Midwifery vs OB service in hospital

I had a midwife with my first, by choice. And an OB with my second, not by choice.

The OB threatened me with an episiotomy after barely 10min of pushing, and injected me with pitocin post-birth (to deliver placenta) without telling me. I only found out about the pitocin bc I happened to overhear two nurses talking about it hours later.

The midwife did give me an episiotomy, but only after 1hr 35min of pushing, and another 10min delay after my husband advocated for me. After I was cut, baby arrived in 2 pushes. She later apologized for having to do it, and said it was the first one she'd done in 3y. Baby and I were both getting distressed and it needed to happen. OB did not need to threaten me with one after only 10min.

There are more differences, but those are the big two things that stand out in my experiences. If I have a third, I will try to get a midwife, birth center birth, or even free birth before I have an OB deliver me again.

I don't think this has to do with midwife vs. OB, but individual people. I personally am very pleased with the midwifery care I have because the same two people have given me significant time throughout the pregnancy - appointments are longer, they ask for followup for any concerns I had, and have requested multiple ultrasounds for a minor issue just to be sure delivery goes smoothly. My friend likes her OB care because she is in and out within 10 minutes every time, and scheduled her repeat c-section without any issue, and likes the efficiency. So in her case, her OB is doing the surgery, but in a spontaneous labour, it would be whoever is on call coming in for the last 15 minutes and nurses otherwise. I personally prefer the idea of having my delivery and postpartum care handled by people who have been following me throughout the pregnancy, vs. relying on my charts.

I don't have personal experience with an OB beyond one of my midwives actually having had a private practice internationally before immigrating here - so I'm a little spoiled, perhaps. But honestly, my 2nd midwife was always much more thorough about discussing my ultrasounds than the OB-turned-midwife.

I did. Please do research on OB though. Some are amazingly wonderful some not so much. My experience: the midwife I was assigned to early on in this pregnancy was well... a bitch. This will be my third child and while I know every pregnancy is different, I already had my birth plan. I want a medicated birth (very low pain tolerance to point of passing out) and I cannot breastfeed due to having extreme mastitis and cellulitis from my last child that almost resulted in a mastectomy. I told the midwife this and she pretty much berated me for both saying I was lying and was just “lazy” I had a very traumatic birth with my oldest and I knew with my youngest and this one I want/ed a medicated birth because I didn’t want to go through that again. (Was induced, grade 4 tear, passed out from the pain multiple times) I started seeing the OB and it was the complete opposite. She is very understanding, has already put in my chart that I want an epidural and that I will be bottle feeding. She reminds me more of a midwife than an actual OB. And is very much more respectable than the Midwife.

What about switching to an OB and hiring a doula?

I only have experience with OBs. I only see "the OB" half of the time because they spend a lot of time at the hospital. The rest of the time is a nurse practitioner (which I don't mind). The NP was as "unhelpful" as your midwife after my last miscarriage - nothing you can do, probably just genetic, probably won't have another one, etc. My OB does dopplers as well (not ultrasounds) and most of the data they get sounds like it's from radiologists, but it's hard to tell. So my experience so far with OBs sounds very similar to your experience with the midwives. (But I haven't had major problems yet in this pregnancy.) Hopefully someone on this thread has tried both! I'm very curious.

I don't know. My mother had c-sections, my grandmother had a c-section, my husband's mother had a c-section - all in different eras, sometimes in different countries. I don't want a c-section, but I wouldn't be surprised if I end up with a c-section. And fuck it, I just want my baby alive at the end of the day.

I’m definitely interested to hear people’s experiences. I feel like my midwife didn’t even give me a heads up that I was measuring far behind what I should have and I was so confused and it led me to tell people I was pregnant when I think it was pretty obvious that things weren’t potentially not progressing correctly initially.

I’m from the US, so this maybe different depending on where you are at. I’m not sure where you are located but it sounds like the hospital that I delivered at has a similar set up. It was a big teaching hospital and both OBs and a midwife practice delivers there.

