OB-GYN v. Midwife

obgyn or midwifeHere’s a fun question for you, ladies: how did you decide between having an OB-GYN or midwife? Who did you want to deliver your baby; who did you ultimately choose? We’ve talked about birth experiences before (here’s my long story — with tips based on what I learned — from the birth of my first son), but not this. OB-GYN? Midwife? OB-GYN with Doula? How heavily did the place of the birth influence your decision (did anyone want a home birth?)?

For my $.02, for my first son, I didn’t strongly consider it either way — I already had a gynecologist I liked, so when we got pregnant I was happy she was an OB as well. I had no reason to distrust my OB-GYN or a hospital experience, and I didn’t even strongly consider a doula.

A lot of those statements fell away for my second birth — I felt totally betrayed by my OB-GYN’s total absence during my three days in the hospital (across the street from her office, for what that’s worth), and I hated the hospital after my lousy experience there. So for my second child I absolutely would have considered a midwife — but by that time I was 36 (37 for the birth), putting me in “geriatric pregnancy” territory, and I worried I might have a problem with blood clots based on some genetic testing we had done — so I wanted to be at the hospital in case anything went wrong. I found a new doctor’s office and a new hospital, and soldiered on; I consider myself lucky that I had a much better experience the second time. Still, my second OB-GYN employed several midwives, several of whom I met during the course of the many (many) prenatal appointments I went to — everyone I met seemed knowledgeable, trustworthy, experienced, and ultimately I would have been happy to have them in my corner when it came time to deliver the baby.

(As for the doula, I wanted both my mother and my husband in the room with me too much to ever really consider a doula — if I hadn’t had such a strong desire I think a doula would have been awesome.)

Ladies, how did you choose between an OB-GYN or midwife? What would you advise new mothers? 

Pictured.

Comments

  1. Canadian says:

    Why would having your mom and husband present preclude a doula? Is that common at hospitals in the States? In my east coast Canadian city you are allowed two support people plus a doula.

    • Curious says:

      +1 to this. Did your hospital have some sort of policy re: the max # people allowed in your room at any one time?

    • I’m in Newdoundland and we were only allowed two support people period – didn’t matter if they were family or doula – two only. So I’m guessing her hospital had a similar max on the people allowed.

      • Wow. Newfoundland. Thanks autocorrect.

      • I’m actually in NL too so this must vary by hospital – Health Sciences in 2014 I could have two plus doula. It was only two total a few years ago though.

        • I was at health sciences too! But it was 2011 and so it was just 2 max. I was there again in 2013, but didn’t even enquire as I knew I just wanted my husband there…aaaand then it was in and out in two hours anyway!

  2. Sorta crunchy says:

    I had a hospital birth assisted by a midwife. I never saw an OB during my pregnancy and I don’t regret it. My midwife was very respectful of my choices and I was able to have the drug-free natural birth I wanted.

    • Sarabeth says:

      Same. It was the best of both worlds – midwifery care, but with an OB in the hospital in case anything happened that required more significant interventions.

      Sadly, I’m moving to a new area while pregnant with my second, and there are not midwifery practices that deliver at hospitals nearby. I’ll probably go the OB+doula route.

  3. layered bob says:

    I really wanted a midwife. I selected a midwifery practice that worked together with the OB-GYN practice that I was at. It was a perfect situation for me – I got the holistic, whole-person, evidence-based approach to the childbearing year that was important to me while having access to an OB for the more complicated parts of my pregnancy.

    The hospital I delivered at had a “birth center” feel on the OB wing. I had the midwives I knew with me through most of my labor, but they were periodically consulting with an OB and I ended up needing an emergency c-section so I’m glad I decided to deliver at a hospital.

    I wanted to avoid as many birth interventions as possible, but I wanted to be able to trust my care providers and not second-guess their recommendations or suggestions. The epidural and c-section rate of the midwifery practice I selected is around 5%, so when they said I needed a c-section, I could trust that I really did need one.

    I also had a doula, which was a tremendous help, although I maybe wouldn’t have needed one since most of the nurses I had in the hospital were very helpful and hands-on. However I did have a couple nurses who seemed to just want to watch the monitor from the nurses’ station, so on their shifts I was glad to have my doula help me labor.

