Husband is concerned about midwife safety

[annablue]

I've been researching birth options for quite a while now, and have made up my mind that I want a midwife at a birth center. My husband is wonderful and wants to support me; however, he's concerned that it's "not as safe" and "things can go wrong." He also wants me to do my prenatal care at a "real doctor" because he thinks they'll be able to spot any complications.

We looked at different websites last night but he felt that they were all biased in one way or another. Can someone provide a very objective article, study, etc of midwives, or cold hard facts? Or just share your own experiences dealing with a concerned partner? Thanks so much!

[Mosaic]

My husband was the same way. I don't have any links for you right off, but I will say that what worked was bringing DH with me to 1) an appt. with the OB and 2) an appt. with the midwife. Any issues he had about experience and level of care disappeared immediately when he MET them and SAW how differently they operated. The midwives asked more questions, listened better, made fewer assumptions, etc., while the OB did his thing and told us to leave, basically. Plus midwives are so grounded: birth is just birth, a happy time when a new baby comes out. That helped DH change his perspective from the drama he grew up watching on tv and hearing about from others and understand that billions of women all over the world have a baby and it's not a major emergency every time.

Plus, DH was glad to hear that midwives (in our state) can only take low-risk patients; so if anything they are even more concerned with identifying potential risks because they know that by law they're required to get you to different care.

[philomom]

Midwives are experts in birth and birth only. Your doc may see women of all ages for anything ranging from birth control to uterine fibroids.


Not all midwives are great. Not all doctors are bad. You will get more face to face time with your midwife. She will also be with you through the whole delivery.. not just phone in and appear at the end like a doc would.

Find someone you trust. Take a good birthing class.

And yes, some fellows are just like this. I'm married to a "just in case" kind of guy. We had natural births. We were in the hospital with a certified nurse midwife. A truly awesome and peak experience both times.

Posters after me will claim that men should have no say in how a woman births. I think that's wrong and sad on so many levels. My husband was the best support during labor a woman could ever hope for. I honored his concerns because these are his children I'm birthing, too. I choose to raise my children with a loving and involved father..... not one that's alienated and stuck on the fringes of his children's lives.

[channelofpeace]

http://www.bmj.com/cgi/content/full/330/7505/1416?ehom

Results 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated.

RE: how much say a partner gets in the birth of his child. I think it is important to talk things over and try to come to a consensus if possible. But it has been shown in study after study that midwives (and homebirth) have as good or better outcomes than doctors (and hospital birth) with far less intervention. So if it comes down to a partner's fear vs. what the woman wants and thinks is best for her, the woman gets to choose.

[thefreckledmama]

I would suggest having a meeting with a midwife at the birth center with your husband. Let him express his fears and concerns, let him ask lots of questions. Doing this can go a long way toward making the men who aren't, much more comfortable with midwife attended births-hospital, birthcenter, home or otherwise.

When we had our first meeting with my midwife, my husband and I compiled a list of all the different situations and complications we were concerned with, and she went through and answered how they would be handled. I think people not in the know about midwifery care are shocked at how knowledgeable and capable midwifes are when it comes to pregnancy and childbirth-they're not just glorified "baby catchers". I think people are also surprised at how well equipped birth centers are with all the technological "gadgets" that may be needed to handle different situations.

Also, midwifes ARE trained to spot complications, not only because they're trained to, but also because in many states there are certain issues and situations in pregnancy that midwives aren't permitted to handle (this varies greatly, and usually state to state)-and when these situations arise, prenatal care either has to involve or be turned over to an OB.

The only real difference between a midwife and an OB in terms of knowledge of pregnancy and birth, is that an OB is a trained surgeon, a midwife is not.

One more thing I'll add about spotting/handling complications...I do shadow care with an OB (insurance issue), at my appointment with the OB, I was spilling protein in my urine, and my blood pressure was starting to creep up (signs of pre-eclampsia). I was told to call the office if/when I started having headaches or severe swelling. When I called my midwife just to let her know since I wasn't going to be seeing her for a few days, she told me I needed to increase my water intake, and increase my protein intake. 3 days later when I saw her my blood pressure was totally normal, and I had no protein in my urine. So where the OB was basically waiting for a problem to develop THEN deal with it, my MW was concerned with WHY I was having the problem, and what we needed to do in order to correct it.

I think if you take the time to help your husband understand the difference in quality of care, it will go a long way to show him how superior the midwifery model of care is over the obstetrical/medical model.

[Storm Bride]

Originally Posted by annablue

I've been researching birth options for quite a while now, and have made up my mind that I want a midwife at a birth center. My husband is wonderful and wants to support me; however, he's concerned that it's "not as safe" and "things can go wrong."

