No Chocolate for Breakfast

Friday, 25 October 2013

$0.02 on the obstetrician vs midwife debate

Recently, and not for the first time, a friend asked in a Facebook post which is best, obstetrician or midwife. I've been mulling it over. I chose the OB route for Liana and midwife route for Caleb and Evelyn. Here are some of the facts and personal opinions on each.

Overlaps in care

Both care professionals will meet with you during your pregnancy at the same frequency - first monthly, then bi-weekly, and weekly by your last month. In both cases you go to their office, weigh in, check levels of sugar and protein, blood pressure and listen to the fetal heartbeat. Both care professional have hospital privileges, deliver babies, and perform the necessary post-delivery baby tests.

Benefits of an OB

Qualified to oversee high risk pregnancies

OBs take care of all high risk pregnancies. If you have high blood pressure, epilepsy, heart disease, diabetes or another serious condition you need an OB. If you start off with a midwife and encounter medical issues such as diabetes, preeclampsia, placenta previa or if you're pregnant with multiples, your care will most likely be transferred to an OB. OBs can perform ceasarian births whereas midwife cannot (through they can perform vaginal breech births which have been making a comeback).

Qualified to write prescriptions and sick notes

This isn't as clear cut but I think the OBs win. Midwives who are registered in Ontario are limited to prescribing drugs that they can administer which include treatments for things like hemorrhages, mastitis and UTIs. OBs on the other hand can prescribe anything. As for sick notes, while midwives can write them some employers don't recognize them and some midwifery practices - such as Eastern Ottawa Midwives - have a policy not to write them. So while pregnant with Evelyn for example, I had to schedule an appointment with my family doctor for a sick note stating my maternity leave start date which was an added inconvenience.

Drawbacks of an OB

Impersonal

I remember subconsciously expecting consistency in care when pregnant with Liana. I'd had the same family doctor my entire life so I was surprised at how many transfers occurred in a nine month period. My family doctor referred me to an OB...he retired, then my second went on vacation, my third went on maternity leave, a few others I met with once each (part of a practice), and in the end I'd never before met with the doctor that delivered Liana. At third trimester visits I was still being asked the date of my last period. All appointments were rushed and often started late. It was a single pregnancy but it gave me insight on several OBs and I have read that the OB who delivers the baby is often not the one who has provided prenatal care.

Minimal presence during labour

As a patient of an OB labour assistance is provided by the hospital nurses on staff (which will rotate due to shift changes), your labour partner(s), or a hired professional like a doula. The OB will only be called when you're 10 cm dilated and ready for delivery.

Higher chances of medical interventions

OBs are more likely to use interventions during childbirth (epidural anesthesia, episiotomies and instrument deliveries). I was curious how much that can be attributed to OBs overseeing higher risk pregnancies and found this one study, Interspecialty Differences in the Obstetetric Care of Low-Risk Women, that compared two groups of women with low-risk pregnancies. The researchers found that midwives used 12.2 percent fewer interventions than physicians, the women who saw midwives rather than OBs had 4.8 percent fewer C-sections, and that fetal and maternal outcomes are equally good when comparing OB and midwife births.

Benefits of a midwife

Informed choice

Midwives give information to their clients so that they may make informed choices for themselves. Rather than sending you for testing they'll explain the test procedure, purpose, risk and leave it to you to decide to get it. When I was pregnant for Caleb for example I opted not to have any ultrasounds performed. I wanted to gender to be a surprise and when it was explained to me that issues that could be found are often false-positives, things we can't do anything about, often spontaneously resolve, provide uncertain results, and hasn't been proven to improve birth outcomes. Also ultrasounds, especially more) may have repercussions for the baby such as premature ovulation, preterm labor or miscarriage, low birth weight, poorer condition at birth, perinatal death, dyslexia, delayed speech development, and less right-handedness (apparently the latter can be a sign of disruption to the developing brain?). I had one done with Evelyn to know the gender and I would have had more done if there was a strong medical reason, but it baffles me how excited pregnant women get at unnecessary ultrasounds. Just be patient - you'll see what your babies look like soon. OBs make you have a 20 week ultrasound and often suggest 12 and 40 week ultrasounds and sometimes many more. That was a giant aside on ultrasounds. But yeah midwives arm you with knowledge, give you time to research and mull things over, and support your decisions as long as they're in line with the law (like you can't decide to not give your baby a blood sugar test after delivery or an apgar test etc).

Availability and time

In general midwife appointments are long, chatty and they never rush you. They are available 24/7 by pager. They also offer continuity of care, meaning they offer care for you and your baby six weeks after delivery, including visiting at home if you aren't up to leaving your home.

Women are active decision-makers in the care they receive; midwives give information to help women make informed decisions. - See more at: http://www.ontariomidwives.ca/midwife/q-a#sthash.7hXFwgqk.dpuf

Choice in location

There's a misconception that Midwives still solely deliver babies at home. Midwives have hospital rights to one or more local hospitals. Both Caleb and Evelyn were born at Montfort Hospital, though I know of Midwifery patients who have also delivered at Queensway-Carleton and the Civic. There's also an Ottawa Birthing Centre in the works, described as "a safe, comfortable, family-centered place to have their baby," which seems like a good middle ground between the comfort of home and a hospitalized setting.

I wasn't interested in home births for two reasons: I like the comfort of teams of doctors and specialized equipment available at hospitals and...the mess. Delivery is very messy and I don't like mess. But the facts show that home births are no more risky than hospital births for low-risk pregnancies. A Canadian study found the rate of deaths was about two per 1,000 for planned home births involving midwives as well as deliveries in hospitals involving either midwives or doctors.

