Monday, May 10, 2010

The Midwifery Choice

Lately, I have received a number of e-mails from fellow bloggers inquiring about my choice to have a midwife for my pregnancy, labour, and postpartum care. Because of these e-mails, I decided that it might be helpful for me to write a post explaining exactly why I considered it important and valuable to have a midwife care for me during this season in my life. If you are pregnant, ever have been pregnant, or might someday be pregnant, you may find this post interesting. If you are not interested in midwifery care, feel free to skip!

Also, I know that midwifery care differs somewhat depending on your location so this post is based solely on my experience having a midwife in Ontario. Therefore, all the info might not pertain to your particular location or situation.

Essentially, in choosing to have a midwife for my pregnancy/birth/PP care, I have chosen to have her as my sole care provider. My midwife (or midwives, rather) are the only care providers I will see throughout the course of my pregnancy, during my delivery, and for 6 weeks postpartum, unless there are any situations that arise that require the consultation or transfer of care to an OB or other specialist. I no longer see my family doctor for care regarding my pregnancy. If I have other, non-pregnancy related concerns, I would continue to take them to my family doctor.

I chose a midwife primarily because it is my goal to have a natural birth without any medical interventions. I know that this may not be possible, and of course, my baby's safety will be the ultimate concern, but that is my goal and so I felt that it was important to have a care provider who would support, encourage, and help me plan and prepare based on that decision. I know it's definitely possible to have a natural birth with a doctor, but in most cases, the doctor only comes in during the last bit of your labor, and so most of the time you are being assisted by nurses. You can't for see or plan who you will have ahead of time or how they will react to your decision. Since my midwife will be my sole care provider throughout the entire pregnancy and labour (and will stay with me the entire time) I feel that she will be a great help because I will have her there to help me prepare and to encourage me and remind me of my goals. She will know well in advance of the time that I go into labour what my desires are and will be able to assist me in that regard.

There are three major aspects of midwifery care that I find very appealing and are what drew me to it.

1. Viewing pregnancy, labour, and childbirth as a normal thing. In a book that I am currently reading, "Birthing From Within" the authors make a statement about the philosophical assumptions of their writing that really sums up this belief. They suggest that "childbirth is a profound rite of passage, not a medical event (even when medical care is part of the birth)". That type of attitude and philosophy is one that resonates with my personal beliefs about birth. Having a care provider who respects and holds those beliefs as well is very important to me. That being said, while my midwives view birth as a natural, normal process, they also understand that there are times when emergencies and difficult situations arise and medical interventions are necessary to ensure the health of the mother and the baby. They are well trained to deal with many of these situations and I am confident that my midwife would never ever withhold medical care or hesitate to transfer me to an OB or other specialist if a need for care she cannot provide arises.

2. Personal, patient-centered and patient-led approach to care. Midwife appointments are longer and more personal than what you may receive from a doctor. At each appointment, I am always scheduled 30-45 minutes so I have lots of time with them. Also, the clinic that I am in care with works on a team based approach. I am assigned to a team of three midwives, who I will meet with over the course of my pregnancy (so far I have met 2 of 3). At any given time, one midwife from each team is on call for labours and other emergencies. By using this approach, the chance of me having to wait a long time for a scheduled appointment or for me having to see a different midwife than one I am familiar with is eliminated. One of my midwives will be in the clinic for each appointment that I schedule. Further, this approach ensures that when I go into labor I will be assisted by one of my three midwives. Having the reassurance that the care provider who will assist me in labour will be someone who knows me is very desirable to me.

They also approach care in a very patient centered way. As I mentioned before, there is not a huge focus on the medicalization of pregnancy unless it is necessary (hello! The clinic looks like a spa - not hospital gowns or stirrups in sight!) and they work under the assumption that an expectant mother often knows what is best for her and her baby. Therefore, as an expectant mother, I can be confident in the fact that I will be thoroughly involved in all decisions regarding the care of myself and my baby. They are open to a variety of options and are highly supportive of both home and hospital births.

