I’m a midwife. On May 5th, we celebrate International Midwives’ Day in Wisconsin, as declared by Governor Doyle on May 1, 2007. Around the world, midwives were recognized on this day for their very special place in the lives and health care of women, families, and communities. Fourteen years ago I answered my calling and joined this profession. This organization of women is devoted to women’s reproductive health care, increasing education of and access to birth options, midwifery care, and the growth of professional midwifery. We still have a long way to go.
Midwives care about good outcomes, for mother and baby, both physically and emotionally. We approach pregnancy as a normal, healthy time in a woman’s life. We believe, really believe, that birth, for a healthy woman, is a time of physical, emotional, and spiritual expansion and growth. We honor her and the process with dignity, patience, and respect. We use technology with prudence. We help women find advanced care when a pregnancy becomes no longer healthy. It’s time to begin exploring your maternity care options.
The Cesarean rate in our country is over 30%! When you combine this with labors that are started artificially and births where a vacuum or forceps are used to pull the baby out, we’re talking over 80% of births are forced, artificially stimulated, or mechanized! This is a staggering example of the misuse of our health care technology and resources in our country. Are you surprised to know that as intervention rates increase, the rates of complications are increasing too? Sadly, our country’s neonatal mortality rate is on the rise. It’s no wonder women are afraid of birth!
Midwifery is the oldest healthcare “specialization.” Midwives today still give care on every continent, in every country, nation, and territory on the globe! The countries that have the best outcomes have midwives at the forefront of women’s health care.
Midwife care in the USA is vastly underutilized. In our country, the number of births attended by midwives is still under 10%. These numbers are slowly increasing as more and more women seek a gentler, more woman-centered approach to pregnancy and birth care. Do you know what choices are available to you?
You Can Choose Your Birth Location
Most women are vaguely aware that they have options about where to have a baby, but very few women thoroughly explore those options. Hospital birth is a relatively recent development in the history of procreation on our planet. Your grandmother was probably not born in a hospital. About 70 years ago, midwifery care became hard to find, and doctors wanted a centralized location to work in, so women started going to hospitals. In the past 30 years, midwifery has once again become a more readily accessible option for women, and so have woman’s choices in what setting to birth in.
If you want to make an educated decision on what kind of birth location is right for you, you need to visit your local hospital, Birth Center, and home birth midwife and ask the right questions! There are organizations that are dedicated to helping you make informed decisions about maternity care. One is the Coalition for Improving Maternity Services (CIMS). Print a copy of CIMS “10 Questions to Ask” brochure and use this as a guide.
Hospitals have OB/maternity units (sometimes mistakenly called birthing centers), where women deliver. A separate nursery is available for efficient monitoring, exams, and treatment of the baby. High-tech equipment and surgical facilities are on the ready. Today, most women in our country still give birth in a hospital. To accommodate mothers who want a more natural approach to labor and delivery, many hospitals have added features like labor tubs and “rooming-in,” where baby spends most of its time in the room with mother. Doctors and midwives work in hospitals.
A Birth Center is a free-standing facility specifically designated for the care of pregnant and birthing women. Institutional care might not be what you need or want, and the Birth Center offers a safe, comfortable, home-like alternative to hospital care. Babies and mothers are given continual care by the same birth team and are kept together during their stay. Birth Center care is available to healthy, low-risk women, which can be determined with your midwife. A Birth Center is equipped with emergency equipment and medication. It is a place for the practice of midwifery, although some doctors work in Birth Centers too. To find a Birth Center in your area, visit the American Association of Birth Centers at www.birthcenters.org.
Home birth with a qualified attendant is a safe option for healthy, well-screened women. A midwife with the CPM credential has had specific training for at-home deliveries. Nurse-midwives and (a few) doctors also attend home births. Usually, a woman receives prenatal care at her midwife’s (or doctor’s) office or clinic, and has made arrangements for a planned home birth. In a birth at home, the mother hand-selects her birth team and birth care is given in the privacy and comfort of her own home. Like in a Birth Center, portable emergency equipment and medication is on site. If a complication arises during the birth, the midwife and family have a medical back-up plan established for transport to the hospital. It is important to check the qualifications of your midwife when you plan to birth at home, as not all birth attendants have the same training, skills, and experience.
