I need to make a correction. I thought my midwife was a Certified Professional Midwife, but she is actually a Direct Entry Midwife. This means she is not licensed with the state. I'm fine with this, because I still feel she has the training, expertise and experience necessary for my prenatal care and my baby's birth. She prefers not to be licensed because our state has many laws which actually restrict what midwives are allowed to do, and she would rather have the freedom to practice without those restrictions.
With that said, I just got done with my first prenatal visit with my midwife, and it was a wonderful experience. My midwife likes to do the first prenatal visit at the client's home, which I think is great. At each visit she does a urinalysis and checks blood pressure and the baby's heartbeat. She doesn't do routine vaginal exams, but will do them at the client's request. I'm just fine with that as well! She does not do routine lab tests (blood test, glucose tolerance test, etc.) which is OK with me. I've had the routine tests with all of my previous pregnancies and have always had normal results from them. I'm not worried about any abnormalities or problems, and I don't feel the need to test for them. She does prenatal checkups at the same intervals as a physician would: once a month until about 26 weeks, then every two weeks until about 36 weeks, and then once a week until the baby is born.
My midwife does not feel the need to have a specific backup obstetrician. She says that in a true emergency in which the mother is transferred to the hospital, you will be left to the physician on duty at the time, and in a true emergency, any physician will have the expertise needed. In a less pressing emergency you may have time to call the various hospitals and find out who is on duty and choose your location based on which physician you prefer to have.
We talked for about an hour and a half. I have never had a prenatal visit with a physician last more than about 10 to 15 minutes. I loved it. Because of my passion for this subject, I was thrilled to have the chance to pick someone's brain and ask all the questions I could think of. She is just as passionate as I am, if not more, and seemed more than happy to talk with me, although it ended up being a late night for her as a result.
My midwife cautioned me about approaching my obstetrician with my home birth plans. I want to have an ultrasound with an obstetrician covered by my insurance. This is more for sentimental reasons than medical. All of my kids have tape recordings and printed pictures of their ultrasounds, and I'd like to have that record for this baby as well. I also like being able to determine the baby's gender positively in an ultrasound, so that's a nice added benefit. My midwife is concerned that my physician may be opposed to home birth and tell me horror stories and try to talk me out of it. I'm not worried about losing my resolve, but I really don't like confrontation. I haven't decided yet if I'll go for one visit and an ultrasound and pretend to be moving forward with my OB, or if I should be completely open about my home birth plans and be prepared to develop some very thick skin. My husband feels I should be completely up-front with my OB, and I'm leaning toward that option at this moment. My doctor has been excellent in working with me with my plans for natural birth and has worked well with my doula, but being open to un-medicated birth is not quite the same as being open to home birth. I have some time to figure it out, so I'll think about it for a while.
I've also decided not to hire a doula for this birth. My midwife has several apprentices, and one of them attends each birth with her. Each of her apprentices is a certified doula and is training as a midwife, so they are more than qualified to assist with the birth. When I birthed my babies in the hospital I needed a doula to act as my support and comfort, as well as be my advocate with the hospital staff and doctor to ensure that my birth wishes were followed. I feel I will have the support and comfort needed with my midwife, her assistant, and my husband there, and I won't have the need for an advocate because I won't be in a hospital setting.