The first decision I had to make when I found out I was pregnant was which type of primary care practitioner (PCP) I wanted to see. Typically in Ontario, women see their family doctors; many of the doctors in our area also have delivering privileges at the local hospital. I’m fortunate enough to live in a city with a large team of midwives as well, so I was quickly faced with a pro-con list.
First on the list was my family doctor. I’ve been seeing him fairly regularly for the last ten years or so, and he’s got a general idea of who I am and the types of health concerns I’ve faced. His wait times are fairly short, and I knew that I could get an appointment within a few days if I needed one. The lab for bloodwork is right downstairs, and the ultrasound clinic is down the hall. It was convenient, close to home, and sounded like a good choice. The problem was that he doesn’t deliver babies. I could see him until 26 weeks, at which point I would be transferred to whichever OB in the area was accepting patients. I didn’t like that level of uncertainty; I’d much rather have someone who could follow me throughout my entire pregnancy.
My other choice was the midwives clinic. I would be assigned a group of three midwives to follow my case; with each appointment, I would see one of the three. There would be a midwife on-call 24 hours a day, reachable by pager, for any emergencies that might happen. Because the midwives are licensed, they could requisition any of the blood work I might need, and they have a great relationship with the ultrasound clinic in the building. If anything were to happen, they have a few OBs that they work with, so my care could be transferred and I could be seen by the midwives at the same time. They operate on the principle of informed consent; all of the tests, scans and treatments that are offered during pregnancy are carefully explained and detailed before they are done (or not done). They also encourage natural birth, either at home or in the hospital.
The problem with the midwives group is the transfer of care aspect. Say I went into labour and wanted an epidural; I would need to have my care transferred to the OB on call at the hospital, and the midwives would be done with my case. After following me for nine months, I would now be the sole responsibility of the OB and the hospital nurses.