Why did you pick a midwife over a doctor?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My reasons were the same as many folks above, including a terrible experience with an OB practice in DC. My midwifery practice listened to me, and took time to know me as an individual patient.

Pregnancy and childbirth is unlike some other medical experiences, in that the comfort of the patient can have a profound impact on the outcome.

But it wasn't all touchy-feely. The midwives also took an evidence-based approach and took the time to explain the evidence for their decision-making.

For example, I had extremely well-controlled GD. Tested 4x a day, never blew my numbers after the GTT, controlled entirely with diet and exercise. The OB practice would have induced me at 38 weeks regardless of my numbers as a matter of protocol, but the midwifery practice let me carry to term based on the evidence around very well-controlled GD. They saw me as more than a checkbox, which let me carry my baby to term and have the birth I was hoping for.

THIS. Thank you. I already posted on this thread with my reasons for choosing a midwife (in a hospital) rather than an OB. I have found some of the other responses frustrating, and couldn't come up with the words for why - this is exactly correct.

If I'm going in for surgery, yup, I want the best possible clinician, not the best bedside manner. But childbirth is very different!

I do wish there was more research/comparisons between outcomes from an OB vs. a CNM in a hospital. When I was trying to look at studies about this in making my decision, there was a real dearth of information on this. Lots of studies on home birth with a midwife, but that's very, very different. And some that compared midwifery to OBs without accounting for location of birth at all, also very different. My instinct is that, yes, there are extreme cases of complex issues where midwives miss things, or can't handle something that pops up, and just the 10 mins it takes to get an OB in the room creates a negative outcome. But that there are also a fair number of people getting c-sections with OBs would wouldn't be getting c-sections if they had gone with a midwife, and a certain very small percentage of those will have negative outcomes because surgery always has risks. I'd love to see numbers on how this stacks up. Even the (agree, somewhat condescending) medical practitioner who commented on page two said "A midwife in a practice with physicians seems fine as there is backup easily available" and that's where I landed - but I'd love to see research on this, especially now that there are so many CNM working in hospitals.

Where did you look, and what search criteria did you use?

I just checked and I found a good amount of information on outcomes of hospital-based CNMs and OBs, including a recent study on outcomes with a total N ~1500.

I'm the PP you quoted. This was over two years ago now, so I honestly don't remember, but if you've found something please post a link! I'm eager to look. Thank you!

Sure. It's a study from 2017 IIRC, so it should have turned up.

Were you at the level of doing a lit review on PubMed, or do you usually just Google for this sort of thing?

[Anonymous]

Anonymous wrote:

Anonymous wrote:"My argument is that inconveniences like long waits and office environment are not the markers of bad patient care, which, up until you responded was what we were discussing."

I'm not going to copy and paste the whole thing, but why do you think the above is true? To people who don't have hours to wait for their healthcare providers, yes, long waits become bad care. If the office environment is such that it ignores patient privacy, or doesn't facilitate communication between front office staff and providers, yes, it becomes bad care.

The quality of healthcare is, to me, comprehensive (and most organizations who research that construct agree). Some aspects of care may be more salient than others, but it all goes into determining quality. Also, if you look at the first page of this thread, most of the women described some version of wanting personalized attention/being listened. One woman on the second page talked about wait times, clearly mentioning that she had experience working as a medical assistant in an OB practice, i.e., it was an informed decision. Why are you focusing on wait times as the reason to argue that the women on this thread can't tell what defines quality care when what PPs are actually mentioning is providers paying attention to them?

I'm a brand new poster to this thread. I have been reading this back and forth with growing annoyance.

I am a woman that had a very normal, uncomplicated first pregnancy become a VERY abnormal very complicated very dangerous pregnancy at week 33 very suddenly. My primary MFM at Georgetown was Dr Zilbermann. He was an enormous d. After stepping in the room to do my first BPP after being hospitalized he pretty casually informed me I was at a high risk of stillbirth. He also managed my care so that I made it to almost 37 weeks and delivered a baby that was breathing on her own. He predicted her stay in the NICU to the day. Dr. Drassinower was MUCH nicer to me and I liked her a lot and I have nothing but good things to say about her, but I trusted Dr. Z more by the end.

I waited for no less than 45 minutes for every appointment I had at Georgetown. They had crappy food and a crappy parking facility and crappy admins. And they saved my life and the life of my baby. And I was so grateful for that that when pregnant with my second I happily waited for those appointments again, and more frequently because I was high risk.

At the end of the day if sh*t really hits the fan, the rest doesn't matter. You really do want that weird antisocial guy that seems to know exactly what's going on with you.

To be fair I also think that overall patient care is important and the two should not be mutually exclusive. In my third pregnancy I got that. I was in a smaller city at a prestigious hospital and never waited more than 10 minutes and had excellent care.

And so if I was choosing I would rank them 1) great environment and great doctors, 2) crappy environment and great doctors, 3) great environment with blah doctors, 4) crappy environment with blah doctors, 5) great environment with people who aren't doctors.

