Post # 1
I recently “graduated” from my RE to a regular OB, and am currently 11 1/2 weeks pregnant. When I initially called to make an appointment with my new OB’s office I was told the OB was on vacation that week so I could meet with one of their Certified Nurse Midwives and then my next appt would be with the OB. I thought this was great, because I liked the idea of a midwife working with an OB. Well my first appt was yesterday, and the midwife told me that in their practice all “low risk” pregnancies are seen by the CNM’s and high risks go to the OB (but they are in the same OBGYN practice). She said all my care and delivery would be with her, and if anything came up in the pregnancy or delivery, then I would work with the OB I had originally requested.
I really can’t decide if I’m comfortable with this, and I’m wondering how others have come to the decision of CNM versus OB. The reasons I am pro CNM are that I want to avoid as many medical interventions during delivery as possible (although I am pro epidurals and under the opinion that I will do whatever I have to do have a healthy baby…no birth plan for this girl). The reasons I am against a CNM are that I have been heavily monitored by a RE, and am used to being given a lot of information on what is going on. This pregnancy was heterotopic (twins with one in my tube and one in my uterus) so not only did I have surgery at 6 weeks, but I also developed a subchorionic hematoma afterwards. There is nothing an OB or a CNM can do for the hematoma, but it was very weird for me to be in this appt and not have her measure the hematoma to see if it had gotten smaller. I definitely became comfortable with a lot of monitoring and information, so it’s scary to me to have someone just look at the baby and say “all good”.
Sorry for the rambling, and I know I’m opening myself up to a natural vs medical birth debate, but what I’m really looking for is advice on HOW to make the decision, not WHY one is better than the other.
Post # 2
- Wedding: October 2011 - Bed & Breakfast
We are hoping to be able to use a midwife in a standalone birthing center. I delivered with a large OB practice my first time around. They were, to put it mildly, useless. I was always a number and not a person. My visits were 10 minutes, tops. They were cold and clinical. And they treated pregnancy as a “condition” rather than a natural part of life. I cannot say that all practices are like this. But my experience was so negative that I have absolutely no desire to deal with an OB ever again. It ios one of the driving forces in my strong preference for an eSET. If we transfer two embies and I end up pregnant with twins, there go my hopes of avoiding doctors and hospitals.
Post # 3
I would not be comfortable with this. Midwives can be incredibly well trained but they aren’t doctors. If everything goes well a midwife is more than adequate but if a problem develops seconds count, and I wouldn’t want ANY delay that could cost me IQ points or fine motor skills. You also see like a complex case I would def make sure my OB was on staff of a hospital with a level 3 NICU and that I was closely monitored.
Post # 4
lovekiss: my experience was very similar with an OB. Fortunately I had hired a doula. Without her I don’t think I would have been able to have the med-free natural birth that I did. She was able to convey my wishes when I couldn’t. The OB just wanted the baby to be born the quickest way possible and tried to force pitocin on me.
When we get around to number two, I will be hiring the same doula and going with a mid-wife at a birthing center.
Post # 5
I saw a midwife for my first pregnancy and had a great experience, so I am seeing a midwife again for this pregnancy. Midwives tend to be much more hands-on and spend more time with their patients both in appointments and during the labor process itself than obs. Otherwise, your care really shouldn’t differ between the two. I also go to a combination midwife-ob practice, so there are obs ready to step in if needed, but my midwife was so knowledgeable and experienced that I never doubted my midwife’s decisions and trusted her completely. All that said, I think whether a low-risk person sees an ob or a midwife if not that important as long as you trust your provider.
Post # 6
It really depends on what you want. There is no right or wrong way to go, just better or worse matches for your preferences I’m switching from a midwife/ob/gyn office to a freestanding birth center midway through my pregnancy, mostly because the practice had terrible wait times, and it felt like some of my appointments were really rushed because they were behind schedule. I felt like I was bothering people by asking them questions (I was “normal” and “low risk” so there wasn’t anything worth discussing with me). At my new place, appointments with your midwife are about 30 minutes, and they expect you to have all of the questions and concerns that a normal, low-risk pregnant woman will still have.
I also like that they will require me to have a birth plan and let them know what I want — one of my appointments later in my pregnancy is just to talk about this. Having a birth plan doesn’t mean that you will insist on having things a certain way even if it puts you or your baby at risk (How many pregnant women would honestly do this? We all want to be healthy and alive, and have healthy and alive babies, right?). It is just a way of letting your preferences be known, so that they can be followed if doing so is safe for you and your baby. Knowing that I am going to a place where they take my preferences into account when delivering my care is very comforting to me. It makes me feel that they care about me as a person and that I’m not just another chart.
One other thing that makes having a midwife rather than an OB a good choice for me is that they spend more time with you during labor and delivery than an OB — in a typical delivery, the OB just comes in at the end to catch the baby. I would rather have a bit more one-on-one care. It will help me feel more relaxed. But you might feel more relaxed having an OB. It all depends on what your preferences are and what makes you comfortable — so think about that and make your choice. And you can always change your mind and change doctors/midwives/practices mid-pregnancy.
Post # 7
As far as I know, the hospital I’m with doesn’t have midwives, and the OBs are covered by my insurance. I’m personally more comfortable having a doctor than a midwife anyway. I wasn’t trying to have a med free birth, I just wanted to get as far as possible before an epidural. I’m higher risk this pregnancy, so I’m definitely staying with the OB.
Your pregnancy sounds too high risk to be seeing a midwife in my opinion.
Post # 8
I am doing a midwife and for me the choice was easy once I met with both of them. Maybe that is something you need to do to make sure who you feel better with.
