Decision OB vs Midwife

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nodito

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This is not a huge deal and I’m not super stressed about it. It’s just what’s currently on my mind and I feel like I could use a sounding board.

This summer my husband and I are moving our family (3 young kids) to a small town about a 40 minutes from here. I am pregnant and currently see a midwife in town. I chose the midwife because in my first pregnancy my OB pushed induction for what I now feel were dubious reasons and the doctor who eventually delivered the baby also intervened in ways that I did not like and do not think were necessary. After choosing my midwife, I was able to have two natural, minimal intervention deliveries, both at 42 weeks. Basically, I like the philosophy that pregnancy and birth are normal and that we don’t need to do anything medical unless there’s clear indication of a problem.

New small town doesn’t have any midwives. The nearest midwives are more than a half hour away, a distance made more difficult by the fact that I have three young kids at home. For each of my appointments, I will need to find childcare in this new town and I think my youngest daughter in particular will have a difficult time with me leaving (she’s clingy and can manage tolerably well with dad on occasion, but that’s seems to be her limit). There is an OB/GYN practice about ten minutes away and the doctors get good reviews, but I hesitate because in my mind, OB = high intervention, which I really did not like about my first pregnancy and delivery.

So I’d like to ask for your prayers for my discernment as well as any friendly, non-judgmental perspective you can offer. Thank you!
 
I like close, convenient medical people.

If it’s hard to get to your midwife, you won’t go, even when you should. (For example, my primary care doctor is a little bit out of my way, and I almost never see him, even though he is really good.)

If you’ve had three unproblematic deliveries already, your OB for your 4th delivery is going to have a lot more confidence in you than your first OB did.

Best wishes!
 
My general philosophy is like yours and I say the OB is worth checking out. If the practice is horrible or just not what you want, then you know you have another option.

One thing I’ve noticed as I have more kids is that I either get more cred with doctors or it’s just harder to push me around, so they don’t. No more “deer in headlights” or, as my husband puts it, “confused customer face” that screams for advice.
 
Is there any option to have a compromise? Maybe an OB that would work in conjunction with a midwife? The only reason I ask because call me paranoid but if something goes wrong in the hospital, they have the equipment and support to use interventional methods if needed. A home birth with a midwife does not necessarily have those resources. Now maybe a good compromise as well would be to talk with your PCP and see them regularly and they can assess your risk and other factors to determine if a there are any concerns (like breech birth, placenta previa, etc).
 
Hi. Before you commit to the OB/GYN’s in your new town, schedule an appointment and interview them. Ask them about their methods; i.e. – do they induce? are they willing to wait if the baby is a little overdue? are they very hands on? Explain your previous experiences with both Dr. and midwives and tell them what type of care you want. Also though, be sure to include that if things should head south, then you’ll bow to their expertise, but if things are progressing normally, then you would like as little interference with the birth process as possible. They will probably work with you. Good luck!
 
Some of you ladies are going to hate hearing this, but I have to mention some things.
  1. It’s not clear that induction does lead to more c-sections:
fitpregnancy.com/pregnancy/labor-delivery/induction-does-not-increase-c-section-risk

“It was long thought that getting induced increased your chances of a C-section delivery, but a new study finds no connection.”

“Berghella has recently authored a new study published in the American Journal of Obstetrics & Gynecology that looked closely at 844 women across five randomized controlled trials. Surprisingly, to us at least, his team found no connection whatsoever between induction and C-sections, specifically in births of single, full-term babies to mothers with uncomplicated pregnancies. This was the case for both failed and successful inductions.”

“For women who were induced at 39 weeks, there was no greater risk of having a C-section than in those induced past 40 weeks. In fact, the inductions that occurred in the earlier week were found to involve less blood loss than a non-induced birth (although the amount was minimal at 50ml) and a lower incidence of meconium staining (in which the baby’s fecal matter is excreted into the amniotic sac, increasing chances of infection and newborn aspiration). That being said, the average weight at birth was 5 ounces lower in induction babies.”
  1. The currently popular 39 week rule for elective deliveries is associated with an uptick in stillbirth rates:
medscape.com/viewarticle/858461

“ATLANTA — Implementation of “the 39-week rule” — which mandates that the elective delivery of babies not occur before a gestational age of 39 weeks without appropriate indication — could be increasing the number of term stillbirths, new research shows.
Investigators found that the proportion of term stillbirths rose from 1.103 per 1000 deliveries before the rule was adopted to 1.177 per 1000 after.”
  1. Have a look at Fig. 1 here:
bmj.com/content/334/7598/833

In that chart, fetal mortality rates fall throughout pregnancy every week up until somewhere between 40 and 41 weeks, when they suddenly rebound, forming a U.

