The Three Types of Care Providers Amongst OBs and Midwives

by Apr 13, 2008Hospital birth, Planning your vbac, VBAC6 comments

Care providers, OBs and midwives, can be broken down into three categories:

1. The ones who tell you outright they don’t to VBACs.  While this is annoying, it is more honorable than the second type of care provider because at least they don’t…

2a. … tell you they are supportive, but then put so many qualifications on their support that it’s almost impossible to have a successful VBAC with them.  I call this a “circus act VBAC.”  They want you to think that if you just jump through all these hoops, you will VBAC.  But what you don’t know as a typical pregnant woman who trusts her OB is, it’s almost impossible to meet the standard they require and, one way or another, you end up with a another surgery.

  • if your baby is less than X pounds
  • if you consent to an IV
  • if you consent to an epidural
  • if you consent to continuous external, or internal, fetal monitoring
  • if you stay in bed the whole time
  • if you come to the hospital as soon as labor begins
  • if you have the baby within X hours of labor starting
  • if you have the baby within X hours of your water breaking
  • if you agree to have a cesarean scheduled at X weeks “just in case” you don’t go into labor
  • if you agree to be induced at X weeks
  • if you go into labor by X weeks and if you don’t, you agree to have another cesarean or be induced
  • it goes on, and on, and on…

2b. Or they tell you that they are supportive, but as your due date gets closer, they start focusing more and more on the risks of VBAC.  Of course, they minimize, or don’t even mention, the risks of having a repeat cesarean.  It eventually becomes clear to you that they will find some excuse either during your labor, or before labor begins, to give you a cesarean.  At which point, how can you trust their medical opinion?  But, they have strung you along for so long – usually this starts in the last couple months of your pregnancy – that you feel stuck and you think that it’s too late to find another provider.  Sometimes it is, and sometimes it isn’t.  It never hurts to check out other providers, regardless of how far along you are.  When you have a provider like this, what do you have to lose?

3.  The smallest group of care providers out there are the ones who are truly supportive of VBAC.  You can find care providers by going here and interview them using the questions here.

What do you think?
Leave a comment.

What do you think? Leave a comment.


  1. “OB or midwife”. I see this all the time.
    Family physicians attend births, also. I like to think we are much more likely to be type 3.

    • I completely agree with you. I do use the term “health care provider” in newer articles, but in the older articles I did use “OB or midwife” more often.

  2. I am 35wks along and felt after some time seeing my OB’s and even the midwife-that followed their model, they were #2. I wanted to so believe that since I’ve done verything that I can to stay in those guidelines and meet all THEIR needs, that in the end I wouldn’t get my vbac. I just switched to a midwife group that I have to drive an hour and a half to but I feel that it will all be worth it, I have my appt. on Thursday-can’t wait. The drive is worth my mind being at ease and the #3-supportive group they are.

  3. As a midwife in a very patriarchal southern state, i have had several clients with the 3rd kind of caregiver. They lead them on with support of a VBAC and then on a visit just before their due date they hit them with a sorry, no we cant do a VBAC. The mothers are crushed and have no where to turn. Several have found me and one lady in particular found me on Wed, we met wed night and she had her VBAC at home on Sat with her friends and families surrounding her. I am hearing more and more stories with this tactic and i makes me so mad. Its even sadder when women just accept another Cs feeling betrayed and lost.

  4. Unfortunately I have a combination of 2a and 2b. I’m 41 weeks along and completely feel stuck. So please talk to your doc early and often if you are serious about a VBAC so you don’t feel backed into a corner like I do.

    • Megan – Just thinking of you – I’m early in pregnancy and planning a homebirth w/ a T incision – I’m more afraid of having to “fight the system” than anything else. I just wanted to give a hopeful shout out – I can’t IMAGINE being at your stage and facing that, but just a reminder that they CAN’T MAKE YOU do anything – even though it seems like it and is intimidating – and I’m so SORRY your in that position. I KNOW it’s late, but have you called/considered any homebirth mdwives in your area…? I have heard of people switching at the last minute – literally 😉 GOOD LUCK with whatever you do that your birth is THE BEST it can be! Be strong and positive!!!! Wishing you WELL! ♥ :):)


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Jen Kamel

As an internationally recognized consumer advocate and Founder of VBAC Facts®, Jen helps perinatal professionals, and cesarean parents, achieve clarity on vaginal birth after cesarean (VBAC) through her educational courses for parents, online membership for professionals, continuing education trainings, and consulting services. She speaks at conferences across the US, presents Grand Rounds at hospitals, advises on midwifery laws and rules that limit VBAC access, educates legislators and policy makers, and serves as an expert witness and consultant in legal proceedings. She envisions a time when every pregnant person seeking VBAC has access to unbiased information, respectful providers, and community support, so they can plan the birth of their choosing in the setting they desire.

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