Midwives Practice vs. Ob/Gyn Practice

[zipzapgirl]

I just found out that I am expecting

I have an Ob/Gyn in the city I work in (1 hr. commute every day), but I think I need to switch to a local doctor for my pregnancy and delivery. I have done a lot of research and think I will use the hospital ~20 mins away, not the closest, but there are no residents and they have lots of birthing options. I'm healthy, 32, and have no elevated risks.

Now I have to choose whether I want to use an Ob/Gyn or the Midwives Center. Either way, I would do all prenatal visits with the respective practice and one of the practitioners would deliver the baby; basically it's all midwives OR all doctor all the way. The midwives area is on the same floor as the normal labor & delivery, same facilities. There is a doctor on call specifically for the midwife patients and emergency C-Sections, Neonatal care or other interventions could be done right there on site. However, you might never meet this doctor until you are being wheeled into surgery, so it's not really that they are working hand in hand, it's really a backup plan.

As I mentioned before, I do not have a current doctor in the area, so my first prenatal visit will be all new no matter what and I am not tied to any current doctor who could do the delivery. I like the idea of the midwives practice, but I am a little scared to go 100% down that path. I feel a little pressed to make the decision now before I go in for my first visit because it would be silly to start the process all new somewhere and then move after 1-2 appointments.

I've done lots of reading and discussed with friends about their deliveries. I would like minimal intervention like pitocin and I really want to avoid a C-Section, but I haven't ruled out an epidural. In general, I am trying to stay open-minded and not get hung up on war stories or philosophy, but I do want to try to have a practitioner who also cares about my health and not just not getting sued, rushing things along, or ignoring my overall long-term well-being.

This has turned into a bit of a ramble, but I am interested to hear opinions on which practice you would go with. Does anyone have any experience or insight?

 

[somethingshiny]

I would call both facilities and ask questions that are important to you.

What rate of intervention do they have?
If you want an epi, could you get one?
Do they advocate laboring at home?
How long after waters break do they want baby out?
What is the overnight routine once at the hospital?
If you go with the Midwife and end up needing a c-section, who would perform it?


After that, I'd make the decision. And, there is no shame in changing your mind and doctor even if you're halfway through. You have to make the best decisions for yourself and your child. I ended up switching doctors with 6 weeks left of my pregnancy. My ins dropped the first so I had to switch, but no one batted an eye.

Good luck with your decision and the pregnancy!

 

[megumic]

Congrats on the good news!

I don't have kids and have never been pregnant. That said, I have done A LOT of research on midwives for both a paper and for my own edification, as we plan to TTC soon and are planning for a homebirth with a midwife.

I would say your best bet is to do your own research first, and personally, I'd meet with both. You want to be comfortable with your practitioner and accordingly should have a few options. If you only meet with one, you won't have anyone to compare him or her to. I would do your research and figure out what kind of birth exactly you want (ideally, as you never know what may happen). Then go into meet with each and without revealing your birth plan, ask them how they would handle xyz situation. I use this approach with health care providers all the time so they don't just tell me what I want to hear, but they tell me what they would do. That way, I can assess how comfortable I am with their logic. Also, I would certainly ask for references from other women who have delivered with each health care provider.

Personally, I think the care you will receive from a midwife will be much different than the care you receive from an ob-gyn. You said in your post that you'd like to avoid a c-section. Your best bet for that is to find a midwife who you are comfortable with, or an ob-gyn who allows you to take your time.

Also, I'd read some books about birthing -- two reccs: Pushed by Jennifer Block and Ina May's Guide to Childbirth. They both have a lot to say about the interventions you mentioned.

A few sites worth checking out:

http://www.mothering.com
http://www.childbirth.org/section/ICAN.html
http://www.midwiferytoday.com/

 

[charbie]

First, congrats!

I have a bit of a commute as well, and while I know you didn't ask this question, are you sure there aren't any docs who may be affiliated with the hospital you want to deliver at but have offices close to work? I ask bc you're going to have a ton of appointments, especially the closer you get to birth, and you want to make sure they will fit in with your schedule. Im also expecting, and found a private practice doc who only delivers at the hospital I prefer, has an office there, but also has an office just a few miles from work. He also has early hours, so I can make appts in the morning and not even miss work. Just a suggestion to maybe look into.

Something I would ask the docs office is why they don't work with MW's. My doc in particular used them in the past but had some not so good experiences with a few, so decided to stay on his own. Its harder for him, especially since its just him, but he prefers it that way.

