Why we switched to a midwife 32 weeks into our pregnancy

April 6 2011 | Guest post by Katie
Shimul Maternity
Photo by Marisa Taylor Photography, used with Creative Commons license.

When I got the mind-blowing "pregnant" reading one snowy December morning, I had little doubt about what came next: call my gynecologist's office and schedule a prenatal visit. I was much more into daydreaming about the microscopic bean floating around in my belly than worrying about things like picking a caregiver. I skipped the first chapter of every new pregnancy book I read. I was ready to get onto the fun stuff like when I was going to start showing!

For my first 19 weeks, things went pretty well. I decided early that I wanted my delivery to be what I imagined — no medication, no epidurals, and no pitocin. My instinct was telling me that centuries of women giving birth without epidurals were evidence enough that my body was equipped to host a strong and powerful birth. I shared this plan with Dr. R and she suggested I "keep an open mind." Not necessarily an unmedicated childbirth battle cry, but she didn't fight my wishes either. It would do, I decided.

At around 20 weeks, I started to think twice about my OB/GYN group. Although my ultrasound was a mind-buzzing high that we'll never forget, we saw another doctor in Dr. R's group. He was arrogant and defensive when I told him I was reading a book on the Bradley Method, and all I could think was "I could end up with him delivering my baby if he's on-call when I go into labor…!" Despite the gentle reassurance from my doula, yoga teacher, and prenatal chiropractor that it's perfectly acceptable to switch caregivers, and that 20 weeks was a great time to make that switch, I was hesitant. The three of them were my circle of pregnancy care that gave me energy. Dr. R was just a means to an end. The dichotomy would be fine.

My yoga teacher-doula-chiropractor triangle all gushed about a local hospital with a midwife program and a focus on supporting unmedicated childbirth if that was a person's wish. Their cesarean rate was 12.7%. My hospital choices had rates hovering around 30%. When we toured the intended hospital, the whole place just felt wrong. But somehow I still wasn't allowing myself to think about switching groups. I couldn't possibly risk offending Dr. R.

The weeks marched on and my belly grew. Time piled yet another reason not to switch onto my list. There wasn't nearly enough time to get to know a new caregiver before my birth. It would be like starting out from scratch and Dr. R and I had built something together. Hadn't we? It was about the same time that I realized she never called me by my name. Did she even know I went by Katie and not Katherine? She would sweep in, answer my questions politely, and leave. It hit me in the face that I was just another chart to Dr. R.

Switching turned out to be so easy, it was a non-event. I called the midwife group and scheduled my 32 week appointment. I called Dr. R's office and asked the receptionist to fax my records to the midwife group. Done. Relief.

My decision to switch to this midwife group turned out to be so essential to the beautiful success of my birth not because I got the unmedicalized birth, but because I ended up with a medicalized one. The ugly face of high blood pressure reared its unexpected head at my 40-week appointment. I made them switch cuffs twice and take my blood pressure by hand. None of it changed the fact that all signs pointed to pre-eclampsia.

It was the doctors who were telling me to stay for monitoring, to stay for induction, to just have my baby since I'm here and full term. But it was the midwife that sat down, looked me in the eye and said she would worry about my health and the health of my baby if I left (which she reminded me was my choice, not theirs). She explained why she felt okay about inducing labor for me and my baby. I agreed to the induction I had dreaded for nine months because I trusted the person I had chosen to guide me in my birth.

I feel comfortable with all of the medical twists and turns my labor took. At first I was sad for having missed out on the childbirth I had envisioned. But our midwife was as centered in our quest for unmedicated childbirth as I was, and that helped me let go of my anxieties when the cascade of interventions took over my labor. Had I stayed with the OB/GYN group, I might have fought harder at the difficult choices I had to make. But I trusted my instincts and my decision was the right one.

  1. Thanks. I have a lot of reservations about my OB/GYN group and I really want a midwife at my birth. I just don't know how to go about switching. Short of asking my current doctors for a recommendation (Awkward!), how do I go about finding a midwife that bills through a hospital or doctor's practice that my insurance will accept?

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    • Do you have a doula or a childbirth educator you've taken classes with? Generally those people will know which practices accept what as far as payment goes and can help you out.

    • Call your insurance. They should have a list of midwives on their specific plan. If you don't get a good answer call back – not all reps are as knowledgable as others…

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      • Their official answer is that they don't cover midwives. However, they cover doctor's visits and hospitals (obviously) so if the midwife bills through a doctor's practice or a hospital that's in network then they'll cover it, but they can't give recommendations because they just see dr and hospital bills.

    • Are there ob/gyn practices in your area with midwives? This is very common in my area, most practices have at least one midwife. (My state only allows certified nurse midwives.) My practice has 3 doctors and 5 midwives; patients rotate through the practice during pregnancy so they at least meet each doctor and midwife (so whoever is on call in an emergency isn't a stranger) and you have the option, within scheduling constraints, to deliver with whomever you choose. (The midwives have fewer scheduling constraints, since they don't do surgeries.)

      I personally, despite being pretty granola, actually get along best with the expert surgeon-doctor in the practice, but part of the reason I chose this practice was that I had excellent, evidence-based midwives to choose from, and that I could receive ALL my care in one place. I could work with a midwife and, if I had a problem only a doctor could handle (as it turned out I did), transition seamlessly to a doctor with the midwife still by my side.

      A good friend of mine at the same practice ended up having an emergency crash C-section after 24 hours of unmedicated labor supervised by one of the midwives — my friend almost died — and the midwife who'd been with her was able to go into the surgery with her and hold her hand while a doctor who already knew her and was in the same practice as the midwife did the C-section.

