A few weeks ago we started analyzing the Clinical Practice Guide on Normal Delivery Care when talking about how the relationship between professionals and women can influence the birth process.
Today we continue with this analysis focusing on a topic that I consider interesting, despite the fact that women who go to a hospital to give birth have little decision power in it: Midwife or gynecologist?
This question can only be asked when childbirth is considered low risk (most if the course of pregnancy has been normal), since in that case it is assumed that there should be no difficulties in childbirth and in that case the woman can be treated by midwives, by obstetricians or both at the same time.
Let's say that the choice when it comes to attending low-risk births is more a matter of hospital protocols and decisions when it comes to managing maternity units than something that mothers may think or request.
But isn't it better to have a gynecologist?
Many people think that the ideal is to always be attended by the person who in theory knows best, since in case of problems they will have more responsiveness and, the logical thing is to think that with this person everything goes better.
However, it has been observed that when a low-risk birth is attended by a midwife, the results are different, to the point that it is recommended that midwives attend these types of deliveries.
What are the results of the studies?
In 2008, a Cochrane review of 11 studies was carried out. The sum of all of them gave a total sample of 12,276 women who were treated in different ways, according to the models discussed above (midwife, obstetrician or a model combined with the attention of both).
The results came to confirm what we said just now, that women who were attended by midwives exclusively used less epidurals, suffered less episiotomies and their deliveries were less instrumentalized. The woman was also more likely to be treated by a professional (the midwife) who had already met before, helping to live the birth in a climate of greater confidence and with the feeling of having greater control. It was also observed that there were more spontaneous vaginal deliveries (less induction) and that breastfeeding was established earlier than in the rest of the mothers.
Regarding the number of caesarean sections, although in other publications it has been observed that there are usually fewer caesarean sections when the person attending the delivery is a midwife, there were no differences between the different care models.
With respect to morbidity and mortality, there are publications that suggest a trend towards higher rates of perinatal and neonatal mortality in this care model. In this review, however, the data is similar in all groups.
Conclusions
A woman who is going to give birth to a hospital cannot decide who should attend to her, so she cannot answer the question "midwife or gynecologist", but simply cross her fingers and ask the heights to be treated, whoever it is, be treated well and above all that your baby is born healthy.
Heeding the studies and experience of mothers the best thing is that births are attended by midwives, since the satisfaction of the mothers is greater and the complications are minor.
This recommendation disappears at the moment when a birth is considered risky, at which time it becomes necessary (and useful) for obstetricians to attend.
Many hospitals are already adopting this work philosophy and to show a button: at the birth of my second child, Aran, and despite the fact that he was born premature (risk delivery), care at the time of delivery was given by midwives. The delivery was vaginal after caesarean section and no episiotomy was performed. At the moment when the baby poked his head there was already a pediatrician waiting, precisely, for his prematurity but, as I say, there was no obstetrician present.
