Conference moira::parenting

	One difference is that if you go with a midwife, you should be committed
	to natural childbirth (ie. without pain medication).  Midwife assisted
	births may not put you through such "standard" procedures as an IV
	hookup, shaving, restricted movement during labor, epistiotomy etc..  
	I would think about the type of birth experience you want to have, 
	and base it on that.  Some hospitals have birthing rooms where they 
	try to take on some of the positive aspects of a midwife-assisted birth, but you
	still have ready access to medical equipment if you need it.
		Linda

    	I had a hospital birth performed by a midwife and not only was I
    induced but I also ended up having an injection, an epidural and an
    episiotomy. Never once did I question her competency and I felt so very
    confident of my midwife that I would not even hesitate to do it that
    way again.

    	I think that it is a common misperception that midwives do not
    allow medication or anything other than biting the bullet. My midwife
    was very compassionate, did not belittle me for taking medication when
    I couldn't take the pain any longer. (in fact, she was almost relieved
    that I was going to get some relief).

    	Even though I ended up pushing for 2 1/2 hours, my midwife was
    there the entire time. I've heard lots of stories about Doctors coming
    in at the last minute just to deliver the baby.

    	Having seen some of the things I've seen, and having heard some of
    the stories I've heard, midwives are the way for me.

    	But never the less, whatever *you* decide is the best choice for
    you.

    				Wendy

    
    
    I also belong to an HMO, Harvard Health, and was recently offered the
    choice between a midwife and an obstetrician for my third pregnancy and
    the subsequent birth of Simon.  My first two children were cared for
    and delivered by doctors, and I had a good experience with the second.
    (The first was mediocre at best).  However, I elected to be under the
    care of a midwife for Simon, and I am still astounded at the
    difference.  It was mainly in the level of care, both for me and my
    pregnant state.  The midwives I saw spent far more time with me,
    upwards of half an hour on many visits, and answered all my questions,
    however peculiar.  They also are much more open, it seems, to any birth
    decision you might make, and encourage written birth plans for hospital
    use.  
    
    To give an example, I was some 17 days late in delivering Simon, way
    passed the stage usually permitted.  I did not want to be induced, and 
    as long as I watched very closely, and underwent the required testing,
    I was not pushed into an induction. (My previous child was similarly
    late, so I had some history of this).  Also, I was permitted to drink
    juice and forgo the joys of an IV in a hospital where ice chips and 
    hep. locks are the norm.  
    All in all, I think that many midwifes are more relaxed and much more
    caring.  Some may also have attended many more births, as had the one
    who finally ushered Simon into the world. 

    My wife and I had an Obst. for our first and a Fallon mid-wife for our
    second.  My wife would take the midwife again in a second.  She was
    very pleased with the attention she got with the midwife as opposed to
    the regular doctor, and the midwifes had a much more friend-ship based
    relationship than strickly business.
    
    If you're worried (as we were) if something serious goes wrong I
    wouldn't worry at all.  My daughter was delivered by the midwife.
    My wife was in what I thought to be a birthing room at St. V's for the 
    entire time until the baby's head was about 2 inches out and then was 
    rushed to the standard delivery room (I had thought she would deliver
    right in the same room she had been in.  Didn't really care though.)
    This was after about 6 hours labor.
    
    We weren't in the delivery room for more than 5 minutes when the
    midwife called the doctor, who was litterally 2 seconds away, to assist
    her.  After Brie was born I was told she had the cord wrapped 3 or 4
    times around her neck and she was near suffocating.  The midwife never once
    left from the time we were in the delivery room until we left that room
    and fully assisted the doctor when he had to help out.  So I wouldn't
    worry.  I forgot that particular midwife's name but they all seemed
    quite nice and very competent.  You never would have known anything was
    wrong either.  No panic from her at all. (Although I'd certainly expect
    that from any doctor or midwife.  The last thing they need is a
    panic-stricken mom.)  I could tell something was not quite right, but
    the whole thing happened so fast and Brie was o.k.  I didn't doubt for
    a moment that she and my wife weren't in the best hands.
    
    Just FYI  We live in Gardner which ended up a 35 minute ride to St. V's
    in Worcester.  (Normally 45 minutes, but it was 2:00 in the morning and
    I was a nervous dad this time.)  We could have chosen Leominster Hosp., 
    less than 15 minutes away,  but not with the midwife program.  
    Well worth the drive!
    
    (And for what it's worth both kids were born on the exact day they were
    predicted, and I was woken up both times at about 2:00 in the morning
    after about 2 hours sleep!)
    
    Thumbs up for the Fallon midwife's (and St. V's nurses too) 
    from this noter (and wife).
    
    Steve (the happy father of a 3 year old and 1 year old)
    

    I go to the Women's Health Associates in Wellesley (affiliated
    with Newton-Wellesley Hospital).  Their practice consists of
    4 OB/GYN's and 4 nurse midwives.  During my pregnancy I was
    asked to alternate my monthly visits between the OB and midwife.
    I too was very impressed with the midwives and agree that they
    seem to spend ALOT more time with the patients.  I will consider
    a midwife next time around.
    
    Instead of just scheduling one visit with the midwife, perhaps
    you could see the midwives over the next few months to help you
    in your decision.  At Women's Health, I alternated until about
    the 6 month, at that time I choose the OB and saw them for the
    remainder of my pregnancy.
    
    Be aware that not all hospitals, require some of the procedures
    that are mentioned in this string.  N-W Hospital has an entire
    wing of LDP (Labor-Delivery-PostPartum) rooms.  There wasn't a
    need to get wheeled to the delivery room last minute.  I was
    encouraged to move about as much as possible ( I think I must
    have walked several miles in the hallways during labor), no IV,
    no shaving, as much gingerale as I could handle to keep from getting
    dehydrated...
    
    Good luck with your choice, although I didn't use a midwife for my
    first child, I was truly impressed with the visits I had with them!
    
    Linda  

    I bet you could schedule an informational visit and ask all the
    questions that concern you. I did that when I switched from an
    ob/gyn to midwives, and based on the answers I got I felt very
    comfortable about it. My pregnancy and delivery were more relaxed
    and less "high-tech", which is what I wanted. However, had I needed
    an M.D., there was one right down the hall during the delivery,
    and the midwives had M.D. backups available for any problems during
    the prenatal period as well. This was at Mt. Auburn Hospital in 
    Cambridge, MA.
    
