Midwives and their role in labour
The word ‘midwife’ means ‘with woman’, but what is a midwife? Historically, midwives have always been around and they certainly pre-date obstetricians by centuries! Today, midwives play a pivotal role in pregnancy care, labour and birth – and even the early post-partum period. Midwives are specialists in normal pregnancy and birth, although research supports the fact that midwife-based care is suitable and beneficial for all pregnant women, even those considered to be “high risk”.
In Australia, there are many models of care available to pregnant women. They range from taking a private obstetrician; to combining obstetrician (or GP) and midwife-based care; to being cared for almost exclusively by midwives. To work out what “model” best fits you, it can help to understand the difference between the midwifery model of birth and the medical model of birth;

In the midwifery model of care

•  Birth is seen as a social event and a normal part of a woman’s life.
•  Birth is the work of the woman and her family.
•  The woman is a person experiencing a life-transforming event.
•  Midwives see birth as a holistic process.
• Midwives engage in shared decision-making between caregivers and birthing woman

In contrast, the medical model of care is quite a different approach;

• Obstetricians view childbirth is a potentially pathological process.
•  Birth is considered the work of doctors, nurses, midwives and other experts.
• The woman is often seen as a patient.
• Obstetricians are trained to focus on the medical aspects of birth (and don’t necessarily see it as a natural process and event.)
• The approach can come across as” professional” care that is authoritarian.

For the most part, when a woman who is having a hospital birth is in labour, she will mostly be cared for by midwives. However, as most hospitals are over-crowded and under-resourced, women will often find that the midwife assigned to them on any given shift will only pop in to see how she is doing every hour or so. Depending on the hospital, your midwife will also come in to perform a cervical check every 4-6 hours to see how the labour is progressing. Midwives will also periodically take your blood pressure, pulse rate and temperature and monitor your baby’s heart rate (usually with intermittent fetal monitoring using a hand-held Doppler). Unfortunately, as much as most midwives would love to provide one-on-one continuous care, it is simply not possible given that each midwife is caring for several women simultaneously on any given shift.
We do know from extensive research however, that continuity of care and continuous labour support play a significant role in a woman’s labour and a woman who is supported throughout will very often have a much easier and shorter labour over a woman who only received intermittent care.
To overcome this problem, a woman could consider hiring a private midwife or even a doula. A doula is a woman who is professionally trained to provide labour support – however, she is not medically-trained and does not provide any medical advice.
Once a woman has reached Stage 2 of labour (the ‘pushing’ stage), your midwife will be with you continuously until your baby is born. In public hospitals when a woman is having a normal vaginal birth, a midwife will very often “catch” your baby (mum – YOU deliver your baby!) and an obstetrician is not required. If there are any concerns for mum or bub, then an obstetrician will usually be called to be present. Certainly, in a situation where an instrumental delivery (vacuum or forceps) is required, then an obstetrician would be leading the team of your caregivers.
In private hospitals, the midwife will generally call your obstetrician when she thinks that birth is close. If baby doesn’t decide to make a quicker-than-planned arrival, your doctor will arrive close to birth and he or she will then remain with you until an hour or so post-partum.
Public or private, the care a woman receives by a midwife will impact long after she has given birth as she is there with her, at her side for one of the most important and defining moments of a woman’s life.
Tanya Strusberg is the only Lamaze Certified Childbirth Educator (LCCE) in Australia and teaches prenatal education to pregnant women and their partners in Melbourne. She and her husband Doron have two beautiful children, Liev and Amalia.
To learn more visit www.birthwellbirthright.com
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