Is a midwife better than a doctor?

 Labour and delivery are key moments that mark the end of a pregnancy. Understandably, there are many anxieties that surround the delivery of a baby. Not least is who actually conducts the delivery. Should it be the midwife, or the consultant obstetrician?

Key decisions surrounding labour and delivery should be made during the antenatal period. It is important to realise that labour and delivery is usually a team effort. You play the main role, with collective supervision between midwives and obstetricians. Neither must be deemed to have a lesser role.

Labour and delivery are natural processes, and for the vast majority, spontaneous delivery is the norm. All that is required is due monitoring to detect any deviation from normality, and act accordingly. Both midwives and obstetricians are trained in conducting normal vaginal deliveries. Neither of them can claim superiority in normal delivery skills. But some studies show an advantageous edge with midwives compared to obstetricians as far as normal delivery is concerned.

So the general idea that you need a consultant obstetrician to be present for a normal vaginal delivery is a fallacy. If everything is proceeding normally, the presence of an obstetrician is hardly required. Midwives will skilfully and safely deliver your baby. Observational studies show that you are far less likely to require interventions during vaginal birth if being supervised by a midwife. We are talking of interventions that deviate from a spontaneous birth. Midwives appear to be more patient, allowing the natural course of events to unfold whilst still upholding your safety and that of your baby.

Do consultant obstetricians have any use then as far as normal vaginal deliveries are concerned? Yes they do. Theirs should mainly be a behind-the-scenes supervisory role. As soon as you arrive in labour ward, your obstetrician should be informed. Part of their briefing is a reminder of your antenatal course and prior plans for your delivery. All being normal, they don't necessarily need to see you in person, but should be easily available should your labour deviate from the norm. They must be kept informed on the progress of your labour. Routine decisions can easily be communicated verbally but your obstetrician must remain ready to physically come in if any complications arise, or unforeseen interventions become necessary.

You retain the liberty to select between being delivered by a midwife or by an obstetrician. Remember that you may not have an advantage either way. When labour is progressing normally and a spontaneous vaginal birth is anticipated, having a consultant obstetrician physically present hardly adds value. What adds value is the team effort, with each member of your delivery team responding appropriately as events unfold. The presence of a consultant obstetrician when hardly anything requires to be done just crowds your delivery room, and adds onto your costs.

Photos: mumsinnigeria.com