OB-GYN vs Midwifery Prenatal Care

I sincerely did not know what a midwife was, until I was 26 years old. I was surprisingly and naively pregnant with my first baby. I went to a birth options seminar at a local birthing education center and was immediately over-taken by a world I never knew existed:

The natural birth community.

I was hearing about cloth diapers and home births for the first time in my life. Before that moment, I genuinely believed that it was my natural and arguably more intelligent right, to admit myself to a hospital, the week I was due, request to be “put under”, and wake up on the “other side”, with a cleaned and perfectly swaddled baby. I believed a small scar, from a planned C-section, could possibly be the “biggest difficulty” in my pregnancy journey.

I had no concept of what a woman’s body was capable of and what pregnancy and labor looked like.

But like so many who have gone before me, I dipped my toes into “natural birth education”, with documentaries, books, podcasts, and personal testimonies, and soon I was completely swept away in the tide of evidence-based birth and empowered motherhood.

While I decided to see a midwife, and ultimately ended up having a beautiful home birth, which you can read about here, I also saw an OB-GYN. I chose to see a medical doctor in addition to my midwife, in order to establish a relationship with a “potential back-up”, and to feel completely safe in my “counter-cultural” decision.

I had an amazing doctor.

I also had an amazing midwife.

In addition to my past pregnancy, as I write this, I am 33 weeks pregnant with my 2nd child. Once again, I am seeing both a midwife and an OB-GYN. I had a respectful and empowering pregnancy and birth experience, my first go-around. And I am having an equally supportive prenatal experience, thus far. Because I have experienced both systems twice now, I feel equipped and eager to share my thoughts from the western medical model and midwifery model, specifically, for pre-natal care.

I decided to share my experiences under 6 different considerations: time, physical health, emotional health, labor/delivery education/preparation, location, and price.

Time:

OB-GYN:

The entire experience from arrival to actually seeing the doctor can take 30-60 minutes, however time with the actual doctor is usually only 10-15 minutes.

Scheduling was usually done with an assistant or the front desk, and if changes needed to be made I needed to call the clinic and often wait or postpone my visit, as the schedule was very full.

Midwife:

Maybe I am extra chatty, but most of my pre-natal appointments lasted 45 minutes to just over an hour.

Scheduling was done directly through my midwife. There was no intermediary. If changes needed to be made I could text or call her at any time, and she was always able to accommodate my schedule.

Sometimes, an appointment needed to be cancelled last minute on her end, because one of her mamas had gone into labor.

Doctor & Midwife were similar in the overall amount of time an appointment might take. However, the time spent actually with the doctor was significantly shorter than the time I spent with my midwife. In addition, scheduling was much more seamless with my midwife. 

Physical Health:

OB-GYN:

I felt very well taken care of physically. The initial screening/questionnaire was thorough.

I saw the Doctor about 9 times. 1x a month until approximately 28 weeks. 1x every 2 weeks until 35 weeks, and then 1x a week until my delivery.

Upon each visit, my weight was always taken, my blood pressure read, and a urine sample was taken.

I had 3 ultrasounds during my first pregnancy. A dating ultrasound, an anatomy/gender ultrasound, and a quick check, because I was curious to see how baby was doing 🙂

I also had the typical health screenings, initial blood test with Rh factor screening &  group B strep. I was asked to go through continued screenings, because I had been in the Dominican Republic, and Zika was a health scare at the time, but I decided not to worry about these screenings. I also did not choose to do the glucose screening with the doctor, because I did my glucose screening with my midwife.

Overall, I felt like I and baby were carefully and intentionally monitored during my pregnancy.

Midwife:

I also felt well taken care of physically.

I saw my Midwife about 10 times after establishing her as our midwife. 1x a month until 30 weeks. 1x every 2 weeks until 36 weeks, and then 1x a week until my delivery.

Upon each visit the baby’s heart rate was checked, I had blood pressure screenings, weight and fundal measurements, and peed on a PH stick. (urine sample)

A midwife cannot do an ultrasound, but she can check the heart rate at every appointment with a doppler, and she can feel for position with her hands.

I had the normal health screenings done with my midwife, as well. Blood work, Rh factor testing, glucose screening, and group b strep test. (*Special note*: the glucose screening with my midwife was based on eating a banana and drinking 16oz of grape juice, instead of drinking a super processed sugary drink at the doctors. I preferred this!!)

Overall, I felt like I and baby were carefully and intentionally monitored during my pregnancy. I will admit that I appreciated having a couple ultrasounds, for my own curiosity and peace of mind. However, I also recognize that they are almost entirely unnecessary and even potentially harmful. (You can read about that here.)

Doctor & Midwife were very similar in physical health care. Even though, it is super amazing to me that a midwife is able to determine positioning based on feeling, having the ultrasounds does give OB’s a leg up, in my opinion. 

Emotional Health:

OB-GYN:

My doctor was very kind. He was super funny and made me feel at ease.

He would always ask me how I was feeling, but more often than not, he did more of the talking. Sometimes, he even made the same jokes at different visits. Every once in a while I felt that I was repeating myself, or he would ask questions about my family, that I had answered at previous visits. It seemed he did not REALLY remember me and my personal happenings, without me jogging his memory.