    Lucy

    Thanks for all of the replies!
    
    Yes, I'm going to research it a bit more before making a final
    decision.  They say they like a decision by mid-pregnancy though -
    which is in another 2 months for me.  My husband is going to try to 
    make it to my next 2 appts with me - my next being with my ob/gyn and 
    then the following with a midwife.  I want him to be able to meet both
    of them also and for the two of us to find out more details like the
    midwife's training and also how close a doctor will always be at St. 
    Vincent's.  
    
    I'm only about 2 miles from St. Vincent's so I'm happy about our short
    commute.  I'm also hoping to be able to get one of their 2
    labor/delivery rooms although I heard they are first come/first serve
    and the nurses at Fallon were saying there are alot of expectant moms
    due in January.  Wouldn't you know I'd choose a busy month %^)
    
    Also, I know the midwife can't do C-sections but how about episiotomys? 
    Are they more apt to spend more time with you during labor or do they
    just walk in for the "grand finale" like the doctor?
    
    Any more experiences/opinions out there?
    
    Thanks!
    
    - Barb  (10 weeks and counting %^)

    	Our midwife (she was working as much with Marc as she was with me)
    was on the hospital floor for the entire 17 hours of my induced labor.
    Although she was not with me constantly until I started pushing,
    she did come in and did hourly checkups.

    	She also performed my episiotomy. A Doctor hovered around alot
    (especially toward the end when it looked like the baby was having a
    tough time (so was I) getting out) but the midwife controlled the shots
    and I felt very secure (If you can feel secure during a first birth)
    the entire time.

    	Oh yeah, she also stitched me up afterwards, the proverbial soup to
    nuts for me.

    				Wendy

    I've had three children - all delivered by the same midwife.  This was
    the only way to go for me!  Chris (my midwife) was right there for me
    and became a real friend (especially by the third kid!).  
    
    My first delivery was kind of a mess so Chris had a doctor in the room
    with us for backup - she PROMISED me he'd only get involved if
    necessary as I really wanted her to do the delivery.  Even with the dr.
    in the room, Chris did the episiotomy, stiched me up after, etc.  The
    dr. (who is also her husband) just followed her lead.  (Actually he
    hung around with my husband while Chris and I did all the work!)
    
    My third baby was the only "normal" delivery I had (the second was only
    2 hours of labor and both Chris and I barely made it to the hospital on
    time).  The third was four hours of labor and, while Chris wasn't in
    the birthing room with me every second, she was close by and
    continually checking.  It was very reassuring knowing she was there if
    I needed her.
    
    While a midwife can't perform a c-section, two of my friends who also
    had Chris as their midwife required c-sections.  Chris was right with
    them through the entire procedure - didn't leave their sides for a
    second.
    
    Linda

    A lot depends on the practice and policy of the hospital where
    you're planning to give birth.  Beverly Hospital (in Beverly, Mass.)
    just redid an entire labor-delivery suite.  It's wonderful.  when
    I had Hollis, we went right to the room where she ended up being
    delivered (a scant 2 hrs. 20 mins. later).  I was a moderate-risk
    pregnancy, since I was 35 and was attempting a VBAC.  Although I
    didn't have a midwife, a couple of L&D nurses rotated through and
    stayed with me and Mike the whole time.  I could have, if I had
    chosen to do so, walked around, squatted for delivery, taken a
    whirlpool bath, etc., etc.  I did get Demerol, which didn't take
    effect because Holly came so fast.  I had the episotomy, but didn't
    have an IV, an enema, shaving, or any of that other crap, which
    I didn't want and felt was unnecessary at best, degrading at worst.
    
    On the same grounds as Beverly Hospital is the North Shore Birthing
    Center, which you can go to if you would prefer a midwife to attend
    your birth.  It's very pleasant and homelike.  If complications 
    arise, you're literally only a minute or two away from the hospital.
    A couple of my friends have given birth at the Center and recommend
    it highly.  
    
    This is a choice that only you and your husband/SO can make.  A lot
    depends on how nervous you are :-) and your general opinion of
    doctors. :-) :-) :-)

    Hi.  I went to a midwife practice and would definitely go back when #2
    comes along.  I disagree with .1  I was given the option of having pain
    medication at 5cm and was greatful I had it.
    
    The big difference that I appreciated with my midwife practice is the
    amount of time they spent with a patient.  The longest I waited was 40
    minutes, but if I needed it, they would spend the same amount of time
    with me.  They treated the whole self and not just the pregnancy... ie,
    they were concerned with their patient's mental and emotional health as
    well.  They were intrested in what the patient's expectations were for
    labor and delivery because they believed that could effect how labor
    progressed.  They also consulted with their physician backups who were
    always available when needed.
    
    My only experience with an OB/GYN for pregnancy was with my
    sister-in-law.  I had to take her to the doctor for an appointment once
    when her car was unavailable.  We waited 2 hours for her to see him and
    she saw him for only 5 minutes.  He was also not available for either
    of her two births and she did not know the doctors who delivered her
    children.  Also, doctors are basically there just to deliver the baby
    and the nurses do most of the work with the patients... A midwife will
    stay with you the whole time and help coach you if needed, and give you
    that extra bit of support.
    
    Mary
    

When do you start seeing a midwife? As soon as you are pregnant, or when it starts getting
closer to delivery?  

    
    
    	I started seeing our midwives from day one. In fact, I've used them
    in the past for routine gynecological checkups and plan to use them in
    the future for additional routine visits.
    
    				Wendy

    It does sound like a midwife would be a good idea when/if I have a
    second.  Do they take "high-risk" patients?  I will be considered high
    risk due to the preterm delivery of my first which makes me even more
    in need of patience, understanding, sensitivity etc.  I am actually
    scared to death to have another baby given the unexplainable preterm
    delivery of Shannon, but if I could meet up with the "right" person to
    care for me (and of course hubby who is even more scared I think) I
    would give it careful consideration.
    
    Any other premature moms go this route?
    
    beth

    Same here - I had used my midwife as a regular "OB-GYN" for years
    before I ever had kids.  She was the first person to have the speculum
    (sp?) on a heating pad so it wasn't so cold being inserted.  I loved
    her immediately!  
    
