Two Views: On how to approach childbirth

MEDICAL: Jan Christilaw, OB/GYN, Professor in the Department of Obstetrics at UBC and Acting President of B.C. Women's Hospital & Health Care

During prenatal visits, I check that the pregnancy is progressing normally. I will help the mom make a birth plan, and I’ll look for risk factors, such as high blood pressure and gestational diabetes.
When a woman’s in labour, a nurse is with her; I check in routinely and monitor the baby’s heartbeat with a machine called a doptone. (We’ve moved away from the routine use of fetal-monitoring machines, since sometimes they falsely report abnormalities.) If the woman needs it, she can have an epidural for the pain. It’s low-risk and may be especially helpful if she has high blood pressure.
Once the woman is fully dilated and pushing, I’m there the whole time. In about 10 percent of first births, the mom will need some assistance because she is too exhausted to push anymore. So we’ll intervene and have to use a vacuum or forceps or perform a C-section.
In almost 15 percent of first births, a C-section is unavoidable: The baby is breech, or the mother’s blood pressure will skyrocket. But with any intervention, there are risks infections, hemorrhaging, even mortality – and Canada’s intervention rates are too high.
As soon as the baby comes out, we assess her colour, muscle tone, reflexes, breathing and heart rate; a normal baby should score above 7 out of 10.
Twenty years ago, midwifery in Canada was illegal. But science has proven that midwife-assisted births are as safe as obstetrician-performed ones. Now, my hospital has a midwives department, and we work as a team to provide the best care for the mothers and babies.

ALTERNATIVE: Gisela Becker, Midwife in Fort Smith, N.W.T., and President of the Canadian Association of Midwives

In most provinces, a woman can choose a midwife as her primary-care provider. We do everything a doctor would, unless she develops risk factors. Then we might transfer her to an obstetrician or collaborate with a doctor.
With a midwife, women can give birth at home, at a hospital or in a birthing centre. I think most women choose what makes them feel safe: For some, that’s their own environment; for others, it’s surgical backup care if anything goes wrong.
If a home birth is taking too long, or the woman needs more pain relief, we move to the hospital. About 12 percent of home births will end in the hospital.
Over 90 percent of the women I help in the North give birth naturally. We let the mother have as many support people as she needs. We help her control pain using relaxation and visualization techniques. We breathe with her and massage her. For birth, we encourage different positions: Women stand, squat or go on their hands and knees.
After the birth, midwives, like doctors, assess the baby on a 10-point scale. We also carry oxygen; only one percent of babies require extensive resuscitation, and they’re likely not the low-risk births we would deliver at home. We provide local anaesthetic, suture women if they tear and carry drugs such as oxytocin, which controls hemorrhaging.
Unlike a doctor, I offer support throughout labour, and women who have that one-on-one care feel safer and more comfortable. They’re less likely to have painkillers or epidurals, and have lower intervention rates, including C-sections.