Trying to understand the midwife route

[Anonymous]

I did GW midwives in January. They never mentioned the diet in any appointments and I am overweight. They told me I am low risk even as a VBAC candidate. Anaya did not judge me when I said lets do the epidural, I think I remember she encouraged me to get it because I had been in labor for so long and she wanted me to rest. I ended up with the doctors because it was a tough labor.

[Anonymous]

Anonymous wrote:I did GW midwives in January. They never mentioned the diet in any appointments and I am overweight. They told me I am low risk even as a VBAC candidate. Anaya did not judge me when I said lets do the epidural, I think I remember she encouraged me to get it because I had been in labor for so long and she wanted me to rest. I ended up with the doctors because it was a tough labor.

I had a very similar experience. Anaya is great.I was very supported in my choice to get epidural and also ended up with OB delivery due to difficulties with labor. I question if the PP who complained about the GW midwives delivered with them recently- everything they say is just so different than my experience (2020) with the midwives. (In addition to epidural use, OBs being pulled in when needed, etc. I’ll also add that when my baby had initial weight issues I was highly encouraged to supplement with formula so the anti formula thing isn’t relevant either- the focus was definitely “fed is best” approach.) yes the midwives are a good fit for women who want to strive for natural birth, healthy lifestyle, breastfeeding, etc., so if you know you don’t want that don’t go with them. However, in my experience they are very supportive and flexible even when you make different choices or have different needs arise and I loved their approach which centers your needs and requests as a patient in what I felt was a really respectful and supportive way. I felt empowered by the care I received even when I made choices like requesting an epidural.

[Anonymous]

I’m glad you had a positive experience. I made a complaint to the hospital because I didn’t want other women to experience what I did. I’m glad that perhaps things have finally changed.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I won't rehash all this ob vs midwife cage match stuff (which is ridiculous IMO because both are looking out for moms no matter what people say, although I would never work with a midwife that was not a CNM).

But the diet stuff drives me insane. Probably I am way too biased to really make an observation but I had hyperemesis three times and pregnant women should, within reason, eat what they can eat. Any group that has a uniform dictation of what pregnant women should and should not eat is suboptimal because every woman is different. What a hyperemesis mom should/can eat and what a GD mom should/can eat are totally different and having a blanket policy up front like this is IMO, bad maternal care.

The GW midwives do not push the diet when you have morning sickness- I was told eat whatever I could keep down (for me popsicles and saltines) and then once I was able in later trimester I incorporated more of their diet suggestions. I don’t know why everyone gets so worked up about the healthy diet. They are not strict about it. Personally I liked having some guidance on what would be an optimal diet.

+1

I’m 20 weeks and we haven’t discussed diet even once. They just said “try to eat as healthy as you can tolerate”

Except the trouble is the guidelines as written are rigid, one-size-fits-all. The words in them are overly prescriptive. Every day eat this, and every day avoid this. They are unrealistic for most women. And sure, it’s great that in real life the midwives are more flexible and do not rigidly promote adherence to these guidelines but then, why have them at all? Or at least, why not revise them to make them more flexible and accommodating of the variety of healthy diets that exist?

There is not one right way to eat healthy. The guidelines ignore individual circumstances, varying cultural backgrounds, different food budgets, food allergies, different eating styles and food preferences, etc. I would argue that they are biased against women from lower socioeconomic backgrounds who may live in food deserts, or be living on food stamps, etc. and therefore are exclusionary of a particular type of patient that they don’t want. Is midwifery care really for everyone? Or just affluent, educated women who are skinny, able bodied and privileged enough to have the time to exercise for an hour a day, who have time and funds to purchase and prepare whole/organic foods for their meals, who have funds to hire a doula, who have partners engaged in the birth, etc?

Frankly, words matter. The impact of those guidelines matters far more than the intentions behind them. Clearly, enough of us have strong feelings about them or were turned off from them enough to avoid becoming a patient that they have an impact. Is that the one they want?

As a former patient, I frankly in hindsight wish I had understood that the rigidity inherent in those guidelines was illustrative of a rigid practice. One that doggedly adhered to a belief in natural birth above all else and in birth, meant providers hesitated to clearly recognize and identify when a birth was beyond their skill set and bring in physicians when needed. I didn’t realize the extent to which they acted as gatekeepers to the doctors, when I thought the word collaborative meant a team based approach. I don’t think promoting maternal suffering is a good thing. You can still be a great mom even with an epidural, a C-section, a formula fed baby, etc. As a FTM I wish I had never bought into their ideology. It is really damaging.

When you get the welcome package from the OBs you get a similar set of dietary guidelines (that also tell you yo avoid white flour!), but since this guideline is shared privately the GW OBs are never accused of being rigid.

I do agree that they might need to find a way of providing the midwifery model of care to people that don’t have the privilege of having two support persons and don’t have the time and budget to follow the guidelines. They could phrase it better as suggestions and emphasize the “do your best” part as they’re doing once you’ve joined the practice.

I have to say that at the meet the midwives event I went to, I was turned off by one of the midwives that came across as more rigid and fundamentalist, but all the others that presented didn’t and that’s why I decided they were a good fit for me. I’ve had visits with three different midwives so far and they are definitely not pushing the diet or exercise guidelines on me, we only discuss topics I need to discuss.

[Anonymous]

Anonymous wrote:I did GW midwives in January. They never mentioned the diet in any appointments and I am overweight. They told me I am low risk even as a VBAC candidate. Anaya did not judge me when I said lets do the epidural, I think I remember she encouraged me to get it because I had been in labor for so long and she wanted me to rest. I ended up with the doctors because it was a tough labor.

Anaya delivered my baby in Charlotte! Imagine my surprise when I moved to DC and found she was at GW! I just love her. Crossing my fingers that she's on call when I deliver in October. My baby was sunny-side up and head slightly tilted, so she had me try lots of different positions to get that guy out.

[Anonymous]

Anonymous wrote:

Anonymous wrote:The biggest difference I noticed between OB and midwife appointments was that the OB appointments took 5 minutes (sometimes I felt like I spent more time with the vital signs people than with my actual doctor) in the midwife ones would take more like 20 or 30 minutes.

I delivered at Washington Hospital Center for my first with midwife care and when I needed a vacuum assisted delivery they called in and OB to help but the midwife stayed in the room and the OB was very welcoming. They had a very copacetic relationship

I’m surprised by this because the WHC OBs seem downright chatty to me. At every visit they have a certain number of things they go over (usually whatever is upcoming (eg glucose test) and then something for L&D like breastfeeding or anesthesia options. I haven’t been watching the clock but I always feel like they spend a lot of time with me and ask more than once if I have questions. I’m kind of struggling to think of what would make the appointments longer.

Idk, maybe with COVID they have more time but I felt the same way about my pre-COVID appointments.

I have Kaiser so I wasn't working with the whc OBS

My OB is really lovely person but definitely not big on long doctors visits