    Also, I had a mild tranquilizer with my last two deliveries - Chris
    gave it to me no questions asked.  In the state of NH she is also
    allowed to write prescriptions - this just started about 3-4 years ago,
    before that she would write the prescriptions and her physician backup
    would sign.
    
    Linda

    Beth... I think it depends on the practice whether a high risk
    pregnancy would be accepted or not.  My practice does not normally take
    high risk patients, but if the midwife practice is in conjunction with
    a doctor practice (ie, same office), then you might be in luck.  I
    think all cases would be reviewed first and then the decision made.
    
    Good luck.
    Mary
    

    Me again!  To answer a couple back:
    
    My first delivery was a month early and I had some major problems (not
    with the delivery itself just the way my body reacted to the baby).  My
    midwife turned my care over to the doctor (actually about 4 different
    doctors) but when it came time for the actual delivery she took over
    (with the dr. there as I mentioned in an earlier note).  Since they
    never really figured out what happened to me, she gave me the option of
    being with the dr. for my second pregnancy.  I chose to stay with her
    but I did visit the dr. for a couple of the regular monthly visits.  As
    it turned out, the dr. wasn't needed for either of my other babies.
    
    My friend was a VERY high risk pregnancy - diabetes.  She had the same
    midwife as me.  What she did was alternate visits - one with the
    midwife, next with the dr.   She needed to be induced and ended up
    needing a c-section.  The midwife was with her through the whole
    procedure (both inducing and section) with the dr. doing the actual
    "medical" stuff.
    
    Hope this helps.

    YEs, midwives can do episiotomies. I believe the theory
    is to avoid doing them. The midwives I went with use hot
    oil massage therapy during the pushing stage to decrease
    the need for an episiotomy. I didn't have an episiotomy
    thanks to this technique.
    
    Alice

    An earlier reply mentioned waiting a long time at the ob/gyn's
    office -- a pet peeve of mine! I used an ob/gyn for my first 
    pregnancy, and I *always* had to wait at least 45 minutes. I
    complained a lot with no result. My impression is that this is
    common. 
    
    With my midwife, the office manager would apologize if I had to
    wait more than five or ten minutes. She took very seriously the
    job of keeping the group on time. To me this was just one more
    piece of evidence that my midwife's group seemed to have more 
    respect for patients than my doctor did, in my experience.
    
    Lucy

Re .14

Beth,

I too delivered my son two months early and this pregnancy may be 
considered high risk.  But I intend on talking with a very highly
recommened mid-wife, who actually does home deliveries :-).  I don't
know if that is a possibility but it certainly can not hurt to look
into the options. 

I was so very nervous in the hospital when I finally went into labor.
The situation with Christopher was more tense as I had to go down to
Brigham and Women's in Boston (I live in NH) and didn't know any of the
doctors (um..maybe medical students) and they seemed even more 
impersonal.

If you are interested I'll keep you posted.  I plan on nine months and
a very comfortable delivery this time!

    >I *always* had to wait at least 45 minutes. I
    >complained a lot with no result. My impression is that this is
    >common.        
    
    My wife and I have been to the OB/GYN six times so far since the start
    of her pregnancy and the longest we've waited is 15 minutes. Of course,
    the majority of the appointments have been after 5:30pm. The practice 
    has three doctors and at least three nurses always on duty.
    
    Mike

    What is the cost of a midwife vs a doctor?  Having a baby can be quite
    expensive.  I am not pregnant, not for a year or two yet.  I just want
    to be and am curious about this.
    
    Catherine

    
    I just had to respond to the waiting issue.  My OB/GYN has a sign at
    the receptionist desk that says, "If you have been waiting longer than
    10 minutes, come see me."  I've never had to see her, and this is a
    large practice with 4 doctors, multiple nurses, and lab people. 
    They're great - I've never been treated this wonderfully at any other
    doctors office.
    
    Bev

    I have been kept waiting at many offices.  But, I (my hubby or child)
    have all been the emergency that holds up regularly scheduled appointments
    so I don't mind waiting so much knowing that someone else needed
    immediate attention.  Kind of puts things in perspective.
    
    -beth

What kind of training do midwives have?  I mentioned this discussion to
my husband, and he was wondering about what qualifications and training
midwives have as opposed to OB/Gyn.

Any ideas?

    RE: last
    
    I'm not sure about all places, but for a midwife to be permitted to
    deliver babies at Concord Hosp in New Hampshire, she has to go through
    the same testing as a full fledged MD.
    
    Linda

    I have a friend who is a midwife.  She had to go thru school and a
    certain number of labor assists before getting certified.  She now
    teaches birthing classes and assists in labor/delivery.  She is
    certified in MA.
    
    -sandy
    

    My midwives' group are all CNMs -- certified nurse-midwives. 
    I don't know if this is a Massachusetts or a national designation.
    It means they are RNs with significant additional training. They
    also must do classes, workshops, etc to keep up their licenses.
    
    Lucy  

    I was also told that part of the additional training is training in
    high-risk pregnancies/deliveries.  Not so they can treat it but so that
    they may recognize it and refer you to a doctor.  At least that is the
    way that Fallon handles the Midwife/Doctor responsibilities.
    
    Thanks for all of the input in this note.  I am starting to lean
    towards the midwife option although I'm going to continue asking
    questions and learning more over the next couple months ...
    
    - Barb

I asked my midwives about qualitifications, etc, the first time I considered
using one. Here's what they told me.  It's kind of like a Master's 
program that specializes in prenatal care and delivery.  Like other certification
programs, you can be certified *without* the educational background, but it is
rare.  (Like law - if you can pass the Bar exam without going to law school,
you're accepted.  But it is really hard to do, and therefore very rare.)

Midwifery is a nursing specialty.  Another one we're all probably familiar with
is the Pediatric nurse-practitioner.  They do special training in pediatrics.

I know that the University of Florida, and Rutgers (I think, maybe Princeton)
have programs for nurse-midwifery.  It's a 1-2 year program and a degree is
awarded.

Midwife certification is on a per-state basis, just like doctors, teachers, 
and lawyers.  There is reciprocity between states, and it depends upon the 
two states involved.  Some states don't recognize another state's certification.

