From: hecht@VMS.SAS.COM
Newsgroups: misc.kids
Subject: Re: OB .vs. a Midwife
Date: 15 Apr 92 20:58:37 GMT
Reply-To: hecht@VMS.SAS.COM ()
Organization: SAS Institute Inc.
X-Bytes: 6495

Hello. I have been reading misc.kids for a few months now and have finally
gotten up the courage to reply to a posting.  (BTW, reading this group has been
great fun.) I have 2 kids,
a 13YO daughter a 1YO son. For my daughter's birth, I had the usual OB care and
for my
son we used a certified nurse-midwife. Both pregnancies were considered
"normal", which
is important in choosing to use a midwife. In the practice I used, the midwives
only took
low-risk patients. 

Anyhow, I will never use a medical doctor again for a delivery unless it is
medically needed.
There was nothing wrong with the treatment I received from the doctor, but the
midwives
were just so much better at treating the pregnancy as a normal, natural event
and  not a
medical condition. This may get a bit long, but I will try to compare my
experiences with 
the OB-Gyn and with the midwife.

The practice that I used that included midwives has 4 medical doctors and 4
midwives in
their practice. When you become pregnant, they offer an orientation that
describes the
advantages of each. You can then decide which you feel most comfortable using.
My first
appointment was with an MD, but the rest of the pregnancy, I rotated seeing the
midwives,
just like you would do seeing the doctors in the practice.

During my visits to the midwives, they were much more willing to take as much
time to answer questions as I needed. This was very different from my visits to
regular doctors. Usually,
doctors make me feel like they have a hundred patients to see and they will
answer my questions, but need to hurry up. Also, the midwives are all women and
the doctors are 3 men
and 1 woman. While this may not be important enough to make you decide to use
midwives, it sure seemed to make a difference in how I felt I was percevied as a
pregnant woman. I know I
didn't express that well, but the midwives just seem to have a more
down-to-earth approach
than male doctors I have seen. Obviously, a female OB may have the same
advantage.

As I neared the end of my pregnany, I became impatient for the delivery. Having
gone 2 weeks
and 2 days over my due date the first time, I was hoping to come closer this
time. However,
unlike the doctor who did an internal exam every visit for the last month of my
pregnancy, the
midwives did not feel that there was any reason to do an internal exam until I
was in labor.
The only reason this is important is that because the doctor started doing
internal exams and 
found that I started dilating (barely), they started trying to initiate labor.
This included stripping the membranes (which has been discussed here already and
hurts like hell) and advising me that soon we may have to induce labor. The
midwives were much more laid back, explaining that in a low-risk pregnancy, the
baby pretty much knows when it's ready to be born.

Now on to the labor and delivery. With midwives, a doctor is on call and in the
hospital in case there is a need for medical intervention. However, the midwives
are certified to administer drugs, including an epidural, perform an episiotomy
(although they rarely do), or stitch any repairs. They do need a doctor to
perform a ceasarean, but I felt comfortable knowing that the
doctor was actually in the hospital and could be there in a matter of minutes if
needed. The biggest advantage of the midwives during labor was that they were
THERE. With my first delivery, a labor/delivery nurse was in charge of me and my
labor up until 30 minutes before delivery. Now this was a very nice person that
I had never seen before in my  life. There was no 
relationship with her, as there is with someone who has seen you throughout your
pregnany. The doctor popped in every couple of hours to do an internal  exam,
and only when I was ready to push did he show up and say "see you in the
delivery room". (Yes, these were the days when you labored in one room and just
when you were at your worst, were moved to a delivery room.) The midwife that
was on call with my second delivery was there the entire time. She helped me
with breathing, panic, positions, walking, relaxing, keeping my husband
involved,
not requiring drugs when I was really almost ready to deliver, and just being
like a friend, since that was what she had become during our 9 months together.

With my first delivery, I had an episiotomy but still had extensive tearing.
With the second, I had no episiotomy and no tearing. I know that the first time,
no one helped me not push so hard at first and that's when the tearing occurred.
The midwife coached me through the pushing stage 
and continuously massaged the perineal area so that no tearing occurred. My
first baby was 8 
lbs. 4 oz. and the second was 8 lbs. 5 oz. so I know that it wasn't the baby's
size that made the difference. 

In my first delivery, my blood pressure shot up (due to severe fear and panic)
and I was immediately put on an IV  with some sort of medication for it that
made me throw up, sweat a lot, and made me quite dizzy. The second time, my
blood pressure went up again (still scared, even though I had already done it
once). But this time, the midwife just talked to me and my husband, helped us
both relax, suggested some music and in 15 minutes or so, my anxiety attack was
over. 

One more quick thought about  husband/coach/partner involvement. The midwives
always treated my husband as a vital partner in the pregnancy, labor, and
delivery. The doctors treated him(of course it was a different husband) as
something to be included because it was current popular opinion that husbands
should be there. In my case, the midwives also made my daughter feel included at
the office visits as well as in delievery, which she attended. 

I'm sorry this got so long but I could go on even more. I guess it boils down to
2 completely different pregnancy, labor, and delivery experiences, one much more
positive than the other.
And I attribute a lot of that positiveness to the attitudes and practices of the
midwives.

And don't let anyone tell you that midwives will refuse to give you drugs if you
ask for them. They can and will give you drugs, but they have a whole lot more
in their bag of tricks that may help you not need the drugs. Most doctos don't
have the time or expertise to do anything other than provide the drugs.

I hope you'll let me know what you decide to do. Whether by doctor or midwife, I
ended up with a beautiful baby each time.

----

Darylene Hecht, VMS R&D, SAS Institue Inc., hecht@vms.sas.com