I guess my only question is...does he think things can't go wrong at the hospital?

He also wants me to do my prenatal care at a "real doctor" because he thinks they'll be able to spot any complications.

What does he think a midwife does?

We looked at different websites last night but he felt that they were all biased in one way or another. Can someone provide a very objective article, study, etc of midwives, or cold hard facts? Or just share your own experiences dealing with a concerned partner? Thanks so much!

hmm...my history isn't the best. However, the only prenatal care I got that was worth spit was when I went with a midwife. Things ended very badly, but it was my fault, not hers (she recommended a transfer, and I didn't go). My last OB was okay...but I was already signing on for another surgery, so there were fewer issues.

My partner? I'm not sure what to say. He was somewhat concerned about a midwife, but he'd already seen what I'd been through with the nightmares and numbness and such from my doctor/hospital experiences, so he knew I needed to do something else. Honestly, if I hadn't already been through all that, I don't know how we would have handled it. The whole "doctors are best" mindset it pretty firmly entrenched in a lot of people.

DH also asked the midwife a lot of questions, and was reassured by her answers.

[annablue]

Originally Posted by Storm Bride

I guess my only question is...does he think things can't go wrong at the hospital?

What does he think a midwife does?

He feels like if something goes wrong at a hospital, there is lots of technology and personnel to deal with it, and a transfer from the birth center to hospital might take too long and it would be too late.

He feels that a midwife might miss something because "she's not actually a doctor" and "isn't as highly trained."

His words, not mine... :

[channelofpeace]

He should definitely know then, that doctors are not with you for most of labor. They typically only show up when you are pushing. So usually it is up to the nurses (or the residents) to "catch" something wrong at the hospital.

Continuity of care is much, much better with midwives.

Has he watched the Business of Being Born? I know it is an eye-opener for a lot of partners.

[Jaesun's Dad]

Originally Posted by channelofpeace

Has he watched the Business of Being Born? I know it is an eye-opener for a lot of partners.

Yes, good film. I was already on board with the birth center but it was one of the first films we watched together and at the time it was important for our (then very tense) relationship too; that we were able to watch it and then talk about it and start to make agreements and decisions as cooperative parents.

I went to almost all the appointments with the midwife and we took birthing classes through the birth center so I felt like I was being involved and included. We did have to go to hospitals for ultrasound and other tests so not everything was strictly done at the birth center.

My partner and her midwife though did have a major personality clash. Interestingly at some point I basically turned into a mini-mediator between them. It was fine and I was glad to do it but I thought that turn of events was interesting. The midwife still though I think was very professional (though admittedly a bit insensitive) and I trusted her. The student midwives were fantastic and provided the compassion and emotional support that the midwife herself didn't convey very well.

Ultimately we did have to transfer to a hospital. We had a written birth plan and had already taken a tour of the hospital. The hospital staff discussed our birth plan with us and followed our wishes as best as was possible (anything they couldn't do as written were pretty trivial things) and one of the student midwives accompanied us to the hospital and stayed with us for most of the time we were there.

The birth center did follow up visits at our home, and we still feel like we benefited from the experience of working with the birth center even though in the end we did need to transfer. I never really had too much concern about professionalism or anything going wrong, and as it turns out I didn't need to be concerned. It all worked out in the end and our baby is now all love and smiles :-)

[Storm Bride]

Originally Posted by annablue

He feels like if something goes wrong at a hospital, there is lots of technology and personnel to deal with it, and a transfer from the birth center to hospital might take too long and it would be too late.

I'm surprised by how many people think that you're definitely going to have an immediate rescue in the hospital. They still have to prep and OR and all that, even if you're labouring on site.

He feels that a midwife might miss something because "she's not actually a doctor" and "isn't as highly trained."

His words, not mine... :

Is he aware of how much of an OB/GYN's training has nothing to do with pregnancy or birth? I've definitely heard way more stories about doctors overlooking complications (due to the "5 minute appointment" syndrome) than midwives doing so...although it can happen with anyone, of course.

