Midwife vs Hospital

[jeromedawg]

Hey all,

I just stumbled across this article/video series and am currently watching: http://money.cnn.com/this-is-birth-with-lisa-ling/?why-i-regret-my-scheduled-c-section

I never really considered midwifery for our first or our current pregnancy but am starting to wonder if it would be an option for us. I think my wife (and especially our parents) would probably be against it just with some of the common perceptions and misconceptions people may have about midwifery and everything involved.

Part of what's got me thinking is the estimate costs involved. Currently, on HSA, I'm estimating costs upwards of $8000 based on insurance estimates (not quoted but roughly calculated from the previous hospital bill and applying coinsurance percentages, etc). We were on HMO select when we gave birth to our first and ended up paying $300 out of pocket (of course, factoring in premiums it's a lot more but still not outlandish given that we would have paid the premiums on healthcare whether or not we were having a kid). Going with a midwife seems like it would be more affordable, even if not covered by insurance. Other than that though, it seems like it can be a more comfortable and personable experience than the hospital. Although, I will say that we had no issues with any of these things the first time around - all the doctors and nurses were really great and my wife never felt rushed or her time cut short with anything.

The video series seems to sort of portray hospitals as the "one evil that twisted the birthing industry into a money-making machine" --- what do you guys think about all this?

[La Bibliotecaria Feroz]

I have attended a home birth. It looked great... for my sister. She felt so strongly about it that she paid the entire cost out of pocket.

My kids were born in the hospital, and that was right for me. It's such a very, very personal choice, and no one should have it imposed on them, and cost should not be a factor unless you're extremely poor. I mean, you certainly have the right to broach the subject with your wife and ask her to learn more about it, but try not to be too forceful.

If you live in a big city, you might have access to a birth center or hospital-based midwifery as other options. To be honest, I'm skeptical about the safety of home birth in the US because we do not have good protocols for transferring to a hospital and because the training and skill level of home birth midwives varies wildly. (Some are nurses. Many are not.)

[catccc]

This can be a very polarizing topic, but here are my thoughts. 

I had midwife attended birth center deliveries for both of mine.  But I was low risk and I had relatively easy (although quite long for the first) labor and deliveries.  The midwife run birth center I chose was affiliated with an OB at a nearby hospital, and on a block that was perpendicular with another hospital.  If anything were to go wrong, we'd have several options on getting additional assistance.  Our midwives were CNMs.  IDK what other kinds of MWs are out there.  Pre and post natal care were amazing.  I'm talking at least 30 minutes each visit with a midwife (there were 3 in the practice at the time), very dedicated to us and our baby, never felt rushed... it helped make the pregnancy a really amazing time for us.

I would have been more hesitant to choose this route had it not been for all the back-up potential built in.  Looking back I think it was the perfect choice.  I have a friend in a nearby state that had a midwife attended birth at a birth center within a hospital.  If your wife had a complication free, drug free delivery the first time around, I would really consider it.  But she could potentially have all those things in a hospital, too.  So I think this decision comes down to personal choice in care and services... I wouldn't hinge it on the cost at all.  It was not a factor in our decision as our co-pay was the same for the prenatal care.  I may have paid a few hundred more for a hospital stay had I gone that route, but ending up at the hospital overnight was a possibility, however remote, with the MW run birth center, anyway.

You will get a ton of anecdotes that will make you lean one way or the other "Emergency c-section, unavoidable, had I not been in a hospital w/ an OB, baby and I would be dead!"  or  "Cascade of interventions led to the worst birth experience ever and preemie that is still struggling w/ xyz due to not baking long enough!"  I will say, I have never personally heard of a nightmare birth center/ MW attended birth story, though.  Like, people are glad to be in a hospital, or so sorry they were at a hospital.  But I don't know a single birth center mom that regretted their choice.  I'm sure there is someone out there, though, I just don't know of anyone.  It just happens that in my circle of friends, about 50% are birth center moms and almost all would do it again that way.  The only mom that chose differently for her subsequent 3 kids was a mom that was to be a birth center mom, but was told she had preeclampsia, ended up getting induced at the hospital.  Baby got an infection there and was on antibiotics, later had gastro-intestinal issues that she felt was related to the antibiotics that wouldn't have been needed had she not been in a hospital, etc.  So for her next 3 she had home births with a CPM (cert. professional midwife, no nursing background).  She's been very happy with her prenatal care and deliveries, but she's the kind of mom that wanted zero ultrasounds and would rather listen to her gut instinct than a medical professional.  I personally cannot rely on my gut that much, it steers me wrong all the time.

Best of luck on your decision, I do really think this is one to be made w/o the price tag in mind.  And congrats on your new LO!

[poppan]

Umm, I think this is your wife's decision. Solely.

(I had a homebirth. I wanted it badly. It was the right decision for me. About halfway through, I think I would have thrown a lot of things at my husband if he had in any way guilted me into the choice.)

[Cranky]

I had my 3rd baby in an out of hospital birthing center, and was very happy with it. I think it must have been cheaper than a hospital birth because our HMO cheerfully paid for us to go out of network.

I do think that home birth is safe - in other countries, where the whole baby delivery system is set up differently. In Britain, it's my understanding that you can choose home birth, have well qualified attendants, and transfer to a hospital if necessary.

In the US, that's not how it works. Midwives that attend home births are largely direct entry, and simply do not have the same level of training that CNMs have. If something goes wrong, it's complicated transferring to a hospital at that point.

I have a friend who lost a baby in a badly managed home birth, and I wouldn't risk it.

If you can find a highly qualified midwife, and a medical practice as a back up, and you are low risk, then it can be a good choice. But it's hard to find that combo in the US system.

[jeromedawg]

Umm, I think this is your wife's decision. Solely.

(I had a homebirth. I wanted it badly. It was the right decision for me. About halfway through, I think I would have thrown a lot of things at my husband if he had in any way guilted me into the choice.)

