Midwife vs. OB for delivery

[amykate]

Hi all!

I am having a very uneventful (=good) pregnancy and my OB suggested I meet with one of the midwives on staff to see if I thought I'd be interested in using one. I agreed, but am not sure this is a direction I want to go for the delivery. Does anyone have an opinion on this? Anyone out there use a midwife?
Thanks in advance!

[mrmansmom]

Hi,
I used a midwife rather than an OB for all of my prenatal care. I had no dealings with an OB (until a problem during delivery during which my midwife consulted with an OB), so I can't make any sort of comaprison, but I really liked using a midwife and plan to do it again (hopefully:)). The reason I chose to see a midwife was because I wanted to have natural (non-medicated) childbirth, and I thought midwives would have more experience with non-medicated births than OBs and they would be more supportive, and I just really really like the natural approach.
I liked the less-intervention-is-better philospohy of the midwives (there were 3 at our practice- it was a regular medical practice with OBs and GPs, etc. and DS goes to his ped there now). We had only 1 ultrasound during the pregnancy. Our appointments were very centered around how I was feeling and what I was going through- we did a lot of talking rather than me doing a lot of listening. There was focus on me maintaing good nutrition and staying active and those sort of 'low-tech' but very important aspects of trying to have a healthy baby and mom. Again, this may be the same situation as with OBs, and I'm sure it varies a great deal just depending on the person you have as your care provider regardless of whether s/he is an OB or midwife. (It was very important to me that the person giving my prenatal care and delivering my baby be a woman.) During labor and delivery we used the birthing ball, water therapy, massage, different positions galore and wlking to help move the baby along and manage pain. I was not hooked up to an IV and could easily move around. I was encouraged to eat and drink during labor to keep my strength up.
So, to summarize, I loved my midwife experience and recommend it to everyone who has those same sort of philosophies. I hope I answered your question!

Oh- and they are not completely opposed to medication. Even though I walked in the door at 2 weeks pregnant for my first appointment and said that I wanted a natural childbirth, during my delivery my midwife asked me at one point if I wanted something for the pain. So having a midwife doesn't mean that you can't have a medicated birth, if that's what you want.

[SeanaRain]

Amykate-

I am currently using a midwife clinic for my care. I've really enjoyed the experience I had. I am from a very rural area and many of my personal philosophies don't really match those of the people around me. I drive 53 miles one way to visit my midwives.

I ended up there because when I first found out I was pregnant I started seeing my normal OB/GYN. We had one appointment early on. Between that and the second appointment, I faxed a list of questions to him that I wanted answered, either my fax or at our next appointment. (The list covered things such as his C-section rate, episiotomy rate...etc.) I received a phone call from him a couple of days later. He basically told me that if those were my concerns, I needed to find another doctor. So, in essense, he fired me. :) No skin off my back!

But that was a bit off topic from your question. Just wanted to let you know how I ended up with the midwife clinic. :)

Oh, and the director of the clinic went through the same list of questions with me one by one with no hesitation. It was wonderful!

[dogmom]

In general a midwife will spend more time with you during your appointments and will stay with you during your labor. An OB will show up during your labor to check on your few times and will come when you are close to delivery, unless there is a problem. Either way, your L&D nurse will be by your side during all your active labor. (Too bad you can't sign up for those ahead of time!) I'm sure there are people here who had midwives will be happy to share there information with you. If the hospital I worked at had a midwife only practice, I would have gone there, but they don't. I would suggest you meet with the midwife and aks her how she is different. The most important thing is to find a practioner you are comfortable with.

Jeanne
Mom to Harvey
1/16/03

[Rachels]

Hi. I used a midwife for my care with Abigail, and I also wrote my dissertation about midwifery vs. obstetrics for normal birth. I can point you toward LOTS of resources for learning about these options if you'd like. Quickly, though, outcomes for midwifery-attended women, regardless of setting, are better. Every study that has been done worldwide has shown midwife-attended birth for low-risk women to be as safe or safer than OB-attended birth, and the 22 countries with better birth outcomes than those in the US all have midwives providing at least 75% of prenatal care. So if you decide this is something you're interested in, just know that it's an extremely safe choice.