The "other" type of midwife, the kind that is not certified and may or may not
have nursing training, etc, is called a "lay midwife".  The usual image is of
the granny midwife assisting births in rural areas, altho that's a stereotype
and unfair.  People who are not familiar with midwives usually assume that's
who someone's talking about.  

BTW, one other thing - it was only last winter that midwives could prescribe
drugs.  (I remember it; my midwife was interviewed on television.)  I
think it's a federal law, not a state law, since the three states I'm familiar
with (MA, NH, and CO) all changed at the same time.

    re: last
    
    just a nit:
    
    I haven't seen my midwife since my three year old son was born - hated
    leaving her but switch to MTHP etc, etc,
    
    So, she was able to prescribe medicine for me three-four years ago in
    NH.  I remember it distinctly because the drug store I went to to have
    the prescription filled made some kind of rude comment about midwifes
    thinking they were doctors (I don't go there anymore!
    
    So, maybe NH had a state law before the Federal one went into place.
    
    Linda

RE: -1

Yeah, maybe.  Two years ago the midwife wrote out a prescription, but it was
presigned by her consulting doctor.  And some prescriptions are for 
non-controlled pills, like some vitamins.

I'm curious.  I'm in NH, and I'll ask the midwife at my appointment next week.

Pat

    To Barb, the basenoter:
    
      I'm also due in January and will be going to St. Vincent's through
    Fallon.  I have chosen to go with the ob/gyn because this is my first
    pregnancy and I'm nervous.  My ob/gyn is wonderful, so I'll think I'll
    continue with him, even though the midwives do sound great, too.  Maybe
    I'll be braver next time...
    
      From your notes, I bet we have around the same due date, mine is
    January 30.  We may be fighting over those nice birthing rooms!  :^)
    See ya there!
    
    - Tammy

    Hi Tammy,
    
    Yes, I am due January 30th also - with our first.  They told me it was 
    going to be a busy time %^)  Since there are 2 labor/delivery rooms we
    can each have one!
    
    I too, really like my ob/gyn.  If I knew he would be there to deliver
    our baby I would probably stick with him.  My chances of getting him
    are next to 0 though (being chief of staff ob/gyn at both Fallon and
    St. V's keeps him busy - I'm sure)  The reason I first decided to meet
    with a midwife is that my doctor was in Africa for the month of
    January! 
    
    I'll let you know what route I decide to go - midwife or ob/gyn.
    
    See ya in January %^)
    
    - Barb

    Hi, Tammy--congrats!
    
    I was the first patient to use one of those birthing rooms at St. V's.  
    When I had Paige, 
    I delivered in the delivery room, but since I had requested a single
    room and there were none available, they let me use the birthing room
    which had just been remodeled, but was not yet equipped for delivery.
    They're beautiful!
    
    -Tracy
     

    
    I used the Fallon midwives for the birth of my son last October - they
    were wonderful!  One of the best things Fallon has going for
    themselves.  I think the Fallon policy is that the midwives handle the
    deliveries that are expected to be normal & healthy.  Any high-risk
    patients are seen by doctors.
    
    [For our childbirth prep classes, we went to a private class led by a
    lay midwife, who also does home births.  She was great - really making
    me think about using her next time around.]
    
    I saw the midwives throughout my whole pregnancy, and even thru the birth,
    I NEVER saw a doctor!  They handled everything.  I feel confident, that
    if a dr. was ever needed, s/he would be available (and I think the
    midwives consult as needed).  
    
    The part I liked best about having a midwife-delivery, was that she was
    there most of the time during my labor (last phase was about 2.5
    hours).  She coached, offered suggestions ( I spent alot of time moving
    around to find more comfortable positions - even ended up on the potty
    towards the end!).  She encouraged my husband to fully participate, and
    didn't get in the way.  
    
    For me, although I asked for medication towards the end, she kept
    distracting me,  since she thought I would be too tired to push if I
    had some.  I was not happy about it at the time, but understand her
    point.  She could tell that the delivery was not far off.
    Lynn used oil massage as the baby was cresting, to prevent tearing,
    and there was only a little that needed stitching (which she did).
    There was a nurse with us at all times in the labor/delivery/recovery
    room - not as nice as the LDRP ( can sleep in that one too!), but very
    comfortable.
    
    Best of luck in your adventure,
    Rachel

         Hi,

         This topic is rather current for me since my son was born July 4th and
         I had a midwife. Before my son was born it seemed to be the right way
         to go, and after the birth I am even more convinced of this.

         Besides the midwife who was with me from the minute I got to the
         hospital until the end there was also the labor nurse assisting. After
         Jonathan was born, and we waited for nursery staff to take a look at
         him etc. I chatted a bit with the labor nurse about her work. Among
         other things the topic of whether her tasks are any different in
         working together with a doctor or a midwife came up, and she said
         that it is quite different. In the case of a doctor she basically
         "ran the show" until the very end when he would come in and take over.
         In the case of a midwife, the midwife would be present pretty much the
         whole time and the labor nurse assist.

         What the nurse said made me think about my own labor and I commented to
         myself that if I had selected a doctor this nurse would have been there
         for most of the time and would have been the major person supporting me
         through labor. Listening to the midwife and the labor nurse, and their
         advice and comments during my labor I could clearly notice a difference
         in the knowledge about the labor process (and what can be done to
         ease/help) that my midwife and the labor nurse had. One particular
         incident sticks out in my mind:

         When I had been pushing for 1 hour (it was going to take 2 hours
         before it was over) the contractions started to slow down in
         frequency. My midwife observed the slow down and since she was
         concerned that loss of momentum was not a good thing she suggested
         that I gently rub my nipples to start the contractions. I tried and it
         worked. It turned out to be a great way for me to decide when to have
         a contraction, I was in complete control and could rest as much as I
         wanted in between, and then "push the button" when I was ready to go.
         Everybody there (my husband, labor nurse and midwife) saw how great it
         worked, whereupon the labor nurse commented: "That works well, I
         wonder why we never suggest that". Her comment still ringing in my
         ears while chatting afterwards, I imagined a situation where
         contractions slows down, and chemical interventions being used to
         start them up again, a situation where you probably have no control
         over speed or frequency of the contractions, and become exhauseted
         from not being able to rest in between.

