Maternity care where I live

We all know that choosing your doctors is important. You may be looking for different things from different kinds of care providers. If you're looking for a heart surgeon, you might want someone with lots of experience in the procedure you need, who's affiliated with a hospital with an excellent reputation, and if s/he'll also take the time to explain things to you it's a bonus. With a shrink you want someone with whom you feel safe, who's patient, and who won't talk down to you. With maternity care providers you want someone who will take the time to really answer all your questions and who shares your philosophy of childbirth. All the books say that this is the most important thing you can do to have the kind of birth you want.

With most specialists there is an ongoing relationship. If you do not feel comfortable with a doctor you can ask for another referral, you can change. With an obstetrician there is an ongoing relationship during the pregnancy, but that person may not be there for the birth. When you're giving birth there is really no option to cancel the appointment, walk out, and start looking for a different doc.

In Toronto, Ontario in the current health care environment, family doctors, obstetricians and midwives are all in short supply. Women are rarely able to interview care providers and choose one who suits them and their family - care providers just don't have time because they're struggling to see the patients/clients they already have.

Many women who would have liked to have a midwife find that if they wait until six weeks of pregnancy (which, let's face it, is when many of us are just starting to realize we've missed a period - not all pregnancies are planned to the minute) then the midwives are all booked up. There may be waiting lists, but no assurance that your name will ever make it to the top. If you do get an appointment, you take the first midwife you can see, because if you don't book with her immediately you might miss your chance. You might not think to ask about holiday schedules, about off-call time, about the chances of having your primary midwife at your birth.

Doctors are run off their feet. With the encouragement of the government and to try and balance the demands of an over-full obgyn practice and a personal life, most doctors work in group practices of varying sizes. Everyone in the group shares call. Some of my clients have doctors who are in groups of 10, 12 or more. So, their chance of seeing their own doctor on the day they give birth is 1 in 10 or worse. Meeting the other doctors in the practice is impossible under these circumstances. There are a small number who make a point of attending their own patients - some of them are extra dedicated, and some just don't play well with others.

So, that means that by far the majority of my clients are attended in labour by people they've never met before. Those who were aware that this would be the situation from early in pregnancy often don't bond with their care providers: "oh, he's okay, but he's not going to be there anyway so it doesn't matter".

As a doula I find it really frustrating to try to help families achieve the kind of birth they want. I can help them have good conversations with their doctor, I can help them write a birth plan and have the doctor give feedback, perhaps put it in their chart, we can luck out and get assigned a nurse who is interested in hypnobirthing/natural childbirth/etc and happy to support a calm environment, and then you can have an on call ob who walks in, flips on the lights, orders a woman onto her back and starts managing the birth according to their standard high-intervention operating procedure.

Even with midwifery care you can run into disconnects. A couple of times I've had clients planning water births who happened to go into labour on a day when their primary midwife was off call, or had another client in labour. The midwife who arrived was not well known to the client, was nervous about water births, and undermined the client's plan.

I can help clients plan, I can help them access information and discover options they didn't know were available. I can help them express their needs and wishes. But I can't change their birth place, their care provider or the underserved health climate we live in. If any of you have any ideas on how to work this way (other than UC!) please share.