GP/Obstetrician or Midwife?

[Spoonful of Sugar]

I just found out I'm pregnant for the first time!

Now I have to decide whether I want a physician or a midwife at the birth. Anyone have a preference either way? (I don't know how it works in the states, but I'm Canadian, and here you can choose either a doctor or a midwife for a hospital birth, but not both.) I really can't decide!

 

[Aliceacc]

Congratulations!!!!

I tend to worry about a lot of things.

And my kids were born completely healthy. But I would absolutely want a doctor nearby, just in case. So if the midwife were in the hospital, I would consider it, but not otherwise.

Also, I will owe my sister forever for her advice: "Alice, repeat after me: 'I want an epidural.' "

I was pretty sure I wanted to go natural. Then the experience hit, and I knew my sister's advice was right for me.

So explore your options, keep an open mind, and have a wonderful pregnancy!!

 

[crazyforgoofy]

Why not 'interview' a few potential service providers - because that's what they are. Ask friends who've recently given birth for opinions.

Do you know what kind of childbirth experience you want? If you do you'll have some idea of what type of person you'll want. Do you want the 'authority figure' type? The down-to-earth type? The 'just the facts, ma'am' type? The intimate 'we're in this together' type? The 'it's your birth experience, I'll help you do exactly what you want' type?

 

[princesssfws]

Here is the states an OB office usually has a midwife on staff. In all 3 of my pregnancies I have seen both a midwife and an OB. I'll just tell you my experiences and let you go from there. Part of your decision will need to be based on your age, general health, etc.

My first pregnancy everything was going great, until about 8 weeks out when I developed toxemia. This isn't anything serious, it is just treated with bedrest. Then at 37 1/2 wks out my DD decided to flip and became breech. At this stage she was too big to flip her back so I had to have a c-section. I believe that only OBs are able to doing surgery so in this case you would have to have an OB.

Second pg and Third pg I was able to VBAC. 2nd DD was delivered by an OB, 3 pushes and she did a small episiotomy quickly and DD was born at 9 lbs.
3rd pg was delivered by midwife because the OB on call didn't show up (he is now doing lipodisolve) son was born after a few pushes with no episiotomy at 7 lbs 11 oz. I did have an epidural for both of these deliveries.

The midwifes tend to be more supportive, more into how you are doing vs. just delivering the baby. They seem to get to know you and your family more.

But if you think there might be complications due to your health or age I would definitely go with an OB.

My dad was a MD and I was pre-med so I usually tend to say go with the MD. But in this case, unless something unexcepted occurs, pg is not an illness and delivering babies has happened since the beginning of time so I would say go with the person you feel most comfortable with. You may have lots of questions and you want to feel comfortable going to your OB or midwife with these.

Get referrals from friends and find out about their experiences.

Congratulations and Good Luck.

 

[trivial]

Spoonful, we're in Canada also. My wife was leaning towards a mid-wife, but when we found out we were having twins and that one of them had a heart defect, we ruled out a mid-wife. Next time around, assuming things go smoother, my wife will go with a mid-wife. You have a lot more contact and communication with a mid-wife, and of course they're great if you're planning on having a home birth.

 

[SmallWorld71]

I know there are lots on this board who have used midwives and doulas, hopefully they'll chime in with that side of things.

I definitely went the other way though. I went into Boston to one of the top pediatric wards and obstetricians in the country. I've known too many people with complications. I am so glad I went that way because even though I was low risk and had an easy pregnancy, I ended up with an emergency c-section.

Either way, definitely take the time to meet with people. If you are not comfortable with someone, find someone else. There are good and bad OB's, midwives etc... and you definitely want to feel that you are in good hands. The 1st place I went to with my son, said they didn't feel it was important to see the patient at all in the 1st trimester! That's when I realized I needed to shop around and switched to someone who was absolutely wonderful and perfect for me.

 

[laluna]

Hi!

I am a midwife here in the UK and we do things quite differently than in the US and Canada but I will offer my advice, if that's OK.

It all depends on your risk status in pregnancy. If all is well and there are no problems then you could opt for midwife led care. We use this criteria for booking ladies for a home birth. Anything high risk such as multiple pregnancy, exisiting medical conditions, breech presentation, estimated big/small baby etc etc (not exhaustive list) should be managed accordingly by an OB, IMO. I dont know whether this applies to where you are but as complications can develop in pregnancy you could change your plans. I think it is best to keep an open mind.

Here, midwives/GPs and OBs work very closely: midwives take the lead and refer to an OB as needed.

