risked out of Wisdom, now what

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
Second, I have to vehemently disagree that desiring an epidural up front does not "fit" with the midwifery model. I think access to midwifery care for lower risk pregnancies should be available to ALL women regardless of their pain relief preferences. An epidural alone does not add significant enough risk to opt out all those women (obviously, as Wisdom will give you an epidural "when needed" without transferring your care mid-labor), many of whom could possibly have far fewer other interventions with midwifery care than with an OB. Why not try to improve care and deliveries for ALL women without judging them for their pain relief preferences? (Again FWIW, I did not/do not want an epidural, but not out of a generalized belief that "natural is better" -- it's mostly an irrational fear of needles in my spine, plus some more minor concern over the possible side effects on me, my labor, and my baby. But if hydrogen peroxide/laughing gas were available here, I would ABSOLUTELY use it. Would they boot me for that too?)

I'm the person you quoted about not wanting tough love. But, I also disagree with you about epidural / midwife connection. Look, they are going for a non-medicated approach. I personally think it is not appropriate to say you want low intervention but yet you want the one intervention that MOST midwifes believe is a big part of the "cascade of interventions." If you want an epidural with otherwise low interventions, you should seek a high touch low intervention OP, get a doula, and advocate for yourself. But a midwife is not necessarily for you. And yes, personally I think this would go for laughing gas, too. Exception for epidural is when mom has labored for a long time and just needs to rest. I don't think midwives are de facto opposed to epidurals. but with most births, they believe they are not needed. I'm not sure why that is such an issue.

+1

Epidurals solely for pain relief come with complications. Midwives are the most practiced and familiar with complications that arise from non-medicated birth. It's not a judgement thing. It's a we-are-best-at-this-kind-of-birth thing. If you go into birth knowing you want anesthesia, you are sort of wasting their expertise and the strength of their model of care. If you just want to hold your baby right away and wait to cut the cord, agree with PP above - just get a doula and find an OB that'll support your plans.

12:54 again. And I have to say, I really hate this attitude, and it IS judgement. Yes, epidurals (REGARDLESS of whether they are "solely" for pain relief or something else) come with complications. However, recent studies indicate they do NOT increase c-section rates, just other interventions for example instrumental deliveries. But aren't those exactly the kinds of interventions that midwives might be better positioned to avoid? I'd love to see a study of epidural patients delivering with traditional OBs vs midwives and see if the complications rate holds steady. I'm just saying, it's not a waste of their expertise at all to say, I want an epidural but I'd still like to avoid forceps so a midwife can help me with epidural timing and strength, labor and delivery positions, etc. Many (most?) OBs just aren't very good at doing that sort of thing, and a doula can only do so much (especially in the face of an uncooperative OB). To suggest that wanting an epidural means you JUST "want to hold your baby right away and wait to cut the cord" and relegating all those women to potentially worse, more intervention-prone care, is absolutely judgy. If you value the midwifery model for "normal" births, surely you can agree that a woman with no other issues to start off, but who gets an epidural, is more likely to have a more successful vaginal birth than one with an OB, right? How is that a waste?

Again, I say this as someone who did NOT want an epidural (I labored for 12 hrs on the highest dose of pitocin without one, including FOUR HOURS of pushing! and damn right I'm proud of that), and I do generally believe that it's "better" to go without, just like I believe that breastfeeding is "better." But I still think that doesn't give us the right to judge--and insult--informed women for making different choices.

[Anonymous]

I'm a PP who supports Wisdom's position on epidurals (though that's pretty far away from the original topic!)

Jeez. Do OBs suck that much? I really hope not. I'd hate to think it's so all-or nothing. Why does anyone who wants to give birth vaginally go to an OB then, if they really just don't help any woman with birth unless she's having a c-section and they push for a cascade of interventions that will make one more likely?

I don't buy it. I have read many posts on this board about OBs that are low-intervention or who "get" the latest science.

I don't personally judge anyone who gets an epidural or a c-section or anything else. We're all doing our best here to make the best decisions for our bodies and our babies, and our providers hopefully are too. I don't think unmedicated childbirth is for everyone. I have a friend who seems completely traumatized by her "natural" birth at a birth center and toughed it out for 50-hours of labor. Maybe she should have been at a hospital. Every woman is different.

But back on the midwife-plus-epidural, can you easily birth in other positions if you have an epidural? I thought you were frequently stuck in bed if you are numb from the waist down. Can you listen to your body and know when to push if you can't feel anything?

