I'm choosing a midwife for my prenatal care for my first pregnancy and I'm keeping my fingers crossed for a home birth over an OB or hospital. I made this decision for a multitude of reasons both personal and practical. Here are some of them.
1. A Midwife Is A Highly Trained & Educated Registered Health Professional
In Ontario, a midwife is a highly trained and educated registered healthcare professional.
Midwives provide primary care for low-risk women throughout their pregnancies, labour & delivery, and several weeks postpartum. With my midwifery practice, it's 6 weeks of care post-partum in-home.
The term midwife conjures up many different emotions and opinions and can be applied to the illiterate village woman who has never seen the inside of a classroom — like the one who delivered all of the babies in my mother's home village in Croatia, including my grandmother, my mother and her 7 siblings — to the highly educated, trained, and regulated healthcare professionals here in Ontario and Canada.
Midwives are fully covered under our healthcare system which means there are ZERO out-of-pocket fees for me; rather, our Canadian socialized healthcare system takes care of everything.
2. There Are Statistically Fewer Interventions With Midwife Care
Just a few examples:
- Midwifery clients have a 38% lower c-section rate.
- Midwifery clients have a 62% lower rate of forceps and vacuum deliveries than women delivering with family physicians.
Cesarean rates in hospitals are rising dramatically. Many medically unnecessary. Many women report feeling forced into them.
Sources & Further Reading:
- A Systematic Review Comparing Continuity of Midwifery Care With Standard Maternity Services
- Maternal outcomes and birth interventions among women who begin labour intending to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses
- Getting the first birth right: A retrospective study of outcomes for low-risk primiparous women
3. With a Midwife, I Choose Where I Give Birth
Midwives have hospital privileges, but they also offer the route of a birth center or the comfort of your own home.
I'm planning for a homebirth, and as long my pregnancy remains low-risk and uneventful, I see no reason to be in a hospital. I also do not want an epidural, an IV, or any other medications.
My midwife is supportive and on-board with these decisions. She has seen countless successful home births.
If something changes during labour and delivery, a midwife knows when to make the call to transfer a labouring woman to the hospital.
I'm not even a little bit anxious or afraid of my impending labour and delivery (yet). I'm looking forward to childbirth. I want to see what my body and mind are capable of. I see it as a powerful and special expression of femininity and womanhood, an initiation into a mystery of which I am wholly ignorant of.
Am I being wholly naive as a first time pregnant woman? Might things change for me?
I can't predict the future. But that doesn't mean I can not or should not also plan, hope, and wish for a certain type of birth experience. And my midwife is there to guide me into the best decisions. So if I do need a hospital transfer or an emergency cesarean, I will trust her word and experience along with my own intuition.
I have nothing but respect and awe for the women who get cesarean sections and epidurals — there is nothing wrong with this — but the thought of either terrifies me beyond belief.
In Ontario, home births are statistically as safe as hospital births.
If I can have a simple and easy labour at home, if a home birth is statistically as safe as a hospital birth here, if I'm having a boring and low-risk pregnancy — why would I not take that entirely logical route? To me a hospital is a place for the sick, injured, and dying and not for the birth of my child if I can avoid it. If any of that changes, so do my plans. It's that simple for me.
Sources & Further Reading
- Why Give Birth at Home?
- Home Birth Safety
- Canadian Women's Health Network on Homebirth
- Home birth with midwife just as safe as hospital, McMaster study finds
- Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician
- New Studies Confirm Safety of Home Birth With Midwives in the U.S.
4. Midwifery Clients Are More Successful At Breastfeeding
None of the women in my family have had significant issues breastfeeding and most breastfed well over a year.
But that doesn't mean I want to take chances or risk my own success at being able to naturally breastfeed my children without resorting to donor breast milk.
A part of the care that midwives provide postpartum to women is assistance and troubleshooting with breastfeeding. It has been demonstrated that women are more successful at breastfeeding under midwifery care.
Sources & Further Reading
- Two sides of breastfeeding support: experiences of women and midwives
- Association between home birth and breast feeding outcomes: a cross-sectional study in 28 125 mother–infant pairs from Ireland and the UK
- Midwives’ Time and Presence: A Key Factor in Facilitating Breastfeeding Support for New Mothers
5. Client Satisfaction Is Higher Under Midwife Care
Women are more satisfied with care by midwives than with care provided by doctors.
Satisfaction scores can be as high as 98% for the midwife group.
Sources & Further Reading
- Evaluation of Satisfaction With Midwifery Care
- Factors Related to Women’s Experiences and Satisfaction with Prenatal Care
- What Mothers Say: The Canadian Maternity Experiences Survey
6. Midwifery Care & Informed Consent
It is respect for the woman's autonomy that underpins the requirement for informed consent.
Midwifery care is founded on respect for pregnancy and birth as normal, healthy, family-centered life events. Midwives recognize the childbearing woman as the primary decision-maker in her care, and commit to empowering families to take on this role by providing time, information, and guidance about choices in maternity and newborn care. Midwives anticipate that you will also actively seek out other sources of information in order to make informed choices.
Midwives promote decision-making as a shared responsibility; we view our role as providing information to assist you in making these important decisions.
Beautifully worded by Aurora Midwives.
Sources & Further Reading
- Informed Consent: Human Rights and Respect in Maternity Care
- Informed consent: Ethical issues for midwife research
7. Midwives Offer Highly Personal Care & Attention & Holistic Healthcare
The midwife assigned to me is the midwife I will see for all of my appointments.
