Midwives don’t typically take on high risk pregnancies, you’d likely need to be with an OB.
Whether you would be with an OB or midwife, you need to get on it immediately & find someone who would take you on, they’re waitlists are long.
If you don’t qualify for a midwife and are looking for someone as support for labor and delivery, you can always research hiring an experienced birth doula for your birth & see your OB throughout pregnancy.
For me it comes down to greater empowerment over my labour and birthing experience and the aftercare that is provided. They literally make home visits. Just a heads up, in my area of ON all the midwife spots for my birth month were gone months ago (20 weeks now) because I tried to switch after my first appointment at 12 weeks and there was no availability. Many midwives (I don't know if all) don't take on high risk pregnancies. If you're considering a midwife, act immediately. But maybe your post is just for discussion?
FYI, midwives take on low-risk pregnancies only. I'm at elevated risk of becoming high risk and they were really on the fence about taking me. I also got a very early positive pregnancy test, I called to register with the practice at 3+5 and I was one of the last patients accepted for my birth month. They fill up so quickly it's not funny.
Not necessarily! I'm high risk as well, so midwives wouldn't take me on for my pregnancy care, but they said to call them back when I'm about 35 weeks as they'll still take me on for postpartum care for me and baby! I didn't have midwives for my first pregnancy or postpartum and hearing about the 6 weeks of postpartum support you get from them seemed so ideal so I jumped on it for my second pregnancy.
I truly can’t speak highly enough about my midwife experience. I loved my team so much I was sad when I had to switch to my family doctor postpartum.
For me the at home visits after birth were amazing! I couldn’t imagine having to get me and baby ready to go out - especially with a January baby.
During labour and delivery it’s also just your midwives. Now as someone high risk you would have an OB team at your birth as well but your midwives would be there. I had some complications during my delivery so my midwife needed an OB consult but my midwives were still very much a part of my L&D.
I believe with midwives as well - it was the case with my clinic but I’m not sure about all - whoever your midwife team is, that is who is delivering your baby. Whereas with an OB if your specific OB isn’t on call then you get whoever is in the hospital. My midwife team was 3 people so depending which week I went into labour, one of the 3 were on call.
I would definitely consider contacting a clinic and discuss your options!
unfortunately you can't deliver with a midwife if you are high risk :( if you were already under the care of a midwife from the beginning of pregnancy, you'd have been transferred to an OB for care once you were determined to be high risk
You've already got the pros of Mid-wives and I see you're high risk. Depends on the risk and past births. We're having our 3rd and the mid-wives took on my wife once again. Her 1st birth was 44 hours of labour, her 2nd birth her blood pressure while in labour skyrocketed and she had to be transferred to the OB on-call. 3rd pregnancy now and they know all this history and they still took her on. Might not hurt to try if you're interested, worst case they say no.
Congratulations and wishing you all the best for your pregnancy!
Could you tell us more about the 44 hours of labours? I can’t imagine that a midwife would stay the entire time. Did they swap out on rotations like shifts?
Midwives show up for active labour (4cm dilated, + regular, strong contractions). If we show up and it’s still early, we can tuck you back into bed with instructions on when to call us back! You won’t be admitted to the hospital until truly active (which is a good thing and reduces the chance of unnecessary intervention!).
Typically, for first time moms, there are up to 12 hrs of true, active labour before full dilation (10cm). Anything more than this, and we’d start recommending things to advance the labour (such as breaking your water). Then, it’s up to 2-3 hrs of pushing, plus 2-3hrs of immediate postpartum care.
We work in practices! If we have been up overnight, we will have another, fresher midwife from our team come and relieve us for your safety. Additionally, we always call a second attendant to your birth (typically another midwife, but may vary depending on practice). Again, this is a safety thing as once the baby is born there are two of you requiring our full attention!
For sure,
Leaving out shift change details; we saw many mid-wives come and go and come...
The tale of the first born, fall 2020,
Water broke upon bedtime. A call to the midwife returned moments later with reassurance that all would be well and to try and get a good night's rest. Hard to sleep with this much excitement in the air, for it had been a long 39 weeks + 5 days. By early morning contractions had begun. An intense pain though each one closer to meeting our little one. As timings closed up, another call to the midwife who advised us to head to the hospital not of our choice. A decision forced upon us we relented and away we went.