Going post-term is dangerous for the unborn baby, which is why OBs are so keen to avoid doing it.
 
The Ob/GYN doctors I had for my youngest two were great. I said I wanted to come straight home with my third, they fought with the hospital for that 🙂 (I recover very quickly.)

Doctors vary a lot: talk with them and maybe contact the La Leche League near you and talk with them about the practice.

Babies can come very quickly, my first took forever, my second only a couple of hours. Also Midwives where Inused to live are only allowed to deliver within a certain distance from the hospital, so they may not be able to take you as a patient anyway.

Look into all aspects before deciding.

Oh, and btw, Congratulations!!!
 
pensmama87 said:
My general philosophy is like yours and I say the OB is worth checking out. If the practice is horrible or just not what you want, then you know you have another option.

One thing I’ve noticed as I have more kids is that I either get more cred with doctors or it’s just harder to push me around, so they don’t. No more “deer in headlights” or, as my husband puts it, “confused customer face” that screams for advice.
Click to expand...
👍 That applies to many situations with doctors, believe me! Well done!
 
at9009 said:
Is there any option to have a compromise? Maybe an OB that would work in conjunction with a midwife? The only reason I ask because call me paranoid but if something goes wrong in the hospital, they have the equipment and support to use interventional methods if needed. A home birth with a midwife does not necessarily have those resources. Now maybe a good compromise as well would be to talk with your PCP and see them regularly and they can assess your risk and other factors to determine if a there are any concerns (like breech birth, placenta previa, etc).
Click to expand...
St Francis:
Also Midwives where I used to live are only allowed to deliver within a certain distance from the hospital, so they may not be able to take you as a patient anyway.
Click to expand...
I should have specified that I don’t want a home birth. I’m planning to deliver in a hospital or birth center regardless. My current midwife delivers at a hospital. If I traveled to the midwives outside my new area it would be to a practice of midwives who also deliver at a large hospital. So the option is between close OBs who deliver at a big teaching hospital or farther midwives who deliver at the same hospital.
 
nodito said:
I should have specified that I don’t want a home birth. I’m planning to deliver in a hospital or birth center regardless. My current midwife delivers at a hospital. If I traveled to the midwives outside my new area it would be to a practice of midwives who also deliver at a large hospital. So the option is between close OBs who deliver at a big teaching hospital or farther midwives who deliver at the same hospital.
Click to expand...
Although, the big advantage to using a home birth midwife if I did decide to go that route would be that they come to you for prenatal appointments!
 
Xantippe said:
Some of you ladies are going to hate hearing this, but I have to mention some things.
  1. It’s not clear that induction does lead to more c-sections:
fitpregnancy.com/pregnancy/labor-delivery/induction-does-not-increase-c-section-risk

“It was long thought that getting induced increased your chances of a C-section delivery, but a new study finds no connection.”

“Berghella has recently authored a new study published in the American Journal of Obstetrics & Gynecology that looked closely at 844 women across five randomized controlled trials. Surprisingly, to us at least, his team found no connection whatsoever between induction and C-sections, specifically in births of single, full-term babies to mothers with uncomplicated pregnancies. This was the case for both failed and successful inductions.”

“For women who were induced at 39 weeks, there was no greater risk of having a C-section than in those induced past 40 weeks. In fact, the inductions that occurred in the earlier week were found to involve less blood loss than a non-induced birth (although the amount was minimal at 50ml) and a lower incidence of meconium staining (in which the baby’s fecal matter is excreted into the amniotic sac, increasing chances of infection and newborn aspiration). That being said, the average weight at birth was 5 ounces lower in induction babies.”
  1. The currently popular 39 week rule for elective deliveries is associated with an uptick in stillbirth rates:
medscape.com/viewarticle/858461

“ATLANTA — Implementation of “the 39-week rule” — which mandates that the elective delivery of babies not occur before a gestational age of 39 weeks without appropriate indication — could be increasing the number of term stillbirths, new research shows.
Investigators found that the proportion of term stillbirths rose from 1.103 per 1000 deliveries before the rule was adopted to 1.177 per 1000 after.”
  1. Have a look at Fig. 1 here:
bmj.com/content/334/7598/833

In that chart, fetal mortality rates fall throughout pregnancy every week up until somewhere between 40 and 41 weeks, when they suddenly rebound, forming a U.