I see no problem with calling the offices at both and scheduling a "meeting" if you will. Doesn't mean they need to do a full examine, just that you will learn about their practices. My doc offers a full birth plan based on your own wants and needs, asking every question possible, leaving all options up to you. See which practice fits better for what you want...you may find there are ob/gyn offices out there who will follow your wishes. I liked the intimacy of a private practice doc, knowing who will see me each and every appt and if he isn't there for the last 20 mins of labor when I actually push the kid out, ill be ok with it.

Good luck, and join us on the just barely preggo thread!

 

[Pandora II]

I'm in the UK and this information is what happens in the area of London I live in:

Here you are mainly seen by midwives

- a low-risk pregnant woman will see only her GP and a community midwife (comes to your house) from the first appointment to when she leaves hospital with the baby (baby sees the paediatrician before leaving hospital obviously).

- I was high-risk and so saw the midwives at the hospital and had 3 appointments with the OBs (2 different ones depending on who was on duty).

When you go into labour:

- low-risk go to the 'home-from-home' side which is staffed entirely by midwives and has things like water-births available. Epidural is not available, only Entonox. If something goes wrong and you need a crash c-section or similar or you decide you want an epidural then you just go down the corridor to the hospital birth centre.

- high-risk or those who know they will want the epi go to the 'hospital birth centre' which is staffed by midwives and OBs. However you will only see the OB if something is going wrong. The midwife will stay with you for the whole labour and deliver the baby.

I had a forceps delivery in the OR and had never met any of the 3 OBs who delivered my daughter. Quite honestly it didn't really matter - they knew how to do a good job and keep us safe and that was what I cared about at the time. Reading PSers birth-stories I've always thought it's a bit weird when people have to wait to push so the OB can get there to catch the baby...

It is FAR FAR more important to like your midwife as you will be spending a very long time with her potentially - I was in labour so long I got through two of them!

Before I was pregnant I was convinced that OB was the way to go and not the midwives - having been through it, I think the OBs are fantastic when there are problems but when it comes to normal straight-forward births then midwives are the way to go.

I will say that I don't know how midwives are trained in the USA and whether they get as much hands on training in actual deliveries as ours do over here.

(One big thing that differs over here is the length of time they let you go after your waters break. Most hospitals here start induction and IV antibiotics if you haven't delivered within 36 hours - from what I understand most hospitals in the USA like you to have delivered within 24 hrs. Having been in that situation it's something I would make sure and check. I didn't want a c-section unless I absolutely had to and I'm sure that in the US I would have ended up with one due to the length of time after my waters broke).

 

[dreamer_dachsie]

In my experience in two pregnancies, you get a lot more time and personal care witha midwife, and aftercare for nursing help too. This may not be offered by midwves in your area so double check. Those benefits are really worth choosing a midwife, and in my experience as well if you need care from an OB they consult or transfer care, and you can get an epi if you want, so I personally see midwives as a bonus above and beyond and OB, because you get all the care you would get with an OB plus more personalized care and time.

 

[MichelleCarmen]

I just found out that I am expecting

Now I have to choose whether I want to use an Ob/Gyn or the Midwives Center. Either way, I would do all prenatal visits with the respective practice and one of the practitioners would deliver the baby; basically it's all midwives OR all doctor all the way. The midwives area is on the same floor as the normal labor & delivery, same facilities. There is a doctor on call specifically for the midwife patients and emergency C-Sections, Neonatal care or other interventions could be done right there on site. However, you might never meet this doctor until you are being wheeled into surgery, so it's not really that they are working hand in hand, it's really a backup plan.?

Hi,
This ended up being my situation. I chose midwives for both pregnancies. With my first, I began with a obgyn and then switched to a midwife group (four ladies who rotated care). I was expecting a risk-free pregnancy and am normal weight (115 lbs approx) however, was dx with gestational diabetes, which put me in the "high risk group." Even with that, the midwives were still my primary care givers.

The midwife group was in a hospital so there was the security of knowing IF there was any problems, a dr. could take over.

What ended up happening was after I was two weeks late, they induced me with pitocin and I had asked for no pain meds, but finally caved and was given a shot of pain medication and when that wore off, opted for an epi. Labor went on for a long time and in the end, I DID need a c/s and luckily there was a dr. close by so everything went smoothly.

With my second, I also chose to have midwives with a planned c/s with a dr. (who I never met beforehand).

Maybe to some it may be a bit impersonal to have a dr. you've never met do a c/s but I can say by the time they told me I was going to have to have one, I didn't care. I was SO tired and just wanted to hold my son.

