OP you need to find your inner power! Yep, OB's and midwifes oversee your care, however YOU are the one giving birth to this child! OB's are literally there incase something goes wrong (and to then cut you open). They are surgeon's. That's what they do. Assuming you and the baby stay healthy and on track, you are the one doing all the work!

I personally could've cared less who was overseeing my care. FWIW I started with an OB, loved her, but wanted a natural birth and week 16 I switched to a midwife. Water broke at 37 weeks, but labor didn't start (after many natural interventions at the birth center), and I ended up at the hospital for pitocin (which lead to an epidural). I was close to a cs (baby stuck behind my pubic bone, had issues tracking her heart rate), but after 2 hours of pushing out she came.

Really OP, you want a good OB in your back pocket as your "just incase". You will spend the majority of time when you're delivering with a nurse anyways, they dr only comes in to check occasionally and when you're crowning.

OP, if you choose a midwife, you'll still have access to all the benefits of hospitals and of OBs. All hospital based midwives collaborate with OBs, who you can see during pregnancy or during labor/birth. If something goes wrong, a midwife would be able to identify that and call in an OB if needed. In many ways, I think there's LESS of a chance of things going wrong if you have midwifery care -- there is some decent research out there that supports this, that your husband may appreciate reading. For example....
http://apps.who.int/rhl/reviews/CD004667.pdf

Midwife-led versus other models of care for childbearing women (Review) 1 Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Main results
We included 11 trials (12,276 women). Women who had midwife-led models of care were less likely to experience antenatal hospitali- sation, risk ratio (RR) 0.90, 95% confidence interval (CI) 0.81 to 0.99), regional analgesia (RR 0.81, 95% CI 0.73 to 0.91), episiotomy (RR 0.82, 95% CI 0.77 to 0.88), and instrumental delivery (RR 0.86, 95% CI 0.78 to 0.96), and were more likely to experience no intrapartum analgesia/anaesthesia (RR 1.16, 95% CI 1.05 to 1.29), spontaneous vaginal birth (RR 1.04, 95% CI 1.02 to 1.06), feeling in control during childbirth (RR 1.74, 95% CI 1.32 to 2.30), attendance at birth by a known midwife (RR 7.84, 95% CI 4.15 to 14.81) and initiate breastfeeding (RR 1.35, 95% CI 1.03 to 1.76), although there were no statistically significant differences between groups for caesarean births (RR 0.96, 95% CI 0.87 to 1.06). Women who were randomised to receive midwife-led care were less likely to experience fetal loss before 24 weeks’ gestation (RR 0.79, 95% CI 0.65 to 0.97), although there were no statistically significant differences in fetal loss/neonatal death of at least 24 weeks (RR 1.01, 95% CI 0.67 to 1.53) or in fetal/neonatal death overall (RR 0.83, 95% CI 0.70 to 1.00). In addition, their babies were more likely to have a shorter length of hospital stay (mean difference -2.00, 95% CI -2.15 to -1.85).

Anonymous wrote:

Anonymous wrote:Not advocating either way, but I also switched around 20 weeks for my 1st, and at 36 weeks for my 2nd! (Not by choice; we moved across the country and it was necessary.) I had no issues either time - in both cases, my primary OB/Midwife was not necessarily going to be the one to deliver me, and with both deliveries, I had never seen the OB/Midwife who was on-call. It may be different if you have established a very close rapport with your OB, but I think it is definitely possible. The first time around, I switched from an OB to a Midwife for the reasons you stated in your original post. I had a wonderful natural birth in a hospital setting (in Boston). It was an extremely slow night in the hospital and the nurse on duty ended up basically being my doula. She stayed with me the whole time and was so encouraging. I did not choose to have a doula the second time around, but really wished I had. Having unconditional, unwavering support throughout you birth by someone who knows you and knows your desires is really invaluable. All the best to you!

Thank you! Yes, with my current OB, it's a practice with a bunch of people so I won't know exactly who will deliver me. I'm seeing the other doctors along the way, but even if i stay with them, I won't get a chance to see all them before I deliver. A natural birth in a hospital setting sounds perfect to me. I guess I'm afraid to commit to the midwife thing because I'm afraid of something going wrong. I'd like to be in a hospital or at least very close by, just in case. Also my husband is a little worried about me looking into all this - he's just afraid something will happen to me and is leaning more towards wanting me to be around doctors and in a hospital. But I'm absolutely going to keep doing my research so I'm informed!!

