The Hunt for the Maverick Midwife

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I went to my last midwife appointment with a considerable measure of nervousness. Following my hours of reading articles about birth trauma, arguments of natural vs. caesarean births, and the process and recovery of caesareans, I was increasingly sure a c-section was the probable aim for me this time. Even if I wouldn’t end up wanting that route after all, it was a viable enough possibility that I wanted to my midwife to at least address it as such, and considerately discuss it with me.

The problem is, from what I’d learned about my current midwife, she was very anti-medical-intervension of any type. And I find it very difficult to be assertive to anyone. It seems bulshy and rude, to me, and I don’t want to be rude. (Rather than be confrontational to someone, it’s much more likely I’ll just passive-agressively blog about my discontentment when I get home.) So I didn’t expect the conversation to be easy.

I asked her when I could get the free consultation with an obstetrician regarding the possibility, which she’d told me at my last visit that I qualified for. She told me it would happen after my anatomy ultrasound, which isn’t due for another six weeks. She then enthusiastically tried to talk me out of considering a c-section, saying the operating theatre is her ‘worst nightmare’, both for herself and her clients.

She knows I had an unpleasant experience with Timmy’s natural birth, but that’s about the extent of it. She hasn’t been interested to hear what actually happened; to know why I’d be considering the surgery so seriously. As far as she’s concerned, it’s always, always, a bad idea.

Despite this midwife having many positive client testimonials (I’ve since concluded they were all by clients who also embraced the ‘natural process’ as the only way to get it done), I didn’t foresee us having a comfortable professional relationship. Although I’d be within my rights to change to a different midwife, I didn’t expect I’d find anyone different. As far as I can conclude, they’re all anti-intervension. I anticipated a bumpy road ahead.

So I had mixed feelings when she gave me the news: she’s pregnant also, and due before me, so will be unable to take my case to its end. I had the option of staying with her anyway, then being transferred to her colleague about a month before I was due, or seeking out a new midwife myself for a case transfer now.

On the one hand I was happy. I could now end our professional relationship without feeling like a diva who just wants someone to cater to her whim and sort her M&Ms into piles of separate colours. But on the other…searching for a new midwife would again put me in the frustrating and futile effort of trying to find what doesn’t exist, and the thought made me tired.

I wanted to know how, if it was even possible, I could find a midwife who would support me in an unpopular decision of surgery. All the information you’ll find in advance, about any midwife, is a name and phone number. Nothing is said about their philosophies or experiences. But I couldn’t just say, “How can I find a midwife who’ll just give me what I want?” (‘…instead of trying to bully me out of it,’ would be the unspoken end to that sentence.)

I tried asking it in a sensitive way. It came out, “I understand that the popular ethos in NZ’s midwifery is to embrace natural methods in childbirth—” …sadists, the lot of you… “—and I don’t want to put a midwife in the position of having to help me to do something she’s not comfortable with—” …I actually don’t care, she won’t be the one being split in half by a giant skull… “—so how can I find one who will be okay with working with a c-section client?”

Not a bad effort.

She didn’t know. I restrained myself from asking, ‘You don’t know how to find them, or you don’t know if they exist?’

“All you can do is ask them,” she said.

I envisioned that being a long and fruitless task.

“Would you like to stay with me,” she said, “or look for someone else?”

I said I wanted to think about it, and we made a new appointment with her anyway, with the agreement that I’ll call ahead and cancel if I find another midwife before then.

With all the midwives in my area, and all the personality types that must be included in that pool, why would they all have the same ethos, and so strongly push it? Not every personality type lends itself to validating the merits of yoga, meditation, healing hot rocks, and believing a woman’s body becomes a superhuman vessel of power and strength when giving birth. So why do midwives all seem to push that? Even to a client that bought it the first time and discovered it to be a load of tripe? (Or at the very least, not ‘her cup of tea’.) Why do they all want me to put myself through another agonising mess, with whatever mental and physical consequences it may bring?

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I found out what must be exactly why, when I discovered the document on a government website that details how much NZ midwives are paid. (Ministry of Health:  http://www.health.govt.nz/publication/section-88-primary-maternity-services-notice-2007) It looks like they get paid in four stages: 1) First and second trimester care; 2) Third trimester care; 3) Labour and Birth; and 4) Post-natal services.

It’s the third stage that’s the key.

