Trying to understand the midwife route

[Anonymous]

I started my pregnancy with the OBs at GW. Loved the OB I started with, but they made it clear as far back as my 12 week appointment that they wanted me to induce at 39 weeks solely based on my age (35). Going into labor naturally (unless medically indicated) and not having to argue about it was important to me, so I switched to the midwives.

[Anonymous]

[twitter]

Anonymous wrote:I started my pregnancy with the OBs at GW. Loved the OB I started with, but they made it clear as far back as my 12 week appointment that they wanted me to induce at 39 weeks solely based on my age (35). Going into labor naturally (unless medically indicated) and not having to argue about it was important to me, so I switched to the midwives.

Interesting. I thought the GW OBs and midwives were on the same page about inductions for AMA moms. I was 35 and had that conversation early on with Whitney and she said as long as I remained low risk I could go to 42 weeks.

[Anonymous]

Recently gave birth with GW midwives. Asked for an epidural and received one without judgement. Was still able to labor in different positions (squatting etc.) despite epidural which I really appreciated. Ended up having to have forceps delivery with OB being pulled in to do it. Was not how I had hope birth would go but overall was a very positive experience. Nurses, midwives, OB etc. all were wonderful. During pregnancy I did my best to follow diet and exercise guidelines but never felt judged- visits had a very supportive vibe. Would go with GW midwives again - feel it is best of both worlds.

[Anonymous]

I'd love to understand more about how nurse-midwives operate in England. My understanding is that the Royal Family uses midwives, but the best OB-GYNS are also in waiting at the hospital and perhaps giving more active advice about whether intervention is warranted. Anyone with more details?

[Anonymous]

True fact: Queen Elizabeth was born by C-section, at home. Yikes!

[Anonymous]

Anonymous wrote:I'd love to understand more about how nurse-midwives operate in England. My understanding is that the Royal Family uses midwives, but the best OB-GYNS are also in waiting at the hospital and perhaps giving more active advice about whether intervention is warranted. Anyone with more details?

The NHS is in the middle of a national scandal over the behavior of midwives in many units. All mothers have to see midwives to start, access to
physicians is restricted, access to C sections is restricted, epidurals can be hard to get as women are pushed to get gas and air, they do tons and tons of forceps to avoid C-sections, they actively try to promote vaginal birth to keep costs down, etc. It is not a system you should have any interest in, no matter what you saw on Call the Midwife or how lovely it might sound. Read specifically about Morecambe Bay and all the infants who died there due to the negligence of those midwives.

https://www.google.com/amp/s/www.independent.co.uk/news/health/nhs-maternity-scandals-mother-baby-deaths-investigation-shrewsbury-a9635896.html%3famp

https://www.google.com/amp/s/www.independent.co.uk/voices/morecombe-bay-scandal-nhs-baby-shrewsbury-telford-death-a9211346.html%3famp

[Anonymous]

My ob at Gw said induction for women especially IVF was recommended at 40 weeks. But, I had the right to refuse. She said she would present the risks and benefits and ultimately was my choice.

[Anonymous]

A prior poster discussed the unfairness of assuming that an ob would have started pitocin...

I delivered with the cnm team at GW. I was on pitocin because my water had broke over 24 hours ago. My contractions were unbearable and I asked for an epidural. The OB attending came in an sat with me through a few contractions. She explained that the midwife was pushing with a patient and asked if she could help me.

I requested and exam.
She checked me (I was the same) and noted some scaring on my cervix which was due to a LEEP I had years ago.
She massaged the scar tissue away, turned off the pitocin.
My contractions did not go away...they kept coming and coming.
I delivered vaginally 2-3 hours later.

The point of my story...some midwives will act as interventionalists and so will some obs. Some will not. I don’t think you can make sweeping judgments.

I know a midwife caught my baby. But, I believe that the ob helped me more then anyone.

[Anonymous]

I won't rehash all this ob vs midwife cage match stuff (which is ridiculous IMO because both are looking out for moms no matter what people say, although I would never work with a midwife that was not a CNM).

