***I want to start this post by saying that I am truly grateful for Obstetricians and the life-saving surgeries that they perform. They have much knowledge and their skilled hands have undoubtedly helped many women and babies survive in dire circumstances.***
I remain unconvinced, however, that OBs are the best caregivers for women with normal, low-risk pregnancies.
I worked with an OB for my first pregnancy (delivered in a hospital without drugs) and I worked with a midwife for my second pregnancy (delivered in a birth center with no drugs)...and the two experiences were night-and-day. The latter experience was truly a thousand times better.
Here are four things that doctors do that generally drive my crazy (if you want to hear my more eloquent - and less snarky - thoughts on this topic, read: Birth Centers Versus Hospitals):
MAKE THE "PATIENT" UNDRESS FOR OFFICE VISITS. On most visits with my OB, I was asked to remove my clothes and put on the obligatory, flimsy hospital gown. She'd walk in, look at the charts, give me advice, check for dilation (see next point), and that-was-that. Not only is removing clothes inconvenient, I also don't like the message that having a hospital gown sends...which is "I am the doctor. You are the patient. You should do as I say." Rather than - "You are a perfectly healthy woman experiencing a perfectly normal stage of life and I am so happy to be a partner with you in this process."
Guess how many times I was asked to remove my clothes during my entire pregnancy when I had a midwife? Only once...and it was actually necessary.
CHECK FOR DILATION OBSESSIVELY. Towards the end of my pregnancy, my doctor checked for dilation at every.single.appointment. This process is entirely unnecessary and can lead to all kinds of undue stress for the mother-to-be. If your due date was yesterday and you're still not dilated, you'll feel worried that the baby might not arrive for another week (in actuality, you could go into labor tomorrow). If your due date was yesterday and you're dilated to four, you'll be on cloud nine, thinking that the baby will be here any minute (when that isn't necessarily the case either).
Guess how many times my midwife checked for dilation for the duration of my prenatal visits? Zero. Nada. Zilch. Even during labor & delivery, the midwife checked only twice (compared to about every 30-60 minutes in the hospital).
GUESS HOW BIG THE BABY IS GOING TO BE AT BIRTH. It drives me bonkers when doctors make estimates without providing a very large disclaimer that they have no idea and could very likely be wrong. Again, a weight estimate typically serves no helpful purpose and tends to only frighten the expectant mama. What can she do about it anyway, even if her baby will be a big one?
Besides, their guesses are - often - wrong. My sister's doctor recently "guessed" that her baby would be over 7 pounds. Real birth weight? Under six.
SUGGEST INDUCTION UNNECESSARILY. Why is it that so many doctors are induction-happy these days? It's always this or that or the other. I certainly am not implying that inducing is always a bad thing. Sometimes it can be medically necessary to ensure the health of mom and baby. BUT that is the rare exception...or at least is should be.
Guess how many times my midwife suggested or implied that perhaps we should induce? Um - never. Surprise, surprise, right?
Note: Obviously, these statements do not apply to all obstetricians...but they do reflect the current "way" of doing things in the medical industry in the US.
Note 2: Pregnancy and birth experiences are not the same for everyone. Expectant mothers and caregivers need to work together to determine what is best in their unique situation.
YOUR TURN: What other things would you add to this list?
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My first birth was supposed to be a home birth, didnt dialate with hard labor at 15 hrs+ went to hospital, they gave me something that caused allergic reation, thus an emergency c-section. 6 years later my due dte for second baby is June 12th. Becasue I have state insurance I'm working with an OB close to my home. HAving a OB now and having a midwife last time is way different. Night and day. My OB's, as I have seen all three in the practice, that they will allow a trial of labor only if I go into labor on the 12th of June, and that if I go over 40 weeks, it will be a repeat c-section. I don't like that I'm feeling like I am being forced to have a repeat CS. My daughter was 41 weeks, and what if this baby is ready to come exactly at 40 weeks. I don't see how they can make me if I stay at home an refuse to be cut open. I want to attempt a VBAC but how could I if I go over 40 weeks? I almost was on the brink of death fromthe 1st CS, was in the hospital for 6 days with a fever of 103, 104, and a bad cough during that winter that severly hurt the area that was stiched. If anyone knows why I have to be cut open at 40 weeks please let me knwo as I have not found any medical reason for this.
The one thing that I received with all of my OB's were the gift of just sitting and listening to me. I would have to say if a doctor doesn't LISTEN then, that is a HUGE NO in my book.
I read somewhere that a doctor will interrupt a patient after 20 seconds of the patient starting to speak. SCANDAL!!!
My OB was pretty good, no major complaints, but the one thing that bugged me was that everyone in the practice assumed I'd end up with a c-section since I'm over 40. (I didn't). I told them if that ended up being what was best I was okay with it, but a couple even suggested I go ahead and schedule a PLANNED c-section. For no reason whatsoever!