    I will definitely seek out a midwifery practice again, and will probably plan to deliver in the hospital again. I have friends who do homebirth and I’m very glad that they have good experiences and can find good providers to support them, but I do feel, in my risk/benefit analysis, that unless you a) live very close to the hospital and b) have very well-trained medical providers willing to attend your home birth, the risk is too high to deliver at home.

    • Anonymous says:

      I wish this kind of set up was more common. My sister in law in Europe said the standard care is midwife assisted birth in a hospital with OBs available for emergencies. She was totally shocked about midwives being associated with home births here and with OBs being used for non-emergencies in hospital births.

      • layered bob says:

        yeah, we’re moving in a few weeks and I really doubt I’ll be able find a similar situation for the next baby. We decided to go ahead and have a baby while living in our current city in part because I knew I could get this kind of care here. It really was wonderful and the evidence, as you say, is for midwives being the default.

    • anony says:

      This was me exactly. I ended up with an emergency c-section after 23 hours of laboring in a hospital that had a birth center feel to it. The surgeon told me there was no way the baby was coming out the natural way, the canal opening was too small (not something that gets dilated much apparently). So basically, without a c-section, I would’ve probably died. No one knew that until they got in there though. And baby’s heart beat and all signs were super healthy as were mine, I just never got past 9cm dilation even after internal monitoring to increase pitocin to the absolute max. I was really glad for the OB/midwife collaboration.

    • Anonymous says:

      This is so similar to my experience that I wonder if we were at the same hospital (GW?).

      I was lucky to not need any interventions from the OBs and in fact didn’t see one at all the year of pregnancy and birth, but we took great comfort in knowing that if anything came up, we were in a hospital with an ER and excellent OBs. At the same time, I loved the midwife model of care and the birthing center like delivery rooms (shower, rub, rocking chair, couch and other options for delivery, natural focus).

      • Thanks for sharing since I just emailed yesterday about joining the midwives at GW! It really seems like the best of both worlds – the care of a midwife but in the hospital working with OBs in case of emergency. Glad to hear you had a good experience there.

    • rakma says:

      Late to this discussion, but I had a similar set up, and thought it was the best of both worlds, especially when I did need more medical intervention post-birth and the transition from the midwife team to the OB team was seamless.

    • I had the same setup, though hospital wasnt too swanky (not at GW). It was great. I had natural labor, no interventions, which was what I wanted. I saw ob for first trimester before switching to mw practice within dane office. I had no particular issues with the obs but I loved the midwives. My husband is a doctor. He had worked with midwives during his med school ob rotation and was very comfortable with this set up- preferred it over traditional ob even.

  4. Crunchy Mama says:

    I really wanted an all natural birthing experience, and given that we only planned to have one, I went all out crunchy and had a home birth with a certified nurse midwife, her assistant, a doula and my husband.

    I did see a maternal fetal medicine specialist for a few ultra sounds during my pregnancy, as he was who my midwife referred to. He did everything himself and specialized in ultra sounds for high risk births and he was confident baby was healthy and home birth was a great option for me as long as I delivered at term (which I did, and the birth experience was great at the ripe old age of 35).

    I loved my midwife experience. Her office was in her home, my appointments were an hour, she listened to everything going on in my life and I wish I could have another just to see her again! I don’t plan to be seeing an OB/GYN ever again unless a health issue warrants it. Midwives all the way!!

    The thing about homebirth…it’s not for everyone, literally. You have to have the stars aligned with the baby healthy and in a good position, mama low risk, being close to a hospital incase of transferring, being prepared, etc. It was a bit nerve wracking as I am a huge planner and I couldn’t be guaranteed delivering at home. You really don’t know how things are going to go until your midwife arrives and assesses you (baby could be breech or your BP could be very high, fetal heart tones abnormal, etc). Not really knowing if things would align for me was stressful (especially as my BP rose a little at the end and I worried I would be too high risk). But if you can deal with the unknowns it can be a beautiful experience.

  5. EP-er says:

    Pregnancy doesn’t agree with me. I had a couple of miscarriages and a high risk pregnancy, which included a Maternal-Fetal specialist. I watch “Call the Midwife” and dream about what it would be like to be in that situation, but honestly? I probably wouldn’t have any children without an outstanding OB & delivery at a hospital with a Level 3 NICU. I know that I am not most people, but for me, every day I am so thankful for the specialists & surgeons that gave me my children.

