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Midwife or obgyn, pros and cons?

post #1 of 21
Thread Starter 
This is going to be our first baby. I plan to have a natural birth with no meds. I hear a lot of women associate midwives with natural births. Does that mean you can't have that with your OBGYN? Why would someone one choose one over the other? What are the pros and cons of working with either? Can someone shed some light on this. Thank you!!!!
post #2 of 21

it is possible to have a drug free birth with an OB/hospital. however, you will have to be really on top of things the whole time and fight for that. hospitals are set up to handle emergencies, and the doctors in them get in that frame of mind where they tend to over-treat and pre-treat with meds. the hospital model of birth views pregnancy and birth as medical issues to treat and resolve, rather than as natural life processes. that philosophy is the main difference between OBs and midwives. midwives see birth as a natural thing that a woman's body was designed to handle. so while you may have a drug free birth with either an OB or a midwife, with an OB a drug free birth is the exception that they will allow you to make. with a midwife, a drug free birth is the norm that they encourage and help facilitate. the other big difference is who directs your care. with an OB, they make the decisions and as a formality they ask if you are ok with what they decide. with a midwife, you direct how your birth goes. with a first baby, it may be appealing to you to have someone else in the driver's seat. or you may already know how you want to give birth and want to be in charge of your own process. with an OB you are statistically more likely to end up with pain meds, an induction, a cesarean, and at higher risk for post-birth infection. both are equally safe as far as they have almost the exact same maternal and baby death rates. 

my first baby was an OB/hospital birth. my hubby is military so my options are sometimes limited, and i went with what was most easily available rather than pushing to have a midwife. nothing went horribly wrong, but i did not end up with the natural birth that i wanted. everyone was very nice, but decisions about my body and my child were made by someone other than me, and a lot of unnecessary interventions were made that ended up making contractions so painful i had to have pain meds. this time i will be using a midwife because i want to be the one in control of my body.

post #3 of 21
Quote:
Originally Posted by mamadiamond View Post

it is possible to have a drug free birth with an OB/hospital. however, you will have to be really on top of things the whole time and fight for that. hospitals are set up to handle emergencies, and the doctors in them get in that frame of mind where they tend to over-treat and pre-treat with meds. the hospital model of birth views pregnancy and birth as medical issues to treat and resolve, rather than as natural life processes. that philosophy is the main difference between OBs and midwives. midwives see birth as a natural thing that a woman's body was designed to handle. so while you may have a drug free birth with either an OB or a midwife, with an OB a drug free birth is the exception that they will allow you to make. with a midwife, a drug free birth is the norm that they encourage and help facilitate. the other big difference is who directs your care. with an OB, they make the decisions and as a formality they ask if you are ok with what they decide. with a midwife, you direct how your birth goes. with a first baby, it may be appealing to you to have someone else in the driver's seat. or you may already know how you want to give birth and want to be in charge of your own process. with an OB you are statistically more likely to end up with pain meds, an induction, a cesarean, and at higher risk for post-birth infection. both are equally safe as far as they have almost the exact same maternal and baby death rates. 

my first baby was an OB/hospital birth. my hubby is military so my options are sometimes limited, and i went with what was most easily available rather than pushing to have a midwife. nothing went horribly wrong, but i did not end up with the natural birth that i wanted. everyone was very nice, but decisions about my body and my child were made by someone other than me, and a lot of unnecessary interventions were made that ended up making contractions so painful i had to have pain meds. this time i will be using a midwife because i want to be the one in control of my body.


What she said!!! Especially the part about fighting for your right to have a natural birth. I attended a birth in Feb at a hospital and the Dr. above the midwife actually threatened the mom to stop care on her if she did not get an IV. An IV! It was awful, and though she ended up with a "natural" birth, (there's not much natural in people pushing mom around, strapping mom to beds, sticking fingers where they shouldn't be, and shouting during pushing.) It was very a stressful experience for her, her husband, and me to go through. 

 

Which leads me to this point: if you want a natural birth, stay out of the hospital. Most hospitals have certified nurse midwives on staff but they are always under the direction of an OB. A certified nurse midwife working in a hospital is very different than a certified nurse midwife working in a birth center or attending home births. 

 

Also, if you end up in a hospital, or just in general, hire a doula!! They will be your best friend and your secret weapon :)

 

post #4 of 21

For me, having had a midwife with DD but still ending up with a c-section, the biggest reason for choosing a midwife was the post-partum care I received afterwards. Our midwife did about 5 home visits just in the first week to check on how things were going, help with breastfeeding, infant care, etc. She never made me feel as if the visits were rushed. I loved having the support after and not having to leave the house to get it. My friends that have delivered with an OB have told me their only post-partum visit was at 6 weeks and in the OB's office.

