OB/GYN vs Midwife vs Fam Practice MD

  1. Am pregnant, due end of year. I love my family practice physician, but he is not board certified in OB/GYN (though he practices "pediatrics, family, obstetrics"). Additionally, he will not be there to deliver the baby if it's his wife's birthday, some other holiday, or vacation. Also, how able is a fam doc in dealing with pregnancy complications, the unexpected?

    I would also love a nurse midwife, but my sister works @ a law firm that specializes in birth injuries. She is adamant that I do NOT get a midwife, since her firm often sues them. I've heard horrible stories. It seems that many midwives do not have adequate training/experience in recognizing potential complications, and consequently docs have been called in too late to prevent injury/death to the baby. Even NURSE (master's prepared) midwives.

    My sister believes that the safest way to go is with a board certified OB/GYN. They have the greatest knowledge/experience in this area. However, my fear is that an OB would be more likely to perform an unnecessary C-section for a borderline mod-risk pregnancy, mostly due to the fear of lawsuit. Perhaps a family doc wouldn't be so quick in judgement for a C-section? Especially my doc, who states that one thing he especially dislikes about medicine is that some docs are quick to make recommendations to pt in fear of lawsuit, ie.just to protect themselves. Lastly, I didn't like the clinical, impersonal approach of the OB/GYNs I observed during my OB rotation in school.

    OB nurses & RN mothers, please help!
    :uhoh21:
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  2. 14 Comments

  3. by   SmilingBluEyes
    if you are low-risk, look into a certified nurse midwife for your care ....they are very safe, very low-intervention (usually) and very, very good teachers. just what you would want, I think.
  4. by   BRANDY LPN
    Where I used to work I worked with OB/GYNs and midwives, They were great, the midwives would always get a OB consult if needed and the OBs were not more likely to cut without reason (c/s or epis).

    Where I work now we only have FPs and they are way quicker to do a c/s or an epis. and use WAY more interventions than necessary. We have an almost 100% induction rate and the rare chance we have someone come in in labor they either had no prenatal care OR we have to take them off the induction book. LOL So of course our c/s rate is high also.

    The most important thing to do is go talk to whoever you choose as a provider and make sure that their goals/outlooks/practices match your expectations. Also I thik that I would want someone who would want a consult with a OB/GYN if anything looked the least bit fishy.

    Congratulations on your pregnancy!!!
  5. by   nurseunderwater
    LPN mom of 3 here....I used a CNM in hospital for #1 (wanted that nicu down the hall) I had a wonderful experience. She made my birth amazing. I am also big on labor assistants if you can get one. They help you to realize your birth plan goals. And, no flaming please, just in case you get a Labor Nurse, like i did, who isn't hearing you and what you desire (as long as what you want isn't contraindicated for you and baby) the labor assist can help advocate for you.

    thumbs up on CNM's - lower c sect rate, lower epis rate, fabulous bedside caregiver.
  6. by   nekhismom
    I vote CNM, for reasons stated above---better care, less interventions.
  7. by   fergus51
    CNMS have been proven to be as safe for low risk women as OBs and have better outcomes in some areas (like c-section rates). I would use a CNM if I were low risk.

    In my personal experience, the worst are family docs I have worked with. They don't do it often enough, so they get skittish at the smallest things and go straight for the section. I think OBs are ok, just wish they didn't look at pregnancy as a disease.
  8. by   canoehead
    Our family docs are less likely to use invasive interventions than the OB/GYN, but some could use guidance in high risk situations and are slow to ask for it.

    The midwives in our area do only home births, and they come in when complications arise at home. Unfortunately, I have never seen one come in without things being royally and completely screwed up. They don't seem to recognize that they need help until 12-18 hours (or more) after the fact. I would NOT go midwife unless they were already privileged in a hospital, and had backup close by.

    Our OB GYN is wonderful, but more invasive than the family docs, but justifiably so. She is more likely to anticipate problems. In a larger hospital nearby I noticed that their OB GYNs are VERY schedule oriented. IE you'd best hope that you go into labor and have your child on their schedule 9-5 or expect some major interventions to make it so. 90% of the births I observed there had episiotomies, and their use of Pitocin was about 4x out small hospital. They also had at least 3x the incidence of pph. Of course, they had sicker patients, and I don't know that those observations can be generalized to other areas.

    My opinion is better the devil you know than the devil you don't, go with the doc that has served you well as a family practitioner, and then cross your fingers that he is available. Maybe he can co-manage with someone he trusts that WOULD be available on his days off so you get good coverage at all times.
  9. by   nurseunderwater
    A really great book about medical birth is
    Birth, An American Right of Passage; Robbie Davis Floyd
    gives some insight into the medicalization of childbirth.....
  10. by   imenid37
    If your sister works at a law firm, then she is seeing the bad things that go on w/ dr's/cnm's. There are many good things about both types of providers. Check out the options yourself. Ask around. Research experienced providers and talk to them/ their office staff/ other nurses/moms in your area who have used these providers. Have a happy pregnancy!
  11. by   Energizer Bunny
    I vote for CNM's as well, and not just because I aspire to be one. I had a CNM with each of my last two and the labors were much better, there was more support, etc. If you want to compare my experiences go here:

    http://www.geocities.com/babybryce100503/

    My last baby's birth story will be there and you can go to either of my other children's sites to read those as well. There is a lot of information on what the midwife did or didn't do in my stories.
  12. by   fiestynurse
    I agree with imenid37. Check it out for yourself! Because your sister works in a law firm that deals with birth injuries, she doesn't have experience with all the great Practitioners that are out there and all the happy healthy births that are taking place every day. Don't let her frighten you and influence your decision. I say - go with a CNM and prove her wrong.
  13. by   fiestynurse
    Great website - CNM2B!!
  14. by   Energizer Bunny
    Quote from fiestynurse
    Great website - CNM2B!!
    Thanks! My other kids' sites are more in depth if you go from Bryce's to the others...but I really wanted to share my birth stories without repeating all the gory details here! :chuckle

    It takes a lot of time that I don't have right now, but I sure will get them caught up before I start school in the fall because there will NEVER be time then!

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