If you are a low-risk woman having a baby, and you want a low-intervention birth, I urge you to consider hiring a midwife for your care. I want to explain some facts that many expectant parents don't realize about the difference between midwives and obstetricians.
What does low-intervention mean? Well, it's different for everyone. For some it means completely "natural": no medications, no interventions. For others it means avoiding a c-section. Midwives are surely experts at unmedicated birth, but they also support families who plan to use an epidural. Choose a provider who facilitates the type of birth you desire every shift they work. Obstetricians are trained surgeons and it's wonderful we can use their skills as needed. But most women will not need a surgeon to give birth. They need a baby catcher!
In this article I am only addressing the choice of an OB vs a Certified Nurse Midwife in the hospital setting. In another post I'll address birth center and home birth options. Of course there are also family practice doctors who attends births and they do try very hard to attend their patient's birth, unlike OBs as we will discuss below.
The first misconception is that it's safer to have an OB "just in case something goes wrong." First of all, when birthing in a hospital it is the nurses who are primarily taking care of you. They are listening to baby's heart rate and determining if everything is going well. They are monitoring mom's vitals. In larger hospitals, there is always at least one OB and one midwife on the floor caring for patients. If something did go wrong suddenly (which is rare), an OB is there to intervene if a midwife needs to ask for his or her expertise. In smaller hospitals or practices, the providers may be receiving updates from the nurse via phone but do not come in until the birth is imminent. At most OB births, the OBs may pop their head in once during the earlier part of the birth, and then the nurse will call them back when the baby is 5-10 minutes away from being born. The longest I've seen an OB hang out in a room was an hour, that same amazing birth that I mentioned above. Hospital midwives are generally more present but many are caring for more than one patient at a time so it may still be the nurse (and hopefully the doula you've hired!) who are your primary support during the hours you are working to birth your baby.
Simply put, hospital midwives can bring in an obstetrician any time to get a consult and can transfer care if mom really needs something that requires an OB's special skill-set, which usually would mean a vacuum or forceps birth or a cesarean birth. Some midwife groups have OBs in their same practice and the rest have a partnership with one of the OB groups at their hospital to handle these situations. Unlike on TV, birth usually unfolds slowly and complications develop over time, not suddenly. There are usually warning signs that extra care may be required and plenty of time to assemble the necessary team.
What if the baby needs help right after birth? Most parents are surprised to find out that as soon as the baby is born, the midwife or OB is not involved in their care (except in a birth center or home birth setting). In the hospital, the midwife or OB continues to care for the mother immediately after birth while nurses with special neonatal training and experience take care of baby as needed and the baby becomes a patient of the pediatrician you've chosen or whoever the on call pediatrician is at that time. Nurses help stabilize babies who aren't transitioning well and then as needed pediatric doctors may become involved.
We often hear "but I love my OB!" Many women have been seeing the same provider for years or decades before having a baby. Unfortunately, most practices (including midwife practices) have an on-call schedule and you will get the provider who is on call the day your baby decides to come. With the larger practices, it is so rare that your actual OB/midwife will be on call that day. Even when they promise they will try to be. What does seem to happen more than mathematically possible is that "the one OB/midwife I really didn't want" is the person who is there. Now, you can ask for a new provider, and I have had students do this, but perhaps there is a better way.
To mitigate this unfortunate phenomenon, I recommend choosing a small practice with only 3-4 providers so you can meet them all. Then go over the parts of your birth preferences you think are the most different from how they normally manage birth with each of them. Really listen to their responses and trust your gut. For example, if you really want to have the freedom of choice to birth in any position, don't just ask if they support this. They will say yes! Ask how many times *this month* they've caught a baby with mom squatting or on hands and knees or standing. This will give you a much better idea of if they are just saying what they know you want to hear or if they are truly comfortable with your requests.
When choosing a provider, the most important thing is that you feel 100% supported and confident that your provider will do everything possible to help you have the birth YOU desire. Midwives are highly trained and educated and they see natural, normal birth all the time. They spend more time with clients during prenatals and after the birth, they can continue to provide well-woman care, annual exams and more!
For more information on hospital birth with midwives, check out the video below and visit any of the following links:
American College of Nurse Midwives
Our Moment of Truth from ACNM
And enjoy the following two videos!