Q. Hi! I am newly married and my husband and I would like to have a baby within the next year or so. However, I had an IUD placed about 4 months ago to provide contraception. Can midwives or providers at your location assist in its removal or do I have to see an OB/GYN to have it removed?
A. Congratulations on your wedding! As certified nurse midwives we provide full scope well-woman services and well as obstetrical care. Whenever you guys are ready, we would be more than happy to meet with you for a preconception visit and removal of your IUD. This will give us a chance to talk about your medical history, review any medications you are taking, and talk about plans for a future pregnancy.
Q. I recently found out that I am expecting my second child. My question for you is in regard to having a VBAC. My first child will be 9 years old by the time this baby arrives. With my first pregnancy labor had to be induced because I developed pre-eclampsia. I labored for 36-48 hours without ever really dilating, and subsequently underwent a cesarean. I am curious what your recommendation would be for me having a VBAC versus going through with a repeat cesarean. My only other medical history is asthma. If you would be so kind as to let me know your opinion, I would greatly appreciate it! Thank you so much!
A. Congratulations on your pregnancy! This is such an exciting time. Thank you for your interest in our practice. We absolutely recommend a trial of labor for the majority of women with subsequent pregnancies. Our VBAC success rate is around 85%. We are also now offering the use of hydrotherapy for labor and birth for many of our women desiring to do so. The chances of success with a VBAC have many variables: moms age and health history, reasons for the first c-section, and mother’s motivation for VBAC to name a few. I would recommend you attend one of our Meet the Midwives events to learn more about our practice and meet all of us.
Q: This is my first child and I was wondering if I choose to have a CNM do I also have to get an obstetrician as well? I am also 8 months pregnant and want to switch doctors and hospitals how do I go about doing this?
A. So glad to hear you are interested in midwifery care. We would be happy to have you in our practice. As long as you haven’t had major complications during this pregnancy, and have had regular prenatal care, you are welcome to transfer to our practice at any time. You do not have to see an obstetrician unless you have complications that would warrant a consultation with the physician. However, you would remain under the primary care of the midwives. Conditions that would preclude midwifery care and warrant physician-only care are the following:
- Currently 32 weeks pregnant without prenatal care
- Prior classical cesarean section or 3 or more cesarean sections
- Pre-existing diabetes (prior to pregnancy) or uncontrolled gestational diabetes in current pregnancy.
- High blood pressure prior to pregnancy requiring medication
- History of cardiac disease or stroke
- Active liver or kidney disease
- Cancer – receiving chemotherapy or radiation
- Mental illness requiring antipsychotic medications
- HIV positive
- BMI > 40 at last menstrual period if you have never delivered a baby vaginally
- Severe asthma requiring hospitalization, intubation
- Current active seizure disorder
Hope this helps answer your questions. We look forward to meeting you. Call 797-7350 to schedule your first appointment with us. This appointment will be 1 hour long so that we have plenty of time to review your records and get to know you. To expedite the process, please go to our website and download the new patient forms, fill out, and bring with you to your appointment. It is also helpful if you can bring your current prenatal records with you, including lab tests and ultrasounds.
Q. I just found out I am pregnant! I have been reading and watching documentaries, etc. I am interested in water birth, but I am most positive I am considered high-risk. I have PCOS, I am obese, and I am 31. What are the chances that I would be allowed to try a more natural birth for my baby-to-be?
A. Congratulations on your pregnancy! There are, indeed, certain factors that add risk to a pregnancy. Being 31 does not increase your risk for pregnancy complications. Having a history of PCOS does make you at increased risk for gestational diabetes and obesity does, indeed, put the mother and baby at risk for complications of pregnancy such as birth defects, still birth, gestational diabetes, high blood pressure and pre-eclampsia, having a very large baby and difficult birth, including an increased risk of cesarean section. Should a cesarean occur, obesity puts mom at risk for anesthesia complications, poor wound healing, hemorrhage and blood clots. For these reasons, women who are having their first baby and have a BMI > 40 are best cared for by physicians. For women who have had successful vaginal births, the BMI cutoff is 45 for midwifery care.
As far as waterbirth is concerned, per hospital policy, women with a BMI > 40 are excluded from waterbirth due to safety concerns associated with mother’s ability to move out of the tub easily in the event of emergency.
Fortunately, obesity is a treatable condition. By making significant changes to your diet and exercise habits you can reduce the chances of developing some of the complications associated with obesity in pregnancy. It is advisable to minimize the amount of weight gain during pregnancy by eating healthy and adding 30 minutes of intentional aerobic exercise 3-4 times per week to your usual routine. New research is showing that for women with BMIs > 30, it is even healthy to lose some weight during pregnancy. Below is some information on healthy eating during pregnancy:
- Maintain a total caloric intake no greater than 2200 calories per day during the first 2/3 of pregnancy. It is only in the last 12 weeks that women need an extra 200 calories a day beyond 2200 calories. This is the equivalent of an apple.
- Always eat breakfast and try to eat 5 small meals or snacks throughout the day rather than 3 large meals.
- Eat at least 4 servings of leafy green and/or root vegetables each day. Limit fruit to no more than 2 servings.
- Eat fiber-rich foods such as oats, beans, lentils, grains, seeds, fruit and vegetables as well as whole grain bread and brown rice and pasta.
- Avoid simple carbohydrates. These are foods made from white flour, white rice, sugars, corn syrups, etc.
- Limit or avoid all together processed foods – foods found in boxes, bags, prepared frozen, microwaveable, etc. These are foods that have been stripped of much of their nutritional value and have added chemicals and preservatives and added salt.
- Eat a diet low in saturated fat, and high in “good” fats: nuts, olive oil, fish oil, etc.
- Avoid the following: fried food, fruit juices, drinks high in added sugars, and other foods high in fat and sugar and “empty” calories – chips, pretzels, candy bars, muffins.
- Watch the portion size of your meals and snacks and how often you eat. Do not ‘eat for two’.
Below is a chart for determining the amount of recommended weight gain during pregnancy:
Recommended weight gain:
Normal weight (18.5-24.9)
Obese (Class 1) (30-34.9)
Obese (Class 2) (35-39.9)
New research demonstrates that women can lose weight safely during pregnancy when following a nutrient-rich 2000-2500 calorie diet.
Hope this information has been helpful to you. If you would like to learn more about our practice, we encourage you to attend our “Meet-the-Midwives” session scheduled the 4th Tuesday evening of every month from 6-8 pm. (In December 2013, this event is scheduled on the 3rd Tuesday). You can register through our website. We look forward to talking with you.
Q. I saw that women with a BMI over 40 is not permitted a water birth. I am very healthy with all normal vitals and active. I was wondering if there were any exceptions for that rule and also if women that are over 40 are allowed a natural birth with a midwife without the water? Thank you!
A. The BMI cut off is a hospital policy. It is in place due to safety concerns associated with the potential for needing to assist the mother out of the pool in the event of emergency. You may absolutely have a natural birth with the midwives and, in fact, we encourage it! We encourage all of our mammas to be up, out of the bed, moving about during labor and birth. The shower is a wonderful option for hydrotherapy, also, and can be used by any woman.
Glad to hear that you are active! Keep up the good work! Eating healthy and remaining physically active are two of the most important things you can do to maintain a healthy pregnancy. Being overweight increases the risk of gestational diabetes, high blood pressure, extra large babies and difficult birth. There is also some research out now that links high carb intake during pregnancy to obesity and sugar cravings in children.
For women with a BMI of 40, it is recommended that a low-carb diet is followed in conjunction with aerobic exercise 3-5 times a week. When this is followed, most women will actually lose weight which is a great added bonus!
Q. I am very interested in birthing my baby via a midwife. I am thinking a water birth would be the way to go, but don't have much time to research or look into such. I am currently seeing an OB/GYN, but don't wanna just go the "easy route." I wanna make sure that I am doing what is right for me/baby. I am not so sure I could do this w/out meds, but the rest I am very interested in.
A. The decision of how and where you have your baby and what type of provider you choose to attend your birth are decisions that have the greatest impact on your birth experience.There are many things to consider: the style of practice and philosophy of the care provider, the setting for birth, the support of other personnel during birth. At Greenville Midwifery Care believe in the Midwifery Model of Care which is a model based on the fundamental belief that pregnancy and birth are normal life events rather than illnesses to be treated or "managed". We believe in non-intervention in normal processes whenever possible. Our focus is on education, support and encouragement to help women make the healthy choices that result in healthy pregnancies and normal births.
A great place to start for information about planning your pregnancy and birth and choosing a care provider that shares your same goals for birth is the organization "Childbirth Connection" at www.childbirthconnection.org and search the link "Choosing a Care Giver".
Hope this helps. Wishing you a happy healthy pregnancy. Feel free to call us to set up an appointment for consultation if you desire to speak to a midwife personally.