Midwifes VS. Doctors

With a midwife one tends to get more one-on-one attention. Go ahead with a midwife and they can decide if you ae high-risk. They'll refer you if you are and then hopefully you'll get a good OB. Read Ina May's Guide to Childbirth.
Best of luck!

Dear Lindsey,
You are not "high risk" just because you are only 16, but because in general, teen diets leave much to be disired, esp when one is growing a new life within. So, it is up to you whether you eat junk and become high risk, or eat a well balanced diet, high in Protein & green leafy veges, don't smoke and have a low risk pregnancy.
In general, midwives place more importance on nutrition and exercise than docs, so I believe your chances of having a healthy birth, would be with a midwife.
Midwives are trained in normal birth. An important part of their training is to do preventative care to keep it low risk and to give collaborative care or transfer care altogether if things are not low risk.
Most complications happen for two reasons:
1) poor lifestyle choices such as smoking, drinking, and malnutrition -(and even over eating can be mal-nutrition, if its not healthy food!)
2) iatrogenic causes - meaning one intervention leads to another, leads to another, when nothing was wrong until someone interfered with the natural process. Granted some interventions are truly needed and life saving, but most happen because of choices we made; for instance, a woman is afraid of pain so she opts for an epidural, which slows labor, it's augmented, baby goes into distress, and needs a C/S, when if instead of an epidural, the woman had learned to relax and not to be scared say by taking a hypobirthing class, or having a waterbirth (called an Aqua-dural, because it relieves pain almost as well as an epidural, without the side effects)or just trusting in God, then the cascade of interventions would never have started!

.

L., first off Congratulations :)

Nextly, I don't have personal preferences on midwives vs doctors, all 3 of my children were born in hospitals with the assistance of doctors and I've yet to have a bad experience with the doctors themselves, I've had 3 completely natural, unmedicated, no epidural births with my second having some issues with being wrong side up and my last one being 10lb9oz and having a very hard time with labor and getting him through the birth canal. My mom had 5 with the last 3 being home births with midwives and she swears they were by far the best experiences.

Either way you choose, doctor/hospital or midwife, get local recommendations and make sure whichever you're using is the best around :)

However, I can't stress enough (as some of the others) how important your diet and exercise routine is while pregnant. Make sure you're eating healthy, drinking lots of water and taking your prenatal vitamins :)

Good luck with everything!!!

L.,

My recommendation to you comes from very personal experience using midwives. When I became pregnant, I was 35 years old. However, all the research shows that hospitals cause more complications than not. So, I decided to go with a midwife. There is alot of politics surrounding the midwives and assisting with births out of the hospital. So, from what I experienced. They will do everything they can to convince you up until the very end to birth in a hospital. There is so much liability resting on their shoulders. After all, this is a life we are talking about. Anyway, I don't know if you have heard of Ina Mae Gaskin and Pamela Hunt. These two ladies were my midwives out on the farm.
http://www.thefarm.org/midwives/index.html
We had a cabin to ourselves and I was in labor for 48 hours. I am a woman that is very in touch with my body. Plus, I was very in touch with my child inside the womb. So, I knew something was not going right. The morning of day 3 we decided to go to the hospital, as the birthing process was not continuing passed 4 centimeter dilation.
My backup ob/gyn (which is what you will have working through a midwife) delivered my son via caesarean section. Why? Because he did what is called a transverse op. Otherwise known as crooking your head sideways and looking back. He was stuck.
The midwives and I worked well together and were able to work fluidly when things went against the natural process.
My recommendation to you after my experience:
1. Instead of midwife, find a doula. you need someone who can 'assist' you during the birthing process. Your main goal is to have it natural, right? No drugs, so you and baby have a wonderful eye opening experience together. A doula is a paid assistance with the same skills of a midwife (if you find a silled doula).
2. Find a hospital that has a midwife wing. It will have a birthing pool, natural birthing rooms, and your doula can be there with you.
3. Have every woman in your life that calms you be in the room with you. STudies show that the process goes smoother with women and the mom is more relaxed than if the husband is in the room. Have your husband be in the room, but not in the middle of everything until the moment to catch the baby.
4. Select an ob/gyn who 'believes' in the natural birthing process.
5. DO NOT go to the hospital until you are 7-8 centimeters dilated. Read books on teaching you how to know where you are in the dilating process.
6. The longer you wait to go to the hospital, the more likely you will give birth naturally. Hospitals do not want you around for days laboring in their ward. It cost them lots of money and they will push for a c-section.
7. Watch birthing videos, practice relaxation techniques, study hypnobirthing, create a calming cd to listen to during the process, excercise daily, eat all veggies, fruit, drink lots of water (lemon water 8+ months, as this will help with your swelling), eat protein, keep a well balanced diet, stay calm, talk to your baby 5+ months and on, be happy, think happy, you & your baby are one now. Trust me, they feel everyting. Sometimes, I believed he could hear my thoughts. crazy, I know.
8. Last, always go with your instincts. Don't let anyone pull you in the wrong direction. you are the only one who knows what is going on in your body. Be strong. Have faith. And, good luck!

