If you're having a baby...
I was in on a midwifery visit today with a client during her 6-week postpartum/discharge appointment, and she was talking about how much she appreciated the care, and how surprised she was that most of her friends knew nothing about it, and assumed it was an expensive baby-having route to take. I'm all about information-offering here on Domestic Affair, so let's talk about midwifery, and midwifery in Ontario in particular, shall we?
Please note that as a midwifery student I'm in a bit of a funny position around all this, so please don't hang off every detail here as the absolute truth, know that I'm offering information and my opinions - opinions I have because, well, I'm human, and those of us drawn to this profession are generally pretty fired up about it.
Let's get some of the basics down:
* Most babies through time and all around the globe have been aided into the world with the help of midwives. Most of them have also been born out of hospital.
* It is also true that most people through time and all around the globe have not had indoor plumbing, but I personally am grateful for hot and cold running water and flush toilets every single day. What I mean to say is, while the way it's always been done is not always the best way, seeing the larger picture can help to give us some perspective. To be even clearer: I am concerned by the path obstetrics is taking with all its interventions, but I do not have a hate-on for obstetricians, nor do I look down on hospital birth - let's just get that one straight from the get go. I simply and strongly support the popularization of midwifery care.
Midwives in Ontario are registered health care professionals. They offer primary care to women throughout their pregnancies, births and during the first 6 weeks postpartum. Their services are covered by the provicial government whether you have OHIP or not (you just need an address). In the past century, obstetricians have become the more popular primary birth attendants in the Western world for a number of reasons (many of them political), though with the resurgence of midwifery across Canada since the early 1990s, midwives are now attending about 8% of all births in the province (and that number is growing!).
Let's compare and contrast a bit, here:
* Midwives are experts in normal pregnancy and birth. They are well trained to identify risks and change plans, consult or transfer care as needed.
* Obstetricians are highly trained to deal with pregnancy- and birth-related risks.
* Midwives work within a framework of Informed Choice - they tell you about your options at every stage and help you choose what's best for you.
* Obstetricians work within a framework of pressumed consent, meaning, when you walk in the door of their office (or hospital) it is assumed that you will be their patient, and assumed that you will go with what they believe is best - with or without sharing information with you.
* Midwives can catch babies at your home or in a hospital where they have privileges.
* Obstetricians can catch or deliver your baby in a hospital where they have privileges.
* Midwives are on-call and work in small teams of 2-4 to ensure that you have practitioners you know at your birth. They will come visit you at home on days 1, 3 and 5 postpartum (and call you on the days in between) to provide support.
* You may never see your obstetrician after they get your baby out.
* are a well woman
* have a healthy, normal, low-risk pregnancy
* appreciate having longer visits with a health care provider (30-60 minutes vs. 5-10 minutes)
* want to be an active participant in the choices you make around your health care in the childbearing year
* want the option to birth at home
* want postpartum support (checking vitals, breastfeeding help, etc) at home in the first week of your baby's life
... then I's say midwifery care is the way you'd want to go.
* have a high risk pregnancy
* are determined to have a birth with interventions (epidural, elective C-section)
* don't want to have to make decisions regarding your health care
* are tight on cash and living somewhere (like, not Ontario) where midwifery services are not covered but doctor's services are
... then obstetrical care is likely the best route for you.
This little rant is really just a starting point, but I hope that we get to a place in time in North America where midwifery care is the default antenatal and postpartum care again (the way it is in much of Europe, for example). Please pass this post, and/or any of the following resources on to anyone you know who might be interested or misinformed.
* College of Midwives of Ontario website
* Association of Ontario Midwives website
* Canadian Association of Midwives website
* The Business of Being Born (documentary)
* Mothers of Change website
* Reconceiving Midwifery
* The Thinking Woman's Guide to a Better Birth
* Ina May's Guide to Childbirth
* Spiritual Midwifery
* Push!: The Struggle for Midwifery in Ontario
* Birth By Design: Pregnancy, Maternity Care and Midwifery in North America and Europe
* Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives