Tell me about midwives vs. GPs vs. OBs

In My Humble Opinion
21

First of all, I had been hoping to have a natural birth. Most of the nurses in the hospital I delivered in were not interested in assisting with a natural birth - they had a particular protocol that they wanted to follow and were not really interested in my opinion about how I wanted my birth to go. Of course, it didn’t go that way anyway, but I really didn’t need one of the attending nurses to tell me, “Oh, so you’ve given in,” after I agreed to an epidural when my doctor told me he was worried about my blood pressure, which continued to rise in part because of the pain. After 28 hours of labor, that was just the icing on the cake.

Second, a different nurse got upset with me for daring to question why I was hooked up to a magnesium sulfate drip. I wasn’t asking to have it taken out (though I wish I had) - I couldn’t even leave the bed on my own. I was asking because I was so out of it I couldn’t remember even having ever been pregnant much less being hooked up to an IV. After my husband explained to me that it was not 2004 like I thought it was - instead it was 2006 - and after understanding that that kid screaming bloody murder was mine, I really didn’t need the attitude in response to a simple question.

Third, the next day when my husband and I decided that we didn’t want our son to have sugar on his pacifier while they did the circumcision, the same nurse said, “Oh, you want your baby to cry?” So on top of having to have an epidural after 28 hours of labor (then another 4 hours of labor after that), then later having ecclampsia, I was also a bad parent because I didn’t want my child to be given sugar within his first days of life.

I think I had a particularly bad experience. However, when I originally broached the idea of natural birth with my OB and the possibility of not following every standard hospital procedure to the letter, he warned me that some of the nurses might push back and some may even be unwilling to deal with me, which was fine. That’s why I wrote up a birth plan. But I never imagined the amount of hostility I would have to deal with. I wasn’t questioning their ability to do their job - I just wanted a say in how I and my son would be treated. It would have been nice to have a third person there who could have worried about that for both me and my husband.

22

Wow, those type of anecdotes really give me the willies about the whole experience. I’ve heard about the catty remarks from my mom but I think out of the whole slew of experiences you’ve detailed I’d be most upset about the sugar on the pacifier thing. My answer would have been “umm, yes I want my baby to cry!!”

Do they have places where you can have a doctor for the birth but it’s a more birthing center type environment? Or in cases of real emergency, they can take you to a hospital very quickly?

23

I’d have to check my pregnancy/birth books, but I’m pretty sure your midwife will visit every day for two weeks following the birth, and quite often for another four weeks after that. That sounds heavenly.

Yes. My husband is a force to be reckoned with if he thinks anyone’s shoving either of us around, but he’ll probably be pretty busy rubbing my back and holding my hand. And neither of us speaks medicalese, so an advocate that would speak the same language as the doctors and the nurses would be more than handy. It’s my pregnancy, my labour, my baby, not a faceless medical emergency.

24

I had a family practice doctor (or GP) for my pregnancy and I liked it. Granted, I haven’t seen an OB for a pregnancy so I don’t have comparative info, but I liked the outlook and the sense of whole-body care–I mean, I saw him for everything, not just what was preggo-related. AND, best of all, I am still seeing him. As is the child who resulted from the pregnancy. Continuity of care is great, and I like that he knows our whole family.

One thing I read–which may or may not be grounded in reality, so take it for what it is worth–is that GPs have a unique perspective because the result of the pregnancy often becomes their patient! They see, firsthand, the result/outcomes of certain care decisions made during pregnancy, labor and delivery, and not just in the moments after delivery.

I had a long labor. I dunno, time is a different thing, and you’ve got hormones and adrenaline working for you some of the time. I stayed awake and lucid a lot longer than you might think. Granted, in the end I didn’t have to push.

I also loved having a doula.

25

I’ve found the post that pushed me over the edge into paid membership. I’m a newborn Doper!

This is a subject I’m pretty passionate about, mostly because I feel that too many people are unaware that there are choices available. I’m glad for you that you’ve approached the issue of a birth caregiver with an open mind! So many people assume that you must have a baby in a hospital with a doctor. Period. Or people assume that this is the only safe way to birth a baby, which statistics show is not true. (I could dig up cites if you really want, but they’re easy to find)

I have had two babies since 2004. Both births were attended by certified nurse midwives in a freestanding birth center in Pittsburgh. I loved both pregnancies and births - they were real peak experiences - and I attribute much of my positive feelings to the care I received.

I was between OBs when I became pregnant with my first daughter. After much reading, I realized how medicalized normal, healthy births can get. I’ve encountered my share of dismissive doctors who treat the patient like a number at best. I knew good OBs were out there, but I didn’t have time to go about finding one. I’ve also heard plenty of stories of doctors that tell the patient what they want to hear regarding things like natural birth support and episiotomies and then go ahead and do what they want instead.

My reading up on pregnancy gave me a strong desire to have minimal interventions in birth. I wanted to move around. I didn’t want food restrictions or “just in case” i.v.s. I wanted a good chance to not need or want an epidural, and had faith in my body’s ability to give birth without me or anyone else tinkering with the process any more than strictly necessary. I decided that midwives would be my best chance at feeling like a respected person instead of patient #3694.

I was right. With the first pregnancy our first appointment with the CNM made my husband’s initial skepticism disappear. It took about 7 months for him to be comfortable with the idea of a birth center birth (my midwives also have hospital priveleges and in a normal, healthy pregnancy the client gets to chose whichever she is comfortable with). I’m pretty certain my mother-in-law is still convinced I’m insane, but is too polite to say so. Every prenatal appointment gave me ample time to ask any questions. I never felt rushed or pushed into anything. The routine bloodwork and standard tests were all done, same as if I had gone to an OB. We declined the triple screen, but did have ultrasounds done. A thorough class that had a natural slant to it was mandatory for clients that wanted to birth at the center. As my due date approached, I felt calm and excited and capable.

Then I had the 54hr labor from hell. (this story to clarify for those wondering how a person copes with such a thing)

I started having contractions New Year’s Day. They were easy and 10 minutes apart. I timed them and walked the neighborhood. I called the midwife for a heads-up. The rule of thumb we had been given in class was to call when they were 5 minutes apart for over an hour, which I did. I went in for an evaluation and found out I was only 2cm dillated. I was sent back home with a scrip for Ambien and managed to get 6hrs sleep that night although the contractions were still 5-10 minutes apart. The second day was uglier. I couldn’t relax through the contractions anymore. I was miserable. They were still coming every 5 minutes. I went in to be evaluated and was still only 2cm. We scheduled an induction - I was to go to the hospital the following night. There went my hopes of being in the birth center, of not having pitocin, and I figured if I had pitocin there was no way I’d make it without the epidural. That night I took an Ambien, but woke 2hrs later at midnight, yelling through the contractions. By 4:30 in the morning I decided that I would like to be knocked unconscious with a bat, or maybe to have an epidural, and had my husband phone the midwife as I could no longer talk. She suggested we meet her at the birth center for a check. I figured it was a waste of time because I was convinced I was still at 2cm, but decided to humor her.

I was dillated to 9.5cm and had started pushing involuntarily by the time we got to the center 20 minutes later. I was thrilled! Gone was my wish for sedation by bludeoning - the end was in sight! I labored in the jacuzzi tub for a bit, and pushed for a very long time. The midwife and nurse were there the whole time, helping when needed, and backing away when we wanted space. My daughter was born in a quiet, beautiful room in a big four-poster bed with my husband beside me. She was placed immediately on my stomach and we were never separated for a moment. After we were all cleaned up, the midwife tucked the three of us into bed and brought us waffles and juice, then left us alone to bond for a bit with the lights dimmed. It was very cozy. They made sure the baby and I were fine by monitoring us for about 7hrs, and we were home in time for dinner. A nurse came out to our house to check on us the next day.

The second birth was even easier, and only 14hrs. The baby was 9 days late, but rather than push an induction, the midwives ordered a non-stress test which she passed with flying colors. Contractions started gently in the morning, got heavy at lunch time, we went to the birth center around 1:30 and I was at 6cm. I hung out in the tub again, part of the time with my belly in the water and an ice pack on my back to try to turn the baby as I was having back labor. The midwife and a nurse were there the whole time, supporting, suggesting, and I was able to make small talk between contractions until transition hit. After only 20 minutes of pushing, my second daughter was born in the same big bed, with the same cozy family time after (only this time we had eggs and English Muffins, and only got one fork so my husband had to feed me). Daughter #2 was born at 6:19 p.m. and we were home in time for the Late Show at 11:30.

I suppose I’ve written a book for my first “real” post, but my point is that I never felt marginalized or condescended to. All decisions were made together as a team, with my full informed consent. With the first baby, I was allowed to labor naturally (by choice) at a time when I believe many doctors would have had me on a pitocin drip by day two. The midwife had a whole bag of tricks for easing back labor with the second baby, and was there with me to suggest them. We never felt that we needed to advocate for ourselves against something we didn’t agree with. My recoveries were short and sweet. The lack of poking and prodding and hospital food was lovely. The positive nature of the prenatal care gave me every confidence that I could have a natural birth and that it could be a beautiful thing. It was.

Birth doesn’t have to be some horrendous ordeal. I’m not going to say it was simple or painless, but it was probably the most powerful thing I’ve ever experienced. I thank my midwives for allowing it to be so, rather than make it into a medical emergency.

26

I wasn’t having full-on contractions the entire time, just for the last 18 hours or so when I had the pitocin drip. I had every intention of having a natural birth so I did not have any anesthesia. Labor is definitely painful but I had read a great book on natural childbirth so I had some techniques for dealing with it. (And I was fine dealing with the contractions as long as I was left alone; the worst pain was when I had to lie down for an examination). By the time babyflower was ready to come out, I was exhausted. The lack of sleep wasn’t the issue, it was the lack of food. They wouldn’t let me eat just in case I needed surgery. And, of course, that is exactly what happened - I was too tired to push (but still tried for 2 hours) and finally ended up with a c-section.

27

That was a big concern for me with a hospital birth as I know I don’t cope well with anything when I’m hungry.
With my 2nd daughter, a urine dip revealed ketones and they actually pushed foods on me. I was lying in the hot tub eating cinnamon toast and oranges and sipping cranberry juice mixed with Sprite. It was lovely (or at least it was between contractions).

28

I had an OB and loved him.

If you want a very personal birth experience, I’d recommend a doula. No matter which professional you hire, they can’t guarentee that they will be able to stand there through the labor - they have other patients in labor and other patients needing to be seen for appointments. Most doulas will schedule their clients in such a way that the chances of them having two births going simultanously are almost none - nor will they decide to go on vacation. A doula is as good as you can get to making sure that someone you pick will be at the birth (except your husband). Of course, the baby could come while the doula is sick and your husband is out of town (three weeks before your due date), but lets hope that doesn’t happen.

With a doula in your pocket, pick the professional that works best for you. If your pregnancy is high risk, I’d highly recommend an OB over any other option since an OB will be right there if a c section is required and will have the most experience in dealing with high risk births (In the practice I went to, I wasn’t given the option of a midwife due to “advanced maternal age” and previous infertility. My sister who conceived via IFV had to use a OB, not a GP or a midwife by contract with the IVF clinic.).

My OB did make every effort to “catch” his own babies - which is rare. Often the practioner on call for the practice will deliver, not the person you’ve been visiting in the office for the past nine months. A girlfriend who had been seeing a midwife because she “really wanted a midwife” ended up with the OB who was on call since her midwife (who had a practice with midwives and OBs) wasn’t on call for deliveries that day. Check out how your practice handles deliveries.

29

Ooh! Lissla! Slightly off-topic, but: go out and get a copy of The Big Book of Birth by Erica Lyon. It is FABULOUS. I’m reading it now – only about 40 pages in – but it is so incredibly great. She explains what happens during each phase of labor, and does so in simple, clear terms. She’s encouraging and positive – she presents your options (drugs/no drugs, and what each drug does, and what effects it has) without telling you what you should do or not do. It’s just wonderful. The book has drawings, too, and that’s great because it’s informative without being so full-color that it’s scary.

I told my husband last night that he definitely needs to read at least certain chapters of it, because he doesn’t really understand the whole labor process. This explains it in straightforward, non-medical language, so I think he’ll get it without being overwhelmed.

If you can’t find it in Canada (it just came out… last month? March, maybe?) send me an email (in my profile) and I will mail a copy to you.

30

When my wife was about to deliver our fourth child the OB present was someone we did not like in the least. With her was midwife from the same practice who had never delivered a child before. At 0800, the time she was to be off the OB got even more grumpy so we convinced her to leave, saying we thought it would still be hours, based on personal past experience. When she left we immediately told the midwife she would be doing her first solo delivery in about 15 minutes, which was exactly correct. Basically, since delivery is not an illness, but a natural process, any one can do it (even police officers and taxi drivers). Go with who you feel most comfortable with, but I predict things will go smoothest for you if you use a midwife rather than an OB. Also, don’t discard the idea of an epidural. When properly done it has little or no effect on the time of labor, and can help quite a bit with the pain. Unfortunately, doing one correctly is fairly difficult. The idea is to dull the sensory nerves while keeping the muscle nerves at full power.

That being said, if, for some reason, the pregnancy is considered increased risk, go with the MD for the baby’s sake.

