After my post yesterday I received a comment from someone I don't know. Here was the comment:
Here is what I don't I don't understand and perhaps you can explain it to me (and i'm not trying to be critical of your choices but I would like to understand them):
Clearly you are having issues - spotting, cysts, fibroid. Yet you won't see a doctor. You might have a serious pregnancy condition yet you rely on a midwife. A midwife is not a doctor. I just don't get why women see midwives. I get that you don't want a c-section but shouldnt you be more concerned about having a healthy baby? I don't understand the aversion to an OB - a highly trained medical professional - especially when you are obviously experiencing a somewhat abnormal pregnancy. It seems like you are more concerned with having some ideal pregnancy and birth experience than the risks you are facing which could seriously harm your baby.
I'm really not trying to harp on you or make you feel bad - I would just like to understand your rationale.
Okay, I am going to admit, I got offended after reading that. It didn't make me feel bad - not at all. It certainly ticked me off, though. Then I decided to really take this commenter at her word - she is not trying to be critical, but she would really like to understand.
So I will explain it.
A midwife is a trained professional. I am not seeing some idiot on the side of the road who saw someone give birth and thinks she's an expert. I am seeing a team of professionals who got their degrees in midwifery, and are licensed. They have rules and restrictions and guidelines. They want the best possible outcome for the patients, and they will do everything they can to get you the outcome that you want, as long as it is safe for you and the baby.
Canadian midwives can do anything that an OB can do, except induce labour with synthetic oxytocin, prescribe drugs during labour, use forceps or vacuum extractor, or do a c-section. I very much do not want any of those interventions, as they all carry great risks. However, if I required them, my care would swiftly be transferred to an OB.
With my midwife, I can give birth in a hospital or at home. The midwives in Canada have hospital privileges, just like a doctor. I have given birth in a hospital, and it was not what I wanted for my birth. Unfortunately, I waited a bit too long into my first pregnancy to try to get into the midwives, so I was stuck with an OB. And things occurred during my pregnancy and at my birth that I really didn't want to happen - and they wouldn't have happened if I had a midwife.
Midwives are experts on "normal" pregnancy. An OB is a trained surgeon, and really should only be there for the small percentage of high risk pregnant women that exist. In most other industrialized countries, this is how it works. Midwives are the primary care provider for 70-90% of pregnant women. The OBs are there for when they are needed - for high risk women and for emergency situations. And you know what? All of those countries have much better outcomes than the United States. The U.S. has one of the highest infant and mother mortality rates of all the industrialized countries, even though the vast majority of the pregnant women are under the care of an OB. All hail the highly trained medical professionals whose interventions create such wonderful outcomes? Not so much.
OBs apply interventions where no interventions are needed. Pregnancy is normal and natural, and the majority of the time it does not require the level of intervention that an obstetrician applies. OBs are great and wonderful when they are needed. I would never suggest getting rid of OBs. They certainly have their place, and they do save lives. But they have also systematically destroyed the process of birth, because they are not trained to treat it as normal. They are impatient, they want to intervene, they want to speed things up, and these interventions cause problems.
Now, let's address my specific situation:
The ovarian cysts are not a problem. I had cysts last time I was pregnant, too. They're leftover from the stimulation from the injectables. They might even be gone by now, although during my first pregnancy I still had them at 20 weeks... still, not a problem.
The fibroid... I have no idea. My midwife would like more information on this supposed fibroid, but I'm not even sure it exists since the only time it was ever mentioned was in ONE ultrasound report at 7 weeks pregnant. If it was going to cause a problem in this pregnancy, it probably would have been mentioned in other reports (I say "probably" because I'm not totally confident in the u/s reports my REs office has been sending).
The hematoma - hasn't been mentioned since 7 weeks, so it might be gone. But yes, we would like to know more.
The spotting - scant brown spotting 3 times a week is hardly anything to switch to an OB over. Especially since there are a couple of things we are already aware of that could be causing it, and none of them are anything that an OB can do anything about at this point.
Finally, the previa. At 18 weeks I had marginal placenta previa. That means my placenta is close to the opening of the cervix. It is not covering it at all, it is just close to it. In the majority of cases of marginal previa, as the uterus continues to expand, the placenta moves up and away from the cervix. Think about drawing a dot near the neck of a balloon that you haven't blown up. When you do blow up the balloon, the dot is not going to end up very close to the neck of the balloon. The same thing usually happens with marginal previa (and often happens with other forms of previa, too).
