Myths of midwifery

When Stephanie Slobodnik became pregnant with her first child, a friend persuaded her to consider using a midwife. “I was a little nervous because I didn’t know anything about midwives,” she says. “Would there be pain relief if I wanted it? That was big with me! Would I have to deliver at home?” The Toronto human resources manager decided to check in with her doctor. “She is quite conservative and I didn’t think she’d be very gung-ho,” says Slobodnik. “But she was. She has several patients who have used midwives and she’d heard many positive things about them.” Slobodnik ended up having such a wonderful experience that she called her midwife as soon as she found out she was pregnant with baby number two—and again with her third.

Slobodnik is one of a growing number of women in Canada who are choosing midwives for a more personal childbirth experience. In the process, they’re finding the stereotypical image of the midwife as an untrained labour coach who only delivers babies at home is more myth than reality. Still, some misconceptions linger. “It’s amazing what we hear from people all the time,” says Lisa Weston, a midwife and vice-president of the Association of Ontario Midwives. Here are seven of the most common midwifery myths, debunked.

Read more: Choosing a midwife or doctor>

Myth #1 Having a midwife isn’t as safe as having a doctor

In fact, choosing a midwife as your primary caregiver is perfectly safe, says Weston. Midwives are able to provide more intensive care than doctors; a midwife typically cares for only four or five women a month, and each visit lasts from 45 minutes to one hour. Midwives also wear pagers and are available day and night. “When you’re responsible for that number of women and spend that kind of time with them, you tend not to miss things,” says Weston. Studies show that midwifery clients experience lower rates of forceps and vacuum extractions, Caesarean sections, episiotomies, infections and babies born requiring resuscitation. As Slobodnik discovered, many doctors and nurses now consider midwives colleagues and may recommend midwifery care to their patients or choose it for their own births.

The majority of midwives practise in offices, some work out of their homes, and a few will even come to your house. Prenatal visits are usually once a month for the first 28 weeks, every two weeks until 36 weeks, and then once a week until your baby is born. Your midwife will monitor your blood pressure, order blood work and other tests if you want them (see Myth #5) and track your progress in the same way a family doctor or obstetrician would. Besides handling any physical problems, midwives help you adapt psychologically and emotionally to parenting, and answer those zillions of questions new moms have. “My midwife spent a lot of time talking to me — not just about the baby, but about how I was feeling,” says Caroline Boone, of Etobicoke, Ont., who became pregnant with her first child at 36. “I was really emotional, and she got me through that.” Midwives also make frequent home visits in the first two weeks after birth to make sure the baby is thriving and to help the new mom adapt. “My midwife, Narges, showed me how to bathe Elizabeth, among other things,” says Boone. “Sure you learn this stuff at the hospital, but you totally forget. And then you’re dealing with your own tub and sink, not the stuff they have at the hospital.”

During the actual birth, midwives work in teams of two: One is primarily responsible for the mother’s care, while the other is devoted to the baby. “I’ve had friends who have said, ‘My doctor was nowhere in sight when it was time to push and the nurses ended up delivering,’” says Toronto mom Suzanne Bartolini. “My midwife was right there with me the whole time.”

If you opt for a home birth, the midwife has all the emergency supplies necessary — oxygen, IV and resuscitation equipment — to manage any situation that arises until the mother and baby can be safely moved to hospital, says Kerstin Martin, president of the Canadian Association of Midwives. “If something about the labour process indicates that it might be safer for the mother to be in hospital, then she goes to hospital. The majority of transfers to hospital are done preventively — not to deal with a crisis but to avoid one.”

Myth #2 If I have a midwife, I have to have a home birth

Actually, 75 percent of midwife-assisted births in Canada take place in hospitals. “I planned a hospital birth right from the start, and my midwife never once pushed me to deliver at home,” says Boone. “I wanted the reassurance just in case something went wrong. And, to be honest, I didn’t want to have to clean up the mess afterward.”

Midwives will always support your right to choose the place of birth—whether it’s at home or in the hospital, says Weston. “As long as the midwife is confident that you and your baby are well and healthy, it’s up to you to decide.” All registered midwives have hospital privileges, and they remain in charge of your care when you’re in hospital unless there are complications. If care has to be transferred to a doctor, that doesn’t mean you lose your midwife, she adds. “Once a woman has been booked into midwifery care, even if she develops a problem such as high blood pressure and needs a doctor, we still provide supportive care, we still attend the birth and we’re still responsible for the baby. And as soon as the woman is well, the doctors return her care to us.”