[Anonymous]

12:54, it sounds like what you are talking about is normalizing midwife care for everyone and reserving OB care for people who require those particular skill sets. I think it's a great idea, and one which I would also love to see.

That said, I think that it's completely reasonable that this specific practice emphasize whatever behaviors it feels are best. If Whitney believes that her diet is the magic bullet that cures all pregnancy ills and insists that everyone at least attempt an unmedicated birth, that's totally legitimate. It's her practice and she is not obligated to work with people who are not interested in her model of care. This practice emphasizes diet, exercise and a commitment to unmedicated birth. Other practices emphasize different things.

I really do not understand the level of vitriol against this particular practice. I get that they are more dogmatic than many, but it's like half this board thinks that Whitney and her colleagues should just accept anyone, regardless of their medical history, regardless of their birth plan, because midwives should be interested in providing care for everyone. I agree that anyone who wants to work with a midwife should have that option, but I don't think that the obvious consequence of that should be that midwives should relax their practice standards because a woman isn't sure if she's going to want an epidural or not.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I thought I would be diagnosed with GD but I wasn't (failed the one hour and was afraid of the three hour). Another midwife had been my midwife whom I saw just prior to the screening test, so I emailed her when I was afraid and needed to know next steps. I am seeing I am glad to have trusted my instinct.

Whitney told me "don't get GD. It would be really, really bad if you got GD" (I have some risk factors - mostly family). I wasn't sure what to say to that, but I can say her words rung in my ears when I failed the one hour and gave me even more ammunition for my body feeling like it was failing me.

I'm not Whitney, so I can'ttell you what she meant by that. But I can tell you what I think she meant.

The midwives take you in and make you like family. If you get GD that would cause them to risk you out, they would lose a family member. It's not a fair way to put it, since you can't control whether you'll get GD or not, but I think that's what she meant.

If you really believe this you are totally drinking the (proverbial) Kool-Aid.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I thought I would be diagnosed with GD but I wasn't (failed the one hour and was afraid of the three hour). Another midwife had been my midwife whom I saw just prior to the screening test, so I emailed her when I was afraid and needed to know next steps. I am seeing I am glad to have trusted my instinct.

Whitney told me "don't get GD. It would be really, really bad if you got GD" (I have some risk factors - mostly family). I wasn't sure what to say to that, but I can say her words rung in my ears when I failed the one hour and gave me even more ammunition for my body feeling like it was failing me.

I'm not Whitney, so I can'ttell you what she meant by that. But I can tell you what I think she meant.

The midwives take you in and make you like family. If you get GD that would cause them to risk you out, they would lose a family member. It's not a fair way to put it, since you can't control whether you'll get GD or not, but I think that's what she meant.

If you really believe this you are totally drinking the (proverbial) Kool-Aid.

Dude, Kool-Aid is not part of the diet plan!

[Anonymous]

OBs are so unfairly demonized. My OBs have all been understanding and accommodating and have wanted best for me and my baby. I was never encouraged or pressured to do any one thing or to get an epidural and I never felt like a head of cattle being moved through a pen. Many OBs are truly compassionate and willing to work with you to have the best birth possible. This is all any woman wants. Whether that's with an OB or a midwife or a doula- I just don't see why any one group has to be targeted as providing a "lesser" birth the way OBs tend to be here.

[Anonymous]

Anonymous wrote:OBs are so unfairly demonized. My OBs have all been understanding and accommodating and have wanted best for me and my baby. I was never encouraged or pressured to do any one thing or to get an epidural and I never felt like a head of cattle being moved through a pen. Many OBs are truly compassionate and willing to work with you to have the best birth possible. This is all any woman wants. Whether that's with an OB or a midwife or a doula- I just don't see why any one group has to be targeted as providing a "lesser" birth the way OBs tend to be here.

I love you, PP. So well put! I feel this way about my OB practice - they were completely, 100% behind an unmedicated birth and so supportive and encouraging every step of the way. I can totally appreciate why people opt for midwives, but it really bothers me when it's presented as the polar opposite of everything OB.

[Anonymous]

Anonymous wrote:12:54, it sounds like what you are talking about is normalizing midwife care for everyone and reserving OB care for people who require those particular skill sets. I think it's a great idea, and one which I would also love to see.

That said, I think that it's completely reasonable that this specific practice emphasize whatever behaviors it feels are best. If Whitney believes that her diet is the magic bullet that cures all pregnancy ills and insists that everyone at least attempt an unmedicated birth, that's totally legitimate. It's her practice and she is not obligated to work with people who are not interested in her model of care. This practice emphasizes diet, exercise and a commitment to unmedicated birth. Other practices emphasize different things.

