Switch to midwife? DH thinks I'm crazy...

pushgal84 · July 2014

I've been doing some reading about natural childbirth (which is something I had wanted from the beginning) and have come to the conclusion that I'm just not that comfortable having a OB oversee the birth. I originally decided to see an OB, not realizing my hospital offers midwives. I have an HMO, so unless I want to pay out of pocket, I'm stuck delivering at a specific hospital with whatever OB is on call. My worry is that even if my OB is on board and supportive of my birthing preferences, that might not be the case with the random OB on call when I go into labor. The midwifery model/approach to birthing aligns with my preferences and I think I would be more comfortable going into the hospital knowing that which ever midwife attends the birth (yet again I'll just get the midwife on call) will be more likely to support my preferences. I'm just so worried if I stay with an OB I'll have to fight tooth and nail to avoid interventions, which sounds like the last thing anyone needs when in labor.

So, DH is not on board with this idea. He kind of likes the idea of a natural birth, but inherently believes OB are superior to midwives. He thinks I've read too many biased books and now have an unhealthy distrust of OB's. I do not think that hospitals and OB's are terrible and cruel, but simply prefer a gentler approach to childbirth and will do anything to avoid a c-seciton if possible (my hospital's rates are 33%!). We've been arguing about switching to a midwife for days now and no matter how much information I offer, he still asks pushes back and thinks our OB is the best (and safest) bet.

All of the information I've found has been biased (which I've taken with a grain of salt) and I'd really like to find some more neutral studies so we can make the best decision possible. Anyone know where I should start? Maybe some good studies that could change his mind? FWIW I do want to give birth in a hospital, just in case medical intervention truly is necessary.

TL;DR I want a natural birth in a hospital overseen by a midwife. DH thinks OB's are superior. Need studies and or literature with facts/statistics so that we can make an informed decision.

sabby2 · July 2014

I don't have any articles on the ready but you can always check out Google Scholar. It gives you peer reviewed articles. As per usual with articles, sometimes all you can view is the abstract and they want you to pay for the rest of the article but you should be able to find some complete articles. Also, if you really want a specific article most local libraries have memberships that would give you access to those articles.

JayneMouse · July 2014

I cannot point you in the direction of any research or studies but I can give you my experiences.

For our first child, I stuck with my OB/GYN practice knowing that I would see whatever doctor was on call at the hospital. I also hired a doula to attend the birth. I wanted an unmedicated delivery but in a hospital setting just in case since it was our first time. While reviewing my birth plan at a routine appointment one of the doctor's told me I would tear myself apart (wanting to avoid an episiotimy) and that I would bleed to death (wanting to refuse routine pitocin after the childbirth). I was lucky that when I did delivery an open-minded OB was on-call and stuck to my birthplan. The only variation in care was that we did do a vaccuum extraction because the OB felt the baby's heartrate had slowed. I agreed because I was exhausted and just wanted him to be safe. The doula commented that the heartrate normally dipped at that point in labor and had come back up before the extraction was done. All in all I had a "good" hospital experience if you exclude the nursing staff who were incompetent. (Didn't get the bar for the bed when requested, didn't get my IV put in in time, let my IV run dry, kept trying to put the monitors on after I had just gotten permission to take it off, pulled my husband away from the delivery to sign paperwork that should have been taken care of already, tried to force a pitocin injection when it wasn't needed, tried to give the baby a vaccine that we had adamantly refused, didn't put baby lo-jack on.)

For my second son, I started out with the OB/GYN practice again because I had experienced two losses in the meantime. At about 27 weeks, I switched to a midwife practice that has a birth center on the hospital grounds. I was much more comfortable with the midwives and had a quick and easy delivery.

I'm planning on delivering with the midwives again for my third.

I feel like this might be one time where you get a bit more say in the matter since you are the one who will actually be going through the labor and delivery. If the midwives can deliver in a hospital setting and they team with the hospital OB's in case of emergency, I see no reason why you shouldn't go that route. Having someone who is more likely to support your birth desires can make a world of difference in how things progress.

JayneMouse · July 2014

Forgot to add, you might want to try watching The Business of Being Born with your DH. It definitely biased but can help get him thinking about things without trying to force him to read a book. It certainly helped my DH.

jcsumm0 · July 2014

You might want to talk to the midwife practice you'll be using. I have been told that some midwives have a very similar approach to birth as OB, while of course some are much more supportive of low-intervention practices.

