Surprising Differences Between OBs and Midwives. Don’t choose your care provider before reading this!

Many people assume that OBs are the best trained professionals in birth. Depending on your circumstance, working with an OB may be the right choice for you. But if you are making plans for your upcoming birth, here’s a quick list of questions to think about. Don’t make assumptions; the answers may surprise you:

 

Questions For An OB:

 

1. What are the chances you will be on call when my birth happens?

2. Who will attend my birth, if not you? How many other doctors are on your call-team?

3. How much time will you be present with me / in the hospital for during my birth?

4. What are your rates of cesarean, forceps, and vacuum birth vs normal vaginal births? *

5. Do you know how to take care of a baby in an emergency, or do you rely on additional hospital staff for that because this is not your area of expertise?

6. Who will be following up with me postpartum for things like breastfeeding support, if anyone? Are you trained in breastfeeding? What are your clients’ breastfeeding success rates?

7. For how long do I have access to your (or someone else’s) support postpartum for things like breastfeeding?

8. Who do I phone / page in the first few weeks if I have any concerns about myself or my baby?

 

After you have your potential OB answer these questions,  I challenge you to go ask the midwives in your area the same questions.

Did you know:

  • OBs typically work in call-teams (large or small), and are often only on call for a small percentage of the week/month
  • OBs typically spend very little time in the birthing room (and sometimes very little time in the hospital altogether) during a woman’s birth process, often only arriving just as the baby is about to be born, and possibly consulting with the nurse intermittently, either in person or over the phone
  • Successful vaginal births are more common with midwives than with OBs (source)
  • Midwives are well-prepared for (unlikely) emergency situations for both mothers and babies, and can provide excellent first-line emergency care
  • OBs are often not trained in neonatal resuscitation / emergency newborn care. Alternative staff, such as a pediatrician, are relied on for emergencies involving newborns**
  • Midwives are typically very familiar with providing breastfeeding support, and are available for support and advice for issues regarding health of both mothers and babies in the first several weeks postpartum
  • OBs typically complete their care of a woman once the baby is born and the woman is considered healthy shortly after the birth. OBs are typically not involved with breastfeeding.
  • Although a common perception is that hospital births with OBs are the safest way for healthy women to give birth, research does not support this perception

 As a birthing woman, there are many options available to you.

Options include choice in care provider (obstetrician, family doctor, registered midwife, independent birth attendant, or “unassisted”) and choice in birth location (home or hospital).

The choices you make can change your chances of having a healthy, normal birth, so it is important to thoroughly research your options and to avoid making choices based on assumptions or cultural misconceptions.

*Women have reported that OBs sometimes say they don’t know their vaginal/cesarean/instrumental birth rates, or say that the rates don’t matter because some pregnancies are high-risk and that changes the care plan. I would argue that anyone who does not primarily attend healthy, normal pregnancies is not an expert in healthy, normal, birth. OBs are experts in unhealthy births, instrumental births, and cesarean births. It is extremely beneficial to have access to obstetricians and their skill-set in our medical system, but important to consider whether or not their expertise applies to you, or whether a different type of professional may have more appropriate expertise that applies to you.

**From the College of Physicians and Surgeons of BC: ” The requirement to have and maintain up to date NRP [Neonatal Resuscitation] certification does not factor in to the College’s registration and licensure process [for obstetricians]”

 

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