According to my understanding of the document, the fee difference for a natural birth versus a c-section is significant. Her total fee would decrease by $507 if she attended the surgery, and $876 if she didn’t. (My current midwife says I’d have to specifically ask for her to be there, if I wanted her to be. She can’t just turn up and expect to be paid for it, as they medically don’t need to be there.)

That gives any midwife at least 507 reasons to steer me away from an elective c-section!

This payment factor was similar to the reports from lay-mums I’d read in various NZ forums. I was hesitant to believe it from such unverifiable sources (because that would mean midwives could feasibly care more about their money than my safety or comfort), but it’s more credible coming from the mouth of the NZ Government, isn’t it? How can I discount it now?

That’s why they so strongly push the ‘natural agony is good’ ethos, I suspect, even to women who have a valid reason to consider alternatives. It’s the most lucrative.

How could I trust any midwife in New Zealand, now?

Later, I was recommended a particular midwife on the basis of her generation and character. (The recommendation didn’t come from someone who’d had her as a midwife, just who knew her personally.) She was reportedly very nice, considerate, and being middle-aged with a long work history, has practiced midwifery in a time when this new-age naturalistic vagina-worshipping hoodoo wasn’t so prevalent. She may be more likely to discuss alternatives seriously.

But it turned out, when she called me back today, she’s fully booked up around my due date.

She suggested a colleague of hers, and with no other names on my shortlist, I agreed to meet this colleague. I expected I’d have to go to her, but she arranged to visit me at home tomorrow, to have a chat. Brownie Point One to her.

Because it will be just a preliminary chat — I’m not officially her client yet — I expect I’ll feel more comfortable to tell her my concerns, and give confident full disclosure of my possible intentions. If she doesn’t want to take a (potentially) elective c-section client, she’s free not to. I wouldn’t have unexpectedly pulled a financial rug out from under her feet.

And even if tomorrow’s meeting should fail, I have one more place of hope.

Today I learned a fellow playgroup Mum had birthed by an elective c-section, and the midwife she’d used was very helpful and supportive throughout the whole process, even being proactive in getting it to happen. This sounded like it. The Answer. The Grail. … The Maverick Midwife.

And if she’s the only one in town, I desperately hope she has a client slot for August.

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(15) Comments

  • Leanne
    06 Mar 2013

    Okay. You remember the night that Captain Zogg made his dramatic entrance? You remember the pain you were in?

    I do.

    Think about that and weigh it up against being impolite to a midwife about what you want, or inconsiderately costing her $500. I think you’ll find the strength to make your views known.

    • Eve
      06 Mar 2013

      Inspiring clarity, right there.

  • Mrs. W
    07 Mar 2013

    Just wanted to wish you luck in your search – be blunt. If this is something you need, you must be desperately clear about it. There’s a Facebook group called The Cesarean by Choice awareness network https://www.facebook.com/groups/403330643071622/, a book – “Choosing Cesarean” by Pauline McDonagh-Hull and Magnus Murphy, and my blog – Awaiting Juno which you may also fin helpful. I also wonder if Jenn Hooper of AIM (Action to Improve Maternity) in NZ may also be able to help.
    Once again, good luck.

  • Awesomemom
    07 Mar 2013

    I am so sorry you have to go through this!!! I hope that you find the care provider that will help you have the kind of birth you want.

  • Lola
    07 Mar 2013

    I wish you all the luck in finding a supportive midwife/OB. My son was born via a requested C, and I couldn’t have been happier with the experience.

    Do you need midwives to refer you to an obstetrician in NZ? Could your GP do the referral?

    • Eve
      07 Mar 2013

      Hi Lola, thanks for the well-wishes! My GP could perhaps do a referral, but only if I show a medical need for care beyond midwifery, I believe. But since GPs don’t tend to do obstetric care themselves anymore, all pregnancy/birth-related issues are typically handled or referred by the midwife on the case. I’m told a woman’s GP used to be a common LMC even just a generation ago, but no more. Now the options are a midwife or obstetrician — and if you don’t have a pre-existing medical need for the obstetrician, you have to pay private care fees for them. So midwives are the typically used option, just because they’re the only free one. So, I could go to an OB if I had a spare $4,000-ish (which I don’t), otherwise I think I have to show a midwife ample justification for a referral — when OB involvement would then be free.

      • Mrs. W
        07 Mar 2013

        Consider getting a tokophobia dx?

