Monday, July 18, 2011

The Midwife Route

Roman Carving of a Midwife Assisting in a Birth


As part of my no-analgesia birth plan, I consulted one of my former coworkers (Andrea) who works at the SPH Maternity unit on the best care provider for me, my needs, and most evidently my about to be born child.  I expressed some issues like "silly" fears and questions, time for me, someone nurturing but well educated.  And again, wanting the no-analgesia birth, and how much support I would get from the staff, my husband, and especially how much I can rely on my own education during though times of heightened discomfort.  I'm not stupid, labor is called LABOR for a reason- "no man is an island!"  Andrea gave some pretty matter-of-fact advice that definitely got the wheels rolling in my head. 

[side info---> BC Women's Hospital Power to Push Campaign: Click Here ]

Firstly, a GP (general practictioner) is sometimes but not always trained in obstetrics and especially not in high-risk pregnancies.  Residents get like a 6-week stint in med school and possibly even residency training on how to deliver a kid.  Your GP should tell you if they're trained or not and either refer you to another GP, a midwife, or an OB based on your needs and circumstances.  When you're using your GP, you are also assigned a 1:1 nurse and a junior resident in the hospital.  My assumption based on our conversation was that the awesome GP's are present not necessarily throughout the entire labour process, but at least present enough (in clocked time) that they're just not there when you're ready to push.  An awesome GP also works as a team with the staff, the good ones don't and kind of make you feel like they're just doing it for the extra money they get.  Did I mention I got some insider info on my GP? (no comment)

Secondly, an OB is trained for high-risk births- but with that being said, you don't have to be in a high risk position to have an OB as our primary caregiver.  Moreover, just because they're OB's with years and years of training, doesn't mean they're all great, that they're all nurse-friendly, that they're all mom/supportive friendly, and essentially not always the right fit for everyone.  OB's often see you after 20 weeks (per my GP) and you need a referal prior to being accepted into their care.  Sometimes, it can take up to a month to get an appt. with an OB just because of all the consults they receive.  While in the hospital, you are also assigned a 1:1 nurse, but this time, you have a senior resident doing all the history taking etc. just because of the "high-risk" label but not always circumstance.  Per Andrea, "They do more vaginal exams and more clock watching because that is just how they are trained. They are more apt to book you for an induction for being over 40 weeks."



Finally, here comes the midwife.  My initial impression of a midwife was someone doing a lot of the "fluff" work.  I really didn't like the idea of having to get to know someone as I devulge my intimate situation and my body.  I preferred to either know someone (like my GP), or get to know someone well educated in the field (like an OB), but I wanted the nurturing roll that wasn't too sterile (which we all know doctors can be).  I know midwives are degree trained and have governing bodies and standards of practice, but their scope of practice is generally not well known (kind of like nursing) possibly because of 1) ignorance from the public, 2) a non-well publicized advertisement on what they can do and what they can do for you, and 3) recommendations are word of mouth- there are good ones and bad ones just like with any other professional.  Midwives are not for high risk births!  (And trust me, you will know and you will be told that you are high risk or not).  Anyhow, per Andrea, "...They actually have more training and education about normal birth than any GP. They do a 4 year degree...All of our nurses would agree that a midwife does the best natural normal vaginal delivery than any OB or GP. Hands down."  This is right up my alley!