[*MamaJen*]

It seems like usually when husbands are against a midwife-attended delivery, it's because of a sort of amorphous gut reaction that it's "not as safe." The typically haven't done any research at all or looked at facts. So it's good that he's willing to look at information.
The Business of Being Born is a good documentary to start with. Also, that homebirth safety study is another good one. There was just another Canadian study showing that homebirth was as safe as hospital birth: http://www.cbc.ca/health/story/2009/...me-births.html.
Also, it's interesting to note that the C-section rate in America is now at one-third of all births. The second you step into a hospital, you are at risk for a slew of interventions that are not evidence based and have bad outcomes, such as epesiotemy, unwarranted induction, continuous fetal monitoring, which actually produces worse outcomes with more c-sections, pushing flat on your back, and so on. Evidence based maternity care is another good report.
In general, it is a struggle to have a "normal" birth in a hospital. It's possible, with a very sympathetic provider, but you're swimming upstream. Your labor will be easier and less painful if you're in a situation in which you feel comfortable and not like you have to fight.
Also, at a birth center, you'll likely have access to a tub, which makes a huge difference.
In general, the best thing he can do is talk to a midwife. She can tell him about her training and experience, what she would do in an emergency, what equipment she carries, and so on. Many people don't realize that midwives are highly trained medical professionals.

[Jaesun's Dad]

Just want to add in regard to the very valid points above about hospitals that I believe even though we did end up at the hospital, we were very well treated and were very well prepared to deal with the hospital staff because of the preparation we got through our birth center. I think we were very well informed because of the extensive dialog with our midwife (which you can't get in rushed appointments) and we had our birth plan because of the birth center and knew exactly what we wanted and did not want before we even arrived. The birth center still acted as our advocate and we appreciated that they were still there for us even though we did need to transfer. Our baby was delivered vaginally with very little time to spare before a no questions asked c-section would have been necessary (his vitals after contractions were dropping frighteningly low) but he still made it pretty much naturally.

If we weren't so well informed and prepared through the months of regular visits at the birth center and the (required) classes we took there I'm afraid of what might have happened. So even though we did not ultimately birth at the birth center it benefited us tremendously nonetheless.

[loveneverfails]

Originally Posted by annablue

He feels like if something goes wrong at a hospital, there is lots of technology and personnel to deal with it, and a transfer from the birth center to hospital might take too long and it would be too late.

He feels that a midwife might miss something because "she's not actually a doctor" and "isn't as highly trained."

His words, not mine... :

Here's my question for him: who is a better judge of when something is going wrong in labor: a highly skilled midwife who is there with you the entire time, or a nurse who doesn't know you and generally is relying on instrumentation and the occasional check in after which the doctor only comes in at the last minute? The L&D nurse is the primary person assessing your condition while you're in labor in a hospital birth. So, do you trust the random nurse assigned to your care at the hospital or do you think you are better off with the person ultimately responsible for your care being with you the entire time?

For example, I tend to have pretty easy labors. So, if I'm in serious pain, my caregiver should be evaluating me for an impending abruption or other things that could explain serious pain. A midwife who knows me, who understands my personality and trusts my judgment, is far less likely to miss a sign of that complication in the making and it's a danged serious issue. I can see how a nurse in L&D, even a well intentioned and kind one, could miss that because my normal is different from the normal for a lot of people. I had two hospital births before two home births. One nurse I think would have caught that sort of situation, but I truly don't think the other would have. And the one who would have missed it was the nurse in the nice, clean, rich suburban hospital where I also contracted MRSA on that trip to L&D.

And in one of my home births we ran into a serious shoulder dystocia, and the fact that my midwife and her assistants all knew eachother and could work extremely well together as a team meant that our emergency situation was handled more seamlessly than I've ever seen a group of people work.

That said, I also interviewed a lot of midwives before settling on one and there are many situations in which I would choose hospital birth. If you *can't* trust your midwife's judgment to know when you need to transfer and when she can handle things herself, do not choose to give birth with this person. I don't think home birth is safe if you don't have a really good midwife, and my standards for what I look for in a midwife are pretty high. My midwife's judgment is my safety net, and it better be extremely solid or I really would be safer where you have more eyes watching things and the cool tools to fix things more quickly if things go wrong.

[katelove]

Below is the abstract from a Cochrane Review (if you aren't familiar with Cochrane this is how they describe themselves "The Cochrane Collaboration is an international, independent, not-for-profit organisation of over 27,000 contributors from more than 100 countries, dedicated to making up-to-date, accurate information about the effects of health care readily available worldwide.") I have included the web address and there is a link to the full text article, including a list of the original papers reviewed, below the abstract.

I won't comment personally on midwifery care as I am a midwife and therefore, biased. However, there is plenty of research available. You could also try Pubmed.

And I second the PPs who suggested that you and your husband make a list of things you're concerned about and ask the midwives you are considering how they would handle them. That's what I would do.


"Midwife-led versus other models of care for childbearing women
Midwife-led care confers benefits for pregnant women and their babies and is recommended.