  6. farrley says:

    I saw a midwife who is part of a practice that included OBs, and gave birth in a hospital birthing center, and I really liked that setup. I knew OBs were consulting and available in case of emergency, but that she was my primary caregiver. She was really present and hands-on in terms of helping with positioning and pain management…I tried for a natural but ended up going the epidural route, and she was very helpful and nonjudgmental when I switched course. She stayed at the hospital throughout my 2.5 days of labor and was a very positive element in an otherwise pretty difficult birth:)

  7. Grace says:

    I’m due in 10 days, and I’m planning a homebirth with two midwives. I’m in Australia, and my midwives are part of a large private midwifery practice that also has a couple of OBs. I feel they’re crunchy but sensible – they’re happy with any interventions that I’m comfortable with, or are necessary, and they always talk through the pros & cons of various tests / procedures, and can suggest alternatives. I’m really happy with the care I’ve received to date – I’ve experienced the hospital system before, and midwifery care makes feel like I’m a person, not another patient on a conveyor belt.

    I made this decision knowing that I’m a low risk patient – in my OB’s words “an excellent candidate for a home birth”, and that I wanted to be in an environment that supported normal physiological birth. I’d advise other new mums to seek out care providers who they can trust, to listen to their guidance, but also trust your intuition.

    • layered bob says:

      I think the homebirth calculus is entirely different in places other than the U.S., and we have a lot to learn from other countries.

      Because of scope-of-practice and malpractice insurance restrictions, it is really hard to find OBs or even certified nurse midwives who are legally able + willing to attend homebirths (at least in all of the states I’ve lived in – scope-of-practice laws can vary by state). So then women who want a homebirth are left with fewer options in terms of the care they can get at home.

      If I could get a well-trained midwife who was legally allowed to perform certain procedures/administer certain drugs and who was on good terms with the L&D staff at a nearby hospital, I would absolutely choose a homebirth. But that’s just an impossible scenario in the state I live in now.

  8. EB0220 says:

    What I would like: Homebirth with a midwife
    What I could maybe talk my husband into: Birth center with a midwife
    What I had: One hospital birth with epidural + mean OB, one unmedicated hospital birth with doula + no OB (baby too fast)

    I did look into midwives for my second pregnancy, but there was only one practice associated with my hospital that had midwives, and I had heard really bad things about the practice in general.

  9. Anon mama says:

    Sometimes, things go very bad very quickIy. I chose a great OB and hospital because I wanted any potential problems to be handled easily. I had an unexpected complication that the OB handled very well, so it didn’t become a big deal (but it could have). I get that midwives are standard of care in many places with excellent medical systems, but for my health and my baby’s, I wanted the skills and experience of an excellent OB, particularly since going with an OB is the norm in my area.

    • Skeptic says:

      This is probably too late for anyone to see, but I find it weird that there are many people on this site that say even ONE DRINK is too much during pregnancy, but then also many that want to/have had home births (I’m not saying any of those people are overlapping but there are probably at least a few). Things can go bad very quickly– god forbid you start hemorrhaging, you may not make it to the hospital in time to save either of your lives.

  10. CommanderShepard says:

    I didn’t have to choose, because my long-time OB/GYN shares an office with a midwife, who I LOVED. I preferred to see her when possible and liked her a lot. The hospital they were affiliated with also had midwives on staff, so they were routinely delivering babies. I loved my midwife at the hospital, she was so wonderful (like, oh wow you’re giving me a foot massage nice), but ultimately my daughter needed the vacuum to make her big debut into this world, so the OB on staff that day had to do that (also a very nice guy). All in all it was a good experience and I liked the set up where generally speaking I was with the midwife, but the doctor was there just in case. I also had a doula and could not recommend that experience enough!

  11. I have had two birth center births with midwives, one in MN and one in TX. Both were fabulous. The midwives are so calm and caring and really spend time getting to know you.

    I chose birth centers/midwives because I believe birth is (typically) a natural process not a medical one. I wanted a low-intervention birth and to be able to really trust my providers if they said an intervention was necessary. I only felt that level of trust with my midwives.

  12. Anonymous says:

    I’ve had 3 extremely healthy, full term pregnancies, and literally could have given birth at home alone with the same outcomes. I would massively prefer a midwifery approach to clinical checking of boxes that I get with my OB practice, but I have zero desire to do the home birth thing, the nearest birth center is far away, and no midwives serve the nearest hospitals. I’m not willing to do a 30-40 minute drive (if there’s no traffic) when I’m in labor.

