Should I use a midwife or an OB/GYN?

September 20, 2007 5:59 PM

Is it a good idea to use a midwife instead of an OB/GYN?

I'm a mere six weeks pregnant and I'm pretty disenchanted by the medical field. I had to advocate for my regular gynecologist to take blood instead of just relying on my urine tests, and the OB I was referred to refuses to see me before I'm eight weeks pregnant. Her receptionists weren't even nice over the phone. I don't like doctors in general and I'm really not looking forward to dealing with them, or any other doctor, for the next nine months.

A friend of mine recently had a baby and raved about her midwife and her home birth. On the surface it seems like a great idea...cheaper, more natural, more relaxed, more flexible. But I just can't get past the feeling that it's a really bad idea to give birth without a doctor around, even though I live in a big city with a hospital less than ten minutes away.

So, has anyone had experience with midwives? Was it positive or negative? Any experience with finding a reputable midwife?

Thanks!

posted by christinetheslp to health (55 comments total)

My understanding is that you should have a doctor through the pregnancy, because they know things and can monitor things thta midwives simply can't.

A midwife for the home birth is apparently great. Have 911 ready to call just in case, but you probably won't need it.

Note: I don't have a womb, and this is all anecdotal.
posted by dirtynumbangelboy at 6:06 PM on September 20, 2007

Oh no! You're going to get totally-- um, agenda-having responses. Of two kinds:

1) You're crazy. Do you know how many women used to DIE in childbirth? You must immediately go to a hospital and stay there until your induced birth turns into a c-section. Your body is very dangerous and must be controlled!

2) There is a conspiracy to convince women that their bodies are lemons, blah blah blah Ina May Gaskin, blah blah blah, yes, have a midwife.

I was born at home, so obviously I am just as slanted as anyone in this thread is going to be. I really urge you to read Ina May Gaskin's Guide To Childbirth and think it over for yourself. Because as much as I am pro-midwife, I think that anyone who gives you advice on this issue is going to be coming from a very strong pro or anti position, and both groups will be claiming to be the only objective one.

Congratulations on your pregnancy! Don't listen to people who will try to freak you out: this is what your body was designed to do.
posted by thehmsbeagle at 6:08 PM on September 20, 2007 [1 favorite]

It's normal not to be seen until around 8 weeks, unless you're high risk. My OB didn't see me until 8wks even though she ended up relating to me as high-risk because of my age. I finally got fed up when she couldn't answer my questions like I was an intelligent adult. Everything was a condescending "You want to do what's right for your baby, right??"

So I switched at 30wks to a group of midwives who practice within a hospital and have OBs as backup in case there are surgical or anesthetic needs. It's the best of both worlds if you think you may want/need medical intervention (or if it's your first, like me). I ended up having a naturally triggered and longer labor than I would have had with an OB (who would have induced a week earlier and gone to a C-section instead of letting me labor it out).

I highly, highly recommend The Thinking Woman's Guide to a Better Birth by Henci Goer. It will open your eyes about the 'medicalization' of birth. In any case, barring any complications, you've got plenty of time to decide. Congratulations!

dirtynumbangelboy, midwives can monitor anything a doctor can, and in fact monitoring has not been shown to have a positive correlation to a healthy birth. I would say, actually, that in addition to any monitoring done with medical equipment, that midwives are more likely to have non-equipment-based skills that aid in a healthy pregnancy and birth.
posted by cocoagirl at 6:14 PM on September 20, 2007 [1 favorite]

As an alternative, you could hire a doula, who can help care for you during labor when you're otherwise occupied. It's likely that whoever your OB is, he or she will not even be on call when you go into labor, so if you do see a doc, ask if you can meet all the call partners.
posted by Addlepated at 6:14 PM on September 20, 2007

IANAW (and I hang out with a great ob/gyn), but the wife of a friend of mine is a doula, and many of my friends have had excellent experiences with midwives in a hospital setting.

I am really impressed by the doula-- she's a very caring, well-trained professional birth advocate. She gets women ready for birth, takes care of them while they are in labor, and helps them adjust to breast-feeding and infant care.

I also know that in many places you can have the experience and comfort of a midwife within the safe confines of a hospital. Midwives where I live are licensed professionals, but in an emergency, a doc is good person to have at hand.

Congratulations. I hope you find a good solution for you.
posted by gesamtkunstwerk at 6:14 PM on September 20, 2007

I believe mid-wives have to have a "back up" ob to cover them.
posted by 6:1 at 6:15 PM on September 20, 2007

P.S. If you tell us where you live, one of us may be able to recommend a good midwifery registry.
posted by gesamtkunstwerk at 6:18 PM on September 20, 2007

I believe one usually has both, with the midwife doing more of the day to day contact stuff. The Kaiser Permanente here in Northern California provides both to their patients. And, in the delivery room, I believe you often have 2- one for the mom and one for the newborn.
posted by small_ruminant at 6:18 PM on September 20, 2007

My wife was able to have a midwife as her primary medical provider throughout her pregnancy while giving birth at a hospital. This midwife was associated with a larger practice that included ObGyns. The midwives in the practice performed all of the prenatal examinations and the midwife on duty at the time of our son's birth was the attending professional at the hospital. In our case, at least, it was possible to use a midwife as the primary medical professional and still have a hospital birth. This provided all the benefits of a midwife (she was there for the entirety of my wife's labor) with the reassurance that an operating room was nearby in case something went amiss. Perhaps this is locale specific (we're in NJ) but it is certainly is something to look into if homebirthing doesn't sit comfortably with you.

My advice to you at this stage is to do all you can to ensure that you get the birth experience you want given insurance and other constraints. However, the important part in the end is to have a healthy mom and a healthy baby. So whatever happens, don't castigate yourself about what could have been as long the outcomes are positive.
posted by mollweide at 6:21 PM on September 20, 2007

I personally would not want to go through 9 months of pregnancy with out a licensed doctor. It sounds like maybe you need a new ob/gyn - yours seems kinda insensitive. I would say go with a midwife too if that appeals to you, but having the tools of a doctor is also wise.
posted by radioamy at 6:21 PM on September 20, 2007

My aunt is a nurse practioner and a midwife. You can get both. There are probably doctor-midwifes out there too.
posted by Ironmouth at 6:26 PM on September 20, 2007