Do you have any friends who have had the type of birth you want? Maybe you could find out their provider. The most natural birth friendly doc in our area is actually a family doctor. Maybe that would be a good compromise for YH?

The other thing you might consider as a compromise is staying with the OB practice and hiring a doula. Your OB is probably not going to be around much during the birth until the end but the doula will be there with you throughout and she can help you make decisions about interventions that are suggested as they arise, and she can help you with dealing with labor and help YH to help you.

Best of luck with your decision.

ashie0610 · July 2014

Someone once told me something along these lines that helped me make the decision to switch... maybe it was even here on TB.

OBs are doctors first and foremost. They learn about alllll kinds of other things besides delivering babies including pediatrics, surgery, psychiatry, etc. They then select their specialty area of obstetrics.

Midwives, on the other hand, are trained for just as long, but ONLY in female reproductive care and delivering babies. They are the true experts in vaginal deliveries because that's essentially all they do every day.

Doctors do lots of different things every day, including many surgeries... that's generally their comfort zone.

If you need a c-section, you are generally going to be in good hands with almost any on-call surgeon... because that's what they do. If a natural birth is important to you, you could luck out with a doctor who supports it with BOTH head and heart, but I believe your odds of success are much better with a midwife.

There are definitely benefits and drawbacks to either and this isn't literature-based, but if you need help convincing your H, you could try explaining it that way. It worked on me and my H.

jcsumm0 · July 2014

As far as research goes, I'd get a well-respected natural childbirth book, Like A Thinking Woman's Guide to a Better Birth (Goer) or Ina May's Guide to Childbirth (Gaskin) and look at the research cited in the back. You may be able to check those books out at your library.

AmandaJean12 · July 2014

I know your doctor may not be the one on call, but talk to him/her about your concerns. My OB is committed to avoiding c-sections unless absolutely necessary, and he told me the other OBs in his practice are the same way. And there are midwives who will have different tolerances for difficulty before they suggest intervention. The classification alone isn't the deciding factor in my opinion.

Emerald27 · July 2014

I just switched from an OB to a midwife TODAY for almost the same reason. My OB is very pro-natural childbirth, but is no longer delivering (only very rarely) at the hospital where I want to deliver, so there's a 99% chance I would be stuck with one of his backups...both of which are not natural-childbirth friendly and neither of which I'll have even met in advance!

I'd take the same approach with your DH that I did with mine on the doula issue. Set up a consult appt with the midwifery practice you like, and have
DH come to the appt. to meet the midwife and see what it's all about. After the consult, he'll likely feel more comfortable.

pushgal84 · July 2014

jcsumm0 said:

You might want to talk to the midwife practice you'll be using. I have been told that some midwives have a very similar approach to birth as OB, while of course some are much more supportive of low-intervention practices.

Do you have any friends who have had the type of birth you want? Maybe you could find out their provider. The most natural birth friendly doc in our area is actually a family doctor. Maybe that would be a good compromise for YH?

The other thing you might consider as a compromise is staying with the OB practice and hiring a doula. Your OB is probably not going to be around much during the birth until the end but the doula will be there with you throughout and she can help you make decisions about interventions that are suggested as they arise, and she can help you with dealing with labor and help YH to help you.

Best of luck with your decision.

We have a regular appt with the OB next week and plan to bring up my concerns and go more in depth into what their standard practices are, then hopefully meet with a midwife and go from there. Unfortunately, if I want to be covered by my insurance (Kaiser HMO) I have to give birth at this particular hospital, and although they offer midwives, midwife or an OB are my only two options. I really like the idea of the doula and OB compromise, but we really don't have any room in our budget for the added expense of a doula.

I have very few friends with kids. Of my 2 friends with kids, one took any intervention offered and did zero research on childbirth and the other ended up with a c-section, then 3 subsequent repeat c-sections.

pushgal84 · July 2014

@JaneMouse Thank you so much for sharing your birthing experiences! Although your first birth had minimal interventions it still reinforces the idea that the vacuum was used when maybe it wasn't really necessary. I'm sure that played a role in how you decided to give birth to your second LO too. It's experiences like these that make me lean towards a midwife.

Emerald27 · July 2014

@pushgal84‌ Another thought on doulas: Doulas can be very pricy, but another option you may wish to consider would be hiring a student doula. Depending on where you live, you might be able to find a student doula for as little as $150. And what a mother looks for in a doula is more that the personalities match and less the experience...so you can have just as great a birth with a student doula as you would with a doula of 30+ years.