         What I'm trying to say is: To me it was/is extremely important to have
         a knowledgeable person present not only for delivery but for LABOR
         itself. My own experience taught me that there are many little
         "tricks" that can make the world of difference for comfort and
         progress of labor (rubbing the nipples to get contractions to pick up
         is only one example of the things that my midwife suggested that the
         nurse did not seem familiar with). There may be labor nurses who knows
         these things too, but I would not want to gamble on what labor nurse
         was on call when it was my turn to deliver my baby.

         Another strong point for me in selecting a midwife is CONTINUITY. I
         saw the midwife for my checkups, she knew my pregnancy history and
         what the concerns had been throughout (low weight gain, low blood
         count). Another very important point to me: I got to know each other,
         she knew my wishes regarding the labor and delivery (things like pain
         relief, positions etc), since we had had plenty of time to talk at the
         prenatal checkups. Also, she came to see me and Jonathan twice at the
         hospital during my 2 day stay, and once we arrived home, she called to
         hear that everybody were doing well. I will also be seeing her for my
         6-week checkup.

         A midwife proved to be the right choice for me. I hope that you will
         be happy and satisfied with your choice. Good Luck!


         Malin

I replied a few notes back saying that I was going with
the OB/Gyn because it was my first pregnancy and I was
nervous.  I made that decision after the first visit with
my doctor because he had spent a lot of time with me and 
answered all of my questions.  

I had my second appointment with him yesterday and it was
very different.  I saw him for approx. 10 minutes and I barely
got to ask my questions.  He told me the results of my ultrasound
(all good news!) and listened to the heartbeat (good news again!).
Then he said that he didn't have anything else for me, that I
was doing fine and he would see me in 4 weeks.  He didn't even
ask if I had any questions.  So, I tried to be assertive and 
asked him a few questions, but I felt that he was backing out
the door as I asked them and so I didn't ask all my questions
because I felt awkward.  He wasn't rude, and I still like him,
but I would like more attention.

Today, realizing how ridiculous it is that I let myself get 
intimidated into not getting all my questions answered, I am
going to call and make my next appointment with a midwife instead
of the doctor.  I think it will be good to make the comparison.  
I have a lot of questions for the midwife, but I will keep an open
mind.  Then I will make my final decision.  I'm 14 weeks along, so
I still have a little time to make the decision. 

It's ironic that I thought I wanted to go with the OB/Gyn because 
I was nervous.  Now I'm thinking that I want to go with the midwife 
because I'm nervous!

Barb, have you made a decision?  I will be meeting with a midwife
at the E. Central St. Fallon -- is that where you would go?  Have
you already met with a midwife?  How was it?

- Tammy

    Not all doctors are alike. My wife's OB/GYNs are excellent and ALWAYS
    ask if she has any questions. We wouldn't consider going to a midwife
    because they aren't physicians and their training is limited. I would
    suggest you find a doctor with a better bedside manner.
    
    Mike

    Hi Tammy,
    
    Yes, I met with a midwife for my first appt (my doctor was out of the
    country for the month of July).  I also go to the E. Central St.
    Fallon.  The midwife I went to was Michele (although I have heard 2
    good recommendations for Lynn).  Michele was really good with me. 
    Spent 45 min with me for a full exam and answered alot of questions.  
    She was even able to locate my baby's hearbeat when I was only 9 1/2
    weeks!  She also noticed my heart murmur (not many doctors do!) and is 
    going to check on the results of the tests I had in January to make sure 
    this isn't going to be a potential problem for me.  She seemed to be 
    very knowledgable and I felt very comfortable with her.
    
    I decided to make my next appt (tomorrow) with my regular doctor.  I 
    want to ask him questions (as many as I can get in) about the midwife 
    practice and his views.  I am getting my husband to go along on this
    appointment.  I am beginning to feel very comfortable with the idea of
    a midwife whereas my husband is still very nervous about the quality of
    care.  I plan on making my 3rd appt with the midwife so that my husband
    can meet her also.  I want both of us to feel comfortable with this
    decision.
    
    I will let you know how my next couple appts go - let me know what you
    think of the midwife (and which one you go to).
    
    I'm also "14 weeks and counting"!
    
    - Barb

    I have different doctors for my two preganancies.  They were very
    different.  My first one was wonderful.  She understood the fear
    of first-time preganant woman and spent lots time with me.  I had
    a wonderful childbirth experience.  My second doctor wasn't as
    caring as the first one and spent much less time with me.  I don't
    know was it beacuse it was my second and I showed less concerned.
    I was lucky that I had no medical problems and I didn't need
    any medical consultations.  So it does depend on the doctors.
    I am sure you can find a doctor who is willing to spend more time
    with you.
    
    Wendy

    I have a question for those who have used mid-wife and doctor.  My
    pregnancies were very "normal" in that I had no risks involved.  On my
    OB appointments they did the following:  weight, blood pressure, hemo
    test, iron check, urine check, heartbeat check, poke the belly, etc. 
    When a mid-wife sees you what is her routine?  I had an ultrasound with
    my first because the doctor and I disagreed about age of fetus.  That
    was the only test.  I had no tests with my second.  What kind of care
    would those who feel a "doctor is the only choice" be getting different
    from what a mid-wife would do?
    
    My impression on what I hear about mid-wife's is that I would go with
    one with any possible subsequent pregnancies (not that any are planned
    right now).  I was confortable with my doctor and the whole process I
    went thru - but I would love the experience of a mid-wife, too.  My
    first labor required pit to keep labor going, my second required the
    internal fetal monitor to keep a check on the baby who was late but
    seemingly not in distress.  I feel that either of the pregnancies could
    have been handled by a mid-wife.
    
    I really liked the doctor who delivered my two kids.  I have since
    moved away and not found one that I am confortable with yet.  If I had
    to I would drive back to Emerson in Concord MA from Nashua easily!!
    
    -sandy
    

Me again.  

I just wanted you all to know that I didn't intend for my last
note (.38) to be a criticism of my doctor.  If I go with the
OB/GYN, I would stay with this doctor, because I do like him
and feel that he is very competent.  I just think that he did
not realize that I would like more attention.  If I stay with
him, I will be more vocal with my concerns/questions.

