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Obstetricians, family doctors and midwives all provide quality care. The differences are largely in their training, and in the environments in which they work. Many times they work together in teams, so mothers-to-be to can benefit from the skills of each.
Obstetricians are specialist doctors. They have studied for four years after medical school, learning about women’s reproductive systems. They know how to manage complications in pregnancy and are trained in surgery of the reproductive system. In offices and hospitals they care for their own patients and provide expert help for family doctors and midwives if complications arise during pregnancy.
Obstetricians have tight schedules and deal with many emergencies, so getting an office appointment can sometimes be a challenge. You may choose to have them work with your family doctor. This gives you the convenience of your family doctor for routine prenatal or other minor concerns but you benefit from the special skills of the obstetrician as needed. For instance, an obstetrician can often turn a baby in breech position from head up to head down, making a natural delivery safer.
Family doctors are physician generalists. They have spent at least two years after medical school learning how to care for the medical and psychosocial needs of people. From tiny babies to the elderly, they treat a wide variety of short term and long term conditions. Much of their time is spent on preventive medicine, such as helping people quit smoking or advising them how to avoid sexually transmitted diseases. They also usually work in offices and hospitals, although this varies somewhat.
Because family practice is such a broad field, many doctors have special interests within it. Some family doctors do not include pregnant women in the scope of their practice. Others enjoy being a part of the childbirth experience and care for many pregnant women, including those whose family doctors do not do deliveries. Many family doctors, especially in rural areas, have an extra year of training, learning special skills such as performing caesarean sections or providing epidurals for pain relief in labor.
Midwifery is less easy to define, as this profession is currently in evolution. In Western Canada, standards and regulations are being developed for midwife registration. There are also plans to set up midwifery training programs. For now, however, midwives have various degrees of training in the care of women through pregnancy, childbirth and after delivery care. Most are either trained as nurses, educated in a midwifery program overseas, or self-taught.
Midwives often provide much of your early care in your home. They may be able to offer you a variety of locations in which to deliver, such as the hospital, a birthing centre, or even at home. They will usually stay with you through the entire duration of your labor. This is different from the physician-nurse team in which your doctor comes and goes through the labor, and your nurses change shifts every 12 hours.
At the moment, only hospital-funded midwives are free of charge to the patient. Otherwise, costs average $1,000 to $1,400 depending on who the midwife is, how many of her services you choose to use, and where you decide to give birth.
Sometimes your choice of caregiver will be obvious. If there are serious problems that threaten the life or health of you or your unborn child (for instance, if the baby will be very premature), you are considered 'high risk.' You will benefit from the skills of an obstetrician and the immediate access to a modern intensive care nursery. No one is interested in recreating the dismal maternal and infant mortality rates of the last century! Low risk women, if they wish, have the luxury of choosing a more personal approach, such as a family doctor or midwife and possibly even a home birth. However, other factors enter the decision-making process.
How do you know if you may have problems such as a baby that does not breathe on its own or serious bleeding following the birth? Many attempts have been made to create the perfect questionnaire to separate the high risk women from the 'low risk.' Unfortunately, we still do not have a perfect method to predict who will have problems. Although we certainly see more complications in women with many risk factors such as smoking or high blood pressure, many of these go on to have normal healthy deliveries. About 50 per cent of women who have complications have no previous risk factors.
Only you can decide who you would be most comfortable with as your practitioner. Often a woman and her family already enjoy a good relationship with their family doctor. This person can follow the pregnancy, answer questions, keep an eye out for problems, and discuss issues such as sexuality in pregnancy and epidurals in labor. At the time of labor and birth, the parents can make well-informed decisions and have a known and trusted person to provide guidance in an unexpected event.
In an ideal situation, the delivery takes place in a comfortable environment where the woman’s support team is welcome. Comfort includes a shower with endless hot water, the option of any number of positions in which to deliver, and good pain relief easily available if requested. As well, this environment has the immediate expertise and technology if an emergency arises where minutes count.
Following the birth, if your care giver is your family doctor, the care continues for mother and child, from early needs such as breastfeeding support to the many years which follow. A midwife could also care for both mother and child, although usually only for the first few weeks. An obstetrician continues to care for the mother after the birth but hands the care of the baby over to either the child’s family doctor or a pediatrician.
If your family doctor doesn’t deliver babies, or if you are looking for a different approach, where should you start? For referral to an obstetrician or to another family doctor that does maternity care, your family doctor is the best person to contact. If you don’t have a family doctor and would like one, your local hospital should have a list of practitioners in your area.
How to find out who practices midwifery in your area depends on where you live. This profession is just in the process of getting organized, so some of this information may be out of date by the time you read this. It is also by no means complete, but should give you a place to begin. In British Columbia, the Registrar of the College of Midwives of B.C. at (604) 875-3580 can give you a list of their members.
In Alberta, there are plans to develop a College of Midwifery since midwives are now registered in the province. For further information, contact the Registrar of the Midwifery Committee for the Health Disciplines Board of Alberta at (780) 415-0492 or look in the Yellow Pages under midwifery. In Saskatchewan and Manitoba, the legalities have not yet been sorted out. Legislation is currently proposed in Manitoba to make midwifery a choice for women in that province. In Saskatchewan, however, such legislation is still said to be far off.
A full description of the pertinent issues and the roles of each type of practitioner is beyond the scope of this article. However, the bottom line is that you need to choose someone who can meet your needs and then remain flexible and informed. To that end, you need to know what you want.
Meanwhile, enjoy those last few nights of sleep and look forward to the days to come - it’s a fine, fine time.
FAMILY HEALTH is written with the assistance of |
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Articles in the Childbirth section of Family Health OnLine are sponsored by:  |