Should you use a midwife with your first birth?

Guest post by Thérèse Charvet

Q: Currently my husband and I are expecting our first baby, and are arguing about whether or not to use a midwife. He says that he has heard that the first birth should be in a hospital because the first birth is the most prone to complications. I absolutely disagree with this and think that birth has been overmedicalized, but would love to hear what the midwife has to say specifically about first births.

Thanks to Jess for submitting this to the OBM pool!
It’s true that first-time mothers who hope to have a home birth have a higher chance of ending up in the hospital than with subsequent births, but there are many first-time mothers who successfully give birth at home and/or with a midwife. [Editor’s note: check out our collection of Getting It Out birth stories, including several home births!] Starting with a positive, confident attitude, choosing a practitioner midwife and comfortable setting that confirms your strength are important foundational ingredients to a successful birth experience.

But there’s no guarantee it will all go smoothly. Giving birth is a great mystery. So it is also important to temper your optimism with a realistic attitude about how much around birth happens without you having any control over it. Ya just never know!!

So yes, it is a reasonable choice to work with a midwife during your first pregnancy. And yes, there is a higher chance of more complications with your first birth. The most common complication for first-time mothers is a long, exhausting labor. In such a case, you might decide to transfer to a hospital and physician care. Ideally your midwife has a good relationship with a back-up doctor and hospital so the transfer would be smooth. This is even more important for first-time moms because it is more likely you will need it. But there’s at least a 50/50 chance that you won’t need any kind of medical intervention so its worth a try.

Either way, whether you successfully give birth at home with a midwife or have unexpected problems that result in a transfer to a doctor and/or hospital — you’ll experience the initiation ritual into motherhood. It’s an awesome, potent rite of passage that will transform you into a wiser, deeper woman.

The ability to “go with the flow” and learn from this transformative, amazing (if challenging) experience called pregnancy and birth is how you will grow your womb-an wisdom. Complications might happen at any point in the child-bearing year that challenge your optimism and self confidence. In such cases, the best thing we can do is cultivate trust, stay engaged and learn from whatever presents itself to learn. That’s how we grow into maturity and wisdom.

I honor your “knowing” that birth in this culture has been over-medicalized and I honor your desire to give birth with a midwife, trusting in your body and that birth is a natural process. It’s a beautiful way to start the journey toward empowered motherhood. May your journey be full of blessings—both expected and unexpected. Let us know how it all unfolds.

Comments on Should you use a midwife with your first birth?

  1. Why not do the best of both worlds? I had a hospital birth with an amazing network of midwives who gave me amazing care, and I knew that if anything went wrong, I was right where I needed to be to have it fixed.

  2. @Sarah – Some states don’t allow midwives to perform in-hospital births.

    My first birth was in November with a midwife at a home in Tennessee (we had to run for the border) and it was amazing. Our plan included provisions for transfer (going to the nearest hospital) if there was an emergency.

    • My comment was going to be a question about the US allowing/disallowing midwives for hospital births – this answers my question!

      In Canada all provinces and territories allow midwife births at home or in hospital, and it’s covered by provincial healthcare.

      • Actually that isn’t entirely true. You can use a midwife for a hospital birth in BC and Ontario but not in Quebec or Nova Scotia. My sister wanted a hospital birth with midwife in Montreal but was not allowed – they used a birthing centre instead. And in some other provinces (such as Alberta unless it’s recently changed) do not cover midwifery care through the Provincial healthcare plan at all so you need to pay out of pocket. So each province has it’s own system (unfortunately).

        • Alberta has changed and does fully fund midwives as of last year (April 2009). The unfortunate part is that because they delayed funding for so long there are very few midwives left here. Most went to provinces where there was coverage and they were able to practice more easily. Its almost impossible to get a midwife now (I tried!).