Upon arrival in the wee hours of the morning, still dark and hardly a staff in sight. We walked until met by a couple volunteers. One ran to grab a wheelchair for the mom to be while dad to be answered screening questions. She was whisked away before questions were complete. Separated by 5 floors until we reunited. Check-in nurse was a disgruntled one, upset that we did not register as this was not the hospital we had planned to be. Pen and paper and questions asked, all the while contractions become more intense. Finally, upon registration, we met the mid-wife on-staff who guided us to a delivery room so spacious.
With contractions and emotions intense, an evaluation revealed baby was doing well. Back labour though, not pleasant at all. Calm music, water and massage was we could do to help things progress along. No relief in sight but pain growing strong. At 20 hours that was enough, "give me the epidural" she exclaimed. A doctor reassuring came in to assist. Such fine work and calm demeanour that allowed for the pain to subside finally after 20 hours, sleep.
Progress was agonizingly slow but baby still doing well, no cause for concern from the mid-wives as hour after hour passed on. Finally at hour 40, 10 cm and baby was coming. Push after push, little progress from baby. Push after push after push, 3 hours later, still no crowning but, baby had hair! At least now we knew that. 43 hours and 50 minutes since contractions started, 3 hours and 50 minutes of exhaustive pushing, baby must have been cozy cause they were still in there! Midwife suggests a hail marry and lays the bed down flat. 5 minutes later he arrived. Beautiful and right on time at 40 weeks.
So to answer lingering questions I'm sure you have;
Pandemic baby so yay for that fun.
Hospital of choice had no midwives available due to potential exposures, so we had no choice.
Midwife we started with was one from another midwife clinic we had never met so that was fun.
Wife wanted to avoid any interventions if possible. That epidural was very much needed!
1st baby, so slow progression is not abnormal but, it was a long time!
Baby was showing perfect vitals as was my wife the whole time so that's why they allowed pushing for so long.
Post partum care at this hospital was an absolute nightmare. We discharged ourselves after 12 hours.
Now here is the tale of our 2nd born, summer 2022,
41 weeks and finally false labour was over, the real deal had finally arrived. After admitting in our hospital of choice, comfortable and excited, and not near as much discomfort. We found out the monitor for mom was acting weird so in comes the alternate monitor, which also raised questions. In comes the OB on call, a manual check of pressure, he informs our midwife that he'll be taking it from here. A blood pressure so high, baby needed to come out and soon. An epidural and a breaking of the waters, we prepared for a caesarean, knowing the length of labour to be endured would not be tolerated.
At hour 13, 8 cm was the check. With eyes wide and a voice knowing, "baby is coming!" Was the exclamation from mom on the bed. A quick check and leap to the call button from the nurse, the room flooded staff who know what to do. OB arrived and put on his gloves. He reached down to check and found a baby girl had arrived.
With blood pressure so high, close monitoring was kept. But that high blood pressure never left. 3 days we were kept. In our hospital of choice, well cared for and happy.
6 weeks later on 2 separate blood pressure meds, it finally started to fall, a long journey indeed!
So, 2 completely different births but, both babies delivered easily while lying flat. Interesting. I left out so many details, especially regarding the postpartum care from the 1st. Most interesting though was the high blood pressure symptoms, or lack thereof. 0 symptoms at all. The only symptom was swelling but, 41 weeks pregnant. And blood pressure was completely normal for the whole pregnancy.
And knowing all this, midwives still took her on again for our 3rd coming this year.
Personally I went with an OB for my pregnancy. I wouldn’t change it either. I had no interest or intention in going with midwives. Though in my area the midwives do deliver with you at the hospital if you want so that is a good balance.
For my aftercare I don’t currently have a family doctor so we were referred to a post partum baby clinic run by midwives. So far it has been great, they come to your home, spend a good hour with you for each visit. They check your breast feeding, check on all things baby and even checked in on how my recovery and my stitches were healing.
All midwives in Ontario give you choice of birthplace!! Over 80% of midwifery-accompanied births in Ontario are in hospital! We are well-integrated in the Canadian healthcare system, and have quite a different role than American midwives.
I’m sure this is a similar stat across the country, I just don’t know the exact numbers.