PLEASE go to the doctor.I was young too with my first and I had a ton of complications, not to scare you but I almost died and my baby was born not breathing. Young girls just arnt supposed to have kids but we do and we need doctors to make sure it goes ok.

L.,

I would highly recommend you see a certified OB/GYN instead of a midwife. I would recommend this soleley based on your age. If you were a perfectly healthy 20 something I would definitely see nothing wrong with having a midwife deliver your baby. The fact of the matter is at such a young age you are at higher risk or everything including pre-term labor and I personally feel you should be in a hospital being treated by a doctor who knows your history. Good luck with the pregnancy and make the best decision for your baby. This is one of those important parenting decisions you will have to make so choose wisely.

It certainly can't hurt to explore the midwife option. If you're in Knoxville, the Lisa Ross Birth & Women's Center is wonderful: http://lisarosscenter.org/. If they feel you are high risk, they will refer you to an OB.

Hi L.,

Congratulations on your pregnancy and having the courage to seek out the options available to you. There's no reason you can't have a midwife, if that's what you want. I've had prenatal care with midwives for all 4 of my pregnancies and the care I received from them far exceeded anything I had ever received from an OB/GYN or even imagined. Not only was I receiving excellent care, I was being educated in the process....thinking for myself and having choices. My first two births were in a free standing birth center and my last 2 were homebirths.

I suggest you read about the midwifery model of care vs. the medical model. Here is a link to a Wisconsin Birth Center that has the information presented very clearly. http://www.morningstarbirth.com/index.cfm?event=pageview&... Once you read each, then decide what you'd like your experience to be like. Some resources, I recommend for you are The Business of Being Born, Ina May's Guide to Childbirth and The Thinking Woman's Guide to a Better Birth. Bottom line, whom ever you choose for your prenatal care, it's your birth...because of your age, you find some that want to dicate what you need to do...follow your instinct and educate yourself during this process.

Another excellent resource is Mothering Magazine. You can read more about it here at www.mothering.com. How far are you from Nashville? There is the Nashville Birth Network as well and you can talk to or hire a doula for your birth experience. They are excellent and will educate & support you through your pregnancy & birth. If you'd like more information on any of the information I shared, please email. I will be happy to pass along what I have.

Peace & Light,
J. Lenz

Hi L.,

I'm not in Tennessee so I don't know the laws there but my advice as a mom of a 17 year old would be to talk with the midwife first. They ALWAYS have the mother and child's best interest at heart. I would trust her to tell you if you should use an OB or not, or be in a hospital or not. And even if she doesn't deliver your baby I would almost assure you that she would be a source of information for you all through your pregnancy. Midwives are usually not in this for the money.

This is a big step for you but I guarantee you that every first time mom is just as nervous and naive as you are. I was at 33. You sound awfully mature simply asking this question. My prayers will be with you through this and I hope you will update us time to time and let us know how you're doing.

God bless,

M.

Wow! Sounds like there are lots of opinions! Please remember that in the end, your goal is a healthy child regardless of how he or she enters the world, and there is no 'extra credit' for natural childbirth vs. using drugs or any of the other choices you will have.

My gut is to tell you to see an OB/GYN now and you can decide in the coming months how you want your delivery to go. You may want to schedule an appointment with the local hospital to see what it is really like...they are not as cold and sterile as you may think. The best thing is to have a professional you like and trust.

I personally had chosen OB/GYN and a hospital with a NICU (Neonatal Intensive Care Unit) for my first delivery and it was good that I had since my little one was ill/premature and if I had not made that choice, we would have been separated.

Best of luck...sounds like you've gotten some goos advice thus far!

Congratulations on this new little life inside of you! And I agree with you about midwives, with the homelike setting and personal care. I've had two home-births and highly recommend midwives and also staying out of the hospital unless necessary.

