Call the Midwife: A walk through of midwifery care
‘ What does a midwife do?
Do I need to see a doctor?
So…is it like you’re helping the doctor?
Are you the doula? No…? Oh, wait, what’s the difference then?
I thought midwives were old ladies in the village.’
These are questions I hear all the time. They’re asked by expecting families, curious individuals at dinner parties when they find out I’m a midwife, and sometimes even other healthcare professionals. The last one might seem odd. While midwives are the norm in the UK, it is still quite new in many countries and not well integrated into the existing medical systems.
HOLD ON…WHAT IS A MIDWIFE?
Skeptical clients and goofballs aside, the hardest time I have answering this question is when I am the one asking myself. That sounds like a cheesy philosophical answer in the making. But when you have been up for 24 hours the third time in a week, and begin to genuinely question if you are doing anything useful in this underpaid profession that somehow has drummed up a passion that underlays your life's entire foundation, it is a real concern. However, as the existential dilemma of a tired midwife is generally not too high on the priority list of expecting families, I am going to write the dinner party answer I give, here.
Feel free to skip between sections:
WHAT IS A MIDWIFE?
THE DINNER PARTY ANSWER
THE MIDWIFE APPROACH
Birth is normal
Beginning to end
A ONE STOP SHOP
1) The midwife see the midwives for all prenatal visits. It follows the same prenatal visit schedule standard for your community. These appointments are generally longer than typical physician appointments (say, 5mins? Just kidding…but am I?). In my practice, appointments are normally booked for 30-45mins. During this time, we discuss upcoming tests standard in the community, do all the blood-pressure-belly-measuring shebang, and check-in with you to see how you’re doing in this crazy adventure you have chosen to embark on. All the routine blood tests, urine tests, sugar-drinking tests, and ultrasounds can be ordered by the midwife. If anything from these tests or your routine check-ups garner further attention, you will receive it. nds to mustering up a better answer to your first-trimester all-day sickness than “...try to hang on until second trimester”. If during the pregnancy a need to see any specialists arise, the midwives will let you know, talk about it with you, get the ball rolling to set up these appointments, and debrief with you after-hand.
I am also including pregnancy loss. This is one overlooked aspect of midwifery that I have found precious and humanizing. Early pregnancy loss is common. Perhaps, that’s why people experiencing it often fall through the cracks in our healthcare systems. Medically, it is often uncomplicated. There is almost always nothing to do to “save” the pregnancy. There is often nothing that needs to be done to help it pass. Like labour, pregnancy loss demands lots of waiting. Emotionally, each person processes it differently, but collectively we tend to sweep it under the rug.
While midwives can not usually prescribe the medications to help this process along or clinically manage the loss, they are normally the first people you call, and the ones checking in. Along the way, they’ll explain what is happening, what may happen in the emergency room at the hospital, and just take in the moment with you. Having answered these pages, I saw these simple phone calls be a place someone can turn to, and heard the voice calm on the other end.
Midwives take care of clients who are healthy, with low-risk pregnancies. This is actually almost everyone. No, it doesn’t mean you have to be under 25, or 30, or 35. If you have certain pre-existing conditions, such as Type I diabetes or high blood pressure, then you may be referred to see an obstetrician for your pregnancy. In some cases, you might be able to have a joint team of midwives and specialists.
You see the midwives for all prenatal visits. It follows the same prenatal visit schedule standard for your community. These appointments are generally longer than typical physician appointments (say, 5mins? Just kidding…but am I?). In my practice, appointments are normally booked for 30-45mins. During this time, we discuss upcoming tests standard in the community, do all the blood-pressure-belly-measuring shebang, and check in with you to see how you’re doing in this crazy adventure you have chosen to embark on. All the routine blood tests, urine tests, sugar-drinking tests, and ultrasounds can be ordered by the midwife. If anything from these tests or your routine check-ups garner further attention, you will receive it.
In some models of care, you see the same midwife or a team of midwives for the entire pregnancy. Midwives are on call 24/7 for urgent concerns. In places like the UK where midwives are well integrated into the hospital, then a working midwife at the hospital would take your call.
CALL THE MIDWIFE!
As you approach term (37 weeks of pregnancy), your midwife team would talk to you about when to call in labour. It depends usually on if this is your first time giving birth. Some midwives like a heads up call. Some don’t. But when in doubt you can call your midwife. They might be a bit sleepy and groggy but they will take your call and calm your nerves. Most times, the midwife chats with you on the phone and by their trained ear, know you are in early labour. They give you their regime for early labour and have you call back later. Sometimes this ‘later’ could be 30 minutes, sometimes three hours, and sometimes the next day. Birth takes patience.
So... you call back later, and it seems like the party is starting! Now, this part differs depending on the community you are in, here are some ways things proceed:
1) Midwife makes the trip - The midwife comes to your home to do an assessment. If you are still early, the midwife makes the trip back home, rather than the all-too-familiar story of the anxious couple rushing to the hospital only to be sent back again. And again. And again. Until they finally give up and just hang out at the hospital making themselves very acquainted to all the hallways.