I 110% agree. I'm not making any decision for or without her. I was posting more asking for feedback from people on midwifery than anything. And my initial statement about my wife (and parents) likely not being comfortable still holds - I'm pretty sure my wife won't be comfortable BUT I also haven't talked to her about it for her to consider whether or not it's something she wants. As far as costs, I agree - that's not something that should affect whether we go one way or the other but it was something I wanted to bring up because it can be a factor - I might be off on the HSA estimates too so who knows. And per the video, they were discussing how many families who choose to use a midwife are often faced with the misconception from others (relatives, friends, family) that they couldn't afford the hospital etc and not because they prefer it over the hospital etc.

My wife didn't have any complications with the first birth and I think she's considered low-risk so she would be an 'ideal' candidate for MW birth, from what it sounds like. I just know she has concerns with doctors who rush her and don't seem to care but we just didn't have that issue last time. And I don't feel like we'll have that issue again.

I think something else that's caused me to reflect on this more is that one of our friends just became a doula and we were briefly throwing around the idea of using a doula (not necessarily her) this time around. I don't think my wife will really want or need one after not having used one the first time... I'm just curious to peoples' thoughts who maybe didn't use a doula or midwife the first time and decided to do it after, etc.

[little_brown_dog]

I had a CNM (certified nurse midwife) attend my in hospital birth and provide my prenatal care throughout my pregnancy. It was the best of both worlds – I got the more holistic/natural approach from a well trained nurse midwife but had immediate access to emergency medical care. Good thing too. Despite a perfect labor and my low risk, my baby got stuck while pushing. Freak things can happen to even low risk mothers in birth.

My personal and professional opinion, as both a mother who experienced a difficult birth and someone who works on women’s health outcomes research, is that homebirths in the US are not safe. There are many reasons for this, but the 2 main ones are 1) lack of appropriate training of home birth midwives (CPMs) and 2) distance from emergency medical care.  In instances where complications do arise, the research is clear that babies are far more likely to die or experience brain damage when not in the hospital. When women give birth at home in the US, intentionally or not, they are choosing to place more risk on the baby, as it is the babies who tend to see the worst outcomes when things go awry in childbirth. More info is available on this thread page 3…
http://forum.mrmoneymustache.com/mini-money-mustaches/trying-to-conceive-the-mustachian-way/msg1154186/#msg1154186

As far as money and home or birth center midwives is concerned, they are not necessarily cheaper and can in fact be far more expensive under different circumstances.
1 – CPMs, home births, and birth centers are usually not covered by insurance plans. This is because of their lack of medical training and the documented riskiness of births (mortality, brain damage) when compared to hospital births. If you have to pay out of pocket, you can spend anywhere from 2500-4000 for the birth. This can be far more than what many people would pay for an unmed, vaginal delivery in a hospital depending on their insurance plan. In my area, home birth midwives charge about $3500 for a birth. My hospital birth, with emergency intervention, cost me a whopping $800 after my $500 deductible.
2 – The midwife fee exists regardless of outcome. If your wife has complications and has to transfer to a hospital, you will most likely still be on the hook for the entire midwife fee in addition to the hospital bills. In these circumstances, you pay for the birth twice.
3 – Lack of malpractice insurance and accountability. God forbid something terrible happens and the baby is injured, most CPMs do not carry medical malpractice because well, they aren’t actually medical practitioners. This means there is no mechanism for recovering damages or holding them accountable. At hospitals there are formal review boards that review adverse outcomes and the hospital would be liable for any harm caused by incompetence. Not so for a CPM.

If you want a more personal touch, look into the CNM model of care which uses trained, advanced practice nurses who almost always attend at a hospital. Very few CNMs will attend births at home due to serious safety concerns.

[englishteacheralex]

Already some great posts on this thread.

Personally, I also do not think home birth in the US is safe. I watched the Rikki Lake movie, got a lot of warm fuzzies about what "my body is made to do" and considered it as an option briefly. My husband was not on board. And, um, it's his kid, too--why would it be 100% my decision? There's a child involved, not just me.

Then I started doing a lot of research. And also (this is probably going to sound funny) considered my knowledge of history and literature. Female characters/historical figures were always dying in childbirth. Infant mortality before modern medicine was very high. The idea that "birth is natural/safe" seems like a fallacy to me. "Natural" childbirth historically has been quite deadly to women and infants.

After having my first and seeing how gnarly even an ordinary labor with no pain meds can get, I now would NEVER have a home birth.

I've heard anecdotally from friends and online that hospitals will negotiate with you and cut you a break on labor/delivery if you offer to pay upfront. Check and see. Not all hospitals are created equal. I LOVE mine; drug-free labor/delivery there was awesome. Nicer than our home would have been (they have air conditioning and a tub with jets).

A great website about the dangers of homebirth: www.theskepticalob.com

[historienne]

I had a CNM (certified nurse midwife) attend my in hospital birth and provide my prenatal care throughout my pregnancy. It was the best of both worlds – I got the more holistic/natural approach from a well trained nurse midwife but had immediate access to emergency medical care. Good thing too. Despite a perfect labor and my low risk, my baby got stuck while pushing. Freak things can happen to even low risk mothers in birth.

I also had a midwife-attended birth in a hospital (two, in fact).  One of those would have been just fine as a home birth.  In the other case, even if I had planned a home birth, I would have had to go to the hospital - my baby came early enough that I needed to deliver somewhere with more sophisticated medical care available for him.  I would not have had a bad medical outcome in this case, but I would have been out much more money, since I would have had to pay the deductible and coinsurance for the hospital birth (which came to about $1500 in my case, out of about $12,000 in total charges) on top of the home birth fee.

[StarBright]

I had two births with CNMs in a free standing birth center that had an affiliation with and admitting privileges at the local university hospital.

I was low risk and both births were super easy (as far as births go) and they took our insurance.

That being said, I only went the birth center route because: They only used CNMs, they had a good relationship with the hospital and seemed to follow pretty strict protocall on when to transfer patients (ie they had very clear and ready answers to my "what if" questions), and they were a mere two minutes away from the hospital if something went wrong.

I loved loved loved my midwife assisted births but I would not feel comfortable doing a homebirth with a CPM.

[catccc]

Oh, we used a doula w/ #2, because we planned on having our 2.5 year old with us at the birth.  (I know, some people think this is nuts, but our kid is atypical.  She came to all of our prenatal appointments, and was excited to join us in welcoming her sibling.)  So the doula was present should kid #1 need attention during a time when I needed DH's attention, and he couldn't provide both.  But our toddler was fine the whole time, and the doula just went with the flow and provided support for me, too.  She was great, I was glad to have her there.

[Cranky]

I hired a doula for my daughter's first baby last spring, and we were all very happy that we did. My daughter was in labor - in the hospital - for 40 hours, and the doula was fabulously helpful.

[acroy]

Priorities:
1) baby safety
2) everything else

Hospital is probably the safest route, as they have everything there in case something goes haywire.
That said, good midwives 1) know how to recognize hi-risk pregnancies and will refuse you 2) work with a backup Dr

For us, the cost was within 20% or so of each other. We are on HDHCP, iirc, the cost to us was around 6.5k via hospital, 5.5k via midwife. Years back, midwives were more like 2k, 2.5k but it's become an 'in' thing, fancy buildings to pay for, so cost has gone way up.

If you are interested, shop around some midwives/birth centers. It's mostly about the 'experience' and comfort level... that's really it.

We have had 3 @ hospital (moderate risk), 3 @ home (low risk, no issues). Plan to have #7 at home.

Congratulations & good luck.

[honeybbq]

 Here it comes---- I was a very fit, happy, healthy pregnant lady until the day I went into labor. My blood pressure shot up, my daughter's heart would stop during my contractions, and I ended up in an emergency C section despite having 0 risk.

I am very very glad I elected to have a hospital birth.

This is entirely anecdotal, but you'll never know when you need an operating table. At the end of the day, all that matters is a healthy baby and healthy mama. I am very supportive of people wanting a doula in a hospital setting though.

[Helvegen]

I personally think it is irresponsible to birth at home unless you literally have no other choice.

Labor and delivery are no joke. Countless women and their babies have died, past and present, for want of immediately delivered modern medicine. This was never made more shockingly clear to me than the pure helplessness and terror I felt delivering my own child and I had that benefit! It was one of the most disempowering experiences of my life. I was completely dependent on others to make sure we made it through.

There is no grand design. Like everything else about our bodies, it is a complete work in progress. If it works, great. If it doesn't, you die.  But overall, it is a numbers game. Just because I exist says nothing about what my ancestors might have suffered to reproduce. My great-great-great grandmother didn't have to survive the birth of her sixth child if my ancestor was the fifth. Same can be said for any siblings of that ancestor who might have died at birth.

I have had to call ambulances before. When seconds matter, help can arrive tragically minutes too late.

Only you can know if you can live with yourself if your baby dies for your choice. I would rather know that I did everything I could have done. Giving birth at home is not doing everything that could have been done. Women and children in the first world are still dying potentially preventable deaths because of this choice.

[englishteacheralex]

I personally think it is irresponsible to birth at home unless you literally have no other choice.

Labor and delivery are no joke. Countless women and their babies have died, past and present, for want of immediately delivered modern medicine. This was never made more shockingly clear to me than the pure helplessness and terror I felt delivering my own child and I had that benefit! It was one of the most disempowering experiences of my life. I was completely dependent on others to make sure we made it through.

There is no grand design. Like everything else about our bodies, it is a complete work in progress. If it works, great. If it doesn't, you die.  But overall, it is a numbers game. Just because I exist says nothing about what my ancestors might have suffered to reproduce. My great-great-great grandmother didn't have to survive the birth of her sixth child if my ancestor was the fifth. Same can be said for any siblings of that ancestor who might have died at birth.

I have had to call ambulances before. When seconds matter, help can arrive tragically minutes too late.

Only you can know if you can live with yourself if your baby dies for your choice. I would rather know that I did everything I could have done. Giving birth at home is not doing everything that could have been done. Women and children in the first world are still dying potentially preventable deaths because of this choice.

I agree. But people can get pretty contentious about this.

[purple monkey]

Might want to think about percentages, as this is a money board,

We are mammals and it is much safer to have an emergency  vaginal birth than a scheduled c-section.

Just like folks in general population do not understand  mustacheianism,  birthing mothers are scared into medicalized birth.

Will Not change in USA for many generations, because it is all about the money.

The Fox is ACOG and the hen house is the mother/baby pair.

http://thefederalist.com/2016/01/13/the-high-u-s-c-section-rate-could-endanger-lives/

Good luck with you decisions.

[little_brown_dog]

We are mammals and it is much safer to have an emergency  vaginal birth than a scheduled c-section.

This statement is just 100% wrong in terms of infant safety. Csections are hands down the safest delivery method for infants, but thankfully they are not typically necessary. In the csection procedure, the risk is transferred onto the mother to ensure that the baby is as safe and protected as possible. That is why premature babies, babies in distress, those with intrauterine growth restriction, or infants with congenital defects are typically delivered via csection. Vaginal deliveries place significant stress on infants as they pass through the birth canal, and it is well documented in the medical literature that fragile infants are safest in csections because they are not placed under as much physiologic stress. If vaginal delivery were truly safer than csections, providers would let all these babies undergo vaginal delivery. They would just tell women with babies in distress to just keep pushing. Absolutely no respectable, well trained, and responsible practitioner, OB or midwife, does this. They call the OR because they know that vaginal delivery is far more dangerous to an infant than a csection.

I get that people love natural birth. That is great and childbirth can be an amazing thing when it goes as it is supposed to. But let’s not live in fake lala unicorn land when it comes to the very real consequences of childbirth. Babies have been dying for centuries in vaginal births, well before the csection procedure and epidurals came along to supposedly "ruin" birth for everyone. Our infant mortality has plummeted in part to medical interventions like continuous fetal monitoring and csections. Those are the facts.