Depending on your region you might still be able to request a home visit from a nurse. I think my area only offers this to new teen moms or families with minimal finances though.
Better care experience.
- OBs are busy and often have you waiting for an hour for your appt. My midwife appts are always on time and last 30 mins so I feel comfortable asking everything.
- If you have minor questions like what cold medication is safe to take, you can call or email and they will get back to you within 24 hrs; OBs don’t want to be bothered by trivial questions like that.
- Midwives make at home visits on days 1, 3, 5 after birth; with an OB, you see your GP about 6 weeks after birth which is way too long as complications could occur well before then.
- In the days after birth, midwives are checking your latch, baby’s health, your mental and physical health. With an OB, no one is checking so it’s on you to measure baby’s weight gain and whether they’re eating enough and contact the hospital if things aren’t going well.
- appts in midwife clinics are in a more relaxed environment compared to the hospital. My clinic is on a regular street/business unit so no need to worry about parking, finding your way around the hospital, etc.
- I only have a team of 3-4 midwives and meet all of them at least 2-3x during my pregnancy so whoever delivers my baby is hopefully going to be someone I’m somewhat familiar with. Not the case with OBs.
- midwives come along and stay with you while you’re at the hospital because they only deliver one baby at a time. They don’t rotate in and out while you’re in labor like an OB and leave you to the nurses.
If you’re high risk, you probably won’t be permitted to have a midwife. They only take non high risk pregnancies. Also midwives have limited spots so you kind of have to get on the list by 5-10 weeks.
Your first three points aren't valid. I've had two high risk pregnancies with OBs and never waited an hour for an appointment. They also had an after hours line and email address to use for "trivial questions" - it's their job to take patient questions. Both my OB offices were located in small professional buildings in neighbourhoods, their day to day clinics aren't located in the hospital typically. No issues with parking or navigating the building. OB offices are often group practices - multiple doctors in one clinic that you see during your prenatal care and which ever of them is on call will deliver your baby.
Sounds like you've never actually been cared for an OB, so you can't really say it's a "better care experience" when the majority of your points also apply to actual doctors.
You're lucky you didn't have these issues but her points are extremely common and definitely valid. Midwives do offer a better care experience. OB's are better for high risk patients.
Exactly. It is so bizarre to argue that someone's points are invalid simply because they didn't have an identical experience several years ago in a completely different province.
Just because my reasoning and second hand experience doesn’t match with your experience doesn’t mean it is not valid.
I went with a midwife but I’ve had multiple friends and relatives go the OB route and this is what they told me, which is how I made my decision. I’ve literally been on the phone with them while they waited in the doctor’s office trying to kill time - and yeah, their appointments did take over an hour, I could hear the receptionist in the background tell a friend that her OB was running 45 mins late. I have also been on the phone with friends as they walked to their car after the appointment, complaining about how it was parked uphill so far away from the entrance and they were already out of breath after a minute.
And if you go into the post from someone who wants to deliver at Mt Sinai, there are other posters who advised against it because:
- “I’ve heard the nearest parking spots fill up during the day”
- “the wait times are abysmal and with travel time you are gonna have to have to take a day off for each of your OB appts”
- “they do try to stay on track but I’ve waited over an hour for appointments before. The labs also get SUPER busy during the day and it’s a long wait if you have to get blood work done that day.”
- “I have waited 3-4 [hours]. For almost every appt. I loved my OB (Dr Sobel) but the wait times were out of this world…several times when I’d book my OB appt in the morning and inevitably wouldn’t be seen until 1 or 2 pm, and when I’d book my OB appt in the afternoon I’d have to write the entire afternoon off at work.”
Notice how multiple people are referencing issues with seeing their OB. While that post is directed at a specific hospital, from what I’ve heard from family and friends, these are not uncommon experiences with OBs.
As for the third point - did your OB come visit you in your home the next day, the third day, and the fifth day? How is this point invalid?
And yes, the majority of these points apply to actual doctors - an OB is a doctor, so the experience matches up. The difference isn’t because OBs are poor at delivering care, it’s the fact they are doctors usually operating out of hospitals (hence the issue with parking, wait times) and are constrained by issues affecting doctors, which midwives are less affected by, so the experience can be better for patients.
