A Different Approach to Healthcare
I'm the writing-midwife for this blog. I write to provide health information regarding pregnancy, birth, baby, and the early days of parenthood; so that parents may soak up this journey with full joy and only a little fear.
The Midwife Approach
Midwifery care may seem different from the traditional medical system. That’s because it is. There are some basic tenets and beliefs that guide the way midwives practice. They differ from region to region, but can roughly be categorized into: birth is normal, and you should probably be making the decisions.
A common response I sense from people after I give my answer to what midwives do, is, “oh, that’s seems simple”.
"You make birth sound like not a bloody-disaster-in-the-making...don’t we make a big deal out of pregnancy? Isn’t it... dangerous?...Don’t we need to be careful of a million things???"
I wrote about what midwives do in my last post . The informative, dinner party answer version. Now I go into more detail on the midwifery philosophies of care, and how the care experienced with a midwife differs from the traditional medical system. Again, feel free to skip through the sections:
Birth, a Physiologic Process
I think this can be a loaded concept. While clinical and cultural opinions may differ, midwives hold the belief that “for the majority of women, pregnancy and childbirth are physiological events”. This means: your body was built to do this, and you’re not ill, even though you’re vomiting all day. This doesn’t mean: everyone can for sure do this and we don’t need modern medicine intervening. It does mean: let’s start this off trusting and respecting our bodies, and give it the best chance to do what it can. Then, we take it from there one step at a time.
The ICM’s scope of practice also outlines that “midwives should be competent in all means of supporting the physiology of childbirth. Women should have access to midwifery-led care, one-to-one support, including the choice of a home birth and immersion in water”. This leads us to where normal and choice intersect.
Choice of Birthplace
Following the thread of birth is normal and let’s give it a chance to be normal until proven not, a part of facilitating physiologic birth is the choice of birthplace. People with healthy pregnancies can choose to have their baby at home, the hospital, or, the birth centre. Being in a place of comfort, safety, and low distraction, wherever that may be for you, is the best place for labour to start and progress. For some, it is where all emergency equipment is right down the hall. For others, it is being as far away from those bright fluorescent lights as possible, in their own dimly lit home.
Scrap the choice of birthplace, you get a choice in everything!
Informed choice is the concept that you are the main decision maker in your care and it is our job to support you in making an informed one. Not just “small” decisions on your preferences such as, which Bon Iver track you want your baby born to, or basic human-right ones like let me hold my baby first, but clinical decisions too. If you want genetic testing. If you want to screen for diabetes. If you want to have an ultrasound. We try our best to present an unbiased set of information, or at least inform you of our bias, and acknowledge you as the primary decision maker. We may make recommend something, or strongly recommend something, or strongly strongly recommend something, but we’ll make our case for it, and respect that we don’t have an authority to “tell you what to do”.
As everything in the world of childbirth, this is also a loaded topic with some contrasting views. I have never had someone choose against a strongly made recommendation, at least not without such good reasons enough to make any specialist shrug their shoulders and say “well, we don’t really know about that”. As always, if you don’t know what decision to make, that’s fine too! You could always decide to follow the community standards, but now you know why, and what you have chosen.
Continuity of Care
Continuity of care is the one-stop-shop concept. Midwives are there all the way: for the pregnancy, labour, birth, and postpartum - together, a full course of care. It’s a part of a client-centred approach. Why separate the pregnancy, birth, and early postpartum periods when it is a complete event in itself, flowing from one phase to the next. It also means the care you need follows you. You don’t need to find a paediatrician for your baby two days after they’re born and your emotions are running high on milk-producing hormones.
In some cases, this also means having the same midwife or the same group of midwives for the entire course of care. This is sometimes called caseload midwifery. It can be helpful when you make that labour call in the middle of the night to hear a familiar voice.
And there you go! At the end of this your family grows and your midwives get some sleep.
Note: My description is based on the Canadian midwifery system, but the approach and philosophies of care are similar worldwide. Specifically, the process of calling the midwife in labour and the assessments may be procedurally different.
If you are interested in reading more, here is a link to the International Confederation of Midwives, which governs midwifery associations world-wide. They have a formal definition of a midwife and lays out the midwifery philosophies, standards, and code of ethics.