Trying to understand the midwife route

[Anonymous]

Anonymous wrote:

Anonymous wrote:But what is the difference between the care from the midwives and the care from the OBs? Except for the handing off in case of complications?

At GW? For someone who is low risk, very little. Midwife patients can deliver in the tub, OB patients cannot. GW midwives want you to go without an epidural and will encourage you to go without unless they feel like you need it (stalled labor, long labor, exhausted mom, induction, etc.), while OBs don't care if and when you get one. But otherwise, very similar. GW OBs see a lot of unmedicated births.

The difference between, say, midwives at Birthcare and OBs at the big private practices? Worlds apart.

But what? Besides the tub thing and the not wanting you to have an epidural?

[Anonymous]

Anonymous wrote:March of Dimes supports midwifery care for low risk pregnant women and shares that in the US low risk women are less likely to have a c-section than the same risk group of women working with an OB. Of course, midwives are individuals just like OBs so there will be varying levels of care between both.

The midwifery model of care promotes birth as a normal physiologic occurrence and are able to manage typical complications of pregnancy and labor. OB model of care starts with the idea that birth is inherently risky and needs to be managed.

You can have a wonderful birth with either, but if you have an opinion about how you want it to go, you may be better served by one or the other. You can have an epidural with either at GW.

https://www.marchofdimes.org/materials/Final%20midwifery%20position%20statement%20August%2029%202019.pdf

I don't understand this at all. The OBs seem to find my pregnancy very normal. What would this mean in terms of actual differences in care?

[Anonymous]

Ok - then don’t get a midwife - no one is forcing you.

[Anonymous]

Anonymous wrote:You’ll be transferred from care: a midwife cannot perform an epidural, forceps, vacuum, or C-section delivery. Though they will likely still involved, the team of OBs will theoretically get involved and be in charge.

OBs don’t perform epidurals either—in both cases the anesthesiologist comes in. Hospital midwives don’t transfer you to OB care just because you get an epidural.

I went with the midwives at WHC because they have no male staff and don’t perform
unnecessary cervix checks. I know there might be men when it comes to actually going to the hospital. As a sexual assault survivor I am really uncomfortable with men touching me. I know male doctors can be great and aren’t rapists but I still don’t want them in my ladyparts if I can avoid it. Also I like the idea of being able to labor in any position I find comfortable, not being rushed to induce or c-section, etc. I’ve met most of the midwives now and feel comfortable with all of them. I really feel listened to. My first few appointments were close to an hour long—I’ve never had a doctor spend so much time talking with me.

[Anonymous]

I had a fabulous experience delivering with the Midwives of Medstar (WHC). And everything was not smooth. And I would never, ever give birth without a midwife in the future. They were absolutely fabulous. I guarantee I would have ended up with a c-section if I had an OB, but I had a trauma-free vaginal birth. Also - whoever said midwives transfer you out if you need an epidural is incorrect - anesthesiologists place epidurals, whether you’re with an OB or a midwife (I had an epidural and never saw an OB).

Longer version of this story:

I originally assumed I’d use my OB/GYN who had been my gyno for years and years. I went in with my husband for pre-conception counseling, and we were so disappointed in that 10 minute meeting, that we started looking into midwives. Bottom line - OBs are doctors. In order to bill enough to stay afloat, their appointments are SHORT. 10 mins. That’s what you get. In our preconception counseling, I was told to stop drinking immediately (I was not pregnant). When I tried to ask why, or discuss more of the dangers, she just kept repeating “it’s not safe to drink.” On other issues too, we had the same problem. Our concern wasn’t the advice (not drinking when you’re trying to get pregnant is perfectly reasonable), but that basically, once you got past her advice, that was the end of the line. There is no discussion or back and forth - there just isn’t time. We felt so rushed.

So, we started looking into midwives. The issue for me was, while I really wanted a vaginal birth if at all possible, I knew I would want an epidural. I had zero interest in a natural birth, but I wanted personal attention. I also wanted to give birth in a hospital, where there’s an OR right down the hall if it comes to that. The Midwives of Medstar at WHC fit the bill. They knew right from jump I was wanted the epidural, and they were totally fine with it. From the first “meet the midwives” meeting we went to, we loved them. They all just have an incredibly soothing presence.

My prenatal appointments were an average of probably 45 mins to an hour. It was my first baby, and my husband and I had a million questions. We showed up with a list every time. We NEVER felt rushed. We always felt listened to. It felt like such a collaborative, healthy, empowering experience.