Going post-term is dangerous for the unborn baby, which is why OBs are so keen to avoid doing it.
Click to expand...
Yes! Very true. OP, I agree with others that it would be a good idea to schedule a chat with the local OBGYNs and see what their philosophy is.
 
Can/does your current midwife travel? Most have a legal limit on practice and travel, i.e. 90 mile radius, so 40 minutes seems doable if she is willing to travel.
 
macstar said:
Can/does your current midwife travel? Most have a legal limit on practice and travel, i.e. 90 mile radius, so 40 minutes seems doable if she is willing to travel.
Click to expand...
No, she’s a cnm. In my state they are associated with a medical practice and have an office and privileges at a particular hospital. They don’t travel or do home births.
 
If I were in your situation, if I could find suitable childcare I would probably stick with the midwife you know and love. We moved toward the end of my pregnancy, and so I was traveling 30-40 minutes to the OB office quite often. At the time, I was working full time but did not have other children, so it worked okay. Is there any way to find childcare for the oldest two and bring your youngest with you? Or maybe even find someone who would be willing to come with you to the appointments and keep the kids busy in the waiting room or somewhere close by? Would your husband be able to stay with them sometimes?

I had some bad experiences at the end of my pregnancy and during delivery that involved a doctor who was in the group practice but not my regular OB. (My doctor was great.) So, even if you find one you like, there’s no guarantee that another who you don’t like so much will not be involved in your prenatal care or the delivery if he or she is on call. If we are fortunate enough to have another, that is what worries me. The situation was so bad that I would very strongly consider one of the CNMs associated with the practice, even though I do love my OB.

There is also the possibility that all the OBs associated with the practice you are considering are lovely and would respect your wishes. It’s probably worth making an appointment to see how you feel about the place and maybe voicing your concerns to see what they say.
 
I have an older OB and she is definitely not high intervention. So I would say, interview the OB to see what their philosophy is on that front and make a decision from there.
 
With baby #1, I was seeing midwives in a group practice. Whoever was on call the day of delivery was who you got at the hospital. The midwives were brand new to the hospital, and the nursing staff had no clue what to do with a nature birth mom in labor. I got my least favorite midwife, and as a first time mom, I didn’t stand up for myself the way I would now. Some things happened that didn’t need to. Bad enough experience that with #2, I switched to a new midwife practice associated with a hospital 30 minutes away, all freeway.

This new hospital had been working with midwives for years and the nursing staff were totally used to natural birthers. I went on to have baby #3 there as well. I took the children with me to most appointments and made a day out of it by going to the zoo after an early morning appointment. If it was a more involved appointment, I arranged childcare or had dh stay home with the children.

On to baby #4, midwives finally started working with a hospital only 15 minutes away so I decided to try out a third hospital. Being #4 I was worried baby would make a quick appearance, so maybe a shorter drive would be better. The midwives had really worked with this hospital to teach the nurses about natural delivery, and I was treated with such respect. I actually had baby the one day the midwives were not on call, and had an OB from their practice. This doctor was used to working with the midwives and I had no pressure to do anything. It was I who suggested we break the water as I didn’t want this to drag on all night.

I think you are right, being an experienced mom gives you a lot more cred in the delivery room and more confidence in speaking up for yourself. 30 minutes doesn’t sound like very far, but where we live, it just takes time to get places. Is there anything near the midwives where you could run an errand, shop for something not in your small town, make the travel worth it? Also, as midwives already work at the hospital you would use either way, can you see OBs and then request a midwife at delivery, when you arrive at hospital? A friend of mine did this and had a great experience. If you alert the nursing staff of your perspective, you could end up with a great nurse, and in my experience, that is what really makes the difference on delivery day.
 
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