Anonymous wrote:Because I absolutely did not want men involved in my care. I could not find a women-only OB/GYN practice, so i went with midwives.

Interesting! I have had horrific experiences with female OB/GYNs and have been looking for a male-only OB/GYN practice. Does anyone know if this exists in the DC area or there is a practice that skews male or will guarantee you a certain OB?

Well my sister is a midwife, and I wanted her to deliver my baby so that was always my top choice, luckily I was not a high-risk pregnancy and got to do this.

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.

If it makes you feel any better, I went the OB route and had the same outcome. Poor communication between the resident and attending. Prolonged second stage. Permanent pelvic floor damage and massive hemorrhage. All future births will have to be C-Sections not that I want to risk another pregnancy. I'm sorry you had a bad experience too.

I had read several books related to pregnancy and conception when friends got pregnant and realized midwives in a hospital setting represented the best model of care for my preferences. They would treat pregnancy as something normal not a disease, while using evidence-based methods and having access to OBs and MFMs in case true medical complications appeared.

I’m in my third trimester and I’ve been seeing both the midwives and MFMs since there are some placental abnormalities and it’s all going good so far.

I have always preferred nurse practitioners for my primary care, so it just made sense to me. I was risked out at 27w due to severe preeclampsia and had my baby at 29w. The midwife practice I went to partnered with a MFM for that purpose and appeared to have a lot of mutual respect. Definitely wouldnt' choose a high risk pregnancy and a preemie, but I was happy with the care I received. I don't see it as an adversarial choice. An experienced midwife with a good record is a great choice until you need different care. If your providers are good actors, they will get you what you need.

Med schools are trying to train doctors to be better with bedside manner so maybe the younger OBs will be better. Many physicians actually use midwives. I had a baby in medical training and had mainly midwife care and was delivered by a younger fantastic OB

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Anonymous wrote:I was low-risk, aside from being in my mid-30s, and wanted to minimize unnecessary interventions. I went with a hospital-based midwife practice that was integrated within a larger OB-GYN practice. I ended up having some level of intervention with all three L&Ds (epidurals for two, NICU ped present at delivery for the third), and it was handled seamlessly. I went to an MFM practice for scans; when I developed complications late in my third pregnancy, the midwives transferred me to the OBs as needed.

I was fortunate that I had skilled medical professionals (CNMs) attending my births; included in their medical training is knowing when they needed to transfer care and/or involve a different provider. That also meant they were with me for most of my labors and all of the deliveries, which isn't typically the case when an OB is attending.

21:17 - can you stop patronizing women, please? Your "caution" is pretty thinly disguised.

+1

I went with a practice much like described above and ended up with a c-section by the OBs. The c-section wasn't because I chose a nice smile over a real medical professional because I'm a dumb laydee. It's because that's the way my birth went, and the trained medical professionals with decent human skills that I chose also had the medical knowledge and skill to handle my care correctly.

DP - there are stupid people everywhere of both sexes. 21:17 is speaking to women because it is women who are choosing who provides their care, not because they think women are dumb.

DP, but come on. That post was dripping with condescension. Do women really need to be reminded about not confusing personality with clinical acumen? Really?

Well, let’s see - just on this thread alone, the reasons given for choosing midwives include the doctor made me wait too long, he talked down to me, it felt like an assembly line, wanted someone loving. All legitimate reasons for choosing someone, and I completely respect that, but not a whole lot to do with clinical acumen. Pregnancy is a vulnerable time. We all want to be protected and nurtured but sometimes the person who can best protect our health and well being isn’t the person who can provide the nurturing. There’s nothing wrong with a reminder that there are times when these roles should be separated.

Another PP alluded to this, but the bolded is bullpuckey. We KNOW that health outcomes are impacted by interactions, and particularly for women of color (see that damning series by ProPublica on maternal mortality outcomes for more). Providers who *listen* to their patients and *trust* them ARE providing better care! You honestly think a condescending physician is providing good care? Shame on you.