          The other sucky side of the problem is that there is only one facility (in Calgary at least) that provides the amenities for water birth- the Birth Center (other than home births). Which you can only access if you have a midwife since no doctor will deliver outside a hospital. Its not a great situation but it will hopefully start moving in the right direction soon!

          • Newfoundland apparently doesn’t have midwives- they were the last to get rid of their old midwife system and switch to doctors and they still haven’t gone back to allowing midwives.

      • It sometimes depends on the hospital too… I know the hospitals in my city really fight it, and the midwives here (which there is a drastic shortage of) basically work out of one hospital outside the city.

  3. Yeah, I just had an amazing first time birth at the hospital with a midwife. Might do it at home next time, but I had a great experience at the hospital; never saw a doctor the whole time I was there, only nurses and midwives. Good luck with your decision!

  4. I have heard that for women having their first babies, the most common things to ‘go wrong – or rather, not smoothly – do so slowly, thus giving you time to go to hospital (if you’re not there already) and/or seek interventions if required.
    Certain complications – like excessive bleeding – are also much more likely for women who’ve had a good few babies.
    Also, if you want to have more children, your first birth is important for them e.g.: if you have a c-section with your first (more likely with an OB) then your subsequent pregnancies are higher-risk.

    bottom line, yes it’s safe if not safer to have a midwife as your primary carer.

    • Agreed. First-time moms in hospitals are more likely to agree to interventions out of fear, interventions that, depending on the state, may ban midwives from attending them in later pregnancies. Worse, in many hospitals, doctors also will not allow anything other than c-sections after prior interventions. In California, midwives can’t attend VBACs for home, and “can” in some hospitals, “can” in quotes because the mom is really attended by a doctor with a midwife present. However it’s very rare for hospital to allow VBACs at all, and to demand subsequent c-sections.

      For first-time moms, labors tend to progress lower. But most doctors consider any progress slower than 1cm per inch to be “stalled” labor, and so demand a c-section or, if you’re “lucky”, Pitocin to speed things up, claiming crap such as “the baby will die.” C’mon, really? If a woman’s not fully dilated and pushing by JUST 10 HOURS, that means something’s wrong? Really? I mean, REALLY?! How many of our mothers gave birth that fast?! (Mine aside – 4 hours for me, 4 hours for my younger brother.) It seems like our grandmas BRAG about who had the longest, and they’re okay!

      So. Fear. Naturally longer (usually) labors. Perfect grounds for a c-section for a first-time mom who blindly trusts the doctors in the hospital, and you’re fooling yourself if you think there’s not a doctor in the background, which most states allowing midwifery require, even for homebirths.

      I think it’s smart to have a midwife for a first birth unless there is a real medical condition necessitating a doctor.

      Myself? Extensive medical history. No large intestine. Small intestine adhered to the front of my uterus. Doctors claimed 100% chance of death with a vaginal birth, 50% with a c-section, and required a c-section. I listened to my gut instinct and went with a midwife for a homebirth, as far opposite as could be without freebirthing. 14 hours of labor (ground #1 in a hospital for a pressured or required c-section, if I was allowed to try vaginally anyway) in which I was comfortable enough to sleep for a few hours. Literally. No drugs. I was sleeping. My baby was coming sunnyside up (grounds #2). At an angle (#3). And she was chin-first. Not crown-down. Chin first. #4. Four individual grounds for a c-section. Instead I didn’t even tear and was making dinner the next night because I felt so good and was taking our baby to see Santa on her sixth day alive.

      It was wonderful to crawl into my own bed afterward instead of being in an impersonal room with strangers walking in all hours of the day or night, having to ask to see my baby (even “rooming-in” usually comes with caveats), etc..

      My wonderful midwife has a great doctor backing her and a transport plan in place in case of emergency. The hospital is the backup plan.

      Pregnancy isn’t a medical condition and childbirth isn’t an emergency. Our bodies are made for this. Trust your body, trust yourself.

