OBs and Midwives Working Together

A growing number of OB-GYNs and midwives are partnering to provide care for moms-to-be.

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When I found out I was pregnant, I chose my OB-GYN for two reasons: She came highly recommended and I had heard through other moms that she was supportive of natural childbirth.

The fact that she also shared her practice with a midwife didn’t play a part in my decision. At the time, I thought you only needed a midwife if you were having a home birth. I knew I was having my baby in a hospital, so what did I need a midwife for?

As it turns out, the midwife in the practice became an integral part of my pregnancy experience. I alternated between my OB-GYN and midwife for each of my prenatal appointments and, by the time I had packed my bag and mapped my route to the hospital, I no longer differentiated between them: I viewed their individual skill sets as both complementary and totally necessary.

What I’d stumbled upon was a collaborative practice between an OB-GYN and a certified nurse midwife (C.N.M.) or certified midwife (C.M.). Setups like it are becoming increasingly popular throughout the United States as obstetricians and midwives hit what some experts are referring to as the sweet spot in obstetrical care.

“Midwives are educated to ensure that women own their bodies and make good decisions about their health and to provide primary care to women across their lifespans,” says Elaine Germano, Dr.P.H., C.N.M., a Glenford, N.Y.-based midwife and senior education policy adviser for the American College of Nurse Midwives in Silver Spring, Md. “OB-GYNs are educated differently. They are surgeons and trained to heal the sick.” The idea is that with both forms of expertise on your side, you’re covered, from natural childbirth to emergency surgery and everything in between.

Recent research backs this up. A 2011 study published in the journal Nursing Economic$ found fewer Cesarean sections, lower rates of episiotomies and higher breastfeeding rates in practices that include both midwives and OB-GYNs. The American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives issued a joint statement of practice in 2011, suggesting that care is most effective when practitioners work together.

In addition, leading experts in obstetrics and midwifery are collaborating on a series of papers supporting joint practice scheduled for publication this fall in Obstetrics and Gynecology Clinics of North America. According to Melissa Avery, a co-author of one of the papers and chairwoman of the Child and Family Health Co-operative at the University of Minnesota School of Nursing in Minneapolis, a joint practice allows you to maximize your care with the support of two pregnancy and childbirth experts who can provide the best care based on your individual needs. Some practices include both midwives and OB-GYNs in the same office. In others, patients primarily see a midwife and will see an OB-GYN if a complication arises.

A collaborative practice that includes surgical expertise and holistic know-how can mean a win-win for you and your baby:

Less waiting, more service You’ll still likely log time in a waiting room, but seeing a doctor or midwife in joint practice can save you precious minutes (or hours). “Most physicians feel rushed,” says Peter Weiss, M.D., an OB-GYN in private practice in Beverly Hills, Calif., who shares an office with a midwife. Weiss often divides his time between office hours, deliveries and surgeries, but by partnering with a midwife, his patients can get more from each appointment. “A typical prenatal visit with a C.N.M. or C.M. will include a health assessment and education about pregnancy, nutrition, fitness, preparation for labor, as well as any factors in your life that are contributing to your health and that of your baby,” says Holly Powell Kennedy, Ph.D., C.N.M., first endowed chair of midwifery at Yale University and president of the American College of Nurse-Midwives.

Natural childbirth is encouraged “Midwives fundamentally believe that a woman’s body knows what to do in labor and how to give birth,” says Michelle Collins, Ph.D., C.N.M, assistant professor at Vanderbilt University School of Nursing in Nashville, Tenn. In a collaborative practice, your midwife will be spending the most time with you during labor—a boon for moms who want to go au naturel, but don’t want to give birth at home. In fact, 96 percent of births attended by midwives happen in a hospital setting.

Midwives can help you manage pain by suggesting helpful labor and delivery positions (view step-by-step photos of squatting and swaying at fitpregnancy.com/laborpositions), pain management techniques (breath work and imagery) and hydrotherapy (warm showers and baths), as well as providing pain medication or ordering an epidural, if needed.

You’re covered in an emergency The majority of births go off without a hitch, resulting in a healthy mom and healthy baby. However, if a complication unexpectedly comes up, a collaborative practice means you have an OB-GYN—most likely one you already know—at the ready. As for my own birth, after three days of laboring at home, I checked into the hospital. My midwife was supportive and gave me the confidence I needed to endure such a long labor. Together with my OB-GYN, they encouraged me to push—so that’s just what I did. My son was born healthy and well after four days of labor. If I’d had just one or the other on my team, my birth experience might have been completely different. But, with an OB-GYN and midwife in my corner, I was able to have the birth I’d hoped for—knowing that no matter what came my way, we could handle it.

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