Midwife vs. OB

posted 3 years ago in Babies
  • poll: Midwife vs. OB (for those who gave birth in a hospital)
    I had an OB and have no regrets : (14 votes)
    24 %
    I had a midwife and have no regrets : (13 votes)
    22 %
    I had an OB and wish I went with a midwife : (3 votes)
    5 %
    I had a midwife and wish I had just gone with an OB : (3 votes)
    5 %
    My midwife was in the room with me most or all of the time (when it was important) : (8 votes)
    14 %
    My midwife was rarely in the room with me (when important) : (1 votes)
    2 %
    My OB was in the room with me most or all of the time (when important) : (11 votes)
    19 %
    My OB was rarely in the room with me (when important) : (4 votes)
    7 %
    I had a midwife and had complications but had no trouble getting a doctor when needed : (2 votes)
    3 %
  • Post # 3
    Member
    9137 posts
    Buzzing Beekeeper
    • Wedding: November 2013 - St. Augustine Beach, FL

    Birth is a natural process.  Women do it every day across the world and a vast majority give birth outside of a hospital and in the presence of some sort of midwife.  Additionally, midwives are very cautious and make sure to take the mom and baby to a local hospital immediately should any complications arise.  Make sure to pick a birthing center close to a hospital and show him how close it is.  Men think of pregnancy as an illness instead of a normal aspect of life.

    Post # 4
    Member
    3769 posts
    Honey bee
    • Wedding: December 1999

    I have 3 girls and had an OB for all 3, a different one for my first but the same for my second and third. I see a family practice physician and how their office works is they deliver their own patients unless they are out of town. So my OB was there pretty much the entire time I was in labor. Once he got there he was the one to do my checks, was in and out of the room, and then delivered baby. He was all for different ways of pushing, moving around-pretty much whatever I wanted to try he was supportive-he is so great!

    I think the most important thing is finding a provider, whether it is an OB or midwife that can support the kind of delivery you are hoping to have. Even if your DH wants you to stick with an OB at the hospital you can still have a great labor and birth.

    ETA: I had abruption of the placenta during delivery with my first, with an absolutely healthy pregnancy and no warning signs. My daughter almost died, and would have had we not been at the hospital. Which is why I personally chose to delver at a hospital with my second and third. But having as natural of a birth as possible was still importnant to me so finding the right provider was key.

     

    Post # 5
    Member
    9412 posts
    Buzzing Beekeeper

    @beachbride1216:  This is what I always worry about:

    midwives are very cautious and make sure to take the mom and baby to a local hospital immediately should any complications arise

    I’d absolutely rather be in the place where complications can be handled rather than be with someone who would have to take me elsewhere to deal with it. I do understand birth is a natural process but a lot of women used to die in childbirth. I’d rather avoid that. Also, I have to have a medical c-section anyway so it’s a no brainer for me.

    Post # 6
    Member
    185 posts
    Blushing bee
    • Wedding: May 2012

    I haven’t had my child yet but we have a midwife and so far I have been really happy with her. She fully explained the process during my first visit. It might be different in Canada vs. in the US but the general practice with the group of midwives that I am working with is that they will be with me the entire time I am at the hospital and will come to my house to check on me (if I want them to) in order to decide when I should go to the hospital. If I have any complications during the pregnancy I will be transferred to an OB and my midwife will stay on and fulfill an assisting/Doula (birth coach) role so that I always have someone with me during the whole birth process that I know well and that knows my preferences. She will even stay with me throughout a c-section if I have to have one.

    I am giving birth at a hospital with a substantial birthing centre so there will be a doctor present at all times if I need a doctor. The nurses that will assist are also experts in the birthing process.

    I am really impressed by the amount of support that my midwife has provided thus far I even have her personal pager number so that if I have any emergency questions I can page her, even in the middle of the night. They encourage making a birth plan with your midwife so that they know what you want and don’t want so that they can speak up for you if you do end up with a doctor. I really didn’t want a doctor because I know that often you won’t end up with the doctor that you have seen throughout your pregnancy, if they aren’t on call when you go into labour.

    I also have all of the same tests that someone would get with an OBGYN so I feel that there are lots of opportunities to catch something if there was an issue.

    Post # 7
    Member
    1548 posts
    Bumble bee

    @red_rose:  I had a midwife and I’m having an ob…. both r good , honestly just depends on the person rather than the type of certification or degree

    Post # 8
    Member
    5745 posts
    Bee Keeper
    • Wedding: April 2011

    With my first I had an OB & really wonder if things would’ve gone differently (better) had I made the switch like a friend of mine did (she’s had 2 uncomplicated natural births). My OB did not support the natural birth process & I was immediately augmented when I arrived at the hospital (prodromal labor @ 2cm). I SHOULD HAVE been sent home. From there I really only saw the doctor when things weren’t progressing like they liked & more interventions were pursued. (arom, internal fetal monitoring, prepped for an epi “just in case”, and to tell me I “needed” a cesarean). Since my labor really followed the same pattern as my second I really wonder if a different approach (a more natural approach) could have saved me from unnecessary surgery AND from my baby needing to be “saved”.

