Natural Birth

switch to midwife at 37 weeks???

I have been set on a natural birth from the get go, but I love my OB (whom I've seen since I turned 18) and kept seeing him for all my prenatal visits. I have/had the idea in my head that as long as everything is going well for me and baby, I'll stay home as long as possible, and head to the hospital (10 minutes from our house) with just enough time to push baby out and no pressure for any interventions. Lofty dreams, I know.

Well I finally got around to watching "The Business of Being Born" last night, and lets just say I'm now borderline terrified to go to the hospital at all, and am really considering changing to a mid-wife at a birthing center. I've realized that no matter how supportive my OB is of a natural birth, it doesn't matter because HE WON'T BE THERE until it comes time to catch the baby anyway. 

So, I know this is pretty late in the game, but does anyone have any advice for this situation. Any knowledge of possible insurance issues I may face? Ideas, suggestions? I'm sure I'm overreacting, but we don't plan to have any more children after this LO, DS's birth was induced and full of all sorts of interventions, and I really want this natural birth experience. 

Thanks in advance! 

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Re: switch to midwife at 37 weeks???

  • Maybe a good compromise would be to find a doula instead of switching. If you like your OB and he supports your decision, the doula will offer the support you appear to be looking for. My only concern with switching so late is that you may not have time to fully figure everything out.  

    If you still want to switch, the first call you should make is to your insurance. Ask them if they cover midwives or birth centers. If they do call around and see if you can find one that will take you. If they don't you should figure out whether you still want to do it, as plan B find a doula. 

    I live in IL where birth centers are illegal, but my insurance does cover delivery by certified nurse midwives.  

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  • I switched to a cnm at 37 weeks and was very happy with her.  If you love your OB (I didn't - that was my big problem), why not talk to him/ her about your concerns?
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  • I tried to switch from midwives who deliver at a hospital to an off-site birthing center at 36 weeks but was told it was too late. They said they set a cut-off at 34 weeks because it's important that they get to know the mom, and vice versa, before the birth.
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  • imagegwendolynclare:
    I switched to a cnm at 37 weeks and was very happy with her.  If you love your OB (I didn't - that was my big problem), why not talk to him/ her about your concerns?

    This. I had a great hospital birth experience with DD. I talked to my OB about my desire for a natural birth ahead of time. She was very supportive, and she WAS there throughout my labor. For example, when I dilated from 1cm to 4cm on Cervidil alone (I was induced due to being 42 weeks), she let me labor on my own for a while to see if contractions would pick up without Pitocin. And later, when I had been laboring hard for a few hours on Pitocin, she walked in and asked if I had been in the shower yet -- because we had discussed my desire to labor in the shower during my prenatal visits. Ummm, no, I was hooked up to a Pitocin IV, fetal monitoring, etc. She told the nurses, "Take her off of all that. Let her get in the shower." So I did, for about 20 minutes. And then it was back to the Pitocin and EFM... but that was the break I needed to get through with no pain meds.

    Funny, months after DD's birth, I was talking to a local doula who was complaining about how the OB of one of her clients had pushed Pitocin on her during her labor. Yep, it was my same OB, who was totally supportive of my desire to avoid Pitocin. So I know that natural birth wasn't her "default," but a simple conversation with her ensured that we were on the same page and allowed her to support me in the way I needed.

    So, at 37 weeks, my first suggestion would be to talk to your OB about your birth preferences. You might find that he's more supportive than you think.

    If you find that he's NOT... no, it's not too late to switch. I switched to homebirth at 36 weeks with DS. My midwife was unfazed; she takes transfers at 42 weeks when OBs start pushing induction, so she considered me to be an "early" transfer Wink

    Mommy to DD1 (June 2007), DS (January 2010), DD2 (July 2012), and The Next One (EDD 3/31/2015)

  • imagegwendolynclare:
    I switched to a cnm at 37 weeks and was very happy with her.  If you love your OB (I didn't - that was my big problem), why not talk to him/ her about your concerns?

    This. I had a great hospital birth experience with DD. I talked to my OB about my desire for a natural birth ahead of time. She was very supportive, and she WAS there throughout my labor. For example, when I dilated from 1cm to 4cm on Cervidil alone (I was induced due to being 42 weeks), she let me labor on my own for a while to see if contractions would pick up without Pitocin. And later, when I had been laboring hard for a few hours on Pitocin, she walked in and asked if I had been in the shower yet -- because we had discussed my desire to labor in the shower during my prenatal visits. Ummm, no, I was hooked up to a Pitocin IV, fetal monitoring, etc. She told the nurses, "Take her off of all that. Let her get in the shower." So I did, for about 20 minutes. And then it was back to the Pitocin and EFM... but that was the break I needed to get through with no pain meds.

    Funny, months after DD's birth, I was talking to a local doula who was complaining about how the OB of one of her clients had pushed Pitocin on her during her labor. Yep, it was my same OB, who was totally supportive of my desire to avoid Pitocin. So I know that natural birth wasn't her "default," but a simple conversation with her ensured that we were on the same page and allowed her to support me in the way I needed.

    So, at 37 weeks, my first suggestion would be to talk to your OB about your birth preferences. You might find that he's more supportive than you think.