For me, the experience part of it was also really important. My midwives were with me for long prenatal visits, really got to know me, and were with me throughout my labor and birth. It's a very different approach than traditional obstetrics, which is by training a high-risk, surgical specialty. If you're in a high-risk situation, bedside manner and long prenatals are not as important as getting your baby out safely. But if you're in a LOW risk situation, those factors may actually contribute to getting your baby out safely.

It was wonderful, anyway. Let me know if you'd like some names of books or articles!


-Rachel
Mom to Abigail Rose
5/18/02

[suribear]

I loved having a midwife. Actually, it was a practice with two midwives (both amazing) and an OB for backup. i can't write much now (kid on keyboard lol) but highly recommend this experience.

Kris

[miki]

I had an OB but a midwife taught the childbirth class I took. The most imporatnt thing I got out of knowing her is that if you are interested in a midwife, make sure her philosophyof childbirth is the same as yours. This one who taught the class was very against any sort of intervention, including all but mild painkillers and made you think that any sort of deviation from completely natural childbirth would lead to a c-section.

Like the previous poster said, the L&D nurse is there with you. Mine seemed like she was there the entire time and did everything I imagined a doula would do. I didn't feel like I needed to have the OB there more than he was.

[NEVE and TRISTAN]

I'm typing one handed so I'll be short...we used a mw thru a local birthing center and I loved the experience. I adore my OB-GYN who is not affiliated with them (infact he has his own mw)...but a birth center environment is what I imagined ...I got an emergency transfer to the hosp due to miconium in my water but my mw was with me a good 16 hours. She and hubby left my side for 10 minutes to grab food...

I think the second you meet his mw you'll know which path to take...
We will be headig out to see her on T's birthday with goodies!!!!

But you'll know I am certain...I'd meet her and see...
Neve
http://home.nc.rr.com/ourbabytristan
AKA "mama2be"-forgot password
and Baby Boy Tristan born @UNC
Feb 25, 2003
Brother to 3 pups "gees" and 2 kitties

[Zansu]

I used an OB for #1 and have switched to a MW for #2.

The key factor for me, along with everything the PPs mentioned, is that the MW will be with you through the ENTIRE birth process. You CANNOT depend on your L&D nurse to be a continuous source of care.

DH and I developed a strong rapport with our original L&D nurse, who then had to go off shift just when things got "exciting" and we really needed her.

You have little to no control over who you get as your L&D nurse, but you can (and should) take the opportunity to meet with the MW. It can't hurt. :)

[starrynight]

I agree you cannot count on the nurses all the time. I had a nurse the whole time with my first labor, only to be checked periodically the second time and half the time the 3rd time. My 2nd 2 labors were in a small(read understaffed) military hospital, my first was in basically a women's hospital where the nurse didn't leave unless you asked her too.

I wanted a midwife the second and 3rd time but my insurance only covered half of it if I went to civillian care for a mw and 100% if I went to the hospital for ob care so I stuck it out with the ob. It wasn't bad but it wasn't totally what I wanted either. It depends what you want, I wanted an unmedicated, intervention free birth. I got that the first 2 times, 3rd time they gave me pitocin yuck :(.

Good luck deciding :).

[llcoddington]

I had a midwife for all of my prenatal care and I loved her! She would listen to anything I had to say/ask and always had time for me. However, when I went into labor, my midwife was not on call, so the ob-gyn delivered Lauren. This worked out well since I had a VERY difficult time getting Lauren out and ended up with a forceps delivery.

Lana
mommy to Lauren 12/5/03

[MelissaTC]

Our practice has 4 doctors and 3 midwives. You rotate through everyone if you wish or you can make your appointments with whoever you want. There is ALWAYS a midwife on call and then a Dr to back her up. If you do not want the midwife, you can make that known and then you will only deal with the Dr. Their policy was to have a prenatal visit with the midwife. Well wouldn't you know it, I fell in love with her. She is just AWESOME and I had dreams of her delivering my little bundle of joy.

Well fast forward to June. Turns out she was going on vacation. :( The OTHER midwife (there were only 2 at the time) was on call. I didn't feel the love from her AT ALl! I did not like her. I am sure she is a nice person but she gave us a bad impression when we dealt with her during an appointment. So I opted for the Doctor only. I couldn't tell the other midwife why and she looked kind of puzzled when I told her that I only wanted the Doctor. I wanted to scream that I loved her...it was the other one I didn't want! In any case, I wound up having a c-section so she wouldn't have delivered him anyway...

