There’s more to birth than doctors

Cross-posted at BlogHer

It seems odd to me now that there ever was a time in my life when I didn’t have much knowledge about birth or birth care providers, but when I became pregnant with my first child that’s exactly where I was at. I knew that I wanted to try for a natural birth, but I didn’t know much more beyond that. And so I found myself an obstetrician since that was what “everybody” I knew did. I didn’t have any local mommy friends at the time to offer up their recommendations, so I made my decision on an OB based on the experience a coworker and his wife had. He told me that their OB had let him catch the baby, and since that was something my husband Jody and I had talked about wanting to do and seemed pretty open-minded to me, I figured we would give her a try.

While I don’t recall interviewing this obstetrician per se, she seemed nice enough – though in retrospect her bedside manner was seriously lacking – and she seemed OK with our plans to have a Hypnobirth. In fact, with a few minor exceptions, she agreed to all of our desires on our birth plan and we figured she’d be a good fit for us. After all, she was saying all the right things, so we had no reason to doubt her. Little did I know that when it came time for me to give birth, all bets would be off.

When my time to give birth arrived, my OB’s true colors came shining through and, when reflecting on the experience several months afterward, I felt violated, disrespected, upset, duped and resentful. Yes, I had given birth to a healthy baby which is ultimately what every woman hopes for, but I believe the process and birth experience matters too and mine was seriously lacking. I was left wondering, could there have been another way? A better way?

Back up a few months to the Hypnobirthing childbirth preparation classes my husband and I attended, where I learned of a couple expectant mothers who had plans to have a midwife at their birth rather than an OB. At the time I didn’t know much about midwives – who they were, what they did – and was happy enough with my OB, so I didn’t bother finding out more information. For example, I had no idea that there was a difference between the type of care a midwife provides and that of an OB. I didn’t know what kind of training or schooling a midwife might have. I didn’t know that there were different types of midwives. I didn’t know if midwives attended births in hospitals and/or birthing centers or just at home. I really didn’t have a clue and I have a feeling that I was certainly not alone in that regard.

Here in the United States, giving birth in a hospital with a doctor is the norm. Yet in the majority of cases a midwife-attended birth in a birthing center or at home is just as safe. However, many women have never heard of midwives or what they have heard is often full of misconceptions.

It wasn’t until I had given birth to my daughter, officially joined the “mommy club,” and made some mommy friends of my own that I began to hear more and more about midwives and learn about the role that they play in helping women prenatally, during birth and postnatal.

A midwife attends a woman in labor - from The Business of Being BornI was fortunate in that one of my best friends ended up deciding on a midwife-attended home birth for her second child. She had such a wonderful experience that when I was pregnant with my second child, I decided to leave my new OB (even though she was a far cry better than my previous one) and have a midwife-attended home birth as well.

Thankfully, the word is slowly getting out and more people are learning about the value and importance of midwives thanks to Ricki Lake’s documentary “The Business of Being Born,” which I highly recommend all women and their partners see. It’s available on Netflix.

Here’s a bit more about midwives to help clear up any misconceptions.

What is the role of a midwife?
According to Midwives Alliance of North America, “Midwives are trained to provide comprehensive prenatal care and education, guide labor and birth, address complications, and care for newborns.” You can read about the different variations of midwives at MANA.

Why choose a midwife?
“Throughout most of the world, and most of history, women have labored and birthed with midwives. It is only in the last few decades that it has become common in the U.S. to birth in a hospital setting with a doctor. Being pregnant and giving birth are normal life processes for which a woman’s body is well-designed. Midwifery care has been proven to be a safe and nurturing alternative to physician-attended hospital birth.” – MANA

How does the care of a midwife differ from that of a doctor?
Midwives practice using the Midwifery Model of Care which is based on the fact that pregnancy and birth are normal life processes. This is a fundamentally different approach to pregnancy and childbirth and is in stark contrast to the standard Medical Model of Care.

