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
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.
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