I know I personally am biased here because my pregnancy was basically like, worst case scenario, but I agree with the PP that people really do put an oversized amount of importance on things that do not really matter in the end. And for the record, I don't think that means black women should accept not being listened to or that there aren't problems with OB GYN care in this country. But the midwifery model (outside of those groups associated with hospital practices) is just insane to me. Midwives in the united states are not trained and monitored in the formal way they are in other countries and until that happens I just do not understand anyone that doesn't have an OB as backup. My pregnancy was so dangerous that there was a real possibility that both myself AND my daughter would have died. I'm so happy my jerky doctor saved our lives, even if I do wish he had been a little more gentle.

I'm a PP from the first page who used midwives (and I'm also the one who commented about how I wished there were more apples-to-apples research on choosing an OB vs. a midwife in a hospital setting). I'm so sorry you had such a scary pregnancy, and I'm so glad you got the care you needed and that you and your daughter are okay. I do want to address the part of your comment that I bolded above - that is not just a throw away, rare situation. The "midwife group associated with a hospital practice" model is very, very common - just in DC proper, you've the the GW Midwives and the Midwives of Medstar (WHC). And in those cases, you're generally talking about Certified Nurse Midwives (CNM) which ARE trained and monitored in a formal way.

In fact, looking at this sheet http://www.midwife.org/acnm/files/ccLibraryFiles/Filename/000000005950/CNM-CM-AttendedBirths-2014-031416FINAL.pdf, they are claiming that for CNMs and CMs, in 2014, 94% of their births were in hospitals. And according to this sheet https://www.midwife.org/acnm/files/cclibraryfiles/filename/000000007531/essentialfactsaboutmidwives-updated.pdf, the majority of midwives in the US are CNMs.

While I'm for freedom of choice in this area, I personally would never use a midwife that was not a CNM, and I would never give birth outside a hospital. But based on the stats above, most people who are using midwives are not doing that - they are doing exactly what you're addressing in your parenthetical. That is the standard, not the exception.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:A caution from a medical professional - never confuse personality/bedside manners with medical skills/knowledge. Some of the loveliest, warmest doctors were terrible practitioners, but their patients loved them. One of the finest doctors I ever had the privilege to work with had terrible bedside manners - and the greatest assessment and interventional skills that saved many patients. Patients/family would complain that he didn’t smile enough, or didn’t tell jokes with them. You’re choosing someone to manage your child’s birth - why take a midwife over a trained/licensed physician? Seems foolish to me - this isn’t a cocktail party where you want to have a fun evening. A midwife in a practice with physicians seems fine as there is backup easily available. I’d go with an OB physician every time - I want the best trained, most educated professional who can step up in an emergency.

Yes +1. I had a midwife assisted birth for my first delivery (was planning an unmedicated vaginal birth) and it was a goddamn train wreck. I had unanticipated complications and needed physician collaboration and it was not handled well - there was role confusion, it was unclear who was in charge, they had different ideas about what to do, etc. The midwives I was with thought pushing for hours was totally fine and didn’t feel the need to warn me of the risks of prolonged second stage or pelvic floor injury so my mismanaged birth resulted with me having permanently injured my pelvic floor so badly I would need C-sections for all future births. I remember looking at my newborn’s bruises face from being stuck in the birth canal so long and regretting with every core of my being that I had prioritized my experience and emotional support needs over choosing the most skilled medical provider. It’s something I still regret to this day.

You again

Lady, get some therapy and stop blaming midwives for your birth experience.

I will blame them because it will forever be inappropriate that they allowed and encouraged me to push for nine hours. I was so delirious and exhausted and ignorant I had no idea this was inappropriate. And I have permanent injuries as a result. So don’t ever tell me to shut up.

You actually should shut up, though. Your experience had nothing to do with the midwives. Blame yourself. Plenty of women push for far longer and everything turns out fine. It's perfectly appropriate. Therapy would help you but you're too dense to realize it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My reasons were the same as many folks above, including a terrible experience with an OB practice in DC. My midwifery practice listened to me, and took time to know me as an individual patient.

Pregnancy and childbirth is unlike some other medical experiences, in that the comfort of the patient can have a profound impact on the outcome.

But it wasn't all touchy-feely. The midwives also took an evidence-based approach and took the time to explain the evidence for their decision-making.

For example, I had extremely well-controlled GD. Tested 4x a day, never blew my numbers after the GTT, controlled entirely with diet and exercise. The OB practice would have induced me at 38 weeks regardless of my numbers as a matter of protocol, but the midwifery practice let me carry to term based on the evidence around very well-controlled GD. They saw me as more than a checkbox, which let me carry my baby to term and have the birth I was hoping for.

THIS. Thank you. I already posted on this thread with my reasons for choosing a midwife (in a hospital) rather than an OB. I have found some of the other responses frustrating, and couldn't come up with the words for why - this is exactly correct.

If I'm going in for surgery, yup, I want the best possible clinician, not the best bedside manner. But childbirth is very different!

I do wish there was more research/comparisons between outcomes from an OB vs. a CNM in a hospital. When I was trying to look at studies about this in making my decision, there was a real dearth of information on this. Lots of studies on home birth with a midwife, but that's very, very different. And some that compared midwifery to OBs without accounting for location of birth at all, also very different. My instinct is that, yes, there are extreme cases of complex issues where midwives miss things, or can't handle something that pops up, and just the 10 mins it takes to get an OB in the room creates a negative outcome. But that there are also a fair number of people getting c-sections with OBs would wouldn't be getting c-sections if they had gone with a midwife, and a certain very small percentage of those will have negative outcomes because surgery always has risks. I'd love to see numbers on how this stacks up. Even the (agree, somewhat condescending) medical practitioner who commented on page two said "A midwife in a practice with physicians seems fine as there is backup easily available" and that's where I landed - but I'd love to see research on this, especially now that there are so many CNM working in hospitals.

