registered midwife vs birth attendant - Mothering Forums

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Old 03-21-2009, 03:01 AM - Thread Starter
 
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Hello all.
I signed up today to try and get advice of where to go! I have been reading all sorts of stories about midwives of all descriptions. It seems that those women who feel they really cant get what they want from registered midwives go to birth attendants. Thats fine and I can see why, when you only have the duration of your pregnancy to go, that this is the best option. But what I cant find is any group of mothers who, having been let down by the system, are trying to change it. I cant find a support group for registered midwives who want to practice in a way to truly meet the needs of women. all I see are comments made about how registered midwives are so medicalised.
So are there women out there trying to change the system? Is there lobying by women to the colleges, to try and force them to allow real informed choice?
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Old 03-21-2009, 11:59 AM
 
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MMmm...not that I've heard of, but I like where you're going with this

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Old 03-21-2009, 12:43 PM
 
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what province are you in?
i haven't heard of that either. it seems like women are either choosing underground midwives or freebirth in my province. i can't imagine how difficult it will be to change aspects of registered midwifery .

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Old 03-21-2009, 01:37 PM - Thread Starter
 
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not so sure I want to divulge which province I am in just yet! But I do get frustrated knowing there are strong opinionated women out there whos voice and passion we could use. It is very hard to change anything if only a few from the inside do it. If it is seen that women DO want to be able to access midwifery care that will support choice fully then we have more of a solid start.
I sometimes feel we have been given up on, but I would love to be able to stay in the system and change (albeit slowly) how the medical profession see birth.
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Old 03-21-2009, 07:15 PM
 
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i'm all for supporting women's access to midwifery care that they want, without having to be bound by so many restrictions (depending on where you are practicing). i think that many of the younger women coming through the canadian education programs don't have an issue with a more medicalized style of midwifery. i worry what happens once the direct entry/apprenticeship older midwives start to retire and how that will impact the art of midwifery.

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Old 03-21-2009, 07:35 PM - Thread Starter
 
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Not sure the younger midwives dont have a problem with medicalisation - just that any other views they had are beaten out of them in their training? I also wonder that if the women that come to you arent pushing for anything more - then you dont see the need to change. So for example if no one asks for a VBA2C then you are unaware that service is needed. If the word on the street is registered midwives wont do that - you will likely go straight to a BA - which like I said in the short term of your pregnancy is fine - but the longer reaching affect is that there is no consumer voice pushing the colleges to realise that they may have it wrong.
If women dont make a push as well - those of us within will not be able to make much headway. Consumer power is always more effective.
I realise the title of this thread is wrong - sorry. It isnt about them vs us - but about getting registered midwives on an even keel so that women who want to can access prvincially covered services.
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Old 03-21-2009, 07:54 PM
 
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no, i get what you're saying. it's an important issue, and i think that many other midwives and consumers feel the same, just that it seems like an uphill battle sometimes.
i admire your desire to bring change.

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Old 03-21-2009, 08:37 PM
 
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Old 03-21-2009, 08:39 PM
 
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Old 03-21-2009, 09:36 PM - Thread Starter
 
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but this is exactly my point. If you as a consumer didnt take it further with the colleges then how can we change. If a midwife wants to support you but her guidelines wont allow it - then she does need to choose - licence or client. Why on earth cant we have both - but by changing the emphasis from allowing the OB community to punish/outcast whatever the midwife - to ensuring that the legal backing is in supporting the women in their choices and giving women the power, not the OB community. You can have both - look at the independant midwives in the UK and some other places, where they are still registered - so have security in that, but can support women in their birth choices. Even in the system in the UK the law supports midwives in supporting women, even if the reality of a staffing crisis means it doesnt always happen. And there are good and bad midwives in any system, and I am sure that the current system does provide a wanted protection to some midwives. But please dont insult me by saying my license is more important than the women. My aim through all the work I do is to try and influence change, which I have chosen to do from within.
Also - no I dont expect women to fight in their pregnancy - and I acknowledged that in my earlier post. But after the fact - when they are able - I would love to see consumer groups tackling the colleges and asking them why they wont support a women centered approach to care.
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Old 03-21-2009, 10:11 PM
 
