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Old 01-08-2012, 04:15 PM   #1
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How to tell midwife I want UAC?

I feel really disempowered as a consumer, not just in this instance but in other ones. For some reason, even though I am paying for a service, I feel like the service provider is doing me a favor and get anxiety about attempting to negotiate and walking if my needs aren't met. I am hoping someone can offer up some advice on how to approach this situation or at least offer a different perspective on what I should do.

So with my first childbirth I had unassisted prenatal and childbirth. This time I feel that I would like prenatal care from a professional. I went to an OB/GYN I was familiar with and didn't feel totally comfortable with the first check-up because I didn't have the courage to tell him I preferred not to have a vaginal exam and I also got the feeling he would not be on the same page with other issues because he and the nurse both emphatically stated it was time to stop nursing my 2 year old, when that wasn't even a question or topic up for discussion in my opinion. I feel it is a personal choice, not medical.

Anyway, I was also familiar with a local mid-wife who I felt seemed a lot more personal and also in support of most of my choices. I had a first pre-natal with her and everything went well, but I asked her at our initial meeting how she felt about providing ONLY pre-natal and post-natal care and she didn't explicitly say no, but steered the conversation to one about her being there but being very hands off during the labor, like staying in the other room. At first this was a thought that was worth considering but now after thinking about it, I really do feel that without any high risk factors, I would prefer only myself and husband present during labor and delivery.

I guess I feel awkward about having the conversation with her. I don't know what her cost breakdown is for each component of her services but I looked at a paper from her to be submitted to insurance which stated labor and delivery at $2000. The total cost for her services is $4000 oop for us, and I asked her if somehow she didn't attend the labor and delivery would we get a refund and she said no. I want to ask her if we can arrange prenatal and postnatal care and agree that she won't be called for labor and delivery, but feel that she might be offended or strongly disapprove. I already paid a $500 retainer fee and honestly don't want to change midwives.

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Old 01-08-2012, 04:28 PM   #2
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Re: How to tell midwife I want UAC?

i would think that as a midwife, that kind of arrangement would make me nervous for many reasons but definitely from a legal/liability standpoint. you can always just not notify her when you go into labor, deliver by yourself and call her when the baby is born but i wouldn't expect a change in her fees. i also think she might know what you were up to after asking about it.

you have to think, from her perspective, being attended by a midwife is optimal and important and something she really values.
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Old 01-08-2012, 04:33 PM   #3
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Re: How to tell midwife I want UAC?

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i would think that as a midwife, that kind of arrangement would make me nervous for many reasons but definitely from a legal/liability standpoint. you can always just not notify her when you go into labor, deliver by yourself and call her when the baby is born but i wouldn't expect a change in her fees. i also think she might know what you were up to after asking about it.

you have to think, from her perspective, being attended by a midwife is optimal and important and something she really values.
This. My midwife would think I didn't trust her or that I wanted to pay her "just in case" but didn't really feel like I needed her. The fee you pay is not just for the service she gives on your birth day, it is for her time and leaving her schedule open for you. Unless she is a midwife who specifies that she will do prenatals only for UC families then I wouldn't expect a price reduction or her willingness to do it.

ETA: I know you didn't ask for personal opinions on what you have chosen but I would rather forgo prenatals and have a trained person there at the delivery than the other way around. (oh, and since it's not advertised in my siggy we do home birth )
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Old 01-08-2012, 04:40 PM   #4
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Re: How to tell midwife I want UAC?

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This. My midwife would think I didn't trust her or that I wanted to pay her "just in case" but didn't really feel like I needed her. The fee you pay is not just for the service she gives on your birth day, it is for her time and leaving her schedule open for you. Unless she is a midwife who specifies that she will do prenatals only for UC families then I wouldn't expect a price reduction or her willingness to do it.
Thank you. That actually makes a lot of sense. I don't mind paying the full amount as long as I feel I am not paying for a service I am not getting, as you stated it isn't just for the service but her availability. Also, if I plan on not calling her for labor and delivery, I would absolutely be up-front about it, not say it was an "oops". I would hope she wouldn't take it personally, considering I already expressed to her that I prefer to labor alone.
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Old 01-08-2012, 04:59 PM   #5
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Re: How to tell midwife I want UAC?

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ETA: I know you didn't ask for personal opinions on what you have chosen but I would rather forgo prenatals and have a trained person there at the delivery than the other way around. (oh, and since it's not advertised in my siggy we do home birth )
Yes it would seem there is more risk for things to go awry during delivery than pregnancy, but I have this inherent urge to be completely alone during labor (not necessarily delivery). I keep thinking "what if she says she is hands-off but when it comes down to it, is just the opposite", that would be a nightmare, I honestly think it would hinder the birth process for me, make it more painful, and possibly lead to complications. In the past I have recognized that I deal very poorly with emotional stress, to the point where it very easily affects my physical health...
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Old 01-08-2012, 05:22 PM   #6
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Re: How to tell midwife I want UAC?