 

Even if I end up with a highly medicalized birth again (not that I'm hoping for it at all!!), I will still hands down choose a midwife for the difference in the quality of care during the pregnancy and especially post-partum.

post #5 of 21

What everyone else said. I think a lot will depend on your options. We had a midwife for two of my four birth and one was the most medicalized births I had:P Our CNM leaned more towards medical than the OB I had with my son. Now my last birth at an independent birth center was awesome and our midwife was very natural orientated. Unfortunely for this birth we have moved to a new state and Direct Entry Midwives are illegal where we are. Luckily the natural birthing community vouches for the midwife practice and hospital that is literally right next door to our home:) I feel confident that I will get the birth I want there.

post #6 of 21

It's totally possible to have an easy natural birth with an OB or CNM. Go with what you feel comfortable with. Personally, I could never again feel comfortable being attended by anything other than a CNM or OB, so that's who I am going with for my births. It's a personal decision. You can get a med-free birth with whatever provider you choose. Just don't accept pain medication.

post #7 of 21

My first was a natural birth in a hospital with a midwife. For me choosing a midwife over an OB was a decision based on a few things: location, how easy/fast it was to get an appointment, personality, and lastly, OBs are surgeons, midwives are (usually) more natural birth focused. It is completely possible to have a natural birth with an OB. You need to do research and find a provider who has practices that align with what you want with birth. I'm sure some of the women here can give you a list of red flags that are indications that the provider isn't a supporter of natural birth.

post #8 of 21

I agree with the other posters. You can have a natural child birth in a hospital with an OB (I had 2 of them) but you do have to be very assertive in letting your wishes be known before hand and through out labor. It is really helpful if your partner knows exactly what your wishes are so that they can be sure to back you up if need be. 

In my experience it was more important for me to know about the hospital and the nursing staff more as much (or more) as to which OB I chose. The nurses are the ones that will be there through your whole labor and your doctor only shows up at the end anyway. 

 

With a hospital birth you may have to make compromises. For example, I felt very strongly that I needed to get up and be able to move where ever/ whenever I wanted so I would not let them hook me up to an IV. However, with my 1st I did let them put in a port (can't remember the exact name but they found a vein and just left it capped) so that they had access if they needed to give me an IV for any reason. Also, they will not let you labor without being monitored so the nurse and I agreed that I would need to be on the monitor for 10 minutes out of every hour. We compromised and it worked for them and me.

 

One thing I would recommend though is staying at home to labor as long as you can. The further you are into active labor the less likely they will be to try to use interventions such as breaking your water.

 

Now that I have moved to a very unprogressive area I would never be comfortable having a hospital birth here...interventions are their norm and they actual DISCOURAGE natural birth. angry.gif  So, it is definitely the HBMW route for me this time!

post #9 of 21

Ditto what everyone else has said.  No matter who you choose to go with,... this person should be doing lots and lots of births that are just like the one that you want to have.  It is always much harder to go against the grain.  

post #10 of 21

Tons of good points on here. I will just add that I have done a midwife birth in Seattle (at home) and in Chicago (hospital). Both ended up intervention free but I felt that the cultural norms in the two cities were just different. I feel that had I had the Chicago midwives for my first birth, which was very long and hard, I might have ended up with intervention. One of them told me that they never would have let me push as long as I did the first. Luckily, my second was fast! I've known women who have had totally lovely natural births with OBs here in Seattle. (I'm not sure anyone tries to do that in Chicago ;) (Nah, I'm sure someone's doing it but my hospital said something like 3% of women deliver there without an epidural. The good news is those birthing tubs were wide open!)

 

I guess I'm just saying, as others have, is that not all midwifes are the same. Ditto OBs. Find someone who gets your philosophy either way. This can be really tough in some geographies, unfortunately.

post #11 of 21

 

 

I've had one OB attended, hospital birth and 2 midwife ateended, home births.  Personally, I will always have a midwife.  My births with her were peaceful and natural.  She was hands off and I felt like she was on my team.  It was exactly what I wanted. 

 

Midwives also have a really high standard of care which is client focused.  No hurried appointments, no pushing you into making decisions because thats how things are done. 

