Midwife vs. Ob

iVillage Member
Registered: 03-28-2003
Midwife vs. Ob
14
Fri, 03-28-2003 - 6:42am
I already posted this question to another board, but I am having a hard time deciding between using a midwife or an ob. With my first child I had an ob and although I really liked the doctor.. I wanted a natural birth and he sort of laughed at me when I told him this and then explained all the different medication options there are! I also delivered in a hospital and the nurses kept asking me if I wanted an epidural yet everytime they came in... so of course after a while I got one.

Anyway.. heres my delima:

I prefer men doctors over women

I feel like an ob would be more knowledgable about pregnancy symptoms or complaints I might have.. cramping, breast pain (those are my two right now LOL)

But...

I really want a natural birth and want someone who will help me through it and be there to keep me going.

What are your suggestions and where can I find a midwife in my area?

And I know that a midwife is probably just as knowledgable if not more so about pregancy and birth.. It's just been instilled in me to use a doctor for so long that it's hard to see past that... if that makes sense?

Sorry this was so long!

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iVillage Member
Registered: 04-22-2003
In reply to: brmom2
Tue, 04-22-2003 - 12:44pm
hey,

I've never had a OB and this is my first pregnancy so I don't have a lot of experience but the little I do have makes me never want to have another baby without my midwife at my side. The experience of the midwife has been so personal and it's wonderful to have the options that she's encouraging me in.. I'm planning for an unmedicated birth and she's been the best in helping me to learn how to deal with the pain and other discomforts I know will be coming, and have already started going through. I also have a friend who's due 4 days after me who went OB and has nothing like the relationship and personal touch that I have been given by my midwife. The other thing I look forward to is the fact that my midwife will be with me from the moment I start labor through to the end, not traveling from room to room accomidating 4 or 5 other's, but focusing on me and my delivery.

but like others have said the best thing I can think of is to go interview, and decide what suits you personally.

~Syndi

iVillage Member
Registered: 03-29-2003
In reply to: brmom2
Thu, 04-17-2003 - 12:36am
Doula? I would never recommend a hospital or an OB or a CNM to anyone. But if you're set on what you're set on, then perhaps a doula might be an option. Perhaps a Doula who is studying to be a MW or at least one who is highly knowledgeable in birth.

FWIW, I've yet to encounter any OB who is more knowledgeable about birth, etc. than any MW. Go to homebirth and unassisted childbirth boards and lurk for a while. Read archives. Then you'll see what I mean. I'm not going to try to convince you because I personally don't even like having a MW at my birth. I do unassisted becasue I am thne in control and more in tune to my body.

Best wishes.

iVillage Member
Registered: 04-06-2003
In reply to: brmom2
Sun, 04-06-2003 - 11:55pm
I hope its okay for a lurker to post their 2 cents!

I prefer men doctors over women

- Hmmm... I not sure what to comment about this one. I could write a whole post on men vs women in attendance in childbirth, so I will just skip this one for now.

I feel like an ob would be more knowledgeable about pregnancy symptoms or complaints I might have.. cramping, breast pain (those are my two right now LOL)

- Quite frankly I don?t believe OB?s are more knowledgeable. They may have more theoretical knowledge on pathological, ie medical conditions, in pregnancy, but the issues you are dealing with are physiological in nature, ie a normal part of pregnancy, any woman who has been through pregnancy will be able to reassure you about the normalcy of cramping, provided it is mild and isn?t accompanied by bleeding, which would suggest a threatened miscarriage, in which case even an OB won?t be able to do anything to turn an unviable pregnancy into a viable one. Many midwives will be able to offer you some nutritional or herbal advice to help though.

- OBs may not be the most reliable experts in pathological situations either. Here?s why. There are approximately 36,000 practicing OBs in the US for around 36 million births per year, this equates to a typical OB being in charge of about 100 births a year. This OB will typically experience one twin birth a year. It would take him/her five years to be confronted with one shoulder dystocia, ten years to see one real placenta previa and a whole career to experience one real eclampsia. So even in emergency situations, an OB cannot really be called an ?expert?. But then again with just 5000 CNM in the US, a midwife will have even less experience of these conditions. Thankfully these truly life-threatening conditions are very, very rare. Except if you are me! Two of my three children had shoulder dystocia, but both were born safely and without trauma at home. One with a lay midwife who performed the Gaskin Maneuver and the other with the sole help of my DH who performed his own version of the Gaskin Maneuver. Had I been in the hospital with an OB in attendance, it would probably have been a major emergency, and both babies would either have been pushed back in and an emergency c-sec performed or I would have had a huge episiotomy and the babies would probably have had their shoulders dislocated as they were pulled from me. As it was, I had skid marks with the one born with the midwife and not a single mark with the baby born with the assistance of my DH.


