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?