The midwifery group and the hospital recently settled a huge lawsuit because they were taking care of high risk patients, when they should have referred them to OBs and MFMs. Several women and children died because of this, so I would make sure that your midwifery practice has a good track record (as well as the OBs). I also attended some classes run by the midwives, and it left a bad taste in my mouth. When I asked about supplementing with formula as necessary they just told me they don’t mention the “f word around here”, and with a lot of other concerns I had just dismissed it as “your body knows how to do this”.

I also wanted more information beyond something I could read myself. I wanted someone who had a lot of experience and had seen a variety of patients with all kinds of problems. Since it was really close I chose a practice that was in the teaching hospital. My OB and nurses were absolutely phenomenal. They always let me come in for heartbeat checks or NSTs. They didn’t dismiss my anxiety or fears, they didn’t treat me like I didn’t know what was going on (I’m in a STEM field adjacent to medicine, my husband is a physician), she always answered all of my questions and was honest, instead of sugar coating things. She admitted when there was no evidence for certain things (like kick counts), and informed me about the newest research and innovation.

My very low risk, normal pregnancy turned into a complicated labor that no one anticipated. My son wasn’t handling labor well, we attempted a lot of interventions to try and do a vaginal birth but he took a turn for the worst in a short period of time and we had to have an emergency c-section done. My husband and I are really thankful that we picked that hospital to deliver at, since a vaginal delivery for us probably would have led to a bad outcome for my son. I think my recovery after the c-section has been a lot smoother than most women who I know had a vagjnal delivery.

It sounds like you are personally wanting more information and would be more comfortable with a higher intervention approach than what you are getting right now. You know you are not happy with what you are getting, and you are still early in the pregnancy. Why not ask around about different OBs and schedule an intake? Meet with them, bring your questions, and see if they are a better fit and able to offer you what you need? You won't lose anything by trying.

Regarding my personal experiences ... I'm a G6 P4, with 3 living kids and 1 child who experienced a random and ultimately fatal birth injury. We have one hopefully healthy kiddo expected in a few weeks. I'm also a NICU nurse and all for any intervention that's going to help us get through pregnancy and birth alive and healthy. But I also appreciate a lightest touch approach when things are low risk. I love to be educated about all the nitty gritty details and I like having my autonomy respected.

I get what I need from a midwifery group that works closely with an OB and delivers in the hospital, but based on my experiences with the OBs who have treated me at various points in different pregnancies and births, I know I would get what I needed with them as well. I've never had a good reason to switch, though, so I never have. At this point I have a frank relationship with the midwives, and can easily discuss any concerns. I know that I would be referred for a higher level of care if I needed it, because I've been referred in the past. Etc.

Ultimately what you're comfortable with is personal. There is absolutely nothing wrong with meeting with another care provider to see if they are a better fit for you than the one you see now.

I think (if you’re able to) switching to MFM might make sense. They’re OBs but have lots of extra training and are able to do/read ultrasounds themselves. Some don’t require you to be high risk to see them. I’m at an academic hospital and will probably end up with MFM for this pregnancy for peace of mind. My genetic counselor recommended it, actually, even though the only “high risk” factor I have is my age (35).

Please take my opinion with a grain of salt because it's just my opinion but OB ALL THE WAY. Not that there aren't crappy OBs and amazing midwives but Midwives simply don't have the back up medical knowledge and resources that OBs have. Not to scare you but someone I know very recently had a 37 week stillborn which could have been prevented if the midwifery practice had acted. I know several women who have been transferred to an OB last minute as well due to emergencies. Now, these are extreme experiences but here in Canada it clearly says even by the association of Midwives themselves that Midwifery care is for low risk pregnancies only. It sounds like because of your history and age your pregnancy is considered high risk. I'm 31 with one prior MMC and they put me in the high-risk category for the MMC alone. I looked into a couple of midwife practices my first pregnancy and I wasn't impressed. This being said I also know people who have had healthy babies with midwives. I personally am more comfortable with an OB considering my past. I love love love my OB but honestly, I would still probably take an OB I didn't connect with personally over a midwife I did. That's just me