I really do not understand the level of vitriol against this particular practice. I get that they are more dogmatic than many, but it's like half this board thinks that Whitney and her colleagues should just accept anyone, regardless of their medical history, regardless of their birth plan, because midwives should be interested in providing care for everyone. I agree that anyone who wants to work with a midwife should have that option, but I don't think that the obvious consequence of that should be that midwives should relax their practice standards because a woman isn't sure if she's going to want an epidural or not.

I'm suggesting making midwifery care *available* to all women, if they so choose, as long as they are not genuinely risked out. Some women will always choose OB care, and that's fine, but I don't think desire for pain relief should be a sole deciding factor.

However, I actually have no problem with specific providers emphasizing certain factors and only taking certain patients, such as Wisdom's focus on diet, exercise, and natural birth--as long as it does not include shaming women (especially for circumstances beyond their control such as the PPs who were implied that GD was their fault, or women who ask for pain relief after labor becomes harder for them than anticipated). Any vitriol I have is due primarily to the shaming, not to making their expectations known up front. I am, though, sad that such a large practice in this area would be so restrictive given the limited options women have for midwifery care here.

I also don't mean to demonize OBs--absolutely there are some who are truly supportive of low-intervention birth, but you have to admit they are a minority (albeit thankfully a growing one). I'd love to see all maternity care on more of a spectrum rather than so polarized, but that's going to take some time and effort both on the part of the medical practitioners and on the part of more women demanding what we want. (This also includes getting hospitals and nursing staff to be more accepting of evidence-based low-intervention policies, especially where they don't have a midwife group to lead the way.) It shouldn't have to be all or nothing, but saying epidural = OB not midwife makes it too black and white.

[Anonymous]

It's a few pages ago now but I just wanted to confirm what some PP said about psychiatric history: having a history alone does not risk you out of Wisdom. They just want to know that you're under medical care for it, because they are not doctors. It strikes me as similar to how they handle other preexistin gmedical problems. I have my issues with the mindset and Whitney was quite hamhanded in dealing with it with me, but it's defensible.

Also in response to a PP from a bit ago, if you read the profiles on the GW MFA site you can see that there are a number of OBs at GW who are very supportive of unmedicated birth. It's one reason I chose Wisdom even knowing that Whitney was odd about my psychi history: if I did risk out, I'd still have great options to get what I wanted within the same system.

[Anonymous]

The weirdest experience I had with Whitney was actually not in an appt but was at the birth and babies fair a few weeks ago. I mentioned that I'd hired a doula who hadn't been to a birth at GW before, and that I'd like to invite the doula to one of my upcoming appts to meet her (whitney)--my doula is relatively new to the field and it seems like a good way for me to help her get established. I forget exactly what she said but it was something like how the doula should be paying me to be getting experience with Wisdom. She said it twice.

My DH, who has started several businesses in his life, calls her a typical empire-builder personality. If you look at what she's done it's hard to argue. Does she worry about making everyone who walks through her door love her, or does she worry about getting the best outcomes for the largest number?

[Anonymous]

Anonymous wrote:

Anonymous wrote:12:54, it sounds like what you are talking about is normalizing midwife care for everyone and reserving OB care for people who require those particular skill sets. I think it's a great idea, and one which I would also love to see.

That said, I think that it's completely reasonable that this specific practice emphasize whatever behaviors it feels are best. If Whitney believes that her diet is the magic bullet that cures all pregnancy ills and insists that everyone at least attempt an unmedicated birth, that's totally legitimate. It's her practice and she is not obligated to work with people who are not interested in her model of care. This practice emphasizes diet, exercise and a commitment to unmedicated birth. Other practices emphasize different things.

I really do not understand the level of vitriol against this particular practice. I get that they are more dogmatic than many, but it's like half this board thinks that Whitney and her colleagues should just accept anyone, regardless of their medical history, regardless of their birth plan, because midwives should be interested in providing care for everyone. I agree that anyone who wants to work with a midwife should have that option, but I don't think that the obvious consequence of that should be that midwives should relax their practice standards because a woman isn't sure if she's going to want an epidural or not.

I'm suggesting making midwifery care *available* to all women, if they so choose, as long as they are not genuinely risked out. Some women will always choose OB care, and that's fine, but I don't think desire for pain relief should be a sole deciding factor.

