Midwifery Care .... an explanation

Midwifery care. A viable alternative to regular doctor/medical care.

So what prompts this post? There seems to still be a misunderstanding in the general public about what midwifery care offers and why it's a good alternative. Case in point. Today, at our midwifery clinic, we had a couple come in for a consultation visit - they weren't sure if they wanted midwifery care for their pregnancy, so it was an opportunity to talk to a midwife and see what is was about. I got to do some explaining! :-) Tina, the midwife in clinic for this morning, and myself were at a birth this morning (watch for a post coming up about that!) and it was a rushed morning. I got back to the clinic 30 minutes before the first client was to show up, and was hoping Tina would get there in time. The couple showed up 15 minutes early (I was still cleaning the bathroom!), and Tina was nowhere in sight yet. As a matter of fact, at 9:30 she called to say she was still 20 minutes away. So .... I had a chance to chat with this wonderful young, obviously Christian couple about midwifery care.

They had been told, and assumed, that midwives were birth coaches. In our conversation they asked questions like " Do midwives stay with you for the birth?" "Do they deliver the baby?" "Can they order blood tests and ultrasounds?"
They were surprised to find out about the 4 years of university training they receive. And surprised to find out that midwives are much much more than birth coaches. They shared their journey to pregnancy (indeed Christian by their comments about prayer, and asking the Lord to bless them with a child) and confided in me. It was awesome. :-)

So I thought I'd do a blog post about the advantages of midwifery care. Here's a list. :-)

1) 4 years of obstetrical training in university with a semester placement in a foreign country like Uganda or India, catching babies and seeing all manner of obstetrical challenges without the obstetrical advances like we have. Their 4 years of obstetrical training likely is as much, if not more, than the average doctor. (not obstetricians though).

2) Holistic/total care ..... they look at the whole woman, not just the fetal heart rate, abdomen growth and weight gain. :-)

3) Better informed choice during pregnancy. Many (not all) doctors don't offer their patients choices when it comes to "routine" tests of pregnancy - like the Gestational diabetes test, blood tests, etc. They just assume that all patients will do all tests, because why wouldn't they? Midwives (not all of course!), offer their clients more choices --- asking if they want the tests before ordering them. Eplaining the positives and negatives - the risks and the benefits.

4) Longer appt times. Dr's offices are generally more busy because they have WAY more patients - and presumably not just maternity patients. Typically, a doctor's appt is 5-10 minutes and includes : a weight check, pee test, fetal heart rate, measurement of your abdomen and blood pressure. Questions you might have? Many times they are deferred or rushed through. Midwifery appt times: 30-45 minutes. You weigh yourself and do the pee check yourself - reporting the results to your midwife. They do the regular stuff, but give you LOTS of time to ask questions and talk about "life". They spend alot of time discussing diet because that plays a huge part in your baby's growth and development,your health and it impacts your labour. They spend time discussing your emotional health as well.
They ask how the other family members are coping.

5) Early labour assessment. When you go into labour it often is tough to figure out if you're in good enough labour to go to the hospital. I hear soooo many times that couples think they're in labour, go to hospital only to be sent home! Sometimes up to 3-4 times! Very frustrating! Your midwife will come to your home in early labour, assess you there and give tips, ideas etc for what to do - ie stay home for a while longer or get your butt to hospital in time! Doulas can be good for this -- but only up to a certain point. The definitive way to assess your progress is through a vaginal exam. Doulas cannot do that. There's also the safety of assessing baby. Doulas cannot listen to fetal heart tones. Midwives can do so in the early hours of labour assessing the well being of baby.

6) Continuity of care. You meet the midwives in your practice. One or two of them will be at your birth. Only they will assess you. That's an important factor because when you have a nurse check you, and then a doctor, and later a different nurse or other staff member at the hospital, they don't know exactly what the previous person felt, and what changes have actually occured. One person, one pair of eyes, one pair of hands .... better to assess progress.
Continuity of care means that it won't be a strange doctor on call or nurse delivering your baby.

7) Better postpartum support. With the decrease in funding for the public health nurses, many many women are not getting looked at when they go home from hospital. Granted, not all women want or need that. But midwives will come see you every other day for a week in your home. Why? To assess your healing, and to watch your baby's health. Early intervention for problems like breastfeeding difficulties, infections and jaundice results in better postpartum adjustment. You also usually see the midwives in their clinic up to 3 times in the first 6 weeks before they discharge you out of care and back to your family doctor.

8) Midwives have better outcomes statistically than their GP counterparts. (this is not comparing them to OB's who deal more with high risk patients, and therefore usually have worse outcomes statistically). Some of you reading this will get your backs up. However, the world stats don't lie. In countries where midwifery care is the norm for low risk healthy pregnant women, maternal and infant outcomes are better. Midwives have lower cesarean rates, lower induction rates, and lower complicated births. (and you might think "of course they have lower cesarean rates- they can't perform them!" - but if a midwifery patient has a cesarean, it counts on HER statistics).

9) Midwifery care gives you the option of homebirth. 'Nuff said. :-)

10) Midwifery care in most of Canada, and for sure in BC, is completely covered by MSP. No cost to you. Free. :-) The best of both worlds!

So there you have it. Anything to add?
I know that some of my readers absolutely LOVE their doctor. This is NOT a bash against doctors. Not at all. I have my favourite Langley doctors too! I think a couple of them would be good midwives. hee hee. BUT as such, they do lack some of the advantages of midwifery care, no matter how good they are. This is not to convince you to choose midwifery care, it's just to inform you. And others. And those people you know. Feel free to share this post with family and friends! I'd love to see alot fo comments and conversation around this. Please do comment!
Feel free to share your thoughts ...but please refrain from midwife/homebirth bashing. :-) Respect all around.

And now ... my day: a birth early this morning, my normal 4 hour Wednesday work-day at the clinic in the later morning, back to school shopping with the boys, a trip to Aldergrove lake with the kids with a McDonalds picnic dinner (and no, I DON'T feel guilty!, showers and dishes and clean up at home, a couple rounds of Whoonu with the older two kids, 3 loads of laundry, some CSI and blogging ......... I am ready for bed. And if I drank wine, I think I'd have some about now.

Good night and thanks for reading!!! (and don't forget to read my post about the perinatal support group being offered this fall!) CIAO!