ETA: And doulas are helpful whether you stick with an OB or change to midwife

pushgal84 · July 2014

jcsumm0 said:

As far as research goes, I'd get a well-respected natural childbirth book, Like A Thinking Woman's Guide to a Better Birth (Goer) or Ina May's Guide to Childbirth (Gaskin) and look at the research cited in the back. You may be able to check those books out at your library.

I'm most of the way through A thinking Woman's Guide to a Better Birth and of the statistics I've shared from the book, DH believes them to be somehow skewed in favor of natural birth and not taking all variables into account. The engineer in DH wants facts and statistics from both sides and likens the natural birth movement to a crunchy cult of Dr. haters that operates off of scare tactics, propaganda, and loose correlations that do not equal causation. He went so far as to say he feared for my life if I used a midwife. I guess I just don't know where to go to get a balanced perspective or at least one that H would view as coming from a reputable source.

pushgal84 · July 2014

ashie0610 said:

Someone once told me something along these lines that helped me make the decision to switch... maybe it was even here on TB.

OBs are doctors first and foremost. They learn about alllll kinds of other things besides delivering babies including pediatrics, surgery, psychiatry, etc. They then select their specialty area of obstetrics.

Midwives, on the other hand, are trained for just as long, but ONLY in female reproductive care and delivering babies. They are the true experts in vaginal deliveries because that's essentially all they do every day.

Doctors do lots of different things every day, including many surgeries... that's generally their comfort zone.

If you need a c-section, you are generally going to be in good hands with almost any on-call surgeon... because that's what they do. If a natural birth is important to you, you could luck out with a doctor who supports it with BOTH head and heart, but I believe your odds of success are much better with a midwife.

There are definitely benefits and drawbacks to either and this isn't literature-based, but if you need help convincing your H, you could try explaining it that way. It worked on me and my H.

Well this is probably way more eloquent than how I explained it to H, seeing as I get so exasperated defending my childbirth views to him these days, but it's essentially what I brought up that initiated to disagreement. Since that wasn't enough to get him on board I've been trying a fact based approach, which obviously isn't going well either. 8-|

pushgal84 · July 2014

theresat858 said:

Many doulas will work on a sliding scale or you can find student doulas in training who will work for free if you cannot afford a doula but want one present for your birth. A doula is helpful no matter what practioner is overseeing your delivery.

The Thinking Woman's Guide is a great book.

I would not be comfortable with anyone besides an OB delivering my baby.

Can you go more in depth about why you feel this way?

Thanks for the tip about student doulas, that might be a good option (@Emerald27 too)

jcsumm0 · July 2014

Another suggestion: see if there is a La Leche League group in your area and attend a meeting if possible. LLL is very much an advocate of active, alert participation in childbirth. They'll have books you can borrow about birth, you can talk to some local moms about their experiences, and it would be a great way to find a doula that might work with you on a budget.

https://www.llli.org/webus.html

ashie0610 · July 2014

pushgal84 said:

ashie0610 said:

Someone once told me something along these lines that helped me make the decision to switch... maybe it was even here on TB.

OBs are doctors first and foremost. They learn about alllll kinds of other things besides delivering babies including pediatrics, surgery, psychiatry, etc. They then select their specialty area of obstetrics.

Midwives, on the other hand, are trained for just as long, but ONLY in female reproductive care and delivering babies. They are the true experts in vaginal deliveries because that's essentially all they do every day.

Doctors do lots of different things every day, including many surgeries... that's generally their comfort zone.

If you need a c-section, you are generally going to be in good hands with almost any on-call surgeon... because that's what they do. If a natural birth is important to you, you could luck out with a doctor who supports it with BOTH head and heart, but I believe your odds of success are much better with a midwife.

There are definitely benefits and drawbacks to either and this isn't literature-based, but if you need help convincing your H, you could try explaining it that way. It worked on me and my H.

Well this is probably way more eloquent than how I explained it to H, seeing as I get so exasperated defending my childbirth views to him these days, but it's essentially what I brought up that initiated to disagreement. Since that wasn't enough to get him on board I've been trying a fact based approach, which obviously isn't going well either. 8-|

I can see why you are frustrated. What if you did some research on education and training for both OBs and midwives so that he could see the similarities in how midwives are educated compared to when doctors go into obstetrics? Lots of medical schools have detailed information about their curricula and rotations online, and you could probably find the midwife info at midwife.org.