Good luck!

 

[baybemama]

I think it really depends on your own perspective of childbirth. OBs think of pregnancy as a medical condition and labor as a procedure. Most midwives that I've met think of pregnancy/labor as a natural occurence first which in most cases does not need medical intervention. OBs are much more inclined to give drugs and use surgery alternatives...which if that's what you want, that's absolutely fine. Plenty of people opt for epidurals and c-sections. If you prefer a provider that will try everything for you to NOT have those things, a midwife is your best bet. For example, most OBs will insist on an IV, monitoring devices, frequent internals, etc. Their "just in case" set-up is comforting to some, overly invasive to others.

Our insurance does not cover midwives so I had an OB. She was very, very nice and well educated. I had a doula who would have preferred me to do everything naturally and was upset when after being induced I chose an epi. And the OB and the nurse at the hospital didn't listen to me at all. For some reason they didn't believe I was in active labor when I told them I was sure I was and complained of how bad the pain was...they kept increasing my pitocin and was surprised when I dilated from 3 to 8 in 2 hours. The contractions became so intense that the baby's heartrate dropped and then they had to give me drugs to halt the labor. I ended up with a c-section. I felt all could have been avoided if they took the time to listen to me. As soon as I had that c-section I went from a laboring mom to a surgery patient and was treated that way my whole stay.

Point of my post...there are pros and cons to both...be sure you know what YOU want, be sure your PROVIDERS are on board with what you want, be sure that you know the unexpected happens and know how you'd want to be treated in those scenarios.

HTH!

 

[TheRatPack]

I went to a large OB practice here in town with my bio children, but a midwife was on call when I went in to labor with both of them and all went well. The practice makes you see all of the doctors during your 9 months so I was familiar with them anyway.

 

[Colinsmom]

I had an OB deliver my first baby, and a midwife (backed up by an OB) deliver my second baby. Both were hospital births, by my choice.

With my first baby, I felt like the OB didn't really listen to me. There was a certain way she expected my pregnancy to go (it was uncomplicated) and as long as the numbers trended the right way, nothing was wrong in her eyes. She ignored positioning of the baby leading up to labor, which in retrospect I think was a big failing of hers. I was required to be flat on my back during labor which probably played a significant role in DS being a posterior baby. I didn't see much of the OB during my labor, until I had reached 8cm or so. She didn't show up for pushing either - just an unhelpful nurse - until it was obvious that he wasn't coming out without some help. I begged for an epidural early on (can't deal with the pain if you are forced to stay in bed) and had a high forceps delivery with a lot of tearing. Came close to a c-section but fortunately avoided it. It was not a positive experience.

The second time, we hand-chose a midwife who delivered out of a different hospital (OB backup is required by law). She took the time to get to know us through the pregnancy, took plenty of time to answer questions and talk through what *we* wanted at the birth, and stayed with us through the labor and birth. She is a strong believer in proper positioning at the time of labor, and had me watch my posture and sitting position leading up to labor (yes, I truly believe it helped in my case). I had no drugs or IV during labor or birth, by choice, but did deliver at the hospital (also by choice). It was a wonderful experience. DH even got to actually do the delivery with the midwife looking over his shoulder (at his request - he's a paramedic). Note that if a c-section had been required, her OB backup would have done it and she would have assisted. Midwives do not do surgery.

That said, there are plenty of midwives who tend towards "birth as a medical event", and some OBs who lean towards the "birth as a normal experience". You really need to talk to the various providers until you find something that "fits" you well. We found our fit with this particular midwife, but if she moved away, we'd consider an OB (with the right mindset) along with another midwife for any future babies.

Congratulations on your pregnancy!

 

[sara74]

I have three children and with each subsequent birth I became more and more aware of pregnancy and birth as something that is natural and less and less as a medical malady. So my view changed from give me the epi ASAP with the first to not having one at all with the third. If I could have convinced DH then I would have had a midwife for the third at least. And by the third there were medical interventions that I realized I could opt out of that I just went along with for the first two. I will say that I was still more comfortable with a hospital birth due to the 'just in case' side of me - but #3 came so fast we almost didn't make it to the hospital anyway!

Do some reading, don't be afraid to change your mind if you want to change practitioners and have a healthy pregnancy!

 

[Stephres]

I have had one with each (a midwife delivered the first and an OB delivered the second). I had wonderful experiences with both. Good luck with your pregnancy!

