What is the difference between a Midwife and a Private Birth Attendant?

Registered Midwives: midwifery was legislated under the B.C. Health Professions Act in 1995. The College of Midwives was formed as a disciplinary body and the first registered midwives began practise in January of l998. By law, registrants of the College have exclusive title to the word "midwife". The BC College of Midwives of B.C. has a testing process, protocols and practice guidelines which members must follow.

Private Birth Attendants: Some women who were midwives prior to the formation of the College chose not to become regulated. To comply with the legislation and meet the public demand for alternatives to the medical model, a new profession of Traditional Birth Attendant or Private Birth Attendant emerged.

Many Private Birth Attendants have years of experience and they can provide more individualized care in response to the family's wishes and unique circumstances. They are paid privately by the consumer and not restricted by professional protocols, malpractise insurance restrictions or hospital committees. Some of the differences between registered midwifery and traditional birth attendants are:

1. Registered Midwives must maintain hospital privileges, provide the choice of hospital or home care, and work collegially with doctors. Private Birth Attendants are home birth attendants and only go to hospital if medical care is warranted.

2. Registered Midwives may not continue to care for women at home who have an overdue pregnancy (past 42 weeks gestation), a baby in breech position, or emotional problems. Private Birth Attendants can use their discretion to individualize recommendations that are appropriate for each pregnant woman.

3. Registered Midwives work in "teams" and there is no assurance that the midwife you prefer will be able to attend your homebirth. Traditional birth attendants make a commitment to have continuity of care with the family's attendant of choice.

4. Registered Midwives do not cook, clean, do laundry, do labour support, massage, etc. They instruct the family to hire help or have relatives do these service chores. Families planning a homebirth with Registered Midwives often hire a doula. Private Birth Attendants take pride in serving all the needs of the birth including providing water tubs, hoses, inflator pumps, etc and putting up the equipment for a water birth and cleaning it/taking it out when the birth is complete.

5. Midwives are authorized to use antibiotics, narcotics, sleeping medications, Vitamin K and a number of other pharmaceuticals. Private Birth Attendants usually carry only an anti-hemmhorhage medication (oxytocin) and they use herbal or homeopathic remedies as needed.

6. If a transport from a home birth occurs, registered midwives continue to provide primary care to the woman in the hospital within the guidelines of practice of the hospital. A Private Birth Attendant, on the other hand, becomes a "consumer advocate" in the hospital but medical management of the birth is done by the physician on call. With both Registered Midwives and Private Birth Attendants. Reception by hospital staff can vary from very supportive and welcoming to outright hostile and obstructive.

7. Clinic visits with registered midwives are in offices. Traditional Birth Attendants do clinic visits at their own homes. Registered Midwives are taught "professional boundaries" and Traditional Birth Attendants are more likely to remain family friends long after the birth of the baby.

It is essential when choosing a Midwife or Private Birth Attendant that you become as educated as possible with regard to all aspects of choosing home birth and the practices of the person you will choose to assist you during this extremely important process.