As for those high csection rates, it is true that some mothers and practitioners want to schedule csections for convenience rather than medical necessity. But these make up a very small number of people. You want to know why csections are so common nowadays? Because...get ready for it...labor complications like failure to progress, stuck babies, and fetal distress are actually quite common. Mothers with things like preeclampsia, diabetes, obesity, or other risk factors are more common (or better diagnosed). Multiple births thanks to clomid and IVF are more common. Add up all of the very real reasons a csection might be considered a reasonable/smart option, and you find that there is actually a substantial number of women and babies who may truly benefit from the procedure. And since the first priority of medical providers is a healthy/safe baby and not some idealized and romanticized vision of birth, we no longer let women just push for 5-6 hours, or go days without labor progress, or let them attempt frank breech vaginal deliveries like its no big deal. We have more csections now BECAUSE we don't want to risk it and we know when things start to look risky. Low risk mothers who are progressing normally do not typically end up with csections.

Moms who choose csections to keep their babies safe are f*cking heroes.

[catccc]

Csections are hands down the safest delivery method for infants, but thankfully they are not typically necessary.

Yes, for babies in distress, a c-section can give them the chance they need for survival.  But for all other babies, for most babies, c-sections are not safer.  Maybe you just forgot to add "in distress" after the word infants and before the comma.  But if this wasn't an oversight, and you truly think that c-sections are the safest delivery method, do you have more detail on a study that supports this statement?  Eugene Declercq, a birth researcher from Boston University, basically an expert in the field, asserts quite the opposite- for low risk situations, a planned c-section is less safe for mom and baby than a vaginal delivery.  That the last data I found (from a 2008 study of 8 million+ US births over a 3 year period) show that the neo-natal deaths are 69% higher w/ c-sections than vaginal deliveries.  And moms are 3x more likely to hemmorhage during a c-section v. a vaginal delivery.

Yes, interventions are great when they are truly needed, like in your case, but overall, they are far over-used in the US.  If you look at something like maternal mortality rate in the US over the last 10 years v. trends in other countries in which c-section rates are closer to WHO recommendations (as opposed to over twice their recommendation, as it is in the US), the statistics are alarming, and quite frankly, embarrassing for the US.

[little_brown_dog]

Csections are hands down the safest delivery method for infants, but thankfully they are not typically necessary.

Yes, for babies in distress, a c-section can give them the chance they need for survival.  But for all other babies, for most babies, c-sections are not safer.  Maybe you just forgot to add "in distress" after the word infants and before the comma.  But if this wasn't an oversight, and you truly think that c-sections are the safest delivery method, do you have more detail on a study that supports this statement?  Eugene Declercq, a birth researcher from Boston University, basically an expert in the field, asserts quite the opposite- for low risk situations, a planned c-section is less safe for mom and baby than a vaginal delivery.  That the last data I found (from a 2008 study of 8 million+ US births over a 3 year period) show that the neo-natal deaths are 69% higher w/ c-sections than vaginal deliveries.  And moms are 3x more likely to hemmorhage during a c-section v. a vaginal delivery.

Yes, interventions are great when they are truly needed, like in your case, but overall, they are far over-used in the US.  If you look at something like maternal mortality rate in the US over the last 10 years v. trends in other countries in which c-section rates are closer to WHO recommendations (as opposed to over twice their recommendation, as it is in the US), the statistics are alarming, and quite frankly, embarrassing for the US.

Yup I was responding to purple monkey's assertion that an emergency/complicated vaginal delivery is safer than a csection. That is just absolutely not true. Complicated vaginal deliveries are almost always far riskier to the infant in that type of situation than the csection would be. And a scheduled csection for a medical reason is usually done because the medical providers have decided it is the less risky route for the infant. Low risk, smooth/normal vaginal labors are definitely safer for mom and baby if everything is going as it is supposed to and it is rare for moms to schedule a csection unless there is a medical need (I think the most recent estimate I've seen was about 3% of csections are completely medically unnecessary). That means the majority of csections are performed on moms who do have legitimate risk factors, in which case it is not fair or accurate to say that vaginal delivery would be the safer option and that these moms should be forgoing csections.

[purple monkey]

http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/

[purple monkey]

http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/

http://www.cdc.gov/nchs/fastats/delivery.htm

[little_brown_dog]

http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/

http://www.cdc.gov/nchs/fastats/delivery.htm

Not to completely derail the thread but those links do not validate your assertion. In the WHO link, they specifically state: “When medically justified, a caesarean section can effectively prevent maternal and perinatal mortality and morbidity. However, there is no evidence showing the benefits of caesarean delivery for women or infants who do not require the procedure.” They also go on to say “Every effort should be made to provide caesarean sections to women in need, rather than striving to achieve a specific rate.” The entire document is all about how it is critical to try to classify medical need to figure out the safest birth method for a mom and baby. No where do they state that it is better for women to attempt a high risk vaginal delivery than receive a csection, and they certainly do not claim that it is safer to have an emergency during a vaginal attempt than a csection. The research on the CDC site corroborates this, as the links show that while csections are riskier than normal vaginal deliveries, they are less risky than vaginal attempts gone wrong. I am really confused why you think these documents back up your assertion that it is safer/better for a baby to suffer an emergency during vaginal delivery than receive a csection. These organizations absolutely do not support that idea whatsoever.

I have never in over a decade in this field ever heard a health official, researcher, or physician from any professional organization say that it is safer for a baby to experience an emergency during vaginal delivery than receive a preventative, planned csection. What they DO say, is that low risk mothers should attempt vaginal deliveries in general because the odds of an emergency occurring to a low risk mom are very low. In low risk situations, the risks of the csection outweigh the very low chance of an emergency occurring during the vaginal attempt. It’s a no brainer. But the trouble is, we are seeing ever increasing numbers of high risk mothers in the US who do not easily qualify for this recommendation. Their risk factors put them at increased odds of having emergencies in vaginal deliveries. So it becomes much more of a gamble.

