LONG LIVE THE MIDWIFE
Once you become pregnant, you will initially be under the care of your family doctor. If you have certain risk factors, you will likely be referred to an obstetrician, or a doctor who specializes in pregnancy and deliveries. If not, you may have the option of applying for midwifery care which typically involves full pregnancy care through to six weeks after the birth. Regardless of where you plan on giving birth, you should take care to choose a care provider that you trust and are comfortable with. Make sure to approach them with any questions early on to ensure that your wishes, values, boundaries and preferences will be respected. The approach to birth care and the quality of care can make or break the birth experience.
A midwife’s training is extensive and comparable to that of a doctor. A midwife specializes in what is termed low-risk birth, which is the most typical type of birth. An obstetrician is a trained surgeon and specializes in high-risk or pathologized birth. As such, midwives are extremely thorough in their risk assessment because they want to minimize the chances of an emergency scenario just as much as you do. In some cases, a midwife and doctor will work in conjunction to give the mother her preference of having a midwife while managing risk factors by having a doctor on call.
In my experience, midwives consult with parents more often than doctors. They present options and promote choice. They guide you as needed and voice strong recommendations when there is reason for it, but they make it clear that ultimate decisions rest with you. By contrast, doctors more often follow a standard protocol and can be a bit more pushy or coercive, often unintentionally, when it comes to treatment for labouring mothers and new babies. You still have the power to self-advocate and make requests, but you may need to educate yourself on the protocol ahead of time, so you know what you want and don’t want. For example, there is an antibiotic eye ointment for newborns that is still routinely given in some hospitals, even though the risk of bacterial eye infections is extremely low in babies whose mothers do not have untreated sexually transmitted infections at the time of vaginal birth. This eye ointment may seem harmless to some, while others would prefer that their newborn baby’s eyesight not be unnecessarily impeded at a time when they are first visually familiarizing with their caretakers. Other preferences to consider immediately following birth include: the injection to help the delivery of the placenta, delayed cord clamping, the Vitamin K shot, the Hepatitis B shot (if applicable), use of cloth diapers, delaying the first bath, outside breastfeeding support and circumcision. Though these are all technically optional, hospital workers tend to follow a cookie-cutter practice with every patient, often operating with your assumed consent unless you speak up and say otherwise. Numerous mothers I have spoken with report being uninformed about or heavily pressured into some of these procedures. If you highly value consultation, choice and consent, a midwife may be a more suitable choice for your pregnancy, labour and birth care.
Under the care of a midwife, you have the option of delivering at home, at a birth centre or in a hospital. A midwife will never keep you from being in a hospital or from using medication or interventions of your choosing. Midwives are more flexible and adaptable. They can set up a workstation right in your bedroom or kitchen without missing a beat. In addition, they often develop a more personal relationship with their clients, which can help you feel more comfortable when you are in what will likely be the most vulnerable state you’ll ever be in. Midwives keep tabs on the baby with minimal disruption to the mama. It’s a cohesive system established between the baby, the mother and the care team with the mother at the helm. Midwives take a lot less credit for their role in your birth than delivery doctors do; the birth mother delivers the baby – the midwife just “catches” the baby, if needed. Of course, their role goes far beyond that, but their position is much more about accommodation and less about interference with the process.
Where midwives really shine is after the birth. They will honour and enforce things like delayed clamping of the umbilical cord and observing the “golden hour”, which is the minimum 60 minutes of skin-to-skin baby and mom bonding time immediately following the birth. They usually weigh the baby in a cozy cloth sling, which I’m sure all babies prefer to a metal weigh scale. In my experience, they also help clean up after a home birth. Before leaving my home, my midwives drained our birth pool, put the laundry in the wash and took out the trash. As an added bonus, in most cases your midwife will come to your home for the first few newborn checkups.