 

[noelwr]

like Pandora, I'm in Europe and you have to go with midwives unless you are high-risk. there just aren't enough ob-gyns here. I went to a midwife practice at the hospital. every time I visited, I would see a different midwife (one was even a man!) as they want you to meet the whole team because you don't know who will be on call during your labor. all they did was listen to the heartbeat and feel my belly on the outside. they weren't qualified to do ultrasounds. I had to make separate appointments. but at least I was in the hospital so if something was wrong, I felt safer that I was nearer to the doctors.

I always knew I'd end up in childbirth with an ob/gyn because of my wish for an epidural, so it wasn't like I was trying to establish a relationship with the midwives. in the end, I had other complications relating to my health and not the pregnancy, so we ended up at another hospital and met with a whole team of different ob/gyns. they were all great and I felt much "safer" with them than the midwives. plus I got to see our baby on more ultrasounds! I was induced and the gyn was young, cute and great, but at that moment in time you really could care less. you just want to get your baby out!

 

[Octavia]

I'm not pregnant, but my OB/GYN recently moved so I have to find a new one. And I am torn because I could stay with an all-physician practice, go to a mixed physician/midwife practice in the city I live in, or go to a midwife-based practice at a birth center that is further away in the suburbs. I'm leaning toward the last option, since what they offer sounds like what I'm most interested in, but a pregnant friend is using them now so I'm waiting to get the full report from her before I make a decision. Really, I think it depends mostly on your needs, wishes, and comfort level. I think it's a great idea to get opinions from other people, if you can, and to talk to people at both practices to get a feel for each. Then you can make an informed decision rather than just guessing.

 

[Pandora II]

like Pandora, I'm in Europe and you have to go with midwives unless you are high-risk. there just aren't enough ob-gyns here. I went to a midwife practice at the hospital. every time I visited, I would see a different midwife (one was even a man!) as they want you to meet the whole team because you don't know who will be on call during your labor. all they did was listen to the heartbeat and feel my belly on the outside. they weren't qualified to do ultrasounds. I had to make separate appointments. but at least I was in the hospital so if something was wrong, I felt safer that I was nearer to the doctors.

I always knew I'd end up in childbirth with an ob/gyn because of my wish for an epidural, so it wasn't like I was trying to establish a relationship with the midwives. in the end, I had other complications relating to my health and not the pregnancy, so we ended up at another hospital and met with a whole team of different ob/gyns. they were all great and I felt much "safer" with them than the midwives. plus I got to see our baby on more ultrasounds! I was induced and the gyn was young, cute and great, but at that moment in time you really could care less. you just want to get your baby out!

I'm not sure which country you are in, but here we only get a max of two ultrasounds which are done in a specialist unit in the hospital by a qualified sonographer (OBs aren't qualified to do in-depth ultrasounds)- I got a couple extra for placenta previa and a specialist cardio-scan because of the meds I was on. When I saw the midwives they would do a urine test, measure the fundal length and feel the baby, listen to the heartbeat and discuss any issues that you might have.

When I saw the OBs, I was sent to see the midwives first to get all the measurements/tests done and then just saw the OB for a chat about my risks.

Also, internals are not done in the UK until you are in established labour to minimise the risk of introducing infection and because it's pointless - whether you are dilated 3 centimetres or nothing at all says nothing about when you will go into labour.

 

[yennyfire]

I used midwives for both of my pg's and deliveries. My rationale was that they were less likely to use medical intervention to "hurry" things along, as long as the baby and I were ok. With my son, I was 10 days overdue and he wasn't looking good on a stress test, so they sent me to the hospital for an induction. Basically, they broke my water and he arrived about 90 minutes later, in the midst of an epidural, which was never completed, lol!

My daughter was induced at 38w because I had slipped a disc in my back and was in such pain, I couldn't walk, much less care for my 18 month old son. They started pitocin, gave me an epi and broke my water. I labored for about 4 hours and out she popped on the way to the delivery room (they were full that day in L&D so I had been in the ER for several hours while they waited for a room to open).

The reason I shared my experiences with you is that both of my births involved pain meds/epi's but were managed by midwives. There was a doc on call had I needed a c-section or had the mw felt there were complications.

I felt that the midwives were much more willing to let me try different positions, showers, massage, etc. They spent quite a bit of time with me, while I've heard that in my practice, the nurses are with you until it's time to deliver. The bottom line is that you have to be comfortable with the person/people who will attend you during L&D. That's how I'd base my decision in the end....