    If you find that he's NOT... no, it's not too late to switch. I switched to homebirth at 36 weeks with DS. My midwife was unfazed; she takes transfers at 42 weeks when OBs start pushing induction, so she considered me to be an "early" transfer Wink

    Mommy to DD1 (June 2007), DS (January 2010), DD2 (July 2012), and The Next One (EDD 3/31/2015)

  • I would talk to your OB about your concerns as the first step.  Hire a doula as the second step. Have you toured the hospital and know their policies? That can make a big difference in feeling comfortable. While you may still be able to switch, you may not because birthing centers and MWs may only take so many patients per month and may not take you on without ample time to assess you and build a relationship. We made our hospital vs. not decision at 34 weeks--36 was the latest we could switch to the MW practice. Ultimately, we decided to go with the more natural-friendly of the two hospitals we toured and hired a doula. I have had 2 vists to L&D already and have been happy with their responsiveness to my desires. Not all hospitals are created equal and they do not deserve automatic vilification. I think BOBB is a great movie to help people expand their options, but don't let it take the place of a relationship you've been fostering with your doctor for many years and have otherwise been happy with.

  • I watched BOBB also and felt the same way. I looked into our local birthing center and it's $3800 total from beginning of pregnancy to end. They do have payment options but stated that I would probably have a hard time getting my insurance (which is pretty good) to cover any if part of it.

    So that being said I decided to talk it over with my OBGYN, stay at home as long as possible, make sure my DH knows what I want, and read up on natural ways (Ina May Gaskin's Guide to Natural Childbirth) to get things going and avoid interventions. If I had more $ right now I'd probably look into getting a doula as well. As long as you stick to your wishes and don't cave and have a support person to help you should be fine in a hospital.

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  • I would start with calling your insurance company and asking them. There's no way for anyone here to know what possible insurance issues you might face as insurance varies so greatly.

    Did this OB you love deliver your DS? If so, talking to him about your concerns may or may not help- as you said, he won't be there till the end anyway and if thinks you need X intervention, which could be open to interpretation anyway, or just wants to get the show on the road and gives you an episiotomy or doesn't want to sit there while you push for 2+ hours, as I said, talking him about it now isn't going to do any good.

    I was an L&D RN for 3 years and even the attitude with "birth plans" from patients to some of the nurses was really sad, the nurses would scoff at them. Sad Not all nurses and some entire units are wonderful, that was just my experience.

    If your insurance is OK with it, your next step is find a midwife willing to take you on. I was set to deliver at a hospital but with midwives and even that worried me about interventions, because I am still in a hospital where there may be certain guidelines or standards of care that the midwives have to abide by. 

    So I just switched to a birth center and new midwives at 31 weeks- however my first appointment isn't until I'm 34 weeks. I didn't have to call my insurance company and ask permission because it's changing after the first of the year anyway! I just know the birth center takes my insurance.

    I would make those calls asap before LO decides to come!

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  • My friend switched to a midwife at 39 weeks.  I know this isn't how it's normally done, but her doctor wanted to induce her and she didn't want to be induced.  She found one through her doula.  We are still deciding between hospital and home so we have decided to interview doula's first and then midwives (based on their rec's) to see if we can make a decision.
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  • I tried to do this at 36 weeks because my OB was set on an epi and did automatic c/s for 9 lb and over babies. My mom had my little sis at 10 lbs with no meds so it was something I wanted to try.

    I looked around and the only person that would take me this late, was the lady from "the business of being born!" She was really nice and I didn't know about this movie until I was telling DH that this lady would take me but it was a home birth...and when I told him her name, he said that she was the doc they used. She was super nice.

    Unfortunately, my insurance won't pay for a non hospital birth so I decided not to go with her. I ended up at this practice with OBs and midwives with the hope of having a midwife deliver me since if you are ok with it and she's the person working that shift, she can deliver you. The OBs were supposed to be supportive of women's choices with med free deliveries too but I got a lecture about how I should consider an epi at my first appt since pain doesn't make it any better.

    Fast forward to yesterday, I started having contractions and we were in snowmaggedon in NYC so I decided to just chill at home and not call the doc since my car was stuck in snow, and there was 28 inches of unplowed snow on our streets. The contractions were pretty intense and my water broke late at night. When we got to the hospital, I was 5cm and quickly moved to 10cm, but I ended up with an OB to deliver. She was awful, it was my first baby so pushing was a new experience. After 45 mins, she got mad and left the room and made comments like "she'll never get the baby out, we're going to do a section, etc" I had no support from her but the nurses were nice. After 1.5 hrs of pushing, my baby was born and the OB quickly sew me up with no meds (was if she  thought that an epi is equiv to lidocaine) and then she left, I haven't seen her since. Baby and I are doing well, but my hubby was getting mad at the way she treated me, and she didn't let him cut the cord.

    The point of my story is, that I didn't think about paying out of pocket for a homebirth. I would have much rather birthing at home or a birthing center, and seeing that the prenatals were done through insurance, I am sure the delivery costs wouldn't have been too much. Although things went great for me and LO, I wish I didn't have to have the experience I had with this OB. So when you do decide if to switch, please consider everything! Honestly I am going with a midwife the next time, and now that I have some experience up my sleeve, I think we will be better prepared. Good luck!

  • You have an OB you like and trust. Why have you not discussed your preferences with him yet? I would not feel comfortable switching providers so late in pregnancy. If you make sure you discuss what you want - and don't want - with your doctor, and he is NB-friendly, you are likely to get the birth you wish.

    That being said, most OBs just show up at the end. Most important is your birth partner being knowledgeable about what you want and asking for a NB-friendly nurse when you arrive in labor. If you get a nurse who gives you a problem, ask for a different nurse.  

  • I'm looking into switching from my OB to a midwife at a birth center. My insurance doesn't cover it as in network but they partially cover out of network. Even though its more out of pocket, I feel it could be a great choice.

    I hope it's not too late for you to switch. Good luck to you and if you can't switch, I agree with the other posters. Get a doula, I hear they really can make a huge difference. 

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