For anyone planning a home birth or using a birthing center, make sure you have a back-up plan to get you to a hospital if necessary. Some birthing centers have these plans in place, but not all of them. So that's definitely something to look at when making this decision.
I was hoping to use a practice that had lots of midwives and OBs when I got pregnant and delivered in a hospital setting. For me, it seemed like the best of both worlds. Unfortunately, the practice in my area that is like doesn't deliver at my preferred hospital. They deliver at one (which is super close to my house) that recently changed to the "baby-friendly" designation and the reviews from those who have delivered there have plummeted (from what I've read, they are just taking things to the extreme in terms of being baby friendly but not providing support to the mom). Until they get things worked out in terms of providing an environment of supporting both baby and mom, I'll be delivering elsewhere.
**TW miscarriage mentioned **
I know a lot of people say they feel OBs can be more "clinical" and midwives are more caring. However, my OB could not have been more caring and personable when I had my miscarriage. She was wonderful and it made a very difficult moment a bit easier. So not all OBs can be clinical and cold. It's about finding the right balance for your situation.
** December BMB Siggy Challenge - Animals in Pools **
Me: 31+ H: 32 TTC Since 11/2015 #1 - MMC 6.5 weeks (2/16); #2 - MC due to cystic hygroma at 20 weeks (10/16); #3 CP (2/17); #4 - Due 12.16.17
**TW: loss mentioned** I really loved the midwife and would choose to see him again. I had a septum removed after my MC and the surgeon ended up cutting my uterus by accident and explained afterward that I will have to have a c-section if I carry to full term. My hope is that I can see the midwife throughout the pregnancy and have the OBGYN deliver (they work at the same practice). I felt the midwife was more personable and helped us through the loss.
I will use an OB and deliver at a hospital. First of all, I just really like my OB/GYN. Second of all, I work in healthcare and would never consider delivering outside of a hospital. As others mentioned, things can go wrong really quickly and I'm not personally comfortable taking that risk.
In my experience, many midwives are great and do provide excellent care. But I love my OB and don't feel like finding someone else just to get a midwife experience. Also, I prefer to know the person who might be doing my c-section. Agree with whomever said that one great option (if it is an option for you) is to find a practice that has both OBs and midwives. However, I think there are so many different aspects of how OB and midwifery practices operate, that it is worth considering that the answer may not just be OB vs midwife, but does this practice offer what I want? At many practices around here, for example, you get delivered by whomever is on call. So your own provider might not even be delivering you. My OBs office has 5 providers and they encourage you to meet all of them at various appointments so you are comfortable with all of them before you go into labor. My sister in law had a different OB and the midwife delivered her because it was the midwife's day on the labor and delivery floor and she had no idea that that might happen. At another practice (which one of my friends had an appointment at and then promptly left) they had over 25 providers and you could be seen or delivered by any of them. Also, for example, my OBs office offers delayed cord clamping, which someone here mentioned. So there are other things to think about besides OB vs midwife.
I had originally wanted a home birth with a midwife and a doula, but I live in a 1 bedroom apartment and felt like that might be a bit difficult. There is an amazing birthing center about 20 min away, and we are attending an orientation there next weekend. It may be premature, but I would like to know what my options are and would like to have a relationship with someone beforehand if complications arise throughout any of the process. I have always had a midwife instead of a gyn, the only reason I am switching to this practice is because my current midwife (and hospital she is affiliated with) is too far from my home.
I am also trying ( in general regarding fertility, pregnancy, birth plan etc) to remain open minded and know that things like our feelings and circumstances may change. But I don't see any harm in educating yourself as much as possible about your options.
If I am low risk I will be doing a home birth attended by a midwife. I am lucky to live in an area which has a ton of extremely experienced, highly qualified midwives. If I for some reason am not low risk I am also lucky in that there is a Midwife group which works through an amazing hospital less than 10 minutes from my house. I currently use this midwife group for my yearly check ups so I already know the midwives well and feel comfortable with them.
When I think about giving birth in my home, with my husband, my mom, and an experienced, qualified midwife I smile. It makes me so happy. I like to think of laying in my own bathtub, having my husband bring me food and water from our own kitchen, having my own clothes, my own bed, not having to labor in the car... These are things I definitely want if my pregnancy goes smoothly.
I am a person who likes to please other people. If I am in a hospital I will definitely want to please the nurses and the OB and anyone else who works there. If I am in my own home, on my own turf, then I can be on my own timeline and I will only have to worry and think about my baby and myself.
Slightly off topic, I was looking into options in the area but one of the major offices has a Christian religious philosophy that I am unsure I am comfortable with. Are lots of offices and their affiliated birthing centers religious?
Also agree this is a fine question for this forum. Most of us are thinking about it i would imagine I will be using a midwife. They are pregnancies and birthing experts. Here in Canada they are able to provide much more personalized care and spend much more time with you than OBGYNs do including home visits after LO arrives.
If anything goes wrong and a c-section etc. is required the OBGYN is there to step in. In my community the midwives have hospital privileges which are the same as a Dr.
Like others have mentioned, I think it is totally a personal choice. Also I am totally with you on the plan-plan-plan-train!
#1 EDD 01/10/19; Team Green! TTC #1 since 01/16; Unexplained IF; Low AMH; Conceived naturally Married 11/12; Dating 05/05 Me: 36 DH: 37
Slightly off topic, I was looking into options in the area but one of the major offices has a Christian religious philosophy that I am unsure I am comfortable with. Are lots of offices and their affiliated birthing centers religious?