 

[gallafamily]

I am also in the US, but I have 4 children & all were delivered by OB. I agree with others who say do your research & interview the OB's & Midwives. They will be able to give you all the info you need, & you may also find that they are all different. My OB was very laid back, & let me decide what I wanted. I absolutely did not want a C-section if at all possible. She was very friendly & got to know my family. She delivered 2 of my 4 children. It was a large group of doctors, & I had someone different at the other 2, but they were also very good & came in wanting to know what I wanted.

The best advise is to do you research & enjoy every moment!

 

[mickeylove2]

I'll just give you the rundown on both. My 1st l/d was horrible! I was young and just went with the flow, the ob was with 3 or 4 women in labor and I didn't get the one on one time that I wanted. I went in and he immediately wanted me to begin walking, he broke my water and then wanted me to lie in bed and push demerol in me. I began vomitting- picture the Exorcist! I got an epidural and them WHAM he sliced me wide open, push, push, here comes the vaccum, and he sucked her out. Then he sewed me up, and left. The bathroom and showers were down the hall about a block away, so there was no modesty when it came to going pee!

Fast forward to my 2nd, my midwife asked me to write up a birth plan, huh what's that? She and my doula hepled me with it. It had every detail imaginable. We get to the birthing center and my experience was wonderful! I had a suite with a futon and a full bathroom and shower big enough to hold 8! I had a completely natural childbirth, I didn't have to have an episiotomy, I was able to do pretty much what I wanted when I wanted, and my midwife was with me almost the whole time, she left when we wanted her to and she was only a few minutes away at all times. My doula never left my side. I was completely happy with my l/d experience!

I suggest that you research both the obs and the midwives in your area, ask questions and ask around in your area.

 

[doulacandice]

I'm a doula and student midwife.

I have went with midwives with all my pregnancies and I will for anymore I have. I feel like midwives take more time with you and get to know you, like they care more. In my experience with OB's and the stories I have heard they are basically for the money, most really do not care about their patients.. (there might be a few thats the exception) I am all for natural birth. I know I can get that more with a midwife. OB's are trained to see birth as a medical emergency.. It's not at all. It's a natural event our bodies were made to do. It's nothing to be scared of and it doesn't need to be rushed at all.. You will hear different from every side. If you plan on having a medical birth, with the epidural and all that then it really doesn't matter.. If you are wanting a more natural birth a midwife is the way to go.

Either way interview who you want, there are some midwives that are with practices who's views are very much like an OB since they work there.. They are opted to inducing and giving drugs just like an OB is and they can under the OB.

I hope this helps! If you would like information about why natural birth is a "better" way to go, just PM me. I would love to be able to give you a list of books and more info!!!!!

Congrats!!! This is such an exciting time in your life!

 

[kpm76]

Well, I think you have gotten some good advice from most of the posts. It really depends on you, your situation and what is important to you. For me and DH, there was no way we would have trusted anyone but an MD to deliver our baby. Yes, pregnancy and L & D is natural etc. but proper delivery can be critical. Not to scare you, but there are things that can go wrong during delivery and I wanted to make sure our baby was in the best hands possible. I am not knocking midwives but I wanted someone who went to med school and was trained and educated to handle difficult situations. I just worry. Also, as for a birth plan, you don't get bonus points for doing it without drugs. I had an epidural and had such a pleasant birthing experience, was very conscious of what was going on....it was wodnerful Prior to the epidural I was puking my brains out so if I had continued on that path, I would not have nice memories of the birth of our DD.

 

[emh1129]

I think the care that you get from a midwife is just so beyond what you'd expect with most OBs. I had an OB with my first and switched to a midwife for my second pregnancy. It's just a world of difference and I didn't know what I was missing until I finally made the switch.
I plan to become a midwife when I'm done with nursing school.

 

[amarberry]

I'm not sure how things work in Canada, but in my experience in the suburban Chicagoland area, the vast majority of midwives work in conjunction with OB practices. I believe in the state of Illinois, all Certified Nurse Midwives must work under the supervision of an OB. The few issues that did come up during my pregnancies were automatically handled by the OBs in my practice. A good midwife knows her or his limits and knows when to defer to the doctor. I never felt that I was getting sub-standard care from the midwives. If anything, I felt like I was getting better care because my midwives took more time to listen to me and my concerns.