In many parts of the world, midwives are the primary providers of care for childbearing women. Elsewhere it may be medical doctors or family physicians who have the main responsibility for care, or the responsibility may be shared. The underpinning philosophy of midwife-led care is normality, continuity of care and being cared for by a known and trusted midwife during labour. There is an emphasis on the natural ability of women to experience birth with minimum intervention. Some models of midwife-led care provide a service through a team of midwives sharing a caseload, often called 'team' midwifery. Another model is 'caseload midwifery', where the aim is to offer greater continuity of caregiver throughout the episode of care. Caseload midwifery aims to ensure that the woman receives all her care from one midwife or her/his practice partner. All models of midwife-led care are provided in a multi-disciplinary network of consultation and referral with other care providers. By contrast, medical-led models of care are where an obstetrician or family physician is primarily responsible for care. In shared-care models, responsibility is shared between different healthcare professionals.

The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women. Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects.

The main benefits were a reduction in the use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman's chance of being cared for in labour by a midwife she had got to know, and the chance of feeling in control during labour, having a spontaneous vaginal birth and initiating breastfeeding. However, there was no difference in caesarean birth rates.

Women who were randomised to receive midwife-led care were less likely to lose their baby before 24 weeks' gestation, although there were no differences in the risk of losing the baby after 24 weeks, or overall. In addition, babies of women who were randomised to receive midwife-led care were more likely to have a shorter length of hospital stay.

The review concluded that most women should be offered midwife-led models of care, although caution should be exercised in applying this advice to women with substantial medical or obstetric complications." http://www2.cochrane.org/reviews/en/ab004667.html

[CallMeMommy]

Originally Posted by loveneverfails

Here's my question for him: who is a better judge of when something is going wrong in labor: a highly skilled midwife who is there with you the entire time, or a nurse who doesn't know you and generally is relying on instrumentation and the occasional check in after which the doctor only comes in at the last minute?

This is a very good point that I've never even thought of before. The nurses are the ones making the primary decisions. Heck, in some hospitals the OB isn't even on-site and has to be called (and sometimes you have to wait for them to call back) if there are questions or concerns from the nurses.

[mntnmom]

Another point to make: your midwife knows YOU. She has heard your heartbeat, and knows your baby's patterns. Extended appointments allow her to understand why you don't want you mother to be allowed in, and how your partner can best support you.
There's a good chance the OB on call has never seen you before. All he/she gets is your chart. Even if he is *your* OB, there hasn't been nearly as much time relationship building. As a pp said, knowing your personality, and hearing your birth stories in full, can make the difference in spotting a problem.

[laohaire]

My contribution.

Midwives are experts in normal birth and in identifying potential issues that would make a birth not normal. They are experts due to training and experience. Some midwives of course are not as experienced, others know more about birth than just about anyone else in the world.

Obstetricians are experts in abnormal birth. They are trained to use machines to find abnormalities and they are trained in procedures to plan for abnormalities. This includes even things like "no eating or drinking" which logically hampers birth (can you run a marathon while fasting? just as absurd as giving birth while fasting). The machines they use can also hamper birth (keep a woman to her bed though moving around is best for her and baby, also monitoring belts are notorious for issues, absolutely notorious. So notorious it's amazing they are used at all).

In other countries, it's considered absurd to see an OB unless you have a problem. It would be like regularly seeing a podiatrist even if you don't have any issues with your feet. Midwives handle the normal births, and part of their training and responsibility is identifying potential issues - in which case they then refer their clients to OBs, experts in complications.

So, it's not about "which are better, midwives or OBs?" They do different things, they are experts in different fields. If your birth is normal, you are best supported by going to an expert an normal birth. Going to an expert in interventions will increase your chances of CREATING an abnormal birth. But of course, if your birth has complications, the OB is the best choice.

I'd recommend your DH think about exactly "what" things can "go wrong" and understand what the reasonable responses for those things are. Probably he doesn't have any idea what could go wrong, just some vague sense that things can be tooting along just fine and then suddenly -- !!

He may be very surprised to find that some of the "emergencies" he might be thinking of are either not emergencies at all, or can be as competently (or more) handled by a midwife. For example, the dreaded "cord around the neck" is actually part of normal birth (something like 1/3 of babies are born this way). Not an emergency. Midwives see it all the time. They slip the cord over the head, all set. Some of them are very tightly wrapped multiple times and might inhibit descent. Now that is a problem but one very competently handled by a midwife - she may have to clamp and cut the cord prior to birth and unwrap it that way. Not a huge deal for an experienced, competent midwife. That's do-able for a doctor too, though you're not guaranteed that the doctor will even be in the room at the time - you might have to rely on a nurse who isn't as well trained to do it.

