Frequently Asked Questions about Midwives
I get asked lots of questions when people find out that I am a midwife, and I love it!
It’s encouraging to see people’s interest and eagerness to uncover more about an important, under-discussed topic. It is though, over sensationalized, over regulated, and over judged. When do we fully give people the time to delve into the psychology of their fears and their goals, discuss the physiology behind their experiences, or explore the nuances of the metamorphosis into parenthood?
Information inconsistency seems to be a staple in this area. Or overly vague information. The most efficient way to find an answer you need is to ask it! Drop a message with the question that’s been buzzing in your mind: an experience, a thought, or a clinical query. I won’t give clinical recommendations, but we can debrief and deconstruct for a more thorough understanding. I wrote about what midwives do and the midwife's approach to maternity care; here are all the interesting questions that didn’t quite fit into those pieces.
Hey, since you’re a midwife, can I ask...?
Must I have a home birth?
Long story short: No.
Long story: It depends. It depends on where you live. Midwives can practice in any setting: home, hospital, birth center. If you let them. Or if they want to. In some regions, hospital bureaucracies with privileges and insurance may prevent midwives from practicing in hospital settings. Some midwives choose to work in the community and avoid the hustle and bustle of a medical institution.
You can totally have a lovely, well-supported, low-intervention birth in the hospital with a midwife. You choose your birthplace, and you can choose a midwife who offers support in your preferred place of birth.
Do I HAVE to have a natural birth?
Absolutely not, because we can’t control what kind of birth we have! But no, you don’t have to be planning a non-medicated, "all natural" birth. Usually, you would also not be planning to have an elective cesarean section birth.
Depending on where you live, it might be completely appropriate to have a midwife even if you are planning a cesarean section. This is the case sometimes when a midwife works closely with an obstetrician. This way, you have all the support and information throughout the pregnancy before your scheduled delivery.
What happens if there are complications with my labour?
Then I say, I'd be really glad to have my midwife there.
Midwives are trained to differentiate between the normal progression of labour from the abnormal, and manage all the shades of grey in between. This management may be involving an obstetrician or pediatrician in your care, as the midwife shifts into a supportive role. The midwife can keep you informed, help you digest information, and as they are likely familiar with your goals and wishes for your birth experience, they can help you make an all-considered decision.
Can I still have an epidural?
But it is always good to talk about pain more. Childbirth pain is peculiar, and we are obsessed with it. It is beneficial to unpack our preconceived notions and have a better understanding - have I built up this fear from over-sensationalized movies? How consuming is this fear?
How we conceptualize the pain affects how we experience it, and in turn, our entire birth. Your midwife can carve out space for a deeper discussion.
Can I have an epidural at home?
No. The medications used and the procedure of getting an epidural requires a hospital space, and an anesthesiologist, the pain-reliever doctor.
What is an epidural?
It is pain relief during labor. A blend of medications (local and regional anesthesia) is given similar to an IV, into a space in the spine.
The anesthesiologist performs this task by: 1) numbing the skin on your back with a tiny needle and some pain medications, 2) inserting the epidural needle into the correct space on your lower spine, which you won't feel the pain of because of step one, and 3) feeding a plastic little tube into this space from which it will remain for the rest of the labor!
What you want it to do: An epidural takes away the feeling of pain from the waist down. That’s your entire pregnancy belly! You can rest, move around in the bed, sleep, all while your body continues working with the contractions. You should still feel pressure, like when your baby moves down lower; possibly shuffle yourself to the bathroom for pee-breaks; and jump into all sorts of different acrobatic positions to help your baby wiggle their way down when you start pushing.
As all things in life, what we want is not always what we get. That's why a discussion with your midwife can be extra helpful, so you are prepared and content with your decision, regardless of the outcome.
Will there be a doctor in the room?
If you are at home? Then no, unless you have a doctor who is a part of your support team and you wanted them there.
At the hospital? Only if they need to be there. Midwives help people deliver their babies. The person they’re helping is YOU. Or whoever is their client. Midwives are capable of managing the birth. If all progresses smoothly, there will probably not be a doctor in your room at the time of birth. Unless they walked into the wrong room at the precise time of your baby's crowning.
If your midwife anticipates the baby needing extra help at birth, a pediatrician may come into the room. If you wanted an epidural, your midwife would call the anesthesiologist into the room. If your labour went off the rails a bit, your midwife may consult of transfer care to an obstetrician.
What is the difference between a midwife and a doctor?
A midwife’s specialty:
Facilitating the normal, physiological process of pregnancy and birth, so that you give yourself the best chance of a natural birth, and an empowering experience.
Providing well-baby and well-woman care after your birth.
Supporting and you and your babe through your transitions the first few weeks after birth. This includes breastfeeding support.
Lots and lots of breastfeeding support.
Family Physician (GP):
They are the experts in having a general overarching knowledge in everything.
For pregnancy: Normal, healthy pregnancies. Much similar to midwives, but some conditions that overlap with their general knowledge will also be manageable by the GP.
Well-baby care: I think well-baby care under most circumstances for healthy babies could be translated to: weigh the baby. At least the first few visits. Similar to a midwife, the GP will refer baby to a pediatrician if they notice something is beyond their area of expertise.
An OB/GYN’s specialty:
Most obstetricians are also gynecologists. They specialize in women’s reproductive health, young to old, menarche (start of periods) to menopause, and also in avoiding pregnancies (birth control).
Surgery - removing fibroids, cysts, hysterectomies, ectopic pregnancies, and cesarean sections.
Specialists when the birth does not go according to plan: prescribe medications to increase your contractions, help you out with vacuum or forceps assisted deliveries.
Specialists when you have some pre-existing medical conditions in pregnancy that need special attention.
**Note the lack of “baby” under their area of speciality. At the time of birth, a second nurse of a pediatrician will be called in to be the baby expert. Also note the word "specialist" everywhere. An obstetrician's real bread and butter is helping you find and fix the problem when something goes wrong.
The baby specialist for when babies get sick!
All the other specialities
There are many doctors and experts in different fields that the midwife or obstetrician can call upon. If you have diabetes, endocrinologists may be involved, if you have a pre-existing heart condition, a cardiologist might be called. If you need breastfeeding support beyond the time a midwife has on their hands, you might hire a lactation consultant.
You may not even have heard about all these specialities until you need them!
What is the difference between a midwife and a nurse?
This question is more relatable to people who live in regions with a maternity care system set up like Canada or USA. Instead of hospital midwives, we have labour and delivery ward nurses who work with the obstetrician to support you in labour.
Labour and delivery ward nurses: They provide labour support and monitor your labour. They do all the nuts and bolts of the work: start IVs, listen to your baby’s heartbeat, internal exams if needed, and call the obstetrician if they spot something amiss, or it’s simply time to have a baby. The obstetrician steps in for the birth, the birth of your placenta, and any clinical aftercare.
A midwife, or a midwife-nurse team will do all of the above, but there is no need to call in the obstetrician when your baby’s about to be born and all is normal. The midwife continues with your aftercare.
There are endless questions and wonderings around pregnancy, birth, and these tidal wave moments that turn our world upside down in a wonderful way. This list attempts to start the conversation.
Future posts in Miscellaneous Questions to a Midwife will be compiled of FAQ from you.
What have you always wondered about?