Natural Birth

Is it necessary to have a midwife?

I plan on delivering in the hospital but want to try for a natural birth.  Is it unheard of to do this without the assistance of a midwife?  I'm not understanding how this all works.....do I have a midwife in addition to my OB.  Are midwives covered by insurance if you already have an OB?  Someone enlighten me...I'm lost!
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Re: Is it necessary to have a midwife?

  • You can choose either a midwife or an OB. You don't need both. It depends on your preference.
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  • I have a midwife in place of an OB.  I go to an OB/Midwife practice where you can chose one or the other.  Generally a midwife is more beneficial when you plan on having natural childbirth (I'm sure there are OB's who are as well).  At least in the practice that I go to, when I am in labor my midwife stays with me through the entire process whereas an OB may be trying to deliver a couple of babies at a time.  In my hospital there is always an OB  there just in case an emergency should happen (csection, etc).  Midwives tend to look at a mother in labor as a natural process and they know that a womans body is designed to handle labor.  OB's tend to look at a woman in labor as being "sick"....... or it's the "how can I fix this mentality" (epidurals for pain, etc).  OB's also tend to put a laboring mom on the "clock"......they want a textbook delivery where a mother delivers within a certain time frame, delivers a certain way (on her back), etc.  Again I am sure there are OB's who are very natural childbirth friendly....... If you have an OB ask him/her alot of questions about what type of birth you want....... your OB may then refer you over to a midwife.  I hope this helps.

    PS...... I also have a doula as well....... she has been amazing during my pregnancy and my hubby and I know that she will only enhance my labor experience.

  • I don't think so.  My aunt had a baby in Sept. and she had a vag. delivery without a midwife.  My mom coached her bc her husband wasn't comfortable with it.  You just have to know what you want and tell your ob what you want.  I suggest reading the Sears birth book.
  • I wanted to make sure the person who would deliver my LO had a similar philosophy that I did, and I felt that I could get that with a midwife.  My midwife works in the hospital that I was going to deliver my DD.  I was guarenteed that she would be there (not some random doctor that was on staff that day).

     It ended up that I delivered six weeks early, so I was bought to another hospital that had great NICU for DD.  I didn't have my midwife (because it was a different hopital). The doctor on staff kept asking if I wanted meds - something that I did not want asked, etc..  He was not very supportive of natural birth.  When the shift change occured a nurse commented that she would make sure she would give me nurses who were supportive and knowledgeable of natural childbirth.  The nurses after that were great, the doctor who delivered DD was great (only in the room for delivery) 

    If you don't go with a midwife you have to make your preferences well known and be able to stand up for your wishes.  I also went with Bradley Method, FANTASTIC!!!  Great info for husband and I; based on husband coaching. We probably would have gone with meds in our situation if we hadn't taken the Bradley classes (we just wouldn't have been as knowledgeable). 

  • You usually pick one or the other - you only need one person to catch the baby :)  Some hospitals employ both doctors and midwives though, so maybe it is possible that even if you have your pre-natal care done by one or the other, you could get checked on by the other during labor?  I don't know.  But you don't actually need to see both during your pre-natal care.  I had a natural hospital birth with an OB.  Never saw a midwife once.  A midwife isn't absolutely necessary for a natural birth, though they *usually* are more comfortable in that kind of labor/delivery environment.  Though, you can also find midwives who are all about meds and interventions too.  You really have to take it on a case-by-case basis.

    And as for insurance, you're going to have to talk to your insurance about what they cover.  But I doubt you can go to 2 practices at the same time - which is what it would be, unless you are going to a practice that has both OBs and midwives on the payroll. 

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  • You can have a natural birth with an OB--there are some great natural-friendly OBs.  Likewise, there are some hospital midwives that aren't actually natural-friendly at all.  It really depends on the person. 

