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Old 01-08-2012, 11:13 PM   #11
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Re: How to tell midwife I want UAC?

The midwife needs to be free of any HINT that she knew about your plan to go UA, and that she endorsed or assisted you. I can see how you'd feel that you're doing a nice thing by keeping her in the loop about your plans, but honestly the nice thing to do when you're taking a risk like that is to leave her out of it.

Kinda like if you know that you can have 5 drinks in 1 hour, and still drive safely ... Telling your bartender that you plan to drive is not a nice thing to do - it puts the bartender in a sticky situation where legally they have to take your keys.

As for the fee ... yeah, like they said: It's not like if she takes you on for everything but the delivery, she can pick up another client for delivery only. When you go for a massage, you pay for the whole hour even if you leave after 30 minutes, because the person can't get another client in for a fraction of an appointment. Yes you'd only get half of a massage, but that's on you, not the massage therapist.

$4000 might be high but might not, depending on everything that is provided. I paid $3500 for prenatal care, plus 8 weeks of postpartum AND prenatal care, and the midwife provided a birth tub. She also saw me at home, or at work, or wherever I wanted, and dropped off custom herbal tinctures a few times. She spent as much time with us as we needed, helping prepare for the birth because we couldn't get to a childbirth class. All that wasn't included was a $65 birth kit.

I would have a lot more conversations with her about how hands-off you'd like her to be during labor. For the most part I've found that home birth midwives have a strong philosophy of letting the Mama lead. Mine were willing to let me be 100% alone after I was in full-blown labor (nobody was even at the house), until I hit a certain point when I'd call them, but keep them out of the room. By the time of the birth I even found my midwife a little annoying and preferred her assistant, but when I told my midwife to back off she did.

This may be an excellent opportunity for you to empower yourself even while you work within a certain system. I'm a control freak, and having to let my midwives help me was a life changing experience. I'm now much more open to what other people (even ones that annoy me) have to offer.

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Old 01-09-2012, 08:32 AM   #12
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Re: How to tell midwife I want UAC?

I am planning a UC this time. There are no hb midwives in this area. Even if I hired one two hours away, I am taking a chance of a UC anyways since my last two labors were so short. I did have my last at the birthing center 2hrs away and gave birth shortly after arriving. I am seeing the OB that delivered my first two. I plan to do an "oops". I also don't want any medical professionals knowing that I plan on UC'ing because I would not want them to try to hold me medically liable or have the state get involved in case something did happen and I had to transfer.
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Old 01-09-2012, 08:46 AM   #13
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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, 09:58 AM   #14
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Re: How to tell midwife I want UAC?

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She might be afraid that if you get prenatal care from her but she doesn't attend the birth, that if anything goes wrong you would try to blame her. Unfortunately the world we live in is crappy sometimes so midwives really have to watch out for themselves.

Example- I was reading a midwife (true) memoir book where she agreed to be a doula for a woman who had previously had a terrible birth experience. She didn't feel comfortable being her midwife because of the woman's medical history and some complications in her current pregnancy.
Well when the woman went into labor she was supposed to go immediately to the hospital due to something going on with the cord and the fact that the baby kept flipping back and forth to breech. She didn't go to the hospital, she wanted to stay home. She ended up calling the midwife and when she got there the baby had already died. The midwife ended up getting sued for millions and millions because she DID go and she IS a medical professional, even though she was only supposed to be acting as their doula.

Anyways, I don't feel like any doctor or midwife will really be on board with a UC, and you will probably just have to see someone for your prenatal care and just...not show up...for the birth.
It is very unfortunate the scrutiny and liability that midwives have to assume which ultimately discourages a lot of them from practicing. I am not sure when the story you mention happened but there are laws in most states that prevent individuals from acting or presenting themselves as medical assistance in homebirths unless they are licensed to do so and the law allows it. Nowadays most midwives would never consider acting as a doula for an unassisted childbirth as it would be legally dangerous to do so.

You are right, it is rare to find medical professionals who are supportive of unassisted childbirth. I am probably being a little too optimistic to think my midwife might be supportive of it or at least not discouraging.
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Old 01-09-2012, 10:20 AM   #15
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Re: How to tell midwife I want UAC?

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Originally Posted by TrennaII View Post
The midwife needs to be free of any HINT that she knew about your plan to go UA, and that she endorsed or assisted you. I can see how you'd feel that you're doing a nice thing by keeping her in the loop about your plans, but honestly the nice thing to do when you're taking a risk like that is to leave her out of it.

Kinda like if you know that you can have 5 drinks in 1 hour, and still drive safely ... Telling your bartender that you plan to drive is not a nice thing to do - it puts the bartender in a sticky situation where legally they have to take your keys.