OP, something else to consider re: switching to a midwife is that sometimes interventions are indicated. So, ideally, you want a provider who will minimize unnecessary ones but also recommend ones that are needed. Hopefully you won't need any interventions, many women don't. I birthed with a midwife in a hospital, and ended up with more interventions than planned, but did have a vaginal birth. I didn't second-guess her for a minute, and it's probably the thing I'm happiest about in choosing a midwife, in retrospect (healthy baby aside).

You'll get more information from your OB and potential doulas, obviously, but I do think it's worth considering that things may not go as planned, and how that might play out with different providers. Either way, good luck!

Anonymous wrote:OP, I just want to add something to these fantastic responses.

There is a HUGE difference between being supportive of natural birth and being highly experienced in natural birth. If you decide to go whole hog natural birth, for instance, and read Ina May Gaskin, you will see just how rare complications are when a practitioner is extremely experienced and trained to handle complications with positioning and other non-medical methods.

Now, these are things I don't think they spend a lot of time covering in med school; on the other hand, there's no way I would want Ina May to perform my c-section (and she wouldn't volunteer, I'm sure). My OB told me she didn't care at all whether her patients had natural childbirth; totally up to us. But her training and experience and worldview were medical, of course, and she was not there to help support me through a natural childbirth and try to avoid Pitocin/epidural-- that was not her job; her job was delivering a healthy baby. So I think even if your OB is supportive of natural birth, you should be aware that the burden is on you, and your provider should tell you this: to stay out of the hospital as long as possible (and this is harder than you think for a first time mom; none of us THINKS she is going to be the one to show up at the hospital 2 cm dilated and in a great deal of pain), to hope you will not have a poorly positioned baby or non-textbook contractions or other issues that most in the medical profession do not have tons of experience handling "naturally."

Just something to chew on and something I'm sure that The Business of Being Born brought up? It's not necessarily a conspiracy-- I don't think so, at least!-- it's just a matter of the training that OBs receive. They know all the worst things that can happen during birth, are trained to deal with them, and in context Pitocin and epidurals seem like medical miracles, not negative things at all. A doula can help you, but doulas actually are not meant to try to intervene in your medical care.

Yes exactly! I think the documentary was trying to say the same thing - that doctors aren't bad and aren't trying to drug you up, but that they are trained to deal with complicated births, and to know when surgery is needed, and to perform a successful c-section and keep your baby safe and healthy. They just aren't used to natural births and if things aren't progressing, they have medicine that works very well to speed things up. My worry is that if I try to stay away from pitocin, and they think I'm not progressing, I will give in to the pressure because honestly, I'm not a doctor and I'm going to listen to the professional - even if there's a possibility everything would have been just fine if I was in a different setting with a midwife! I think that's what everyone has been warning me about here - and what you're trying to say too. If I go with the hospital setting with the OB, and even with the doula, I need to realize that it might not be easy to stick to my plan, and I have to be ok with that, if that's what I choose. They're just not used to seeing and handling natural births in hospitals, and perhaps particularly Sibley hospital.

Anonymous wrote:Not advocating either way, but I also switched around 20 weeks for my 1st, and at 36 weeks for my 2nd! (Not by choice; we moved across the country and it was necessary.) I had no issues either time - in both cases, my primary OB/Midwife was not necessarily going to be the one to deliver me, and with both deliveries, I had never seen the OB/Midwife who was on-call. It may be different if you have established a very close rapport with your OB, but I think it is definitely possible. The first time around, I switched from an OB to a Midwife for the reasons you stated in your original post. I had a wonderful natural birth in a hospital setting (in Boston). It was an extremely slow night in the hospital and the nurse on duty ended up basically being my doula. She stayed with me the whole time and was so encouraging. I did not choose to have a doula the second time around, but really wished I had. Having unconditional, unwavering support throughout you birth by someone who knows you and knows your desires is really invaluable. All the best to you!

Thank you! Yes, with my current OB, it's a practice with a bunch of people so I won't know exactly who will deliver me. I'm seeing the other doctors along the way, but even if i stay with them, I won't get a chance to see all them before I deliver. A natural birth in a hospital setting sounds perfect to me. I guess I'm afraid to commit to the midwife thing because I'm afraid of something going wrong. I'd like to be in a hospital or at least very close by, just in case. Also my husband is a little worried about me looking into all this - he's just afraid something will happen to me and is leaning more towards wanting me to be around doctors and in a hospital. But I'm absolutely going to keep doing my research so I'm informed!!

