Tuesday, July 6, 2010

Mainstreaming Midwifery- are OBs the answer?

I've been reading a little bit lately about the suspension, reinstatement, and subsequent resignation of a popular SoCal OB, Dr. Biter. There's an entire group dedicated to his saga, and I really enjoyed a blog The Navelgazing Midwife wrote about the situation. I don't know enough about the details to address Dr. Biter's situation directly, but it did get me thinking about how we view the hospital experience from a patient perspective vs our expectations of our providers in the same setting. I've seen OBs like Dr. Biter referred to as "a midwife in OB's clothing" and that concept brought me back to something I've been intending to write more about: the mainstreaming of the midwifery model of care.

Here's what I want to know: When women flock to OBs who support birth as a natural physiological process, why are they doing that? I've read that OBs whose practices are similar to the way midwives practice are often incredibly overbooked and women wait hours for their appointments. I've seen and heard members of the birth community rave about Dr. So-and-So who truly supports his patients, has fabulous bedside manner, and should be at the top of everyone's list when they are looking for a provider. I've listened to other moms talk about the kind of care they wish they'd received from their OBs, and even though that care sounds an awful lot like midwifery, most women- even the lowest-risk women- absolutely believe they require an OB's care to have a safe pregnancy.

What would maternity care look like if low-risk women were directed to midwifery care instead of being shoehorned into the only "good" OB practice available? What if those OBs worked with large midwifery groups, where low-risk women received care from midwives, secure in the knowledge that they'd have an incredible OB backing them up if they did become high-risk? What would it take to see true partnership between OBs and midwives in the US- similar to what seems to be the norm in many other countries? I understand that the relationship between obstetrics and midwifery in the US is complex (to say the least), but there clearly are OBs who are willing to buck the system. Could they be the answer to increasing midwifery care for low-risk women? Or is it unrealistic to expect any OB to tell a woman she's low-risk and doesn't need obstetric care for her pregnancy?

I don't have the answers to these questions but they are asked honestly. Women seem to want the kind of care midwives offer, but they want that care from an OB. Up next in my musings: why don't midwives have the kind of instinctive trust and respect we give OBs?


  1. Good questions!

    I've been to many hospital births attended by OBs with reputations for supporting normal birth, and I can tell you they are far from normal!

    If we want to have a functioning, healthy, woman-centered maternity care system in this country that uses midwives as the primary providers for low-risk women (as most of the rest of the world does) a LOT needs to change within the field of obstetrics, starting in medical school.

    Obstetrics needs to be redefined as a surgical specialty for high-risk pregnancies and births -- that is where their education and training is most valuable -- in the OR. Hospitals need to employ midwives independently of OBs, and homebirth midwives need firstly to be legalized in all states.

    We have such a long way to go.

  2. Yes, a very long way to go, with no easy way to get there. Even if we managed to change obstetrics, we'd still have to change public opinion and that's not a small task either. I try to think "one woman at a time" will get us there... isn't it said that it only takes 15% to start a revolution?

  3. Hi Pam -

    When you talk about women flocking to OBs, I personally think a lot of that is due to insurance companies. Speaking from personal experience, my insurance company absolutely will NOT pay for any portion of a planned home birth. And, in order to see a CNM / Birth Center, I have to get a referral from a primary care physician / doctor.

    Unfortunately, finding a doctor willing to refer you to a Midwife (or, in most doctor's eyes, "Witchdoctor") is down right impossible.

    So, in order to receive affordable care, we simply go to the OB/GYN as we're told...

    Honestly, I would have been able to see a MW and receive better care had I been on Medicade during my first pregnancy than I did with a highly regarded OB/GYN on my insurance. I know this because my SIL went that route.