Midwife -- How does it work?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Are you sure your friend did not recommend a doula? I think a midwife plus an OB would be pretty unusual.

My two cents is that, if you have a good OB and a good partner, you don't need a doula. If you have doubts about either, though, a doula might be helpful. If you do get a doula, do not be cheap about it; find one with tons of experience and excellent references.

Helpful, thank you! So, midwives and OBs are seen as either/or?

Yes, Either an OBGYN or a midwife delivers your baby. One or the other.

Since midwives cannot perform C-sections, if you need a C Section, you will be moved over to the care of the OBGYN, essentially.

I was in the care of midwives for my entire pregnancy. Even when it became clear I would need a c-section (breech) I continued to see them. While the actual procedure was performed by an OB, the midwife explained everything to me in the OR and held my hands during epidural before DH was allowed in. I had a very positive experience with this model of care and recommend it.

Are you in the DC area? which practice did you use?

[Anonymous]

I delivered with Loudoun Community Midwives in Landsdowne where you have the option of a separate wing in the hospital if you want a natural birth. You can also deliver in the regular L&D wing if you want or need anything intravenous or an epidural.

Re OB vs Midwife, an OB is a trained surgeon and a Midwife is trained in physiological birth. Many OBs also support physiological birth and many Midwives are certified nurses who practice inside a hospital and may play a supportive role in the birth if you need to transfer to an OB for a surgical birth.

My experience with midwives have been they offer a superior level of personal care during the pregnancy. Again, I'm sure there are OBs who take more time with their patients than the OBs I saw for a while during most of my first pregnancy.

[Anonymous]

Because I know this will come up, not all people who call themselves midwives are Certified Nurse Midwives.

A midwife who practices in a hospital in always a CNM--they are licensed RNs with additional graduate-level education specifically in midwifery and women's health.

Some birth center midwives are all CNMs. I believe all the Birthcare midwives are. The midwives at the center I used (not in DC, and sadly since shut down) only had CNMs.

Occasionally, CNMs, like the ones at Birthcare, will also do homebirths. Home births are where you will run into people calling themselves midwives when they have little to no education.

As an aside: is anyone else bothered that a medical professional, albeit outside of their specialty, doesn't understand the role of a midwife?

[Anonymous]

Anonymous wrote:Because I know this will come up, not all people who call themselves midwives are Certified Nurse Midwives.

A midwife who practices in a hospital in always a CNM--they are licensed RNs with additional graduate-level education specifically in midwifery and women's health.

Some birth center midwives are all CNMs. I believe all the Birthcare midwives are. The midwives at the center I used (not in DC, and sadly since shut down) only had CNMs.

Occasionally, CNMs, like the ones at Birthcare, will also do homebirths. Home births are where you will run into people calling themselves midwives when they have little to no education.

As an aside: is anyone else bothered that a medical professional, albeit outside of their specialty, doesn't understand the role of a midwife?

I.suspect OP misunderstood what her friend was trying to say. No offence, OP but it is confusing when you don't have a background. People get things Drs say twisted all the time.

And honestly- its not an either/or with MDs and midwives. My midwife consulted with the OB on my case. It's a team effort.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Also, to answer your other question, if you deliver in a hospital with a midwife practice, you will be able to have an epidural, just like with an OBGYN.

The midwife or the OBGYN doesn't administer the epidural, they will call in the anesthesiologist to do it.

Eh, not necessarily. Some midwife practices are very anti pain relief and will actively discourage and attempt to withhold it from you.

This isn't true at all. Stop fear mongering.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Also, to answer your other question, if you deliver in a hospital with a midwife practice, you will be able to have an epidural, just like with an OBGYN.

The midwife or the OBGYN doesn't administer the epidural, they will call in the anesthesiologist to do it.

Eh, not necessarily. Some midwife practices are very anti pain relief and will actively discourage and attempt to withhold it from you.

