Need advice on OB/midwife (sorry, long)

mcatmay · May 2011

I mentioned to you ladies that i'm moving this coming July to Gaithersburg (just closed on my new home yesterday!). Well, i switched to Capital Women's Care and had my first OB appt yesterday so they could get to know me for more than a month before birth. I liked the doctor's bedside manner a lot (Dr. Rangnath) and the fact that he was quite direct when asked a question but, after we discussed that i'd like a natural birth and asked what the C-section rate was, it was obvious he wasn't a fan of my plan and explained the C-section rate was 30%!!! He justified it by saying that it was the national average (it is), but then i saw that numbers of C-sections went sky-high from 2000 to 2007 (only numbers CDC has), increasing by 53% in MD.

Long story short, i'm not comfortable with getting a c-section unless absolutely necessary (obviously there's NO WAY i'd put my LO in jeopardy and if it's what needs to happen, then that's what will happen) and i'm not sure whether to a) switch OBs, b) get a midwife or c) stay the course. I'd love some advice on other OBs and their c-section rates or any recommendations for midwife practices. I found this midwife practice:

https://www.midwiferycareassociates.com/index.html

Midwifery care associates that does in hospital delivery and works with Simmonds, Martin and Helmbrecht practice. Anyone know whether they're good to work with? Any other recommendations?

Sorry for such a long post - just really unhappy right now and trying to figure out what to do next. TIA!

hollace · May 2011

Can I ask why it was obvious he wasn't a fan of your plan? I find that most physicians are pretty straight shooters when it comes to patient care so it may be that he just had a matter of fact attitude. Or it may be he really didn't like your plan As for rates/risks, yes, you are always going to get quoted the national average, it's just the easiest way to explain the odds. The fact that you liked his bedside manner has to count for something though. I know nothing about that practice, but overall if you want a natural birth you should be able to make that happen (again, given that unseen events do not present themselves) in any institution. It looks like in 2007 the c-section rate in MD was about 33%, roughly the national average. (yes an increase of 53% over a 10 year period from ~21%-33%):

https://www.cdc.gov/nchs/data/databriefs/db35.htm

This is definitely a go with your gut situation. However, you are a little short on time. I personally feel that so long as they understand that you do not want a c-section unless medically necessary then you should be fine. The other key is to make sure your husband is there and able/comfortable to be your advocate. If he isn't comfortable to be able to state your desires (as you'll be a little preoccupied) then maybe look into a doula or another friend/family member that can help with that. Likewise, if you make your desires known to your L&D nurse they will also work on your behalf.

WinesNot Whines · May 2011

I had a natural/med-free birth at Holy Cross Hospital in Silver Spring with an OB from a different CWC office. It went very smoothly and no one ever questioned my plan. I took a childbirth class, read a lot of books, and hired a doula, so I felt prepared. My OBs were totally on board with my plan. Are there specific things that your OB didn't like about your birth plan? Or was it just a general feeling you got? I went in with a specific list of preferences (like no routine IV, I wanted to be able to move around, intermittent fetal monitoring, etc.) and we talked about each one.

DCtoLowcountry · May 2011

I delivered DS with Midwifery Care Associates, who I would recommend, and I'm ashamed to say I don't even know their c/s rate! I think your experience is typical of providers (I'm including OBs and midwives) who quote the national rate for c/s. In my experience providers may be skeptical about med-free childbirth not because it can't be done, but because they want you to stay flexible for all the options.

I also had a doula and would recommend one for continuous labor support. Even with a midwife I was glad to have that support. GL!

mcatmay · May 2011

Thank you for the input, ladies. To answer some previous questions, the reason i think the OB wasn't on board was because of his reaction to my bringing up a natural birth plan. Like i said earlier, he was wonderful and both DH and I were sitting in his office, having a conversation, but when i brought up the whole natural birth option, starting with, "I'm not married to any one decision but i really would like the least interventionist birth possible", his face changed. You know that eyelid flicker people have when they suppress an eye roll? Ok, i know, it's not a lot to go on but DH picked up on it too. Then, his nurse, who saw me afterwards, was explaining to me why they used Holy Cross rather than Shady Grove and (again, she was fabulous in every other way) laughingly said, "you know, all those mothers who think they want to have a natural birth until they actually get there, well, they scream when they get to shady grove because the anesthesiologist is not DIRECTLY on the floor 24/7, he's just on call" (as opposed to Holy Cross). And, last but not least, when i asked the OB whether they routinely induced, he said 'not unless it's medically necessary". So i asked him whether they let women go to 42 weeks - and, in a slightly garbled/shocked voice, he replied, "No, No! Never 42 weeks - there's no way we'd go past 41 weeks". He replied that they used US to guide them to the size of the baby (another ding) and by the end of it, i had no confidence in any of the process there. Did i dig in my heels and state what *I* wanted? Nope. Maybe i just need to do that - but my confidence in one of the docs that could be there just plummeted.