I actually haven't heard of any yet. I will say, for what it's worth a lot of hospitals have clear religious philosophies as well. I'd expect if you're hiring them for a medical service that they can remain professional and focused on the job they were hired for. If there is something specific you are worried about (as an example maybe they won't allow certain procedures, etc.), maybe try to find some reviews or talk to them directly about your concerns? Ultimately, if it makes you feel uncomfortable, you might have to decide to go elsewhere.
me . early 30's | h . mid 30's | < 3 . 2013
ntnp #2 . summer 2018
*siggy warning*
ttc#1 . jul 2015
mmc . mar 2016 | 6w2d
dx PCOS (non-IR) / subclinical hypothyroidism . summer 2016
tx metformin, levothyroxine, LP progesterone, femara + trigger + ti . fall/winter 2016 BFP! . jan 2017 DD . oct 2017
My OB/GYN (who I really like) told me in my pre-TTC that they have midwives on staff at the office and birthing center. I can choose to work with my doc or the midwives throughout any pregnancy and delivery. I will deliver in the hospital, but it's a newer place with individual suites, monitors that can be worn while mobile, etc. while there, I can again have either. I'll feel more comfortable with an OB/GYN, I'm thinking, but I might try to have an appointment or two with the midwives along the way just to see if I actually prefer them.
Me: 30 DH: 32 ~~ TTC #1: Sep 2015 ~~ BFP: Mar 2016 ~~ Daughter: Nov 2016 TTC #2: April 2018 ~~ BFP: May 2018 ~~ EDD: January 2019
I like the idea of a doula (less trained but kind of like a midwife) in a hospital setting with an OB, that way I get the best of both worlds. I can have a birth plan but also have the hospital in case anything gets complicated.
I am in Canada though so we have the option to be in the hospital setting but still have a midwife... so that is something I would consider too. I have had LOTS of friends have home births but I personally would be a bit to scared.
@mjolk I work for a christian hospital chain, the only thing that they do differently is that they don't do abortions or sterilizations. If it is medically necessary to save a mother's life, it is a whole different story, but they don't do them voluntarily. The person would have to go to another hospital, or women's health center. Other than that, nothing is different, they have end of life options for all faiths, not just christian, so I thought that was also very open minded of them. Obviously there are crosses around and they have a chapel, but those things don't affect patient care in the least.
TTC #1 - December 2015 Me:31 H:31 DX: MFI - 1% Morph 12/16 -IVF #1 - Antagonist Protocol w/ Lupron trigger ER - 11 retrieved- 9 mature - 7 fertilized - 3 sent for PGS on day 5 - No normals (1 XXX Embryo - may use in future) 3/17 - IVF #2 - Antagonist Protocol w/ HCG trigger ER- 13 retrieved - 11 mature - 8 fertilized - 2 sent for PGS on day 5 -2 Normal FET #1 - 5/16/17 - BFP! - Beta #1 5/25 - 156 - Beta #2 5/30 - 2562 - Beta #3 6/1 - 5191!
I've been reading from the start, but I just wanted to post because! I was intent originally on doing a birth center, but I can't because I have Type 1 Diabetes. That upset me, because I irrationally had fears about ob/gyns forcing me to have a csection due to my medical history. But a friend explained to me about doulas and how they are like a best friend coach to help support your birth plan and can help stand up for you but also be there as a neutral voice if deviation is needed from your plan for safety. So I will have a doula and my ob and MFM. Woooo. The doula will be in charge of my insulin pump when the cord is cut, because my DH will probably be too distracted to remember to save my life by resetting insulin amounts (of course I'll show her which mode to switch to probably 100 times over the pregnancy)
Me: 27 years old DH: 27 years old Type 1 Diabetes since 2001, MTHFR hetero A1298T Dogs: Raider 4 yrs, Dex 4 yrs
Married in July 2014
TTC #1 since late Feb 2016
BFP #1 3/29/16 MMC: 5/5/16 BFP #2 7/6/16 SCH, D&C 8/4/16 BFP #3 12/26/16 EDD: 9/6/17 My Chart / My Diabetes/Pregnancy Blog My Type 1/TTC/Pregnancy Podcast: Juicebox Podcast Episode 118 A1Cs: 1/12/16 6.7% 5/25/16 6.0% 11/2/16 6.1% 3/22/16 5.8% 4/27/17 5.4% 6/13/17 5.3% "Sugar Fancy Tutu"
Thank you ALL so much for all of your information, experiences and responses! I am so grateful, and wish I could respond to every single one! You have all certainly given me A LOT to think about, and I will be taking all of this into consideration. I am so happy to have a place to connect with so many people about these questions!
Me: 31 DH: 32
Married: 10/4/14, Together Since: 5/21/06 Children: 1 (girl, 3 years)
TTTC #1 since April 2015, Started Treatment Dec 2015 5 Cycles of IF treatment until BFP! (IUI, Gonal-F, Letrozole)
BFP: September 5th, 2016 Born: May 22, 2017
TTTC #2 since September 2020, Currently in Testing phase
Unfortunately, this decision has been made for me because I live in a small town/work for an independent hospital with no midwives. There are actually only 2 OB practices (5 Drs total I believe) to choose from. I have recently wondered if I could get my insurance to pay for a midwife at the hospital about an hour away since my in-network doesn't offer that service. Not really sure it's a fight I want to get into. As a medical professional, I also would never do anything but a hospital birth.
It's really interesting to me how differently healthcare professionals view hospital births. I completely agree that a hospital would be the safest place to give birth if you are high risk or if anything went wrong, yet the idea of giving birth in a hospital scares me. From what I've heard about hospital births in my area at least, you are very restricted. Unnecessary continuous monitoring and fall risk protocols limit the mamas ability to walk around as much as she wants. They often restrict food and fluid intake in case of need for anesthesia despite such restrictions not being evidence-based. There is a lot more pressure put on the mama for inductions and c-sections if things are not progressing quickly enough, as well as other interventions such as episiotomies and use of forceps. There's also the increased risk of nosocomial infection that accompanies any hospital stay. That being said, birth center and home birth do have higher risk if there is a complication, because as @TheBorg7of9 said, if there's a real emergency, a 10 minute transfer to a hospital is too long. I guess I'm willing to take that small risk over the many other risks of a hospital birth and rely on my midwife team to properly assess and transfer to a higher level of care early before it becomes an emergency. I'm not in any way saying you or anyone else is wrong, because everyone has their preferences and methods of weighing the pros and cons of any situation. This is the information I've gathered and how I've applied it to what is important to me, and I'm interested to hear other healthcare professionals' reasons for going the hospital route.
