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Old 09-01-2007, 05:59 PM   #1
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Doula, midwives and Ob's?

My hubby's insurance covers a midwife or an ob at the same rate ($20 first copay, and then 100% of the rest). Im not sure what the difference between a midwife and a Ob is though? Can someone help me out there? Im thinking of changing drs anyways, im not too hot on mine.

Also, what IS a doula? Im not sure that DH ins covers one, but i also dont know what they do!

Thanks!!

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Old 09-01-2007, 06:30 PM   #2
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Re: Doula, midwives and Ob's?

i think a doula is one who helps you L&D the baby at home?
a midwife you can go to the dr to see and an OB is a reg baby dr that delivers babies and deals with female medical issues for a living.
I go to an OB, its a private office and they have about 6 midwives working there also, its great! i get to see the midwives but i dont rarely have my appts with them because i have c/s with these last 2 kidos of mine so the OB who will deliver and do my c/s is the one i mostly see but for those who have vag births, they will deliver with a midwife at this birthing center
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Old 09-01-2007, 06:43 PM   #3
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Re: Doula, midwives and Ob's?

Whats the difference between a "birthing" center and a hopsital? Ive always gone to the hospital, and changed drs so i could go to a different one this time (bad experiences at the other hospital). Can i still have an epi at a birth center? Im not hot on my dr, im considering changing, but im not really clear about midwives... Are you say they are, or arent drs? IM so confused!

Wow mama, thats a nice preggo belly! Im too shy to post mine!
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Old 09-01-2007, 07:21 PM   #4
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Re: Doula, midwives and Ob's?

A midwife is NOT a doctor (e.g. didn't go to medical school). However, there are varying types of midwives - CNMs (certified nurse midwife, this type most often has hospital priviledges), lay midwives (have plenty of experience, but probably not an "official" certification recognized by the hospital, but probably does homebirths).

That's all can help you w/ now - I had an OB for both of mine. From what I've heard, a mw will be more focused on you & possible nutrition, supporting you through pregnancy & L&D, whereas an OB is a really a surgeon trained in delivering a baby (and possibly associated surgeries).
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Old 09-01-2007, 07:50 PM   #5
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Re: Doula, midwives and Ob's?

A doula is someone who is just there for you to help you through your labor. There are different services that doulas provide, some only come for the birth and help you labor comfortably and some offer post partum services like cooking and cleaning, etc. I have never heard of insurance paying for a doula as they are not in any way medically affiliated. Doulas can go with you to a hospital or birth center or assist you at home. Many people hire a doula to come to the hospital with them especially if they have an OB but want additional support during the labor portion or feel they could use someone to advocate for them to the hospital staff regarding following their birth plan.

I'm sure there are others who might be able to explain the whole midwife vs. OB thing more eloquently than me but I have some time so I'll give it a shot. There is a fundamental difference in philosophy between Obstetric care and the care of a midwife. An OB looks at pregnancy and as a medical condition that needs to be treated and birth as a medical event or procedure. A midwife looks at pregnancy as a normal, natural process and birth as a natural process and sees their job as being to help you keep everything normal so as not to need "medical" care. An OB or a family practice MD that delivers babies will be there to "catch the baby" but are not a part of your laboring process generally. That's part of the reason some people hire a doula.
It gets confusing because now there are more CNM (certified nurse midwives) who work right within OB practices that actually practice much more like an OB than like a traditional midwife. I happen to see a CNM who is independant and follows the more traditional midwifery model. My appts focus much more on building a relationship with my DH and I and preparing mentally/emotionally for the birth than on medical "stuff". CNM's generally deliver at a hospital or birth center. A CNM has a degree as an RN and then has gone on to an additional midwifery school as a post graduate program. The CNM's who are more medical minded and work with an OB practice will likely only be there for the actual delivery as well, like an MD. The independant CNM's will be there with you for the entire labor as well as part of your emotional support as well as the "medical" care. As far as I know, a CNM could get you an epidural if you really wanted/needed one and you were in the hospital.
A "lay" midwife is a midwife that delivers at people's homes. Many of them are trained and certified through various midwifery programs but they are not medical or nursing school type programs, it is a training and apprenticeship program. They will definately be with you through then entire process and often stay for a while after the birth as well.