I know it sounds silly re-reading it - i was just hoping to find someone more in line with my thinking. But you ladies are right - at the end of the day, i am responsible for my body and i just need to speak up and make my voice heard. I don't want to be intransigent at all and i DO plan to be flexible - i just don't want to end up having an induction or a c-section because it's just 'what's done' in that practice.

mssaint · May 2011

I hoped for a med-free birth at Holy Cross (but after PPROM, they induced me and i ended up with a c-section). My OB, another CWC office, had no problems with my plan, though.

Actually, I am really happy about my experience with them, even though it turned out pretty much opposite of what I wanted. They let me labor for almost 2 days after my water broke because the baby was fine (although they wouldn't budge on monitoring, which I was fine with because it was 4 weeks early). Nobody pushed an epidural on me - I made the decision for the epidural 8 hours into the induction/16 hours into labor. Even when it came time to decide on the c-section, my OB said he'd let me continue to labor overnight as long as the baby stayed healthy on the monitor. At that point, it had been 41 hours and I was exhausted and hadn't progressed past 5 cm in 12 hours, so I decided on the c-section. As it turned out, the baby was wedged into my pelvis and the OB had to basically plant a knee on my chest to wrestle LO out. I would never have delivered him vaginally.

Anyway, I felt very empowered and like they took my desires seriously. I do commend you for doing your research, though. I never even asked about the c-section rate!

WinesNot Whines · May 2011

I don't blame you for being concerned after having that conversation. I wouldn't be happy either. Women can and do have med-free births all the time. I don't know anything about the midwifery practice you mentioned, but I can recommend my OB practice - the CWC office on Georgia Ave. in Silver Spring (Drs. Band, Resta, Sine, Lizardo, Tyau). They didn't push any unwanted interventions on me and they didn't question my birth plan at all. They were totally fine with everything. I also highly recommend hiring a doula.

tomandcourt · May 2011

mcatmay:
Thank you for the input, ladies. To answer some previous questions, the reason i think the OB wasn't on board was because of his reaction to my bringing up a natural birth plan. Like i said earlier, he was wonderful and both DH and I were sitting in his office, having a conversation, but when i brought up the whole natural birth option, starting with, "I'm not married to any one decision but i really would like the least interventionist birth possible", his face changed. You know that eyelid flicker people have when they suppress an eye roll? Ok, i know, it's not a lot to go on but DH picked up on it too. Then, his nurse, who saw me afterwards, was explaining to me why they used Holy Cross rather than Shady Grove and (again, she was fabulous in every other way) laughingly said, "you know, all those mothers who think they want to have a natural birth until they actually get there, well, they scream when they get to shady grove because the anesthesiologist is not DIRECTLY on the floor 24/7, he's just on call" (as opposed to Holy Cross). And, last but not least, when i asked the OB whether they routinely induced, he said 'not unless it's medically necessary". So i asked him whether they let women go to 42 weeks - and, in a slightly garbled/shocked voice, he replied, "No, No! Never 42 weeks - there's no way we'd go past 41 weeks". He replied that they used US to guide them to the size of the baby (another ding) and by the end of it, i had no confidence in any of the process there. Did i dig in my heels and state what *I* wanted? Nope. Maybe i just need to do that - but my confidence in one of the docs that could be there just plummeted.
I know it sounds silly re-reading it - i was just hoping to find someone more in line with my thinking. But you ladies are right - at the end of the day, i am responsible for my body and i just need to speak up and make my voice heard. I don't want to be intransigent at all and i DO plan to be flexible - i just don't want to end up having an induction or a c-section because it's just 'what's done' in that practice.

