Puvirnituq

Monday Musings: Midwives

Today is International Day of the Midwife – wishing all these amazing birthworkers a very blessed day!

Our midwives made a huge difference in the way we labored and birthed Otter – HERE is Part 1 of her birth story and HERE is Part 2 – it’s long so I split it up.  (I was impressed I was able to compress 3 days into two blog posts – lol.)

As we fought for homebirth rights again this legislative session in Arizona, one thing became crystal clear for me.  We cannot change our abysmal birth outcomes until we change the paradigms around birth in our country.

Doctors putting down midwives…hospital midwives touting their credentials and college degrees…homebirth midwives asking to be recognized for their skill set and knowledge that has been handed down through the ages.

And I mean that literally: there is no way the human species would have survived if these women didn’t know a thing or two about birth.  How many species have we seen become extinct in our lifetime?  It happens! If birth was as dangerous and mysterious and frightening as the scare-tactic practitioners would have you believe, we would have been gone AGES ago.

While there are fabulous and atrocious providers in all three categories of pregnancy care providers, it is time we demand better.  I would be thrilled if by the time our children are having children, midwives are caring for the majority of the population that is low-risk with the “watchful waiting” model of midwifery care. And, obstetricians are still in practice to care for the high-risk pregnancies that truly need a different skill set and level of care.  It is possible to rewrite our birth paradigm and have everyone (well, almost everyone!) respect each other and get along.

There is no doubt that modern medicine has improved outcomes for women with true complications of pregnancy and childbirth – here are a few cases where we can definitely be grateful: Twin-to-Twin Transfusion Syndrome, NICU care that allows preemies to survive and thrive, cesarean births for mothers with transverse babies, placenta abruptia, placenta accreta – these are all situations where modern medicine has had a positive impact.

However, we have to ask ourselves – how have we gotten to the point where almost 33% of all births end with surgery? Why have we dropped (AGAIN!) in maternal mortality rates – we are now ranked 50 in the world.  Why are we ranked at 56th in the world for infant mortality rate?? Something is seriously and desperately wrong with maternity care.  Birth is not a pathogen; it’s not an illness that needs to be managed and controlled.

I ask families to research the possibility of midwifery care.  HERE is a look at a recent study that demonstrated that midwifery-led care dramatically improved outcomes.

From the Midwives Alliance of North American (MANA) website, here are some of the benefits you might expect from midwifery 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 and
    • identifying and referring women who require obstetrical attention.

Also from MANA:

What women love is that there is more to maternity care with a midwife than checking blood pressure, fundal height, weight and urine checks.

  • You will see a familiar face at each of your appointments, and you will be given adequate time to ask questions and address your concerns.
  • Your midwife is a specialist in pregnancy, birth and postpartum care who has designed a complete program of care to nurture healthy pregnancy, joyful birth and confident parenting.
  • You will receive individualized, culturally appropriate, family-centered full-scope prenatal services, and continuous care and support during labor and birth.
  • Your midwife will incorporate shared decision-making into your care so that you will feel informed and empowered to make good health decisions for you, your infant and your family.
  • Your midwife has the skills and knowledge to facilitate healthy normal childbirth, to assure comfort and safety for you and your baby, and to accommodate your family’s needs.
  • You midwife has a plan for collaboration with obstetricians, pediatricians, and other specialists in the rare case where medical care for mother or your baby is needed.
  • You will receive nurturing postpartum care and support in your home and the midwife’s office in the weeks and months after birth as you adjust to your new baby and the changes in your family.

Source: http://www.mana.org/about-midwives/midwifery-model

Midwives have long served the underprivileged and the marginalized by society. Making them available in community health care centers would address the needs of the communities ravaged by the disparity in health care based on the ability to pay for care.  I am ashamed to read that the difference in birth outcomes would be drastically improved along color lines – we are living in 2014!! This should not even be a discussion about racial barriers and access to care, but it is. IT IS.

Not all families are comfortable with the idea of homebirth.  Those families who want to birth in a hospital setting have the options of midwifery care from hospital-based Certified Nurse-Midwives.  They have the training to use medical interventions plus they are taught about birth as a normal function of the female body, not a pathogen that needs to be managed and controlled as dictated by the obstetrical model of care.  Our experience as we hear our student’s birth stories is that they tend to use them judiciously within the “watchful waiting” model of midwifery care.

The bottom line is this: families are seeking respectful, personalized, humanized care in droves. Midwives and the midwifery model of care are definitely staying and growing in the USA.  It’s time to rewrite our birth paradigm and find ways for all care providers to forge new pathways to mutual respect and understanding so that mothers and babies have a chance for a future.