Where did you look, and what search criteria did you use?

I just checked and I found a good amount of information on outcomes of hospital-based CNMs and OBs, including a recent study on outcomes with a total N ~1500.

I'm the PP you quoted. This was over two years ago now, so I honestly don't remember, but if you've found something please post a link! I'm eager to look. Thank you!

Sure. It's a study from 2017 IIRC, so it should have turned up.

Were you at the level of doing a lit review on PubMed, or do you usually just Google for this sort of thing?

Dr. Google, for sure. I'm definitely a layman when it comes to stuff like this, so very possible I missed what I was looking for! I'm trying to find the study you're referring to and I'm still coming up dry - hoping you can help me out!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:A caution from a medical professional - never confuse personality/bedside manners with medical skills/knowledge. Some of the loveliest, warmest doctors were terrible practitioners, but their patients loved them. One of the finest doctors I ever had the privilege to work with had terrible bedside manners - and the greatest assessment and interventional skills that saved many patients. Patients/family would complain that he didn’t smile enough, or didn’t tell jokes with them. You’re choosing someone to manage your child’s birth - why take a midwife over a trained/licensed physician? Seems foolish to me - this isn’t a cocktail party where you want to have a fun evening. A midwife in a practice with physicians seems fine as there is backup easily available. I’d go with an OB physician every time - I want the best trained, most educated professional who can step up in an emergency.

Yes +1. I had a midwife assisted birth for my first delivery (was planning an unmedicated vaginal birth) and it was a goddamn train wreck. I had unanticipated complications and needed physician collaboration and it was not handled well - there was role confusion, it was unclear who was in charge, they had different ideas about what to do, etc. The midwives I was with thought pushing for hours was totally fine and didn’t feel the need to warn me of the risks of prolonged second stage or pelvic floor injury so my mismanaged birth resulted with me having permanently injured my pelvic floor so badly I would need C-sections for all future births. I remember looking at my newborn’s bruises face from being stuck in the birth canal so long and regretting with every core of my being that I had prioritized my experience and emotional support needs over choosing the most skilled medical provider. It’s something I still regret to this day.

You again

Lady, get some therapy and stop blaming midwives for your birth experience.

I will blame them because it will forever be inappropriate that they allowed and encouraged me to push for nine hours. I was so delirious and exhausted and ignorant I had no idea this was inappropriate. And I have permanent injuries as a result. So don’t ever tell me to shut up.

You actually should shut up, though. Your experience had nothing to do with the midwives. Blame yourself. Plenty of women push for far longer and everything turns out fine. It's perfectly appropriate. Therapy would help you but you're too dense to realize it.

Oh please. I'm the pp. who posted about her mom. Definitely the midwives fault for pushing her away from c section (mostly because they can't do it so they avoid it)

[Anonymous]

My sister was my support person at both my at-home water births. She is now having her 1st using the same midwife I used. I will be her support person. She is due in 3 months. I think my sister has only ever been in a hospital when she broke her leg skiing at age 12. (She is now 32; I was 32 and 36 with my own births). I don't think we ever considered a hospital birth with an OB practice.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My reasons were the same as many folks above, including a terrible experience with an OB practice in DC. My midwifery practice listened to me, and took time to know me as an individual patient.

Pregnancy and childbirth is unlike some other medical experiences, in that the comfort of the patient can have a profound impact on the outcome.

But it wasn't all touchy-feely. The midwives also took an evidence-based approach and took the time to explain the evidence for their decision-making.

For example, I had extremely well-controlled GD. Tested 4x a day, never blew my numbers after the GTT, controlled entirely with diet and exercise. The OB practice would have induced me at 38 weeks regardless of my numbers as a matter of protocol, but the midwifery practice let me carry to term based on the evidence around very well-controlled GD. They saw me as more than a checkbox, which let me carry my baby to term and have the birth I was hoping for.

THIS. Thank you. I already posted on this thread with my reasons for choosing a midwife (in a hospital) rather than an OB. I have found some of the other responses frustrating, and couldn't come up with the words for why - this is exactly correct.

If I'm going in for surgery, yup, I want the best possible clinician, not the best bedside manner. But childbirth is very different!

I do wish there was more research/comparisons between outcomes from an OB vs. a CNM in a hospital. When I was trying to look at studies about this in making my decision, there was a real dearth of information on this. Lots of studies on home birth with a midwife, but that's very, very different. And some that compared midwifery to OBs without accounting for location of birth at all, also very different. My instinct is that, yes, there are extreme cases of complex issues where midwives miss things, or can't handle something that pops up, and just the 10 mins it takes to get an OB in the room creates a negative outcome. But that there are also a fair number of people getting c-sections with OBs would wouldn't be getting c-sections if they had gone with a midwife, and a certain very small percentage of those will have negative outcomes because surgery always has risks. I'd love to see numbers on how this stacks up. Even the (agree, somewhat condescending) medical practitioner who commented on page two said "A midwife in a practice with physicians seems fine as there is backup easily available" and that's where I landed - but I'd love to see research on this, especially now that there are so many CNM working in hospitals.

