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Family Centered Maternity Care

02/08/2013

Belle

FIRST: Good thoughts/prayers and vibes are being requested for the Professor. In a few hours he’ll begin a day-long interview process at his No. 1 job choice out west. My palms have been sweating for him all morning, and his interview has not even started! 

This post might be a little scattered so prepare for lots of bullets. I have lots rolling around in my brain and am having a hard time processing it all. I hope this helps!

Yesterday I had my consult with a new doctor who I’ll refer to as Dr. S. Dr. S is a third year resident in the University’s Family Medicine (FM) department. FM has been working really hard during the past few years to improve their maternity care. Today they provide “family centered maternity care,” which is a unique, approach to maternity care and obstetrics care is provided for the mother and family before, during and after birth – meaning I won’t have to hunt for a pediatrician for just a month or two before we move.

Family Centered Maternity Care emphasizes the following:

  • Spontaneous Labor – they will let you go up to 42 weeks before induction. Because of this, their induction rate is extremely low – most mamas will naturally labor before 42 weeks. 
  • Moving & walking during labor – they WANT you to move around to help labor progress naturally
  • Continuous labor support – my doctor, Dr. S, will be with me during my entire birthing process. When I go into labor I will call her. I’m then encouraged to labor at home for as long as possible. When it is time to move to the hospital I will call her again and she’ll meet me there and help us deliver.
  • Avoid routine interventions – when I asked about episiotomy Dr. S gave me with this look that clearly said, “how archaic!” She explained that there is no medical evidence that this procedure actually helps birth in most circumstances. In her three years of practicing she could site only two times she had to do one due to medical emergency when the baby became stuck and all other options had been exhausted.
  • Upright and spontaneous pushing: this is a biggie for me. I’m an active person who likes to move through discomfort. I can’t imagine having to lay on my back to push a baby out. I also have read a lot of evidence that says pushing is MORE effective when done as the mother feels necessary, which means breathing during pushes, grunting and moving.
  • Keep you and your baby together: FM practices kangaroo care at birth. Immediately after the birth of our sweet Chicken he or she will be dried off and placed on my chest. We will both be covered with a warm blanket and a hat put on the baby’s head. We will be allowed to rest and bond “skin-to-skin” for up to TWO hours. We are encouraged and assisted in beginning to breast feed at this time.

All of this is expected of the FM practitioners and are not issues I will have to “fight” for. In addition, Dr. S explained that:

  • The University hospital maintains the lowest c-section rate because they allow mothers to labor as long as they need to. There is no 12 hour cutoff as long as mother and baby are doing well. There is no administrator watching the clock as you “take up space” during a long labor. FM practitioners and the University hospital do NOT want to slice and dice their patients unless the mother or child are in distress and all other corrective measures fail. 
  • Dr. S is comfortable with and encourages Hypno Babies, and is even taking the course herself.
  • I am encouraged to have a doula. When I mentioned I was bringing a doula to the midwife she gave a lukewarm reply and did not know the doula I had selected. Dr. V knows my doula, and actually cares for her entire family in the FM practice.
  • She also said my weight gain is NOT excessive and that, frankly, I look fantastic for 20 weeks and hardly look pregnant. She emphasized that EVERY woman is different and that as long as I’m staying active and eating well I have nothing to worry about.
  • FM and Dr. S encourage you to take birthing classes outside of the hospital so that you learn more about your options. Hospital birthing classes often tell you how you will give birth rather than give you your options during birth.

And now for the few negatives about switching to FM:

  • Dr. S will be out-of-town for three days the week prior to my due date. This, she believes, should not be a problem because first time mamas almost always go past their due date. Should my labor start while she is gone, though, she will make sure I have another FM doctor ready and waiting to attend my birth. She said that all FM doctors aspire to the same standards, although she is a little more gung-ho about natural childbirth then the other practitioners. No matter what, I will be attended by a FM doctor, not a doctor from OB and will have my wishes respected. 
  • And finally, the University still practices continual fetal monitoring. The monitors they use are portable belt things that will still allow me to move freely. Dr. S explained that she is working on changing this. Currently patients have had success with doing intermittent fetal monitoring where you wear the monitor for 20 minutes and then are taken off of it for an hour. She is also fighting to have all nurses trained so they can monitor only by listening to fetal heart tones – which is what I want. If the stars align and the right nurses are on staff when I’m laboring this will be possible. But it is a crap shoot.

There are things about the FM clinic that are not as plush as the other clinic. The midwife’s clinic is lavishly decorated, everything is new and shiny and pretty in the exam rooms, all the equipment is new and state-of-the-art. FM is in an older building. The decorating is non existent gray walls, blue chairs, older exam room equipment. The hand-held doppler Dr. S used was older and not as flashy. At first all this made me really uncomfortable but as I spoke with Dr. S I realized that fancy bells and whistles and pretty rooms are not what makes a successful birth. Competent people who support you are.