Csections in the US are predominantly a function of risk mitigation. Talk to anyone educated in obgyn, nurse midwifery, public health, etc and they will tell you that csection rates in the US are mostly a symptom of the larger issue of poor maternal and prenatal health. When you have sicker/riskier moms, you have more nervous practitioners recommending csections because they don’t want to risk the vaginal attempt failing. We are struggling to figure out what is safest for those babies and moms who don’t easily fall into the vaginal delivery box. It's easy for us to sit here while looking at population data and say "well we should just tell those high risk moms and docs to risk the vaginal delivery!" but not so easy when it is your baby that could suffer brain damage or death if luck isn't on your side. It's not so easy when you want to try to reduce the preventative csection rate without accidentally increasing the the emergency csection and birth injury rates. It has very little to do with greed or ignorance, and everything to do with the difficulty in managing an increasingly risky childbearing population.

[KCM5]

Ignoring the argument above :)

Midwife in hospital. That's the correct answer.

I had one hospital birth with a CNM. In our case, I can't know if there would have been an issue had it been a home birth, but her heart rate did drop precipitously at one point, leading to the room being flooded with medical personnel including a doctor who stayed until things stabilized. A bit of hard pushing lead to proper heart rate and when she came out she did have a broken collarbone. We certainly wouldn't have known about the heart rate had I been receiving intermittent monitoring with a stethoscope. Would that have harmed her? I don't know. But it does feel good to know that if anything had gone wrong, we were right there where she could have been out of me via c section in literal minutes rather than tens of minutes or a half hour or more.

[norabird]

Agree about a birthing center located in a hospital. Safety but a supportive environment.

[firelight]

We did midwife in hospital as well. For us, the major factor driving it was that the midwife was with us for most of the labor and delivery while the doctor said she'll usually come only once the baby started crowning. Since we were first time parents, we needed the extra care from midwife to keep our sanity. During labor I was super happy that my midwife checked on me every hour and that she stayed with me throughout my pushing stage. I'd have been considerably less happy/more stressed if we had gone with the doctor and had to go through pushing with just the nurses around and have the doctor come to just catch the baby. I'm sure the nurses were great but having someone specifically checking on us with whom we had built a relationship over the past couple of months was invaluable!

[StarBright]

We did midwife in hospital as well. For us, the major factor driving it was that the midwife was with us for most of the labor and delivery while the doctor said she'll usually come only once the baby started crowning. Since we were first time parents, we needed the extra care from midwife to keep our sanity. During labor I was super happy that my midwife checked on me every hour and that she stayed with me throughout my pushing stage. I'd have been considerably less happy/more stressed if we had gone with the doctor and had to go through pushing with just the nurses around and have the doctor come to just catch the baby. I'm sure the nurses were great but having someone specifically checking on us with whom we had built a relationship over the past couple of months was invaluable!

This is a great point! My CNMs were with me through my entire active labors- they spent hours with me, I swear during my first birth my MW didn't even leave to go to the bathroom. It was amazing (I am totally one of those women who came out of childbirth and couldn't wait to do it again). We would have gone with the midwife in the hospital but for some reason our insurance didn't cover the hospital midwife, just the birthcenter midwife.

I agree with all that a midwife in a hospital setting seems to be the best case scenario.

[La Bibliotecaria Feroz]

Midwife in hospital was not an option for me. (I had seen one during pregnancy, but there was only the one and she was off that day.)

A doula can be a way around that problem. I mean, I just had my mom, but she had been at all my sister's births (plus her own) so she was pretty with-it. She had more perspective on the whole thing than XFP did.

[purple monkey]

There is this mmm site for early retirement and financial independence.
All financial planners make money for folks to NOT FIRE.
Being able to fire is almost exclusively done by the outliers, MMM, ERE, etc.

The general public almost always listens to professional financial planners.

It is the same concept with birth in the US.  It is all about the money and convenience. The more interventions, the more money is made by the facility, medical professionals, etc.

Also, the majority of emergency c-sections are in late afternoon, late evening, and early morning so the obgyn can go get dinner, go to bed or leave to go open the office.

The snow job is that American women are sicker than any other 1st world country women, the risks are higher and the mother/baby pair is safer by the hospital and the obgyn attending. Also, everyone else's birth experience must be validated and so even more women are warned to not trust birth.

There are more infection possibilities in a hospital than any other place on earth.

It is a BIG lie that several generations of women and their partners have fallen for. There are many grandmothers that only know about a twilight birth, mothers that know about forceps, and now emergency c-sections.

Birth is not complicated. In fact, the stages of birth is predictable and there are only a handful of complication possibilities. Most complications now are a result of the interventions. Again, there are a few complications that warrant c-sections.

Also, not all health care professionals openly display letters after their name.

Just as so few listen to the mmm folks, even fewer listen to midwife options.

Good luck OP, whatever you decide.

Godspeed!!!

[Mikila]

OP, talk to your wife about this.  Share the videos and research you are doing with her and see what she thinks.  Maybe you could research the pros and cons together. 

Now, I would recommend a birth attended by a midwife rather than a doctor (unless there are complications), especially if you are within a few miles of a hospital.  Also, check out the licensing requirements for midwifes in your state.  A midwife should be a nurse imo and have plenty of experience. 

I think Americans do treat birth as some medical procedure that needs to be done in a hospital.  American women have been frightened into thinking that only a doctor will do.  But, a woman's body is formed to deliver babies without intervention.  In the vast majority of births, surgical intervention is unnecessary and invasive. 

Americans have C-Sections and other interventions such as pitocin shots (to speed the birth along) at much higher rates than in other developed countries where women generally birth in a Birth Center or at home.  From the National Birth Center Study II:

"As a result, many women in hospitals receive interventions, whether or not they need them. Almost all women (87%) who labor in hospitals undergo continuous electronic fetal monitoring, 80% receive intravenous fluids, 47% have labor artificially accelerated with medications, and 43% of first-time moms have labor artificially induced.[7], [8] In addition, 60% of women giving birth in hospitals are not allowed to eat or drink, 76% are restricted to bed, and 92% give birth lying on their backs.[7] There is strong evidence that routine use of these practices, when carried out without medical indications, has few benefits and many potential harms for healthy mothers and babies."

http://www.birthcenters.org/?page=NBCSII     You may find this interesting.  If available, a birth center may offer the best of both worlds to your family.

