Would you give birth in a midwifery led unit?

[SunnyRain]

how many doctors, of MANY specialties (GP's included), are all about the academics, and are only doctors because they got good grades in school, not because they have a genuine passion for helping PEOPLE.

OH BOY, Not very many!! I've been surrounded by specialists and surgeons all my life. Including one of Australia's leading specialists in HIV research and others who worked alongside Fred Hollows. If it was school grades that drove these people they'd be financial consultants or lawyers.

Are you just scare mongering for the hell of it, or do you enjoy making the experience of pregnancy and the prospect of going to hospital even more stressful than it needs to be? You're actively working against creating the calm birthing experience that you advocate (I'm not just referring to the person I quoted, I've moved on to a broader audience).

Perhaps all these women having negative experiences would have a much better time if they could relax. White-coat syndrome is a real syndrome and you people who keep yapping about how awful doctors are really aren't helping, you're creating a negative perspective on something that needn't be so bad.

Yes this is my first pregnancy, but I'm not worried because I trust my obstetrician and I also know how to communicate with doctors instead of fearing them unjustly.

[BellyBelly]

This is a great discussion... if you don't like what you hear you don't have to participate. This is the joy of the internet, we can exchange experiences and learn. I haven't heard anyone call doctors crap or useless etc. Everyone has clearly said they have a place so I see no reason to change the direction of the conversation. Glad you are happy with your care - just as women should be allowed to have obstetric care and be happy with it, so should women who want midwifery care. See you have what you want so why should it matter? Clearly 74% of women in this poll want access to midwifery led care and I can tell you, only 3% of Victorian women give birth in a birth centre, 0.4% born before arrival, 0.3% planned homebirths and the rest hospital. HUGE difference based on this poll. Thats over 96% in hospital, obstetric based care. When 74% are saying we want something else. Not such a big deal when its not what you want isnt it? What if we took away obstetric care? Ooooh wouldnt there be a huge uproar then!

Women wanting midwifery care should be angry! They dont get THEIR choice.

[briggsy's girl]

OH BOY, Not very many!! I've been surrounded by specialists and surgeons all my life. Including one of Australia's leading specialists in HIV research and others who worked alongside Fred Hollows. If it was school grades that drove these people they'd be financial consultants or lawyers.

it's fantastic for YOU that you have had great experiences with those you've been surrounded by - for a lot of us, that obviously isn't the case. i was not scaremongering, i was simply stating something i myself have observed. there are doctors out there that have NO IDEA how to relate to people. they have academic skills you wouldn't believe, can repeat every single function of the human body but when it comes to actually RELATING to people, putting them at ease, they have no idea! it doesn't mean they're not good at what they do, but that is not what you need when you're going into childbirth - you need to be comfortable. as you say, white-coat syndrome exists, and for some people, the thought of birthing in a hospital environment scares the crap out of them - birth isn't supposed to be a medical procedure.

as kelly so adequately said, you have been able to make your choice - the rest of us should be able to as well!


FWIW, i live in a rural area, and the only OB of any repute is leaving the area for a position down Melbourne way - better money, and definitely more prestige - and i don't blame him for it. from what i've heard, we're now left with two ob's that are far too scalpel-happy, with very ORDINARY reputations. unless i have a homebirth (which my DH isn't comfortable) i have no choice but to give birth at the local hospital, as there is NO OTHER OPTION. for ME, in MY CIRCUMSTANCES, i would love to have the option of birthing in a midwife led centre with close affilliations with the hospital IF it is deemed necessary that i need more help. White-coat syndrome doesn't just come from what you read online - it comes from being in an environment that makes you anxious for whatever reason - and knowing those ob's are the ones on call when i will birth scares the crap out of me already.

[Schmickers]

Hi there JuJu,

I can certainly sympathise with your position. I worked in paediatric oncology for six years, and I often reflected with dismay that so very many children had cancer! But when you put it into context, you realise that your views are somewhat affected by your position; we took almost every case of childhood cancer in the entire state, for instance, so what we saw was only a tiny proportion of the paediatric population (thank goodness!) Working in a Level 3 NICU, I'm sure you receive referrals from a very wide geographical area and a large population. When you only see the worst of the worst, it is easy to become accustomed to seeing that as the "norm".

While the focus of this thread was on midwifery-led care, as opposed to home birth, I guess you could argue that homebirth is simply midwifery-led care in a home, rather than a separate centre, and you raise some points that I think it is important to address.

