An Interesting Conversation

Well, interesting in my opinion, anyway. As I've mentioned before, I am a union representative. This basically means I attend a meeting every 6 weeks or so. Running for the position was a last-ditch attempt to drum up some enthusiasm for the aspect of academic emergency medicine that interested me the least... administration. It was an attempt that failed miserably. So now, every six weeks, I attend meetings that are largely spent listening to the same few people talk (the ones who are obviously loving the sound of their own voices, mostly) while the rest of us try to pay attention. This month's meeting was actually pretty interesting. Partly because it was the 'road trip' meeting and wasn't in Toronto like all the others, and partly because the bulk of it was spent debating what stance we should take as a union on the privatization of the health care system in Canada. But more on that later.

After each meeting we go for dinner. I was sitting with a second-year peds resident and a second-year obs/gyn resident, the latter I knew fairly well. We were talking about which obstetrician at our academic centre we would want to deliver our own children. There was some gossip, some banter, and then I mentioned that if I was a low risk pregnancy, I'd likely opt to be delivered by a midwife.

Well, you'd think I had announced my intention to give birth in a hot tub in the middle of the next union meeting. Both the budding obs/gyn and the budding pediatrician looked horrified. Immediately, they felt the need to share stories where an 'obvious' complication arose and the midwife failed to call for help. I explained my reasoning-- I honestly feel that midwives give more complete care than obstetricans do, particularly in the post-natal period. In an academic centre, the obstetrician walks in to supervise the resident for the last few minutes of the delivery unless something goes wrong. The labour & delivery nurse is the one guiding you through the process, and it's not like you get to pick your nurse. If you get a good one, it's a great experience. If not, tough titties. By delivering with a midwife in the hospital, you have the best of both worlds. You have the low-intervention, attentive, one-on-one, continuous care of a midwife but if something goes wrong and help is needed, the obstetrician is just steps away.


The two other participants in this conversation were horrified at how irresponsible I was being with my future baby's care. The obstetrics resident didn't understand how I could trust my midwife to know when something was wrong. Um, dude? That's what they're trained to do. And moreover, I told him that it was awfully pompous of him to assume that a midwife with 15 years of experience delivering babies would be less qualified to detect a potential problem than him, with a year and a half of obstetrics under his belt. In fact, as a second year resident, his total time in obstetrics was likely less than six months, all told. But somehow, he figured that he had been magically granted the ability to detect impending problems in labour and delivery and fix them in such a timely manner that he could single-handedly assure a good outcome.

Maybe I'm exaggerating slightly, but all but that last sentence was completely true. What is it about medicine that often refuses to acknowledge the contributions of other members of the health care team. Why would this guy be so threatened by the idea of a midwife offering comperable care in low-risk pregnancies? It's not like there will ever be a shortage of patients requiring obstetric care. It's not like midwives will ever be allowed to perform c-sections. It's not like this guy even intends to spend his life delivering babies... he intends to focus on gynecology as a career. But yet, the idea of a midwife being able to detect late decels in a rhythm strip as well as he could put him immediately on the defensive.

Why can't we all just get along?