High risk for what complications during pregnancy? Also, do doctors actually handle those complications better than midwives? On average, midwives have better results with certain populations, and this is possibly due to their more personalized care, longer prenatal visits, more attention to the woman who is pregnant (rather than just to her "clinical signs" like blood pressure and weight -- you know, treating you like an individual, rather than a widget on a machine), nutritional and dietary recommendations, etc. For instance, (http://bit.ly/4Eugn) this midwife who works among the lowest-income women of Washington, D.C., cut the rate of preterm birth (the biggest cause of infant mortality) in half, although her clientele is considered to be at-risk. And as this link shows (http://bit.ly/8YLQsm), even the government recognizes that midwives do a better job than doctors:

"Certified nurse midwives attended a greater proportion of women who are at higher risk for poor birth outcome: African Americans, American Indians, teenagers, unmarried women, and those with less than a high school education. Physicians attended a slightly higher proportion of births with medical complications. However, birth outcomes for certified nurse midwives were better even after sociodemographic and medical risk factors were controlled for in statistical analyses."

There are a few different kinds of midwives -- CNMs which are certified nurse midwives and allowed to practice in every state, but most only practice in hospitals (much of the time due to politics); CPMs which are Certified Professional Midwives, who have completed an intensive training program and passed a certification test (similar to or perhaps identical to ones that CNMs passed), but who were not Registered Nurses prior to becoming midwives; and non-certified midwives, who may be just as qualified as CPMs or CNMs, but just did not take the certification test. Just over half the states have legal CPMs, and in the remaining states, they are either legally restricted or there is a legal "gray area" in which they can practice midwifery, but certification is not recognized -- in these states, a midwife may have all the qualifications of a CPM but choose not to sit for the exam, simply because it's a waste of money since the credential isn't recognized. Other midwives may not become certified because they don't see a need, or don't want the government telling them what to do.

With that in mind, take your time and talk to the midwives about their qualifications, ask for referrals, ask what their track record is, when they transfer care during pregnancy and/or during labor, who they would transfer you to, do they have a back-up doctor, what you're at risk of developing due to your age, are they comfortable with handling your situation, etc. If the midwives you've met with are either CNMs or CPMs (or both), then you can be assured that they have met the requirements necessary for certification in your state. If the midwife is not certified, that is not necessarily an indication of anything wrong, and you may still feel safe with her, but you may also wish to go with a different care provider. I've had both a CNM and a CPM with my two different births, and there wasn't much difference between the two -- both times I got hour-long prenatal visits with no waiting time before, time to talk about any concerns with the pregnancy or with life, great prenatal care, counseling on nutrition, etc. I can't imagine going to a doctor to get a two-hour long wait and a 10-minute prenatal visit, and calling that "better care." Plus, the in-labor care midwives give is *awesome* (at least home-birth midwives, which is all I've had, but probably also at birthing centers and sometimes with hospital-based midwives as well). Doctors tend to manage your care over the phone, barely even in the hospital except when you give birth, with the nurses basically in charge.

It may be that there is some reason why you would need to see a doctor, either now or in the future; but "just because you're 16" doesn't seem to be one of them.

Midwives tend to be extremely compassionate and tend to spend more time with you and are all about your emotional well being along with your physical well being. Doctors are great, but tend to be more about business - because they are so busy. If you choose a midwife, just make sure it's a Certified Nurse Midwife (as opposed to a "lay" midwife who may not have formal schooling/college). CNMs are highly trained and would have the judgment to send you to a doctor if there was a need. Or, as the previous poster suggested, utilize both, then you have the best of both worlds. A midwife cannot perform surgery (do a c-section) if the need arose. That has to be a doctor.

UNLESS, UNLESS the midwife has her office and delivery room
inside a hospital, on the same floor as the hospital's labor and delivery rooms ~ ~ ~ ~ do not go with a midwife. I have heard too many times about a sweet young woman having trouble delivering her baby, sometimes with an obstetrician and sometimes with a midwife.

My own granddaughter, with an epidural, had trouble - the baby hung in the birth canal! I was a nightmare.

Find a Dr. that uses a hospital with birthing rooms, and insist on an epidural. Our youngest grandchild was born in
a birthing room, we were all there-except my husband. We
shared in the glorious event and no one, no one was in danger..

Have an epidural. All 3 of my grandchildren were delivered with an epidural. After the baby is delivered, everyone is rested - the mother especially - the baby is un-druged as it would have been with pain killers that I used when my 3 were born!

I DO NOT UNDERSTAND WHY A YOUNG WOMAN WOULD CHOSE TO SUFFER
ALL THAT PAIN AND MISERY FOR HOURS AND HOURS WHEN SHE CAN
HAVE AN EPIDURAL, KNOW EVERYTHING THAT IS GOING ON IN THE
DELIVERY ROOM ~ ~ ~ ~AND BE WIDE AWAKE AND RESTED TO GREET
HER NEW BABY.
G. Wells

I recommend Central Carolina Ob-Gyn if you are in Greensboro. They have both midwives and doctors on the staff. I do not know if they do home births, you might ask that. I saw a midwife through both my pregnancies, but ended up having C-sections (one was an emergency, the other was planned only a week in advance). It doesn't matter how your child arrives, as long as he or she gets here safely and soundly. Good luck!

