A Father's Experience with Midwives
Here is an article I wrote back in 2003, shortly after the birth of our 2nd son.
When we first found out we were pregant with our second child, my wife mentioned that she wanted to go through the midwives rather than with a doctor. While I agreed out loud to her, inside I was saying to myself "Midwives?! So what, 'boil lots of water and rip up some bedsheets'?". I was not too thrilled about this new development, and secretly hoped that as time went on my wife would slowly change her mind. Boy, did I have lots to learn!
The first several appointments I did not go to myself, so my only experience with midwives in the first few months was second hand through my wife. But the difference was quite apparant already. After every appointment she was energized and excited, and came home with lots of fresh information she'd learned. She certainly seemed an awful lot happier than she'd been during our first pregnancy. But still in my head was lingering the boiling water and bedsheets. Aren't midwives bongo-drumming, granola-crunching, mother-earth type witch-doctors? Shouldn't we be involving real medical professionals here?
Boy, did I have a lot to learn.
Today's midwives - at least here in Ontario - are a world apart from the widwives who delivered babies through the ages. While they carry forward the age-old traditions of caring for the mom and child, they have definitely updated their skills with the help of modern science. Boiling water and ripping up bedsheets - ha! It wasn't until the 4th or 5th month when it became readily apparant that my wife was not going to change her mind about this, that I started asking lots of questions and educating myself with answers that surprised me.
First of all, midwives in Ontario take a four year university degree in midwifery, and graduate with a Bachelor of Health Sciences. This program is offered jointly by McMaster, Ryerson and Laurentian universities, and is basically a highly-specialised degree which combines many aspects of both nursing as well as medical doctors. Wow, finding out that alone set my mind considerably at ease. They aren't witch-doctors!
But one of the key beliefs of midwifery happens to coorespond with one of my key complaints about the medical profession today - midwives believe in educating the mother (and father) to-be. They believe in arming the parents with the information they need to make decisions themselves - in empowering you to be your own best advocate for your own care. Whereas most doctors operate on the motto of "I know what's best for you, but I don't have time to explain it to you. And you probably would not understand even if I did have time". Doctors tend to present procedures and treatments as though you have to undergo them just because the doctor says so. Somewhere along the way they neglect to tell you that legally speaking, there are very few procedures or treatments which you are required to undergo. Midwives are a world apart from this approach to your health care.
As my wife's pregnancy progressed, I began to attend more and more of the midwife appointments, and began to learn first-hand just how much better this approach is than going with a doctor. For one thing, we spent a lot more time with the midwives leading up to the birth, than we did with the doctors for the birth of our first child. You get checked more often, and each appointment lasts much longer because the visits are an educational experience for the parents-to-be. By the time the big day is upon you, the midwives know you very well, as you do them. There is no fear of the unknown from either party.
Another huge benefit of a midwife is that when the big day is finally upon you, the midwives come first to your home and monitor the mom to ensure she really is ready to have the baby. For our last birth my wife went into labour about 2am, and by 11am she had decided it was time to go to the hospital. There the doctor examined her and told her "nope, not ready yet. please go back home". Back home! But she was sure this was it! So off we went back home again. And even though we were only a few short blocks from the hospital, by the time we were halfway there my wife's labour had progressed considerably. The contractions had become far more intense, but she was afraid to go back to the hospital again lest she be sent home once more. So she spent 2 hours in agonizing labour here at home before I finally managed to convince her we should go back.
This time around we called the midwives at 6pm and told them we were pretty sure this was it. By 7pm they were here in our home examining my wife, and at 9pm the decision was made - yup, this is definitely it - let's go to the hospital. Wow, what a world of difference from last time around!
And things would prove to get only better still, when compared to last time. We made it to the hospital and were quickly checked in. The midwives had the majority of the paperwork already completed for us, so all we had to do was sign a few forms after we were already comfortable in the birthing room. My wife didn't get automatically hooked up to a hydrating IV - she had the option to however, if she wanted. Instead, she chose to do things the old fashioned way and have a glass of water nearby at all times, and take regular drinks from it. After being there for about an hour something seemed odd - it was too quite. Then it struck me that there was no parade of nurses constantly going in and out of the room - telling you to do this and that, shoving things in you and pulling things back out. Never once asking if you wanted any of it. In fact, the odd time a nurse did come to the room this time around, she would knock on the door and would not enter until invited in by one of the occupants. Wow, what a difference. Privacy!
