“Grab some clean towels and boil the water, my water broke.”
This is hardly the reality for moms-to-be nowadays, at least not in major cities. There is a plethora of options—some people choose to have a midwife birth their baby, others a doula, and many more a physician. The choices don’t end there, as you can use a family physician, the standard in most Canadian cities, or an obstetrician. There are many further options, including hospital versus home delivery and medication options. We’ll leave those for another time.
When I was pregnant with my first child, I was in the midst of a Pediatric Emergency Medicine Fellowship in Toronto. I was working at the Hospital for Sick Children, conveniently located across the stress from Mount Sinai Hospital. Many of my friends and colleagues had positive experiences using obstetricians there. It seemed a no-brainer to see one of them for my pregnancy and delivery care. My family doc was a drive away, and Mount Sinai a brief walk.
Now, I had a very strange, unpredictable delivery. I was dilated for weeks before I delivered Dylan, my first. My obstetrician, a no-nonsense, tell-it-like-it-is woman (which I truly value), thought it best to break my water in hospital. She wanted to deliver Dylan and worried that my labour would be fast. She was right, but still didn’t deliver him.
My water was broken and she left to do a Caesarean Section. She didn’t think it possible that I would go into active labour before she returned in an hour. This was my first pregnancy, after all. She was wrong. I went into immediate, intense labour and with no doctor in the room, Dylan came out within two hours. No time for an epidural. No doctor was in the room, leaving my husband to catch him. If you don’t believe me, I have the video to prove it. My husband had the video camera in one hand and caught Dylan with the other—how’s that for a visual?
As it turns out, I didn’t actually need anyone in the room to help us, let alone an obstetric specialist! For many women, a midwife and/or doula could actually be superior and provide more holistic care.
What is a midwife?
A midwife is a registered health care profession who provides primary care to low-risk pregnant women throughout the pregnancy and for 6 weeks after delivery. Registered midwives in Ontario complete a four-year university degree through the Ontario Midwifery Education Program, and they complete a mentorship year before they practice on their own. They are available to clients 24 hours a day and seven days a week. If you see a midwife in Ontario, you will not see a physician unless there are complications during pregnancy.
Midwives are involved in all aspects of pregnancy and help with both non-medical and medical issues. Many midwives are former nurses and in Canada they train through the Canadian Association of Midwives (CAM). Midwife care is covered in Ontario, and there is no need to pay out of pocket.
What is a doula?
Doulas are assistants who provide emotional and some physical support during childbirth. They only provide non-medical help to moms. They are certified through various institutions, such as DONA and CAPPA. Doulas, like midwives, are involved in both pre- and post-partum care. Doula support is not covered in Ontario, and parents must pay out of pocket for their services. Depending on what support parents need, these prices are variable. Doulas work alongside physicians and midwives, so if you have a doula you need a midwife or doc, too.
What do physicians do?
Physicians follow patients every 2-4 weeks during the pregnancy, usually from 12 weeks onwards. The care provided by a family physician and obstetrician tend to be the same, unless the pregnancy is deemed high-risk, in which case more investigations and more frequent appointments may be required. Though some physicians provide tremendous emotional support, most follow the pregnancy with a medical focus with minimal to no holistic support.
Though women usually describe being followed by a physician, nurses perform most hospital-based care. Some women are even followed by Nurse Practitioners who act independently to provide care throughout pregnancy. Nurses are usually the health care providers who are present with mom during labour and provide most postnatal care. They assist the physician during active labour and delivery.
I initially chose a physician and have developed a relationship with her and seen her for each of my pregnancies. I relate to her very well and am comfortable with her style and no-nonsense attitude. Despite missing delivering Dylan, when she came into the room for Ryan’s delivery, she looked at me and said, “Why haven’t you started pushing?” That labour was also short and sweet.
I do always consider using a midwife or doula as well in pregnancy, though I don’t think I require as much emotional support now as I did with my first. Perhaps I am more of my own 'expert’ now and know what I want and need. Depending on what you plan and expect from your caregiver during pregnancy and delivery, you can best chose the provider.
What kind of provider did you use? Would you use the same person or service next time?
Before you make any decisions, read this: Home Birth vs Hospital Birth.