I am 22 weeks pregnant. There is absolutely no reason for me to be transferred to an OB right now. An OB would only do what my midwife can do anyway - send me for ultrasounds, and order any tests I need. I am going for an ultrasound next Thursday, requisitioned by the midwife, and if my placenta hasn't moved by an appropriate amount, then I will go for another ultrasound at 28 weeks.
If I end up with placenta previa continuing into the 3rd trimester, then we will consult with an OB.
Now, these parts enraged me: "I get that you don't want a c-section but shouldnt you be more concerned about having a healthy baby?[...] It seems like you are more concerned with having some ideal pregnancy and birth experience than the risks you are facing which could seriously harm your baby."
Wow, that sounds so offensive.
First of all, the "risks I am facing"?? I am not classified as high risk by any means. Not even an OB would consider me high risk at this point. I am still extremely low risk. Nothing am experiencing is going to "seriously harm" my perfectly healthy baby.
Obviously I care about the health of my baby more than I care about having a c-section. However, I 100% do not want a c-section unless it is absolutely necessary. News flash: c-sections have way more risks than vaginal births! C-sections are not healthy for mothers and babies. It is great that we have the option of c-sections when they are legitimately and medically necessary. But a c-section rate of over 30% is insane! Do you think 30% of people need a c-section? They don't. In areas were women are almost exclusively taken care of my midwives who have a very low rate of interventions, the c-section rates are less than 2%. If you just leave people alone, less than 2% of women end up needing a c-section. The reason the rate in the U.S. is over 30% is because of OBs and their unnecessary interventions, which end up causing problems for mother and baby, which then necessitates a c-section. Another reason the rate is so high is because OBs are cut-happy. They are impatient, and they will totally lie to their patients and tell them they just will not be able to vaginally birth that baby, and it must be cut out of them. Who knows, maybe the OBs actually believe that. But it is a load of crap.
There are legitimate reasons - health reasons, for both me and the baby - that I want an "ideal pregnancy and birth experience." I am a very knowledgable, educated person, not an idiot who doesn't know what she's talking about.
A midwife will continue to check on my previa, so that if I do have a c-section, I will know that it is absolutely necessary. An OB might look at the 28 week ultrasound, and if I still had marginal previa, he would just schedule a section, even though there would still be time for my placenta to move out of the way as my uterus expands, and even though when you only have marginal previa, doing a trial of labour - in a hospital - would be a safer option than a c-section.
(Many) OBs are bossy. They are bullies. Often, they really don't give a crap about what you want.
My midwife actually cares about what I want. She knows I want a natural home birth, and she is going to do her best to help me get it (as long as it is safe for me and the baby). She is not going to send me over to an OB for something that is very easy for us to keep an eye on right now. I do not want to be sent to an OB right now, because as I said, there is absolutely nothing that an OB can do for me right now that my midwife can't do. How would a 5 minute appointment with an OB, who would hardly tell me anything, be better for me than 45 minute appointments with my midwife where we carefully look over every report and discuss every option and then decide on the best course to take?
It wouldn't be better for me. That's the long and the short of it. Like I said, there is absolutely nothing that an OB can do right now that my midwife can't do. If the previa persists until the end of my pregnancy, and a c-section is necessary, my care will be transferred to an OB. But that is a worst-case scenario. And yes, for me, that is a worst-case scenario. I have done a ton of research, and I have experienced an entire pregnancy with an obstetrician. I choose not to go that route again unless it is 100% medically necessary.
If you had an OB and you loved your experience, I am happy for you. Mine was okay, but in the end, it is not what I want for myself or my baby this time around. I do not want a paternalistic doctor telling me what will or will not happen, laughing at me when I bring in a birth plan, inducing me for a less-than-great medical reason, giving me an episiotomy when I expressly stated I did not want one (and I did not NEED one), cutting my baby's cord before he was even placed on my chest even though I expressly stated I wanted to wait, and holding my screaming child who had just been born upside down by the ankles instead of kindly giving him to me.
There are hundreds of other reasons I want a midwife. But the bottom line is that I feel that I am in better care with my midwife than I would be with an OB. I am fully informed about what is going on with my body and my baby, and I have much more control over what is going to be done throughout this pregnancy. I am not placing myself or my baby at risk by having a midwife. I firmly believe (and the statistics support this belief), that I am in a much better position and at much lower risk because I have a midwife.