Why I chose a midwife

27 06 2011

So awhile back DrugMonkey went all pissy about women choosing midwifes or home births over a OB/Gyn.  My apologizes for not linking directly to the post, but I’m short on time and can’t remember  where it was. I do know I linked to it in my birth story post over at my old blog. He, along with others seem very critical of women choosing alternative methods for birthing. I can not comment on what things are like in the USA since my understanding is that things vary dramatically from state to state and I know little about the healthcare system, other than it cost individuals a shitload of money and that if you’re going to get seriously ill, you damn well better be stinking rich.  Yes I’m a pinky socialist commi that believes in universal health care, universal daycare and quality public education. Go here to tell me tell me that.

Up here in the Communist Canada, women under the age of 36 who are healthy, with a low risk for complications  have a choice of having their prenatal care being provided by either a midwife or a general practitioner (GP).  Older women, or women with risk factors for complications are referred to OB/Gyn.  When monkey was conceived I was (and still am) a healthy woman with a low risk for complications. My family doctor asked whether I wanted to be referred to Obstetrics GP clinic or a midwife as she herself does not deliver babies and most family doctors don’t.  When I asked her opinion she very clear that it was personal choice and that both midwives and GP’s provided good care. As a snobby scientist, I initially made the choice to go the GP route.  The GPs that do specialize in deliveries form clinics, where 7 different doctors come in 1 1 day/week and then are on call 1 day / week.  They always come in and are on call on the same day. So Dr.Friday would be in the clinic on fridays but on call for deliveries on Tuesdays.  There was a high probability that the person who saw me regularly in the clinic would not be the person delivering my child.  This was odd to me. Although multi-doctor clinics are becoming the norm in my neck of the woods, I grew up going to a GP who had a practice on his own. His nurse knew exactly who I was when I called. The same is true of my current family doctor. She has a small practice and they know exactly who I am when I call. I LOVE it.

Anyway, so I started with the traditional route but found that I was getting frustrated with the care. I was basically a patient number. I would go in and they would have me pee on a stick, check my weight, blood pressure and then tell me I have to go for test xyz without any explanation. It was very paternalistic approach, which I found frustrating. The last straw for me was when I was told that I had to go for a gestational diabetes test. When I asked why, I was simply told everyone has to.  I just looked at the nurse in confusion. Why do I need to go for an 2 hour uncomfortable test simply because you say so? Other than my age, I had no risk factors for gestational diabetes.  My diet is quite healthy and I eat the recommended diet already. I was still running and going to the gym. And to be honest I would’ve had no issue taking the test if they had actually taken the time to explain it to me as opposed to saying I had too because they said so.

It was around this time that our prenatal class discussed midwifery and the benefits of having a midwife.  Mr.SM didn’t really care either way, as long as I was comfortable with the care since really it was my body going through everything (He is an amazing man).  Since I was pissed off at the condesending way I was being treated, I looked in midwifery. I discovered that my colleagues on the Women in Science organization that I volunteered for had used midwives and were very happy with the care and highly recommended that route. They gave me names of different practices and I made appointments to visit them.  The practice I chose had well educated, experienced midwives.  They had all originally been nurses working in maternity wards and once our province legalized midwifery they completed 4 year university degree program. They had a strong science background but as opposed to thinking they knew best they were coming from a perspective of being present to advocate for the mom and to provide evidence based care. To provide the information in clear, factual manner and to empower me to make the decisions. I was very happy with the care I received when monkey was born and have gone back to the same clinic.

Another clear difference between the USA and where I live is this idea of birthing centers. We don’t have those that I’m aware of, but our maternity wards are in essence set up as birthing centers. I labored and birthed in the same room, which is equipped with a tub or shower.  When monkey was born, my care was transferred to an OB/GyN because of the need to use a vacuum so I was never at risk.

I can give a couple of examples of further differences. This time around the midwifery practice I go to have a new midwife as one had retired. For two separate appointments, this midwife was >30 minutes late arriving (no she was not delivering the night before) and had taken a personal call while during my appointment with her. I was not impressed. I let the practice know that the behavior was rude, disrespectful and unprofessional. I was given the option of having a mediated discussion with the midwife or not having her involved in my care. I have chosen to not have her participate in my care. I’m not quite comfortable telling someone off and then having them care for me while I’m most vulnerable. I do not believe this accommodation would be made in the obstetrics GP clinic.

Another example is the group B streptococci bacteria. All pregnant women are screened at 37 weeks as was I. My midwife gave me the information on it and what happens if  I had tested positive. Of the moms who test positive for GBS, 50% pass the bacteria onto their child during birth. Of the 50% that get the bacteria, 0.1% get sick and of those that get sick only 2% die. So if I tested postive the risk to my child would be .5 x .1 is 0.05% chance of getting sick. After that the chance of dying is 2% of .05%. If I was at the GP clinic, I would simply be told that I have to take antibiotics while giving birth (which leads to yeast infections and thrush for the baby).  The midwife are also required to provide me with the antibiotics unless I refused which I would’ve. Why? Because we hospitals are dealing with alot of super bugs and antibiotic resistant bacteria.  Many believe its due to the over-prescription of antibiotics and / or their misuse (ie not finishing your prescription because you feel better).

