Early Opinions Wanted: OB vs Midwife

[MissMusic]

I know its super early, but I'm switching practices so I need your input.

LSS, I'm switching to an office that has both MWs and OBs, but I need to choose which care I would like to receive.

I'm having trouble deciding because I like the MW idea for unmedicated births, support, and avoidance of c-section. The hospital here has the highest c-section rate in the nation I believe, and that scares the shit out of me. I've heard a LOT of bad things about it being a baby factory, with people laboring in the halls because there's not enough rooms. So NO THANKS. The new office works with a different hospital.

OBs might be best because:
-I will be 35 any day now, which puts me at a higher risk
-I had a c-section previously
-I'm worried about emergency situations
-I'm not considering a home or water birth
-MWs can't perform emergency services like c-sections

MWs might be best because:
-I'm not a number or "another preggly lady"
-someone to advocate for me
-they make their best efforts to avoid c-sections
-they aren't going to push pain meds or other meds on me
-an OB will be on call in case they are needed

If you had the choice, which would/did you choose, and why?

[doodler]

Are there any other local moms that you can network with to find out more about the practice?

For example there are OB practices around here that are totally VBAC friendly and those that have the reputation for being anti-VBAC.

[doublehammock]

I'm going to a smaller practice this time around because I don't want the factory feel.

However, I'm high risk, so I'm not comfortable forgoing an OB's care because there are some interventions I'm ok with.

If I was low risk I would be pushing for a MW at a birth center.

[steveo]

MissMusic I assume you are aiming for a VBAC this time? If yes, I gotta say I would stick with an OB. The risks are small, but if they happen they are devastating. Can the MWs even be responsible for your care if you're VBACing?

Also, any practice that has both MWs and OBs is going to be way different than what you experienced (that's my guess, at least). There are many OBs supportive of unmedicated births, VBACs etc., you name it. Don't think that just because they are an MD instead of an MW they won't respect you and your preferences (I have an OB that is a perfect example of that -- they are out there!).

Also @ismellbooks being "very firmly anti-epidural" so early in this game did make me chuckle. I used to be "firm" about so many things...then real life happened. Definitely feel strong in your choices, but also don't discount changing your mind (this is coming from someone with an unmedicated vaginal birth that resulted in a brutal 6 week long and painful recovery, and an emergency c-section from which I bounced back in a matter of a couple of days). Nothing is black and white, no matter what Ricki Lake tells us...

[steveo]

Aug 10, 2015 14:31:50 GMT -5 @ismellbooks said:

Aug 10, 2015 14:29:16 GMT -5 steveo said:

Also @ismellbooks being "very firmly anti-epidural" so early in this game did make me chuckle. I used to be "firm" about so many things...then real life happened. Definitely feel strong in your choices, but also don't discount changing your mind (this is coming from someone with an unmedicated vaginal birth that resulted in a brutal 6 week long and painful recovery, and an emergency c-section from which I bounced back in a matter of a couple of days). Nothing is black and white, no matter what Ricki Lake tells us...

Oh sure. A lot could change between now and April, but I'm pretty bullheaded, and when I get my mind around something, I tend to stick with it. Only time will tell.

I do too. That's why & how I went unmedicated the first time. But just to be clear: it was totally a mind over matter thing for me, I never actually thought an epi was particularly bad for me or baby.

My recovery really still gives me the shivers. Shit popping out of stitches, silver nitrate to close things back up, barely walking at 5 weeks, it was so painful.

Also, FTR, my milk supply was fine for both kids, but actually better with DS2 than DS1. So now I'm thinking maybe I'll try for VBAC with epi this time just to test every kind of delivery method possible. Better birthing through (anecdotal) science ...

[MissMusic]

Aug 10, 2015 14:29:16 GMT -5 steveo said:

MissMusic I assume you are aiming for a VBAC this time? If yes, I gotta say I would stick with an OB. The risks are small, but if they happen they are devastating. Can the MWs even be responsible for your care if you're VBACing?

Definitely feel strong in your choices, but also don't discount changing your mind

1) Yes I'm aiming for VBAC, sorry if that was unclear.
2) I'm flexible.  I'm going to do whatever I can to have a VBAC, but if there's an issue or a danger I am ok with a repeat section.  I'm also fine with laboring as long as possible and asking for meds if I need it.  No shame in that.  If I can go all the way, great.  If not, thats fine.  I'm going to go with the flow because I feel like if I'm too stuck in a birth plan, I will be stressed out if it changes--which it probably will, in some way.

