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Old 01-10-2009, 12:10 PM   #1
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WWYD? (MW, OB, etc)

Hi ladies!

I know I have some time to decide on this, but I don't like to rush into decisions and I'm trying to figure out just what my options are, so I'm tossing it around now. I have been seeing a MW at the north location of this particular practice for this pregnancy. I like her and I'm hoping for a natural birth, which I think is often more likely with a MW vs an OB. However, I am also high risk because I had a preemie last time, and the other day, the high risk docs decided they want me to have an u/s for cervical checks every 2 weeks. This has to be done at the south location. (FTR, everything looks fine now, and everyone's cautiously optimistic, I think this is just their standard practice for HR patients.)

I saw the MW the next day and she said that since the other office would be seeing me so often, that office will just take over my regular care as well. (They have me seeing a regular OB next time, but they said it's still a HR appointment. ) I asked about switching back to her if I made it to a certain point, and she said I could at 36 or 37 weeks. (For this discussion, I'm going to assume that I do make it full term and there's no medical need to stay with an OB.)

Here's the catch, though - I recently found out that the MWs are only at the hospital during the day, Monday-Friday. If I happen to deliver during one of those times, then I might get a MW. They usually are there as backups in case the oncall OB is very busy or has to go into surgery, but I think I could request one if they're there. If they're not, I'd get whatever OB is oncall. It's a very large practice and it's practically impossible that I'll see all the OBs before I deliver, let alone get to know how they feel about intervention. I asked the MW about a few things relating to intervention to try to get a feel for their general policies, but I didn't get a lot of clear answers....she mostly said it depends on the doctor and the situation. She did say that I could end up with a c-section for failure to progress, but when I asked her what they considered failure to progress (ie, is it a certain amount of time from water breaking), she said it depends.

So I've come up with a few possible options, but I'm not sure how good any of them are. I feel strongly about being comfortable with the person who delivers our baby, and it's looking unlikely that that will happen since with this practice, I'll probably barely know them if I've even met them at all.

1) Just stay with the OBs and try to meet as many of them as possible and try to get as much info as possible from each one about what they would do in various situations. (They'll love me! )

2) Switch back to the MW at 36 weeks and request her or another MW if it's a weekday during the day, but know that the odds are good that I'll end up with an OB anyway.

3) Switch to a different, smaller practice at 36 weeks so I'll at least be fairly sure of who will be delivering. (Not sure of the logistics of doing this, who I'd go to, or if they'd take me that late....and I'd still have a pretty limited amount of time to get comfortable with them.)

4) Switch to a birthing center at 36 weeks....there is one near me that looks nice, but I have no idea if they'd take me since I am HR (though I wouldn't be once I got to 36 or 37 weeks). I still wouldn't really know them that well, but I'd know that they're supportive of natural birth.

5) Other - I'm open to suggestions!

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Old 01-10-2009, 12:17 PM   #2
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Re: WWYD? (MW, OB, etc)

I would switch back to the MW you have been seeing once you are at a point where they will let you. And then hope and pray you deliver when they are available. In the mean time, meet as many of the OB's in your practice as you can. That's what I would do because switching to someplace new at 36 weeks isn't going to buy you any time with new people either.

As far as your current group of OBs: Not that they all don't have their own way of doing things, but you might find that they all agree on certain things and you won't need to worry as much about it. There are two OB's in my practice and two MW and you rotate through all of them. The OB's both do things the same, and tend to be more like common MW practices.
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Old 01-10-2009, 01:00 PM   #3
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Re: WWYD? (MW, OB, etc)

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I would switch back to the MW you have been seeing once you are at a point where they will let you. And then hope and pray you deliver when they are available. In the mean time, meet as many of the OB's in your practice as you can. That's what I would do because switching to someplace new at 36 weeks isn't going to buy you any time with new people either.

