Obstetricians, family doctors and registered midwives all provide quality care. The differences are largely in training and where these experts work. Many times, different caregivers work together in teams, so mothers-to-be to can benefit from the skills of each.
Obstetricians are specialist doctors. After medical school, they spend four years studying women's reproductive systems. They know how to manage complications in pregnancy, and are trained in surgery of the reproductive system. In offices and hospitals, they care for their own patients. They also provide expert help for family doctors and midwives if complications arise.
Obstetricians have tight schedules and deal with many emergencies, so getting an office appointment can be challenging. You may choose to have an obstetrician work with your family doctor. This allows your family doctor to provide routine care during your pregnancy, while the obstetrician's special skills can be used if needed. For instance, an obstetrician can often turn a baby in a breech position from head up to head down, making a natural delivery safer.
Family doctors are physician generalists. They spend at least two years after medical school learning how to care for the medical, psychological and social concerns of people. From tiny babies to the elderly, they treat a wide variety of short and long-term conditions. They spend much of their time preventing illness, as when helping people quit smoking or advising healthier lifestyle choices. Usually, they work in offices and hospitals.
As family practice is such a broad field, many doctors have special interests within it. Some family doctors do not include pregnant women in their practice. Others enjoy being a part of the childbirth experience. They care for pregnant women, including women whose family doctors do not do deliveries. Many family doctors, especially in rural areas, do an extra year of training in special skills. For instance, they may learn how to do caesarean sections and provide epidurals for pain relief in labour.
Midwives often provide much of the early pregnancy care in the home. They may offer a variety of locations in which to deliver the baby, such as the hospital, a birthing centre, or even at home. They usually stay with the woman through the entire labour. This is different from a doctor and nurse team, in which the doctor comes and goes through the labour, and nurses change shifts every 12 hours.
Access to a registered midwife varies greatly from province to province. Although it is a long-standing profession, midwifery in Canada has evolved tremendously over the last 15 to 20 years. Some provinces, such as British Columbia, Ontario, and Quebec, have well-established midwifery programs. Universities offer specialized education, and midwives are available in both cities and rural areas. While Albertans have good access to midwives in some areas, there are waiting lists. Midwives are often unavailable in rural settings. In other provinces, midwifery is less well established.
Provincial health care plans generally cover the costs of services provided by doctors. Some provinces cover midwifery care, but this varies. Patients are often required to pay some or all of the costs, depending on the province, which services are used, and the chosen location of delivery.
Sometimes your choice of caregiver will be obvious. If serious problems threaten you or your unborn child, you are considered high risk. For instance, your baby might be premature (born very early). In this case, you will benefit from the skills of an obstetrician and immediate access to an intensive care nursery. No one wants to recreate the dismal maternal and infant death rates of the 1800s! Women whose pregnancies are considered low risk have the luxury of choosing a more personal approach. This might be a family doctor, a midwife, and possibly even a home birth.
However, other issues should be considered. You cannot know if you will have problems, such as serious bleeding following the birth, or a baby who does not breathe on its own. Many attempts have been made to distinguish higher risk women from the low risk. Unfortunately, there is still no perfect way to know who will have problems. Women with many risk factors, such as smoking or high blood pressure, certainly have more complications. However, many high-risk women do have normal healthy deliveries. On the other hand, about half of women who develop complications have no previous risk factors.
Only you can decide whom you would be most comfortable with as your care provider. Often, a woman and her family already enjoy a good relationship with a family doctor. This doctor can follow the pregnancy, keep an eye out for problems, answer questions and discuss issues about pregnancy, labour and delivery. At the time of labour and birth, the parents can make well-informed decisions. If something unexpected happens, they have a trusted person to guide them.
Ideally, a baby is delivered in a comfortable environment where the woman's support team is welcome. Comforts may include a shower with endless hot water, the option of any number of positions in which to deliver, and good pain relief that is easily available if requested. As well, this environment has the immediate expertise and technology needed if an emergency develops and minutes count.
Following the birth, if your caregiver is a family doctor, the care continues for mother and child. Your doctor can see you through early needs like breastfeeding support to the years that follow. A midwife usually cares for both mother and child, but only for the first few weeks. An obstetrician continues to care for the mother after the birth, but hands the baby's care over to a family doctor or pediatrician.
If your family doctor does not deliver babies or you prefer a different approach, where should you start? Your family doctor is a good starting point for referral to an obstetrician or to another family doctor who does maternity care. If you do not have a family doctor and would like one, a web search is usually helpful. Try the College of Physicians and Surgeons of your province. In smaller centres, the local hospital should have a list of care providers in your area. To find a registered midwife, visit the Canadian Association of Midwives website (www.canadianmidwives.org).
Finally, keep in mind that you should choose someone who can meet your needs, and then remain flexible and informed.