[suribear]

Now that I can write in peace :)

My practice had two midwives and an OB. I didn't like the OB but I LOVED both the midwives. I had limited options since I was trying for a vbac.

I also hired a doula. After all that I did have a c/s :( but the doula and midwives were in attendance for support and initial breastfeeding, etc... It made a world of difference to me! No L & D nurse can take the place of a doula, IMO. They really go above and beyond and focus just on you, plus they are there the whole time, while nurses go on shifts. You also can't choose your nurse. I had some awful ones the first time around!

Midwives stay the whole time, too, or at least most of the time. And they really made me feel important during exams, took their time, didn't talk down to me at all and they were very gentle. I would go back in a heartbeat :)

Kris

[amykate]

Thanks everyone!

I actually really like my OB, but I have to rotate between the 4 others as possibilities for the delivery. Thus, why meeting the midwife is a good option as I believe she would be the one to deliver for sure if we selected her. I'll find out more about that when I meet her. I actually am planning on using an epidural, not having a non-medicated birth. So you are right, I will need to make sure my style and thinking is in sync. Thanks!

[trumansmom]

Random thought - I wonder if there is a difference in rates between male and female OBs? Or am I being sexist? :)

Jeanne
Mom to Truman 11/29/01 and EDD 4/23/04!

[Rachels]

Lots of midwives will support you in a medicated birth. While they strongly believe in a woman's ability to birth naturally, their primary objective is to support you in having the birth you want.

-Rachel
Mom to Abigail Rose
5/18/02

[trumansmom]

I have an OB whom I adore. Fortunately/unfortunately, so does the rest of the world, so occasionally she isn't available when I need her. So for my backup for pre- and post-natal visits, I have found a midwife in the same practice whom I love as well. If I hadn't already found and fallen in love with my doc, I definitely would have switched. She is incredibly attentive, and after the birth of my son (which my doc, not mw attended), she called me at home a couple of times to see how nursing was going and to offer up some tips. She definitely went above and beyond.

However, that being said, if you plan on having an epidural (and I did and will again), you really may be better off going with an ob.

But, it's completely a personal decision. There is a lot to be said both ways.

Jeanne
Mom to Truman 11/29/01 and EDD 4/23/04!

[american_mama]

I had an OB for most of my prenatal care in Washington DC and then moved to Minneapolis in my 7th month, where I chose a midwife practice for all my remaining prenatal care and birth. I also went through a later miscarriage with the midwives.

I loved the midwives. They definitely spent more time with me than my OB, although some of that was due to regional differences (hectic Washington DC versus. more relaxed Minneapolis). You can easily get a feel for this in advance by asking how long you typically spend with the doctor (5 minutes) or midwife (20 minutes).

I didn't agree with everything about my midwives - they were nonchalant about prenatal vitamins, and sometimes those appointments were a little TOO chatty - but I had great confidence in their philosophy and their skill in normal births. At a "Meet the Midwives" night, several of the midwives replied that they are experts in normal births, and that's all they desire to be. If forceps or anything complicated is needed, they consult and/or defer to an OB. They aren't trying to go beyond their expertise to show how great they are - far from it.

SOme people choose midwives because they want a near guarantee that the person delivering their baby will be female, since almost all midwives are. Even if your OB is female, there is no guarantee that she will be on call that night, and she probably shares a practice with male OBs. Some people choose a midwife because they want a more natural, less interventionist birth, which is what I wanted.

I didn't like the midwives quite as much during my miscarriage because I had a minor complication, and I thought my midwife seemed a little unsure of herself. But, she did consult with an OB on those occasions. I also think some of the difference is that a midwife may be inclined to show uncertainty whereas doctors fake confidence more - obviously, there are advantages to both approaches, depending on your personality as a patient.

Good luck with your decision. The act of choosing in and of itself has great benefit because you learn about options and your preferences, and I think that process lasts far beyond childbirth.

