Why use a Midwife?

I recently posted a few images on my Instagram stories that contained statistics released from the Association of Ontario Midwives (see below). Then when I asked if anyone wanted to hear about my experience using midwives for my two pregnancies and deliveries, the overwhelming majority responded, “yes.” So, here we are!

Image taken from The Association of Ontario Midwives.

You may be wondering what a midwife actually is. Midwives are experts in normal, low-risk pregnancies and reproductive health. They provide care to pregnant women, deliver babies and attend to a new mother and her baby until 6 weeks after delivering. Midwives offer and arrange all of the same routine tests that an Obstetrician would (i.e. blood work, ultrasounds, genetic testing, urine tests, etc.) during a pregnancy.

In Ontario, where I live, a woman has the option to choose between a Midwife or Obstetrician to be her primary care provider during pregnancy. If you live in Ontario, you can use a midwife at no cost, just as you would an OB.

I do want to mention that a midwife and a doula are not the same, because I've heard this come up several times before.

“A midwife is not a doula! A birth doula is a trained labour support person who provides emotional and physical support to those giving birth and their families. While not medical professionals, doulas can offer a wide range of comfort measures. You would find and pay your doula yourself, as doula services are not covered by the Ministry of Health and Long-Term Care. If you are considering having a doula at your birth, talk about it with your midwife.”

Association of Ontario Midwives 

Here's a little bit of background information about my deliveries for context before I address each of the specific questions I was asked on my Instagram poll. I was fortunate to have two healthy, low-risk pregnancies that I used Midwife care for. I received care at The Midwives Clinic of East York-Don Mills. From start to finish, the experience I had there far exceeded my expectations. I had student midwives involved in my care for both pregnancies and I really enjoyed having an extra set of hands involved. I also used a doula for both of my pregnancies. I hired Dr. Adrienne McRuvie from Oma Chiropractic & Wellness and she was an indispensable member of my birth team.

My first pregnancy was a planned home birth, which resulted in a non-emergency transfer to the hospital for delivery. I had been in prodromal labour for 3 days before my active labour started. This basically means that I was having regular contractions for 3 days, but they were 10-15 minutes apart and I wasn't more than 1cm dilated.

By the time early labour started, I was completely drained, exhausted and in so much pain from the days leading up to it. Because my daughter was in occipitoposterior position (head-down but her back was towards my back), it was causing me to have tremendous lower back pain. I actually feel like tremendous is an understatement for the amount of pain I was in. Back labour is no joke.

Once I began active labour at home, my midwives and doula came over to prepare for my delivery. I was really enjoying being able to walk around my house with my husband and Mom, and using the blow-up birth tub we had rented. The lights were dim and we had beautiful music on. It really was exactly what I had hoped it would be. When I became 6cm dilated, my progress halted for several hours and I wasn't dilating further. At that point I had been in labour for about 14 hours.

Here I am, at home, in the tub with my doula coaching me through a contraction. My midwife and student midwife were setting up their delivery and post-delivery equipment on my dining room table.

After a discussion with my midwives, I felt that I needed the epidural to relieve the pain I had been experiencing for days. I felt like I was suffering, and couldn't manage anymore (a feeling I didn't have with my second). I had nothing left in my tank and I knew I still had ways to go until I would have to start pushing. I needed some pain relief and rest so I could have the stamina to finish the journey, and the epidural made that possible. My midwives also wanted to me to get Pitocin to speed up my labour since my water had already been broken for a while. 

We were all on the same page with the new birth plan, so everyone packed up at my house and headed to the hospital where my midwives had privileges to remain my primary caregivers. My husband drove me to the hospital with my Mom in the car, while I sat on a beach towel in the back seat of our car having epic contractions (no one wants amniotic fluid on leather seats).

I was in labour at the hospital for an additional 19 more before my daughter was eventually born (including over 2 hours of pushing). Everything went well and our sweet baby girl came out vaginally with no tears, weighing 7lb 13oz. I was 41+2 weeks gestation when she was born. She was born at 4AM and I was home by 4PM that same day. It wasn't the labour and delivery I had imagined and hoped for. But it happened exactly the way that it needed to and I don't resent the way the events ended up unfolding.

Holding my sweet girl at the hospital shortly after delivering.

My second labour, with my son, progressed a lot quicker. I decided to deliver at The Birth Centre and it was a fantastic experience. My husband came home from work one day, and I was in the bath with my toddler. I told him that this was the real deal and it was time to call my midwife and doula. My amazing Mom stayed home with our daughter and we rushed off to the birth centre. We got there around 8:30PM and our baby boy was born at 2AM. He was also born vaginally with no tears, weighing 8lbs. I was 39+3 weeks gestation when he was born. We were back home by 5AM and our daughter woke up to a new baby brother at home that morning! It was perfect.