Where do *you* get off comparing the health effects of systematic racism to the minor inconvenience of waiting too long for an appointment? Because that is what we are talking about here. The studies correlating maternal experience to outcomes are not talking about waiting room waits or rude doctors. No one here has said or even suggested that they picked a midwife because they felt that their race was affecting the medical care they received with an OB. If you can’t see the difference between built in systematic racism in healthcare and a doctor with poor bedside manner, I don’t know what to tell you.

Signed, a Woman of Color tired of others presuming to know what’s best for me

16:13 again. By the way, I’ll be sure to tell my Head of Department OB, who has some of the worst beside manner that I’ve ever seen, what terrible care he provided me when he saved my life. After all, I can’t honestly think that a condescending physician can possibly provide good medical care. I’ll be sure to pick the nice one next time over the better qualified one since some lady on the internet told me so.

Do what you want, but don’t presume to speak for me or anyone else. Where did I say I was talking about wait times? You picked something I didn’t even mention to make your point. Inasmuch as rudeness relates to things like not *listening* to patients, yeah, it does affect the quality of their care. How many times did Serena Williams have to insist that she had a PE postpartum before she got a provider to listen to her? But, right, that doesn’t matter.

My point was that things like patient-provider interactions DO matter for the quality of care. Systemic racism is one of the most extreme examples of how interactions matter. I didn’t say those interactions are the only part of it, but you also can’t discount them. Stop trivializing women’s experiences just because they don’t comport with your own.

Nice deflection. You sought to shame me for my opinions (those are your literal words “shame on you”) and you brought up racism when there was literally no one on this thread discussing racism. When your attempt to shame is addressed and you are told that I don’t need to be saved by you, you insist that I’m presuming to speak for you. I have no interest in speaking for you or for anyone other than those who have experienced what I have. Our voice matters and no amount of shaming from you will change that.

Anonymous wrote:

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Anonymous wrote:I was low-risk, aside from being in my mid-30s, and wanted to minimize unnecessary interventions. I went with a hospital-based midwife practice that was integrated within a larger OB-GYN practice. I ended up having some level of intervention with all three L&Ds (epidurals for two, NICU ped present at delivery for the third), and it was handled seamlessly. I went to an MFM practice for scans; when I developed complications late in my third pregnancy, the midwives transferred me to the OBs as needed.

I was fortunate that I had skilled medical professionals (CNMs) attending my births; included in their medical training is knowing when they needed to transfer care and/or involve a different provider. That also meant they were with me for most of my labors and all of the deliveries, which isn't typically the case when an OB is attending.

21:17 - can you stop patronizing women, please? Your "caution" is pretty thinly disguised.

+1

I went with a practice much like described above and ended up with a c-section by the OBs. The c-section wasn't because I chose a nice smile over a real medical professional because I'm a dumb laydee. It's because that's the way my birth went, and the trained medical professionals with decent human skills that I chose also had the medical knowledge and skill to handle my care correctly.

DP - there are stupid people everywhere of both sexes. 21:17 is speaking to women because it is women who are choosing who provides their care, not because they think women are dumb.

DP, but come on. That post was dripping with condescension. Do women really need to be reminded about not confusing personality with clinical acumen? Really?

Well, let’s see - just on this thread alone, the reasons given for choosing midwives include the doctor made me wait too long, he talked down to me, it felt like an assembly line, wanted someone loving. All legitimate reasons for choosing someone, and I completely respect that, but not a whole lot to do with clinical acumen. Pregnancy is a vulnerable time. We all want to be protected and nurtured but sometimes the person who can best protect our health and well being isn’t the person who can provide the nurturing. There’s nothing wrong with a reminder that there are times when these roles should be separated.

Another PP alluded to this, but the bolded is bullpuckey. We KNOW that health outcomes are impacted by interactions, and particularly for women of color (see that damning series by ProPublica on maternal mortality outcomes for more). Providers who *listen* to their patients and *trust* them ARE providing better care! You honestly think a condescending physician is providing good care? Shame on you.