Fewer interventions

This was covered above. Births attended by Midwives usually have fewer interventions – such as continuous electronic fetal monitoring, epidurals, and episiotomies – without any difference in outcomes for women or their babies. Women who opt for midwifery care tend to have a lower rate of cesarean section, too.

Drawbacks of a Midwife

May need to transfer care

This was also covered above. Midwives will need to transfer your care if pregnancy becomes high-risk. You also may need to visit your family doctor during your pregnancy for sick notes and prescriptions.

May steer towards natural childbirth

All that nice stuff about informed choice I mentioned? It may come accompanied by snide remarks and mild debates if you lean towards certain practices. Midwifery practice is based on the belief that childbirth is a natural process, not a medical one. While this may make sense to you during your pregnancy you may change your mind once your in labour. For example midwives *should* respect your request for painkillers but in my experience they'll push you to go "a little bit longer" (which while in pain will make you want to punch them in the face).

Advice

Rationally I think: go midwives! Stats Can reported that the majority of Canadian mothers who gave birth during a three-month period were happy with their labour and the birth of their child. Among those who had a midwife delivery, 71% rated it as "very positive" compared with 53% of women who had their babies delivered by obstetricians/gynecologists, family doctors or nurses and nurse practitioners.

Personally I'm on the fence. I have yet to have a "very positive" experience with either. Most recently both Darcy and I were disappointed with our primary midwife for Evelyn's birth (Darcy more so than I - his account can be found here and mine here). Basically there are good and bad OBs and midwives out there and it's just a question of finding one you like.I read online that you should interview to find a right fit...which is a bit of a joke considering you usually get on a waitlist. All you can really do is narrow down a practice, wait for an opening or request someone in particular that was recommended, and hope for the best. If you have an amazing experience with a care provider you'll have priority in subsequent births. Once your baby is born it won't matter that much to you anyway.

Sunday, 20 October 2013

Month 4 Milestones

Here's the fourth milestone installment.

Evelyn's new things are:

- holds toys

- sits in bumbo chair
- stands in excersaucer

- sleeps less! wakes up 2-3 times a night, regularly
- turns from back to side
- enjoys xylophone version of 90s alternative music
- entertain herself babbling and holding toys for short periods of time
- wears size 9 months clothing

Dex strikes again

Daddy hair tickles

Sister kisses

Serious bubble making

Wednesday, 16 October 2013

Thanksgiving time outings

Met Ronin

Close friends of ours that live down the street had their baby boy. His name is Ronin and we'll be seeing a lot more of him!

Ronin cuddling with his daddy

Evelyn watching golf on the giant screen

Maya turned two

We commuted to Smith Falls to celebrate the birthday of a very special little girl. Of note: bubble machines are hours of fun and I will own one before Evelyn's first birthday party!

Birthday girl chasing bubbles

Maya's brother and Evelyn's friend Isaac ( he has super strength!)

Evelyn in her party dress

One of our gifts to Maya was Little People superheroes - there's even a lil Wonder Woman!

First sleepover in Mountain Grove

Other than Evelyn's first night in the world that was spent at the hospital, this was her first time spending an overnight away from home. Grandma bought her one of those cute playpen bed/change table combos and everything. Evelyn was unfortunately grumpy for a lot of the visit but there were sweet happy moments that took place, as well.

Oh no: Uncle Roger bought her a doll that supports the wrong team! Confused baby.

Look at all the love!

Morning time naked baby wiggles

Grandma kisses

Evelyn with great-grandma

Walk in Old Aylmer

Old Aylmer is beautiful! I honestly had no idea. Visited a friend's new home and we went for a stroll with the babies. Such a charming little town. Not at all like Hull or Gatineau - more like Chelsea or Wakefield.

Evelyn and her almost one year old buddy Leo

Giving Dominique big smiles

Thanksgiving picnic

This was our first picnic of the year. We pack up pinwheel sandwich wraps and sporty activities and head to the local park. It's one of our only family outings that includes Dexter.

Mommy and Liana day

Liana and I try to get out once a month, just the two of us. This month we chose to go for lunch at Cafe My House and then shopping at Terra 20. The food was delicious but pricey. Not pictured below was a tomato and nut cheese salad (my first time trying a nut cheese and to my surprise it was AMAZING!), butternut squash balls topped with a black bean sauce, and taramisu.

Liana and her giant tempeh burger main

Liana's raw butternut squash, lemon and maple dessert (tastier than it sounds!)

No pictures available outings

Evelyn and I also went shopping with a very pregnant friend at the local posh baby stores. We had a late night visit with an out of town friend. We had a lovely thanksgiving lunch at my parents' in the company of my cousin and her family. And we had a full day visit from a friend. Guess I just try to balance taking a lot of pictures without feeling like I have to have the camera at arms reach all of the time.

Hanging around the house

Evelyn sitting on mommy's spot

Liana's homework setup - good thing we have a lot of counter space

Evelyn playing with her favourite toy while mommy preps dinner

Liana working on an art project

Gearing up for a stroll

Sitting down makes her look so big!

Getting some fresh air

New toy

Why so serious?

Liana giving Evelyn a fussy Evelyn a baby massage

Sisters hanging out

A rest after helping mommy rake the front lawn

Make do seat after making a giant diaper mess on her swing

Friday, 11 October 2013

The Fantastic World of Mr Caleb a la Nintendo DS

Caleb has a Nintendo DS that has two built in cameras - an inner and outer camera - and ten funky lenses. The resolution is terrible but it's a neat extra on a system Caleb has its gaming capabilities. He's had it for years as it was previously Liana's but only recently started taking pictures with it. He was running out of space so I uploaded the almost 500 photos he took throughout the summer. Here are some of the images he thought to capture.