ETA I also think I'm biased because my brother and I were born at home, as well as my niece and nephew, and my SIL is a home birth midwife. I also never got to see a birth during my maternal child clinical so I don't have any personal experience with hospital birth and would like to hear a more informed opinion!
*Possible TW - birth story*
@zrain - I don't disagree with anything you've said. For me, I'm strong and an advocate for myself. Often hospitals practice the things you've mentioned (including where I work/delivered/will deliver), but if you ask to see the actual policy on things that are important to you, it's often a different story on IF these are necessary the majority of the time. I am very up front with my Dr and nurses about how I want to labor, and they are compliant with the as long as it's not "officially" against policy. Unfortunately, I had to be induced with DS due to gestational hypertension (after fighting induction and monitoring X 2 weeks), so I had many more interventions than I would have liked. In the absence of that, I think the key is laboring at home as long as possible. Walking in at 7 or 8 cm doesn't leave time for interventions. With all of that said, I just can't take the "what-if" factor. I have too many friends and myself who've had birth complications. I am fully aware that my complications may have been caused/exacerbated by induction. I get really, really sad when I think about it, but it became a necessary intervention I never wanted. In the end, I almost had a CS. No position in the world was bringing DS down the birth canal with, what we found out, was cord wrapped head and body. Fortunately, my Dr. was excellent and, with some suction, was able to deliver him. Anyway, this was way longer than I expected. It's something I feel strongly about. Others have the opposite view, which is ok too! I just don't think hospitals have to be filled with inevitable interventions if mama/daddy/support person are advocates for themselves/mama/baby. PS...My hospital doesn't have a birth pool which I would totally love! I'm not sure if they allow laboring in the shower or not...I didn't have the opportunity with DS and didn't ask since I didn't plan on arriving with enough time to do so.
I agree that you have to be a strong advocate for yourself. I worry that in the moment I wouldn't be able to fully stand up for myself and what I want. DH is also a nurse and I know he is a firm advocate for his patients, but I worry that when it's me, he'd be scared and might lose some of his steadfastness. I guess that's one of many good reasons to get a doula for a hospital birth. I'm glad that you're able to be so strong and upfront!
Thank you for the advice about laboring at home as long as possible! If when I'm pregnant I develop some reason that I do end up needing to deliver in a hospital, I hope I can stay at home as long as possible beforehand. One nice thing about the midwife I picked last time is that if I do have to transfer to a hospital, she and her two assistants come to the hospital with me to be my super doula team and support me and be my advocates. I am a little nervous about labor since I have inappropriate sinus tachycardia (anything that makes your heart rate go up normally, such as anxiety or exercise, makes mine inappropriately high). My cardiologist and midwife don't think it'll be an issue, but it's such an un-studied condition, and an acquaintance of mine had it get a lot worse when she was pregnant. I'm trying to keep an open mind in case birth center isn't a safe option for me. I appreciate your input and advice!
Me: 29, DH: 29 Married 9/27/14 TTC #1 since 8/15/15 BFP: 1/2/16, EDD 9/13/16 - MMC 2/10/16 BFP: 3/17, EDD 11/23/16 November 2016 April Siggy Challenge - April Showers
@Zoey1019@virginiahamThanks for the responses. I was concerned they would forbid the options or discussion of not carrying to term if the baby was found to have serious defects. Perhaps that is not something I should even be wondering about, but my state is fairly anti-choice. I guess all I can do is ask them how they handle those situations and decide from there.
I watched the Business of Being Born, and I really liked it. I saw the comments here recommending it, and I'm glad I did. It's admittedly biased, but I loved the information. My dream birth would be a water birth with the option to have an epidural if I asked. But, that can't happen for me. There are no hospitals near me that allow water births, and I'm not sure a midwife is allowed to give an epidural at a home birth. I could be wrong, but that's my current understanding based on what I've looked up in my area.
I planned on just using a CNM and not bothering with an OB. I'm biased as a nursing student, but I think nursing tends to push a much more holistic model than doctors do. Doctors are there to look for problems, and an OB is a surgeon to boot that would definitely rather be safe than sorry. So would I, but within reason. Anyway, since most births are uneventful, I don't see the point of using a doctor unless it's necessary, and since I planned on going to a hospital there wouldn't be one far away.
However, I found out I had a MMC at my 8 week appointment and that was the first time I met the OB that runs the office I go to. He had such good bedside manner and treated me so well, it made me think twice about my previous anti-OB stance and I would trust him with my next pregnancy and hopeful birth.
I've considered home birth/birthing center in the past but I'm not really comfortable with that, especially since I myself was a large and C-sectioned breech baby. It does help though that hospitals here are pretty crunchy- one in particular even provides acupuncture and sometimes doulas, and birthing tubs are pretty much a standard option. If I felt like my only other option was a very traditional and very medical birth, I might feel differently. My best friend's mom had home births, but given that we lived about 15 minutes away from the hospital, that made nervous. It's true things don't usually go wrong, but when they do they can get terrifying very quickly, so I'd prefer to have emergency care at standby.
My sister also considered home birth and ended up going to a birthing center for her first two. She brought up a good point- if something did go wrong, she didn't want it to happen in the place where she lived and would have to be reminded of it in that way.
That said, it's my goal to be a CNM and I would love to help others with home births one day!
@FiancB Since my MC I've been thinking about going back to school to be a CNM too. I think that would be amazing, and my back isn't doing well as a bedside nurse so I think I need a change anyway.
Me: 29, DH: 29 Married 9/27/14 TTC #1 since 8/15/15 BFP: 1/2/16, EDD 9/13/16 - MMC 2/10/16 BFP: 3/17, EDD 11/23/16 November 2016 April Siggy Challenge - April Showers
I love this discussion because I've researched midwives before out of curiosity. Does anyone know when is the appropriate time to consult with a midwife? I tried to bring up TTC with my regular OBGYN but she basically told me to call her once I was KU. Would you contact a midwife prior/during TTC or after you've got a positive test?
