Experience with Midwives at Capital Women's Care

[Anonymous]

Help! I'm moving to the DC area at 28 weeks and had planned on using the Midwives at Midwifery Care Associates and delivering at Shady Grove. Just found out that they do not take my insurance and am now scrambling for another option. I am very committed to a natural childbirth and would strongly prefer using a Certified Nurse Midwife as opposed to an OB/GYN. So my questions are:

1) Does anyone have any experience with the midwives, Fran Knoll and Sheila Barrett, at the Forest Glenn, Silver Spring location of CWC?
2) Do they only deliver at Holy Cross or do they have deliver privleges elsewhere, such as Shady Grove?

CWC's website is not that useful so I really appreciate any feedback. Thanks so much.

[Anonymous]

Hi there, I am using this practice and I have been really, really happy with them (I am 30 weeks). I, too, plan to have an unmedicated birth and the practice has been supportive. Further, Holy Cross has it's own doula program, which the physicians at Capital Women's Care are very supportive of and my sense is that if the hospital offers it, it says something about the facility. You should know that while the office has the midwives you mentioned they do NOT deliver the babies. (My guess is this is for liability reasons). However, the fact that they have them on staff says something about the practice, too, in my opinion. I don't have experience with other practices, but have been very happy with the level of care, the seriousness with which they take my concerns, and the ease of getting appointments (and being seen on time...or even EARLY if I arrive early).

[Anonymous]

OP here. Thanks for your feedback. It is really disappointing to hear that the midwives don't deliver - kind of defeats the purpose if you ask me. Who are you currently seeing at CWC? Do they rotate you through all the OB/GYNS and then you get whoever is on call when you go into labor (this is a situation I was hoping to avoid)?

Thanks again.

[Anonymous]

Hi again. My official doctor is Dr. Ein, but, yes, this is one practice where you rotate through and get whomever is on call. However, the reality of things are, even if you go to a one person practice, you may not get the doctor you saw the whole time, anyway, when it is time to deliver (they can't ALWAYS be available for EVERY birth). I do think that while the midwives don't deliver you, the fact that they have them on staff says something about their philosophy, and I have yet to meet a Dr. there that I did not feel comfortable with/like. In fact, my first post-prego appointment was with one of the midwives (Nurse Knoll) and my husband and I actually felt her to be the most brusk and cold. However, at a later appointment when I was scheduled to have a follow up sono because they could not find the heart chambers in the first one (and I was looking forward to it and was anxious), and they scheduled me at a time when the tech wasn't there, she was VERY KIND and understanding and the staff scrambled to get me the sono, etc. etc. (and everything was fine). I guess I would say, if you are dead-set on being delivered by a midwife, then clearly this is not the place for you. However, if you can tolerate the idea of being delivered by a doctor, but want one (or ones) who listens well, answers questions, is fairly laid-back, but responsive, and you like Holy Cross (all single rooms, order off a menu whenever you like, and offer doulas), then this is a great practice.

[Anonymous]

Thanks so much - I think they might be the best option for me at this point. I guess I need to call and see if they are accepting new patients. Do you happen to know if Holy Cross L&D rooms have tubs? It's not clear on the website.

[Anonymous]

Hey there. I don't know if they have tubs...I would be very interested to know. If you call the hospital, I am sure they will tell you if they have them in the birthing suites. Actually, if you find out, and could post it, that would be great

I don't know if they are taking new patients....I would guess that they are, but they were my GYN before my OB, so I can't say. Best of luck to you.

[Anonymous]

In my opinion, the practice has midwives simply to entice new patients, as well as being able to pay them less for the same work (prenatal visits) that a physician would do. Holy Cross is NOT supportive of natural birth in any significant way. The doulas who work there are paid hospital employees, and thus must "tow the company line" so to speak. I don't say this to discount anyone who has had a positive experience with those docs or that hospital or those doulas.

OP -- there are other midwifery practices in the area who actually deliver babies in the way you are hoping for. Check out the DC Birth Center (www.developingfamilies.org). They cater to underserved inner city women; however they happily accept anyone and offer spectacular care. You can choose to either deliver at their birth center or at Washington Hospital Center. Special Beginnings is another really wonderful birth center (www.specialbeginnings.com). The birth center is close to Annapolis, however I know of many women in DC who travel there for their births. Again, you can choose to either deliver at the birth center or at Anne Arundal Medical Center, which is in my opinion the best hospital in the area for natural birth. Both of these birth centers have big tubs and do water birth. No hospital in the area allows water birth - even MCA (who I realize you can't use) is not allowed to do water births due to the regulations at Shady Grove. There is also a midwife who works as a solo practicioner at Washington Hospital Center who is absolutely amazing. Her name is Whitney Pinger and she will support the type of birth you want. She only delivers at WHC, so no tubs for birthing, but she will catch your baby in the shower or wherever you happen to be in the room Let me know if you can't find her contact info - I think if you google her you can find it. I would go with any of these practices ten times over any OB practice in the area -- even one who has midwives on staff.

Hope this helps.

[Anonymous]

Question to the PP..did you deliver with Capital Women's Care? What you said was a bit alarming and different from my experience thus far. The research I have done into the Holy Cross Doula program (largely on this board) had yeilded very positive experiences and there do seem to be some pluses to having the doulas employed by the hospital (like the fact that they know the doctors and the facility and they can actually accompany you before your husband into the operating room, if G_d forbid you need a c-section). I think your remark about the midwives in the practice was a bit harsh, but if you have delivered with them or know specifics about the practice, I guess you know! If you don't have that person information, what you are saying is strong and a bit scary (perhaps for no reason) for those of use who use the practice.

It is really great that you can provide the OP with midwifery options, if that is what she chooses.

