Trying to understand the midwife route

[Anonymous]

Anonymous wrote:

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.

Did you ever consider that midwives have lower rates of these procedures because they can’t perform them? And also—the fact that midwives may be less likely to intervene when warranted, allow prolonged pushing and labors which can result in maternal and fetal injuries, etc. I chose midwives for my first thinking all the research supported that and there could be no downsides, and ended up finding out that yes, there are downsides. They just aren’t often discussed. An important question: would you rather have a more qualified provider who may be more inclined to give you a C-section if they are concerned with your labor, or a less qualified provider who might not appropriately respond to a critical situation when necessary by doing needed interventions because they view the trajectory of your labor as “normal” or don’t want to transfer your care? Obviously for an uncomplicated delivery a midwife is great but if you have complications (which can’t be prevented)—ask yourself what matters more.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Did you ever consider that midwives have lower rates of these procedures because they can’t perform them? And also—the fact that midwives may be less likely to intervene when warranted, allow prolonged pushing and labors which can result in maternal and fetal injuries, etc. I chose midwives for my first thinking all the research supported that and there could be no downsides, and ended up finding out that yes, there are downsides. They just aren’t often discussed. An important question: would you rather have a more qualified provider who may be more inclined to give you a C-section if they are concerned with your labor, or a less qualified provider who might not appropriately respond to a critical situation when necessary by doing needed interventions because they view the trajectory of your labor as “normal” or don’t want to transfer your care? Obviously for an uncomplicated delivery a midwife is great but if you have complications (which can’t be prevented)—ask yourself what matters more.

DP, but midwives are less qualified to do certain procedures than OBs, but they are not less qualified to identify risky situations. Any competent midwife knows the limits of her training and hands off to the OB when necessary. I had complications in my second labor and my midwife was on the phone lickety-split to the NICU, who promptly sent one of their docs over. She (MW) explained how things would go, and that if it went a certain way, the doc would immediately take over. There was no confusion or ego involved.

I'm sorry you had the experience you did, but please don't presume that all midwives are that unprofessional and incompetent.

[Anonymous]

Anonymous wrote:

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.

I'm the PP with the 60 hour induction. After the fact, I spoke with two different doctors (friends/relatives). Neither is an OB, but both did rotations in the obstetrics unit of a hospital during their trainings. They both said, unprompted, that they were told not to let an induction go that long, and both teams they worked with (in different areas of the country) would have given me a c-section.

Now - maybe there are risks to a longer induction, so per another posters point, maybe you want to err on the side of caution, have an OB, and in my case, get the c-section. But I am confident that an OB would have given me a c-section, and while I guess I can't "know" - I have some real solid evidence to that effect.

[Anonymous]

I had my first child with GW OBs, second with the GW midwives. Both were unmedicated, and overall good experiences. Overall I thought the second labor was nicer because I had a water birth. It was really as comfortable as giving birth can be. The first time, though, I never felt pressured to get an epidural and the L&D nurses at GW are great and very supportive of unmedicated childbirth.

Prenatal care was good both pregnancies. Both were low risk and with no underlying conditions, so I realize that makes a huge part of it. The midwives never asked me about diet, but I was pretty strict and liked the diet. It forced me to be disciplined and I was worried that being pregnant with a toddler would make me rely on takeout pizza too often otherwise. I also was sick with a virus during my second pregnancy and the midwives were really caring - constantly followed up to find out how I was doing, etc.
In short, if you're choosing between GW OBs and midwives, I think you'd be fine with either.

[Anonymous]

Anonymous wrote: An important question: would you rather have a more qualified provider who may be more inclined to give you a C-section if they are concerned with your labor, or a less qualified provider who might not appropriately respond to a critical situation when necessary by doing needed interventions because they view the trajectory of your labor as “normal” or don’t want to transfer your care?

I chose #3 for my two births: Qualified midwives who would respond to a critical situation when necessary by having a qualified OB do needed interventions. Of course it would be dangerous to have a midwife unwilling to transfer care when necessary, just as it would be dangerous to have a GP unwilling to transfer a patient to a specialist when necessary.

[Anonymous]

Anonymous wrote:

Anonymous wrote: An important question: would you rather have a more qualified provider who may be more inclined to give you a C-section if they are concerned with your labor, or a less qualified provider who might not appropriately respond to a critical situation when necessary by doing needed interventions because they view the trajectory of your labor as “normal” or don’t want to transfer your care?