Anonymous wrote:OP, it is NOT too late to switch. I switched at 25 weeks to midwives from an OB practice and it was the best decision I could have made. I think my baby's birth would have turned out so, so differently had I stayed with the OBs. Because I switched to midwives, I was able to avoid induction (the OB would have induced at 41 weeks, my baby was born at 41 weeks 4 days), have access to much better pain relief options (the midwives made a tub available for labor, and monitored me very intermittently so that I could move around), and just received care that was already in line with my preferences, so I didn't have to fight for what I wanted.

I understand that feeling like "I'll just stick with where I'm at, and do something different next time", but what happens this time could determine your options next time. If you stay at Sibley and end up with a cesarean, then your options next time around will be much more limited (not all providers are supportive of VBAC or have good VBAC success rates). Also, switching is really not a big deal. I remember being really intimidated at the thought of switching, but it was tough.

A doula is not going to trump an unsupportive provider or setting, so while her support would likely be very useful no matter what path your birth takes, I don't think it's wise to assume that a doula is going to be the answer as far as you being able to have a no/low intervention birth. As a doula myself, I've been hired by women who have similar preferences to yours, and who are with providers/settings similar to yours, and it can be a real uphill battle for them to have the kind of birth they want.

This is an interesting essay: "The First Birth: No Do-Overs"
http://mamabirth.blogspot.com/2010/12/first-birth-no-do-overs-currently.html

Anonymous wrote:OP here: Thanks so much everyone! I'm 22 weeks, so it might be too late for me to switch to a midwifery practice - and it scares me a bit to switch in the middle like that since I've just discovered all this info. I'm thinking I should try the doula route so I can get the support of working towards a natural labor in the hospital and learn techniques to cope. And since it's my first baby, I'll still be there with my Dr. in the hospital if anything goes wrong.
I actually live in Woodbridge, VA. I liked my ob/gyn a lot and just stayed with her, and she delivers at Sibley - she assured me I'd have plenty of time to get there and she's had patients who live further away than me. I'm going to talk to her next time I see her and see how receptive she is to natural birth. Hopefully all goes well and the next time around I'll feel comfortable choosing a midwife!

That's exactly what I'm worried about - having to get a c-section at Sibley and then likely to lose my chance to have a natural birth in the future too. If my doctor does not seem very supportive when i talk to her, then I'll be less likely to try the OB and doula route. I'm going to look into midwife practices near me and start visiting them to see if I'm comfortable with that. Thanks for the info and the essay - I'll check that out!

Anonymous wrote:

Anonymous wrote:OP here: Thanks so much everyone! I'm 22 weeks, so it might be too late for me to switch to a midwifery practice - and it scares me a bit to switch in the middle like that since I've just discovered all this info. I'm thinking I should try the doula route so I can get the support of working towards a natural labor in the hospital and learn techniques to cope. And since it's my first baby, I'll still be there with my Dr. in the hospital if anything goes wrong.
I actually live in Woodbridge, VA. I liked my ob/gyn a lot and just stayed with her, and she delivers at Sibley - she assured me I'd have plenty of time to get there and she's had patients who live further away than me. I'm going to talk to her next time I see her and see how receptive she is to natural birth. Hopefully all goes well and the next time around I'll feel comfortable choosing a midwife!

If you're in Woodbridge, definitely take the Rosebud Doula birthing class: http://rosebuddoula.com/. If you can get Amy as your doula, you will be set, but if not, she can get you in touch with other excellent doulas close to you.

A doula will come to your house in early labor and go with you to the hospital. That continuity and constant care will be wonderful. I can't recommend Amy's childbirth class more highly! And if your OB is not receptive and supportive, it's not too late to transfer care. I've changed practices at seven months and at 36 weeks, and I'm so glad I did, both times. Best wishes!

Thanks!! I will definitely try to take that class, looks awesome! And thanks for the reassurance with switching, I'm going to look into that too.

Anonymous wrote:OP, I just want to add something to these fantastic responses.

There is a HUGE difference between being supportive of natural birth and being highly experienced in natural birth. If you decide to go whole hog natural birth, for instance, and read Ina May Gaskin, you will see just how rare complications are when a practitioner is extremely experienced and trained to handle complications with positioning and other non-medical methods.