I love this discussion because I've researched midwives before out of curiosity. Does anyone know when is the appropriate time to consult with a midwife? I tried to bring up TTC with my regular OBGYN but she basically told me to call her once I was KU. Would you contact a midwife prior/during TTC or after you've got a positive test?
It depends. The midwives here just do pregnancy stuff so you call when you get a BFP. I've heard that other places have midwives that do general women's health stuff so you could see them for paps and be a patient prior to TTC.
I love this discussion because I've researched midwives before out of curiosity. Does anyone know when is the appropriate time to consult with a midwife? I tried to bring up TTC with my regular OBGYN but she basically told me to call her once I was KU. Would you contact a midwife prior/during TTC or after you've got a positive test?
It depends. The midwives here just do pregnancy stuff so you call when you get a BFP. I've heard that other places have midwives that do general women's health stuff so you could see them for paps and be a patient prior to TTC.
At the practice I go to for general women's health they have midwives that you can see for that. I haven't seen one, though, so I don't know if the experience is any different for annual exams.
I love this discussion because I've researched midwives before out of curiosity. Does anyone know when is the appropriate time to consult with a midwife? I tried to bring up TTC with my regular OBGYN but she basically told me to call her once I was KU. Would you contact a midwife prior/during TTC or after you've got a positive test?
It depends. The midwives here just do pregnancy stuff so you call when you get a BFP. I've heard that other places have midwives that do general women's health stuff so you could see them for paps and be a patient prior to TTC.
I went to see my midwife for my last annual and let her know I was going to TTC and she pretty much just told me all the generic things - but what do you need them to tell you? There's not really anything they can do for you until you conceive.
I love this discussion because I've researched midwives before out of curiosity. Does anyone know when is the appropriate time to consult with a midwife? I tried to bring up TTC with my regular OBGYN but she basically told me to call her once I was KU. Would you contact a midwife prior/during TTC or after you've got a positive test?
It depends. The midwives here just do pregnancy stuff so you call when you get a BFP. I've heard that other places have midwives that do general women's health stuff so you could see them for paps and be a patient prior to TTC.
I went to see my midwife for my last annual and let her know I was going to TTC and she pretty much just told me all the generic things - but what do you need them to tell you? There's not really anything they can do for you until you conceive.
I have some concerns regarding my thyroid issues. This issue shouldn't impact my ability to get KU, have a healthy baby or delivery; however, it does impact my weight. I want their honest opinion on whether I'm at a healthy weight to get pregnant, potential weight gain during pregnancy, issues associated with weight gain. My OBGYN said I wasn't obese, so it's not an issue; however, I feel like it is in my mind.
Since midwives are a bit more holistic/natural, I'm hoping they would at least take the time to give me information/answer my questions so I make a good decision regarding TTC at this time. I want to be as healthy as possible.
I have some concerns regarding my thyroid issues. This issue shouldn't impact my ability to get KU, have a healthy baby or delivery; however, it does impact my weight. I want their honest opinion on whether I'm at a healthy weight to get pregnant, potential weight gain during pregnancy, issues associated with weight gain. My OBGYN said I wasn't obese, so it's not an issue; however, I feel like it is in my mind.
Since midwives are a bit more holistic/natural, I'm hoping they would at least take the time to give me information/answer my questions so I make a good decision regarding TTC at this time. I want to be as healthy as possible.
I can pretty much promise you that unless you are obese they wont have much of an opinion about it - it's just not their area of specialty. I would suggest seeing your general family medicine doctor and discussing ways to keep your thyroid as stable as possible during your pregnancy. There are a lot of thyroid problems in my family and it never messed with anyone's pregnancies. There is data that shows being obese can have various short and long term effects on pregnancies/babies but since you say you are not obese I don't think you really need to be worrying a ton about that. I mean for the average person you would want to shoot for a "normal" range BMI (feel free to Google your way to a BMI calculator) for pre pregnancy to put yourself in the best health for fertility and for your baby. If you are below or above you may struggle with fertility/birth/health of baby afterwards more than someone within that normal range - according to studies.
I think this is a great question. I’ve also thought about this a lot in case we get around to needing to make this choice. I also volunteered at a traditional midwifery clinic in Guatemala. I bet mothers will have some good advice for you too, what have you heard from them?
Here’s my reading:
In terms of neonatal mortality and birth injury, hospital birth is overall safer for babies. Most detached birth center / home birth midwifes in the U.S. are CPMs - Certified Professional Midwives - who don’t have the training to deal with an emergency, and who sometimes have so little training that they don’t even know what they don’t know. The SkepticalOB Amy Tuteur writes ‘[CPMs] are required to have only a high school diploma, a course of unmonitored self-study that can be completed at home, and attend only 40 births (approximately the same number that I attended in my first week of residency training.)” An OB or Certified Nurse Midwife will have seen dozens to hundreds of emergency cases while a CPM may have never even seen one. That said the risk of c-section is higher for moms in hospital (~25% of low risk hospital births in 2013 were c-sections… I don’t know for home births but I’d guess it’s much lower, like 5%). Multiple c-sections get risky for moms (e.g. adhesions, internal bleeding, etc.). And of course you are restricted in some settings from drinking eating moving etc.
As others say above I think each family has to weigh up the risk-benefit ratios for themselves… However, I'd caution everyone to keep in mind you can shoot to have a safe, unmedicated vaginal birth for your baby, but you can’t choose it. I think for people who shoot for it, the stats show it's wise to get care from a trained provider (OB or Certified Nurse Midwife) you trust and plan to be in or very near a hospital. There’s no guarantee you’ll need the backup, but why roll the dice?
When it comes to an OB vs. a CNM, I have heard of some CNMs who know better repositioning techniques and who work better with mom’s wishes. However, I’ve also heard of CNMs who were very interventionist and not very mom-centered at all. I think the important thing is you work with someone you trust who comes recommended, if you can. In a lot of rural places that means an OB because CNM’s are unfortunately not entirely common. I hope we see an increase in the # of CNMs in the U.S. in the future!
