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I would choose the midwife, no question! Midwives are experts in labor and delivery, whereas OB's are more generally trained. I want the experts! My son was delivered by two midwives and they were awesome.
I'm going with an OB. The midwife in my practice is nice and very informative, I'd rather just go with an OB, especially since this is my 1st and I'm no sure what will go on.
I second the Midwife. The OB would most likely literally just be there for the birth, as a nurse would probably be who checked you, watched you, etc.
A midwife, like pp said, are highly skilled in birthing... unlike many Dr. who are more skilled in surgery.
It is really great that you've found a practice that has OBs with a low c-section & intervention rate....
I think you should really think about how you want your birth to go... a Midwife would be there much more with you, coaching you, and adjusting postitions, etc for your birth & the OB would be more along the lines of what a nurse has seen (not that she'd be coaching you... just checking you) and then making their decision from there.
I think in the event of a needed c-section, a Midwife who had been there & knows that would be best is better than a Dr. getting 2nd/3rd hand info and making that decision.
I was at Swedish and the NPs and the OBs I saw were great, but I waited until my OB's call day to go into labor!
I plan to use a midwife. I like having the more attention, plus in my experience, I like their bedside manner much more.
I strongly disagree about midwives being the experts over OBs. OBs trainings is longer and more comprehensive- they are the experts on the entire female reproductive system. An OB is well-trained in surgery IN ADDITION to having far more training in OB. In the shorter training the midwives do, there is no way for them to understand pathology, medications and other things at the level of OBs. The only advantages are that midwives are generally more warm and fuzzy and generally have lower C-section rates. (This doesn't necessarily mean good things though, as midwives almost always only take the cases that appear easy to start with, and I have seen way too many women who should have had a c-section but the midwife incorrectly delivered vaginally or delayed it, thus lowering the rates.)
Number 4- continuity is a big reason. I want someone who has seen enough pathology and knows me well enough to catch a complication- that means an OB who is good at continuity. I have seen WAY too many bad outcomes to ever consider a midwife, including some of my patients. As a family physician no longer doing ob, I have already forgotten more than most midwifes will ever know, and (in this area) I am still not as competent as an OB.
I recommend a midwife!! Mine was awesome during a very long/stressful labor!!
I would also recommend a midwife! I had an amazing experience. I went to a practice with several of each. I'm in a small city and I think there were only 2 other women in labor at the hospital the 24 hours I was there in labor. I wanted as few interventions as possible, and loved the attention from the midwives. Very little wait at apts, long appointments, more involved but hands off approach... I got very lucky that despite it being quiet on the maternity ward, my favorite midwife came in for my delivery even though she wasn't on call. I got basically one on one attention from her for the last 12 hours of my delivery.
I think that OBs and midwives are both very knowlegable, but in almost all cases if you go with an OB, they show up for the delivery and you are cared for by nurses during your entire labor. With a midwife, you have more attention during labor from the midwife. I felt like it was hit or miss with the nurses. I had 3 over the 24 hour period, and really wasn't a fan of some of them, so it was nice to ask for the midwife to get my questions answered.
I feel like it's such a personal decision. I went with an OB because I just feel more comfortable with them. I'm paranoid and think everything bad will happen to me so I just want a doctor just in case. There's both OBs and midwives where I go so if something did happen they would have an OB there on call for me, but it still just freaks me out.
Is there anyone you just click with? Most likely theyre all competent in their field so its who makes you feel comfortable and takes the time to answer your questions. The two midwives at the practice I went to retired before I got pregnant so midwives were not an option. But as far as OBs, some I went to I really liked, they answered questions and took time to ask questions to make sure everything was going well even if just briefly at each appt. Some I went to though were really not that good so I'd come home to google and pubmed to answer questions. So if there's someone you have a good repertoire with that might be more important than title.
@MrsDG: I'm going to be delivering at Overlake (GroupHealth), if all goes as expected. I've heard Swedish is fantastic. Lucky that you delivered with your OB!
