Why I Chose a Midwife Over and OB/Gyn

[amileegirl]

First, I want to say that anyone with half a brain can take blood pressure, read a pee-stick, take weight, measure fundal height, check off a list of routine yes/no questions, and make notes.   These are NOT special skills, which is why any doctor willing to do the grunt work is just as capable as a nurse, assistant, or midwife are all equally qualified.

As for vaginal checks, they are completely unnecessary and a definitly an infection hazard no matter if a midwife or OB/Gyn does it.

First some definitions:

A Gynecologist is a specialist in the function, diseases, disorder, and other specific problems of female genital and reproductive anatomy.    Sometimes this includes some of the same functions performed by a Urologist.   Not all gynecologists are obstetricians, choosing to focus all their energy on one dicipline so that they can hone their expertise.  Or they may find that the unpredictability, special attentions, and long hours of labor and delivery is not productive for their practice.

An Obstetrician is a specialist of surgery of and relating to labor and birth.    Obsetricians train in gynecology and do perform the same functions as a gynecologist and may practice both.  However, some obsetricians who find that a dual specialty leaves little time for honing expertise in one area, instead become focused specialists in obstetrics and take care of only high-risk pregnancies that may require medical assistance, special monitor, or sometimes surgery.

A Midwife is a specialist in labor and birth.  She is NOT a specialist of surgery.     She is trained in the same basic skills as any gynecologist and obsetrician and nurse.   An especially good midwife or one in practice for a long time also takes on a basic role as counselor.    One of a midwife's special skills is non-surgical management of the common problems of pregnancy, labor, and birth -- and the ability to recognize when a referral to a specialist obsetrician is the best course of action.

Next some observations:

A gynecoloist and obsetrician is trained to seek, diagnose, and treat problems.   They are specialists in disorders. They pay little attention to conditions of wellness.       ALL doctors are also trained to keep an emotional distance from patients.     There are some (especially those with small practices) who do break this mold and have a more personal approach, but they can be difficult to find.   Not all OB/Gyns are good at their jobs.

There are different types of certifications of midwives.   The traditional midwives are specialists of normal labor and birth, variations of normal, and prevention/managment of common/minor problems.     She is trained to see a pregnant woman as a individual CLIENT not a patient.   And provides one on one attention to a woman, focuses on mental well being, as well as physical wellness.     A nurse-midwife is classically trained and may tend to see pregnant women as patients and often are restricted to stick by stringent rules of the OB or hospital to which they are assigned.    Not all midwives are good at their jobs.

My Personal Comparison List

OB/Gyn

PRO:  Specialist of surgery and the best choice for a complicated, true high risk pregnancy
PRO:  Specialist of disorders and complications.  Especially good for pre-existing conditions
PRO:  Able to prescribe medications for serious conditions.

CON:  Dual practice disciplines means far less focus on really honing either the surgical skill, or the gynecological skill. 
CON:  May not have had much experience with normal vaginal birth (or a new obsetrician may not have attended very many births period).
CON:  Malpractice and insurance woes may lead to an over diagnosis of problems or "just in case" interventions that can lead to serious consequences.
CON:  Sees woman as patient and tends to keep a professional emotional distance
CON:  Office visits with patient tend to be short and terse
CON:  No guarantee that they will attend the birth or perform the surgery.  Any OB on call at a hospital will be attending.
CON:  May rely on routine rules regardless of wellness or individuality of the patient.
CON:  See birth as a problem to be managed and may tend to over-manage.
CON:  Tend to be hostile towards patient initiative, attentiveness, and questioning and midwifery
CON:  Adhere to the oudated medical model of pregnancy management
CON:  Reliance on medication for speeding up labor requiring futher interventions.
CON:  Reliance on medication for pain management rather than suggesting alternatives.
CON:  May appears only at the moment of delivery or when summoned for an issue.
CON:  May have and abundance of patients
CON:  Do not attend homebirths under any circumstances.
CON:  Likely insists on an supine position or half-reclined position for birth even if such a position is not the best for the patient.
CON:  May have a very high rate of routine, unecessary episiotomy; vaginal tears common

GOOD OBs:  
Do not run patients through an office visit like Jiffy Lube. 
Do not take offense to refusal of vaginal checks or treatment (optional or not)  
Give advice and professional opinion, but ultimately accepts patient decision.
Take a hands-off approach to wellness care.
Talk with patient NOT at patient.
Attempts to establish a relationship with patients.
Address questions and concerns with professional sincerity
Encourage patient health care personal responsibility
Researches prescriptions before prescribing even if that means calling a Pharmacist to confirm
Has a strict policy of full disclosure to all patients
Observe pregnancy and labor, and intervene only if strictly necessary
See a c-section as a major surgery and an absolute last resort
(especially good OBs have breech birth experience)
(especially good OBs have VBAC experience)