    That said, most OBs are not trained in natural childbirth or natural techniques to address labor complications.  There are lots of studies comparing OB care to midwife care for low-risk pregnancies and they consistently find that midwives have lower rates of interventions, inductions, instrumental deliveries and cesarean section--yet they have comparable mortality rates and lower morbidity rates (morbidity is things like infections, injury, etc.).  This shows that OBs do more interventions and cesareans on low-risk women not because their patients need them but because that is how they are trained.  If you hire a surgeon, you're more likely to end up in surgery.

    Again, the individual person and their beliefs matter too.  So I suggest that you meet with the care providers available to you and ask questions.  Their title alone can't tell you the whole story.  But generally, I would choose a midwife if I had the option and wanted a natural birth.

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  • image iris427:

    You can have a natural birth with an OB--there are some great natural-friendly OBs.  Likewise, there are some hospital midwives that aren't actually natural-friendly at all.  It really depends on the person. 

    I think this is such a good point because I definitely know a midwife is very anti-natural birth.

    OP to answer your question NO you do not need a midwife I would just say you need a care provider that is supportive of your beliefs and philosophies of how birth should be. You would only need one or the other and most insurance I believe will cover a midwife.

  • Most people will either see a midwife or an OB, though there are some practices that have both midwives and OBs. 

    A few differences between midwives and OBs:
    - OBs are doctors; midwives are not.  If you do have issues that come up that a doctor must handle or monitor, you will need to deal with an OB.  It's possible that you will still be able to work with your midwife if this happens.

    - OBs are usually more accustomed to patients that do not desire a natural birth (e.g. patients who want an epidural for sure, repeat c-sections, etc.).  That said, if you have a midwife, you can still get pain meds if you decide you need them (assuming you are at a hospital).  While there are natural-minded OBs out there, there are also OBs who are very intervention-happy and aren't as willing to let nature take its course.  Either way, it is important to interview your potential care providers and find the person that is right for you.

    - A midwife is likely to spend more time with you during active labor than an OB.  This is especially important if you aren't planning on hiring a doula.   

    Many midwives are covered under insurance.  Don't get discouraged if you look up midwives under your insurance and don't find any.  If the midwife works with a doctor, it's possible that only the doctor's name will be listed in your insurance roster.  It's best to call the office directly (not the insurance company) and find out if the midwife is covered by your insurance.

  • Knowing what your provider's philosophies are (and if they match up with what you're looking for), and how often they do interventions is more important than if they're an OB or a midwife, I think. This article has good questions to ask...http://www.themidwifenextdoor.com/?p=769

    I'm personally more comfortable with the midwifery model, and the fact that most midwives are women. But like a pp said, just like OBs can be very supportive of low-intervention birth, midwives can be intervention-happy also. hth

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  • Definitely not unheard of.  I have a good friend who has had five children naturally, in a hospital with an OB.  The reason I chose to have a midwife-assisted birth is because I didn't trust myself not to ask for the epidural if I knew it was an option.  As it turns out, I was right - there is no way I could have had a natural birth in the hospital.  I would have asked for that epi for sure. 

    And actually, I'm pretty sure that in a hospital, I would have ended up with a c-section.  DD was sunny-side-up and I had pretty heinous back labor, and as a result, progress was slow.  If I had been in a hospital, and they had asked me if I wanted pitocin and an epi, I would have said yes.  I'm pretty sure my labor would have slowed even more and then it would have been off to the OR with me.  Being at home allowed me to have the birth that I wanted, despite my own weakness.  I had no other choice!

  • image iris427:

    You can have a natural birth with an OB--there are some great natural-friendly OBs.  Likewise, there are some hospital midwives that aren't actually natural-friendly at all.  It really depends on the person. 

    That said, most OBs are not trained in natural childbirth or natural techniques to address labor complications.  There are lots of studies comparing OB care to midwife care for low-risk pregnancies and they consistently find that midwives have lower rates of interventions, inductions, instrumental deliveries and cesarean section--yet they have comparable mortality rates and lower morbidity rates (morbidity is things like infections, injury, etc.).  This shows that OBs do more interventions and cesareans on low-risk women not because their patients need them but because that is how they are trained.  If you hire a surgeon, you're more likely to end up in surgery.