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But after the fact - when they are able - I would love to see consumer groups tackling the colleges and asking them why they wont support a women centered approach to care.
i think part of the problem is that at least in alberta, consumer groups have been so burnt out on pushing for funded midwifery that they aren't anxious to take on anything new. i was part of the movement when i had my first homebirth, 12 years ago ... and that is a long time and people burn out. although there must be a new crop of consumers wanting change.

i do think it is a good idea and worth a shot if you can get the interest. problem is i think there is a small core of women who want real choices (and i think alberta is fairly "liberal", even with registration and funding) and the rest of women are just happy to have a midwife. then again, i could be completely wrong, i haven't been involved with a consumer group for a number of years now.

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Old 03-22-2009, 03:55 AM
 
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Old 03-22-2009, 01:21 PM
 
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you make some good points lisa.

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Old 03-22-2009, 02:04 PM - Thread Starter
 
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So Lisa maybe this isnt the right forum for me. I am not looking for a battle with mothers - I have enough of that with the system. Neither am I saying there shouldnt be unlicensed midwives if thats what you want.
But in countries where there has been change it has come from the consumers. As much as I take on the points you have made, and see the poor way in which you have been treated, I have to take issue with the reasons why midwives might want resistration. I am ot prepared to put my family at risk of me being prosecuted for my job. at the end of the day I believe I should look after my children first.
I also believe the system has it wrong - that women should be put first, and I cant see, for myself, how ignoring that will change anything.
I know there are registered midwives who want support in changing the system.
I will continue to try and seek out that support, but I dont have the energy to be compared to fast food chains and accused of not caring - so I will leave this conversation alone, aplogise for upsetting you and choosing the wrong forum, and keep trying to support women where I can and in the best way I know how.
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Old 03-22-2009, 02:13 PM
 
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it's not the wrong forum. maybe trying the birth and beyond forum, or the birthing professionals forum, you might get more visibility and input there.

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Old 03-22-2009, 10:18 PM
 
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I think if you want responses from Canadians you should leave it here... to me the issues are different because I don't think we are consumers in Canada... we are taxpayers... and the real question is how do we effect change in our medical system period! IME people who choose TBAs do so to become consumers, which gives them the power to choose their services... Also rules are different in each province so its hard to know what exactly you are getting at without knowing where you are? it has to do with the history of TBAs in each province before register midwifery, what was the status quo before? what did people expect? I have heard that in BC and Alberta the registered midwifes have a lot more rules than the TBAs or/and midwives before registration and most have to do with liability and insurance issues... and the mdiwives are so busy that if you don't follow all the rules they can drop you and you are easily replaced by a new patient... this IS different than doctors even... with my family doctor I have had to sign AMA (against medical advice forms) if I did not follow their advice, but I was never threatened with losing my doctor...

I don't know of anyone trying to make changes... and I am not sure how they would do it... also the people most affected are either pregnant or have young chidlren and likely have little time to spearhead the cause... most people I know who feel strongly about it choose to have unassisted birth, or use a TBA... good luck!

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Old 03-23-2009, 01:48 AM
 
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Susie, I think you are right to keep it in the Canada forum as well. Its a hot topic obviously! Very close to all of our hearts. Please don't be put off. There are women in this forum who have been badly hurt by the medical establishment and are rightfully angry.

I agree with your point that clients need to push within the system to make it more closely match our needs. I have had 3 children in BC, all with registered midwives. I am one of those people who generally prefer to work within the system, I guess. In 2 of the three births I was 80 - 90% satisfied; with the other one I was really not at all happy with the care I received. The unsatisfactory birth was my first one, however, in the 9 years since then I've been a little busy! I never complained in any formal way at all. I guess I just assumed that my experience was so long ago that it is no longer relevant. I really appreciate what you wrote here. Its given me lots to think about.
How do you envision it working? What would need to happen in order to effect any real change?
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Old 03-23-2009, 01:49 AM
 
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but this is exactly my point. If you as a consumer didnt take it further with the colleges then how can we change.
susiemidwife, I appreciate the work you are trying to do. I don't know much about your industry, and don't have strong feelings one way or the other. I just wanted to pipe in and say that statements like the above one will be taken as an attack to a lot of people. You may not have meant it as criticism, but that's how some people will take it. When I was new on this forum, I found I didn't know the unwritten rules and probably wrote some inappropriate things that other people may have thought were offensive or silly.

