Do I want an OB-GYN or a midwife?

[ourbabygirl]

I'm 25 weeks along and a few weeks ago, my midwife moved to Florida, so I need to switch over to someone else. I had an OB for my last two pregnancies, but he wasn't the same person who delivered my babies (I had them on weekends and just got whoever was on call, which I'm sure would've happened whenever I would have delivered). I didn't have a bad experience last time, I just thought it would be nice to try a midwife this time, hoping she would be the same person to help me deliver, and would maybe make it less likely that I would end up with a c-section. For my first delivery, I had an epidural because I didn't know any better (didn't really know there was another choice), and my second, I had a doula and no epidural. My doula has since moved out of state, so I need to find a new one of those as well, but my previous doula told me that she thinks I should deliver at home; she's worried I won't make it to the hospital in time (both of my deliveries were very fast, 2-3 hours or less). DH won't let me deliver at home, so I figure that a doula and midwife would be kind of a compromise (plus at this hospital I believe there are bathtubs I can use while in labor).
But now that I'm kind of in-limbo between providers, I'm wondering if it's even worth it to go for a midwife (I think my hospital has someone filling in until they find someone permanent).

If you deliberately chose a midwife or an OB for your prenatal care and deliveries, could you please share why? Certain advantages or disadvantages?

Thanks for your help!

[rollycolly2007]

My midwife (ARNP, CNM) is so great that I won't need a doula because she will be at my side during labor. She's very easy to talk to and answers all of my questions. She provides her medical opinion on an issue, but supports whatever DH and I want.


Expecting DS 03/18/15!!!!!
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[SnuggleBuggles]

I started w an ON w ds1 and by the midway point was in an OB practice with a CNM. The CNM was my primary. I just liked that we were on the same page with birth philosophies. Nothing I was looking to do, like labor out of bed, no meds...was contrary to her normal birthing philosophy. There were some OBs in that practice I'd have had to fought to have a normal, low/ no intervention birth and I just wasn't in the mood for that. I thought of birth as a natural, normal process that usually goes well without help and wanted a care provider that believed that too vs someone who viewed it as an emergency waiting to happen. That's why I went with a CNM. Ds1 was a hospital birth with one and a doula. Ds2 was a birth center birth with a CNM. I didn't feel the need for a doula again. 1, I was confident in my abilities and 2, I didn't need an advocate as the birth center was 100% in line with my birth plan.

Bonus with my CNMs was that my appointments were less rushed as they didn't see as many people where I was.

I'm obviously biased but I see no downside if the CNM has a working relationship/ partnership w OBs. If they have someone they can seek expertise if things get complicated or someone that can swoop in in an emergency, it works for me.

There are great OBs and CNMs out there so don't go by title alone. I'm surprised your one that just moved didn't refer you to someone else.

[AnnieW625]

With DD1 I went to two medical groups (the first Kaiser, for the first 5 months I was pregnant, and the second for the second 4 months I was pregnant due to an insurance change to Blue Cross because I wanted to deliver my first at a large regional hospital with a well known nicu.....just in case) and at each practice saw a rotating doctor or PA and for the most part I was fine with that. The practices did that because each doctor was on call on X night a week and they wanted to be familiar with the other obs in the practice. Some of the doctors had a better bedside manner than the others of course, but the doctor that ended up delivering Dd1 was the supervising ob for the practice (so he was in the hospital most of the time) was amazing and he got DD1 out healthy and in less than hour so I was happy as the hospital supposedly had a policy that you couldn't push for more than 2 hrs (and then it would be c section time). I wasn't able to have an intervention free birth with DD1 because I was GBS+, then my labor had stalled after my water was broken for three hours so I needed pitocin, and I was still convinced I didn't need an epidural (I am death fully scared of needles!) so I went from 5cm and comfortable to about 8 cm and in full pain in less than 2 hrs. so DH got me an epidural at the nick of time because less than an hour later I was 10.5 cm and ready to push.