Where do *you* get off comparing the health effects of systematic racism to the minor inconvenience of waiting too long for an appointment? Because that is what we are talking about here. The studies correlating maternal experience to outcomes are not talking about waiting room waits or rude doctors. No one here has said or even suggested that they picked a midwife because they felt that their race was affecting the medical care they received with an OB. If you can’t see the difference between built in systematic racism in healthcare and a doctor with poor bedside manner, I don’t know what to tell you.

Signed, a Woman of Color tired of others presuming to know what’s best for me

16:13 again. By the way, I’ll be sure to tell my Head of Department OB, who has some of the worst beside manner that I’ve ever seen, what terrible care he provided me when he saved my life. After all, I can’t honestly think that a condescending physician can possibly provide good medical care. I’ll be sure to pick the nice one next time over the better qualified one since some lady on the internet told me so.

Do what you want, but don’t presume to speak for me or anyone else. Where did I say I was talking about wait times? You picked something I didn’t even mention to make your point. Inasmuch as rudeness relates to things like not *listening* to patients, yeah, it does affect the quality of their care. How many times did Serena Williams have to insist that she had a PE postpartum before she got a provider to listen to her? But, right, that doesn’t matter.

My point was that things like patient-provider interactions DO matter for the quality of care. Systemic racism is one of the most extreme examples of how interactions matter. I didn’t say those interactions are the only part of it, but you also can’t discount them. Stop trivializing women’s experiences just because they don’t comport with your own.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I was low-risk, aside from being in my mid-30s, and wanted to minimize unnecessary interventions. I went with a hospital-based midwife practice that was integrated within a larger OB-GYN practice. I ended up having some level of intervention with all three L&Ds (epidurals for two, NICU ped present at delivery for the third), and it was handled seamlessly. I went to an MFM practice for scans; when I developed complications late in my third pregnancy, the midwives transferred me to the OBs as needed.

I was fortunate that I had skilled medical professionals (CNMs) attending my births; included in their medical training is knowing when they needed to transfer care and/or involve a different provider. That also meant they were with me for most of my labors and all of the deliveries, which isn't typically the case when an OB is attending.

21:17 - can you stop patronizing women, please? Your "caution" is pretty thinly disguised.

+1

I went with a practice much like described above and ended up with a c-section by the OBs. The c-section wasn't because I chose a nice smile over a real medical professional because I'm a dumb laydee. It's because that's the way my birth went, and the trained medical professionals with decent human skills that I chose also had the medical knowledge and skill to handle my care correctly.

DP - there are stupid people everywhere of both sexes. 21:17 is speaking to women because it is women who are choosing who provides their care, not because they think women are dumb.

DP, but come on. That post was dripping with condescension. Do women really need to be reminded about not confusing personality with clinical acumen? Really?

Well, let’s see - just on this thread alone, the reasons given for choosing midwives include the doctor made me wait too long, he talked down to me, it felt like an assembly line, wanted someone loving. All legitimate reasons for choosing someone, and I completely respect that, but not a whole lot to do with clinical acumen. Pregnancy is a vulnerable time. We all want to be protected and nurtured but sometimes the person who can best protect our health and well being isn’t the person who can provide the nurturing. There’s nothing wrong with a reminder that there are times when these roles should be separated.

Another PP alluded to this, but the bolded is bullpuckey. We KNOW that health outcomes are impacted by interactions, and particularly for women of color (see that damning series by ProPublica on maternal mortality outcomes for more). Providers who *listen* to their patients and *trust* them ARE providing better care! You honestly think a condescending physician is providing good care? Shame on you.

Where do *you* get off comparing the health effects of systematic racism to the minor inconvenience of waiting too long for an appointment? Because that is what we are talking about here. The studies correlating maternal experience to outcomes are not talking about waiting room waits or rude doctors. No one here has said or even suggested that they picked a midwife because they felt that their race was affecting the medical care they received with an OB. If you can’t see the difference between built in systematic racism in healthcare and a doctor with poor bedside manner, I don’t know what to tell you.

