GP/Obstetrician or Midwife?

[SplashMountainMama]

A lot of the posts from people preferring to use mid-wives seem to be coming with the message that it made for a more pleasant experience for the mother. While that's all good and well, IMO, the enjoyment of the mother should come second to the safety of the baby. No one can predict exactly how a labour and delivery will progress and if a problem were to develop I wouldn't want to be in the position of not realizing it because you weren't being monitered as regularly or of having to be transferred to a hospital mid-way through delivery. Honestly, your child is not going to care where he/she was delivered or whether or not it was an OB or a mid-wife so I have a hard time with mothers-to-be making it all about them. I have had 6 kids all delivered in hospital (2 of them delivered by nurses) and not one of my kids has ever said "Gee, I wish I'd been delivered at home by a mid-wife." Sorry, if this comes across as a bit snotty, but I know 3 women who delivered with mid-wives and 2 of the 3 have children that now have special needs because of complications during delivery. I know this isn't the norm, but it has to make you wonder. Good luck to the OP in making your decision and congratulations!

 

[Minniemouse07]

A lot of the posts from people preferring to use mid-wives seem to be coming with the message that it made for a more pleasant experience for the mother. While that's all good and well, IMO, the enjoyment of the mother should come second to the safety of the baby. No one can predict exactly how a labour and delivery will progress and if a problem were to develop I wouldn't want to be in the position of not realizing it because you weren't being monitered as regularly or of having to be transferred to a hospital mid-way through delivery. Honestly, your child is not going to care where he/she was delivered or whether or not it was an OB or a mid-wife so I have a hard time with mothers-to-be making it all about them. I have had 6 kids all delivered in hospital (2 of them delivered by nurses) and not one of my kids has ever said "Gee, I wish I'd been delivered at home by a mid-wife." Sorry, if this comes across as a bit snotty, but I know 3 women who delivered with mid-wives and 2 of the 3 have children that now have special needs because of complications during delivery. I know this isn't the norm, but it has to make you wonder. Good luck to the OP in making your decision and congratulations!

Actually there are multiple studies done that show midwife attended births having better outcomes (less complications, fewer emergency c-sections, etc.) when compared to similar low risk births attended by OBs.

I don't have time to find the specific studies and statistics right now (I'm supposed to be working) but they are out there.

Oh and our midwives at the birth center actually did MORE monitoring than in the hospital... it was just person to person monitoring (along w/ a doppler and a stethescope) as opposed to electronic. That is why I think they caught my dd's issue so quickly.

I specifically went to the midwives at the birth center because I wanted my child to be SAFER than she would have been with an OB/GYN!

 

[SplashMountainMama]

LIke I said, it was just my opinion. I also said that my opinion was probably biased because of the situations I personally know of that did not end well. If the birthing centers are just as safe or safer than a hospital than I feel that would be ok. I just think a lot of women aren't choosing it because it's safer, but rather it's because what they always imagined giving birth would be like and need to fulfill that for themselves. It's the same for having/not having an epidural. Some women are actually made to feel bad for asking for one which I think is ridiculous. Sure, women had babies for years without epidurals, but once upon a time they also used to do all surgeries without anesthesia (sp?). Would you go in for other surgery/ procedures and decline anesthesia just because years ago people survived without it? I had an epidural for all, but 1 of my babies and for me, it was a much more enjoyable experience when I wasn't screaming in pain , but again, everyone's experience is unique.

 

[emh1129]

I specifically went to the midwives at the birth center because I wanted my child to be SAFER than she would have been with an OB/GYN!

Exactly. That's why I chose the midwife practice that I did. My midwife was with me throughout my whole labor and delivery, vs. the OB I used to see who would have waltzed in at the end to catch the baby. I know not all midwives spend the entire time with the mom in labor, but in general they do spend quite a bit more time than a traditional OB would.

And for some of the pps who mentioned how far we've come with regards to maternal/baby care in the U.S., I recommend looking at the worldwide maternal/infant mortality statistics. For all of our technology, we are ranked below many other countries where midwifery is the standard universal care.
Many of the things women need to be 'saved from' in the hospital were in fact created by interventions.
I think OBs definitely have their place, I just think it's naive to think that healthy women with uncomplicated pregnancies need to have one.

 

[jodifla]

Actually there are multiple studies done that show midwife attended births having better outcomes (less complications, fewer emergency c-sections, etc.) when compared to similar low risk births attended by OBs.

I don't have time to find the specific studies and statistics right now (I'm supposed to be working) but they are out there.