Using the peanut ball helped me progress from 5-7cm quickly! My student midwife had the doppler on my stomach listening to the baby's heart rate, while my doula was massaging my hips and back.

There was a significant difference in duration of labour and a difference in the sensation of pain compared to my first. Not having back labour the second time was a massive game changer! At the birth centre I was able to go in and out of the bath and shower with my husband, lay in the large bed with the peanut ball, and use nitrous oxide for pain management. I liked not being confined to a bed the way I was at the hospital since I was hooked ups to machines for the Pitocin and Epidural.

Here my doula was doing the Rebozo technique to me at the birth centre.

Now onto the specific questions from my Instagram poll!

Q: Explain the process of selecting a midwife vs OB.

A: As soon as you find out you’re pregnant, go see your family doctor to get blood work done to confirm your pregnancy. Then call the midwife clinic closest to you and ask if they have any availability. For Ontario residents, click here to see a list of midwifery clinics. You’ll need to tell the clinic approximately when you think you’re due. Using the date of your last period, you can plug it into Google by searching “due date calculator.” Put your name on the clinic waitlist if they have one. You can try contacting another Midwife clinic nearby to see if they have availability.

If there is a hospital you have your heart set on delivering at, find out which midwife clinic has privileges to deliver there and contact that clinic to get a midwife. When you call the clinic, you will be matched with whichever Midwife team has availability for the course of your pregnancy and delivery.

With the clinic I used, I had a primary midwife and secondary midwife. Some clinics have teams of 3 or 4 midwives. Each visit, I alternated appointments between the two women, which allowed me to get to know each of them and establish relationships with both throughout my pregnancy.

The reason they do this is in the case that your primary midwife is on another birth or unavailable when you go into labour, your secondary midwife, who you already know, will be there. This was so comforting to me knowing that I wouldn’t end up with someone random at my delivery. Unless of course there was a rare situation where both of my midwives were at births or were unavailable. The clinics schedule them quite well to avoid this and try to ensure that someone on your birth team will deliver your baby.

Q: How did you find one you trusted?

A: Because the demand is so high for a midwife in Ontario, and there are often wait lists, you don’t typically have the luxury of interviewing several and choosing one, as you may be able to do with OBs. At least I didn't. As I mentioned earlier, you are matched with whichever midwife or team of midwives are available at the clinic for your pregnancy and due date.

I will say that between my 2 pregnancies, I had over 6 different midwives provide care for me at some point during my pregnancy, labour or postpartum care, and each one of them was exceptional. It takes a very special, dedicated and compasionate person to enter this field and I think would you would be hard-pressed to find one who didn't make you feel safe, comfortable and well-cared for.

Q: Why the birth centre the second time instead of trying home birth again?

A: I had my heart set on a home birth for my first delivery. I wanted it so badly. I thought that if I had a hospital birth, it would be this terrible medical experience where none of my desires would be respected, and I'd be stripped of my autonomy. That wasn't the case at all.

The hospital experience was great because I still had my doula and my midwives by my side the entire time, providing my care. I quickly realized that as long as I had my birth team with me, it didn't matter where I delivered. Ultimately, we all want a safe delivery with a healthy baby in the end and I'd do whatever I had to in the moment to achieve that with the least interventions possible.

For my second delivery, I wanted to try a home birth again, but I also had to factor in my 20-month old daughter. I couldn't predict what time of day I'd go into labour. I was worried that if it was during the day and she was awake at home, she may get scared seeing me in labour and in so much pain. I felt that I would probably end up worrying about her during my labour at home and wouldn't enjoy the experience. I didn't want to feel stressed and have that interfere with my delivery. The birth centre seemed like the perfect middle ground between a home birth and hospital and it turned out to be exactly that. I loved my experience there!

At the birth centre, getting ready to head home with baby #2. He was 2.5 hours old!

Q: What is the biggest benefit of having a midwife vs OB?

A: Please keep in mind that I've never personally used an OB. But I’ll pick my three personal favourite aspects of having a midwife.

The first one is the length of the appointments. Each appointment was allotted 30-45 minutes, depending on what had to be done during that session. I loved having the time and space to ask all of my questions and get to know my midwife. I never felt rushed during an appointment or like I was being pushed out the door. There isn't a nurse who comes in to do parts of the exam - it's just your midwife the whole time. There is absolutely an emotionally supportive component to midwifery care that I greatly valued and felt like I needed during such a vulnerable time.