As far as your current group of OBs: Not that they all don't have their own way of doing things, but you might find that they all agree on certain things and you won't need to worry as much about it. There are two OB's in my practice and two MW and you rotate through all of them. The OB's both do things the same, and tend to be more like common MW practices.
Yeah, I think switching to a different practice at 36 weeks will only get me anything if I somehow know ahead of time that they're very pro-natural birth (I guess from recommendations, since of course no doctor's going to say, "Yes, I will push you into things you don't really want and aren't really necessary!").

I did forget to say that I know that one of the OBs rolled his eyes at a mama when she told him she wanted a natural birth, generally didn't listen to her, and told her she wouldn't be "allowed" to go past 41 weeks. Ugh. So I'll be trying to avoid that one, but there isn't really anything I can do if he's the oncall.

From 16-36 weeks, I'll be going every other week, and if I'm seeing the regular OBs every time, then that's about 11 appointments. There are 13 regular OBs in the practice. So I could at least meet the majority of them....it just might be hard to get a good reading from only one visit.

BTW, what part of FL are you in?
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Old 01-10-2009, 04:29 PM   #4
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Re: WWYD? (MW, OB, etc)

I don't have time for a very insightful reply, but I just wanted to say that I feel your pain! I saw in the other thread (17P) that you're at a university medical center too...there are SO many residents at mine!!! It makes me crazy. There are 6 MWs but I'm not sure if they'll let me co-manage care. I would much prefer to have 1 of 6 MWs attend my delivery over 1 of 30-something OB residents! I still haven't gotten up the courage to ask if a MW can attend my birth.
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Old 01-11-2009, 12:54 PM   #5
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I don't have time for a very insightful reply, but I just wanted to say that I feel your pain! I saw in the other thread (17P) that you're at a university medical center too...there are SO many residents at mine!!! It makes me crazy. There are 6 MWs but I'm not sure if they'll let me co-manage care. I would much prefer to have 1 of 6 MWs attend my delivery over 1 of 30-something OB residents! I still haven't gotten up the courage to ask if a MW can attend my birth.
Wow, that's a really huge practice! And somehow I hadn't even thought about the residents here....the webpage lists 13 OB/GYNS who are also on the faculty of the university, but I'm sure there are more residents. Not that there's anything wrong with them, but if I'm in a high risk situation, I'd really rather have a high risk specialist who's had lots of experience, and if I'm not, then I don't see any reason why I can't have a MW.

I was so happy that this practice had MWs but now it seems like it probably doesn't really matter. I delivered at the same hospital with my DS, but the OB I had been seeing didn't have privileges there, so I had a new and different doctor every day (I was there for several days before I delivered). When I did deliver my DS, I think there was 1 full-fledged OB there and 4 residents, one of whom did the catching and whatnot. The other doctor just kind of supervised. By that time, I knew that I was going to be delivered by Dr. Random and I was much more concerned about DS, so it didn't really bother me. But this time, I was really looking forward to hopefully going full term and then just being able to deliver with a MW and not have to worry about the intervention stuff so much and have a nice normal birth.

When I asked the MW some questions the other day, she said something along the lines of well these are good things to think about when maybe you're a little further along....I know it's early, but I'd rather know ahead of time if they're going to be very pro-intervention so I can figure out what I want to do about it. I don't want to find out at 35 weeks if they have a problem with me walking around or laboring in the tub or are really pushy with the meds. Besides, like I told her, if I don't end up going full term, I'm prepared - I know what happens, I know what my options are, I know what to ask. It's not what I want to happen, but if it does, I'll be ready. It's the full term stuff that I'm clueless about.
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Old 01-15-2009, 03:21 PM   #6
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Re: WWYD? (MW, OB, etc)

Well, I have a little bit of an update. The mama I talked to who had kind of a bad experience with the one OB before ended up having her baby when he was the oncall. Everyone's happy and healthy but the doctor and the hospital were not very respectful of her wishes and wouldn't even allow her to be off the monitors so she could walk around, let alone labor in the tub, even though everything was fine and we had both been told that both those things were allowed. So, either we were lied to or were given misinformation....either way, it's not giving me the warm fuzzies about having a natural birth there. There was some other stuff too, but I won't get into it since it's not my story to tell and it all pretty much fell under that same category anyway.