    Again, the individual person and their beliefs matter too.  So I suggest that you meet with the care providers available to you and ask questions.  Their title alone can't tell you the whole story.  But generally, I would choose a midwife if I had the option and wanted a natural birth.

    This, exactly.

    P.S. We call midwives who are all about the interventions medwives. Wink

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  • The hospital we delivered at had midwives (which is why I chose it). I had a midwife in place of an OB. I loved having a midwife because I knew she supported my birth plan.

    That being said I do not think it's vital to have a midwife. It's most important to find a doctor who supports the kind of birthing experience you want. There are doctors who say "oh yeah, we support going natural" but have never actually seen someone go naturally, so don't really know what that means or what it takes.

    My advice would be to figure out what's important to you- how much medical intervention do you want or think is ok? Then find a doctor who supports and even promotes that kind of labor and delivery experience.

     My cousin just had a natural hospital l&d with her regular OB. she and her husband took Bradley classes and went over their birth plan with the doctor and nurses and everything went great.

    Just do the research- find out what really is/isn't necessary and then stick to your guns. It's your experience, your body, your baby.

    P.S. I had a 20 hr l&d and while it wasn't easy, I'm so glad I did it. I'd do l&d a million times over and can't wait to experience it again.

  • Oh, and the only reason our midwife was covered by insurance was because her expenses were billed through the hospital. If we had decided to do a home delivery with a midwife not associated with the hospital she would not have been covered.

    Another thing to think about is the use of a doula. My husband and I didn't do any classes, but we had a lady who was training to be a doula come with us and she was a great coach for DH and I and was able to speak on our behalf a lot of the time.

  • Thanks ladies!  Lots of food for thought here and much appreciated!  I feel like I'm so behind and have so much to think about - its a touch overwhelming but this helps!
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  • I delivered my son naturally with a midwife in a hospital and received all of my prenatal care from a midwifery practice after I was about 8 weeks.  My midwives are certified nurse practitioners so they could prescribe drugs, etc. and deal with any small problems.  Their care was fully covered by my insurance company. 

    I'm actually planning to continue seeing the midwives for my pap tests, etc.

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  • The most important thing is the orientation of the practice you are going with. In general, MWs are more naturally oriented, but as PP pointed out there are OBs that have a more patient-centered approach and MWs that follow the medical model. Aside from word of mouth, asking for their statistics on interventions is a way to evaluate how natural they are.

    The next thing to look into are the standard policies & procedures for L&D at the hospital that the practice delivers out of, practices can vary widely and you want to be forewarned if you are going to be pressured on something that is important to you. You can find this out by getting statistics on the hospital interventions and by talking to the head nurse in the L&D unit.

    To my knowledge, most states require MWs to be supervised by an OB, and if there is an issue with your care that calls for medical supervision that the MW isn't legally allowed to handle than the OB steps in. So you just need to find the MW that you want to go with, not hire an OB in addition to a MW.

    The bottom line is that you need to be an educated consumer but if you do your homework you stand the best chance of getting the expereince you want, wherever you birth. Good luck!  

  • I see you are in Boston.  I would suggest that you avoid Brigham and Women's if you want a natural birth.  Despite the fact that they have a practice of 16 or so MW, their epidural rate is 95%.  I was seeing this practice until about 25 weeks and I met several different MW at that time.  For me the experience was less than favorable- I pretty much could have been seeing an OB.  They were not at all what I expected- they were as a PP posted said, medwives, not midwives.

    Oh and you should also avoid Mass General.  They like to advertize the fact that they have a room with a tub for laboring, but I learned (from a nurse who used to work there) that the nurses try to give that room away to women planning on getting epidurals, so they don't have to "deal" with the natural birth Mamas using it.

    Just a little inside info. :)


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