What Caregiver?

INFORMED CHOICE:

MIDWIFE OR DOCTOR?

By Angela Anderson

Previously published in Birth Issues, Winter 2011

Helga Himer Photography

Helga Himer Photography

When a woman discovers she is expecting a baby, she has many options for a primary caregiver: family doctor, obstetrician and midwife. Most women seem to know who these caregivers are, but many may not know the specific benefits offered by each.

Midwives have been delivering babies for many centuries. Often, a woman invites her midwife into her home to give personalized care. This care requires sensitivity and intimacy one is unlikely to find in a busy obstetrician’s office where there is little time to ask important questions, or to feel validated about ones decisions, mostly because the doctor makes these decisions. Different procedures are followed by each of the caregivers throughout prenatal care and during labour and birth. Of the many differences between midwives and doctors, the most important is that most midwives encourage informed choice and provide individualized care for women, whereas most doctors treat pregnancy as a medical ailment in what they feel to be the most effective manner.

In choosing a caregiver for prenatal care, a woman should know what she can expect at a regular appointment. When and what test will be offered or expected of her, and what will likely happen upon her due date. All caregivers have different ways of providing prenatal care. Appointments with midwifes are relaxed because they book appointments that are 30 to 60 minutes long. This allows the woman, her family, and the midwife to establish a trusting and intimate relationship with one another. With this time, the woman and her practitioner come to understand what each others’ roles are at her birth. It is a relationship of comfortable partnership.

Waiting in an obstetrician’s office, in contrast, can be tiring because they regularly run behind schedule by more than an hour. This happens because they book appointments every five minutes. At a family physician’s office, appointments and wait times generally depend on each individual doctor. Some run late and others are on time, but they tend to be less busy than an obstetrician is. Unlike midwives, doctors rely heavily on nurses to do all vitals before the appointments—such as measuring the mom’s blood pressure, testing the woman’s urine sample for proteins and sugar, and weighing-in.

Midwives usually empower a woman to participate in her own assessment of routine prenatal measurements. Some midwives even omit routine assessments of weight, since there is little scientific evidence of its predictive value.1 Midwives also encourage their clients to ask questions and make individualized choices about whether to accept routine tests for blood glucose levels, Group B Strep., and ultrasounds. Doctors, on the other hand, prefer if women accept all tests unquestioningly, even when the testing is unnecessary. For example, a monogamous couple could safely choose to not be tested for syphilis.

As a woman’s due date approaches2, midwives generally do not suggest non-medically indicated labour induction because they believe a baby should come naturally. A doctor, however, may suggest induction at an early prenatal appointment for simple reasons of convenience. The differences in prenatal care between midwives and doctors are just the beginning. The closer a woman is to birthing her baby, the more the differences are apparent.

By the time a woman begins labour, she should have a good idea of what will be the procedure of her birth. Midwives and doctors treat the birth of a child very differently. Midwives often hold the view that birth is natural and little intervention should exist while doctors usually act like pregnancy and birth are medical conditions. They take every precaution to quickly and effectively remove a baby from the mother’s womb. Birth can be a beautiful experience for all in attendance, or it can be a disheartening memory.

A home birth experience with a midwife can be calm and private. Imagine, a mother gently rocks back and forth on her yoga ball to help ease the baby into position. The father is beside her, rubbing her back and whispering sweet encouragement into her ear. The woman’s mother may be cooking lunch in the kitchen, and the midwife is quietly preparing for the baby’s arrival by filling the birth pool and making the bed with a plastic sheet. A woman takes her time labouring and eats lunch with her family. As contractions grow stronger, she immerses herself in the warmth of the birthing pool where she will give birth to her child, and the father will catch his baby. After the birth, the newborn’s siblings hold the infant only minutes after the birth to join in the celebration. It is later, after the mother has nursed her newborn and the umbilical cord has ceased pulsing, that the father is able to cut the cord and take his small infant to rest. The midwife then tends to the mother and stitches her tear, if she has one. The midwife and mother leave the couple alone to sleep together with their newborn. They clean up, and the midwife leaves when she knows everyone is healthy and taken care of.