Then he could then draw his own conclusions based on all the facts and he definitely wouldn't be able to say it's biased.

pushgal84 · July 2014

Nicb13 said:

JayneMouse said:

Forgot to add, you might want to try watching The Business of Being Born with your DH. It definitely biased but can help get him thinking about things without trying to force him to read a book. It certainly helped my DH.

This movie is garbage.

From what I've read about it, I'm pretty sure it would just cement DH's stance on natural birth scare tactics and lack of hard evidence.....

AmandaJean12 · July 2014

I'm in the not comfortable with anyone but an OB delivering my baby camp.

I'm hoping for a vaginal, drug free birth but I've had a lot of friends need emergency intervention and I want the person delivering my baby well versed on all options. And, I wouldn't be here if it weren't for a last second emergency c-section so even though I don't want one, I want to know the person delivering is ready to do one.

But that's totally just me. I understand the appeal of a midwife, it's just not for me.

pushgal84 · July 2014

@Nicb13 care to expand on your "ditto" too?

pushgal84 · July 2014

Nicb13 said:

OP, I am glad you are really thinking this through and it is a very, very important decision that you are making but with that being said...I think you are overthinking this. I'm not telling you which direction to go in, but I wouldn't stress this as much as you are.
But take my opinion with a grain of salt because I love my OB and I have no fear that he, or whoever else is on call, won't listen to my wishes during labor.

I suppose this is where we differ. I love my OB, it's the dozens upon dozens of other possible on-call OBs that I am not familiar with or their approach to the birthing process. (seriously there's a dozen OBs at each location in my city and several locations city-wide that all attend births at one hospital)

Maybe I'm stressing about it even more since H seems to be completely opposed to my preferences and I'm feeling like if my own H doesn't value my opinion, then why would a random doctor?

persephonerose · July 2014

pushgal84 said:

Nicb13 said:

OP, I am glad you are really thinking this through and it is a very, very important decision that you are making but with that being said...I think you are overthinking this. I'm not telling you which direction to go in, but I wouldn't stress this as much as you are.
But take my opinion with a grain of salt because I love my OB and I have no fear that he, or whoever else is on call, won't listen to my wishes during labor.

I suppose this is where we differ. I love my OB, it's the dozens upon dozens of other possible on-call OBs that I am not familiar with or their approach to the birthing process. (seriously there's a dozen OBs at each location in my city and several locations city-wide that all attend births at one hospital)

Maybe I'm stressing about it even more since H seems to be completely opposed to my preferences and I'm feeling like if my own H doesn't value my opinion, then why would a random doctor?

I honestly think that is probably more of an issue than which OB you end up with. You and your DH need to be a team when it comes to L&D regardless of using an OB or midwife. He needs to know your wishes and be willing to fight for them, even if he doesn't fully understand why you want XYZ. I think you should work with him on what you want when it comes to L&D instead of focusing on who is going to catch the baby.

ADH0906 · July 2014

Nicb13 said:

pushgal84 said:

@Nicb13 care to expand on your "ditto" too?

I think it all comes back to really liking my OB and just simply being more comfortable with an MD delivering my baby. I don't have sites or statistics that have brought me to this opinion; it's simply just how I feel I guess.

I am not very picky when it comes to the birth though. I want an epidural, am not opposed to being induced, don't care about Pitocin and just want the doctors to do what is necessary to get my baby out safely. I trust my OB and his staff 110%.

I think you're way overthinking this too. I actually see a midwife. She operates out of an office with an OB, has a PhD, and also teaches midwifery at the university. I chose her because I appreciate a whole-woman approach to all my care (including gynecology) and that she is more open minded to med-free births in general.... recommended a doula, etc. That said, I want an epidural and she
is completely on board with that. I haven't had any less testing because I'm seeing her; in fact, I see a MFM as well. I'd wager that her care is not a whole lot different from most OBs.

From what I gather from the BTDT camp, your labor nurses and support partner have much more to do with how your labor goes than your OB does. If you are looking for a specific birth experience, you have to be your own advocate.

pushgal84 · July 2014

I'm glad so many of you, who's opinions I greatly respect, weighed in on this and thanks for the reality check. I think I need to put the books down and take a step back and re-evaluate why I'm so worked up/worried. I'm going to shift my focus to more clearly forming my birth preferences and getting them down on paper so I can address them with my OB and DH.

