The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Sunday, January 15, 2006

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?

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Blogger Erin said...

If I hadn't needed c-sections with both of my kids due to their large size (my second was over 11 lbs), I would have definately used a midwife and delivered (at least the first) at home.

Here in the States, c-section rates have increased to over 25%. It has come to the point where everyone seems to be having them, and those of us who have them and truly NEED them are getting a bad rap.

Stand by your decision. It's your body. Your baby. And, heck! You're a doctor! You know the risks and benefits better than most anyone!!

12:31 AM

Blogger doctor T said...

It's so good to hear from a level-headed, non-prejudicial doctor. I would love to have a midwife for my first pregnancy but I'm afraid that my hip dysplasia and arthritis will make it impossible. Boo.

1:09 AM

Blogger Couz said...

Don't get me wrong... I went through a phase when I honestly thought that an elective c-section would provide me with the most predictible outcome. I've mellowed somewhat (probably since it's been months since my time in a tertiary care obstetrical centre) but I can tell you one thing-- if anyone so much as MENTIONS the word "forceps", I'm going for the c-section. ;-)

7:40 AM

Blogger Nikki said...

I couldn't agree wtih you more - midwives simply spend more time with their patients, because that's how their model of care is set up. They're awesome.

7:20 PM

Blogger Dustin said...

YES! Why wouldnt you want that one-on-one care and attention?! Even though my wife and I are years away from having children we have already talked about it and plan to have a mid-wife, assuming no complications are indicated. We know several people who have had mid-wives and they cant speak highly enough of them.

Its really a pity that this doctor you were talking to could not be more open-minded about it and accept that there are other options out there and to deal with it.


PS I really enjoy your blog. You are a great writer and have a very interesting and entertaining point of view. :-)

6:19 PM

Blogger sweet_de said...

I would have my midwife in a heart beat. Even when they discharged me at 4 weeks, I had asked if I was outside their region if they would still take me, and they mentioned since I'm a past client they would.

My midwifes were amazing, prenatally, during labour and my post natal care.

Even when my daugher was not gaining wait on a good scale, they made sure to come every other day for 2 weeks to check on her. NO ob would do that.

I commemerate you for standing your ground. AS all midwife births are not at home, hell I got transfered at last second for forcept deleiver. Child was a monkey with cord around neck arm and leg, nothing the midwife could predict or prevent. :-)

2:51 AM

Blogger Kim said...

I bet if that was a female resident she would have understood completely! And I don't mean to be sexist, I just think that male residents might view pregnancy/delivery as a mine field whereas a female OB/GYN would view it as a normal, healthy process!
A woman understands.......

4:48 AM

Anonymous Anonymous said...

Well written piece!
My ex-wife and I delivered our first 2 kids at a fairly progressive rural hospital, our birth plan pretty much defined how things went.The Nurses delivered both of our Hospital births.
Our next 2 kids were born with the assistance of Midwives.
We were within a half hour of a hospital where they can do C-Sections, which is a requirement under the Provincial Act governing Midwives. We had 2 different Midwives since between pregancies one of them moved to Ontario where the practice of Midwifery is funded to some degree.
Our local Doctors out here are all orignally from South Africa, where almost all routine (i.e. non-high risk) pregnancies are delivered in Hospital by Midwives.
Large amounts of time were taken by the Midwives to get to know the mother, and the whole family. This was different than our experience with Doctors, who are usually overbooked and in a bit of a hurry.
In sympathy with Doctors even including pre-natal visits they are paid much, much less than a Midwife(which we paid directly,) and requistely they spend much, much less time. The Doctors that came to deliver our first 2 babies were way more concerned about being interupted while dining out or rousted from bed.

Thanks for you blog, it provokes thought!

11:50 AM

Anonymous Anonymous said...

I see my midwife on the same prenatal schedule as an OB, so she knows my history just as well. When it comes to labor, when I call her, she will come. And stay and monitor me the ENTIRE TIME. With my first birth I saw a doctor for 20 minutes so he could 'catch'. Other than that the nurses left me alone and presumably reported to the doctor. He didn't look at me, just ordered interventions which I had to refuse. He didn't even come in to talk to me about interventions or my refusals.

Why is an OB better for a normal birth?

And take a look at the studies that show that for low-risk birth, homebirth with a well-trained attendant has the same outcomes in terms of maternal and fetal health and mortality.

I know you're talking about hospital midwifery, but it's the model of care that makes the process safer. And by safer I mean fewer complications b/c of fewer interventions.

6:15 PM

Anonymous Anonymous said...

You are definitely a different breed of doc. I like how you think. Where are you planning to practice after graduation??

6:12 PM


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