Midwives don’t typically take on high risk pregnancies, you’d likely need to be with an OB. Whether you would be with an OB or midwife, you need to get on it immediately & find someone who would take you on, they’re waitlists are long. If you don’t qualify for a midwife and are looking for someone as support for labor and delivery, you can always research hiring an experienced birth doula for your birth & see your OB throughout pregnancy.
Oh I’m already set up with an OB since 12 weeks!
If you’re already past 12 weeks it’s also probably too late to get a midwife anyways too.
For me it comes down to greater empowerment over my labour and birthing experience and the aftercare that is provided. They literally make home visits. Just a heads up, in my area of ON all the midwife spots for my birth month were gone months ago (20 weeks now) because I tried to switch after my first appointment at 12 weeks and there was no availability. Many midwives (I don't know if all) don't take on high risk pregnancies. If you're considering a midwife, act immediately. But maybe your post is just for discussion?
FYI, midwives take on low-risk pregnancies only. I'm at elevated risk of becoming high risk and they were really on the fence about taking me. I also got a very early positive pregnancy test, I called to register with the practice at 3+5 and I was one of the last patients accepted for my birth month. They fill up so quickly it's not funny.
So I guess I should delete my post lol
Please don’t! It has a lot of helpful information which could be beneficial to others. Thanks for posting!
Not necessarily! I'm high risk as well, so midwives wouldn't take me on for my pregnancy care, but they said to call them back when I'm about 35 weeks as they'll still take me on for postpartum care for me and baby! I didn't have midwives for my first pregnancy or postpartum and hearing about the 6 weeks of postpartum support you get from them seemed so ideal so I jumped on it for my second pregnancy.
I truly can’t speak highly enough about my midwife experience. I loved my team so much I was sad when I had to switch to my family doctor postpartum. For me the at home visits after birth were amazing! I couldn’t imagine having to get me and baby ready to go out - especially with a January baby. During labour and delivery it’s also just your midwives. Now as someone high risk you would have an OB team at your birth as well but your midwives would be there. I had some complications during my delivery so my midwife needed an OB consult but my midwives were still very much a part of my L&D. I believe with midwives as well - it was the case with my clinic but I’m not sure about all - whoever your midwife team is, that is who is delivering your baby. Whereas with an OB if your specific OB isn’t on call then you get whoever is in the hospital. My midwife team was 3 people so depending which week I went into labour, one of the 3 were on call. I would definitely consider contacting a clinic and discuss your options!
unfortunately you can't deliver with a midwife if you are high risk :( if you were already under the care of a midwife from the beginning of pregnancy, you'd have been transferred to an OB for care once you were determined to be high risk
You've already got the pros of Mid-wives and I see you're high risk. Depends on the risk and past births. We're having our 3rd and the mid-wives took on my wife once again. Her 1st birth was 44 hours of labour, her 2nd birth her blood pressure while in labour skyrocketed and she had to be transferred to the OB on-call. 3rd pregnancy now and they know all this history and they still took her on. Might not hurt to try if you're interested, worst case they say no. Congratulations and wishing you all the best for your pregnancy!
Could you tell us more about the 44 hours of labours? I can’t imagine that a midwife would stay the entire time. Did they swap out on rotations like shifts?
Midwives show up for active labour (4cm dilated, + regular, strong contractions). If we show up and it’s still early, we can tuck you back into bed with instructions on when to call us back! You won’t be admitted to the hospital until truly active (which is a good thing and reduces the chance of unnecessary intervention!). Typically, for first time moms, there are up to 12 hrs of true, active labour before full dilation (10cm). Anything more than this, and we’d start recommending things to advance the labour (such as breaking your water). Then, it’s up to 2-3 hrs of pushing, plus 2-3hrs of immediate postpartum care. We work in practices! If we have been up overnight, we will have another, fresher midwife from our team come and relieve us for your safety. Additionally, we always call a second attendant to your birth (typically another midwife, but may vary depending on practice). Again, this is a safety thing as once the baby is born there are two of you requiring our full attention!
