Mixed Practices- Doctors & Midwives

LKHoffa

I was curious what everyone's experience was with offices that have both doctors and midwives.

In my practice, the doctor is fabulous. He is knowledgeable and has a fabulous bedside manner. The 2 midwives both are nice, but I'm not as wild about them. One of the midwives recently told me that my iron levels were getting low and that I should start eating red meat again (which I haven't eaten in 2 years.) At my next appointment, I asked my doctor about it, and he said that my levels were great, considering that I was pregnant. 

My practice rotates, so whoever is on call will deliver the baby. 

Does anyone else who has a similar office setup to this have a preference of midwife over doctor or vice versa? Any reason why the preference? (I have a friend who prefers the midwife in her practice because the midwife was very helpful in helping her not to tear during delivery, which I can definitely understand.)

curlylocks3

My OBs office is the same way. I really like one of the midwives and if I were a candidate for midwife care and didn't love my OB as much as I do I would strongly consider her for my primary. The other midwife I'm sort of meh on. I don't think it's anything about her midwifery training, just her in general. My delivery will definitely be handled by an OB, but if that weren't necessary I would have no problem with the second midwife doing my delivery.

tbmadeamistake

My office used to be a mix of both (4 OBs and about 8 midwives).  Last time I saw mainly midwives because I had heard about how they were more patient-centered and willing to be as natural as you wanted, etc.  I also just really liked them all.  Same basic set up, except they always had both a midwife and OB on call so you could choose which you wanted for delivery.  I chose the midwife and ended up on pitocin and chose an epidural.  I spent the majority of my labor with the nurses and DH, and then midwife came in most of the 2+ hours of pushing and delivered C. 

Since then, they have stopped sending the midwives to deliver for financial reasons, and all but one of them has left the practice (not a midwife if you're not delivering babies, so I can understand that).  Given that I spent most of the time with the nurses last time and the midwife just came in for pushing to make the catch, I decided to stay with the same practice and use the same hospital, because I was comfortable there.  This also means that I've been seeing only the OBs this time around. They are all awesome!  They spend just as much time with me during appointments and are just as supportive of my wish to try for an all natural birth again. 

Long story short: I think you'll be fine with whichever one you choose, and depending on how your delivery goes, you may only really see them for the occasional check and pushing/delivery anyway.

catsinawindow

With DS, i went to a mixed practice with 2 doctors and 1 MW.  I like the MW better than the 2 doctors, and one of the doctors much better than the other one (although I trusted them all and would have felt comfortable having any of them deliver my baby).  I think the MW and I just "clicked" better and I preferred the MW model of care (more patient-focused, individualized, and education oriented).

I had an emergency induction with DS (due to PreE) and it happened to be when none of my care providers were on call (boo).  I wasn't crazy about the two doctors that I saw at the hospital when I was laboring with him.  Therefore, I decided that with future children, I would definitely go to a practice where there were enough care providers that someone was always on call.  That way I could always know the person who would be delivering me.

I also chose to go with an all MW group this time.  I chose to do this because I prefer the MW model of care and I think they will be more supportive of my plan to have an unmedicated birth.

Good luck with your birth!

MrsCase1

My office has three doctors and one midwife. I only ever see my doctor, not the other two. Midwife covers for doctor during overflow.

I do not like her. She is not a reflection of all midwives an I am not opposed to them AT ALL but in this instance I am glad there is no way possible she will deliver me (repeat c/s) because she is a total flake. 

tbmadeamistake

kaysa2 said:

2) Midwives, as much as I love the concept of them, are not doctors, and do not have the type of advanced training necessary when you have any type of pregnancy complication.  I had HG and had to beg for drugs.  My asthma went undiagnosed for months and even up to my last visit with them I had to defend the drugs prescribed to me by my allergist so that LO and I could get enough oxygen.  The midwives wouldn't stay off me about my weight gain, even when shown recent medical journal articles about fitness pre-pregnancy, continued fitness in pregnancy, and weight gain.  

______stuck in the box_________

This depends on the type of midwife they are, mine were all certified nurse midwives.  No, not as much training as a doctor, but a shit ton more than a regular old midwife.  There were limits on what they could do, though mine was able to order the pitocin and epidural.  They were also very much so on top of all things medically related to my pregnancy, and to any pregnancy.  The OB and Midwives were always on call together so that if anything did go wrong during labor/delivery, the OB could come in and do a section or take over and he/she would already be up to date on what had been going on because they spoke just about once an hour.  I think it depends on the midwife and the practice.

MrsCase1

kaysa2 said:

My old office was mixed - six midwives to one OB and one MD.  Some of midwives were also nurse practitioners.  I was also rotated through, since it was unknown who would be on call during delivery.

I hated it.  Hated it so much that I just transferred to a new practice last week, where I have one MD who specializes in obstetrics (but for some reason isn't an actual OB), and her resident (it's a teaching hospital).  She will be there for the birth.  

I switched for a number of reasons.  

1) The quality of care and difference of opinions between eight different care providers at the old practice was insanity.  Every one told me a different thing, there was no continuity, and they all had different opinions on things to eat, things to do, etc.

2) Midwives, as much as I love the concept of them, are not doctors, and do not have the type of advanced training necessary when you have any type of pregnancy complication.  I had HG and had to beg for drugs.  My asthma went undiagnosed for months and even up to my last visit with them I had to defend the drugs prescribed to me by my allergist so that LO and I could get enough oxygen.  The midwives wouldn't stay off me about my weight gain, even when shown recent medical journal articles about fitness pre-pregnancy, continued fitness in pregnancy, and weight gain.  

