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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA
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I've been wondering what families look for in their dream midwife. I'd love to hear your thoughts on the subject.
I live in quite a small town and even so have the choice of 7 midwives to attend my birth and only 30 min drive away in one of our larger towns there are probably well over 50 more so it really made me think why did I choose the ones I did.
The midwife I had for my first birth came on recommendation from my Doctor who although I liked and respected as a medical doctor I didn't want to handle my pregnancy. At the time I was 5mths pregnant and needed to find a midwife who had a vacancy for my due date. When I first spoke to her she seemed in agreement with some of my main ideas and she seemed nice so I booked with her (knowing I could change if I was not happy). I also had a student midwife sitting in for experience, and she was great as she was still full of enthusiasm and genuine interest. I was very happy with the care I received from my midwife - she had her own small office and I would go to her for my visits. Although she was friendly I can't say we built up a very close relationship and one of my big regrets was she did not meet my husband before I went into labour so in between pushes I was introducing them - weird! Because my labour was so short I didn't really have time to test our relationship but I did feel safe in her care. The one thing that disappointed me was that I ended up having the injection to deliver the placenta which I had put down in my birth plan as only if necessary - she recommended it at the time and I was in no mood to argue but found out later from others that she was pro the injection and was not comfortable not using it - I would have preferred she had told me this rather than just paying lip service to my not wanting it.
I changed midwives for my second pregnancy not because I was unhappy with the first but because I wanted someone who lived closer and would be able to get to me at shorter notice. I had heard good things about her from others and when I went up to the birth center to take advantage of their free pregnancy testing (all midwives here do this!) I met her and instantly clicked. This midwife would come to my home for visits and also this saved a 30min trip with a 2yr old! At first I found it hard to get used to the more casual, less formal approach, but being in your own home broke down a lot of the barriers. Once I got used to this I realised I really liked this better and I felt more comfortable discussing things with her. She also met my husband several times so they developed a good relationship and were both joking around during the birth and keeping me laughing!
I think though we need to be realistic and not expect a dream midwife and accepting that they are normal people too makes you feel less the patient and more the partner. Just 6 weeks before my due date my midwifeís husband of 13 yrs left her with no warning for someone else and her whole world crumbled. To expect her to carry on as normal would have been unfair and this is where the friendly relationship we had kicked in and I was able to be supportive of her too. After Shaun was born I looked up to find the midwife crying too - she said with all the bad things in her life at the time It was great to see something going so well and beautifully - they really made it a special moment for us too.
Another thing I must mention was that I think itís important for midwives to not get too friendly and lose their professional distance for when things go wrong - I made it quite clear that should any problem develop that meant we were taking a risk by being at home I wanted to transfer to the hospital. I have heard of some midwives who get so caught in their clients wish to stay at home that they allow the women to take a risk that had she been thinking more clearly she would not have taken. For me this was very important - having respect and trust in her ability to remain the professional.
What are the qualities that you absolutely had to have?Experience, compassion, understanding and TIME!!!!
What are the extra qualities that you were hoping for?Sense of Humor, Time for other children in the family.
What were the qualities you didn't anticipate would be of such value to you?Soothing massage hands
What are the qualities that you absolutely had to have?For our first homebirth (my first birth) I needed someone with a fairly medical-model protocol. It's interesting how quickly this changed, but when we chose our midwife as our monitrice during our second trimester (weren't planning on a homebirth at that time) we wanted someone who could help us stay home as long as possible before going to the hospital. We were comforted by the fact that she had been primary at 2000+ births, was an RN before she became a direct-entry midwife (not CNM). Her partner, also a lay-midwife, had no such background, but was wonderful to talk to. At 35 weeks we decided to switch to homebirth, and the "monitrice" became our primary midwife. We attended homebirth prep classes (in addition to the Bradley classes) with the partner. When we went into labor (only 3 weeks after we chose homebirth) we were glad that the partner was the one on call for the night shift. She was warm, enthusiastic, and very experienced (1000+ births as primary). Those characteristics turned out to be more important to us.
This time around, if we get pregnant, our primary concern is expertise, as measured by at least 200+ births as primary (we're in a different state with extremely different climate for homebirthing), who has clear protocols, and is warm and enthusiastic. I want someone I can actually do the whole nine months of prenatals with. I want to experience what I hear so often on this list about developing a close, trusting relationship with a woman who believes totally and unreservedly in the wonder and miraculousness and naturalness of birth. I want my midwife to come to my home, instead of having to trek to an office all the time. (I don't mind occasional visits, just would like SOMEONE at my house), and who I have a total trust in (I think I didn't have time to do that the last time since we "switched" to homebirth so late in the game.)