Even better still was that the midwives were with you through the entire process. From your first appointment when you were only a month or so pregnant, right through til when the baby was finally born. Last time around the doctor we'd been visiting went on vacation just before the birth, and we ended up meeting his replacement when he entered the birthing room while my wife was in heavy labour. And even if you did end up with the same doctor, you'd be dealing with strange nurses, and at shift-change you'd be dealing with yet more strange nurses all of who knew nothing at all about you except what they read in your file a few minutes beforehand. The midwives start from day one tandeming you between your two primary midwives - one appointment with one, the next appointment with the other. Back and forth your appointments go between the two, so that you are already very familiar with your midwives and you will already know each other very well on the day of the birth. One of the two primary widwives run the show on the big day. But you also have two secondary midwives whom you meet well in advance, too. One of them will assist the primary in the birth.
In our case we also were asked and agreed to allow a student midwife follow us the entire 9 months, so we had 3 midwives in attendance at our birth. By way of comparison, during one of our ultrasounds a few weeks before our birth, one of the doctors decided to slip in and relieve the ultrasound technician and use the opportunity to train a couple of interns - without asking us if we minded, of course.
Back to the birthing room on the big day, the doctor only shows up for the grand finale. Last time around the nurses cared for my wife right up until it became obvious the baby would soon be here. Then they call the doctor who jumped out of his bed to come in and deliver the baby. We had to wait about an hour for him to arrive, and during that time my wife had the urge to push but was told by the nurses not to until the doctor got there. He was there for a total of just about an hour. Needless to say this did not happen with the midwives - they'd been monitoring my wife for hours already by the time the grand finale was upon us, and they knew exactly what to do, and when. There would be no waiting this time around.
Here in Ottawa you give birth in a birthing room, and a few hours later you get moved to your regular room. Last time around my wife was in the hospital for 3 days, and it was not until well into the 2nd day that we finally got a private room. The co-occupant she had to share her semi-private room with was very obnoxious, and had 5 or 6 guests in at a time even though this was beyond the allowed limit. This time around we gave birth in the birthing room just like last time, but instead of getting moved to a regular hospital room we opted to just go home after the few hour wait. The midwives gave my wife a few stiches where required, and monitored her for the next few hours. When they were convinced she was OK to be moved, they helped us out to the car with our things and we drove home. Oh, we had the option of staying a few days in a regular room, but the doctors last time never informed us that this was in fact optional. They of course know what is best for you, and you do not need to know what your options are. So our total stay in the hospital this time was just under 6 hours.
Once you are at home, the doctors have long-since forgotten you. You do have an option for a public health nurse to come visit you a few days later if you like. Midwives on the other hand schedule 3 visits in the first week after mom is back home again, just to ensure all is still going well with mom and baby. And of course they come to your home for the visits. Then there are several more visits in the next few months.
All is not so rosey from the point-of-view of the midwives, unfortunately. While the province likes midwife-assisted births because they are much less expensive than doctor-assisted births, they do not fund midwives the same way as doctors. Doctors get paid by the hour, where midwives get paid by the birth. It's all or nothing for a midwife - if they provide 12 weeks of care, or attend the birth, then they get full payment. But as already explained, midwives spend an awful lot more hours per birth than doctors do. In most cases the midwife will provide 6 or more months of care prenatal, and then 6 weeks of post partum care. There is also the fact that at any time a doctor can declare the pregnancy 'high risk', at which point the law says that care must be transferred from the midwife to a doctor. We almost had this happen to us, in fact. The worst part of it was that the specialist at the children's hospital did not consider the pregnancy high-risk, but the obstetrician in the high-risk unit of the birthing hospital perhaps needed a little extra cash for christmas time and tried to get care transferred. That is of course nothing but wild speculation on my part, but there was no other way to explain why he was telling one story to us, and a completely different one to our midwives. He almost seemed to be playing us off each other.
If midwifery is truly to be successful here in Ontario, there are some changes required on the part of the government to ensure that midwives get paid for the actual work they are doing. And doctors have to be educated on midwife care, as well. We found that some of the doctors we dealt with either were completely misinformed as to the nature of midwifery - as I myself was at the beginning of this journey, or they felt threatened by the midwives and became secretive and generally tried to throw up road-blocks whenever possible. Not all of them were like this, but all it takes to endanger the health of my wife and child is one doctor to hold back information from the midwives. We had one doctor who was not forwarding full ultrasound details to our midwives, and even worse yet was telling one story to us to our faces, and something exactly the opposite to the midwives. He was obviously lying to one of us or the other. We're still not sure which.
There are huge waiting lists for midwives here in Ottawa, so hopefully this will be an incentive for the government to keep things moving in the right direction. In Sweden 75% of all births are conducted by midwives, and interestingly enough the maternal death rate there is significantly lower than in North America.
Canada : 6 in 100 000
USA : 17 in 100 000
Sweden : 2 in 100 000
See this WHO document for details.
I am sure there are more details I've forgotten, but it should be pretty obvious by now just how much better our experience was this time around with the midwives, when compared to our experience last time around with the mainstream medical system.