The majority of births in the United States happen in an actively managed hospital setting. Active management means that the medical staff has an active role in the labor process- doing vaginal exams, inserting an IV if the patient is hungry or thirsty, augmenting the labor via Pitocin or Cytotec to help speed things up, artificially breaking the amniotic sac... All of these things are active management of labor.
Midwives come from a different philosophy. They understand that the bell curve for pregnancy and labor is massive, with many variations being within the normal range. They care for the emotional and mental (and in some case, spiritual) needs of the mother, in addition to her physical needs. A point I found interesting when I switched from obstetric care to midwifery care was that I was no longer a "patient" but a "client". If you consider what this means, it is monumental. In obstetric care, you are viewed as a person who has a problem, an illness of sorts. You are pregnant and they must monitor you to make sure that you get better. But as a client, you are going to your midwife to continue to make sure everything is going well, as you assume it must be. Midwives are consummate experts when it comes to normality. And with that comes the immediate recognition of abnormality. For example, in banks the forgery department for legal US tender doesn't scrutinize all the variations of the dollar bills. They study the real deal over and over and over, and are able to immediately detect a fake. The same applies in midwifery. Midwives have attended the labors of hundreds of women, from whenever the woman calls them to the baby emerging. So, they have seen the hundreds of variations of normal.
Another difference in midwifery (and this is pronounced "mid-WIF-ery", though some choose to pronounce it "mid-WIFE-ery") is that they don't "deliver" babies. They "catch" babies, so some of them are called "baby catchers." If you think about what that means, it is again, interesting. Why do babies need to be delivered from their mothers' bodies, as if they were dangerous, malignent places? Midwives simply catch the babies who are making an entrance into the world.
Did you know that the majority of babies worldwide are caught by midwives or someone acting as a midwife? Did you know that the World Health Organization recommends that pregnant women who are low-risk and healthy should have midwives as their primary care providers? The statistics are staggering. The United States has the absolute highest mother and infant mortality rates of any of the industrialized countries. In fact, a friend of mine sent me an email about her friend who passed away during childbirth this past week. The routine epidural numbed her from the waist up, instead of the waist down. She went into respiratory distress, had an emergency cesarean section, hemorrhaged and died. It was her fifth child. Do you know who has the lowest maternal and infant death rates in the world? Finland. Why? Well, depending on who you ask, there are various reasons. One may be because Finland doesn't have the high rates of obesity that the US has, and therefore healthier babies are born there. Another may be that premature babies born before 25 weeks aren't counted as infant mortalities, but are considered miscarriages. But the most conclusive reason is because the majority of their births are attended by midwives. When a Finlander calls the hospital to let them know she is in labor, the hospital sends out a team of midwives to assist her. The midwives will transport her to the hospital if she needs to be. Otherwise the babies are born in their own homes. Is that strange? I don't think so. In the US, when a person calls 9-1-1 for an emergency (say he/she is having chest pains) a cardiac surgeon isn't sent out to assess the situation- a trained EMT is. That EMT can determine whether the person is having heartburn, indigestion, or is really having a heart attack. They can administer some oxygen and assist the person, or can immediately transport that individual to the hospital. It makes sense.
Another aspect of midwifery care that differs from obstetric care is the fact that midwives' practices run on a smaller scale than the local OB practice. This means that the amount of time spent on you is greater. My midwife scheduled my appointment for the following month or week at say, 10 am. I showed up at 5 minutes to 10 am, and was seen from 10am to 11am. What in the world takes an hour, you ask? Well, the first 30 minutes were spent in discussion- how I was feeling both physically and emotionally about the pregnancy, how my nutrition was, whether I was doing my Kegel exercises, and any questions I may have were answered. And the last 30 minutes was the "medical" side- the protein check, heart tones, blood pressure, and the like. In my OB practice, my appointment was at 10am. I was seen around 11:30am, and was walking out the door by 11:50am. The care in a midwifery practice is much more personal, more nurturing, more supportive of the natural process- in my opinion.
And finally, midwives don't have the fear of litigation that obstetricians have. Therefore they can feel able to treat you like a well person, instead of a sick person. The decisions that are made for you in an obstetric practice are based on the fear that you will sue them- ie. EFM (constantly listening to the baby's heart beat), IV (giving you liquids because of their non per oris mandate- or nothing by mouth, in the event that you must have an emergency c-section)... all of the interventions that seemingly prevent you from being able to sue them are actually probably creating the problems in the first place! In midwifery practice, you are accepting the fact that there is no medical intervention, but you are placing your trust in your midwife's ability to detect a problem and get you to the appropriate medical care if an emergency arises. A huge North American study was done a few years back that showed the safety of a planned homebirth with a certified birth professional (ie. midwife) versus hospital birth. You should read it.
