I am hoping to use a midwife and give birth at home (given that I am healthy enough..will find out at my first checkup). I also want to use an OBGYN for all lab tests, sonograms, and for back up in case I can't give birth at home. How should I go about bringing this up? Should I just keep my mouth shut until later on?

I ask this because I called a doctor that I was told was affiliated with the local midwives in town, and when I asked if it was the right doctor, the receptionist wasn't sure and didn't seem to want to say anything. They said they would have to speak with the doctor and call me back.

Is there a # you can call to speak to an actual midwife? It might be best to start with her and see what dr. she is affiliated with.

here (ontario, canada), I just went with the midwife (hating my dr. and all)...they are qualified to perform most of the tests, like the PAP nastiness, or they fill out the required paperwork and send you off for whatever needs doing, if you consent to it...you generally have the right of refusal and my mw was good about it all....they should also be able to draw all necessary bloodwork. You may want to ask your mw about their transfer of care policies.

I think CNM's (certified nurse midwives) can do all the needed tests. i went with a group that is affiliated with a local hospital so of needed, there was always an OBGYN as back-up. It might be nice to find one that can do the tests since thats what alot of your visits consist of.

Also in Ontario - My midwives have admitting privileges at two hospitals: I gave birth in a hospital due to being 2 days shy of 37 weeks.

Well, I have a meeting with the midwives on the 16th, so I will find out what I need to do.

I feel so torn because I want to deliver at home, but I have insurance that covers almost everything. It costs nearly $2000 for the midwife service. That's not too bad, I know, so I am going to try to balance it out.

**so anxious!**

I'm not sure how things work where you are, but you might be able to put it on a payment plan if you ask your mw.....my sister did that when she had her last baby (in Alberta)....so it might be an option.

I did all this research (insurance/payment related) prior to just going with my ob from my last delivery. If I had gone with a midwife, using a birthing center rather than a hospital, the insurance would have only covered a small portion, b/c they'd consider those services "out of area." So one way I thought about rationalizing the expense . . . I never had the full-blown wedding experience. Childbirth is an experience like that. You want to remember it always as something you did "right," not only for your well-being and your baby's well-being, but because, when you ask a woman, "What is the one moment you would live over if you had the chance," often it is just that - the birth of a child. It is worth that extra expense, I think.

Of course, I meet with my OB from last time, I was happy with her and her expertise and she convinced me things would be better this time. I am determined that they will.

Some of these words are very reassuring. I am going ot go to an OBGYN in addition to using the midwifery service. I have medical insurance through work, so I might as well take advantage of it. The doctor I am going to is one that the midwives recommend. It is not their primary back up doctor, but 2nd or 3rd in line.

The way I rationalize it is to use an OBGYN for the physical aspects of being pregnant, and using the midwives for the mental and spiritual aspects. Women I have talked to,t hat have used the midwives, say that most of the time doctors don't really care if they are the ones assisting in delivery. They are more concerned with your prenatal care.

I figured with the costs of their services (and they do set up payment options), I would ask family and friends to make a contribution to the midwife fund, whatever they can give.

it's all about to become really real.

Austin has weird laws, VERY weird being that Austin is a liberal town. Midwives are not allowed to assist deliveries in the hospitals.

On my first OB appt. I expressed a bunch of concerns. Some of the biggest ones were that some of the tests they administer give false positives and as a patient, I wasn't adequately informed. I was completely covered for my first pregnancy insurance-wise so I was like, "Hey, why not? It's free." But tests like the one done for Downs Syndrome gave me a false positive, so I was concerned, even though I kept telling myself I shouldn't be.

I opted out of a lot of the tests this time, only doing what was absolutely required. What it boiled down to is most *all* visits except the very first one and the last month or so are -

weight
Blood pressure
pee in a cup
check baby's heartbeat
"Do you have any questions?"
"See you in a month/two weeks"

Seriously. When the visits become weekly, they are all about cervical exams, as is the first visit (where lots of blood is taken, too - about five vials - and various tests are run).

Just be sure you are comfortable. You can always switch if you have doubts along the way. Don't let anyone convince you otherwise.

The thing about OBs is, they're SURGEONS. They are trained in worst-case scenarios, and have a hard time, I think, trusting that everything in most women's births is generally going to go fine. Humans don't really NEED episiotomies, or inductions, or (dare I say it?) pain-relieving drugs. Yes, sometimes drugs are helpful to an individual woman, and sometimes (SOMETIMES, not nearly so often as a doctor recommends them) an induction is, in fact, medically indicated. But mostly, research has shown that ANY medication or testing offered in labor is likely to send a woman down the slippery slope that ends in c/section: major abdominal surgery that has enormous risks and impact on both the birthing woman and her baby. One in FOUR pregnant women in the U.S. now have c/sections, a much larger percentage than anyplace else in the world (except, maybe Brazil, from what I've heard) ... and clearly, if the human race REALLY required that kind of intervention to perpetuate itself, we'd have been a dead species for millenia.

