GP/Obstetrician or Midwife?

[rt2dz]

I have not read the replies. I have nothing against midwives. I know many people who go that route and have had great results. However, I was very happy that I had a doctor.

My first pregnancy was basically easy and uncomplicated. But the birth was a nightmare. We both almost died and it was very good that we were in a hospital. After that, with my history, a midwife wouldn't touch me. OK, that's not exactly true, but a midwife would have to work closely with a doctor and I would still have to deliver in a hospital. My second pregnancy was problematic and required a doctor.

Anyhow, with my experience, I'd definitely go the OB route--just in case.

ETA--My OB-GYN is so wonderful. She is the best and the care and time she takes is great. She is the perfect example of what all Drs. should be. If you encounter an OB that isn't like that, try another!!

 

[glass slipper girl]

I think what is important is to think about what you want for your prenatal care, your labor and delivery etc. and then interview care providers to find one that meets with your expectations. Nothing drives me nuts more than hearing the extreemes from either side of the doctor/midwife, hospital birth/home birth, pain relief/drug free delivery debates. The most important thing to remember is that there are good doctors and bad doctors. There are good midwives and bad midwives. Same with doulas.

I have 3 kids. I approached my first pregnancy with the attitude that this was all new to me and I didn't think I could be expected to know when I was 6 weeks pregnant if I wanted a drug free delivery or not. The important things to me were to find someone who would listen to me and not either talk down to me or gloss over things. I wanted to see the same person at each visit as much as possible and I wanted to deliver somewhere that had no issue with having my husband and my mom in the room for the delivery (actually both of my parents were there for DS #1s birth - my Dad sat in an area of the room where he didn't see anything embarassing but he got to be there for the delivery - which he refers to as the single most incredible moment of his life since he wasn't able to be in the room for my birth). My kids were delivered by 3 different practices. I loved the 1st two and liked the 2nd. The practice that delivered my 1st baby had big staff changes and "my" doctor had moved out of state so I picked a different doc for baby #2. I could not have loved her more if I tried. She was beyond fabulous! Unfortunately my insurance wouldn't cover her for baby #3 so I had to pick yet another new practice. Them, I wasn't as happy with. My first two I saw the same doctor every week. I had "office appointments" (meaning I met them in their office - like with the desk not the stirrups!) with their partners so I had a chance to ask questions or say hello to them just in case they delivered me but in both cases every effort was made for your doctor to deliver you. I had "my" doctor both times. Meds were not pushed on me, I was not made to lay flat on my back or to stay in bed etc. The doctors listened to me completely and honored my requests as much as they could (DS #1 was a preemie as a result of complications with the pregnancy so there were things I would have liked to do different but couldn't b/c of that situation BUT I did understand why those things were in his best interest). My 1st doctor gave me great advice saying that it was her standard practice to instruct the hospital nurses not to offer any type of pain relief. She made sure her patients were educated on their options and we were to ask for it if we wanted it but that way we wouldn't feel it was being "pushed" in any way. Dr. #2 loved that idea and supported my choice to do that for baby #2. I had an epidural with all 3 kids but not until I hit transition so I only had it for at most 75 minutes. I approached all 3 saying if I need it, I'll get it but I'm not making a definite yes or no decision until I'm actually IN labor. I would have gone w/o for DS #2 but I was already 5 cm dilated (and not in labor) when we made the choice to admit me and break my water the morning after my 37 week appointment - my call, no pressure from my doc - so I went from nothing to transition immediately. I was throwing up between contractions so I had no time to "regroup" for the next one. If that hadn't been happening I would have gone "no meds" for him.

In short, I had "midwife like experiences" from my doctor delivered hospital births. I also have a friend who went with a midwife and LOVED her for the pregnancy but hated her for the delivery. She made my friend feel horrible for deciding she wanted meds and then for "not pushing with enough focus" after an hour and half of pushing. Total opposite of what you hear about most midwives. Good and bad in both docs and midwives. Doesn't matter which you pick, just educate yourself, ask questions and hope you pick a "good" one. If not, don't be afraid to switch if you feel you need to.

Congrats on your pregnancy!