LightBright515 · July 2014

I'm in the OB only camp.

I think it's important to understand a little bit of everything to make sound decisions. So I don't slight them on having a specialty. And for OB's who have been practicing in their specialty for a while, they are more invested knowledge wise in their specialty than the broad areas of medicine.

And I second the idea of being more vocal and holding your OWN ground with hospital personnel. Obviously backed with the right information.

<--- has her own bias as a hospital worker, and knowing the system.

pushgal84 · July 2014

theresat858 said:

pushgal84 said:

Can you go more in depth about why you feel this way?

Thanks for the tip about student doulas, that might be a good option (@Emerald27 too)

Because an OB has gone to medical school and received a lot of training in what to do if things go wrong. My OB is trained to cut me open if needed; there would be no delay waiting for the on-call OB to get ready for an emergency C-section. Additionally, and I think this is the more important part for me (in most labors, the doctor is just a baby catcher) --- I just cannot fathom obtaining maternity care from a provider who never went to medical school. A midwife may have attended hundreds of more births than my OB, but does she understand the biochemistry behind preeclampsia? Does she know how to interpret studies about drugs and interventions? What kind of science background does she actually have? No way of knowing. Clinical hours only really tell part of the story.

I will agree that I am more comfortable having all my prenatal care with an OB and having more or less immediate access to emergency care at a hospital if needed is the #1 reason I want to give birth in hospital, but maybe I could just have a gentler labor & delivery with a midwife? I see the benefits of both and really wish there was a happy medium. Maybe the doula and OB combo really is the way to go.

LightBright515 · July 2014

theresat858 said:

pushgal84 said:

Can you go more in depth about why you feel this way?

Thanks for the tip about student doulas, that might be a good option (@Emerald27 too)

Because an OB has gone to medical school and received a lot of training in what to do if things go wrong. My OB is trained to cut me open if needed; there would be no delay waiting for the on-call OB to get ready for an emergency C-section.

Additionally, and I think this is the more important part for me (in most labors, the doctor is just a baby catcher) ---

I just cannot fathom obtaining maternity care from a provider who never went to medical school. A midwife may have attended hundreds of more births than my OB, but does she understand the biochemistry behind preeclampsia? Does she know how to interpret studies about drugs and interventions? What kind of science background does she actually have? No way of knowing. Clinical hours only really tell part of the story.

I love your reply. A "love it" was not enough!

AmandaJean12 · July 2014

If you can't afford a doula, do you have a family member or friend that understands where you're coming from and can be another support person? Obviously it would be ideal if DH was on the same page and could fill that roll, but maybe another woman would understand in a way he's not right now.

I'm not saying a doula doesn't have skills and experience beyond just another support person - but it might be a possible middle ground given the circumstances. Another advocate who has a clearer head in the moment and will calm your nerves.

pnwlover12 · July 2014

Forgive my ramblings as I try to get to my point.

>-

This is my second pregnancy and we chose a midwife from jump with this baby. I loved the OB I had for my first pregnancy. She was thoughtful, took her time with me, and I felt she was more than 100% competent to handle any situation that may arise. However, I only saw my OB for maybe a total of 45 minutes during my labor that lasted 17 hours, so my OB had nothing to do with our decision to use a midwife.

What really influenced me was the experience I had overall at the hospital. I caved about 4 hours into labor and got the epidural (I was trying for a med-free birth). I was doing great managing my contractions on my own, until they pushed the pitocin (which I felt was unnecessary as I was progressing great and my water broke on its own at home before I even went in). I'm sure this is just anecdotal as I don't have any statistics or numbers for you, but literally, within 20 minutes after the pitocin was pushed, the contractions went from painful but manageable, to SOMEBODY IS GOING TO FUCKING PAY FOR THIS AND IT'S YOU DH! Even if that was just a coincidence, in my mind, it was a direct result of the pitocin, so that is a huge part of why I am choosing a birth center this go round. They don't have that shit in stock

Now to the problems I had with the epidural. Because of the belt I had to wear to monitor LO's heartbeat, I had to be laying on my back the entire time. Anytime I tried to roll from side to side they would lose baby's HB and threatened me with c-section. So, I was laying on my back for about 14 hours before I was able to get up. Afterwards, my tailbone felt broken. It hurt so bad to sit down on it or lay, I couldn't get comfortable to sleep well. It was a nightmare. I want to be able to get up and move, be in the tub or use my exercise ball, or at the very least, change positions.