The Midwives Model of Care includes:

  • monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle
  • providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
  • minimizing technological interventions and;
  • identifying and referring women who require obstetrical attention

The application of this model has been proven to reduce to incidence of birth injury, trauma, and cesarean section.

The women I know who have experienced both the medical model of care and the midwifery model of care prefer the midwifery model. Personally, when I saw my midwife for my prenatal care I felt like a real person, rather than just a number (which is how I felt at one OB’s practice, that I left I might add). I loved that my prenatal appointments with my midwife lasted an hour at a time and never felt rushed. I loved that I formed a bond with my midwife and that she knew me (and my daughter who accompanied me to all of my prenatal appointments) before I gave birth.

MamaAudrey at Deconstructing Motherhood remarks about her decision to go with a midwife and birthing center instead of a doctor and hospital:

I felt like I was in control of my pregnancy at the birth center and that my voice was important. At my doctor, I felt like just another number with a voice that needed to be silenced when heard. Thus began my prenatal care with nurses and midwives.

Mary at My First Pregnancy Ever agrees that there is a big difference between the two models of care.

And I think I can now rant about why I love my MW better than my doctor already. I went to my doctor on the 7th and saw the MW on the 9th. Both were very nice to me but you can so see the difference in their scope of practice.

She goes on to compare and contrast the two visits.

Ultimately the decision on who to have attend her birth is up to the mother, but it is my hope that women might learn from my mistakes and do their research ahead of time. Interview more than one doctor and/or midwife until you find one that is right for you. Knowledge is power.

Related links:
Midwives Alliance of North America
The Big Push for Midwives
Citizens for Midwifery
Midwifery Today
Motherbaby International Film Festival
The Business of Being Born

Blogs by Midwives:
Close to the Root by Kneelingwoman
Navelgazing Midwife
The Journey of an Apprentice Midwife
Homebirth: Midwifery Mutiny in South Australia
Midwife: Sage Femme, Hebamme, Comadrona, Partera
Meconium Happens

* Photo credit: Business of Being Born

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18 thoughts on “There’s more to birth than doctors

  1. What a great post – so informative! I used a MW and Hypnobirthing, but unfortunately had a C-section due to an anatomical issue (big baby with extremely small pelvis). Althugh I am grateful that my daughter and I both emerged unharmed, I feel cheated of the birth experience I had hoped for.
    Anyway I agree that women are under-informed about birthing in the US and cannot wait to see TBBB.
    I was watching The Baby Story yesterday and the OB was yelling “GET ANGRY!” to he mom as she was pushing – it made me want to cry for her! ****sigh****

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  3. Thanks for this informative post! Your experience mirrors mine — I thought my OBs were fine until, well, they weren’t! I went on to have a wonderful, empowered birth with my second child (in the hospital though). But when I was pregnant the first time around, I had no idea until near the end that a midwife was even an option — much less a birth center. How does this stuff NOT get talked about!?

  4. GREAT post. I had a team of midwives through an HMO with my first child and though I ended up with an emergency C-section due to frank breech, I still really felt good through the whole process. My midwife even assisted the ER OB who did my daughter’s delivery – she made it very clear that she would still be “with [me] all the way”.

    With my son last year, I chose a second C-section for a variety of reasons, so I immediately went with an OB. However, this time around I was in the military treatment system (my second husband is military) and I was pleasantly surprised that the hospital offered me three options: my regular family practitioner’s team, a midwife team, or an OB team. WOW – how very empowered I felt – especially knowing how things were in the “old school” military hospitals when my mom had me. ;-) I had my C-section, no regrets, and the surgical/anesthesia team were so amazing that I literally walked out of the hospital feeling as tho I’d been at a SPA. No April Fool’s joke there.