Not to say that some c/sections aren't truly necessary. But in this country, way more are done because a doctor wants to get home to watch "the big game" or, more often, wants to cover his ass in case of a malpractice suit. Did you know that OBs have the highest rates of being sued for malpractice of any medical specialty?

Remember that doctors' malpractice insurance as well as hospital protocols drive the way they practice medicine, largely. They're going to suggest tests which, as has already been mentioned here, are MUCH likelier to give you false positives (say there is a problem when there isn't) than false negatives. And if you're in any kind of high-risk group, or even a wisp of high-risk, they're going to push tests in a very big way. Trust me, because I was 38 when I got pregnant the first time, it spun us into a hellish series of tests, many of which have their own risks which the doctors minimize.

Nobody's done a definitive study on whether ultrasounds have any negative effect on babies, didja know that? ULTRASOUNDS, for god's sakes, which pregnant women have routinely without ever thinking they're any more dangerous than, say, peeing in a cup! Ultrasound results are almost never perfectly definitive, and the weight "measure" is up to 10% off every time -- how many women do you know who've been cajoled into inductions or c/sections because of "big babies" that turned out to be only 8 pounds or so? And just having an amnioscentesis can create a miscarriage ... plus, the amnio itself has only a VERY limited range of information which it can give you definitively, again, sending you off in a fear cycle and torrent of further testing, none of which has a perfect capability of reporting what they're testing for.

*sigh*

Sorry to rant, but can you tell this is a big hot-button for me? I spent the last half of my first pregnancy in constant fear that I'd have to be flown halfway across the country for emergency fetal surgery because of a problem they saw on my baby's first ultrasound. I had, if I remember correctly, seven ultrasounds, and ended up birthing my baby 70 miles away in the nearest university medical center ... and he was fine. I wasn't: I was badgered into an induction, and it ended in a c/section.

It takes a LONG time for many women to recover from c/section, and it's not necessarily the outer scars that are the worst of it. My DH and I very seriously considered never having another child after the first. (Our second snuck in when we weren't being perfectly careful, or I'm not sure there would have been a second, because we were seriously considering DH having the Big Snip.)

Anyway, I'll stop ranting now and conclude with my best advice: if you want a midwife and a homebirth, then find a midwife who you can trust and TRUST HER. You'll get better prenatal care, FAR BETTER, from a midwife who will likely spend 30-60 minutes with you in each visit (an OB visit is lucky to last ten minutes); she'll do all the urine testing that you get in an OB office; if she thinks you need further testing, she'll know how to get that for you from a doctor who's less likely to bully you.

Don't let yourself get scared or bullied. And even more than you trust your midwife, trust yourself. Trust your own body to do it's work. In the end, when you're holding your beautiful baby in the privacy and comfort of your own home, surrounded only by people you love and trust completely, you'll be SO glad you did.

Luci

You said a lot of truths there!

I just heard from an old friend whose wife is due around the 20th and they scheduled an induction for this THURSDAY!

"the baby's been estimated at 8 lbs. and 'A' was 2 cm. dialated and 50% effaced last Monday... So, we went ahead and scheduled an inducement date although the doctor anticipated that she would go into labor before 3/11."

Where and how does anyone get an estimate of baby's weight inside your body? And since when is 8 pounds outside the normal range for delivery?

YES! Just because a DOCTOR recommends an induction or ANY test for that matter, that doesn't mean it is medically necessary. You can say no. You can do your research and say no, and half the time the doc while come back and agree that their are risks to the procedure or false positives in the test results, but only after you have expressed your doubts.

Yes, I worked at a medical board and very few ob/gyns haven't been sued for malpractice at one time or another.

ask your midwife who they use for back-up. chances are, they use one practice for back-up/transport. when i was pregnant with my first i used my (insured) ob's and paid a midwife. complications (typically high blood pressure or presentation i.e. baby in a funny position) arise in the last trimester, often the last weeks. i think it is prudent to have a relationship with your back-ups either way. if you have reputable nurse-midwives on staff at your local hospital use them. often these gals share your non-interventionalist ideals in the "safety" of a hospital setting. and its covered. if you have a lay midwife on the "outside" you will likely have to pay her, but usually in installments (being paid in full by 36 weeks) but she will usually accompany you to the hospital and be there to advocate for you if and when you go. $2000 is good! my midwife was $3k! and, oh yes, most importantly, congratulations!