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Yes it would seem there is more risk for things to go awry during delivery than pregnancy, but I have this inherent urge to be completely alone during labor (not necessarily delivery). I keep thinking "what if she says she is hands-off but when it comes down to it, is just the opposite", that would be a nightmare, I honestly think it would hinder the birth process for me, make it more painful, and possibly lead to complications. In the past I have recognized that I deal very poorly with emotional stress, to the point where it very easily affects my physical health...
Maybe you could talk to her about what you need, even get her to sign something that says she will not touch you or whatever without you asking her to? I have used the same midwife for 10 years and she is a personal friend but I can imagine it is harder dealing with someone you don't really know.
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Old 01-09-2012, 09:46 AM   #7
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Re: How to tell midwife I want UAC?

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Yes it would seem there is more risk for things to go awry during delivery than pregnancy, but I have this inherent urge to be completely alone during labor (not necessarily delivery). I keep thinking "what if she says she is hands-off but when it comes down to it, is just the opposite", that would be a nightmare, I honestly think it would hinder the birth process for me, make it more painful, and possibly lead to complications. In the past I have recognized that I deal very poorly with emotional stress, to the point where it very easily affects my physical health...
I understand this totally, but I'm still going with a midwife for the labor and birth. I really would like to be alone for this birth (my husband slept through most of the labor, also). I was alone with my first because that's just the way it worked out, and I'm afraid that if there are a bunch of people there this time, that labor will be harder and/or longer, but I've decided that I can't take the chance of there being a complication that a trained midwife could have anticipated and helped with. We also have no idea how we are going to pay our midwife, but we'll figure it out somehow. I do worry about if she'll be hands-off enough for my comfort level, but I think that the risks outweigh the benefits. My midwife had 2 unassisted births herself before becoming liscenced. I think she is more careful now than she was then, but I still hope that she'll be hands-off unless there is a possible problem.

that said...I really wouldn't want to pay 4000$ for prenatal care and postpartum only. I would probably just consent to having her at the birth and pay her for the whole thing.
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Old 01-09-2012, 11:28 AM   #8
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Re: How to tell midwife I want UAC?

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I understand this totally, but I'm still going with a midwife for the labor and birth. I really would like to be alone for this birth (my husband slept through most of the labor, also). I was alone with my first because that's just the way it worked out, and I'm afraid that if there are a bunch of people there this time, that labor will be harder and/or longer, but I've decided that I can't take the chance of there being a complication that a trained midwife could have anticipated and helped with. We also have no idea how we are going to pay our midwife, but we'll figure it out somehow. I do worry about if she'll be hands-off enough for my comfort level, but I think that the risks outweigh the benefits. My midwife had 2 unassisted births herself before becoming liscenced. I think she is more careful now than she was then, but I still hope that she'll be hands-off unless there is a possible problem.

that said...I really wouldn't want to pay 4000$ for prenatal care and postpartum only. I would probably just consent to having her at the birth and pay her for the whole thing.
I feel very much the same way. I will see how I feel when I actually get in labor and probably decide in that moment whether to call her or not. I am just afraid that I am going to feel as intolerant to the presence of others as I was with my first childbirth. I couldn't bear my husband to even be in the same room with me and was so relieved he slept through most of my labor in another room. Maybe now that I know what to expect I will be able to tolerate other people being around. I honestly don't know how other women do it, especially in hospitals when multiple people are coming into the room talking to and touching you, even doing vaginal exams! It seems torturous!
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Old 01-08-2012, 04:33 PM   #9
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Re: How to tell midwife I want UAC?

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Originally Posted by newmommy13 View Post
i would think that as a midwife, that kind of arrangement would make me nervous for many reasons but definitely from a legal/liability standpoint. you can always just not notify her when you go into labor, deliver by yourself and call her when the baby is born but i wouldn't expect a change in her fees. i also think she might know what you were up to after asking about it.

you have to think, from her perspective, being attended by a midwife is optimal and important and something she really values.
hmmm, that is kind of what I thought her thinking may be, along the legal/liability standpoint. I don't understand how making an agreement to provide pre-natal care would obligate her to be responsible for labor and delivery. Is that a law or something that I don't know about?

Do you think $4000 is a reasonable amount to pay for pre-natal and a post-natal check-up?
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Old 01-08-2012, 04:40 PM   #10
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Re: How to tell midwife I want UAC?

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hmmm, that is kind of what I thought her thinking may be, along the legal/liability standpoint. I don't understand how making an agreement to provide pre-natal care would obligate her to be responsible for labor and delivery. Is that a law or something that I don't know about?

Do you think $4000 is a reasonable amount to pay for pre-natal and a post-natal check-up?
I think that is a bit steep. My midwife is $2500 and that includes a doula and she is high for this area.
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