There Are Different Types of Health Care Providers for Pregnant and Birthing Women
Many women automatically assume that when you find out you’re pregnant, you need to find an Obstetrician/Gynecologist (OB/GYN) to get your necessary lab tests and prenatal care started. This is not so! An OB/GYN is a surgeon and a disease specialist for women who are sick or high-risk and need high-tech, interventive care. They anticipate problems during the course of pregnancy and birth. Their specialties are diseases and disorders of the female reproductive organs and surgery.
Family Practice physicians are medical doctors who provide whole-life care to all members of the family. Family physicians have attended most of the deliveries in our country in the past 70 years. To find a Family Practice physician who delivers babies in your area, call the hospital OB unit and ask for the names of family doctors with delivery privileges. If your pregnancy became very high-risk, your family doctor would likely refer you to an OB/GYN.
Midwives have been around for a long, long time. Before credentials were established, midwives learned the art and science of birth care through traditional methods of study. First, by watching, listening, and practicing as an apprentice midwife, then, as scholarly texts became more available (and less taboo for women), we began studying the sciences of anatomy and physiology.
Today, there are two types of credentialed midwife: the Certified Professional Midwife (CPM) and the Certified Nurse Midwife (CNM). The CPM is a midwife who offers complete prenatal, birth, and postpartum care including lab tests and other screenings. She is nationally certified and trained to identify risk factors and handle complications that may arise. She collaborates with other health care providers and refers women who become high-risk. The CPM’s specialty is vaginal birth with the lowest degree of intervention possible. CPMs have the lowest C-section rates of all maternity care providers (2-5% nationwide). She has special training in out-of-hospital birth.
Another type of midwife, the CNM has an expanded scope of practice in that she has the ability to write prescriptions for medications that may be necessary during pregnancy, birth, and postpartum. She has a degree in nursing and additional training in midwifery. Many CNMs work in a group practice, meaning they rotate on-call days where they attend deliveries. CNM care in the hospital is often more personalized than physician care. CNMs can be employed by large medical practices or be in private practice. They work primarily in hospitals and Birth Centers, and an increasing number are offering home birth services.
The Natural Place to Start for Women’s Reproductive Health Care
Look for a midwife who is committed to the Midwives Model of Care. They work in all settings. Education plays a central role in this model of care and women are expected to make educated and informed decisions about their health care. The services your midwife offers will depend on her scope of practice. A woman can begin using a midwife for her first gynecologic appointment and Pap test. A midwife may offer family planning and birth control, STD screening, and other lab tests. She gives pregnancy care from start to finish and can offer menopause education, resources, and therapies.
The Midwives Model of Care©
The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.
The Midwives Model of Care includes:
Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
Minimizing technological interventions
Identifying and referring women who require obstetrical attention
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.
Midwives Model of Care – Copyright (c) 1996-2007, Midwifery Task Force, Inc., All Rights Reserved. Used with permission
Ideals vs. Reality in U.S. Births
WHO Recommendations – taken from a report on the Appropriate Technology for Birth, published by the World Health Organization in April 1985.
CIMS Suggestions – taken from The Mother-Friendly Childbirth Initiative from the Coalition for Improving Maternity Services (CIMS), 1996, www.motherfriendly.org. BFHI = Baby-Friendly Hospital Initiative.
2004 U.S. Stats – most taken from Births: Final Data for 2004, National Vital Statistics Report Vol. 55, No. 1, September 29, 2006 http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_01.pdf.
No longer reported – In revising birth certificate reporting, NCHS no longer collects this information. Last reported rate (2003) is included here.
* Listening to Mothers Report, October 2002, p. 1
** “National Hospital Discharge Survey 2004: Advance Data,” Vital Health Statistics, No. 371, May 5, 2006.
*** Mothering Magazine, No. 112, May/June 2002
Copyright 2006 BirthNet. 215 Partridge St, Albany, NY 12203 Permission granted to freely reproduce in whole with attribution.
Paula Bernini Feigal, CPM is Owner/Director of Morning Star Women’s Health and Birth Center in Menomonie, WI.