Nelson Dream Team Mailbag

This week's show highlighted the role of midwives in the delivery of maternal care in Nelson, BC.  It also took focused on the high degree of cooperation between midwives, family doctors and obstetricians in a small city in the interior of British Columbia.  For me, the show had many things to talk about.  First off, instead of interviewing guests in a studio, I got to travel to Nelson to witness midwife Ilene Bell and obstetrician Dr. Raz Moola in action at Kootenay Lake Hospital.  I had the time to put together the photo album that adorns our web site and that has proven so popular on our Facebook page.  I got to speak to Tanya Williams during her labor and after the delivery of baby Cash.  After hearing the program, many of you had things you wanted to say.

Not surprisingly, many of you wanted to share your own experiences in childbirth. 

Amanda Rutherford of Wardsville, Ontario sent us this: "I just wanted to thank you so much for this program! It shows that doctors can work and trust midwives. I personally used a midwife for both of my pregnancies and had successful deliveries. My first was a little complicated.  My womb muscles were not contracting strongly enough to turn my son and my midwife wanted to induce me.  But to be able to give me an induction by IV, she had to transfer my care to the obstetrician on call. The obstetrician waited two or three hours later to order an induction.  I sensed that this was because the obstetrician did not want to work with a midwife.  It is sad that they feel this way since midwives are very competent and know what they are doing.  I trusted all the midwives I came into contact with during both of my pregnancies. Thankfully, after the induction, about nine hours later I had a beautiful healthy little boy with no further complications. I really hope in the future obstetricians, physicians and midwives with see the benefits of midwifery."

Beth Close of Brentwood Bay, BC sent us this:  "My husband and I moved from Alberta to BC because the BC medical plan covers midwives while in Alberta you have to pay thousands of dollars for their services.  I believe in the philosophy that pregnancy is not a medical condition.  Women have been doing it since the dawn of mankind and it makes sense to be supported by women who have knowledge of pregnancy and labor.  When I got pregnant everything was fine and things looked good.  At thirty weeks, my membranes ruptured but I did not realize it.  When I went for my midwife appointment they tested the fluid and told me my membranes had ruptured and I had to go to the hospital.  I had wanted a home birth but obviously that was out of the question at that point.  My son was born at thirty-one weeks and four days.  My midwife was not there but had arranged for a GP to deliver the baby.  She was great and everything went well.  My son was small but perfectly healthy. He was in the NICU for three weeks and got very good care.  All the nurses were amazing.  At thirteen months, my son is healthy and meeting all his milestones."

Debbie Baker of Brampton, Ontario writes:  "I listened to your program and was happily reminded of the successfully planned home birth of my son in March 1990. I had wanted as "natural" a birth as possible (in the hospital) with my first child in 1986, but the doctor who came in place of my own, insisted on using the "technology", the use of which caused me to have a herniated disc.  The pain made breast-feeding difficult and hindered my bonding with my daughter.  The surgery reduced the pain enough allow me to enjoy being a mother and wife.  But even now, twenty-five years later, my back bothers me.  I am sure the back-herniation would have been prevented if the doctor had been more attentive to me, instead of relying on the machines.  When I became pregnant again, I sought other options and was fortunate for my friends in La Leche League.  They recommended a midwife.  My son Matthew was born at home, as planned, with my husband participating.  I am grateful for my midwife's experience and compassion.  I am also grateful to my family doctor for encouraging me to make my choice.  Pregnancy and child-birth are not "illnesses", but natural events in life and should be treated as such."

Mavis Close of Penticton, BC writes:  "Congratulations to the Dr. Raz Moola and to midwife Ilene Bell on their cooperative care for their patients in Nelson.  What a fantastic refreshing interview thank you.  I am now a senior and was fortunate to deliver my three sons in England where home delivery was common and c-sections rare.  I needed a c-section for my first son (1963) in a hospital after a disappointing long labor at home.  Contrary to what North American women believe, I did not need a c-section with my second son or for my third son.  I learned that depended on the reason for the c-section in the first place.  Nelson sounds like a terrific place to live and have babies, very progressive in caring medicine and allowing women choices instead of the more common factory belt "we know best" approach."

Many of you were as affected by the birth on the program as was I. 

Christine Davis of Toronto writes:  "I enjoy your show tremendously every week.  I cried when baby Cash was born.  It's so inspiring to see Dr. Raz and Ilene Bell working together.  They are a great team and have a lot to teach the rest of us in both life and work.  Hats off to Dr. Brian Goldman for bringing so many issues about our health care system in Canada to our attention.  Keep up the great work!"

One of my long-time email correspondents Tom Anderson sent this email:

"Funny, I used to think of Nelson as a big city.  My youngest daughter was born in a lakeside cabin on Vancouver Island during a snowstorm.  The fire kept going out in the fireplace, other than that we had no problems."

"My wife was busy fixing breakfast when one of our daughters was born.  The contractions didn't seem to be bothering her much, but at some point she apparently felt some activity under her apron and decided maybe she should lie down or something.  Her pants were only half off when the baby literally jumped into my hands -- still in the "bag of waters" which immediately fell apart in a big splash.  I exclaimed, "It's a girl" and we both started laughing and crying all over the place.  I suppose I should mention that this occurred in a small cabin atop a 6000 foot mountain with no running water or other conveniences.  Yet everything went beautifully.  It was the happiest moment of our lives."

Nelson may be located in BC, but the way care is organized there may be the exception rather than the rule.  Dr. Jennifer Grant of Vancouver writes: 

"Thank you for an intelligent and interesting discussion of the roles of various providers in childbirth. I appreciated hearing your perspective on the matter. Certainly part of the discussion rang true to my experience, however I feel that you missed some important points."

"I have had two children - one with midwives and one with obstetricians - and the difference was night and day.  My experience with midwives was one of consultation. I was in the driver's seat; all decisions were informed and ultimately made by me.  Time was taken to assure that I understood what was being said and that I was willing to proceed with any action proposed.  This was an empowering experience and one that partially redeemed my previous experience with obstetricians, which was fragmented.  I was passed from person to person.  Decisions were rarely (if ever) discussed with me.  Interventions were pushed without discussion of the consequences and my expressed desire for a vaginal birth was ignored.  Indeed a c-section was counseled without considering all options and without offering time for discussion.  It was only in a retrospective review of my chart that it became obvious that a vaginal birth while not likely was still possible (without undue risk to me or baby)."

"This is part of a broader trend.  Matched women (on an intention to treat analysis) who are attended by obstetricians versus midwives have a substantially higher probability of c-section and other invasive interventions, many of which are not evidence based.  This suggests that interventions are used aggressively by obstetricians and the result is declining quality of care for women and their babies.  Indeed our rates of c-section have increased from six percent in 1970 to over twenty-five percent today and much higher in certain parts of the country.  There are many reasons for this, including litigious, financial and convenience. There is a substantial body of literature defining the problem, but very little research on solutions. This has become an enormous public health problem. Almost one third of women deliver surgically resulting in complications for them, their babies and for future pregnancies - not to mention the increased cost to our health care system.  This has a substantial morbidity with respect to the mental health of the women involved.  I certainly sympathize with the physicians who have lost patients; however, I think that there has been a substantial discounting of the effect of an unwanted and often unnecessary intervention has on the mother."

"There needs to be a long and serious discussion in this country about the impact that maternity decisions have on the health of women. I would argue that this is THE most important issue in women's health today. Women need to have better information about childbirth, their options and need to be better supported by their care providers.  Thank you for promoting this discussion."

And thanks to all of you for enriching the discussion.

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