Yikes. That would really make me nervous, too! Not just their reluctance but their snitty attitudes. The midwifery practice you mentioned is Rockville has gotten good reviews on this site. If you'd be into it, there are also a couple of birth centers (one in DC and one in Alexandria).

mcatmay · May 2011

Mssaint, it sounds like you had a really GOOD experience (well, besides the really long labor and exhaustion ;-) You were an active participant in the decision making process and that's what matters at the end of the day....that's pretty much all i'm looking for.

Wines, thank you for the recommendation - they will be another practice i call on monday to get more information. It sounds like you also had the type of experience i'm looking for. I'll look into seeing if a doula is affordable for us or not but i know i'm interested in following up on that if it's financially doable for us.

At the end of day, i want to trust my doctors to take my opinion into account, no more, no less... and i hope that they will guide me into making wise decisions!!! I, by no means, pretend to know it all but i do know what my comfort level is. Thank you again for the advice!!!

Mrs.Handy · May 2011

If you were in VA, I would totally recommend my practice Physicians & Midwives. It's in Alexandria. They were very natural birth friendly and the default is for your baby to be delivered by a midwife unless there are complications. I loved all my midwives. I had a med-free birth at Inova Alexandria and I labored at home with a doula for as long as possible as encouraged by my midwife.

Our doula even complemented on my midwife and how amazing she was. She was with me practically the whole time I was pushing (3 hours eek!) and really got me through it. I'm convinced if I would have had an OB, they would have never let me push for that long without an episiotiomy, c-section.

Definitely consider it if you are willing to travel a little.

Other than that, definitely find a place you are comfortable with and hire a doula if you stay with an O.B. Also labor at home as long as possible. I got to the hospital when I was 9.5 centimeters dilated so basically all I did was push there.

WinesNot Whines · May 2011

I also recommend laboring at home as long as possible. I was 6 cm when I arrived at the hospital. I could've lasted longer at home, but my husband was freaking out a little by that point.

Mrs.Handy · May 2011

WinesNotWhines:
I also recommend laboring at home as long as possible. I was 6 cm when I arrived at the hospital. I could've lasted longer at home, but my husband was freaking out a little by that point.

Lol. That's funny. DH was the one discouraging me, telling me that I should wait a little longer to go to the hospital....

I told him, no, it's time to go. Listen to the pregnant woman! I knew it was time.

JKM416 · May 2011

I can't speak from much experience, but I've had one appointment at Midwifery Care Associates so far, and it's what I'm looking for. My DD was born with a civilian OB/midwife team (but was induced and had a pretty standard hospital birth, but the experience was a good one). DS was born through the military system and I hated everything about it. So my experiences are all over the place (but both were med-free), and with this third one I was committed to finally getting the birth I most wanted - hence going with both midwives and Shady Grove (because I'm hoping to use one of the labor tubs). I believe that they used to operate as a separate midwife practice with an independent birthing center, but it was closed and so they joined up with the OB practice.

I was impressed with the midwife we met with and what seems to be their hands-off, low intervention style and that they let you go to 42 weeks (with monitoring). As far as I could tell, the midwives also stay with you a lot more during labor to help you through it, whereas the typical OB stops in every few hours and then shows up at the very end, and you're left in the hands of the nurses the rest of the time. C-sections are definitely not their default solution to any little thing that could be construed as a problem or risk.

Good luck - I hope you find a good match. I had underestimated the importance of having your OB be "on your side" and well-versed in your wishes, because I was very frustrated with how I was treated while in labor with DS and felt completely ignored and talked-down to. If you're not getting good vibes from this other OB, switch...and I think midwives are a great option.

mssaint · May 2011

mcatmay:
Mssaint, it sounds like you had a really GOOD experience (well, besides the really long labor and exhaustion ;-) You were an active participant in the decision making process and that's what matters at the end of the day....that's pretty much all i'm looking for.
Wines, thank you for the recommendation - they will be another practice i call on monday to get more information. It sounds like you also had the type of experience i'm looking for. I'll look into seeing if a doula is affordable for us or not but i know i'm interested in following up on that if it's financially doable for us.
At the end of day, i want to trust my doctors to take my opinion into account, no more, no less... and i hope that they will guide me into making wise decisions!!! I, by no means, pretend to know it all but i do know what my comfort level is. Thank you again for the advice!!!

