In British Columbia, midwifery is a publicly-funded practice, so women with uncomplicated (low-risk) pregnancies have the choice of receiving their pre and post-natal care from either a midwife or an obstetrician. Both options are covered by the provincial Medical Services Plan at no cost to the patient, and most registered midwives have privileges at one or more hospitals.
Since 1998, all midwives in BC must be registered with the British Columbia College of Midwives, which entails the completion of a four-year university degree program in midwifery or an approved equivalent. They have the ability to provide routine pre and post-natal care, and in the event of any issues outside of their scope of practice, can temporarily or permanently transfer all or a portion of the woman’s care into the hands of an obstetrician or other specialist.
We felt that there were several advantages to using a midwife. For a woman who opts to see an obstetrician, unless there are early pregnancy complications, specialized prenatal care does not begin until the fifth month of the pregnancy. Instead, the woman sees her family doctor as the primary caregiver until week 20. This late start can make it difficult for a woman to establish a good rapport with the OB. Prenatal appointments with a midwife begin immediately. In my case in particular, I did not have a family doctor at the time I discovered I was pregnant (an unfortunately common situation), and I did not feel comfortable having my initial prenatal care cobbled together by a walk-in practice.
Obstetric appointments are typically about fifteen minutes in duration, which doesn’t leave much time for anything other than routine diagnostics and perhaps a brief discussion of any points of concern. Our midwife appointments are 45 minutes long, and include discussions on nutrition and exercise, the emotional aspects of pregnancy (for both of us), options for birth, and any topics or concerns we wish to have addressed. We never feel rushed and always feel listened to. The clinic also has a lending library with informative books and DVDs that we can borrow free of charge.
Although we have ultimately chosen not to pursue a home birth, using a midwife left this option open for us so that we could do so if we felt comfortable. Obstetricians will not attend home births.
Our midwifery practice consists of three midwives who rotate being on 24-hour call. This means that if we have any urgent concerns at any time, we can receive advice and/or care from our midwives, and potentially avoid an unnecessary trip to the emergency room. This also means that when I go into labour, the on-call midwife will come to our home to assess my progress, so we don’t end up going to the hospital too early and then being sent home to wait.
Having a practice of three midwives (we visit with each one on a rotating basis) also means that unless extenuating circumstances arise, we will have somebody we know and trust attend our birth. The midwife will be present through the entire process; not just the delivery itself. There is no guarantee that a woman’s obstetrician will be the one on call at the time of birth, and obstetricians only poke their heads into the room to check in periodically until the big moment. The extended level of birth support and consistency of care offered by midwifery has been proven in studies to greatly reduce the risk of medical interventions such as emergency caesarian sections and forceps use.
After birth, our first two weeks of post-natal care with the midwife will take place in our home, which is virtually unheard of in conventional medicine these days. The visits will not just be for the purpose of weighing and measuring the baby, but also to assist with breastfeeding, infant care (bathing, diapering, etc.), and any other concerns I might have as a new mother.
Finally, I really enjoy the open-minded and holistic approach that midwives take towards pregnancy and childbirth. Midwives do not treat pregnancy and childbirth like a medical condition; rather, it is considered a normal, healthy and exciting part of a woman’s life. Our visits and interactions are relaxed and informal, but still very professional. They provide us with unbiased information and encourage us to make our own educated decisions. We do not get pressured into taking any diagnostic tests that we wish to decline, and they have a mandate to support any choices we make insofar as they are safe and healthy for both me and the baby. They are also open to the involvement of family members and other birth professionals, such as doulas.
Thus far, we have been extremely pleased with our decision to choose a midwife for my pre and post-natal care, and I feel confident that I am being well looked after.