Signed, a Woman of Color tired of others presuming to know what’s best for me

16:13 again. By the way, I’ll be sure to tell my Head of Department OB, who has some of the worst beside manner that I’ve ever seen, what terrible care he provided me when he saved my life. After all, I can’t honestly think that a condescending physician can possibly provide good medical care. I’ll be sure to pick the nice one next time over the better qualified one since some lady on the internet told me so.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I was low-risk, aside from being in my mid-30s, and wanted to minimize unnecessary interventions. I went with a hospital-based midwife practice that was integrated within a larger OB-GYN practice. I ended up having some level of intervention with all three L&Ds (epidurals for two, NICU ped present at delivery for the third), and it was handled seamlessly. I went to an MFM practice for scans; when I developed complications late in my third pregnancy, the midwives transferred me to the OBs as needed.

I was fortunate that I had skilled medical professionals (CNMs) attending my births; included in their medical training is knowing when they needed to transfer care and/or involve a different provider. That also meant they were with me for most of my labors and all of the deliveries, which isn't typically the case when an OB is attending.

21:17 - can you stop patronizing women, please? Your "caution" is pretty thinly disguised.

+1

I went with a practice much like described above and ended up with a c-section by the OBs. The c-section wasn't because I chose a nice smile over a real medical professional because I'm a dumb laydee. It's because that's the way my birth went, and the trained medical professionals with decent human skills that I chose also had the medical knowledge and skill to handle my care correctly.

DP - there are stupid people everywhere of both sexes. 21:17 is speaking to women because it is women who are choosing who provides their care, not because they think women are dumb.

DP, but come on. That post was dripping with condescension. Do women really need to be reminded about not confusing personality with clinical acumen? Really?

Well, let’s see - just on this thread alone, the reasons given for choosing midwives include the doctor made me wait too long, he talked down to me, it felt like an assembly line, wanted someone loving. All legitimate reasons for choosing someone, and I completely respect that, but not a whole lot to do with clinical acumen. Pregnancy is a vulnerable time. We all want to be protected and nurtured but sometimes the person who can best protect our health and well being isn’t the person who can provide the nurturing. There’s nothing wrong with a reminder that there are times when these roles should be separated.

Another PP alluded to this, but the bolded is bullpuckey. We KNOW that health outcomes are impacted by interactions, and particularly for women of color (see that damning series by ProPublica on maternal mortality outcomes for more). Providers who *listen* to their patients and *trust* them ARE providing better care! You honestly think a condescending physician is providing good care? Shame on you.

Where do *you* get off comparing the health effects of systematic racism to the minor inconvenience of waiting too long for an appointment? Because that is what we are talking about here. The studies correlating maternal experience to outcomes are not talking about waiting room waits or rude doctors. No one here has said or even suggested that they picked a midwife because they felt that their race was affecting the medical care they received with an OB. If you can’t see the difference between built in systematic racism in healthcare and a doctor with poor bedside manner, I don’t know what to tell you.

Signed, a Woman of Color tired of others presuming to know what’s best for me

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I was low-risk, aside from being in my mid-30s, and wanted to minimize unnecessary interventions. I went with a hospital-based midwife practice that was integrated within a larger OB-GYN practice. I ended up having some level of intervention with all three L&Ds (epidurals for two, NICU ped present at delivery for the third), and it was handled seamlessly. I went to an MFM practice for scans; when I developed complications late in my third pregnancy, the midwives transferred me to the OBs as needed.

I was fortunate that I had skilled medical professionals (CNMs) attending my births; included in their medical training is knowing when they needed to transfer care and/or involve a different provider. That also meant they were with me for most of my labors and all of the deliveries, which isn't typically the case when an OB is attending.

21:17 - can you stop patronizing women, please? Your "caution" is pretty thinly disguised.

+1

I went with a practice much like described above and ended up with a c-section by the OBs. The c-section wasn't because I chose a nice smile over a real medical professional because I'm a dumb laydee. It's because that's the way my birth went, and the trained medical professionals with decent human skills that I chose also had the medical knowledge and skill to handle my care correctly.