The most important example is what is happening right now. I am currently past my due date. I’ve been unsure what to do ie have an induction or not.  I did not get a dating ultrasound because I was being lazy and didn’t want to time out of my limited work day so my due date is based on my last cycle. Since my cycle is irregular, its not the most accurate dating measure.  Typically, the fetal heart rate can be heard at 10 weeks gestation, but when I was 11 weeks  (according to my cycle) the midwife could not find the fetal heart rate but was able to hear it when I came in the next week, at 12 weeks gestation.  I went for standard ultrasound at 20.5 weeks which ensure the baby is growing normally.  At that time, all of the inmate’s  growth measurements were hitting target for being at 19.5 weeks.  Same thing when I went in for the emergency ultrasound at 33 weeks according to my cycle, the inmates measurements were consistent with being 32 weeks.

This weekend I did a pubmed search on post term (PT) pregnancies to find out the risks involved and what I should do. What I found out is that (a) I should’ve got the dating ultrasound done. It reduce the number of PT pregnancies simply because it better predicts the due date. Secondly, I found that there appears to be an increased incident of C-sections with induction and that the major reason for advocating for induction vs expectant management is a reduction in cost (pubmed link).  Which isn’t to say there isn’t a risk by going beyond 42 weeks.   Right now I feel like I am finishing my 40th week and will be heading into my 41st. I will probably try non-pharmacological inductions at some point this weekend.  Both Mr.SM and I are comfortable with this.

One of the major problems with medicine today is that medical community not only look at the risk to their patients, they need to look at the risk to themselves financially.  This is why antibiotics will be given to mom despite the low risk to the baby.  They also have to look at the cost of providing care, which is why decision will be made on what is cheaper vs what is best. I understand the cost pressures and I don’t know how to balance the two different needs.  But outside of these very real and hard decisions, the other problem facing medicine is its paternalistic culture. I experienced it first hand with both monkeys pregnancy and the death of my grandfather.  Its been well documented in books such as our body ourselves.  I know there are good doctors out there (my own family doctor being one of them) and the culture may be changing but its slow and as women we need to advocate for our health and care.

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8 responses

27 06 2011
bean-mom

40 weeks! I can’t imagine. I hope the baby comes safely out soon!

And I’m sorry to hear you’ve been subjected to condescending treatment by doctors. I’d be pissed, too, if no one took the time to explain to me why a test or procedure was being ordered. I’ve felt well-treated by by ob/gyns and primary care doctors, and I also like my children’s pediatrician. Now our pediatric dental office is another story…

Midwives have recently come in for some bad press in America because of some horrific incidents, like this one where a midwife tried to deliver a breech baby at home to a 43-year old first-time mother. http://www.slate.com/id/2293389/ But to be fair, there are criminally negligible, arrogant and incompetent physicians as well as midwives like the one in the article. Midwifery is not quite mainstream here, though, so I think bad incidents attract more press.

It sounds like the system you have in Canada works well (and hey, socialized medicine! This is one American that likes the sound of that!) The kind of birthing room that you describe is becoming popular here as well–I gave birth to my second kid in one like that (much better than my first delivery).

Hope the time passes fast, and baby #2 comes soon!

28 06 2011
scientistmother

I’ve heard some crazy ass stories about some flakey midwifes, but as you said its not there are not physicians that make some horrendous decisions as well. Midwifery is regulated with by Colleague same as Doctors which helps. For example, now that I’m a week past my EDD I have to go see a physician. A 43 yr old would never be allowed to be taken in as a patient either.

I do like our system up here, but then again I”m a socialist 🙂

28 06 2011
Jenny F. Scientist

I had midwives with Bug and now midwives with #2. They’re all CNMs, who have delivered in hospitals and have a ton of experience, and my main reason I love them is they’re less likely to go all intervention-y *unless I need it*. All I really want is to know what’s going on (to the extent that it’s not an emergency!) and to know that if my medical professional says “Do X” they mean I really need it.

#2 will, if there are no complications, be delivered IN A HOSPITAL by CNMs. I really think healthy babies mostly need catching and very little else.

In my state all licensed midwives must be ‘advanced practice’ nurses which means they are at least RNs and have done a 2- to 3-year additional training solely in midwifery.

28 06 2011
DMB

I am a female scientist (with a PhD) and I had my first baby with a midwifery practice in the Netherlands and my second (as a home birth) with midwives in Canada. Both experiences were wonderful. I am a huge advocate for midwives! They give women choice AND they save the healthcare system money by reducing interventions and supporting normal birth.

28 06 2011
scientistmother

Jenny F. Scientist – welcome to the Blog! I agree, I want to what is going on and if they recommend X, why? Pro & cons then let me make the decisions. Defensive medicine is a bad thing. I understand why, with the proliferation of malpractice suits it happening, but still a bad thing. I find its interesting how different each state is in terms of what qualifies one as a “midwife”.

DMB – I am 100% for the empowerment of women, which is why I chose the midwife route. I do honestly believe many doctors are trying to be more evidence based and are trying to empower their patients, but its a slow change

29 06 2011
jo(e)

When I was pregnant with my first and checked out the practitioners in my area, I chose a midwife because her philosophy about childbirth was most similar to mine. I had a wonderful experience.

29 06 2011
Zee

I fully believe that if I had not had midwives and been at a birth center I would have had a C-section. So am forever grateful for both. Also I would like to add that Doulas are awesome!

29 06 2011
scientistmother

jo(e) – glad to hear you had a great experience
Zee – oh I think that if I had a GP, I too would’ve been told I had to have a C-section as well.

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