Oh and our midwives at the birth center actually did MORE monitoring than in the hospital... it was just person to person monitoring (along w/ a doppler and a stethescope) as opposed to electronic. That is why I think they caught my dd's issue so quickly.

I specifically went to the midwives at the birth center because I wanted my child to be SAFER than she would have been with an OB/GYN!

Wow, you are really kidding yourself here.

First of all, it's not the OB who takes care of the baby. It's the specialized pediatricians you'll find at the HOSPITAL.

 

[jodifla]

Exactly. That's why I chose the midwife practice that I did. My midwife was with me throughout my whole labor and delivery, vs. the OB I used to see who would have waltzed in at the end to catch the baby. I know not all midwives spend the entire time with the mom in labor, but in general they do spend quite a bit more time than a traditional OB would.

And for some of the pps who mentioned how far we've come with regards to maternal/baby care in the U.S., I recommend looking at the worldwide maternal/infant mortality statistics. For all of our technology, we are ranked below many other countries where midwifery is the standard universal care.
Many of the things women need to be 'saved from' in the hospital were in fact created by interventions.
I think OBs definitely have their place, I just think it's naive to think that healthy women with uncomplicated pregnancies need to have one.

But as the midwive proponents have stated, they don't use epidurals. So frankly, that would knock it out for every woman I know IRL.

Like I said, three best friends, each with two kids, one naturally, one with the epidural.

Not ONE would do natural childbirth again.

Enuf said!

 

[K and K's Mommy]

I had all three with an OB. I actually know no one who has used a midwive. I don't think they are very common in the midwest. As many people have said, I would interview different people and ask friends/family/ co-workers in your area for referrals.

I actually had all three natural, and I would do it again. I am definitely not a "natural" type person, but I am very afraid of needles!! My DD was the hardest, but the nurse who helped me was awesome! I love my OB practice, but I will say the nurses are the ones who help during labor - and of course, my dear husband!

Good luck!

 

[Minniemouse07]

Wow, you are really kidding yourself here.

First of all, it's not the OB who takes care of the baby. It's the specialized pediatricians you'll find at the HOSPITAL.

If you read my LENGTHY post about our birth experiences, you would know that our birth center is across the street from a hospital. A hospital w/ a Level III NICU. If anything untoward happened during a birth I promise you my child would be in the NICU, attended by neonatal specialists just as quickly as any child born IN the hospital.

There are no pediatricians at a birth unless there is a known risk factor before the actual birth. The first people to care for your newborn are the OB/GYN or midwife and the labor & delivery nurses.

A birth outcome is based upon the care that the mom receives both prenatally as well as during labor and delivery...no pediatricians there.

It is a proven fact (based on peer reviewed studies) that the more interventions given to a mom in labor, the higher the chance of complications during delivery (as well as a much higher chance of c-section). Women who have epidurals statistically have a higher chance of having a c-section (see below where I cited specific studies), as well as complications from the epidural including, headaches, fetal distress, drop in mom's blood pressure, paralysis, numbness and nerve damage.

So... if I go to a health care provider for my child's birth that has a hands on policy for labor & delivery (ie they don't leave me alone in a room hooked up to a monitor and show up to catch the baby), an extremely low c-section (12% instead the national rate of 31%) and epidural (about 15% get transferred to the hospital for an epidural) rate, treat pregnancy as a "normal" event...not a medical emergency, and is across the street (literally) from a hospital w/ a Level III NICU... that is the best of all worlds to me.

Having our child at the birth center, gives us the best chance to have a low intervention birth...which means a less of a chance of needing a NICU or a neonatal specialist for my child.

Epidural Studies - From the 90's but still valid data...

Thorp, JA et al (1993) The effect of intrapartum epidural anesthesia onnulliparous labor: a randomized, controlled, prospective trial. AmericanJournal of OB/GYN. 169 (4) 851-858.
Nulliparas in spontaneous labor were randomized to epidural (n=48) ornarcotic (n=45 analgesia. The only cesarean in the narcotic group was theonly woman who opted out into the epidural group. The risk of cesarean withepidural was 50% at 2cm, 33% at 3cm, 26% at 4cm, and nil at 5cm. They stoppedthe study early on ethical grounds when the results became clear to theresearchers.Thorp JA et all (1991) Epidural Anesthesia and cesarean section for dystocia:Risk factors in nulliparas. American Journal of Perinatology. 8(6) 402-410.
This study is even better, because they separately analysed and comparedgroups of women receiving epidural at different dilations and stations withgroups of women receiving no epidural and then further grouped them by theirprogress in labor and were therefore able to compare the effect of theepidural on labor progress and dystocia. It is fairly confusing to abstract,but the whole text makes clear that epidural women were more likely to haveoxytocin and cesareans for dystocia.Morton SC, Williams MS, Keeler, EB,Gambone JC, Kahn KL (1994). Effect ofepidural analgesia for labor on the cesarean delivery rate. OB/GYN. 83(6)1045-52.
A meta analysis of published studies on above topic reveals a 10% increase insections when epidural was used.