Where did you look, and what search criteria did you use?

I just checked and I found a good amount of information on outcomes of hospital-based CNMs and OBs, including a recent study on outcomes with a total N ~1500.

I'm the PP you quoted. This was over two years ago now, so I honestly don't remember, but if you've found something please post a link! I'm eager to look. Thank you!

Sure. It's a study from 2017 IIRC, so it should have turned up.

Were you at the level of doing a lit review on PubMed, or do you usually just Google for this sort of thing?

Dr. Google, for sure. I'm definitely a layman when it comes to stuff like this, so very possible I missed what I was looking for! I'm trying to find the study you're referring to and I'm still coming up dry - hoping you can help me out!

Sure, no problem! Google gets you pretty far, but you might well find more references (in the medical context) by using https://pubmed.ncbi.nlm.nih.gov/ . From the user perspective, it works a lot like Google. There are a lot of specific filters and stuff you can use, but that's more advanced. For your purposes, think of it as a free alternative to Google that might get you more specific results.

I was looking at these:

Women's Health Issues. Jul-Aug 2017;27(4):434-440. doi: 10.1016/j.whi.2017.01.002. Epub 2017 Feb 16.
The Cost of Nurse-Midwifery Care: Use of Interventions, Resources, and Associated Costs in the Hospital Setting
Molly R Altman 1 , Sean M Murphy 2 , Cynthia E Fitzgerald 3 , H Frank Andersen 4 , Kenn B Daratha 5
PMID: 28215984 DOI: 10.1016/j.whi.2017.01.002
--> (N is 1444)

Nursing Health Care Perspectives . Jan-Feb 1998;19(1):26-33.
A model for the future. Certified nurse-midwives replace residents and house staff in hospitals
L A Ament 1 , L Hanson
PMID: 10446546
--> (from the abstract, this one is referencing studies from as far back as the nineties, so looking through the reference list might get you more gold to mine)

There are ways to legally get copies of articles for free, if you have to pay to access them otherwise (i.e., they are behind a paywall). Even if you are just looking at the free abstract, you can also use the "similar articles" link on PubMed to expand your search quickly to find other articles that might be relevant. There is also a section that lists other articles which have referenced the one in front of you, and that's usually another useful place to look.

If you want any more detailed info on how to access any of that, just post back.

Best wishes!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My reasons were the same as many folks above, including a terrible experience with an OB practice in DC. My midwifery practice listened to me, and took time to know me as an individual patient.

Pregnancy and childbirth is unlike some other medical experiences, in that the comfort of the patient can have a profound impact on the outcome.

But it wasn't all touchy-feely. The midwives also took an evidence-based approach and took the time to explain the evidence for their decision-making.

For example, I had extremely well-controlled GD. Tested 4x a day, never blew my numbers after the GTT, controlled entirely with diet and exercise. The OB practice would have induced me at 38 weeks regardless of my numbers as a matter of protocol, but the midwifery practice let me carry to term based on the evidence around very well-controlled GD. They saw me as more than a checkbox, which let me carry my baby to term and have the birth I was hoping for.

THIS. Thank you. I already posted on this thread with my reasons for choosing a midwife (in a hospital) rather than an OB. I have found some of the other responses frustrating, and couldn't come up with the words for why - this is exactly correct.

If I'm going in for surgery, yup, I want the best possible clinician, not the best bedside manner. But childbirth is very different!

I do wish there was more research/comparisons between outcomes from an OB vs. a CNM in a hospital. When I was trying to look at studies about this in making my decision, there was a real dearth of information on this. Lots of studies on home birth with a midwife, but that's very, very different. And some that compared midwifery to OBs without accounting for location of birth at all, also very different. My instinct is that, yes, there are extreme cases of complex issues where midwives miss things, or can't handle something that pops up, and just the 10 mins it takes to get an OB in the room creates a negative outcome. But that there are also a fair number of people getting c-sections with OBs would wouldn't be getting c-sections if they had gone with a midwife, and a certain very small percentage of those will have negative outcomes because surgery always has risks. I'd love to see numbers on how this stacks up. Even the (agree, somewhat condescending) medical practitioner who commented on page two said "A midwife in a practice with physicians seems fine as there is backup easily available" and that's where I landed - but I'd love to see research on this, especially now that there are so many CNM working in hospitals.

Where did you look, and what search criteria did you use?

I just checked and I found a good amount of information on outcomes of hospital-based CNMs and OBs, including a recent study on outcomes with a total N ~1500.

I'm the PP you quoted. This was over two years ago now, so I honestly don't remember, but if you've found something please post a link! I'm eager to look. Thank you!

Sure. It's a study from 2017 IIRC, so it should have turned up.

Were you at the level of doing a lit review on PubMed, or do you usually just Google for this sort of thing?

Dr. Google, for sure. I'm definitely a layman when it comes to stuff like this, so very possible I missed what I was looking for! I'm trying to find the study you're referring to and I'm still coming up dry - hoping you can help me out!

Sure, no problem! Google gets you pretty far, but you might well find more references (in the medical context) by using https://pubmed.ncbi.nlm.nih.gov/ . From the user perspective, it works a lot like Google. There are a lot of specific filters and stuff you can use, but that's more advanced. For your purposes, think of it as a free alternative to Google that might get you more specific results.