My point is that while this is an open-minded and supportive site, it will probably be better received if you tread lightly on contraversial topics, regardless of which forum you post in. Also, when you mention not wanting to divulge what province you're in (not that I personally need to know, but like I said, I'm not in the know about your industry and don't know what the specifical laws are), it sends a message of mistrust that might rub some people the wrong way. I'll leave it at that, and wish you luck with your endeavour.

ETA - Oh, and just from personal experience, I find it easier to protest the way something is being done when there is information posted like who to write to, their address, an outline on the points that are on the table, and perhaps a form letter that people can copy, then add their own comments before sending. The easier you make it for people, the more people are likely to respond.

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Old 03-23-2009, 02:29 AM
 
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Old 03-23-2009, 01:51 PM
 
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I've been thinking about this since I read your post yesterday morning. I don't know why there are no groups fighting for better care, maybe there should be. It seems like such a big and overwhelming task, since there are so many things we would want to change. When women are not directly in need of care from a midwife, it's really easy to just forget about it and not put energy into it, because having a baby or young kids around gives us other priorities.

I would be happy to work with people if a group was formed, but I don't know where to start.

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Old 03-23-2009, 04:31 PM
 
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I find this thread interesting.

I personally have had only great experiences with our registered midwives in BC, so I don't have too much to complain about or want to change.

I think we are extremely lucky to have Midwifery covered by medical so we don't have to pay out of pocket for services. I also think we are lucky to have a few traditional birth attendants in the area that can be used if you don't feel comfortable with the registered midwives.

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Old 03-23-2009, 05:10 PM
 
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I've been thinking about this since I read your post yesterday morning. I don't know why there are no groups fighting for better care, maybe there should be. It seems like such a big and overwhelming task, since there are so many things we would want to change. When women are not directly in need of care from a midwife, it's really easy to just forget about it and not put energy into it, because having a baby or young kids around gives us other priorities.

I would be happy to work with people if a group was formed, but I don't know where to start.
Forest, you said it so much better than I did!!
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Old 03-23-2009, 05:17 PM
 
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I've been thinking about this....

Im in BC. We are inbetween a rock and a hard place here. On the one hand we are very very lucky that midwives are covered by our medical system, and we dont have to pay. We are also very very lucky that midwives are legal. We are also very lucky that we have some of the best schools for midwvies (UBC is renowned in Canada for their midwifery).

However - with all that luck comes pitfalls: because its covered by medical and we dont have to pay it has to be regulated. Because it has to be regulated there has to be rules - and because there are rules, there will be some that disagree with them. Further, because there are rules, there needs to be somewhere for people to learn the rules (procedures etc) - and in going to school midwifery becomes more medicalized.

I dont think there is a way to get around that. When looking for a midwife on Vancovuer Island I found that most of them came from heavily medicalized background, and many of them were ER or L&D nurses themselves - I think most in that position have seen too much, and are just too paranoid to treat birth as a normal function of the body (Im a believer in UC if it matters)

There was one midwife who seemed to think different, she had an anthropology background and the only reason she went to school is because she "had to" based on our system - its the way it is. But I doubt there are many MW's like that. I think because birth is so pwerful that even those who start out believing birth is natural go to school see all the "what ifs" and then there opinion is always slightly medically skewed.

Also, the reason there isnt a group lobbying to change things is because midwifery care is what people lobbied for. People were sick of dr's & hospitals and wanted another option, wanted more choice - and they fought back. They did write letters, they did protest - and we campaigned. Thats how midwifery care came to be as "accepted" as it is. But midwifery in and out of itself hasnt risen to such a status yet that there is enough of a voice to lobby against it and make it better. Yes it needs to happen, but its hard to fight against the change that we fought so hard to get in the first place? Does that make sense?

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Old 03-23-2009, 06:29 PM
 
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Makes sense to me, Lindsay!