@troubled: I think you're making a good point. I guess one thing I'm trying to figure out is if it makes any sense to make a decision based on one particular OB or midwife when they won't necessarily be the one to deliver me. Did you find that who you saw for prenatal care mattered more than who was with you for labor and delivery?
i also think this is a personal decision and just depends on what you're looking for. both OBs and midwives are fully trained to deliver your baby, but obvs an OB would step in either way if you ended up needing a c-section or if there's some kind of emergency. i think it has more to do with what you are looking for as far as the CULTURE of the practice you visit and the way your provider talks about and treats your pregnancy - as others said, a midwife is probably going to be more warm and fuzzy and lean towards hoalistic approaches to your care, while an OB will be more medicine-focused and may have a more direct bedside manner (although that's not always true...plenty of OBs are easy to talk to and appreciate hoalistic approaches too...you just have to find them!).
i also started out seeing both and was sure i wanted to stick with the midwife since i was interested in a natural water birth. however, i changed my mind about the water birth and after a few visits, i found that the waits for appts were insanely long, the midwife staff was so small that they were stretched extremely thin (appts rescheduled several times, no guarantee that a midwife would be available when i go into labor) and didn't actually have the time/energy to provide the kind of care i was looking for. i decided that FOR ME, ease of appts, a small hospital with few delivery rooms (aka a little more attention from nurses), an open-minded response to my desired birth plan, and an OB that i was generally comfortable with was what i really needed. so again, it's not that one is better than the other; it really is about what you feel most comfortable with.
i would also echo @guitargirl in that midwife practices usually only accept very healthy pregnancies with no signs of problems, so they are bound to have lower c-section rates. also women who wish to have a c-section for whatever reason are probably not very likely to seek care from a midwife either (although i do believe they are not as quick to go that route).
My biological Dad and Step mom have gone both ways. An OB the first, and a midwife the second. The preffered the midwife (and home birth).
However, since this is our first, DH and I are going with an OB since we don't know what will happen. This OB did both of my bff's pregnancies, so I trust him.
I think they are both trained in their own ways, so either one should be capable of handling your pregnancy.
I personally will be going with a midwife. My midwife will deliver the baby vaginally and will actually assist the OB in the case of a c-section, so she will still be involved in the process no matter what.
One of the things I like about the midwife is the extra amount of time I receive.
I was recently pregnant (but miscarried) so my experience being pregnant is very short. However, while everything was happening, my midwife was great. She took as much time as I needed, and she did an ultrasound at every visit. She also let me come back in after 1 week after we noticed something was wrong, instead of waiting for 2 weeks as the OBs require. I told her that I couldn't possibly go 2 weeks without knowing anything, so she allowed me to come back in sooner. I did have to see an OB (in the same practice) to confirm the missed miscarriage, and he did the D&C procedure. He was a lot shorter in my appointments-- he barely had any time and only answered the quick question before leaving the room.
My midwife on the other hand, had me come to her office after each appointment, and we talked about what was going on. She was so much more available to me, both time-wise during our appointments, and emotionally.
Overall, I feel like my midwife is more caring and more personal. I want my pregnancy experience to be a good one, so I appreciate the attention and time.
GOOD LUCK with your decision!
I had a doctor (midwives are not available in my area), and an on-call doctor I had never met delivered Addie, instead of my regular OB. I really liked the doctor who delivered Addie, but I'm not sure that it really mattered who was there, since I had a relatively short, easy labor with almost no complications.
If you have complications, or if you have a very specific birth plan in mind, and you may deliver with a care provider other than who you see normally, you might want to consider having a birth advocate with you during labor (e.g. family member, friend, partner, doula, etc...). I say this because different care providers have different styles, and if you have complications, what one OB/midwife may suggest (interventions or no ionterventions, etc...) may not be in accordance with your preferences and with what you agreed on with your regular OB/midwife. A birth advocate would be able to communicate your wants/needs to the unknown care provider and help you negotiate your care.
@red_seattle: I would say who's there for labor and delivery matters more, but I didn't really have any complications during pregnancy so all of my visits were fairly short. It was just nice to have a pleasant conversation and reassuring answers during those quick prenatal visits though.
I didn't get to choose the dr there for labor and deliviery, there were a couple that were in and out, two were pleasant though their visits were probably a matter of 2 minutes long but they were helpful and positive in those 2 minutes. The one who was there during the later part of labor and did the delivery I don't like (but I hadn't seen her during prenatal appts - there's like 12 OBs at the practice I went to), she added stress, was super snotty, and I ended up re-tearing, which may not have been her fault but if she'd provided the info she gave me when I went back to her it potentially could have been avoided.
But if you don't get much of a choice in who delivers you I guess it would be hard to make your decision off of that unless there's someone you really want to avoid.
@guitargirl: Ditto so much!