 

[mickeylove2]

Wow, you are really kidding yourself here.

First of all, it's not the OB who takes care of the baby. It's the specialized pediatricians you'll find at the HOSPITAL.

I have to know... wht are you talking about??? I didn't read anywhere in the PP post that said that the OB takes care of the baby, not a peditrician... Did I miss something???

 

[mickeylove2]

But as the midwive proponents have stated, they don't use epidurals. So frankly, that would knock it out for every woman I know IRL.

Like I said, three best friends, each with two kids, one naturally, one with the epidural.

Not ONE would do natural childbirth again.

Enuf said!

The midwife that I saw for my pregancy WOULD have had an anesthesiologist come up and give me an epidural if I wanted one, so I don't know what midwives you have talked to who said that they don't use epidurals! My midwife would have let me have/do just about anything that I wanted to make my l/d comfortable, except deliver on the toilet! (I almost did)

 

[jodifla]

If you read my LENGTHY post about our birth experiences, you would know that our birth center is across the street from a hospital. A hospital w/ a Level III NICU. If anything untoward happened during a birth I promise you my child would be in the NICU, attended by neonatal specialists just as quickly as any child born IN the hospital.

There are no pediatricians at a birth unless there is a known risk factor before the actual birth. The first people to care for your newborn are the OB/GYN or midwife and the labor & delivery nurses.

A birth outcome is based upon the care that the mom receives both prenatally as well as during labor and delivery...no pediatricians there.

It is a proven fact (based on peer reviewed studies) that the more interventions given to a mom in labor, the higher the chance of complications during delivery (as well as a much higher chance of c-section). Women who have epidurals statistically have a higher chance of having a c-section (see below where I cited specific studies), as well as complications from the epidural including, headaches, fetal distress, drop in mom's blood pressure, paralysis, numbness and nerve damage.

So... if I go to a health care provider for my child's birth that has a hands on policy for labor & delivery (ie they don't leave me alone in a room hooked up to a monitor and show up to catch the baby), an extremely low c-section (12% instead the national rate of 31%) and epidural (about 15% get transferred to the hospital for an epidural) rate, treat pregnancy as a "normal" event...not a medical emergency, and is across the street (literally) from a hospital w/ a Level III NICU... that is the best of all worlds to me.

Having our child at the birth center, gives us the best chance to have a low intervention birth...which means a less of a chance of needing a NICU or a neonatal specialist for my child.

Epidural Studies - From the 90's but still valid data...

Are most birth centers across from hospitals? I can see how you would feel that's the best of both worlds.

But I wasn't interested in delivering without an epidural after talking to my friends about their firsthand experiences doing it both ways. And since I was 40, I wanted a DOCTOR.

There was a neonatologist at my son's birth. He was the first one to deal with our son.

A high school friend is a nurse anesthetist and gives epidurals every day, so we had a long talk about epidurals. Like any medical procedures, there are risks. Those don't put me off at all. I hate pain way worse than needles.

 

[Aristomommy]

In my area many hospitals are now open for different types of births. Instead of arguing about what is best in general, it should be a decision between a woman and her provider of choice. I had a good experience with an OB and also with a midwife practice with my 2nd. I was high risk with my 2nd towards the end of the pregnancy and the midwives were still involved even though an OB took over for the most part. It's important to research the providers and facilities in your area and also talk with friends that had a good birthing experience. What I liked about my experience with midwives was the personal attention, their willingness to listen to my preferences about the kind of birth I wanted. Even though my labor was high risk, they allowed be to get into a tub which made my pain level lower. I didn't want any meds and they respected that and suggested various pain relief techniques.

 

[jodifla]

The midwife that I saw for my pregancy WOULD have had an anesthesiologist come up and give me an epidural if I wanted one, so I don't know what midwives you have talked to who said that they don't use epidurals! My midwife would have let me have/do just about anything that I wanted to make my l/d comfortable, except deliver on the toilet! (I almost did)

There was a PP who mentioned that her midwife didn't do epidurals. I would assume that would be an option for midwives who work with doctors, but probably those who work on their own would be able to?