Then I developed gestational hypertension at 38 weeks. I ended up need an induction. The induction and labor took, no exaggeration, 60 hours. That’s two and a half DAYS. The midwives switch shifts every 12 hours, so I saw five shifts, three different midwives, in the hospital. They were incredible. Supportive. Empowering. Knowledgeable. Understanding. It really felt like a team effort to get this baby out. There isn’t an OB on the planet who will let your induction go that long. But the midwives let me go on. They sat with me while I cried. They discussed options, for long periods of time. They answered my endless questions. They made it clear - if you want a c-section, say the word, you can have one. They kept a careful eye on my stats, and were very open about what signs would mean that was the recommended path, but I never hit those. They gave great advice on when to get the epidural. And my little one came vaginally, eventually. Despite some real low lows, I wouldn’t change a thing, and I absolutely couldn’t have done it without them.

[Anonymous]

Anonymous wrote:

Anonymous wrote:You’ll be transferred from care: a midwife cannot perform an epidural, forceps, vacuum, or C-section delivery. Though they will likely still involved, the team of OBs will theoretically get involved and be in charge.

OBs don’t perform epidurals either—in both cases the anesthesiologist comes in. Hospital midwives don’t transfer you to OB care just because you get an epidural.

I went with the midwives at WHC because they have no male staff and don’t perform
unnecessary cervix checks. I know there might be men when it comes to actually going to the hospital. As a sexual assault survivor I am really uncomfortable with men touching me. I know male doctors can be great and aren’t rapists but I still don’t want them in my ladyparts if I can avoid it. Also I like the idea of being able to labor in any position I find comfortable, not being rushed to induce or c-section, etc. I’ve met most of the midwives now and feel comfortable with all of them. I really feel listened to. My first few appointments were close to an hour long—I’ve never had a doctor spend so much time talking with me.

This is a great answer that makes a lot of sense.

[Anonymous]

Anonymous wrote:I had a fabulous experience delivering with the Midwives of Medstar (WHC). And everything was not smooth. And I would never, ever give birth without a midwife in the future. They were absolutely fabulous. I guarantee I would have ended up with a c-section if I had an OB, but I had a trauma-free vaginal birth. Also - whoever said midwives transfer you out if you need an epidural is incorrect - anesthesiologists place epidurals, whether you’re with an OB or a midwife (I had an epidural and never saw an OB).

Longer version of this story:

I originally assumed I’d use my OB/GYN who had been my gyno for years and years. I went in with my husband for pre-conception counseling, and we were so disappointed in that 10 minute meeting, that we started looking into midwives. Bottom line - OBs are doctors. In order to bill enough to stay afloat, their appointments are SHORT. 10 mins. That’s what you get. In our preconception counseling, I was told to stop drinking immediately (I was not pregnant). When I tried to ask why, or discuss more of the dangers, she just kept repeating “it’s not safe to drink.” On other issues too, we had the same problem. Our concern wasn’t the advice (not drinking when you’re trying to get pregnant is perfectly reasonable), but that basically, once you got past her advice, that was the end of the line. There is no discussion or back and forth - there just isn’t time. We felt so rushed.

So, we started looking into midwives. The issue for me was, while I really wanted a vaginal birth if at all possible, I knew I would want an epidural. I had zero interest in a natural birth, but I wanted personal attention. I also wanted to give birth in a hospital, where there’s an OR right down the hall if it comes to that. The Midwives of Medstar at WHC fit the bill. They knew right from jump I was wanted the epidural, and they were totally fine with it. From the first “meet the midwives” meeting we went to, we loved them. They all just have an incredibly soothing presence.

My prenatal appointments were an average of probably 45 mins to an hour. It was my first baby, and my husband and I had a million questions. We showed up with a list every time. We NEVER felt rushed. We always felt listened to. It felt like such a collaborative, healthy, empowering experience.

Then I developed gestational hypertension at 38 weeks. I ended up need an induction. The induction and labor took, no exaggeration, 60 hours. That’s two and a half DAYS. The midwives switch shifts every 12 hours, so I saw five shifts, three different midwives, in the hospital. They were incredible. Supportive. Empowering. Knowledgeable. Understanding. It really felt like a team effort to get this baby out. There isn’t an OB on the planet who will let your induction go that long. But the midwives let me go on. They sat with me while I cried. They discussed options, for long periods of time. They answered my endless questions. They made it clear - if you want a c-section, say the word, you can have one. They kept a careful eye on my stats, and were very open about what signs would mean that was the recommended path, but I never hit those. They gave great advice on when to get the epidural. And my little one came vaginally, eventually. Despite some real low lows, I wouldn’t change a thing, and I absolutely couldn’t have done it without them.

It sounds like you got awesome care.