Dr. S was not the warm, fuzzy personality I had initially hoped for. She is down to earth, matter-of-fact and extremely passionate about natural childbirth and evidenced based care. A few bloggers mentioned on my post about breaking up with my midwife that finding my “soul mate” provider might be a tall order, but that if I could find a competent provider with the same ideals as I have I’d be doing pretty darn good. While I don’t think Dr. S is my soul mate, I do feel that she and I would make a good team.

All considering, I feel that FM is the best place for the myself, the Chicken and the Professor. I think that, given our minimal choices in the area, that FM will give the best birthing experience possible in a hospital setting. Would a home birth be better? Hell yes! Would I do it if I could? ABSOLUTELY! I am a reasonable person, though, and know I have a complex history. I also know how hard we fought for this little Chicken and the guilt that would weigh on me should a home birth go bad would be absolutely crushing. I signed the medical release forms after meeting with Dr. S, requesting that my records from the midwife be transferred, and then set my next three appointments.

I feel good knowing that I will be birthing somewhere that supports me. I also feel good knowing that I’ll be at the University hospital where they have access to all my weird autoimmune history (a big deal should something go wrong). And the Professor feels good knowing that his wife won’t go bat-shit crazy when a doctor says “well, time’s up… let’s slice and dice!”

Whew, that was a lot. How do you guys feel about this? Any tips for  how I can fight for monitoring to be done via doppler and heart tones only?

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15 Comments

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  1. February 8, 2013

    Wow, this all sounds amazing!! I agree — you definitely won’t care about pastel colour schemes or whatever when you’re in the midst of labour; as long as you have people you trust looking after you, that’s what matters. I think you’re finally set for care providers now. 🙂 Fingers crossed for Professor today! While I’d personally love to see you guys become hipster NYC parents, I guess I could settle for west coast, as long as you retain your sarcasm and edge. 🙂

  2. SRB #
    February 8, 2013

    This sounds much more in line with the kind of pre-natal, birthing, and post-natal care you are hoping for. Muuuuuch better! As for continuous monitoring, just because it s hospital policy, it does not mean that you are resigned to it. You can still refuse it as “routine” and request intermittent monitoring instead. Think of it as “informed refusal”… you can always refuse a procedure or routine practice if you don’t want it (and barring emergency, of course). You always have the right to be assertive, say “no” and have that be respected. Sounds like Dr. S will respect that.

    Best of luck Professor! EEEK!

  3. February 8, 2013

    Despite the couple drawbacks, I love FM and Dr. S! Sounds like the best possible option for you, much more what you are looking and hoping for. I hope, once you start attending your prenatal appointments there, you will continue to be just as happy as you were upon first meeting them. Yay!

  4. karaleen #
    February 8, 2013

    Sending out super awesome thoughts for the professor! I am a West Coaster and love it so I secretly hope he comes this way. And I think you will love it out here too….

    Thought on Dr. S and the FM group…it really does sound like it is much better for you than any of the other option out there. I really like the philosophy and the basic goal of natural whenever possible. I had to have c-sections but was so very grateful that with the exception of about 15 minutes when they are closing me up and my DH was holding baby…they believed babies did better next to mama. So once they closed me up, baby was placed skin to skin on me and stayed there for over an hour. It was AWESOME. all vitals and care of the baby were done while on my chest and I nursed baby for the first time in the recovery room.

    No situation is perfect…but this really does sound like a great fit for you Belle. I’m so happy you found them.

    kd

  5. jak #
    February 8, 2013

    here’s my lame theory that might be true (when i figure out how to alter time this will be my next phd thesis) – i dont think we have enough “historical control data” on healthy, non-medicated vaginal births (no IV fluids, no antibiotics, no narcotics, certainly no epidurals) to understand the healthy, normal patterns of fetal heart rate during labor. so when EFM is conducted more data is collected than docs/nurses know what to do with. they see a blip and freak out. that blip could be totally normal, but since everyone is worried about lawsuits, and they dont know what “normal” is, they begin interventions based on possibly meaningless blips in the continuous EFM. the data dont exist to support EFM as protective to baby. the data do exist to show that EFM increases c-section rates. full disclosure: I HAVE CONTROL ISSUES AND A DISTRUST OF AUTHORITY. hahahhaa:)

    i think you’re right on about all this though and your chances of delivering naturally here are great compared to other options. this sounds really in line with your ideals and i think its good that your doc is so new. less indoctrinated that way:)))))) – like you said though, the only issue is continuous EFM. all the natural birth ‘perks’ doc s mentioned are contingent on everything looking ok with the baby, ie no heart rate flubs or blips or dips. so, if there is a flub, blip or dip, you may lose those perks. but, you can refuse certain aspects of care. even if they are “standard”. see if you cant make a deal/condition with your doc that says as long as you do not a) have an epidural, b) run a fever (sans epidural), or c) take whatever you agree to is an inordinate amount of time to labor, that EFM will not be used. maybe this is crazy, but can you ask doc s “what if i refuse EFM unless certain conditions/events occur?”

    very excited for professor husband:) i hope everything goes well and that he ends up with several choices of uni to work at!!!!

    when’s your 20 wk u/s? next friday or so????

