Edited by StephM76 - 1/9/11 at 9:42pm
I think it depends on what kind of difference you want to make, if you want to change things in obstetrics it might make more sense to be an OB, but if you just want to help women both could be influential. Here midwives do more hospital births then home births. I would also look into laws to see if OB's in your area are able to do home births.
I can only speak about how I feel.....knowing what I know....your perspective may be different. But for what it is worth.
While many OB's are ignorant of how beneficial natural birth is to mother and baby and also seem to be ignorant of many ways in which a mother can have a natural birth successfully (which you being a HB Mom could totally change in your office......there are other reasons why they have a hard time serving women and families:
1) malpractice - anything goes wrong (even if it isn't their fault at all) and they can be sued. Their malpractice insurance is so expensive they don't want it going up any more and they don't want their career ruined. Unfortunately so many women decide to sue no matter what if there is an issue. Didn't have Mom on the continuous monitor? Why not the court will ask? Didn't give her the C/S at the first hiccup on the heartrate? Why not the court will ask? The world is sue happy.
2) Too many patients to make a difference. I think many doctors in every profession find out when they leave medical school that they have hundreds of thousands in student loans and now they need to find a job. Well they aren't in a position to take more loans to open their own practice so they have to open one with several other people or go to one already open. And also to pay off those student loans they also need to sign up to accept insurance because there is no time to build their own clients - they have bills to pay. So they take insurance but they realize quickly that they have so many damn patients that they can't hardly remember their names. Ok - so even if you are better at remember names and faces better than me.....how do you give individual care to SOOO many women? I'm a doula and feel that I can only service a few women a month before i feel overwhelmed.....I have a family and kids so I'm sure if I were single it would be easier.
3) In hospital I hardly EVER see the OB during the labor. I'm not sure if this is because the OB is out somewhere eating bon bons or if they are very busy. I imagine they might be very busy either seeing patients, completing paperwork or sleeping on a 24 hr shift. But how can an OB make a difference to women if they aren't there during the labor? Sure they can be gentle during the pushing stage. And they can make some real differences in those moments after the birth that the Mom wants to bond with the baby and the nurses want to take the baby away. They could advocate more in that situation.... But the OB's I know are in and out - even the nice ones don't spend that much time with the family in office appointments OR the birth. And I think this is because they are restricted not because they are bad people.
OB's also see ALOT of complications. Fact is epidural rates are at 80% or something like that. Interventions cause SO many complications. And while being a natural minded OB you might convince some women to birth naturally and they might love it you also will have most of your ladies hooked up to every tube they can get their hands on and see high rates of complications because of it. But I would imagine after a while all those complications would get to you - you'd start to fear birth just like they do and start advocating more and more for preventative interventions to avoid tragedies. This is just a risk of course - maybe you won't become fearful at all or lose sight or your original goal.....
So I guess if I were you I'd shadow some OB's (maybe some that have more of a natural philosophy like you) to see if it is the right job for you. Same of HB midwives (who have a lot of work IMO!! ) :) and hospital midwives (who have some of the same restrictions as OB's but usually a smaller caseload (although not always).
Have you read the book "Pushed"? It discusses the politics behind birth in America and might explain better some of the things I mentioned.