notes on a midwife.

*Disclaimer* *I am rather passionate about this topic. Mostly because I am rather educated on this topic. As a result, I have an opinion about it. I realize opinion posts can come across as rather one-sided. For anyone interested in this topic I do have a side that I sit in, but I do try extremely hard to see both sides. As a result, if you choose to engage in a discussion about it I will not attempt to dissuade you, judge you, prove you wrong or tell you that you are wrong. I will simply tell you why I feel they way I do, based on the information I have. As with all opinions, we can gather new information and change our minds. However on this topic I doubt I will :) *

One of my patients the other day asked what the difference was between a nurse-midwife and a doula.
Inside I kind of laughed. And then I felt sad because I'm sure a lot of women don't know. I'm sure that's why they choose lay midwives who aren't trained in fetal resuscitation, obstructed birth, post-partum hemorrhage, shoulder dystocia and the myriad of other issues that brings home birth mothers into the hospital.
How can women give their baby the best chance at life if they don't even know the difference?
For your information...

A doula is somebody that may or may not have any formal training (and by training I mean a two week class). They are often women who have had children themselves, and take on a SUPPPORTIVE role in birth. They are not medical professionals, nor do they make or can contribute to making medical decisions. They are there to be an encouraging voice in natural labor, to hold hands, play music and massage feet.

And therin lies where the nurse-midwife comes in. A nurse-midwife is a health care professional who has first completed a bachelors of science in nursing degree. They then go on to obtain their Masters (and now Doctorate) in Advanced Nurse Practice in Nurse Midwifery. They take a national exam to be certified. They are overseen by a professional nursing board. They are autonomous practitioners with a minimum of 6 years education. They have performed observed births, taken pharmacology classes and understand how to manage complicated labors. They are the guardians of natural birth. They are legally allowed to deliver in hospitals, own their own clinic and see patients on their own. They can also prescribe.

Obstetricians are medical doctors. They have a four year undergraduate degree, a four year masters degree in medicine, and a four year residency in obstetrics and gynecology. They are primary care providers for women in both before, during and after pregnancy as well as surgeons. OBGYN's are famous for C-sections, but they also do a variety of other gynecological surgeries. These providers are guardians of complicated births. Midwives turn over their patients to doctors when they are older mothers, have co-morbidities like diabetes, hypertension, heart disorders and pregnancy complications like placenta previa and abruptio and fetal abnormalities. OB docs are highly trained and specialized. Many women are wary of them because they think they are out to pull you into a c-section. While some OB docs definitely do abuse c-sections as an easy way out, c-sections are necessary in about 8% of births (statistically speaking). 8 in every 1,000 women will have complications that will warrant surgical intervention.

Lay midwives (who rarely call themselves that) do not necessarily have any formal medical training, and tell women that they can deliver their babies. They have to do this at home or in personal birthing centers because they cannot legally do so in a hospital setting. It is my understanding that lay midwives are the most associated midwives with complications (maternal and fetal death). For the life of me I could never understand how somebody without adequate training (shadowing just isn't enough people) could put themselves in a place where they are setting themselves up to fail. I could never promise to do something that I was not 100% sure I could do as safely as possible. While I am a nurse, and have been trained how to do an emergency birth ('catch the baby') and have labor and delivery experience I would never go to another country or home town and say that I could deliver babies. Heck no! If something happened to a mother or baby because of me, I wouldn't be able to live with myself. I would have known that I did not have the adequate training.

I am pretty passionate about the role of nurse-midwives (CNM's). I think it is a more holisitc way of managing labor (for low-risk, young women). They have equal outcomes to OBGYN's. Hopefully in the future when I am in OB doc I can be a positive voice for this profession, committing to be a back-up doctor for CNM's to whom they can call for support and advice.

I will, however, remain strongly assertive against lay midwives. Obviously I believe in personal choice. When women make informed decisions to chose lay midwives, more power to them. I am not say all lay midwives are bad. They are just a few rotten ones out there. My issue is when women are placing the health and safety of themselves and their infants into the hands of someone who has not been upfront about their training and abilities.

Personally I would choose to place the life, health and safety of my baby as my top priority, not my birth experience. I believe having a positive birth experience is possible in the hospital, which is great because its also the safest place for your baby to be if something goes wrong. I know that deep down inside if I lost my baby because I gave birth to it in the way I wanted (i.e. at home, unassisted, in a rural area etc) and something happened to my baby, I would be so, so gutted at myself. But I realize some women want a birth experience that is different. That is fine. We all live with our choices in the end!

I love this topic and willing to discuss it with anyone!