I chose #3 for my two births: Qualified midwives who would respond to a critical situation when necessary by having a qualified OB do needed interventions. Of course it would be dangerous to have a midwife unwilling to transfer care when necessary, just as it would be dangerous to have a GP unwilling to transfer a patient to a specialist when necessary.

It’s nice to think that midwives always transfer care when they are supposed to but I’m living proof that they don’t and I know a number of other women on the same boat. Until CNMs divorce themselves from the CPMs and CMs and stop making natural physiologic childbirth the most important aspect of care, and remove some of the dogmatic views that they entrench in women during their training, the profession will continue to have bad apples who don’t know their scope. Unlike PAs, midwives are all about their own professional autonomy.

But sure, 60 hour poster, your kid didn’t get brain damage so I’m sure you feel like you made the best choice. But I bet you would have sued your midwife if anything was wrong with your baby.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: An important question: would you rather have a more qualified provider who may be more inclined to give you a C-section if they are concerned with your labor, or a less qualified provider who might not appropriately respond to a critical situation when necessary by doing needed interventions because they view the trajectory of your labor as “normal” or don’t want to transfer your care?

I chose #3 for my two births: Qualified midwives who would respond to a critical situation when necessary by having a qualified OB do needed interventions. Of course it would be dangerous to have a midwife unwilling to transfer care when necessary, just as it would be dangerous to have a GP unwilling to transfer a patient to a specialist when necessary.

It’s nice to think that midwives always transfer care when they are supposed to but I’m living proof that they don’t and I know a number of other women on the same boat. Until CNMs divorce themselves from the CPMs and CMs and stop making natural physiologic childbirth the most important aspect of care, and remove some of the dogmatic views that they entrench in women during their training, the profession will continue to have bad apples who don’t know their scope. Unlike PAs, midwives are all about their own professional autonomy.

But sure, 60 hour poster, your kid didn’t get brain damage so I’m sure you feel like you made the best choice. But I bet you would have sued your midwife if anything was wrong with your baby.

60 hour poster here. This is really fair. Obviously, I'm super supportive of midwives - have done it, will do it again. But I think this thread has actually really achieved its goal, which is to tease out what the real difference is. I imagine the whole thing is really helpful to the OP. There are degrees - certainly there are going to be really hands on OBs. Really risk-averse, highly trained midwives. Midwives who are too quick to transfer. OBs that go above and beyond to avoid a c-section. The world is a complex place. But there are some overarching, general differences in approach that I think this thread really teases out in a productive way, as to generally, what the two experiences are like.

One thing I will add, that goes with your brain damage point - I could not find studies/stats that specifically dug into the difference in safety between a Certified Nurse Midwife in a hospital vs. an OB in an hospital. All the studies I found were about midwives in birthing centers or at home, compared to OBs in hospitals. As midwifery comes back in a big way and grows in popularity, I would really like to see a comparison of outcomes (and particularly, adverse outcomes) between these two groups in a hospital setting.

One final point that you alluded to, but is worth spelling out for the OP, is the difference between Certified Nurse Midwives (CNM), Certified Professional Midwives (CPM), Certified Midwives (CM), and non certified midwives. In doing my research, there is a HUGE difference between these in training and preparation, and my love of midwives is limited exclusively to CNM, the highest level of midwifery training. I would never, ever, use one of the types. Something for anyone considering the midwifery route to consider.

[Anonymous]

Anonymous wrote:

Anonymous wrote: An important question: would you rather have a more qualified provider who may be more inclined to give you a C-section if they are concerned with your labor, or a less qualified provider who might not appropriately respond to a critical situation when necessary by doing needed interventions because they view the trajectory of your labor as “normal” or don’t want to transfer your care?

I chose #3 for my two births: Qualified midwives who would respond to a critical situation when necessary by having a qualified OB do needed interventions. Of course it would be dangerous to have a midwife unwilling to transfer care when necessary, just as it would be dangerous to have a GP unwilling to transfer a patient to a specialist when necessary.

Just to clarify, I had qualified midwives in a hospital who were supposed to transfer my care when necessary. The hospital environment and the OBs down the hall mean nothing unless the midwife brings them into your room. Just saying. Midwives failing to consult/collaborate/and transfer care can and does happen in a hospital environment. It can and does. And it’s not rare.