Birth Center can mean a lot of things. Some hospitals call their OB dept a "Birth Center" but generally when someone says they are delivering at a Birth Center as opposed the a hospital they mean an alternative place outside the hospital (but usually near one). An alternative birth center is more of a home type environment, more comfortable, sometimes you can have a water birth, etc. You could not have an epidural without being transferred as far as I know because for an epidural there must be an anethesiologist on staff and a birth center wouldn't have that.
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Old 09-01-2007, 08:05 PM   #6
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Re: Doula, midwives and Ob's?

OH OH OH!! Go to Heather Caudell at Medical Center of Lewisville. Seriously. I *LOVE* her. She's an outstanding midwife. She does the births there at the hospital. I didn't find her until I was 19 weeks along after my boyfriend and I got "fired" from our @sshat of an OB down in Irving.

I could not possibly speak highly enough about Heather and her dedication and compassion. The day before I was to be induced she called me personally to check on me, and after the birth of DD#2 she sent a little hand written card (no OB I know would ever do that).

My L&D with DD#2 was pretty well painless and I don't think it would have been if I hadn't had such wonderful support from my boyfriend and Heather both. I also credit her in part for my success with breastfeeding. She noticed DD#2 was thrusting her tongue and rooting around and she told the nurse that her exam on the baby could wait and promptly put her to my breast.

If you want her number PM me and I'll give it to you!

Okay.. I'll get off my soapbox now.
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Old 09-01-2007, 08:28 PM   #7
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Re: Doula, midwives and Ob's?

Midwives are generally not medical and are more personal... will spend more time with you and help you acheive the birth you want. they have the best statistics for births even with twins and breeches. their training involves a naturalistic approach, thus less complications.

a doctor goes by the rules only and is going to be more for intervention, technology and such. they have the higest rate of c-secs, maternal and infant death here in US.
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Old 09-01-2007, 08:43 PM   #8
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Re: Doula, midwives and Ob's?

Quote:
Originally Posted by nacke View Post
Whats the difference between a "birthing" center and a hopsital? Ive always gone to the hospital, and changed drs so i could go to a different one this time (bad experiences at the other hospital). Can i still have an epi at a birth center? Im not hot on my dr, im considering changing, but im not really clear about midwives... Are you say they are, or arent drs? IM so confused!

Wow mama, thats a nice preggo belly! Im too shy to post mine!
I delivered at a hospital with an OB and at a birthing center with a midwife (see my avatar)... so I've experienced both sides. I'm also a post partum nurse in a hospital... so that's another perspective I have.

Most midwives have an advanced nursing degree (a masters of nursing in midwifery). They are highly qualified to treat lots of complications and work independently from docs (they can prescribe meds, etc without having a doc's approval).

A *true* birthing center is a freestanding building (not attached to a hospital) that is run by midwives. Some hospitals call their L&D "family birthing center" so don't let that confuse you. No, you cannot get an epidural at a birthing center. Some birthing centers will do narcotics. However, I wouldn't let that discourage you necessarily. I delivered in water and the jacuzzi helped immensely with the pain during labor. The midwives are used to natural childbirth and can coach you on what to do to help. Having natural childbirth in a birthing center with a midwife is a totally different animal than trying to have natural childbirth in a hospital. With my birthing center birth, I didn't have an iv, could move around as I pleased, could drink or eat (didn't want to eat but they offered me breakfast during labor), I was never strapped to monitors (they got the heartbeat with a doppler every 30ish minutes). It was amazing how much less painful it was than my hospital birth... and I gave birth to a baby that was over a pound heavier

I had a hospital birth with DD and had an iv narcotic but no epidural. It was overall a good experience... but after delivering in a birthing center, I will never deliver in a hospital again unless there are complications.

DH was initially opposed to the birthing center (he was afraid of the what ifs that can go wrong... however, birthing centers are less likely to have complications), but afterwards he was amazed at how much better our midwife attended birth was. Everything was just so comfortable. We got to have DD in the room for the birth, the lights were kept low (the midwife used a flashlight to see when the baby was crowning), there was no rush to hurry up and deliver me so she could get back to the office or whatever like we felt when an OB delivered us.