I was with an Ob/Gyn practice through my pregnancy, mainly through laziness (they were 5 minutes from my house!) and the belief that I could make things work out the way I wanted them to. I had read some books on natural childbirth (Ina May's Guide to Childbirth kicks serious ass) and knew I was leaning that way, and all the doctors I met through the office (a different one every time, of course) said that certainly I could try to go natural. At 34 weeks I took the hospital tour, thank goodness. It really opened my eyes to the reality of hospital birth: the nurses are, for the most part, in charge and of course you can't choose who you want since it depends who's on shift when you come in. The hospital has a very medicalized view of birth, which is fine for them and fine if you have a complicated situation. If not, though, you will almost certainly find yourself agreeing to procedures you do not want and being told that you "must" do certain things while you are in a very vulnerable position. If you truly want to have a normal, natural birth in a hospital (and I assure you you are not crazy for wanting to have a natural birth! The benefits to mother and child are well-documented), you are going to need an advocate such as a doula or perhaps an on-staff midwife.
I ended up leaving the practice I had been with and transferring to a freestanding birth center that is entirely midwife-run. It is across the street from a hospital in case of emergencies, and honestly the majority of emergencies in birth can be dealt with just as quickly by crossing the street as they can if you're already in the building. The midwives at my birth center had admitting privileges, of course, and a long and successful history in dealing with the hospital in a way that was best for everyone. Had I started my pregnancy with the birth center, the midwives most certainly would have handled all of my pre-natal care, just as they did once I transferred to them. The biggest difference I found in the prenatal care was the time the midwives took with each woman (first visit was an hour! subsequent visits were 30 minutes) as well as the focus on total care. In all the time I was visiting the very well-respected Ob/Gyn practice, not one person had me fill out a diet sheet or really discussed overall health in any depth. Visits were 15 minutes or less, and the focus was definitely more on "what could go wrong" rather than "what you can do to help things go right." Since I only have one child, I can only comment on my midwife-assisted birth, but it was truly great and although not easy I felt completely supported and safe the entire time -- in every way.

My friend also went with the midwives for her second child, and although initially a big believer in hospital birth (due in no small part to her own congenital heart condition which she thought precluded her from any type of "alternative" care) declared the difference between the birth of her first and second daughter to be night and day. She's now training to be a doula, with the idea of being a midwife down the road!

But don't take my word for it -- do some reading (again, Ina May Gaskin is incredible, as is Michel Odent), call around and see if you can find some midwives or a birth center to interview or attend an information session, and know that you will make the right choice for you and your baby! If I can help with any more information, feel free to e-mail me -- it's in my profile. Good luck and congratulations!
posted by chihiro at 6:27 PM on September 20, 2007

If you want MORE testing and MORE doctor appointments, going the midwife route seems illogical. While a midwife would be more likely to listen to your requests, typically a midwife would err on the side of less intervention rather than more.

As a side-note, in my last pregnancy (granted, not my first) I didn't call my doctor's office until 10 weeks or so. While I think they were disturbed by that, I was happier that way, but I did have previous experience to guide my decision.

Generally I'd second hmsbeagle that only you can decide what will be good for you (and having had so many different positive experiences with childbirth, I'd argue that there's no absolute good or bad), and anecdotes will only help you so far. You need to visit your local hospital, see what their birthing department and rooms are like, find a doctor and read up on their policies, and talk to a few different midwifes.

Also, if you decide to go with a hospital setting, writing a birth plan can go pretty far in achieving the results and feel that you want for your delivery.
posted by artifarce at 6:28 PM on September 20, 2007

I live in Milwaukee.

It's not that I want more testing and more appointments...it's that I want more thought given to my care! If it was just me I wouldn't mind as much, but since I have another little life at stake I want people to give some thought and time to its care.
posted by christinetheslp at 6:36 PM on September 20, 2007

See a doctor regularly to make sure all the medical bases are covered, but also see a midwife and have a midwife handle the birth process.

Also -- make sure that you like your doctor and your midwife. There's no reason to have a caretaker you don't like.

Mrs. alms and I had our child at home and it was an amazing, wonderful experience. I can't imagine having done it any way. Of course, if the pregnancy had been high risk (which the medical testing would have shown), we would have done a hospital birth. But given the fact that it was a normal birth, home was appropriate, that's what we did, and it was great.
posted by alms at 6:39 PM on September 20, 2007

As long as nothing really awful happens at delivery then a midwife is probably better as they will give you more attention. If on the outside chance something goes seriously awry, you want a professional skilled in all things surgical to perhaps save your baby in the nick of time. Our first child went into serious distress and was saved with an early delivery. Perhaps a midwife would have seen this, perhaps not. A midwife at the hospital and a doctor who doesn't mind having midwifes do the normal deliveries is probably the best all around bet.
posted by caddis at 6:41 PM on September 20, 2007

I had to advocate for my regular gynecologist to take blood instead of just relying on my urine tests, and the OB I was referred to refuses to see me before I'm eight weeks pregnant.

These are both totally normal responses from your Gynecologist and Obstetrician. Unless you have a history of early miscarriage, or you had IVF and there's a high risk you're carrying multiples, there's no need to monitor your actual HcG levels via blood test when a simple positive/negative pee test will do just fine. And there really isn't anything an OB could even do for you anyway before 8 weeks, which is about the earliest you can even see anything on an ultrasound (and sometimes not even then). A midwife would, I think, tell you much the same thing, and if anything would probably be less inclined to do any kind of medical monitoring, blood draws, ultrasounds, vaginal exams, glucose screening, etc. than an OB/GYN.

That said, there are some pretty awful doctors out there who treat a perfectly natural process like pregnancy and birth as if you were going in for open heart surgery and need a highly specialized team of (primarily male) doctors to "fix" you or "save" you (or the baby). One word to sum up that mindset: episiotomy. Or forceps. Or Cytotec (look it up). Bleh.

But there are also some awesome doctors who will listen to you and your concerns, who are genuinely nice people interested in what's really best for you and your sprout, which may in fact be a much more hands-off kind of attitude. And they won't shiver if you mention you have a "birth plan" written out with your preferences for labor and post-labor. Heck, some may help you write one! So, your options vary; don't tar all the good doctors just coming up in the field with the same brush as the old school jerks who thought things like standardized twilight sedation for laboring women was a peachy keen idea.

Finally, you're at six weeks right now, so you may want to get your situation straightened out soon, while you're still kind of functional, because you're just about to run into six to eight weeks of miserable nausea and fatigue starting any day now...

And finally finally, CONGRATULATIONS!

