So I am very newly pregnant, but have known before I got pregnant that I will be having a home birth. My parents and the three people that we have told keep asking me when I will be going to the doctor. I try to explain that my midwife is who I will receive my care from, although it may be different in their eyes, it is plenty sufficient. One of them actually told me that she thought that having a natural birth put much more stress on the baby.... I don't feel like I need a doctor to confirm my pregnancy, I know I am pregnant and so does my midwife. We may go for a fun ultrasound, if we want to know the sex of the baby, but i do not need to see my baby every couple of weeks. Well there was my vent, is anyone else having this problem?
Re: Am I missing something?
Doesn't this sort of thing vary widely by midwife? It's my understanding that some homebirth midwives do not provide these services and are not capable of doing these tests.
I think you have a very skewed view of what OB/GYNs do... and if your midwife really just has a conversation with you every month, that's not enough.
You need to be tested for blood type, and maybe your DH if you are negative, to know ahead of time if there is Rh incompatability. You should also be tested for STDs, anemia, any clotting disorders... there are plenty of important things that doctors (and midwives!) can learn from standard blood testing done in the first trimester. It's not just about confirming pregnancy.
You need the glucose tolerance test later in pregnancy to find out if you have gestational diabetes. Your urine should be checked at every appointment for protein, as it is an indicatior of preeclampsia.
OB/GYNs don't do ultrasounds at every checkup. Some only do 1 anatomy scan at 20 weeks (and this is NOT about finding out the gender, it is about making sure baby is healthy so that if something is wrong, the correct specialists are in attendance at the birth to help the baby if needed). I will have 3 total - one to date the pregnancy at 8 weeks because my cycles are long, 1 elective for the nuchal translucency test, and the anatomy scan at 20 weeks. My doctor is not there to just show me my baby every couple of weeks...
I'm in no way saying that your midwife isn't going to provide you enough care. It's very possible that she will do all these things and you just don't know it yet. But proper prenatal care is the same whether you see a midwife or an OB.
Ditto! I saw midwives for both of my pregnancies, one was a practice that also included OB's but I never saw them, the other was a home birth midwife and I had all the tests I needed.
To the OP...you will hear lots of ignorant comments about home birth if you choose to share your plans. It's an unfortunate part of the birth culture in our country. So many people think that anything medical must be good and haven't bothered to look into it so they just repeat (incorrect) things they've heard or believe. I personally LOVE modern medicine, but I didn't want it to be part of my births unless it was absolutely necessary
I go back and forth between trying to educate people and just completely ignoring them depending on how receptive they are. I like talking about my HB experience especially because I feel like if I hadn't heard people talking about their experiences, I might never have had mine. Knowing that "real" people did home births and not just crazy hippies made it seem like a possibility for me too.
wow. lots of misinformation in some of these responses.
a MW can either perform all necessary tests herself, or write a referral to a laboratory that can perform them, then send her the results, which she will then interpret and provide adequate care or refer a mama to someone who can.
unless a medical need develops, there is no inherent need in pregnancy to ever be seen by a doctor. lab workers who draw blood and test for various things are not doctors. they are lab technicians. their only job is to draw the blood and test it and send the results to a qualified medical provider, whether that is an OB or a MW, it doesn't really matter. both are trained to interpret and provide the care (or referral for care) that is appropriate. not all OB offices are equipped to do this either. many of them will send you to...gasp, the exact same laboratory that MW mamas visit (i know, i was sent to the same place by my OB in my first pregnancy and then by my MW in my second).
if you know you have no STDs, there is no need to retest. the GD test is not 100% necessary. there are other ways to determine whether you/your baby are at risk or whether you need to be on a GD diet or whether you need additional care beyond her scope of training. a good MW can lead this discussion and help you decide what is right for you. many of the standard tests that are routinely performed in the obstetrical model of care have symptoms or warning indications that are simply overlooked b/c of the rush of patients in and out. in this environment, it is much easier and more reliable to test for them rather than to observe for them. this notion that only tests are adequate prenatal care is grossly misled. in the midwifery model of care, the condition of the mama and the baby is largely gained by observation. you can't observe adequately in a 3.7 minute conversation...especially when 2 of those minutes are spent with your face down in a folder of notes.
I have had care by a number of midwives and two doctors during my two pregnancies. frankly, my MWs did a LOT more with me at appointments than my doctors did. my OBs took urine samples, weighed me and spent 3.7 minutes talking to me. my MWs spent an hour talking to me. they got a much better assessment of what was going on in my pregnancy.