A very skilled mid-wife that is able to pick up on fetal distress that requires hospitalization may still run the risk of long term or permanent damage to the baby. In a emergency situation there needs to be interventions taken with-in seconds to minutes to guarantee the most optimal outcome for the baby.

I'm sorry, JuJu, but that is simply not backed up by the research. There are no midwifery or obstetric interventions that have to be performed within "seconds" to ensure the well-being of mother and baby during the birth. Complications are rare during labour and birth in a normal, healthy woman, and when they do present, they present with early warning signs that an experienced and adequately skilled midwife will detect. Thomas et. al. in 2004 examined a cross-section of births that occurred in the US that ended in caesarean, and compared the time interval between the decision being made to perform a caesarean, and the procedure actually happening; they found that there was a 75 minute window between the detection of complications and the commencement of a caesarean, for best outcomes.

We are talking all it takes is a few minutes of decreased oxygen supply to the baby to cause permanent brain damage. People who delivery their babies at home may have no ideal that there was fetal compromise during delivery, if they were not hooked up to a fetal monitor during the delivery.

During normal labour, it is not possible for the baby to be deprived of oxygen. It receives oxygenated blood from the mother's placenta. The "danger period" for oxygen deprivation is during and immediately after birth. Once more, in a midwife-led setting, the use of opioid-based pain relief for the mother is reduced, active labour and birth reduces time spent pushing and birthing the baby, and as a result the baby is not as likely to suffer respiratory depression at birth or immediately after. In terms of monitoring, the Cochrane Review in 2006 by Alfirevic et. al. showed continuous fetal monitoring has been shown to be no more effective at preventing neonatal complications as the periodic doppler monitoring that midwives use. It also restricts movement, which actually increases the likelihood of some birth complications.

As for me, I would not take the risk of compromising my baby delivering at home.

Once more, your opinion is not supported by the current evidence. As far back as 1997, analysis of the existing literature at that time by Olsen indicated that there was no difference iin fact hospitals had a higher incidence of low Apgar scores (babies which are slow to breathe and move after the birth) and serious penineal tears than hospital births. These results were backed up by Ligtermoet in 1998. The same year, Murphy & Fullerton examined home births in the US and found that they were as safe as hospital birth as long as hospital support was available for transfer in the event of complications. More recently, in 2002, Parratt & John examined home births in Victoria, and found that they were equally as safe as hospital births; in 2005, a very large study was conducted in the US by Johnson & Daviss, which found overwhelmingly that homebirth with appropriately skilled midwives was as safe or safer than hospital birth. They even went so far as to make the statement that "There can be no more doubt about the safety of homebirth" in a media release about their research findings.

Not to say bad things don't ever happen in the hospital, and a lot people have wonderful deliveries at home. You don't know if you are going to have a smooth delivery until it's over.

Statistically, actually, you do. Homebirth midwives follow quite stringent admission criteria to screen women who may be at higher risk during birth. It is for this reason that the results are as they are; because with appropriate screening, advice, and support during pregnancy, you do know that you will have a trouble-free birth, or at the very least, that if something changes, you will have time to deal with it.

I think you have much better outcome for you and the baby at a hospital with a highly skilled doctors and staff.

That may be your personal opinion, but it is certainly not the reality of our current health care system.

References
1. Olsen O. Meta-Analysis of the Safety of Home Birth. Birth. 1997;24(1):4-13.
2. Ligtermoet H. Safety in childbirth. Birthings. 1998:9-12.
3. Murphy P, Fullerton J. Outcomes of intended home births in nurse-midwifery practice: a prospective descriptive study. Obstet Gynecol. 1998;92(3):461-470.
4. Parratt J, Johnston J. Planned homebirths in Victoria, 1995-1998. Australian Journal of Midwifery: Professional Journal of the Australian College of Midwives Incorporated. 2002;15(2):16-25.
5. Johnson KC, Daviss B. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 2005;330:1416.
6. Alfirevic Z, Devane D, Gyte GML. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Cochrane Review). (Date of most recent substantive amendment: 24 April 2006). The Cochrane Database of Systematic Reviews. issue 3, 2006.
7. Thomas J, Paranjothy S, James D. National cross sectional survey to determine whether the decision to delivery interval is critical in emergency caesarean section. BMJ. vol 328, no 7441, 20 March 2004, pp 665-668.

