WHY YOU SHOULD CHOOSE AN OB RATHER THAN A MIDWIFE

I love obstetricians.

Sometimes I think midwives get a bad deal when it comes to our image. I won’t speak for all midwives with this post…but I will speak for myself. Let me make this clear – I am NOT anti-doctor, I am not anti-hospital, I am not anti-intervention. Please read that sentence again….thank you.

I would go so far as to say that I LOVE a good obstetrician!! I am so very grateful that when there is a woman who has complications or issues – I have someone qualified and ready to deal with those issues so that I don’t have to! When I have a client whose birth is not going the way we had hoped, when there are special challenges that need interventions in order to ensure a good outcome, then I am so glad that we have a hospital with those interventions available to us!

OBs are high risk specialists as well as surgeons. They are trained and experienced in dealing with those high risk situations that I gladly step away from and nudge towards them with a grateful smile – “Here….YOU deal with this…glad I don’t have to!”

So what is the benefit to choosing an OB over a midwife? If you have medical issues that could interfere with the pregnancy having a good outcome – you should see an OB! If there is a need for a cesarean – you need to see an OB! I am trained to identify these issues, but not to deal with them. You need someone with a totally different set of skills than I have. (notice: I did not say better…I said different.)

Midwives and doctors make up the complete ‘whole’ when it comes to maternity care. Midwives are trained in HEALTHY…how to maintain healthy, how to identify unhealthy, and how to determine if we can bring ‘unhealthy’ back to healthy or if we need a doctor. OBs are trained in UNHEALTHY…how to respond to unhealthy when it occurs, appropriate responses as unhealthy threatens mom and/or baby. Midwives are not trained in how to deal with the major problems of unhealthy…we transfer those people to an OB. An OB is not trained in normal, healthy pregnancy…they are not trained in how to respond to healthy and keep it healthy…their training is in the complications.

I gladly utilize the skills of an OB for my unhealthy mothers and babies! Why is it that an OB doesn’t gladly utilize the skills of a midwife for their healthy mothers and babies? Why is it that I’ve never gotten a referral from an OB? “This woman and baby are healthy! They have no reason to be at a hospital…they should be seeing a midwife!”

It’s a nice dream, though! OBs and midwives working together for the common goal we all share – the best outcome for this mom and baby.

I see some OBs right now squirming in their seats reading this…yelling at their computer screen the mantra that we hear so often, “But things can go wrong QUICKLY in a birth!! ALL women should be at the hospital in case those things go wrong!!”

To those OBs yelling at me right now (remember I love you!) – do you think we don’t know that there are things that can go wrong quickly? I know all about hospital births, have seen HUNDREDS…have you ever seen a single solitary homebirth?? Have you ever asked what equipment we bring? What skill set we have to deal with the big emergencies that can happen? Yes, midwives specialize in healthy and send to you the unhealthy women….but we also know that emergencies in birth can occur, and because of that we ARE trained in THOSE issues and are ready to respond to those issues in an appropriate manner while we transfer to the hospital. In other words, we start the response process you would have started in the hospital ANYWAYS…therefore the response is not entirely all that different than if they’d had a hospital birth. (oxygen and resuscitation equipment, pitocin, etc…yes, I carry all of that)

Here is what I don’t understand – why would you not want to see someone who is a specialist with what you are dealing with? If I have a heart issue, I’d like to see a cardiologist. If it’s a skin issue, I want a dermatologist. If I am dealing with an unhealthy pregnancy, I’d want to see an obstetrician….but, if you are dealing with a healthy pregnancy, wouldn’t you want to see a midwife? You know, the person specially trained in that area?

So what’s wrong with a birth center run by midwives that is attached to a hospital? Nothing! But what’s wrong with staying home? Why should a woman in labor have to leave the comfort of her home? If her home is not comfortable to her, then a birthing center is a great alternative! But if her home is where she is most comfortable, then why should she have to leave? I’m all about safety, and if it were safer to have your baby at a hospital or in a birthing center, I’d be all over that!! But it’s not. The empirical evidence shows homebirth outcomes to be as good as hospital outcomes.

steps up to her pulpet proudly, taking a moment to look over the crowd before clearing her throat to begin

I HAVE A DREAM! I dream of a world where midwives and OBs work hand-in-hand. Where healthy mothers and babies are happily encouraged to see a midwife, and unhealthy mothers and babies are happily encouraged to see an OB. A world where the common goal for healthy families bonds the two sides together through their mutual respect for each other. I dream of a world where there is TRUST – trust in birth, in the midwife that she will provide good care as well as transfer care when appropriate – but also trust in the doctors that they will not do unnecessary interventions but will ONLY respond to PROBLEMS.