Secondly, I liked being involved in my own pregnancy and that my values and desires were respected. I never felt like things were just being done to me without my understanding. They would always explain what they were about to do and why it needed to be done, and gave me the opportunity to ask questions. It made me feel like I had an active role in my pregnancy and I wasn't just observing from the sidelines. It was empowering to understand what was going on in my body during each stage of the journey.

Lastly, the postpartum care was exceptional. I really loved that for the first 6 weeks postpartum, myself and my baby were still in the care of my midwives. The first week or so, they even came to my house for the check-ups. It was so great to lay on my couch during these visits and not have to drag the baby out to a doctors office one day after delivering.

Laying on the couch during a home check-up later that day I got home from the birth centre. My midwife was assessing my new baby boy while my student midwife was assessing me. They were so sweet and let my daughter to play with her stethoscope so she felt involved. My mom was there too!

A few additional benefits that stick out for me include: decreased chance of unnecessary interventions during labour, higher rates of succesful breastfeeding after delivery, and decreased perineal tears. There are so many more, but I digress.

My midwife weighing my daughter during a postpartum home check-up. Look at those adorable little baby feet poking out!

Q: Nervous about not having a doctor deliver (if something goes wrong, etc.)

A: Something that I found very comforting about midwife care is that they stay with you the entire time you're in labour until you deliver your baby. They aren’t leaving the room every few minutes to check on other patients. They are only allowed to attend to one woman in labour at a time. You have their undivided attention. Because of this, they are often able to pick up on undesirable changes in labour early and act accordingly. A midwife is highly-trained to handle a range of emergency situations. If you are delivering in a hospital and something went beyond the scope of practice of the midwife, they would call for medical intervention immediately. If you were delivering at home or at the birth centre, they would call 911 and have you transferred to the hospital immediately if that was required.

Q: Did you have a supportive extended family about using a birthing centre?

A: With my first baby, I decided I wanted to have a home birth pretty early on in my pregnancy. My husband was completely onboard. Initially, a lot of my family members and friends were shocked and voiced their opinions about the safety of it. Most people were just concerned since they hadn't heard anyone do it before, and their fear sometimes came off as unsupportive, though I don't believe that was their intention.

The more I informed the people around me about the logistics and safety of a home birth, the more support I got. Not every pregnant woman is a candidate for a home birth. A high risk pregnant woman would not be granted a home birth. It wouldn't be a safe option for her or her baby. I was having a healthy, low risk pregnancy with no complications, so I was eligible to have one (even though it didn't end up that way).

When I decided to deliver at the birth centre for my second pregnancy, everyone was supportive right away. They saw how even though I didn't deliver at home with my first, I laboured at home safely for many hours and was in amazing hands that transferred me to the hospital before it was an emergency situation. I felt that after my first delivery, my family gained trust and respect for midwifery care and for the fact that I was making informed, educated choices about my birth plans.

Q: What stage of labour was the nitrous oxide used? Describe the effects.

A: During my second birth, when I was at the Toronto Birth Centre, I used nitrous oxide for pain management. I asked for it when I was around 6cm dilated and used it intermittently until around 8cm dilation. It has to be self-administered which I didn't mind, but I've heard some people have a hard time holding the mask on their face. I would put the mask on my face at the start of a contraction and take it off at the end of it. I kind of got into a rhythm with it for a while and I liked the distraction.

The effects are so short term that it often wore off before the next contraction started. It gave me a bit of a "high" feeling, but didn't make me feel out of control. I felt more loopy than anything. This was the first time I had ever used nitrous oxide (many people have used it at the dentist), so I was a bit nervous not knowing what to expect. It was less mind altering than I imaged it to be. I liked that it wore off so quickly that by the time I started pushing, the effects were totally gone. I was glad because I wanted to feel everything while I was pushing for my second delivery since I had an epidural with my first.

I want to finish this post by saying that I don't think there is anything wrong with using an OB. That is not what this is about. Obstetricians are an integral part of the medical system and many pregnant women require their expertise to carry out a safe and healthy pregnancy and delivery. The point of this piece is to expose people who don't already know to the midwife option so they can make an informed choice about their own prenatal care. Everyone has to make the choice that they are most comfortable with. For a healthy, low-risk woman, a midwife is a fantastic option that I wish more people knew about.

I hope this information was helpful! Please leave a note below if you have any other questions or comments.