There is a wealth of research, studies, etc which you and your wife may read together to decide for yourselves.  Congratulations on your baby!

[cchrissyy]

There are midwives in hospitals.

2 of my 3 babies were born in major hospitals with Certified Nurse Midwives doing every aspect of prenatal care, labor, delivery, and postpartum

[Primm]

There is this mmm site for early retirement and financial independence.
All financial planners make money for folks to NOT FIRE.
Being able to fire is almost exclusively done by the outliers, MMM, ERE, etc.

The general public almost always listens to professional financial planners.

It is the same concept with birth in the US.  It is all about the money and convenience. The more interventions, the more money is made by the facility, medical professionals, etc.

Also, the majority of emergency c-sections are in late afternoon, late evening, and early morning so the obgyn can go get dinner, go to bed or leave to go open the office.

The snow job is that American women are sicker than any other 1st world country women, the risks are higher and the mother/baby pair is safer by the hospital and the obgyn attending. Also, everyone else's birth experience must be validated and so even more women are warned to not trust birth.

There are more infection possibilities in a hospital than any other place on earth.

It is a BIG lie that several generations of women and their partners have fallen for. There are many grandmothers that only know about a twilight birth, mothers that know about forceps, and now emergency c-sections.

Birth is not complicated. In fact, the stages of birth is predictable and there are only a handful of complication possibilities. Most complications now are a result of the interventions. Again, there are a few complications that warrant c-sections.

Also, not all health care professionals openly display letters after their name.

Just as so few listen to the mmm folks, even fewer listen to midwife options.

Good luck OP, whatever you decide.

Godspeed!!!

And... that's why the infant survival rate is so low in "developed" countries like the US compared to "third world" ones, right? Because of the massive amounts of unnecessary interventions?

Oh, wait...

Also (directed at anyone who knows) is it still a "thing" in the US to use the emergency/elective nomenclature when referring to c-sections? I wonder why you haven't adopted the 4 phase classification that the rest of the world uses yet? Or is that terminology only used by people not directly involved in evidence-based obstetric care?

[purple monkey]

[/quote]

And... that's why the infant survival rate is so low in "developed" countries like the US compared to "third world" ones, right? Because of the massive amounts of unnecessary interventions?

Oh, wait...


[/quote]

https://www.washingtonpost.com/news/wonk/wp/2014/09/29/our-infant-mortality-rate-is-a-national-embarrassment/

http://healthjournalism.org/blog/2014/05/data-shines-a-light-on-c-sections-maternal-mortality/

[SirOcelot]

I have personal bias on this subject, because if my daughter hadn't been delivered in the hospital via emergency c-section, she would be dead.  Or brain damaged.  But she was, and she's fine -- though she spent a week in the NICU recovering from a severe case of meconium aspiration syndrome.

Cross-country comparisons suggest that the optimal c-section rate is about 20%, and that exceeding this rate is safer than undershooting it.

Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality

[RelaxedGal]

We did midwife at a hospital.

Glad we did, the staff were awesome, happy to do anything I was up for (hot tub, birthing ball, mirror to watch the baby pop out, bar at the foot of the bed to squat/push, warm washcloths on the perineum to avoid tearing, mineral oil massage for the same reason, all sort of good things like that.  The monitoring was... more than I would have liked. I spent a lot of time in bed, hooked up to the heart rate monitor when I would have liked to walk around but the baby's heart beat was hard to find.  And it slowed down when I tried the squat bar, so I was back on my back, in bed.  The baby inhaled amniotic fluid that gushed out just as she tried to take her first breath, so they called in a specialist.  Needed?  Apparently not, the nurses had it all sorted out before he arrived but we wouldn't have had that option at home.  This was back in 2011 before the Affordable Care Act so we paid a flat fee ($5,000?) for prenatal care through delivery and discharge.  I don't know if that specialist would have been an extra fee nowadays.

Downside: we went with a large-ish  practice and the midwife on call the night my daughter was born wasn't one I'd seen at the prenatal visits.  She was still great, but I wish I'd had someone I knew.  The labor and delivery nurse was hospital staff, so I was going to have someone I'd never met in the room either way.

[gaja]

Norway is a country with long distances and harsh climate. In the far north, the birthing mothers are transported to the hospital weeks before the due date, and live with relatives or in hotels (paid by the state). Some smaller communities have midwife run birthing centers located away from the hospitals. These only accept very low risk births, but still the statistics show that they have a disproportional amount of injuries to the mother and/or baby. Most of them are therefore getting closed down.

For us, everything that has to do with birth is free; all controls before and after, all controls, all doctor's and midwife's visits, etc. We also have 1 year maternity leave, so the timing of the birth is irrelevant. All choices are therefore based on what is best for the baby and mother. You can't get a c-section unless the doctors agree that it is medically necessary, and they are very restrictive. Midwives are the ones running the maternity wards, doctors are on call in case something goes wrong. In total, this sounds like what the rest of you describe as birthing centersat hospitals.

For my second child, there were no warning signs, and I could have easily chosen to give birth at home without any doctors protesting. But if my baby hadn't been born in a hospital, she would be dead now. Unlike most of the stories about things going wrong, it was not a case of a emergency c-section. Her head got out, and then everything stopped. Including her breathing and heart. After some panic, the midwives managed to pull her out, and she was rushed to the doctors to bring her back to life. Then they flew her to a larger hospital with the helicopter that was standing by, medical personell was with her the whole time. She has a lasting shoulder injury called Erb's palsy, but more importantly: her brain appears to be ok. We are still looking out for late damages; 6 minutes with no oxygen is not healthy.

I would have survived with no apparant damage if I had given birth at home, but a single midwife (or a couple of them) would never have been able to bring the baby back to life. She would have remained dead. The only thing that saved her, was that the maternity ward was located at the hospital, with all resources available within minutes.