This is just my experience. I know a ton of women who have birthed at the hospital and had pitocin and did just fine (or at the very least, didn't hate their experience). I would say that because you are already giving birth in a hospital, using a midwife won't matter in the sense that if a medical emergency does arise, an OB is coming in and taking over. But if you have a complication free labor/birth, an OB won't even be necessary. So really, you would be getting the best of both worlds.

ashie0610 · July 2014

pushgal84 said: theresat858 said: pushgal84 said:
Can you go more in depth about why you feel this way?

Thanks for the tip about student doulas, that might be a good option (@Emerald27 too)

Because an OB has gone to medical school and received a lot of training in what to do if things go wrong. My OB is trained to cut me open if needed; there would be no delay waiting for the on-call OB to get ready for an emergency C-section. Additionally, and I think this is the more important part for me (in most labors, the doctor is just a baby catcher) --- I just cannot fathom obtaining maternity care from a provider who never went to medical school. A midwife may have attended hundreds of more births than my OB, but does she understand the biochemistry behind preeclampsia? Does she know how to interpret studies about drugs and interventions? What kind of science background does she actually have? No way of knowing. Clinical hours only really tell part of the story. I will agree that I am more comfortable having all my prenatal care with an OB and having more or less immediate access to emergency care at a hospital if needed is the #1 reason I want to give birth in hospital, but maybe I could just have a gentler labor & delivery with a midwife? I see the benefits of both and really wish there was a happy medium. Maybe the doula and OB combo really is the way to go.
____________________________________________________________________
This is exactly how I feel too, @pushgal84. I've already made my decision but I really like reading responses from both sides of the opinion. I am generally VERY risk-averse. TBH, if my midwives were not part of a larger OB practice, I don't know if I'd be going that route. For me, the happy medium is knowing that one of my midwives will deliver me if this pregnancy is complication-free, however the second I start to show signs of high BP or any other kinds of complications though, they leave the room to get one of my doctors. A doctor and a midwife from my practice are both scheduled to be at the hospital on any given day. It stinks that it has to be an either/or decision in a lot of cases.

Anyway, I'm probably not much help, but just want you to know you're not alone in feeling conflicted!

ETA: Sorry, no idea what's up with the quote boxes.

irisheyes317 · July 2014

@ashie0610‌ I feel the same way. I see a practice that includes both midwives and OBs. I like knowing that as long as I stay low risk, I can stick with the midwives, but that I would be switched to an OB if there is any sign of complications in the pregnancy or delivery. The OBs also review my files during pregnancy, and there is an OB and a midwife on call at the hospital for delivery. Personally, it's the only way I feel comfortable with a midwife practice. @pushgal84‌, if there's a practice like this around you, it might be a good compromise to look into.

I would also second the recommendations to look into student doulas. I'm also getting a doula, because I really want to be prepared for a pain med-free delivery (since I might not be allowed an epidural). I decided to get the doula even though I will likely be having a midwife attend delivery, because the midwives, like the doctors, are generally not around for the majority of labor. I wanted some who could help me through the tough parts when the midwife may not be around.

Emerald27 · July 2014

@theresat858‌ Answering your question "what kind of background in science does she actually have?" In my new midwifery practice, all of the midwives hold MS' in nursing, and one has a PhD. I know that some midwives are not certified nurse midwives, but assuming that they all have a limited scientific or medical background and are just operating off experience is not fair.

ETA: my pregnancy will be managed by both my midwives and an MFM practice due to DS' IUGR, so I do see doctors in addition to the midwives. However, this midwife practice has an in-office lab, tests urine for protein and takes bp at every appointment, and carefully discusses any symptoms or concerns the mother is feeling. They work closely with the mothers, are very knowledgable, and I would absolutely trust their care for my pregnancy even if I didn't need to be seeing the MFM.

chauliodus · July 2014

ashie0610 said:

Someone once told me something along these lines that helped me make the decision to switch... maybe it was even here on TB.

OBs are doctors first and foremost. They learn about alllll kinds of other things besides delivering babies including pediatrics, surgery, psychiatry, etc. They then select their specialty area of obstetrics.

Midwives, on the other hand, are trained for just as long, but ONLY in female reproductive care and delivering babies. They are the true experts in vaginal deliveries because that's essentially all they do every day.

