Choosing Your Maternity Care Provider
In our role as birth doulas, we attend births with couples in Vancouver, BC who have chosen one of three options for their care provider. This is either:
1) a GP (specializing in maternity care),
2) an obstetrician, or
3) a midwife
There are numerous family doctors who specialize in maternity care and attend births. They have general medicine training with additional schooling for maternity care. They provide prenatal care during pregnancy and follow up postpartum care in their office. They work with low risk, healthy pregnant women. Some practices may have one or two doctors working as a team. Others are large group practices and there is no guarantee that couples will have the doctor they’ve seen during the pregnancy be in attendance at the birth. They will be attended to by the doctor who is on-call that day.
This is also true of obstetricians. Obstetrical training focuses on pregnancy and birth complications. They provide surgical care during pregnancy and childbirth (perform Caesareans). They can care for normal healthy pregnant women, but fundamentally they are specialists for high risk pregnancies, or when medical procedures are needed during labour and birth. There are always obstetricians on-call in hospitals, should their support be needed. If their obstetrical expertise is required, OBs work alongside the primary care provider during the course of a labour. They provide consultation to help determine how to proceed. If a woman’s primary care provider is an OB, a pediatrician is in attendance at the birth to check over the baby, as OBs do not provide care for newborns.
Midwives are experts in normal physiologic birth. They train for four years within the School of Medicine to learn how to care for low risk, healthy pregnant women. As a primary care provider they care for the pregnant woman prenatally, during the labour and birth, and provide follow-up care for a full 6 weeks postpartum for both mother and newborn. This includes home visits in the initial week after birth. Midwives are also skilled in breastfeeding support and provide infant care education. They may practice solo, or work in teams. Their clients get to know each midwife in the team. Prenatal appointments are usually 45 min or longer to ensure comprehensive care, compared to 15 minutes with doctors. They come to the home to assess labour progress and provide continuous support during active labour until the birth. They complete the newborn care exam and other basic tests. At the heart of midwifery care is the idea that birth is a normal, healthy part of a woman's life. While they will call on medical technology when it is clearly needed, midwives discourage the routine use of ultrasound, fetal monitoring, induced labour, episiotomies and Caesarean section. Midwifery care, due to being non-interventionist, results in cost-effective care, significantly lower rates of Cesarean sections and lower rates in premature and low birth weight births. Midwives identify and refer women who need the specialist care of an obstetrician. In some circumstances they provide collaborative care, working with an obstetrician, if one is required. With midwives, the place of birth can be either hospital or home. Midwives are the only care providers who are trained to attend birth at home. Peer reviewed research conducted in BC shows
'that planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and adverse maternal outcomes compared with planned hospital birth attended by a midwife or physician.'
It’s interesting to note that midwives are the primary care providers for healthy pregnant women in most countries around the world, with the exception of North America. Here we allow low risk healthy pregnant women to be cared for by specialists; Ie. Obstetricians, who are experts in abnormalities and problems. That creates problems in its own way. As research shows, midwifery care results in lowered rates of intervention and surgical births. The type of care provider needs to fit the level of care required for the individual. It’s about appropriate care.
One of the most important decisions couples make is who they choose as their care provider. Research has shown this to be the largest influence when it comes to birth outcomes. We suggest interviewing care providers to see who fits best for the care couples want to receive. Research options and gather information. Ask questions. Choose wisely.
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