3) The MD at my former practice was my favorite one, but since there was no guarantee of getting her, and I had lost all trust in the midwives, it wasn't worth taking a 1/8 chance for delivery.

Switching was the best decision I have made thus far in this pregnancy.  My new MD is attentive, doesn't question other MD's medications, is up to date on current medical research (presumably because she is at a teaching hospital and has to be), and as a result I no longer dread prenatal checkups.

@kaysa2 I understand why at some offices they want you to meet everyone because whomever is on call will deliver you. However, that stressed me out very badly. I am thankful I do not have to worry about not having an actual relationship with the person I am going to be relying on for a very serious event in my life. Eight people sounds like sheer chaos. I think it is a good idea you switched.

ElTrain5

I'm at a small practice that has about four midwives and two doctors. Between the four of the midwives, there's a definite difference in medical knowledge and overall approach. They are all nurse midwives but at least one seems VERY wishy washy whenever I ask medical questions or ask her reasons for reccomending/not reccomending thing. Whereas another one seems right on the money and very up to date. They're all pretty nice, but there's one I really clicked with and I hope she's on call for my delivery. The doctor is at the practice full time and attends all births (apparently he is "in hospital" for each birth in case he is needed), and you can also see him for appointments if nessexary. They just hired a second doctor as a backup (who I haven't met yet). I like the fact that the doctor is involved in the practice and not just used as a "backup" in case someone needs a section. That seems to be common at the midwife groups around me. Over all I do like the midwife approach for pregnancy and delivery, but I will probably see the doctor for ongoing gyno care since I have medical issues that require more complicated medication and occasional surgical intervention (endometriosis, hormonal imbalance, Etc.)

whoberry

My office is also a mixed practice and it's part of a teaching hospital.  You choose whether you want to be part of the midwife program"or stay with a doctor.  There's even a 3rd option called "centering" where you have your appointments with a group of other pregnant ladies and a midwife. 

I'm seeing the midwives and they rotate us through so we meet with each one.  I did see my regular ob/gyn for my first two visits and then switched into the midwife program.  So far so good!

flerlgirl

My OB office for DS was the same way. The CNMs were awesome. The doctors, notsomuch. In my particular practice, the doctors were very rushed and made it clear they did not have time for questions or concerns. The CNMs, on the other hand, were very patient and knowledgeable. 

At my current practice, it is just OBs and nurses. My OB is fabulous and so are the nurses. 

That is my experience. 

elle_tee19

I'm in the military, so I'm not even sure how many OBs and Midwives are in the "practice", but I haven't seen an OB my entire pregnancy, just the same midwife every time. I was told that when I go into labor, I could ask for her if she's working, but if she's not, I'm SOL and will have an OB/midwife I've never met.

I don't really care though...I just want someone there to get that baby outta me. (I say that now; with my luck I'll get a terrible OB/midwife) X_X

MrsCase1

@LaurenT92 I actually think that is a good, healthy attitude to have!

LKHoffa

Thanks for your thoughts, ladies! It's really interesting to hear all of the different options out there. I'm from a smaller town, so I may not have as many, but I am definitely going to evaluate after L&D and see if a bigger practice would be a better option or I want to stick with where I am. Good luck!

kittenslove

I'm in a special circumstance, but it am actually assigned a midwife and an MFM. I love them both, and like both of their approaches to treatment. I can't say I prefer one to the other, but I do use them for different resources. For instance, my general concerns and questions I go to my midwife. Specifics about my baby's delivery and my recovery, I go to MFM. I go to MFM about how baby is growing, if I am worried about decreased movement ect, but go to the midwife about things like weight gain questions, constipation etc. The hospital I am bring treated at, you are assigned both, as well as any other specialists you may need (I have 6 doctors, plus a surgeon, social worker and doula). They meet weekly as a team and review your case. Because it is a high risk/rare diagnosis based practice in a children's hospital, it is very individualized and they only deliver about 100 babies/ year there. So my experiences maybe/ are not normal.

dmahanWed170597

kittenslove said:

I'm in a special circumstance, but it am actually assigned a midwife and an MFM. I love them both, and like both of their approaches to treatment. I can't say I prefer one to the other, but I do use them for different resources. For instance, my general concerns and questions I go to my midwife. Specifics about my baby's delivery and my recovery, I go to MFM. I go to MFM about how baby is growing, if I am worried about decreased movement ect, but go to the midwife about things like weight gain questions, constipation etc. The hospital I am bring treated at, you are assigned both, as well as any other specialists you may need (I have 6 doctors, plus a surgeon, social worker and doula). They meet weekly as a team and review your case. Because it is a high risk/rare diagnosis based practice in a children's hospital, it is very individualized and they only deliver about 100 babies/ year there. So my experiences maybe/ are not normal.

My experience is some what similar to this!  I am at a practice with midwives and OBs but also see an MFM every two weeks for a cpam.  We also have a pediatric surgeon we met with last week.  I really like my midwives and the OBs I have met with but I will be asking if an OB can be present at the birth just in case there are complications.  I think it really comes down to who you are comfortable with. 

rastrau

I also attend a mixed practice - 7 CNMs and 3 OBs. I have met all of the midwives and they're the ones who will attend my delivery. I clicked with some and not others, but that was mostly a personality thing - they've all been great about answering my questions and providing information - but again, some better than others. I'm hoping for a particular two to be on-call when I deliver, but I'd be happy with just about any of them. I haven't met any of the OBs - and I will only if I end up with a CS.