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21st-Jun-2012 03:38 pm [doctors/midwives]
for my 1st pregnancy i saw an ob dr. i didnt care for her and was a bit freaked out a week before delievery day when she told me she would not be in the delivery room. maybe thats normal but i felt like i was thrown into a room with drs i didnt know and didnt know what i expected/wanted with my delivery. most of them pushed for an epidoral as soon as i got there where as if i had had my dr, she would have encourged me and told me i could do it without...because she knew thats what i wanted. so with this pregnancy i switched ob's. but she informed me early on that she would not be called when i go into labor. and that made me a little sad. what is it like with a midwife? are they typically at the delivery? how do i go about finding a midwife? tell me your likes and dislikes about them.

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21st-Jun-2012 09:50 pm (UTC)
It depends on the practice, just as with an OB. Larger practices work on a rotation. Smaller practices will usually catch their own patients whether OBs or midwives.

Both Midwives groups I was with this pregnancy had a call rotation. One was always at the hospital and would be called if you showed up in labor.

My current OBs work out of the hospital. I will get whoever from the practice is on call.
21st-Jun-2012 10:01 pm (UTC)
I assumed you still meant a hospital birth.

If you are having a homebirth, the midwife will typically be there or may have a partner. They try to plan to avoid schedule conflicts.
22nd-Jun-2012 01:10 pm (UTC)
Many partner and small group practices (both OB and midwife) have call rotations too, but they are also more likely to schedule your prenatal visits with both/all of the providers so you have a chance to meet them and get to know them before your delivery.
22nd-Jun-2012 01:15 pm (UTC)
My annoyance with two recent small group practices was that while during the week, one of the group would be there for delivery. On the weekends, holidays or during vacations, they shared call with a different practice. In that event, your baby would be caught by someone you never had a chance to meet.

I was more comfortable with practices that handled call rotation internally.
23rd-Jun-2012 01:42 am (UTC)
Yeah, sounds like it would be a sweet set-up for them (guaranteed weekends and holidays!), but not so awesome for their patients. :-/
21st-Jun-2012 10:04 pm (UTC)
I LOVED my midwives. At My OB/GYNs practice you have the choice of doctor or Certified Nurse Midwife. I chose midwife b/c I fell in love with how equally hands on and hands off they were. I felt they were more in tune with my wishes and never pushed their own agendas on me. Not once with my second child did they mention c-section when I was measuring big for a solid month towards the end and they are all very pro VBAC.

I say midwives because I saw all of the midwives in the practice because they make it a point to make sure you know them all. It is never a guarantee that the midwife/dr you chose will be in the delivery room with you. They rotated throughout my pregnancy so at each appointment I got to know all 7 of the CNMs. With my first pregnancy, the midwife on call was the only one I had not met (she was rather new) and she was so awesome and encouraging. We even joked a bit after I gave birth to my first child. With my second birth I was in labor during a shift change so I saw 2 different midwives both of whom I knew and liked. They were both shocked at how quickly I gave birth and the second one was pleased I was able to do it all natural w/out an epidural. (she was a little pushy w/ natural birth, but was a wonderful midwife overall so I overlooked that)
21st-Jun-2012 10:33 pm (UTC)
I find it weird that neither OB would be at your delivery. The practice I went to with my first had 2 OBs and my primary doctor was there on and off throughout my labor and they actually both did my c-section, together. I would be extremely uncomfortable not having the doctor I knew for 9 months there with me. If you still want an OB, over a midwife, i would suggest finding a practice where they at least try to make it to their patients' deliveries...
21st-Jun-2012 10:46 pm (UTC)
This is what I thought too...weird. Both my kids were born under OB's and both had an OB present at the birth. I find it strange that they wouldn't even be called...? Mine were called even for a couple of false labors!
22nd-Jun-2012 01:02 pm (UTC)
Heh, I always found it weird that you (overseas) seem to always have the OB present at birth! In Germany, we have regular Gyn offices, and Gyn offices with some OB. While in the last case they do the c-sections of their own patients, it doesn't seem to be normal here to have an office gyn attend the birth**. Usually with a hospital birth you get the OB or group of OBs who work the ward in the hospital, and who you might get to know when you do the tour beforehand. But even then in the clinical setting, Obs are mostly only called when there are complications, high risk pregnancies or to give the mom a look-over after birth or cathing - here, it seems to be common for midwives to do the catching.

