To OB or not to OB?

(Trailer for BBC show Call The Midwife, which I totally want to see, even though we aren’t using one. Any of my British readers seen this yet?)

I’m not sure how it goes in other places around the world, but here in Ontario, the moment you get pregnant you have to decide whether you want an OB or a midwife to deliver your baby. Thanks to our public healthcare system, both of these options are 100% free, but you can’t have both. I must say, I’ve generally heard that having a midwife makes the entire experience much more enjoyable. You get a lot more attention, they’ll come to your house and take time to explain things to you, and there’s much more offered in the way of post-partum care, like help with breastfeeding. Having said this, all the doctors I know who’ve had babies have opted for an OB. Maybe this is because they don’t need all that extra hand-holding, or perhaps it’s because they know something I don’t about the treatment you receive in hospital when you’re registered with an OB rather than a midwife. I’m not totally sure, but ultimately, hubs and I decided to go with an OB.

Why? Well, a few reasons:

1. We both come from families of doctors, who all advocate this choice; also, we can always turn to our parents/siblings if we need medical advice at 11 p.m. on a Sunday, so the “availability” factor isn’t really an issue.

2. I don’t think doing infertility treatments necessarily means your pregnancy is “high risk” but I have high blood pressure and I’m worried it will come into play later on. I want an OB to take responsibility for identifying and treating pre-eclampsia, not a midwife.

3. Thanks to a few good connections, we managed to get paired up with the head of obstetrics at the best hospital in Toronto, a 10-minute drive away. He gets rave reviews. We are not about to turn this opportunity down.

Having said all this, I might very well switch to a midwife if/when we end up getting pregnant for a second time. So far, our experience in the “traditional” system has been a bit confusing — there is no one to really guide us through everything, nobody telling us what information we need to bring in order to get ultrasounds done, nobody informing us which part of which building we should be going to afterwards to make an appointment with the OB, no explanation of how these pee sticks work and what bloodwork should or shouldn’t be done. It’s all on us to keep asking questions and demanding to be seen by someone, which is a bit frustrating. But at least we’re type A and can deal with it.

I also think it’s interesting how worked up people will get talking about care providers. The debate somehow gets watered down into polarized sides — you’re either in the “natural” camp or the “medicalized” one, which drives me crazy. Newsflash: Just because you choose to go with an OB, doesn’t mean you sign on to induced labour and epidurals and all these other drugs. You can still voice your opinion on what you do and do not want, and you can be in and out of that hospital in under 24 hours if you play it right. I don’t buy into theories that doctors are out to make money on their patients (certainly not in this country) or would put their own interests above that of a mother and baby in labour.

Anyway, that’s our plan… and our reasoning. I think if we really want to indulge, we may look into hiring a post-partum doula to help with the craziness of having a newborn, but that’s still under consideration. So tell me: Who did you choose — or who would you choose — for your care provider, and why? And do you pay any attention to friends or family members who don’t agree with your decision?

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23 thoughts on “To OB or not to OB?

  1. I chose an OB. I’ve never had a bad experience with the medical field so I don’t see any reason to change now. Plus I love my OB. She’s amazing! One of the reasons I wanted to stay with an OB is because of the monitoring available. I may have complications due to my high BP so I wanted to be with a medical practice to ensure I would get extra monitoring and medications if needed.

    I would like to try for an unmedicated birth but it’s not a big deal to me. I’ll probably tap out and beg for the epidural after 30 minutes of labor and I’m okay with that. I just want to go with the flow and see what happens. I had a plan with this whole getting pregnant thing and when it failed it tore me apart. I have a feeling I would react the same way if I tried to plan my birth and it didn’t go the way I wanted it to. I don’t want to spend the first few days, weeks, months of my child’s life beating myself up because things didn’t go as planned. So we’ll just see what happens.

    Wow. . . that was way more rambly than I wanted it to be. Good luck deciding which one you want!

