dcmom
Post 05/21/2013 21:19     Subject: risked out of Wisdom, now what

Haven't read the whole thread so sorry if some of this was covered by other responses--

WISDOM I believe decides how much risk they want to take on a case-by-case basis. I had depression/PTSD when I was an OB patient, but it was controlled by drugs/therapy and they were okay with it. I know someone else who had high blood pressure but didn't need meds for it. I know someone else who had gestational diabetes but was able to control wit diet and exercise, no drugs. All of us were able to stay with WISDOM and deliver there successfully. I do think that when there are multiple risk factors--controlled GD and high BP, e.g.--that you are more likely to be risked out. I don't think this is to reduce their C-section rate but rather because it is in fact what is best for you, that patient.

OP, I have heard absolutely wonderful things about Dr. Tham Metz at GW and would urge you to try her if you are risked out of WISDOM. I have heard she is absolutely supportive of natural childbirth.

Good luck!
Anonymous
Post 05/21/2013 20:17     Subject: risked out of Wisdom, now what

I was at 6.5 cm when they checked. Midwife said she was going to move the cervical lip and then I would push, which I had been trying not to do til that point. Baby popped out about 30 minutes post check. I think had she not moved the lip I would have torn and I am glad they did as I was very surprised that I was only 6.5 to me that seemed like time.
Anonymous
Post 05/21/2013 15:44     Subject: Re:risked out of Wisdom, now what

Not to sidetrack to much, but the wisdom midwives do internal checks? I told my midwife at the first appointment I didn't want any and she said that's fine as they don't generally do them anyway. Wondering if I should address this again. It was my understanding that they follow the body's signals, not the cervix.
Anonymous
Post 05/21/2013 15:01     Subject: risked out of Wisdom, now what

Anonymous wrote:
Anonymous wrote:To me it's less about whether the doctors are "epidural pushing, back labor forcing monsters" and more about the extent to which the doctors are trained/equipped to assist mothers in natural childbirth. The Wisdom midwives had a great framing of their work vs. OBs, which is that they are skilled in handling low-risk, normal births (the majority of births) while OBs are trained to handle high risk births- even if the majority of the patients aren't high risk, sometimes when you are a hammer everything looks like a nail, at least in my experience with OBs. That's their job.

I gave birth with Wisdom and had a good birth and pregnancy with them, but the fact remains that there are very few places where there are trained midwives - people trained in normal birth and handling risks of normal woman - esp those that practice out of a hospital. There are few choices.


My former doctor is about as good as it gets for a medical doctor. He was downright enthusiastic about natural childbirth and extremely supportive. the key difference, though, is a midwife is specially trained in achieving natural childbirth and brings skills to the table that will help you get that, and it is not just that she is dedicated to not interfering and supporting, but she can help you get it. And the environment at GW (and at FHBC for that matter) is set up with that in mind. The nurses are used to natural births and can support.

Midwifes can offer clutch assistance, that hinges on years of experience managing natural births, they are knowledge about best pushing positions to turn a baby that is not optimally positioned, they know natural methods to speed up or slow a labor just by changing positions (standing will sometimes speed up, lying on side will sometimes slow down, for example). I loved my doc, I really did, but ultimately there was a one-two punch to having an OB at my birth rather than a midwife. For one thing, doc checked me, realized I was 7cm dilated, and declared I would not be giving birth until 7 the next morning or so and went home for the night. So an hour later, when I got an absolutely incredible urge to push, and indeed, my body was pushing for me, the poor nurse had no idea what to do, only kept telling me "do not push, do not push, if you push with a cervical lip, you will have a c-section." So I wasted a ton of energy breathing through urges to push. Then doc arrived 20 mins later or so, I was pretty pooped from NOT pushing, but had lost the urge to, and then he checks, yep, 10cm, go ahead and push. Then after 20 minutes of pushing, he declares I'm not pushing effectively, so let's turn me over from my hands and knees position, which had felt really good, to sitting back against the bed, with spreadeagled legs. All I could think about was the charlie horse in my ass from the position, how my thighs hurt from DH and the nurse holding them back, and I said "i hate this position!" he said, by all means, turn back over, but I felt this overwhelming need to conserve my energy.

