Now, more than ever before, women have the ability to make choices in their care during pregnancy and childbirth. This blog post will explore the evolution in care providers and discuss the options available to mothers today.
100 years ago, most women gave birth at home surrounded by female relatives and the birth was supervised by a female midwife. The rise of the medical profession and the lack of professional midwife organizations contributed to the marginalization of midwifery care by the early to mid-1900s.1 Birth came to be seen as a medical condition requiring care which was dictated by physicians. While midwifery was never illegal, it was not recognized or covered under provincial healthcare insurance systems.
Women demand more say in their healthcare.
Despite this, the Department of Health and Welfare (now Health Canada) began to actively recruit midwives to serve in northern and remote areas of Canada beginning in 1939.2 Beginning in the 1960s and peeking in the 1980s, the women's rights movement coincided with women wanting more say in their healthcare. This resulted in a resurgence and wider social acceptance of midwifery care.
Ontario was the first province to regulate midwifery in 1991. Interestingly in many parts of Europe, including the Netherlands and the United Kingdom, more than 80% of births are attended by a midwife. Contrast this with less than 10% of births in Canada, which are attended by midwives3. Most women in Canada choose to be cared for by their family physician or an obstetrician.
Making the personal choice for your childbirth plan.
Choosing between an obstetrician, family doctor or midwife is ultimately a personal decision. A good place to start is by reviewing the differences between each one of these primary care providers.
According to the Association of Ontario midwives, "midwives are healthcare professionals who provide government-funded expert primary care to pregnant people and their newborns". Midwives are experts in the care of healthy low-risk pregnancies. While you are under the care of a midwife, you will not have a doctor unless there are concerns or complications with your pregnancy. Midwifery care is the only prenatal care that comes with options of where the birth will take place, as midwives will deliver babies in their patient's home, in birth-centers or in hospitals. Of note, 80% of midwife-assisted births take place in hospital.4 Family physicians are also qualified to provide safe and comprehensive prenatal care for women during their pregnancy, labour and birth; however, they only deliver babies in a hospital. Both midwives and family doctors are able to order tests during pregnancy including ultrasounds, blood work and even genetic testing.
Obstetricians are physicians who specialize in pregnancy, childbirth and a women's reproductive system. They are the only care provider able to perform cesarean sections, if required. As with family physicians, they only oversee childbirth in a hospital setting. In addition to caring for healthy low-risk pregnancies, they can care for pregnancies which are complicated or higher risk. They have additional training to manage these complex pregnancies. In fact, in some particularly high-risk situations you may be referred to a Maternal-Fetal Medicine Specialist, who is an Obstetrician with three additional years of training in high-risk pregnancies. The rise of Obstetrical care has coincided with many medical advancements, resulting in better outcomes for moms and babies. This is particularly so for high-risk pregnancies and when complications occur during child-birth. If a medical emergency arises, an Obstetrician is trained to manage the situation.
Unfortunately, you cannot have both a midwife and a doctor as your primary care provider. A primary care provider is the medical professional who is most responsible for your care. If serious complications do arise during your pregnancy, which necessitates a consultation or a transfer of care, your midwife or family physician will remain involved to provide supportive care or will remain the primary caregiver with consultations as necessary with an obstetrician. All prenatal care by midwives, family physicians and obstetricians is funded by the Ministry of Health and Long-term Care.
Factors that I considered in my decision.
You may be asking yourself, 'why wouldn't I choose an obstetrician with their advanced training and ability to handle complex and high-risk situations'? There may be several different reasons why. Both midwives and family doctors are able to provide more time with their patients during pre-natal appointments. Midwife visits during pregnancy will last between 30 and 60 minutes. Visits with family physicians are typically booked for 15 minutes and obstetricians can be significantly less.
Another difference, while under the care of a midwife versus a physician, is that you will typically be cared for by two or three midwives throughout your pregnancy. This allows for a continuity of care and a high likelihood that you will know the person who will be delivering your baby. When you are under the care of an obstetrician or family physician, the person who delivers your baby will be the doctor on call at the time that you go into labour. This can be a concern for some families as the individual that you have selected and trusted with your pregnancy may not be the same person who ends up delivering your baby.
My personal choice may be surprising to some. I practice medical negligence law and have a greater than average understanding of medical complications, risk factors and prenatal care. When it came time to have my own children, I selected a midwife. The reason why was influenced by my personal experience and to some degree the knowledge I gained in my practice.
While I have been involved in cases with both obstetricians and midwives, I had seen a number of concerns with obstetrical care that I wanted to avoid. There are inherent pressures that exist within the healthcare system and have greater impact on physicians during childbirth. One example is that a physician may be responsible for two or more people in labour. I had concerns about not knowing who would deliver my baby. I had concerns about an over-reliance on medical interventions and I wanted an intervention-free birth. I liked the fact that my midwife would be present during my entire labour. Typically, with family physicians and obstetricians, your labour is being monitored by the labour and delivery nurses and the physician will check in periodically and be present for the birth of the baby. This was a personal decision influenced by personal experience and personal preferences.
In the end, you get to make the call.
The decision of who cares for you during your pregnancy and childbirth is a personal medical decision most definitely not a legal one, but having greater understanding of what each healthcare provider can and cannot offer you will lead to a more satisfying experience. A reputable online source that can assist you in making your decision is OMama (link – http://www.omama.com/en/pre-pregnancy/choosing-a-maternity-care-provider.asp). OMama is an Ontario project supported by eHealth Ontario to provide trusted information on pregnancy, birth and early parenting. The OMama site includes links to various other sites to assist you in making your choice of care provider.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.