There was a midwife in my doctor's practice. But I loved my OB...he was a great guy. He practically missed his own birthday party to deliver my son. We had to throw him out, and his partner delivered my son. She stayed with me the whole two hours of pushing, coaching me and giving me reassurance.

 

[Minniemouse07]

There was a PP who mentioned that her midwife didn't do epidurals. I would assume that would be an option for midwives who work with doctors, but probably those who work on their own would be able to?

There was a midwife in my doctor's practice. But I loved my OB...he was a great guy. He practically missed his own birthday party to deliver my son. We had to throw him out, and his partner delivered my son. She stayed with me the whole two hours of pushing, coaching me and giving me reassurance.

That may have been me... our BIRTH CENTER doesn't do epidurals, if you are in labor at the birth center and want an epidural you are transferred across the street to the hospital. All the midwives have full privileges and they just attend your birth at the hospital instead.

 

[mickeylove2]

Are most birth centers across from hospitals? I can see how you would feel that's the best of both worlds.

But I wasn't interested in delivering without an epidural after talking to my friends about their firsthand experiences doing it both ways. And since I was 40, I wanted a DOCTOR.

There was a neonatologist at my son's birth. He was the first one to deal with our son.

A high school friend is a nurse anesthetist and gives epidurals every day, so we had a long talk about epidurals. Like any medical procedures, there are risks. Those don't put me off at all. I hate pain way worse than needles.

The birth center that I delivered at is attached to a hospital by a walkway, they even share the same parking lot. Also, no offense at all, but at 40, I would think that you would be considered more highrisk and I know the midwife that I saw wouldn't have taken you on as a patient. I had an epidural with my 1st and all natural with my second, I wouldn't have another epidural if you paid me! The experience was much more enjoyable with my 2nd and the pain wasn't anywhere near what I expected!! But that's a totally personal choice.

 

[mickeylove2]

There was a PP who mentioned that her midwife didn't do epidurals. I would assume that would be an option for midwives who work with doctors, but probably those who work on their own would be able to?

There was a midwife in my doctor's practice. But I loved my OB...he was a great guy. He practically missed his own birthday party to deliver my son. We had to throw him out, and his partner delivered my son. She stayed with me the whole two hours of pushing, coaching me and giving me reassurance.

I wouldn't think that a MIDWIFE would do the epidural anyway, the OB doesn't, an anestesiologict does.

 

[jodifla]

I wouldn't think that a MIDWIFE would do the epidural anyway, the OB doesn't, an anestesiologict does.

Yes, I misspoke. I meant I wouldn't go to a place where epidurals weren't on the table from the get-go.

 

[mickeylove2]

Yes, I misspoke. I meant I wouldn't go to a place where epidurals weren't on the table from the get-go.

I wouldn't either! That's a choice that a mom to be has a right to make, I haven't heard of a birth center or hospital, what have you, in my area, that would not have that option! That's insane!!! That's definitely not someplace that I would want to deliver.

 

[cab0899]

I haven't read all the posts and I know my view is very one sided because I have lost a child. I would want to have my child at the most specialized, most well equipped hospital with the best trained and specialized staff that I could possibly find. I know my case and other horror stories are rare but they do happen to some of us. I would have put up with worst possible labour if I could have left the hospital with my baby. Why not go with the biggest safety net possible.

 

[kpm76]

I haven't read all the posts and I know my view is very one sided because I have lost a child. I would want to have my child at the most specialized, most well equipped hospital with the best trained and specialized staff that I could possibly find. I know my case and other horror stories are rare but they do happen to some of us. I would have put up with worst possible labour if I could have left the hospital with my baby. Why not go with the biggest safety net possible.

I'm so sorry for your loss I completely agree with you. I delivered at one of the top hospitals in the country and it's 100% dedicated to women and babies. They have a NICU, not just a Special Care Nursery and deliver close to 10,000 babies every year. They do have an alternative birthing center within the confines of the hospital if that is the route you take. I said countless times when I was pregnant how lucky I was to have this state of the art facility as an option. Though I had an uncomplicated (text book actually) pregnancy, experience tells me that an uncomplicated pregnancy does not equate to an uncomplicated delivery. I wanted to be in a place where specialized care was foot steps away.

I think everyone on this thread has made the best decisions for themselves and their families. I don't think that any mom set out to put either themselves or their baby in harms way. It's so unfortunate that we beat one another up over choices we make. The whole epidural argument is ridiculous. Some seem to think that because they had unmedicated births that they are somehow superior to the ones who did not. Why can't we just support and encourage one another instead of tearing one another down?