A birth in the care of a doctor, which can only take place in a hospital, can be very different. A typical birth may unfold like this: a woman goes to the hospital after her water breaks. A nurse escorts her in a wheelchair to the maternity floor. She is asked to change into a hospital gown and a machine is strapped across the woman’s sensitive belly; this monitors her contractions and the baby’s heart rate. After an hour, if she dilated three centimetres and her contractions are less than five minutes apart, the woman goes to a birthing room. At this time, the nurses try to convince her to have an epidural to make her birth bearable. If she has not progressed, then she is sent home, or she labours in the waiting room. Nurses come and go from the birthing room assessing her progress many times during the birth. In my own experience, when the nurse decides that the woman is ten centimeters, she is directed to push only after the doctor arrives. A woman is unlikely to give birth with the same doctor that she had at her prenatal appointments because the hospital only has one or two doctors on call for deliveries. Another stranger, the doctor, comes into the delivery room and assists the woman in ejecting her baby. Obstetricians are not opposed to using metal instruments to extract a baby, and sometimes, a woman’s birth canal is deemed too small to deliver, in which case the woman would have a caesarean. While in recovery, the infant may be given formula and care from the nurses who change shift every eight hours. All night long, the nurses come in and out of the mother’s room, not allowing the mother or newborn to sleep. A mere twenty-four hours later, the mother and baby are discharged from the hospital.3

Helga Himer Photography

Helga Himer Photography

One of the cornerstones of the Canadian model of midwifery4 is continuity in care. Unlike most obstetricians and general practitioners, midwifes care for the expectant mother and fetus from conception, and in some cases preconception, through the entire labour, delivery, and beyond, through the first six weeks postpartum. Throughout the majority of Canadian provinces, midwives also are able to attend their clients in their choice of birth setting. This includes hospital births. They encourage clients to make the environment soothing, and without breeching the protocol of the hospital, they encourage women to labour in different positions, to use birthing balls and stools, and to birth in a tub (when appropriate). Midwives encourage positions that are optimal for delivering and for relieving pain. They help a woman to fulfill her desired birth plan. They will not force or coerce a woman into interventions she does not want. This can be a great option for a couple or family who is uncomfortable with a home birth, but still want the freedom of birthing with a midwife.

The many differences between midwives and doctors affect the mother’s satisfaction with her birthing experience. Although some women and doctors feel this satisfaction is unnecessary, another woman would argue it is essential for her and the relationship with her baby. No matter what choices a mother selects for her maternity care, she has a right to be educated about each procedure and experience, to allow her the freedom and power that comes with making informed choices.

Angela Anderson is a 29-year-old mom. She has a beautiful 3½-year-old daughter and an 18-month old son. She has been married for 4 wonderful years to her Prince Charming. She is a full-time student at Concordia University and will graduate with a BA in Psychology and a minor in Music in May 2012. She loves to sing, and has enjoyed taking private lessons at school. She also enjoys learning about genealogy, and loves to bake bread and sew.

Notes:
1. Dawes MG, Gudzinskas JG., “Repeated measurement of maternal weight during pregnancy. Is this a useful practice?” British Journal of Obstetrics and Gynaecology. vol.  98, no. 2 (1991): 189-194.
2. 70% of first-time, white moms in North America will still be pregnant at the time of their assigned due date, making it particularly relevant to know what your caregivers recommended course of care is if you pass you due date.
3. Childbirth Connection. “Listening to Mothers Surveys” and “Reports I and II.” 2002 and 2006. Childbirth Connection website, accessed October 2011: http://www.childbirthconnection.org/article.asp?ck=10068
4. The 6 basic principles of the Canadian midwifery model of care are continuity of care, caregiver autonomy, choice of birth setting, evidence based care, health and well-being and informed choice.  These are summarized on the Canadian Midwifery Regulators Consortium website, accessed October 2011: http://cmrc-ccosf.ca/node/25
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