As far as having an expert in labor and delivery, possible complications, and taking you through to surgical interventions if necessary, an OB is absolutely the top choice. That said, if you're low-risk, a midwife will likely do just as good of a job managing a simple labor & delivery. So it should really come down to who you click with. If the OBs in your practice are in tune with your views though, it seems like having someone who you know is an expert and can handle anything that comes your way would be the obvious choice. If you like the midwives more, however, then by all means go for it. Just know that a nurse midwife is not better trained in obstetrics than an OB/GYN.
@Miss OBG: I agree. I heard a very good point from someone: "You're going to pay the same for a midwife or an OB, so why on earth would you take the one less qualified?" While I have seen several babies with brain damage from mismanaged midwife deliveries, it only took one to convince me.
I think midwives are great. However, they only do ideal pregnancies and really that's all they should do. I think if you feel comfortable with the OBs, their low c-section rate is awesome, and you'd pay the same...I'd probably go w/ an OB. But then again, I'm not pregnant. I'm all about knowing that the worst case scenario would be covered by the best person qualified and I really truly believe that OBs are more equiped for that. However, if you had previous births with no complications and/or you saw a huge disparity in service between the OBs and midwives, then I'd go with a midwife. Do what you feel the most comfortable doing! Good luck!
I just would not feel comfortable with a midwife. It is a personal choice for each person and each pregnancy. I am in the medical field and there are just so many uncertanties. If something were to go wrong say hemorrage from the uterus or something that needed you to go into surgery immediately - I would want to have an OB in the room who could immediately start taking steps to save the baby or my life vs. a midwife who would have to go get help...
But I don't know your situation or how comfortable you feel with your pregnancy. So you and your partner need to make that choice together.
I also found this interesting
http://news.discovery.com/human/babys-death-raises-questions-about-midwife-safety-110512.html
@laural: I think that article shows something about midwives who aren't licensed. But I'm very certain that the midwives associated with the OP's caregiver's practice are CNMs and therefore highly educated. Most CNMs are prepared for a lot of issues like placental abruption/uterine hemorrhage and since this is in a hospital, the OP would have access to a doctor pronto. So it's not the same thing as a direct-entry midwife (CPM?) who is performing a homebirth and isn't licensed by the state.
My best friend had her first child with an OB and hated it. Her labor was incredibly long and was full of complications that she believes were due to the OB consistently interfering with the birthing process. So the second time around she tried a midwife and loved her. I think it's a very personal decision. For me, I have lupus and know my pregnancy will likely be high risk, so going with a doctor will be a priority.
OP: I think if you're intending a natural, unmedicated birth, maybe you could labor mostly at home b/c it seems a lot of labors are long (as long as your water hasn't broken).
I'm not sure this is a decision that anyone else can take for you, really. I would go OB every time, but that's a personal feeling. I want someone with high level academic training, and who can deal with anything that arises, since labor can go so wrong so quickly.
I've never had any children, but in my personal experience of midwives and OBs, I've found midwives to be more dogmatic in their views in a kind of mother-knows-best way (often invoking Nature/Mother Nature etc as reasons to do things), while OBs are more open to considering best practice in the light of the latest research. As a scientist, I really need more solid arguments to make life-changing decisions than "it's best/more natural"
However, I can appreciate that for some women, being bombarded with lots of medical jargon and apparatus would be upsetting, and many women feel that too much clinical intervention makes pregnancy and birth into a disease.
You really have to go with your gut feeling on this one...do you generally feel more at ease with OBs or midwives?
Even a high risk pregnancy can go through a midwife up until that last few minutes. My first child was born at 34 weeks and the midwife delivered him. I adored her and wish she was still around so I could be with her again. However I have a new practice now. I have been having a rough pregnancy and I love the nurses and midwives at my practice. I met one of the doctors when I had to go to the ER and be admitted a few weeks ago. I get a different Midwife almost every time I go but I have liked all of them so far and I am sure that if I wanted to work with a particular person I could arrange that. However I am pretty flexible. I like getting to know all of them. Of course it helps that the practice is adjacent to the hospital so there is always a doctor and a midwife on call at all time :)
What about going to the OB and having a doula too? (I don't know much about doulas but it might be something to look into).
Agreed.
I'm not pregnant now but I just feel more comfortable with a OB. Especially for my first child, def. I want to know that she is there right now and not have to wait for the midwife to contact her. I'd assume if you chose to go with a midwife for delivery when you go to labor the OB will not be there unless the midwife decides to call her?
