A midwife stays with you the whole way.
In my post Prenatal Care without Waiting Rooms I stated that one of the biggest pros of midwifery care for me was the difference in prenatal care I experienced as an expecting mom. I had my first three children using OBs in a conventional hospital setting and my last two births under the care of midwives at home. Second to the prenatal care, my next favorite aspect of midwifery care was the continuity of care. When you select your midwife, you are selecting your birth team.
Whether you desire to work with an OB or a midwife, you will likely spend a lot of time researching, calling, and asking friends for references as you select a care provider for your pregnancy. In the typical scenario, an OB you select will be in a group practice and you very likely do not have a choice in which provider will actually be on call and help to deliver your baby. That may not always be the case, but often it is. One of the only ways that doctors in a group office can work to avoid this disruption is to encourage or find medical cause to schedule an induction; then you are conveniently scheduled for this procedure on your OB’s scheduled hospital day.
Even if you are fortunate enough to go into labor on your own and your doctor is on call at that time, you will see him/her very little during your labor hospital stay. Upon arrival at the hospital you will have a nurse assigned to you (and others) and she/he will be your primary resource until shift change. For some women, this process works well. Maybe labor progresses well, they have a nurse who loves their job, it was a slow day at the hospital and patient ratios are lower allowing the nurse to spend more time with the patients they do have, and the mother delivers before further interruption in their care by a shift change. I am happy for those women and their positive experiences.What if any one of those things had been different?
Rather than listing a myriad of negative scenarios that could ensue, let’s assume you’ve heard your own stories and know that it is not always such a pleasant experience.
The crucial point is, you don’t pick your nurse(s) at the hospital!
All this work in choosing the best OB for you (or your insurance), and you see them twice during labor and delivery if things are going well:
- Once upon admission, after the nurses have done their assessments and asked a myriad of questions getting you into the system – while you’re laboring and trying to find “your happy place.”
- Second to catch your baby, after the nurses had you do some pushing without them to make sure you’re not going to take too long and that you’re pushing effectively – at least for most first-time moms.
Are there exceptions? Of course there are! These are generalities made for comparison of the common/usual experience.
How does this differ with midwifery care?
I’m glad you asked. Remember, you are typically spending about an hour for each prenatal appointment throughout your pregnancy with your midwife. If you have a question or concern at ANY time throughout your pregnancy you are given your primary healthcare provider’s direct contact information. That means you can call your midwife directly at 7:00 pm or on a weekend if you start bleeding/spotting! Not her answering service, not a nurse who will page a doctor to have him/her call you back; you will call your midwife directly.
Even if questions arise that aren’t an emergency, you still have direct contact information so that you can get the answers to your questions before your next appointment. Whether your midwife prefers email or text for such communication, she will let you know. You will be communicating directly with her, your primary healthcare provider.
Typically, home visits are scheduled around 37 weeks of pregnancy so that your birth team gets a practice run before the big day and can find your house, note any special circumstances such as entry or gate codes, review your birth plan and the roles of participants who plan to be present for the birth. All of this helps everyone to be on the same page and to anticipate the best way to help prepare for the birth of your baby. When labor begins, you will call and speak directly to your midwife.
For my clients, I am the first one to arrive to assess them in labor. Vital signs are taken, physical and emotional support given and birth set-up continues as needed. At the appropriate time, a second member of the birth team is called to assist with the birth. That means if it is early, you don’t have multiple people watching you; the person you have come to have a relationship with throughout your prenatal care is present and supporting you. There are no shift changes.
Your midwife also remains with you during your immediate postpartum period. Instead of having nurses take over, checking your vitals and helping with breastfeeding, your primary healthcare provider (midwife) will stay to do those things. The bond and information you’ve shared throughout your pregnancy is carried on and built upon instead of being interrupted. You are valued and treated as an individual versus just one of many. Your midwife is on call for you 24/7!