You’re pregnant, huh? Now what? Let’s talk: Midwives vs OB

So, you saw a double line, plus sign or maybe one little word that changed everything.  Pregnant.  Let me be the first to say CONGRATULATIONS!  You are about to embark on the most important, scary, hard, yet oh so exciting and amazing journey of your life.  While pregnancy can evoke lots of different emotions, sometimes all at the same time, I remember the one always at the front of my mind was awe.  I mean seriously, you’re growing a child inside of you.  A real person!  Wowza!

Over the next several weeks I will be posting a series of entries highlighting some of the more important and perhaps controversial topics associated with being pregnant.  My goal is to share my thoughts, have conversations with some of you and provide some food for thought for others of you who are looking for answers.  I’ll be working my way through pregnancy to labor and finally the birth of your beautiful baby – starting with first things first.  You’re pregnant…now what?  What are your options and how do you go about choosing a provider for your care during the most important 9 months of your life?

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“Wait, what?  You go to a midwife??? (insert shocked face) Why???”

“You see a midwife?  So does that mean you’re planning on having your baby at home?”

“What’s a midwife?  Like back in the old days?”

“A midwife?  So everything has to be all natural?  Do you actually think you can do that?”

No joke, these were some of the things I was asked on a regular basis after telling people that I was seeing a midwife for my prenatal care back when I was pregnant with our daughter.  While I can’t say that the lack of true understanding of what a midwife is was surprising (given the fact that although midwifery is on the incline it still isn’t widely used in the United States) I was somewhat shocked by the stereotypes that still accompany the term ‘midwife’.

I have always been someone who favors the more natural approach in my life.  I don’t take a lot of medicine, limit the toxins going into my body and look for more natural remedies to use in my home.  For as long as I can remember I have also been someone interested in (okay probably more like obsessed with) pregnancy and childbirth.  Before I was even married I read book after book about pregnancy, particularly natural choices in pregnancy, therefore when I did get pregnant I knew right away that I would be seeing a midwife as opposed to a regular OB.  Luckily for me, there is a group of midwives associated with one of the hospitals nearby – they deliver at the hospital, insurance fully covers their services and they work closely with an OB should something go wrong – so my choice was easy.  Maybe you, however, don’t have as much experience with midwives and therefore don’t even know what they really are.

Let’s talk facts…

  • There are several different types of midwives: Certified Midwife (educated in midwifery and certified based on the requirements of the American College of Nurse-Midwives, Certified Nurse Midwife (educated in midwifery and nursing and certified based on the requirements of the American College of Nurse-Midwives, Certified Professional Midwife (professional independent midwife certified by the North American Registry of Midwives – required to have knowledge of and experience in out-of-hospital settings), Direct-Entry Midwife (provide care in settings out-of-hospital, independent practitioner), and Traditional Midwife (usually referred to as community midwives, aren’t licensed or registered.)  FYI my midwives were CNM.
  • In the USA in 2011, Midwives attended 7.8% of all births
  • According to a research study conducted by Dr. Peter Schlenzka, in a review of over 800,000 births, there were no advantages of a standard obstetric hospital approach over a nurse-midwife setting inside or outside of the hospital
  • Use of the Midwives Model of Care has been shown to drastically reduce the presence of birth injuries, trauma and Cesarean sections.
  • Midwives provide much more personal, hands on care, working WITH the mother to ensure the best pregnancy, labor and delivery experience possible.
  • Childbirth being tended to by midwives have reduced infant and mother mortality rates.
  • Women who receive continuous care from midwives are less likely to have a baby before 37 weeks, or to lose their babies before 24 weeks.
  • Statistically, women who use a midwife are more satisfied with their care and have a more positive labor and childbirth experience.
  • Women under the care of a midwife see increased breastfeeding initiation and overall success

World Health Organization statistics show that births attended by midwives have lower infection rates, lower Cesarean section rates, fewer complications and healthier outcomes—thus, lower overall medical costs—than physician-attended hospital births.  -World Health Organization

How about some myths surrounding midwives…

  • A midwife only delivers babies at home – while some midwives deliver babies at home or in birthing centers, the majority of midwives in the United States deliver babies in a hospital setting.  In fact, statistics say that of the childbirths that take place under the care of a midwife, 95% occur in a hospital.
  • If you go to a midwife, you have to have your baby naturally with no epidural – statistically mother’s who are under the care of a midwife are less likely to have an epidural during labor, however it doesn’t mean that they can’t have one just because they’re seeing a midwife.  While midwives might encourage a more natural approach, they ultimately strive to empower the mother to take control of her labor experience and what she desires, whether or not it is natural.  However, they are equipped with some great pain managing techniques – which will be discussed in a future post!
  • Midwives aren’t well trained/what happens in the event of an emergency? –  I chose to see a group of midwives who were all Certified Nurse Midwives and had gone through extensive training and certification through the American College of Nurse Midwives.  In addition, my midwives all have their Master’s in Science of Nursing degree.  Finally, they have an OB on staff that is able to step in at any point should the pregnancy or childbirth take a turn and become an emergency situation.  I felt that my midwives were highly educated and very well trained especially in the area of pregnancy and childbirth.  As someone who desired a natural childbirth experience, midwives were much better trained when it comes to pain management and staying away from unnecessary medical interventions.

Using an obstetrician may be a disadvantage if you desire a more natural, hands off approach to pregnancy and childbirth. Obstetricians are trained to manage complications using many medical interventions. Some possible disadvantages to using an OB/GYN include: Increased risk of an episiotomyinduction or assisted delivery, Increased chance of cesarean birth.  -American Pregnancy Association

When would it be appropriate/necessary for you to choose an Obstetrician (OB)?

  • If you already see an OB/GYN that you are comfortable with, have built a relationship with and who you feel would suit your desires and goals during your pregnancy and childbirth experience.  At the end of the day it’s all about what you want.  If you feel that your current OB is completely supportive of those desires – whether they’re to have a natural experience or not – then that’s great!
  • If you are high risk.  Women deemed high risk, whether due to age, health, multiples, etc. should see an OB/GYN.  Although midwives are trained to deal with complications as they arise, a regular OB has a deeper understanding of dealing with high risk situations and there’s a good chance that a midwife would refer you to one anyway.
  • If you want a painless labor and delivery, like the idea of being induced (please do your research first…more on this topic in a later post!) or are open to and hope for as many medical interventions as possible/as your OB deems “necessary”.  While you can still have an epidural with a midwife, inductions are not very likely and as a whole they will be very slow to introduce medical interventions during labor unless it is an emergency situation.

The bottom line…

While I know the prospect of choosing your pregnancy healthcare provider can seem slightly overwhelming, at the end of the day all that matters is what you as the mama wants.  The best thing that you can do for yourself and your baby is to educate yourself on your options and make a choice that will ensure you feel empowered to have the pregnancy, labor and childbirth experience that you desire.  My wish for you is that in addition to taking a little time to do some research, you might question the “norm” and think about what type of care is best for you and your baby.  Be sure to stay tuned for my next post on pregnancy: “What is a Doula?”

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PS – The following are great resources on midwifery care:

Midwives Alliance of North America

American Pregnancy Association

American College of Nurse-Midwives

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http://www.mana.org/about-midwives/what-is-a-midwife

http://www.midwife.org/Essential-Facts-about-Midwives

http://americanpregnancy.org/labornbirth/midwives.html

http://www.mana.org/about-midwives/midwifery-model

http://www.huffingtonpost.com/2013/08/20/midwifery-benefits_n_3787058.html

http://americanpregnancy.org/planningandpreparing/choosingob.html

https://www.multicare.org/file_viewer.php?id=8270‎