This isn't true at all. Stop fear mongering.

oh, come on. I was with GWU midwives. I had a very positive experience with them. But they are EXTREMELY upfront about the fact that delivering with them is a commitment to not using epidurals, which is what most people think of when you say "pain relief." Do some of their patients get epidurals because it is determined by the midwives that it is the best course of action for that particular patient? Yes. But they will try every other pain relief option first and remind you that you wanted a drug-free delivery before calling in the anesthesiologist.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Also, to answer your other question, if you deliver in a hospital with a midwife practice, you will be able to have an epidural, just like with an OBGYN.

The midwife or the OBGYN doesn't administer the epidural, they will call in the anesthesiologist to do it.

Eh, not necessarily. Some midwife practices are very anti pain relief and will actively discourage and attempt to withhold it from you.

This isn't true at all. Stop fear mongering.

This is entirely true of the GW midwives. They require you to be committed to natural birth (ie this means no pain relief) as a criteria for enrolling in their practice. And if you use homebirth midwives (which range from CNMs to CPMs to CMs—as there are several types of midwives with varying degrees of experience and training) cannot administer an epidural—only an anesthesiologist can do that. They also may not be able (legally) or willing (based on philosophy) to administer IV pain relief medications like fentanyl.

OBs have far more training that midwives. They are trained in physiologic birth like midwives are and can also fully handle all complications of labor and delivery—including operative vaginal delivery (forceps, vacuum) and perform C sections. Midwives cannot do any of these procedures. So if you deliver with a midwife and have complications you need to be in a collaborative care model so there is a plan to transfer care appropriately to an OB—but that means it is fully contingent on your midwife to make that call at the right time. Sometimes this works well, other times it does not, especially in cases when the laboring mother is at home and has to transfer to a hospital meaning precious time is lost.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Also, to answer your other question, if you deliver in a hospital with a midwife practice, you will be able to have an epidural, just like with an OBGYN.

The midwife or the OBGYN doesn't administer the epidural, they will call in the anesthesiologist to do it.

Eh, not necessarily. Some midwife practices are very anti pain relief and will actively discourage and attempt to withhold it from you.

This isn't true at all. Stop fear mongering.

This is entirely true of the GW midwives. They require you to be committed to natural birth (ie this means no pain relief) as a criteria for enrolling in their practice. And if you use homebirth midwives (which range from CNMs to CPMs to CMs—as there are several types of midwives with varying degrees of experience and training) cannot administer an epidural—only an anesthesiologist can do that. They also may not be able (legally) or willing (based on philosophy) to administer IV pain relief medications like fentanyl.

OBs have far more training that midwives. They are trained in physiologic birth like midwives are and can also fully handle all complications of labor and delivery—including operative vaginal delivery (forceps, vacuum) and perform C sections. Midwives cannot do any of these procedures. So if you deliver with a midwife and have complications you need to be in a collaborative care model so there is a plan to transfer care appropriately to an OB—but that means it is fully contingent on your midwife to make that call at the right time. Sometimes this works well, other times it does not, especially in cases when the laboring mother is at home and has to transfer to a hospital meaning precious time is lost.

In my experience, although they did require a commitment to "natural" birth, they were also the ones to recommend an epidural when I had been pushing for hours with little progress. Note, I am not promoting them--I actually had a pretty lousy experience with the GW midwives--but did want to offer a data point about their epidural practices.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Also, to answer your other question, if you deliver in a hospital with a midwife practice, you will be able to have an epidural, just like with an OBGYN.

The midwife or the OBGYN doesn't administer the epidural, they will call in the anesthesiologist to do it.

Eh, not necessarily. Some midwife practices are very anti pain relief and will actively discourage and attempt to withhold it from you.

This isn't true at all. Stop fear mongering.

This is entirely true of the GW midwives. They require you to be committed to natural birth (ie this means no pain relief) as a criteria for enrolling in their practice. And if you use homebirth midwives (which range from CNMs to CPMs to CMs—as there are several types of midwives with varying degrees of experience and training) cannot administer an epidural—only an anesthesiologist can do that. They also may not be able (legally) or willing (based on philosophy) to administer IV pain relief medications like fentanyl.