I would only add one thing. As a late loss mom, it is difficult to communicate just how agonizing it is to look back --endlessly and obsessively-- at the decisions you make regarding the care for your pregnancy. We lost our son at 33w5days. We know what happened in our situation but only because we demanded an autopsy. This experience has caused me to read a lot about pregnancy loss and stillbirth. It is unbelievable how much is not known, how many mothers do not have answers.
Whatever you choose should be something that you can defend to yourself even under (especially under) circumstances of loss.
I think this is a great question. I’ve also thought about this a lot in case we get around to needing to make this choice. I also volunteered at a traditional midwifery clinic in Guatemala. I bet mothers will have some good advice for you too, what have you heard from them?
Here’s my reading:
In terms of neonatal mortality and birth injury, hospital birth is overall safer for babies. Most detached birth center / home birth midwifes in the U.S. are CPMs - Certified Professional Midwives - who don’t have the training to deal with an emergency, and who sometimes have so little training that they don’t even know what they don’t know. The SkepticalOB Amy Tuteur writes ‘[CPMs] are required to have only a high school diploma, a course of unmonitored self-study that can be completed at home, and attend only 40 births (approximately the same number that I attended in my first week of residency training.)” An OB or Certified Nurse Midwife will have seen dozens to hundreds of emergency cases while a CPM may have never even seen one. That said the risk of c-section is higher for moms in hospital (~25% of low risk hospital births in 2013 were c-sections… I don’t know for home births but I’d guess it’s much lower, like 5%). Multiple c-sections get risky for moms (e.g. adhesions, internal bleeding, etc.). And of course you are restricted in some settings from drinking eating moving etc.
As others say above I think each family has to weigh up the risk-benefit ratios for themselves… However, I'd caution everyone to keep in mind you can shoot to have a safe, unmedicated vaginal birth for your baby, but you can’t choose it. I think for people who shoot for it, the stats show it's wise to get care from a trained provider (OB or Certified Nurse Midwife) you trust and plan to be in or very near a hospital. There’s no guarantee you’ll need the backup, but why roll the dice?
When it comes to an OB vs. a CNM, I have heard of some CNMs who know better repositioning techniques and who work better with mom’s wishes. However, I’ve also heard of CNMs who were very interventionist and not very mom-centered at all. I think the important thing is you work with someone you trust who comes recommended, if you can. In a lot of rural places that means an OB because CNM’s are unfortunately not entirely common. I hope we see an increase in the # of CNMs in the U.S. in the future!
Steph
Just to make this fair - the requirements you give for CPMs are the absolute minimum for SOME certifications. This example you give might be the experience of a brand new, completely inexperienced midwife - brand new midwives like this nearly always work with older, more experienced midwives for several years after finishing their certifications before doing it solo. For someone having a home birth they could easily go with a midwife who is extremely experienced (some of the midwives in my area have been practicing for 30 years, so much more than many of the OBs at the hospital I'm near). I would even point out that many midwives have far more experiences with unmedicated birth than any OB has ever seen or experienced.
I don't want to get in an OB/CNM/CPM battle, but I think it's best to be fair to all sides. Each has their own specialty and you just need to figure out what's best for you. If you want to have the option of an epidural/pitocin/immediate access to surgery then an OB is great. If you want completely unmedicated then a midwife might be the better option. And, because I'm picky about statistics - you saying that neonatal infant mortality happens less in the hospital, I would like to point out that with low risk, healthy women (who are the only ones who should ever have a planned home birth!) the mortality rates are so close that there is no significant statistical difference. We are talking a fraction of a percentage of difference.
Again, not looking to argue - I just dislike when I see false claims about this stuff.
This is certainly a personal choice where a lot of factors are relevant in making the decision to use a CPM for hospital or home birth delivery. I don't judge anyone who plans to use a CPM at a hospital or for a home birth, but I will be choosing a different path. I hope to minimize the medical intervention used during my labor and birth, and for that reason I will be hiring a doula to assist me. But I will have my OBGYN deliver my child in the hospital where all options are available to me and my child. If I need medical intervention for my comfort or for the safety of myself and child, I will have it immediately available. If I have an emergency, I am in the best place to have one where a variety of staff and experience is available to treat me or my child. For me, there is a peace of mind that comes with that.
Also, FWIW, the hospital I will be using for any possible future delivery is very "mom centered". It has a nice birthing center with private birthing suites, a doula and CPM staff you can work with, and provides tools and assistance to those who prefer a more "med-free" approach. This certainly goes a long way in supporting my birthing goals. So it made my decision that much easier.
Me: 27 - DH: 33
Married: June 2011
TTC #1: January 2016
BFP #1: February 22nd
2016 MC w/ Misoprostol: March 21st 2016 -Blighted Ovum
alanna3622 - I am so sorry for your loss. How are you doing now?
@antoto - Thanks for bringing a different perspective. That data I have seen defends the statement “Low risk birth is safer for baby in the hospital.” I base this argument on two datasets: [1] MANA’s 2014 paper shows the risk of low-risk home birth from 2004-2009 was 1.6/1000. [2] CDC Wonder shows the risk of neonatal mortality is 0.38/1000 for a hospital births for a roughly equivalent sample (low-risk hospital births to white mothers 2004-2009; the MANA mothers are 92% white). That is a 1 in 2631 mortality risk for hospital and 1 in 625 mortality risk for homebirth. The absolute difference in risk is small for an individual, however it's not insignificant. More data from other time periods and states would be extremely helpful and would certainly influence my argument. Is there data that indicates my claim is false?
I appreciate that you bring another perspective about CPM’s. Many people have very strong feelings about this issue. I think it is a great point that many CPMs have more experience with unmedicated birth. It's indisputable that on average the risk of c-section is much higher for low-risk hospital births, 25% in hospital to ~5% for home birth. Tuteur’s main point is just that more than other birth providers, it can be harder to judge whether your CPM will be able to recognize/handle a birth emergency in time. I also think individual circumstances will vary a lot. I feel everyone should do their own research, talk to former patients, weigh the risks and benefits for themselves, and choose a provider they trust. I think in weighing the risks moms should be aware that while home-birth will significantly lower their c-section risk, it does present a very small but not insignificant risk to babies compared to hospital.