I do feel compelled to defend the WHC OBs on the appointment length front - all of my appointments have been lengthy (I’m not sure exactly how long) and they have always answered all of my questions in a caring and not at all rushed way. I’m not saying the midwives aren’t great, I’m sure they are.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I had a fabulous experience delivering with the Midwives of Medstar (WHC). And everything was not smooth. And I would never, ever give birth without a midwife in the future. They were absolutely fabulous. I guarantee I would have ended up with a c-section if I had an OB, but I had a trauma-free vaginal birth. Also - whoever said midwives transfer you out if you need an epidural is incorrect - anesthesiologists place epidurals, whether you’re with an OB or a midwife (I had an epidural and never saw an OB).

Longer version of this story:

I originally assumed I’d use my OB/GYN who had been my gyno for years and years. I went in with my husband for pre-conception counseling, and we were so disappointed in that 10 minute meeting, that we started looking into midwives. Bottom line - OBs are doctors. In order to bill enough to stay afloat, their appointments are SHORT. 10 mins. That’s what you get. In our preconception counseling, I was told to stop drinking immediately (I was not pregnant). When I tried to ask why, or discuss more of the dangers, she just kept repeating “it’s not safe to drink.” On other issues too, we had the same problem. Our concern wasn’t the advice (not drinking when you’re trying to get pregnant is perfectly reasonable), but that basically, once you got past her advice, that was the end of the line. There is no discussion or back and forth - there just isn’t time. We felt so rushed.

So, we started looking into midwives. The issue for me was, while I really wanted a vaginal birth if at all possible, I knew I would want an epidural. I had zero interest in a natural birth, but I wanted personal attention. I also wanted to give birth in a hospital, where there’s an OR right down the hall if it comes to that. The Midwives of Medstar at WHC fit the bill. They knew right from jump I was wanted the epidural, and they were totally fine with it. From the first “meet the midwives” meeting we went to, we loved them. They all just have an incredibly soothing presence.

My prenatal appointments were an average of probably 45 mins to an hour. It was my first baby, and my husband and I had a million questions. We showed up with a list every time. We NEVER felt rushed. We always felt listened to. It felt like such a collaborative, healthy, empowering experience.

Then I developed gestational hypertension at 38 weeks. I ended up need an induction. The induction and labor took, no exaggeration, 60 hours. That’s two and a half DAYS. The midwives switch shifts every 12 hours, so I saw five shifts, three different midwives, in the hospital. They were incredible. Supportive. Empowering. Knowledgeable. Understanding. It really felt like a team effort to get this baby out. There isn’t an OB on the planet who will let your induction go that long. But the midwives let me go on. They sat with me while I cried. They discussed options, for long periods of time. They answered my endless questions. They made it clear - if you want a c-section, say the word, you can have one. They kept a careful eye on my stats, and were very open about what signs would mean that was the recommended path, but I never hit those. They gave great advice on when to get the epidural. And my little one came vaginally, eventually. Despite some real low lows, I wouldn’t change a thing, and I absolutely couldn’t have done it without them.

It sounds like you got awesome care.

I do feel compelled to defend the WHC OBs on the appointment length front - all of my appointments have been lengthy (I’m not sure exactly how long) and they have always answered all of my questions in a caring and not at all rushed way. I’m not saying the midwives aren’t great, I’m sure they are.

I’m the PP with the 60 hour induction. I should clarify that my OB/GYN is not affiliated with WHC. She is with Capital Women’s Care and delivers at Sibley. I don’t have any experience with the WHC OBs - they may very well be excellent.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:But what is the difference between the care from the midwives and the care from the OBs? Except for the handing off in case of complications?

At GW? For someone who is low risk, very little. Midwife patients can deliver in the tub, OB patients cannot. GW midwives want you to go without an epidural and will encourage you to go without unless they feel like you need it (stalled labor, long labor, exhausted mom, induction, etc.), while OBs don't care if and when you get one. But otherwise, very similar. GW OBs see a lot of unmedicated births.

The difference between, say, midwives at Birthcare and OBs at the big private practices? Worlds apart.

But what? Besides the tub thing and the not wanting you to have an epidural?

Birthcare midwives, all CNMs, by the way, do all births at their center or at homes. They don't practice in a hospital at all. It's about a far away from the typical OB model as possible. You may view that as a positive or negative.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:But what is the difference between the care from the midwives and the care from the OBs? Except for the handing off in case of complications?

At GW? For someone who is low risk, very little. Midwife patients can deliver in the tub, OB patients cannot. GW midwives want you to go without an epidural and will encourage you to go without unless they feel like you need it (stalled labor, long labor, exhausted mom, induction, etc.), while OBs don't care if and when you get one. But otherwise, very similar. GW OBs see a lot of unmedicated births.