OBs have far more training that midwives. They are trained in physiologic birth like midwives are and can also fully handle all complications of labor and delivery—including operative vaginal delivery (forceps, vacuum) and perform C sections. Midwives cannot do any of these procedures. So if you deliver with a midwife and have complications you need to be in a collaborative care model so there is a plan to transfer care appropriately to an OB—but that means it is fully contingent on your midwife to make that call at the right time. Sometimes this works well, other times it does not, especially in cases when the laboring mother is at home and has to transfer to a hospital meaning precious time is lost.

In my experience, although they did require a commitment to "natural" birth, they were also the ones to recommend an epidural when I had been pushing for hours with little progress. Note, I am not promoting them--I actually had a pretty lousy experience with the GW midwives--but did want to offer a data point about their epidural practices.

DP here (also with a not-great experience with GW Midwives, coincidentally), and unless I'm misremembering my first meeting with them, they do perform both forceps and vacuum delivery. I remember I was like, "how is that a selling point? that sounds terrifying" and the MW told me it was less scary/dangerous than a C-section. I think the above PP might have more agenda than facts.

[Anonymous]

Anonymous wrote:I delivered with Loudoun Community Midwives in Landsdowne where you have the option of a separate wing in the hospital if you want a natural birth. You can also deliver in the regular L&D wing if you want or need anything intravenous or an epidural.

Re OB vs Midwife, an OB is a trained surgeon and a Midwife is trained in physiological birth. Many OBs also support physiological birth and many Midwives are certified nurses who practice inside a hospital and may play a supportive role in the birth if you need to transfer to an OB for a surgical birth.

My experience with midwives have been they offer a superior level of personal care during the pregnancy. Again, I'm sure there are OBs who take more time with their patients than the OBs I saw for a while during most of my first pregnancy.

Your definition of OB sounds biased, sorry.

Certified nurse midwives are registered nurses with a master’s degree (two year program) in midwifery.

OBs are physicians who have a bachelor’s degree, and then done four years of medical school and four years of residency for a total of 12 years of training. They have medical and surgical training and can perform surgery.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Also, to answer your other question, if you deliver in a hospital with a midwife practice, you will be able to have an epidural, just like with an OBGYN.

The midwife or the OBGYN doesn't administer the epidural, they will call in the anesthesiologist to do it.

Eh, not necessarily. Some midwife practices are very anti pain relief and will actively discourage and attempt to withhold it from you.

This isn't true at all. Stop fear mongering.

This is entirely true of the GW midwives. They require you to be committed to natural birth (ie this means no pain relief) as a criteria for enrolling in their practice. And if you use homebirth midwives (which range from CNMs to CPMs to CMs—as there are several types of midwives with varying degrees of experience and training) cannot administer an epidural—only an anesthesiologist can do that. They also may not be able (legally) or willing (based on philosophy) to administer IV pain relief medications like fentanyl.

OBs have far more training that midwives. They are trained in physiologic birth like midwives are and can also fully handle all complications of labor and delivery—including operative vaginal delivery (forceps, vacuum) and perform C sections. Midwives cannot do any of these procedures. So if you deliver with a midwife and have complications you need to be in a collaborative care model so there is a plan to transfer care appropriately to an OB—but that means it is fully contingent on your midwife to make that call at the right time. Sometimes this works well, other times it does not, especially in cases when the laboring mother is at home and has to transfer to a hospital meaning precious time is lost.

In my experience, although they did require a commitment to "natural" birth, they were also the ones to recommend an epidural when I had been pushing for hours with little progress. Note, I am not promoting them--I actually had a pretty lousy experience with the GW midwives--but did want to offer a data point about their epidural practices.

DP here (also with a not-great experience with GW Midwives, coincidentally), and unless I'm misremembering my first meeting with them, they do perform both forceps and vacuum delivery. I remember I was like, "how is that a selling point? that sounds terrifying" and the MW told me it was less scary/dangerous than a C-section. I think the above PP might have more agenda than facts.

I had a forceps delivery and would never say it was less dangerous or scary than a C section. It caused massive damage to me and injured my baby as well. I will have planned C sections for all future births and would not recommend forceps as being preferable. The injuries they cause are well known, which is why they are used in less than .5 percent of all birth in the US.

