Pregnancy Complications and Your Midwife

With the various types of obstetric providers that can care for you during your labor and delivery, some women choose to be seen by a midwife. Different categories of midwives exist, but the bottom line is that they all care for low-risk women. However, some women who start out as low-risk don’t remain that way, so it’s not uncommon for women to wonder what happens if they need to have their care transferred from a midwife to an obstetrician at some point in their pregnancy.

In general, there are various types of complications that will lead your midwife to consult with a physician. Some examples include a history of a preterm delivery, a prior stillbirth, placenta previa, prolonged labor necessitating a Cesarean section, or a serious maternal disease such as cardiac disease or diabetes requiring insulin. However, not all of these mean that you will have to leave your midwife’s care completely.

While practices do vary, many midwives are able to consult with an obstetrician informally (such as via a phone discussion). Midwives can also usually have their patient be seen by an obstetrician for a one-time office consult during a woman’s prenatal care so recommendations can be made, but the woman can still continue primarily with her midwife.

Another scenario is when a midwife will consult an obstetrician or maternal-fetal medicine specialist for a procedure such as an amniocentesis for genetic testing or an external cephalic version to try turning a breech baby. If all goes well, the pregnant woman can still go on to deliver with her midwife.

However, sometimes a complete transfer of care is needed and appropriate. This occurs whenever any issue is outside the realm of a midwife’s care, and these are often more serious concerns such as placental abruption, a very preterm delivery, and eclampsia. In this scenario, your midwife will inform you of the need for transfer, discuss your care with an obstetrician, arrange for transfer to a hospital (if you are not in one), or introduce you to your new medical team (if you are already there), and defer medical decisions to the physician.

When this kind of transfer happens, it can often be very stressful for the patient and her family. The hope for an easy, low-risk delivery has not materialized, and this can be hard to accept in the midst of difficult labor. This is even more dramatic when a woman needs to transfer from a home birth or birth center to an unfamiliar hospital. To make this easier, some midwives are able to stay present in the role of a support person (much like a doula), but this is not always feasible.

Many women feel a sense of loss when this happens: the loss of a low-intervention birth, the loss of continuity of providers, and a sense of loss of control. Seeking out support is important, and having a follow-up discussion with your midwife about what happened to be sure you understand the details can help you process this.

Sources:

• College of Midwives of British Columbia
• Indications for discussion, consultation, and transfer of care
• 17 March 2014.
  Rowe RE et al
• Women’s experience of transfer from midwifery unit to hospital obstetric unit during labour: a qualitative interview study
• BMC Pregnancy Childbirth
• 2012 Nov 15;12:129
• doi: 10.1186/1471-2393-12-129.
  J Walker
• Women’s experiences of transfer from a midwife-led to a consultant-led maternity unit in the UK during late pregnancy and labor
• J Midwifery Womens Health
• 2000 Mar-Apr;45(2):161-8.

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