[MissMusic]

Aug 10, 2015 13:59:46 GMT -5 doodler said:

Are there any other local moms that you can network with to find out more about the practice?

For example there are OB practices around here that are totally VBAC friendly and those that have the reputation for being anti-VBAC.

There was a post a few months ago on the local Mom's Club FB page, and I bookmarked it.  The practice I'm switching to came very, very highly recommended--more than half of the 17 replies said they were great.  I can ask them about midwife vs OB once I'm ready to spill the beans.

The practice I'm switching to is very VBAC supportive while my last one was "eh, we don't like it but you can try".  They also deliver at the Baby Factory hospital which I've had several people tell me tried to push pitocin on them when they weren't progressing fast enough, even though they were actually doing fine.  They just want you out of there to make room for the next person, so I'm afraid that if I stay with a practice thats "meh" about VBAC, I'll end up with a section anyway because of the hospital.  Switching practices and hospitals would remedy this.

[ciaobaby]

Every pregnancy and delivery is different, but I tend to lean towards an OB. Just like steveo, my OB is very open and supportive of birth plans. She asked me what my initial plans were so she could be prepared and supportive of my wishes. I ended up having a c-section due to a face presentation position. DS came out looking like Rocky because he'd been pressed up against my pelvic bone all day; the nurses and MW all said thought that they were feeling his ear during internal checks, when in actuality it was his nose. Sometimes you can still deliver vaginally when the baby is in this position, but based on the way his chin was positioned it could have been bad news if I had tried pushing. Luckily when my OB got there, she was able to immediately assess what was truly going on. We hadn't planned on the c-section, but I am glad that my OB was able to quickly and accurately identify the issue so both DS and I stayed safe. Are you able to meet with the OB and talk over your concerns and hopes for this pregnancy/delivery? Luckily it sounds like you will be at a better hospital whether you decide on a MW or OB since the office doesn't work with the 'baby factory'!

[doublehammock]

ICAN is a great resource for those wanting to vBAC. I would look to see if you have a local chapter of FB page.

[PiradicalMaid]

MWs definitely attend VBACs and usually have higher success rates.

From everything you've said, if I were you, I would go with a MW. Now, I see MWs normally anyway (and we're planning to deliver out of hospital), so am in some ways biased towards them, but it sounds like you want a lower intervention experience and more personalized care, and I think you'd be most likely to get that with a MW. I see a MW at a practice that also has OBs, which is great, because they can consult with the OBs if need be, but I can still meet with them. In fact, I had to go in today for some issues I'm having with progesterone supplements, and the MW managed my appointment and took a minute to run something by the OB, but the MW and I came up with a treatment plan together. Like was brought up before, MWs can always send you to an OB if you have something going on that's out of their scope. I've even seen that mid-birth at a hospital and it was totally seemless.

@ismellbooks, there is nothing wrong with not want an epi I didn't want one last time and did fine without it. I'm not planning on having one this time, either. I am fine with needles, but don't do well with pain meds. They make me so sick. Of course it's good to have some flexibility, but it is also ok to know your body and know if an epi isn't the best choice for you!

[Deleted]

My practice with DD had 4 OBs and 1 MW. I just went with whoever happened to be on call, which was the one doctor I hadn't met prior to giving birth!

Everyone in the room really encouraged me that I could... and would be delivering DD without a c-section, even when I was all "I can't do this!" No one pressured me for an epidural, they just told me that if I want one I had to let them know so they could get me on this list. I sort of thought I'd try to do unmedicated but I was shaking so badly, in so much pain and I couldn't get control of my breathing. Things moved quickly with DD, that I'm not sure I could have had her vaginally without an epi.

I wouldn't necessarily pick a MW because you assume the OBs won't be as good. Can you meet with some of the people working in the office prior to picking? I think I could have requested a specific doctor if I'd wanted to after I'd met with them but I just didn't really care who was there to catch DD.

[jags8]

I wish I could have a midwife but there are none where I go. In my whole city there is only one. So dumb.

[MissMusic]

Great input, lots to think about. I'm really only asking now because I need to schedule appointments in advance up to 16w so I can plan my work, etc. I can't do that until I pick which care I'll be getting.

Love the stories, love the insight. Thank you!

[wilburbud]

My practice consists of midwives and ob's- and I love that. My midwives handle my care from start to finish. The only time an MD Gets involved is if things turn high risk- and then they see me WITH a midwife