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Building Your Birth Team (Doctor or Midwife?)

So, you're going to have a baby. Congratulations! One of the most important decisions you will make in the coming weeks is choosing who will support you through this journey. You might plan to birth alone in the woods. Lovely! You don't need to worry about building a team. However, most people giving birth these days prefer to have some support through the birthing process. This can include medical support from a doctor or a midwife, emotional, physical, and educational support from a doula, and the irreplaceable support of people who love you.

(photo by Alyssa Kellert)

There are a few different options when it comes to choosing a medical care provider. Here in British Columbia, you may have a family doctor (GP) who attends births, you may find a group of Obstetricians (OBs), or you can seek out a local midwifery clinic. (See our Q&A section to find our favourite local midwifery groups.) Let's explore these different options, to give you a good idea of what type of support will best suit your needs.

Obstetricians and midwives have different models of care. (GPs fall somewhere in between, depending on their training and philosophy regarding birth.) Before we go into the differences, let's look at some similarities.

1. Both models of care are covered by MSP (medical services plan), so there's no extra cost to you.

2. Both physicians and midwives generally work in teams. You can find out the size of their team in order to figure out the likelihood of having your doctor attend your birth. For example, some OBs are only on call one day per week, which would make it highly likely that someone you don't know will be on call when you are having your baby. Midwives tend to work in groups of 3 or 4, and they make sure to book your prenatal visits with each member of the team, so you'll get to know them all before you give birth.

3. Both midwives and physicians are trained to manage emergencies in the birth process.

4. Both doctors and midwives can order and interpret tests and discuss results with you.

Now let's note some of the differences in care.

1. OBs are highly trained to medically manage birth, especially high-risk cases, whereas midwives are highly trained in supporting physiological (sometimes referred to as 'normal' or 'natural') birth. Pregnant people with medical conditions such as high blood pressure, epilepsy, heart disease, or diabetes will likely need to be cared for by an obstetrician, and people with low-risk pregnancies can choose a family doctor or midwife.

2. OBs can perform surgical births (c-sections), and midwives and GPs can not, although in most cases they will still support you in the OR if you end up needing a surgical birth. In fact, in many cases when any complication arises that requires a consultation with an OB, the midwives will remain a part of your birth team.

3. Midwives tend to book longer appointments prenatally, generally around 30-45 minutes compared to a doctor or OB's 5-15 minutes. Midwives want to make sure they answer all of your questions and explain your options. They even offer home visits in the first weeks after your baby is born, to support as you recover and learn to care for your baby. All appointments with physicians take place in their clinics.

4. Midwives can attend home births and hospital births, and OBs (and most GPs) only work in the hospital.

5. Midwives are trained to help babies who need extra attention immediately after birth. Maternity doctors are not, so if a baby needs help a pediatrician will be called in. If you are planning a home birth, you will be supported by two midwives; one to focus on your medical needs, and one to focus on your baby's safe entry into the world.

(photo by Alyssa Kellert)

Both of these models of care are needed, and both have their specialties. If you can, it's a good idea to 'shop around' and find the care provider that feels right for you! Connection is a big part of what helps people feel safe and comfortable in the birth process, so you want to feel that with your care provider. It's important to note that some OBs and doctors lean more toward the midwifery model of care, supporting physiologic birth, and some midwives can be more medically minded than others. Ask lots of questions when meeting potential care providers, to find out if their philosophy matches yours! If you're leaning toward finding midwifery care, it's a good idea to call them as soon as you know you're pregnant, because they tend to be fully booked quickly.

Whichever model of care you choose, you can add to your support team by hiring a doula. Again, it's important to feel a good connection with this person. Their job is to keep you feeling safe, supported, respected, and comfortable throughout your pregnancy and birth, and in your first weeks as a new parent. If you'd like to learn more about that, feel free to explore my website and leave a note if you'd like! I, too, tend to be fully booked months in advance, but I can always recommend other marvelous local doulas for you to meet with if I'm unavailable.


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