There's too many unknowns I want a medical doctor there, personally.
I chose a midwife and feel it was because of her I was able to avoid a c-section. I went in wanting a natural labor and she was fully on board. It turns out I had some very serious complications, undiagnosed severe pre-e with liver complications. She had been consulting with an OB the entire time, and waited until it was necessary to let me know I would need to be on medication. I think since she didn't stress me out and waited until I was about 8 cm, I was able to deliver without a c-section or the use of pitocin, although once being confined to the bed and laboring on my back I chose to have an epidural.
Lots of good points raised here-- and that's what I was hoping to do-- maybe someone would have a point I hadn't already considered.
I've only seen 1 OB (2x) and 1 midwife (2x) so far, so I looked into the profiles on the other OBs and midwives. to get a sense of them as a group. (They have profiles on each of their providers online.) The OBs mostly had sparse profiles-- not much in terms of their philosophy or approach to medicine. The only thing that really sticks out for me is that one of the OBs is male. I've never had an exam by a male doctor, so the idea that he may end up delivering me if I go with the OBs is giving me pause-- I'm just more comfortable with female doctors for gynecological stuff.
BUT, the midwives are definitely more touchy-feely in their approach to birth/medicine, based on their profiles--- and I'm not sure that that will calm me down most in labor, or if a more direct communication would be most reassuring. Something to think about.
- @Laural & Beekiss: Yep, these are CNMs, trained, licensed by the state, delivering in a hospital setting. It's not the same as the situation in the article at all. And I have to wonder about the mother-- did she know the baby was breech? If so, why would she attempt a vaginal birth?
-@Beekiss: I think you're right-- my OB recommended I labor at home as long as possible if I want to avoid being induced or unnecessary interventions. Her words "I would take a bath, go for a walk, go see a movie, take another bath, then take another one, then maybe come in after that."
@cvbee: an OB with a doula is an option... if we can afford it. But is definitely something to look into.
@regerberadaisy: Well, a doctor would be at the hospital as well-- so it's not like I would be waiting for the OB to arrive from somewhere besides just down the hall. I could be wrong, but in a truly horrific situation (hemorrhage, etc.) an OB would still have to bring in help and/or materials (blood, etc.). It's a situation that's worth looking into, but at this point the delay caused by a midwife calling in back up doesn't seem like it would actually be enough of a delay to change whatever the end result might be. If I'm wrong though, then you're right-- having an OB may be the better way to go.
Anyway-- thanks for all the points you guys have brought up. I'm still thinking it all through, and definitely see both sides (which of course, makes things harder). If I come to a decision, I'll let you know. I'm planning to make a decision by early next week.
@Rumplestiltskin: These are all really good points, and I think really capture the difference. Frankly, it's not just OBs vs. midwives but doctors vs. nurses in general - it's a different training philosophy. Doctors go through years of schooling and hands-on training to think critically, appreciate evidence-based medicine, and provide compassionate care that is rooted in science. Whereas nurses focus on patient care first (often with great results as far as compassion), but rather than thinking critically about why we do the things we do, they focus on protocols and think anecdotally about what has worked in the past. Ultimately, the ideal situation is to have both parties involved, but I believe that because of their training, physicians are better equipped to make difficult and fine-tuned decisions.
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I've been going to a practice with both OBs and midwives, and I've seen both OBs and midwives from the practice for prenatal care so far, but pretty soon I have to choose one and stick with it through the last trimester + labor. I thought maybe you guys might have some thoughts on one vs the other, because I keep going back and forth on it.
I'm not highly opposed to intervention, but I'd rather avoid an epidural, c-section, use of pitocin, etc. if possible. Overall, both the OBs and midwives lean towards non-intervention, and their c-section rates are really low, so it doesn't make a difference one way or the other in that sense. And I'm definitely going with a hospital birth, so that's no difference (midwife or OB) either. The midwife panel rotates being on-call, just as the OBs do, so when it comes to delivery, it only comes down to whether I get an OB or a midwife-- I won't necessarily get to deliver with my doctor or my midwife.
After talking to one of the OBs and one of the midwives, it seems like there are 5 differences between them (as a group) at this particular practice:
With that in mind-- any other considerations I should be thinking through in this decision? Overall, I think I'm leaning towards going with the midwives, but I'm not seeing any major differences (these all seem little), so I'm trying to think through how much those little difference matter.