OP - join the club! you will hear a lot of this. you have two choices: either advocate for yourself and for the many other voiceless women who choose homebirth as a viable and SAFE alternative to hospital birth, or keep quiet about your plans.
Yes, yes, yes. all of this.
I saw a midwife and had all the standard blood tests, ultrasounds, pee tests, etc. not sure how different it is in the US. The only real difference I can see is that my midwives really explained the tests to me, and most were optional and my choice (ultrasounds, gestational diabetes test, etc.)
They are trained in normal births. It was explained to me in my first appointment that if anything came up during my pregnancy that would make me high risk, I would need to be transferred to an OB. They would still assist with my care and be present at the birth if I wanted.
This. OP, please confirm that your midwife WILL do these tests (or send you to a lab to have them done).
~~~ EDD for Baby #2 6/28/15~~~~
if you believe this is necessary, clearly you have no idea what a midwife does. unless there are issues beyond the scope of a MW's training (in which case you should not be under the care of a MW anyway), there is no need to see a doctor at all.
being pregnant is not inherently a medical condition requiring the care of an obstetrician. if that is how you choose to get your prenatal care, that's great. but know that is a choice, it is not necessary.
Ditto...that kinda made me LOL what are these "precautions" you speak of.
My sister's appointments with her OB are literally over in 3-5 minutes where every appointment I've ever had with a midwife has been 30-60+.
If you desire a homebirth then go for it. Just keep in mind that lay midwives differ from certified midwives. Certified midwives are nurses who have gone through extensive training and are qualified to do prenatal care and checks and deliver "low risk" home births. However, if you have a lay midwife, these people have only taken a class and are not medical professionals at all. They have no actual medical training. This is where people run into trouble. They are NOT qualified to deliver a baby nor provide prenatal care. Stay away from these lay midwives. I am an OB nurse and I support women's choices to have homebirths with midwives, just make sure they are certified and not lay midwives.
not exactly true either.
there are different types of certified midwives. not all are nurses. and just because your midwife is not also a nurse does not mean that she is not competent to provide prenatal care or attend your birthing.
i suggest anyone who is unclear about what a midwife does or what her education is go to this site and read the definitions: https://mana.org/definitions.html.
Please do this before you spread more false information about midwifery! there is already enough bad information out there!
Uh, for what? "Precautionary reasons" isn't very specific. Not necessary at all.
Amen!
CNM = Certified Nurse Midwives
Most CNMs are part of OB practices, but do their own prenatal, deliveries, and post-natal care. They can also be part of free-standing birth centers. All are trained through the medical community - nursing school with a masters or advanced degree in midwifery. They have privileges to delivery at hospitals or their own birth centers and can do all the same testing and requirements of an OB/gyn minus the surgical parts. They follow a plan of midwifery care, which is different than OB care - it basically looks at child birth as a normal process and supports a woman medically and emotionally (look up "Midwifery Model of Care" to get full definition).
OB = Obstretrician Doctor/Surgeon
Obviously utilized for most higher risk births and are generally the doctors first thought of for pregnancy. They can do prenatal, deliveries, and post-natal care and obviously are also surgeons. Deliver in hospitals. Some OBs can also view child birth as a normal process that doesn't need a lot of intervention, but historically they see mostly high risk or intervention cases in training and practice so can get a slightly different viewpoint.
Direct Entry Midwives
Midwives that do Homebirths can be CNMs (yes, same as in hospitals with same training), CMs, CPMs, DEMs, etc. There are a lot of certifications and this website can help you distinguish the level of training somewhat: https://mana.org/definitions.html. But all midwives who deliver at home are licensed (usually by your particular state).
Most midwives who do homebirths prefer to be called just midwives or direct entry midwives, but all have extensive training for low-risk births (and some have even attended higher risk births also). Each state decides what can/cannot be attempted at home and licenses midwives for direct entry. For example some states allow VBACs ( vaginal birth after C-sections) at home and some don't. It depends on the level of training and privileges as to what they can do. Most can draw/send you for blood work and some can also send you for ultrasounds/scans - it depends on their certifications. Most cannot prescribe meds and need to refer you to a CNM or OB for that. They too follow the Midwifery Model of Care.
Hope that clears up some misconceptions - basically a low risk birth candidate can use any of the 3 styles of care for their entire pregnancy. It's just a preference for the low-risk mother to decide which level of care she likes best.
...baby #3 is here...
