Reflections on Midwifery

April 15th, 2012 by Potato

Wayfare (and, I suppose, myself) chose to go with a midwife as the care provider for her pregnancy. As it turns out, the delivery was handled by an OB (and 2 other doctors and like 7 nurses), but that’s the way things go sometimes. In fact, I think that our case shows that the system in place in Ontario is a good one: had things progressed as planned, it would have been the midwife attending the delivery. Yet when preeclampsia lead to an induction and a complicated birth, the hospital on-call medical team was there and ready to help. Just because you choose a midwife doesn’t mean you give up the resources of the hospital in the worst-case scenario.

There are a tonne of resources out there about midwifery and how to make your decision, including several books (I know, Wayfare read many of them). In short, a midwife is someone who is a specialist in helping women in pregnancy and through to early post-natal care (such as breastfeeding), with a focus on natural delivery. It is a regulated profession, and in Ontario their use is covered by OHIP. There are many points in the debate about using a traditional physician or OB for pregnancy or a midwife, but the main ones are the potentially unnecessary interventions in physician-assisted births, and that midwives try to put the patient’s wishes first. In particular, the high Caesarean rates. A C-section is an invasive surgery, and while it’s very much needed in the delivery tool-kit, there’s a charge that it’s vastly over-used because it makes the doctor’s life easier at the expense of the patient’s wishes. The advocates of midwifery say that the majority of pregnancies and deliveries are very natural processes, and don’t require interventions or the specialized training of a surgeon. Instead, they need the support and guidance of a patient midwife.

So a midwife will work towards a natural birth, helping with positions and what-not, and can also provide some measure of interventions if needed. They’re very attentive to their mothers-to-be, with a typical midwife visit being an un-rushed affair with lots of opportunity to ask questions and get coaching along the way. There’s also a very good chance that the midwife who provides your prenatal care will be the one to help you through the delivery, whereas with a physician you may just get whoever is on call at the hospital that night. Plus she comes by a few times after birth to check on the baby and answer our many, many questions, which helps a lot since it takes a while to get around to getting a family doctor or pediatrician.

After all the research Wayfare did, and our own experience with the process, I think a midwife was a really good way to go, and I’d recommend it to other pregnant couples. If we haven’t high-risked ourselves out of the option, we’ll go with our midwife again. I make that recommendation with just a few minor caveats though:

The first is the big one for me: though midwives do hospital deliveries, many people associate the idea of a midwife with a home delivery, and many of the books and articles on midwives are intertwined with those on home births. They push not only a midwife for your natural (or mostly-natural) delivery, but also a home birth as being the best option. I was uncomfortable with the home birth idea before-hand (our plan was a midwife-assisted hospital delivery), and after our experience I think you’d have to be half-crazy to try a home-birth. Yes, a midwife has first aid training and certain supplies, but if something goes seriously wrong there’s just no way she could handle it. If you tear something (or in engineering speak, blow out an O-ring) and decide that yes, you would very much like the epidural after all, you’re out of luck. So if you start reading up on midwives and come across this information on the magical wonder of a home birth, I’d say to skip over that option. Indeed, I wouldn’t even necessarily pick a regular hospital delivery: I had “NICU on-site” as one of my criteria for picking a hospital, and in hindsight was really glad it was.

The second is that midwives are something of an “alternative medicine” practice, and tend to associate with other such practitioners. So you can quickly run down the line from your midwife with her care and sets of evidence-based practices and standardized blood workups to a referral to a naturopath, herbal preparations, or further down the line to acupuncture or out-right quackery like homeopathy. Yet they do also provide the good care of checking the fetal heart rate, prenatal screening, regular monitoring of the mother’s blood pressure and urine glucose/protein, etc.

The third is a bit of give-and-take: a pro for using a midwife is the patient-centred care, helping you to shape the way your own pregnancy and delivery will go. Whether you want it to be at home or in the hospital, with drugs or without, they will help work with you and develop that plan. But they make a lot of things that are standard-of-care sound optional: for example, a quick vitamin K injection is standard after birth as newborns can sometimes be a little deficient, and it will help them clot. I found that with some of the midwives instead of “we normally do this, but if you really object we can avoid it for you” it was “well, if you want, we can give vitamin K. Totally up to you.” Just the way it was put made me a little afraid they were just a touch too flexible sometimes, and wouldn’t default to the standard-of-care if the new moms were even a little bit apprehensive about interventions.

But those are all very manageable caveats. In the pro column you have a great pregnancy resource who is very unrushed and patient with your endless lists of questions (well, maybe we’re a bit abnormal in the number of questions we can come up with), patient-centred care, totally open to trying to meet your wishes for the birth experience, with a good chance of your primary or secondary midwife actually being the person who will attend the birth. You can page her any time if you have a concern, and usually hear back promptly.

IMHO a midwife-assisted hospital birth is a great way to go, giving you the best of both worlds: good patient-centred care for a calm, natural delivery your way in the majority of cases where that’s possible, while still being able to summon 3 doctors and 7 nurses in an instant for the minority of cases where it’s needed.

3 Responses to “Reflections on Midwifery”

  1. James Meyer Says:

    We’re having baby #4 within a week or two, and we’ve gone with midwives each time. I would never go back.
    The first we experienced a hemorrhage that required doctor intervention, but the midwives did the actual delivery.
    The second was breach and ended up being a C-Section.
    The third was a surprise breach and required doctors as she was delivered naturally (no drugs even).
    This fourth we are hope to do at home, but if need be, we aren’t far from a hospital.

    Though we have needed doctors each time (so far), I would not give up midwives in place of them. The midwives stayed with during each birth, the care leading up to and out of pregnancy is amazing. After 4 pregnancies, we know our midwives quite well.

    I’m very blessed to live in Ontario as well where this care is free.

    We’re will opt for Vitamin-K if the birthing is rough, but we’re going to obtain it ourselves from goodness me from an organic source as the synthetics are not something we trust.

  2. Joe Q. Says:

    Our story: Used a mid-wife for pregnancy care during first pregnancy, but developmental issues with the fetus forced a transfer-of-care to a high-risk OB clinic. Wife ended up being induced at 39 weeks. We did hire a doula who happened to be a midwife-in-training, and the nurse present at delivery was a midwife in a former life, so we had a better experience than most. (The kid is perfectly healthy, by the way.)

    For kid number 2, there were no complications during pregnancy, all care was provided by the midwife, delivery in the hospital with midwives. Wife went into labour at midnight, irregular contractions until about 9-10am, then increasingly regular frequent contractions. At hospital at 2pm, baby born 6pm with no epidural or other drugs, home by 9pm.

    I agree with you that many people automatically associate midwives with home births. I think much of this comes from the US, where midwifery is a fringe thing. We had no interest in having the baby at home.

  3. Potato Says:

    Thanks for your experience, Joe!