As I read these replies and think about what I am expecting from
childbirth, I think that the midwife program might just be great
for me.  I tend to be very emotional about most important things
and feel that I am one of the people who would like the extra
"hand holding" and reassurance.  

Anyway, I am going to check it out and I will let you know what
I decide.  

- Tammy

    Just a quick update -
    
    I went to my Fallon doctor this month.  I was extremely pleased with
    the attention I got from him.  He answered my questions before checking
    the baby so I didn't feel like he was in a hurry to get moving - and he
    answered my questions in the detail I was looking for.  I asked him
    about the midwife program.  He said it has been very successful at
    Fallon and is often good for first-time Mom's since we're apt to be a
    bit more nervous and they can spend the extra time with us.  He was
    also reassuring in saying that there is always a doctor within a minute
    or two away in case of any problems during delivery.  He recommended
    that I continue alternating (doctor - midwife) until about month 7 and
    make my final decision then.
    
    I am leaning towards going with the midwife but feel better that I can
    continue alternating until month 7.  Something reassuring about having
    my doctor check on me and our baby as well as the midwife ...
    
    - Barb

That sounds great, Barb.  I'm glad you liked the appt.
with your doctor.  (It sounds just like the first appt.
I had with my doctor.)  It's nice to have two good things
(a good doctor and a good midwife) to choose from, right?

I didn't realize that you could continue alternating
between midwife and doctor through your 7th month.  
I thought they would make you make a decision about 
mid-way through.  I'm glad to hear that you don't have
to decide so soon. You get the best of both for seven
months -- it almost seems like cheating!  :^) 

I made an appointment with a midwife, but they also kept
my scheduled appointment with the doctor.  So maybe I
will keep alternating for a while, too.  That's also good
news for my husband because it gives him more opportunities
to meet them both. 

- Tammy

    
    
    I had a question regarding the hospital stay after delivery.
    
    I was wondering if a doctor tends to keep you in the hospital
    longer (visa versa) after delivering the baby and also wondered
    if the midwive's believe you should stay longer/shorter time.
    
    I had a midwife with my son Nicholas.  I had him late Friday
    nite.  I left the hospital on Monday nite (vaginal birth but
    complicated).  They did not pressure me to leave and asked me
    on Sunday if I wanted to stay or go and I said that I'd stay
    one more nite.  I was relieved and grateful for that.  They
    didn't try to boot me out of the hospital.  My blood count was
    off and I couldn't stand up without passing out so I was glad
    I got to stay that extra day.  Because of the difficulty with
    the delivery of my first born, I have decided to go to a doctor
    this time.  I was wondering if a doctor is different from a 
    midwife in this particular situation.  Any experiences on this??
    
    Thanks,
    Chris

    My first was born in '85, we had John Hancock insurance - we were in
    from early Monday morning till Friday (me) and Saturday (him - high
    bili count).
    
    My second was born in '87, BCBS - we went in Tuesday afternoon and I
    was out Thursday (before dinner).  I was told that if the baby was born
    50 minutes later (midnight Wednesday), I could stay till Friday.  In
    other words, I was rushed out on Thursday - as long as I was out before
    midnight Thursday night.
    
    This took place at Emerson Hospital in Concord, MA, but I don't htink
    that matters.
    
    -sandy
    

Hmmm...well, I used a doctor and Shellie used a midwife.  We both delivered
at the Birth Center at the same hospital.  We both delivered on a Friday
and we both left on a Sunday.

Usually the birth mother will leave the next day.  In my case, it was a very
rough delivery.  In Shellie's case, the baby was still admitted to the hospital
(on oxygen), and Shellie was feeling pretty well, but had been in a wheelchair
for much of the pregnancy and we were still figuring out how well she could
walk again (very well, it turned out, after only a couple of days).  In my case,
my doctor did the delivery but was gone over the weekend.  The backup doctor
was a jerk, but I just told him (not asked, *told*) that I was in no condition
to leave yet, and he complained about it, but let me stay ("You're lucky you're
not under an HMO or they would have you out of here!").  I'm sure my own doctor
would have given me no trouble about staying an extra day; I couldn't walk
unassisted even to the bathroom a few feet away. 

So, in my opinion, it depends on the medical professional.  If you have a 
compassionate, understanding doctor/midwife who treats you like an individual
then you should have a hospital stay that is as short or long as is
appropriate.  If your doctor/midwife rushes you along, doesn't listen, 
treats you like a number or a nuisance, then you are likely to be hustled
out of there the following day, unless you need to stay longer and complain
very loudly.  Of course, if you are feeling fairly well the day after and
are fine about going home, it would be unusual for either a doctor *or* a
midwife to keep you longer.  :-)

     Carol

I suspect the differences around length of stay have more to do with
medical coverage than with doctor vs. midwife.  Matthew Thornton says
24 hours vaginal / 3 days C-section unless there are extenuating circumstances.
My doctor typically does 48 hours vaginal / 4 days C-section unless there
are extenuating circumstances.  I suspect that this is what the insurance
review boards (or whatever they're called) recommend.  

I agree with Carol that it depends on the medical professional you choose.  I
delivered on a Tuesday afternoon with the first twin naturally and the 
second twin by C-section.  My doctor said she could let me go home on Friday,
but kept me an extra 2 days due to the dual delivery and the fact that my
babies weren't going home, so I could be closer to them.  But she had 
obviously taken Insurance 101 as she knew how to do the paperwork so the HMO
(HMO Blue) wouldn't give me a hard time.  As she described it, I looked like
I was dying in my chart with temperatures etc. every hour. 

The insurance company can't force you to go home early if your doctor has
a medical reason for you to stay, and I'd bet most doctors can find a medical
reason fairly easily if pushed. I know that the girl (and I do mean 'girl' --
I don't think she was more than 16 or 17) in the next bed to me who delivered
naturally on the Tuesday that I delivered was still in the hospital when I 
left and would probably get a few more days there.  She was diabetic so her
doctor had no trouble justifying the extra time to the insurance company.