With both of my children, I have gone with mixed practices that have both OBs and midwives. I am definitely more inclined to want to deliver with a midwife, but it is reassuring to be established with an OB in case of a complication. My DD was caught by a midwife and my son was caught by an OB from a completely different practice (since he delivered after only five minutes of pushing and was seconds away from being delivered by my labor and delivery nurse ). With my deliveries, 95% of the work was done by the labor and delivery nurses. The doctors and midwives (at least where I live) show up for a couple of minutes here and there and don't arrive until the very end. If you're concerned about complications, choosing a good hospital with a highly experienced staff is probably more important than the midwife vs OB issue.

I must say that my post-partum care with the midwife was about 100 times better than the post-partum care that I received from my OB. My midwife (and her partner in the practice) visited me several times in the 24 hours that I was at the hospital after delivery. My OB with my son blew into the hospital long enough to say that I could go home. Maybe this had more to do with personality than anything else, but you seem to hear this type of scenario over and over again.

Others have mentioned it, but keep an open mind towards natural childbirth. Both my children were delivered without the intervention of drugs/epidural and it was incredible. Did it hurt...of course, but it wasn't unbearable and it's not like you have to go through it everyday. I also feel that by not being numb and having more control over your body, in a lot of ways, you may have a much easier delivery. I felt GREAT afterwards. Honestly, I could have taken on the world after delivering. If you have any interest in this, I would highly suggest taking Bradley classes. Feel free to PM me if you have any questions about it.

Good luck, and congrats!

 

[Minniemouse07]

We went to a freestanding birth center with both of our children. They are staffed w/ 5 midwives.

With our first, her heartrate wasn't what it should be during the last part of labor and I was transferred across the street to the hospital. My midwife, along w/ the back up OB, decided that it would be best to be at the hospital "just in case." Dd was fine. Everyone was very concerned due to the heartrate decelerations but her Apgars were 8 and 10. Everything went exactly as it should of based upon the events and I had full confidence in both the midwife and the OB.

I did however HATE the hospital. Majorly archaic rules and nasty nurses.

With ds, we were able to give birth at the birth center and it was a wonderful experience. Like night and day as compared to our hospital experience w/ dd.

With both kids, our prenatal care was top rate. The midwives (you met with all of them) took their time and made sure we had all the info we needed to make ALL the decisions we needed to. We were never informed that a procedure/test/scan was taking place... the pros and cons were explained to us and then we decided if we would do it.

They were also ALWAYS on time. Each appt was 30min and only ONCE in two pregnancies (that's a lot of appointments!!) were they "late." The midwife came out to the waiting area and told us she was running late...asking if we wanted to reschedule. When I asked how late she would be... she replied 5min! I told her that it was okay.... we would wait!

Huge contrast to the TWO hour wait we had to get an ultrasound at 8wks to establish an EDD w/ our second pregnancy.

If we had complications w/ either pregnancy, I would have gone to an OB.

I look at it this way... If I'm getting check ups and doing normal every day medical care (I'm in the pregnancy is a "normal" event camp), I go to my general practioner.... If I have a brain tumor, I go to a brain surgeon. Same w/ pregnancy... If I have a routine pregnancy w/ no complications, I go to a midwife....If I have toxemia, high blood pressure, etc., I go to an OB.

I'm a research geek so I read a bunch before both pregnancies. My favorite books were:

Ina May Gaskin - Ina May's Guide to Childbirth
Henci Goer - The Thinking Woman's Guide to a Better Birth
William Sears - The Pregnancy Book, The Birth Book & The Baby Book (Three separate books)

The book I HATED the most... What to Expect When You're Expecting... the most alarmist, useless book for pregnancy. Basically states the worst case scenario for everything and then says to do whatever your dr tells you to (no thinking for yourself allowed). Their suggested diet is also one of the most unrealistic ones on the planet (you can have 1/2 a bagel once a month for a "treat!)!

Congratulations and good luck!

 

[CarolinesMom]

I just found out I'm pregnant for the first time!

Now I have to decide whether I want a physician or a midwife at the birth. Anyone have a preference either way? (I don't know how it works in the states, but I'm Canadian, and here you can choose either a doctor or a midwife for a hospital birth, but not both.) I really can't decide!

Congratulations!!! I have had an OB for both of my births. My labor and delivery with my DD was pretty text book, but my DS it was not the case. I truely believe if I did not have a skilled OB there, I would have had to have a C-section or DS could have had brain damage. The cord was wrapped around DS's neck and we tried several different methods to aleviate the pressure on his neck while I contracted. My OB could have given up and performed a C-section, but she kept cool and put a catherter between the cord and DS's neck and floated it. I was able to deliver him naturally.