Also, the midwives I see aren't overly concerned with specific details such as weight gain. This has been a tremendously positive aspect of care for me. When I was still seeing my family doctor, the prenatal nurse placed a huge emphasis on the number of pounds gained/lost. Since I was very sick at the beginning of my pregnancy, I lost a significant amount of weight. I got to the point where I started to feel guilty about this and worried about putting my unborn baby at a disadvantage. My midwives have eased these concerns and have helped me readjust my attitude to be focused on healthy eating and healthy living rather than focusing specifically on the number of pounds I gain or do not gain. This attitude works really well for me. In fact, they don't even weigh me at my appointments, but offer a scale in the washroom so I can keep track of my own weight on an accurate scale on a month by month basis. Unless they see a problem (i.e. gaining way too much, or way too little) they are more concerned with ensuring that I am healthy.

3. Postpartum care. Lastly, I chose a midwife because of the level of postpartum care I will receive. The on-call midwife from my team will come to my house when I go into labor and monitor me at home until it's time to progress to the hospital (or help continue labour at home if a home birth is planned) that way I will be able to labour at home as long as possible and don't have to worry about showing up at the hospital way to early. She will then accompany me to the hospital and remain with me throughout active labour and delivery. Then, when I am discharged she will come to my house within 24 hours, 2 days, 5 days and 7 days to check on us. Also, there is a 24 paging service so if anything happens, she will come more often. A friend of a friend had her midwife from this same clinic come every day for the first 2 weeks because she was having difficulty breast feeding. Then, I will go to the clinic at 2 weeks, 4 weeks and 6 weeks where she will check up on both baby and myself. After 6 weeks, I will go back to my regular doctor and resume care there.

Perhaps I should have broken this post up into a three part series, it ended up becoming quite a bit longer than I had anticipated but I hope that if midwifery care is something you are interested in, you may have found something in this post that was somewhat helpful or interesting. I am by no means an expert, as I am pretty new to all of this myself, but I would be happy to (try to) answer any questions you have.

These are some of the main reasons that I found midwifery care to be appealing to me. I am not saying that this is the right choice for everyone or that midwives are better than obstetricians or other doctors. I am also not saying that the choices I have made and the viewpoints I have will be right for everyone. Simply, the care that is provided by midwives seems to align more closely with my personal beliefs and so I was most comfortable going this route for my pregnancy and birth.


SnoWhite {Finding Joy in My Kitchen} said...

Thanks for sharing, my friend. This is very helpful and informative :)

Land of Blissful Chaos said...

I think having a midwife is a wonderful idea!

Holly said...

You've made a good, well thought out choice! It's so nice that you have this option, too. I had to kind of go "underground" to get my midwife.

Gina said...

I pretty much think my OB walks on water. But if I didn't, I would absolutely choose a midwife. I feel so much more comfortable advocating for myself this pregnancy regarding natural childbirth and I am so lucky that my doc backs me up on that. I think this post is great and so informative. Good for you! :)

Jackie said...

Sounds like your choice is very well researched and you are most comfortable with your decision, which is the most important. I am excited you have chosen to attempt the delivery with no pain medications. It can be done w/o an epidural! :)

Kristen said...

hmm, very good information! Not that I am pregnant or married but I do like reading stuff like this :) I hope all is well and forgive me for being a neglectful blogging friend!

KatiePerk said...

Very interesting post. I think the team aspect of the midwives at your clinic makes a lot of sense!
Thanks for sharing this info!

Brittany Ann said...

I use a nurse-midwife for all my GYN concerns now and will most definitely use one for my OB needs when necessary. It's much more comfortable for me. When I was working in health journalism, I covered women's health, and I became all too familiar with the harms of medicalizing birth. It's not for me. I can be extreme about this topic, I know, but I'm 100-percent in support of the midwifery model for all women's care, and I think many women would be surprised how comprehensive and wonderful it really is! I've been nothing but pleased!

Annie said...

i have been thinking more and more about a midwife. i'm learning through blogs. i had never even heard of one before.
i hope you had a wonderful mother's day, beautiful momma to be!! :)

Birdie Woods said...

Hey! Just wanted to let you know that I've awarded you "The Sunshine Award" =) Go to my blog to check it out!

Jaclyn_Rose said...

That's a great explanation!

I'm from BC, so we don't have OBs, I never really looked into a midwife because I found one clinic that had managed to just to pregnancy related care (even though they technically can't specialize in that one area)... but you're right, I only saw my doctor for the 3 contractions that I pushed for, and for him to sew me up after... luckily we lucked out with a GREAT nurse!

I might have to look into a midwife for next time :)

Anonymous said...

I love midwives! I'm in Ontario as well, and have had midwives for all five of my children's births.