My Prenatal Experiences with a Yukon Midwife

***by Asheya Hennessey***

When a home pregnancy test confirmed my pregnancy with my second child this past summer, one of the first people I called with the good news was Christina Kaiser. Christina is one of two practicing midwives in the Yukon, where midwifery services are currently not funded by the government and not integrated into the health care system. Christina was happy to hear my news, and we booked an appointment for a few weeks later. She has been my primary health care provider during this pregnancy ever since.

I am now seven months pregnant, and I thought it was about time that I shared my experiences. There are so many things I enjoy about having a midwife for my prenatal care, it's hard to know where to begin! I think this will end up being a bit of a compare and contrast, as a doctor was my primary health care provider for my first pregnancy, and I can't help but see the differences. I think my previous experience with a doctor has also helped me to appreciate Christina's care all the more.

One of the first things that struck me as being different from the prenatal care I received from a doctor is that Christina comes to my home for appointments! I can remember waiting over an hour in the doctor's office for a fifteen minute appointment, but Christina sits in my living room and we usually talk for over an hour. I love having the time to tell her how I am feeling, both physically and emotionally, and to ask tons of questions about different pregnancy and birth related options, such as what remedies I can use for heartburn, or what the pros and cons of a water birth are. There are different things to discuss at each stage of the pregnancy, such as whether or not I want to get an ultrasound, or if I want to get tested for Strep B, or if I prefer an active or passive approach to the third stage of labour, and as each topic comes up I can ask Christina for information and then I get to make the decisions without pressure from her. With the doctor it was quite different: it was more of a 'this is the way things are done' and if I wanted something different I felt I had to argue my case.

I also really appreciate how Christina remembers what I've said in previous appointments. For instance, I knew I didn't want to listen to the baby's heartbeat with the Doppler, which is an ultrasound device. I was okay with waiting to hear the baby's heartbeat until it could be heard with a fetoscope. When I was pregnant the first time, I told my doctor right away that I didn't want to use the Doppler, but she kept forgetting and I had to keep saying 'no thanks,' which felt a bit awkward. Once I told Christina that I didn't want to use the Doppler it was never an issue, and I still felt that if I changed my mind I could always ask for it.

A typical appointment starts with Christina asking how I am feeling, so I share my different pregnancy related woes, such as nausea, heartburn, backache, fatigue, mild cramping, cravings or whatever else I have been experiencing. It's great having someone listen to you complain, and you know that it's actually part of what you are supposed to be doing! My sense is that asking how the woman is feeling is an important part of how a midwife takes care of her client, because not only does it make the woman feel cared for, but what the woman is feeling may reveal something that is a symptom of a problem, which will allow the midwife to catch it and be able to address the problem. My pregnancy is perfectly healthy and normal, but it's reassuring to know that I'm being listened to in case there is a problem.

After we discuss how I am feeling, we usually discuss some informational sort of topic that has to do with my options, such as remedies to treat my complaints, or tests in pregnancy, or options in childbirth.

Christina takes my blood pressure and my pulse at every visit, and she gives me the choice of whether or not I would like to be weighed. I always opt to be weighed because I like knowing how much weight I've gained in the pregnancy. Similar to how it's done at the doctor's, I pee in a jar and she checks my urine with one of those little strips of paper that gives information about pH and leukocytes and other things that could be indicators of potential problems. Once my belly got big enough, she started measuring it at each appointment.

I like how our appointments are casual, and if there's something I've been meaning to mention but forgot about, there's lots of time to remember. Another aspect of the care I'm receiving that I really appreciate is that I can call Christina if I have questions or concerns in between our appointments. I called her once because I had taken a bath with eucalyptus essential oil, and felt quite sick. I was concerned, because of course after I'd taken the bath I looked up eucalyptus and saw that it was contraindicated in pregnancy. She was able to provide me with information and advice over the phone. I've also called her when I've been feeling really emotional and scared that I was going to lose the baby - this has happened to me in both pregnancies around 22 weeks, and it was really nice to have a professional to talk to at length this time! I've called her with a few other concerns as well, and it's always so comforting to know that she is easily accessible.

Having my two year old son around for the appointments, in the familiarity of our own home, has also turned out to be a bonus that I didn't anticipate. He can play with his toys, get a snack etc. while we visit, and he also gets to participate in some of the 'new baby' activities, like using a stethoscope to listen to my heartbeat, measuring my belly, and listening to the baby's heartbeat with the fetoscope. I think that being part of caring for the baby while the baby is still inside me helps him to bond with the baby and feel even more excited about the birth of the baby. We are planning a homebirth, so I think it's also really great that he can get used to Christina being in our home, and it is helping to prepare him for her presence at the birth.

I believe that Christina's philosophy about pregnancy and childbirth is very similar to mine, which is that pregnancy and birth are a normal part of a woman's life, and it is better not to interfere or use interventions unless there are actual problems that need to be addressed. This is a pretty basic tenet of the midwifery model, while the medical model tends to come at pregnancy as an abnormal condition, which only makes sense because doctors are trained to address and find solutions for states of ill health. It's very relaxing for me to be working with a health professional who has a similar philosophy, because I don't feel that I have to convince her into my way of thinking or fight her about the decisions I make. I also don't feel intimidated by her; I can ask questions and express my thoughts without feeling like there is a hierarchy and I'm on the bottom. I think this sense of equality is demonstrated in something as basic as how I address her: I call her by her first name, whereas doctors are most commonly referred to by their last name with the title of 'Dr.' in front, which sets up the hierarchy before you even meet the person.

I am very happy that the health professional who will be attending the birth of my baby is someone who I have gotten to know and like, and that she similarly knows me. When I gave birth to my son in the hospital I was quite anxious because I didn't know who would be my nurse or even which doctor would be attending. And I knew that they wouldn't know me, which would make it harder for me to communicate my choices. I am eagerly anticipating birthing this child at home, surrounded by people who know me and who I know. And not having to drive to the hospital when I am having contractions is just a bonus! I trust Christina, and I think this is very important. I know that research indicates that fear can make labours longer and harder, and so I am very grateful to be able to give birth in an environment where I feel safe, and where I trust that my health professional will listen to me.

If you would like to know more about Christina and how to contact her, you can visit www.yffm.ca/midwives.htm