    With my hbac my midwife was with me the whole time (I never had to go ask where she was & we chatted while I labored). She was very on top of any issues I had (my b/p started to rise & then DD became tachycardia) And she quickly assessed both DD & me at every turn (this was something that took significantly longer to be handled in the hospital b/c my ob wasn’t always the one there… a nurse would come in & give her 2 cents but they waited to call the obgyn, the one that would be actually caring for me, until they were no longer comfortable).

    I’d also like to point out that there are SOME things that would be very sudden & need to be dealt with very quickly, ie. cord prolapse being one… but many times since MW don’t intervene with unnecessary intervetions their happenings aren’t as prevalent…. I know obgyns that would arom & that in itself could attribute to a cord prolapse if the baby isn’t really engaged yet (a MW with a midwifery model of care won’t under normal circumstance rupture your membranes), also pitocin is routinely given in hopsital births & attributes to issues like pp hemorrhage, placental abruptions, decals in the baby, and numerous other problems (it’s so diffifult with common practices to really say if a problem was because of the intervention or if it would’ve happened anyways).

    I do know that my MW has seen a placental abruption in one of her moms & was able to get her transferred still non emergent just fine….. since she’s there the entire time it’s easy to pick up on signs of problems (obviously the individual skilled in birth is going to be more qualified to see a problem than a nurse) and to assess what should be done.

    I trust my MW 100% knowing her skills set & history  & know that I would be much more attended to by her than an obygn. She told me very simply the last time we visited “Oh we have to be more on top on things b/c we don’t have the “oh we’ll just take them for  a cesarean” like obgyns do”… and really after thinking more about it that is how alot of hospital births with obgyns go b/c IF/WHEN things go south from intervention they can quickly take you back & “fix” the problem. When you don’t have that option you must be more intuned, much more proactive, but respect the process much more as to not inhibit it.

    As for prenatal care….. Midwifery model of care cannot even be compared to obgyn care in how much better it is. I’m aware of EVERY common test, given the full right to informed choice, my questions are ALWAYS answered, I’m never rushed, and a top priority of my MW is that I build a relationship with her & trust her b/c trust in birth is important (if you are lacking it you stall & labor can be inhibited in how it should progress….. part of the reason why so many women stall as soon as they get to the hospital, fear, insecurity, & not being in control).

    Post # 9
    Member
    5745 posts
    Bee Keeper
    • Wedding: April 2011

    I’d also like to point out an important thing to know on hospital vs. out of hospital births….

    Many hospitals have vbac bans b/c they cannot accommodate the recommendation of having a 24 hr on site staffed anesthesiologist AND to be able to have an OR team ready in 30 minutes or less. (this is the #1 reason for vbac bans).

    IF your hospital cannot accomodate the vbac recommendation then you are no closer to an OR room IN the hospital than a mom transferring calling ahead from a homebirth or birth center birth. (definitely something to ask about)

    Post # 10
    Member
    3677 posts
    Sugar bee

    One thing to do is to find and compare the statistics for all the places you are considering giving birth at: find out their C-section rates, for starters, and if you can get more details about their low-risk C-section rates, their rates of induction, augmentation, episiotomy, etc., that can give you both a clearer idea about how to compare them.

    Optimal C-section rates for healthy, low-risk women should hover around 5% (in all the reading I’ve been doing, that seems to pretty consistently be the number of pregnancies that present serious enough difficulties to really require it); high-risk cases ideally will be more in the 15% range. Right now the national average is 32.8% across the board, with low-risk pregnancies ending in C-section over 25% of the time, and first-time mothers ending up with them over 25% of the time as well. That’s way too high. Individual hospitals’ rates vary quite a bit, though, as do individual practitioners. So, try to find out the rates for the places you’re looking at as well as for the providers who work there. The hospital itself might have a high rate, but there may be a doctor there who does a good job at keeping his/her individual rates low. The in-hospital birth center might have a really high transfer rate (important to ask about this, since by definition birth centers don’t do C-sections on site), and many of those transfers might eventually end up with sections. (Some of those, obviously, are going to be entirely justified because they presented complications and were legitimately risked out, but be skeptical if the transfer-culminating-in-section rate is higher than 15%, and if the baseline transfer rate is high on its own. Naomi Wolf writes in Misconceptions about the in-hospital birth center she attempted to use with her first baby; it basically existed for marketing purposes for the hospital but very few women actually gave birth there; the standard practice was to use it to attract couples who wanted a natural birth, but then one excuse or another would be found to transfer them to the regular L&D ward. Wolf found that the bait-and-switch made her labor extremely difficult, both physically and psychologically.)

    If there is a freestanding birth center in your area, I would encourage you to look at that too. Your DH might take some convincing, but you often have a better chance of getting a truly supportive, non-interventionist birth experience than you do at an in-hospital birth center, where they are still bound by hospital protocols such as holding you to the Friedman curve (i.e. time limits for each stage of labor, based on statistical averages that are shorter than they should be due to flaws in the research approach used to generate them).

