Midwife or OB? Hopsital or Other?

Midwife or OB?  Hopsital or Other?
When you discover you’re pregnant, after the initial shock or elation, the next step is to decide how you want to care for baby, and yourself, while you prepare to welcome baby into the world.

Just how do you want to welcome baby? What sort of prenatal experience do you desire? What is available in your area? Are you in a position to consider a VBAC (vaginal birth after cesarean)? Are you high risk for some reason? In general terms, there are several options.

Standard, traditional, Western medical care for pregnancy and birth typically involves an obstetrician, his/her team of nurses, the hospital out of which he/she delivers, and their shifts of LDR (labor and delivery) nurses. If you are there in labor, more than 12 hours, you will encounter the typical change shift, and meet new nurses. No matter where you are in your progress. The nurses see you through, communicate to the doctor for you, and when it’s time to pop that baby out, the doctor arrives for the catch. Generally speaking. You also have a wide array of pain medication options, and are in the hospital setting, should an emergency arise. This is very comforting for some.

One variation on this involves something I did, after our first child was a last minute cesarean. I chose a CNM (certified nurse midwife) that saw me though out my pregnancy, and was my sole care provider and advocate in the hospital I chose. At the time, this is where I felt most comfortable, in light of the previous surgical outcome. Turns out, she had to contact the doctor that shared her practice, and we had a second cesarean. In that moment, I was glad to be right down the hall from the OR, as I was completely exhausted, and in excruciating pain. But this route is one that can be good for women, who want a midwife, and the option of a doctor she’s already met, if necessary.
Another consideration is a birth center. A place I still drool over. This would have been my choice, had I known in the beginning what I know now. A team of highly qualified CNMs run the center, the prenatal care, the deliveries, and typically create a setting that is very close to feeling like home. On average, a woman will stay in close contact with her midwife when labor begins, and stay at home till she feels she’d like to come in to the center. At that point, the midwives do everything possible to empower the laboring woman to do this as her body was designed to do. Low lighting? OK. A birthing tub? Check. Soft music? Loud music? Whatever you want. Birthing balls, age old, tried and true birthing positions. And a level of medical equipment to be on the ready, just in case. Often, these centers are close to hospitals, for the unexpected emergency. And these midwives generally will come to your home, to assist, should you want to birth there. Show you the resources to gather what you want for birth, like a home birthing tub. And continue to come daily, as much as you need, to help with lactation, early questions, follow up health care, and the health and development of your baby, the first few weeks.

Some women will not have pregnancies that reasonably allow for a birth center or home birth. But some women find, that a doctor may have determined a pregnancy not fit for this, and a midwife will have a different opinion. These are decisions you will have to research and make on your own. But do just that. Read. Investigate. Prod. Ask questions. Take charge of your pregnancy and delivery as much as you are able. Know there are options.

And if you happen to have family that don’t get the whole “midwife” thing, like mine did not, at first (we must have been trying to save money, they thought!)know these statistics:

A 1991 study examined single vaginal deliveries between 35 and 43 week. With controlled socio-demographic and medical risk factors, these results were discovered:

1. Neonatal mortality was 33% lower for births attended by CNMs.
2. Low birth weights were 31% lower for CNM attended births.
3. On average, the birth weights were 37 grams higher for CNM attended births, and
4. Infant mortality rates were 19% lower for CNM attended births.

In addition, when differences were examined among obstetricians, family practitioners and CNMs caring for low-risk women, these were the results:

1. An 8.8% cesarean section rate for nurse-midwives.
2. A 13.6% cesarean section rate for obstetricians.
3. A 15.1% cesarean section rate for family physicians, and
4. 12.2% fewer resources were used by nurse midwives, as compared to group of physicians.

You may need or desire an OB, and a hospital delivery. You may want a cesarean no matter. It is your choice. But if you would like to know all the options, get busy getting informed. I can only say from personal experience that my time with Judith and Colleen, 2 midwives that cared for me and my last 2 babies, and assisted in their births, was lightyears beyond my experience with the 5 doctors I saw for our first baby. I left the first practice, unsatisfied with the level of compassion, and rotated among the second practice’s 4, without the idea that it could be even better.

For me, the mere memory of Judith hugging me tight during the eventually administered epidural brings a smile, and sometimes, sweet tears. And Colleen’s quiet directions to my husband, when he just wasn’t quite sure how to help me, makes me want to do it all over again. She gave him the confidence to support me. After his feeling so helpless during our first birth, I’ll never forget that. There surely are OBs out there with this level of personal care; I just didn’t meet them. My midwives were there with help and suggestions before we even knew what we needed. And they’ve inspired me to go back to school and become one myself, some day.

Whatever you choose, just do so informed. Blessings on the journey.

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