Midwife vs Doctor an ancient battle

I know that I’m probably kicking the proverbial hornets’ nest here, but after this mornings’ Twitter discussions, I think it is time that we start talking about this issue.

I have been a procedural GP Obstetrician for 20 years and have often clashed with my Midwife colleagues about certain issues and decisions.  We need to realize that doctors and midwifes are a bit like men and women, one is from Venus, the other from Mars.  We have quite different perspectives and point of views when it comes to antenatal, intra- partum and post natal care and these differences can and often do lead to some serious finger pointing between the “planets”.

It is important to remember however, that we all have the same end point in mind and that is the safety of our patients and in this case, the safety of both mother and baby.

There are a few important points to make here.

1.   Patient confusion.

Our difference in opinion on certain issues can and often do lead to patient confusion and may lead a patient to not discuss certain issues with either party.  This makes a very difficult time even harder and I do think has been of the major causative factor in the massive increase in cases of post natal depression.

2.   Responsibility.

Who is responsible for what and who gets to make the decisions?  As doctors we often feel that this is our privilege as we are ultimately the responsible persons and certainly will be the ones held responsible should anything go wrong.  This is not true.  The decision should ultimately be the patients’ and we as doctors and midwifes should make sure that our patients are fully informed about their decisions, but we can not and should not decide for them and should respect their decisions even if it is not what we believe.

3.   Accountability.

Here is a “biggie”.  Up to now, the doctor has been held responsible for everything and his insurer has been the first port of call for many a compensation lawyer.  I do think that with shared responsibility, comes shared accountability and that should include decisions made by fully informed patients.

So what is the solution to the problem.  Well, for starters, there are no problems, just a difference in opinion on many topics during the antenatal, intra-partum and post natal periods and the management of these issues.  We all need to respect these differences and not allow our own view on them to influence, change or confuse our patients in there own decision making process.  I do however think there need to be urgent regulation of private midwifery practices, who often exploit their unique relationship with their patients, to influence their decision making.  The regulation of these practices should be a collaboration between the RANZCOG and the ANC.

In the end of the day it is all about the health and safety of mother and baby and the respect of choice.



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