1} Is a vaginal birth your priority? As a profession, midwives are ardent supporters of vaginal births. OB-GYNs may or may not be. “You should ask about the doctor’s C-section rate and philosophy,” recommends Niebyl. If it’s important to you, make sure your care provider supports vaginal birth.
2} Do you want your caregiver with you during labor? “Nurse-midwives offer a lot of labor support. They spend more time with patients than a physician can because we get pulled in so many different directions,” says Niebyl. If you have a doula (someone trained to support and help advocate for you through labor and delivery) or other support system, though, this may not be a deal breaker for you.
3} What are your plans for pain management? “In a hospital setting, lots of midwives’ patients ask for and get epidurals,” says Niebyl. However, midwives will likely encourage trying medication-free methods to manage pain first. “We usually look for pain management techniques that support the natural process,” says Judy Berk, C.N.M., a certified nurse-midwife at Brigham and Women’s Hospital in Boston. “That might mean showers, massage, acupressure techniques, homeopathy, switching positions or trying a birthing ball.”
4} What are you hoping will happen at the hospital? More OB-GYNs than midwives have strict protocols. Some doctors want their patients in bed with an IV, hooked up to a continuous fetal monitor. Midwives generally encourage patients to move around and are also more likely to use intermittent rather than continuous monitoring, according to Johnson. Speak to your OB-GYN well before your delivery date to find out about his or her policies for childbirth in the hospital—and make sure they mesh with your expectations.
5} Do you want (or need) more support and advice for your transition to parenthood? “Midwives do a lot of counseling for nutrition and exercise and also on the emotional changes that happen when it comes to becoming a parent for the first time or adding another child to the family,” says Berk.
6} Are you considered high-risk? “I encourage healthy patients to go to the nurse-midwives,” says Niebyl. “But OB-GYNs are trained to manage someone with diabetes or other complications.” Some midwives, though, co-manage higher-risk patients alongside OB-GYN colleagues; that means you may see both a midwife and an OB-GYN during your pregnancy. Who ultimately delivers your baby will likely depend on your medical circumstances.
7} What does your gut say? Justine Arian, a doula and birth coach in Huntington Beach, Calif., urges women to trust their instincts about whom they choose to deliver their babies and even where. “Meet different doctors and midwives and visit hospitals or birthing centers. Ask yourself, ‘Is this where I see myself giving birth?’ ” says Arian. You can be sure you’re not making decisions based on unfounded fears by taking the time to educate yourself about your options. “Women have to give birth where they feel safest and most supported,” she says.
Last year with the birth of my second son approaching, I faced all these questions again. I was thrown a curveball and ultimately needed a C-section with my first son, so my choice the second time around was a little more complicated. I could attempt a vaginal birth after C-section (VBAC) with a midwife in a hospital, but my gut told me a VBAC wasn’t the right decision for me. In the end, I received nearly all of my prenatal care from my midwife, but an OB-GYN delivered my son by C-section. This was the best choice I could make for my family, and the outcome was fantastic—all 7 pounds, 7 ounces of him.
The second time around If you had a Cesarean section with your first child, a midwife may still be an option for your second baby—even if a C-section has been recommended. Midwives don’t perform surgery, but you can certainly discuss with your OB-GYN or midwife the possibility of a vaginal birth after C-section (VBAC). Right now, whether a midwife or an OB-GYN can offer VBACs is often dictated by a hospital’s policy. For home births, the midwife can make the call.