Opinions re. Midwifery?

[Guest michca]

I'm not exactly sure if I'm posting this in the right section, but since midwifery services are tied in with primary care of pregnant women, I thought this might be the most appropriate place.

 

Anyway, I am strongly considering obtaining a second degree in midwifery should I not be successful in this year's application cycle for medicine.

 

I am just curious, for those med students, and residents out there (esp. those in Ontario and BC which have legalized and fully funded midwifery programs)- have you had any interaction with midwifery students/midwives? Were those interactions positive? Do hospitals/obstetricians/family physicians seem to be open to the concept of midwifery care within the hospital setting?

 

Furthermore, do you foresee midwifery care as a positive option in health care, esp. given that the numbers of family physicians willing to do obstetrics is steadily declining?

[Guest 007]

This is just my lowly undergraduate opinion, but I do prenatal tours at a hospital in Ontario and quite a few of the expectant families have midwives arranged to do the delivery. Whenever we've asked questions of the labour/delivery or postpartum staff they've been positive responses and in my opinion, midwives delivering babies is considered about the same as a family doctor coming in to deliver. Usually there aren't that many of either in the community so the hospital staff know the individuals quite well.

[Guest lothya]

I realize that this thread is kind of old, but I love to talk about my experience with midwives. I'm a medical student, and my child was born a few months ago, and our family was followed by a midwife, although the delivery took place in a hospital. I was very impressed with the prenatal care offered by our midwife. So much of preparing for a new baby during a healthy, normal pregnancy is psychosocial stuff - (how is the family preparing for the baby? What kind of support structure is available to the new parents? etc.) The counselling skills of the midwife, as well as the time that she took with us was fantastic. Our appointments were as long as we needed them to be (up to 90 min) and no waiting time. This allowed her to take a *very* detailed history, and lots of relevant medical things came up that we may not have mentioned in a shorter visit. It was also great that all of the post-natal follow up was done by her (rather than splitting the visits between the obs/nurse/pediatritian as is usual). After following a pregnant patient this year who was seen in the hospital, I could certainly say that our experience was much more pleasant.

 

That said, knowing that physicians were available who could make decisions on medical matters was extremely comforting. I am very optimistic that cooperation between the two fields will lead to better care for pregnant patients and their families.

 

L.

[Guest therealcrackers]

Both sides agree that the LACK of communication that currently exists is a significant problem. The experience I had was that for uncomplicated deliveries, mothers were extremely happy with the care provided by a midwife. If something went wrong, however, and the OBs had to be called in to assist or deliver a child in distress, nobody was very happy; the OBs complained out loud (this is a medical student hearing this) that the consults come in rather very late, the mothers were suddenly introduced to an OB abruptly and when they were in considerable distress, often requiring forceps or a C-section, and the midwives seemed to resent the presence of the OB team (any and all! especially the med students) despite everyone wanting to work in the best interests of the mother. This may be from the focus on the technical issues from the OB point of view (that being the reason they were consulted) versus the more holistic view from the midwife. I agree midwifery is a far older profession than obstetrics, but the upstart profession has some technical skills and advantages therein. The level of communication HAS to improve if there is any medical threat identified to mother or child.

 

My 2 cents.

[Guest Scared in the Woods]

My fiancee is a student midwife, but have just been accepted to UWO for Med's, so I'm looking forward to hearing a lot of complaining from both sides about the other!

 

I agree with therealcrackers that a lack of communication and knowledge on both sides is a major issue. A few facts that people might be curious about:

 

1) the program is similar to an MD program, kind of. Its 1.5 years of classwork, 2.5 years following a series of preceptors with increasing levels of responsibility, then a year of being a full-fledged midwife, but still being monitored by a senior midwife. Training includes a month with an L&D nurse, a month with an OB and a month restricted elective.

 

2) Midwives have come through three streams to be registered as RM's. Some were working "a-legally" (not illegal, not legal) until they were legislated about a decade back, had to write exams, then continue to practice as RM's or be put out of work. Other's have gone through one of the 4 year programs described above (via McMaster, Ryerson or Laurentian). A third bunch are foreign trained and had to jump the usual type of hoops to work here.

 

3) RM's do home births, but they do arrive with resuss equipment, oxygen, pain meds and all the goodies a local hospital (not tertiary care centre) would have.

 

4) They offer care starting at some point prenatally and ranging to 6 weeks post-partum. They specialize in normal birth, although the range of procedures performed/used differs from midwife to midwife and can get complicated. They don't do C-sections, or insert epidural analgesia.

 

The profession suffers from all the same problems medicine and every other profession has. Some people are good, some are idiots, some are pricks.

 

I would warn you that the hours for being a midwife are scary. During training, expect to be on call 27-28 days per month (that's continuously: 24/7 for all but your one three-day weekend off a month). Things improve once you're fully trained, but the max time off I've heard is 2 days/week, and is usually lower. McMaster is notoriously hard on students, including serious problems like people being reprimanded for taking time off for family emergencies (no joke). We've moved a total of 5 times because of the program, although that's more than average. A lot of midwives are burned out by the lifestyle (much like doctors and nurses) and aren't in any way kind to student RM's.

 

Pay is about 25% of what OB's make, but the training time is shorter by the time for residency.

 

Feel free to PM me if you want more info: scaredinthewoods@yahoo.ca