What are the extra qualities that you were hoping for?Hmmm, close to home, total availability, unconditional acceptance, good homebirth ed classes, lots of info on how to prepare for homebirth, stuff like that. I'm an abuse survivor, and the trust element permeates everything. Lots of videos to watch, stories to read, etc.
What were the qualities you didn't anticipate would be of such value to you?The emotional factors: I still carry around a feeling like I did something "wrong" during my birth, because the postpartum visits were so "cold". I wanted to have deliriously happy midwives, and I didn't have them. I never heard them say "great birth", even though I tried to elicit that kind of response. I was very pleased, a little shell-shocked, and I just needed enthusiasm and warmth afterwards. Sort of "Mother-substitutes" because my mother had long been dead and I didn't have anyone to get that kind of feedback from. I got, instead, detached professionalism. It felt cold. I don't know exactly what the problem was, whether it was me or them, or a function of the short time we had been working together as a team. I still feel like I let them down somehow, even though the birth was wonderful, the most empowering event in my life. I don't want to feel that way after the next birth. I want a warm, intimate relationship, based on mutual respect of course.
I had my dream midwife.
She was so calm, so spiritual, so motivating and relaxed. She was the only midwife I interviewed with. I loved her from the start. She was recommended from a great friend who used her. When I really realized how great she is was at another friendís homebirth I attended and she was the midwife. This was after Emily was born. First we had a blessing way (it was like a shower but spiritual) Beth (the midwife) made a doll out of herbs from her garden and told why she had used each herb and what it all meant to a women. It was so great! I cried. Then after the birth we made Angie (my friend) a bath and the midwife put herbs and fresh cut flowers in it. The flowers were cut at the top and only the tops floated in it. It was beautiful!!! This only brings me to one sad thing. I have moved and Beth lives 1500 miles away and next time I have a baby she will be unable to be my midwife. I hope and pray I can find someone as powerful and wonderful as her.
Thank you for caring to ask such important questions. I have a dream midwife in my mind and heart - I had expectations that were not met by my midwife. As a result, my expectations are greater in number than before! I have talked with 6 midwives since it happened.
There are obvious ones like compassionate, willing to listen, competent. Here are the specifics.
I am many of these things to my clients whether as a diabetes educator or as a childbirth educator - I go the extra mile with a smile everyday. I have met a lot of midwives these days who I am not sure why they chose the profession and always say 'I can't do that because of liability." I have met a minority who share the passion for childbirth and the disgust with the present day technological birthing routine that is so dangerous for the mother, baby, on- lookers such as Dad or family. They can live with liability without it effecting their babies and mothers.
My dream midwife would have to not be afraid of me. Moms who have OBs that wrong them can always find hope in a midwife. I was wronged by a midwife - so I am a challenge. It will take a lot of time to trust a midwife again. I met a midwife who looked forward to the challenge and wanted to make up for my sad experience. That is a special person.
It's always seemed that there is no one approach that's going to work for everyone, and it's really great to hear people articulating the different things they want and need from a midwife.
Maybe this is the ultimate definition of a dream midwife - one that is able to figure out exactly which approach each mother needs and wants and adapts accordingly!
Dream midwives. I wish. In the UK, while our right to homebirth is preserved our right to choose a midwife is much more problematic. There are just a few places where you can choose one-to-one care and get the midwife with you throughout pregnancy, labour and birth.
The normal practice is to see one midwife antenatally, one (or more) during labour and delivery and back to the first postpartum! B****y stupid system if you ask me!!! Thought you might like to see who I liked and disliked and why from my little collection
During my pregnancy, birth etc I had the following string of carers
Antenatal midwife Nicky - excellent generally and very positive about my decision to have a homebirth even though she admitted she is terrified of them personally. She did however misinform me about a few things - I know it was unintentional as I have given her articles which contradict her since and she was genuinely pleased to have the info. Her most positive feature was that she was prepared to argue with the doctor and buck the system on a few occasions too!! Refereed me very reluctantly to be induced and pushed the system to its max limit on how long before we did.
Antenatal Doctor - who was wrong regularly, obstructive and pigheaded, refusing to read information I gave her contradicting her "opinions". Her most endearing quality was that she went on holiday from week 39 and didn't return until my son's 6-day check!!! I will not see her _ever_ again if I'm pregnant. I don't deny her the right to her opinions but she failed to acknowledge facts, refused to discuss - just lectured and obstructed.
Senior Registrar - this is a British variant of the OB/GYN animal. I was referred at 38 weeks as baby was not engaged and Nicky wanted to check that there was no obvious reason for failure to engage. This man was a moron. He was wrong, rude and very nearly got a punch in the nose. He did get a complaint and when I finally ended up in hospital for the birth I made them mark my notes that this man was to be refused access to the room I was in. They told me it wasn't necessary as he was on paternity leave - his poor, poor wife!!