/33 weeks tomorrow over here! And with a planned hospital birth and an awesome OB/GYN. Planning on an epidural, yes, but as for other "interventions", no no no. No Pitocin or Cytotec for me, thanks, even it means a longer labor. Birth balls and squatting, if possible; why not have gravity help things along rather than stick me on my back on a gurney and make me fight it for six hours? And I may even get to have my newborn stay in-room with me during my hospital stay and not get sent to a nursery, which would be great.
posted by Asparagirl at 6:44 PM on September 20, 2007

I recently worked with a photographer who did a really extraordinary photo essay on midwifery, maybe you'd like to see it.
posted by The Straightener at 6:47 PM on September 20, 2007

It perfectly fine to use a midwife, as long as you're evaluated for any health risks along the way. However, some midwives/birth centers have stringent guidelines for who can see them, because they don't want to be responsible for a high risk birth. If you have high blood pressure, are overweight, diabetes etc., you would probably be turned away by a midwife, or may have to switch to an Ob/Gyn midway through your pregnancy if you develop complications.
posted by saffry at 6:55 PM on September 20, 2007

There must certainly be practices in Mwke that focus on woman-centered birth, work with hospital birthing centers that attempt to mimic home-birth environments and have both nurse-midwives and doctors in the practice so that you get the best of both worlds. You can decide now to do home birth and then change your mind. Or not. You don't have to sign anything right now.

Check your state laws to make sure midwives are registered and licensed. Check your insurance (if you have it) to make sure it covers midwives, deliberate home birth or other nontraditional (isn't that crazy) birth options.

I do not believe, in major metro areas like Chgo-Mwke there is going to be ANY discernible difference in quality or safety of care between licenced physicians as opposed to licenced midwives. Having put two kids almost thru college, I've met lots and lots of moms and heard lots and lots of birth stories (plus contributed my own) and have seen no discernable difference in outcome from home birth, medical birth, birthing center, midwives and doctors, and I've heard them all. Of course, it's all anecdotal and IANAD, but just sayin.

How to find this stuff out? Talk to all your friends with babies. I found out about my ob-gyn through the mom-network. There weren't midwives (just medical doctors oh well haha), but they made sure their patients got into the birthing center (20 years ago birthing center beds, even here in Chicago were at a huge premium) and provided what I ironically think of as "midwife quality" care.

Congratulations and have a wonderful journey!
posted by nax at 6:56 PM on September 20, 2007

My sister had my most recent nephew at home with a midwife. I was completely against it from the start. I am of the mindset that there is a reason we stopped having home births and moved onto doctors.
I just feel that there are to many things that could potentially go wrong, and I'd rather be safe than sorry. Besides, it just doesn't seem very sterile to give birth at your house...
My sister absolutely loved the experience though. She said she'd do it again in a heartbeat. She still visited a doctor during the pregnancy though.
posted by Becko at 6:56 PM on September 20, 2007

I recommend a family doctor who has a strong interest or informal specialization" in prenatal and postnatal care. My family doctor has a feminist midwifery approach but can still do all the things that a doctor can do. The appointments are longer than you get from an OB. And the great thing is that she took on me, my child and my husband as permanent patients. With an OB or midwife, the relationship ends six weeks after you have the baby. (Of course, you can still go back to your old doctor if this family doctor won't take you on or you simply want to do so.)

I am having an elective C-section in 2 weeks, because of genuine medical problems that cannot be mitigated in any other way. However, with my first child, my doctor was committed to a natural delivery, even though it ended up being a 2.5-day labour. In fact, at 52 hours, when I asked if I could have a C-section, she talked me out of it. This is another great example of the midwifery approach. Perhaps you can ask your own doctor if they know a GP who delivers babies and has a strong interest in doing so.
posted by acoutu at 6:58 PM on September 20, 2007

for what it's worth, both of my children (i'm male) were born at home with a midwife with no complications.

if you don't like doctors (or hospitals) you might be alot happier at home.

the nice things about the homebirths were:

we developed a personal relationship with the midwives (we moved in between births) before the birth and the midwife was present for the entire birth.

there was no car trip to the hospital once labor started, we could relax at home.

alot cheaper than an uninsured hospital birth.

reducing stress and anxiety i think is very important for reducing complications.

but like all things, there are also not so good and even bad midwives. we seemed to get two very good ones but have heard disquieting stories about other people's experiences.
a homebirth definitely involves taking alot of personal responsibility (and risk) for the experience.

birthing centers can be good but if they are too closely affiliated with a hospital they may be forced to adopt some of the bad aspects of the 'medical model' for liability reasons. it might be difficult to know this ahead of time.

ultimately, wherever the birth occurs you will be the one doing all of the work and you've never done this before. i think the midwife can be a good 'coach' if you trust her...
posted by geos at 7:13 PM on September 20, 2007

though this may go without saying, a nsfw tag on that midwife gallery above is warranted. congrats and good luck
posted by andywolf at 7:20 PM on September 20, 2007

The laws for midwives differ from state to state so check yours. I had a midwife for all three of my children and it was a wonderful experience. Midwives do not necessarily do home births -- both of my midwives (two different states) were associated with an OB/GYN practice and there was a requirement that one appointment be made with one of the MDs. I'm not sure if this was a state law or something particular about the practice. Working with a midwife is working with a highly trained medical professional who has focussed their training only on childbirth (altho some do regular gyno care too). Both of my midwives were truly wonderful - lots of time taken during appointments, concerns about me and my health as well as how the impending child would impact the whole family, never rushed and most importantly were incredibly positive about progress during labor.

For all my births, I was in the maternity ward at a local hospital and my midwife was there during labor and delivery- I know so many people whose OBGYN wasn't on call or didn't get there in time and so the birth was overseen by a maternity nurse with the MD on call brought in at the last minute. Maternity nurses are great but they don't know YOU like your midwife will. I am quite convinced that very mild interventions during my first birth prevented my having a c-section -- no physician would have made the suggestions my midwife did to speed up labor. Both midwives asked my permission for all procedures and at the same time made suggestions about comfort.

I would never consider having a home birth - if something went wrong requiriing heavy duty intervention, I would have a difficult time justifying this choice BUT I would have all of my children again with a midwife and highly recommend it for anyone who is interested. Neither of my midwives were insistent on any particular aspect of the labor - unlike others in this thread, my labors were a partnership with my midwife and surprisingly thrilling experiences.

Congratulations and good luck with your baby!
posted by bluesky43 at 7:22 PM on September 20, 2007

Only one piece of advice...

Get a midwife who matches your philosophies.

My examples are from doulas, but it will carry over to midwives. I wanted to be a doula and joined a yahoo group for doulas. Some of them have extremely strong opinions and will tell you never to have meds because of the risks, never allow C-sections, etc. Just make sure the midwife will do what YOU want her to. Ditto if you do hire a doula... you want her to stand up for what YOU want, not what she wants.

I talked to my OBGYN about being a doula. She said she had one doula who was with a patient, and the woman had been pushing for 3 hours. The doc said it was time for a C-section, and the doula said no, let her try some other positions. She got so obstinate about it that they had to ask her to step out. The time for alternate positions was maybe after pushing for an hour. After 3, the poor mother was so exhausted she wouldn't have had the strength to continue on.
posted by IndigoRain at 7:23 PM on September 20, 2007

It's difficult for me to post this, even though I feel compelled to do so. First of all, my leanings are pro-midwife on the thehmsbeagle agenda spectrum, but our personal experience makes me swing towards ambivalence. Second of all, I don't want an emotional anecdote to overshadow all the complicated pros and cons of the debate.

