Monday October 6, 2008
Guess Who's At the Delivery?
This week, our show is about the well-established pattern whereby you see a physician or an OBGYN for prenatal care and a perfect stranger does the delivery.
This is probably the 3rd or 4th most common complaint I hear from people at cocktail parties (after "I had to wait in emerg for 27 gazillion hours" or "I can't find a family doc" or "Let me tell you about a doctor who really screwed up the diagnosis of my ______________ (father, mother, brother, you fill in the blanks)."
I get buttonholed regularly by women who are ticked off their OB or FP wasn't there for the delivery. We got a lot of feedback from women who say they switched to a midwife and said the delivery went way better.
Fair enough. But don't think that choosing a midwife means they'll be there for the delivery. People do have to sleep, you know. In the interests of impartiality, Anita van Polen of London, Ontario writes:
"My midwife was not present for my child's birth - it was her weekend off! The issue of not having the person you saw during the course of your pregnancy present at your delivery does not only happen with obstetricians!
I do have to qualify that, though, by saying the level of care I recieved from my midwife pre and post-birth far exceeded that which I recieved from my OB/GYN (for the birth of my first child). I would highly recommend using a midwife for those with low-risk pregnancies."
You can all go back to sleep now! z-z-z-z-z-z-z-z-z-z-z-z-z-z-z
Previous Comments (17)
Thank-you for recognizing midwives for their quality and continuity of care for low-risk women. It seems that North American culture is so caught up in in the overuse technology and this shows when women are using OBs for low-risk pregnancies and births. Research and experience shows that midwifery care is best suited for low-risk women and that midwives play a key role in reducing the skyrocketing c-section rates. And, as your midwife guest on the show shared, midwifery groups have the ability to ensure that you will know the person involved in one of the most intimate experiences of your life.Kay Gees, October 6, 2008 1:32 PM
I had a home birth with my son attended by my husband, two midwives and a doula. My prenatal care was provided by two midwives whom I met thoughout my pregnancy. One of them was always available should I need them throughout my pregnancy and for the delivery.
The delivery was an awesome experience that I would not have wanted with a complete stranger, which is what I likely would have had if I had my prenatal care with an OBGYN. MIDWIVES ARE AWESOME!!!!!Tara Forshaw, October 6, 2008 2:03 PM
One of the major issues around accessing a midwife seems to be that OBGYNs control hospital access in too many communities. The OBGYNs refuse hospital privileges to midwives, limiting the ability of midwives to do hospital deliveries. Home births are great for low-risk pregnancies, but for a midwife to run a practice they require access to the medical system's facilities. OBGYNs shouldn't be the ones deciding who has hospital privileges.Chris Bodnar, October 6, 2008 2:51 PM
I had a 5 day labour and was passed to over 8 physicians. At every hand over it was like calling the bank and having to start my story at the beginning. No one physician was able - either due to time constraints or workload - or willing to see me through my long and demanding labour. As it was my first pregnancy I was not confident that my labour was abnormal and kept relatively quiet.
At the end of day five I was induced and given an epidural - I was suffering exhaustion, as was my baby. The result was meconium aspiration and near death for my daughter. She spent 18 hours fighting for her life. Thankfully she survived, but had one physician tracked my progress I would have had an emergency c-section much earlier in the labour and such trauma would have been avoided.Anne Smithers, October 6, 2008 3:04 PM
I was pretty shocked at the offhand way the two OBs you interviewed said they would induce labour to tip the odds of a woman delivering during their call schedules. Do they also warn these clients about the increased risks of induction, which include increases in epidural and narcotic use during labour as well as higher caesarean rates? Even something as seemingly innocuous as stripping membranes carries an increased risk of infection and of premature rupture of membranes (which in turn carries its own risks). While it is certainly of benefit to see a familiar face at the foot of the labour bed, the midwifery model of ensuring this by having small call groups in which practitioners share prenatal care, seems eminently preferable to medical meddling with the timing of labour.Jennifer Landels, October 6, 2008 3:09 PM
. It is unrealistic for women to demand that their doctor be always present for the birth. The important issue is the qualifications of the provider. With current health care problems we can't make petty demands. If your child was bleeding to death do you insist on caregivers that you know personally. We don't have the funding for doctors to sit around ignoring other patients in case you need them.
Midwives can dedicate all of their time to deliveries, etc. Family doctors and ob/gyn's have much more on their plate. Also we must look at remuneration. There is a discrepancy in pay between caregivers. Midwives are much more expensive than family physicians. I expect that the ob/gyn is most expensive but I don't know for sure. Most doctors prefer not to deliver babies during office hours because they have to walk away from other patients. This means a loss of income as well. Middle of the night is tough because of exhaustion. Weekends and evenings are best for the doctor's convenience. Doctor's are expected to be available to help the midwife if she gets in trouble.