        • Eve
          07 Mar 2013

          I’d actually never heard of tokophobia until I chatted with the Mum who’d had the Maverick Midwife! (She had been granted a c-section because she had primary tokophobia.) In what I’ve managed to discover about it since, it certainly sounds plausible that I have secondary tokophobia. My second baby is a long way off yet, and I’m already having nightmares about it’s arrival! I wonder if I have to consult a specialist, to get a diagnosis. I suspect my GP won’t be considered qualified. Tokophobic Mum had to go through a string of psychiatric processes before she could get a c-section.

          The midwife I spoke to today (the ‘colleague’ at the end of my blog post) referred me to a Birth Trauma counsellor, who I anticipate will get in touch with me soon. I wonder if chatting with her will make any difference.

          • Mrs. W
            08 Mar 2013

            The birth trauma counsellor is likely to be helpful – but ask your GP about a referral to a psychiatrist. Also can GP’s refer to ob/gyn’s or just midwives in the NZ health system? Further (sorry to rain on the proverbial parade) – not all OB’s are supportive of maternal request cesarean, as such finding an OB who is supportive can also be a challenge (if your system is anything like Canada’s).

  • Ms Kate
    08 Mar 2013

    We emigrated here from the US in 2008. It was absolutely the right move for us – we prefer the lifestyle, the beautiful multiculture, the social safety net, the way people are cared for as opposed to corrupt, right wing America.

    We are so grateful to be here.

    But we realise we probably sacrificed any third child we might have had. I was 40 and had vertical CS X2 for my previous kids and a history of low progesterone and preeclampsia. I would have needed to access high risk pregnancy care with an OB from the moment of pregnancy confirmation. And we live in a small town. My first GP (she wasn’t for long) actually sneered at me when I asked about my options should we want to try again.

    It was very sad, but we’re kind of OK with it now. Kind of.

  • Cori
    08 Mar 2013

    I sincerely hope you find a healthcare provider who provides you with the care you expect and deserve!

  • Ruth
    15 Mar 2013

    Hi a question for you mumma. Firstly where are you in NZ? Secondly is there are way that the things that happened in your first labour could be changed so as to not happen with this next one?
    Can you hire a Doula – to help with positions etc.
    I’m sorry I don’t know what happened with your previous birth are you able to give us a quick over view as to what went on please.

    • Eve
      15 Mar 2013

      Disclaimer to others: this answer contains what some might deem ‘over-sharing’.

      I’m in Hastings. To be fair, I don’t think the labour itself was abnormally bad, as far as first-time labours go. It was 11 hours, and mostly in water, which helped a lot. It was the birth itself and following recovery period that turned sour.

      My previous birth gave me:

      3rd degree tear, extensive blood loss, catheterised immobility for 3-4 days;
      Inflammation (6 months later, pap smear was agonising);
      Bleeding lasting over 2 months (I don’t know if this is normal) — wet pads made thighs raw and painful;
      Large painful long-lasting hemmorhoids;
      Duration of soreness created back problems needing expensive chiropractic care course (ongoing);
      (Mis)diagnosed with PND, from chronic exhaustion, and stress culminating from the above list

      My concerns if I have another natural birth:

      Now-present scar tissue makes opening even less amenable to passing a baby, and he/she’s statistically likely to be bigger than Timmy was;
      Previous birth trauma will make it impossible for me to relax enough for successful natural birth;
      Trauma of another natural birth would bring repeat consequences of physical injury and stresses on relationships in the family, including resentment/difficulty bonding with the baby

      As the concerns are more to do with the physics of the birth, and the recovery, I don’t expect a doula would help. I need this next delivery to be a managed delivery, rather than letting nature throw whatever it wants at me again. Because clearly, nature doesn’t like me very much. And it’s quite mutual.

  • Concerned
    20 Mar 2013

    If you don’t address the fear you have, it will sit with you for the rest of your life. It’s hard, but your world as you know it will open up if you deal with it then educate yourself on natural birth. And not opinion pieces from so called experts, real experts. Watch The Business of Being Born, read anything Michael Odent. A real ‘natural labour’ is devoid of fear. It biochemistry at its perfection.

    • Mrs. W
      15 Apr 2013

      Or she could have a cesarean and be happy with that path. She’s Been There, Done That, and would prefer to not do it again, you granola munching twat.

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