But...

I really want a natural birth and want someone who will help me through it and be there to keep me going.

- Well, you don?t actually say it, but I am assuming you are planning a hospital birth and so would therefore be looking are hiring a certified nurse midwife rather than a lay (home birth) midwife, yes?

IMHO you really have to work hard to get a natural birth in a hospital, it just isn?t conducive to birthing as nature intended. And as many people have and will point out some OBs are very supportive of natural birth and some midwives are totally influenced by the medical model of childbirth. Then you have to factor in the nurses, which are probably just as important in a hospital setting because it is they that will caring for you throughout your labor, the OB will only put in an appearance once you start pushing. So I would recommend, regardless of whether you have an OB or a CNM, you stay home for as long as possible and turn up at the hospital when you are ready to push. If you go this route, then I would highly recommend you hire a doula to sit with you while you labor at home. I would however, be very careful in your choice of doula. What I write next will probably not be popular with everyone on this board, but it is just my opinion of who and what a doula should be. A doula should be a woman who has given birth ?normally? and should be the mother figure a laboring woman should rely on throughout labor. To labor effectively and naturally a women needs to feel safe and secure but not observed. A good doula should be able to create the environment where the laboring woman can do just that. I don?t believe a doula needs to coach or support. If the laboring woman is allowed the freedom to labor instinctively in safety, she will labor effectively and efficiently.

What are your suggestions and where can I find a midwife in my area?

- The phone book is always good a place to start. Interview several to see how you ?gel?.

And I know that a midwife is probably just as knowledgeable if not more so about pregnancy and birth.. It's just been instilled in me to use a doctor for so long that it's hard to see past that... if that makes sense?

- I have partly stated my opinion of this above. But I would like to mention a bit more about prenatal care offered by an OB vs a midwife. An OB is trained to look for abnormalities and pathological conditions. He/she relies on standardized tests for this. These tests often have a negative effect on the emotional state of a pregnant women. You just have to read through the posts on the expecting club boards to see that. They seem to come back from their OB visits with at least one thing to be worried about. Blood pressure too high, too low, too much weight gain; too little weight gain; anemic, placenta is low, baby?s too big, too small, positive GBS culture at 37 weeks etc... A pregnant women is no longer allowed to be blissful. Take the example of pregnancy induced hypertension. There are authoritative studies that show PIH is associated with good outcomes. But most OBs will worry a pregnant woman with that ?diagnosis?. PIH is not pre-eclampsia and does not warrent treatment. It actually is a normal physiological consequence of pregancy, an adaptive response, and could be considered a good sign of placental activity. OB Michel Odent uses the example: ?when you have a brain tumor, you have a headache; but when you have a headache, it does not mean you have a brain tumor?. The prerequisite for pre-eclampsia is the presence of protein in the urine. Otherwise there is no need to worry a pregnant woman. A midwife will treat pregnancy as a physiological state of being and will be much more likely to try and protect the emotional well-being of her client and will spend time to ensure this. Of, course this isn?t always the case as many will point out, but in general a midwife will spend much more time with a pregnant women that will an OB. When I had my midwife assisted home birth, my midwives spend between one and one and a half hours with me each visit. Most OBs spend a total of ten minutes with each patient. Also, I wasn?t my midwife?s patient, I was her client. This is an important distinction. Pregnant women are not sick!

This post has gotten very long. But I guess my point is generally speaking a midwife is going to provide you with a more nurturing/ holistic model of care than an OB, although there are exceptions. Knowledge is power, and I would highly recommend you do as much research as you can on prenatal testing and labor practices in hospitals regardless of whether you ultimately hire an OB or a CNM. I would also assertain if the OB or CNM practices evidence based care rather than SOP which tend to have their basis is convenience rather than sound science. Stay home for as long as you can and consider hiring a doula to sit with you while you labor.


Deborah

Mama to Ginny (elective c-sec - breech), Sasha (HBAC- with shoulder dystocia, cord around neck and nuchal arm) and Toby (UC - born gently and safely in the caul with cord around the neck, shoulder dystocia and nuchal arm - all ?medical emergencies? in a hospital setting!)