Example in the US: https://www.google.com/amp/s/www.cbsnews.com/amp/news/whistleblower-doctors-vs-midwives-obgyn-risks-career-to-protect-moms-babies/

Example in the U.K.: https://www.google.com/amp/s/www.independent.co.uk/voices/morecombe-bay-scandal-nhs-baby-shrewsbury-telford-death-a9211346.html%3famp (11 babies died)

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: An important question: would you rather have a more qualified provider who may be more inclined to give you a C-section if they are concerned with your labor, or a less qualified provider who might not appropriately respond to a critical situation when necessary by doing needed interventions because they view the trajectory of your labor as “normal” or don’t want to transfer your care?

I chose #3 for my two births: Qualified midwives who would respond to a critical situation when necessary by having a qualified OB do needed interventions. Of course it would be dangerous to have a midwife unwilling to transfer care when necessary, just as it would be dangerous to have a GP unwilling to transfer a patient to a specialist when necessary.

It’s nice to think that midwives always transfer care when they are supposed to but I’m living proof that they don’t and I know a number of other women on the same boat. Until CNMs divorce themselves from the CPMs and CMs and stop making natural physiologic childbirth the most important aspect of care, and remove some of the dogmatic views that they entrench in women during their training, the profession will continue to have bad apples who don’t know their scope. Unlike PAs, midwives are all about their own professional autonomy.

But sure, 60 hour poster, your kid didn’t get brain damage so I’m sure you feel like you made the best choice. But I bet you would have sued your midwife if anything was wrong with your baby.

60 hour poster here. This is really fair. Obviously, I'm super supportive of midwives - have done it, will do it again. But I think this thread has actually really achieved its goal, which is to tease out what the real difference is. I imagine the whole thing is really helpful to the OP. There are degrees - certainly there are going to be really hands on OBs. Really risk-averse, highly trained midwives. Midwives who are too quick to transfer. OBs that go above and beyond to avoid a c-section. The world is a complex place. But there are some overarching, general differences in approach that I think this thread really teases out in a productive way, as to generally, what the two experiences are like.

One thing I will add, that goes with your brain damage point - I could not find studies/stats that specifically dug into the difference in safety between a Certified Nurse Midwife in a hospital vs. an OB in an hospital. All the studies I found were about midwives in birthing centers or at home, compared to OBs in hospitals. As midwifery comes back in a big way and grows in popularity, I would really like to see a comparison of outcomes (and particularly, adverse outcomes) between these two groups in a hospital setting.

One final point that you alluded to, but is worth spelling out for the OP, is the difference between Certified Nurse Midwives (CNM), Certified Professional Midwives (CPM), Certified Midwives (CM), and non certified midwives. In doing my research, there is a HUGE difference between these in training and preparation, and my love of midwives is limited exclusively to CNM, the highest level of midwifery training. I would never, ever, use one of the types. Something for anyone considering the midwifery route to consider.

You can’t easily compare outcomes because OBs will always see women with health complications and risk factors that midwives cannot see. Midwives will always see healthy low risk women. OBs see always going to be managing complex and high risk pregnancies. By virtue of those facts alone, midwives can and should have better outcomes. The OBs will always be the one performing C sections, forceps, and vacuum deliveries. So you can’t compare the outcomes to find a group superior because it’s like comparing apples and oranges.

Also, midwives are not growing in a big way. They deliver a tiny fraction of babies in the US. And the studies that demonstrate how safe midwifery care is are frequently from Europe and do not translate to the US. In those countries the midwives have more rigorous training, do not see women with risk factors, and have much more aggressive transfer protocols. The midwives are also fully integrated into their hospital and health systems, unlike in the US which has three tiers of midwives who are all in alliance with each other despite the massive differences between their education and training.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: An important question: would you rather have a more qualified provider who may be more inclined to give you a C-section if they are concerned with your labor, or a less qualified provider who might not appropriately respond to a critical situation when necessary by doing needed interventions because they view the trajectory of your labor as “normal” or don’t want to transfer your care?

I chose #3 for my two births: Qualified midwives who would respond to a critical situation when necessary by having a qualified OB do needed interventions. Of course it would be dangerous to have a midwife unwilling to transfer care when necessary, just as it would be dangerous to have a GP unwilling to transfer a patient to a specialist when necessary.

It’s nice to think that midwives always transfer care when they are supposed to but I’m living proof that they don’t and I know a number of other women on the same boat. Until CNMs divorce themselves from the CPMs and CMs and stop making natural physiologic childbirth the most important aspect of care, and remove some of the dogmatic views that they entrench in women during their training, the profession will continue to have bad apples who don’t know their scope. Unlike PAs, midwives are all about their own professional autonomy.