  5. Thank you so much for this post!
    I don’t take medications in my every day life so why would I take them while having my child?
    Me and my fiance want a home birth and I REALLY want a water birth. My mother on the other hand says that we should give birth at the hospital. Both my mother and my grandmother’s first births went without any complications and their second births were had many.
    We looked into having a water birth at the hospital [we found out they have the tubs] but they don’t allow the actual birth to take place in the tub, which I’m not sure if I completely understand there reasoning.
    I think having a midwife, even if I had to go to the hospital would help me a lot. Doctors seem to want to make it so you have to be in the bed with medications, midwives just seem more relaxed and willing to let you have the birth you want.

    I have a question though, some what off topic, a friend of mine said that if you have no medications and then they have to rush you in for a c-section that you won’t be given anything. This only worries me because both my mother and grandmother have had to have c-sections… I don’t see how they could possibly cut you open and allow you to feel everything. Wouldn’t your body go into shock?

    • I had an out-of-hospital water birth with a midwife as my first birth; totally wonderful.

      As far as what your mother and grandmother had, remember that medicine and maternal/prenatal care has come a long way. Try to determine the circumstances behind their c-sections; maybe it was something that could’ve been avoided.

    • I believe the reason for not allowing births to happen in the tub, while allowing tubs came from a couple of water births in which the babies died. They didn’t die from the birth, they died because they were kept underwater “swimming” because the adults/caregivers thought that since they hadn’t drawn their first breath yet, the placenta would provide the oxygen needed. Unfortunately, the placenta stops providing oxygen shortly after birth due to the hormones in the mother’s body, regardless of whether the baby has taken a breath or not. I believe this happened in Russia, not in the US, but it made hospitals very nervous, so they changed their policies.

    • No, I don’t believe they EVER do c-sections without anesthesia–except maybe in a 3rd world country under desperate conditions! In this country, in a dire emergency, they would offer “general” anesthesia (put you to sleep) if they didn’t have time for an epidural.

  6. I wish I had a midwife for my birth, because my doctor was late to show up! Being told to not push when half of her head has already been pushed out then sucked back in is not very fun! I’m not anti-doctors (or a very violent person), but I could have killed this one… with my bare hands…

    I think having a midwife there the whole time would have been a much calmer experience!

  7. Go for it! After two births, I really want to do a homebirth now. This time around I thought “I will do a natural hospital birth with a Dr. to ease my worries…” Well, it ended up going mostly that way- I had a natural birth in the hospital, but I was really disappointed at how impersonal it felt, since I just got whatever staff was on call. So while you can do a natural birth at a hospital, I wish I’d had the personal connection and comfort of a midwife or doula.

  8. i am convinced that had i NOT had my baby with midwives i would have had a c-section. though for a first-timer my labor was relatively short, just 12 hours, it was “complicated”. i was at fully dilated and at a +2, basically pushing, for five hours. none of the OBs at my local hospital, which has a 40% cesarean rate, would have allowed me to go that long without serious intervention. hell, i don’t think i would have been able to physically go that long strapped to a bed and hooked to monitors and an IV. i would have been begging for an epidural. also, at some point, my baby turned posterior and there aren’t many OBs around here who are willing to do the work to turn a sunny side up baby – midwives are.

  9. Thanks for this article, it came at the right time for me! My husband and I have chosen to go the midwife/birth center route for our first baby…which has lead to quite a few raised eyebrows and “YOU can’t do THAT!”s. I know that I “haven’t been there” and there is always the possibility of complications, but it’s nice to have a little confirmation that it CAN be done!

  10. For my first child, I had a hospital birth with an epidural. Between the epidural, the catheter, the fetal monitor, IV, etc., I felt like a machine. I was flat on my back the entire time and my primary care during the labor and delivery was done by a med student (she was lovely, but a student nonetheless). The doctor supervising her didn’t show up until the very end. It was not a pleasant experience in the slightest (unless you count the enormous high the epidural gave me).

