Modern Day Midwife; An Interview

Stuff That Doesn't Suck: Midwives! 

For those of you who are not aware, I was lucky enough to have a midwife (well really a team of midwives) as my caregiver for both pregnancies. I had enough knowledge preceding pregnancy to want to research midwifery practice more and I ultimately decided it was the right option for me. Thankfully I had that option.


Convincing Hubs at first was hard. He was misinformed, as many people are, about the true nature of midwifery and pre and post-natal care. He thought midwives were an old-timey now-defunct institution that only people in remote villages and hippies still used. He thought Doctors have 7+ years of education so how can they not be the best option?


But, thankfully, after some nagging he watched Business of Being Born with me. We both agreed that although like most documentaries it had a very narrow scope of the con side of things, it did a great job of illustrating how midwifery works in the modern world and that, for me, it was probably a great choice.


Also thankfully, I live in a place where I have the option to use midwives for my prenatal care as part of our provincial health plan completely free to me.


My experience was overwhelmingly amazing. My second even better than my first, if possible. If you want to read more about my birth story, go here.


Nicole was my main Midwife, even though she was a student at the time and the whole shebang was overseen by my two main midwives, she handled the majority of my prenatal visits and attended my birth (in addition to my other midwife Andrea.)


I asked Nicole if she'd be interested in doing an interview with me about being a midwife in 2012. She recently finished her midwifery certification and is now fully-fledged amazeballs at catching babies.


Here's what we discussed!  My questions are in Teal (duh!)

Nicole delivered Carter in December, 2011!

Name: Nicole Del Vecchio

Age: 27

Occupation: Midwife (and self-proclaimed superhero)

Children: None.

Do I still want children despite all I have witnessed? Absolutely.

In my experience the majority of midwives decide to pursue the career after having children, either with positive experiences with midwives or negative experiences with OB's. You are pretty young and are still living the single life (jealous!) what made you want to catch babies?

Becoming a Midwife was never really in my life plan. When I graduated high school I went to Laurentian University to pursue a Bachelor of Science with a major in Biomedical Biology with intentions of going to medical school and doing a specialty in Paediatrics. I have always loved children and wanted to work with them. It wasn’t until my third year of university that I started to lose direction and question whether medical school was right for me. I didn’t really think I had what it took to become a doctor. I didn’t know anything about midwives until speaking with an old family friend about her birth experiences (as women do). She had midwives for all three of her children (each born in the comfort of their own home). She encouraged me to do some research and swore up and down that I would make a great midwife one day.

In my fourth year of my program I applied to the Ryerson Midwifery Education Program (MEP). The application process included the general application, a supplementary essay in which I had to address four questions, and an interview. After my essay was reviewed, I was waitlisted for an interview however I never received the call that year. I was devastated. I didn’t know until that moment how much I wanted to become a midwife. The following year I applied to the Laurentian University MEP and was accepted. And so began the hardest four years of my life.

The Business of Being Born totally sealed the deal for me when it came to choosing a midwife as my prenatal caregiver, do you think the documentary accurately portrays midwifery in North America? And do you think it has helped to increase awareness about our options as preggos?

I think the Business of Being Born is a fantastic documentary, though it has been some time since I have watched it. I think it does portray Midwifery accurately in North America and I feel that it has helped to educate women about what it means to have a midwife. Despite scope of practice being different across provinces and state lines, there are a lot of similarities built in to the foundation of every midwife philosophy and the Business of Being Born shows women the differences between obstetric and midwifery care which I think is something of value. 

How many births have you attended?

I have been to 102 births to date (yes I keep track).

I've heard some tales through the grapevine about midwives who push for home births and labour without intervention, even against the patients' wishes, do you have a philosophy about that?

I’m sure we’ve all heard tales of health care professionals who ‘push’ personal beliefs on patiens/clients. Unfortunately there are ‘cowboys’ in every profession. When it comes to my personal practice and beliefs, I would never do anything to intentionally disrespect the wishes of the women in my care. That being said, no one on this earth can completely control what happens during a pregnancy, labour, birth or postpartum period. I do my best to facilitate the wishes of each of my clients as long as there’s a mutual understanding that safety comes first. My goal at the end of it all is a happy and healthy mom and baby.