With baby 2 we were back at Kaiser as Blue Cross had gotten really expensive and the Kaiser office we went to then was larger than the first so I had the midwife option assigned to me. I did a birth plan, and thought the whole mid wife process was like what people had written here, a nice slower process with more attention and thought to the whole birth. The midwife was nice enough, but I waited in a cold room once for 30 minutes in a hospital gown for the midwife, she didn't seem overly concerned that my 16 week old baby wasn't moving (this is a common side effect of trisomy 18 as babies grow at a much slower rate, but at the time no one knew I had a tri-18 baby), and when I complained to her about having to wait 30 minutes to see her her response was that she sees a lot of patients just like an ob, and sometimes we have to wait. We lost baby 2 to trisomy 18 so I never delivered the baby with a midwife, but there was still a chance due to rotation schedule that she could have been off call when I needed her as well.

We stayed with Kaiser at the same location for DD2 and I had a wonderful ob for prenatal care. He was a little old school about things and did mention that he didn't think I needed to gain more than 25-30lbs because I hadn't lost all of the weight I gained with baby 2, which was close to 30 lbs., but overall I was really happy with him and happy I hadn't been assigned to a midwife. I would have happily returned to the high risk ob I saw at the end of my pregnancy with baby 2 as I liked him a lot, but was relieved I didn't see the same doctors. A resident ended up delivering DD2 as my ob had gone off call not 30 minutes before she was born. I had an iv of nubane with DD2 and that was nice so I could sleep through the night as my water had broken at home and I was barely 2cm dilated. My labor was still only about 3 to 5 cm at 6 am so 7 hrs. post water breaking so I could potentially need pitocin, which I told the nurse I wouldn't get without an epidural, but in the hour I progressed from 5 to 7 with little to minimal pain and then at the next nurse check I was already at 8 and I asked for the epidural and the nurse said no so I told her that after the next round of heavy contractions I wanted to push and they let me. I pushed for 20 minutes. The most pain I had was probably post 7 cm, but it was still less pain than I had with pitocin. Getting stitched up though without an epidural was a weird feeling though because the only other set of stitches I ever got were from tearing with DD1.

I think you will get a god feeling on your own if you go with a midwife or an ob and I think with either situation the situation may not be perfect, but in the end you have to chose the practice you are more comfortable with.

[brittone2]

I'm 25 weeks along and a few weeks ago, my midwife moved to Florida, so I need to switch over to someone else. I had an OB for my last two pregnancies, but he wasn't the same person who delivered my babies (I had them on weekends and just got whoever was on call, which I'm sure would've happened whenever I would have delivered). I didn't have a bad experience last time, I just thought it would be nice to try a midwife this time, hoping she would be the same person to help me deliver, and would maybe make it less likely that I would end up with a c-section. For my first delivery, I had an epidural because I didn't know any better (didn't really know there was another choice), and my second, I had a doula and no epidural. My doula has since moved out of state, so I need to find a new one of those as well, but my previous doula told me that she thinks I should deliver at home; she's worried I won't make it to the hospital in time (both of my deliveries were very fast, 2-3 hours or less). DH won't let me deliver at home, so I figure that a doula and midwife would be kind of a compromise (plus at this hospital I believe there are bathtubs I can use while in labor).
But now that I'm kind of in-limbo between providers, I'm wondering if it's even worth it to go for a midwife (I think my hospital has someone filling in until they find someone permanent).

If you deliberately chose a midwife or an OB for your prenatal care and deliveries, could you please share why? Certain advantages or disadvantages?

Thanks for your help!

I started with an reproductive endo since we went through IF, then moved to an OB/gyn once I was through the RE's care. I hated the practice. I started reading, knew I wanted to aim for an unmedicated birth, and started talking to a local doula. She let me know in a very gentle way that the hospital I was planning to deliver at had very dated policies with regard to L&D. She suggested I consider a local practice of MWs and deliver at a different hospital. They were all CNMs. It was a much better fit for me overall, although there were still some things about my labor that were very much like you'd get with many OB/gyns. I asked for no coached pushing, and the mw who caught DS1 laughed at that in my birth plan. I ended up with (surprise!) coached pushing in labor, even though I didn't need it at all, and didn't want it. Nurse holding my legs back, counting, the whole thing. That was one of my only regrets, as I should have been more assertive. There was no crisis, I could have followed my urges. I had a small tear, but the next day, I was sooooo sore in my legs and abs from the "hold your breath and push" approach. I felt like I had run a marathon (and my labor was quite short for a first timer).