I was looking at these:

Women's Health Issues. Jul-Aug 2017;27(4):434-440. doi: 10.1016/j.whi.2017.01.002. Epub 2017 Feb 16.
The Cost of Nurse-Midwifery Care: Use of Interventions, Resources, and Associated Costs in the Hospital Setting
Molly R Altman 1 , Sean M Murphy 2 , Cynthia E Fitzgerald 3 , H Frank Andersen 4 , Kenn B Daratha 5
PMID: 28215984 DOI: 10.1016/j.whi.2017.01.002
--> (N is 1444)

Nursing Health Care Perspectives . Jan-Feb 1998;19(1):26-33.
A model for the future. Certified nurse-midwives replace residents and house staff in hospitals
L A Ament 1 , L Hanson
PMID: 10446546
--> (from the abstract, this one is referencing studies from as far back as the nineties, so looking through the reference list might get you more gold to mine)

There are ways to legally get copies of articles for free, if you have to pay to access them otherwise (i.e., they are behind a paywall). Even if you are just looking at the free abstract, you can also use the "similar articles" link on PubMed to expand your search quickly to find other articles that might be relevant. There is also a section that lists other articles which have referenced the one in front of you, and that's usually another useful place to look.

If you want any more detailed info on how to access any of that, just post back.

Best wishes!

CORRECTION: --> (from the abstract, this one is referencing studies from as far back as the [eighties], so looking through the reference list might get you more gold to mine)

PS: Note that studies from 15-25 years ago aren't necessarily relevant to current protocols and outcomes, but if you look at the older studies on PubMed, sometimes you can check out other articles that have referenced the old studies but put it in a more up-to-date context. It's a spiderweb.

Think of medical research as an ongoing conversation. People replicate studies and may or may not be able to confirm the results, or they bring up issues with earlier research that got missed, or they look at how it works in a new context. It's always worth looking forwards and backwards from a given article to see how the conversation got there, and where it went after.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:A caution from a medical professional - never confuse personality/bedside manners with medical skills/knowledge. Some of the loveliest, warmest doctors were terrible practitioners, but their patients loved them. One of the finest doctors I ever had the privilege to work with had terrible bedside manners - and the greatest assessment and interventional skills that saved many patients. Patients/family would complain that he didn’t smile enough, or didn’t tell jokes with them. You’re choosing someone to manage your child’s birth - why take a midwife over a trained/licensed physician? Seems foolish to me - this isn’t a cocktail party where you want to have a fun evening. A midwife in a practice with physicians seems fine as there is backup easily available. I’d go with an OB physician every time - I want the best trained, most educated professional who can step up in an emergency.

Yes +1. I had a midwife assisted birth for my first delivery (was planning an unmedicated vaginal birth) and it was a goddamn train wreck. I had unanticipated complications and needed physician collaboration and it was not handled well - there was role confusion, it was unclear who was in charge, they had different ideas about what to do, etc. The midwives I was with thought pushing for hours was totally fine and didn’t feel the need to warn me of the risks of prolonged second stage or pelvic floor injury so my mismanaged birth resulted with me having permanently injured my pelvic floor so badly I would need C-sections for all future births. I remember looking at my newborn’s bruises face from being stuck in the birth canal so long and regretting with every core of my being that I had prioritized my experience and emotional support needs over choosing the most skilled medical provider. It’s something I still regret to this day.

You again

Lady, get some therapy and stop blaming midwives for your birth experience.

I will blame them because it will forever be inappropriate that they allowed and encouraged me to push for nine hours. I was so delirious and exhausted and ignorant I had no idea this was inappropriate. And I have permanent injuries as a result. So don’t ever tell me to shut up.

You actually should shut up, though. Your experience had nothing to do with the midwives. Blame yourself. Plenty of women push for far longer and everything turns out fine. It's perfectly appropriate. Therapy would help you but you're too dense to realize it.

Really? You must be a CPM or a crazy free birther if you think pushing for NINE hours is anything other than medical malpractice.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My reasons were the same as many folks above, including a terrible experience with an OB practice in DC. My midwifery practice listened to me, and took time to know me as an individual patient.

Pregnancy and childbirth is unlike some other medical experiences, in that the comfort of the patient can have a profound impact on the outcome.

But it wasn't all touchy-feely. The midwives also took an evidence-based approach and took the time to explain the evidence for their decision-making.

For example, I had extremely well-controlled GD. Tested 4x a day, never blew my numbers after the GTT, controlled entirely with diet and exercise. The OB practice would have induced me at 38 weeks regardless of my numbers as a matter of protocol, but the midwifery practice let me carry to term based on the evidence around very well-controlled GD. They saw me as more than a checkbox, which let me carry my baby to term and have the birth I was hoping for.

THIS. Thank you. I already posted on this thread with my reasons for choosing a midwife (in a hospital) rather than an OB. I have found some of the other responses frustrating, and couldn't come up with the words for why - this is exactly correct.

If I'm going in for surgery, yup, I want the best possible clinician, not the best bedside manner. But childbirth is very different!

