Choosing a midwife or doctor

When two heartbeats blipped on the ultrasound monitor, my hopes for the delivery I’d always wanted went flying out the window. When you’re expecting twins, your birth plan choices can become more limited — I needed an OB, and a Caesarean birth was likely.

Read more: A guide to expecting twins>

For women facing a low-risk pregnancy, though, there’s much more to consider. Do you want a home birth, or to deliver at a midwife centre or hospital? What’s the difference? What about pain medications? Who’ll be in the birthing room? And what, exactly, is a doula?

Read more: Myths of midwifery>

Laura O’Rourke, a mom of two in Halifax, chose an obstetrician for both of her sons’ arrivals. She endured a 38-hour hospital labour with her first son, Cameron. When her second child, Gavin, went two weeks past her due date last year, she resisted her doctor’s suggestion to induce, worried the intervention would trigger an even more difficult labour.

“I really wanted things to go naturally,” she says. They stuck to her birth plan, and she eventually had a relatively quick 16-hour labour. “It’s great to listen to your doctors, and to get an opinion, but there are other choices. They know the medicine, but you know yourself.”

Read more: Long labour survival guide>

For most women, the toughest decision is whose care to seek. Canada gives three options for primary caregiver: OB, family doctor or midwife (where available). Obstetricians attend hospital deliveries, but there is no guarantee that your OB for prenatal care will be on duty the day (or night) you go into labour.

Some family doctors provide care right up until birth, while others will transfer care to an OB for the final weeks of pregnancy and labour.

Midwives are gaining in popularity, but access varies widely, says Anne Wilson, former president of the Canadian Association of Midwives. Ontario has more than 600 midwives, but in northern Canada and the Maritimes, midwifery practices can be hard to find. In Ontario, Quebec, British Columbia, Manitoba and Alberta, where the government regulates and funds midwifery, the cost is covered.

Midwives tend to be non-interventionist, Wilson says, but they can access drugs and other interventions as needed, including — at most hospitals — ordering a doctor-administered epidural, if requested. They provide all of the standard examinations and screenings, and are the only practitioners trained in home birth. (The vast majority of midwife births are conducted in hospitals, however.)

Regardless of what kind of care you choose, expect to attend prenatal appointments every four to six weeks, increasing to every two weeks at 30 weeks, and weekly after 36 weeks.

The next big question is who will be in the room for the birth. A partner or parent — or both — is common. Depending on how many people are allowed in the birthing suite, you might also want to consider a doula, a trained support worker who provides emotional and physical help before, during and after labour. The cost of a doula package that includes two prenatal visits, labour and delivery, and a postpartum visit ranges from $300 to $1,500.

Midwives continue to check on mom and baby for a few weeks after birth, and will also come to your home in the first days after birth (as will most doulas).

Montrealer Jian Chang* and his partner Dee opted for obstetric care for their first pregnancy. “We know clearly what a doctor-patient relationship entails,” Chang says. “We are more comfortable going ahead with that than having the extra emotional support of midwives and doulas. Ultimately, you decide what you truly need for a safe birth, and what you want for your own comfort.”

*Some names have been changed

A version of this article appeared in our March 2013 issue with the headline "Choosing a midwife or doctor," pp. 75.