[Cassius2]

Clare - then they should be midwives

yeah, but from what i have read and heard, being a midwife here in Australia is an uphill battle to find respect and acknowledgment of experience and knowledge in what is ultimately THEIR field...only for the strong!

Briggsy's girl: academic education is not reflective of a person's ability to relate to people. Also, most doctors are not academic. academic is a term that implies that they have gone on to further study and have dedicated themselves to a particular field through the completion of PhD (trust me, requiring loadsss of passion!). in the case of OBs they have gone to university to get a degree. that's it. MOST dont have a PhD, because, like you said, they don't give two hoots about what they are doing.

The state of care in rural areas is abysmal. i can only talk from a QLD perspective, but it is the pits. in a country town where some family lives there used to be a midewife centre. (basically because there wasnt a hospital close enough to deliver babies). the centre was really successful. until they closed it down. the claim was funding, but the rumour was that the local hospital (which is not at all convenient to the people in the district, not to mention extremely dangerous - my aunt was having a heart attack and they sent her home with a bottle of mylanta) was basically getting narky about the drop in numbers of women birthing there and applied pressure. the end result was that women were (and are!) holding off (and rightly so!) until the very last minute to go to the hospy and have their babies, resulting in many being delivered in carparks, on the side of the road etc in extremely terrifying circumstances. Seriously, WTF is so bad about Midwife-led centres???? what freaks the establishment out so much? is it that they can't make money out of it? i find that hard to believe! i mean, if McDonalds fast food restaraunts can make money outta the cr#p they serve as 'food' surely....

I have to say that I am waiting for the day that BB opens its own Midwife Centre!! bring it on!!!

[Trillian]

Perhaps all these women having negative experiences would have a much better time if they could relax. White-coat syndrome is a real syndrome and you people who keep yapping about how awful doctors are really aren't helping, you're creating a negative perspective on something that needn't be so bad.

Excuse me? You're showing your naivety there. I dare you to tell that to the women who've suffered VERY REAL trauma during an obstetric led birth. By telling them that maybe they would have had a much better time of it if they just relaxed totally devalues what they had to live through. Some even go so far as to call their birth trauma rape - yes, that's right - these women feel so violated from their experience that this is what they liken it to. You know what scaremongering is? When an ob tells a woman who is labouring fine, but is just taking a little too long for their liking that if she doesn't consent to a c/s that her baby will die - that's scaremongering. When women wanting to have a VBAC (Vaginal birth after ceasarian) are told all sorts of half truths about the risk to their baby and to themselves unless they have another c/s - that's scaremongering. When women aren't allowed to go to term of 42wks or beyond because of perceived risks to the baby from deteriorating placentas - thats scaremongering.

We don't scaremonger here. We educate. It's not a nice reality, but that's the way it is. You could almost call it our 'duty' to help educate women looking for better ways to birth. We help take away some of the naivety, because quite frankly, it is scary how many women go into pregnancy and birth 100% sure that their Ob has only their best interest at heart. But I have news for you - they don't (and I speak in the collective, because obviously not ALL obs are like that) - they are worried about lawsuits, about their reputations. They want to make life simple for THEM. You owe it to yourself and your baby to make sure that you are educated and are prepared for any eventualities that may come up. You are doing yourself a disservice if you don't.

[BellyBelly]

what freaks the establishment out so much?

$$$$$$$$$$$$$

[Schmickers]

Thank you, Trillian. I heartily agree.

[Toomanytoomany]

I wish people would stop bashing doctors. There aren't any obstetricians here to defend themselves, but there are plenty of midwives and doulas getting their jibes in, it doesn't seem a fair or balanced argument.

Given that the AMA seems to dictate how the policy is formed on this issue, I think it balances the scale a little.

Have you ever read a newspaper article about anyone you know? They are always, ALWAYS completely and utterly wrong about every detail, and yet we turn the page and instantly take the next thing we read as gospel.

I'm a journalist so I'm aware of how newspapers work. Anyway, from my experience, from policy decisions, and from listening to the stories of other women, the article meshes with the reality.

Why are people so anti doctors, it's very strange. Do you really think someone would become an obstetrician, of all trades, if they were an evil person? These doctors help women every day deliver babies safely. Many women truly appreciate their efforts.

This is the biggest straw-man of these arguments. People aren't anti-doctor. Mostly, they are against unnecessarily medicalised birth which can lead to a cascade of interventions, a lack of empowerment for the birthing woman, worse outcomes for her and her baby, and a higher health bill for the country. The plea to be grateful for this kind of misguided thinking on childbirth furthers the idea that women should submit to what they're told and be grateful for it. Sorry, I'm not doing that. Or at least, I did, and then I learned better.