31

I went with a midwife for both of my births. My reasons were: 1) I like the less-medicalized approach (although I ended up using a wide variety of medications with #1), 2) I liked the more dedicated attention a midwife provided, especially during labor. With my first, the poor midwife spent about 27 hours with us. I don’t think most OBs will do that. I was very grateful. With my second - a much shorter labor - I was pretty much left alone with the midwife coming in occasionally to make sure I was still doing my thing. I don’t think she said more than a couple of sentences to me between the time I arrived and the time I started yelling that I wanted to push. That was also much appreciated.

Good luck with your pregnancy!

32

The degree doesn’t matter near as much as whether or not your personalities mix. I should have had an OB for births 3-5 (I was technically high risk) but I chose an GP because I loved her bedside manner. I could ask her questions and get thoughtful answers. i was never condescended to and I never had her views pushed on me. I had as much control over my births as you can have.

As long as you are choosing a competent professional, go with someone who meshes with you best.

33

Both of my children were born at home in the company of a wonderful midwife (she’s written a delightful book about her experiences which I highly recommend: http://www.babycatcher.net/)

My wife was very resistant to letting go of the first, our son. The midwife was incredibly patient and resourceful in her handling of both the mother and me, the nervous dad. After stalling for hours, she finally put my wife in the bathtub on her knees and gave her an enema. Bingo. Apparently the body has an “everything out, right now” response.

But having learned that the fastest way out was to head straight into the pain, my wife practically projectile-delivered our second child. When the contractions started coming regularly we called the midwife. She asked a few pertinent questions over the phone and realized that things were happening very quickly so she jumped into her VW bug and sped over, jumping the curb and doing a doughnut on the front lawn to stop the car.

Right she was, ten minutes later we had a healthy baby girl.

I’ve attended a few hospital births and visited many recovering moms in hospital. Everyone is different and must decide for themselves what they want, but the comfort and convenience of having the baby, pulling the sheets and rubber undersheet off the bed to expose another fresh set of sheets below and climbing in *already at home * with our new baby was pretty hard to beat. And warm, nurturing, confident safety of being in the care of an experienced midwife made the experience profoundly human, in the best sense.

34

Oh, one of my favorite topics! Short answer: MIDWIFE!

Long answer: from my reading, it seems that OBs are generally taught how to handle pathological pregnancies and deliveries (and thank Og we have them for that, I’m not saying they’re evil), and they are taught that technology is by definition good. Unfortunately, they also have to worry about being sued a lot, in a culture that perceives intervention as responsible and watching and waiting as negligent. Thus, OBs tend to want to hook women up to the machine that goes “Ping!”, do routine IVs, starvation, confinement to bed, worry about “a big baby” (when in reality estimates are pretty damn unreliable), induce labor for no good reason, and resort to c-sections at the drop of a hat. If you have an uncomplicated pregnancy, this approach is likely to cause problems, rather than solve them.

I think the thing that makes me craziest is what I call the “OB intervention cascade,” which I see in birth stories all the damn time. OB does an u/s, and says the baby is “big,” so suggests induction. Mother and baby aren’t ready to give birth, so the induction is tough. More and more pitocin is used, which causes monstrous contractions - way more painful and more dangerous to the baby. So of course an epidural is required, as well as continuous EFM, which means mom is stuck in a bed, which slows labor, and the EFM is likely to give false positives on the baby being in distress. So of course then the doctor says they have to do an emergency c-section. The baby and mother go through all the risks of that, and maybe the baby is even premature after all. Compounding that, c-section is hell on baby’s lungs, so baby is in the NICU, mom is recovering from surgery, breastfeeding is disrupted or destroyed, and mom and baby’s health is further compromised. And usually everyone is so thankful to the doctor for “saving” the baby! :mad:

Midwives tend to look at birth as a healthy process, and go for low intervention, which is less risky for mother and baby. They also tend to have more rapport with the family, and stay with the mother to help her through labor.

But there are OBs that take the “midwife” view and midwives (especially those that practice in hospitals or in OB practices) who take the “OB” view. You have to talk to the individuals involved.

Super long answer is this: read The Thinking Woman’s Guide to a Better Birth, by Henci Goer, and/or Ina May’s Guide to Childbirth by Ina May Gaskin. They both cover a lot of the science on routine obstetric intervention, and address things like chosing a caregiver. Also, take a Bradley class- they are fabulous!

I really loved Ina May’s discussion of Sphincter Law. Basically, humans need calm, safety, and privacy to relax sphincter muscles. Imagine trying to pee on a toilet in the middle of a hospital room, with no lock on the door, lights blazing, and strangers walking in and out all the time, checking on your progress, intimating you can’t do it, and sticking you with needles and stuff!