2) Home Labouring - The midwife comes to your home to do an assessment. You are ready to be admitted to the hospital or birth centre. You are coping really well at home, enjoying your own space, and the midwife is enjoying the way-better-than-hospital-food snacks you have generously prepared. So, we decide to hang out at home for a while longer. The midwife has all the tools to monitor the labour’s progress, the baby, and you.
3) Home birth! - The midwife comes to your home to do an assessment. You are in active labour, so the midwife stays. Along with the midwife, a heavy, back-breaking backpack of emergency supplies, birth supplies, oxygen tanks, stays as well. When it’s close to baby time, the midwife will call a second midwife for an extra pair of hands and a clear, non-sleep-deprived mind.
4) Going to the hospital - Your midwife and you decide to meet at the hospital or birth centre for an assessment, or maybe they ask you to come in. The midwife will assess you and determine if you are ready to be admitted. If you are, yay! They will stay with you for the whole labour, minus pee breaks.
In short, your midwife is there for you throughout your labour.
If there are any concerns, the midwife may consult the obstetrician. The midwife-obstetrician team and you, will decide on a plan. If the decision is to not continue labouring, then the obstetrician will help you have an assisted delivery. If all’s well to continue labouring, the obstetrician leaves to be called back if needed again.
If anything throughout the labour or birth seems off, the midwife will consult with an obstetrician. If needed, the obstetrician may be there at the time of birth for an assisted delivery, vaginal or otherwise. If the labour goes smoothly but your baby wants to give us a heart attack while you are pushing, then a pediatrician may be in the room at the time of birth. If there is a larger than the expected situation, then all the hospital’s staff, and all the hospital’s resources will be there for you and your baby. ush in. They may tell you that you can feel your baby’s head! Eek! But it is some great motivation. And they’ll respect you when you decline all of that. Then the midwife will catch the baby, or your partner, or a sibling, or another important person of your choosing, or yourself(!) and bring that slimy, slippery, warm thing to your chest, which your eyes will meet and deem the most perfect baby. And they are.
There is generally a pause here in the room. We let the family soak it all in. The midwife is attentively observing you and baby to make sure everything is alright as you continue to cry and shake and cuddle the newest addition on planet earth.
The midwife helps you to deliver the placenta, and sometimes offer you a “placenta tour”. It seems gross, but I highly recommend it. Your body grew this organ that caused the early anxiety-inducing spotting, the nausea, the all-day sickness, and was the lifeline to your baby for 9 months. I say it deserves a peek.
If anything throughout the labour or birth seems off, the midwife will consult with an obstetrician. If needed, the obstetrician may be there at the time of birth for an assisted delivery, vaginal or otherwise. If the labour goes smoothly but your baby wants to give us a heart attack while you are pushing, then a pediatrician may be in the room at the time of birth. If there is a larger than the expected situation, then all the hospital’s staff and all the hospital’s resources will be there for you and your baby.
BABY'S HERE: POSTPARTUM
Midwives are also trained to do suturing. I won’t get into that now, but that’s another thing that comes with this full-service deal. tend to leave you to hold your baby skin-to-skin uninterrupted. We’ll do the paperwork, monitor your bleeding, and continue keeping an eye on everyone. You will stare at your baby, mesmerized.
Midwives are also trained to do suturing. I won’t get into that now, but that’s another thing that comes with this full service deal.
We’ll help you latch your baby for their first breastfeed. Sometimes, even in the operating room. You’ll watch your baby eat; completely intrigued and proud and blown away that they know how to do this already. We’ll weigh the baby, eventually, and do a head-to-toe newborn exam to confirm what you already know - that your baby is perfect. If there is anything that should be checked out more, we call a paediatrician or set you up with an appointment. Before we leave, we’ll give you a whole bunch of information that you will forget, on what to expect, how to care for yourself, and when you’ll see us next. Though we know that no matter how many times we say get some rest, you’ll end up gazing at your baby for longer than recommended, we still say it. Then we leave you to sleep.
Most often, you leave the hospital sooner than under physician care. The midwives are responsible for all the routine tests offered for the baby. In Canada, midwives are still on call for you for 6 weeks after birth. Depending on the community you’re in, the midwife may do home visits the first-week post-birth. This is where they check up on your recovery, weigh the babe, and most often, help with breastfeeding. You sometimes graduate to clinic visits after baby is two weeks old. If there are concerns for you or baby that arise during this time, we would do the initial assessment, then refer you to an obstetrician, or baby to a pediatrician as needed.
Then, we send you off and see you again for the next time!
My description in this post 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.
Did you experience something different? Were you expecting midwifery care to be something else? Share your thoughts in the comments!
I write about midwifery care philosophies and how midwives may approach birth differently than a more medicalized system in part 2.
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.
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