But when my wife gave birth to our son four months ago, it took the longest three minutes in the history of the universe for him to take his first breath, and a good twenty minutes after that for his breathing to stabilize. In our case, it was a welcome sight when 15 doctors and nurses all burst into the room and took care of him within seconds of delivery. I can't imagine what it would have been like to wait for an ambulance in those circumstances (he's fine now).

So I guess, at least in a case like ours, and I honestly don't know how rare that sort of complication is, the options of a midwife in the hospital (or working with a kickass doctor who has absorbed midwives' critiques of medicine) would be far preferable to staying at home or delivering in a birthing center without easy and quick access to a hospital.
posted by umbú at 7:36 PM on September 20, 2007 [1 favorite]

first of all, see if you can find a better doctor. you are lucky to have so much time ahead of you--i think it would be a good idea, even if you do go with a midwife. is there a natural-birth interest group in your area? contact the la leche league--they may have good resources. also, there are lots of midwives that are nurse practitioners, which might be a good choice.

my pops is an ob/gyn, so i am a little biased. but here's my two cents: the leading cause of death for women before obstetrics (and penecillin) became an accepted field was childbirth. i really don't want to scare you--the odds are still very good that you could deliver this baby by yourself in the bathtub (if you wanted) with no complications. i definitely don't think childbirth is an emergency, but it does carry undeniable risks, and you should have a plan to address those. if you test positive for certain bacteria, if you have certain complications, if your baby has certain complications, you'll be much better off delivering in a hospital. them's the facts. on the other hand, if at 38 weeks, you're doing great and the baby is turned and ready to go, by all means stage-manage the birth the way you want. i don't have children of my own, but i really do empathize and support that you want it done a certain way, and i think you should be able to, if you get the all-clear.

since you have time, i would suggest doing all the research you can about the resources available to you. no matter what you decide to do about the birth, i would stay involved with a medical doctor throughout your pregnancy, simply because if you find an amazing midwife who helps you through the birth of your dreams, and then an emergency arises, you'll have a quick point of contact and your information will be on file and easy to access. so that's a benefit to consider. hopefully you'll never need it, of course. but, just in case.

good luck on whatever you decide! i think no matter how it happens, you'll find the new little person in your life was worth it. :)
posted by thinkingwoman at 7:37 PM on September 20, 2007

What you want is a Certified Nurse Midwife. These are nurses with advanced degrees in midwifery who are licensed to deliver babies in birth centers and hospitals. I used CNMs for both of my babies and would absolutely do so again.
posted by Biblio at 7:48 PM on September 20, 2007 [1 favorite]

Ditto on the midwife / OB practice. We started with the OB side of the practice, and they said in not so many words "we generally thing the low risk women that don't want interventions are better with the midwives", so we switched to the midwives for the next appointment. Same office, same hospital, same nurses, no-drugs birth and when we needed a physician consult there was one on the floor. It was perfect for us - not too hippy, hospital setting, but less clinical than the OBs in the same practice. (Chicago)
posted by true at 7:54 PM on September 20, 2007

The_Straightener-- that photoessay is great. The photographer captured such a great sense of calm in the pregnant (and birthing) ladies. Thanks for linking. :)
posted by thehmsbeagle at 7:59 PM on September 20, 2007

At any point in your pregnancy and labor, your midwife can recommend that you go to the hospital 10 minutes away; you'll get medical attention as quickly as you would in the maternity ward. On the other hand, if you have a hospital birth you can be pretty sure your doctor won't send you back home to a midwife if labor is going too smoothly.

Whatever you decide to do, I highly recommend finding a great birthing class. My wife and I took a Hypnobirthing class in preparation for a hospital birth last year, and it was incredibly helpful. Even though we really liked my wife's nurse-midwife, we still had to deal with quite a few "birth-as-medical procedure" style nurses, and we knew from the class exactly how to deal.

P.S. I understand your feelings of urgency and concern, but you really don't have to make this decision immediately. 40 weeks is a long time, and your first trimester is more about you and your body than about getting care for the baby (unless you're a high-risk new mom.)
posted by danblaker at 7:59 PM on September 20, 2007

Um, no, midwives can't actually test and monitor the way doctors can. Or, at least, I've never heard of any non-MD midwives who can, for example, do an amnioscentesis.
posted by dirtynumbangelboy at 8:26 PM on September 20, 2007

My only advice is to make sure you go into the next 34 weeks knowing you don't have a whole bunch of control. The women I feel most sorry for are those that have a very very detailed idea of how their birth is going to go and they are devastated because it doesn't all go as they imagined. Stuff happens - roll with it and consider any outcome that ends with a healthy baby and a healthy mom a success. Most hospitals and practices will have a mid-wife practice associated with them. I know a number of people who've had deliveries with a mid-wife in the hospital.
And Asparagirl - I hope I'm not telling you anything you don't know here - but as soon as you get that epidural it's on your back - no tubs, not squatting no birthing balls. You can get yourself some fentanyl or other narcotics to take the edge off (don't fool your self it still really freaking hurts) but once that needle goes in your epidural- you're down for the count. Bring a book or two - I was in bed for 9 painless hours before my little girl joined us...
posted by Wolfie at 9:08 PM on September 20, 2007 [1 favorite]

I have a certain bias - our daughter was born with a midwife, and my ex-wife is a midwife. I am pretty confident that midwives who have received 4 years of training and have subsequent experience are generally very good. That includes knowing when to hand over to an obstetrician. And by "very good" I mean better than a general practitioner who generally won't see as many births as a midwife does.

Having said that, "midwife" as a professional term means different things in different places, and may or may not denote a health professional with a tertiary degree.

Statistically it doesn't make much difference. It's actually hard to judge the stats, because obviously the really bad cases tend to end up in hospital with obstetricians, which skews things.

In the event that I ever become a father again I would have no hesitation if the mother wants a midwife-led pregnancy and birth.

Based on your statement "I don't like doctors in general" I think you would be better off with a good (which here means experienced and reputable and with good stats) midwife, simply because it's important that you be able to communicate effectively.

Re home-birth, the statistics fly around. Now here's a thing. We planned a home birth. Our midwife had concerns about the way our daughter was developing (insufficient amniotic fluid), and we ended up with an induction at the hospital. The midwife did the induction and supervised the labour. The point here is that the midwife identified the problem, worked with other medical professionals, and we ended up with a safe birth. That's professionalism, and it's what you should look for.
posted by i_am_joe's_spleen at 10:13 PM on September 20, 2007

And Asparagirl - I hope I'm not telling you anything you don't know here - but as soon as you get that epidural it's on your back - no tubs, not squatting no birthing balls.

