When it comes to birth, which is more important: the practitioner or the place?

June 15 | Guest post by Jamie
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I had my 20-week appointment with my midwife this week and she announced that she's moving to a new hospital. She told me that I can either stay where I am with a different midwife, or I can follow her to the new place. My next steps are to meet with the new-to-me midwife, but also to tour the other facility. I know friends who have had positive birth experiences in both places, and also have a friend who delivered with this other midwife. Therefore, I think I am fortunate in the decision department.

I have two good choices ahead of me — stay with a midwife whom I know and trust already or stay closer to home with a hospital and staff I know and like already.

I'm wondering from other mamas, though, which do you feel is more important for the birth: the practitioner or the place? Are there other factors I should be considering?

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  1. For me it was more about the place, than the person.

    I chose to give birth in a hospital that has 3 levels of care: midwife, midwife assisted by OB, and strictly by a Dr. I wanted an unmedicated and midwife birth, but in the case that I needed more intervention, I did not want to have to travel via ambulance. Everyone in the hospital gave birth in the same area and so an attending Dr would be close if needed.

    The midwife practice rotated a midwife for each pre-natal apt, so, in theory, I would have met all of them by the time I gave birth. In my case I had a midwife I didn't know, but I felt comfortable in the place that I chose.

    1 agrees
  2. For me, the place was most important. HOWEVER, I didn't build a relationship with one midwife throughout my pregnancy, I rotated between 5. If I had a special relationship with one person, my feelings might have been different.

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  3. Tentatively, I'd say location. I don't know how midwife care varies from OB care, but I spent more time hanging in my room, watching television, than I did with my OB during the labor itself. The staff was all great.

    That said, I did love my OB. She was the right amount of Very Serious and Comfortably Chatty that I needed to feel comfortable.

    1 agrees
  4. I would say the practitioner is more important. You will want to be with a person you trust. They will be making decisions for your care. The facility is not nearly as important, in my opinion.

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  5. Before I had my baby I would have said person, but having been through the experience I'm leaning towards place.

    There's just so much more to a hospital stay than the time your midwife is delivering you. The L&D environment and nurses play a HUGE role in how comfortable you are, and then there's postpartum. I only spent 12 hours in labor, but I was in the postpartum unit for 3 days. I was so glad we chose a hospital which really supported breastfeeding and had great nurses, as well as reasonably comfortable rooms and rational policies.

    1 agrees
  6. I would want to know why she is moving to a new hospital — is it a neutral factor, like it's closer to where she lives, or are there things about the hospital she's at now that she doesn't like, that might affect you? That could be a factor in your decision.

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    • Good question: her move is a positive career one that will allow her to finish some necessary schooling to get certified for primary care as well. She had been with her first hospital for 18 years and was sad to leave from that perspective. I didn't hear anything negative from anyone about her decision.

  7. Good question! I really lucked out and loved the hospital, hospital staff, my midwife, and my OB/GYN. I have to say that my husband I still talk about how great the hospital was. The midwife was there for the labor and stayed with me when I had a c-section, but the hospital nurses are the ones who where around helping take care of me the rest of the 4 days we were there. My husband and I loved the food, the comfort and size of the room, the attitude and helpfulness of hospital staff. I really felt comfortable the first time I visited, too. So… I don't know if I answered your questin very well, because for me, the people who "came with" the place were great, and so was the place itself.
    I'd say take a few tours, and talk to nurses, and visit the websites of the hospitals.
    I've visited freinds and thought "Oh ugh! I would not want to spend the night in this room." obviously they didn't mind the room or they wouldn't be there…

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  8. Definitely the practitioner. Five of my babies have been born at the same hospital. The ones that were attended by a midwife have been vastly different from those attended by a doctor, even though all of them gave worked out of the same office.

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  9. Probably the place. My ob was not on duty when I went into labor and the attending ob was pretty grumpy and not who I would have wanted. BUT it didn't really matter because the important part was having my doula, my partner and the big tub where I did most of my laboring. The ob was only the for the last five minutes and my thoughts of 'ugh what bad bedside manner' were quickly replaced by 'omg baby!'