But the diet stuff drives me insane. Probably I am way too biased to really make an observation but I had hyperemesis three times and pregnant women should, within reason, eat what they can eat. Any group that has a uniform dictation of what pregnant women should and should not eat is suboptimal because every woman is different. What a hyperemesis mom should/can eat and what a GD mom should/can eat are totally different and having a blanket policy up front like this is IMO, bad maternal care.

[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.

However, you better hope the midwives bring in the OBs at the right time and that they do it well and that everyone’s role is clear. The trouble is that midwives are educated in a very different childbirth model than physicians so what a midwife may see as “normal” may be seen very differently by a physician - and as the patient you may find yourself navigating their different perspectives (is one may think your labor is progressing normally and the other may not), which is not what you want to be doing when you are in the worst pain of your life, and when your child’s entire life and the entire future of your pelvic health is at stake.

In my experience, the transfer to OBs was not done in a timely fashion, it was done poorly, there was confusion about team roles and leadership, and the midwife and Ob had different opinions. I ended up permanently injured due to the poor decisions made in their wonderful “collaborative care model” (which perhaps yields the very best outcomes for some pregnant women, but certainly did not for me) and I made a well documented complaint to the practice and to the hospital over the many issues our family experienced with it during my delivery. For that reason alone I can never recommend midwifery care, though you will find many on here who like them and have positive experiences. Many births will be uncomplicated and straightforward and for those you don’t need a hospital—any decent EMT or even your partner with a towel will do. But for births that are complicated, they can go very badly and trust me, when your child’s life is on the line you will find yourself wishing for the world’s very best doctor and you won’t care in the slightest if your birth was “unnatural” as long as you both make it out alive and intact.

Good luck with your decision.

I agree that the midwives are gatekeepers to the OBs in a way that I did not feel good about in retrospect. I felt very confused when an OB suddenly came in saying I would need a c section in a way that clearly indicated he was unhappy with how the midwives had let me progress. My baby was born in distress so I’m glad he took action when he did.

[Anonymous]

The biggest difference I noticed between OB and midwife appointments was that the OB appointments took 5 minutes (sometimes I felt like I spent more time with the vital signs people than with my actual doctor) in the midwife ones would take more like 20 or 30 minutes.

I delivered at Washington Hospital Center for my first with midwife care and when I needed a vacuum assisted delivery they called in and OB to help but the midwife stayed in the room and the OB was very welcoming. They had a very copacetic relationship

[Anonymous]

Anonymous wrote:I won't rehash all this ob vs midwife cage match stuff (which is ridiculous IMO because both are looking out for moms no matter what people say, although I would never work with a midwife that was not a CNM).

But the diet stuff drives me insane. Probably I am way too biased to really make an observation but I had hyperemesis three times and pregnant women should, within reason, eat what they can eat. Any group that has a uniform dictation of what pregnant women should and should not eat is suboptimal because every woman is different. What a hyperemesis mom should/can eat and what a GD mom should/can eat are totally different and having a blanket policy up front like this is IMO, bad maternal care.

The GW midwives do not push the diet when you have morning sickness- I was told eat whatever I could keep down (for me popsicles and saltines) and then once I was able in later trimester I incorporated more of their diet suggestions. I don’t know why everyone gets so worked up about the healthy diet. They are not strict about it. Personally I liked having some guidance on what would be an optimal diet.

[Anonymous]

Anonymous wrote:The biggest difference I noticed between OB and midwife appointments was that the OB appointments took 5 minutes (sometimes I felt like I spent more time with the vital signs people than with my actual doctor) in the midwife ones would take more like 20 or 30 minutes.

I delivered at Washington Hospital Center for my first with midwife care and when I needed a vacuum assisted delivery they called in and OB to help but the midwife stayed in the room and the OB was very welcoming. They had a very copacetic relationship

I’m surprised by this because the WHC OBs seem downright chatty to me. At every visit they have a certain number of things they go over (usually whatever is upcoming (eg glucose test) and then something for L&D like breastfeeding or anesthesia options. I haven’t been watching the clock but I always feel like they spend a lot of time with me and ask more than once if I have questions. I’m kind of struggling to think of what would make the appointments longer.