Cathy

    In my case the first (the stillbirth) was induced with prostaglanden
    suppositories.  I delivered about 6:45 p.m. and the doctor basically
    said I could go home anytime I felt like going.  I went home Thursday
    morning feeling well physically fine.  I had a great delivery, not even
    a stitch.  Of course she only weighed 5lb-9oz, and of course the doctor
    was sensitive enough to know there were many emotional issues with this
    birth and knew it best that I not be kept near the newborns any longer
    than absolutely necessary.
    
    In the case of AJ's birth, I had him on Friday at 4:45p.m. by a
    c-section.  I had to be completely knocked out, due to the epidural not
    working.  Beccause AJ was sent to NICU and had surgery, and was
    physically up and down, he sent me home on my 7th day. (yes you read
    right that's day 7!)  By the time I went home my stitches were out. 
    I'm not sure what the doctor wrote, but he said something to justify
    the stay.  I'm mean what's the big deal, I went home Thursday morning,
    was back in Thursday night, Friday three times and Saturday in the
    midst of a blizzard to feed, and love my baby.  The Doctor even told me
    not to drive, ya right.  No doctor's order is going to keep me away
    from my newborn thank you!  
    
    Both of these were under John Hancock.  I had approval for 3 days
    natural in 1985 and (I think I remember right) 5 days for a section.  I
    think JH and most others have cut back considerably since this.
    
    Lyn

Over here, you stay as long as the doctor and you feel is necessary.  I stayed
12 days after a Caesarian with Dirk in 1978 (but then I almost died) and 11
days with Mark in 1980, a VBAC and also a very difficult delivery.  The 
insurance almost never (at least that I've heard of) argues.

In fact, when I had my shoulder operated I should have been in a private room
but they didn't have any so I had to share with a woman who had had a 
hysterectomy.  She had been in the hospital two weeks, sharing the room with 
her husband.  She certainly wasn't happy to see me but told her doctor she
didn't feel ready to go home yet because she still had a temperature of 37.5�C
(about 99.3 ?).  I had an attack of claustrophobia forcing her to evacuate her
guests and she left the next day.

They may be excessive here but I also feel that you don't need the added worry
of being hassled or chased home when you feel you aren't ready.  When a doctor
DOES feel you should leave, he will normally tell you.  In fact I have had
doctors threaten to put me BACK in the hospital if I don't slow down.

Cheryl

Here, in the UK the length of stay in hospital depends on a number of factors:
a first born with no complications will probably be 2 or 3 days in hospital, a
subsequent child without complications and you can go home the next day if you
wish (some stay longer for a rest).

I had emergency c-section and thus prem twins. I stayed in hospital for 13 days 
and all on the private health plan (admittedly most of this was due to the 
doctors having problems stabilising my blood pressure after the toxemia got
out of control) even though the last few days was waiting for the twins to be 
given a clean bill of health.

The average for c-sections here seems to be 7 to 10 days.

    
                                           
    This topic made me wonder how much time my insurance plan covers for
    delivery.  In case anyone's interested, HMO Blue covers whatever the
    provider orders.  They mentioned that it is typically 2 days for a
    normal vaginal birth, but they do not have any pre-set rules for
    length of stay in the hospital. 
    
    Martina

    
    
    I have Matthew Thorton Healthplan (HMO).  With my son, I thought
    for sure I'd get the 'boot' the next day (I was really hurtin',
    but then again, who isn't!) but they let me stay.  I hope if I
    have a hard time again (although this time I'm with a dtr. not
    a midwife like last time) that they allow me to stay especially
    since I'll have a 16 month old at home.   Give me strength! :)
    
    

    Well I guess it's about time for an update - since Marc is 5+ months
    old already!  Where does the time fly ... ?
    
    Since I started this note, I thought I would put in an update.  I made
    the decision to go with a Fallon midwife and am very happy with my
    decision.  I met most of the midwifes before delivery and liked all of
    them - but did have 2 favorites (luckily the one that delivered Marc
    was one of my favorites!)  
    
    We had Marc at St Vincent Hospital in Worcester.  In addition to feeling
    very comfortable with the Midwifes (I had 2 - the regular midwife and a
    student) - the nurses were wonderful!  
    
    My delivery was very easy (if any can REALLY be called EASY).  My water
    broke at 2PM, I met the midwife at the hospital at 4PM.  Had regular,
    frequent contractions that felt like monthly cramps 'til about 6PM. 
    After that, I wasn't all that comfortable %^) but delivered Marc at 9:48
    PM after 1/2 hour of pushing!  
    
    They tried to let me go without an episiotomy but Marc's heartrate 
    started dropping too low - so they had to.  But at least they let me
    try as long as they felt was safe for me and our baby.
    
    Also, at any point I could have had drugs - only thing is that I didn't
    know (and they didn't know) how far along I was until I felt like
    pushing!  By that time it was too late %^)
    
    The post-delivery was my problem since I hemorrhaged.  They tryed to 
    get me to the bathroom after and I passed out on them - so I was flat
    on my back 'til the next morning and on iron pills for a few months
    after to rebuild my blood supply.
    
    The midwifes were very supportive throughout - and afterwards.  They
    apologized for not being in my room more during active labor - but that
    they had no idea how fast I was progressing.  Actually I was glad to be
    alone with my husband - and wouldn't have wanted them around any more
    than they were.  They were there when it counted %^)
    
    They encouraged me to take a hot shower during labor - and I highly
    recommend it.  It felt great! and may have helped my labor progress so
    quickly.
    
    I delivered in a Labor - Delivery - Recovery room.  After 2 hours you
    are supposed to be moved to a regular post-partum room.  Because of my
    hemorrhaging, I was in the LDR room for more like 4 hours.  Afterwards
    they moved me to one of their 2 Labor - Deliver - Recovery - Postpartum
    rooms (it wasn't open when I went in).  I understand that if you these
    are not supposed to be given out AFTER someone has delivered but I
    believe the midwifes/nurse bent the rules a bit.  I was sooo...
    thankful.  The LDRP room is a private room - and I think that is bound
    to speed one's recovery immensely!
    
    One thing I liked about the midwifes is that they have a 2 week follow-up
    appt - consultation only - and then a 6 week physical.  The 2 week was
    a good time to ask questions - and for them to make sure everything was
    going OK.
    
    I was a bit concerned at first about having a student do the actual
    delivery.  I hadn't been prepared that one might and was very nervous
    at the idea at first.  I gave her a chance though - and once I saw how 
    well she and the regular midwife worked together I felt very comfortable.
    
