Friday, June 14, 2013

Midwife vs. OBGYN - 2 of 3

So you’re going to be a dad and your wife comes to you and says, “What you think about using a midwife to deliver our baby?”.

This is the 2nd part of a previous post.  It is a collaboration of what my wife and I learned from the three midwives we interviewed as well as the experiences of several other couples who have had kids in the past 12 months and used a variety of OBYGNs and midwives.


Difference 2 - Options  
I don’t know if you know this or not, I didn’t until recently, but doctors operate under very strict regulation by the insurance companies.  Their malpractice insurance company governs a lot of what the doctors can say or do, based on what they will cover and what they won’t cover, based on what they believe will be less likely to allow a malpractice lawsuit.  Now most of the time that means keeping you, the patient, healthy and happy, so it’s no problem.  But what happens when there is something that might be better for you the individual, that insurance won’t cover; or if there’s something you probably don’t need, but the doctor has to prescribe it for you, regardless of the side effects or the financial costs, because the doctor doesn’t want to appear negligent at any time.

A guy I knew went to the doctor for a physical, and the doctor said that his cholesterol was a little high.  Not anything to be concerned about, but the doctor wanted to prescribe him some cholesterol medication.  The guy asked his doctor about a recent article he read about taking a garlic supplement to lower cholesterol. His doctor informed him that he couldn’t advise a patient to take a supplement, because if anything were to happen, he as the doctor would be held responsible, where if prescribed a drug, the pharmaceutical company would be liable.

By no means am I trying to make doctors or anybody out to be a villain.  If I were in their shoes, I wouldn’t want to risk getting sued and/or losing my livelihood either, but it’s important for us as patients to understand where the doctors are coming from, and that you have the right and obligation to ask questions, research the treatment the doctor is wanting to put you, research other possible treatments.  Doctors might hate WebMD, but no doctor should have a problem listening to their patients and addressing their concerns. 

Midwives have more freedom to give you options.  Where doctors are given a playbook that they have to follow, midwives can lay open the doctor’s playbook and explain all the options, the likely outcomes for each option, and the costs of the different tests or procedures.  Rather than saying ‘here is the situation and when would you like to do this?’; its more, ‘here is situation, you have option A, B or C, here are the pros and cons, what would like to do?’  It’s like a team relationship versus leader, follower.
  
Using a midwife also can also offer a variety of options on where you deliver your baby.  I thought if you used a midwife that meant you would have to have your baby at home but that wasn’t the case.  Some midwives have made arrangements with certain hospitals, so they could deliver babies there if that was the parent’s choice.  Another group of midwives had an apartment that was laid out like a home, which gave the person a comfortable environment, without having to worry about what your own house looked like at delivery time. Plus, it was close to the hospital if any problems were to develop.

Something else with midwife is some have different levels of care.  If you’re like me, you seen enough medical drama to fear the unpronounceable condition that are possible.  So one of my first question for each midwife was what if something goes wrong?  They informed me that 80 percent of all pregnancy complications are foreseeable before a mother goes into labor. Depending on what the condition, there are treatments to correct the issues before it could become a risk, but if the midwife feels like the situation is over them they send you to an OBGYN.  The midwives we visited with had a list of OBGYN that were willing to take over care for a mother that was having problems, even to the day of delivery. 

For the person who likes the choices that a midwife offers, but would feel more comfort being in a hospital with an OBGYN, some midwives will serve as a birth coach of sorts.  The midwife will meet with you and find out your wishes and then during delivery when you’re preoccupied with actually having the baby, she will make sure that your wishes are followed, ask the questions you don’t even know to ask and  present you with other options than what the doctor might not have suggested.

Although midwives can offer you some benefits, there are options that you sacrifice with a midwife that an OBGYN can offer you. A doctor can write prescriptions.  Although prenatal vitamins don’t require a prescription to purchase, the prescription will typically allow them to be covered by your insurance.  That goes for sonograms as well.  Both doctors and midwives can read them, but insurance will only cover it if it was ordered by a doctor.   

Pain. This may be the deciding point right here.  Only doctors can prescribe pain medication or can perform an epidural.  So if your wife wasn’t considering going all natural, then you definitely want see an OBGYN.    

Doctors will only deliver your baby at a hospital where there is staff ready to do whatever it takes for the wellbeing of you and your baby.  At the hospital they have access to certain equipment, medicines and tools necessary to do things that just a few decades ago were unthinkable.  They have been able to deliver babies as early as 21 weeks and have them survive.  If a serious issue arose while you were seeing a midwife, you would potentially have to jump to another health care provider, whereas an OBGYN would be able to take care of you through all but the rarest conditions.


Well once again, this point was long one, so I’ll end this post here.  I have one more point on the subject and then that will be it for this series and I’ll move on to other essential insights to this whole new world of becoming a dad.


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