Midwife -- How does it work?

[Anonymous]

First pregnancy here. I'm 15w and a patient at Capital Women's Care. A friend of mine who's a physician (not an OB) recommended that I look into getting a midwife in addition to an OB for the birth. The way he put it was: the midwife is there to make sure you have a good birth experience, the OB is there to make sure the baby is ok.

We will deliver at Inova Fairfax. And I don't believe CWC offers midwifery services. So, is it possible to find a midwife who will work with an existing OB practice? Are midwives only for women who want to do a "natural" childbirth? (Not me...give me the drugs.)

As you can tell, I know nothing about how to come up with a birth plan or the right provider mix. Any help would be appreciated!

[Anonymous]

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

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

[Anonymous]

Your friend is describing a doula, not a midwife. A midwife delivers your baby (is there to make sure the baby is okay), unless you get transferred out due to risk factors or need a C-section. At that time you would have an OB and not a midwife -- you would not have both in the room, one for you and the other for the baby. That's not how midwifery works.

A doula is there to make sure you have a good birth experience, that you understand what the medical professionals (midwife or OB) are advising/asking, to give you emotional and physical support through labor, but not to catch or take care of the baby.

[Anonymous]

Wait, are you talking about a DOULA? A doula is someone who helps with the birth experience and is in the room while the OBGYN *or* Midwife (typically, it is an either/or, unless you end up needing a Csection or other intervention that can only be performed by an OBGYN) delivers your baby.

[Anonymous]

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

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

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

[Anonymous]

Anonymous wrote:

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

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

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

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

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

[Anonymous]

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

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

[Anonymous]

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

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

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

[Anonymous]

Anonymous wrote:

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

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

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

Ah, okay. My experience has only been with the large midwife groups like Physicians and Midwives, which are not anti-pain-relief.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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

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

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

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

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

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

[Anonymous]

Anonymous wrote:

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

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

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

Perhaps but my awesome midwife recommended an epidural when I was at 9 cm for several hours and not progressing. She wisely suggested that my body needed the relief and rest to progress that final cm. I agreed, got the epidural, slept for 30 mins, woke up and was at 10 cm and ready to push. She also did an amazing job ensuring minimal tearing with both of my 9lbs+ babies.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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

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

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

Perhaps but my awesome midwife recommended an epidural when I was at 9 cm for several hours and not progressing. She wisely suggested that my body needed the relief and rest to progress that final cm. I agreed, got the epidural, slept for 30 mins, woke up and was at 10 cm and ready to push. She also did an amazing job ensuring minimal tearing with both of my 9lbs+ babies.

That's awesome!

[Anonymous]

Your friend is confused about the difference in care provided by an OB, a midwife, and a doula. OBs and midwives essentially provide the same care, with the exception being that midwives do not perform c-sections ever. A doula is not a medical care provider and is there for support for you. S/he can provide some forms of relief during labor such as massage and help with positioning, as well as moral support, which is very important, but they do not deliver babies, full stop.

If you are already feeling like you would like pain medication during labor, you might be more comfortable with an OB for prenatal care, but even that does not guarantee it. My OB was very supportive of me avoiding pain medication for as long as possible while I was in labor and didn't suggest an epidural even once during my 11-hour induction. He literally asked once at a prenatal visit around 36 weeks. When I checked into the hospital, the admitting nurse asked about my preferences, noted it in my chart, and then the next person to mention pain meds was me, saying "I need that epidural now, please summon your anesthesiologist!"

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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

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

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

Ah, okay. My experience has only been with the large midwife groups like Physicians and Midwives, which are not anti-pain-relief.

NP, and I think the only local midwife practice that has been known to discourage epidurals are the GW midwives. And even then, it's not all of them, but some definitely do (at least from what people have said).

I delivered all three of mine with Midwifery Care Associates, who were fantastic, and absolutely not anti-pain relief.

[Anonymous]

I had one with MCA at Shady Grove Hospital and I don't think they were anti-pain relief. Which would have been possible, since it was at a hospital.

Other one I had with Birthcare in Alexandria, and yeah - you are at birth center or your home for delivery, so there is no epidural unless you transfer to hospital. They do want you to take classes to understand coping techniques and the mechanisms of it all. This was all really great though, not in a "anti-epidural" way. (But yeah, epidurals have their own risks - which is why you have professionals administrating.)