[Anonymous]

And also, the OBs do forceps and vacuum. Operative vaginal birth is NOT in a midwife’s scope of practice.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Also, to answer your other question, if you deliver in a hospital with a midwife practice, you will be able to have an epidural, just like with an OBGYN.

The midwife or the OBGYN doesn't administer the epidural, they will call in the anesthesiologist to do it.

Eh, not necessarily. Some midwife practices are very anti pain relief and will actively discourage and attempt to withhold it from you.

This isn't true at all. Stop fear mongering.

This is entirely true of the GW midwives. They require you to be committed to natural birth (ie this means no pain relief) as a criteria for enrolling in their practice. And if you use homebirth midwives (which range from CNMs to CPMs to CMs—as there are several types of midwives with varying degrees of experience and training) cannot administer an epidural—only an anesthesiologist can do that. They also may not be able (legally) or willing (based on philosophy) to administer IV pain relief medications like fentanyl.

OBs have far more training that midwives. They are trained in physiologic birth like midwives are and can also fully handle all complications of labor and delivery—including operative vaginal delivery (forceps, vacuum) and perform C sections. Midwives cannot do any of these procedures. So if you deliver with a midwife and have complications you need to be in a collaborative care model so there is a plan to transfer care appropriately to an OB—but that means it is fully contingent on your midwife to make that call at the right time. Sometimes this works well, other times it does not, especially in cases when the laboring mother is at home and has to transfer to a hospital meaning precious time is lost.

In my experience, although they did require a commitment to "natural" birth, they were also the ones to recommend an epidural when I had been pushing for hours with little progress. Note, I am not promoting them--I actually had a pretty lousy experience with the GW midwives--but did want to offer a data point about their epidural practices.

DP here (also with a not-great experience with GW Midwives, coincidentally), and unless I'm misremembering my first meeting with them, they do perform both forceps and vacuum delivery. I remember I was like, "how is that a selling point? that sounds terrifying" and the MW told me it was less scary/dangerous than a C-section. I think the above PP might have more agenda than facts.

I had a forceps delivery and would never say it was less dangerous or scary than a C section. It caused massive damage to me and injured my baby as well. I will have planned C sections for all future births and would not recommend forceps as being preferable. The injuries they cause are well known, which is why they are used in less than .5 percent of all birth in the US.

Sure. I think they're scary too. I'm just addressing the PP's statement that CNM's cannot perform assisted vaginal deliveries. I don't think that's correct.

[Anonymous]

I’m the PP who had an assisted vaginal delivery and I have extensive knowledge of midwifery. Midwives cannot perform vacuum deliveries or forceps deliveries. It is outside their legal scope of practice. Only obstetricians can legally do them. At GW if you need an operative vaginal delivery (forceps or vacuum) it will be done by an obstetrician. The midwives do not do it.

[Anonymous]

Anonymous wrote:I delivered with Loudoun Community Midwives in Landsdowne where you have the option of a separate wing in the hospital if you want a natural birth. You can also deliver in the regular L&D wing if you want or need anything intravenous or an epidural.

Re OB vs Midwife, an OB is a trained surgeon and a Midwife is trained in physiological birth. Many OBs also support physiological birth and many Midwives are certified nurses who practice inside a hospital and may play a supportive role in the birth if you need to transfer to an OB for a surgical birth.

My experience with midwives have been they offer a superior level of personal care during the pregnancy. Again, I'm sure there are OBs who take more time with their patients than the OBs I saw for a while during most of my first pregnancy.

NP who also delivered with Loudoun Community Midwives. I, too, had a great experience with them. I got an epidural with absolutely zero pushback from the midwife. I delivered with them several years ago, and I just wanted to clarify from PP's post that I don't believe they are delivering at Inova Loudoun anymore. I was informed that all deliveries are now handled at Stone Springs instead.

It is my understanding that, of all of the CNM practices in the area, GW is the only one who seems very strongly opposed to epidurals.