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What is Midwifery?

A friend expecting her second baby this coming October recently lamented to me in an e-mail:

…most of the women who go to OBs do not know - or at least believe popular misconceptions - about what midwives do. Every woman would want midwifery care for herself and baby if they knew what it truly was…. All the women I know who used midwives were women who wanted individualized care and somebody to be there to support them through their whole birth experience. Somebody who knew them and who they trusted; rather than a practice where you rotate through providers and get whoever is on call. Some had natural births, some with epidurals, etc. but the most important aspect was that relationship and better care. (Jennifer Harper)

As a childbirth educator and a doula, and most importantly as a mom of 5 children, I couldn’t help but  agree with her.  I’d used OB practices for my first two births, and on the whole, was happy with those practices. They provided what I expected—efficient 15 minute appointments during which I saw my OB for 5-sometimes 10 minutes (after sometimes up to an hour sitting in the waiting room!), who were moderately interested in me as a person, not just a medical condition.

When I switched to midwifery care for my 3^rd child, I was really taken aback by the difference….barely any time spent in the waiting room, but then my appointments—which began with me doing my own “pee & weigh” (after all, I can match up the colors on the dip stick and operate the scale just as well as the nurse can—why not let her do things I can’t do?)—were 30-60 minutes of discussion with my midwife. We talked about nutrition, exercise, birth—the things you’d expect a healthcare provider to discuss. But we also talked about families, gardening, and home renovations—at length. And this was important.

Because when a woman feels that her care provider cares about HER, not just her medical condition, she feels more vested.  She’s more likely to follow recommendations about nutrition and exercise.

And the research shows that women who are cared for in this way are less likely to give birth prematurely[1] or to low birth weight babies[2]—the two primary causes of infant mortality in America.
In Europe the vast majority of prenatal care and birth care is provided by midwives who work one-on-one with women. While I’m not about to say that the European model of care is perfect, I will say one thing.

They’ve got lower cesarean rates[3] and better infant mortality and maternal mortality rates than America does.[4]

So what is it that midwives do?  Midwives specialize in providing care for low risk women–both during pregnancy, and routine gynecological care.  They can order blood tests, ultrasounds, and some medications.  Because they are accustomed to attending the majority of a woman’s labor (rather than just showing up near the end to catch the baby), they often can suggest positions and techniques that will help to facilitate labor.  Also, women are physiologically programmed to want to “hang out” with other women–when women hang out with other women they produce oxytocin, the hormone that causes contractions, and they produce endorphins, the body’s natural pain killers.  Because of this, the mere presense of a midwife with the laboring woman helps labor along.  Though women who are planning for an unmedicated birth will often seek out a midwife rather than an OB, women who want to use epidurals can still use midwives in a hospital setting.  Midwives typically work in consultation with an obstetrician, just as a family practice Dr. would work in consultation with a cardiologist.  That is, as long as the pregnancy is going along normally (or the patient’s heart is not showing problems) with only specific complications, the midwife can provide care, but the midwife would refer the woman to an OB if significant problems or risks were to develop. 

In America approximately 8% of hospital births are attended by midwives–in comparison to most European nations where the default is for pregnant women to see midwives, and only “high risk” women see OBs. But unfortunately, in the Lehigh Valley, I’d estimate that as few as 3% of births are attended by midwives.  And I believe it is about to get worse.

Earlier this year a woman in labor with her 10th child arrived at the hospital, and her baby was discovered to be breech.  Due in large part to a study that was published in 2000, there has been a wholesale movement away from allowing breech babies to be born vaginally.  What has not been widely published is a follow up study that was done 2 years later that examined the problems in that original study, and found that there were no long term health difference between babies born vaginally compared to those born via cesarean, indicating that vaginal birth can be a safe option for breech babies.[5]

The laboring woman and her husband both wanted to continue on with their plans for a vaginal birth, however the staff at the hospital did not offer them that option, but told them that a cesarean must be performed.  Finally after arguing for a period of time, the father turned to the midwife who had attended his wife during her pregnancy and asked her if she could “catch” a breech baby.  Having practiced midwifery for 14 years, this midwife could indeed catch a breech baby, and told them that she could.  Further, her consulting OB agreed that this woman was a good candidate for a vaginal breech birth.  The hospital staff protested, but the woman refused cesarean.  The consulting OB was called in to the hospital, and the midwife caught the baby without any medical mishap.

However, I have been told that the hospital did not want the midwife to make this option available to the woman–she was only to have offered her a cesarean birth with “choices” about things like whether her incision would be repaired with staples or sutures.  It appears that because the midwife offered a choice that the hospital felt was inappropriate, she has been denied priviledges at the hospital.

Now to be sure…I believe this incident did not happen in a vacuum.  It was simply the “straw that broke the camel’s back”–in a string of other situations where the midwife offered women options that the hospital did not want to have offered…without a single poor medical outcome.  So I believe the problem that occurred is that the hospital did not want women to be able to make their own choices about their care. 

It is my belief that it is the role of care providers to present the pros and cons of various options of treatment, then it is up to the individual to choose the appropriate choice FOR THAT INDIVIDUAL.  What I choose is not always going to be the same as what another person would choose.

If you believe that women in the Lehigh Valley deserve to have freedom of choice in their birthing options, please join us on Facebook, or join us at 10 a.m. this coming Saturday for a peaceful protest across the street from Lehigh Valley Hospital on Cedar Crest Blvd.

[1] http://www.popline.org/docs/0348/736091.html; http://betterbirth.blogspot.com/2007/11/has-remedy-for-prematurity-been-found.html; 

Tags: breech, cesarean, childbirth, choice, Doctor, hospital birth, Lehigh Valley Hospital, midwife