But sure, 60 hour poster, your kid didn’t get brain damage so I’m sure you feel like you made the best choice. But I bet you would have sued your midwife if anything was wrong with your baby.

60 hour poster here. This is really fair. Obviously, I'm super supportive of midwives - have done it, will do it again. But I think this thread has actually really achieved its goal, which is to tease out what the real difference is. I imagine the whole thing is really helpful to the OP. There are degrees - certainly there are going to be really hands on OBs. Really risk-averse, highly trained midwives. Midwives who are too quick to transfer. OBs that go above and beyond to avoid a c-section. The world is a complex place. But there are some overarching, general differences in approach that I think this thread really teases out in a productive way, as to generally, what the two experiences are like.

One thing I will add, that goes with your brain damage point - I could not find studies/stats that specifically dug into the difference in safety between a Certified Nurse Midwife in a hospital vs. an OB in an hospital. All the studies I found were about midwives in birthing centers or at home, compared to OBs in hospitals. As midwifery comes back in a big way and grows in popularity, I would really like to see a comparison of outcomes (and particularly, adverse outcomes) between these two groups in a hospital setting.

One final point that you alluded to, but is worth spelling out for the OP, is the difference between Certified Nurse Midwives (CNM), Certified Professional Midwives (CPM), Certified Midwives (CM), and non certified midwives. In doing my research, there is a HUGE difference between these in training and preparation, and my love of midwives is limited exclusively to CNM, the highest level of midwifery training. I would never, ever, use one of the types. Something for anyone considering the midwifery route to consider.

You can’t easily compare outcomes because OBs will always see women with health complications and risk factors that midwives cannot see. Midwives will always see healthy low risk women. OBs see always going to be managing complex and high risk pregnancies. By virtue of those facts alone, midwives can and should have better outcomes. The OBs will always be the one performing C sections, forceps, and vacuum deliveries. So you can’t compare the outcomes to find a group superior because it’s like comparing apples and oranges.

Also, midwives are not growing in a big way. They deliver a tiny fraction of babies in the US. And the studies that demonstrate how safe midwifery care is are frequently from Europe and do not translate to the US. In those countries the midwives have more rigorous training, do not see women with risk factors, and have much more aggressive transfer protocols. The midwives are also fully integrated into their hospital and health systems, unlike in the US which has three tiers of midwives who are all in alliance with each other despite the massive differences between their education and training.

60 hours here. Yes, definitely hard to compare, but not impossible. You could say the same thing about stats for home births and birth centers with a midwife vs. hospital with an OB, but I found that stats and studies of that were readily available (although obviously imperfect).

Midwifery is definitely growing. Per this article in The Atlantic:

https://www.theatlantic.com/health/archive/2015/06/midwives-are-making-a-comeback/395456/

From 3% of all births in 1989, to 9% in 2013. That’s a significant increase.

[Anonymous]

Not sure where you are, but I delivered with Midwifery Care Associates at Shady Grove in MD for both kids. It was great. I loved being at the hospital in case but also having midwives.

I personally found the rhetoric of the GW Midwifes offputting. I only got through the online bits of info you quoted, but really, I didn't want to feel like someone was judging what I ate. The midwives I went with were very supportive of a whole range of options but approached things from the perspective of being less interventionist than an OB. It was great for us.

I don't recall exactly, but I'm sure if I had needed an epidural, the midwife would still have delivered. C-section, definitely not. I had a doula and was very glad I did, even with midwives.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: An important question: would you rather have a more qualified provider who may be more inclined to give you a C-section if they are concerned with your labor, or a less qualified provider who might not appropriately respond to a critical situation when necessary by doing needed interventions because they view the trajectory of your labor as “normal” or don’t want to transfer your care?

I chose #3 for my two births: Qualified midwives who would respond to a critical situation when necessary by having a qualified OB do needed interventions. Of course it would be dangerous to have a midwife unwilling to transfer care when necessary, just as it would be dangerous to have a GP unwilling to transfer a patient to a specialist when necessary.

It’s nice to think that midwives always transfer care when they are supposed to but I’m living proof that they don’t and I know a number of other women on the same boat. Until CNMs divorce themselves from the CPMs and CMs and stop making natural physiologic childbirth the most important aspect of care, and remove some of the dogmatic views that they entrench in women during their training, the profession will continue to have bad apples who don’t know their scope. Unlike PAs, midwives are all about their own professional autonomy.