**Thing is that the insurance for the OB part is humongous! The employed OB/Gyns at the hospital are insured via hospital, everyone with an office has to pay the insurance by themselves, and it's the highest insurance fee of all sub specialties, so many can not afford it (I know locums who only do gyn and no ob for that reason)! So unless someone is really interested in c-sections and surgery, they won't do obstetrics, and just to prenatal and postpartum care. The birth itself is then left to hospital, birth center or home birth midwife (and yes, we had a midwife crisis because their insurance fees were also shooting up to the stars).
22nd-Jun-2012 01:04 pm (UTC)
OP, as others have said, midwives are usually very experienced at what they're doing, which is birth and pre-/postpartum care. If you're worried, I'd try to get in touch with the group of midwives who is attending the hospital you're going to, and try to get to know them and maybe even find one you harmonize best with.
21st-Jun-2012 10:52 pm (UTC)
I chose a hospital birth with a midwife. The practice had 6 or 7 midwives and after the first few visits I started rotating through them to get to know them all. There were 2 midwives that I really did not like but I got lucky and my favorite midwife was the one at the hospital the day I went into labor. The prenatal care I received was very non-clinical in a way. I did get weighed, peed in a cup, measured, etc but they always asked me how I was feeling, asked my husband how he was feeling about the pregnancy, and always had time for any questions we had. My birth could not have been better. My midwife knew I wanted a natural birth so she met me as soon as I got to the hospital, made sure the nurses assigned to me understood that, and got a tub ready for me as soon as I got checked in. She gave me so much confidence and reassurance. She did have to leave for 2 hours but she came right back and stayed with me until I delivered. I never once was offer any drugs for pain and the nurses encouraged me to try any position I wanted to be in. My son was born with meconium all over and they thought he would have to go to NICU to get checked out but my midwife pushed for him to stay with me and I was still able to have my bonding/breastfeeding time and then the NICU staff came to give him a bath right in my room.
21st-Jun-2012 11:11 pm (UTC)
I've used a midwife for both of my pregnancies.

Likes: They spend more time with me than my OB did. They are more sympathetic and understanding when it comes to my "issues". They believe that my way is the right way. (With a little guidance.) They won't pressure me into medications. I have the option to birth in a hospital or at home. (We chose a home birth the first time and hope to do the same this time.) My midwife was there. The clinic operated on a rotation schedule but I considered all of the midwives "MY" midwives. I met with all 3 women on my team and 2 of them ended up at our birth but I knew and was comfortable with both. Often at appointments more than one midwife would sit in so that they could get a good idea about who I was and what my birth plan was. It was a really wonderful experience and barring any complications I intend to use a midwife for subsequent pregnancies as well. :)
22nd-Jun-2012 12:20 am (UTC)
I had similar OB experiences as you with my first two pregnancies. With my third I went with a home birth midwife and could not be happier with that decision. I have never in my life felt that kind of trust in and compassion from a care provider. Even if home birth is not for you, you could seek out a birth center or even just a smaller OB/GYN practice that has both midwives and OBs on staff...then you could find someone who is a good fit for you. The midwifery model of care is totally different than an OBs but it's all going to depend on who you see and where you go. Good luck!
22nd-Jun-2012 12:42 am (UTC)
I had a midwife throughout my entire pregnancy with my daughter. I saw the same midwife for every appointment, except two toward the end when she had a family emergency/sick kid. It turned out that I had an emergency cesarean, and either my midwife or her assistant, who I also saw for virtually every appointment, was there to hold my hand, support both my husband and me, and my first memory upon waking from the surgery was the assistant midwife holding my baby to my breast to nurse. It was fabulous, and even though the c-section was lightyears away from what I wanted, the midwives being there made the experience a little less terrifying. I highly recommend midwifery care if you’re seeking a natural pregnancy and birth, as well as a more personal relationship with your practitioner. My midwife is independent, so she has no affiliation with any hospitals. She has her own freestanding birth center, and also does home births. I would suggest finding a similar midwife, because often hospital midwives are bound by specific hospital policies. As for finding a midwife, I’m not much help as I found mine by word of mouth. But I would start with a Google search. Midwives in Kansas City, MO, for example. If you’re looking for a home birth midwife, then make sure to add that to your search terms. Good luck!
22nd-Jun-2012 12:46 am (UTC)
Another alternative is a family practice doctor.
That's who I see. The only reason he wouldn't be at the birth is if he was out of town. He delivered my first and will be there for my second (first was a natural hospital birth and I'm planning on that for the second).
22nd-Jun-2012 02:04 am (UTC)
I also had a FP doc, who I chose when no midwives were available for my due date. He was all sorts of awesome, and I definitely plan to go with him for the next babe should it happen again that none of the local midwives can take me. :)
22nd-Jun-2012 12:52 am (UTC)
my midwife (homebirth) has been practicing for 20 years and never missed a birth. WHOAH. mine came close though, she made it by 10 minutes.