Do you even call your preggo's patients? What's the term you use for clients? ... Is it clients? *facepalm*


I refer to the women I care for as clients. The reason I call them clients and not patients is because I expect the women I care for to take an active part in their care. As midwives we view women as the primary decision makers when it comes to formulating a plan of care that best suits their individual needs. I personally feel like calling a woman a patient implies I am operating under an informed consent model rather than informed choice.






Being that you haven't gone through the arguably most excruiciating and degrading experience of your life, but have witnessed it a hundred times over, how do you feel about giving birth yourself some day?

It’s true I haven’t experienced, how did you put it? Arguably the most excruciating and degrading experience of my life. I would still like to have children of my own one day. I’d like to believe that I will be able to have home births (because they really are amazing) but I don’t know how I’m going to react to the pain. I have no way of testing my threshold for pain tolerance but maybe I’ll be one of those mythical women who experiences ‘silent labour’ (but I won’t be holding my breath for that…I know better).

(ed note: I was referring to the pain of labour and not labour itself. I’m sure many women would liken it to the magical place of rainbows and puppy-dogs and lollipops but for me it was a moment where I at the same time felt both like a super hero and the victim of a terrible massacre against my body. Lol)

What "type" of preggo do you think would benefit the most from using a midwife and why?

In my experience I feel as though young mothers really do benefit from having a Midwife as their care provider. I think this group of women benefits most because of the time we spend educating our clients and encouraging them to participate in their care. We want women to be the primary decision makers when it comes to choosing what’s right for them and the families they are building. Being a teen mom isn’t an easy experience which is where I feel that the continuity of care that a young woman receives from a midwife helps a woman (no mater her age) build confidence and she knows that the midwives she’s seen through her pregnancy WILL be the ones at her birth. They will be the ones there to support her and give her what she needs through her labour experience. Teenage mothers are making a brave decision to become parents and when there’s trust between a client and her care provider it can set the tone for her birth experience and give her confidence in her new role as a mother.

How do you feel about the current availability of midwives worldwide and specifically [where we live] in Ontario? Do you think that our Government is supportive of midwifery practices?

Midwifery is continuously growing which is fantastic. That being said, we still have a long way to go before we get to where we should be. I know that as a New Registrant (a midwife in her first year of practice) it was not difficult to get a job. The demand is there but the government support could be better. I could get in to pay equity and funding for the Midwifery Education Program in Ontario but those topics that could take forever to discuss.

Give us a glimpse of your two-week work schedule as a midwife.

Each practice runs their call schedule a little differently. Where I work we do shared care. There are two teams of two midwives respectively. One midwife from each team is on call each week and there are two clinic days per week. When I am on call that is all I am doing. I don’t have any clinic. My sole responsibility is taking care of whatever comes through my pager or messages left on the voicemail at the office. That includes, but is not limited to, births (primaries and back-ups), pre and postnatal home visits, questions, concerns, pre and/or postnatal triage at home or in hospital if warranted, breastfeeding support phone calls or home visits, and general check-ins.

How do you feel about midwife/OBGYN co-practices like they have in the US/Europe? Is that something we should be working towards in Canada?

It would be incredible to work within a well-oiled co-practice. I believe in some of the more rural and remote areas in Ontario there are midwives who work that closely with family doctors. I think that in the future co-practices could start popping up which would be beneficial for interdisciplinary relationships as well as clients. Midwives have come a long way in the obstetrical world and we are constantly moving forward. The keys to great interdisciplinary relationships are communication, and mutual respect and I feel as though we are headed in the right direction when it comes to educating our clinical peers about what we do.

What do you think is the biggest overall misconception about modern day midwives?

The biggest overall misconception about modern day midwives is that we’re all a bunch of tree hugging, grass smoking, Birkenstock and long skirt wearing hippies who only do home births and show up at your house for a birth with a bucket for hot water and some towels.