Oh, I agree with your list! Although I never had an OB- but for these very reasons :). I think its outrageous that they guess birth weight, and then induce women a week or two ahead of time because the "baby is getting too big". What woman is going to argue with that? It puts so much fear into the mother (which is their plan to stay in control). I'm trying to tell this to a friend that was just told she is going to have to be induced two weeks before her due date because the baby is getting to big (she is due next month), and the truth is- early inductions, and unnecessary interventions lead to unnecessary c-sections, and all the risks and complications that go into that. The c-section rate is 35% in America, and the death rate for mothers is higher (I think maybe the highest) in 1st world countries. I would add to your list that OB's aren't about informed consent, and it actually annoys them- they would rather you take their advice, and be quiet, and do as they say. The other thing I would add to your list is that your midwife is personal- your appointments are long as they get to know you, and what you are like. Thus making them a better advocate. My midwife is a great friend now, as she asks me about my life, and what is stressing me. She also is there through the whole process of labor and delivery with me, and doesn't just walk into "check" me, leave, and only come back when I'm ready to push. A midwife is there for you, supporting you, (literally massaging perineal the whole time), and answering all your questions as to what is happening to your body, calming your fears. It's night and day difference the amount of care you receive with a midwife vs an OB
I'll add to your OB list.
5) Break your water out of routine habit when it is not necessary and probably actually contributed to complications in childbirth that resulted in horrific recovery.
I had an OB with #1 and a midwife with #2 and #3. I love, loved LOVED the midwife experience. I, too, felt like the whole experience was much more "medical" with #1 and more natural and nurturing with #2 and #3.
I still had epidurals with all 3 (my midwives' philosophy was that the mother-to-be calls the shots, and so if you want an epi, you can have it. If you want to go natural, they will help you do that.) I'm all about the epidural.
My midwife practiced out of her home which was so much more pleasant than going to a doctor's office.
I agree with all of those! I switched from an OB to a CNM midway through my pregnancy and couldn't have been happier. And I had a pretty decent OB, which frightens me about who else is out there lol.
I will add this:
OBs are test happy. He wanted me to do every genetic test out there and didn't make it seem like an option. My midwife only offered one test and they didn't seem to suggest it too much.
Obs are also procedure happy. Delayed cord cutting? No episiotomies? No monitors? Not happening.
I still delivered in a hospital but loved my midwives and the support they offered. It was more like a friend was with me more than a doctor.
I understand what you mean by guessing weight. My office has 3 midwives, which people usually see unless they are high risk, they also do 80% of deliveries. Then they have 3 doctors for the high risk pregnancies. Well I am measuring 42 when I am 33 weeks along so they did a US to find out how big the baby was and it seems that he is estimated at 5 pounds and 6 ounces. Then she said I have 30(I don't know the unit they measure the amniotic fluid with) of amniotic fluid and that is probably why I feel so big. Anyway the midwife said she wanted to have the doctor see me because they would want me to talk to a doctor anyway. So I saw a doctor and he was saying how the baby was pretty big for the week I am at and they were going to schedule another US at my next appointment to see how big the baby is then. He said we might have to talk about a c-section because his shoulders might get stuck. When with my second child they induced me because they thought she might be big but she only turned out to be 7 pounds 15 ounces. So I know that these estimations are just that and are nowhere near being factual.
Gosh, after reading all these comments it seems that doctors and nurses need to take a course in human relations. Sheesh!
I went with a family practice clinic for my first baby, I didn't really have a choice since I was on state insurance. I also didn't meet the doctor who actually delivered until delivery day since there were 8 doctors who rotated. However, he turned out to be fabulous for me, not pushy at all.
My pre-natal appointments were a nightmare though. The nurse practitioner I saw for the first 7 months actually accused me of being the one to "harm" my baby when I wondered aloud if all the ultrasounds I'd had were going to be okay. Then, the other female doctor (who was my age with no kid) basically started talking about induction before I was 40 weeks "if" I were to go past 41 weeks. She had no idea what would happen - I actually went into labor on my due date - but she scared me for no reason.
For all of these reasons plus the fact that I felt like I had NO control in the hospital I am going with a local midwives clinic this time around and having my baby at their birthing center. I must say that so far they have been absolutely fabulous and having friends give birth there (and at home with them) makes me so much more comfortable! Now I just hope I can survive without the drugs... :)
I don't like the undressing bit either. I even went in one time for mastitis, and the nurse told me to take off all my clothes! Like my lower half needed to be exposed for that!
Another thing that drives me crazy is when OBs hold the health of your baby above your head. I hate it when people say, "All the matters in the end is a healthy baby." That's not ALL that matters.
I had the same experience as you...OB with #1, midwife with #2. I'll never go back to an OB if I can help it. LOVED LOVED LOVED my midwife experience. I would give birth every day if I could have the same experience again.
i agree with most here who say that they had a totally different experience with OBs. With my first pregnancy I had an OB who I loved. I don't think I removed all of my clothes at any appointment. I removed my bottoms for the strep B test and to check for dilation once, and I actually asked for that since I was clueless. My OB said she wouldn't consider inducing until at least 41 weeks, which I was fine with. I didn't make it that far at all, which was fine by me!
I switched to a midwife this pregnancy because I had an awful doctor deliver me (not my OB, as she was out of town) and I didn't want to risk having her again since she was still in the practice.
This time I undressed at my initial appointment to do a regular exam and later to have them look at something (at my request). Since I'm only at 31 weeks there hasn't been any mention of either induction or dilation.
My OB never guessed how big the baby would be, but did have me have an ultrasound at 35 weeks since I was measuring big. The ultrasound tech estimated the weight based on measurements. Who knows if it was correct, since the baby was born 3 weeks later and larger than the estimate, which was to be expected.
I'm currently pregnant with my first child and after my first appointment and ultrasound, I switched to a midwife birthing center. It was night and day. Comparing experiences with friends in town who have OB's, I know I made the right decision. I've never stripped down completely, I'm not rushed at appointments, I'm not getting lectures for declining quad screens and other tests and I'm encouraged to be active in my pregnancy and labor. I fill out my own chart at each appt and the midwive takes a full 30 minutes to meet with me.
I agree that there are many great docs out there, but in a smallish town like mine, most take the view of pregnancy as a sickness, not a natural part of life. Oh, and don't even get me started on the hospitals! (and I work at one!)
I went with a family doctor because of the experiences my friends had shared about working with the local OBs, which were basically the same ones on your list. My doctor was amazing! I've since moved to another state where the options are overwhelming - Provo, UT had one hospital and my doctor's clinic was across the street from it and Mesa, AZ has about 7 different doctors just on my street. I feel that I was extremely lucky finding the doctor in UT, but think I might opt for a midwife for the next baby because I have a low tolerance for being told what to do and unnecessary procedures. And I feel it would be pretty time consuming finding a family doctor that shared my point of view.
As far as guessing baby size, I had a pretty funny experience with my baby. My doctor thought that I would have an average 7lb baby, but my son was a whopping 9lb 13oz. I still laugh about how everyone in the delivery room was shocked.
What is interesting is that the US is more dr-led in births than most countries. I had my son in the UK and it was all midwifery led and I loved it. No weight checks, no undressing, no internals until I was past 40 weeks, and even then it was my choice to have a membrane sweep, I could have said no. They did an ultrasound at 41 weeks 3 days, guessed he would be 8.5 lbs, I was induced at 42 weeks and he was 6lbs13oz. If they had induced earlier, like they would here in the US, he would have been smaller. I am using a midwife group in the US whenever I have another and hope to have another good experience!
I also have a friend who was recently induced early because her baby was measuring "huge" and was supposed to be 10+ pounds. She ended up with a long painful forced labor that ended in a section and a 6 pound baby girl. I wish that was the only time I've heard of that happening, but it is extremely common.
I totally agree with you Stephanie. I have been to two different OBs in two different hospitals and they were both just like this. They also just don't have the necessary experience to assist a drug-free labor. Alice was posterior and asynclitic (facing up and her head was to the side) and when I arrived at the hospital at 9cm my OB broke my water for no reason at all (except, you know, because that's what they do) removing the fluid and with it-- any chance of her turning to a better position.
Then, of course, the OB had no clue how to position me to encourage rotation because nearly all of her patients are completely numb and helpless in situations like this. She said I was her first to deliver a baby in this position without drugs, and it was NOT easy. After two hours of pushing, she even remarked, "If you would've had an epidural I could've pulled this baby out with forceps an hour ago". Um, NO THANK YOU.
My first birth was even more medically over-managed if you can believe it. Induction before my due date, pitocin as high as it would go, epidural, heart rate decelerations, the whole works. Sadly I think most women don't even realize how over-managed their births are and what they could be like without the OB constantly tinkering around with things that have not been scientifically proven to help the process.
Great list, I couldn't agree more! My friends were so anxious toward the end of my pregnancy when I didn't know whether I was dilated yet. I was thankful not to know! I think it would have made me crazy either way.
As I was reading through this post I couldn't disagree with you more... Although my experiences are obviously different then yours. The only times I was asked to remove my clothes(bottom half only) was when they needed to check dialation(which only happened twice at doctors visits)... I was reccomended not to have inductions but opted for one because I wanted to have enough time to get antibiotics for my strep B... Which I had with my first also and it was a short labor. It was actually good that I was induced because my amniotic fluid was green from the baby. One of my doctors said that guessing the weight of the baby was a waste of time because you really don't know how much the baby will weigh. I have heard people say the doctor thinks the baby is going to weigh well over 8 lbs and the baby ends up weighing about 6..
