I find it interesting that when I read natural birth type blogs and posts online, women love their midwives. This is not to say there are not obstetricians who are well liked, but I think the relationship is somehow different. But I am not convinced it is better.
A major complaint lain against obstetricians is that we don’t know what normal birth looks like. Women complain that we are just surgeons, and we only know how to cut. Therefore, a pregnant women is just setting herself up for intervention if they seek obstetrical care. What utter nonsence. I am far more than just a surgeon. I am a well trained physician, I have comphrensive knowledge of normal and aberrent physiology. My skill set extends beyond pregnancy, I have specialized in the care of women, all women. I help women who want to be pregnant, I help those that don’t want to be pregnant. I help women with complicated pregnancies, I help women with postpartum complications. I help women with problems that have nothing to do with pregnancy at all. Most importantly, I don’t do any of thise by myself. I am part of a team that cares for women.
Lets look at the example of labour an delivery. The so called advantage of a midwives if that they are specialists in normal pregnancy. That should only include low risk pregnancies, but lets save that for another day. They provide prenatal care, intrapartum care and postpartum care. If you have an uncomplicated pregnancy, you and your baby should be cared for by a familar person. Thats great. But the other claims about midwivery, as compared to obstetrical care are make believe.
Example 1: My midwife will be there the enitre delivery. Unlikely, unless you have a private midwive at a home birth. If you have a short labour, sure the same person will be present, but if you have a typical first-time labour, it could last more than 24 hours. Do you really want a care provider to delivery you precious newborn if they have been awake and caring for you for more than 24 hours? Doesn’t sound like a good plan. Furthermore, if you request an epidural, then a nurse will need to be involved, because in most centres, midwives are not qualified to manage them. If you need oxytocin, some centres will request a transfer of care bacuase they consider this outside of the scope of a midwife. Your midwive will (should) only be in charge if everything is normal, but that is beyond anyone’s control.
Example 2: The doctor will only be there for a few minutes at the end. Isn’t that a good thing? I thought we were intervening too much, but our absence is the problem. This also fails to neglect an important member of my team – the labour and delivery nurse. If doctors are specialist in the complications of pregnancies, than nurses are the true specialists in normal pregnancy.
I AM A MEMBER OF A TEAM
There is nothing that I do in labour and delivery that I could do without the assistance of a team. Nurses are the core of this team, but we should not forget the many other members – anaesethiologists, paediatricians, house clearns, lab technicians, porters, hospital switch board operaters, etc. (I am sorry if I have left anyone out). Maternity and newborn care takes a team, why would you ever just want one person looking after you and your newborn?
Nurses are an often forgotten member of the maternity care team, particularly by the vocal natural birth internet world. These nurses work 12 hours shifts, and spend their time caring for pregnant women and their families. If you consider that a home birth midwife may have 2-3 clients per month, a labour and delivery nurse will care for that many patients (or many more) in each 4-day shift cycle they work. They see the normal and the abnormal. They truly are the specialists in normal pregnancy. Unlike midwives though, they don’thave any difficulty call for help when things variate from normal. Why not? Because they also know they are part of the team. The next story you read about an angry mother complaining about the doctor’s absence, think about the nurse who was probably with that patient for their entire shift. Many studies that looked at the benefit of one-to-one care were actually looking at nurses. Not doulas, not midwives, but those nurses. Those highly underappreciated nurses.
Having a baby isn’t about your experience or your midwfe’s experience. Its about your baby. I want you to feel safe and respected during your delivery, but I also want you to be cared for by the best possible team available. Midwives needs to join that team, instead of setting themselves about as an alternative model of care. We all care. Why can’t we all work together?