We get cross when pathologists overservice but people aren't accused of being anti-pathologist when they do so. It isn't denigrating the value of pathology, or the hard work pathologists do or the long hours they put in, to suggest that overservicing is not a good thing.

[Toomanytoomany]

Perhaps all these women having negative experiences would have a much better time if they could relax. White-coat syndrome is a real syndrome and you people who keep yapping about how awful doctors are really aren't helping, you're creating a negative perspective on something that needn't be so bad.

Yes this is my first pregnancy, but I'm not worried because I trust my obstetrician and I also know how to communicate with doctors instead of fearing them unjustly.

You know, it's not easy to relax when a man walks into your cubicle when you are twenty years old having preterm contractions, tells the nurse to prep you for a pelvic exam, does the roughest one on you that you have ever had without personally addressing you once, snaps off the rubber gloves and then walks out the room without even speaking your name. Not only was it personally traumatic, it was dumb - why would you do a digital pelvic exam on a prematurely contracting woman? Evidence suggests that this is the best way to irritate a uterus and heighten the risk of infection.

I could go on, but that would be anecdote. What is not anecdote is that countries which have a higher rate of specialist care as the norm also have the highest caesarian rates and do not have the highest outcomes for mother and baby.

I'm sorry that the evidence makes you uncomfortable, but for most advocates of midwife based care, that is what motivates them. Sticking our fingers in our ears and singing "lalalala" because we don't want to frighten people doesn't lead to better outcomes.

[christy]

I am one of the women who suffered a traumatic birth at the hands of an obstitrician. I was under a midwifery care unit in a hospital and I hadn't seen an ob until I was 42 weeks. From that point on it was all scare mongering and all my choices were taken away. I actually had to ask a midwife to stay with me during one scan at 42 weeks and help decipher what he said. She helped me understand that I had choices and didn't have to go along with everything the OB wanted. In the end the birth was still traumatic.

My second birth, I was at the same hospital. I wasn't allowed the midwifery care unit as I was considered "high risk", I still saw mainly midwives and had 2 Ob appointments before I hit 41 weeks. At 41 weeks the Ob told me I was going to have a still born for wanting to choose differently to what she wanted (repeat c/s) I insisted on proof of the stillborn theory & she backtracked and said that it would "likely be a still birth". Imagine telling that to a 41 week pregnant woman who was well read on birth choices. I was like a bull and refused to see her again. She made an appointment for an u/s to prove to me that I needed to have the baby straight away, luckily it showed I didn't need to and everyone was okay. I gave birth spontaneously 2 days later with no obstitricians around. Not one came to check on me until after and I needed some stitches. I didn't see one for 2 hours after birth. I only needed them because Jovie came out with a hand on her head, otherwise they would have been completely unnecessary. Only around to scare monger me.

[Sass]

This is a great discussion... if you don't like what you hear you don't have to participate.

I just remembered why I don't participate in these forums.

Call me naive but I think having dissenting opinions and voicing them actually adds to the discussion.

If I want to hang out in a militant forum where opposing viewpoints aren't welcome then I can go hang out at MDC.

[MantaRay]

Kuraiza, I totally understand where you are coming from. When I was pg with my first, I had the same opinion. Nothing but an ob for me - that's where you get the best care, right? Nothing like knowing the person who will be delivering your baby, right? I get how you feel hun, I truly do. And you know what, I had a truly great ob too, one of the very best I would say! And I would still say that.

So what changed my mind about mw vs ob? My first birth actually. DS1 decided to arrive on a Friday night/Sat morning when my ob wasn't on call. The ob who was on call is also a pretty good ob, but he had already had a cs and a vb before me, and another woman in labour. The poor guy was probably exhausted and wanting to catch every little bit of sleep he could over the weekend. So, I copped the cascade of interventions.

First my waters were broken. This caused sudden, intense contractions (and I was having a back labour too for some reason). And because these pains hit while I was lying on my back being monitored, I wasn't dealing with it well. The anaestitist was there having just done a cs, and was about to leave, so I was pressured into an epidural with the "it's now or never" line and being told I would be in that much pain for at least 8 more hours (if they had read my file they would have known that my ob was expecting me to have a quick labour like my mum, and in fact I did have quick labours so the 8 hours was rubbish). So I gave in to pressure and had the epidural. I warned them I had low bp and sure enough that made it worse. Labour slowed, baby went into distress and I couldn't even raise my head without feeling like I was going to pass out. So flat on my back I pushed without feeling. I ended up needing forceps, an episiotomy, therefore stitches. I had a lot of pain afterwards from that and also other problems which I won't go into here.