I'm really surprised by a lot of these responses. While some of it may come from misunderstanding of what both midwives and OBs do, it's also important to note that midwifery is a state's rights issue (absurdly, imho...). Therefore, some posters may be speaking accurately for what happens near them. Not all midwives have the same training, certification, and licensing. Nor do they all offer the same services. If the original poster is getting the care she needs from a midwife, she doesn't need to see an OB concurrently at any point in her pregnancy. In fact, where I am, concurrent care can cost an OB his insurance if care is provided beyond 22 weeks. So it's hard to find an OB willing to do this beyond that, and many won't do it at all if they know you'll not be delivering with them (since insurance payment is often a bundled package). Where I am, licensed midwives are able to test urine, send out lab work and order ultrasounds, just like at a doctor's office. We do have a few renegade homebirth midwives who aren't licensed. I'm not sure what their practice entails, as I've never worked with one.
Just continue to educate your family, sm. In the end, their opinion matters not at all.
NorCalMOMS bio* NorCalBOTB* babywearingBIO
Harmony Doula
Oh well, if that's what you would do...
For what it's worth, my MWs' office is actually in the same office as the OBs. Never once did I see a doctor, nor was it recommended that I do so. God willing it will be the same this pregnancy.
You obviously are operating under limited knowledge on the topic of MWs.
Goodness, there are a lot of misconceptions about midwifery flying around in this thread. Looks like a few people were able to clarify and clear things up though.
Deviating in any way from the norm makes people nervous. They'll ask silly questions or be fearful on your behalf because they simply don't know any better. Telling people you are having a home birth can be an opportunity to share and inform-expect a lot of questions every time!, otherwise you can just keep your plans to yourself, or only those closest to you. If your family has concerns try giving them some direction about where they can go to learn more about what midwifery care and home birth really mean.
When I first told DH I wanted a home birth he was under the impression that meant we were going to have the baby out in the barn (never mind there are no barns remotely near us), but now he will brag openly about our home births and makes a point of correcting anyone or offering them resources to do their own research on the subject.
Home Birthing-Breastfeeding-Cloth Diapering-Baby Wearing-CoSleeping-Delayed/Selective Vaccination Mama to Charlie (5yrs) and Madeline (21mos)
My wife went through this with some folks. However, she is pretty strong and has no problem telling people they are entitled to their opinions but she's entitled to ignore them as well. This isn't midwifery in the 1600s, it's 2012 with all the technical advances of it. My wife also took the time to time the drive to the hospital, in rush hour, in the event that we have to transfer. When people freak out about it, she has that info to supply them with. I have watched her diffuse potential bombs simply by being able to say how long it will take to get to the ER if we need to. You are fine, don't need to see an OB (also, I know our insurance doesn't cover concurrent care so we would have to pay OOP if she did that), but you do need to know some things. Your risk level, Rh factor, family history of diabetes (not necessarily GD), family history (a thorough one), basically everything you would take to an OB office.
Does your MW do home births?
No
Up until recently (long story) I was going to a CNM who worked with an OB and also did home births. She did all tests, with the exception of ultrasounds, in her office. Now I'm seeing two CPMs in a birth center and they do all tests, including ultrasounds, in office. They have an ultrasound tech that comes once a month for those who need it. I've never seen an OB and have had the same amount of tests and medical procedures that i would with an OB except those that I have specifically opted out of. Obviously things vary state-by-state but where I'm from all types of midwives can offer home births and any medical testing necessary for a low-risk pregnancy.
I didn't see a Dr. at all during my last pregnancy. Totally unnecessary.
This post is very odd for this board. Usually posters are pretty informed here.
This thread is just proof of how many mom's are so horribly misinformed about the North American health care system. If you take a look at statistics (which are ALL available online, varying between countries and state to state) you'll find a lot of fact that contradicts the whole "doctor is safest" misconception.
To the OP, I'm sorry you have been made to feel like you have to defend your decisions to your family/friends (and on here too!). When I announced my pregnancy, (baby #2) I was extremely lucky that my husband, parents and family members are on board 100% for my homebirth plans and me getting my prenatal care from a midwife. It wasn't until I went to the "homebirth information night" run by my local group of midwives that I saw how many moms-to-be are met with such negativity from who should really be main support roles. I can't imagine! I watched the documentary "The Business of Being Born" when it first came out, which is what started me on the journey of "hmmm, that makes so much more sense!" before deciding to have another baby. Maybe get your parents and friends to sit down and watch it? It answers so many questions, and addresses those that find midwives to be "not enough" for your prenatal care. It should at least open up more of a conversation!