I do wish there was more research/comparisons between outcomes from an OB vs. a CNM in a hospital. When I was trying to look at studies about this in making my decision, there was a real dearth of information on this. Lots of studies on home birth with a midwife, but that's very, very different. And some that compared midwifery to OBs without accounting for location of birth at all, also very different. My instinct is that, yes, there are extreme cases of complex issues where midwives miss things, or can't handle something that pops up, and just the 10 mins it takes to get an OB in the room creates a negative outcome. But that there are also a fair number of people getting c-sections with OBs would wouldn't be getting c-sections if they had gone with a midwife, and a certain very small percentage of those will have negative outcomes because surgery always has risks. I'd love to see numbers on how this stacks up. Even the (agree, somewhat condescending) medical practitioner who commented on page two said "A midwife in a practice with physicians seems fine as there is backup easily available" and that's where I landed - but I'd love to see research on this, especially now that there are so many CNM working in hospitals.

Where did you look, and what search criteria did you use?

I just checked and I found a good amount of information on outcomes of hospital-based CNMs and OBs, including a recent study on outcomes with a total N ~1500.

I'm the PP you quoted. This was over two years ago now, so I honestly don't remember, but if you've found something please post a link! I'm eager to look. Thank you!

Sure. It's a study from 2017 IIRC, so it should have turned up.

Were you at the level of doing a lit review on PubMed, or do you usually just Google for this sort of thing?

Dr. Google, for sure. I'm definitely a layman when it comes to stuff like this, so very possible I missed what I was looking for! I'm trying to find the study you're referring to and I'm still coming up dry - hoping you can help me out!

Sure, no problem! Google gets you pretty far, but you might well find more references (in the medical context) by using https://pubmed.ncbi.nlm.nih.gov/ . From the user perspective, it works a lot like Google. There are a lot of specific filters and stuff you can use, but that's more advanced. For your purposes, think of it as a free alternative to Google that might get you more specific results.

I was looking at these:

Women's Health Issues. Jul-Aug 2017;27(4):434-440. doi: 10.1016/j.whi.2017.01.002. Epub 2017 Feb 16.
The Cost of Nurse-Midwifery Care: Use of Interventions, Resources, and Associated Costs in the Hospital Setting
Molly R Altman 1 , Sean M Murphy 2 , Cynthia E Fitzgerald 3 , H Frank Andersen 4 , Kenn B Daratha 5
PMID: 28215984 DOI: 10.1016/j.whi.2017.01.002
--> (N is 1444)

Nursing Health Care Perspectives . Jan-Feb 1998;19(1):26-33.
A model for the future. Certified nurse-midwives replace residents and house staff in hospitals
L A Ament 1 , L Hanson
PMID: 10446546
--> (from the abstract, this one is referencing studies from as far back as the nineties, so looking through the reference list might get you more gold to mine)

There are ways to legally get copies of articles for free, if you have to pay to access them otherwise (i.e., they are behind a paywall). Even if you are just looking at the free abstract, you can also use the "similar articles" link on PubMed to expand your search quickly to find other articles that might be relevant. There is also a section that lists other articles which have referenced the one in front of you, and that's usually another useful place to look.

If you want any more detailed info on how to access any of that, just post back.

Best wishes!

Thanks! This is really helpful. It's interesting to see this from a cost perspective - we have good insurance so that was not a factor in our decision, but it's interesting nonetheless. It's so frustrating that you can't see the full article! The first one you linked to is particularly interesting, and does back up my instincts. Copying the results and conclusions sections of the abstract here for everybody:

Results: Reduced use of selected labor and birth interventions (cesarean delivery, vacuum-assisted delivery, epidural anesthesia, labor induction, and cervical ripening), reduced maternal duration of stay, and reduced overall costs associated with CNM-led care relative to OB-GYN-led care were observed for medically low-risk women in a hospital setting. Maternal and neonatal outcomes were comparable across groups.

Conclusions: This study supports consideration of increased use of CNMs as providers for the care of women at low risk for complications to decrease costs for the health care system. The use of CNMs to the fullest extent within state-regulated scopes of practice could result in more efficient use of hospital resources.

I do think, even with a large study, you're missing the extreme cases, several of which people on this board have experienced - birth, no matter the situation, generally goes well. So I'd still be interested in a much larger study, with a huge N, as major problems are probably, what, 1 in a 1000? That means you're talking about one or two cases in a study this size. You're not going to be able to see a statistically significant difference very easily! But this does back up my general thought that by using a midwife, you're decreasing the chance of a c-section without increasing your risk of complications.

The c-section this is really relevant to me, as I want a large family. While your first c-section isn't dramatically more dangerous than a vaginally delivery, your third or fourth is, so I really wanted to avoid one if possible (and I did! Yay midwives!)

Thanks again!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My reasons were the same as many folks above, including a terrible experience with an OB practice in DC. My midwifery practice listened to me, and took time to know me as an individual patient.

Pregnancy and childbirth is unlike some other medical experiences, in that the comfort of the patient can have a profound impact on the outcome.

But it wasn't all touchy-feely. The midwives also took an evidence-based approach and took the time to explain the evidence for their decision-making.

For example, I had extremely well-controlled GD. Tested 4x a day, never blew my numbers after the GTT, controlled entirely with diet and exercise. The OB practice would have induced me at 38 weeks regardless of my numbers as a matter of protocol, but the midwifery practice let me carry to term based on the evidence around very well-controlled GD. They saw me as more than a checkbox, which let me carry my baby to term and have the birth I was hoping for.