    With my second baby, I had her at a different hospital than the first as I wanted a water birth, and there’s only one hospital in the region that is equipped for it. All of my prenatal care, with the exception of my initial 8 wk measurement u/s and my 20 wk u/s was given by midwives associated with the hospital’s birthing center. I had a very complicated pregnancy due to a bad gallbladder and a nasty rare infection. But the care was amazing.

    I wasn’t able to have the water birth because my DD came super fast (2 hrs 45 min from the time my water broke) and they weren’t able to get water in the tub before she was born. But I managed to go without pain meds. It was very painful, but a wonderful experience, and am glad I decided to go with midwife care. Having the baby at the birthing center, I felt, gave me the experience of a natural birth with the comfort of knowing that if something went wrong, I was already at the hospital, especially considering the birthing center is nearly 45 min away from my house.

    I’m currently pregnant with #3 and am likely going to make the attempt at a water birth again (assuming this one isn’t in such a hurry to be born, lol). It’s well worth the drive.

  11. My mom want to have a home birth with me but I felt like taking my sweet time coming out to the world. 24 hours later and the water hadn’t broken, the midwife decided it was time to go to the hospital.

    But this was back in the 1980s in New Jersey, where home births are ILLEGAL. Crazy! So when they got to the hospital, they had to lie and say the midwife was my mom’s sister so they wouldn’t get in trouble with the law. Even then, the doctor gave my mom a chewing out for “waiting so long” to come to the hospital.

    My mom says to spite the doctor I decided to stay up there another 2 days >:)

  12. I went halfway between home and hospital the first time by choosing a birth center with midwife which was just what I needed. Second time I had a homebirth with (the same) midwife.

    While part of me says that you should go with what you feel is right, I also feel that your significant other should have a say. More then likely they are going to be there to assist and you want them to have their mind on what matters, not worried about location.

  13. I gave birth for the first time last August at home with a midwife and her student (who just graduated), a doula, a friend and my honey. It was intense and gnarly and absolutely wonderful. I trusted them implicitly, and when they said we should transfer to the hospital because the baby’s heart rate was low, I knew it was important, and that they wouldn’t tell me that otherwise. Aspen wasn’t having it, though, and she came tearing into the world literally a minute later.

    I had asked my midwives what their transfer rate was, and around 25% is normal for first-time moms.

    The most important thing is to trust your caregivers, and the mode of care you choose.

  14. The majority of women I have met who homebirth do so because of a traumatic hospital birth, myself included. Have a Q & A with your midwife or several midwives. Encourage your husband to research. The more you know, both of you, the more confident you will be in your decision and during your birth.

  15. i have a 13 month old son. he’s my first and we had him at home. everything was absolutely perfect, and i know that i wouldn’t have had it any other way. it was the most amazing experience, and couldn’t have gone better. not to mention my prenatal care with my midwife was so personal and extraordinary!

  16. As an out-of-hospital midwife, I just wanted to clarify some numbers: while I do think it’s accurate to say that you have a “more than 50/50 chance of having no complications”, we have about a 10-15% transport rate depending on the year. This does include non-first time mamas, but the majority of the women we see are having their first babies. So I think it’s safe to say that you have a way higher chance than 50% of not needing to go to the hospital! 🙂
    Some of that will depend on the laws in your state, because sometimes we do have to go in for reasons that are not “emergencies” but are simply outside of our legal protocols.

  17. I live in the UK, didn’t realise how lucky we are over here. I have a choice of hospital, midwife centre (also at the hospital) or homebirth (as long as classified as low risk). I am hoping for a homebirth, which will mean I can have 2 midwives with me during the delivery. This is all covered by the National Health Service but I could hire a birthing pool for around £30. My local women’s hospital is 5 mins away if we have any problems.
    Saying that, I’m only 27 weeks so I might have a massive panic and end up checking into the hospital at the first twinge of labour!

