Trying to understand the midwife route

[Anonymous]

FTM here and originally we thought I was high risk so at 17 weeks, have only seen docs but now should be able to switch.

I love the idea of natural childbirth and will aim for it, but also being realistic at any possibility happening. So then, wondering a few things:

- GW web site says they 'ask that you eat “real” foods and do not consume processed, refined foods, including white flour and sugar' -sounds great but not always possible for me given time and money constraints - do they really judge/not accept if I don't follow that exactly?
- if I do end up needing epidural, c-section, etc. - do they hand me over to OB GYN in the hospital or they cover some aspects of 'unnatural' childbirth?

[Anonymous]

Two of my children were born with hospital affiliated midwives. One was at GW, the other at Shady Grove. Both midwife practices are affiliated with a doctors practice so that if at any point you risk out, they transfer you to the physicians they’ve partnered with.

Regarding GW, people get really worked up about their diet requirements. In reality, they barely mention it during the appointments. I was actually pretty disappointed that they weren’t stricter because I was hoping to use it as a starting point to revamp my diet. They always asked how I was doing and if I had questions, and said try to eat healthy but that’s it. No different than any other OB or midwife. Other friends who have delivered with them have had similar experiences. The only time they talked about diet a little more in depth was during their information session. Aside from that, it was very much a “do your best” approach.

When I made my first appointment, the person on the phone told me to write down everything I’d eaten in the past 24 hours and bring it with me so we could discuss diet. I was looking forward to getting a critique of my diet and maybe suggestions for improvement—something! I was really disappointed and a little annoyed that they didn’t talk about it at all. When I brought it up, the midwife was like “Yeah, definitely focus on eating healthy — there are lots of suggestions on our website” and then moved on to something else.

[Anonymous]

When I started at WHC I tried to figure out the difference between the midwives and the OBs and all I could gather was the midwives have a yoga ball. I had no preference coming in so I just defaulted to the OBs but honestly I still don’t get the difference.

[Anonymous]

Agree with PP re GW midwives and the diet stuff.

As for interventions, the GW midwives actually recommended an epidural for me after a very hard, long, and unproductive labor. The docs administered the epidural, and the baby wound up a forceps delivery, so a doc handled that, but the midwives stayed involved and followed up with me after.

FWIW, for my second, I did not use the midwives and did not even try to go without an epidural. Going natural seemed really important to me the first time around. But after experiencing the magical power of an epidural, it wasn't even a close call for me.

I was also not super happy with all of the midwives, and I felt like they really screwed some things up, which contributed to the long hard labor and the forceps delivery. Fortunately, it all worked out. The baby is healthy and I don't appear to have been too messed up by the foreceps, but it was not willing to roll the dice with them again.

GW docs were all awesome. Some of the midwives are awesome, and I know there's been some turnover, so my experience may no longer be current.

[Anonymous]

I delivered with WHC midwives so would just say midwives are more holistic and I believe will make it easier for you to have an unmedicated birth or at least fewer interventions if possible. However the midwives at WHC actually wanted me to do more GD tests than my Kaiser OB (I’m with Kaiser so they still had to approve). I think this was because of their hospital affiliation but still weird. Other piece of advice is that midwives are not doulas. I still believe that a doula is extremely helpful if you want an in medicated birth. The midwife is not going to be able to provide that extra support and I kind of expected that with my first but really they are the medical provider.

[Anonymous]

I had my first at GW with the docs. I wanted no medical intervention. I’d met with a midwife group NP early in pregnancy and she assured me there’s a lot of crossover there and the doctors would support my birth plan to the extent they could. Appointments during pregnancy were the same.

The doctor and nurse when I arrived at hospital in labor were awful. He has since retired, but he was not supportive of no medical intervention and pushed pitocin. I was scared and took it. Probably would have had an epi. But there was a shift change and the new nurse was amazing. Totally supportive, lots of ideas to try. New doctor was also great.

So my sense is with the docs it may be a crapshoot if who is on call when you deliver. But I’ve also heard that since that doc retired it’s more reliable.

Delivered my second at WHC with an epi, and while I didn’t like the way the epi made me feel, it was nice to not be out of my mind in pain. I saw my husband cut the cord. I saw them announce the baby’s sex. I missed all of that the first time. But like I said I hated the epi. I’m glad I’m not having a third!

[Anonymous]

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.

[Anonymous]

I delivered with MCA at Shady Grove. Maybe labor stalled at one point after like 20 hours so I had outpacing and an epidural at my midwife’s insistence. She still delivered the baby. I was glad to be in her care as I wouldn’t likely have ended up in a c-section given how long my labor took.

I also had gestational diabetes and they were really good about taking care of me and that. I had to get regular ultrasounds in the last half of my pregnancy, but again was able to stay with the midwives

[Anonymous]

Anonymous wrote:I delivered with WHC midwives so would just say midwives are more holistic and I believe will make it easier for you to have an unmedicated birth or at least fewer interventions if possible. However the midwives at WHC actually wanted me to do more GD tests than my Kaiser OB (I’m with Kaiser so they still had to approve). I think this was because of their hospital affiliation but still weird. Other piece of advice is that midwives are not doulas. I still believe that a doula is extremely helpful if you want an in medicated birth. The midwife is not going to be able to provide that extra support and I kind of expected that with my first but really they are the medical provider.

What do you mean by “more holistic?”

[Anonymous]

Not sure where PP got her info that midwives can't do epidural deliveries. I've had 2 deliveries handled by midwives. Both were inductions, and I got an epidural both times. Of course the epidural was placed by an anesthesiologist (just as it would be with an OB), but the midwife handled everything else.

[Anonymous]

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

[Anonymous]

i delivered with midwives at GW. was a great experience. we're one and done but would do it again.

im pretty strict about my own diet. especially so when i was eating for me and baby. was on the same page as the midwives, but it was never really a conversation.

[Anonymous]

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

[Anonymous]

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

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

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

[Anonymous]

I delivered my first with Physicians and Midwives in Alexandria. Had an epidural. Delivery was great, I actually had three midwives there while I was pushing because it was shift change and there was a new midwife shadowing the midwife on call. The doctor popped his head in a some point, but that was it.

This was several years ago, it looks like their practice has grown quite a bit since then, but I really liked everyone I saw there. I was bummed when we moved across the country and there weren’t any similarly structured practices.