 

[Ellielovesdisney]

I hate to get involved in this discussion but I feel a need to respond to the extremely argumentative post that most ob's are in it for the money and do not care about their patients. I thought this was a Disney Board!! I have been an obstetrician for 10 years...It is a career that requires a lot of training and sacrifice of personal time. Most of us do not think of delivery as an "emergency" or diagnosis. I do this job because I love delivering babies and providing care to my patients. There are many jobs that I could make more money doing with less effort. I can't tell you how many nights I haven't slept because I am worried about someone, or something that happened to someone.
There are certainly some OBs and some Midwives you will like more than others. I would suggest interviewing some and then picking based on the person...not the profession. (as long as you have an uncomplicated pregnancy)

 

[SmallWorld71]

I hate to get involved in this discussion but I feel a need to respond to the extremely argumentative post that most ob's are in it for the money and do not care about their patients. I thought this was a Disney Board!! I have been an obstetrician for 10 years...It is a career that requires a lot of training and sacrifice of personal time. Most of us do not think of delivery as an "emergency" or diagnosis. I do this job because I love delivering babies and providing care to my patients. There are many jobs that I could make more money doing with less effort. I can't tell you how many nights I haven't slept because I am worried about someone, or something that happened to someone.
There are certainly some OBs and some Midwives you will like more than others. I would suggest interviewing some and then picking based on the person...not the profession. (as long as you have an uncomplicated pregnancy)

DH and I couldn't agree on a boy's name for our youngest. Our OB was so wonderful we decided to use his name if the baby was a boy. It was a girl though......but we always felt like we were in great hands.

 

[Ellielovesdisney]

Good to hear!!! I shouldn't take one persons opinion so personally.
Congrats on the pregnancy!!

 

[portia9]

I think we may have similar care here in Australia as you do. I had midwives attend all of my births and I wouldn't do it any other way. They were wonderful, supportive and I definitely had the births I wanted.

 

[portia9]

I also wanted to add that a normal healthy pg is not a medical issue. It is not an illness. I don't feel that a doctot is necessary unless there are problems and while everyone can tell a horror story, birth isn't as complicated as we make it.

 

[northriver]

Sorry didn't have time to read the other replies.

Both my children were born after completely natural labor and delivery.

DS was born in 93 with a woman doctor, 14 hour labor, they made me lay flat on my back in bed most of the time and when the doc showed up she cut a HUGE episiotomy, ouch. For awhile I had Nurse Cratchit too. You just never know who will be "caregiving".

DD was born in 05 with a midwife, 2 midwives work at the OB office but I was guaranteed one of the midwives for my delivery. Midwife arrived at the hospital about the same time we did and cared for me thru the entire labor and obviously delivery. She was awsome, labor was 7 hours total, 3 hours from the time I arrived at the hospital. I really believe it was due to the care of the midwife. I did have complications, DD showed distress, first meconium in the amniotic fluid and later distressed heart tones. She was born with the cord tightly wrapped around here neck. When it was time to push, the midwife made it clear she was serious - and I pushed with everything I had to deliver dd safely! Then, after deliver, I had retained placenta and lost quite a bit of blood, and I'll spare you the gory details BUT the midwife handled it fabulously - I was SO impressed with her abilities. She kept DD and I safe thru a difficult delivery and I'll be eternally grateful to her for that.

Natural labor teaches you that you are stronger than you know, teaches you where you can find your inner strength. It is a great lesson to learn - you'll need to find that strength over and over again as you raise your children.

 

[melis79]

My vote is on an Obstetrician.

Both GP and Midwives are not able to handle or care for you if you have any high risk complications develop at any stage of your pregnancy (twins or multiples, gestational diabetes, pre term labor, pre-eclampsia, placenta previa, need csection, etc). So if you are with a GP or midwife, they will either need to transfer your care to an OB, or some midwives/GP's elect not to transfer care to an OB (when they transfer care they lose out on billing for the majority of the pregnancy- loss of $$$) and rather have the pt consult with OB for Hi risk issues and try to manage the case together. Which makes it more complicated for the patient as they are seeing two providers for their pregnancy, more appts, more stress.

