All women want a healthy pregnancy and hope pregnancy and birth both proceed without complication. In fact, when low-risk and healthy they may be excellent candidates to work with a midwife.
What is a midwife? Midwives provide basic obstetric care to low-risk women. They spend more time with their clients. Many prenatal visits are 45 minutes to an hour, focusing on the life and family of the expectant woman. Midwives also take the ‘clinical’ out of the pregnancy and birth experience. Typically midwives establish close relationships with their clients and many practice in a homelike environment of a birth center (link: http://www.birthcenters.org/)
Midwives are not physicians so when medical issues are present, a consultation with a doctor may be necessary. Such complications may include high blood pressure and gestational diabetes. In these types of situations, the expectant woman will be referred to a medical physical (ob/gyn) for further evaluation. The midwife may already have an established relationship with an ob/gyn or the woman may select one on her own.
In some instances, especially when connecting for the first time, great care needs to be taken in establishing the relationship between the midwife and ob/gyn. After all, the practice of midwifery is often foreign to trained medical doctors in the US and there are usually stark differences in education and training, client care and management and location of practice.
It is critical to the experience of the woman that the midwife and physician work closely together on behalf of the client, especially when the client wants the close bond with the midwife to continue through birth but medical oversight or intervention is needed.
How can a midwife and physician work closely together? A team approach is needed for this work:
1. If the health care providers do not know each other, take the time to establish a relationship. Schedule a call or time to meet to share credentials, philosophies and client care strategies. During this time you can acknowledge difference in practice areas and make a commitment to doing what is in the best interest of the client. Acknowledge that you both bring a specialty to the table that the expectant woman would like as part of her pregnancy, labor and birth of the child.
2. Respect the boundaries of each other’s practice. If the client is in need of substantial medical care, the midwife may need to take a back seat to the physician. Likewise, if the complication is relatively minor, the physician may have a set of protocols for the midwife to follow but release the client to the midwife for primary care.
3. Clear communication is key for the sharing of information on how the client is progressing. When the woman visits with either practitioner, the other should be consulted so all parties are up-to-date. The client should not be acting as a middle-woman in sharing of test results and progress.
4. Being clear in responsibilities will help both the expectant woman and also clearly define your practice areas. The midwife and the doctor should be clear on who is taking the lead and when the client will need to be seen.
Great communication and a plan will help both the midwife and the physician to bring the best level of care to the client. With the common goal of ensuring that the dyad both remain healthy during pregnancy, labor and birth, it is easy to see how a plan can come together. While traditional obstetricians and midwives may seem like odd bedfellows, expectant women see value in the services of both and therefore all caregivers should work together.