We moved by the time I was pg with #2. I had DD at a freestanding birth center near an academic medical center. That was a much, much better experience for me personally. My labor was very short (which was a concern leading up to the birth after having a relatively quick first labor), so didn't really use the tubs, etc. Prior to labor I had discussed my experience with the first MW and the coached pushing, and they were totally supportive of letting me follow my own urge to push, etc. the 2nd time. I pushed in sidelying, ended up with no tearing (could also be because it was a 2nd birth), no massive soreness the next day. I went home 4 hrs after DD was born. She never left my side for exams, hearing test, etc. which was nice. With my first, we roomed in, but he still had some procedures done out of the room. They did our 1 and 2 day followups at home (sent out a nurse) which was fabulous.

With my third pregnancy, I stuck with the same FSBC and MWs. I contemplated a HB, but wasn't sure, and when I had looked into it in the past, most of the MWs in that area were an hr away or more. AFter having a verrry fast labor with #2, I was a little worried. Then at the very end of my pregnancy, one of the CNMs from the local teaching hospital was opening her own practice. She had previously practiced as a HB CNM for years, then did her stint in the hospital for a few years, and then went back into practice as a HB MW. I had a meeting with her, and decided to go that route even though I was like 36w or so at that point. I ended up having a HB with her. I had both the CNM and her assistant (nurse who was finishing midwifery school) present. I loved that experience, I felt I was in capable hands, felt confident about transfer options, and enjoyed having my post natal appts at home.

All 3 experiences were different. My MW for birth #1 might have been more "medical" than some OB/gyns, kwim?

[sste]

I would also focus on the specific provider's reputation and affiliations (e.g., are they delivering a birthing center or hospital that is natural/non csection friendly) rather than type of provider. I have known a few friends to have midwives that were surprisingly oriented toward interventions, C-section, etc and friends were surprised. A lot of variability there. Also I did have one friend whose midwife put her on bedrest for three months!! We tried to check around on her behalf as the rationale for this seemed crazy and indeed there was not a strong basis for the bedrest. Friend however was in such a panic she didn't want to hear it. If there is ANY complication like that I would high tail it not only to an OB but to a high risk OB/MFM for a second opinion.

Personally I am not a candidate for any of this due to my pregnancy history (even the high risk OBs don't want me for the most part). *But* if I was what I would look for personally is a team approach where I would see the midwive routinely but also have access to and consultation if needed with a partnering OB -- this is becoming more common in larger practices.

[KpbS]

I would go the OB route given my medical history. I'm a believer in "interviewing" a practice to see if their philosophy and style is compatible with yours. Best of luck!

[gymnbomb]

*But* if I was what I would look for personally is a team approach where I would see the midwive routinely but also have access to and consultation if needed with a partnering OB -- this is becoming more common in larger practices.

This is what I had. I saw a midwife for all of my care and for my delivery (in a hospital, but in the alternative birth center which you have to have a midwife to use) but the practice I went to had a number of midwives and a number of OB's who were available if needed. They always have both an OB and a midwife at the hospital too in case anything comes up during delivery. It was perfect for me.

[azzeps]

Around here, most of the midwifery groups are just that, group practices, where you get whoever is on call when you show up in labor. Maybe if you have a super long labor, then "your" midwife will get called to lend support, but in most cases you get who you get. This is the very reason I chose a home birth for my second baby. I did not want to play Russian roulette with who my provider would be. I wanted to know exactly who would attend me. It worked out great. Personally, I think that having an OB is overkill for most healthy moms with normal pregnancies. I think most midwives are better equipped to handle normal birth, which most births are, than OBs, just due to their perspective and training. If your husband does not want to birth at home, you could consider a free standing birth center, if you have those where you live.

Best wishes and enjoy the rest of your pregnancy!