Saturday, April 15, 2017


As a grizzled veteran of three births, I thought I might offer some observations which compare and contrast the various birth options we've experienced in the Gatineau/Ottawa region. Who knows - it might offer some food for thought for prospective parents. Keep in mind this is from a father's perspective. Also, fair warning: this is long, and probably only mildly interesting.

The three different facilities we went through (in chronological order) are:
  1. The Gatineau Birth Centre (Maison de naissances)
  2. The Montfort Hospital in Ottawa
  3. The Gatineau Hospital 
Before the Birth

Prenatal visits are nerve-wracking, especially as a first-time parent. There are many questions, and many doubts associated with this new experience. They range from 'when am I going to feel those first kicks' to 'what the hell is this bloody show' (don't Google that until you have to).

It's hard to know what's normal and what's not, and it sure helps to have someone that can take the time to explain it to you.

To this day, I am still of the opinion that the best prenatal follow-ups we received in this regard were at the birth centre. For those who might not be familiar with this option, in birth centres, midwives run the show instead of doctors. They offer a more relaxed environment than the hospital, where nervous soon-to-be parents can take the time to express questions and concerns (if I recall correctly, the appointments are about an hour long) They also take the time to get to know their patient's views and expectations on a personal level. As soon as high-risk factors manifest themselves, they refer patients to the Gatineau hospital.

In the hospital setting, the approach is much more... methodical.

At Montfort, once you arrive, you check in (a very quick process), and there are series of standard follow-ups and questions administered by nurses (Blood pressure time! Weigh-in time! Any cramping? Bleeding? Etc. ). After this, you wait in a room, and your doctor shows up. We'd spend generally between 10-20 minutes speaking with the doctor about how things were going in general, getting the regular doctor-administered checkups (you don't need details) and discussing our history / autopsy results / possible ways to minimize risks.

At the Gatineau hospital, it sometimes felt like there was someone who's job it was to try and waste as much of your time as possible. At the beginning of the Juliette pregnancy, when we had a scheduled follow-up, we'd walk up to the counter which administered the external clinics to check in. You would get called within generally 15-20 minutes of your scheduled time. But then some genius decided that, no, that's too easy. First, you need to go to the general check in (in the same general room). But not right away when you get there. You need to grab a number first. And if you're there at a busy period, it's an easy half hour or more before your number is called. When you're finally seen at the general check in, all they do is.. give you your file. Then you bring that file to the same exact counter you used to just check-in at.

And then you wait the usual 15-20 minutes to be seen. And at the end of it all, you need to take another number at that general check-in to book your next appointment.

WHY? Why would this be necessary? What are you possibly accomplishing, my fellow bureaucrat, by adding this extra step? This is why people hate us.

Anyway. Comparing our two hospital settings, it was interesting to note that while at Montfort, the dad is welcome to be present during the nurse-administered portion of the check up, there is an explicit sign in Gatineau which notes that companions must wait in the general waiting area. I imagine there's a good reason for this (patients waiting for their gynecologist in their hospital robes may not be too comfortable to be sitting next to an excited dad), but it still feels like there's a design flaw. I still had to walk through that same area for the actual doctor's follow-up.

The actual follow-ups were much quicker than at Montfort, and usually lasted all of five minutes (we weren't even asked the usual series of questions we'd become accustomed to, regarding any cramps or bleeding). Maybe this was due to an assumption that we would know to report anything that was off, but this was never clear.

It's interesting to note that the best and worst prenatal follow-ups were both in Gatineau. It feels like the two systems could probably learn from each other.

The Birth

The birthing centre offers a relaxed environment for those who aim to give birth naturally. They don't offer epidurals. For that reason, a fair amount (I don't remember the precise number) end up transferring to the hospital during the birth. If I recall, there are circumstances where your midwife can still be present during a hospital birth, but I think this is fairly limited since the province wishes to refrain from duplicating care.

Objectively, I continue to realize that outcomes at birth centres are no worse than ones at hospitals. And yet, speaking as the outlier that did not have a positive outcome, I cannot say that I would recommend it. If things take an unexpected nosedive, commuting elsewhere is the last thing you will want to do.

Both Montfort and the Gatineau Hospital were surprisingly equally impressive to the birthing centre as far as being able to offer a comfortable birthing environment. All three facilities offer baths, and various types of equipment that help get through labour.

When you are admitted in the hospital setting, you are assigned a nurse. When there is continuous monitoring, they are there at all times; when there isn't, they check in at regular intervals (more and more frequently as labour progresses). We had excellent nurses in both hospitals.

A couple of points where i'd give the edge to Montfort over Gatineau:

1. The initial method suggested to induce labour was simply the use of a hook. That's all that ended up being necessary. In Gatineau, while our doctor was quite open to the hook as a first method, this was not the initial approach suggested, and was met with surprise.

2.At Montfort, laughing-gas is offered as a pain-relief method, whereas it is not in Gatineau. Pain has a way to make you feel 'to hell with what I thought I wanted', so it's probably not a bad thing to have a method that can be administered very quickly during the dire few moments where there's doubt.  

One thing to keep in mind about Montfort is that it is a teaching hospital. That can mean the birthing room getting surprisingly crowded when the big moment comes. I can't even tell you how many people were there in our case. Too many to count at a time where my focus was elsewhere.

In Gatineau, as far as staff, there was only one doctor and one nurse during the birth. This made the experience feel much more relaxed (though it stands in contrast with the standard for non-teaching hospitals in Ontario, where I was told two nurses are called during the birth - one for the mom, one for the baby). Overall, both Montfort and Gatineau were quite good - I don't know that I'd recommend one over the other for the birth.

After the Birth

The first few minutes after a birth (that goes well) are exhilarating. It's hard to believe what's just happened; that there's a brand new, living being right there, crying a beautiful cry, that you're now responsible for.

The first couple of hours, you're on a bit of a high, running on adrenaline, slowly calming down, and settling into this new reality.

And at a certain point you think 'Okay. Great. What's next?'. You start to think 'When does the whole nursing thing start? When do we get to go home?'

At Montfort, we first got pretty good support with nursing. A nurse came in, and helped coach Kayleigh through how she should do it. It all seemed to be going pretty well. Until that nurse's shift ended, and the next nurse told her to do slightly differently. And same thing with the one after that. And the one after that. Advice that is not uniform from nurse-to-nurse is quite frustrating.

This was in the context of doctors telling us we needed to stay at the hospital longer than the initially-hoped-for 24 hours, because William had lost a bit too much weight for their liking, reasoning that staying would help us get additional support in figuring out nursing. Argh.

In Gatineau, the postnatal care was just excellent. Check-ins seemed better timed, and the advice was consistent. Though admittedly, they might have just figured we needed less advice than first-time parents.

Final thoughts

Perhaps not surprisingly, each facility is better than others at certain things. There seems to be a pretty good opportunity for increasing quality of care if they would just speak to each other about the things they do well. However, that would mean measuring client satisfaction, and identifying strengths and weaknesses in a systematic way, at the point of service delivery, by actually asking for feedback when people are discharged. If that isn't done, maybe we should take the time to ask why not.

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