  18. Just throwing in my late-to-the-party $.02 here.

    We had our first child at home in July 2009. I’d never been pregnant before, had a very active, complication-free pregnancy, and it ended up being a good freakin’ thing we’d PLANNED to give birth at home, because everything moved so fast that we wouldn’t have made it to the hospital if that had been the plan.

    Ultimately, you have to go with your gut – and listen to any niggling concerns/worries, read up, and do what feels right to you and feels like the best choice for you, your partner, and your baby. If a midwife-assisted homebirth is what works for you, DO IT! You gotta believe in yourself. 🙂

  19. I’m currently just over 5 months with our first child and we’ve been working with a wonderful midwife practice. We had a bit of a bumpy first trimester that caused just about every bell and whistle screaming “hospital birth” to go off but we stuck with the practice and I’m so glad we did!

    I suggest, if you’re feeling a lot of fear related to this issue, to read a book called “Spiritual Midwifery” which is about a practice of midwives that have been working together since the 70’s. It’s a series of birthing stories, in essence, which drives home a few key points that i found HUGELY helpful:
    1. trust yourself, your body and the natural process of birthing, and your midwife
    2. relax! let the process and your body do what it’s built to do and the BEST way to help it all is to stay physically and mentally very relaxed.
    3. this experience can happen anywhere – hospital, birthing center, or at home. If you are fully engaged in labor with a team of supportive and in-tune professional midwives who know you, your body, and that baby, it’s about the experience between all of you, not the location.

    The book is a total hippie fest (which I’m fine with) and i understand some of the language may seem a little flighty but the messages are good, clear, and very calming and helpful. Good luck!!

  20. During my doula training I had read a lot about home and hospital births and had made my decision from there as to what I was going to do (I wasn’t even pregnant). When finally it stuck and we were on our way into parenthood… I picked a midwife and didn’t regret it. I knew that if there were any complications during my pregnancy or labor and delivery the hospital was close and I could go. My midwife was wonderfully sensitive and attentive. Plus, she had many alternative remedies for common problems.

    Regardless, of where you have your baby the outcome is wonderful. However, laboring at home is much more intimate and relaxing. I can state this because on my second night of laboring I decided I needed to go to the hospital. I was exhausted and my mom and husband couldn’t provide me with anymore optimism as they were drained themselves. With having a midwife they can join you at home when you finally decide you need their company. I am unaware of an obstetrician that offers this service.

    If you need hands on help during your labor it is also a good idea to have a doula. She won’t take away your husbands role just assist when he becomes tired.

  21. While the rate of hospital-transfer for first time mothers planning homebirth IS higher than women who have previously given birth, it still hovers only around 10%. Most of these transfers are for long, difficult labors where mama is exhausted and needs some help with rest and pain relief. And even in these cases of transfer there is still a huge benefit to laboring normally at home. Many of these women, had they started in the hospital, would have had interventions that significantly increased their odds of a cesarean or compromised baby.

  22. When I had my son, it was in a hospital because it was the only option we could afford with a mere $250 copay. My HMO wouldn’t cover a home birth or birth center birth. I did my research though and was able to transfer my care to a hospital that was significantly more friendly to a drug-free birth. The nurses were extremely accommodating to my birth plan and my husband and I got absolutely no flack about our choices.

    I know I am one of a lucky few who had a positive drug-free childbirth in a hospital. That being said, I really don’t want to give birth in a hospital again. I really want a home birth, but my husband still isn’t comfortable with it. I found a few websites that ask dads who’ve been there for home births give their thoughts on the subject. Here’s one:

    I can’t find the other sites right now, but
    maybe Offbeat Mama can get some dads to write about their home birth experiences???

    I plan to have my husband read these sites when I get pregnant again, to see if I can sway him to a home birth. Maybe having your husband read some insight from the dad’s perspective could help put his mind at ease for doing a home birth, or at least considering a birth center instead. Best of luck!

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