Post # 1
I found out I’m pregnant the other day, yay! Darling Husband and I are overjoyed, but it seems surreal. I know we’re very early at about 4 weeks 2 days, but I guess it’s time to line up a midwife and what not. I’ve been looking through the directory of my state’s Midwives Association and have streamlined some options for Darling Husband and I to talk about. I also got Ina May’s Guide to Childbirth today and am reading through the bit on choosing a caregiver. I have a list of a million questions, although I’m going to move states before the baby is born so in some ways this is a “practice run” in finding a really great midwife.
But I’m hoping some of the Midwife bees (I know I’ve seen you, I just don’t know who you are specifically) and some of the Mama bees who were cared for by a midwife / had a home birth can help me out. I have a few questions about logistics that I don’t quite understand, and I have a few “experience” questions.
1) OB or Midwife First? So I don’t have a regular OB right now (moved here in the last year, and I’ve actually always preferred the care at Planned Parenthood). I assume I’ll need to get one of those too. Should I try to find an OB indepdently now, or should I choose a midwife and then ask her if she recommends anyone. Frankly, I’m nervous about a negative OB being a jerk about my opting for a midwife-assisted pregnancy. Thoughts?
2) Maybe a dumb question, but how do I get an ultrasound? I’m not sure we really need the early ones, but we would like a gender scan for large abnormalities and gender around 18-20 weeks. What is the logistical process for this? I guess perhaps I’m still a bit fuzzy on the overall intersection of backup doctor care and primary midwife care?
3) Is it ok to ask for a discount since we’ll move states in the third trimester and not birth with this midwife? If so, what is a reason per cent reduction?
4) I’ve noticed a few bees mention that they had a negative experience with their midwife. I don’t remember who it was, but two bees mentioned that they had ignored red flags that suggested their midwife might not be the best care provider. If you had a bad experience please share your personal experiences of what indicators I should look for for a poorly engaged midwife.
5) If your midwife was awesome – what was the moment you *knew* she was the one you wanted?
Thank you so much in advance for taking the time to answer!
Post # 3
Second, there are a whole bunch of OB offices with midwives on staff (mine is one!). So if you need both, you might want to consider a practice like that, where your OB will strongly support your decision to use a MW/have a low-to-no intervention birth!
Post # 4
I only have a midwife, I don’t see an OB at all. For my annual exams I still see a midwife. In my area there are only two practices of midwives so the choice was pretty easy.
Your OB or midwife will refer you or conduct the ultrasound when it is the right time. You don’t need to do anything.
If you have insurance why would you ask about a discount? I’m asusming you don’t have insurance?
I love my group of midwives. There are some I like more than others, but I LOVE going to a midwife vs an OB. The experience for me has been completely different. So much more personal and personable. I’ve never waited more than 5-10mins for my appts and each appt typically lasts 20-30 mins. They ask all kinds of questions and encourage me to ask as well. I just feel like a time slot with an OB and like a true patient and person with a midwife.
Post # 5
@Mrs.LemonDrop: Congrats on the pregnancy!
I used a midwife practice in a hospital, so I didn’t interview and select ONE specific midwife. There are five in the practice and they rotate being on-call just like most OBs. They work within the hospital as well, so the admission process and associated screening tests are all within the health system. I had all the routine bloodwork, ultrasounds, etc that I would have had even if I saw an OB.
To answer your questions as much as they apply:
1- you can go through your primary care provider or gyn to confirm your pregnancy with a blood draw (some do, some don’t) and to get suggestions for a midwife. You don’t have to start with an OB to be referred to a midwife. Honestly, I’d start with your insurance above all else, since many services are probably covered.
2- u/s are ordered by the provider. Depending on your age and other risk factors, you may get a nuchal translucency (NT) scan which is done around the end of the first trimester. Some do a dating u/s as well, or a viability scan for those who have had multiple MCs or other issues. The anatomy scan is done about midway through, and then if you go past your due date they’ll do a Non-stress test which also does a u/s to check your placenta & amniotic fluid.
3- I’m not sure about this one, since I went through my health insurance.
