Thursday, February 21, 2013

OB/GYN and Midwives: It's not a fight, it's personal preference.

Sidenote to my pregnancy posts:  As I post I plan to be completely honest about my feelings and thoughts as we ride this rollercoaster into parenthood.  I plan to use this blog as a way for me to process this journey.  Thanks for taking the time to read.

This was a debated topic in our house for a while, but truthfully it shouldn't be a fight between professionals.  Choosing a midwife or OB/GYN is entirely personal preference.  John didn't know why we wouldn't use an OB/GYN and I definitely knew I wanted a midwife.  We both did a lot of research, but still couldn't come to a conclusion.  Here's a very short version of my understanding of the differences.  I looked at Certified Nurse Midwives because that's what I was interested in.  There are others that have lower levels of schooling that work in birthing centers, but I wasn't interested in that.  Admittedly I am pro midwife, but I tried to get an accurate representation of both sides.  Keep in mind as well there are broad generalizations about both sides.  I don't believe every OB believes that pregnancies are problems and I don't believe all midwives are a sure way to avoid being induced, having a C-section or other interventions. 

1. Schooling = 4 year undergraduate program, Medical School, Residency and Licensure
2. Treats all patients from low to high risk.
3. Views childbirth as an issue that needs to be remedied (child delivered as safely as possible)
4. Can perform surgical procedures if needed.
5. More monitoring during labor including fetal monitors. 
6. Generally in the labor room to check their patient a few times and during pushing
7. The doctor who treats the patient during pregnancy is most often their doctor during labor

Certified Nurse Midwife (CNM)
1. Schooling = 4 year RN program and a Masters in Midwifery
2. Generally treats low risk patients, often will refer a high risk case.
3. Generally offers a more hands off, less interventions approach to childbirth.
4. Views childbirth as a natural process in a woman's life.
5. Have lower rates of induction, Cesarean, epistiotomies and other interventions.
6. Cannot perform C-sections.
7. Have higher rates of natural, vaginal deliveries.
8. Around most of the time during labor.

1. Deliver in a hospital setting.
2. Order epidurals and other medications.
3. I would say they both have hearts for women and babies.

With those facts I was still very pro midwife.  It's valuable to know as well that I've had bad luck with doctors in the past, so I was biased from the start.  Before we even started trying to conceive I knew I wanted to go into the experience with an open mind (as much as I could).  I actually saw an OB/GYN for a physical/preconception appointment since I hadn't been to the doctor in over five years and I loved her.  Even so, I still didn't feel that my heart was pointing me in that direction.

Now John had very valid points in his OB/GYN argument.  He didn't understand why we wouldn't choose the person with the most schooling.  Logical, but I kept reassuring him that if I was high risk or became high risk I wouldn't fight having to switch.  He also initially thought I was against delivering in a hospital because a fair amount of midwives deliver at birthing centers or in homes.  I reassured him that that wasn't the case and I thought a hospital was the best choice for us.  I love that his concerns basically centered around my safety and the safety of our little dragon warrior.  He's such a wonderful husband and he's going to make a great dad.

As we were still locked in our game of tug-o-war I figured out that choosing an OB or a midwife would also include choosing the clinic where we'd go for appointments and the hospital where we would deliver.  Fairview Southdale Hospital is the closest to us, but I had read/heard a few negative comments about how midwives were treated there.  Plus any midwife I would choose would actually be at a separate clinic and only delivered at the hospital.  Which I thought was probably partly to blame for the bad relationship between the OBs and the midwives.  I figured that the stress of that strained relationship was the last thing I would need while I was in labor.  As I continued reading I found Methodist Hospital which isn't too much further away.  Their midwives work in a clinic attached to the hospital and their midwifery program has been there for 10+ years, so the relationship between the doctors and midwives is well established.  John was still on the fence, so I was excited when I found a Meet the Midwives night at the hospital.  John said he was happy to go.  It was weird because we were actually the only couple that wasn't pregnant or very visibly showing.  I was curious what these couples had been doing for prenatal care, but I tend to be on the over prepared side of every situation.  They all told us about themselves, their philosophy as a practice and stats on their practice.  The one that stuck out to me was their Cesarean rate is 9% and the average in some states is up to 40% (See source below).  After they talked for a while individuals asked questions and we got a tour of the birthing floor.  It was currently under construction, but still nice.  Everything will be completed by the time John and I deliver!  After this experience I was jumping for joy and John said he was ready to be on board if it was what I really wanted.  Well it was/is :)  Since we had decided right after we found out we were expecting I called and made my first appointment, January 16th.

We have had two appointments with one midwife so far and the next one scheduled is with a different one.  The one downside to this collective practice is that we get whichever midwife is on call when we deliver.  After being anal about every other detail this didn't bother me.  I'm still not sure why, but I think it has to do with the fact that all the women we met were so compassionate and friendly.  I just don't see us having a problem with any of them.  I'll save the details of the two appointments for another blog post.  Thanks for reading!

Quiz to see which option is for you:

The Business of Being Born (It's streaming on Netflix. SO good!)

There is a plethora of information about this topic and I read many more articles, but I couldn't find them all to post here.  If you want more information just google it.  

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