I 'unknowingly' used a midwife with my first, loved her and chose to have a midwife for my next five. On the sixth, though, the midwife had gone off rotation and one of the doctors in the practice had come on and he was the one who delivered. It was a night and day experience and I look back and wish that I would have insisted on one of the midwifes being there instead.
All six were uncomplicated births, so I also wish I had considered true birthing centers. The hospital calls theirs a birthing center, but it is nothing like those you describe. They weren't 'bad' experiences and there were many kind and skilled professionals there, but I think there is a lot that is unnecessary in a hospital for most births.
I also agree that many OBs are 'pushing' inductions, especially with first time moms. I know several who were slightly overdue and let their OB convince them to be induced and ended up having to have a C-section when their labor didn't progress. I realize there are times when that is a benefit, medically, but I think those times are a small percentage. There is one thing that is certain - no woman has ever been pregnant forever! Your body knows what to do when it is time.
I hate that doctors check the weight. My midwives aren't even having me step on a scale this time, and I'm so much happier. Weight gain is totally irrelevant in most mothers. I think it's only truly important when they're worried that a woman might not be gaining enough weight, and they're suspecting IUGR (Intra-Uterine Growth Restriction) or malnutrition. Otherwise, ditch the scale, please.
I started out with a midwife for my first but switched over to an OB after just a few visits. My OB was wonderful- although she did get a "talking to" by my husband on our first visit. We had waited for an hour in the waiting room and then a half hour in the treatment room. Come to find out, she had been visiting with drug reps while we were taking time out of work and school to be there.
My second pregnancy- I was put on bedrest from week 24-34 due to preterm labor. I was grateful for their constant checking of dialation, because if things had changed at all from the 24-34th weeks I would have ended up in the hospital on a steroid and IV.
I loved all of my OB's and wasn't very impressed with the midwife group I tried.
Sorry you had such a yucky experience with your first. :(
Mind if I sing the praises of my doctor? He's not an OB, because he refused to perform abortions in school. (True story!) He's family practice, and specializes in mamas and babies. He was my doctor for all three pregnancies.
I never once was checked for dialation, for the same reasons you gave. Yay!
I never once had to put on a hospital gown. When I did the strep B test I just slipped my pants off real quick.
Even when my water broke and I didn't start laboring until 13 hours later (with 2 of my pregnancies) he never suggested pitocin and never made me hook up to an IV.
And... I have to give credit to our hospital/birth center. Their staff pretty much left us alone, too. It was lovely!
I think it really must depend on your OB practice. Mine has a mix of midwives and doctors and they ask you to see everyone at least once during your pregnancy. I was only asked to remove my clothes on three visits, one for my initial pap, and twice to sweep my membranes to see if they could get labor started. I had an ultrasound that put my baby at 11 pounds, and elected to have a c-section, induction wasn't even brought up. He was born at 10 lbs, 12 oz. healthy and happy in a hospital. No gestational diabetes, just a big giant baby.
The point is, everyone is different, just as every doctor or midwife is as well. Here, we have hospitals that are more like birthing centers that have jacuzzis in the room and we also have hospitals that are Level 1 trauma centers with unbelievable NICUs. I think it's a matter of choosing the right place and doctor for you, and less about discounting something that may work well for someone elses birth experience.
Interesting post to read. My first child was born overseas & I only did all my doctor visits in Austria.
With #2, we were in the States for the first 5 months. What a difference I noticed! I was actually looking forward to getting back to my doctor in Austria (she's Persian, but is fluent in German & English). She is personable and caring. She gives out her cell phone number to her patients and encourages them to call her when needed.
It wasn't that I had a bad experience in the States...it was just different. It took much longer, and felt much more formal than my experience in Europe. I believe one has to find what works for her...whether it's through an OB or a midwife!
I have had a few close friends who have had similar opinions about OBs. I've been blessed to have a doctor whom I've really liked. My first pregnancy was high-risk and my second was healthy and "normal". Both girls were delivered at the hospital. I must have fell into that rare catagory of women because I too did not have to undress for every visit, nor did my doctor check for dialation frequently. He did however guess both girl's birth weights and both were off :-) I look forward to reading what your other readers have to say. Great post.
I had 3 of my babies with OBs and one with a midwife in a hospital setting. I found really no difference personally. Better bedside manner and more time spent between the midwife and me but otherwise indiscernable (sp?). I wonder if it depends on where you live? I can honestly say none of my caregivers did any of the 4 things you mentioned above. I wonder if that means I was in the Twilight Zone? EEEK!