I heard someone say when you give birth with an OB "you are delivered"... when you give birth with a midwife "you birth your baby". It's just a different mindset. Of course there are exceptions. Some OBs practice with a more midwife mindset and some midwives (especially those based in hospitals) have more of the OB mindset.

I just LOVED going to a midwife. Every appointment was great. The birth was an absolute perfect experience. Even little things. With my hospital birth they checked my cervix like 8 times (in a four hour time frame). With the birthing center... they checked me when I arrived in labor, when I got into the tub, and upon my request when I wanted to push. They would not check your cervix at all if you didn't want them to.

I felt like my birthing center birth was all about how I wanted things. My hospital birth was in accordance with hospital policies. Birthing centers are great. I know there is one in the Dallas area. Call. Go on a tour. Have a baby there. I could do commercials for Nativiti here in Houston. Like, everyone is tired of hearing me talk about it I loved it so much. A friend of ours was there for the birth (she was DD's "babysitter" for the day). She said she called her mom on the way home and said "if I ever have another baby I am going to do that".

If you have more questions you are more than welcome to pm me. Just my
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Old 09-01-2007, 09:05 PM   #9
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Re: Doula, midwives and Ob's?

In a bit of a response to paintedbison ..

I did a hospital birth with DD#2 and had a midwife (as noted above )

I only had a hep-lock until I ended up having to have pitocin administered (stalled for 3+ hours at 7cm) but I had been in there for induction initially but went into labor on my own 7 1/2 hours prior. I also had the monitors and cables in place, but only had to hook up to the machine every hour or so for about 2 minutes. Otherwise I was free to roam around as I pleased. I chose to stay in my room and pace. I didn't eat or drink because of the scheduled induction, although food during labor is not permitted at the hospital anyhow in case of emergency c-section. I totally understand that reasoning and was okay with it.

I requested as part of my birthing plan not to have excessive internal checks. I got to the hospital at 7am and had my daughter at 8:19 and I don't think I had more than 5 internal checks in the 12 hour time frame. In fact we got so good at hooking up the monitors when needed that the nurse hardly had to come into the room except to check and make sure we didn't need anything.

And yes, there's a birth center on Lovers Lane in Dallas.
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Old 09-01-2007, 10:06 PM   #10
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Re: Doula, midwives and Ob's?

I've had experience with both ob's and midwives. In my experience, midwives take more time during their appointments (for me, it was 20 minutes with the midwife, sitting down, vs. 5 minutes with the ob, him standing the whole time). It feels more intimate with a midwife, since there is no Doctor title and white coat creating that hierachical feeling that I often get with doctors. I will say that sometimes my midwife appointments felt a little unfocussed and talk-y, but that's hardly the worse thing you could experience.

Midwives also usually spend more time with you during the birth. Mine was there for maybe an hour before pushing and through the whole pushing stage. I think many ob's just show up for the pushing phase.

I think midwives are also less definitive than ob's. If you like a definite answer, if you like your doctor to convey certainty and authority, iif you want your doctor to be in charge of you, you'd probably prefer an ob. I think ob's sometimes fake that certainty, but it can be reassuring at times. Sometimes it can just be irritating.

Many people choose midwives because they want a natural birth (no epidural) although midwives can still order epidurals and attend your birth if you have one. Midwives are generally more open and, in my opinion more skilled, at low intervention births. Another reason people choose midwives is because they want a woman doing their prenatal care and attends their birth, and almost all midwives are women. If you can choose an all-female ob practice, you could accomplish the same goal.

Lastly, you need to find out how much autonomy the midwife you are considering has. Does she actually attend the birth or just do your prenatal care? If she attends the birth, is she the person who admits you to the hospital and is responsible for your care, or does she operate under an ob? With my first DD, I went to a whole group of midwives who practiced in the same hallway, but independently of the ob practice. They were listed as my care provider in the hospital and I never saw an ob.

My midwives did not do vaccuum birth and I think did not use forceps. If those were needed, they called the ob who was on call and present in the same hospital, same wing. I do think they could cut and stitch an episiotomy (although they performed far less of them than Ob's). If a c section was needed, they typically accompanied the mom through the procedure, but were not involved in any aspecct of the surgery. You should ask how the midwife you are considering handles those common complications.
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