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Natural Birth
danuli8
member
Over-40 parents...what we lack in vigor, we make up for with cunning.
Intro and question--ob vs. midwife (sorry, long)
danuli8
member
I have actually posted in a few threads in here without introducing myself, which is rude, so I thought I'd do a proper introduction before asking my question. I am expecting my first child at the ripe old age of 41 with my 44 year-old husband. We have been married 18 years. We were going to have kids 5 years ago, but just as we were going to start trying, I had a TIA (small stroke). I was not overweight, not a smoker, not sedentary--it was a bolt from the blue, possibly exacerbated by stress. A three-day hospital stay found only a PFO (it is so common that 1 in 4 people have this generally harmless heart defect) and a bicuspid aortic valve (the valve has two leaflets instead of three, but mine closes just fine and there is no insufficiency (leakage)). A bicuspid AV is the single most common genetic heart defect, found in roughly 1-2% of the population. I was put on 81 mg of daily aspirin and sent on my way. I have had no problems since and took up running in 2009, logging three half-marathons, two ten-milers, and many shorter races and losing 10 pounds along the way. I took Pilates classes for two years beginning in 2010 and was in the best shape of my life when I conceived.
I asked my gynecologist (whom I adore) to recommend an OB when I got pregnant. I have seen this OB three times and really like her. When I asked her how she felt about doulas and if she could recommend some, she did, so she is clearly not totally averse to natural birth. I interviewed one of these doulas on Sunday, and when pressed, said my OB is super nice and everyone loves her, but she is an OB through and through and she may start suggesting interventions sooner than I would like because she follows the medical model of managing risk, and not the midwifery model that birth is a natural, healthy process. She also said (again, at my prompting--she did not volunteer this) that at the last birth she attended with my OB, the patient ended up getting a c-section that the doula felt was unnecessary. This gave me pause. Basically, I wondered if I should switch to a midwife to have a better chance at a natural birth, but I know that midwives only handle low-risk patients. I'm afraid no midwife around here will take me on given my age and history, and I don't want to burn bridges with my OB. As I said, I DO like her, but I am afraid that when push comes to shove, she might get on me about failure to progress or throw me into an intervention spiral that ends in a c-section. I know that if I am allowed to take all the time I need, I can do a natural birth--and if I do decide to get an epi or whatever, I want it to be MY decision, not someone else's.
I see my OB for my 20-week appointment on Monday. I thought about just looking her straight in the eye and saying, "I have decided to go natural. Barring a true medical emergency, no induction, no pit, no epi, no c-section, laboring in the tub and on the birthing ball, walking around as much as possible. Are you comfortable with a 41 year-old stroke victim doing that, or should I find another doctor?" What do you guys think? I would really appreciate some advice.
UPDATED Mon 11/19 4:30 PM: I had my 20-wk appointment with the OB today and told her about the doula I hired (who is very pro-NB) and she said, "Oh, good, she's really great." I then said I wanted to bring a rough draft of my "Birth preferences" (since I agree that the term "birth plan" is kind of an oxymoron) to my next appointment so we could review it together and see if there was anything that needed to be revised. She was OK with that too. I said that I had done a lot of reading, given it a lot of thought, and that I really wanted to go natural and felt confident I could do it. I mentioned I was looking into hypnobirthing and how I thought it could help me relax, and she actually said that a lot of problems in labor crop up because people are so tensed up and stressed out, so it would be a good tool to help me. In short, she didn't say I was crazy, and she didn't make fun of my choice or say I shouldn't do it. She was actually pretty supportive! I think I was just overreacting earlier. So it looks like I will be going for a natural hospital birth, but with my doula, the tub, my DH, and hypnobirthing to draw on, I feel I am setting up the best possible conditions to succeed. I really appreciate everyone's advice, especially those who thought I was foaming at the mouth a little bit. (I think you were right.)
Over-40 parents...what we lack in vigor, we make up for with cunning.
This discussion has been closed.
Re: Intro and question--ob vs. midwife (sorry, long)
I don't think OB always equals unwanted interventions - it sounds like you are educated about your options and aren't afraid to speak up for yourself - that goes a long way.