So I called the birthing center today to see if it would even be a possibility to go there. The gal I talked to said that since I did have a previous preterm delivery, that she would need to speak to the MW and their consulting physician, and I would probably need to do prenatal care with the dr instead of the MW, but I'm okay with that. She is supposed to get back to me in a few days, but she didn't seem to think that my history would automatically exclude me from delivering there. She did say that they would want me to transfer in before 36 weeks (and it sounded like probably ASAP), and I'm okay with that too. I would like to still see the high risk OBs at my current practice until 36 weeks as well, just in case something does happen, but I doubt that will be an issue....the HR OBs told me before I even got pregnant that they would co-manage with whoever my regular OB was - I just decided to do everything at the one practice so it would be easier, and because I thought I could eventually deliver with one of their MWs.

So, I will update when I hear back, hopefully with good news!
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Old 01-17-2009, 07:52 AM   #7
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Re: WWYD? (MW, OB, etc)

At our local midwife birthing center, they will see HR moms, but you just have to also see their supervising doctor, who is a perinatologist. They might make you birth in the hospital, depending on what makes you HR and how that is during the birth. But if you are seeing a midwife practice, it is likely that their supervising doctor agrees with their philosophy. IME, midwives who are just backups in big OB practices will not be able to help you get the birth you want, and you need to find a different practice.

Good luck!
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Old 01-17-2009, 09:05 AM   #8
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At our local midwife birthing center, they will see HR moms, but you just have to also see their supervising doctor, who is a perinatologist. They might make you birth in the hospital, depending on what makes you HR and how that is during the birth. But if you are seeing a midwife practice, it is likely that their supervising doctor agrees with their philosophy. IME, midwives who are just backups in big OB practices will not be able to help you get the birth you want, and you need to find a different practice.

Good luck!
Well I heard back from the birthing center yesterday and they said so far, they don't see any reason why I can't deliver with them. They do want me to at least have a consultation with their OB, but from the history I gave them over the phone, they said that I probably won't even have to continue to see him for prenatal care.

In my first pregnancy, I had a placental abruption which eventually led to PPROM and preterm labor. My OB at the time said that sometimes PA just happens randomly - it could have been due to how the baby implanted in the first place, for example, and in a case like that, would be unlikely to happen again. Before we started TTC this time, I went to the HR docs to have them review my records and get checked out. They ran lots of tests and couldn't find anything wrong with me that could cause what happened. In the end, they said they felt that it was probably a fluke and that I was not at a particularly high risk for it to happen again, but they wanted to monitor me closely JIC. I'm all for being cautious, so I'm fine with that, and if I do end up having a problem again, then obviously I'll be delivering in a hospital since that's the best place in those circumstances. So I'm glad to have the perinatalogists and a plan in place JIC, but so far, indications are that everything is good.

We're scheduled to take a tour of the BC next Monday, so I should know more then. I feel a lot better now at least knowing that I have some options.
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Old 01-17-2009, 09:33 AM   #9
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I don't have time for a very insightful reply, but I just wanted to say that I feel your pain! I saw in the other thread (17P) that you're at a university medical center too...there are SO many residents at mine!!! It makes me crazy. There are 6 MWs but I'm not sure if they'll let me co-manage care. I would much prefer to have 1 of 6 MWs attend my delivery over 1 of 30-something OB residents! I still haven't gotten up the courage to ask if a MW can attend my birth.
My OB told me that I can have a MW attend my delivery if she wasn't there and it was in my birth plan, but and OB still did. After all that planning and talking and they didn't listen anyway. Very frustrating.
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Old 01-17-2009, 09:38 AM   #10
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My OB told me that I can have a MW attend my delivery if she wasn't there and it was in my birth plan, but and OB still did. After all that planning and talking and they didn't listen anyway. Very frustrating.
So sorry, mama! That is exactly the kind of stuff I am worried about though.
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