Midwife and OB Care: A Comparison

As I mentioned when I introduced myself, I am planning to have a midwife-attended home birth, rather than a hospital birth. I do, however, have a regular OB/GYN at my local clinic, and I went to see her about seven weeks into my pregnancy, hoping to build a rapport with her in the (relatively unlikely and highly undesirable) event that I would experience some sort of complication during home birth that would necessitate transfer to a hospital for medical intervention. I therefore have the unique and enlightening opportunity to compare the prenatal care provided at a clinic or hospital by a OB/GYN and the care provided by my midwifes. It is quite the stark contrast indeed.

While I was at the OB/GYN’s office for approximately 45 minutes, I only saw the OB/GYN for about 15. I was first seen by a (very kind and peppy) nurse who asked me a whole battery of health questions. She then went over a sheet of topics that she was required to discuss with me at my first prenatal visit. One of them was nutrition, which she glossed over by saying, “Eat whatever you feel like.” Really? It is a good thing for my unborn child that I am not craving Twinkies and Pepsi. Somewhere in the “things you should avoid” list I made a reference to listeria, and she was shocked by my knowledge. Apparently, at the doctor’s office, they do not expect women to be informed about or in charge of their pregnancies. She also asked me one question about exercise: do you work out? I responded by saying yes, about five hours per week. I attempted to continue by explaining exactly what sort of activity and asking if there were any more effective workouts I could do to make labor easier, but she interrupted with an “oh, that’s great” and continued on her list of questions.

After she left and I changed into the requisite hospital gown (no clothes on underneath, of course) the OB/GYN came in the room and promptly performed a pelvic exam. She asked no questions about my health, well-being, nutrition, or anything along those lines, but did tell me that I needed to get a flu shot. When I refused, she gave me a threatening lecture about how I could end up in the hospital or dead because of the flu virus. Never mind that I am a generally healthy and robust individual who has never had a single issue with the flu, that the flu shot is laced with formaldehyde and mercury (which we are supposed to avoid at all costs, especially during pregnancy – stay away from that fish!), and that the flu shot is not even guaranteed to protect against the flu. It is no more than the CDC’s best guess as to which strains are going to be most prevalent in the coming year; it might provide immunity against a couple of strains, but certainly not all of them. But in any case, I refused the flu shot and got a lecture and a scowl, as I was sitting with my legs spread, feet in stirrups, in a hospital gown. I am sure it is fairly easy to look down on somebody when they are in such a position, and I certainly did not feel like I was on equal footing with my doctor, or equally involved in my own and my baby’s care.

I visited my midwives for the first time about a week later, and the experience was infinitely more pleasant and helpful. Nick and I sat and talked with them for an entire hour, and I got to remain fully clothed for the entire visit. They began by answering all of the questions Nick had about the logistics of home birth, and all of my questions about what sorts of interventions they would or would not perform on my baby after birth. In terms of the flu shot, they emphasized that it was entirely my decision to get it or not to get it. In terms of possible procedures performed on the baby, they were willing to give us all of the information they had on vitamin K administration (oral and injected), antibiotic eye drops, cutting of the umbilical cord, weighing, and Apgar, and then allow us to make our own, informed, decision about if, when, and how we would like them to perform any of these interventions. I feel that as a parent I should be responsible for my child’s health, and an active and informed participant in the medical decision-making process, and (unlike my OB/GYN), my midwives certainly seem to agree with me.

During our hour with the midwives we also discussed pain-management (nonmedical, of course) during labor and childbirth preparation classes. This discussion was entirely lacking at the doctor’s office. We left with the names of several people in our area who are childbirth educators, as well as two books from their lending library concerning natural labor and delivery. The staff at the clinic gave me a folder full of information about their OB/GYN department, along with a sheet of nutritional recommendations that I found absolutely abhorrent (I will be discussing that sheet of paper tomorrow) and a book that I will also be discussing in the weeks to come. And believe me, it will not be a thumbs-up review.

What I took away from my first two prenatal visits is that midwife-supported pregnancy and birth is focused much more on prevention, on keeping women and babies in optimal health, and on giving women the tools, knowledge, and sense of power they need to make it through labor naturally. The medical model of prenatal care is exactly that: medical. There seems to be little focus on staying healthy, getting fit for labor, or being informed or knowledgeable, and much more of an emphasis on medical interventions. And there is a strong sense of disproval when a patient refuses medical intervention. I mentioned the word midwife (not even home birth – I did not dare), and I got a look of reproof for that even stronger than for refusing the flu vaccine. Even after only one visit to the OB/GYN, I can see why the more than one in three births in the United States is by c-section.

