How Do I Choose My Midwife?
|June 25, 2012||Posted by myfr8796 under Pregnancy blogs|
How Do I Choose My Midwife?
My Friend the Midwife has recently provided you with an excellent resource on what a midwife is (http://myfriendthemidwife.com/2012/06/whos-your-midwife) , how we became midwives and with whom we work. Now, you can use that juicy information to start narrowing things down about what is best for you. Women ask us honest and good questions about what it is that we do. Becky and I are often surprised that some women are in shock and awe when we answer them that we deliver babies in a hospital. In fact, long ago on a date, I got asked if I deliver babies in barns! There are so many misconceptions and stereotypes – both good and bad – that we have decided to clear it all up.
This is a wonderful time to be a woman, either contemplating getting pregnant or already on your way, because you have so many choices on how you would like to birth – and you can make those choices realities – by learning a little about yourself first. So ladies, now that we’ve talked your ear off about who we are, this one is for you!!
What kind of birth do you want? I know, I know – we’re laying it on thick today! But seriously, close your eyes. Think about who you are in your everyday life and how you react to your life events. When you envision the moment you give birth; where you are, who is with you, and would you want the option of pain medicine available. There are no wrong answers here. Be honest with yourself!
To help you figure out some of these steps “My Friend the Midwife” has put together “Birth Mapping”. This is a great start to choosing what is best for you.
Most healthy women have three options on where to birth: hospital, birth center, and home. No one else has to be certain about the place you want to birth other than you. After you have become firm in your belief you can share your ideas with your partner. This can lead to an open dialogue about your philosophy. From your philosophy will stem the single most important choice you have to make. Who is your provider? It is from that decision that the rest of your pregnancy experience will flow, including where you birth. The type of midwife you will have and the environment you birth in are synonymous.
In our experience, when a woman or family expresses concerns, anxiety or even sharp disapproval for their birth experience, it usually greatly has to do with the environment they are in, their own birth experiences, or that it did not match with their values. Birth is not a fad! Own your experience and save yourself the disappointment! You don’t have to do ANYTHING because someone else tells you its right.
Any kind of maternity care provider does not have a crystal ball or a corner on knowing how things will turn out. Birth is extremely powerful in EVERY setting and it is never predictable. Though childbirth follows a common physiological process, it has as many twists and turns as there are women who do it. But, choosing a provider who is transparent and honest about what they are able to provide to you is paramount when making these decisions. Sometimes you meet a great match and sometimes you may just not “click” with a given midwife or other provider. Don’t feel bad about changing maternity care providers, but we do recommend doing it as early as possible to ensure you have enough time to build a solid relationship. A good midwife would want you with the right person, even if it’s not themselves!
A woman feeling as though she is in good hands during her birth experience is so powerful. As family members and providers it is one of the most important things that women have entrusted us with. We are mammals after all! We didn’t always have homes and hospitals, shelter if you will, to give birth in. Women had to choose a safe place when labor began.
We are hard-wired in our neurological system to stop labor when we feel unsafe. Our ancient, protective ‘fight or flight’ hormones, epinephrine and norepinephrine will try to shut down woman’s natural oxytocin that generates active labor. If a woman feels unsafe, oxytocin will not be able to ‘talk to’ her uterus and her labor, in essence, will stop! Making your choice to be in a place where you feel really safe is essential to normal effective labor. Feeling on ‘high alert’ and guarding yourself from your birth environment triggers this unhelpful hormonal cascade. Tell that ‘fight or flight’ response you’ll see them next time Bloomy’s is having a sale – You have a baby to have!
Choosing Certified Nurse Midwife/Certified Midwife) in a hospital
For many women and families, this is a wonderful option. Perhaps you have a medical condition and the hospital is the safest place for you or perhaps you just feel safest there. Some women like the immediate availability of intervention if it is needed. They like the option of having pain medicine if they so desire. Keep in mind hospitals do have protocols, for example: when a baby is monitored and for how long, IV access, and when to come to the hospital after your water has broken. By having a midwife in the hospital (like Becky and I are), while you and your midwife might genuinely need certain protocols, you can have hands-on care with someone who understands that you only want interventions with necessity. Ninety-Nine percent of the time, you do have enough time to have a risk/benefit discussion with your provider in ANY setting. If you fall into that 1% when your provider has to make time-critical decisions for you and your baby’s well-being, you can choose a provider that you feel has your best interest in mind. It is these time critical situations that may potentially persuade you to choose a hospital. If it does, it is OK to have those feelings, you are not alone.
One great positive to having a CNM/CM, as outlined in our Who is Your Midwife post, they do provide GYN care as well. Continuity of care through your childbearing years and even up through menopause is a wonderful thing we are able to provide!
CNM/CM/CPM (Certified Nurse Midwife/Certified Midwife/Certified Professional Midwife) in a Birth Center
If you don’t want to give birth in the hospital or at home – this is the one for you! You can encounter every type of midwife in this setting as well. This is again a wonderful and safe option for women and their families. Midwife-focused care models in birth centers have great statistics. For example in 2006, the Family Health and Birth Center in Washington DC, who serves the underprivileged, had a Pre Term Birth (< 37 weeks) rate of 5%, Low Birth Weight rate of 3% and a C/Section rate of 10%. Who can argue with that? This is truly a low intervention setting and epidurals are not available. Keep in mind, that the midwives who practice in this setting are well versed in labor support and other forms of non-medicinal pain management techniques, so you’re in incredible hands. Birth Centers also very often have birthing tubs! Quite a few birth centers have affiliations with hospitals that allow for a safe transfer if an emergency arises. We recommend checking out and touring the birth centers in your area (there are over 200 of them in the country) if this interests you. Make sure you ask about any protocols or policies so you have no surprises on your labor day!
As previously mentioned in our Who Is Your Midwife post, CPM’s have great knowledge of out of hospital practice, so they might be of great help to you here.
CNM/CM/CPM (Certified Nurse Midwife/Certified Midwife/Certified Professional Midwife) at Home
We have movies like “The Business of Being Born” and midwives like Ina May Gaskin to thank for showing women that they, in fact, do have this option. Statistics from the Center for Disease Control state that the rate of homebirth is climbing, the highest since 1990, accounting for 0.72% of all birth. Giving birth in the home, there really are no policies and procedures. This type of birth relies on the trust and relationship built between the woman, her support system, and the midwife. You can find any type of midwife to attend you at home. Perhaps you can ask the midwife about her philosophy, how she would suggest to proceed in different scenarios and what her plan is in the small instance where emergency does arise to make sure she is right for you. We really suggest going back to the post Who Is Your Midwife and thinking about if a CNM, CM or CPM would be right for you in the home.
The American College of Nurse-Midwives, World Health Organization, and the American Public Health Association have all released statements of support for planned home birth with low risk women. Even the American College of Obstetrics and Gynecology Committee on Obstetrical Practice, who have historically been opposed to home birth have recently released a statement claiming that hospital and birth center birth are the safest, but they support a woman’s right to make an informed decision about their delivery site! Well, my, my, my! Is that the winds of change we feel blowing???!?!?!? My Friend the Midwife has to say we strongly support women making informed choices about their birth. After all, that’s why we’re here! Like we said before, no one else has to be certain about where you want to birth other than you!
We hope this has helped you on your journey. It is no small job to really think through what is best for you. It’s up to you to make the most of your options and choices, ladies! All you have to do is be deep rooted in your beliefs and the options are endless!
A special thanks to JoAnne P. Davis. Without your love and expertise, this piece would not be the same. xoxo