Idk, maybe with COVID they have more time but I felt the same way about my pre-COVID appointments.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I won't rehash all this ob vs midwife cage match stuff (which is ridiculous IMO because both are looking out for moms no matter what people say, although I would never work with a midwife that was not a CNM).

But the diet stuff drives me insane. Probably I am way too biased to really make an observation but I had hyperemesis three times and pregnant women should, within reason, eat what they can eat. Any group that has a uniform dictation of what pregnant women should and should not eat is suboptimal because every woman is different. What a hyperemesis mom should/can eat and what a GD mom should/can eat are totally different and having a blanket policy up front like this is IMO, bad maternal care.

The GW midwives do not push the diet when you have morning sickness- I was told eat whatever I could keep down (for me popsicles and saltines) and then once I was able in later trimester I incorporated more of their diet suggestions. I don’t know why everyone gets so worked up about the healthy diet. They are not strict about it. Personally I liked having some guidance on what would be an optimal diet.

+1

I’m 20 weeks and we haven’t discussed diet even once. They just said “try to eat as healthy as you can tolerate”

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I won't rehash all this ob vs midwife cage match stuff (which is ridiculous IMO because both are looking out for moms no matter what people say, although I would never work with a midwife that was not a CNM).

But the diet stuff drives me insane. Probably I am way too biased to really make an observation but I had hyperemesis three times and pregnant women should, within reason, eat what they can eat. Any group that has a uniform dictation of what pregnant women should and should not eat is suboptimal because every woman is different. What a hyperemesis mom should/can eat and what a GD mom should/can eat are totally different and having a blanket policy up front like this is IMO, bad maternal care.

The GW midwives do not push the diet when you have morning sickness- I was told eat whatever I could keep down (for me popsicles and saltines) and then once I was able in later trimester I incorporated more of their diet suggestions. I don’t know why everyone gets so worked up about the healthy diet. They are not strict about it. Personally I liked having some guidance on what would be an optimal diet.

+1

I’m 20 weeks and we haven’t discussed diet even once. They just said “try to eat as healthy as you can tolerate”

Except the trouble is the guidelines as written are rigid, one-size-fits-all. The words in them are overly prescriptive. Every day eat this, and every day avoid this. They are unrealistic for most women. And sure, it’s great that in real life the midwives are more flexible and do not rigidly promote adherence to these guidelines but then, why have them at all? Or at least, why not revise them to make them more flexible and accommodating of the variety of healthy diets that exist?

There is not one right way to eat healthy. The guidelines ignore individual circumstances, varying cultural backgrounds, different food budgets, food allergies, different eating styles and food preferences, etc. I would argue that they are biased against women from lower socioeconomic backgrounds who may live in food deserts, or be living on food stamps, etc. and therefore are exclusionary of a particular type of patient that they don’t want. Is midwifery care really for everyone? Or just affluent, educated women who are skinny, able bodied and privileged enough to have the time to exercise for an hour a day, who have time and funds to purchase and prepare whole/organic foods for their meals, who have funds to hire a doula, who have partners engaged in the birth, etc?

Frankly, words matter. The impact of those guidelines matters far more than the intentions behind them. Clearly, enough of us have strong feelings about them or were turned off from them enough to avoid becoming a patient that they have an impact. Is that the one they want?

As a former patient, I frankly in hindsight wish I had understood that the rigidity inherent in those guidelines was illustrative of a rigid practice. One that doggedly adhered to a belief in natural birth above all else and in birth, meant providers hesitated to clearly recognize and identify when a birth was beyond their skill set and bring in physicians when needed. I didn’t realize the extent to which they acted as gatekeepers to the doctors, when I thought the word collaborative meant a team based approach. I don’t think promoting maternal suffering is a good thing. You can still be a great mom even with an epidural, a C-section, a formula fed baby, etc. As a FTM I wish I had never bought into their ideology. It is really damaging.