointments with the midwives before you go back to the high-risk OB.

pc150805

Thanks everyone for your support and honesty! I was having a really rough day yesterday and just felt like I was making the wrong decision no matter what I did. I'm going to go back to my high risk doctor, even though I'm only slightly high risk at this point. I know they'll take my concerns into consideration and that they will call me back when they say they will. They will know about medication and I won't have to go to 6 different places to get good answers.

Thanks again! Between you ladies and DH I feel a lot better today. 

flyer23

pc150805:

Thanks everyone for your support and honesty! I was having a really rough day yesterday and just felt like I was making the wrong decision no matter what I did. I'm going to go back to my high risk doctor, even though I'm only slightly high risk at this point. I know they'll take my concerns into consideration and that they will call me back when they say they will. They will know about medication and I won't have to go to 6 different places to get good answers.

Thanks again! Between you ladies and DH I feel a lot better today. 

I would really really give some careful consideration to how you want to be treated throughout your entire pregnancy. Not just right now.

If you see a high risk OB, you will likely be treated like a high risk patient, because that is who she is used to dealing with. This might not sound so bad when you have been a high risk patient for your entire pregnancy to date! Certainly, you'll be with a provider who is more familiar with what you've been through, who is used to dealing with nervous pregnant women, who may be able to give you more reassurance and hand-holding.

The downside is that you said you want a natural birth and... well, if your OB's passion were natural birth, she would not have chosen to be a high risk OB.

On the flip side, a midwife's passion IS natural birth. She is not going to treat you like a high risk patient -- at least, not by default -- because high risk patients don't have natural births. She IS going to help you have the kind of birth you said you want.

Also, most natural-birth friendly providers are very open to giving women what they want. If you haven't had a discussion with your midwife yet about your concerns and fears and what you need from her, I strongly recommend that you do so before you switch. Just to give some examples of how my midwives treated me...

- They readily agreed to progesterone testing when I asked for it, and in fact, ordered up a full round of infertility blood testing, even though I had only been TTC for four cycles with one miscarriage. (Most doctors will wait until you've been trying for at least a year without getting pregnant at all, i.e. miscarriages "reset the clock," or until you've had at least three miscarriages.)

- When I happened to get pregnant on the cycle that I had had progesterone testing done, they readily agreed to another post-BFP round when I asked for it, even though my mid-LP levels had been OK. They even threw in beta HCG levels to give me some more reassurance.

- When my post-BFP progesterone levels had dropped from the mid-LP levels, to borderline levels, they readily prescribed progesterone supplements.

- When I asked if I could have a first appointment at 6 weeks rather than the usual 8 weeks, they readily agreed to that.

- When I asked if I could have an early ultrasound at 6 weeks, again to provide some reassurance... and then later, when I asked if I could do an NT scan at 11 weeks, once again to provide a little more reassurance... yep, they readily agreed to all that, too, even though they usually only do one ultrasound per pregnancy, at 20 weeks.

Note that I had to ASK for a lot of these things, because they weren't the "default" for my midwives, even though they might be the default at a high risk OB. That was totally fine by me. They were absolutely willing to do everything I asked for, without hesitation. And once I got out of the first trimester, I was really a pretty normal patient for the rest of my pregnancy, and I was happy to be with a provider who treated me as such.

All that said... I do agree with previous posters who said that you need to feel comfortable with your provider, and if you really feel like you can't be comfortable with your midwife, then you should find someone else! I just think that you haven't given your midwife enough of chance to make you feel comfortable -- and if you do give her that chance, you may find that she's a much better fit for the second 2/3rds of your pregnancy, even if she wasn't a good fit for the first 1/3rd.

pc150805

flyer23 - Thanks! I understand where you are coming from but I just can't go that route. I need to know that when a scan comes back with placenta previa and a subchorionic hematoma that they are going to reach out to me and that I'm not going to have to call in a panic for some answers. When she says she's going to check with a doctor that she actually does and then calls me with the information.

The fact of the matter is that I am a high risk patient, no matter how anyone treats me. At this point I'm more worried about getting to delivery than the actual birth. If I want a natural birth (and it's medically possible) then that's what I'll have a doctor can't force me to do something that I don't want to do unless me or baby is in danger. But if the MW minimizes a risk or over looks something because I didn't know to ask, then I'm not going to even get to delivery. I just can't take the risk that something will be overlooked and I feel with her it's more likely to happen. I guess the bottom line is that I don't want my natural birth desires to overshadow potential problems because if it's a natural birth or a healthy baby, then cut me open.

I'm a little bothered by your statement "because high risk patients don't have natural births". That's just not true. My mom was a high risk patient and she had two natural births. A coworker of mine was a high risk patient and she had a natural birth. Several other people I know were labeled high risk and had natural births.

My "team of OBs" are the only reason that I'm pregnant today because they were super proactive and didn't wait the typical year. They recognized that something was wrong and that I needed further testing before we tried again. They found a blood clotting disorder and a major progesterone problem (as in my body barely produces progesterone ever and it's worse during pregnancy).

Again, I really appreciate your input but I'm going with my gut. I've ready talked with both providers and I've switched. I'm still really looking forward to planning a natural birth!! 

flyer23

pc150805:

The fact of the matter is that I am a high risk patient, no matter how anyone treats me.

Oh! I am sorry. You said in your original post that the high-risk OB said it was fine for you to see a midwife. I took that to mean that you're now low risk. If you are still high risk, then that's a very different story, and absolutely, a high risk OB is the right choice for you.

pc150805:

I'm a little bothered by your statement "because high risk patients don't have natural births". That's just not true. My mom was a high risk patient and she had two natural births. A coworker of mine was a high risk patient and she had a natural birth. Several other people I know were labeled high risk and had natural births.

You're absolutely right! What I meant to say was "high risk patients don't have natural births with midwives." Midwives are for low risk patients. But of course, you don't have to have a midwife to have a natural birth...

Best of luck to you!

Kitttkattt

Will your insurance allow you to see both? Or see the doctor wil whatever point in the pregnancy that you no longer have issues, then switch to a midwife?

stahlop

You definitely want to go with the provider you are more comfortable with.  My friend has the same clotting disorder you do (at least I assume it's the same one) and her first provider never found it.  She had to miscarry 4 times and change providers before she found out what was wrong.  I hope everything goes smoothly for the rest of your pregnancy.

pc150805

Thanks again everyone! I'm much more comfortable with my decision now and I can't tell you how much I appreciate your advise/guidance you all gave me some good things to think about! Hopefully come May I'll have a god birth story to share!!