Last night we trekked up to Foggy Bottom to meet the midwifery group at GWU Hospital. The info session was packed, but we luckily got there hella early and so got good seats. I have very mixed feelings about this group. On the one hand, their core values and ethics seem to be perfectly in line with mine. On the other hand, they seem to be a little bit defensive and I'm starting to get the feel they don't like me very much. Not exactly the relationship you want with the woman who is helping you deliver your baby...
I've had several email exchanges with this group. They seem to be very accessible, though they weren't super great about answering questions/addressing concerns via email. They sent me their packet of info - all about nutrition, exercise, their values, etc. - but wouldn't address any specific questions. Instead, I was told to come to the info session. I mean, I get it. Their practice is overwhelmed. They take 30 deliveries per month, they have four midwives on staff, they need to hire another, and they operate in a teaching hospital which means they are mentoring both midwifery students and med students, not to mention quarterly lectures to OB/GYN doctors in the hospital on the benefits of natural, physiological childbirth. So maybe they would answer all the questions I cared to ask if I were a patient of their practice? I'd like to think so.
We didn't get to tour the delivery rooms, so I don't know what those look like. If GW is still on the table after tonight's meeting in Chantilly, that is next on our to-do list. The good news is this group still has openings for February. Though, given the turnout at the meeting last night, I'd bet that isn't going to last very long. They also told everyone several times that we could donate to their group, which I thought was a bit much, but not a deal breaker.
So, the meat of the meet: They have been in operation at GW for just over a year, though each midwife has over 20 years experience. They have a 3% c-section rate. This is very encouraging. They have had a lot of success with things like VBACs (2 c-sections and 12 vaginal births after cesarean), which, while it doesn't apply to me, is also encouraging in that they want to support natural childbirth as much as possible. They have one labor tub for water labor and a second one on order, and they highly encourage hydro-therapy (laboring in water), though not necessarily water birth. They are very serious about proper nutrition and exercise. The head midwife explained that birth is an athletic event and you have to train for it. She also felt very strongly that you should only be eating food that people 200+ years ago would recognize as food. No packaged, processed, fake foods. I couldn't agree with this sentiment more. They are strict in their requirements for who they'll accept in their practice - only healthy women with normal, low-risk pregnancies, who will adhere to their nutritional and exercise guidelines. (To the best of your ability, obviously. They aren't policing you after all.) It's more about accepting women into the practice who are committed to the same goals and ideals.
I asked why they chose to operate in a hospital setting rather than in a birthing center or home birth setting, and the answer I got was one of the things I liked most about the session. The midwife responded that hospitals are where the majority of births are occurring and hospitals are where the most change in how childbirth is handled is needed. They feel a moral and ethical obligation to operate in a hospital and provide access to midwives to women who might not otherwise have considered it. "Every woman deserves a midwife." It was a powerful message and one that I could not agree with more.
I also asked during the session if they could address the difference between Certified Professional Midwife and Certified Nurse Midwife. This is where they seemed a bit defensive. They didn't want to discuss that particular topic during the meeting ("it's not really appropriate to discuss that here" - I'm not sure why. It seems appropriate to me.), though they did go out of their way to say that they were all CNMs, and that 95% of midwives are CNMs and 90% of CNMs work in a hospital environment. After the meeting, they told me I could look on midwife.org for a paper outlining the differences between the two, but it basically boils down to training. CNMs are trained as nurses in nursing school, and CPMs are more "direct entry", I think. But in the Commonwealth of Virginia, both are legal and both have certification standards. At any rate, I mentioned that I had read that sometimes CNM can be subject to doctors orders (I may have used the word "subservient"...). The head midwife responded that it was certainly true that some midwifes practice "med"wifery rather than being truly dedicated to natural childbirth. She then said that if I was concerned about that, maybe this wasn't the practice for me... This is the second time she's told me this, so maybe she's trying to give me a strong hint that I'm ignoring?
I don't get the impression that these women are subservient to the OBs on staff - quite the opposite, in fact. But her defensive attitude at what I think are perfectly valid questions put me off a bit. We've backed off the idea of having a home birth, so GW isn't a bad option for us, but I am still a bit wary about being in a hospital setting. Though the midwives support natural childbirth, the hospital still has strict regulations on how the infants are cared for after the birth. They are required to go to the nursery for evaluation during the postpartum phase (about an hour if the parents go with the baby and/or monitor the nursery staff. This seems ridiculous that you have to follow your baby around to make sure they are doing anything you told them not to, and to make sure they give your baby back in a timely manner - my Mom had just this problem with hospitals and nurseries when my brother was born and I do not want to repeat that experience), and there have been some struggles over the nursery staff giving the newborns bottles and such. They also have to go back to the nursery to be given a physical before discharge (about another hour). The midwives say they are happy to release the mothers from the hospital early - say within four to six hours, but that the pediatricians don't want to release the newborns that early. I'll say this much: no one is telling me I can't take my baby home when I want to. Childbirth is not a pathological occurrence and I will not be treated as such. There's no reason to delay me from taking my baby home just because they want to poke and prod him/her some more. No way, Jose. (end rant) The midwives did also say that they go out of their way to make it happen if you want it to, but that it's one of the ongoing growing pains of having a midwifery practice in a hospital.
So, overall, I'm feeling so-so about the whole thing. I love their commitment, their attitude about natural childbirth, their ideas about health and nutrition. But I am wary about the hospital setting and the possible undermining of my wishes by OB staff. And I'm not super happy about the baby being taken away to the nursery and being held against my wishes. I also get the feeling that I am just educated enough to make them defensive and as a result, I get the feeling that they don't like me very much. That may just be pregnancy hormones though... Oh, and I'd have to go up to GW for my prenatal check ups, but it's super close to the metro so not that big of a deal. I'm going to keep in touch with them and make my final decision in the next week or so. I also have one more appointment with my regular OB, but that's just to tell her that I'm moving to a midwife practice for the birth.
The last nice thing about GW is that it's a lot closer than Chantilly, though still a pain to drive. We'll see. I'm looking forward to the info meeting tonight. Hopefully that will help cement my decision one way or the other.
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