[gaja]

I thought midwife was midwife, but re-reading the replies I tried figuring out the US system. It sounds downright scary. No way I would let a CM be in charge of anything related to my health. According to this website it sounds like some of them have no medical education at all, except for an apprenticeship? http://study.com/articles/How_to_Become_a_Certified_Midwife_Education_and_Career_Roadmap.html

Why hire a CM or doula at all, OP? They have no more medical training than a "wise woman". You could just as well ask your mother and grandmother to help out. They have given birth, so they have experience, right? I have no problem with people hiring CMs or doulas in addition to medical personell; they can probably give good comfort. But to consider choosing them instead of medical personell sounds dangerous. Unless you believe in the survival of the fittest?

Our midwives have a bachelor degree in nursing, the authorization to work in a hospital as a nurse, at least one year experience, and then they take two more years at university to be a midwife (~master degree). They are medical professionals, and highly respected. Still, few of them agree to do homebirths without close access to hospitals and doctors.

[catccc]

I thought midwife was midwife, but re-reading the replies I tried figuring out the US system. It sounds downright scary. No way I would let a CM be in charge of anything related to my health. According to this website it sounds like some of them have no medical education at all, except for an apprenticeship? http://study.com/articles/How_to_Become_a_Certified_Midwife_Education_and_Career_Roadmap.html

Why hire a CM or doula at all, OP? They have no more medical training than a "wise woman". You could just as well ask your mother and grandmother to help out. They have given birth, so they have experience, right? I have no problem with people hiring CMs or doulas in addition to medical personell; they can probably give good comfort. But to consider choosing them instead of medical personell sounds dangerous. Unless you believe in the survival of the fittest?

Our midwives have a bachelor degree in nursing, the authorization to work in a hospital as a nurse, at least one year experience, and then they take two more years at university to be a midwife (~master degree). They are medical professionals, and highly respected. Still, few of them agree to do homebirths without close access to hospitals and doctors.

I know of two varieties of midwives in the US, CNM (Certified Nurse MW) and CPM (Certified Professional MW).  The CNM educational requirement is a masters in nursing, much like the midwives you describe where you are.  I would not personally be comfortable with a CPM, but I was very comfortable with the CNMs that I used.

Someone else mentioned their MW not being the one on call- the Birth Center I attended made sure that you had good relationships with all 3-4 midwives in the practice, so you were comfortable with whomever happened to be on call when you were ready to pop that baby out.  The midwives also met regularly to discuss patients so they were all always on the same page with me.

[norabird]

The midwives/doulas are valued for their emotional support and expertise plus can advocate for you. It's still important to have access to a doctor in case it's needed, but basically all my friends have had doulas and found them to be incredibly helpful for the process (they get involved early). I don't think this is an either/or--it should be a both/and.

[little_brown_dog]

I thought midwife was midwife, but re-reading the replies I tried figuring out the US system. It sounds downright scary. No way I would let a CM be in charge of anything related to my health. According to this website it sounds like some of them have no medical education at all, except for an apprenticeship? http://study.com/articles/How_to_Become_a_Certified_Midwife_Education_and_Career_Roadmap.html

Our midwives have a bachelor degree in nursing, the authorization to work in a hospital as a nurse, at least one year experience, and then they take two more years at university to be a midwife (~master degree). They are medical professionals, and highly respected. Still, few of them agree to do homebirths without close access to hospitals and doctors.

Yes you are correct. The CPM (certified professional midwife) requirements in the US would definitely not pass muster in most other developed nations - that is why it is silly when people claim that "homebirth is safe in Europe!" CPMs do not have to have ANY higher medical education (nursing, physician) whatsoever. This is one of the reasons why homebirth in the US is unnecessarily dangerous - most of the midwives conducting them are woefully underprepared to handle anything going wrong. They are basically just people who have passed a test, taken some CPR training, and witnessed/attended a few births before. Since they lack higher level medical training, many of them also just simply don't have the knowledge to know when a pregnancy or birth is getting too risky and must be upgraded to hospital level care. As a result, every year in the US we have multiple stories of CPMs with no medical training attending home breech births, multiple births, VBACs, etc. It's absolutely stupid and insane and babies die unnecessarily.

If the US wanted to make homebirth safer, the first thing they could do would be to require that anyone wishing to receive a midwife certification must receive a bachelors level education in nursing, with an intensive clinical requirement. The second thing they could do would be to enforce strict penalties to force accountability on any midwife who does not screen out high risk mothers or send them to the hospital. Attempt a known breech/VBAC/multiple birth at home on purpose? Lose your certification. Simple as that.

[catccc]

But let's not gloss over the fact that there are CNMs in the US, too.  Not just CPMs.

[purple monkey]

I have personal bias on this subject, because if my daughter hadn't been delivered in the hospital via emergency c-section, she would be dead.  Or brain damaged.  But she was, and she's fine -- though she spent a week in the NICU recovering from a severe case of meconium aspiration syndrome.

Cross-country comparisons suggest that the optimal c-section rate is about 20%, and that exceeding this rate is safer than undershooting it.

Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality
[/quotce]

Any quote or study from  obgyns will always be biased.

Who benefits from this?

Might wonder why so many healthy young perfect weight mothers etc., always have emergencies.?

Cause HCPs will not give up the convenience and money.
 

Same concept as posting retirement information from full service brokers.

[Gin1984]

But let's not gloss over the fact that there are CNMs in the US, too.  Not just CPMs.

Yes but the majority will only operate within a birthing center or hospital. A home birth is likely to be only performed by a CPM.

[SirOcelot]

Any quote or study from obgyns will always be biased.

What sources will you accept? If your opinions are unfalsifiable, there's no point in arguing with them. 

I did enjoy this quote from one of the links you posted earlier:

"[M]ost American babies, regardless of socio-economic status, are born in hospitals. And while in the hospital, American infants receive exceedingly good care - our neo-natal intensive care units are among the best in the world. This may explain why mortality rates in the first few weeks of life are similar in the U.S., Finland and Austria. But the differences arise after infants are sent home. Poor American families have considerably less access to quality healthcare as their wealthier counterparts."

