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pregnancy update: The Great MidWife Controversy

i feel for zeldman. i really do. it's hard to believe that things are moving along so quickly. it feels like we're hurtling towards october. i hear it slows down in the third trimester, so we'll see.

observant regular readers may remember that, while we had an early ultrasound in week 10, we should have had an "official" 18-20 week ultrasound last week. that didn't happen, for a variety of reasons, not the least of which being that our OB/GYN ditched us after she discovered that we were going to have the baby at home with a midwife. that's right, at least with certain doctors, the hippocratic oath be damned if you decide to go with a midwife.

kris decided to be upfront with the ob/gyn and told her on her second visit what her eventual plans would be. incredibly, the doctor's response was to tell kris that she didn't want to "clean up someone else's mess" if something went wrong and then went on to tell kris all manner of horror stories about non-hospital births! when kris challenged her on the ethics of denying healthcare to someone for such a spurious reason, the doctor backpedalled a bit and said that she would have to consult her partners. my guess is that you're seeing what happens when you start messing around with a hospital's pregnancy profit center. all the margin is in the actual birth itself, so there's not much incentive for a doctor to pick up all the low margin prenatal work without the payoff. and don't even get me started on what kind of person you would need to be to tell a healthy pregnant woman horror stories about what happens when you have an at-risk pregnancy in the home. it's comparing apples and oranges. she should know that there isn't any documented evidence that having a baby at home is dangerous if you're a healthy woman with a normal pregnancy. but hey, people will do the darndest things to make a buck. undeterred, kris talked with our midwife and we found a doctor that is more than happy to work with a midwife to make sure that kris isn't at risk for any complications and can have the baby the way we want.

so, we've got a backup in place, however, the doctor couldn't get us in for an appointment for the ultrasound until week 24, which is a couple of weeks from now. that's the bad news. the good news is that our new doctor is going to do one of those super cool 3d ultrasounds, so i should have some amazing pictures to post.

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6/07/2004 07:49:00 PM 9 comments

9 Comments:

horrible horrible horrible. go your wife for being strong in the face of an economically-driven & -desperate doctor. there is a kind of inherent tension between midwifery and traditional (hospital/hmo-) medicine, unfortunately, due to our health care system, etc but still, this kind of attitude just makes that tension unbearable. congrats on sticking to your guns!

By Anonymous Anonymous, at 9:52 AM  

Wow. Sad to hear how it originally started, but glad to hear that it sounds like you're getting somewhere.

We've just had our third home birth with a midwife (it was supposed to be the same midwife that delivered our first two children, but sadly she was at another birth) and I can't say enough about the experience (I posted a few details and plan on adding more later)

Is this your first?
Cheers,
Derek.

By Anonymous Anonymous, at 10:09 AM  

Our son was born at home 6 1/2 months ago (everything went great). I'll one up you on the doctor story - we couldn't find a doctor who was willing to serve as a backup. They felt that by simply seeing us they would have been promoting something that they clearly did not believe in. Hosptial profit center - sure, but don't forget that many many OB/GYN's think you're making the wrong choice.

By Anonymous Anonymous, at 11:24 AM  

congratulations derek - and good luck on continuing to work with kampbell at separating his contents from his presentation. yes, this is our first, although i was lucky enough to see an at-home birth [1] which helped shape our opinion of what was best for us.

on finding a backup, i think we were fortunate to have a midwife who has been working in our geographic area for 20 years and who has an extensive list of doctors who know that having a baby at home is perfectly safe if no risk factors exist and there's a trained midwife involved. had our midwife not had that list, i think we might not have been able to find a backup either and we probably would have been a lot more hesitant to go with a midwife.

relatedly, our midwife is involved in long term study designed to show that having a baby at home is as safe and more affordable than in-hospital births, which she hopes will convince "payers" to start reimbursing since it will save them money. i don't know what anyone else's experience has been, but apparently you can submit a bill ( with the appropriate birth billing codes of course ) after the birth and you can occasionally get reimbursed after they see that nothing bad happened and that it ended up being far cheaper than a trip to the hospital. our hmo appears to occasionally reimburse. in any case, we're happily participating in the study. hopefully it's well designed.