I have had 3 babies, all delivered by physicians. My daughter was delivered by my husband in an emergency situation. I had positive experiences all around. Some of the anecdotes leave me shaking my head. One woman refused to lose dangerous weight so she went to a midwife for a V back. Both were very lucky to enjoy a good outcome in this situation. I'm surprised and disturbed that the midwife agreed to take her on. It's amazing how many people choose to take risks and then want the doctor to bail them out. ie. smokers, morbidly obese,Lynn, October 6, 2008 3:29 PM
I am a registered midwife in Ontario, and was pleased to hear your show about who will be in the delivery room. i just want to add that midwives are legislated in most of the provinces and territorieas in Canada. In Ontario, Quebec, British Colombia, manitoba, North West Territories,Nunavut,Saskatchewan midwifey is funded by the government and there is no cost to women to use the service. Midwives ofer women continuity of care as discussed in your program, other tenants central to midwifery care include informed choice, choice of birth place, and the belief that pregnancy is a healthy normal process and profound transition in a woman's life. Thanks again, just thought I would offer some more information for women interested in midwifery.Erin Croteau, October 6, 2008 5:12 PM
Women want to know for sure that they can count on someone KNOWN to them to support them in birth: enter, the DOULA. Doulas (or professional labour support people) offer continuous emotional, physical and educational support to women and their partners. According to research births with Doulas have been shown to be shorter, require fewer interventions and lead to fewer cesarean deliveries. We know this works, so why don't we work toward providing more of this kind of support? I think the impact Doulas could have on our health care system would be significant. It is time to go low-tech, high touch!Jill Simon-Sinclair, October 6, 2008 7:36 PM
My wife gave birth with her MD. It was planned as an induction and we felt very reassured with our own OB doing the delivery.
I was interested to hear that OB were being offered gifts and possibly monetary inducements to deliver. I wondered if this was legal in our system? Also, the show did not address how much does a doctor get paid for a routine birth. I would have been interested to hear how much OHIP paid for the service as well as how much a midwife bills OHIP. Personally, I would never trust a midwife with a delivery, much less a quack like a "doula". Good god, what the heck is a "doula" and what business do they have in the medical community?I'll stick with the MD thankyou.B.C. Kantor, October 9, 2008 9:31 AM
It was great to see a perspective on life within the L&D ward, and the balance that doctors attempt to strike in handling a busy caseload. Just a note on a previous poster's mention of risk; like doctors, midwives are well-educated on risk factors and may vary in terms of what risk they feel comfortable taking on with a client. For each client, it's based on evidence-based care as relating to her situation. Certainly, for any caregiver to recommend that a woman lose weight during pregnancy could result in lifelong health implications for the fetus.
Not many know exactly how highly-trained midwives are. Their four-year professional degree includes anatomy and physiology (depending on the school, often alongside medical students), reproductive physiology, pharmacology, nutrition, and often genetics, epidemiology, and research methods (for a start). They have several years of clinical placements both in midwifery clinics and with family physicians, obstetricians and pediatricians. Midwives can order all the tests and prenatal screening (if desired) that one would with a family physician, can prescribe a limited number of drugs and can admit clients to hospital or assist them in delivering at home. They do home visits the week following the birth and follow each mother-child dyad until six weeks postpartum.
I had wonderful support with my midwives and would wholeheartedly recommend their care to anyone starting a family.Monique, October 9, 2008 12:10 PM
I too fully support the midwifery model. I have three children, the first born in a hospital and the other two born at home with the care of midwives.
The midwives unquestionably delivered better care than the hospital did. They spent a lot more time at each prenatal appointment examining me, answering questions, and explaining my choices at various points along the way. When the big day came, they not only helped me physically and emotionally through the labour, but were wonderful coaches for my husband, who was supportive but didn't necessarily know how he could best help me.
With my second and third births, having my baby at home meant my older children could relax and play at home under the care of older relatives, and pop in to the "delivery" room (our bedroom) every so often to see how things were going. They never felt excluded from the process of welcoming their new sibling into the world.
The midwives never insisted that I lay on my back in the bed (the most uncomfortable labour position ever invented), except for a necessary internal exam. I was free to move about, take a shower, walk up and down the hallway, and finally deliver my baby in any position I chose (on the bed on my hands and knees, with a birthing ball for support, as it turned out).
The fact that I knew and trusted my caregivers removed a level of stress from the birthing experience, making it that much less frightening. If more women had this level of care, I am positive that there would be fewer interventions. And it has been shown that once a woman has one intervention, the likelihood of further, more serious interventions goes up.
