Nat'l birth w/MW and high-risk possibility

CDMay2006

I'm sorry for posting a question without an intro first, but I don't know where else to get a variety of informed feedback.

My pregnancy is not considered high risk, but I have multiple risk factors for both GD and pre-e.  That said I really, really want to deliver at a birth center with a midwife.  I can choose between a MW (LM/CPM) and a MW group (all CRNs).  This is my first pregnancy and while I've done lots of research, i'm really learning as I go.

Does anyone here have experience managing/avoiding these (despite risk factors) and delivering successfully out of hospital with a midwife?  Or in-hospital with a midwife?  Or input on the subject?  (I skimmed the board's birth stories and didn't see any with similar circumstances.)

I am 5w 2d so I have a little bit of (but not much) time to make a decision.  And of course I could transfer care as needed down the road, but I'd like to avoid that if possible (which also maximizing my chances for an intervention-free birth).

Thanks for reading

CDMay2006

I'll check back in case anyone else has something to add, but thank you both for your input!

angelacez

Seriously look into the brewer's diet.  It's been said to keep off pre-e and it's a lower carb/sugar diet so it would also help with GD.  It's not hard to stick to, at least I don't think so, and it's worth trying.  Plus it's all healthy food so it can't hurt right?! 

CDMay2006

Mrsveinotte:Talk with your MW and see what they say.   For me I wanted a home birth, but I am not a good candidate for one.  We are having a hospital birth with a MW.This is part of my concern.  If I go with the mw I prefer, she doesn't deliver at the hospital (only at the birthing center), so if I needed a hospital birth, she wouldn't be an option.  I could go with the CNMW group, but i'm less excited about that, though they can deliver at the birth center or the hospital.

I wish i could predict the future! 

Thanks, everyone, for your thoughts! 

pixieprincss

Since a CPM cannot rely on drugs and belive in a woman's body  to birth a healthy baby as the default rather than the exception, she will hopefully focus heavily on any lifestyle, nutritional, and herbal things you can do. A transfer late in care certainly is a possibility, but the CPM is likely your best bet for finding natural ways to avoid these conditions as much as possible. Here is the story of a friend of mine that had GD, managed it with diet, and just had a homebirth with a CPM: https://givingbirthwithconfidence.org/?s=great+expectations. This is her whole story in reverse order (from birth to early PG).

SpruceGrouse

I was high risk because I had strokes in my history.  I am on blood thinners and was on them my entire pregnancy.  I may not be good with advice because I am in Scotland and birth is handled by midwives here.  Because I was high risk I had to have an OB involved with my prenatal care who was a sort of advisor for the midwives in charge of me.

Because I was on a high dose of blood thinners they had induce me at 40 weeks using cervidil in order to make sure I could get blood thinners out of my system first, this was an important safety step for me.  So I had to compromise my natural birth a bit.  They didn't give any IV meds which was nice.  I had to have a heplock for safety.

During labor I had a midwife with me the whole time, I didn't see the OB until pushing.

Because of my dangerous history, I had to allow them to monitor me a bit, I was still free to move around how I wanted.

I think that it would be ok to talk with midwives about your risks and perhaps they could  work with your high risk doctor as well?  Sorry I don't have good advice, it is different here to begin with.  All I'm saying is that I did it with a midwife but I had to make a few compromises for safety.

SarahinMD

I would think any midwife would transfer you if problems developed. My midwives are backed by an OB. My BP started creeping up towards end of pregnancy, but lab tests were always normal. As a precaution, was put on magnesium sulfate immediate after my daughter was born. Not fun, but otherwise birth was totally healthy and normal.

Treatment for GD and pre-e will start along natural routes anyway, prob. (diet), and only real cure for pre-e is delivery. I second the recommendation that you look into Brewer diet, also be very serious about some light exercise, at least a half hour, each day. To be honest, I followed Brewers diet until late in my last pregnancy (I got lazy about it), and that's when BP started creeping up.

Personally, as much as I'd have loved a homebirth (and honestly, if I'd gotten in better shape before conceiving, it would have helped) given the BP creep at the end of pregnancy, I'm glad I delivered in hospital. We did nearly all labor at home, so it wasn't like I was in there for hours. SO...you can definitely have a natural birth and be conscious of all those factors. And a midwife will make sure you have whatever support you need. In my case, even when BP went up, I never had a DR come in--midwife consulted and care for it. Had need for DR come up, midwife would have been present along with them.

CDMay2006

Thank you all for your input!
I've looked into the brewer diet and i'm a little confused, but if I understand it right (i'm vegetarian, so the modified version), i pretty much follow it already (though it's gotten harder recently as food mostly makes me gag), and for exercise I at least walk 30 minutes a day (moderate pace), plus a few gym sessions (jogging and weights) every week, so i'm ok there.
The MW consults with an OB (i have not met him/her), so she has medical support (without requiring me to see an OB).  I had not thought about the other option -- that i'd continue to see her for general care and delivery and see an OB to manage specific risks.
Thanks, again for your responses -- it's a lot to think about and I appreciate your thoughtful input.