Are you low-risk and healthy? Are you interested in having a natural childbirth experience? Then you should choose a midwife. There are more and more available and you can interview one within a few days. In the Upstate there are many wonderful women serving pregnant women as midwives. My personal experience has been with Labors of Love- Linda Weaver and Amy Bixby. I cannot sing their praises loudly enough. But there are others out there as well. Your childbirth experience is a once or twice (maybe more!) in a lifetime experience. Your pregnancy, labor, and birth is as special as you are. Find someone who treats you that way!
Showing posts with label childbirth. Show all posts
Showing posts with label childbirth. Show all posts
Monday, April 20, 2009
Monday, April 13, 2009
Choosing Natural Childbirth
During our first pregnancy, my husband and I chose to go against common and had a natural childbirth experience. I have to say that I have never gotten quite so much flack about a decision ever before in my life. Friends and acquaintances said things like, "Good luck- you just wait until that first contraction hits you." or "You will be begging for your epidural before too long." or "Why don't you just have a c-section?" I didn't want an epidural, nor did I want a c-section. I felt like my body had been created do have this baby and just to prove everyone wrong, I was determined to have a natural birth.
A few things I found out along the way:
First- some people call a vaginal birth a natural birth. I agree that this is the way that nature intended for the baby to come out, but I am not in agreement that this is natural birth, unless the following can be claimed:
1. No drugs given to induce labor (pitocin or cytotec)
2. No drugs given to augment labor (pitocin or cytotec)
3. No drugs given to dull the discomfort of labor (including epidurals and stadol)
I would agree that a natural birth had been experienced even if labor had to be induced or augmented, but was done so with a non-chemical method. There are lots of them out there that aren't widely used. Several methods for natural induction include, but are not limited to: walking, nipple stimulation, sexual intercourse, stripping membranes, castor oil, various herbal treatments, and acupressure. Methods for labor augmentation that don't require drugs but have been found relatively effective are: changing positions during labor, walking, nipple stimulation, sex, and the Foley bulb (a manual cervical dilation device).
Second- childbirth education classes are worth the cost. There are lots out there to choose from. Lamaze, Hypnobirthing, and The Bradley Method are just a few that are readily available in our area. Some cost money. Others don't. The local hospitals offer courses and you can find some held at birthing centers. Your primary goal is to find a class that coincides with your goals. I'm a personal fan of Bradley- I took it during my first pregnancy and have taught it for the past year. I like the common sense approach to childbirth and the fact that there is nothing in the curriculum that is earth-shattering. My students learn a lot, and I've been fortunate to have a 95% un-medicated vaginal birth rate.
Third- a natural childbirth can drastically reduce your hospital bills. There are some insurance companies out there that are happy to pay 100% of the cost of your birth regardless of what is billed, but those are few and far between and are generally offered by large corporations. For the rest of us, individual, small group, or other insurance is what we have to work with. Most of those plans offer maternity coverage at 80-90%, and you have to cover the remainder, probably up to some sort of deductible or maximum out-of-pocket expense. When I put a down payment for my intended hospital birth, I received an invoice for the anticipated total expense for the birth and stay. It was nearly $12,000 and didn't include all the newborn procedures. We all know that a Tylenol in the hospital can be billed at a ridiculous premium (I heard somewhere it could be $4- $7 for each tablet!) so can you imagine how much an IV, pitocin, Stadol, epidurals (plus the cost of the anesthesiologist), etc could be? I don't know exactly, but would imagine that $20,000 would not be out of the question. And all this is on top of the prenatal OB costs. If you are responsible for 10%, that would be $2,000 out-of-pocket vs. $1,200, and at 20% you are looking at $4,000 vs. $2,400. I don't know about you, but I can find something better to do with $800 or $2,400 than shove it in my back.
Fourth- everyone assumes that the worst is going to happen. While I completely understand that our healthcare professionals see the absolute worst case scenario on a regular basis, I also know that staying healthy and low-risk during pregnancy drastically reduces those instances. I must assume that I will have a textbook birth experience until otherwise advised. Because I didn't want my care based on all the things that could possibly go wrong, I eventually switched to the care of a midwifery practice, where normal is assumed unless otherwise assessed.
