Week 39: Midwifery vs. OB models of care

I am shocked at the differences between midwifery and OB care. The 39 week appointment is always a time of trepidation for me as a doula and for my clients. It’s the appointment where providers order ultrasounds to check for low amniotic fluid and to measure the baby, or more often, talk about results of sizing ultrasounds done the week before. It’s the time when they start talking induction, big baby, possible c-section if the baby seems “too big.” It’s the time they evaluate cervical dilation which always ends up being not enough, no matter whether it’s 0cm, 1cm, 2cm. It’s when they schedule that 40 week or 41 week induction. It’s the time they start warning that the baby hasn’t dropped yet or hasn’t engaged, or is posterior, or isn’t in the optimal position.

There is a lot of work for a doula to prepare a client for this onslaught. I always try to have a conversation with clients to suss out how they feel about induction, to remind them the sizing ultrasounds and dilation checks are their choice, to find out if there are important questions they want to be asking about any of these interventions the OB might be scheduling. This often leads to long phone conversations on these topics, emailed articles from Evidence Based Birth or VBACfacts.com, discussions of evidence if they are interested, explanations of what induction might entail, lists of questions to ask the provider. The debrief after the appointment is often disappointing because they only had 15 minutes and didn’t get to talk in depth about what they wanted, or because they simply agreed to all the procedures out of fear, fatigue or not wanting to rock the boat so late in the pregnancy.

I have had midwifery care before but have never been to the 39 week appointment because I had my baby early. I had that appointment this week. It is striking how laid back and easygoing it was, and I can’t help going over and over in my head the raw emotion I would get from my clients after their OB 39 week appointment. The midwife measured my belly, listened to the baby for a second, and took my blood pressure. After that, we chatted about life, how I was feeling, possible heartburn remedies. She asked if I wanted a reminder on how to know when to call her when I was in labor. And then, we ended early and I went home.

I can’t believe these two types of providers are seeing people for the same thing.


About investigatingbirth

My investigations of birth began in 2009 when I was trained as a doula. I helped women consider the evidence on common interventions, and helped them prepare for the physical and emotional challenge of giving birth. After some time it became clear to me that there was another type of challenge that I was unable to adequately prepare them for, the challenge of the maternity system. But it was only after my own traumatic birth in 2013 that I realized how little I had understood. I began to ask questions that few around me - doulas, nurses, midwives, doctors - were comfortable hearing. Questions like: Under what circumstances, and for what reasons, do doctors not practice informed consent? How do hospitals deal with other patient populations vulnerable to abuse? How does loss of professional autonomy, for obstetricians, and professional authority, for midwives, impact the quality of care they are capable of providing - regardless of their training? This blog will collect noteworthy information that attempts to answer these and other questions. Most of what you see here will be aggregated from other sources and analyzed. You will also see original interviews, and the occasional opinion piece or personal story, as I try to piece together a clear picture of the system in which American women give birth.
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