Then he said we may need to do an episiotomy and I guess that was the motivation I needed - I shot baby out like a buttered biscuit, to the tune of a third degree tear, for a 6 lb baby. I believe this is because I was in a very bad position for pushing, one that encourages tears. So then I was pushing in a position that hurt my hips, didn't feel right, and put a tremendous amount of pressure on my tailbone. I had a third degree tear with a 6 lb baby. I do believe a midwife would not have put me into such an unnatural position knowing that pushing in that position greatly increases chances of tearing AND does not open the pelvis as much as squatting allows. Additionally, with a midwife, I would not have been alone, with a frantic nurse trying to find someone, ANYONE to come in and look into my vagina and tell me it was okay to push, and that baby would have been out in a couple of squirts. As it was, I lost all of my oomph. (Ironically, doctor snapped at the nurse and said she should have let me push...but I don't think it was her fault).

anyway, I'm in NO WAY bitter about my birth. I would still highly recommend my provider as someone who is a great choice for a person who needs an MD but wants to go drug free. The ways he was awesome far outweighs the negative, despite the tear and fear that crept into the process. But, he's not a midwife.

I know there are some who would say I might have torn anyway (maybe) or that I should have just pushed (yeah, hindsight is great) when I felt the urge, or that a doula would have made a difference. But the truth is, a doula would NOT have done a thing; I would not have trusted her to make a medical decision. But a midwife? Yeah.

Anyway, that's my story, and sorry if too long, which I think illustrates the difference between even the most wonderful OB and an actual midwife. It's knowing what you need to help mom do to get baby out without medical interference, not just "not interfering" that makes all the difference.

--

I'm the person you quoted and totally agree. I'd also be interested in hearing the doctor you mention.

Having said that, I *did* give birth in hands and knees partially b/c I had been told that was a good position. I teared, just a little. The midwife at Wisdom wanted me on my back, ironically, as she was doing a check until our doula whispered perhaps I should go back to how I had been comfortable. So, you never know...

Anonymous
Post 05/21/2013 12:36     Subject: risked out of Wisdom, now what

Anonymous wrote:Hi, I'm the OP-- I should've known that my topic would've generated a lot of discussion (Wisdom: them's fighting words!), but at the time I just learned about the diagnosis and it was on a Saturday and I couldn't talk with anyone for several days and I really didn't know what was going on (I have the emotional stability of a teenager right now, it seems). My apologies to anyone who was frustrated or vexed by the discussion.

Anyway, I still don't really know what's going on (I will see someone this week), but now that I've known about the diagnosis for awhile, I just have two points:

1) Part of why I freaked out was because I had a set idea of what labor and delivery would look like (well, I mean, no one really knows until it's happening, but you have a rough idea). I've just become more aware that there are variables beyond my control because of the GD. I may still have an uncomplicated, natural birth, or I may have one that requires a lot of intervention. Most likely, I may have something in-between. I can try to do what I can for a natural birth, but I need to trust that the OBs/midwives/whoever will end up delivering the baby know what's best for my health and the baby's.

(This isn't knocking anyone who elects to have a c-section, btw--I have friends who have done so and do I like them less? To each their own)

2) At the same time, I acknowledge that hospitals/OBs/midwives have inclinations on natural vs. assisted labor and delivery. In an ideal world, I'd try to find OBs who are more aligned to how I view labor and delivery (well, in a truly ideal world, I wouldn't have GD in the first place). But time isn't my friend: I'm at 29 weeks, I have to address this GD issue right away, and GW already has my medical records. Plus, I hear the GW OBs are all right. So, I'll just stay where I am for now, and it was reassuring to hear that some people also risked out of Wisdom and they also were OK in the end.

This doesn't address a lot of the issues raised in the last several pages (to be honest, I haven't read through it all so I'll do that when I have a little more free time), but I think it's good that there is even a discussion going on about how there should be more options for women to approach labor and delivery. The next question is, how do you get the prevailing medical establishment on board to be open to those options as well (I'm really thinking of Inova Fairfax, which is nearby where I live)? Do you volunteer to be on a committee at a hospital, do you donate money in such a way that reflects your beliefs? I don't really have any answers, but it's something to think about.

Sorry for going on for so long!


I, too, live so, so close to Inova Fairfax that it seems asinine to drive between 20-60 minutes, depending on traffic, to a different hospital. I think we are spoiled by the illusion of choice. If one looks at the entire metro area (and, sorry, DCUM purists, this board has many non-DC residents), sure, there are options, but are they geographically accessible? How many patients can x-practice take? Is everyone equally vocal and assertive about their choices in birth? Does everyone even know equally what is a choice, what is best practice, what is for someone's convenience?