if you are annoyed by being pushed for an epidural, don't have an OB. if you don't want an epidural to even be an option, don't have a hospital birth. a birth center might be a nice compromise if you want to be close to emergency care ...
22nd-Jun-2012 01:10 am (UTC)
At the midwifery practice that I use there are 4 midwives. You see them all over the course of cour pregnancy, and o e of them will for sure be with you for labor and delivery!
22nd-Jun-2012 02:43 am (UTC)
My original OB/Gyn was part of a large practice so I ended up switching to a practice with one OB and one nurse midwife. I started out seeing the OB, but later met the midwife and I really liked her. I felt like she was really listening to my concerns. I didn't mind the OB either and I think the very small practice made all the difference because I was able to get to know them both. The CNM was going to be with me during my labor and delivery, but I ended up getting pre-eclampsia and she couldn't be there for high risk labors I guess. It was nice to at least know who was going to be checking on me and performed my C-section when it came to that. :-)
22nd-Jun-2012 04:09 am (UTC)
Like other people have said, it's going to depend on what kind of practice you go with. In my city there are three midwives who have independent practices but who sub for each other as needed. I loved my midwife, did not click at all with a substitute who was there for a few appointments, and the actual delivery was attended by a third midwife who fortunately I did click with.

I went to the hospital when my water broke and my first midwife happened to be there for another delivery and checked me out before she went home. The midwife who did the delivery got there right before pushing started and my husband and I were pretty much alone otherwise. Next time I'd like to have a doula so that we do have someone who we get along with who can work as support and an advocate who will (most likely) be there for the entire labor.
22nd-Jun-2012 05:03 am (UTC)
To find my midwives I called my insurance company to see who was covered, and which hospitals they covered and then picked the group that delivered at the hospital I wanted.

My midwives are a group practice, there was only three with my first baby, but now I think there's 6. I see a midwife at each appointment, trying to see each one at least once before labor. When I go into labor the midwife on call will meet me at the hospital and deliver my baby. They also come in and keep tabs on me, doing all the cervical checks and just seeing how things are going. I've really liked having midwives.
22nd-Jun-2012 01:36 pm (UTC)
My first two were with OB's. One was named Dr. Kwak, (<--- can't make that up!) and was really big on scheduling c/s for convenience. Neither OB was present at delivery. The first was delivered by labor nurses, the other was delivered in the ER less than 20 minutes after I arrived. My visits with OB's were strictly 15 minutes or LESS, they were very invasive, did lots of cervical checks, unneccessary bloodwork/labs and I had an ultrasound at nearly every appt. (which is not necessary). Nothing was ever explained to me; I felt like I was just there to observe the OB's do their thing and wasn't allowed a say-so.

My 3rd and 4th were delivered by the same midwife (CNM with hospital privileges). She was always available to answer questions, and never limited my appointment time to "15 minutes or less". DH was able to become really involved in the whole process, which was great for him and our marriage. She met us at the hospital for L&D and didn't leave until she saw we were good with breastfeeding. With our 4th, some nasty things happened with overly eager RN's and an anesthesiologist; she helped my husband push a med cart (no idea why that was there in my room) in front of the door so no one else would come in. Ha!

My 5th is being delivered at a birth center with midwives. This practice is more like an OB practice, where you see someone different at each appt. and there isn't much time to get to know your CNM. You can request that certain midwives be in attendance for the birth but it's really a crap shoot based on scheduling, vacations, etc.
23rd-Jun-2012 06:04 am (UTC)
I had a midwife who practiced solo. She did have back-up midwives from another practice (home births require a secondary midwife). As far as I know, she attended the births of all her clients, which despite her best planning and taking on clients with spaced-out due dates, sometimes meant one birth after another, and little sleep in between.
Commenter purdy286 explains best why midwives are so awesome. It is woman-centered care, and leaves lots of time for getting to know one another. She asks you a lot of questions, and you get to make informed choices on tests and procedures. She'll probably want to meet your husband and other children.

Finding a midwife depends where you are. Put in your state or province name + midwives. I know in Canada, there are provincial websites for midwifery, where you search in your area. In the USA I'm not sure how they work, though I have heard they sometimes share practices with OBs.
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