[I'm a red panda]

I plan on using a CNM at a hospital, an OB can step in if surgery is needed. It was actually the OB/MFM specialist from my last (high risk) pregnancy who referred me to the midwives. The OBs at our hospital really like the midwives for low risk, low intervention births. Not every pregnancy needs an OB.

We have CNMs in my area who do homebirth, but it is extremely expensive... For most, more than the hospital. I'm just not interested in the cleaning involved!  And I wouldn't use a CPM, personally...

But I also plan to "waste" the money in a doula. It's too bad insurance won't cover some of it: way cheaper (for them) than an epidural, and evidence based to reduce its usage... (And should I end up with a c section, I really appreciate that the doula will be with me after my husband leaves with the baby)

[englishteacheralex]

We had a doula for my first birth. I really liked her but I don't think I'm going to bother with a doula the second time around. She was the best doula I could have had, but her presence still felt kind of unnecessary to me. I'm an introverted person and it turned out that I'm even more introverted during labor. I really just want to go into my own little world and cope with the pain without much help. Having a relative stranger there, as nice as she was, just made me feel like I had to entertain someone, which is draining.

Second time around, I'm with a practice of six CNMs and two OB/GYNs. I've seen all of them during my pregnancy and any of them could be present at birth. I'm giving birth at the same place as last time: a birthing center within a hospital. They're all pretty great, honestly.

It's weird, for the first one I was SOOOO dialed in on labor and preparing for the whole thing, and now I'm not really even thinking about it that much, comparatively. I guess what I learned from the first go-round is that labor/delivery is just a crazy, intense force of nature--like a hurricane--and you can go in with knowledge/preparation (that helps!) but in the end you really don't know how it's all going to go down and you can't really control it. I'm kind of "winging it" this time.

You know, the kid shows up and then you're like...who cares about labor/delivery, I have a tiny infant to take care of now. Why did I spend so much time worrying about how he was going to get here?

[LadyStache in Baja]

Sorry didn't read all the responses yet, but something in your OP jumped out to me:

You said you don't think your wife would like it.

The only thing that matters in HER birth is how comfortable SHE feels.  She is the protagonist here.  You're not birthing.  You can talk about options, but she is the decider.  I can't stress this enough.

I had two hospital births and then an at-home midwife for my last birth.  It was awesome, FOR ME, because it's something I believed in strongly.  If your wife doesn't believe in it strongly, then she's not going to relax.  Not relaxed=tight down there=bad birth.

For me, the hospitals definitely made me tense because of all the interventions (ugh, cervix checks every 20 minutes, Doctor, get away from my vagina!), all the onlookers (everyone just get the fuck out of my room and let me birth!), and being somewhat confined to a small bed that makes it difficult to move around and change positions.

At home, I had our queen mattress on the floor, so I could crawl, move, whatever.  Also just being at home made me so much more comfortable.  And trusting the midwife 100% that she wasn't gonna pull some intervention on me made that experience better. 

So yeah, a midwife in a comfortable place that leaves the birther in control is better.  But if your wife is wary of that, or scared of birth in someway because something might go wrong, then she's gonna be stressed out about something going wrong, and she'll likely need to be rushed to the hospital.  I really think birthing is a head game. 

Along those lines, I recommend getting the HypnoBabies CD set.  I used it for my last birth and it really helped me feel in control and relaxed.  It's basically just reprogramming your mind for birth (to undo all those dramatic birth scenes one sees on TV over a lifetime).  You start around the 5 month mark, but you can start later if you missed that already.  "With each wave I feel, I relax more and more".  :)  I miss birthing!  I'd do it again and again if it didn't come with a baby!

(ETA: I do not mean to shame all the women who have had interventions!  Modern medicine does good things, too.  I just think that if you're scared of birth or nervous with your care--whether that's your doctor or your midwife, then it's going to affect the incredibly complex physiological system of hormones and muscles that have to work together perfectly for a successful natural birth.  Also, yes it's "natural", but we are no longer "natural humans"--we live in a totally sedentary society.  We don't squat daily.  We don't walk long distances hardly ever.  So our pelvic muscles may not be in shape to birth.

To the OP, I'm assuming your wife is a smart lady.  Why do you think she wouldn't have researched this on her own if she were at all interested?  The fact that she isn't looking into it, probably means it's not for her!  I don't think she needs you to show her the research.  She's going to feel like you're trying to convince her and she doesn't need that.  She needs to be empowered as a fucking adult who is capable of making decisions about her body on her own.  100% respect for her as a person who can handle her life.  That's what she needs while she's birthing, and it's what she needs now.  Let her take the lead, you follow.

[obstinate]

The midwives/doulas are valued for their emotional support and expertise plus can advocate for you. It's still important to have access to a doctor in case it's needed, but basically all my friends have had doulas and found them to be incredibly helpful for the process (they get involved early). I don't think this is an either/or--it should be a both/and.

I don't really get why you would need somebody to "advocate" for you. Doctors are already bound by their professional oaths to have your best interest at heart. It's totally unclear to me why you'd want another less-educated and less-informed layer between you and the doctor.

My son was born in hospital with OB attending. It was a totally normal (I.e. With epidural, vaginal) birth.

[norabird]

It's great that you had a good birth experience obstinate! Not everyone has a doctor who listens to their birth plan or makes them feel heard/safe.


Sent from my iPhone using Tapatalk

[obstinate]

But I mean surely the same could be said of a midwife or doula? You shop around to find a doula who will hear you. So instead of doing this to find a doula, do it to find a doctor? I guess if you're very constrained by insurance circumstances I can see a case for this, but I hear of people who have plenty of options of which doctor to use who still go with a doula. This is the situation I'm curious about.

I also worry that feeling "heard" might sometimes be code for having one's wishes acceded to. If one's wishes are unsafe, then that would be a bad idea.

But anyway, it's none of my business really. People should do what works best for them. I just am not fully clear on the circumstances where using a doula is more optimal than finding a doctor who communicates well.