For labor and delivery, what's in a title?

Although midwifery-led maternal care is a growing trend in the US, it is still often regarded as inferior or alternative care.
Although midwifery-led maternal care is a growing trend in the US, it is still often regarded as inferior or alternative care.

A few months ago, I was working on labor and delivery, and I assumed the care for a patient who was having her fifth baby. She had not received her prenatal care with midwives; however, it is common for the midwives at our hospital to care for women who are low risk in labor, regardless of where she had her prenatal care.

The patient had happily consented to midwifery care while in the triage unit. Most low-risk patients at our hospital seem to prefer midwifery care during labor and birth and often request to be cared for by the midwives.

When I came into the patient's room, she was coping well, but she was working hard through her contractions. She was not talking much, and her mother was at her side. I introduced myself as the midwife, and her mother immediately asked me where her daughter's doctor was. I explained that her daughter's physician was not on-call that day. She regarded me rather skeptically as I cared for her laboring daughter.

Shortly before the patient was ready to push, a brand-new, first-year resident that was working with me came into the room and introduced herself to the patient and her mother. As soon as she said, “I'm Dr. W, the first-year resident working with the midwife today,” the patient's mother's face lit up.

“Oh I'm so glad the doctor is here,” she said. “Not that I mind a midwife, but I know the doctor knows what to do if anything bad happens, and I feel better having her here.”

The resident and I just looked at each other, dumbfounded. We both knew that she'd been working as a resident on labor and delivery for all of 4 weeks. We both knew that I have delivered hundreds of babies unassisted by a physician, whereas she has to be supervised by an attending provider for the next 4 years. We both knew that in the event of an emergency, I would most likely be better equipped to handle it than she would. The resident tried to explain this to the patient and her mother, but her words seemed to fall on deaf ears.

The word “doctor” is what this mother was stuck on. To her, that word meant skill, knowledge, and experience. It brought her a level of comfort that the word “midwife” did not, despite my 7 years of catching babies and 13 years before that as a nurse. She didn't understand that a first-year resident with the title of doctor before her name is vastly different from the attending physician that her daughter saw for her prenatal care.

When I posted this as a little anecdote on my personal social media, there was an outcry among my friends. One friend posted that she thought midwives were better than doctors. But I jumped in quickly to correct that. I don't feel that one profession is better than the other, but that we each have our strengths and work best when we are using a collaborative model for patient care.

Midwives are regarded as the provider of choice for pregnant women in the United Kingdom and most of Europe. Although midwifery-led maternal care is a growing trend in the United States, it is often regarded as inferior or alternative care.

It is time for midwifery to move into the mainstream of healthcare, or at least the mainstream of maternity care. Midwifery should be the gold standard for every low-risk pregnant woman, with collaborating physicians ready to take over if complications arise. Every woman deserves a midwife.

Robyn Carlisle, MSN, CNM, works as a full-scope midwife in Philadelphia. 

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