OP, I wrote to Inova and let them know that I am interested in a climate that is more similar to Wisdom's model, not because it's the end-all, be-all birth experience, but because by and large what they do is supported by evidence. They don't tell women at 5 cm but not in labor that they better be induced because they "can't walk around like that". From what I know about them, no one's going to say it's c-section time just because that's what the clock says (Friedman's curve has been disproven, but it's still the standard of care most places), etc.

If you are interested in unmedicated/low-intervention/evidence-based birth, let the hospital where you would like to deliver know. Tell your provider. Of course we should all be advocates for ourselves, but it's insane that we expect every single woman who wishes to give birth in anything but the most standard way should have to push against an entire system.
Anonymous
Post 05/21/2013 10:52     Subject: risked out of Wisdom, now what

Hi, I'm the OP-- I should've known that my topic would've generated a lot of discussion (Wisdom: them's fighting words!), but at the time I just learned about the diagnosis and it was on a Saturday and I couldn't talk with anyone for several days and I really didn't know what was going on (I have the emotional stability of a teenager right now, it seems). My apologies to anyone who was frustrated or vexed by the discussion.

Anyway, I still don't really know what's going on (I will see someone this week), but now that I've known about the diagnosis for awhile, I just have two points:

1) Part of why I freaked out was because I had a set idea of what labor and delivery would look like (well, I mean, no one really knows until it's happening, but you have a rough idea). I've just become more aware that there are variables beyond my control because of the GD. I may still have an uncomplicated, natural birth, or I may have one that requires a lot of intervention. Most likely, I may have something in-between. I can try to do what I can for a natural birth, but I need to trust that the OBs/midwives/whoever will end up delivering the baby know what's best for my health and the baby's.

(This isn't knocking anyone who elects to have a c-section, btw--I have friends who have done so and do I like them less? To each their own)

2) At the same time, I acknowledge that hospitals/OBs/midwives have inclinations on natural vs. assisted labor and delivery. In an ideal world, I'd try to find OBs who are more aligned to how I view labor and delivery (well, in a truly ideal world, I wouldn't have GD in the first place). But time isn't my friend: I'm at 29 weeks, I have to address this GD issue right away, and GW already has my medical records. Plus, I hear the GW OBs are all right. So, I'll just stay where I am for now, and it was reassuring to hear that some people also risked out of Wisdom and they also were OK in the end.

This doesn't address a lot of the issues raised in the last several pages (to be honest, I haven't read through it all so I'll do that when I have a little more free time), but I think it's good that there is even a discussion going on about how there should be more options for women to approach labor and delivery. The next question is, how do you get the prevailing medical establishment on board to be open to those options as well (I'm really thinking of Inova Fairfax, which is nearby where I live)? Do you volunteer to be on a committee at a hospital, do you donate money in such a way that reflects your beliefs? I don't really have any answers, but it's something to think about.

Sorry for going on for so long!
Anonymous
Post 05/21/2013 07:55     Subject: risked out of Wisdom, now what

I'm the PP who first brought up how unfairly OBs are demonized, and listed my own great OB practice on this page. I think if a midwife can help you achieve the birth you want, that's great- just as great as if an OB can help you achieve that, or a doula. But my original point was everyone seems to think that OBs are these judgmental a-holes who exist only to make you feel bad about your pregnancy and your choices and to make you feel stupid if you choose to have a natural childbirth or try to make you feel as though you can't "handle" one. In my experience, this is not true, but from the many Wisdom threads I've read on this board, the Wisdom midwives, and this Whitney in particular, DO have a habit of making women feel "not good enough" for their practice, or "not good" at pregnancy, or as if they're failing in some way because they can't make their bodies exactly here to Wisdom's idea of the perfect pregnancy. It's just interesting to me how much heat OBs get when the Wisdom midwives seem, frankly, just as bad as the worst OBs.
Anonymous
Post 05/21/2013 07:45     Subject: risked out of Wisdom, now what

There are good OBs and bad midwives. Wisdom benefits from GWs resources yet few patients appreciate what the staff and resources at GW are really offering them.

My GW doc is very supportive of natural and no/low intervention....she even said her job was to help prevent a c section. If you take th time to know your provider, you might be surprised.