Midwives are for low-risk, normal births. Obstetricians should be called in when the pregnancy is high-risk, or during labour when things are not going normally. This is when their expertise can be best used.
I hope that one day, every normal, low-risk pregnant woman will have a midwife to help her through one of the most important times of her life.Alexis, October 11, 2008 5:29 PM
Love your show. The topics are relevant, and all views are represented.
I was a registered midwife in Ontario until 2004 and I have to say that my practice, and others that I knew, struggled with fatigue and practicing safely for many years. It was an issue that concerned me greatly and I found my concerns fell on deaf ears for the most part. Within my practice, we, my partners and I, decided to do what we could to reduce our on call hours while maintaining continuity with the clients. (Continuity of Care, meaning no more than 4 midwives involved in a woman's care, was a college standard in Ontario while I was practicing). we developed several different call schedules in an attempt to solve this problem. Our first few attemtps with a call schedule were successful at maintaining the continuity piece but did not sufficiently deal with the fatigue. The last call schedule, which was a 24 hour on call system, worked better at reducing fatigue but about 40% of our clients had met more than 4 midwives during the course of their care and resulted in our practicing outside our college standards. We found that many of our clients were happy to meet several midwives through the course of their care in order to have a familiar face at their delivery. Of course some were not so happy and felt that they had met too many midwives. A small number wanted "their midwife" which we could not guarantee and they typically went to a different practice where they were guranteed the involvement of no more than 2 midwives. I'm not sure that midwives have the call thing "in the bag" yet but I am very happy that there now seems to be dialogue regarding this very challenging issue.Andrea Patchett, October 11, 2008 5:49 PM
Hello and Thanks for your great show. I caught only the tail end but wanted to add my thoughts. Continuity of care throughout a pregnancy, birth and post-partum can be provided by a Doula or Birth Assistant. I have been doing this for over 10 years, helping women and families make informed choices that best suit them for there birth experience. In hospitals, birth clinics or homes, Dr's or Midwives, drugs or no drugs. How ever the experience goes a Doula or Birth Asssistant is there for the women and her family and all there questions. We do not preform any medical tasks and may not always know the answers but we are always there to help you find them. Do it with a Doula!Amanda Williams (Doula), October 12, 2008 3:48 PM
Hello, I belive that the most important person delivering, birthing a child is the other person involved in the unity that created the life. When a father can be present to connect and support the mother I think it is ideal. If not dad some dear and loving family member or friend could be great emotional support. The more support the better. Humans have been giving birth without doctor's for HOW LONG??
My wife worked so dilegently during her pregnancy to eat healthy, stay amazingly fit and limber. She had no issues during pregnancy, not even morning sickness. So we were confident. We were blessed to be able to birth our first child alone. We had midwife support we just didn't call for help, it was amazing.
I belive birth can be one of the best experiences a father can have.
I'm not certain whether Dr. Goldman made it clear how midwives are compensated, whether by government insurance or by private payment. I would think that if they are compensated differently, this could account for differences in service. As Dr. Marshall Barkin pointed out, once he was no longer able to charge patients a premium for extra services and was limited to government payments, he felt the financial need to take on more patients and be less available for deliveries. Are midwives able to charge privately? Please clarify.Valerie Lawson, October 20, 2008 12:27 PM
Provinces that have licensed midwives pay them either a salary or a set fee per course of care. As with physicians, extra-billing violates the Canada Health Act and is thus prohibited.Brian Goldman, October 20, 2008 12:44 PM
A midwife caught my first daughter at a hospital and it was the best experience I have ever had. Now I am pregnant with my second daughter and I am really looking forward to doing it this way again. I think because of the care provided by the midwife team throughout the pregnancy made my labour and delivery a very pleasant experience. My appointments lasted almost an hour each time and when it came time for labour they were available by phone/pager to answer all of my questions. The labour midwife came to my house to assist with the labour and at my call we headed out together to the hospital. My hospital stay was minimal because I had that care. Once at the hospital the midwife stayed with me and my husband in the delivery room. When I was ready to push the delivery midwife showed up and caught my daughter. She then stayed with me for the full four hours before I was discharged to a recovery room. The next morning I went home and later that afternoon the midwife came to the house again to see how we were all doing. All of the visits for the first two weeks after delivery the midwife came to the house so we didn't have to bring a newborn out to a clinic in the middle of the winter. My husband was also very pleased with the service because they made him feel very comfortable with the whole process. He never missed an appointment!! I hope that more women choose this route so that more doctors can go back to the practice of catching babies instead of just doing all the other stuff!!Natasha, October 27, 2008 3:45 PM