Having since had a 3 hour labour in a conduicive and comfortable position, without an epidural, I know now what labour can, and should be like. And how insidious the cascade of interventions is. And this is with an ob who is definitely one of the better ones!!

Kuraiza, I truly hope that you have a better experience than me.

[Schmickers]

I just remembered why I don't participate in these forums.

Call me naive but I think having dissenting opinions and voicing them actually adds to the discussion.

If I want to hang out in a militant forum where opposing viewpoints aren't welcome then I can go hang out at MDC.

Sass,

I have just checked the records, and no posts have been edited or moderated from this thread. We have also not thus far had to post any warnings to the thread. Discussion has been civilised, though passionate at times. Your only contribution to the thread was to discuss your own experience, and your more recent post I quoted above.

I think you perhaps miss BellyBelly's point? Saying "if you don't like what you hear, don't participate" does not equate to "If you don't agree with what you hear, don't participate". We have had men and women from all walks and all viewpoints post to this thread to voice their opinions, and it has sparked some interesting, and I think very valuable debate. As yet, I am not aware of anyone who has been unfairly criticised or excluded from this thread. Any concerns that the Mod team have been made aware of have been dealt with in the best possible way - through intelligent debate. It is certainly true that the prevailing viewpoint is that midwifery-led birthing services are a great option and that the overwhelming majority of voters in the poll, and respondents to the thread, would choose that option. That does not mean that people who would not choose that option should leave the thread; on tbhe contrary, that is exactly what this thread is for, examining both sides of the argument and testing whether the claims of Dr. Mourik hold true when applies to a community of well educated, well informed men and women. The entire crux of this thread, indeed, illustrates that this is not the case.

Sass, if you have any specific concerns, I encourage you to contact myself (schmickers@bellybelly.com.au) or any of the other moderators. Often the quickest way to do so is to use the "Report Thread" button at the top of the post that concerns you. But making spurious claims that this forum is militant and oppresses dissenting opinions does not add to the discussion. Whether your viewpoint agrees or disagrees with the majority view, you are welcome to participate here.

[briggsy's girl]

i think Kel has been seriously taken out of context with her comment :

This is a great discussion... if you don't like what you hear you don't have to participate.

it was in response to someone telling people to stop scare mongering as they're a first time mom-to-be, telling people that simply relaxing will make their negative experiences not seem so bad:

Perhaps all these women having negative experiences would have a much better time if they could relax. White-coat syndrome is a real syndrome and you people who keep yapping about how awful doctors are really aren't helping, you're creating a negative perspective on something that needn't be so bad.

i think it's a pretty simple thought process - if you're coming in to read a thread that you don't agree with, a thread that creates anxiety in you - simply CHOOSE not to read!! this whole discussion is about why people should be able to CHOOSE their mode of care. there has been no shutting down of pro-ob post, there has simply been response to points raised. this is obviously an emotive topic for so many people - there are those who have birthed the way they wanted, those that have been through traumatic births, and those of us who haven't been there yet - everyone comes from a different background, a different experience. and everyone will have a very different view point on what THEIR ideal birthing experience is/would be.

we all have choices - and if someone doesn't want to read about peoples negative experiences, they don't need to open the thread again...

[Sass]

I'm sorry - you can't see how "if you don't like it then don't participate" has connotations of being unwelcoming to people with dissenting opinions? What about "if you don't like it then post your reasoning why and maybe we can come to some sort of understanding"?

From a man who can extrapolate an accusation of an oppressing regime on a forum that modifies and deletes posts from a comment that it's unwelcoming to opposing viewpoints (based on a comment from the forum creator) I find that very hard to believe.

Also, if you really believe that that was what I was saying why would you offer a solution of reporting a post (by the forum creator) to the moderators of a forum that I believe is oppressive and deletes or modifies anything that they disagree with? It doesn't even begin to make sense.

Regardless, I'm not here for a flamewar. I chose to not participate on these boards after I first joined because of the vibe I got -whether correct or not - from many of the posts I read that any opinion other than the 'party line' was unwelcome here.