If you are interested in a midwife, you might see if there aren't some who do take high risk patients. In my area, there are two hospital based midwifery practices (and you see only the midwives unless there are complications; they have backup docs but aren't a part of an OB practice). They do take some high risk patients that say the local birth center midwives will not.
If I were you I might poke around and see what the options are - your OB doesn't have to know that if you are worried about her reaction. There may also be other OB options that would suit better. I think it's also worth saying that while your doula may be right...she may also be wrong in her assessment - might not hurt to see if you can get some other opinions on this OB for a more balanced picture.
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My advice would be to explore your options. It never hurts to just look around and see what your options are. It definitely sounds like you're interested in exploring the option of a midwife so I'd find out who is available in your area and just start by seeing for sure whether they would be able to attend your birth or if you're too high risk for them. If they are able to help then I'd meet with them just to see what you think.
As far as your current OB I would ask A LOT of questions to try to gauge just how truly natural birth friendly they are. The important thing for me isn't whether someone is an OB or MW, but rather what their theory on birth is. I would definitely want to go with a provider who viewed birth as a natural process rather than someone who feels the need to control everything and jump right in with interventions.
It sounds like you have an idea already of how you would like your labor and delivery to go. I think you're right about just being upfront about what you want with your OB. Better to find out now what their thoughts are on your plans than waiting til the very end. You definitely want to be on the same page and be able to trust in your provider's opinions.
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Ok, so I've underlined some things you said that I want to touch on. First, you mentioend that you've seen the OB several times and like her. That's an important thing to keep in mind. Also, she seems like she is willing to discuss your birth plan and to hear you out. More good points.
Next, the doula you interviewed said the OB will follow a more medical approach to managing risk. What else would you expect? They are a medical doctor.
This is not a bad thing.
The doula felt the c-section was unnecessary? Did she go to medical school? I'm guessing there was no way for her fully comprehend the reasons behind the doctor's decision for the c section.
And finally, you said that if you are allowed to take all the time you need, you will have a natural birth. Unfortunately, this is not always the case. You could labor for days, and make no progress, and you and the baby's life could be in danger. See what I mean?
Bottom line- you have to feel comfortable. If you like this doctor, and she agrees with your plan and agrees to help you be successful, great! But remember- her job is to make sure you and the baby are healthy and survive the birth. I'm sure she would like to see you get the birth experience you want. But if it means the baby is in danger, I would hope you would opt to let the doctor make a decision as to what's best.
I am a proponent of natural birth. I had one, and I am so grateful. It was not easy, and having gestational diabetes made it even more difficult. My son was having a hard time through the contractions. It was scary. If at any time my OB had said "This baby needs to come out NOW, we're going to the OR" I would have trusted her.
I would love to see every woman who wants a natural birth have one. But the reality is, some aren't good candidates for it, and some need to be just a tad bit open minded enough to see that a)it's not the end of the world if it doesn't happen, and b) the bottom line is- everybody wants a healthy baby, and sometimes you have to compromise what you want in order to get that.
Not all OB's are created equal. I'm actually switching from a midwife to an OB because the OB is more supportive and educated in natural birth practices than the midwife that delivers at the hospital of my choosing.
I would actually approach things without detail. In this case I would ask your OB leading questions to hear her thoughts on topics before showing her how you feel. Sometimes it seems that a doctor will bend their truth just a little in order to keep a patient. Perhaps saying things like "So some women on a pregnancy forum I visit were talking about going past their due dates, is this something that comes up often and how do you handle it?" Similarly styled questions about how long she'll let you labor and other things you have strong feelings about might reveal how she'll respond during the actual labor/birth.
Honestly, this sounds very confrontational. I think you should ask questions, research other providers, ect, but I would not go to your next appt and say all this. You really can not predict what will happen with labor and delivery. It almost seems like even if there is an actual medical reason for some intervention, you might blame the OB. That being said, you want to trust your provider. I would try to ask lots of questions to find someone you are comfortable with. Good luck.