Doctors do lots of different things every day, including many surgeries... that's generally their comfort zone.

If you need a c-section, you are generally going to be in good hands with almost any on-call surgeon... because that's what they do. If a natural birth is important to you, you could luck out with a doctor who supports it with BOTH head and heart, but I believe your odds of success are much better with a midwife.

There are definitely benefits and drawbacks to either and this isn't literature-based, but if you need help convincing your H, you could try explaining it that way. It worked on me and my H.

It sounds like someone told you doctors go to med school, rotate a bunch then pick ob and voila! They are an ob dr. Yes, you rotate through a bunch of different stuff, but then you do a residency in a specific specialty. If you do OB/gyn you spend 4 years doing only Ob/gyn, then can do additional subspecialty years in specialties like MFM. 4 years of residency is probably equivalent to 8 years of midwifery with 80 hrs workweeks as standardI don't think I would discount doctors because they spent 2 years rotating through various specialties while a med student. I would argue that having a basic background in all types of medicine and pathophysiology is very helpful. When you have a hx of Crohn's or any type of disease/disorder a OB is going to be familiar with the basics more than a midwife. "Doctors" don't all do surgeries all day long. I doubt you will find an ob who is not in their comfort zone at a vaginal birth. Implying that OB's are more comfortable in an OR and doing surgery is misleading. Of course they are comfortable there, they do them all the time, but they do lots of vaginal births and women's health.

KingsDaughter76 · July 2014

I HIGHLY recommend a midwife attended birth in the hospital!! You will get a wonderful birth experience and they still have OB backup in case of emergency. I have used a midwife with all but one of my births and I 100% prefer the midwife approach! :-)

ashie0610 · July 2014

chauliodus said:

ashie0610 said:

Someone once told me something along these lines that helped me make the decision to switch... maybe it was even here on TB.

OBs are doctors first and foremost. They learn about alllll kinds of other things besides delivering babies including pediatrics, surgery, psychiatry, etc. They then select their specialty area of obstetrics.

Midwives, on the other hand, are trained for just as long, but ONLY in female reproductive care and delivering babies. They are the true experts in vaginal deliveries because that's essentially all they do every day.

Doctors do lots of different things every day, including many surgeries... that's generally their comfort zone.

If you need a c-section, you are generally going to be in good hands with almost any on-call surgeon... because that's what they do. If a natural birth is important to you, you could luck out with a doctor who supports it with BOTH head and heart, but I believe your odds of success are much better with a midwife.

There are definitely benefits and drawbacks to either and this isn't literature-based, but if you need help convincing your H, you could try explaining it that way. It worked on me and my H.

It sounds like someone told you doctors go to med school, rotate a bunch then pick ob and voila! They are an ob dr. Yes, you rotate through a bunch of different stuff, but then you do a residency in a specific specialty. If you do OB/gyn you spend 4 years doing only Ob/gyn, then can do additional subspecialty years in specialties like MFM. 4 years of residency is probably equivalent to 8 years of midwifery with 80 hrs workweeks as standardI don't think I would discount doctors because they spent 2 years rotating through various specialties while a med student. I would argue that having a basic background in all types of medicine and pathophysiology is very helpful. When you have a hx of Crohn's or any type of disease/disorder a OB is going to be familiar with the basics more than a midwife. "Doctors" don't all do surgeries all day long. I doubt you will find an ob who is not in their comfort zone at a vaginal birth. Implying that OB's are more comfortable in an OR and doing surgery is misleading. Of course they are comfortable there, they do them all the time, but they do lots of vaginal births and women's health.

I don't think anyone would disagree that my comment was an oversimplification in the interest of keeping it short.

To be clear, I am not knocking OBs at ALL. A doctor delivered my son and could very well deliver this one and that would be perfectly fine by me! OP asked for ideas on how to help her husband understand that midwives could also be another good option too.

