On Midwives, Doulas, and "the System"

Yesterday I linked to an article originally posted to the Positive Birth Movement website, and written by a former NHS midwife. The National Health Service, the UK's universal health care system, has long been considered a model of midwifery care to imitate the world over, because of its approach to childbirth. As you might guess, the UK never lost its connection to women assisting other women during labour, and as the medicalization of childbirth occured, midwives remained an important part of maternity care.

The author of the piece, however, was disenchanted with the system that she had become a part of. I won't paraphase the entire thing, but it certainly gives the impression, as she points out, that midwives are becoming more akin to our own understanding of labour and delivery nurses than autonomous care providers for low risk women. 

This got me thinking about our own midwifery model, so recently revitalized in Ontario. Demand far outpaces the number of available midwives to attend births in the province; at one point there were estimates that one in three women requesting a midwife would not find one. The US has a different system for midwives, that also seems more akin to nursing at times, as many professional midwives train first as nurses. Here, midwifery is a complete university degree, separate from nursing, and even from the standard hospital as teaching centre, which makes it quite unique. 

We can't know how our system might be different if we hadn't lost touch with our midwifery model during the 20th century. But it's interesting to see how rebuilding that level of care from the ground up has led to a standard of care that encompasses all aspects of pregnancy, labour, birth, and the postpartum period for mothers, and a low intervention rate for babies. And with the impending opening of Toronto's first Birth Centre, I think we have a lot to look forward to as we grow into a model of care for birthing women that embraces the normalcy of the childbearing year as a life event.

The author of the original piece ultimately decided to abandon her role as a midwife in favour of becoming a doula and holistic childbirth educator, feeling that these roles were closer to what she had envisioned her job to be. It seems like the track we are on here in Toronto, as well as the province, is a system that respects the hospital standard of care for emergencies, but that is giving women the confidence to birth their children as they choose, whether that is in their homes, a birth centre, or a hospital, under the guidance of midwives who are there to support and guide, rather than to direct the progress of a birth.

What has been your experience with the midwifery model of care? Where and under whose care would you feel most comfortable giving birth?