This may be an excellent opportunity for you to empower yourself even while you work within a certain system. I'm a control freak, and having to let my midwives help me was a life changing experience. I'm now much more open to what other people (even ones that annoy me) have to offer.
I am sure it wasn't your intention but comparing someone driving drunk to having unassisted childbirth is a little offensive and really not the best analogy, simply because driving drunk is illegal and there are laws in place that deter establishments from serving/selling alcohol to inebriated consumers. Unassisted Childbirth is 100% legal and no more "risky" than assisted childbirth if the birther/attendants are prepared to deal with potential complications. Across the board of risks, some are greater and some are less when comparing assisted and unassisted births.

Also, It feels really dishonest to me to not let her know that I won't be calling her for the birth, it isn't necessarily an issue of being nice or not, for me there is no equivocating. I don't understand why you and a few other posters feel that letting her know that I won't be calling her for labor, implicates her in the outcome of that labor. She can tell me that she doesn't agree with my decision and possibly deny me pre-natal care or even insist that I call her, but ultimately me not calling her is my sole decision. I can't turn around and sue her if I have a bad outcome due to her not being there to help when it was clearly my fault that she wasn't there. Is there a law that if a midwife provides pre-natal care but doesn't attend the labor and delivery that she is still possibly liable for the outcome?

Hmmm, for example, say a mother receives prenatal care from a midwife who fails to diagnose gestational diabetes and the baby ends up being 11 lbs and suffers nerve damage due to shoulder dyostacia during an unassisted childbirth. Is the midwife on the hook? Should she be?

OR, during an unassisted childbirth a child is born experiencing respiratory distress and none of the attendants are versed in neonatal resuscitation and by the time the ambulance arrives the child has already suffered some form of mild hypoxia. Is this an obvious reflection on the birthers choices or is the midwife who wasn't even called somehow on the hook? Seems unlikely to me, but if there are laws supporting that please direct me to them.

On your last paragraph, I actually thought this might be an opportunity to allow myself to trust someone else. I have a hard time with that but I am not sure I am ready to make such a big step, especially when it is concerning one of the most profound events in my life. I guess I will know if I am ready when I am in the moment, if I do decide to have the midwife present it will be too late to change my mind if I am not...
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Old 01-09-2012, 10:28 AM   #16
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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 01-09-2012, 10:38 AM   #17
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Re: How to tell midwife I want UAC?

I couldn't imagine my husband not being there while I was in labor and delivering our baby.

It sounds like you prefer to be up front and honest with your MW- if she refuses prenatals after- do you have any other choice in MW's?
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Old 01-09-2012, 10:55 AM   #18
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Re: How to tell midwife I want UAC?

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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.

Thanks
I would really encourage you to somehow gain the courage to stand up for your wishes. I am a chicken and will often ask hubby if he can help me express my wants. You might be surprised how accommodating your caregivers will be. Our current OB agreed that I don't need an IV if I don't want one even though it will be a hospital birth, and wouldn't ask me to get one unless we ran into complications. (that he said he doesn't anticipate, I've had uncomplicated births in the past with the exception of an epidural gone horribly wrong). My husband asked if he could catch the baby. And our OB had no hesitation in answering YES!! He has agreed to be very hands off, and just be there to "supervise" if you will. He completely trusts my instincts and just says to call if I need him.
They do have a liability to consider, and I would fully understand if he felt the need to step in. But as much trust as he puts in me, I know he has the best interest of my health and the health of my baby at heart and will let me know when I need to reevaluate our birth plan.
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Old 01-09-2012, 10:55 AM   #19
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Re: How to tell midwife I want UAC?

My understanding that once you signed a contract, your MF officially becomes your medical provider. Anything that happens during your pregnancy, birth and postnatal is HER responisibily. Regarless it was your decision to have UC.
If you do it to save money, I'd go with OB. They should reimburse you the cost of birth, which is about 1/2 of their charges. I do not think they risk anything if their patient (!) opts to birth at home.

I would not do it to a MF. Most of them do not have malpractice insurances and risk loosing a license.
Plus, they do not differentiate actual birth and prenatal care. Most of MW I talked to believe that 90% of their work is done during the prenatal visits. So you won't save much even if you find the one who agrees to provide only prenatal care.

Hugs, hope everything works well for you.
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Old 01-09-2012, 11:14 AM   #20
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Re: How to tell midwife I want UAC?

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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!
Sounds like we had a similar experience, but in my case I just didn't know that labor was progressing and didn't wake my husband until transition and pushing hit. I realized afterwards that I just didn't need him and labor probably went faster because I was alone. We got to the hospital just in time to finish pushing, no vaginal exams at all. I truly didn't understand how lucky I was until I went to a few doula births at a local hospital; I have no idea how anyone gives birth after a labor in a hospital...it seems so disruptive. I know there are women who should be in a hospital and feel safer there, but I truly wish that hospitals made it easier for women to give birth there.
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