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9 Responses to Midwife and OB Care: A Comparison

  1. Dasha Ivashniova says:

    Yep, I am really glad I switched my insurance plan to be able to have a midwife instead of an OB/GYN! Although I ended up giving birth with a lot more medication than I intended to receive, I am really glad it was not administered without me being involved in the discussion.

    Dasha.

    • elliemaeh says:

      It is so horrible that none of the university-sponsored insurance plans cover midwife care – it is so much cheaper than giving birth in a hospital, you would think that they would jump on that bandwagon. I have until October to get a new plan, though, so hopefully I can avoid paying out of pocket.

  2. Linda Nelson says:

    Hi Ellen,
    Just one quick thought, maybe you should change your OB/GYN doctor. I had a similar experience with this doctor when my primary care physician referred me to this OB/GYN for family planning. I was not impressed with with the bedside manner or attitude of this doctor. I also felt this doctor did not really listen to what I was saying. When I did have somewhat of an emergency, and was told by the ER that I needed to see an OB/GYN, I was told by this OB/GYN and staff, I could not get in for two months unless there was a cancellation. Needless to say I found myself a different doctor. Actually, it was my OB/GYN doc who delivered Nate, although this doc was soon to be retired, the doc was, wonderful, compassionate and caring just as he had been with me almost 20 years earlier when I was pregnant!! Not all doctors are like your OB/GYN! Although it is unlikely that you will need an OB/GYN for your delivery, I would suggest you find one you can connect with in case any complications do arise and an OB/GYN is needed.
    With all my love (as always),
    Linda
    XOXO

    • elliemaeh says:

      That is a good idea, and I have thought about it. There are two other OB/GYNs at Riverview that I could see for prenatal care, and I might have to make a switch. The unfortunate thing about a hospital delivery in Janesville, though, is that there is only one OB on call at any given time, and if I did have an emergency situation (in the unlikely and unfortunate event that it did happen) the baby would be delivered by whatever doctor was in the clinic at that time. But it might be in my better interests to develop a relationship with another one of the OBs, just on the off chance that if I would need to go to the hospital and that specific person would happen to be working at the time. At least my prenatal care would be more pleasant! The one thing that actually makes me feel better, though, is that I know if I do end up having to transfer I will have a husband plus two midwives advocating for me and the baby, and I bet the three of them could stand up to any of the Riverview OB/GYNs.

  3. Katie Lubke says:

    Ellen,

    First of all, congratulations! I didn’t know you were expecting. It’s a very exciting time!

    Just a couple thoughts:
    If you are looking for a different Riverview doctor, I have been seeing Dr. Rozeboom. He is not real “touchy-feely” but he does give good information regarding recent research and nutrition. He is still very medically based, but has so far been very respectful of our decisions (no flu shot). We have also elected to go to St. Mary’s for any hospital care. I hope you can enjoy a beautiful home birth, but maybe keep St. Mary’s as your back up? We brought our birth plan to St. Mary’s for Calvin’s birth and they were absolutely wonderful! They followed it better than I wanted to at the time : )

    We also elected to take a 10 week birthing class taught by Bobbi Thomson. She was teaching the Bradly Method at the time and has recently transitioned into teaching the Brio Method. She currently lives in Janesville, but is moving to Beloit early this summer. She did a very nice job of covering nutrition, the stages of labor, relaxation techniques, and breastfeeding. She provides a very holistic approach to parenting. If you’re interested in her contact information, just let me know.

    Take care and again, congrats!

    • elliemaeh says:

      Thanks so much! We are probably going to have babies born within a couple of weeks! I have seriously thought about switching OBs, so I might have to check out your doc. The prenatal experience has been wonderful so far, with the exception of doctor visits, so I would really like to make them a bit more pleasant. That is pretty impressive that he was okay with you passing on the flu shot. Even my general practitioner, way before I was ever pregnant, frowned on me for refusing the vaccine.

      The Brio method is relatively new to me – from the looks of it, a relatively new method in general – but I poked around, and it does seem like it might be a little good fit for me and Nick, especially as first-time parents. And hey, if it helped you to stick with your birth plan, it must be helpful!

      I like the idea of lots of in-depth teaching, and some more postpartum information as well. A lot of the birthing classes I have looked at seem not to spend very much time on that part. That would be awesome if you could send Bobbi’s information our way. Our midwives also have a few suggestions of birthing classes, but I think that we are going to want to check around, talk to a lot of different people, and see what is the best fit before making a final decision.

  4. Pingback: Negative Book Review: Why is Pregnancy Viewed as Pathology? | A Mom On A Mission . . . . . . to nurture and nourish her family

  5. Proactive says:

    Beautiful template! Was it free?

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