@ BelcherEars - thanks for sharing. Sorry to read about your recent MC. It’s great that you have a hospital with a birthing center you can use for any possible future delivery.
Hey @dizzyducky I'm having a hard time following those links you posted - it could just be my work computer. However, I looked up this study: https://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/abstract from 2014 which had a huge data set of nearly 17,000 women and the results for neonatal mortality was 1.3 per 1000. So out of 17,000 women who gave birth at home about 22 women had a loss. Even if you look at ACOG (the most biased source against homebirth... so I trust the first study I posted more) for this the statistics you cite don't match up either - they list homebirth at 1.5 per 1000 and Hospital as .4 per 1000 for nonanomalous neonatal deaths (edited to add in ACOG link https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Planned-Home-Birth). So looking at these statistics I think it is important to point out that we are working with TINY numbers here (again, nearly to the point of being statistically insignificant - since you have to assume a certain amount of margin of error). Saying you have a .0015% chance of something vs. a .0004% chance is a very, very, very small difference. And again even with these numbers I'm taking it from ACOG - the most biased source I could think of against homebirth.
As far as the sources you are trying to compare - I don't believe it's wise to compare two different sets of women like this simply because I don't believe it's good science. To say absolutely for certain that one is X amount safer than another you would need one study that had a large data set and was double blind. Understandably this study does not exist, and probably will never exist. Without this study it just CAN'T be said absolutely conclusively that a hospital birth is a specific measurement safer. So the numbers you are comparing - I just don't think that's fair.
Something you have to be careful with a lot of those studies (not the one you cited, just in general) out there about home birth is that they can sometimes be looking at ALL births that occur at home, not specifically planned home births with a CPM. So this would include women who birth so fast they don't make it to the hospital, women who choose to have an unassisted home birth (ahhhhhhhh terrible, would never suggest anyone do this), etc. So what I have seen is that when you further control for those factors the difference between home and hospital reduce even more.
You could definitely argue that a hospital with a high level NICU center would absolutely be better at saving babies in those extremely rare circumstances. But what about a hospital with a lower level NICU, or no NICU... etc etc.
And of course as you mentioned, with a home birth women experience significantly (definitely statistically significant) less of c-sections, episiotomies, vaginal tearing, pitocin for labor augmentation, and epidurals.
Re: *NOT PREGNANT JUST THINKING AHEAD* Midwife vs. OB GYN...Thoughts?
**TW miscarriage mentioned **
I know a lot of people say they feel OBs can be more "clinical" and midwives are more caring. However, my OB could not have been more caring and personable when I had my miscarriage. She was wonderful and it made a very difficult moment a bit easier. So not all OBs can be clinical and cold. It's about finding the right balance for your situation.
** December BMB Siggy Challenge - Animals in Pools **
Me: 31+ H: 32
TTC Since 11/2015
#1 - MMC 6.5 weeks (2/16); #2 - MC due to cystic hygroma at 20 weeks (10/16); #3 CP (2/17); #4 - Due 12.16.17
I really loved the midwife and would choose to see him again. I had a septum removed after my MC and the surgeon ended up cutting my uterus by accident and explained afterward that I will have to have a c-section if I carry to full term.
My hope is that I can see the midwife throughout the pregnancy and have the OBGYN deliver (they work at the same practice). I felt the midwife was more personable and helped us through the loss.
In my experience, many midwives are great and do provide excellent care. But I love my OB and don't feel like finding someone else just to get a midwife experience. Also, I prefer to know the person who might be doing my c-section. Agree with whomever said that one great option (if it is an option for you) is to find a practice that has both OBs and midwives. However, I think there are so many different aspects of how OB and midwifery practices operate, that it is worth considering that the answer may not just be OB vs midwife, but does this practice offer what I want? At many practices around here, for example, you get delivered by whomever is on call. So your own provider might not even be delivering you. My OBs office has 5 providers and they encourage you to meet all of them at various appointments so you are comfortable with all of them before you go into labor. My sister in law had a different OB and the midwife delivered her because it was the midwife's day on the labor and delivery floor and she had no idea that that might happen. At another practice (which one of my friends had an appointment at and then promptly left) they had over 25 providers and you could be seen or delivered by any of them. Also, for example, my OBs office offers delayed cord clamping, which someone here mentioned. So there are other things to think about besides OB vs midwife.
I am also trying ( in general regarding fertility, pregnancy, birth plan etc) to remain open minded and know that things like our feelings and circumstances may change. But I don't see any harm in educating yourself as much as possible about your options.
When I think about giving birth in my home, with my husband, my mom, and an experienced, qualified midwife I smile. It makes me so happy. I like to think of laying in my own bathtub, having my husband bring me food and water from our own kitchen, having my own clothes, my own bed, not having to labor in the car... These are things I definitely want if my pregnancy goes smoothly.
I am a person who likes to please other people. If I am in a hospital I will definitely want to please the nurses and the OB and anyone else who works there. If I am in my own home, on my own turf, then I can be on my own timeline and I will only have to worry and think about my baby and myself.
TW: Loss
If anything goes wrong and a c-section etc. is required the OBGYN is there to step in. In my community the midwives have hospital privileges which are the same as a Dr.
Like others have mentioned, I think it is totally a personal choice. Also I am totally with you on the plan-plan-plan-train!
TTC #1 since 01/16; Unexplained IF; Low AMH; Conceived naturally
Married 11/12; Dating 05/05
Me: 36 DH: 37
ntnp #2 . summer 2018
*siggy warning*
ttc#1 . jul 2015
mmc . mar 2016 | 6w2d
dx PCOS (non-IR) / subclinical hypothyroidism . summer 2016
tx metformin, levothyroxine, LP progesterone, femara + trigger + ti . fall/winter 2016
BFP! . jan 2017
DD . oct 2017
TTC #2: April 2018 ~~ BFP: May 2018 ~~ EDD: January 2019
I am in Canada though so we have the option to be in the hospital setting but still have a midwife... so that is something I would consider too. I have had LOTS of friends have home births but I personally would be a bit to scared.