  13. Philanthropy Girl says:

    What I really wanted: birth center, natural birth with a midwife.

    What I got: preterm emergency c-section, followed by a full-term scheduled c-section two and a half years later.

    I started the midwife route with my first, and things didn’t go well. I thought I was covered in case of emergency. My midwife team worked out of an OB-GYN’s office, and was five minutes from the hospital. I wanted more hands off care, but discovered that in the course of an emergency, the hands-off care I had wasn’t prepared. The details are pretty traumatic, so I don’t want to go in to them, but I will say that I was disappointed with the response I received in an emergency and probably had grounds for a malpractice suit.

    In my second pregnancy my perinatologist had a CNM in his practice and although I didn’t see her throughout my pregnancy (since I was high-risk and medically necessary c-section), she did all of his follow-ups and I really liked her. I mostly just watch wistfully as my friends head off to their medically uncomplicated pregnancy at the birth center, while remaining grateful for modern medical care that makes sure I can have safe pregnancies with healthy babies.

  14. Carrie M says:

    Great topic! I had a hospital birth with husband + doula presented. My OB practice had 2 midwives, and they encouraged patients to see all caregivers during the pregnancy since you could end up with any of them delivering your baby. I ended up with the midwife I knew plus one who had just started at the practice. They were great. I ended up getting an epidural after 30 hours of laboring (first half lightly, second half back labor), and they all supported and even encouraged that decision (without being pushy at all).

    I was happy to be in the hospital because I had meconium and then the next day our baby was taken to the NICU with breathing issues. I loved the NICU staff and, even though I ended up with an epidural and not being able to take my baby home at discharge, I would still consider it a wonderful experience. I felt respected and cared for, and I felt like my baby got the best possible care.

    I really liked the book recommended often here – Natural Hospital Birth – for those who want ideas re how to have few interventions but either want to be in a hospital or need to be because it’s the only option.

    As a first timer, I liked having a doula. But I’m not sure I’d get one again. She was helpful and calming and did all the right things, so it was a good experience. But I’m not sure it’s necessary now that I know what to expect, though of course everything could be different the second time around!

  15. anon in NJ says:

    I live in the state with the highest rate of C-sections, and I REALLY wanted to avoid a C-section. I also have a bit of a personal history with medical overreactions and cascading interventions, so I was pretty nervous about ending up in a situation where a C-section SEEMED medically necessary. Luckily, in our area, there is a midwifery group which does about 70% home births, 30% hospital births–this was exactly what we were looking for: a low-intervention, home-birth type experience, but in a hospital. In hindsight, this was absolutely the right choice for us. When I arrived at the hospital, the baby had a high heart rate, and then my water immediately broke with meconium in the fluid. A jumpier OB may well have diagnosed a baby in distress, and sent us off for an emergency C-section. Instead, our midwife said this could be due to dehydration, and administered IV fluids. Sure enough, half a bag of fluids later (plus, frankly, me settling in to the bed and having less adrenaline), and the heart rate was right where it should be.

    Frankly, our particular midwife experience was also what my husband needed. He needed emotional support through the labor, and our midwife stayed in the room through the entire experience. Had we had a more typical OB/nurse birth experience, we would have absolutely needed a doula for HIM. He needed reassuring (even just through quiet presence) that everything was going to be okay, and his wife and child were not going to die in front of him. It all sounds very dramatic, but birth was a really intense experience–since we were fortunate enough to not have had major medical situations before, we just didn’t have much emotional preparation for this.

    • anon in NJ says:

      One more point–I think two of the biggest philosophical considerations to consider in choosing any type of medical provider, including for birth, are 1. your views on data, and 2. your views on risk. (These could also be called two sides of the same coin.)

      For many people, more data=good. After some previous medical experiences, I believe that that is not necessarily the case. I also want to consider the quality of the data and what we would do with the data. If a test has a very high rate of false positives/false negatives (such as ultrasound measurements predicting a baby’s weight at birth), or if it wouldn’t change our plans for the pregnancy (e.g., cervical exams in the last weeks of pregnancy), we didn’t want any part of it.

      Likewise, shit happens. We can reduce the risk that shit will happen (e.g., we give birth in clean environments to reduce the risk of infection), but we cannot fully prevent any shit from ever happening. So how far do you want to drive down the risk? How do you evaluate the relative risks of one event over another?