Now, these are things I don't think they spend a lot of time covering in med school; on the other hand, there's no way I would want Ina May to perform my c-section (and she wouldn't volunteer, I'm sure). My OB told me she didn't care at all whether her patients had natural childbirth; totally up to us. But her training and experience and worldview were medical, of course, and she was not there to help support me through a natural childbirth and try to avoid Pitocin/epidural-- that was not her job; her job was delivering a healthy baby. So I think even if your OB is supportive of natural birth, you should be aware that the burden is on you, and your provider should tell you this: to stay out of the hospital as long as possible (and this is harder than you think for a first time mom; none of us THINKS she is going to be the one to show up at the hospital 2 cm dilated and in a great deal of pain), to hope you will not have a poorly positioned baby or non-textbook contractions or other issues that most in the medical profession do not have tons of experience handling "naturally."

Just something to chew on and something I'm sure that The Business of Being Born brought up? It's not necessarily a conspiracy-- I don't think so, at least!-- it's just a matter of the training that OBs receive. They know all the worst things that can happen during birth, are trained to deal with them, and in context Pitocin and epidurals seem like medical miracles, not negative things at all. A doula can help you, but doulas actually are not meant to try to intervene in your medical care.

Wonderfully put, PP! I also wanted to suggest reading Ina May Gaskin's book, "Ina May's Guide to Childbirth". Hands down the most comprehensive book covering natural childbirth.

You're not too late to switch.

OP, I just want to add something to these fantastic responses.

There is a HUGE difference between being supportive of natural birth and being highly experienced in natural birth. If you decide to go whole hog natural birth, for instance, and read Ina May Gaskin, you will see just how rare complications are when a practitioner is extremely experienced and trained to handle complications with positioning and other non-medical methods.

Now, these are things I don't think they spend a lot of time covering in med school; on the other hand, there's no way I would want Ina May to perform my c-section (and she wouldn't volunteer, I'm sure). My OB told me she didn't care at all whether her patients had natural childbirth; totally up to us. But her training and experience and worldview were medical, of course, and she was not there to help support me through a natural childbirth and try to avoid Pitocin/epidural-- that was not her job; her job was delivering a healthy baby. So I think even if your OB is supportive of natural birth, you should be aware that the burden is on you, and your provider should tell you this: to stay out of the hospital as long as possible (and this is harder than you think for a first time mom; none of us THINKS she is going to be the one to show up at the hospital 2 cm dilated and in a great deal of pain), to hope you will not have a poorly positioned baby or non-textbook contractions or other issues that most in the medical profession do not have tons of experience handling "naturally."

Just something to chew on and something I'm sure that The Business of Being Born brought up? It's not necessarily a conspiracy-- I don't think so, at least!-- it's just a matter of the training that OBs receive. They know all the worst things that can happen during birth, are trained to deal with them, and in context Pitocin and epidurals seem like medical miracles, not negative things at all. A doula can help you, but doulas actually are not meant to try to intervene in your medical care.

Not advocating either way, but I also switched around 20 weeks for my 1st, and at 36 weeks for my 2nd! (Not by choice; we moved across the country and it was necessary.) I had no issues either time - in both cases, my primary OB/Midwife was not necessarily going to be the one to deliver me, and with both deliveries, I had never seen the OB/Midwife who was on-call. It may be different if you have established a very close rapport with your OB, but I think it is definitely possible. The first time around, I switched from an OB to a Midwife for the reasons you stated in your original post. I had a wonderful natural birth in a hospital setting (in Boston). It was an extremely slow night in the hospital and the nurse on duty ended up basically being my doula. She stayed with me the whole time and was so encouraging. I did not choose to have a doula the second time around, but really wished I had. Having unconditional, unwavering support throughout you birth by someone who knows you and knows your desires is really invaluable. All the best to you!

I agree it is NOT to late to switch, and you should. I switched OBs at 23 weeks (for other reasons than you), and it was no problem. Pregnancy is still long at that point.

Travelling from Woodbridge to Sibley seems insanely far, and Sibley is really not a hospital worth travelling to. I live close to Sibley and don't want to deliver there. They make you pay $290/night to have a (small and dingy) private room, and they are probably among the least supportive of your favored birth method. You have much better options in the area.

OP, it is NOT too late to switch. I switched at 25 weeks to midwives from an OB practice and it was the best decision I could have made. I think my baby's birth would have turned out so, so differently had I stayed with the OBs. Because I switched to midwives, I was able to avoid induction (the OB would have induced at 41 weeks, my baby was born at 41 weeks 4 days), have access to much better pain relief options (the midwives made a tub available for labor, and monitored me very intermittently so that I could move around), and just received care that was already in line with my preferences, so I didn't have to fight for what I wanted.