Oh, I know -- but we're hoping to go with the newer "walking epidurals" (still somewhat of a misnomer, but definitely less numb and you can get into other positions somewhat), or else the new low-dose one which you can adjust somewhat with the push-button to regulate your own anesthesia dosage as the labor wears on.
posted by Asparagirl at 10:41 PM on September 20, 2007

Oh for the love of Pete.

First of all, in plenty of 1st world countries outside the US, it is normal to never see an OB and only see midwives through pregnancy.

In this US, this is an option but not the norm. That does not mean it isn't a perfectly normal choice to make.

IMHO at this point you should be exploring your options rather than trying to make decisions. No critical decisions need to be made at this point in your pregnancy. Be an informed consumer. Read some books. Come up with a list of questions and concerns you have about different scenarios - like potentially not being allowed to eat or drink in a hospital setting vs critical care in an emergency home birth situation. Interview an OB, an independent midwife, and a birthing centre practice. Make the decision YOU are most comfortable with.

Personally, I am all about the home birthin' midwife babies, but that is because its what has always felt right for me - that's how I feel safest, most comfortable and most in control. If another woman feels the same way about a scheduled hospital c-section, then more power to her. There are no hard and fast rules here; don't let anyone scare you into thinking there is a "best" decision, because there is not. There is only the decision that is best for you.
posted by DarlingBri at 10:53 PM on September 20, 2007

I'm pregnant with my fourth right now; all my pregnancies have been handled by midwives. The care and hand-holding given by my midwives just can't be compared to the rushed appointments friends have had with ob/gyns. With my midwives I have always had access to all of the latest tests and screenings, except that rather than being pressured into chosing more or less medical intervention I was given a lot of information and I made up my own mind about all of it. The hour-long appointments allow for a lot more in-depth infomation sharing and the midwives have always been available 24/7 for any forgotten questions. Midwives here are highly trained and on the look-out for any complications, they refer to medical specialists for the slightest thing wrong. They also work in groups so there is always at least two midwives present for the birth, one to focus on the mother, one for the baby regardless of whether it is a hospital or home birth.

I agree with chihiro that a hospital birth (sans midwife) is run by the nurses on shift that night. I've been at several friends' hospital births where their wishes were ignored during labour because the ob/gyn didn't sweep in the room until the last minute to catch the baby. I had to go to the hosipital for my second child because of a medical complication and rather than being allowed to push when my body was ready (and was pushing involuntarily anyways) I had to wait until the on-call ob-gyn found time in his schedule to stop by my room for a few minutes to actually catch the baby. Midwives show up as soon as the labour begins and stay for hours after the birth, reassurring the mother that everything is normal (most women have nothing to compare it to and aren't sure if what they are feeling is right) and monitoring in a positive way the health of both mother and baby. One friend in a hospital had a loud monitoring device that amplified her baby's heart beat and I found her labour nerve-wracking because all we focused on was the sound of the heart, no talking or enjoyment of the process of giving birth. Her ob wasn't around to reassure us that everything was okay and the nurses only seemed to dash in the room quickly and make disparaging noises or curtly say everything was fine.

I was very happy with my home births, I had relaxed labours reading books, talking on the phone and visiting with the family and friends that came for the birth. Immediately after the births I as able to have a shower with the products I liked and go downstairs to eat home-cooked food and visit some more with my family. The only downside to home births is the need to have to stay on top of housework in the last few weeks - I've opted to drive to my parent's house to give birth each time so I didn't have to worry about housework (and they have a bigger bedroom for the fifteen or so people I usally have at my party/births). My sister didnt want the midwives to see her dirty dishes so she opted for a hospital birth (not that they'd care, but she did). It is a pretty personal decision, some friends can't fathom wanting control or responsibility for their pregnancies and want to hand over all control to a doctor, some like me enjoy the whole process and need to feel a sense of control over decsions. Good luck with whatever you choose.
posted by saucysault at 12:06 AM on September 21, 2007

Congratulations!

We had our daughter at a birthing center 9 months ago. The pregnancy was complicated from the beginning starting with a threatened miscarriage at 7 weeks. There was even abdominal surgery at 22 weeks to deal with an ovarian cyst. Through the whole thing we worked with various OB/GYN's and specialists along with our midwifes. We actually had 3 midwives. The senior midwife, a back up and an apprentice.

The midwives had hospital privileges at the facility we'd had our previous issues looked at and we went through and developed a birth plan that specified what set of circumstances would trigger a transfer. Potential issues like fetal distress, prolonged labor, etc.

The birth itself went fabulously. We had a water birth and it was quick and really pretty optimal. My wife was GBS positive, but her water broke right at the end and it wasn't a problem. No antibiotics needed.

After the birth was a bit tougher. My wife had some hemorrhaging issues and had to pass a clot. They were able to deal with it and administer drugs to help as well as give her IV fluids. Our daughter also had issues with her lungs transitioning properly. They provided blow-by oxygen and we stayed over night. All 3 midwives stayed the whole night.

The next day her breathing was still shallow and rapid. It wasn't life threatening, but it wasn't right either. We looked over our birth plan and decided that we had met the criteria for transport, so we took her to the hospital. After further oxygen and observation, her lungs settled down and she was just fine. She's had one cold in the 9 months since and that's it.

We could have probably not even gone to the hospital, but we made a plan and it was the right thing to do. So I would say to talk to midwives, talk to OB's, find the right plan for you. They can work together and the important thing is to have the best birth possible. And to love every day with your kid after it.

dirtynumbangelboy: an amniocentisis isn't a regular monitoring procedure and it wouldn't be done on a whim by a OB, it would be a scheduled procedure done by a specialist. A Midwife can send a mother to get one just as easily.
posted by afflatus at 12:17 AM on September 21, 2007

ps, there is no "right" way to have a baby, just the right way for you. I'm a proponent of natural child birth, but remember, you're bringing a new little member of your family into the world. The important part is to feel safe, comfortable and happy with the way you are doing it. If you need a hospital, that's fine. If you need drugs, that's fine. If you need family and friends and a home cooked meal at your house, that's awesome too.

There are pros and cons to everything but you're going to spend a lot more years having to make a lot more decisions with this kid. So take it easy and do what feels right. There are 6.5 billion people on the planet. We are meant to have babies and evolution set you up to succeed at this. Take comfort in that fact. You'll do brilliantly.
posted by afflatus at 12:35 AM on September 21, 2007

Um, no, midwives can't actually test and monitor the way doctors can. Or, at least, I've never heard of any non-MD midwives who can, for example, do an amnioscentesis.
posted by dirtynumbangelboy at 11:26 PM on September 20 [+] [!]

amniocentesis does not lead to healthy babies, only to dead babies. Anyone who skips the testing from a real doctor during pregnancy is a fool. Don't skip the regular blood and ultrasound testing. There probably will be no problems, but if there are do you really want to ignore them? To the extent you can get these through a midwife, fine. However, when it comes to amnio, all it will tell you is whether to abort or not, hence my opening comment.