DP - there are stupid people everywhere of both sexes. 21:17 is speaking to women because it is women who are choosing who provides their care, not because they think women are dumb.

DP, but come on. That post was dripping with condescension. Do women really need to be reminded about not confusing personality with clinical acumen? Really?

Well, let’s see - just on this thread alone, the reasons given for choosing midwives include the doctor made me wait too long, he talked down to me, it felt like an assembly line, wanted someone loving. All legitimate reasons for choosing someone, and I completely respect that, but not a whole lot to do with clinical acumen. Pregnancy is a vulnerable time. We all want to be protected and nurtured but sometimes the person who can best protect our health and well being isn’t the person who can provide the nurturing. There’s nothing wrong with a reminder that there are times when these roles should be separated.

Another PP alluded to this, but the bolded is bullpuckey. We KNOW that health outcomes are impacted by interactions, and particularly for women of color (see that damning series by ProPublica on maternal mortality outcomes for more). Providers who *listen* to their patients and *trust* them ARE providing better care! You honestly think a condescending physician is providing good care? Shame on you.

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.

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.

Anonymous wrote:

Anonymous wrote:Nothing beats the thrill of not knowing if you'll die from a PPH.

Just kidding. Bleeding out from a PPH is actually quite tiring. And I felt sick to my stomach, too. Or at least I did until I lost consciousness before waking up as a different hospital 24 hours later.

Not PP, but I always tell friends to ask about how the midwife would handle a PPH, and how quickly they can get you someplace they can give you a transfusion. I actually found bleeding out from the PPH to be really relaxing...I was the only one in the room not freaking out! It's now how I hope to go, when my time comes.
I had no warning signs for the PPH, by the way, and was told I had a model vaginal birth when the baby came out! The bleeding started a couple hours later.

Ask the same question of any OB, as well. Not just midwives. This is a scary complication that can occur regardless of who is handling delivery. I've had 3 friends suffer from PPH that were just barely caught in time...all 3 in the hospital, and 2 under OB care, not CNMs. For the most part, after delivery in a hospital setting, it is on the nurses to catch this...at least, that has been my experience.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I was low-risk, aside from being in my mid-30s, and wanted to minimize unnecessary interventions. I went with a hospital-based midwife practice that was integrated within a larger OB-GYN practice. I ended up having some level of intervention with all three L&Ds (epidurals for two, NICU ped present at delivery for the third), and it was handled seamlessly. I went to an MFM practice for scans; when I developed complications late in my third pregnancy, the midwives transferred me to the OBs as needed.

I was fortunate that I had skilled medical professionals (CNMs) attending my births; included in their medical training is knowing when they needed to transfer care and/or involve a different provider. That also meant they were with me for most of my labors and all of the deliveries, which isn't typically the case when an OB is attending.

21:17 - can you stop patronizing women, please? Your "caution" is pretty thinly disguised.

+1

I went with a practice much like described above and ended up with a c-section by the OBs. The c-section wasn't because I chose a nice smile over a real medical professional because I'm a dumb laydee. It's because that's the way my birth went, and the trained medical professionals with decent human skills that I chose also had the medical knowledge and skill to handle my care correctly.

DP - there are stupid people everywhere of both sexes. 21:17 is speaking to women because it is women who are choosing who provides their care, not because they think women are dumb.

DP, but come on. That post was dripping with condescension. Do women really need to be reminded about not confusing personality with clinical acumen? Really?

Well, let’s see - just on this thread alone, the reasons given for choosing midwives include the doctor made me wait too long, he talked down to me, it felt like an assembly line, wanted someone loving. All legitimate reasons for choosing someone, and I completely respect that, but not a whole lot to do with clinical acumen. Pregnancy is a vulnerable time. We all want to be protected and nurtured but sometimes the person who can best protect our health and well being isn’t the person who can provide the nurturing. There’s nothing wrong with a reminder that there are times when these roles should be separated.