      I think that if you are philosophically aligned with your care provider on these two ideas, then everything else is likely to fall into place.

      I had all of this in the back of my mind going into the provider selection process, but what really drove it home to my husband was our ultrasound experience. Our midwifery practice did not perform ultrasounds themselves, so we went to the local maternal-fetal medicine team for our 20 week anatomy scan. (Our midwives did not require this scan, since I was under 35 and not planning a home birth, but here is where the risk assessment comes in–my husband and I wanted to rule out the possibility of major defects incompatible with life or requiring immediate intervention at the moment of birth.) The ultrasound technician spent the better part of an hour examining our baby from every angle while we watched. Then the MFM doctor came in, and tried to convince the baby to move into a different position so she could see a few last details. Baby wasn’t having it. Finally, the doctor declared sorrowfully that as far as she could see, everything was fine, but she couldn’t see the few lowest vertebrae, nor had she gotten an ideal view of the heart. Thus, she could not completely rule out the possibility of spina bifida or a heart defect. We should come back in two weeks for another anatomy scan to examine the spine, and we should have an even more specialized specialist perform a fetal echocardiogram to rule out heart problems, since the baby had been conceived via IVF.

      Now the view on the monitor had been clear enough that even I could tell that the baby had a basic four chambered heart, inside the chest, beating away at the correct speed with all valves opening and closing. The IVF heart defect possibility was news to us. I did a little more research, and discovered that one study in the 1990s had suggested this possibility–and not even our fertility doctor was familiar with it. My husband and I decided that, at this point, we were comfortable proceeding with the pregnancy with no further scans. After all, at this point our risk of major defects able to be detected by ultrasound was very, very small. When we told the MFM specialist this, she clearly thought it a very unwise decision, and spent quite a while trying to talk us out of it. Why wouldn’t we want to go to every length to know every piece of information that could possibly be known? It was as if we were signing ourselves out of the hospital against medical advice.

      (The part that made me flaming mad was when the midwifery practice received the official report. It stated simply that the MFM practice had been unable to image the heart, and we should return for an echo. they were clearly not comfortable committing to paper that they had been able to see most of the heart, and everything they had seen looked good. If the information was not fully complete, they were not comfortable drawing any conclusion.)

  16. LaurNY says:

    I am currently 34 weeks pregnant and looking forward to an OBGYN + doula assisted birth in a hospital. While I really like the idea of a midwife delivering me – as a working woman it just wasn’t feasible. I hate to say it, but I had to go with a doctor that was close to my office since there are so many appointments. The Midwives available to me are a 25 minute drive and I just couldn’t get away from the office for that much extra time to drive there. I hope I don’t regret this….I do have concerns about unnecessary medical interventions with a traditional OBGYN practice. I hope that by voicing my concerns early and to both my husband, doula and doctors, that I will avoid any issues. I do sense that some of my doctors struggle to avoid an eye roll when I ask about their C-section rate, episiotomy rate or any other “crunchy questions” and that concerns me. I a first time mom and 38 years old so considered “high risk” but that was really not a factor in this decision and I am hoping for a natural childbirth.

  17. Katherine K says:

    OB. I had the option of either, and was more comfortable with the idea that my provider would be able to perform a C-section (and handle emergent situations) faster than a certified nurse midwife, who does not perform surgeries.

    Interestingly, the CNM at my practice was on call the weekend I delivered. She was dismissive when I went into early labor and misdiagnosed me. When I was admitted, I insisted that one of the two OBs in my practice be in attendance instead, and was delighted with the care I received from both OBs throughout delivery of my two kids.

  18. Don't tell me there's a reason says:

    What I wanted:
    a birth center with a CNM. We’re in a decent-sized city, so we’re very close to hospitals. There is one midwifery practice at a hospital, but it’s at the hospital that our insurance specifically excludes. So we chose a CNM who loves science, who worked as a pediatrics nurse at the big children’s hospital before starting her practice, who is trying to start a birth center, who has great respect for parents and for women’s bodies. She was that perfect intersection of skillful & normal and respectful of our choices and needs.

    What I got:
    a miscarriage. The midwife (Victoria Fl0yd, in case anyone in Indianapolis needs a midwife) was kind and supportive and accessible, even though we hadn’t yet had our first appointment with her. She helped us through. When the time comes again, we’ll call her immediately. She has all my respect.

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