    I agree with you wholeheartedly – the KEY here is to have as much knowledge as possible and to seek a great fit. Moms who walk away from their birthing experience with a light in their eyes have gotten great care; I fear for the ones whose light has been dampened through fear or a loss of their options at the hands of a changeable doc.

    That said, what I really stopped by for was to tell you about a contest for a free soy candle on a friend’s blog. You and your readers may really enjoy it – good luck if you enter. http://www.homesteadoriginals.com/?p=54

  5. Great post and lot of information!
    I had midwife assisting in every birth (3) and even though I always just was helped by the midwife who was on duty at the hospital, and didn’t have the personal connection the whole pregnancy, I felt it the right way for me.

    I saw an OB the whole pregnancy, but was delivered by a midwife. Two of my children were born in Europe, and this is normal over there.

  6. I loved using a midwife too. I wanted to homebirth with my first, but when I went into preterm labor at 23 weeks, that was the end of that. I went on the carry fullterm and my (male) OB turned out to be a bit of a cad.

    With my next three babies, we had new insurance that let me go with a midwife. Plus,I was mentally ready to forgo the epidural. Epidural = yuck. My three youngest arrived drug-free, in a lovely hospital with my midwife.

  7. I always think it is interesting that I had a very different midwife/OB experience. I have to share just to demonstrate that it is more important WHO the caregiver is, not what their credentials are. You can have great natural care from an OB, and you can have horrible care from a midwife. Choosing one or the other doesn’t guarantee your experience.

    When I got pg with Kate, I KNEW that I wanted a midwife and was considering a home birth or birthing center, but we ended up choosing the birthing center in the hospital. Thank goodness we did. I expected my midwife to be with me through labor for support. She didn’t even make it in time for the delivery! A random resident walking by in the hall delivered Kate. I had a quick labor, but I was there for several hours so it isn’t like she didn’t have time. Looking back, she was busy listening to the nurses and not to ME (via the phone). In fact my midwife suggested I go home to labor (via the phone), and I gave birth just 30min later. I was also very disappointed in my after care. Plus we had huge problems during pregnancy when a potential birth defect was discovered. The midwife’s response? “My prayers are with you.” No medical information, no referrals to a genetic counselor, nothing. In retrospect, I can’t believe I didn’t change providers at that point.

    For my second pg, I opted to see the OB we consulted during my first pg regarding the potential birth defect. She was wonderful. She was at the hospital through my entire labor and often in the room. She was very encouraging of unmedicated births, she suggested that I skip the IV & antibiotics despite being Group B Strep Positive since I have quick labors. It was an amazing experience.

    I am still very pro-midwife, and I definitely think that many OBs are intervention prone. I just don’t like to see the issue become polarized. I think it is important to remember that you can get poor care or good care from either type of practitioner.

  8. Excellent post! I recently foudn out I am expecting again and hated to repeat the fellings I felt with my old OB-that they didn’t even know my name when I was giving birth-she had to check my chart.My name is Kitty it isn’t hard to forget.I chose a practice and it is wonderful and I was given the choice between an OB or midwife-it is so nice to have the choice to choose a midwife.

  9. I had midwives for both my pgs. I was very happy with their care, more so with my 2nd than the first.

    Like Kristen, I think good care can come from an OB too, and bad care from midwives also. My 2 midwives were entirely different. In hindsight, I should have chosen someone with more experience when pg with Tim, but everything was so new that I didn’t think it necessary. Not that I had bad care, just that my 2nd midwife was so much more thorough and supportive.

    What perhaps is the most important is that pg women with normal pregnancies have the option of WHO they want to care for them.

    In NZ we have a model whereby you choose a Lead Maternity Carer (LMC). That person can be a midwife or a general practitioner specialising in maternity, or an OB. If you choose a midwife, they will refer you to an OB if they feel it is necessary for whatever reason. (I think if you choose an OB, you also get the hospital midwives looking after you during the birth). The system here isn’t perfect by any means and there is a severe shortage of midwives and GPs who do maternity. But what I like about it is you can “shop around”.