That's exactly how I felt -- that I was an active participant. I actually have no regrets about my birth experience (although I had a really easy and quick recovery, so my experience was probably better than a lot of people). I also felt like a participant throughout my pregnancy. After 28 weeks, I got GD, and then PIH, so I became high-risk. I was on bedrest from 32-35 weeks. Especially through all of that, the practice took the time to explain things and listened to my concerns.

I go to the same practice as Wines. I like all of the doctors, but I love Dr. Lizardo (who I saw through the bedrest/PIH weeks) and Dr. Resta (who did my c-section). I also love Dr. Sine, who was a great resource postpartum. A few other bumpies go to them also.

umdbride · May 2011

sorry I'm super late and haven't read many of the other replies, but I used Midwifery Care Associates in White Flint and loved them. I was like you in that I wanted a natural birth, but I wasn't married to it considering I had no idea what labor or contractions would feel like. Everyone at MCA was great for all my appointments, lots of dialogue, no question was too simple, etc. The only midwife I didn't care for was Nina because she was more pro-testing and interventions and I felt she was dismissive and sometimes defensive to some of my questions about those tests. But, she was brand new and I only saw her twice early on in my pregnancy and all the other midwives say she's gotten much better since then. I ended up having a natural birth with Karen and Dusti in attendance and it went better than I hoped for. When I got to the hospital I was saying I wanted an epidural my contractions hurt so bad and I was only 4cm, but with their help I did it without any meds I'm still a little amazed myself! Also, i LOVED that the midwives were there as soon as I was admitted to the hospital vs. the OBs that get there when you're crowning.

GL to you, having a doctor or midwife you feel comfortable with means so much!

DCtoLowcountry · May 2011

I just wanted to add that although I loved delivering DS with MCA and would recommend them, I didn't have a midwife with me throughout labor. There was another MCA client delivering so Sharon (who's now retired) split her efforts. I was really glad to have the doula. OK, end of my commercial - GL again!

umdbride · May 2011

DCtoLowcountry:
I just wanted to add that although I loved delivering DS with MCA and would recommend them, I didn't have a midwife with me throughout labor. There was another MCA client delivering so Sharon (who's now retired) split her efforts. I was really glad to have the doula. OK, end of my commercial - GL again!

oh true! I forgot a lot of the details already Embarrassed I think I was lucky and there wasn't anyone else in labor. Also, Dusti just got her privileges transferred to Shady Grove that morning so she needed to do 3 observed deliveries and mine was her first at that hospital. Karen was technically observing but I kind of got 2 for the price of 1 Wink

mcatmay · May 2011

You ladies are SO cool!!!! Thank you for all the responses, all of them have been incredibly helpful - i didn't get to call the midwife practice or the silver spring CWC practice today yet (one of those workdays where you remember you haven't had lunch at 4pm) but it is on my list for tomorrow. I will keep you guys in the loop as to where i end up going but the recurring theme from everyone is to switch if i don't feel comfortable and i just think it's the right thing to do. You all have seriously been a wealth of information - can't thank you enough!!!

iamrobyn · May 2011

I just delivered at Shady Grove under the care of Dr. Simmonds. We started out with the midwives (MCA) but when we found out we were having twins (@22 weeks) we had to move over to the OB side of the practice because of the higher risk. We liked the midwives for the time we had them - I'd recommend checking out one of their open house sessions for Q & A. It was really helpful. We were disappointed we couldn't remain in their care but felt we got excellent help and support from Dr. Simmonds. He never discussed c/s with us beyond making sure we knew if it was a medical necessity it would have to happen. Our babies were head down since February so we all just assumed it would be a vaginal delivery and it was.

cookiemonster82 · May 2011

I'm late on this but I wanted to reply.

I had an unmedicated labor/delivery with MCA. We started out at Simmonds & Simmonds, but eventually switched over to the midwives. Chris (who has since left the practice) was my midwife and she was wonderful. I'm now pregnant with DS2 and using MCA again. They have gotten a few new midwives since my first pregnancy... I believe Angel and Karen are the only ones I knew from before... but my experience so far has been positive. The only one I worry about is Nina. I saw her post partum with DS and she didn't seem as confident and comfortable as the others. Anyway, I highly recommend their practice.

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