OB-GYN v. Midwife
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Here’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.
{related: informed consent questions to keep with you in case of emergencies}
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?
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.
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.
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.
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.
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.
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:)
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.
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.
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.
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!
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.
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.
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.
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!
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.