[1] http://snowdeal.org/section/ex_machina/archives/2002_01_01_index.html#8736006

By Blogger e3, at 11:55 AM  

interesting conversation -- I have a question though -- how does the doctor as backup system work where you are? and are you setup with just one midwife or two? here, we are required to have two midwives there. one is the primary and then a second serves as support for the first... as for backup, we don't actually have to find a backup, but we did pre-register at the hospital so that we didn't have to fill out any paperwork if we had to go in an emergency...

i suppose things are very differen there for you?

Derek.

By Anonymous Anonymous, at 12:11 AM  

"how does the doctor as backup system work where you are? and are you setup with just one midwife or two?"we have a backup midwife who is recommended by our "primary" midwife on the off chance that she can't make the birth. she's good at managing her schedule and claims that in her 1,200 births she's never had to use a backup midwife, so i'm not worried about that aspect of things.

it's our midwife's personal policy to have a backup ob/gyn in the loop who is willing step in if circumstances warrant such action. normally, the backup doctor will perform procedures that she can't perform ( prenatal blood panels and ultrasounds ), generally just stay abreast of developments and be "on call" on the due date.

i don't think it's legally mandated but our midwife also requested that we sign a form that states that we'll go to the hospital if she decides that's necessary during the birth. naturally, responsible midwifes are wary of being put in the position of being forced to deliver an unexpectedly high risk baby.

rather than freaking me out, i've been quite impressed that our midwife is a pragmatist. a homebirth is safe under the right circumstances, but that doesn't mean it's always safe and it's nice to know that she's not willing to risk her reputation ( and lives ) with fanatics who think that the medical establishment is always the wrong answer.

By Blogger e3, at 12:55 AM  

I have a bit of a bias on this issue. My sister was a midwife for a number of years and is now a lactation nurse. My mother-in-law is not only a midwife, she is a domicilary midwife who is also an advocate.

Having said that, my two sons had very differnt births. My first son was born via an "emergency" c-section. He was breach and theree wasn't enough amionic fluid for him to turn around so the doctor, who by most accounts is very midwife friendly and knew of our family predilictions, "recommended" that we get the baby extracted for his own good. Note: This is major surgery. It involves an extended recovery period during a time that you also happen to have a baby to take care of. I recommend that you avoid this if you can.

Our second son was born at home (VBAC=vaginal birth after caesarian). My sister came out of retirement and my wife had some of her closest friends present for the birth (me too!). The recovery period was much shorter and the baby came out looking around the room to see who was there. He was more ready to be out of the womb than our first.

I'm very pro-midwife!

By Blogger jjh, at 8:12 PM  

http://www.midwife.org/prof/display.cfm?id=86

Statistics on unnecessary c-sections. The main site has a lot more news.

A sample:
"In a study that examined differences among obstetricians, family physicians and CNMs in the care provided to low-risk women, the cesarean rate for patients of CNMs was 8.8%, compared with 13.6% for obstetricians and 15.1% for family physicians.
Am J Pub Health 1997;87:344-351"

By Anonymous Anonymous, at 9:39 PM  

thanks for the link on c-section statistics. kris can't find the sources at the moment but she had read a recent article that claimed that the percentage of women who actually need c-sections stays constant at around 3-5% of total births and that the rest are done for liability/risk reduction reasons. i'm not sure what the current national average is, but kris says she read recently ( again, can't find the source, so take it with a grain of salt ) that it's around 30 percent.

we asked our ob/gyn for her and her groups c-section statistics and for a list of guidelines that would dictate the procedure be performed. unfortunately, she ditched us before we could get the data. hopefully our new backup doctor will be able to provide us with his statistics.

if memory serves, our midwife claims to have a c-section rate of less than 1% ( out of a total of 1,200 births), but of course, she's already selecting out mothers who would be at-risk for for the procedure so it's not quite a fair comparison.

By Blogger e3, at 10:48 PM  

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