The real advantage of a midwife is on the birthing day when they can devote the whole day to you rather than have one of the doctors from the practice show up and help you and three or four other mothers at the same time. Critical testing for the baby's vital signs should be done and if the baby goes into distress and needs assistance coming out the midwife or doctor needs to know. If it gets really bad and you need an emergency c-section, rarish, and you are at home rather than in the hospital you have just put both your life and your baby's life at risk. This is the way to do it safely with a midwife.
posted by caddis at 1:35 AM on September 21, 2007

I am an OBGYN, and I strongly recommend that you get a midwife to lead your antenatal care, be present during labour, and if possible make the delivery. But that doesn't mean you shouldn't have an OBGYN involved in your antenatal care too. Although pregnancy and labour are wonderful normal processes, obstetricians are still helpful to have around for a number of reasons, some of which have already been touched upon:

1. Specialist antenatal screening and assessment.
2. Specialist advice and medical care in the event that the pregnancy encounters complications
3. Instrumental and caesarean deliveries, often unwanted but necessary interventions in around 3 in 10 deliveries (higher in first deliveries).

Pretty much everything else can be confidently and capably handled by midwives, and you will benefit hugely from the holistic, non-interventional, one-on-one care they can provide.

Lastly, this is not an evidence based recommendation, but I personally would never consider an home birth at a first delivery. This is an opinion shared by most obstetricians and many midwives. A huge majority of home deliveries will be happy and successful, but the occasional disaster is enough to put me off entirely. A midwifery led birthing suite, with rapid access (if required) to obstetric and paediatric services is an excellent alternative.
posted by roofus at 2:36 AM on September 21, 2007

I have nothing useful to add on the whole pregnancy care front, I just wanted to say don't leap in and judge your doctor by their receptionists' manner. I've (purely anecdotally) noticed a strange positive correlation between great doctors and bitchy receptionists.
posted by corvine at 4:45 AM on September 21, 2007

Many people do not realize that there are two types of midwives in the US. This is different from all other industrialized countries. There are certified nurse midwives (CNMs) who go through a rigorous education program involving substantial clinical experience. These midwives are equivalent to the midwives in other first world countries.

Then there are direct entry midwives, a second, inferior class of midwives. Anyone can call herself a direct entry midwife. Direct entry midwives have created certification programs for themselves, as well. These involve much less educational background, very little clinical experience, and no clinical experience in dealing with complications. These midwives practice at home out of necessity. They do not have the minimum education or experience to be allowed to practice in hospitals.

Most CNMs work in hospitals and have backup from physicians arranged and available. Some do homebirths. DEMs on the other hand are not allowed in hospitals, work in people's homes, generally have no emergency back up, and simply call an ambulance if things go wrong. CNMs attend approximately 10% of vaginal births in the US. DEMs represent a fringe movement. Only about 0.6% of births in the US are homebirths and that has not changed in the past quarter century.

You will hear advocates of homebirth claim that homebirth is as safe as hospital birth or even homebirth is "as safe as birth gets". There is no scientific evidence to support those claims. Virtually every study done to date shows that homebirth has an excess neonatal death rate of 1-2 per thousand ABOVE the neonatal death rate of low risk women giving birth in hospitals. Indeed the National Institute for Clinical Excellence, a health watchdog organization in the UK recently conducted a comprehensive review of the homebirth literature. According to their report:

"... The quality of evidence available is not as good as it ought to be for such an important health care issue, and most studies have inherent bias. The evidence for standalone midwife led units and home births is of a particularly poor quality.

The only other feature of the studies comparing planned births outside [physician] units is a small difference in perinatal mortality that is very difficult to accurately quantify, but is potentially a clinically important trend. Our best broad estimate of the risk is an excess of between 1 death in a 1000 and 1 death in 5000 births. We would not have expected to see this, given that in some of the studies the planned hospital groups were a higher risk population."

Homebirth advocates will give you citations for scientific papers that they claim show that homebirth is as safe as hospital birth. None of them do. All of them compare outcomes for homebirth (low risk white women, no medical complications, no pre-existing conditions, no prematurity, etc) with national mortality figures that include prematurity and all possible complications or with out of date studies extending back decades.

The paper cited most often, Outcomes of planned home births with certified professional midwives: large prospective study in North America, by Johnson and Daviss is the most rigorous of all homebirth studies. Johnson and Daviss are long time public advocates of homebirth; the study was commisioned by MANA (the Midwives Alliance of North America, the umbrella group of homebirth midwives) and was funded by a homebirth advocacy foundation.

The paper claims to show that homebirth is as safe as hospital birth, but it does not. That's because it never compares homebirth directly with hospital births for low risk women in the same year. That's not surprising. The neonatal death for homebirth was almost 3 times higher than the neonatal death rate for comparable risk women in the same year. They just leave that information out of the paper entirely. Instead, they compare homebirth to out of date papers extending as far back as 1969.

Of note, MANA, which collected the homebirth statistics in 2000 used in the Johnson and Daviss study, has continued collecting the same statistics for the intervening years. So MANA has a large repository of data on homebirth from 2001-2006 encompassing approximately 30,000 cases. That information is available, but not to the public. According to MANA, the information will be released only to "friends of midwifery", only after a formal application process, and only if the recipient signs a legal confidentiality agreement which prohibits disclosure of the statistics to anyone else. I suspect that the data shows definitively that homebirth is not as safe as hospital birth and that is why the information is being hidden from the public.

Good luck with your pregnancy and with whatever choice you make. You've started on an incredible journey (parenthood) that will leave you elated, exhausted and perplexed at turns, but you will surely experience joy unlike any you have known before!
posted by DrAmy at 4:51 AM on September 21, 2007 [6 favorites]

The statistics fully back midwives and home births as safe. But, if you want ranting anecdotal what-not...

I think most of modern obstetrics is useless. That pee-in-a-cup, get-weighed pre-natal "care" is largely BS; those aren't really useful routine tests, and...and why are you in such a hurry to be seen, anyway? There's nothing to be done so early on. It's pretty patronizing stuff, "pre-natal care."

I have a one-month-old and a huge pile of irritation with obstetricians and hospitals. We planned on a midwife and home birth. We moved mid-pregnancy; couldn't find a new midwife in time. Shortly before my daughter was born the supposedly low-intervention OB got induction-happy, and I ended up signing a refusal of treatment form -- refusal of "treatment" for the disease of "labour." It was an extremely distressing thing to go through in that state; we'd put a fair amount of trust in the bozo doc in question and had to find a new one rather quickly.

