I am going to outline the 3 types of care providers you can have in BC and what they can and cannot do for you. I am also going to explain the difference between a midwife and a doula – did I lose just lose you? If so you are not alone, many new mothers do not know what either are or many think they do the same thing, fear not I will clear it up for you.
When you are looking for prenatal care you can look to an obstetrician, your personal family doctor or a midwife. It is important to note that they are all covered by MSP so you do not have to pay any out of pocket expenses and they all offer very different care models.
Let’s start with an obstetrician (OB); you can get a referral to one from your family doctor or likely even by going into a walk-in clinic. They are highly trained professionals who have gone to med school and then completed an additional 5 year training program to become an OB. They learn how to manage high-risk pregnancies and in many countries the only women they care for are considered high-risk. They are the only care provider of the 3 we will talk about that can perform a cesarean. When you go to an OB you generally have your appointments with them at the hospital but some do have offices as well. During your visits you can expect to have your weight checked, they will likely ask you to give a urine sample so they can test for sugar and protein in the urine, they will check your blood pressure, listen to your baby’s heartbeat, and measure the size of your belly. This all takes about 5 minutes, then you can ask a question or two but they will likely want to have you be on your way due to the large volume of patients they see on a daily basis. You will generally see the same OB throughout your pregnancy but when it comes time to deliver you will get the OB on call and generally there are 5-8 of them on a rotation depending on how big the hospital is so you could be looking at a 1 in 8 chance of seeing the OB that cared for you during your pregnancy. When you are in labor your OB will pop in and out of your room to check in on you and generally will not stay with you in the room until you have started pushing, they will assist in delivering your baby (you are really the one doing the hard work) and shortly after they will leave. They will follow up with you after you are discharged by having you come to see them and you will be discharged at 6 weeks and at that point your care would return to your family doctor.
So on that note you may have the option to have your family doctor be your primary care provider for your pregnancy, it is becoming more and more rare to have a family doctor that will do full prenatal care and deliver but if your family doctor offers this then you have yet another option. Your family doctor has gone to med school but has not normally done specialized training centered on pregnancy. Your family doctor can refer you to specialists along the way if needed and will oversee your care throughout your pregnancy. Your appointments would likely be at the family practice and would follow the same basic outline as with an OB but you may have a little bit more time for questions and the appointment will likely last around 10-15 minutes. As far as who will deliver your baby; this would have to be a discussion had with your doctor as some will promise to attend your birth while others share a rotation with other doctors and whoever is on call that night would deliver. Similar to an OB your doctor would pop in and out during labor and be present when you are pushing. Your doctor would continue your postnatal care and beyond.
Another option would be to have a midwife look after your care. Midwives are highly trained in prenatal care and must complete a 4 year specialized program before becoming certified in Canada. Midwives are best suited for low risk pregnancies and would normally transfer care to an OB should any major concerns arise during your pregnancy or birth. The most important thing to do if you would like a midwife is to call a clinic as soon as you get a positive home pregnancy test as midwives are limited in the number of patients they can take on and they normally have a waiting list of 10-30 people per month depending on the practice. You can search for midwives practicing in your area by going to http://www.bcmidwives.com/find-a-midwife Midwives are known for their women-centered care, your appointments will be in their office, will include everything that would have been covered with an OB or family doctor but your appointments will range from 30-45 minutes so you have more time to go over any questions you may have and become better informed about the journey you are on. Midwives do take a more natural approach to childbirth but you are able to have medication with a midwife should you choose to. With a midwife you may choose to birth at the hospital, at home or at a birth center whereas with an OB or family doctor your only option would be the hospital. Your midwife will order all of your prenatal tests needed (blood work, ultrasounds etc.) and can also write you prescriptions for pregnancy related issues. When you go into labor you would call your midwife and they would likely come to your home to assess you and see if it would be a good time to go to the hospital if that is your choice. Your midwife will likely stay by your side for your entire labor and birth. Your midwife will deliver your baby and can give you stitches should you need any. After delivery your midwife will come to your home for your first 2 postnatal visits, the balance of your postnatal visits will be at their office and you will be discharged at 6 weeks postpartum. Many midwives work in a shared practice where there are multiple midwives working at the same practice sharing the care, you will see all of the midwives throughout your pregnancy at different appointments so you know all of them, when you go into labor you will be taken care of by the midwife on call, to whom you have already met during your pregnancy.
So what is a doula? A doula is a labor coach who would meet with you during your pregnancy to go over your birth preferences and work with you to prepare for birth. Your doula will attend your birth and be with you throughout your entire labor supporting both you and your partner. They will offer massage, allow your partner to have a break to get something to eat or go to the washroom and make sure you have support the entire time you are in labor. Doulas are trained with knowledge on childbirth through various training options. Doulas are not medically trained and cannot offer you medical advice nor can they perform any sort of medical exams for you, that is what your midwife or OB/doctor would do. Doulas are for hire and can generally range from $500-$900 and you can find a doula at http://www.bcdoulas.org/find-a-doula
So who is the best care provider for you? Only you can answer that question. Each option is unique and has it perks and drawbacks. It is important you are cared for in a way you feel most comfortable and confident.