Post # 9
With your surgery and hematoma, I would expect you to still be closely monitored by the OB in the practice. At the next appt with the OB, I would discuss your current condition and request you be moved to the OB’s schedule. I had a midwife delivery and she was awesome. But, if I had early complications it would have been a different story. If this OB will not see you, I would consider finding a new practice.
Post # 10
whitums: I preferred an intervention-free and out-of-hospital birth so I went with a birthing center that had CNMs. I met with all of them (there were seven) over the course of my pregnancy, so I would know whoever was on call when I went into labor. I was low-risk and had a very healthy, normal pregnancy. If anything had come up during my pregnancy I would have been referred to the OB associated with the practice, and if something had gone seriously wrong during or just after the birth, the birthing center is 5 minutes from the hospital. Studies show that outcomes are better for both moms and babies if they are seen and attended by midwives, IF you are low-risk (I can find those studies if you are interested). Anyway, the midwives always took a lot of time to talk to me and my husband and to go over any questions or concerns we had. BUT, they do not treat pregnancy like a medical condition (instead considering it a natural state, only performing interventions as needed at not routinely). So, I only had one ultrasound, and while I felt the midwives were very involved with me and my pregnancy, I was not ‘fussed over’ nor closely monitored. But again, I was very low-risk and healthy.
Post # 11
I wanted to have a med-free birth and my office, like yours, has a CNM group and OB’s so I decided to work with the CNM’s. I had a great experience all around! The CNM’s and OB’s work very close together at my office, especially during delivery in case there are any complications. Although most people chose the CNM’s because they want a minimal intervention med-free birth, they made it know that they were happy to support women in every choice that they have during labor (epidural etc.). I would suggest you talk to the office about your concerns. Talk to the midwife about your histroy and concerns and ask her if they will continue to take measurements, what you can expect each month, and if there are any checks or precautions you have to take. Request to see an OB at one of your appointments and ask the same questions. It’s possible the OB wouldn’t have taken measurements either. There’s should be no reason you can’t see an OB if you request a visit. The best choice for you comes down to what your are more comfortable with. And, some OB groups are great about supporting intervation free births too. Hopefully talking to them will give you a good sense.
Edit to say, by the way I am also almost 12 weeks pregnant with my second! 🙂
Post # 12
whitums: I think it’s a little funny that you’re worried about not getting enough information from a midwife. I go to a midwife and I feel they give me A LOT more information than the doctors office would. For example instead of “pee in the cup for me” she actually has us test our own urine for glucose and protein with a little stick indicator (the same thing the nurse would do for the OB) and let her know if it changes colour. She explained why these measures are important and what steps would be taken if the stick changed colour. And that’s just one example, she also explained the (evidence based) usefulness of the glucose tolerance test in far more detail than the doctor would have. The reason I know that is because I work in a doctors office so I see how their OB appointments go.
The thing that made me extremely comfortable with a midwife (I am an evidence based, I want to give birth in a hospital with modern medicine if I or baby needs it, etc kind of girl..) was that they gave me a booklet to go home with after our first appointment. It outlined exactly when and how my care would be transferred to an OB if needed. It listed the conditions that would require them, by law, to transfer the care. This made me feel very comfortable with my choice as they take this very seriously. Also, if my care does get transferred, they will still be as invovled as I want them to be (for example if I need a c-section they could resume the mother-baby care after with the surgeon also checking in on me).
My experience is different because you seem more high risk, and I’m at a separate midwife clinic. Where I live (Ontario, Canada), you usually see your family MD until 28-32 weeks then are transferred to an OB. Here I get to see my midwife all the way through! So different than what you’re going through.
Post # 13
ginmar: +1. My doula gave me more information then the OB ever did.
Post # 14
I choose OB because of my history with miscarriages… When i finally got a pregnancy to stick, I wanted to make sure I had the very best medical care possible. Once you stop worrying about the early pregnancy stages, you start worrying about early labor/ issues, and then just general labor and delivery concerns. I love that my OB does ultrasounds at every appointment– it’s really helped me with my MC PTSD and seeing baby and hearing how good everything looks inside. No, they don’t sit down and chat me for 30 minutes at every appointment, but they certainly slow down and talk to me when I have questions or if there’s something they want to educate me on. I’m also very much about getting epidural and I don’t even want to think of the potential stress of having something go wrong during delivery and having to have a “transition” plan. I just want my doctor to be there and ready for anything. Maybe/probably if I’d never had losses, I’d feel differently.
Post # 15
ginmar: AwkwardCoconut: My experience with the midwife, information wise, was very different from yours. Mind you, this was my very first appointment with her, so I have no idea how things would/will go down the road. I felt like she dismissed my hematoma, although I do understand that there isn’t anything anyone can do about it either way. I had said that I wanted measurements of the hematoma to know if it was getting better and she would not do them, but said if I had a NT scan they would “probably” measure it then. She said to just compare my ultrasound pics. That kind of rubbed me the wrong way. I am also used to getting measurements of the baby, but she did not do that either. Again, this could just be because it was my first appointment. I didn’t feel like she wasn’t open to questions, it’s more that I expected her to want more measurements and information not only for me, but for herself.
Thank you all for your opinions and stories, I appreciate them! I think all along my feelings with the delivery has been very much in line with the way midwives work, but after so much monitoring already and lots of drama with TTC, it is very hard for me to feel okay with letting go of being seen by a doctor. I think I will give the midwife a chance and see how things go, knowing I could always switch or be switched to an OB if I need it.
I want to reiterate that I am not considered high risk, as a few people referred to me that way. I had surgery 6 weeks ago and at this point, that has zero impact on my pregnancy. The hematoma is also small, on the opposite side of the placenta, and has not caused me to have any bad bleeding, so it’s something that will just go away in a couple more weeks and that’s that.