Consultant - the top of the medical tree. She was nice but very, very wrong. She told me I was tight and would not get through a birth without at least an epis and probably a section. She was actually nice because she was prepared to listen and give me lots of information. She explained why she thought what she did and took lots of time
Hospital antenatal midwife 1 - of unknown name as she never introduced herself. Came into the room while I was waiting to see the Senior Registrar and asked me for a urine sample. Came back saying "Did you have protein in the sample when you saw your own midwife? Very helpful (not). Upset me by her attitude and lack of sensitivity
Hospital antenatal midwife 2 - didn't introduce herself because she was ill but hitting midwife 1 for her insensitive comment. She told me that there was absolutely no sign of protein. Excellent bedside manner. Gentle and kind without being patronising and picked up my vibes that I was distressed very quickly.
L&D midwife 1 - can't remember her name. A bit bewildered that anyone should arrive in the delivery suite in tears. Husband (superhero) explained why and she tried to be soothing but she was a bit distant and I don't think she ever understood why I was upset to be there.
L&D midwife 2 - Steph. Actually the one who ended up breaking my waters to induce labour. Nice, gentle but I guess not very experienced and would probably not have left me long enough for labour to start naturally after the ARM. She was nagging a bit to get the drip up.
L&D midwife 3 - Barbara. The closest I could get to a midwife from heaven. She was probably about 55. Oodles of experience and the confidence to ignore the system as far as possible. Comments like "Well if your waters broke naturally we'd not worry for the at least the first 24 hours anyway" and "Go on - get outside - go for a walk and relax a bit - I'm sure you're coming along nicely and a little walk in the sunshine will make you feel much better - it's hot and stuffy in here" and that after the ARM.
She was there for Peter's birth. She was almost not there most of the time. She left me to it but never left the room. She sent her helper out to get anything we needed. When I got to 5cm she offered me the birth pool as my birth plan indicated and arranged the sign off from consultant care required for this to happen. She never pushed but told us afterwards that she was thrilled we had taken it.
She offered me Entenox, but never pushed. It was phrased like "the contractions are quite intense. If you feel you'd like some pain relief I can set up the gas and air - just let me know" I declined but then sent my husband running for her less than 5 minutes later and there was no trace of I told you so about her.
She didn't touch Peter after his birth. She stayed 2 hours after he shift to be there for his birth and the next morning when she came to see me up on the ward she said she'd not slept because she'd so enjoyed our birth and was still on a high. I got the impression she'd enjoyed working with someone that didn't take the induction thing lying down - if you'll pardon the pun - and was prepared to make her body do everything it was capable of. She was even happy to let me go no meds on delivering the placenta, which is very unusual.
She obviously understood me as she helped my husband a couple of times when he was losing touch with it. He was stoking my hand too hard and annoying me and she showed him what the problem was and how to stop winding me up. She also managed to be light hearted throughout and very laid back about exams. She was trying to check the fetal heart beat on and off for about 20 minutes but I kept pushing her away when the next contraction came. She did struggle to find it on another occasion but she never showed any sign of concern, which I think a less experienced midwife might have done. She just exuded knowledge and common sense. Oh and she very gently told my husband to shut up when he was getting carried away with excitement when I was pushing. She said "It's OK - she knows what she's doing you know." Right on Barbara. She got an official compliment that I sent through the hospital.
Care assistant - Rita. Barbara's sidekick. Not a trained anything - acted as a gopher but I suspect would have been more involved if my husband had been less than brilliant. Her main function was to run backwards and forwards getting iced water and cold flannels.
L&D midwife 4 - Brenda. A bit cold. Probably annoyed that she'd been shouldered out by Barbaraís overstaying her shift! She was efficient and helpful but had already checked us in to a ward without checking. If I hadn't been so elated and tired I would probably have said no but she had not felt the need to read my birth plan as the birth was over. Had she done so she would have read the bit about going home immediately.
Ward midwife 1 - told me not to walk round holding my baby. I might drop him!! Also told me off for not sleeping - I just wanted to lie awake and gaze at my baby.
Ward midwife 2 - arrived at 7am (Peter was born 9:30pm and I was warded at 1am) and asked "When was this baby last fed" Got a very frosty answer, which was a lie but I was determined to be left alone so I gave her the answer I knew she wanted.
Ward midwife 3 - refused to allow me home as Peter had not had a wet nappy (Husband got Barbara to sort her out) and then tried to delay us because she hadn't done the paperwork.
Paediatrician - very young and delightful lady doctor who examined Peter and was completely and genuinely impressed with him. I told her that he should have been a homebirth but that he'd been a water birth. She was really positive - she said she was glad he'd had to be born in hospital because otherwise she wouldn't have met him, which I took the way she intended as being a nice comment.