5- I requested that I be scheduled with each midwife in the practice at least once during my pregnancy so I wouldn’t have a stranger in my crotch on the big day. I felt like I ‘clicked’ personality wise with a few more than others, but as a whole I would have been ok with any of them. My favorite one was the one who had started the practice and I just had a warm, inviting, supportive, and encouraging vibe from her. It was a good fit, just based on our interaction at my appointment. Luckily, she was the one on call when I went into labor!
Post # 6
My method won’t work for you if you want a non-hospital birth, but I picked a group of midwives that work out of an OB/GYN office. They have access to all their knowledge/resources and deliver at a hospital, but so far I am still getting the more natural-birth focused, individualized attention midwives are known for. There are two of them, and I alternate between them for every appointment so that I can get to know both. Whichever one is on call when I go into labor will be the one who delivers. What I looked for when I first met these women was if they seemed kind, positive, and supportive of my primary goals (no epi or c-sec). I totally realize I may not achieve my goals, but it makes me feel better knowing I have someone who wants to help me try!
Post # 7
1) I think it depends on the care that you want to receive and the type midwife you want certified nurse midwife or a certified professional midwife? Do you want to deliver at home ultimately and have all your appointments with a midwife either in her office or in your home? Or do you want to deliver in a birth center or hospital? In the US, generally you can see a midwife in her own practice, at a free-standing birth center, or within an OB practice that is part of a larger health system or hospital. Plenty of people just go with midwives and never see an OB unless there is some kind of complication. If you want a mix of both, I’d seek out an OB practice that also employs midwives. If you only want a backup OB who you could see ONLY in the case of an emergency, I’d definitely see the midwife first and go with her recommendation about who should be your backup and when you should meet him or here.
I should say, this all might depend on where you live. In my city, there is only one hospital-based OB practice that also has certified nurse midwives. CNMs are not allowed to do home-births and this hospital only has CNMs working in them, not CPMs. CPMs do exclusively homebirths as we no longer have a free-standing birth center. To start, I just call the offices of those care providers are most convenient to you and fit the description of what you’re looking for as far as the type of care.
2), 3) These all depend on who you hire, how you plan to pay – out of pocket or insurance? I cannot have a midwife at all – my insurance does not allow me to deliver at the one hospital in town that has CNMs and no insurance companies in our area cover a homebirth.
Post # 8
I guess I should add that insurance isn’t a deciding factor here. I have a high deductable for 100% insurance so I’d pay about the same price either way.
@kenziemt: Thanks. Here, I basically have options of CNMs who work in a local hospital system. (Although I’m not fond of the system for several reasons unrealted my pregnancy) or I have CPMs available in private home-based practices. We have no freestanding birth centers here either, which is what I would have probably chosen.
Post # 9
How far do you live from the nearest hospital with advanced capabilities? If you’re pretty close by, and could be easily transported in the event of an emergency, then maybe check into the home-birth midwives. If you live in the middle of nowhere, and the nearest hospital doesn’t have any emergency capabilities, you may be better off looking into something closer to or in a major hospital.
I will say, having had a hospital birth myself, if your midwife is on board with your birth plan and is supportive of your goals and views on interventions, then you should be ok. I also had two doulas to support me and my husband, so if something were to come up my husband would have felt supported and empowered enough to be an advocate on my behalf if he needed to be.
Post # 10
@DaneLady: Well, right now I’m living less than a mile from a major hospital and less than 15 minutes from several others.
But like I said we’re moving states in the summer. While we’re not sure exactly yet (waiting on phd offers for DH) all of the options are major cities – Pittsburg, Boston, New York and DC. As soon as I get the Michigan care stuff figured out and we accept an offer, I’ll start working on the new options. But without knowing where we’re moving and what insurance we’ll have at the end (moving states constitutes a “life change” and our BCBS policy is tied to Michigan residency apparently) I can’t actually worry about birth care yet per se. (Obviously that’s shit because I am working on it, but can’t make any final decisions without more information.)
Post # 11
@Mrs.LemonDrop: I moved to a new state mid-pregnancy and had midwife-led care throughout.
During the first part, I saw midwives at a hospital-based practice and we paid per appointment. I looked online to find a midwife to transfer to at our new location, and finished the pregnancy through a freestanding birth center. (Ended up transferring and actually giving birth in the backup hospital, but my midwife was still my provider and I was able to go med-free, etc.) Your midwife at your present location might be able to help you connect with a midwife wherever your end up – you can also look on the MANA website for resources in your search.