Overall, I sort of felt as though I was just another mama on his very long list of patients. I know he cared about me and maybe would have taken more time with me, had he known I was planning a hospital delivery, however, I cannot say he was all that concerned about my or my husband’s emotional well-being.

Midwife:

My midwife routinely checked on my emotional well-being. She would also ask how my husband was feeling and spent a lot of time delving into fears, joys and my personal pregnancy experience.

My midwife would leave purposeful spaces of silence in our meetings, to seemingly draw out any stifled emotions. I always felt very free to share, while she listened to both my husband and I diligently. In addition, she always had very actionable advice and encouragement to take with us.

Overall, I felt like my midwife was, in many ways, more akin to a counselor, somedays. Her curiosity about my emotions and willingness to dig a little deeper, helped me understand that my emotional health was so incredibly important to the health of my growing baby and eventual delivery.

Doctor & Midwife showed pretty stark differences when it came to emotional well-being. My doctor was kind, but did not take the time or energy to grapple with my internal “feelings”, quite like my midwife did. 

Labor/Delivery Education/Preparation:

OB-GYN:

I was offered a lot of literature, which I could read on my own. In addition, a hospital based education class was offered, but did not fit with our schedules. I was told that should I come to the hospital to deliver, that I would be mostly able to request my own birth plan (which was encouraging) however, I was not instructed on any real positions, or processes I should be aware of in labor-land.

Midwife:

I was offered a lot of literature, all of which, we addressed in our prenatal visits. We discussed labor and delivery preparations at length, I was given a birth supply list and she helped me establish my birth team and each person’s role.

We talked about what to eat/drink leading up to labor, how to do perineum massage, what to have prepared, and what sorts of signs to look for as labor was progressing.

Doctor & Midwife offered similar education, however, my midwife was much more thorough. Of course, this could have been because the doctor knew I was not planning to come to the hospital to deliver. And yet, my opinion is that the doctor did not necessarily need me to be quite as “well-equipped” when it came to birth preparation.  Considering there are so many helpers and interventions at the hospital (namely, the route of doing a C-section) it seemed that pre-labor preparation was not as critical to my or my baby’s health in a hospital setting. 

 

Location:

OB-GYN:

Hospital or Clinic.

Process: Must check-in, wait in waiting room, go through preliminaries with nurse, wait in check-up room, meet with doctor.

Hospital clinic waiting room. Sterile. Clean. Decently comfortable seating. Really harsh lighting.

About 45 minutes from my home.

Midwife:

Their office/location. (2 options)

Process: Possibly a waiting room. 1 location was 20 minutes away and the other was about 40 minutes away.

Very comfortable seating. Pictures of babies and moms on the walls. Cozy and warm.

One home visit prior to baby’s arrival, and then multiple home visits after the baby is born.

Doctor & Midwife locations were very comparable as far as ease of access. However, my midwife met in places that felt homey and inviting. The doctor’s office felt more clinical and systematic.
*Special note* This blog is specifically talking about pre-natal care, but I would be remiss not to mention how AMAZING the postpartum visits to my home were! I didn’t need to get ready or put the baby in a carseat for weeks! My midwife came right to my home, drank tea with me and checked on both baby and family, alike!

 

Price:

OB-GYN:

Covered pretty readily by most insurance plans, but depending on your plan, what happens during your labor, and in-network vs. out of network fees it can cost anywhere from $10,000-$250,000.

Midwife:

Midwives are typically not covered by insurance. (Mine was not covered the first time, but there is some coverage offered this time! Yay, Wisconsin! ;)) Midwives typically work on a sliding scale, in order to meet the needs of their clientele. So, the cost of midwifery care can be anywhere from $2,500-$8,000.

Doctor & Midwife costs are drastically different. Doctors and hospital visits are much more costly. However, many insurances will typically cover doctors, so midwives end up being more expensive for the average out-of-pocket payer. Luckily, in my current pregnancy, my insurance is helping in costs! yay! 

I truly loved both of my prenatal care teams. And I sincerely tried to write this blog from an “unbiased perspective”. Of course, it is probably obvious that I have an inclination toward midwifery care, as I believe pregnancy and birth are natural processes that should receive medical intervention only when necessary. That being said, I sincerely wish every woman could experience the sort of emotional care and comfort that I associate with midwifery care. I wonder how different my pregnancy would have been, if I ONLY saw a doctor. I would not have had the lengthy conversations, or in-depth education that my midwife offered. I would not have been empowered to let my body lead and to trust my instincts, had it not been for someone who encouraged me in that way.

Given both systems of prenatal care, I believe the midwifery model rises as the more beneficial model to the overall health and success of mama and baby…but I also believe that the PERFECT scenario is one that includes an emphasis on midwifery care and a backup with a medical doctor who is supportive and capable to help in an emergency. 

*Special note* If you are a high risk mama who does not qualify for out-of-hospital care, I highly recommend finding a doula, or a nurse-midwife who can be more of the emotional support and education, within a hospital setting.