Myth #3 If I have a midwife, I can’t have an epidural

Many moms-to-be assume that midwives are only for women who have easy labours or can handle pain. “Absolutely not,” says Weston. “One of the cornerstones of midwifery is that the woman is the primary decision maker. If she decides she wants an epidural, we would never say, ‘No, you can’t have it.’ We spend a lot of time during the pregnancy talking about labour and birth, and what your options are. Then it’s entirely up to you.” After discussing the pros and cons of pain relief with her midwife, Bartolini remained undecided. “I said, ‘I’ll see how it goes, but I want an epidural if I can’t handle the pain,’” she recalls. “I was in labour for two days, then I got induced because the dilation wasn’t progressing. When my contractions started coming on hard and fast, I knew I was going to need an epidural.” Since only an anesthesiologist can administer an epidural, that meant a temporary transfer of care from the midwife to hospital staff. “But as soon as Evan came, they handed him to my midwife,” says Bartolini. “She took care of the baby while the doctors took care of me.”

There are women who know they want an epidural right from the beginning, and there are women who are just as adamant they don’t want one, says Weston. “We have to talk to them about when an epidural may be needed—and not even for pain relief. If labour is going on and on, you have to find a way to move ahead and it might be an epidural. And it might be the midwife who suggests it.”

Myth #4 Midwives don’t have any formal training

Most midwives are trained professionals who are considered specialists in normal pregnancy and birth. In the seven provinces and territories that regulate midwifery, midwives must complete a four-year university program and register with their provincial regulatory body to legally practise midwifery (see Midwives across Canada). “Students spend four years concentrating only on pregnancy, labour, birth and newborns. It’s extremely focused training,” says Martin.

In some provinces, Aboriginal midwives have an exemption clause, allowing them to practise in their own communities without being registered. The Six Nations of the Grand River Territory in Ontario, for example, has an independent training program for Aboriginal midwives, and authority to practise comes from the Six Nations Council. In provinces where midwifery isn’t regulated, there may be lay midwives who have informal training, but are not regulated by any provincial organizations.

Myth #5 You can’t get any prenatal tests if you have a midwife

“A lot of women think, Oh, there are certain things I have to go to a doctor to get,” says Weston. But in provinces where midwifery is legislated, the tests that doctors typically provide to pregnant women—genetic screening, ultrasound, lab tests — are provided by registered midwives as well. Midwives also explain the purpose and potential outcome of each test before you decide whether to take it. In provinces where midwifery is not regulated, midwives can’t order tests, and you will need to see a doctor periodically for blood work or an ultrasound.

Myth #6 Midwives are expensive

In 1991, Ontario became the first province to pass a midwifery act (which was put into effect in 1994). “Before regulation and funding, the only people who could afford midwives were women who had money,” says Weston. Now, in all provinces and territories where midwifery is regulated (except Alberta), midwives’ services are paid for by your provincial health care plan. That means your midwife will provide complete prenatal and birth care, and also care for you and your newborn for six weeks after the birth. However, you can see your family doctor for other non-pregnancy health concerns, such as a sore throat or urinary tract infection. If pregnancy complications arise that aren’t within your midwife’s scope of practice, she’ll consult with the appropriate specialists.

Myth #7 Doulas are the same as midwives

While a doula may offer the same emotional and physical support to a woman during labour as a midwife does, she doesn’t provide medical care or deliver babies. “The main focus for the midwife is medical, while for the doula it’s non-medical,” says Carolyn Thompson, a doula and executive director of the Childbirth and Postpartum Professional Association of Canada (CAPPA Canada). During labour, doulas help moms-to-be with relaxation techniques, positioning and other non-medicinal pain-relief measures. Many doulas offer postpartum care as well, including breastfeeding support. More women are opting to have both a doula and a midwife, says Weston, who worked as a doula for 10 years. “Having that extra pair of hands really helps.” Services are not covered by provincial health care plans; the cost of a doula ranges from $300 to $1,800 for what Thompson calls the “whole birth commitment” — two to six visits during pregnancy, being present throughout labour and several visits after the baby is born. Some private insurance plans reimburse for doula services.

For a list of doulas in your area, contact CAPPA at cappacanada.ca.

Originally posted in February 2009.