I came back in response to the email sent to forum members because I wanted to participate in the poll and maybe add my experiences in NSW to the anecdotal evidence. Within a page of me posting there was a response from the forum creator that backed up my previously held opinion. Your further post has just compounded that opinion.

I posted my comment before to show kuraiza that there were some posters that appreciated her perspective even if they don't hold the same opinions and because I assumed, perhaps erroneously, that BellyBelly staff may like to know why some people don't stick around here.

I will cede that the last sentence in my post was unnecessarily inflammatory but it was posted as a kneejerk response to the disgust I felt at BellyBelly's comment. I was actually coming back to edit it out having had a chance to cool down and reflect that it was probably not appropriate but found your post and here we are.

I'll not post again and hope that the board can get back to the original topic, which is certainly more worthy of discussion.

[Cassius2]

I think that there has been a bit of argy bargy on this forum. and i think there is quite a negative vibe going ATM.

I voted that I would go for Midwife-led care, because I honestly think that for a normal healthy pregnancy and birth that is what is needed and i wish i had that option.

I don't really like reading posts that tell me that my choice to go for an OB for the birth of my DD was because i chose to 'submit to what they're (women like me i guess!) told and be grateful for it'. I think this is really mean. especially in a country that doesnt have real options for women in birth. Like i said before, I chose to go private and OB as I knew that i could have a water-birth, that the maternity centre was run on midwife continuity of care and that there were lactation consultants that could come 24/7 to any woman staying there. This was as close as I could come to my ideal. no, it wasnt ideal as i would have loved my DH and family be able to have stayed with me for more than 2 nights, but it was the best option that was available. Not every person going through an OB is naive or submissive. we just try to work out the best possible path available to us.

I hate that what i took to be an empowering birth is being thrown back at me here as mere submission to the establishment. I know that there is no personal attack happening, but flippant comments really cut deep whether personally addressed or generally. I had a natural, no intervention birth surrounded by my loved ones. yeah my OB was there but he wasnt making me 'submit' to what he was saying, in fact he wasnt really saying much, just smiling like a fool and letting me get on with it (while the midwife applied my lip gloss ).

Please, let us advocate for the right to choose. let's advocate for funding for midwife led centres.

[Smoke Jaguar]

For goodness sake, 'militant'? I don't think so. In my experience, this forum is moderate in comparison to some others I've participated in...where I was moderated, then banned from posting, within hours banned from reading...all because I chose to be moderate instead of foaming at the mouth in agreement with people holding more extreme views than my own!! I've been enjoying the diversity of responses here, even where I don't agree with a viewpoint. It all confirms my convictions about how childbirth ought to be.
The way I see it, the peddling of fear is what influences first-timers to believe that they need to be medically supervised so as not to risk their health and that of the baby. Ironically, women who trust the medical model of birth for the health and safety of mother and baby are the ones who will ask for/accept pain relief that overrides the health and safety of the baby and can interrupt the establishment of breastfeeding. The mother has foregone advocacy for herself (she's given all agency to the OB), most likely has no realistic birth plan (if one at all) and her partner is inculcated into this 'doctor knows best/has your best interests at heart' fantasy so has no concept of what kind of support the mother/baby dyad needs during labour (because it is criminal to let a mother believe she can make 'choices' during labour when she's in the most vulnerable state nature can render her). ETA: Here, I'm talking about the first-timers who have chosen medicalisation out of fear - I just read your post, Cassius, after I posted!
I don't know what it will take to get through to first-timers that they are not being negligent by foregoing medicalised care in normal pregnancy, and in fact enhance their bonding and establishment of breastfeeding (which leads to a happier, healthier human being, long-term, not just in the first couple of years when MCHN's obsess over charts and overlook the skill of simple observation - another story for another day!) .
The midwife-led model, from my experience, does not separate the mother/baby entity at any stage of the game. They treated us like a unit and even during some PPH, they made sure DS was on me while they treated me. They also trusted me - it was more than a matter of me trusting them. It was a mutual understanding and they could see that I was highly empowered. The attending midwife ended up thanking me for my birth because all she had to do was fill my tub and watch me birth my baby. They were not threatened by the knowledge that we had done a Hypnobirthing course, nor by the fact that I stated that I was going to labour, hopefully (and I did), entirely at home.
The referring OB for the birth centre that I had to see (for hospital policy) was great. When I presented to him and he asked me some questions about how I felt he said "well, you're fine, you're just pregnant". Duh!