Postnatal midwife - Val. Stand in over the weekend while Nicky was on holiday. Really nice and laid back. Happy to help with anything I wanted, answer any questions.
All of which brought us back to Nicky again. Which was a relief. Nice friendly face. She did actually visit me twice in the hospital. Once on the afternoon when labour was underway and just after I arrived up on the ward because she'd been with a homebirth that evening which had had to transfer in because of problems with the newborn.
Quite a list huh!!
Next time I will cut out all but the midwife and her assistant by having the home birth.
I on the other hand booked direct with the midwives (NHS) Saw two for home antenatal visits. The same allocated midwife, Jeanette, was terrific all through my pregnancy and didn't push me into any hospital visits. She kept me calm during my long labour and delivered Bethan peacefully and was on top of everything. Even when my bleeding was excessive she calmly explained everything. She got it under control, so I never left my own house. I even had Jeanette for my postnatal and baby visits. I really cannot fault any of my care. It was totally 100% caring. I would tell anyone thinking of a homebirth to book direct with the midwifery unit, which is of course your right. Cut out the middle man ;-)
I had a very straightforward labour and pregnancy - if they have any complications then it will run into a cast of thousands. My friendís wife had ventouse delivery and for that about 7 people ended up in the delivery room!
You can also tell them that while the labour and birth were fine, _everyone_ on the ward afterwards was down right nasty. It was almost like they put a sign up saying "This one wanted a home birth" so they could all come and annoy me. I was out of there in less than 12 hours from being put up on the ward, because I would have really hurt someone otherwise!
Interestingly enough when our NHS antenatal group met afterwards they all said the same thing - care after delivery was awful. One woman had asked for help because she was struggling to breastfeed and was told by the midwife on the ward that she couldn't help because there just wasn't time and if her baby needed food she had better get a bottle of formula from the fridge. Unbelievable. Fortunately the lady kept trying and when her antenatal midwife saw her 24 hours later she went mad with them in the hospital and helped the lady out. She ended up feeding fine.
I couldn't, hand on heart, tell anyone that a hospital birth was awful for me but, I wouldn't stay a second more than was necessary another time if that was where I ended up. I would even discharge myself after a section after my experiences.
You ask an interesting question. Here are my thoughts.
I want someone with thorough training - in Europe things are different from the US and midwifery training is much more formal. I want someone who's attended homebirths and hospital births, who's seen a wide variety of situations, and who has developed reactions and instincts that will kick in as needed. (In a lay midwifery situation, I guess this would mean someone who had attended a LOT of births a secondary before starting to practice as a primary and who had taken lots of courses on the theory of childbirth as well).
On the other hand, I don't mind if the person doesn't have a whole lot of post-qualification experience. The midwife who delivered my daughter had only been doing homebirths for 6 months - so we were only about the 12th. But she had 3 years of midwifery school, 3 or 4 years of hospital practice and 1 year working in a hospital in Chad - where facilities were more basic than in our house and where she'd had to learn to rely on her instincts not on the machines. The midwife who will deliver my expected baby only started doing homebirths in the last year (when the other one went out on maternity leave) but again, she has tons of experience and has given birth at home 4 times herself.
In a lay midwifery situation, I guess this would mean I would be OK to use someone who hadn't attended a lot of births as the primary midwife, provided she'd lots of experience as a secondary.
I want someone with a professional attitude - she's not there for herself, she's there for me. (So, if she has unresolved issues surrounding her own births, I want her to shut up about it - or better still, resolve them !)
Oh yes, ideally I want her to have given birth herself - but not to assume that that means she knows everything. (My doctor is a great one for this, she had a very difficult pregnancy, trial labour and C-section - so she thinks pregnancy and delivery are always crises - after all she's BEEN pregnant. Not appropriate for me, though great for a friend who did have a traumatic pregnancy.)
I want her to be telepathic :-) I want her to be able to tell when I want space, when I need help, when I want to make a decision, when I want her to take it for me.
I want someone who will be honest with me - about protocols and policies and days off etc. (Mine has made it clear from the start, for example, that she will not deliver a breech at home. Better to know this kind of thing all along and make your plans than find out on the day that the midwife wants to transport for something you didn't even think about.)
I want someone who won't make assumptions about me, my beliefs or my preferences, but who will ask and, if not comfortable with me, suggest I go elsewhere.
Someone else mentioned transport - again, I want my midwife to transport with me if necessary.
I want to do my pre-natal care with the midwife (didn't happen for 1st pg, happening this time - huge difference). I also want her to do my postnatal care. (follow up visits, physio etc.)
I think it would be difficult to welcome some into my home who I disliked - but I don't think I need to be close friends.
I guess my main themes are mutual trust and honesty !
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