THIS. Thank you. I already posted on this thread with my reasons for choosing a midwife (in a hospital) rather than an OB. I have found some of the other responses frustrating, and couldn't come up with the words for why - this is exactly correct.

If I'm going in for surgery, yup, I want the best possible clinician, not the best bedside manner. But childbirth is very different!

I do wish there was more research/comparisons between outcomes from an OB vs. a CNM in a hospital. When I was trying to look at studies about this in making my decision, there was a real dearth of information on this. Lots of studies on home birth with a midwife, but that's very, very different. And some that compared midwifery to OBs without accounting for location of birth at all, also very different. My instinct is that, yes, there are extreme cases of complex issues where midwives miss things, or can't handle something that pops up, and just the 10 mins it takes to get an OB in the room creates a negative outcome. But that there are also a fair number of people getting c-sections with OBs would wouldn't be getting c-sections if they had gone with a midwife, and a certain very small percentage of those will have negative outcomes because surgery always has risks. I'd love to see numbers on how this stacks up. Even the (agree, somewhat condescending) medical practitioner who commented on page two said "A midwife in a practice with physicians seems fine as there is backup easily available" and that's where I landed - but I'd love to see research on this, especially now that there are so many CNM working in hospitals.

Where did you look, and what search criteria did you use?

I just checked and I found a good amount of information on outcomes of hospital-based CNMs and OBs, including a recent study on outcomes with a total N ~1500.

I'm the PP you quoted. This was over two years ago now, so I honestly don't remember, but if you've found something please post a link! I'm eager to look. Thank you!

Sure. It's a study from 2017 IIRC, so it should have turned up.

Were you at the level of doing a lit review on PubMed, or do you usually just Google for this sort of thing?

Dr. Google, for sure. I'm definitely a layman when it comes to stuff like this, so very possible I missed what I was looking for! I'm trying to find the study you're referring to and I'm still coming up dry - hoping you can help me out!

Sure, no problem! Google gets you pretty far, but you might well find more references (in the medical context) by using https://pubmed.ncbi.nlm.nih.gov/ . From the user perspective, it works a lot like Google. There are a lot of specific filters and stuff you can use, but that's more advanced. For your purposes, think of it as a free alternative to Google that might get you more specific results.

I was looking at these:

Women's Health Issues. Jul-Aug 2017;27(4):434-440. doi: 10.1016/j.whi.2017.01.002. Epub 2017 Feb 16.
The Cost of Nurse-Midwifery Care: Use of Interventions, Resources, and Associated Costs in the Hospital Setting
Molly R Altman 1 , Sean M Murphy 2 , Cynthia E Fitzgerald 3 , H Frank Andersen 4 , Kenn B Daratha 5
PMID: 28215984 DOI: 10.1016/j.whi.2017.01.002
--> (N is 1444)

Nursing Health Care Perspectives . Jan-Feb 1998;19(1):26-33.
A model for the future. Certified nurse-midwives replace residents and house staff in hospitals
L A Ament 1 , L Hanson
PMID: 10446546
--> (from the abstract, this one is referencing studies from as far back as the nineties, so looking through the reference list might get you more gold to mine)

There are ways to legally get copies of articles for free, if you have to pay to access them otherwise (i.e., they are behind a paywall). Even if you are just looking at the free abstract, you can also use the "similar articles" link on PubMed to expand your search quickly to find other articles that might be relevant. There is also a section that lists other articles which have referenced the one in front of you, and that's usually another useful place to look.

If you want any more detailed info on how to access any of that, just post back.

Best wishes!

Thanks! This is really helpful. It's interesting to see this from a cost perspective - we have good insurance so that was not a factor in our decision, but it's interesting nonetheless. It's so frustrating that you can't see the full article! The first one you linked to is particularly interesting, and does back up my instincts. Copying the results and conclusions sections of the abstract here for everybody:

The costs are not just monetary.

Results: Reduced use of selected labor and birth interventions (cesarean delivery, vacuum-assisted delivery, epidural anesthesia, labor induction, and cervical ripening), reduced maternal duration of stay, and reduced overall costs associated with CNM-led care relative to OB-GYN-led care were observed for medically low-risk women in a hospital setting. Maternal and neonatal outcomes were comparable across groups.

Conclusions: This study supports consideration of increased use of CNMs as providers for the care of women at low risk for complications to decrease costs for the health care system. The use of CNMs to the fullest extent within state-regulated scopes of practice could result in more efficient use of hospital resources.

I do think, even with a large study, you're missing the extreme cases, several of which people on this board have experienced - birth, no matter the situation, generally goes well. So I'd still be interested in a much larger study, with a huge N, as major problems are probably, what, 1 in a 1000? That means you're talking about one or two cases in a study this size. You're not going to be able to see a statistically significant difference very easily! But this does back up my general thought that by using a midwife, you're decreasing the chance of a c-section without increasing your risk of complications.

The c-section this is really relevant to me, as I want a large family. While your first c-section isn't dramatically more dangerous than a vaginally delivery, your third or fourth is, so I really wanted to avoid one if possible (and I did! Yay midwives!)

Thanks again!