I think the default for most people is that a doctor will deliver their baby. My point is that midwives are, in many cases, just as qualified to do just that. They may not be doctors and can't handle many other medical scenarios, but they can do a great job helping moms have a great birthing experience.

golfingdarwinfish · July 2014

(Sigh)

persephonerose · July 2014

golfingdarwinfish said:

(Sigh)

Translate? I don't speak Sigh Language

golfingdarwinfish · July 2014

persephonerose said:

golfingdarwinfish said:

(Sigh)

Translate? I don't speak Sigh Language

Sorry, the comments about MD training (which left out fellowships and just how much work and time goes into pursuing a specialty) really bothered me. They apply much more to a GP or IM rather than let's say an OB, oncologist (or a subspecialty n pediatric oncology) rheumatologist or neurologist. Physicians are exposed to a multitude of specialities and disciplines during their training, but the further you get from residency the more that knowledge becomes outdated and stale. It's there to set a foundation; when you specialize it basically goes out the window. You are by no means a generalist and the fact that a specialty is chosen after that foundation has been installed is by no means a bad thing or a reason to second guess the training or knowledge of a specialist. Of COURSE you select speciality post foundation; you devote YEARS to learning your specialty and only months to each rotation that sets the foundation.

Ugh, I explained that poorly.....

persephonerose · July 2014

golfingdarwinfish said:

persephonerose said:

golfingdarwinfish said:

(Sigh)

Translate? I don't speak Sigh Language

Sorry, the comments about MD training (which left out fellowships and just how much work and time goes into pursuing a specialty) really bothered me. They apply much more to a GP or IM rather than let's say an OB, oncologist (or a subspecialty n pediatric oncology) rheumatologist or neurologist. Physicians are exposed to a multitude of specialities and disciplines during their training, but the further you get from residency the more that knowledge becomes outdated and stale. It's there to set a foundation; when you specialize it basically goes out the window. You are by no means a generalist and the fact that a specialty is chosen after that foundation has been installed is by no means a bad thing or a reason to second guess the training or knowledge of a specialist. Of COURSE you select speciality post foundation; you devote YEARS to learning your specialty and only months to each rotation that sets the foundation.

Ugh, I explained that poorly.....

No I think I understand what you mean. It takes a very long time to become a Doctor of any sort. While they do residency and explore a lot of general topics they are focusing on the information and research that is current at that time. Once you specialize you focus more on learning and keeping up to date with the research from your chosen area. This probably leaves less time to go back and keep up with the research in other fields.

My PCP is a D.O. Her philosophy is that while she tries to treat the whole body she does not know everything. There is a reason why there are so many sub-fields and specialized medicine now a days and that is so people receive better treatment.

Emerald27 · July 2014

@golfingdarwinfish‌ I think you explained it well.

I don't think any good will come from criticizing OBs/specialists (especially for @pushgal84‌ who is trying to convince her DH that it isn't nutty to switch to a midwife). It simply isn't true that OBs are not experts in their field, or that they don't know a LOT about human reproduction, pregnancy, birth, complications, etc.

That argument is unsound and won't get you anywhere...

BUT I do think that a better argument for midwifery care (if you prefer to use a midwife) CAN be that OBs tend to take less time with their patients, they are often less about the "whole woman" and the birth "experience" more directly focused on just delivering a healthy baby, looking at the bloodwork results, numbers, etc.. Some OBs do not place much value on birthing naturally, and if that is the case with your OB and a natural birth is important to you, then make the switch!

It would probably take the same amount of time to prep you for OR and for the on-call physician to scrub in for a cesarean if one was necessary, as it would take to get your own OB ready, should an emergency cesarean be required. If you're birthing in a hospital, whether working with an OB or midwife you'll be surrounded by an experienced and knowledgable team of nurses, and if you are working with a midwife, she will stay close to you throughout your labor (and will call for the on-call doctor at the first sign of medical necessity).

The birth experience with a midwife can be vastly different from the OB experience. That's not to say that either is superior, or that you can have a better experience with one over the other. I think it's a very personal decision what kind of provider you choose.

elsie2014 · July 2014

Emerald27 said:
@theresat858‌ Answering your question "what kind of background in science does she actually have?" In my new midwifery practice, all of the midwives hold MS' in nursing, and one has a PhD. I know that some midwives are not certified nurse midwives, but assuming that they all have a limited scientific or medical background and are just operating off experience is not fair.

This! I'm glad someone else said something! I am delivering in a hospital, but I will be attended by a midwife from the birthing center minutes away, and my prenatal care has all been at the birthing center. The head midwife has a phd from Harvard and the rest all have Masters degrees in Nursing and are incredibly knowledgable. And I feel like the care and concern I have received from them far outweighs the care or received from my OB before I switched.

I love my midwives, I am confident in their education and experience. Just do some checking around and ask lots of questions before you select one.

Want a personalized experience?

Switch to midwife? DH thinks I'm crazy...

Re: Switch to midwife? DH thinks I'm crazy...

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