[AngelaS]

A CNM has delivered both of my girls and I go to her for my annual check ups too. She's FABULOUS! I totally trust her and recommend her to all my friends. :D

[hovegator]

As an RN who has attended hundreds of births, i just want to add my two cents. 1.Please make sure it is a CNM- certified nurse midwife- and not a lay midwife. The CNM is a registered nurse, has been through at least 2 years of graduate level study and is usually employed by a hospital or OB-GYN. 2. Please be sure that the midwife has MD back-up available at all times and that the MD can be there within minutes. Also, she should deliver in a hospital, not a birthing center separate from the hospital! 3. Lastly, please DO NOT go for a home birth. As we say in the NICU (where i have cared for too many neurologically damaged children as a result of home births that went wrong) "Home Delivery Is For Pizza"!

My overall experience with CNMs has been good. they are quite patient during labor (more patient than i am!) and really seem to honor what the mother wants (however crazy it seems to the rest of us nurses!) :)

Good Luck!

[sirensrise]

hi, i went to a practice where all the staff rotate and you get whomever is oncall that night when you deliver, i met most of the docs and the midwife in my prenatal care. and on the night i deliver the midwife was oncall, so the midwife delivered the baby. i did not get an episiotomy(spelling?) i dont know if i had an OB they would have done it, but i end up with very little tear anyway. i think if there is a doc around just in case then midwife is great. they let you have more time and will be less likely to push you for a c section. i myself prefer to know that there is a doc somewhere nearby or oncall just in case.

[MinnieMouse]

Please be sure that the midwife has MD back-up available at all times and that the MD can be there within minutes. Also, she should deliver in a hospital, not a birthing center separate from the hospital!

I sooo don't agree w/ this as a necessity.

We had our daughter through a freestanding birth center. The center has been there for close to 25yrs and has had over 4,000 births there. Five midwives (all CNMs) work at the center as well as a number of RNs. The birth center is across the street from a hospital that has a Level 3 NICU.

I was one of the moms that had to have an emergency transport to the hospital. We arrived at the birth center at 2:45pm and I was already 8cm (only had been in active labor since noon), and complete by 3pm. By 3:10 the midwife had detected a possible problem with dd's heart rate, by 3:20 the decision to transfer me was made and by 3:30 I was in the ambulance on the way across the street to the hospital. Bethany was born w/ forceps assistance at 4:04pm by the back up OB for the birth center.

I was told by the hospital nurses the next day that the OR was standing and ready for me to have a section, and that I wouldn't have gotten in there any quicker if I had been at the hospital in the first place.

There is a place in the greater world of childbirth for freestanding birth centers. I see it as a compromise between a home birth and a hospital birth. I personally am not comfortable w/ home births (for me I have no problem w/ them for others) but I was also VERY not comfortable w/ the thought of a hospital birth. I LOVE that ours is across the street from the hospital. I also LOVE that the hospital has NOTHING to do w/ the birth center other than being it's backup hospital (ie no oversight and it's not "part" of the hospital system). The birth center runs under it's own rules and reports to it's own board of directors.

The care that I received from the birth center was first rate. When we have our second child (not trying yet) we will go back there in a millisecond.

Edited to add...I forgot to mention... Beth was born w/ great APGARS, her heart rate was falling each time I pushed because her cord was short and wrapped around her neck 2x so getting her out ASAP w/ the forceps delivery was exactly the right thing to do :-).
:-)
Christine

[Rachels]

Christine is right! If you read any of the extensive literature at all, you'll know that having a midwife attend your birth is as safe or safer than having an OB attend if you are low-risk (as at least 75% of women are). Hospital births for low-risk women involve a HUGE increase in unnecessary intervention, much of which has been demonstrated over and over to increase complications for moms and babies. Every country with better outcomes for moms and babies than the US (and there are about two dozen) has midwives attending at least 75% of all births, and in most cases, a doctor never sees the mother for any reason. Some of those countries involve at least 30% of births occurring at home. There is no increase at all in perinatal mortality for babies born out of the hospital with midwives. The literature is absolutely clear about the safety of midwifery and the relative danger of obstetrics for low-risk birth.

The "medical advice" given here simply isn't based in scientific evidence. I wrote my dissertation about this and read over 500 birth-related studies (with seven courses in statistics helping me to feel confident in interpreting them). You just can't demonstrate that midwifery is unsafe for low-risk women. It just isn't true.


-Rachel
Mom to Abigail Rose
5/18/02