I may be a bit biased but I have worked in OB for almost 7 years and have seen so many patients who have rec'd such a poor and outdated care from midwives and GP's. I have seen alot of bad outcomes and bad care by GP's and midwives... many women who followed their instincts and came to see our OB's against the advice of their provider and ended up having some severe pregnancy problems that did require medical intervention asap. Babies that could have died in utero had they continued with the advice of their GP's.

Not to say that GP's and midwives are not good. There are some great ones out there, and those ones are good options for a normal low risk pregnancy. But the thing is, you never know if you are going to develop pregnancy complications.

For me, I would MUCH rather from the get go be with a specialist who can take care of all of my needs, low risk, high risk, etc. and have a nursing staff that is available to answer my calls who specializes only in OB/GYN.

Ok, my two cents!

Congrats on your pregnancy and hope things go well!

 

[jodifla]

For all of you who think pregnancy isn't an "illness" or medical problem, you should wander around a turn of the century or earlier graveyard and see all the moms and the newborns buried there. Pregnancy/childbirth killed a lot of women before today's medical knowhow.


I'd consider using a midwife attached to an OB, but not a freelance one, for the same reason I wouldn't do a home birth. I wouldn't want precious seconds lost if the medical attention was necessary.

 

[blana]

If my GYN practice had the option, I'd have happily opted for a mid-wife, but ours doesn't have one. I knwo some near me do, but no where near all, and I liked my practice, already felt comfortable with some of the doctors, etc. That said, as others have stated, the OB was not really there except for the pushing phase of labor for me. Had a great L/D nurse though, who helped through the whole process.

 

[bunnyscootles]

For all of you who think pregnancy isn't an "illness" or medical problem, you should wander around a turn of the century or earlier graveyard and see all the moms and the newborns buried there. Pregnancy/childbirth killed a lot of women before today's medical knowhow.

This is HIGHLY debatable, midwifery has to be the oldest profession on earth and we as a human race have made it so far! A lot of mothers going to the hospital to have a baby around the early part of the century did not have good outcomes (think:child bed fever ) but we've all come a long way now. We know what germs are for instance.
I think OB's are best when used as specialists. Midwifes are best used for uncomplicated pregnancies. There are midwives who practice more like an OB and the other way around as well. You really have to decide on how you look at pregnancy and birth. The more you read about this subject I think the more your opinion will shift one way or the other.
I found a book Childbirth Without Fear that really changed my whole way of thinking about it. Grantley Dick-Read (the author) was an obstetrician in the 30s and 40s who attended women in childbirth in their homes in England (London I think). He observed several women having calm, almost painless births. One woman in particular, after refusing Dick-Read's offer of pain relief (in those days it was Twilight Sleep or cloroform mask) commented, "but it wasn't supposed to hurt was it doctor?".
I could go on for HOURS about this sort of stuff, but I will leave you there

 

[portia9]

For all of you who think pregnancy isn't an "illness" or medical problem, you should wander around a turn of the century or earlier graveyard and see all the moms and the newborns buried there. Pregnancy/childbirth killed a lot of women before today's medical knowhow.

Well I don't think pg is an illness. Women did used to often die in childbirth but you cannot compare that to our society now.People generally died younger and with conditions that don't kill people now but that doesn't mean we visit a doctor on a daily basis. Woman had no idea what was going on with their pgs, now it would be a rare person that doesn't have u/s, blood tests, bp taken etc etc so identifying potential problems is much easier to do. That means that higher risk people can be identified prior to labour. There are always going to be people that have complications in pg and these are the people that should see OB's.

 

[portia9]

Sorry double post

 

[sskem96]

Try to get some recommendations from your local OB nurses! I am an OB nurse, and attend deliveries to care for the newborn. Some of the doctors that have great bedside manners and their patients love them are not the ones that the nurses consider good doctors. Your first impresstion of a doc's personality is not an indication of their medical skill. The nurses see the docs and midwives on a daily basis, and know who is truely caring, even if they aren't always so cheery with their patients, and who has poor skills with forceps or tears nasty episiotomies with their hands on a medicated patient who doesn't know what's going on "down there". I work at a hospital with about 1700 deliveries a year, and there's only a couple docs in the whole town that I would allow to touch me. The same goes for choosing a pediatrician for your baby. A pediatric or nursery nurse who works with all the pediatricians in town knows them best. Check with your friends and see if they know any OB nurses that you could talk to.