Midwife FAQ (edited for importance to me, but copy and pasted from Bloom Midwives and Commercial Drive Midwives)
  • How much does it cost to have a midwife?
    Midwifery care is covered by MSP (medical services plan) - so if you have a BC Care Card then it will not cost you anything. The only possible additional cost is for those planning a homebirth.
  • Can I have a midwife and have my baby in the hospital?
    Absolutely. Midwives are trained to catch babies both at home and in the hospital. Your midwife can help you decide which place of birth is right for you.
  • When should I call to make my first appointment with a midwife?
    Contact us as soon as you know you are pregnant. Midwives take on a relatively small number of clients each month to ensure that they are able to provide the personalized care that each woman deserves.
  • Can midwives order all the tests required in pregnancy?
    Registered midwives in BC can order all investigations required for pregnancy. If there are any concerns then the midwife will discuss these with you and consult with either your doctor or an obstetrician.
  • Why do some midwives call themselves registered midwives?
    There is an organization in British Columbia called the College if Midwives of British Columbia. Its role is to protect the public's interest as it relates to midwifery care in BC. They create policies and guidelines for midwifery care and they ensure that all midwives registered with them meet their high standards for training and experience. Midwives who are members of this College are called registered midwives http://www.cmbc.bc.ca
  • What is the difference between a midwife and a doula?
    Midwives and doulas have different but also overlapping roles. Some women choose to have both a midwife and a doula at their birth. You might also consider having a doula at your birth if your caregiver is a family doctor or obstetrician.
    "A doula who accompanies a woman in labor, mothers the mother, taking care of her emotional needs throughout childbirth. A doula also provides support and suggestions for partners that can enhance their experiences of birth. A postpartum doula continues that valuable emotional support and guidance, helping a family make a smooth transition into new family dynamics"
                - definition from the Doula Association of North America.
    "The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in the mother and child, the accessing of medical care or other appropriate assistance when necessary and the carrying out of emergency measures when necessary."
                - definition from the International Confederation of Midwives
  • How often do I come for prenatal visits?
    You would see your midwife in the clinic every 4-5 weeks until you are 28 weeks pregnant; then every 2-3 weeks until you are 36 weeks pregnant. After 36 weeks you see your midwife every week until you have the baby.
  • Can I have a doctor and a midwife?
    If you choose a midwife she will be the one looking after you during your pregnancy, labour and birth, and taking care of you and your baby until six weeks after your baby's birth. You may choose to see your doctor once in the beginning of your pregnancy, and if you have health concerns that are not related to pregnancy (for example bronchitis). If you aren't sure if your concern is related to pregnancy just ask your midwife and she can help you to get the care you need.
  • Can my partner and/or my other children come to my prenatal visits?
    Of course.
  • Can I have the option of using medications for pain relief if I have midwifery care?
    Yes. This is your birth and we truly want it to be an experience that you leave feeling listened to, well supported, and proud of your achievement - regardless of how it unfolds. We encourage you to remain open to different options as birth is a journey that cannot entirely be predicted nor controlled. Midwives are experts in normal birth and possess skills and experience to assist women to birth their babies with minimal intervention and without the use of medications. Your midwife can answer your questions about the ways to help you with your labour and birth ranging from the use of heat and water to narcotics and epidurals.
  • Who looks after me and the baby after the birth?
    Your midwife continues to look after both you and your baby after the birth until your little one is 6 weeks old. Your midwife will see you very frequently in the first week after your birth to help you with breastfeeding and to ensure that both you and the baby are healthy and happy. These visits happen in the hospital (if that's where you are) or at home. After the first week you will visit with your midwife when your baby is 2 weeks old, 4 weeks old and 6 weeks old. These visits happen in the clinic.
  • What happens if I develop complications with my pregnancy or during my labour?
    Midwives are skilled at caring for healthy women and their babies. They are also skilled at identifying concerns as they arise. If your midwife is concerned she will discuss this with you and then arrange for you to be seen by another medical professional, most likely an obstetrician, or for your baby to be seen by a pediatrician. The same is true during labour and birth. If a concern develops during this process your midwife will arrange for an obstetrician to meet you and to provide their assistance.
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With that being said, I have my first midwife get-to-know appointment tomorrow.  This midwife comes highly recommended and conveniently/inconveniently steps away from SPH.  The midwife route seems to be something that is the right fit for me.  It's not like i'm planning a home birth (crazy people! but that's just my unresearched opinion).  It'll be in the hospital, the midwife will have access to present nurses, technology, support, and the NICU.  I'm really happy about the 6weeks post partum support- there are so many things than can arise after the baby is born (ie. not latching on).  

Furthermore, I think that this midwife will be a great support for the husband as honestly, explaining stuff to him really pisses me off as he takes so long to process it (i'm sure he's just as nervous so I can easily forgive).  I also have concluded that during the heightened times of pressure (literally and figuratively) someone that can help Gene without making him feeling helpless, but rather making him feel like he has something to contribute [after what he did to me (LOL j/k)] and thereby boosting his personal morale and sense of accomplishment, can only reap positive results.

I'm quite intrigued by this road, not necessarily excited by it yet, but i'm sure that that'll come in time.

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