[Anonymous]

I am an independent doula who has worked with both CWC and Holy Cross a number of times. That's where I get my information. I actually think the midwives are great and provide good care, and the doctors are good and nice too. The problem is that they don't really do natural birth. This is, in part, proven by the fact that they won't even allow the midwives to catch babies. If they truly respected and agreed with midwifery type births, they would find a way to sort out the insurance issue, just as thousands of other OB and midwifery practices in this country have done. Not that they disallow natural birth or anything, but they just don't do the things that really make a natural birth possible. Does that make sense? Yes, if you really educate yourself, really fight hard, get a good doula, AND everything goes pretty much perfectly, then you do have a good chance of getting your natural birth. However, if all those things don't happen, your chances are very slim because that practice and that hospital does not understand what they need to do to facilitate a non-interventive birth. Just ask them. How many women in their practice wind up NOT getting pitocin or an epidural? If they had to guess, what would the percentage be? Again, based on personal experience I would bet that only about 3-5% of all women at Holy Cross have completely unmedicated deliveries. So whether or not that is by choice or lack of support, it still says something about the experience the doctors and nurses have: they don't know how to do natural birth.

And, I know from personal experience that the holy cross doulas do not have the same freedom as an independent doula. Being hospital employees, they must always consider their employment first. Yes, it's nice that they can accompany you into a c/section - but that's not really why you're hiring a doula, is it? Most people hire doulas because they want someone who will advocate for you or give you suggestions about your choices. Someone who works for the hospital is never going to contradict what a doctor or nurse is saying, even if it might be in your best interest.

I don't mean to be a downer. I strongly believe that there is a path for every woman. If you feel great about your docs and you trust them and really have faith in the path you've chosen, then that really is the most important thing. However, whenever someone says they really, deeply want a natural birth, that they want to deliver with a midwive, that they want to be allowed to move and eat and drink and not be rushed, etc. etc., I strongly encourage them to seek out a care provider who knows exactly how to do birth in that way.

[Anonymous]

To follow up on the PP, I've heard some people rave about DCBC but I had a first visit there and was extremely disappointed. It was total chaos, they relied heavily on trainees and the trainee who saw me made a few obvious mistakes.

I felt that they may provide a really important service to many women who don't have good options thanks to lack of health insurance, but in my situation I could find better care.

[Anonymous]

PP, I'm so sorry you had a disappointing experience there. That sounds awful. Did you give them your feedback? I know that they do everything they can to provide quality care to their patients, and I'm sure they would be extremely receptive to your thoughts. Where did you wind up going?

[Anonymous]

To the PP before the PP Thanks for explaining where you got your info. While I am glad to hear you were speaking from experience, I am not so glad it hear it either! My DH and I are starting a hypnobirthing class next week to aid in my plan to go unmedicated, and I have spoken with my doctors about my desires for such a birth. The one thing I have been told is to "stay at home as long as possible", because once you get to the hospital, people get anxious, ect. I am hoping to use the Holy Cross doula for the positive mentioned by others, and, frankly, because they are much more affordable than a private doula. Given my choices (as I have stated), would you have any other suggestions for things I can do to insure or help get me toward having an unmedicated birth? Thanks!

[Anonymous]

would you have any other suggestions for things I can do to insure or help get me toward having an unmedicated birth?

- Commit yourself to not getting induced. The pressure to get induced can be enormous. Do your research and feel comfortable in refusing induction for anything other than a true emergency.

- Labor at home until you are well into active labor, in transition, or even until you start to feel the urge to push (usually for a first time mom it is still 1-3 hours after you feel this first urge, until your baby is born).

- Have a plan with how you will cope with the pain of labor (hypnobirthing is good)

- Discuss with your doc ahead of time every possible thing you can think of. Under what conditions do they recommend induction? How do they induce? (Holy Cross uses Cytotec routinely!!!) Under what conditions do they require CFM? What are their protocols if your membranes rupture prior to the start of labor? Under what conditions do they limit your general movement? How do they encourage you to stay hydrated and keep your energy up? At what point would they offer pain meds? What positions do they allow for pushing? Under what conditions do they tell you how to push? Obviously you can't anticipate every possibility, but you can take the time to discuss and think about a lot of them. Depending on how satisfied you are with your doctors answers, you might either feel reassured or you might feel like you really need to find care elsewhere, even though you are already 30 weeks (MANY women change care providers at this stage of pregnancy).

- Write a short and simple birthplan that addresses your most serious concerns.

- Don't be afraid to stick to what you want, even if someone is pressuring you about something

- Hire an independent doula who can labor with you at home and offer you opinions that might differ with the hospital. Usually student doulas and doulas who practice further outside of DC charge less. You might have to search, but you could probably find one who charges the same or slightly more than what you are paying for the Holy Cross doula. The big benefit is having someone who can help you stay at home during labor

- Be realistic and flexible. Recognize that your chances of having interventions or a c/section are much higher simply because you are with care providers who do these things routinely. Make sure you are satisfied that whatever you feel the benefit is of birthing with this particular practice at this particular hospital, is worth this tradeoff.

[Anonymous]

Thank you so much for taking the time to answer my question.

[Anonymous]

OP here - thanks everyone for the rich and attitude free discussion As I mentioned I am very disappointed that I can't use Midwifery Associates as several of my friends have had excellent experiences with them and they seemed like the perfect fit to me. As a first time mom I have the jitters and I liked the idea of being in a hospital just in case.

Honestly - I don't like the idea of having to "fight hard" for my natural childbirth, I want to be supported and encouraged. The insurance company website says something cryptic about DCBC - like "these providers may or may not be covered please contact your plan administrator". I'll make the phone calls and see what I can find out.

Thanks again for all of the great information - unfortunately I don't think Whitney Pinger is covered by plan either - it looks like it's either CWC or DCBC.