  10. Amen, Amy! Homebirthing is the best choice I ever made! It felt incredible to ‘fire’ my OB and transfer my care to my MW’s. I finally understood what it was to exercise my rights as a patient.

    As for my homebirth story–I have finally gotten to the part where I actually give birth to my daughter on the Birth Stories page at http://www.JulianArts.com

  11. Great post! When I found my midwife half way though my first pregnancy I jumped ship immediately. The quality of care is just so much better and I could see that in every way.

  12. Hi Amy,
    Great post! I totally agree that women should do the research on this!! Knowledge is power, for sure. I was fortunate enough to have my son at home- except that the midwife never made it…long story short…my mom and husband caught Tristan! It was an experience I’ll never forget. I had several little bumps in the road while choosing the MW route…at 36 wks. prego I was told by my midwife she could no longer see me as she had an ongoing legal battle that had come to light. So, w/ 4 wks. left to go…I had to get myself aquainted with a different MW even further from my home. Where I live there are absolutely NO MW’s in town and their not supported by the local hospital either!! Initially, I had planned a water birth at birthing center about 1hr. 1/2 from my home…but at 36 wks. I decided I didn’t want to go any further than that so it was best that a MW come to my home and I deliver in the water here. Well, Tristan had other plans for me and came 1 wk. 1/2 early and came so fast that I didn’t even make it into the birthing pool that was set up in our bdrm. The MW was still on her way but was on the phone during delivery…and arrived about 10 mins. after Tristan was here. I had a rollercoaster ride…but both MW experience were great. There’s no doubt in my mind that I will give birth in my home again. I think it’s the best right a woman can have, but that’s just me. My sister has worked for an OBGYN in town for 15 yrs. and thankfully was kind enough to be a back up physician in case of an emergency! The 2nd MW required that I visit the OB at least once (CA state law) but my 1st MW didn’t even mention it. So, I had to go in and see the Dr. at the very end and of course they wanted to do an ultrasound and all sorts of unnecessary test…but I stuck to my guns and didn’t allow it. They were cool about it. I also did the hypnobirthing and wasn’t really able to apply it but I did have minor contractions from 11pm to about 7AM (when my water broke) and I felt like a mama bear in cave- doing my thing! I wanted to also add a related link…www.pregnantinamerica.com- I heard about this when I was pregnant and don’t know why it hasn’t come to the theater’s yet. Thx.

  13. Excellent post Amy! Yes I too wish that I had known more about my birth options. My OB (who is excellent for the record) I think instilled in me a little bit too much fear of anything but his own ideals. i had a myomectomy (which my OB performed) prior to having children and had some pretty bad scarring on the uterus. Therefore, my OB said that C sections were my only option. It’s only been in recent months that I’ve looked into midwives/doulas more since my close friend is using them instead of her OB. What I’m finding is that midwives are more attentive of the emotional, spiritual and psychological side of childbirth as well as the physical aspect. ARe doulas relatively similar to midwives? Sometimes i find that they are used interchangeably.

  14. Amy! Long time no talk to!

    So funny you post about this. I’m expecting baby number 2 (well number 3 if you count the surrogacy), and I’m shooting for a homebirth. I was searching for a picture of a homebirth (more of a logo) and you came up on page 3 or 4! Then I come and read this post and it just made me so happy. You know what I’ve always loved about your blog? You give information, I feel much more educated after reading your blog. Thank you!!!!

  15. I LOVED “The Business of Being Born.” My husband and I don’t plan to have children, but if we are blessed with a wonderful surprise, I’ll go the midwife route for sure…

    Have you read the book “Baby Catcher”? Love. It!

  16. My first baby was born at a hospital and I did feel violated and nothing went like I wanted it to go (other than having a vaginal delivery). My second baby was born at home with a CPM and was absolutely perfect. I hope I never have to go back. I guess I am crunchy too.

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