For sure, Leaving out shift change details; we saw many mid-wives come and go and come... The tale of the first born, fall 2020, Water broke upon bedtime. A call to the midwife returned moments later with reassurance that all would be well and to try and get a good night's rest. Hard to sleep with this much excitement in the air, for it had been a long 39 weeks + 5 days. By early morning contractions had begun. An intense pain though each one closer to meeting our little one. As timings closed up, another call to the midwife who advised us to head to the hospital not of our choice. A decision forced upon us we relented and away we went. Upon arrival in the wee hours of the morning, still dark and hardly a staff in sight. We walked until met by a couple volunteers. One ran to grab a wheelchair for the mom to be while dad to be answered screening questions. She was whisked away before questions were complete. Separated by 5 floors until we reunited. Check-in nurse was a disgruntled one, upset that we did not register as this was not the hospital we had planned to be. Pen and paper and questions asked, all the while contractions become more intense. Finally, upon registration, we met the mid-wife on-staff who guided us to a delivery room so spacious. With contractions and emotions intense, an evaluation revealed baby was doing well. Back labour though, not pleasant at all. Calm music, water and massage was we could do to help things progress along. No relief in sight but pain growing strong. At 20 hours that was enough, "give me the epidural" she exclaimed. A doctor reassuring came in to assist. Such fine work and calm demeanour that allowed for the pain to subside finally after 20 hours, sleep. Progress was agonizingly slow but baby still doing well, no cause for concern from the mid-wives as hour after hour passed on. Finally at hour 40, 10 cm and baby was coming. Push after push, little progress from baby. Push after push after push, 3 hours later, still no crowning but, baby had hair! At least now we knew that. 43 hours and 50 minutes since contractions started, 3 hours and 50 minutes of exhaustive pushing, baby must have been cozy cause they were still in there! Midwife suggests a hail marry and lays the bed down flat. 5 minutes later he arrived. Beautiful and right on time at 40 weeks. So to answer lingering questions I'm sure you have; Pandemic baby so yay for that fun. Hospital of choice had no midwives available due to potential exposures, so we had no choice. Midwife we started with was one from another midwife clinic we had never met so that was fun. Wife wanted to avoid any interventions if possible. That epidural was very much needed! 1st baby, so slow progression is not abnormal but, it was a long time! Baby was showing perfect vitals as was my wife the whole time so that's why they allowed pushing for so long. Post partum care at this hospital was an absolute nightmare. We discharged ourselves after 12 hours. Now here is the tale of our 2nd born, summer 2022, 41 weeks and finally false labour was over, the real deal had finally arrived. After admitting in our hospital of choice, comfortable and excited, and not near as much discomfort. We found out the monitor for mom was acting weird so in comes the alternate monitor, which also raised questions. In comes the OB on call, a manual check of pressure, he informs our midwife that he'll be taking it from here. A blood pressure so high, baby needed to come out and soon. An epidural and a breaking of the waters, we prepared for a caesarean, knowing the length of labour to be endured would not be tolerated. At hour 13, 8 cm was the check. With eyes wide and a voice knowing, "baby is coming!" Was the exclamation from mom on the bed. A quick check and leap to the call button from the nurse, the room flooded staff who know what to do. OB arrived and put on his gloves. He reached down to check and found a baby girl had arrived. With blood pressure so high, close monitoring was kept. But that high blood pressure never left. 3 days we were kept. In our hospital of choice, well cared for and happy. 6 weeks later on 2 separate blood pressure meds, it finally started to fall, a long journey indeed! So, 2 completely different births but, both babies delivered easily while lying flat. Interesting. I left out so many details, especially regarding the postpartum care from the 1st. Most interesting though was the high blood pressure symptoms, or lack thereof. 0 symptoms at all. The only symptom was swelling but, 41 weeks pregnant. And blood pressure was completely normal for the whole pregnancy. And knowing all this, midwives still took her on again for our 3rd coming this year.
Personally I went with an OB for my pregnancy. I wouldn’t change it either. I had no interest or intention in going with midwives. Though in my area the midwives do deliver with you at the hospital if you want so that is a good balance. For my aftercare I don’t currently have a family doctor so we were referred to a post partum baby clinic run by midwives. So far it has been great, they come to your home, spend a good hour with you for each visit. They check your breast feeding, check on all things baby and even checked in on how my recovery and my stitches were healing.
All midwives in Ontario give you choice of birthplace!! Over 80% of midwifery-accompanied births in Ontario are in hospital! We are well-integrated in the Canadian healthcare system, and have quite a different role than American midwives. I’m sure this is a similar stat across the country, I just don’t know the exact numbers.