Me:31 H:31
DX: MFI - 1% Morph
12/16 -IVF #1 - Antagonist Protocol w/ Lupron trigger
ER - 11 retrieved- 9 mature - 7 fertilized - 3 sent for PGS on day 5 - No normals (1 XXX Embryo - may use in future)
3/17 - IVF #2 - Antagonist Protocol w/ HCG trigger
ER- 13 retrieved - 11 mature - 8 fertilized - 2 sent for PGS on day 5 -2 Normal
FET #1 - 5/16/17 - BFP! - Beta #1 5/25 - 156 - Beta #2 5/30 - 2562 - Beta #3 6/1 - 5191!
Type 1 Diabetes since 2001, MTHFR hetero A1298T
Dogs: Raider 4 yrs, Dex 4 yrs
BFP #2 7/6/16 SCH, D&C 8/4/16
BFP #3 12/26/16 EDD: 9/6/17
My Chart / My Diabetes/Pregnancy Blog
My Type 1/TTC/Pregnancy Podcast:
Juicebox Podcast Episode 118
A1Cs:
1/12/16 6.7%
5/25/16 6.0%
11/2/16 6.1%
3/22/16 5.8%
4/27/17 5.4%
6/13/17 5.3%
"Sugar Fancy Tutu"
Children: 1 (girl, 3 years)
TTTC #1 since April 2015, Started Treatment Dec 2015
5 Cycles of IF treatment until BFP! (IUI, Gonal-F, Letrozole)
Born: May 22, 2017
TTTC #2 since September 2020, Currently in Testing phase
Thank you for the advice about laboring at home as long as possible! If when I'm pregnant I develop some reason that I do end up needing to deliver in a hospital, I hope I can stay at home as long as possible beforehand. One nice thing about the midwife I picked last time is that if I do have to transfer to a hospital, she and her two assistants come to the hospital with me to be my super doula team and support me and be my advocates. I am a little nervous about labor since I have inappropriate sinus tachycardia (anything that makes your heart rate go up normally, such as anxiety or exercise, makes mine inappropriately high). My cardiologist and midwife don't think it'll be an issue, but it's such an un-studied condition, and an acquaintance of mine had it get a lot worse when she was pregnant. I'm trying to keep an open mind in case birth center isn't a safe option for me. I appreciate your input and advice!
Married 9/27/14
TTC #1 since 8/15/15
BFP: 1/2/16, EDD 9/13/16 - MMC 2/10/16
BFP: 3/17, EDD 11/23/16
November 2016 April Siggy Challenge - April Showers
TW: Loss
Me:31 H:31
DX: MFI - 1% Morph
12/16 -IVF #1 - Antagonist Protocol w/ Lupron trigger
ER - 11 retrieved- 9 mature - 7 fertilized - 3 sent for PGS on day 5 - No normals (1 XXX Embryo - may use in future)
3/17 - IVF #2 - Antagonist Protocol w/ HCG trigger
ER- 13 retrieved - 11 mature - 8 fertilized - 2 sent for PGS on day 5 -2 Normal
FET #1 - 5/16/17 - BFP! - Beta #1 5/25 - 156 - Beta #2 5/30 - 2562 - Beta #3 6/1 - 5191!
I planned on just using a CNM and not bothering with an OB. I'm biased as a nursing student, but I think nursing tends to push a much more holistic model than doctors do. Doctors are there to look for problems, and an OB is a surgeon to boot that would definitely rather be safe than sorry. So would I, but within reason. Anyway, since most births are uneventful, I don't see the point of using a doctor unless it's necessary, and since I planned on going to a hospital there wouldn't be one far away.
However, I found out I had a MMC at my 8 week appointment and that was the first time I met the OB that runs the office I go to. He had such good bedside manner and treated me so well, it made me think twice about my previous anti-OB stance and I would trust him with my next pregnancy and hopeful birth.
I've considered home birth/birthing center in the past but I'm not really comfortable with that, especially since I myself was a large and C-sectioned breech baby. It does help though that hospitals here are pretty crunchy- one in particular even provides acupuncture and sometimes doulas, and birthing tubs are pretty much a standard option. If I felt like my only other option was a very traditional and very medical birth, I might feel differently. My best friend's mom had home births, but given that we lived about 15 minutes away from the hospital, that made nervous. It's true things don't usually go wrong, but when they do they can get terrifying very quickly, so I'd prefer to have emergency care at standby.
My sister also considered home birth and ended up going to a birthing center for her first two. She brought up a good point- if something did go wrong, she didn't want it to happen in the place where she lived and would have to be reminded of it in that way.
That said, it's my goal to be a CNM and I would love to help others with home births one day!
Married 9/27/14
TTC #1 since 8/15/15
BFP: 1/2/16, EDD 9/13/16 - MMC 2/10/16
BFP: 3/17, EDD 11/23/16
November 2016 April Siggy Challenge - April Showers
At the practice I go to for general women's health they have midwives that you can see for that. I haven't seen one, though, so I don't know if the experience is any different for annual exams.
Since midwives are a bit more holistic/natural, I'm hoping they would at least take the time to give me information/answer my questions so I make a good decision regarding TTC at this time. I want to be as healthy as possible.
I think this is a great question. I’ve also thought about this a lot in case we get around to needing to make this choice. I also volunteered at a traditional midwifery clinic in Guatemala. I bet mothers will have some good advice for you too, what have you heard from them?