    • Yeah, this is my thinking too — I really am not emotionally attached to any birth plan or whatever; I just want to be surrounded by doctors and nurses and drugs and get the damn baby out of me with as little pain as possible…

  2. Call the midwife is my favorite recent show. It is absolutely brilliant. Watch it watch it watch it! Plus, I trained with the girl who plays Trixie and she is lovely.

  3. In the states, most insurance companies (evil, vile, insurance companies…) don’t cover a midwife, so many women go to the OB, which is covered. Although, now after doing some research, the cost of out of pocket expenses I’ll need to pay even for a hospital birth are roughly the same as a midwife. I am going the OB route as I feel comfortable with mine, and he’s been my OB for 9 years, but am still a bit nervous about medicalizing the birth process so much. The statistics are pretty staggering when you look at C-Section rates for hospital births vs births w/ a midwife or at home. (30% vs 5%) Even after knowing all of this info, I’m still unable to fully commit to a home birth because of the small small SMALL chance that I may need a procedure to be done incredibly quickly in order to save the life of the baby.

    • This fascinates me! I’m so curious what an average birth in the U.S. ends up costing the patient (even if they do have insurance)… my mother remembers, after delivering me, receiving a print-out from the hospital of what everything cost, but then the final amount owing was of course $0. But when she saw what the true price of treatment was, it was kind of shocking.

      I totally forgot to look into the C-section rates at my hospital… I have heard those stats before, and I know it’s technically possible for a midwife to deliver a breeched baby and deal with all these other complications that would probably require a C-section in a hospital, but that still makes me nervous…

      • Depending on what your deductible is, and whether or not you get a C Section or epidural, out of pocket expenses can range from $1,000-$2500. I’ve never met anyone who has had a $0 hospital bill in the states, even with insurance. It’s nuts!

      • My husband has a cousin who paid $100 for her son’s birth. They have awesome insurance because her husband is a government contractor of some kind.

  4. I would have liked the option of having both a midwife and an OB but, as in Ontario, Saskatchewan makes you choose one or the other. My age puts me in the higher risk pregnancy category, so I thought it would probably be best to go with an OB, just in case I had some problems. Plus, I’m a terrible wimp, and I’m fairly certain I’ll be wanting an epidural.

  5. I see benefits for either one! I know friends who’ve had great experiences with both. I agree with you, there’s so much crap about choosing care providers. I chose an OB because I work in the medical field and feel comfortable with that choice. I also pretty much had to because I’m high risk. I see an OB, a Maternal Fetal Medicine specialist, and my immune specialist. I still think I would have chosen an OB, even if I wasn’t high risk. It’s just a better fit for me personally. :)
    I had a rough time settling in with all my doctors at first, but now it’s pretty much smooth sailing. My OB is actually really cool and caring. I like her a lot. :)

    • See, I find this so interesting — everyone who works in medicine always opts for the OB rather than midwife, and I can’t totally figure out why, unless it has to do with being familiar with the system already or perhaps feeling less intimidated by hospitals and people in gowns…

      • i’m in medicine (a phd toxicologist just moved from med research to consulting and my husband is a research biochemist prof associated with a medical university) and we opted for midwife at a birth center:) at first i thought i’d stick with my OB who i loved. but the more i started reading about “active management” of labor the more i started to realize that all the interventions actually muck up the natural processes and can snowball into what ends as an otherwise unnecessary c-section, the more i became set on midwife.

        docs are wedded to medicine. they are not likely to criticize the system or admit its faults. but if you look at the facts. the actual facts in publications, not just some crap your doctor rattles off (because he/she is indoctrinated), home birth and birth center births are just as safe, IF NOT SAFER than hospital births. some of this has to do with there being more high risk patients seen in hospitals, but in no way do the high risk patients account for the discrepancy in c-sections vs vaginal births at hospitals vs birth centers or home births. something else (active management of care) is driving the snowball effect.