I didn't want to deal with wisdom even after it was recommended to me because it felt like a job, not pregnancy. I already have a job. But If it works for you, great. Just like if your OB works for you, great. Never understood the DCUM mommy war pushing, starting as early as pregnancy. Everyone makes choices that work for them. I for one am happy midwives exist, the more choices for women the better.
Anonymous
Post 05/21/2013 00:05     Subject: risked out of Wisdom, now what

Anonymous wrote:To me it's less about whether the doctors are "epidural pushing, back labor forcing monsters" and more about the extent to which the doctors are trained/equipped to assist mothers in natural childbirth. The Wisdom midwives had a great framing of their work vs. OBs, which is that they are skilled in handling low-risk, normal births (the majority of births) while OBs are trained to handle high risk births- even if the majority of the patients aren't high risk, sometimes when you are a hammer everything looks like a nail, at least in my experience with OBs. That's their job.

I gave birth with Wisdom and had a good birth and pregnancy with them, but the fact remains that there are very few places where there are trained midwives - people trained in normal birth and handling risks of normal woman - esp those that practice out of a hospital. There are few choices.


My former doctor is about as good as it gets for a medical doctor. He was downright enthusiastic about natural childbirth and extremely supportive. the key difference, though, is a midwife is specially trained in achieving natural childbirth and brings skills to the table that will help you get that, and it is not just that she is dedicated to not interfering and supporting, but she can help you get it. And the environment at GW (and at FHBC for that matter) is set up with that in mind. The nurses are used to natural births and can support.

Midwifes can offer clutch assistance, that hinges on years of experience managing natural births, they are knowledge about best pushing positions to turn a baby that is not optimally positioned, they know natural methods to speed up or slow a labor just by changing positions (standing will sometimes speed up, lying on side will sometimes slow down, for example). I loved my doc, I really did, but ultimately there was a one-two punch to having an OB at my birth rather than a midwife. For one thing, doc checked me, realized I was 7cm dilated, and declared I would not be giving birth until 7 the next morning or so and went home for the night. So an hour later, when I got an absolutely incredible urge to push, and indeed, my body was pushing for me, the poor nurse had no idea what to do, only kept telling me "do not push, do not push, if you push with a cervical lip, you will have a c-section." So I wasted a ton of energy breathing through urges to push. Then doc arrived 20 mins later or so, I was pretty pooped from NOT pushing, but had lost the urge to, and then he checks, yep, 10cm, go ahead and push. Then after 20 minutes of pushing, he declares I'm not pushing effectively, so let's turn me over from my hands and knees position, which had felt really good, to sitting back against the bed, with spreadeagled legs. All I could think about was the charlie horse in my ass from the position, how my thighs hurt from DH and the nurse holding them back, and I said "i hate this position!" he said, by all means, turn back over, but I felt this overwhelming need to conserve my energy.

Then he said we may need to do an episiotomy and I guess that was the motivation I needed - I shot baby out like a buttered biscuit, to the tune of a third degree tear, for a 6 lb baby. I believe this is because I was in a very bad position for pushing, one that encourages tears. So then I was pushing in a position that hurt my hips, didn't feel right, and put a tremendous amount of pressure on my tailbone. I had a third degree tear with a 6 lb baby. I do believe a midwife would not have put me into such an unnatural position knowing that pushing in that position greatly increases chances of tearing AND does not open the pelvis as much as squatting allows. Additionally, with a midwife, I would not have been alone, with a frantic nurse trying to find someone, ANYONE to come in and look into my vagina and tell me it was okay to push, and that baby would have been out in a couple of squirts. As it was, I lost all of my oomph. (Ironically, doctor snapped at the nurse and said she should have let me push...but I don't think it was her fault).

anyway, I'm in NO WAY bitter about my birth. I would still highly recommend my provider as someone who is a great choice for a person who needs an MD but wants to go drug free. The ways he was awesome far outweighs the negative, despite the tear and fear that crept into the process. But, he's not a midwife.

I know there are some who would say I might have torn anyway (maybe) or that I should have just pushed (yeah, hindsight is great) when I felt the urge, or that a doula would have made a difference. But the truth is, a doula would NOT have done a thing; I would not have trusted her to make a medical decision. But a midwife? Yeah.

Anyway, that's my story, and sorry if too long, which I think illustrates the difference between even the most wonderful OB and an actual midwife. It's knowing what you need to help mom do to get baby out without medical interference, not just "not interfering" that makes all the difference.
Anonymous
Post 05/20/2013 23:29     Subject: risked out of Wisdom, now what

To me it's less about whether the doctors are "epidural pushing, back labor forcing monsters" and more about the extent to which the doctors are trained/equipped to assist mothers in natural childbirth. The Wisdom midwives had a great framing of their work vs. OBs, which is that they are skilled in handling low-risk, normal births (the majority of births) while OBs are trained to handle high risk births- even if the majority of the patients aren't high risk, sometimes when you are a hammer everything looks like a nail, at least in my experience with OBs. That's their job.