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  10. Well, I think it's sort of a mixed question. I would say the provider is less of an issue if the pool of providers you are choosing from have similar views and general approaches to problems. For instance, my OB didn't actually deliver my baby, but her partner did, and while I met the OB when i was fully dilated and ready to push, I knew that she had similar views to my OB and that the care would be reasonably similar. I had strong feelings about where I wanted to deliver, for personal as well as broader reasons. I really loved the nurses, the pro breast feeding approach (not a formula coupon in site) and the food. I think where things can get dicey is if you switch from one category of provider to another — like from midwife to OB, if that's not your preference. Approach to care can be different and I think that's where the conflict arises.

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  11. Def for me its the palce, during my 27 hour labor and 5 day stay at the hospital with my son i saw my midwife a total of 1 hour while i delivered my son and only about 3 quick peeks in through out my stay {10 mins tops} and most ppl i know have a relativly close experiance, the doct/modwife has a lot of ppl to care for both women delivering and their regular workload of visits at there office they can not possibly be there as long as you need them. Yes they help guide you through decision making processes but honestly for me it was convos with the nurses that were on shift with me for 8 hours at a time who helped me through the most. My midwife was wonderful while she was there but she was only one person, you end up with an entire support system throughout your stay for me the 90% interaction with everyone else is way more important than the 10% i got with my midwife

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  12. Like some others have said, I had a group of midwives, so I saw several different ones during my pregnancy (and yet another in the hospital). Also, the day I went into the hospital (with pre-eclampsia) I had to see an OB. That said, however, I only really interacted with the OBs twice — one swept my membranes, and one (with a resident) did the actual delivery (which took under an hour). The midwife on duty did come see me and bring me ice, even though she wasn't allowed to attend me bc of the pre-eclampsia, which I thought was really nice. But really, I only interacted much with the L&D nurses, and not even with them much. Of the 18 hours in L&D, I was alone with my husband for the VAST majority of it.

    That said — I did choose the midwife practice at the hospital, so everyone there knew I wanted a low-intervention birth, even though I couldn't have a midwife at that point, and I really appreciated that they respected that (I wasn't offered pain medication, etc., until I asked for it). They also spent hours and hours stabilizing us; I feel if we had simply transfered into there instead of having a relationship with the practice, we might not have been treated so patiently.

    Most of the time you don't have a GUARANTEE that This Particular Person will deliver your baby, so I feel that the Practitioner is not so important — if you have a setup where that is pretty much guaranteed, you might feel differently.

    1 agrees
  13. I think the practitioner is more important, but like previous commenters have mentioned there are a lot of situations where you won't be with the practitioner you thought you would! If your midwife will be with you throughout the labor that's one thing, but if you'll mostly be dealing with nurses or if you'll have a different practitioner if your midwife is off-duty, then you should be looking at the whole team, not just one practitioner.

    I do think it's REALLY important to have a provider you trust. I had a team of three midwives and the head midwife was terrific and supported me through some tough prenatal decisions. But she wasn't at as many of the postnatal appointments and I feel like I got some bad information from the junior midwife. Whoever's in charge of your care, if they say, "I think you need to consider such and such intervention," you don't want to be wondering whether you can trust that their opinion is what's right for you.

    1 agrees
    • You also mentioned your current hospital is closer to home. I have to say I did really like delivering at a birth center that was a 5 minute drive away rather than my other option which was a half hour drive away. Sitting in the car having contractions was NOT fun, and will probably be my main reason to have a home birth next time. 😉

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  14. I didn't mind moving around while pregnant except for the extra paperwork. If they both have plenty of "pros" in their column, then perhaps it will come down to ease of commute, room size, and after care.

  15. I would say it really depends on how the care system where you live works. I'm with a great midwife practice in Toronto and have built an amazing relationship with both my midwife (who I have seen for all but 4 of my appointments) and my doula. So for me I would have to say it's the people. The midwife and doula both stay with you for a long time after and help establish breast feeding so I know I will have plenty of quality time with them. Also, if there are no complications you can leave the hospital after 3 hours. We put off buying a home in another city so that I could remain in my midwife's care.
    However, if circumstances were different and say I didn't build such good relationships, the place would definitely be more important.

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  16. I would say that it depends on a lot of different factors and is obviously going to be different for everyone… if you aren't attached to your midwife or hospital, then other things to consider are: how far is each location, what is the c-section rate of each hospital, what are the facilities like at each place, are you low-risk or high-risk (if you're having complications the closer hospital might be a better idea), is the staff accommodating to your specific birth wishes at both places? You may find that by doing some research and asking some more questions about each location that one may end up standing out as better for you than the other, same with the midwives.