The difference between, say, midwives at Birthcare and OBs at the big private practices? Worlds apart.

But what? Besides the tub thing and the not wanting you to have an epidural?

Don't discount the tub. I credit laboring in water with helping me avoid an epidural and keeping my labor relatively short for a FTM (~7 hours). Nothing against anyone going with the drugs I just didn't want anything in my system unless I really couldn't cope. I was pleasantly surprised to learn that I could cope, and I was lucky my baby was in a good position and not overly large either.

If I ever give birth again I would sign on with midwives just for the tub access!

[Anonymous]

My friend had an epidural and said she felt like Whitney was judging her, but a midwife still “caught” her baby.

I had 2 babies with the GW midwives. I am old and overweight and they didn’t give me any shame about my weight. I did my best with the diet and they were gracious.

Baby 1 - 30hr labor with pitocin at the end. Midwives were awesome - I saw 3 or 4 through shift changes. They told me I could get an epi and sleep or use pitocin and power through. No one pushed me to do either - just options - I felt supported.

Baby 2 - 2 hour labor. I arrived in transition. The baby’s heartbeat was showing stress. There was apparently an OB / surgical team behind me, waiting to do an emergency C. I couldn’t see them and the midwife kept me really calm and pushing. Baby born 40 min after we parked the car. Later my husband told me everyone seemed really scared and on edge. I felt supported and empowered to trust my body.

I had 2 wonderful, empowering birth experiences.

[Anonymous]

I delivered at WHC with midwives and I'm certain I would have been given Pitocin (and maybe even had an emergency c section) if I'd had an OB. My water broke at 6am and I didn't deliver until 630 am the next day. My mom was induced with me for that reason (too much time since broken water) and it did lead to emerg c section. I am so grateful to Beth and the team for allowing me to labor naturally.

[Anonymous]

Anonymous wrote:I delivered at WHC with midwives and I'm certain I would have been given Pitocin (and maybe even had an emergency c section) if I'd had an OB. My water broke at 6am and I didn't deliver until 630 am the next day. My mom was induced with me for that reason (too much time since broken water) and it did lead to emerg c section. I am so grateful to Beth and the team for allowing me to labor naturally.

I think it’s great that you had a positive experience but I thinks it’s categorically unfair for you and other posters to say, an OB would not have let me do x, y, or a. You don’t know that. You have no way of knowing that. You didn’t deliver with an OB. The fact that you prefer a midwife to an Ob shows your preference but it’s not fair to assume an OB provider would not be as supportive of natural childbirth as a midwife. Most OB practices in the DMV are very supportive of unmedicated vaginal birth so to try and promote a narrative that they are not is irritating.

[Anonymous]

I delivered with the midwives at WHC and I ended up getting induced and needing a c-section, and I still had a great experience! I felt listened to, supported, and really well taken care of. The midwives were there for the c-section, they did everything except place the spinal block and perform the surgery. I could have had the same experience with an OB, but I'm going with the midwives again. The WHC midwives specifically are very nonjudgmental- if you want an epidural- great, going for an unmedicated birth- great, they're supportive either way.

I just wanted to share the perspective that the midwife route isn't just about avoiding a c-section (which very well may be the thing that saves you and you baby's life!) For me, it was about feeling supported and listened to, which a good OB would do as well, but I think is more "core" to a midwifery practice.

[Anonymous]

Anonymous wrote:

Anonymous wrote:March of Dimes supports midwifery care for low risk pregnant women and shares that in the US low risk women are less likely to have a c-section than the same risk group of women working with an OB. Of course, midwives are individuals just like OBs so there will be varying levels of care between both.

The midwifery model of care promotes birth as a normal physiologic occurrence and are able to manage typical complications of pregnancy and labor. OB model of care starts with the idea that birth is inherently risky and needs to be managed.

You can have a wonderful birth with either, but if you have an opinion about how you want it to go, you may be better served by one or the other. You can have an epidural with either at GW.

https://www.marchofdimes.org/materials/Final%20midwifery%20position%20statement%20August%2029%202019.pdf

I don't understand this at all. The OBs seem to find my pregnancy very normal. What would this mean in terms of actual differences in care?

New poster here. In low-risk pregnancies, mothers end up with fewer interventions and fewer c-sections with midwives than OBs. (30% fewer c-sections for first-time moms, 40% fewer for those with previous deliveries.)

https://www.reuters.com/article/us-health-birth-midwives/fewer-c-sections-when-low-risk-deliveries-handled-by-midwives-idUSKBN1WP38D

I chose midwives to reduce the likelihood of interventions, knowing that they would pass me off to an OB if they felt interventions were warranted.