The hospital was a @#$& nightmare for all three of us (took a fair hassle to get them to realise Dad staying was important -- this under a banner of "...a family-friendly hospital!"), and I'm told it was good as maternity wards go. Hospitals are NOT appropriate places for intelligent, healthy adult women and their babies. We went home as quickly as possible, but it wasn't quickly enough.

During labour I threatened to leave several times; it was the only way to get anybody to listen to me, and we were actually quite prepared to walk out. I still wonder whether we wouldn't have been better off doing it in the park right near the hospital.

The nurses were idiots and I could not keep them away. Hopsital birth is dignity-free, and the nurses are a big part of it. More than one was confused by the request for a closed door and general privacy; one made a snide comment about my "not liking people" because I wasn't into wandering the halls and chit-chatting with the other labouring women. Bizarre. After the birth, it was a lot of trying to scare us about our (thoroughly robust) baby's health and some token bad breastfeeding "advice."

Re. "hospital births where their wishes were ignored during labour because the ob/gyn didn't sweep in the room until the last minute" -- I saw as much of my OB as I wanted to; the problem was not her absence, but just too much presence from the nurses. After the birth, I wanted to take a bath. (Yes, yes; you can take a bath post-partum without problems.) Nurses: "No." New Dad got a harsh look on his face and walked off to try to get me a bath, which ended up with a call to the obstetrician, and her saying "I think a bath is a fine idea, but it's not a medical thing; I can't order a bath for you." So I went home filthy. Between that and the food, there was no "recovery" involved. Nurses run the show to a fair extent, and nursing is not a profession with a high intellectual bar to entry.

Re. "Everything was a condescending "You want to do what's right for your baby, right??"" -- beware that one. It is invariably not right for you, and only extremely rarely right for your baby.

Keep in mind that the definition of an "emergency c-section" is a c-section within a half hour. The midwife we initially had did a great job of setting our minds at ease with good answers to our "What happens if...?" questions about various emergency scenarios. I highly recommend going and interviewing a midwife. And I recommend listening to your gut on pretty much everything -- if you find an OB you like (I had misgivings about my first one that I quashed; shouldn't have), that's cool too.

The American Way of Birth is a good read, as is the Henci Goer book mentioned already.
posted by kmennie at 4:56 AM on September 21, 2007

I switched from an obstetrician to a certified nurse-midwife at about 22 weeks (in large part because I wasn't thrilled with the OBs apparent assumption that being 5' and skinny implied probably I needed a C-section). My CNM delivers in a hospital and has OB backup. This turned out to be relevant, as my daughter ended up needing assistance to leave the womb (vaccuum extraction---not as bad as it sounds).

The things I liked about working with my CNM:
* she is very mellow
* she was with me in the delivery room almost all the time
* she was willing to go with what I wanted---if I'd decided on an epidural, that would have been fine; I didn't want one, that's ok too
* did I mention the OB backup? For me that was very important: the notion of a home birth just sounds crazy to me, although I certainly know people who think it's a good idea.

The thing is, you don't have to decide between "clinical hospital no one cares" and "oovy groovy home birth no modern medicine". The nice thing about working with certified nurse midwives is that you have the best of both worlds. It's more mellow (at least in my experience) than working with a big OB practice, but you have all the benefits of modern medicine.

Having said that, 6 weeks is awful early to be stressing about stuff. I know it's all exciting, but there's a long time to go. Agreed that anyone I've talked to says that really, 8 weeks is plenty early enough to be seen unless you know there are issues.
posted by leahwrenn at 5:31 AM on September 21, 2007

Many people do not realize that there are two types of midwives in the US... There are certified nurse midwives (CNMs) who go through a rigorous education program involving substantial clinical experience....

Then there are direct entry midwives, a second, inferior class of midwives... They do not have the minimum education or experience to be allowed to practice in hospitals.

In my experience in Massachusetts the opposite is true. CNMs privately recommend home births, but they cannot attend home births because of professional liability issues.

In terms of experience and certification: the direct entry midwives I've known personally have gone through a years long apprenticeship program and have probably been at more births than most newly-minted OBGYNs. In Massachussets direct entry midwives have been lobbying for the state government-based certification, but the medical lobby has successfully blocked those efforts. As a result, women need to do more of their own research to make sure they have a good midwife (probably a good thing in any case), and doctors can continue to criticize midwives as being untrained and unlicensed (a bad thing, I think).
posted by alms at 6:56 AM on September 21, 2007

Wow - way too many responses to read. So I'll tell you about my wife's experience with midwives.

She (we) had a midwife for both of our two children, both at home. First of all, midwives are government regulated here in Ontario, so there are a lot of standards about midwife behaviour. The midwife does her own assessment and if she discovers anything unusual, she'll send you to a ob/gyn right away. She's still your midwife, but the ob/gyn handles the tricky stuff. In some edge cases, the midwife may recommend a hospital birth (and that's always an option if you want it) so resources are closer at hand. The story we were told was that it didn't make much of a difference being in a hospital vs a home-birth, as they don't have surgery rooms standing by, so if there was a last minute complication, the ambulance ride wouldd take the same amount fo time as it would to prep a surgery room. Our midwives had a fair amount of gear with them, including ultrasound heart monitors and oxygen in case of problems.

So, aside from all that, my wife had two kids with two different midwives (we moved and they're allocated regionally) and both times went fine. The first birth was long (40 hours?) but that doesn't have much to do with anything. The second was alot quicker. No pain medication either time - if you want an epidural, you'll have to be in a hospital. My wife liked the privacy and comfort of being at home. It certainly was convienent for me to be able to have a nap and a few meals during the 40 hour labour. She liked being able to hang out in the shower indefinitely and to walk around half-dressed. With our second kid we also went for a walk around the block after contractions started - it was a very nice summer evening, so that was kind of neat. Go for a walk, come home, have a baby.

Both pregnancies were uneventful, so there were no issues for us having a midwife. We enjoyed the more hands-on care and the after-care as well. She breast fed both times and while it was fine in the end, it was challenging to start, especially for the first one. Having someone who knows what to do with breastfeeding helped a lot.

I don't really know what's different for US midwives. But if you have any more questions, my email is in my profile.
posted by GuyZero at 6:58 AM on September 21, 2007 [1 favorite]

alms:

"CNMs privately recommend home births, but they cannot attend home births because of professional liability issues."

The are "professional liability issues" because insurance companies, who only care about the bottom line, have actuarial data to show that homebirth is more dangerous than hospital birth and result in lawsuits and large payouts.

