Women’s strongest feelings [in terms of their birthings], positive and negative, focus on the way they were treated by their caregivers. ~Annie Kennedy & Penny Simkin
Normally when I tell people I birthed my son in a freestanding birth center with a midwife attending, I am met with either blank stares, a confused “Oh” with a head nod, or else a barrage of questions, depending on how well I know the person. (And who knows what kind of reactions I get behind my back!) I know the reason I get these reactions is because birthing outside a hospital setting is not the norm in the United States and people just don’t know there’s another way to do things!
Since I am so passionate about it, I thought I would create a five-part series on my blog to demystify midwife-supported natural childbirth. I will seek to shed some light on common questions such as:
- What is a midwife and what do they do?
- Is it safe?
- What if something goes wrong?
- Who chooses to birth this way?
- Why do people want to birth this way?
- What is prenatal care like?
- What about the pain during labor?
Common Misconceptions About Midwives
Many people still think a midwife is the old woman from the village who tells everyone to get hot water and clean towels, rather than someone who’s truly trained. When you hear about midwives attending births today, what do you think? I bet many of you think one or more of the following:
- All midwives are the same.
- That’s old fashioned.
- Having a midwife is not as safe as having a doctor.
- Midwives don’t have any formal training.
- Midwives only attend home births.
- You can only see a midwife if you are pregnant.
- You can’t get prenatal tests if you have a midwife.
- You can’t have an epidural if you have a midwife.
Before I address some of these misconceptions, let’s get some background information about midwives.
What is a Midwife?
The word midwife means “with woman” and a midwife’s philosophy of care is one that is directed at the woman and her individual reproductive needs. As part of this woman-centered model of care, a midwife usually offers a variety of options and seeks to eliminate or minimize unnecessary interventions. This philosophy of care is represented by the Midwives Model of Care:
- 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
Basically, the midwife nurtures the family through a normal, physiological process.
Differences Between a Midwife and a Doctor
It (birthing) is not a medical event. There is almost no hope of a peaceful pregnancy and joyous birth within the medical system. Every woman needs and deserves the kind of nurturing and care a midwife provides. ~Jan Tritten
Since many people are familiar with how a doctor handles pregnancy and birth, here is a brief comparison between doctors and midwives to shed some light on midwifery style.
- Midwives believe that birth is normal, until proven otherwise. Doctors believe that birth is complicated, until proven otherwise.
- Midwives believe that childbirth is a natural event, requiring medical intervention only in special circumstances.
- Midwives provide prenatal care and are also the birth attendants. This means they often stay with patients throughout the labor rather than showing up to catch the baby at the end.
- Doctors are surgeons and deal with complications. Midwives do not do surgery, but they are better trained in natural birth and use techniques that are no longer taught in medical schools (often because the hospitals want to go right to C-sections).
- Midwives are also more likely than doctors to encourage natural birth practices such as unmedicated birth, birthing positions, and drug-free pain relief techniques.
- Midwives also usually allow women to eat and drink during labor.
Misconception: All midwives are the same.
Fact: There are two main categories of midwives in the United States: Certified Nurse-Midwives (CNMs) and Direct Entry Midwives (DEM). They differ in education and licensing requirements.
- Certified Nurse Midwives (CNMs): Educated in both nursing and midwifery, CNMs possess at least a bachelor’s degree and have completed a university-affiliated nurse-midwifery program accredited by the American College of Nurse-Midwives, and passed the exam. CNMs are legal and can be licensed in all states; most practice in hospitals and birth centers. In most states CNMs must have some kind of agreement with a doctor for consultation and referral; practicing without such an agreement can lead to loss of license.
- Direct-Entry Midwives (including Licensed Midwives): Have trained in midwifery through self-study, apprenticeships, midwifery school, or a college program and are especially prepared to attend births in out-of-hospital settings (freestanding birth centers and individual homes). They may or may not be certified by a state or national organization. Their legal status varies according to state; they are licensed or regulated in 27 states. In most states licensed midwives are not required to have any practice agreement with a doctor.
- Certified Professional Midwife (CPM): One type of Direct-Entry Midwife, CPMs are midwives who have trained in midwifery and are certified by the North American Registry of Midwives. CPMs must have completed education in several core areas as well as practice clinical skills under the supervision of a licensed midwife. They practice most often in homes and birth centers.
Different types of midwives will support different birth situations, also. Since CNMs have an agreement with a backup doctor it usually affects the clients they accept, accepting only those that the backup doctor would agree to backup and transferring care to the doctor when certain situations arise.
For example, due to the agreement with their backup doctor some CNMs might not accept clients for a vaginal birth after a Cesarean section (VBAC), if they are pregnant with multiples (twins, triplets, etc.), and the CNM would transfer care to the doctor at delivery if the baby is breech. The CNMs may be willing and able to attend such births, but they have to abide by the terms they agreed to with their backup doctor.
Whereas I know that many (maybe even most) CPMs will support a VBAC. I don’t know how common it is, but I have heard of local midwives who deliver twins and breech babies. They still have a backup plan in place in case one is needed, of course, but without the restrictions of a doctor they are free to accept clients of their choosing.
