Registered Midwives are autonomous, primary maternity caregivers who are experts in supporting physiologic birth. Under the midwifery model of care, midwives are responsible for providing compassionate, non-authoritarian, individualized, evidence based care that reflects and respects the birthing person’s identity, personal values, autonomy, their knowledge about their body, their pregnancy and their own unique circumstances.
How Does This All Work?
Registered Midwives are publicly funded through Alberta Health Services, which means that Albertan families do not currently have to pay for Registered Midwifery care out of pocket, which was the case prior to 2009. Registered Midwives generally provide midwifery care throughout the childbearing year (first trimester to 6 weeks postpartum) and have the ability to order lab tests, ultrasounds and can prescribe medications during pregnancy. Many Registered Midwives also have additional knowledge around herbs, homeopathy, nutrition and other natural supports. Pregnant people are able to apply for midwifery care under their own authority – no referrals are needed from any other caregiver.
Challenges In Accessing Care
Finding midwifery care can be challenging, especially if you live in a rural or underserved area where midwives are not already well established. Most midwives are only able to take on a limited amount of clients every month and waitlists are often long. Many areas have no access to any maternity caregivers at all – these are very real and formidable challenges. Some people are able to arrange to travel for care, or find other creative solutions within or outside of the system, but I recognize the stark reality that many people do not have equal access to all choices in caregiver.
Ask For What You Need
When there’s scarcity around being able to choose a caregiver, it can feel very overwhelming and downright emotionally unsafe for parents to ask for what they need if they do get into midwifery care, because of fears around being perceived as “too difficult”. However, it’s been my experience over the past ten years that when a maternity care relationship is not in alignment due to lack of communication or lack of acceptance for either person’s values, limitations or boundaries, that this rarely results in a positive birth experience for anyone involved unless those things are addressed.
Most caregivers want to know if there’s a problem, so that a mutually beneficial solution can be found. Even though it might feel risky and awkward (and may not have the desired effect), my advice is to let your caregiver know if the care you are getting is not the care that you need. At the very least, you’ll know whether or not the caregiver that you are working with is the right person to attend your birth well before you are in labour.
Get Clear On What You Do Want
If you haven’t already, spend some time to consider what you DO want in a midwifery care relationship. Many pregnant people often have a very good idea of what they DON’T want from listening to other families’ birth stories and the increased availability of online information around routine birth practices and “the cascade of intervention” – birth plans are highly indicative of this in our culture. While you can’t ever have 100% control around how any given birth plays out (and there is no caregiver on the planet that can promise you 100% safety either), you can do your best to learn how to support your body and baby throughout labour, and surround yourself with a supportive birth team that you trust to help you navigate challenging circumstances if they arise.
Are You Actually Aligned?
Every caregiver is a human being, with their own style of practice, their own experiences and beliefs around how to best support birth, and their own personal boundaries that determines which situations they are able to support. Birth is politically and socially complex, and there can be a lot of barriers to navigate when providing care to folks making autonomous choices depending on where the caregiver is practicing, what rules and regulations are governing their practice, and if there are supportive, collaborative care relationships available in their area.
If you know that you want a “hands off” homebirth and plan to decline some or all routines or make choices that might fall outside of cultural norms, connect with a midwife who regularly attends homebirth, and is comfortable supporting that wide spectrum of choice. Likewise, if you know that you are going to feel the most comfortable in a highly medicalized hospital setting, with routine monitoring and interventions and definitely plan on accessing an induction of labour or epidural, engage the services of a midwife or a physician who regularly provides that style of care in a hospital setting.
Don’t make assumptions – just because someone is a midwife, doesn’t mean they are going to fit into a stereotype or be the right fit for you. Be honest about what you are looking for in a midwife (or any caregiver), and ask for transparency in return. Even if you aren’t perfectly matched, being honest about what you need early on, gives time for your midwife to either meet you where you are at, or to help you find another midwife (or physician) who might be a way better fit.
No matter who you choose to enter into a caregiving relationship with during your pregnancy, it’s important that you feel supported, respected, and physically, emotionally and psychologically safe.
Like I always tell my clients, “If it’s not a hot yes, then it’s a no”. Sometimes an honest “We aren’t a good fit”, is the kindest option, even when it’s a hard conversation to have.