The info night my husband and I attended concentrated on the safety concerns most people have when going into a homebirth or having a natural birth, and a lot of mom's attending found it so reassuring. Maybe your midwife runs something similar? I live in Canada, so things are a little different here (though, not by much!) but midwives do all the same tests during pregnancy as an OB/GYN and have all the same "clearance" in hospitals etc. Having done the OB/GYN and hospital birth experience once before, I can hands down say that my midwife experience so far has been far more stellar then with an OB.
Good luck with everything, and keep us posted!
Delbride2012- are you asking about HBs bc you are looking for a rec for a HB MW in Chicago? If yes, PM me.
I had an OB hospital birth with Ds and never ever would have considered a HB. Then I did more and more research until Dh and I decided that a HB was right for us the 2nd time around. I can't tell you how different my care has been this time, and I've only had 2 apts. One time with Ds my OB didnt even realize I was pg. I was 8 mos along!!! She didn't know me or take the time even to read my chart before asking me questions about my period. Awkward. Now, I have my MWs cell number and we've texted about some small questions I've had. The amount of care is crazy different. Oh, and they tested my urine and sent out my blood work already.
Before I got pregnant I was interested in HB; right now I'm firmly on the hospital birth side, but I am questioning the assumptions that made me change my mind. So, probably not for this birth, because my understanding is that HB is a better option for second-time moms, but I may be interested again in a couple years!
Huh? A Certified Nurse Midwife (CNM) and a Certified Professional Midwife (CPM) are both certified. Now, who they are certified by and the requirements of that certification vary. It sounds like you understand the CNM qualification, but maybe not the full implcations of the CPM qualification. This is quite a normal misunderstanding since CPM guidelines vary by state and certifying authority plus not all direct-entry midwives elect to be certified (which would thus mean that they are not a CPM, but rather just lay midwives).
Yes, a CNM has mainstream, medical and hospital training and additional schooling on top of a nursing degree. But a CPM certified by a high-quality organization should also have plenty of logged hours of both medical knowledge and hands-on time. It is a different educational path (and yes, fewer hours), but not NO educational path as you've asserted.
A CNM must (in my state) work in affiliation with OB whereas a CPM does not. For me, that freedom that a CPM has makes all the (positive) difference in the world. My MW actually is both a CNM and a CPM, but she doesn't use the CNM part of her credential because the CPM gives her more power to practice in an autonomous way that is the best fit for her, albiet in my state CPMs cannot administer any medication even if their educational background and credential has prepared them to do so.
More Green For Less Green
In addition to the providers already mentioned, don't forget that Family Practice docs also deliver babies, usually low-risk cases, or high-risk cases with OB backup.
General good prenatal care, by any provider, should include:
-discussion of current problems/questions/issues & education on pregnancy, labor and delivery
-the taking of a thorough medical history including ob/gyn hx, etc.
-reliable & prompt medical management of any conditions that come up during the pregnancy (severe nausea/vomiting, dehydration, influenza, UTI, etc....)
-measurement of blood pressure and weight at each visit
-initial assessment for anemia, blood type, and immunity or non-exposure to things that can cause serious complications (rubella, hepatitis, HIV)
-periodic screening of the urine for glucose, ketones, protein.
-appropriate screening for gestational diabetes
-offering of blood tests/ultrasound combo to assess for genetic defects, if patient/family are interested in these things or have +family hx
-referral to a higher level provider if the patient is at anytime identified as high risk or develops an unusual problem
BFP #2: m/c at 7w, February, 2014
BFP #3: It's a BOY! Please be our rainbow! Due February, 2015
*everyone always welcome*
I admit--I didn't read all the replies
But--from what I read, there's a lot of misinformation on both sides--or rather, good info on both sides because: There are different kinds of midwives. Every state licenses midwives differently and there are different levels of licensing and training. Your midwife may be a nurse practitioner who can do pretty much everything an OB's office could do. She could also be a direct entry midwife without the training and licensing required to do these things. She could be somewhere in between. So ask her, and if the common tests you see others having performed and know are usually performed (like bloodwork, etc) aren't going to be part of her care, look to your options to supplementing with an OB if you feel you need to.
For me--I have seen two midwives over the course of my pregnancy, both CNM (certified nurse midwives) who took care of all my tests and care. At the practice I'm with now, the midwife is affiliated with an OB, whom I met because he's the go-to if there's an emergency. But this is in no way a necessity of working with a midwife!