And finally- determination and staying low-risk mean everything. If you are determined to have a natural childbirth experience, you cannot listen to the naysayers. Surround yourself with people who support your decision and then stick to it. It's safer for you and your baby. It's less expensive. It's empowering. But you have to stay low-risk by having a healthy diet and a proper pregnancy exercise plan. Educate yourself and your spouse so you know what to expect during labor. And talk to other women who have done it. As Dr. Marsden Wagner said (and it is a loose interpretation of his quote)- How can a woman be expected to survive the challenge of motherhood if she is constantly being told that she is incapable of handling the challenge of labor?
A few things I found out along the way:
First- some people call a vaginal birth a natural birth. I agree that this is the way that nature intended for the baby to come out, but I am not in agreement that this is natural birth, unless the following can be claimed:
1. No drugs given to induce labor (pitocin or cytotec)
2. No drugs given to augment labor (pitocin or cytotec)
3. No drugs given to dull the discomfort of labor (including epidurals and stadol)
I would agree that a natural birth had been experienced even if labor had to be induced or augmented, but was done so with a non-chemical method. There are lots of them out there that aren't widely used. Several methods for natural induction include, but are not limited to: walking, nipple stimulation, sexual intercourse, stripping membranes, castor oil, various herbal treatments, and acupressure. Methods for labor augmentation that don't require drugs but have been found relatively effective are: changing positions during labor, walking, nipple stimulation, sex, and the Foley bulb (a manual cervical dilation device).
Second- childbirth education classes are worth the cost. There are lots out there to choose from. Lamaze, Hypnobirthing, and The Bradley Method are just a few that are readily available in our area. Some cost money. Others don't. The local hospitals offer courses and you can find some held at birthing centers. Your primary goal is to find a class that coincides with your goals. I'm a personal fan of Bradley- I took it during my first pregnancy and have taught it for the past year. I like the common sense approach to childbirth and the fact that there is nothing in the curriculum that is earth-shattering. My students learn a lot, and I've been fortunate to have a 95% un-medicated vaginal birth rate.
Third- a natural childbirth can drastically reduce your hospital bills. There are some insurance companies out there that are happy to pay 100% of the cost of your birth regardless of what is billed, but those are few and far between and are generally offered by large corporations. For the rest of us, individual, small group, or other insurance is what we have to work with. Most of those plans offer maternity coverage at 80-90%, and you have to cover the remainder, probably up to some sort of deductible or maximum out-of-pocket expense. When I put a down payment for my intended hospital birth, I received an invoice for the anticipated total expense for the birth and stay. It was nearly $12,000 and didn't include all the newborn procedures. We all know that a Tylenol in the hospital can be billed at a ridiculous premium (I heard somewhere it could be $4- $7 for each tablet!) so can you imagine how much an IV, pitocin, Stadol, epidurals (plus the cost of the anesthesiologist), etc could be? I don't know exactly, but would imagine that $20,000 would not be out of the question. And all this is on top of the prenatal OB costs. If you are responsible for 10%, that would be $2,000 out-of-pocket vs. $1,200, and at 20% you are looking at $4,000 vs. $2,400. I don't know about you, but I can find something better to do with $800 or $2,400 than shove it in my back.
Fourth- everyone assumes that the worst is going to happen. While I completely understand that our healthcare professionals see the absolute worst case scenario on a regular basis, I also know that staying healthy and low-risk during pregnancy drastically reduces those instances. I must assume that I will have a textbook birth experience until otherwise advised. Because I didn't want my care based on all the things that could possibly go wrong, I eventually switched to the care of a midwifery practice, where normal is assumed unless otherwise assessed.
And finally- determination and staying low-risk mean everything. If you are determined to have a natural childbirth experience, you cannot listen to the naysayers. Surround yourself with people who support your decision and then stick to it. It's safer for you and your baby. It's less expensive. It's empowering. But you have to stay low-risk by having a healthy diet and a proper pregnancy exercise plan. Educate yourself and your spouse so you know what to expect during labor. And talk to other women who have done it. As Dr. Marsden Wagner said (and it is a loose interpretation of his quote)- How can a woman be expected to survive the challenge of motherhood if she is constantly being told that she is incapable of handling the challenge of labor?
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