I would encourage you to talk to your parents about this issue. They will know the resources that are available in your community. I would also encourage you to quickly get good prenatal care to insure that you have a healthy baby.

First of all I want to tell you how proud I am that you have chosen to keep your baby and be a responsible parent. As for your question, I would definately recommend a doctor versus a mid-wife. You are going to need the watchful eye of a physician to make sure that everything is going as it should. I will be praying for you and your baby. God Bless and have a wonderful day!
G.

Find a midwife that delivers in a hospital..they always have a back up MD incase something happens. I have had friends with normal pregnancies...have very devastating outcomes..I don't want to scare you, but hospitals have everything needed if something happens. Most the time it wont, but for the safety of you and the baby. I work in the hospital setting, so I am a little biased, but I did deliver with a midwife my last baby..it was a wonderful experience. Besides, being so young, the nurses in the hospital are there to help you care for your baby and teach you what to look for and everything. Good luck to you!

In some areas there are hospitals that have a midwives facility in the hospital. This gives you the best of both worlds. You can have the midwife experience but be at a hospital in case of complications. In Nashville they have something called The Midwives at Vanderbilt. You deliver at Vanderbilt Hospital but are under the care of the midwives unless a doctor needs to step in.

I don't know anything about what kind of prenatal care a midwife gives, but if they do all the monitoring that a regular doctor does, I don't see why that would be a problem. Treat the interview process like you would for a doctor and make sure you are comfortable with them before you keep them as your midwife.

Another alternative is a doula. I believe you would usually have to pay out of pocket for this, but basically a doula is an advocate for the mother. She is not a doctor or midwife though, she wouldnt be responsible for your prenatal care or delivery. But you would get a person who is there just to help you through the process and make sure your wishes are carried out.

Good for you for getting good prenatal care, whatever form you decide on! That is one of the biggest high-risk issues with young pregnancies. Whatever you choose, make sure you get good prenatal care and you are definitely starting off the right way. Good luck!

Wow you are so mature for your age. I went to the birthing center in Chapel Hill NC. I loved the midwives there. As long as you are healthy other than your age I think there should be no issue with you going to a birthing center. Going to a hospital is more dangerour in my opinion as OB/GYN often offer a C-section when it is not really neccessary. I used water as pain relief during my labor and delivered in the tub. This was not an option in the hospitals around here. You should definately watch the movie the business of being born so that you have more information about the dangers of hospitals. Hospitals also make natural birth more difficult as things like fetal monitoring and IV's make it hard to move which is important to pain relief and bringing the baby down the birth canal. Good luck with your impending addition. Also you may want to start thinking about birth control now so that when you have the baby you are prepared. IUD's are wonderful and almost 100% effective.

Each Center or group has its own set of rules they go by and they will let you know if you are a good candidate to be with their group. Everyone whether midwives or OB's are in it to have healthy babies and moms! I know the birth center in my area had their own set of rules as to who they would and would not work with and if they felt that person needed to be in the hospital, then that is where they delivered. Also, some midwives deliver in hospitals also, that could be an option if you were considered high risk.
Just ask around and do the tours or question and answer sessions they offer. Best of luck for a healthy pregnancy and delivery. Also, now is a great time to learn about all the benefits of breastfeeding and the resources and groups in your area to help you with that.

I am sorry I can't offer you a suggestion on midwife v. doctor, I am just not that informed. I do want to commend you for doing the responsible thing and asking for advice. You could just have easily tried to pretend the pregnancy doesn't exist and not get help, and in the process endangering you and the baby. Congratulations on trying to do the right thing even before the baby is born (I say trying because in many cases we don't always know what the right things is until too late, but at least your trying).

You can and see if a midwife would take you.

Hi L., Just wanted to let you know there is no reason you can't have both.Do some research in your area to see if you can find an office that has both. This is what I did. I was coached for natural childbirth by my midwife and also had regular Dr appointments at the same office with my OBGYN. When it was time to deliver both the midwife and Dr were there working together. I am happy about my choice, after nearly 60 hours in labor, thats right nearly 3 days, I ended up with a Cesarean. I had all the emotional support from my midwife who decided with the Dr that enough was enough and the baby had to come out. If you have the option this is the best of both and becoming more popular around the country. Congratulations and Good Luck! I am sure you will figure out whats best for you.
- L.