It’s a beautiful world with flowers and a stream and wildlife grazing and a home built right in the middle…and an operating room around the corner. Won’t you join me there?

18 Comments

  1. Vivi wrote:

    I delivered in a hospital because of some complications, but I was seen only by midwives. Those girls kept the hospital staff on their toes. I’m forever grateful to them and can’t speak highly enough of the care I received. By-the-way, I love your site!

    Friday, February 5, 2010 at 11:47 am | Permalink
  2. Shari wrote:

    It’s a beautiful dream! I am holding onto the hope that by the time my daughters are ready to have children of their own it will be a reality.

    Friday, February 5, 2010 at 11:51 am | Permalink
  3. Kewal wrote:

    Well said, Stephanie!

    Friday, February 5, 2010 at 11:52 am | Permalink
  4. Maren wrote:

    You are amazing. Very well said!

    Friday, February 5, 2010 at 12:10 pm | Permalink
  5. Becky wrote:

    It does happen occasionally. When I was pregnant with my twins I was seeing a high risk OB due to some early bp issues. He was head of the OB dept at the time, and his private practice included himself, another OB, and a midwife. He was a very very popular OB in the area, and he hated turning people away…honestly in the 3 pregnancies I saw him through I often wondered if the poor man ever went home. Anyway…if a woman’s pregnancy was going along smoothly he would ask them to see the midwife, assuring them that if he was needed he’d be around. He even sent me to her a time or two (though I personally didn’t care for her, but that had to do with personality and philosophy rather than the title of midwife). Sadly that doctor has mostly retired now (he doesn’t have a private practice anymore, he only teaches at Case Western and works 1 day a week on labor & delivery). But once upon a time there was an OB who did send healthy pregnant women to a midwife…and didn’t get his panties in a bunch over every little thing. How I miss him!

    Friday, February 5, 2010 at 12:48 pm | Permalink
  6. Just one question… Are you EVER wrong? Once again, i agree completly and say BRAVO. Well said.

    Friday, February 5, 2010 at 12:51 pm | Permalink
  7. Rebekah C wrote:

    I loved this one and I heartily agree, 100%. We all have such important roles to play, why can’t we play them nicely?

    Friday, February 5, 2010 at 1:43 pm | Permalink
  8. Diana J. wrote:

    Absolutely lovely!! 🙂

    Friday, February 5, 2010 at 4:00 pm | Permalink
  9. Rebecca wrote:

    Stephanie, first of all, BIG HUGS to Brian for urging you to start a blog. Because of your experience, insight, and passion, we, your grateful clients, can pass this information on in hopes of educating families who otherwise are not aware of the value of a midwife!

    Friday, February 5, 2010 at 10:38 pm | Permalink
  10. Michelle H wrote:

    Hear, hear! Well said!

    Saturday, February 6, 2010 at 1:23 am | Permalink
  11. Marie wrote:

    I love the honesty of this article…I am having my first homebirth after three hospital births. I am a healthy woman who delivers healthy babies, so why why be in a ‘sick house’ to have a baby? We as a society are so disconnected to what is natural; our bodies are designed to concieve, labor, and deliver our offspring. If complications occur then we seek help from the medical professionals, but why rely on them before hand? I advise ALL expectant mothers to do their research before finding a doctor and a hospital to trust their beautiful experieces of motherhood with. My midwife and doula are amazing women who understand, listen, and cherish my experience as much as me. I in no way feel like a number, a walking dollar sign, or a spectical, like I have always felt at the OB offices/hospitals.

    Saturday, February 6, 2010 at 3:23 pm | Permalink
  12. Amy wrote:

    I love this…everything I believe, written much better than I ever could 😉

    Sunday, February 7, 2010 at 4:39 pm | Permalink
  13. DuQuoi wrote:

    so there are a few OBs out here who refer their healthy Moms to the midwives in the practice, and even practice “midwifery style” obstetrics with their high-risk patients. And in the middle, they meet on “shared care” — the best of both!