    Post # 11
    Member
    881 posts
    Busy bee
    • Wedding: September 2012

    Haven’t had my baby yet but thought I would share my SILs story.  She gave birth in a birthing center that was connected to a hospital.  She had a midwife.  Originally she had wanted to do a home birth, but thankfully did not.  She was fairly low risk, the birth went great and she delivered naturally.  However, she suffered uterine inversion when trying to deliver the placenta.  She lost a lot of blood and needed transfusions and also needed emergency surgery to put her uterus back into place.  There happened to be a doctor available at that time from the hospital who had seen one of these cases before (this is an extremely rare complication and the fact that this doctor has now seen 2 means they are probably qualified enough to write the book on how to handle them).  She had also been put on IV fluids since she threw up during labor.  This also helped when emergency surgery was needed as they already had an iv in place.  Essentially, had any one of those things not worked exactly the way it did, my SIL would not be here anymore.  I think it’s great that you have a hospital nearby should you need one, but if that doctor had been doing a c-section or delivering another baby at the time I do not know what would have happened.  However, there are also many OBs who may not have handled this rare situation correctly so even being in a hospital and having an OB doesn’t alleviate all of the concerns.  Just something else to think about.

    Post # 12
    Member
    3769 posts
    Honey bee
    • Wedding: December 1999

    @runsyellowlites:  “As for prenatal care….. Midwifery model of care cannot even be compared to  obgyn care in how much better it is. I’m aware of EVERY common test, given the  full right to informed choice, my questions are ALWAYS answered, I’m never  rushed, and a top priority of my MW is that I build a relationship with her & trust her b/c trust in birth is important (if you are lacking it you stall & labor can be inhibited in how it should progress….. part of the reason  why so many women stall as soon as they get to the hospital, fear, insecurity, & not being in control).”
    Read more: http://boards.weddingbee.com/topic/midwife-vs-ob#ixzz2ZDo9kvBu

     

    I am so glad you found this in your provider, but many are able to find physicians with the same kind of relationship. It is really unfortunate that every post of this nature you go the absolute extreme in posting about MDs and hospital births. I get that you had a birth that didn’t go as planned, but this is just not how it goes for everyone.

    ETA: My abruption was not caused by any of those things you listed. And there would have been no time to transport safely. Just my story, of course everyone is different.

    Post # 13
    Member
    3677 posts
    Sugar bee

    Another thought: you might ask the midwives you are considering to describe their working relationship with the local OB/GYNs. There is often, unfortunately, a lot of hostility and resentment between the two groups (especially from OB/GYNs toward midwives, but it does cut both ways), but there are also individual practitioners who work well together and have genuinely collaborative relationships. I have been lucky to find a midwife who has a really good working arrangement with a cooperating MD at the nearby hospital, which goes a long way toward reassuring us about how things will be handled on the off chance that a complication arises in labor, or if something happens prior to the onset of labor that results in me getting risked out of the birth center (i.e. a breech presentation, etc.).

    That’s an important question to ask *any* midwife you are thinking of working with, actually: what happens in the event that I get risked out late in the pregnancy, or have to transfer during labor? Where do I go, and who do I go to? Is it going to be someone I know ahead of time/can choose, or will it be the luck of the draw for whoever is on call at that time?

    Post # 14
    Member
    2740 posts
    Sugar bee
    • Wedding: April 2010

    I saw a certified nurse-midwife who practiced with a group of OBs.  She was very supportive of my plans for an unmedicated birth in a hospital setting.  Yes, birth is a natural process that women have carried out for millenia, but complications can and do arise.  I had a healthy, low-risk pregnancy, but was set on a hospital birth because if something went wrong I wanted every medical advance available to me and my baby should the need have arisen.

    Post # 16
    Member
    5745 posts
    Bee Keeper
    • Wedding: April 2011

    @ieatunicorns:  I know that it seems as such (given my own personal experience) but I’ve just spoken with many many moms & reviewed countless stats regarding birth outcomes, interventions, the risks associated with, the morbidity rates, cesarean rates, etc from both hospital births & MW out of hospital births and really I think they speak for themselves.

    I think when you speak with midwives that have less than 5% cesarean rates, almost no severe tears (both my MW combined have only seen 1 4th degree tear in 25 years combined practice & lots of WB moms right here talk about the 3rd & 4th degree tears they acquired in their hospital births), never lost a mom, never lost a baby, delivered breech, vbac, and multiples (all things that would make a mom likely a cesarean in a hospital setting) it really changes the faith one has in the way the current medical system approaches birth. If these moms are able to birth with minimal morbidity with MW why is it so different with obgyns? Why are they suddenly given quite possibly unnecessary episiotomies, assisted deliveries, &/or cesareans?

    Like I said, those things really speak for themselves, regardless of my or another moms in this community’s personal experience and I think it should really cause all us moms to take an honest look at maternal & birth care here & really question what’s going on…. Why do the two model of care differ SO much in outcome (not mortality wise, which is the same).

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