Thursday, August 09, 2007


Almost 15 weeks update: the midwife question

See, bloggy peeps? I take your advice! I went ahead and scheduled an appointment with the midwife, just so I could keep my options open for a little while longer.

First, I have to tell you that I heard the baby's heartbeat, and all seems fine. What, you haven't been obsessing over it, thinking of it every two hours half hour six minutes like I've been? Heck, it took me until I was on the bus on the way to the appointment to figure out that I wasn't having heart palpitations and trouble breathing because of any larger fear of the midwife herself, but over knowing she would have a doppler and I was afraid to face the possible silence like last time.

The bad news is, I really liked the midwife and the whole philosophy of midwifery care. I mean, that's bad news because if I had hated her on sight, it would have been a lot easier to simply go back to my OB and carry on.

There are a handful of concerns that I can't quite shake, mostly having to do with scenarios when something goes wrong. To her credit, even though my OB has no bedside manner whatsoever, when she couldn't find the baby's heartbeat with the doppler at my 16 wk appointment last year, all she had to do was walk me over to the ultrasound clinic on the other side of her office, and she did the scan herself to try to find the baby. I know it would never be that easy with the midwife, even though I understand that they do have full referral access for all that stuff.

I think the one thing that most surprised me and most concerned me is that even with a hospital birth, the midwives don't use the fetal monitoring tools like the heart rate monitor. With Simon, I can still clearly remember after many hours of stalling labour when I finally began to have serious contractions there was one terrifying moment when the baby's heart decelerated significantly enough (140s to low 60s) for the nurse to demand of Beloved that he push the call button for assistance. There was no real emergency, and in hindsight it was probably just the stress of passing a baby the size of a Toyota through an opening the size of an orange, but the idea of not hearing that reassuring whoosh-whoosh-whoosh throughout the labour seriously freaks me out.

Here are the other niggling concerns I have:

With Simon, I was 10 days late when they finally started induction, and even then he took more than 24 hours to come out. I asked the midwife about induction, and she said they consult with an OB when you are 42 weeks. Ugh. Did I mention Simon was 10 lbs? I know, nothing says the next baby will be that large or that late, but still...

I have every intention of delivering at the hospital and staying at the hospital for as long as they'll let me. With Tristan, I was terrified to go home because I didn't want to be solely responsible for the mewling little mass of perfection, and with Simon I left after 24 hours (against the doctor's and nurses' objections) because it was the first time I had ever been separated from Tristan. When the midwife said that it's standard practice after midwife deliveries for the mother and baby to go home after three hours, assuming all is well, I told her that I wanted to take full advantage of the hospital stay and she laughed and said it's funny how mothers with more than one at home tend to say that.

Of course, there's the fact that midwives no longer have priviledges at the Ottawa Hospital, so I'll have to deliver at the Montfort, but the more I talk to people in the community about this, the less this concerns me. But still.

There are many things I like about midwifery care:

* the post-natal care. The first couple of weeks with baby at home have been rough on me both times. The midwife comes to visit you at home at least five times in the first two weeks after baby is born, and I find that incredibly reassuring.

* longer appointments with more holistic care.

* will know the people who are with me when I'm actually delivering the baby, and they'll know me (as opposed to taking a gamble on the nursing staff, and the 1 in 10 chance that my own OB is on call that day.)

* when I told the midwife about how at Simon's birth the anesthesiologist said I was his most difficult case in more than 500 epidurals (!) she suggested we could make an appointment for a consulation with an anesthesiologist before the birth to discuss options. (Seriously! Why did my OB not do something like this after I told her how much trouble the anesthesiologist had at Tristan's birth?)

* office is very conveniently close to where I work for appointments, as opposed to the OB who is two long buses away.

* no traumatic memories attached to the midwife's office.

* when I couldn't help myself and cried a few tears of relief when I heard the baby's heartbeat yesterday, she smiled and rubbed my arm and said, "Everything's fine!" in a very comforting voice. As opposed to my OB, who didn't touch me or express any overt sympathy through the entire miscarriage experience last year. In fact, it was the ultrasound tech, following up on what the OB started and confirming that the baby had died, who took a moment to physically touch me and tell me how sorry she was. It's just a more humanized level of care.

So, I don't know. Through the course of the afternoon yesterday, I changed my mind five times. If it weren't for the fetal monitoring part, I'd be comfortable making the switch. Then again, it's not like I'm lacking anything with the OB's care, and I know she's world-class in her field.


I do know that through this most difficult month, as 16 weeks come and go, through a complete fluke of timing in the overlap of care I've got an appointment every week this month. Yesterday I saw the midwife, and tomorrow I go for my final IPS blood test. Next week, I go for my scheduled 16 wk appointment with the OB, to hopefully discuss the IPS test results. The week after that is my first clinical appointment with the midwife, should I choose to go that route. And the week after that is the ultrasound. I couldn't have planned that better if I'd tried!

So, what say ye, bloggy peeps? You're the board of directors at DaniGirl Inc, and we need to make a decision today on the direction of the company. What do you recommend?