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?