Hemorrhage (bleeding out after birth) is a concern, but it's not a straightforward issue of "you're better off in the hospital for it." In most states, midwives can carry pitocin, which is the exact same remedy that would be applied in a hospital. Most hemorrhages are not too urgent and can transfer to a hospital and get care in the same amount of time if the woman was there in the first place. Many hemorrhages are CAUSED BY DOCTORS so that's a monkey wrench in the calculation of what's safe? They are typically caused by doctors pulling the placenta out. Seems many docs do this even though it's known to be dangerous. They are impatient and want to leave. Midwives are there for the long haul and aren't in a rush.

Baby not breathing? Midwives carry oxygen same as doctors. What would happen in a hospital if the baby was not breathing? Suction, oxygen, CPR. All are done by midwives the same as in the hospital. They don't have magic "make baby breathe" crash surgery at hospitals. If suction, oxygen and CPR don't work, then it doesn't work at the hospital either.

Anyway, I never saw Business of Being Born but I hear it's extremely effective at opening conversations between husbands and wives, and it's supposed to be very convincing for husbands. I'd start there. Your husband doesn't really have any idea of what he's afraid of, but he also doesn't have any idea of how effective (or not) all that technology is, or any concept of iatrogenic (doctor caused) problems. Doctors are great when you're hurt. But birth is almost always normal. What can a doctor do other than get out of your way if you're not hurt? What happens if they try to do something when you're not hurt? Medicine? Surgery? They all have their risks and complications, better to leave a healthy person alone and save the medicine and surgery for those who need it.

[Storm Bride]

Originally Posted by mntnmom

There's a good chance the OB on call has never seen you before. All he/she gets is your chart.

This is totally true. I was seeing my family physician for prenatal care with ds1. He was pretty good (he and his wife work together, and at that time, they had the best track record in my municipality for making it to births). I went to the hospital after 20+ hours of labour, because we (me, mom, sister, ex) were a little concerned that things weren't progressing normally. I had VEs by a nurse and a resident back-to-back, which determined that I was almost fully dilated. They sent my ex to get me ice chips, told me they couldn't find a head, ran an ultrasound over me, determined that ds1 was in frank breech position and told me I was having a c-section. From that point on, nobody listened to a word I said, including "no". I never even met the surgeon until the next morning. He knew nothing about me at all, except that I was pregnant, in labour and my baby was breech.

And, according to the conventional wisdom, first babies can't flip breech at term (I do not believe this, for the record - I'm 100% certain ds1 did so). If that's true, then the doctor missed my baby's position. This is a straw man, because ds1 was definitely head down just two days earlier.

[Storm Bride]

Originally Posted by laohaire

In other countries, it's considered absurd to see an OB unless you have a problem. It would be like regularly seeing a podiatrist even if you don't have any issues with your feet. Midwives handle the normal births, and part of their training and responsibility is identifying potential issues - in which case they then refer their clients to OBs, experts in complications.

I'll throw in my two bits about this, too, because I'm Canadian, and I had my first baby when midwifery was still illegal in my province. (I believe it was legalized the following year, actually.)

I saw my family practice doctor. Everyone I knew saw their family doctor, unless they'd already been deemed high risk. When I was pregnant with dd1, I saw my family doctor (actually, my family doctor's wife, as my original doctor had quit doing obstetrics). I had one consultation with an OB in the first trimester, to discuss VBAC...because I was now "high risk" because of the uterine scar. Until we discovered that dd1 was breech at 39 weeks, I continued care with my family doctor. I ended up with a c-section, with the consulting OB, but I didn't see him all through the pregnancy. Nobody was concerned - before she went footling - about me having the VBAC, as I was a "good candidate", and there was no reason to have an OB doing my "care". My family doctor is fully capable of asking how I'm feeling, recommending a prenatal vitamin (which is all the nutritional "counseling" I ever had from a non-midwife), doing bp, and having me pee in a cup. It would never have occurred to me, or anyone else I've ever known, to see an OB/GYN for a normal, low risk pregnancy.

In fact, when I was pregnant with dd2, after four c-sections, and a stillbirth, I did half my prenatal visits with my family doctor and half with the OB. An OB just isn't needed for routine prenatal testing.

[To-Fu]

I recommend reading Henci Goer's book:

http://www.amazon.com/Thinking-Woman.../dp/0399525173

It's evidence based and addresses all sides. It really helped my partner and me decide on our first home birth.

Best of luck!