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iVillage Member
Registered: 03-28-2003
In reply to: brmom2
Sat, 04-05-2003 - 2:33pm
It sounds like you might be interested in getting a doula if you can.

You said, "I really want a natural birth and want someone who will help me through it and be there to keep me going."

That sounds like the job description for a doula. Because no matter how wonderful any OB is, or how much they support natural childbirth, I have never heard of one that actually attends you during labor except once you start pushing. I had an OB w/ my first & she didn't get there till halfway through pushing. But I suppose there are a few exceptions out there.

Rachel

iVillage Member
Registered: 03-26-2003
In reply to: brmom2
Mon, 03-31-2003 - 12:07pm
I like the fact if I need to talk to my OB for 30 minutes about being depressed he will patiently sit there, listen, and help me. His practice is extremely busy! I was in there this morning....no seating room first thing and women pouring in. He is one of THE most popular in our city. That is how everyone knows who he is here. I just could not have asked more from anyone caring for me and my baby. And personally, it is just me, but I HAVE to have a medical professional (hospital setting, hospital bed, nursing staff) to feel 200% comfortable and totally safe & satisfactory feeling! JMHO for me.
iVillage Member
Registered: 03-25-2003
In reply to: brmom2
Mon, 03-31-2003 - 10:06am
Yeah, I agree with you there.

The prenatal care I received from my midwife (RM) was still far superior to anything I have seen personally or professionally from an OB practice. She was able to spend more time with me, focusing on the emotional and psycho-spiritual aspects of the pregnancy as well as the physical stuff. OBs usually see such a huge volume of women, both because the medical model is more popular among the mainstream and to be able to avoid malpractice insurance, they are not able to provide that level of support, even if they wanted to.

Even though my midwife’s approach was more clinical than I would have wanted, I don't know if I would have made that trade-off.

Christy

Christy
Stay home rocky mountain mamma to

iVillage Member
Registered: 03-28-2003
In reply to: brmom2
Mon, 03-31-2003 - 8:14am
Oh, you are right.

I am speaking in generalities. Despite being of the "midwife" mindset during my second pregnancy I saw an OB because he was very "midwife-like."

There are also midwives who operate in a very "OB-like" fashion.

I switched to a midwife for my 3rd pregnancy only because I wanted a homebirth.

I do have to tell you though, even as great as I thought my OB was--and as great as I still think he is, dealing with a good midwife was VERY different. Night and day.

Jenn

iVillage Member
Registered: 03-28-2003
In reply to: brmom2
Sun, 03-30-2003 - 7:31pm
Don't forget the good old fashion family doctor!! I love mine. He helped me deliver my 9lb 11oz dd with NO episiotomy and NO TEARING! He told me that he gets the best of all worlds, he gets to see babies come into the world, then he gets to see them grow up.

I agree absolutely with what was said above about it not being concerned about the initials after the name. Interview with care! Good luck!

Hugs

Lisa

Avatar for cl_sidhe66
iVillage Member
Registered: 03-27-2003
In reply to: brmom2
Sun, 03-30-2003 - 2:42pm
Great ideas! I agree!

dee

iVillage Member
Registered: 03-25-2003
In reply to: brmom2
Fri, 03-28-2003 - 11:41pm
I personally don’t think the initials make much of a difference. I do agree with Jen that the midwifery model of care promotes “the normalcy of pregnancy and birth”, whole-woman prenatal care, education and informed choice, but not all midwives practice the midwifery model to the tee. I actually know of a couple OBs who are more midwife-like in their approach to maternity care than the majority of the CNMs in the area (and even some RMs, sadly enough).

I would suggest interviewing several potential care providers (both OBs and CNMs) and base your decision on the person with whom you are most comfortable and who is most supportive of your birth preferences. Make sure the facility you choose to give birth in is conducive to the birth you want, as well. What procedures are routine and how will standard hospital protocol impact your birth? Does the nursing staff seem supportive of unmedicated birth? Do they have doulas on staff? What is their epidural rate? There are so many things to consider…

I also agree with Jen on letting the nursing staff know, either verbally or in a birth preference sheet (or both), that you know pain medication is available and, if you want it, you’ll ask, thanks very much ;o)

Best of luck,

Christy

Christy
Stay home rocky mountain mamma to

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