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I'm sorry but if you are a medical professional of any stripe and when asked to look at an incision miss a large opening in said incision, I would never go back. That is beyond the pale, IMO.

@Mae: that is kinda off putting too for sure...

The last con on your OB list, is the reason why I ended up scheduling my C with my preferred OB. Best case scenario you have an easy-breezy textbook VBAC. Worse case scenario you need lots of intervention i.e. RCS. Do you want an unknown doctor advising let alone performing a cesarean on you?

Go for the consultation at 10 weeks even if you already start care at your Midwife practice. You may like the office and be comfortable with what he says.

I'm voting the OB and here's why:

I tried to have a vbac, so I totally get why you want that and the stress of finding the right provider. They will not induce for a vbac because pitocin increases the risk of uterine rupture. I think that is pretty universal among all providers. Depending on the provider, they may be wiling to break your water if your dilated enough to "induce" you. I found an OB that I knew had delivered other VBACs. He's in a practice with others, so there was definitely a chance that someone else would deliver. I asked about the vbac thing is someone else ended up being the one that delivered and he said everyone in his practice was fine with delivering VBACs but that they each delivered about 85% of their own deliveries anyway. So, once you know you have an OB that is pro VBAC, you've got a good start. Here's why I personally recommend an OB, regardless of your last experience (which doesn't sound like you loved in practice, even if you loved the idea of it). I really hope you have a successful VBAC, but there's also a chance you may not. You may not go into labor. You may have high blood pressure again. You may have some other reason that necessitates a c-section. For me, I would not want to go into surgery with just any OB. There are ones that are more gifted at surgery and ones that are not as good. I would hate to have that decision made by whoever was around at any given moment if things went south. I liked the idea of having a provider who was very supportive of VBAC and very capable in the OR as well. After 41 weeks, I hadn't gone into labor and my OB would have let me go another week, but we decided to go ahead and schedule the sections at that point (I hadn't dilated a single centimeter with a 9 lb baby at 41 weeks).

If you had 100% confidence in your midwife practice, I think it would be a tougher call, but where not everything was really great care, for me the OB practice would be better. And remember if you meet with the OB for your appointment and don't get answers you like, you can always switch to the midwife practice or find a different OB.

@Mae: Is there any way you can start off with the midwives and then do a consultation with the OB at 10 weeks before deciding which you'll continue care with? I really like the midwifery model but it does sound like that particular midwife was dismissive and I'd have a hard time trusting her too. There are other midwives in the practice though, right? How do you feel about them?

@Mae: Oh also, make sure to ask about inducing for a VBAC. They may not use pitocin but some practices will do cervidil/break you water.

Is that midwife practice consisting of CNM's? I am so surprised they would miss something like this (though, I would assume all aftercare related to a c-section would be done by the OB office who performed it).

I can see why you'd have trust issues here.

If you truly want a VBAC, I think finding a care provider who will support you is the key. If you go with the OB, a doula would be an amazing advocate for you. My fear is that this midwife group might be less likely to see any problems, and more focused on the VBAC. Does that make sense? The OB knows there's always a chance for c-section, but paired with the doula, the might try everything (they safely can) for a VBAC.

I delivered at home with midwives, so I am definitely not anti-midwife. I just think your particular situation was pretty scary, and shouldn't have happened (with proper training and care).

@Mae: so sorry you had to deal with that - what a horror show!! That's still a deal breaker for me - she is providing your healthcare and IMO, she failed in a huge way to miss that. That's not a miss I personally could get past.

@Mae: All of those concerns are super valid. I'm sorry you are having to deal with this ... I'm sure it's stressful.

I would recommend checking with your local ICAN chapter (most have facebook pages) for suggestions of practices that are vbac supportive. They are an invaluable resource.

Based on your history I would definitely go with the OB. I wouldn't be able to trust that particular midwife practice after that experience.

When searching for a midwife/OB with my first child, I REALLY wanted a midwife, but the hospital I delivered at didn't allow midwives. I was shocked! I ended up going with a very naturally minded OB, and the entire practice has a similar philosophy. It was a great experience. In your case it sounds like this OB might be similar. I would just confirm that the others are as VBAC friendly and willing to follow your plan if your doctor is not able to deliver.

I'd do the OB practice. Continuity of care, while nice to have, isn't a big sticking point for me. Every pregnancy can be/is different, and any doc will get your history and listen to you when you talk about what happened previously. Each of my 3 has been delivered in different states, at different hospitals, with different providers.

I also wouldn't consider the 8w/10w first appointment/dating ultrasound a sticking point. It seems very important right now, this early, but you'll have a LOT of pregnancy left after that, and far better to be trusting and happy with the care for that!

Convenience would be a big thing to me, especially when appointments get more frequent. And if your attempted VBAC fails, I'd much rather be with a provider I picked (and/or his partners, if necessary) than a random.

I've also found that during my labors/births, it was really the nurses that I had most interaction with. I delivered once with my primary doc and twice with the docs on-call, and the on-call docs were wonderful (and only there for the pushing!). As long as you know they would support a VBAC practice-wide, I'd pick them.

As far as the timing of the first appointment, you could go to the midwives for that early first appointment whether you plan to stay there or not. Switching practices during pregnancy is very common.

I had a vbac 3 weeks ago after a similar first experience to you. (Also 18 hour labor ending in a C).
I strongly urge you to join your local ICAN group on FB and ask/search for a vbac provider.
I chose a provider in the area that is well know for being pro-vbac. Best choice I've made!
There is a difference between pro-vbac and vbac supportive.
Oh and he was willing to let me go overdue and do a gentle induction. (Small amount of pitocin, no ripener) Thankfully I ended up not needing the induction.