    At my 2 week appt, I expressed the concern I had felt at first about
    having a student.  They apologized for not preparing me before
    delivery.  At my 6 week appt, the midwife informed me that this was
    discussed at they "midwife meeting" and that, having students was a new
    program.  They were happy for my feedback.  They are putting together a
    better program around this now.  After all - 1st time Mom's in delivery
    have other worries on their mind - they don't need this one!  I was
    happy to hear that my concerns were taken seriously.
    
    Guess I got a little lengthy - but I hope it helps make someone else
    who is now facing the midwife/doctor decision make a decision that they
    will feel comfortable with.  
    
    I know that for me, if I could have been guaranteed that my regular
    doctor would deliver Marc I would have stuck with him - because I
    really do like him and feel comfortable with him.  Since I know I could
    have any 1 of x number of doctors though ( and disliking some of them )
    I was happy I went with the midwifes!
    
    - Barb ( who now has a WONDERFUL little boy - Marc Philippe Nault!)

    This is an interesting topic for me...
    
    I am currently 13 weeks along, and the practice I go to, has both
    midwives and doctors.  Its Women's Medical in Fitchburg.  I had my
    first appointment with a midwife 3 weeks ago, and next week, I have my
    2nd appointment with a doctor.  
    
    I was informed by the midwife that if I had a normal delivery it I
    would be attened by 2 of the 5 midwives on staff, and that a Dr would
    be available if there were any complications. She stated that the Dr is
    at the hospital, but only comes if needed, and that the midwives are
    with you the entire time.  
    
    I  will be having appointments with 2 midwives and 1 doctor through
    most of the pregnancy, and twords the end, I will get a chance to meet
    everyone else, (since there is no guarranty which one will be there
    when I deliver)...
    
    I did feel comfortable knowing that the 2 midwives (whomever they are)
    will be with us (hubby and me) the entire time, and that the doctor is
    readily available.
    
    I will keep you posted how I make out....
    
    I have met the doctors before, and the 3 of them are great (the whole
    practice is women :-) )
    
    Sorry for rambeling
    Anne Marie
     

    
    I used Women's Medical in Fitchburg for the birth of my daughter Anna.
    For most of my labor I had one of the midwives with me. I ended up
    having one of the doctor's for my delivery, but I don't know if it was
    cause I had merconium in my fluid when they broke my water, or because
    there were 3 of us delivering at the same time so I was the one that
    ended up with the doctor. It didn't matter to me. Everyone I've dealt
    with at Women's Medical is wonderful.
    
    Patty

    I guess my personal opinion is that Doctors are over paid.  :-)
    We went through five hours of labor together, with the nurses tending
    to us the whole time.  The doctor came in, put on his gloves, and 
    pulled out the baby, did a little stiching and left.  The nurses
    did most of the work.  :-)

    I saw an md through most of my pregnancy, but opted for a midwife at
    home for delivery for Carrie and Atlehi.    
    
    The midwife, was there from 9:00 PM and stayed until two hours after
    the babies were born, then came by every day and checked with me often
    for the next two weeks.  
    
    What I really appreciated about midwife vs Dr. was the willingness to
    let me do what felt best for me, and not to get impatient when things
    slowed down because I got nervous.  She just helped me get my focus
    back on what I was doing so I didn't work against my body and slow
    things down more.  She was willing to suggest changes in position,
    which helped this last delivery be the most comfortable and fun birth
    experience we have had.
    
    Meg

    Hello,
    
    I just spent a weekend in the hopsital with a couple of dear friends
    who lost their baby moments before the birth.  They had started labor
    at home with a midwife present a couple days before being admitted to
    the hospital.  36 hours after the water broke, she was admitted.
    
    I can't share too many details for fear of lawsuits, but let me say
    that many women have told me in the aftermath that the envioronment in
    the womb changes rapidly after the water breaks, and if after 8 - 12
    hours (max) the baby hasn't been delivered, a doctor should be
    consulted immediately.  After 24 hours, a c-section may be necessary.
    
    In addition to losing the baby, the mother became infected (as was the
    amniotic fluid) and spent nearly a week in the hospital, just down the
    hall from all the crying babies.
    
    My friends have been through hell and I feel for them.  Please -
    fiercly investigate your midwife - leave no stone unturned, find out if
    they were ever involved in dangerous births or stillbirths and don't
    just take their word for it.  This is your life and your baby's life at
    stake, don't worry about hurting her feelings - if she's an honest,
    caring midwife, she'll understand your intense investigation.
    
    I'm not a parent but I'm sure natural childbirth is a miraculous,
    beautiful experience.  I'm equally sure that if there are
    complications, it would be much better to forgo natural plans and save
    lives.
    
    FWIW,
    
    
    Steve

    Steve,
    Please make sure your friends know about what support is out there
    for them; we've talked about perinatal loss a number of times in this
    conference, as some of us are survivors.
    My cousin was born 2 days after the water broke, and as a direct result
    was dramatically sick and handicapped for the rest of his short life.
    The complications finally killed him, my aunt's only child, at 13.
    This is a real terror for anyone in the family. We're all sort of
    trained because of Ulrich's death, to be sure that the babies are born
    in a reasonable time after the water breaks.....
    
    Again, my sincere sympathies for your friends.....
    
    Monica

    
    	Steve, 
    
    	So sorry to hear of your friends' loss.  I will pray for them.
    
    	As for time between water breaking and delivery, Emily was
    	delivered some 60 hours after my water broke.  I was admitted
    	to the hospital 20 hours after my water broke, induced a few
    	hours later, then labored for 37 hours.  She was not delivered by
    	C-section, but her heart rate and my temperature were monitored
    	carefully for the 37 hours of labor.
    
    	Karen
    

    Steve,
    
    Your note pulls at my hearstrings as well.  Loosing a baby at birth has
    to be the most awful experience any couple, and family has to endure.
    
    As a survivor of an at term still birth, it has to be the most awful
    let down from all the months of excitement and anticipation.  The whole
    thing really gives you a real different perspective on life and birth
    itself.
    
    As Monica said, please read note 502 so you can gain some insite into
    what you have experienced.
    
    I will keep you and the parents in my thoughts.
    Lyn