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  17. Definately the practitioner! I´d prefer an experienced midwife over any special place, but then I´m quite quick with the laboring and birthing stuff anyways.

  18. I think the place is more important if your midwife works as part of a team because if she does, there's no guarantee that she would actually be the one to attend your birth. I would only consider following a specific person if I was absolutely, 100% assured that they would be the one who is there when the baby is born.

  19. I think the practitioner is more important. My doctor changed hospitals as well… She's awesome and it was incredibly important that we were on the same page for the un-medicated delivery I wanted. I assumed that the hospital she was changing to would have the same standards she held… and they did. I would do it again in a heartbeat.

  20. That's a really tough one to puzzle out.
    I had "planned" (ha!) a birth-center birth with midwives, and ended up going to a hospital for an induction 18 days after my due date.
    The midwife I connected most with from the birth center wasn't there much (other births), and the center pretty much dropped me once I was admitted to the hospital.
    The hospital itself was great, though, but that greatness was caused by both people and place. I felt more safe (not medical-safe, though it was, but sort of a enveloped-with-care safeness) in the hospital than I ever had at the birth center, and the two nurses who worked with me through the two days of laboring before the emergency C-section I required were the most calm, straightforward, comforting people. Just what I needed at that point in time.

    I guess what I'm getting at is that it's a choice you make in your headspace – a decision to be comfortable either "anywhere" or with "anyone"? If you're going into it with solid support from your partner or family (if applicable), you might be comfortable sticking with the place you're at & working with another practitioner. If you're relying on your practitioner to run the show, stick with her.
    Be well!

  21. I don't have firsthand (as the birthing mother) experience with this, but I myself was born in a birth home with a midwife. When she moved to a hospital environment, my mother followed, and went on to have two natural births in the hospital. I was young but present at both – I can remember fanning her with a paper fan during labor with my little brother. She always speaks positively of all her births. From my own hospital birth experience, I would say that the nurses – the ones who were there the entire time – were the ones who had the most impact (negatively in my case, unfortunately).

  22. I dont have any children, yet. But I work in a hospital (granted, I dont work in L&D), and I would have to say place. The hospital staff (RNs, CNAs, etc) are the ones you will be spending the most time with. You need to be in a place where you are comfortable and trust the staff.

  23. Depends what your body needs. My 3rd baby was born 2 hrs from the first contraction so being close to home was of great importance for us when planning no 4. She was 7 mins away from being born in our old volvo (luckily with chocolate brown interior). So being closer to home and not down town was a must next time.

  24. With my recent pregnancy I was planning a home birth and thus the provider was most important. I needed to feel utterly comfortable and trusting in them and their judgement. That said, if I had been planning a hospital birth location would have been very important. Supportive breast feeding culture, "baby friendly" environment, flexible attitudes towards newborn vax, rate of c-section, attitude towards laboring out of bed, water birth options, time line ( how long will they let you labor before they insist on interventions?) would all be very important to know the answer to as the culture of the hospital often dictates the parameters of the provider. Good luck in your decision making.

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  25. For me, the place is most important. . . the person is important as well, but place takes the cake!

  26. Both the place and the practioner matter. Every maternity ward has it's own birth culture. In some the nurses have experience with natural birth and are happy to support it, and the doctors (or back-up doctors in the case of midwife attended births) are more patient and accommodating (more likely to support intermittent monitoring, eating during labor, walking the hallways, etc.)

    And it depends on the style of your practioner. Some midwives and docs like to be in the patient rooms as much as possible and will be real partners in your labor, and others will be in the call-room until the nurse calls them to say the baby's head is showing. If you expect the midwife to be more hands-on then it makes sense to give preference to the provider over the place.

    You should definitely take the tour of the new place, and meet the other midwife at the old place before you make a decision. Sometimes there are intangibles that will sway your decision. This isn't something that can be done just by making a list of pros and cons.

    Good luck!

    1 agrees
  27. I'd be looking at the c-section rate for both hospitals and both providers. Talk to the other midwife or midwives and see the vibe you get. Tour the other hospital and know their policies in relation to you birth plan (for example: do they allow free movement in labor). I would kind of be weighing both.

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