 

All that said, I believe it really depends on the person, not their job.  Their are plenty of natural minded OB's out there, just as there are some awful midwives.  You need to find someone with whom you feel comfortable.  Either way, you can have a natural birth...though I do think that with most OBs, it is harder.

post #12 of 21

Please don't spread misinformation. CNMs aren't "always under the direction of an OB" and depending on the state you live in, "most hospitals" don't have CNMs. I know, I'm one, and I work both in hospital and in a free-standing birth center owned by myself, another midwife and an obstetrician. Over the years it's become clear to me that natural births are most easily accomplished outside the hospital. I'm not saying a natural birth is not possible in hospital--it's just more difficult because people are programmed to see the hospital as a hostile environment. This induces stress hormones and lowers pain tolerance. There's always the exception--some women feel safe in the hospital, so one never says never. I work in close concert with licensed professional midwives as well, and they offer wonderful services. Hopefully in your state there is a full slate of midwifery providers to choose from.

post #13 of 21

 I can vouch that natural births with an OB are possible.

I was planning with midwife throughout pregnancy only to head in to hospital when I went into labor early.

 

I had no OB and of course my midwife could not practice there so we had the on-call Dr. Who turned out to be a true blessing.

 

My first child was born at 35 weeks due to PROM(pre-mature rupture of membranes, (water-broke)).  Frank Breech vag delivery with Episiotomy. No meds other than the local.

 

My second child I decided to have this OB as a back-up. Same plan of midwife/pre-natals and home birth but I was evidently off on my dates (calculated from implant bleed instead of menst) 35 week PROM again but AP-GAR for DS was at 38 weeks dur duh.gif   Natural, No assistance,  Dr. sat at the foot of the bed and Hubby caught DS.

 

Even with my amazing OB it was still challenging to deal with the nurses. They are programed to help 'sick' people and frankly women in labor are not SICK! splat.gif

I am so very thankful for their experience when we are sick but just having a baby should be a relaxing joyous experience.

I feel like under the odd circumstances with my first child it was a wonderful birth but we had to fight the whole time to get it.

 

Tips I learned.

 

1. Have a well written birth plan with detailed services you would like to refuse or be educated about if they become necessary.

 

2. Check-in at the last minute. Really, labor in the parking lot if you have to, less chance of a stressful labor being pressured by their routines.

 

3. Bring food

 

4. check yourself out as soon as you feel you are ready. Feeling taken care of is wonderful but so very much cheaper at home thumb.gif

 

 

For a hospital birth with OB:

Make sure you trust this person to LISTEN to what you want! Someone that supports your ideas/wishes. Research everything about the hospital's procedures and services, be comfortable with everything PRIOR to going into labor so nothing is a surprise. This will help you stay in control of your birth and help you not feel like an invalid.wink1.gif

 

For a Midwife:

Stay at home and drink tea lol.gif

 

(Oh, our CNM in the hospital has a track record for stripping the membranes (without the patent's consent) during checks. Not saying they're all bad but our is.)


Edited by BumkinsMum - 4/17/12 at 7:57am
post #14 of 21

 

You can have a natural birth with an OB....but chances are it will be an uphill battle. 

 

I believe in going with the expert in what you are looking for.  You don't go to a heart surgeon to get a general check up and I look at birth the same way.  OBs are trained surgeons.  The vast majority have witnessed few if any natural births.  If you want a natural birth go with a specialists that performs 50 or 100+ of them a year and has the experience to give you what you are looking for safely.  OBs are simply not trained to deliver babies naturally...and while they can "catch" a baby like anyone else in an uncomplicated birth....in the event some extra help is needed (non medical) the midwives are trained to provide the necessary assistant without meds the OB is not.  If you choose to deliver in a hospital...should something go wrong...OB is always on call. 

 

That being said...there are good OBs and bad OBs...good Midwives and bad Midwives....its important to do your research. 


I had a natural water birth at Morristown Hospital last year with Hackettstown Midwives and it was simply amazing and everything I could have hoped for.  If you are in the North Jersey area...I highly recommend them and Morristown Hospital as well. 

 

Also...if you want to increase your chances of having a natural birth...sign up for Bradley classes.  It is a big time commitment (12 2 hour sessions) but the best investment you could possibly make!

post #15 of 21
I have had three midwife attended hospital births that were great, totally natural and very relaxed. This will depend a lot on the hospital you go to, though. A hospital that does not have a lot of natural births will probably have nurses that don't know much about them. I was lucky that the hospitals I birthed at were very progressive, encouraged moving, walking, bathing/ showering, and eating and drinking. A lot of hospitals still want you in bed on an IV and munching on only ice chips... hard to believe, but I've heard some recent stories that shocked me! So a hospital tour is a must if you are considering that option.