MIDWIVES

PRO:  Specialist of well-woman care during normal pregancy, labor, and birth.
PRO:  Performs all routine skills normally performed by obstetric assistants
PRO:  Sees women as clients who are personally responsible for their  own health
PRO:  Sees birth as a normal process requireing no management unless a problem arises
PRO:  Client base kept small
PRO:  Nearly always guaranteed to be at the birth, but works with at least one or two other midwife in such a case or clients birthing at the same time.
PRO:  Sees herself as a facilitator, and the woman as the birther.  She catches babies, she does not deliver them.
PRO:  Wealth of knowledge of several birthing positions, variations of normal labor (breech, posterior, etc), relaxation techniques shared with client, and technieques for common and manageable problems of labor and delivery.
PRO:  Has access to all routine basics such as oxygen, infant CPR, basic urine tests, etc.
PRO:  Encourages patient education
PRO:  Makes housecalls at the end of pregnancy and for the birth and after the birth
PRO:  No episiotomies, vaginal tears rare.

CON:  Not a specialist in high-risk pregnancies nor surgery.
CON:  Can not write prescriptions
CON:  Can not repair vaginal tears (even if she knows how, laws may prohibit it)
CON:  State laws may restrict her practice or require affiliation with an OB, which may result in divided attention or reluctance to suggest hospital transfer for unmanageable complications.
CON:  May be inexperienced if new.
CON:  May over manage birth just as diligently as classically trained obstetricians.
CON:  Some may be hostile to all medical personnel
CON:  May be relucant to aknowledge the usefullness of modern medical care

GOOD Midwives:  
Set aside at least an hour for patient and allows patient to use 10 minutes or the whole hour
Are certified in infant and adult CPR
Do not take offense to refusal of vaginal checks or treatment (optional or not)  
Encourages patient responsibility (ex.  allows patient to take own weight at appointment, read pee-stick, teaches how to take fundal height if asked, and instructs on the use of a home fetoscope if desired)
Has a lending library
Has birthing tools on hand and for use (birthing stool, birth balls, birth tubs, fetoscope, etc)
Give advice and professional opinion, but ultimately accepts patient decision.
Take a hands-off approach to wellness care.
Talk with client NOT at client
Attempts to establish a relationship with clients
Knows when a complication can not be managed alternatively and suggests transfer
If client wants to birth on her head, midwife employs the use of a step ladder to accomodate
Address questions and concerns with professional sincerity
Has a strict policy of full disclosure to all clients
(especially good midwives have breech birth experience)
(especially good midwives have VBAC experience)

My Ultimate Wish for the Future of Women Care in the United States

Physicians must choose a dicipline:  Do you want to be a gynecologist or an obstetrician?

Physicians that choose to be obstetricians must apprentice with a midwife and attend 50-100 natural vaginal births.

Traditional Midwives would attend all normal labors and deliveries at home or hospital as client wishes.

Nurse Midwives would primarily work in a hospital and must apprentice with both an obstetrician and a midwife.

Obstetricians would work as equals with midwives and nurse midwives and be available for complications or surgery as they were trained to do.

A pharmacist would be consulted for all prescribed medications.

 

Note:  I had thought to see both an OB and a Midwife at the same time.  Why not?   A general practitioner doesn't care if I see a podiatrist.   I have nothing against surgical expertise so why shouldn't I seek to establish a relationship?     However, the OB was very adamantly against the idea for no explicable reason other than that I could not guarantee that I would have her attend my birth since I wanted a homebirth (which only the midwife does).  "I don't work with midwives."    Well, la-dee-dah, you don't work with a urologist either!  What's that got to do with the price of eggs? 

You spend 5 minutes with me, answer my questions long-and-suffering like, and all you did was check the chart your assistant filled out!  What have you done that is so special to warrant such an attitude?     My midwives sets aside a whole hour for me.  She doesn't shove a packet of brochures at me either.    I take my weight and she rights it down, she shows me the pee stick to let me read it, she takes my blood pressure and shows me the numbers, she takes my fundal height and explains it.   I said no vaginal checks and she hasn't insisted that I do.    She can use a fetoscope and remembers my name without looking at the chart -- can you?   Then she leaves the floor open to me to leave or ask questions or just chit chat.     When I hit third trimester she ill come to MY HOUSE every two weeks so I don't have to lug my pregnant self to her office.  She will attend my birth, clean up, and visit MY HOUSE for post partum checks.

[logansmomma2007]

May. 28, 2009 at 8:05 PM

I agree with you.  I have access to both and I prefer my midwife.  She rocks!

[ToddlerBrain82]

May. 28, 2009 at 9:54 PM

[SxdUpAngel]

Jun. 18, 2009 at 2:47 PM

WHY was this posted the day after I went on vacation?  ; )

I completely agree.  I'm so freaking excited about the midwife!  My office of OBs has been caught in lies, didn't want me to know that my iron level got worse, and they really do act as though it's Jiffy Lube.  When I ask for a test, they have to have a million reasons for me to want it.  Umm, how about the fact that my insurance pays you, you work for me, and I prefer to have a hand in my healthcare.