I gave birth with Wisdom and had a good birth and pregnancy with them, but the fact remains that there are very few places where there are trained midwives - people trained in normal birth and handling risks of normal woman - esp those that practice out of a hospital. There are few choices.
Anonymous
Post 05/20/2013 21:01     Subject: risked out of Wisdom, now what

Anonymous wrote:
Anonymous wrote:
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.


Would both of you mind sharing your OB's names? That has not been my experience with OBs, and I would love to know the name of some of the fabled high-touch, low-intervention docs.


I go to a practice of five female OBs- Loudoun Physicians for Women. First appointment they asked me "What are your expectations of us and your birth?" And they were totally amenable and understanding of my answers with no judgment or pressure. And they have privileges at the Loudoun Birthing Inn which is where I will give birth- and the Birthing Inn gives privileges to OBs, doulas and midwives. Very welcoming and all encompassing. Not all OBs are epidural pushing, back labor forcing monsters, I promise.
Anonymous
Post 05/20/2013 19:38     Subject: Re:risked out of Wisdom, now what

Anonymous wrote:
Anonymous wrote:
Anonymous wrote:9:59 again.

I also meant to say re: "GD being the mom's fault", I have a hard time believing that Whitney, who has been a midwife for a long time for a lot of women, would actually believe that. I know she thinks that their dietary guidelines will result in the healthiest pregnancy possible, but I also doubt that she believes any deviation from this diet will result in GD.

I do think it's possible that in individual cases, it is possible that a particular woman is not managing her diet the way Whitney would like. When I was pregnant with my first, I ate a lot of gelato. I also ate a lot of shitty carbs. I slacked big time on green leafy vegetables. My sugars were pretty high as a result, though not so high that I needed to get the 3 hour test. Some women eat better than others. Some things you eat can have adverse effects on your health and one of those things is GD. So while I don't think that it's "the woman's fault" that she had GD, I think there are also times when better attention to diet could have prevented it.


PP who had GD with Wisdom and was not risked out. You don't want to believe that she thinks that because it's a bit outrageous, and yet she does (and I have confirmation that she believes this from a source beyond my personal conversation with her). I will say it one last time -- I followed their diet to the letter. Maybe there are some cases where better diet could have prevented GD, but mine was not one of those cases (unless following their diet somehow leads one to GD). To treat all women with GD as if it is their fault and this wouldn't have happened to them if they had just tried harder when they have been doing their damnedest to follow the stupid diet is demoralizing and patronizing. I cried all day that day thinking it was my fault somehow. IMO it's not OK to treat all women with GD as failures and accuse them of not being sufficiently diligent just because some may not be. It's over the top.

I honestly hope my previous experience was an anomaly, but I don't think it is.


I totally agree that that's a shitty way to treat someone, regardless of how the GD manifested. But you also need look no further than this board to know that there are people who actively advocate saying that you followed the diet even when you didn't and never intended to. I'm sorry she was a jerk to you and I hope your subsequent experiences are better.

Out of curiosity, have you (or any of the former clients with complaints) actually talked to Whitney about your concerns? What was the result of that conversation, if so. If not, why not?


This is the PP you quoted. I have not spoken to Whitney about it, but I have discussed it with one of the other midwives.
Anonymous
Post 05/20/2013 19:32     Subject: risked out of Wisdom, now what

Anonymous wrote:
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.


Would both of you mind sharing your OB's names? That has not been my experience with OBs, and I would love to know the name of some of the fabled high-touch, low-intervention docs.
Anonymous
Post 05/20/2013 19:30     Subject: risked out of Wisdom, now what

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.


Hospital- and evidence-based midwifery practices that support unmedicated birth? I live in VA, and it's drive in to Wisdom or all the way out to Loudon. There aren't that many options.
Anonymous
Post 05/20/2013 18:46     Subject: risked out of Wisdom, now what

Anonymous wrote:
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!


Except when it's glucola - when you're not just allowed to drink shit, and GMOs and dyes and additives and preservatives, but required to do so. Or you're kicked out. So much for healthy eating / drinking.