At my birth, there will be a second backup midwife present to assist us both as needed.
Every appointment I have been to (not many due to COVID) has been friendly, caring, and highly personalized.
I don't feel like just another patient. My midwife has a motherly warmth and caring about her that is calming and reassuring.
I have never felt that level of personalized care from a medical doctor. I generally feel a high level of anxiety whenever I've had to go in for anything.
My midwife treats me as a whole person, not just another pregnant patient.
8. Midwives May Be Less Judgemental of Your Choices
My body, my choice.
Your experience may be different but I felt completely comfortable being honest about my decisions and beliefs with my midwife.
When I told my midwife I would not take prenatal vitamins but rather was following a Weston Price Ancestral Health Diet For Pregnant And Nursing Mothers — she didn't even bat an eye.
When I told her my folate intake was coming from eating liver. That I was taking cod liver oil. That I was drinking raw milk and fermented raw milk kefir smoothies, she didn't treat me like an imbecile or attempt to lecture me.
When I bloodwork, the glucose test and plethora of screenings pregnant women typically undergo and told her I would only be getting the two standard ultrasounds at 12 and 20-weeks and a urine test — she didn't try and force me. She didn't talk down to me.
She simply told me about my options, informed me about the risks, and allowed me my freedom and bodily autonomy.
My pregnancy is not an illness or a disease and I refuse to be treated like a patient. I'm just a mother-to-be, like billions before me and after me.
If that changes, so will my decisions.
Medical interventions and tests serve their purpose and I am grateful to them and the incredible things they have done for women and humanity — but I only consent to them when absolutely necessary and so far they have not been.
9. Because It Is My Right As A Woman & Mother To Be. Because Midwifery is Evidence-Based. Because of Actual Feminism
If you want to learn about the horror show that was and is woman's prenatal care, I urge you to read two books that offer insight into the history of midwifery and obstetricians while also giving you real, practical knowledge and traditional wisdom.
Black women are three to four times more likely to die from pregnancy-related causes than white women, according to the Centers for Disease Control and Prevention. It's partly why the overall rate of pregnancy-related deaths has climbed over the past two decades, making the maternal mortality rate in the United States the worst in any industrialized country, according to a 2016 analysis published in the journal The Lancet.
The first book I already mentioned at the beginning of this article, but it bears repeating, and that's Ina May's Guide to Childbirth.
The second is much older, from the 1930s (updated frequently), and that is Childbirth Without Fear: The Principles and Practice of Natural Childbirth by Grantly Dick-Read, a doctor who had his reputation frequently marred by going against the medical system.
Both are empowering, eye-opening reads.
In North America, midwives were driven out of practice by the medical establishment in the early 20th century in a concerted smear campaign that has had devastating consequences for women's prenatal healthcare that still echo today.
They saw childbirth as the money-maker it remains today.
Why is no one marching against this? I see countless women in the mainstream media marching for reproductive rights, but what about pregnant women and their newborns?
I don't know.
I didn't even hear about these things until I got pregnant myself and when I learned the history I was furious. You should be furious too.
The slander against midwives was successful. By 1955, only 1% of U.S. births took place in the home. Only 8% of the births in the United States are now attended by midwives, while 70% of the European and Japanese births are attended by midwives. As a result, the United States has the second-worst newborn death rate in the developed world. Only Latvia, with six deaths per 1,000 births, has a higher infant mortality rate than the United States. The U.S. also has the highest maternal mortality rates. The safest country to give birth in is Sweden, which has a midwife (or two) at almost every birth, and these same birthing professionals actively involve themselves in prenatal care too. The Swedish do not treat pregnancy as a disease that needs pharmaceuticals, intensive hospital care, and intervention by doctors. Their babies are the better for it.
Sources & Further Reading
10. Choosing A Midwife Takes Some Burden Off of Our Healthcare System
Canada has socialized healthcare, meaning that I do not pay a cent out of pocket for seeing a midwife, obtaining ultrasounds, and any tests, or for labour/delivery and postpartum care.
Socialized healthcare isn't "free" though as we like to say as our hard-earned dollars pay for it in taxes. Seeing a midwife frees up hospital beds and doctors/nurses for the pregnant and labouring women who truly need it as well as the other patients.
Our healthcare system is stressed enough as it is.
Midwives are a vital, cost-effective part of a health-care system that is under strain. Their role should be expanded, not scaled back.
Midwives perform a vital service. They take 17 percent of births out of the hands of Ontario’s obstetricians and primary care physicians, whose services are urgently required elsewhere in our system. They provide an extraordinarily high level of pre- and post-natal care, offering the same diagnostics and monitoring women would receive from a physician for labour and delivery. In providing home visits after birth, they also reduce the need for new parents to haul their infants into doctors’ waiting rooms full of sick patients. This type of care is of particular importance in rural and remote areas, where expectant and new mothers are even farther away from (already limited) pre- and post-natal care. The effects of midwifery care on patients are clear: mothers who have been in their care overwhelmingly report a high level of satisfaction and tend to return to midwifery care for later pregnancies. Further, mothers who have received midwifery care tend to require less medical intervention and spend far less time (if any) in hospital. In other words, the midwifery model of care saves money.Why Is Ontario Cutting Midwife Funding?
These are my personal reasons for choosing midwifery care over an OB. Your reasons for choosing one or the other will be highly personal as well. If you have a high-risk pregnancy, you will not have a choice. If your pregnancy suddenly becomes high-risk, you may be transferred over to an OB.
Whatever path you choose — it's your decision to make. There is no right or wrong here.