Here’s my reading:
In terms of neonatal mortality and birth injury, hospital birth is overall safer for babies. Most detached birth center / home birth midwifes in the U.S. are CPMs - Certified Professional Midwives - who don’t have the training to deal with an emergency, and who sometimes have so little training that they don’t even know what they don’t know. The SkepticalOB Amy Tuteur writes ‘[CPMs] are required to have only a high school diploma, a course of unmonitored self-study that can be completed at home, and attend only 40 births (approximately the same number that I attended in my first week of residency training.)” An OB or Certified Nurse Midwife will have seen dozens to hundreds of emergency cases while a CPM may have never even seen one. That said the risk of c-section is higher for moms in hospital (~25% of low risk hospital births in 2013 were c-sections… I don’t know for home births but I’d guess it’s much lower, like 5%). Multiple c-sections get risky for moms (e.g. adhesions, internal bleeding, etc.). And of course you are restricted in some settings from drinking eating moving etc.
As others say above I think each family has to weigh up the risk-benefit ratios for themselves… However, I'd caution everyone to keep in mind you can shoot to have a safe, unmedicated vaginal birth for your baby, but you can’t choose it. I think for people who shoot for it, the stats show it's wise to get care from a trained provider (OB or Certified Nurse Midwife) you trust and plan to be in or very near a hospital. There’s no guarantee you’ll need the backup, but why roll the dice?
When it comes to an OB vs. a CNM, I have heard of some CNMs who know better repositioning techniques and who work better with mom’s wishes. However, I’ve also heard of CNMs who were very interventionist and not very mom-centered at all. I think the important thing is you work with someone you trust who comes recommended, if you can. In a lot of rural places that means an OB because CNM’s are unfortunately not entirely common. I hope we see an increase in the # of CNMs in the U.S. in the future!
Steph
*****TW: Loss*****
I would only add one thing. As a late loss mom, it is difficult to communicate just how agonizing it is to look back --endlessly and obsessively-- at the decisions you make regarding the care for your pregnancy. We lost our son at 33w5days. We know what happened in our situation but only because we demanded an autopsy. This experience has caused me to read a lot about pregnancy loss and stillbirth. It is unbelievable how much is not known, how many mothers do not have answers.
Whatever you choose should be something that you can defend to yourself even under (especially under) circumstances of loss.
I don't want to get in an OB/CNM/CPM battle, but I think it's best to be fair to all sides. Each has their own specialty and you just need to figure out what's best for you. If you want to have the option of an epidural/pitocin/immediate access to surgery then an OB is great. If you want completely unmedicated then a midwife might be the better option.
And, because I'm picky about statistics - you saying that neonatal infant mortality happens less in the hospital, I would like to point out that with low risk, healthy women (who are the only ones who should ever have a planned home birth!) the mortality rates are so close that there is no significant statistical difference. We are talking a fraction of a percentage of difference.
Again, not looking to argue - I just dislike when I see false claims about this stuff.
Also, FWIW, the hospital I will be using for any possible future delivery is very "mom centered". It has a nice birthing center with private birthing suites, a doula and CPM staff you can work with, and provides tools and assistance to those who prefer a more "med-free" approach. This certainly goes a long way in supporting my birthing goals. So it made my decision that much easier.
Me: 27 - DH: 33
Married: June 2011
TTC #1: January 2016
BFP #1: February 22nd 2016 MC w/ Misoprostol: March 21st 2016 -Blighted Ovum
BFP #2: July 6th 2016 EDD: March 15th 2017
M17 October Siggy Challenge: Animals in Costumes
**TW : loss**
—————
alanna3622 - I am so sorry for your loss. How are you doing now?
@antoto - Thanks for bringing a different perspective. That data I have seen defends the statement “Low risk birth is safer for baby in the hospital.” I base this argument on two datasets: [1] MANA’s 2014 paper shows the risk of low-risk home birth from 2004-2009 was 1.6/1000. [2] CDC Wonder shows the risk of neonatal mortality is 0.38/1000 for a hospital births for a roughly equivalent sample (low-risk hospital births to white mothers 2004-2009; the MANA mothers are 92% white). That is a 1 in 2631 mortality risk for hospital and 1 in 625 mortality risk for homebirth. The absolute difference in risk is small for an individual, however it's not insignificant. More data from other time periods and states would be extremely helpful and would certainly influence my argument. Is there data that indicates my claim is false?
I appreciate that you bring another perspective about CPM’s. Many people have very strong feelings about this issue. I think it is a great point that many CPMs have more experience with unmedicated birth. It's indisputable that on average the risk of c-section is much higher for low-risk hospital births, 25% in hospital to ~5% for home birth. Tuteur’s main point is just that more than other birth providers, it can be harder to judge whether your CPM will be able to recognize/handle a birth emergency in time. I also think individual circumstances will vary a lot. I feel everyone should do their own research, talk to former patients, weigh the risks and benefits for themselves, and choose a provider they trust. I think in weighing the risks moms should be aware that while home-birth will significantly lower their c-section risk, it does present a very small but not insignificant risk to babies compared to hospital.
@ BelcherEars - thanks for sharing. Sorry to read about your recent MC. It’s great that you have a hospital with a birthing center you can use for any possible future delivery.
As far as the sources you are trying to compare - I don't believe it's wise to compare two different sets of women like this simply because I don't believe it's good science. To say absolutely for certain that one is X amount safer than another you would need one study that had a large data set and was double blind. Understandably this study does not exist, and probably will never exist. Without this study it just CAN'T be said absolutely conclusively that a hospital birth is a specific measurement safer. So the numbers you are comparing - I just don't think that's fair.
Something you have to be careful with a lot of those studies (not the one you cited, just in general) out there about home birth is that they can sometimes be looking at ALL births that occur at home, not specifically planned home births with a CPM. So this would include women who birth so fast they don't make it to the hospital, women who choose to have an unassisted home birth (ahhhhhhhh terrible, would never suggest anyone do this), etc. So what I have seen is that when you further control for those factors the difference between home and hospital reduce even more.
You could definitely argue that a hospital with a high level NICU center would absolutely be better at saving babies in those extremely rare circumstances. But what about a hospital with a lower level NICU, or no NICU... etc etc.
And of course as you mentioned, with a home birth women experience significantly (definitely statistically significant) less of c-sections, episiotomies, vaginal tearing, pitocin for labor augmentation, and epidurals.