But sure, 60 hour poster, your kid didn’t get brain damage so I’m sure you feel like you made the best choice. But I bet you would have sued your midwife if anything was wrong with your baby.

60 hour poster here. This is really fair. Obviously, I'm super supportive of midwives - have done it, will do it again. But I think this thread has actually really achieved its goal, which is to tease out what the real difference is. I imagine the whole thing is really helpful to the OP. There are degrees - certainly there are going to be really hands on OBs. Really risk-averse, highly trained midwives. Midwives who are too quick to transfer. OBs that go above and beyond to avoid a c-section. The world is a complex place. But there are some overarching, general differences in approach that I think this thread really teases out in a productive way, as to generally, what the two experiences are like.

One thing I will add, that goes with your brain damage point - I could not find studies/stats that specifically dug into the difference in safety between a Certified Nurse Midwife in a hospital vs. an OB in an hospital. All the studies I found were about midwives in birthing centers or at home, compared to OBs in hospitals. As midwifery comes back in a big way and grows in popularity, I would really like to see a comparison of outcomes (and particularly, adverse outcomes) between these two groups in a hospital setting.

One final point that you alluded to, but is worth spelling out for the OP, is the difference between Certified Nurse Midwives (CNM), Certified Professional Midwives (CPM), Certified Midwives (CM), and non certified midwives. In doing my research, there is a HUGE difference between these in training and preparation, and my love of midwives is limited exclusively to CNM, the highest level of midwifery training. I would never, ever, use one of the types. Something for anyone considering the midwifery route to consider.

You can’t easily compare outcomes because OBs will always see women with health complications and risk factors that midwives cannot see. Midwives will always see healthy low risk women. OBs see always going to be managing complex and high risk pregnancies. By virtue of those facts alone, midwives can and should have better outcomes. The OBs will always be the one performing C sections, forceps, and vacuum deliveries. So you can’t compare the outcomes to find a group superior because it’s like comparing apples and oranges.

Also, midwives are not growing in a big way. They deliver a tiny fraction of babies in the US. And the studies that demonstrate how safe midwifery care is are frequently from Europe and do not translate to the US. In those countries the midwives have more rigorous training, do not see women with risk factors, and have much more aggressive transfer protocols. The midwives are also fully integrated into their hospital and health systems, unlike in the US which has three tiers of midwives who are all in alliance with each other despite the massive differences between their education and training.

85% of all pregnancies are healthy and low-risk, and 90%+ of pregnancies and births are managed by OBs in hospitals. By virtue of those facts, OBs should have better outcomes. Instead they have an embarassingly high maternal mortality rate compared to other countries, an infant mortality rate that has been stagnant for 20 years, a ~20% rate of birth trauma, and childbirth is more dangerous now than it was for the previous generation, all despite the "advances" in technology i.e. skyrocketing rates of medical management and intervention.

Sometimes the way labor is managed by medical providers has unintended effects, even if it makes all the logical sense in the world that it should be helpful. Everyone is quick to blame modern women for being too unhealthy, fat or old to have babies safely, but there is something called iatrogenic harm in medicine and it has a role, too. If you've had a lot of dealings with doctors chances are good you've experienced it firsthand through overdiagnosis, overtreatment, incompetent or uncaring providers, or medical mistakes. It's no surprise more women are opting for the low tech high touch midwife model: choosing a provider with medical expertise who treats new moms as human beings whose experiences matter, and who don't view the day your child is born as simply another medical event like having a tumor removed.

[Anonymous]

It’s the iatrogenic harm poster, I didn’t realize you were still around.

Got any citations for your claims above?

Also, you’re not quite right about maternal mortality. Racial disparities, lack of access to health care, etc. play a much larger role than you’re alluding to and less tech and more touch is not necessarily the answer, despite what midwives say.

It’s also not fair to paint provider groups with a broad brush, since obstetrics is female dominated and many midwifery practices have infiltrated the profession, but you can keep pushing that tired narrative if you’d like. Midwifery has just as many tough love, masochist midwives who think the pain of birth is required of all women to prove their womanhood and commitment as mothers just as much as obstetrics suffers from doctors who treat birth like a medical event.

http://www.skepticalob.com/2020/01/the-scandal-behind-the-scandal-of-us-maternal-mortality.html

[Anonymous]

You do realize you can have a natural childbirth with an OB, right?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: An important question: would you rather have a more qualified provider who may be more inclined to give you a C-section if they are concerned with your labor, or a less qualified provider who might not appropriately respond to a critical situation when necessary by doing needed interventions because they view the trajectory of your labor as “normal” or don’t want to transfer your care?