 

[Disney 'Ohana]

Congratulations!


I've had both OB/hospital delivery, unplanned home delivery where my dh delivered our son, and a midwife/hospital delivery.

I would interview both and pick the one you feel most comfortable with, someone who feel will best help you. And decide based on that.

 

[MommyBryn]

With DD I had an OB...a midwife just wasn't my "thing" and I wanted the "pregnancy experience" of seeing an OB. It was fine, I really liked him. But this time I'm doing things totally different...a homebirth direct entry midwife (appts not starting until 22 weeks, by my choice), and hopefully a UC delivery. I just don't find it necessary (despite my miscarriages before DD, but this time I just prayed about it a TON before I came to this decision) to have all the early intervention and testing done throughout the pregnancy. If I feel the need, I'll seek further care.

 

[jodifla]

Well I don't think pg is an illness. Women did used to often die in childbirth but you cannot compare that to our society now.People generally died younger and with conditions that don't kill people now but that doesn't mean we visit a doctor on a daily basis. Woman had no idea what was going on with their pgs, now it would be a rare person that doesn't have u/s, blood tests, bp taken etc etc so identifying potential problems is much easier to do. That means that higher risk people can be identified prior to labour. There are always going to be people that have complications in pg and these are the people that should see OB's.

You can't compare it now, because women go to OBs and are treated for things like preeclampsia. Many breech births or other difficult births are dealt with by C-sections, not things that midwives can handle.

I'm sure that midwives are more nurturing and provide a more touchy-feely experience.

And the thing that would put me off a birth center is you can't always identify who will end up needing a higher level of care...lots of times, emergencies pop up. I have one former co-worker who tried to deliver at home with a midwife and ended up needing to go to the hospital for a c-section.

I have another who ended up needing a life-saving hysterectomy. Her delivery wasn't progressing well at the hospital, so they decided to go for the C-section, and while they delivered the baby, they realized there was another problem so severe that a hysterectomy had to be performed on the spot. If she'd tried to deliver naturally, she would have bled to death.

Why take a chance with something so important? Like I said, walking around and seeing all those dead women and children (everybody dying in childbirth, which was clear from the gravestones) in Cape Cod graveyards convinced me.

 

[jodifla]

This is HIGHLY debatable, midwifery has to be the oldest profession on earth and we as a human race have made it so far! A lot of mothers going to the hospital to have a baby around the early part of the century did not have good outcomes (think:child bed fever ) but we've all come a long way now. We know what germs are for instance.
I think OB's are best when used as specialists. Midwifes are best used for uncomplicated pregnancies. There are midwives who practice more like an OB and the other way around as well. You really have to decide on how you look at pregnancy and birth. The more you read about this subject I think the more your opinion will shift one way or the other.
I found a book Childbirth Without Fear that really changed my whole way of thinking about it. Grantley Dick-Read (the author) was an obstetrician in the 30s and 40s who attended women in childbirth in their homes in England (London I think). He observed several women having calm, almost painless births. One woman in particular, after refusing Dick-Read's offer of pain relief (in those days it was Twilight Sleep or cloroform mask) commented, "but it wasn't supposed to hurt was it doctor?".
I could go on for HOURS about this sort of stuff, but I will leave you there

I was the last one of my friends to have a child. I had three close friends, each of which had one childbirth with an epidural, and one natural childbirth.

EACH ONE told me they'd never do a natural childbirth again.

 

[Minniemouse07]

You can't compare it now, because women go to OBs and are treated for things like preeclampsia. Many breech births or other difficult births are dealt with by C-sections, not things that midwives can handle.

I'm sure that midwives are more nurturing and provide a more touchy-feely experience.

And the thing that would put me off a birth center is you can't always identify who will end up needing a higher level of care...lots of times, emergencies pop up. I have one former co-worker who tried to deliver at home with a midwife and ended up needing to go to the hospital for a c-section.

