In Ontario, registered midwives are regulated by the College of Ontario Midwives. This means that midwifery care is quality controlled by the same mechanism as doctors and nurses. Midwives order all the same routine blood, urine and ultrasound tests as doctors. Midwifery care is paid for by the Ministry of Health just like the care you receive from doctors and nurses. Midwives have hospital admitting privileges, just like doctors. Essentially, midwives are the real deal.
Midwives are qualified to take care of people throughout pregnancy, labour, birth and postpartum and also care for babies until 6 weeks of age. Midwives are primary care providers and are part of the health care system. Midwives are independent practitioners. This means that we do not work for, or under the authority of doctors. If a situation develops that is outside of the expertise of a midwife, then the midwife will consult with or transfer care to the appropriate physician. This is exactly the way your family doctor practices medicine. Most of the time, your family doctor manages your care. If you develop (for example) kidney disease then a nephrologist, a doctor who specializes in problems with the kidneys, will be called in at that point. If you don’t have kidney disease, then you don’t need a nephrologist. Your family doctor will care for your overall health in a way that a nephrologist can’t. Midwives provide a model of care that safely meets the needs of the average childbearing person with high rates of satisfaction and will call in the pathologist as needed.
But things can change very fast during a birth! What happens if an emergency develops quickly? If that happens, your midwife will skillfully manage the emergency.
Midwives are qualified and capable of dealing with emergencies that develop without much notice. We use the same knowledge, skills, techniques, equipment, supplies and medications that are used by obstetricians and nurses to deal with emergencies. Midwives are also very skilled at identifying when things might go wrong. Usually, by the time someone needs an obstetrician or paediatrician, the doctor is well informed of the situation and is standing by.
Still not convinced that midwives are safe? I’m always curious about why people have such doubts. At least for some people the reason is likely that there are stereotypes about midwives that still persist. For example, that midwives are hippies. I’ve addressed that misconception in a blog post here.
You can certainly choose to believe the stereotypes – many people do. I even recently heard that a local family doctor asked a patient why she would want to go back to the dark ages and have a midwife! Perhaps that particular doctor is not stereotyping but is under the misconception that his patients would not have access to modern health care or pain medications if in midwifery care. But he should know better! Midwives have been a regulated part of the health care system in Ontario for over 20 years. We have oodles of data that confirms that midwives provide high quality health care with excellent outcomes that are just as safe as physician care.
What about home birth? Surely, that can’t be safe, you say? First, it is important to note that you do not have to have a home birth if you have a midwife. Midwives maintain hospital admitting privileges and offer the choice of giving birth at the hospital, at home or in a birth centre if there is one near you. Midwives carry out careful assessment of risks and will make recommendations about the safest planned place of birth for a particular client. Midwives want people to give birth where they feel safest and most comfortable.
We are lucky in Ontario that we have excellent research evaluating the safety of home birth in Ontario and in other provinces. All the research says the same thing about the type of midwifery care we have here in Ontario, people who plan to give birth at home have no more complications or bad outcomes than people planning hospital birth with a doctor. But – people planning home birth with a registered midwife have lower rates of c-section, vacuum or forceps assisted births, hemorrhage, and babies requiring resuscitation. Now, I work in a community where the c-section rate for the obstetricians is the same as for the midwives. It is important to understand that the statistics are not the same for every community for every outcome. But on a provincial level, the research applies. I will talk more about the home birth research in a future blog post.
The bottom line is that midwives are just as safe doctors. There is no question about this fact. Keep checking in for future posts on why you might want to choose a midwife. Or, sign up here to receive blog posts directly to your in-box.