Our practice definition of integrated is as follows:
In.te.grat.ed. The combination of separate elements to provide a harmonious, interrelated whole.
This definition speaks of us, as a doctor and a midwife who are indeed separate elements, who are each independent practitioners, holding different skillsets, knowledge, and experiences, having been trained in vastly varying environments. But, as different as our training may have been, and as contrasting as our individual styles may be (ha!), we do indeed harmoniously practice together (well, perhaps I lie. Harmoniously, not always. Sometimes the boxing gloves nearly come out...) coming to each other to consult, share knowledge, and learn equally from each other.
But what does that look like for a woman in our care? Patients usually choose one pathway- physician care or midwifery care. Some patients, on occasion, choose to do a blend of both.
Having individual clients allows us to give continuity of care, in a personalized way. I love having my "own" clients, as the relationship that develops between a midwife and the woman and her family is a cornerstone for birth. Understanding,Trust, Respect...which of course go both ways.
An interesting thing has been happening lately. More and more people are choosing to forego the hospital and they are choosing 'Out-Of-Hospital' birth. Our Out-Of-Hospital birth rate for the coming months has sky-rocketed. Planned birth center and home birth is at an all-time high for us (hmmm...I wonder why?).
With the rising percentage of our patients choosing OOH birth, another interesting thing has begun to happen- patients are asking if their births can be attended by Glen, in addition to myself. And honestly, I go back and forth between whether this is good or bad. On one hand, I'm offended. No seriously. It offends me. I have had more than one client request if Glen can be there...you know, 'just in case.' In a professional, pleasant, but very overt way, I've had to put it out there. A midwife is trained to, and capable of, functioning independently. A midwife specializes in normal birth. A midwife is trained to recognize abnormal and is skilled to intervene when needed and seek a higher level of care, when appropriate. Having a doctor in attendance does not guarantee you a good or better outcome. You are no safer having a doctor at your birth center birth than you are having a midwife attend your birth center birth. And further, let's remember that statistics show that low-risk, healthy women with low-risk, healthy pregnancies have just as good, if not better, outcomes compared to low-risk moms within the hospital, under the care of a doctor. So...again...on one hand it might be looked at as offensive to the midwifery profession or even myself as a midwife.
But, with my initial emotional feelings pushed aside, is there a positive to families desiring to have their Out-Of-Hospital birth attended by a physician?
Well yes, I suppose there is! Let's think about it: there is a vast demographic of women and their families who may not ever have considered delivering their baby outside of the hospital, who would have otherwise, without a second thought, delivered in the hospital setting (and therefore potentially encountered various restrictions and interventions that may not have been needed). If having a doctor attend their birth- so that they can have an unmedicated birth center waterbirth- opens the gateway for more families to feel comfortable choosing that, then one might argue, Why Not?
So, what say you?