However, I actually have no problem with specific providers emphasizing certain factors and only taking certain patients, such as Wisdom's focus on diet, exercise, and natural birth--as long as it does not include shaming women (especially for circumstances beyond their control such as the PPs who were implied that GD was their fault, or women who ask for pain relief after labor becomes harder for them than anticipated). Any vitriol I have is due primarily to the shaming, not to making their expectations known up front. I am, though, sad that such a large practice in this area would be so restrictive given the limited options women have for midwifery care here.

I also don't mean to demonize OBs--absolutely there are some who are truly supportive of low-intervention birth, but you have to admit they are a minority (albeit thankfully a growing one). I'd love to see all maternity care on more of a spectrum rather than so polarized, but that's going to take some time and effort both on the part of the medical practitioners and on the part of more women demanding what we want. (This also includes getting hospitals and nursing staff to be more accepting of evidence-based low-intervention policies, especially where they don't have a midwife group to lead the way.) It shouldn't have to be all or nothing, but saying epidural = OB not midwife makes it too black and white.

I completely agree re: the shaming not being okay.

That said, I remain confused as to why you think that Wisdom doesn't make its expectations known up front. These things are certainly well known on this board, and their website lists them pretty prominently - http://wisdommidwifery.blogspot.com/p/about-wisdom-midwifery.html

I agree that it would be nice if they were less restrictive, but I really didn't find their expectations that restrictive. Most practices (OB and midwife alike) will have nutritional guidelines. I started my first pregnancy with RHJ, who are nothing if not a typical large OB practice in DC, and they have nutritional guidelines on their website as well (http://www.rhjn-obgyn.com/patient/expecting/default.asp). At Special Beginnings, I was asked to fill out a food log for a week so that they could ascertain what additional nutritional guidance I would need from them.

I think that the annoying thing about Wisdom is how binary the perception of them seems to be. It's like you're either with them or against them. At the end of the day, their guidelines are ones that I would likely be following anyway and my commitment to natural childbirth is what brought me there in the first place, so not really something they need to insist upon. The impression that I got from Whitney that very first time we met was that once she realized she was already preaching to the converted, the preaching itself stopped and her slightly less than stellar bedside manner was what was left.

[Anonymous]

I guess judgmental DC women don't like to be judged?

(signed, judgmental DC woman)

[Anonymous]

I think the problem is that we are all judging ourselves too much, and so we can't take it when our care provider is critical.

But I'm so tired of all the Wisdom-bashing on this forum. I so appreciate all the people who have said, look, the practice is what it is, if you don't dig it, there are so many others. It's not a sorority that you need to get into. I promise, it isn't.

The real question is, what should the OP do? She wants a midwifery model of care, but she's risked out of GW's midwifery program. Should she look for another midwifery practice? An OB? Which OB, since I'm pretty sure they're not all secretly plotting to strap her to the table and force all kinds of unnecessary interventions.

[Anonymous]

Anonymous wrote:

I really do not understand the level of vitriol against this particular practice. I get that they are more dogmatic than many, but it's like half this board thinks that Whitney and her colleagues should just accept anyone, regardless of their medical history, regardless of their birth plan, because midwives should be interested in providing care for everyone. I agree that anyone who wants to work with a midwife should have that option, but I don't think that the obvious consequence of that should be that midwives should relax their practice standards because a woman isn't sure if she's going to want an epidural or not.

It's funny because it wasn't so long ago that it was the exact opposite. From reading this board, you would think that Whitney walked on water. The Wisdom patients got rather cliquish, actually. Some backlash was inevitable, I guess.

[Anonymous]

Anonymous wrote:I think the problem is that we are all judging ourselves too much, and so we can't take it when our care provider is critical.

But I'm so tired of all the Wisdom-bashing on this forum. I so appreciate all the people who have said, look, the practice is what it is, if you don't dig it, there are so many others. It's not a sorority that you need to get into. I promise, it isn't.

The real question is, what should the OP do? She wants a midwifery model of care, but she's risked out of GW's midwifery program. Should she look for another midwifery practice? An OB? Which OB, since I'm pretty sure they're not all secretly plotting to strap her to the table and force all kinds of unnecessary interventions.

That's not OP's question. She had some very specific questions about specific doctors that the doctors themselves could answer if she just asked them. If she makes her next appts with them, they'll be in her Follow My Health contact list and she can email them directly to ask, or she could wait 2 weeks til her next appt. She wasn't asking whether she should find other midwives or leave GW.