A Midwife is Not a Midwife Is Not a Midwife

I am 13 weeks pregnant now, and this is the point in pregnancy where most people either have found a midwife, or are in the process of finding a midwife to work with. There is wide variation in the timing of this, but most people have a first appointment between 12-16 weeks it seems. Luckily, I don’t have to do this since between myself and my dear friend Maryn, I have all the pregnancy and birth support a lady could want. I say luckily because I have seen what a “make or break” process this can be, and I don’t say that in a fearful way.

I say this because choosing a care provider (if you are going to choose one) is a really important piece of the pregnancy puzzle that largely gets ignored! So this is my public service announcement. Most people seem to think that midwives are all the same, maybe with different personalities that they get along with better or not. Should I choose the sweet grandma or the energetic newbie? The midwife with dreadlocks or the one who wears scrubs? It is treated as a mainly superficial choice, as if whoever they pick will be midwifey and help them have the pregnancy and birth they want. Right?

I’m here to tell you this isn’t the case. I don’t think one midwife is better than the next. I really am a believer in the “it takes all kinds” philosophy, because there truly are plenty of women out there who want homebirths that wouldn’t mesh well with my version of midwifery, and would be much better off with someone who was a better fit. What DOES make me upset/angry/mentally insane is when I see women choosing care providers that have clearly conflicting beliefs, but since they didn’t know what to ask, or even that they HAD to ask, the woman keeps going for appointments and starts feeling more and more uncomfortable. (Admittedly this also takes a midwife who is pretty oblivious, but we’re talking about mamas taking responsibility here)

I would love to help people avoid that whole trap, especially since sometimes it really isn’t until the birth that they realize “oh crap, this midwife is not on the same page and this is going to be really dramatic”. I see this happen the most with midwives who also think a midwife is a midwife is a midwife so they don’t take the time to screen clients and make suggestions if they may work better with a colleague of theirs instead.

The best case scenario is that she starts looking into other options and does some more interviewing to find a better fit with someone else. Usually these people already knew there were other options, and were already confident in what they wanted, so they can clearly see the lines in the sand as they have more and more grating encounters with their midwife. Hopefully this happens early enough in her pregnancy that she isn’t feeling rushed or frantic about finding someone new. Other times, the mama decides she will just “make it work” even though she recognizes that this isn’t an ideal pairing, and that she will figure out something different for next time. Unless there are serious constraints, I think that anyone who says “I would hire someone else next time” before the birth EVEN HAPPENS should really just hire someone else before the birth THIS TIME. The worst case scenario is when a mama or a couple is maybe just going to the midwife because they wanted a more natural option, but they aren’t super educated about what that means or what they want. Their midwife starts suggesting things they are uncomfortable with or confused by (whether it is more or less medical than they wanted), and they just end up going along with it since they think this is just what midwifery care is, and they lack confidence/time/knowledge/empowerment whatever it is to choose something different for themselves. These folks end up having bad pregnancy and birth experiences, just because of this discord, even if everything goes smoothly. It is not an empowering experience to feel confused or out of the loop, and clearer communication on the part of both parents and midwives could pretty easily remedy this. If parents just knew that different midwives approach issues differently, and treat clients differently, they could have found a better match from the get go and avoided the whole thing.

Parents should really look into all their options, and make sure they are as clear and detailed as they can be about what they want in order to eliminate confusion. Sometimes it is still tricky since providers may say something that means one thing to them, and another to the parents. For example, a provider may say that are open to doing delayed cord clamping, which to them means at 1 minute, while the parents think it means 2-3 hours (or vice versa). If they don’t ask again in more detail, they won’t realize until the birth that there was a big misunderstanding. This seems to be the case most often when parents aren’t 100% clear and educated about what they want beyond a “natural birth” and a few very basic concepts. If they start doing more research and start asking more detailed questions during the course of pregnancy, that is when the red flags usually start popping up.

I’ve sat with too many frustrated mamas in late pregnancy who are just realizing that they picked a provider that wasn’t a good fit. Let’s promise to help our friends and community members really understand their options so they can have the best pregnancy experience from the very beginning.