Midwife or doctor? Which should I choose?

A better question is actually: How well do you know your midwife*(**) or doctor*** (and how well does he or she know you)? Just because a care provider has a great personality does not necessarily mean he or she will adequately support your plans for a natural birth. And just because he or she indicates support for your wishes, does not mean that support will actually come to fruition in the delivery room.

World rocked? Phew! I know it’s a lot to take in, so take a deep breath. The journey of a thousand miles begins with a single step!

So how is one to know whether a provider is truly supportive of natural deliveries? A supportive provider is thorough, attentive, provides evidence-based information, treats each mom as an individual rather than working from a pre-determined model of care, and is backed by other supportive providers.

*Certified nurse midwives (CNMs) are registered nurses who have graduated from a nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME) and have passed a national exam. CNMs do not have the expertise to perform surgical birth, however most CNM-based practices are set up so that at least one obstetrician is available as a back-up. CNMs are permitted to attend births both inside and outside of the hospital.

**Certified professional midwives (CPMs) train through apprenticeship with a qualified midwife and attend a midwifery program or school in order to specialize in birth outside of the hospitals. CPMs do not attend hospital birth, but a good CPM has a formal arrangement with an OB in case of the need to transfer care. Ask plenty of questions about the experience and credentials of the midwives you interview and be sure you feel comfortable with the other providers who support them.

***Obstetricians are surgeons who specialize in high-risk pregnancy. Technology and drugs are at these care providers’ fingertips. The only trouble is that a number of OBs have started using these medical interventions for a higher percentage of women than is statistically necessary. And CNMs who are strongly influenced and managed by OBs tend to follow suit, otherwise she’s a fish swimming upstream.

Bring in a copy of your birth preferences (which you’ll have formulated by week 5 of Hypnobabies class) and let it be a springboard for conversations during your prenatal visits. If it’s met with resistance, skepticism, or any form of apathy, it’s time to consider switching to a different provider.

While I know it can be stressful and inconvenient to make a switch, I can promise that once you’ve made the leap, you’ll never look back. And to switch to a provider who is already set up to practice in a way that is supportive of normal, healthy birth, makes getting your preferences honored much less stressful in the hospital.

The care provider who acts as a “lifeguard” sees better results. A good lifeguard watches closely, but doesn’t teach the swimmers how to swim. Many complications are not imminent emergencies, and a prompt, controlled response means baby is born safely and does not need to be separated from its mother in those first critical moments of bonding, warmth and love. 

Remember, as the World Health Organization states: In normal birth there should be a valid reason to interfere with the natural process.

It’s also worth noting that normal birth is defined as:

  • Spontaneous in onset, low-risk at the start of labor and remaining so throughout labor and birth.​​​
  • The infant is born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy.
  • After birth mother and infant are in good condition.​​​

However, as the labor of many high-risk pregnant women have a normal course, a number of the recommendations in this paper also apply to the care of these women.​​​

For low-risk and some high-risk women, the midwifery model of care is not only safe, but very beneficial for both mother and baby. More personalized, one-on-one care and attention is a particularly important benefit. Consider Intown Midwifery, Providence Midwifery (and ISIS Ob/Gyn, who share call at North Fulton Regional), and SEE Baby Midwifery who will be offering water birth at DeKalb Medical Center starting in March 2015.

midwife or doctor

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