    Sunday, February 21, 2010 at 5:35 am | Permalink
  14. elfanie wrote:

    DuQuoi:
    Would they EVER refer to a midwife if they didn’t have one in their practice? What about referring for a birthing center birth…or homebirth? Would they ever say, “you’re healthy…there’s no reason for you to be in a hospital”?

    Sunday, February 21, 2010 at 10:21 am | Permalink
  15. Kelli wrote:

    Your dream world sounds a bit like the netherlands. Wait, I’ll find it…

    Thursday, March 4, 2010 at 8:05 pm | Permalink
  16. Kelli wrote:

    What does the maternity care system look like in the Netherlands?
    Midwives are the primary care providers for all low-risk pregnant women and are fully integrated into the Dutch maternity care system. Midwives are independent, autonomous care providers and can attend births at home or in the hospital. Low-risk women are placed into “primary care” with midwives, and women who are at increased risk for complications are placed into “secondary care” with obstetricians; in other words, midwives are the routine provider for most pregnant women, and OBs are the specialists.

    A woman might start out in primary care at the beginning of her pregnancy, and if risk factors arise during pregnancy, in labor, or during the postpartum period, she would be transferred into secondary care with an obstetrician. If the problem is resolved in secondary care, the woman goes back to primary care with a midwife. At the onset of labor, if a woman is in primary care, she can choose to give birth at home or in the hospital with her midwife.

    Thursday, March 4, 2010 at 8:11 pm | Permalink
  17. Tepary wrote:

    I have thought a lot about this post since I saw it a few months ago. I must admit it really angered me at the time. Primarily the problem came down to this – as some one who had a high risk pregnancy reading that it was an unhealthy pregnancy/birth really irritated me. Call it high needs, exceptional needs, high risk, but unhealthy has all sorts of connotations as if there were choices I was making that made it so. I did not. Please be careful with your word choice. I did everything in my power to make my child’s passage into this world as peaceful and healthy as possible. My perinatologist helped me do that. Respected my birth plan. Was an advocate for as few interventions as possible and I never ever felt like I was a dollar sign.

    I work in an environment (not the hospital where I had my child) where OBs and midwives work together. I see them as two sides of the same coin, working with the shared goal of healthy women, healthy pregnancies and healthy children. A perinatologist is a high risk OB, one who works with those of us with high risks with the same goals as the aforementioned.

    I love the approach of the Netherlands. I wish I could have gone through the centering program of my local birth center, but it wasn’t available to me. I value midwives and OB – please respect my birth experience with its one modified intervention for the beautiful powerful experience it was and don’t call it unhealthy.

    Friday, September 23, 2011 at 11:33 pm | Permalink
  18. Hannah wrote:

    Me me me, I will join you there!!! 😉 *thunderous applause* Thank you, thank you, thank you for this post!! I think all too often, those of us who prefer homebirth have this unfair anti-hospital, anti-doctor stigma attached to us, and I hate it! While I was planning my homebirth, everyone who didn’t know much about homebirth would ask me, “But what if you have to transfer to the hospital?” as if it was a bad thing! And I’d always reply, “Then great! I’d be right where I needed to be, and grateful for the hospital!” But I also did everything I could to stay as healthy as possible during pregnancy (plenty of healthy food and water, rest, exercise, chiropractic care, acupuncture, etc) so that I would have a healthy delivery and avoid that hospital, which I did, thank you very much! My homebirth was the most stunning, life-changing, miraculous experience of my life… 90 minutes of active labor and 4 pushes, thank you very much! 😉 It was healthy and beautiful and natural, and I was so glad to be in a home setting instead of a hospital, where I don’t believe that same experience would have been possible at all. I was on hands and knees, on the floor, in the dark, with nobody in the room except my midwives, doula, and husband. I don’t know of many hospitals who could accommodate those kind of births. 😉 Anyway… tangent aside… yay for wonderful midwives and OBs who work together in perfect harmony! It’s a beautiful picture and it’s happening in some places (my midwives have a wonderful relationship with their backup OBs, and their OBs respect the midwives immensely), and I hope oneday to see it happening like that worldwide!!

    Thursday, July 5, 2012 at 9:08 am | Permalink

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  1. Why You Should Choose an OB Rather Than a Midwife « Team Willms on Friday, February 26, 2010 at 10:56 pm

    […] a midwife blogger I hadn’t heard of. I clicked over to check her blog out and found a blog post that well articulates the difference between the services of an OB and those of a midwife. She […]

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