I have another who ended up needing a life-saving hysterectomy. Her delivery wasn't progressing well at the hospital, so they decided to go for the C-section, and while they delivered the baby, they realized there was another problem so severe that a hysterectomy had to be performed on the spot. If she'd tried to deliver naturally, she would have bled to death.

Why take a chance with something so important? Like I said, walking around and seeing all those dead women and children (everybody dying in childbirth, which was clear from the gravestones) in Cape Cod graveyards convinced me.

As someone who went to a birth center w/ both of my pregnancies (dd, now 6.5yo and ds, now 2yo)..and was transferred to the hospital w/ the first.... I WHOLEHEARTEDLY prefer a midwife at a birth center over a hospital birth, no contest.

Our birth center is across the street from the hospital and in fact they did a study and discovered that moms that were transferred from the birth center actually were prepped for any emergency c-sections FASTER than moms that were already in the hospital!

It may be that the midwives closely monitor the moms themselves and don't rely on machines?? I don't know but they have the stats to prove the results of the study.

In our case, I arrived at the birth center at 2:45pm already at 8cm and went to 10cm by 3pm. Once I started pushing dd's heartrate fell (as is normal) but then it wouldn't come back up again (which it was supposed to do). The midwife noted the problem at 3:10pm and we made the decision to transfer to the hospital by 3:20pm. At 3:31pm I was in the ambulance w/ an IV on my hands and knees on the gurney on the way across the street and started delivering dd at 3:40pm. Dd was born, forceps assisted delivery at 4:04pm in the hospital with the back up OB.

Turns out she had the cord wrapped around her neck and the cord was short. Both are common but not generally together. SO each time I pushed the cord wrapped tighter around dd's neck, causing her heartrate to drop.

Dd's APGARs were really great and she was perfect. BECAUSE of my midwife's close monitoring, we were able to make a decision quickly. The "emergency" processes that the birth center have in place worked exactly as they should have and I'm grateful for it.

I do have to say that I HATED the hospital. We were constantly bothered the entire night we stayed there. The nurses came in about 5 or 6 times insisting that I would get more rest if we sent dd to the nursery (no, I'll get more rest if you stop coming in to tell me this!) and really weren't much help at all. Dh and I found it very restrictive and not comfortable at all. It was "mandatory" to send the baby to the nursery (dh went w/ dd) to be bathed and checked over, and then she had to go into the warmer because the bath dropped her temperature.

Thankfully, we were able to leave the evening following the birth (about 28hrs after). We were all MUCH more comfy at home.

Conversely, we had ds at the birth center. We arrived at 4:01am in the middle of a snowstorm and he was born at 4:21am (I have quick labors... only 4hrs for dd and 2.5hrs for ds!). Ds also had excellent APGARs and never left our sides. Instead of a warmer, he was placed on my chest...skin to skin... with warm blankets on top of him. His temp was monitored and it came up pretty quickly. Dh, ds and I all napped for a few hours, had some breakfast, showered and then we gave ds his first bath! We left the birth center about 3:30pm the following afternoon.

The nurses from the birth center came to the house for a followup visit about 2-3 days after the birth (for both kids) and then we did the normal 6wk post partum check.

Our birth center only accepts moms that are "low risk." At the first sign of any kind of complication (pre-eclampsia, breech, multiples, etc.) they are referred to the back up OB and unless risk free must give birth at the hospital. They also consider any birth before 36wks or after 42wks as "high risk" and they must go to the hospital as well.

Going to a midwife or a birth center is NOT akin to crawling into a cave to give birth and cutting the umbilical cord w/ a rock. These women are trained for YEARS in "normal" childbirth and know what a complication looks like. They also know when to call in an OB when needed. Our birth center is fully equipped w/ many medical necessities...just no epidurals.

Oh and I gave birth to two kids w/o epidurals and would do so again in a millisecond. Sure it hurt but it was over quickly. I also have quick labors... if they were longer I may have needed one. I definitely feel that epidurals have a place in the birth tool box, I just don't think as many people need to use the tool as much as they currently do... if that makes any sense!

To be honest I would rather give birth w/o an epidural than have a root canal again. Tooth pain hurts WAY worse than childbirth!