      This is a really good option for many women and I wish such practices were more widely available. You know the doctors in such practices are open to more natural practices, and that the midwives in such practices are well-trained and not flakey or promoting dangerous practices … and there's absolutely no problem at all laboring at a hospital with a midwife (in any way you choose) when your midwife is with an ob/gyn practice.

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      • Koimichra, it may not have come through on the post, but that is exactly what I had too. It was a really strong partnership between the midwives and the OBs and the team made it feel seamless to me.

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        • Me too! The midwives pracitce at several clinics, and deliver at two hospitals. They are supported by an OB. I had to have a cesarean and the midwife came in to the OR and it was such a great comfort. I live in the Twin Cities, MN. Lots of people use midwives here.

          • Oh funny, Jessi, I'm from Minneapolis, MN too. The midwife group I'm referring to in the post is from HCMC.

  2. I've actually been seeing a midwife for all my yearly gyno appointments for years now and we're going forwards together as my pregnancy progresses. I've been really lucky in that my OB/GYN office has three docs and three midwives. Over the years, I've seen one of the docs and all three of the midwives for whatever issues and checkups. I'm now starting to realize that they are a unique practice and I'm lucky to have found them.

  3. Love this post! I, too, have a midwife I adore, and I, too, ended up with a difficult birth due to health issues. While I had a hard time coming to terms with my C-section, I never doubted my midwife's judgment. Thanks, Katie, for reminding me what a gift that is.

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  4. Awesome post! I switched at 20 weeks from an OB to a midwife group during my first pregnancy. And while I didn't get the dreamy, unmedicated birth I longed for, (3 days of back labor led me to total exhaustion and an epidural and pit to finally dilate enough to push my big boy out) I feel pretty certain that I wouldn't have been "allowed" to labor as long as I did if I'd stayed with an OB and instead would have been rushed to surgery–which was the ultimate in interventions I hoped to avoid and did.

  5. I also worked with awesome midwives for what ended up being a somewhat complicated, medicated labor & delivery. The whole thing really hammered home for me how important it is for laboring women to have caregivers they trust. The fantastic patient-caregiver relationship I have with my midwives is what made it possible for me to get through a scary labor and feel good about it.

  6. i wish i would have with my last baby! i wanted to do a v-bac but the doctor was very discouraging of it and kept pressuring me into a c-section! even though i had one very successful v-bac one one birth before my c-section. i have always regretted it. we had moved in the middle of my pregnancy and i had to get a new doctor.

  7. Awesome post! I think it's so important to have a provider you trust. I loved the midwife who delivered my daughter but I'm sure their are OB/GYNs out there that are awesome as well!

  8. I switched at this exact time too! How funny! I was not brave enough to do it but thanks to my fiance he assured me we were doing the right thing. With how my labor went I am almost positive I would have had a c-section with an OB!!!!
    Thanks for this post- if I had read this earlier in my pregnancy I would have made the move earlier to switch so I hope somebody will get the courage because your post!

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  9. this could totally be my story (including the pre-eclampsia induced ending), except the situation with the OB was really horrible and the switch did not go nearly so smoothly. i actually attempted to execute the switch the same way after a series of really awful experiences and the OB actually called me and confronted me about switching before consenting to release my records. the things i (and you) feared about making the switch away actually happened, which in hindsight served to cement that i really was doing the right thing.

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  10. I saw a mid-wife one time before I signed onto the one for the birth– 7 months into the pregnancy. since it was #3 I was not as worried.

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  11. This was just what I needed to read! I'm 19 weeks right now, and when I brought up the idea of an unmedicated birth to my doctor (or rather one of the 5 have seen), she said the same thing, "keep an open mind." My husband and I are thinking about "shopping" around, but the idea of switching doctors seems overwhelming. This post had made me certain that I at least need to examine my other options.

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  12. I switched from an OB/GYN to a midwife at five months after my OB literally patted my arm and told me that I wouldn't want to "mess with all that stuff" (i.e. attempt an unmedicated birth). The C-section rates at the two hospitals on our insurance were near 40% so we opted for a home delivery. It went great and I've never regretted the decision.

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  13. I have a similar story in regards to high blood pressure, an "emergency" C-section, and hiring a doula. Having someone around who was unquestionably my advocate, who had talked with me about my goals and ideals, and who walked me through what to expect at each stage of the procedure, made all the difference. I didn't switch practitioners but I was able to relax and trust my OB/GYN a lot more when I felt like I had a backup second opinion from someone who was very experienced and capable but not embedded in the medical system.

  14. Thanks for all of the kind words, all. Strong partnerships are a must for a positive birth experience! and @Nicole: I am so glad that my story could reach you! Go with your instincts. Anyone who's interested in reading the *full* unabridged version of my birth story can click through the "Get to know Katie better" link at the bottom of the post 🙂

  15. I did 50 hours of labour and had a c section. Like you I had a midwife who I trusted. When she said it was time for drugs, I didn't hesitate. When it was time for a c section, I knew it was the right choice at that time. I am so grateful for the care I got to get through that difficult labour and delivery and that I never doubted the decisions made along the way.

  16. Yes! I switched to midwives at 31 weeks with my munchkin, and my story is much like yours. I got that twitchy feeling with the OB, and it just got worse and worse. With my midwife, I was induced at 41 and 4, got an epidural, but delivered viginally and KNOW I made the right choice.

  17. Im currently 32 weeks and I have this overwhelming desire to switch from my OB to a midwife. I have already scheduled an appointment with a midwife group and Im excited, although Im terrified of the pain that's coming. Can anyone give me any info/advice to settle my spirit? lol

  18. I didn't realise that this difference existed between maternity care in the US & UK. In UK hospitals, babies tend to be delivered by midwives. Doctors only intervene if something goes awry!

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