Misconception: That’s old fashioned.
Fact: Even though midwives have helped women give birth since the beginning of time, working with a midwife is not an old fashioned concept. Midwives are extremely knowledgeable about all modern aspects of health and childbirth. Choosing a midwife is not radically different or nonconformist. It is a viable option for childbirth.
While still a small percentage of total births, the number of births attended by midwives the United States is growing. In 2008, approximately 8.0% of births were attended by midwives, more than double the 1990 rate of 3.9%.
While physician-attended births are still the norm in the United States today, midwives attend births in most of the world. The percentage of European births attended principally by midwives is 75%. That’s quite a difference from our 8%! In fact, Europe has lower neonatal mortality rates than the United States and many people attribute that fact to who attends most births in Europe – midwives.
Misconception: Having a midwife is not as safe as having a doctor.
Fact: Research shows that midwives are the safest care providers for the majority of women with normal pregnancies and births. Midwifery clients experience lower rates of forceps and vacuum extractions, Cesarean sections, episiotomies, infections, and babies born requiring resuscitation.
Midwives deal with normal, low-risk pregnancies and therefore complications are rare. (The majority of pregnancies, about 80%, are low-risk.) If the pregnancy deviates from normal or there are medical issues, care can be transferred to an obstetrician or to a hospital, and the midwife can still be there as a supportive person in her care.
Using an obstetrician for normal birth is like using a pediatrician as a babysitter. ~birthing specialist Marsden Wagner
Misconception: Midwives don’t have any formal training.
Fact: A midwife is not just a friend or a supporter through the birth process; midwives are highly educated medical professionals who happen to specialize in child birth and female reproductive health.
Midwives are specialists in normal birth.
CNMs attend a graduate program in midwifery — a form of medical school condensed to include specialized education in caring for pregnant women and female reproductive health.
DEMs and CPMs gain their knowledge through a variety of methods, which is usually a combination of the following: apprenticeship, workshops, self-study, a midwifery school, or a college/university program.
Certified midwives are trained in basic life support for newborns and, in the event of sudden complications with your baby after birth, can care for the baby until a pediatrician or neonatologist (an intensive-care specialist for newborns) is available.
Misconception: Midwives only attend home births.
Fact: While most CPMs and DEMs practice in out-of-hospital settings, most midwife-attended births in the United States occur in hospitals with CNMs attending. Of all the midwife-attended births in 2008, 91.6% were in a hospital and 8.3% were out of hospital (freestanding birth center or home birth).
However, there are more and more freestanding birth centers starting to appear that are run by CNMs, like the one where I birthed my son (see picture below). Freestanding birth centers are not associated with a hospital and are sterile, modern medical facilities that are often dressed up to provide a more homey atmosphere than a hospital.
At my birth center, I have the option of birthing at the center or at home. This is a case where a CNM does attend either a birth center or home birth, depending on where the client chooses to birth.
Misconception: You can only see a midwife if you are pregnant.
Fact: The services of a midwife depend on the certification and licensing credentials obtained and the practice restrictions within each state.
CNMs are licensed to provide prenatal care and perform deliveries, but also provide gynecological care from adolescence to menopause. These services include: annual gynecological exams, family planning and preconception care, prenatal care, labor and delivery support, newborn care, and menopausal management. Midwives generally provide reproductive education directed at fertility, nutrition and exercise, contraception, pregnancy health, breastfeeding, and quality infant care.
CNMs can prescribe medications in all 50 states.
Misconception: You can’t get prenatal tests if you have a midwife.
Fact: The tests that doctors typically provide to pregnant women — genetic screening, ultrasound, lab tests — are offered by midwives as well. Midwives also explain the purpose and potential outcome of each test before you decide whether to take it. You are able to decline certain tests if you wish (as I did). They are not required.
For example, a professional sonographer visits my birth center once a month to perform ultrasounds. If you want an ultrasound, you can have one right at the birth center.
Misconception: You can’t have an epidural if you have a midwife.
Fact: Since most of the midwife-attended births in the United States take place in a hospital, there is access to pain medication including epidurals. When it comes to using pain medication during labor, the choice is that of the laboring woman. While midwives are skilled at supporting a drug-free approach to birth, they also respect the right of the woman to choose the pain relief method she desires. If a midwife’s patient wants an epidural, the CNM would order it and the anesthesiologist would administer and monitor it.
Epidurals are not available for the 8.3% of midwife-attended births that are outside a hospital, and injected narcotics (also called opioids) are usually not available either.
However, women who want to birth without pain medications often specifically choose midwives for their ability to provide natural labor support. Midwives are skilled at helping women to labor naturally utilizing techniques such as position change, hydrotherapy (labor in water), massage, and other holistic modalities.
While many people may still believe birthing with a midwife is like birthing in a barn, I hope I’ve shed some light on the truly special and important type of care a midwife provides. Stay tuned for part 2 of this series, answering in more detail the questions regarding safety of midwife-supported natural childbirth.
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Wendy – ParentingTips365.com
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