"the direct entry midwives I've known personally have gone through a years long apprenticeship program and have probably been at more births than most newly-minted OBGYNs."

As it happens, I am an obstetrician in Massachusetts and I am quite familiar with the training requirements for OBs , CNMs and DEMs. There are DEM programs that require attendance at only 25-40 deliveries before certification. I attended more deliveries in the first MONTH of my residency (which lasted years) than most DEMs do throughout their entire training.

Take a look at the training requirements for a direct entry midwifery school (which does not require a college degree) and compare them to the requirements of a CNM training program (which is a Master's level program). The requirements for DEM training are paltry by comparison. Indeed, there are no midwives in the industrialized world (Europe, Australia, etc) who have as little training as DEMs.

What is most important is that DEMs have literally no clinical experience in managing complications. The only reason that you need an attendant at all is to handle complications and they don't know how. They go out into practice without ever even seeing a neonatal resuscitation. let alone doing one. They go out into practice without ever managing a hemorrhage, an abruption, a shoulder dystocia or anything else.

We already have midwives (CNMs) with a long record of providing outstanding, safe care. There is simply no reason to have a second class of midwives with less training and less experience than anywhere else in the industrialized world.
posted by DrAmy at 8:07 AM on September 21, 2007 [1 favorite]

I'm 7 weeks along, and coming up on my first OB appointment next week. I found a doctor's office where I will see and interact with BOTH midwives and the obstetrician, and have the opportunity to work with both to develop the birth plan that makes me most comfortable. In picking out a doctor, I did not consider any doctor who would not permit both a doctor and a midwife to be involved to varying degrees according to my preference. I'm not educated enough about the different concerns yet to have made a decision on a number of issues, and will consult with both the OB and the midwife (and my Mother, and friends who have experienced childbirth), but I know this is a "charged" question. Why not try to get the best of both worlds?
posted by bunnycup at 8:40 AM on September 21, 2007

(We're in Italy, but I don't think that changes the gist much.)
We were of a similar frame of mind from the get-go. During an early visit to a hospital specialised in natural birth we met a wonderful, very experienced midwife. Sara participated for several months in group pool exercises with her. We ruled out homebirth because of excess distance to nearest hospital, then visited the chosen hospital beforehand in order to reach an agreement with the staff there that our midwife would be present and participant during the birth (luckily she was well-known enough that they were ok with that).
She was instrumental to the birth of our first child (and, a year and a half later, of our second) before, during and after, each time following through the birth and first month after in association with an equally wonderful colleague of hers. The bond that formed was fundamental, a source of great courage and inspiration; it also gave us the determination to see eye-to-eye with the medical staff, and to resist their predictably unnecessary intrusions as far as was possible.

If you find the right midwife for you (by no means an easy task) it can make an enormous difference in the entire experience.
posted by progosk at 8:41 AM on September 21, 2007

Having now read the previous comments: what thehmsbeagle said.
posted by progosk at 8:57 AM on September 21, 2007

I have friends who went with a midwife instead of an OB and had a great experience. As long as you don't end up in a high-risk category, you should be fine and have a positive experience.

I'm currently pregnant with spontaneous triplets, so unfortunately it wasn't an option for me. Boo.
posted by pyjammy at 12:31 PM on September 21, 2007

Also....congratulations! :)
posted by pyjammy at 12:34 PM on September 21, 2007

Hi Christine, and congrats on the new baby!

I hope you'll read this, since its ZOMG! a whole 24 hours since you posted your question; a bit over two years ago I was in the more-or-less the same place you are now; newly pregnant and trying to find the healthcare choice that was right for me.

What I want to stress to you in this answer is that it is really, really about finding the choice that is right for you and your baby, in your pregnancy. Many sources site that a "lack of satisfaction" with the whole birth experience as something that could be an indicator for Post-partum depression, so its really very important that you put yourself, your partner, and your baby into a healthcare situation that you are all comfortable with. Some women prefer a highly medicalized birth; some do not. Some women feel more comfortable "surrendering" (not my word) to the idea that someone else (a doctor, etc) is in control and guiding the process; some do not. No one can tell you what is the right choice for you.

For me, the best choice was a midwife-assisted birth at a freestanding birth center. I made this decision for many reasons, but the biggest deciding factors for me were that a) I wasn't sick, and saw no reason to give birth in a germy hospital full of sick people; and b) I had many friends who felt disempowered by their OB/GYNs (even female ones); often they said they felt like they had no say about anything that took place.

I was not low risk (38, obese) and although I had an easy pregnancy it was not without its ... challenges (diagnosis of borderline gestational diabetes; Strep positive; really severe edema towards the end). Also, I didn't get along at all with my primary midwife, but was fortunate that their "backup" midwife service was a good fit for me and actually ended up being the partnership that attended the birth.

Because of the issues with my pregnancy, I did see more traditional medical professionals from time-to-time (two ultrasounds, a few visits with a specialist for the possible GD, etc), and without fail I came away from those visits stressed out and feeling like there was no way I could have a healthy baby. My personal experience is that the OB/GYN in particular focused very hard on everything that could go wrong, and that issues that might only be a 1% chance were presented with the same weight as issues that would have a 40% chance, and with more weight than the fact that the odds were very strong that there would be no problems at all.

In short, the OB/GYN treated my entire pregnancy as an illness to be cured; the midwives treated it as a natural process to be monitored. Its a big difference in outlook.

I gave birth at Ballard House, which is a freestanding birth center here in Portland about one minute from a local hospital. (This is a birth center near you) I chose the birth center because it was the bright center line between a germy hospital (sorry, bias there) and a home birth. The atmosphere was very home-like (big tub for water birth, I have birth on an actual bed, living room available if we had chose to have family or friends there (which we did not)), but there was equipment readily available to handle most birth issues and I could be transported to the hospital at any time and be in ER within one minute and the Maternity Ward within 5 minutes.

When my son was born, my labor went very fast. I was able to labor in the tub (oh so wonderful), and there were only five people in the entire building - myself, my partner, the two midwives and the birth assistant. After my son was born, he was never away from myself or his father at any time - his dad even put him in the scale to weigh him. That really, for me, was the best part of our decision - that it was o intimate and relaxed, and that this tiny new person was never away from us for even a single second.

Don't feel like you have to choose the first provider you talk with. Interview them. Visit centers, when the time comes. Hospitals; birth centers; whatever is available. Read a lot, but try very hard not to get frightened. The birth industry in America fees on what might go wrong; on the worst cases; on the mistakes. Don't let anyone scare you. Just make the decision that you are most comfortable with, and don't be afraid to change your mind if you feel like the whole experience isn't something that is comfortable for you.

My email is in my profile. Drop me a line anytime.

Again, Congrats and Good Luck.
posted by anastasiav at 7:48 PM on September 21, 2007