My personal story is that I did all this research, and as a result had an unmedicated birth in a freestanding birth center with midwives. It was an excellent experience, and I was surprised - it was nowhere, *nowhere *near as hard or as painful as I suspected. I was “allowed” to eat and drink as I wanted, and no one pushed drugs or interventions on me. I felt safe and relaxed. I highly recommend it!

Congratulations and good luck.

35

I chose OBs who had their own practices and were not part of practices with other OBs. That meant that I would only deal with one doctor and would not be handed off to some other doctor from visit to visit. Midwife was not a possibility for me due to risk factors like age, gestational diabetes, and group B strep. I also had a partner I could rely on to be with me during labor. If I had not, I would have strongly considered having a doula. I found having someone who knew my preferences and would back me up essential.

I had my first child in a hospital without an epidural. I went to the hospital about 9 am and at 5:19 pm, my daughter was born. The nurses were great even though not having an epidural was clearly unusual to them. One scoffed at me when I first arrived and I requested she not be allowed in the room again. I did not see her again. After I gave birth, my nurse allowed me to nurse my daughter for nearly an hour despite the usual protocol being to give babies of diabetic moms sugar water. She made good suggestions that helped me get started nursing and then confirmed that my daughter was latched and swallowing and that colostrum was visible at the corners of her mouth. She put off the nursery twice to allow me to continue nursing. By the time my daughter was finished eating, her blood sugar was in normal range and so they did not giver her any formula or sugar water.

My son was breech at 36 weeks and would not turn. My doctor who had been very good about discussing things with me stopped answering my questions and so I changed OBs. He would not discuss the reasons he was making certain choices and kept insisting my son was about the same size as my daughter had been, which shook my confidence in him; I could tell that I was carrying a much bigger baby this time. I had moved so the location of the hospital and OB’s office was inconvenient, and I had issues with security guards harassing me at the hospital after I had asthma attacks due to other patients with perfume, so the OB not talking to me was just the last straw.

I lucked out and found a great OB who had his own practice, and his office was only 10 minutes from my house. He still advised a c-section, but was much better at articulating why and gave me assurances that he would verify my baby was still breech via ultrasound immediately prior to surgery and if he was not breech then he would induce me so I could give birth vaginally and we would not risk him tuning again before I went into labor. I expressed colostrum prior to the scheduled surgery so that he could still be exclusively breast fed. As it happened, not only did he stay breech, the cord was wrapped around his neck three times. C-section was a very fortuitous choice for me. My partner was able to stay with my son and fed him my colostrum and even though that was a very unusual choice, the nurses were supportive and did not scoff, but instead praised our foresight. The doctor was great during surgery and for follow up. The incision healed very quickly and is barely visible. The worst part of it was that I had a rash and itchiness due to some of the pain medicines in the spinal I was given. Still the relief they gave me was worth it. I was able to nurse my son well as soon as I was out of recovery, and I don’t think I could have done so well so soon without the pain medicine.

If you have minimal risk factors, a midwife may be a good choice for you, but if it turns out you need a doctor, having an OB with a single doctor practice is a good way to go, especially one who is a competent surgeon. In any case, have someone at your side who has your interests in mind whether that be a partner or a doula.

36

I will tell a true story. Make of it what you will. My daughter-in-law is a family practitioner who also has an MSc in epidemiology and biostats. She also delivers babies, scads of them. When she got pregnant, she said that OBs had worse outcomes, statistically, than either family doctors or midwives. She added that there were only three or four family doctors doing deliveries in all of Manhattan and she was one and another was her colleague (who was presumably reluctant). (No idea about the other one or two and it seemed clear that she would have preferred her clone). At any rate, she chose a midwife in a hospital and was entirely happy with the results.

37

This is no doubt largely due to the fact that GPs and midwives will generally not take on high risk patients and will transfer patients that become high risk to OBs. Nor do midwives or GPs get last minute patients through the ER who have had no previous prenatal care. This is not to denigrate midwives and GPs in any way, or even question the validity of the statistic, but it doesn’t mean that OBs cause the bad outcomes.

38

IIRC, in studies where such variable were controlled, and only low risk, non-emergency pregnancies were compared, OBs still had poorer outcomes. If for no other reason, this would probably happen just due to continuous EFM, which gives greater false positives for fetal distress without compensatory protection against harm, thus leading to more c-sections without saving more babies.

39

What’s the definition of better outcomes?

40

Dangerosa, the metric I see most is perinatal deaths, either maternal or infant. Midwives also have lower c-section rates (for similar risk pregnancies), and of course an unnecessary c-section by definition is a poorer outcome, involving pain and restriction of movement at the very least, and possibly disrupting breastfeeding, as well as increased health risks for mother and baby.