I chose #3 for my two births: Qualified midwives who would respond to a critical situation when necessary by having a qualified OB do needed interventions. Of course it would be dangerous to have a midwife unwilling to transfer care when necessary, just as it would be dangerous to have a GP unwilling to transfer a patient to a specialist when necessary.

It’s nice to think that midwives always transfer care when they are supposed to but I’m living proof that they don’t and I know a number of other women on the same boat. Until CNMs divorce themselves from the CPMs and CMs and stop making natural physiologic childbirth the most important aspect of care, and remove some of the dogmatic views that they entrench in women during their training, the profession will continue to have bad apples who don’t know their scope. Unlike PAs, midwives are all about their own professional autonomy.

But sure, 60 hour poster, your kid didn’t get brain damage so I’m sure you feel like you made the best choice. But I bet you would have sued your midwife if anything was wrong with your baby.

60 hour poster here. This is really fair. Obviously, I'm super supportive of midwives - have done it, will do it again. But I think this thread has actually really achieved its goal, which is to tease out what the real difference is. I imagine the whole thing is really helpful to the OP. There are degrees - certainly there are going to be really hands on OBs. Really risk-averse, highly trained midwives. Midwives who are too quick to transfer. OBs that go above and beyond to avoid a c-section. The world is a complex place. But there are some overarching, general differences in approach that I think this thread really teases out in a productive way, as to generally, what the two experiences are like.

One thing I will add, that goes with your brain damage point - I could not find studies/stats that specifically dug into the difference in safety between a Certified Nurse Midwife in a hospital vs. an OB in an hospital. All the studies I found were about midwives in birthing centers or at home, compared to OBs in hospitals. As midwifery comes back in a big way and grows in popularity, I would really like to see a comparison of outcomes (and particularly, adverse outcomes) between these two groups in a hospital setting.

One final point that you alluded to, but is worth spelling out for the OP, is the difference between Certified Nurse Midwives (CNM), Certified Professional Midwives (CPM), Certified Midwives (CM), and non certified midwives. In doing my research, there is a HUGE difference between these in training and preparation, and my love of midwives is limited exclusively to CNM, the highest level of midwifery training. I would never, ever, use one of the types. Something for anyone considering the midwifery route to consider.

You can’t easily compare outcomes because OBs will always see women with health complications and risk factors that midwives cannot see. Midwives will always see healthy low risk women. OBs see always going to be managing complex and high risk pregnancies. By virtue of those facts alone, midwives can and should have better outcomes. The OBs will always be the one performing C sections, forceps, and vacuum deliveries. So you can’t compare the outcomes to find a group superior because it’s like comparing apples and oranges.

Also, midwives are not growing in a big way. They deliver a tiny fraction of babies in the US. And the studies that demonstrate how safe midwifery care is are frequently from Europe and do not translate to the US. In those countries the midwives have more rigorous training, do not see women with risk factors, and have much more aggressive transfer protocols. The midwives are also fully integrated into their hospital and health systems, unlike in the US which has three tiers of midwives who are all in alliance with each other despite the massive differences between their education and training.

85% of all pregnancies are healthy and low-risk, and 90%+ of pregnancies and births are managed by OBs in hospitals. By virtue of those facts, OBs should have better outcomes. Instead they have an embarassingly high maternal mortality rate compared to other countries, an infant mortality rate that has been stagnant for 20 years, a ~20% rate of birth trauma, and childbirth is more dangerous now than it was for the previous generation, all despite the "advances" in technology i.e. skyrocketing rates of medical management and intervention.

Sometimes the way labor is managed by medical providers has unintended effects, even if it makes all the logical sense in the world that it should be helpful. Everyone is quick to blame modern women for being too unhealthy, fat or old to have babies safely, but there is something called iatrogenic harm in medicine and it has a role, too. If you've had a lot of dealings with doctors chances are good you've experienced it firsthand through overdiagnosis, overtreatment, incompetent or uncaring providers, or medical mistakes. It's no surprise more women are opting for the low tech high touch midwife model: choosing a provider with medical expertise who treats new moms as human beings whose experiences matter, and who don't view the day your child is born as simply another medical event like having a tumor removed.

DP here but this is ridiculous. What a pathetic straw man. It’s one thing to look at actual differences in practices and outcomes but when you come and say that OBs don’t treat moms as human beings, how can I take you seriously on anything else? That’s outrageous and silly.