Ah, you can't draw that specific conclusion from this study. That's why you should be assessing it in the context of the broader research conversation.

[Anonymous]

I wanted minimal interventions and thought a midwife was my best chance to avoid a c section. I used a hospital based midwifery practice - best of both worlds.

[Anonymous]

Anonymous wrote:

Anonymous wrote:"My argument is that inconveniences like long waits and office environment are not the markers of bad patient care, which, up until you responded was what we were discussing."

I'm not going to copy and paste the whole thing, but why do you think the above is true? To people who don't have hours to wait for their healthcare providers, yes, long waits become bad care. If the office environment is such that it ignores patient privacy, or doesn't facilitate communication between front office staff and providers, yes, it becomes bad care.

The quality of healthcare is, to me, comprehensive (and most organizations who research that construct agree). Some aspects of care may be more salient than others, but it all goes into determining quality. Also, if you look at the first page of this thread, most of the women described some version of wanting personalized attention/being listened. One woman on the second page talked about wait times, clearly mentioning that she had experience working as a medical assistant in an OB practice, i.e., it was an informed decision. Why are you focusing on wait times as the reason to argue that the women on this thread can't tell what defines quality care when what PPs are actually mentioning is providers paying attention to them?

I'm a brand new poster to this thread. I have been reading this back and forth with growing annoyance.

I am a woman that had a very normal, uncomplicated first pregnancy become a VERY abnormal very complicated very dangerous pregnancy at week 33 very suddenly. My primary MFM at Georgetown was Dr Zilbermann. He was an enormous d. After stepping in the room to do my first BPP after being hospitalized he pretty casually informed me I was at a high risk of stillbirth. He also managed my care so that I made it to almost 37 weeks and delivered a baby that was breathing on her own. He predicted her stay in the NICU to the day. Dr. Drassinower was MUCH nicer to me and I liked her a lot and I have nothing but good things to say about her, but I trusted Dr. Z more by the end.

I waited for no less than 45 minutes for every appointment I had at Georgetown. They had crappy food and a crappy parking facility and crappy admins. And they saved my life and the life of my baby. And I was so grateful for that that when pregnant with my second I happily waited for those appointments again, and more frequently because I was high risk.

At the end of the day if sh*t really hits the fan, the rest doesn't matter. You really do want that weird antisocial guy that seems to know exactly what's going on with you.

To be fair I also think that overall patient care is important and the two should not be mutually exclusive. In my third pregnancy I got that. I was in a smaller city at a prestigious hospital and never waited more than 10 minutes and had excellent care.

And so if I was choosing I would rank them 1) great environment and great doctors, 2) crappy environment and great doctors, 3) great environment with blah doctors, 4) crappy environment with blah doctors, 5) great environment with people who aren't doctors.

I know I personally am biased here because my pregnancy was basically like, worst case scenario, but I agree with the PP that people really do put an oversized amount of importance on things that do not really matter in the end. And for the record, I don't think that means black women should accept not being listened to or that there aren't problems with OB GYN care in this country. But the midwifery model (outside of those groups associated with hospital practices) is just insane to me. Midwives in the united states are not trained and monitored in the formal way they are in other countries and until that happens I just do not understand anyone that doesn't have an OB as backup. My pregnancy was so dangerous that there was a real possibility that both myself AND my daughter would have died. I'm so happy my jerky doctor saved our lives, even if I do wish he had been a little more gentle.

I’m so happy the jerk doctor saved your lives, too!

Also, you admit your bias. “Things that do not really matter in the end” was *your* experience. That doesn’t mean these things don’t matter to other women. What about women who skip appointments because they know they have to wait interminably? Or the ones who don’t bother sharing information that seems trivial to them because they know they’ll be dismissed? PP right that you summarily dismiss midwives as a whole, when CNMs have a great deal of medical training and expertise. I’d never go to a CPM, but a CNM in a hospital? Why not?

Other PP: yeah, it’s not productive to keep going back and forth. Believe me, I know well how scheduling appointments and falling behind works (and the issues with insurance reimbursement)—and it’s great when the long waits are because providers are caring for their patients! But sometimes they’re just overbooked. And sometimes, those long waits mean that women just get up and leave, because if they stay any longer, they’ll get fired from the job that’s crappy about their medical leave (as happened repeatedly to my MIL—not during pregnancy, but for other medical reasons). You’re right: warm and fuzzy doesn’t necessarily mean good medical care and unpleasant doesn’t mean bad medical care. But, also, women on this thread generally weren’t talking about someone unpleasant, they were talking about someone who doesn’t listen to them. And what I was really protesting was the confusion of those things.

[Anonymous]

Anonymous wrote:My sister was my support person at both my at-home water births. She is now having her 1st using the same midwife I used. I will be her support person. She is due in 3 months. I think my sister has only ever been in a hospital when she broke her leg skiing at age 12. (She is now 32; I was 32 and 36 with my own births). I don't think we ever considered a hospital birth with an OB practice.

Do you vaccinate?

[Anonymous]

My middle baby weighed 9 lbs 6 oz at birth and I picked physicians and midwives for baby #3 because I didn’t want a dr to try to induce me early due to concerns about baby size. I kind of split the baby - if you will - because the practice also had physicians if needed. Overall I was happy with my care with them, and they did not induce me.