  6. I read a bunch of books on natural birth, the low complication rates, etc, but ultimately decided on an OB (I’m also in the medical field). I ran across this website, that albeit controversial, brings up excellent questions and statistics for midwives and home births. It was enough to make me want my baby to live, not die!! http://www.skepticalob.com/

  7. I’m not in Canada, not pregnant and no experience about anything related to pregnancies, but I can tell you I would probably have chosen an OB as well (too bad you can’t have both). I have a couple of girlfriends super into natural stuff and they had a midwife, both ended up needing to go to the hospital and needing more drugs than they would have liked to. I agree, for your first pregnancy I would have picked an OB as well.

    • Yeah, I’ve heard scary stories from people about home births going very wrong, and I really don’t want to find myself in that position (not that I’d ever remotely consider a home birth, but yeah — I could care less about the “natural” thing).

  8. This is such an interesting discussion! I still haven’t really settled on OB vs Midwife. I’m in the states, though, so only the OB would be paid for. Since I’m really broke, I’ll likely be forced to go with the OB even if I’d prefer a midwife (which I think I personally would!) I think you are absolutely right about it depending on the stories and people you are surrounded by. I live in a very all-natural-is-good part of Southern California where midwives and doulas are all the rage right now. Even my OB said to me that if he was a woman, he’d want to go to a midwife instead of an OB unless something was counter-indicated in your pregnancy (i.e. diabetes, high BP, previa, etc). But he’s from Italy and they’re pretty into midwives over there. So I do think it’s largely cultural. If you work in medicine or have lots of doctors in your family, it’s only natural to want to be with doctors! But if you’re like me and all the moms you know are watching “The Business of Being Born” and reading books by Ina May Garten, then you’re gonna want a midwife! :) Personally, if my OB was a woman, I’d be more a little more excited about things, but with US insurance the way it is, I have NO choice in my provider or my hospital or even considering a midwife, so I’m stuck with this old Italian OB guy! Anyway, sorry for the tome (ack!), but the #1 most important thing is that you are comfortable with your care provider and it sounds like you are so woohoo – bring on the baby!!! :)

    • Check into how much $$ your deductible is for the hospital. Many times, a midwife is just as much (or just slightly more) than the hospital, even with insurance.

      • hmmmmm. i’m in the US and the midwifery practice we are going to (a birth center) is actually CHEAPER than the hospital and almost totally covered by our insurance. not that hospital wouldnt be covered, it’s just that we chose a CNM because that’s what we wanted. wonder if it’s a state thing and not US thing per se. we are in MD while you are in CA.

  9. I am also in Ontario, and chose a midwife. But I ended up visiting my doctor countless times for complications of pregnancy my midwife could not treat, like UTIs and cholestasis. It was rather annoying. My care, in the end, was transferred to an OB anyway, so my midwife was not part of my labour and delivery at all. It was not what I had pictured for myself, that’s for sure- I really wanted to be surrounded by a small group of familiar faces, and that was sooooo not the way it ended up happening! For these reasons, if I had it to do over again, I would choose an OB. Many people have great experiences with midwives, but if you want to keep the number of caregivers involved to a minimum, I feel that an OB is the way to go.

    • Really interesting to hear you say this! As everyone says, midwives are great if you’re low risk and end up having zero complications… but you never really know what can go wrong in those 9 months, and the list of problems is endless. I also worry a lot about the relationship between OBs and midwives… I would hate to be with a midwife, who then sends me to an OB for some sort of specific treatment and then have the OB roll his/her eyes at having to pick up the pieces or whatever. I’m sure most of them get along just fine, but yeah — a minimum number of caregivers sounds right to me!

  10. Depending on your insurance, midwifery is very often covered in the United States so long as you deliver in a hospital or birthing center. Many, many hospitals have their own team of midwives and an OB on call only if needed.

  11. Can’t really weigh in on the whole midwife vs OB thing because I don’t know much about midwives… EXCEPT from the two episodes of Call the Midwife I saw. I wanted to watch more but couldn’t because I had a bunch of conflicts with other shows being on at the same time. I’d recommend catching it if you can.

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