I understand that feeling like "I'll just stick with where I'm at, and do something different next time", but what happens this time could determine your options next time. If you stay at Sibley and end up with a cesarean, then your options next time around will be much more limited (not all providers are supportive of VBAC or have good VBAC success rates). Also, switching is really not a big deal. I remember being really intimidated at the thought of switching, but it was tough.

A doula is not going to trump an unsupportive provider or setting, so while her support would likely be very useful no matter what path your birth takes, I don't think it's wise to assume that a doula is going to be the answer as far as you being able to have a no/low intervention birth. As a doula myself, I've been hired by women who have similar preferences to yours, and who are with providers/settings similar to yours, and it can be a real uphill battle for them to have the kind of birth they want.

This is an interesting essay: "The First Birth: No Do-Overs"
http://mamabirth.blogspot.com/2010/12/first-birth-no-do-overs-currently.html

Anonymous wrote:OP here: Thanks so much everyone! I'm 22 weeks, so it might be too late for me to switch to a midwifery practice - and it scares me a bit to switch in the middle like that since I've just discovered all this info. I'm thinking I should try the doula route so I can get the support of working towards a natural labor in the hospital and learn techniques to cope. And since it's my first baby, I'll still be there with my Dr. in the hospital if anything goes wrong.
I actually live in Woodbridge, VA. I liked my ob/gyn a lot and just stayed with her, and she delivers at Sibley - she assured me I'd have plenty of time to get there and she's had patients who live further away than me. I'm going to talk to her next time I see her and see how receptive she is to natural birth. Hopefully all goes well and the next time around I'll feel comfortable choosing a midwife!

Anonymous wrote:

Anonymous wrote:OP here: Thanks so much everyone! I'm 22 weeks, so it might be too late for me to switch to a midwifery practice - and it scares me a bit to switch in the middle like that since I've just discovered all this info. I'm thinking I should try the doula route so I can get the support of working towards a natural labor in the hospital and learn techniques to cope. And since it's my first baby, I'll still be there with my Dr. in the hospital if anything goes wrong.
I actually live in Woodbridge, VA. I liked my ob/gyn a lot and just stayed with her, and she delivers at Sibley - she assured me I'd have plenty of time to get there and she's had patients who live further away than me. I'm going to talk to her next time I see her and see how receptive she is to natural birth. Hopefully all goes well and the next time around I'll feel comfortable choosing a midwife!

I switched to the Loudoun Community Midwives at 28 weeks pregnant. I am SO much more relaxed and happier since I did that, and so regret not doing it the first time around-- I liked my OB, prepared for a natural birth, but ended up with an epidural and Pitocin and vacuum extraction at Fair Oaks. Now, maybe that would have happened no matter what, but I really trust my midwives this time around. If you have any doubts, it's not too late to switch to most practices, Wisdom being an exception. Best wishes!

P.S. They all deliver in the hospital, Inova Loudoun, so a nice compromise if you are cautious/hesitant about home or birth center birth.

Anonymous wrote:OP here: Thanks so much everyone! I'm 22 weeks, so it might be too late for me to switch to a midwifery practice - and it scares me a bit to switch in the middle like that since I've just discovered all this info. I'm thinking I should try the doula route so I can get the support of working towards a natural labor in the hospital and learn techniques to cope. And since it's my first baby, I'll still be there with my Dr. in the hospital if anything goes wrong.
I actually live in Woodbridge, VA. I liked my ob/gyn a lot and just stayed with her, and she delivers at Sibley - she assured me I'd have plenty of time to get there and she's had patients who live further away than me. I'm going to talk to her next time I see her and see how receptive she is to natural birth. Hopefully all goes well and the next time around I'll feel comfortable choosing a midwife!

If you're in Woodbridge, definitely take the Rosebud Doula birthing class: http://rosebuddoula.com/. If you can get Amy as your doula, you will be set, but if not, she can get you in touch with other excellent doulas close to you.

A doula will come to your house in early labor and go with you to the hospital. That continuity and constant care will be wonderful. I can't recommend Amy's childbirth class more highly! And if your OB is not receptive and supportive, it's not too late to transfer care. I've changed practices at seven months and at 36 weeks, and I'm so glad I did, both times. Best wishes!