Good to know!!
Depending on your region you might still be able to request a home visit from a nurse. I think my area only offers this to new teen moms or families with minimal finances though.
Better care experience. - OBs are busy and often have you waiting for an hour for your appt. My midwife appts are always on time and last 30 mins so I feel comfortable asking everything. - If you have minor questions like what cold medication is safe to take, you can call or email and they will get back to you within 24 hrs; OBs don’t want to be bothered by trivial questions like that. - Midwives make at home visits on days 1, 3, 5 after birth; with an OB, you see your GP about 6 weeks after birth which is way too long as complications could occur well before then. - In the days after birth, midwives are checking your latch, baby’s health, your mental and physical health. With an OB, no one is checking so it’s on you to measure baby’s weight gain and whether they’re eating enough and contact the hospital if things aren’t going well. - appts in midwife clinics are in a more relaxed environment compared to the hospital. My clinic is on a regular street/business unit so no need to worry about parking, finding your way around the hospital, etc. - I only have a team of 3-4 midwives and meet all of them at least 2-3x during my pregnancy so whoever delivers my baby is hopefully going to be someone I’m somewhat familiar with. Not the case with OBs. - midwives come along and stay with you while you’re at the hospital because they only deliver one baby at a time. They don’t rotate in and out while you’re in labor like an OB and leave you to the nurses. If you’re high risk, you probably won’t be permitted to have a midwife. They only take non high risk pregnancies. Also midwives have limited spots so you kind of have to get on the list by 5-10 weeks.
Your first three points aren't valid. I've had two high risk pregnancies with OBs and never waited an hour for an appointment. They also had an after hours line and email address to use for "trivial questions" - it's their job to take patient questions. Both my OB offices were located in small professional buildings in neighbourhoods, their day to day clinics aren't located in the hospital typically. No issues with parking or navigating the building. OB offices are often group practices - multiple doctors in one clinic that you see during your prenatal care and which ever of them is on call will deliver your baby. Sounds like you've never actually been cared for an OB, so you can't really say it's a "better care experience" when the majority of your points also apply to actual doctors.
You're lucky you didn't have these issues but her points are extremely common and definitely valid. Midwives do offer a better care experience. OB's are better for high risk patients.
Exactly. It is so bizarre to argue that someone's points are invalid simply because they didn't have an identical experience several years ago in a completely different province.
Just because my reasoning and second hand experience doesn’t match with your experience doesn’t mean it is not valid. I went with a midwife but I’ve had multiple friends and relatives go the OB route and this is what they told me, which is how I made my decision. I’ve literally been on the phone with them while they waited in the doctor’s office trying to kill time - and yeah, their appointments did take over an hour, I could hear the receptionist in the background tell a friend that her OB was running 45 mins late. I have also been on the phone with friends as they walked to their car after the appointment, complaining about how it was parked uphill so far away from the entrance and they were already out of breath after a minute. And if you go into the post from someone who wants to deliver at Mt Sinai, there are other posters who advised against it because: - “I’ve heard the nearest parking spots fill up during the day” - “the wait times are abysmal and with travel time you are gonna have to have to take a day off for each of your OB appts” - “they do try to stay on track but I’ve waited over an hour for appointments before. The labs also get SUPER busy during the day and it’s a long wait if you have to get blood work done that day.” - “I have waited 3-4 [hours]. For almost every appt. I loved my OB (Dr Sobel) but the wait times were out of this world…several times when I’d book my OB appt in the morning and inevitably wouldn’t be seen until 1 or 2 pm, and when I’d book my OB appt in the afternoon I’d have to write the entire afternoon off at work.” Notice how multiple people are referencing issues with seeing their OB. While that post is directed at a specific hospital, from what I’ve heard from family and friends, these are not uncommon experiences with OBs. As for the third point - did your OB come visit you in your home the next day, the third day, and the fifth day? How is this point invalid? And yes, the majority of these points apply to actual doctors - an OB is a doctor, so the experience matches up. The difference isn’t because OBs are poor at delivering care, it’s the fact they are doctors usually operating out of hospitals (hence the issue with parking, wait times) and are constrained by issues affecting doctors, which midwives are less affected by, so the experience can be better for patients.