    • February 8, 2013

      I agree with the concept that no one has enough neatly analyzed data to really know what is normal. I see this in my rheumatology appointments all the time. It does not surprise me at all that it would also be present in labor and delivery. And I share your lack of trust in authority 🙂 I think doctors might groan when they see my name on a chart.

      20 week ultrasound is on TUESDAY! I’m so ready to see my baby on the big screen!

      • jak #
        February 8, 2013

        bhahaha! they probably have a code for patients like you – maybe it says, “PDC” on your charts for “pushy demanding customer”. my gran and my best friends mom worked in the same ER when i was a kid. they said they used to have codes like these to help identify patients. one was “FLK” for “funny looking kid”, hahaha!!

  6. Amy #
    February 8, 2013

    This sounds amazing! So glad that you trusted your gut and took action to explore your options. It sounds like this is definitely the way to go!

    As for the monitoring, I would say to just keep asking about it and expressing your wishes and interest in the nurse training at every single appointment. Maybe even ask Dr. S which nurses she thinks will be the most open to it, and try to talk to those nurses about it at your appointments if possible (not sure if the same nurses would staff the office/clinic and the L&D department?). You have some time, hopefully the training will get underway soon and you won’t have to wear the monitor when the time comes!

  7. February 8, 2013

    Good luck professor!!!! Let’s go West Coast!!!! FM sounds amazing! You are so right when you said that it is the capable people helping you during birth that matter, not how big your room will be or how fancy a place you are in. As for the fetal monitoring I am not really sure. Is it their policy that your baby must be constantly monitored? For this issue I would suggest just knowing what your rights are as a laboring mother. There are many medical interventions that we have the right to decline, not sure if this is one. I can’t wait for your 20 week ultrasound!!!!!

  8. February 8, 2013

    Yay! Sounds much better, so glad you’ve switched Dr.’s! As to the fetal monitoring, I was induced, (light induction that was no longer in my system but still an induction) and thus had to have continual fetal monitoring in the hospital I birthed at but it was like you’re mentioning here, it was portable and I gotta say…it wasn’t that bad. I took a bath, spent a LONG time in the shower, was moving A LOT, spent very very little time in the bed and honestly the monitors didn’t bother me. In fact I hardly noticed them. They continually had to be readjusted because I was moving so much but the nurses were very good about waiting for the end of the contraction to come readjust them without making me move from wherever I was ie. the shower, so don’t be discouraged by this one aspect of the hospital that you’re uncomfortable with.

  9. February 8, 2013

    Wow, that sounds amazing. I LOVE that the doctor is with you the whole time! That’s insane! My doctor was literally there for 10 minutes. Which is crazy since just my pushing phase was 2.5 hours! Even our delivery nurse came and went. If we didn’t have a doula we would have been on our own 90% of the time. Welcome to Canada – where health care is free for a reason….
    This sounds fantastic belle, I hope you love your choice.

  10. February 8, 2013

    Good luck to the Professor!

    I am so thrilled for you! It sounds like you have found the right person for you. HOORAY!

  11. Romy #
    February 8, 2013

    I think you need to do what feels right for you – and if that is Dr. S, I’m happy for you 🙂
    I personally am too aware of the fact that things can and do go wrong to want to even consider a home birth or even a hospital one with intermittent fetal monitoring – or to be left to go overdue by that long. I talked about this with my doctor and he said that a lot of women think there is no urgency in childbirth, that you can push for as long as is needed and the baby will be fine. But he has seen lots of cases where the baby’s heartbeat dropped very suddenly without any good explanation. His own baby (3rd child) died during childbirth which I am sure has something to do with the fact that he advocates a more medical approach. But I personally could never forgive myself if my baby died in week 42, or if it died during delivery because I didn’t want to wear a fetal monitor. The risks are small but they are there, and if something does go wrong I want to be able to look back and know that I did everything possible to avoid that bad outcome (same as with IVF! my clinic said sex was fine after the transfer but to avoid it if I thought it might be something I would point to and feel guilty about if IVF were to fail).
    It’s all about the level of risk you’re willing to assume and the type of birth you feel most comfortable with. It’s great that you have so many options to explore.

  12. February 8, 2013

    My tip for dopler monitoring is to remember you are the client (not a patient) paying for services and can refuse anything. Doesn’t matter what hospital policy is or “how they normally” do things. I just had twins 8 weeks ago and had a great dr that was on board with what we wanted. She wouldn’t have done things the way we did, but we were educated and knew the risks and after she confirmed we understood what we were doing she was fine with our requests like intermittent monitoring, etc. However we had to fight numerous nurses because we weren’t going according to their schedule or doing things the way they did them. We never had to sign any waivers because it never got that far, but we were ready to sign any waivers to remove the nurses from liability if that is what they were worried about. We constantly had to assert our rights though and tell them no we weren’t doing it their way. They didn’t like it, but they can’t make you do anything you don’t want too. My husband was a great support in taking care of all this so that I could focus on birthing my babies. Talk to your dr and tell her you want the intermittent monitoring to be done via dopler so she can run interference for you with the nurses.

  13. February 9, 2013

    This sounds like a wise decision Belle. Medical monitoring yet supportive care: just what you are looking for. Glad you found this practice 🙂

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