For the past month I've been rotating with the midwives, as I outlined here. One of the things I was most looking forward to this month was getting to attend a tub birth. Delivering in the tubs, which are fairly spacious and definitely still located inside the hospital room, seems to make most of the physicians delivering babies nervous. As a result, I'd never seen one, and was very curious. It didn't seem that this wish would be made reality until the last day of my rotation. Due to some quirks of the healthcare system that I won't enumerate due to HIPPA requirements, this particular mother decided to labor in the tub. The whole process went very quickly and easily, and she and I caught the baby together. So exciting!

This whole rotation has made me think a lot about how I'd like to do antepartum, intrapartum, and post-partum care in my own future practice. While lots of things, like having 30 minute rather than 10 minute prenatal visits to allow for questions and teaching, have helped me to understand why so many women so strongly prefer the midwifery model to the physician model of care during pregnancy, few things seem to emphasize this as starkly as the tub birth. In the world of low risk, low intervention pregnancies and births, there's no reason not to get in the tub and deliver there if that's what the woman wants. It's warm, is really helpful for pain during labor, and is a great way to get skin-to-skin with your baby right after birth. In the world of high risk, high intervention pregnancies and births, it seems that behind even the most benign of deliveries lies a strong concern about something possibly going wrong, and the need to do everything possible to prevent that.

This preoccupation with potential problems is what physicians are trained to do. We see the possibility of a critical airway with every cough, spinal cord compression with every twinge of back muscles, and hidden malignancy with every fever. While we are continually told in school to think "horses, not zebras" when we hear hoof beats, the rare and the bizarre are emphasized in lectures, exams, and the questions we're asked on rounds. How then, is the well-intentioned medical student to take a step back and recognize a truly uncomplicated and normal process as it takes place, rather than waiting and finally conceding after the fact that nothing went wrong? After working with the midwives for a month, I confess that I haven't shaken the niggling doubts I have each time someone mentions a mother pushing for seven hours before her baby is born. I think that most of the midwives have some doubts too. But they've helped to remind me that most women know how they want to birth their babies, and that most of the time, they're right.