I had my first with registered midwives, and at the time I thought it was awesome. It was only after the 6 week appointment, and then as I learned more about midwifery and birth, that I began to see what had not been so great. I was comparing my midwives to doctors, and that's not a useful way to rate midwifery care. I had thought the stuff I didn't like was just me, but it wasn't. Unless someone has either had a baby, or done a lot of reading/being around birthing women, they wouldn't know what was worth fighting about.

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Old 03-23-2009, 07:28 PM - Thread Starter
 
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I would love to point you in the direction of this article to get a more articulate sense of what I am thinking. I found it yesterday and got quite excited! http://birthlove.cyclzone.com/pages/...wifery_BC.html
I work in the system, and when I started here had to behave in a certain way as I was working someone elses practice. Now I can work in my style, and find inventive ways around some situations - but I actually really object to having to play the system, I would rather be able to just support the women in their choices and tell the OBs that is how it is.

Is there AIMS over here? That is quite a strong UK organisation that I think is also quite active in Australia. http://www.aims.org.uk/aims.htm They are mostly consumers that fight to change the system - with great success much of the time.

I think looking at a midwives background can be misleading. I think if you read my CV you might assume I had a medical bias - but I dont think that is how I think now!
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Old 03-24-2009, 06:39 PM
 
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I had a registered midwife attended pregancy and delivery in BC and while I was extremely happy with the care I received during the pregnancy, I was disappointed with being handed over to the OB when my labour moved from "normal" to "abnormal". But, 4 years later, I realize this was more to do with being attended in hospital by the midwife on my team who was not great in hospital. Had I been attended by the other midwife on my team, I believe my birth outcome and delivery experience would have been very different. Both were accomplished, skilled and registered midwives, but one had spent the majority of her career in a foreign hospital where she was used to fighting for "normal" birth experiences for her clients, the other (the one I had) wasn't, and she was not comfortable pushing the boundaries in a hospital setting. She was, I understand and truly believe, a great midwife, but more comfortable in a home based birth setting.

The reason why I have chosen NOT to become involved in pushing for a change in how registered midwives are allowed to care for women in my province is because I do not at all support the "birth attendant" who is at the forefront of this fight in our province. I know people on this board who love her, but I do not. I fall in the middle of the midwifery movement I guess. I think there is a very valid reason why midwives should be registered and supervised by a governing body, but I also think there is a very long way to go in terms of getting the medical system as a whole to recognize the normalcy of birth and to stop viewing birth as something to be managed from a "worst case" perspective.

Maybe if I was planning on having more children I would be willing to go to bat for that cause.
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Old 03-24-2009, 08:27 PM
 
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May I ask why you think midwives should be registered and supervised by a governing body? I guess that's always been one of my issues with it - what exactly is it supposed to accomplish?

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Old 03-24-2009, 08:49 PM
 
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May I ask why you think midwives should be registered and supervised by a governing body? I guess that's always been one of my issues with it - what exactly is it supposed to accomplish?
For the same reason I believe that doctors and dentist should be licensed and regulated. A few bad apples can really spoil the barrel, and I think that any person who has authority over someone else's body and physical well being should be held to certain standards. Of course those standards are subject to opinions/fearss and that is where over-medicalization has come into play in the birth arena. But I believe non-regulated care can be just as dangerous as overly-regulated care.
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Old 03-24-2009, 08:59 PM
 
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Canadians expect and deserve and pay for Universal medical care. Midwifery care is part of Best Practices for pregnancy and Birth. It makes sense that it should be included in our Health Care system. As things stand, if people want to choose and pay separately for unregistered unsupervised care, they can but I don't think that's good enough. Personally, I'd prefer to work to improve the care that is available to Canadian women in the National Healthcare system.

This system requires registration and supervision of doctors, why not midwives? I don't think that registration and supervision of midwives is wrong. I do have issues with who is doing the supervision (doctors, not other midwives, it seems) and the increased medicalization of childbirth. Shouldn't there be room for improvement within the system? Shouldn't women have other options besides opting out altogether?

I guess I feel like its akin to fighting for women's right to vote and then accepting that we're only allowed every second election or something. KWIM?

Yes we've won part of the battle. Does that mean we should stop fighting for the rest?
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Old 03-24-2009, 09:08 PM
 
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