Midwife? Family Doctor? OB/GYN?

When I was pregnant with my first child, I didn’t know that I had options for my maternity care. Once I had my pregnancy confirmed by my family doctor, I was promptly given my instructions: “Refer to Obstetrics.”

After asking for referrals, I made my first appointment with a highly recommended OB/GYN.

One of the perks of being her patient was a copy of What to Expect When You’re Expecting.  While perusing the pages, I read of different caregivers—OB/GYN, Family Doctor, and Midwife. My first reaction was that this book needed to be revised. What responsible parent-to-be saw a midwife for a pregnancy? Seeing a family doctor for pregnancy was something that went out of style with my parent’s generation, so obviously another outdated practice! Since I was “with the times,” I continued seeing my OB/GYN, trusting that I was doing the absolute best for my baby and myself.

I soon learned there were tests, interventions, and monitoring — sometimes without medical reason or necessity. When it came time for the birth, interventions upon interventions fell like dominoes in a chain reaction. Every hour or so, there was talk of a c-section.

Needless to say, I no longer blindly accepted what others deemed to be right. I also learned that my experience wasn’t atypical as most of my friends, except the ones who rejected it, were given Pitocin or other measures to start or augment labor.

How had we become a society in which women were no longer considered able to give birth without the help of medicines, machines, and excessive monitoring? Were women suddenly broken? Or was there something else going on?

While I continued to use an OB/GYN for my next two births, I also hired a birth doula, which made a positive difference and helped me feel more empowered.

Then I decided to step out! I had my fourth baby with a family doctor and my fifth baby at home, with the assistance of Midwives.

Since I have experienced the different modalities of care, friends and acquaintances have asked my opinion on these different providers.

Pros and Cons of Different Care Providers

OB/GYN

Most women see an OB/GYN during their pregnancies. While mine was personable, the office was very “medical,” with many tests and monitoring. Long waits and an emphasis on labs and results led me to feel as though I was being put through a system, especially when it came time for the birth.

I quickly understood why a woman might want to shout, “Oh, is the machine having the baby?” whenever a doctor or nurse tells her she’s not experiencing a painful contraction because it’s not registering on the monitor. As someone who strives for natural pregnancy and births, I felt as though my desires were more or less tolerated, rather than supported. On the other hand, if there was a need for emergency intervention, the doctor was equipped.

Family Doctor

A family doctor is able to see the whole family but has extra training in obstetrics. If I needed tests or other interventions, he had access; but he was genuinely supportive of doing things as naturally as possible. While I loved that he was able to see the whole family, I think this contributed to the busyness of his office. In some ways, he was busier than my former OB/GYN.

Midwife

When I told my parents I was seeing a midwife for my fifth pregnancy, they had the idea that I was seeing a “Granny Nurse” from times past. Today’s midwives are highly trained in prenatal care, birth, and newborn care. State requirements vary, so you will need to check the laws in yours as you interview providers.

As for appointments, I enjoyed an hour speaking with the midwife and her apprentices and assistants. Not only did she check the routine things — blood pressure, protein, etc. — but she also asked about nutrition and my emotional well-being. When “Birthing Day” arrived, these ladies felt more like friends and sisters, rather than care providers. I also had the confidence in knowing that if we needed interventions, they knew the appropriate time to transport and would even be able to communicate with the hospital staff.

Advice for Moms-to-Be

If I were a first-time mama-to-be and not quite ready for a homebirth, but wanted to have as natural of a pregnancy and birth as possible, a family doctor who practices obstetrics is a great way to begin.

Note, I have met a couple of great OB/GYN providers who were supportive of mother and baby friendly care.

Above all, read, research, talk to your friends about the details of their maternity care and birth experiences, and interview several care providers to find one with whom you feel comfortable. Another important aspect to talk about is the difference between prenatal care and birth support. Some women have experienced exceptional prenatal care but found the same provider used unnecessary interventions when they got to the big day.

A great site to find resources is Birth Network, where you can find local chapters, providers, and information for your state.

I’m still concerned about the high use of interventions. I’m not a doctor or a midwife, but common sense easily points to a problem in today’s current system. That said, I believe women should give birth where they feel most comfortable, so if that’s in a hospital setting, I highly recommend hiring a doula — a birth advocate who can help you understand your options and support you during your labor and birth. If you’re unable to locate one through a Birth Network, check out DONA or CAPPA.

What provider did you choose, and did you enjoy the experience?  Any advice to share?

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