To dispel the misconception, I have completed a 4 year Bachelors of Health Science degree in Midwifery at Laurentian University (one of the three schools in Ontario to offer the program). I did two and a half years of placement, including separate placements at two midwifery clinics, and placements with; an OB/GYN, a nurse in labour and delivery, in the NICU, with a Lactation consultant and at a support centre for teenage mothers. I have privileges at two hospitals in my community, so if a woman I am caring for wishes to have a hospital birth we are free to do so. When it comes to being prepared for a home birth our supplies list is quite extensive including, but not limited to:

SUPPLIES

Regular fetoscope

Doppler fetoscope

Adult Stethoscope

Infant Stethoscope

Sphygmomanometer and adequate sized cuffs

Thermometer

Baby scale and slings

Ophthalmoscope or other suitable method for assessing red reflex

Infant resuscitation bag and mask

Sterile speculum

Heat source for the baby (i.e. heating pad)

Suitable time-keeping device

Four hemostats

One pair scissors for cord cutting

One pair scissors for episiotomy

Needle driver

Mosquito forcep

Scissors for suturing

Ring forceps

Portable suction equipment

Cord blood tubes

Cord clamps or ties

Sterile gloves

Clean gloves

Sterile lubricant

Infection control supplies as needed to meet public health guidelines and directives

Urinalysis supplies

Blood drawing supplies and tubes

Amnicator or suitable method for assessing amniotic fluid

Maternal non-rebreathing oxygen mask

Feeding tubes (8 Fr.)

Syringes

Needles

IV supplies

IV fluids

Urinary catheters

Amnihook or suitable alternative for rupturing membranes

Infant oropharyngeal airways

Suture material

Sharps and points waste container

Antiseptic solution

MEDICATIONS

Oxygen – sufficient for transport of mother and baby

Oxytocic drugs

Epinephrine hydrochloride (1:1,000)

Diphenhydramine hydrochloride (Benadryl)

Local anesthetic

Eye prophylaxis

Vitamin K

While I do own a pair of Birkenstocks, and a couple of “midwife-y” skirts…I have not actually hugged a tree since I was about 8 years old, I live for fashion and I love doing my make-up. I also choose shave my legs and arm pits though I respect women who decide to go as nature intended.

If someone you knew was thinking about pursuing a career in midwifery, what would you tell them?

I would tell them that becoming a Midwife is an emotional rollercoaster. It was the hardest four years of my life and it was totally worth it. As a student during placement, I got just 4 days off a month. I was always on call or in clinic or both. It’s not for the faint of heart. You have to be sensitive yet aggressive, supportive yet sometimes pushy. It’s all about balance, adaptation, and being able to evolve into whoever your client needs you to be at any given point in time whether that’s someone to share in their joy, someone to vent to, a shoulder to cry on or a super support coach. Someone who chooses to become a Midwife does so because it’s what they love, it’s who they are. Being a Midwife is a lifestyle, not a job.

Be honest here, I was the best EVER at giving birth, right? Can you remember how it went down 7+ months later?

Of course I remember! It was my last day of placement and when you arrived there weren’t any beds available. You arrived at the hospital at 5-6cm and you were contracting well. I remember thinking “Holy crap we’re not going to get her into a private room in time, she’s going to have this baby in triage!” Considering it was your second time I figured things would move along quickly, so once we got you into your room, I busted out the birth ball for you to bounce on (which I don’t think you appreciated too much). You bounced for a while and maintained your cheeky/cheery disposition (in between contractions at least), but then you started to get tired so you got into bed. At some point you requested to be checked because you were starting to feel “pushy.” I checked and you were 7-8 so I advised you get back on the ball, which you did begrudgingly (but thank you for listening to me!). It seemed as though you were only on the ball for two minutes when you swore up and down that it was time to push. I checked you again and you were fully dilated and ready to push and Carter was born not long after. You did beautifully and you make incredibly cute kids! (I’m secretly hoping you will have more!!) 

(Note she never said "yes" or "no" to my totally direct but cheeky question about being the best birth giver? That's just how midwives roll! They answer all of your questions in the most diplomatic-but-make-you-feel-like-superwoman way that they can.)