I know there are some OBs out there that really do believe in as little intervention as possible, but I am still wary of them in general because I have heard SO MANY stories from friends who interviewed a bunch of OBs and midwives, and found an OB that was "totally pro-natural birth"... but when things were taking a little longer than they liked, or whatever other silly reason, it was suddenly intervention-city. This happened recently to a friend of mine, she was taking a while to progress and rather than suggesting things like walking, nipple stimulation, showers, etc, he told her to have an epidural because that would speed things up. Now, I'm no expert, but I've read a lot about birthing and taken birthing classes and even pro-epidural people will say that it usually slows things down. So unsurprisingly, it didn't work and she ended up having pitocin, then pushing was relatively quick for a first baby, only one hour, but she had some vaginal injuries which took a long time to heal, and that seems like something that happens more often with pitocin and epidurals... it's fast and you can't feel anything to let you know to slow down, so it makes sense.

So personally, I wouldn't see an OB unless I was high risk, but if you ask around and manage to find one that actually practices what he/she preaches, then it might work out for you. The hospital is still going to be a whole separate ball game, though, so still look at that.

Also, research midwives just as much as you would an OB, I have heard some horror stories about them, too.
post #16 of 21

So how do midwives in hospitals like the Kaiser hospital here in California give their services ?  Are you saying the hospital midwives are not under OB's and they "are on their own.?"  I don't understand that how that can be because if you're any kind of staff person in a hospital be it a doctor or nurse , you would have to go with the regulations and policies of the hospital.. so for example if the mother in labor was in labor for hours and there's a hospital policy about limits how long the patient is in labor ....the attending hospital midwife would have to go with that policy and be in conflict with advocating patient's right to be in labor for however long, right?  

post #17 of 21

How a midwife is licensed depends on the state. Some midwives have independent practice. Some require a collaborative agreement with an OB in order to be licensed. Some (very few) require a supervising OB to be licensed. It depends on the state.

post #18 of 21
It depends on the practice. I believe any licensed midwife in CA has to have a relationship with a hospital or OB in case of an emergency, but what that actually means varies. The midwife practice I go to nominally has an OB they work with, but they don't really work with her. They do send patients to her if they are deemed too high risk. The birth center is inside a hospital, so during an emergency or if certain time limits have passed (the only one I am aware of is so many hours after water broke, I think it's 24 or maybe 36 but there may be others), they send the mother down to regular L&D and are seen by OBs. The OBs there are very progressive, however, the L&D still has a very low C-section rate (for a hospital at least, I think it's like 12-15% for first time mothers) and less than 1% episiotomy rate.

The freestanding birth center near me has an OB that they work with in emergencies/ hospital transfers, but like at my practice he is not there supervising the midwives.

I don't know what Kaiser's policies are exactly, but I have not heard good things about their maternity services here in San Diego.

Even homebirth midwives are going to have their own limits and so on for liability if nothing else, though they may be more lax than hospitals. These are the kind of things to ask about from any care provider and the hospital/ birth center they practice at.
post #19 of 21

 

Quote:
Originally Posted by themothership View Post

My first was a natural birth in a hospital with a midwife. For me choosing a midwife over an OB was a decision based on a few things: location, how easy/fast it was to get an appointment, personality, and lastly, OBs are surgeons, midwives are (usually) more natural birth focused. It is completely possible to have a natural birth with an OB. You need to do research and find a provider who has practices that align with what you want with birth. I'm sure some of the women here can give you a list of red flags that are indications that the provider isn't a supporter of natural birth.

 

Exactly this. 

 

OBs are doctors, who are experts in illness and surgery. Midwives are trained to handle birth as a natural part of a woman's life. I preferred the midwife approach. 

post #20 of 21

 

Quote:
Originally Posted by TheDivineMrsM View Post

 

 

Exactly this. 

 

OBs are doctors, who are experts in illness and surgery. Midwives are trained to handle birth as a natural part of a woman's life. I preferred the midwife approach. 


If you're a healthy lower risk mom the best outcomes are with midwives for both mom and baby.  You can research it, it's actually a fairly easy conclusion to make from the research that is out there.  

 

I chose midwives for all my births as well.  I went into researching it open minded and the results of the research were so obvious that I had to go with the midwives (regardless of having a lot of family members/friends who are doctors LOL).  Avoiding that first cesarean is so important as well, especially if you want a large family.  I initially didn't even anticipate that I would...just loved everything about birthing, breastfeeding, babyhood, etc.  

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