... With Obstetricians
If you wish to have a hospital birth, your chances of having a natural, uncomplicated birth are optimized by
carefully selecting your obstetrician and hospital, and by hiring a "Doula" --a Professional Labor Companion.
Many doctors are used to working with women who hire Professional Labor Companions, and doctors who
work with midwives have lower cesarean section rates.
Delivering babies by abdominal surgery has been steadily rising in America over the past two decades,
so that now 25% of births in hospitals are performed by cesarean section. When comparing the
U.S. C-section rate to other western, industrialized countries, one finds that those countries
which employ midwives for the majority of births have significantly lower rates
than ours; and also have lower infant mortality rates. The U.S., despite having
the most advanced technology and highly trained medical personnel,
ranks 26th in Infant Mortality. That means 25 other countries--most
of which have integrated midwives into their maternity care
system--lose less babies in the first year of life.
Epidural anesthesia, Pitocin augmentation of labor, vacuum extraction of fetus, episiotomy
and separation of newborn and mother are standard in American hospitals. Undoubtedly,
there are circumstances where medical procedures such as these are necessary,
but many parents and professionals now question the routine use of such interventions
such as episiotomy, continuous electronic fetal monitoring, IVs, etc. In many cases, the
routine intervention of these procedures leads to iatrogenic
**(If your client is choosing a hospital birth with
an OB, encourage her to interview several and choose well; one
who has the same birthing philosophies as she does and who
will be an asset to her birthing experience.)
***(Most people spend more time researching buying a car or decorating the baby's nursery than
they do choosing their birth care providers, yet the impact is great.)
With Certified Nurse Midwives
CNMs are Baccalaureate Degree, Registered, Board Certified Nurses who have advanced degrees and
training in Nurse-Midwifery. While they have hospital-based training, they treat pregnancy and
childbirth as the normal, healthy process it is. CNMs can do almost everything independent from
the obstetrician; although a doctor is available for supervision, consultation or referral
if necessary. CNMs can conduct prenatal exams, prescribe medications, deliver the
baby, suture, etc. (just about everything short of C-Section or Vacuum Extractor).
Most CNMs are supportive of clients hiring a Professional Labor Companion,
however you must be aware that they are subject to the same protocols
and routines that obstetricians in a hospital setting are.
A hospital CNM can sometimes help a woman wanting to
minimize her need for medication, shorten her length of
labor and need for Cesarean section.
Freestanding Birth Centers & Water Birth
"Freestanding" Birth Centers are not inside of or affiliated with a hospital, rather they are independently-run
by midwives or physicians, often in collaboration. This is an excellent choice for the woman who does not
wish to birth in a hospital environment yet is not comfortable giving birth at home. While birth centers
do not provide any additional measure of safety than most planned homebirths with qualified midwives,
they may provide the expectant couple with the psychological comfort necessary to enable the
mother to relax; and wherever a woman feels the most comfortable, she will give birth the easiest.
Out-of-hospital birth centers are designed for women having low-risk pregnancies who
want drug-free birth with minimal intervention in a home-like environment.
Family membersmay participate in the birth, and C-Section
rates are much lower than most hospitals.
Childbirth at Home
The Benefits of Homebirth
Birth at home provides parents with intimacy, privacy, comfort and a family-centered experience.
Outcomes for mother and baby are excellent, rates of C-Section and hospital-transfers are
low and parental satisfaction is very high. Childbirth at home is a safe and legal option
for healthy women having normal pregnancies. It is for those who have a very strong
desire for natural childbirth and who are willing to take an additional level of
responsibility for their health care and baby's birth. At home, the parents
and midwife are in control of the birthing environment.
Is Homebirth Safe?
In urban areas, emergency services are expeditiously obtainable. While there is the
chance that a rare, but critical emergency might occur wherehospital services may not be
able to be obtained quick enough, most complications can be corrected prenatally,
or handled by an experienced midwife at the bedside. Homebirth midwives have
the training, equipment and medicine to handle complications. Some of
what they bring is: fetal heart rate auscultation device such as a Doppler or fetal
stethoscope, oxygen for mother or baby, suturing materials, medicine and herbs to
control bleeding, IVs, and newborn resuscitation equipment. However,
many of these interventions, which are routine in most hospitals,
are only used if needed in a home setting.
Renting Tubs for Home Waterbirth
Birthing tubs can be purchased or rented for a birth in water within the privacy and comfort
of your own home. To rent a tub, contact Global Maternal/ Child Health Association or
go to Karil Daniel's WaterBirth Website, http://www.waterbirthinfo.com, on the
Internet. Many freestanding birth centers offer birthing tubs, also.
Homebirth with Certified Nurse-Midwives (C.N.M)
The Certified Nurse Midwife (CNM) holds a Bachelor of Science degree in Nursing (BSN),
has passed Nursing Board examinations, has one to two years work in Labor and Delivery
in a hospital and has then obtained a Masters degree in Nurse-Midwifery. After
completing the Nurse-Midwifery program, the candidate must pass the American
College of Nurse Midwifery (ACNM) board examination to obtain certification.
In 50 states, the Certified Nurse-Midwife can establish a birth center
or homebirthpractice. But the vast majority work in hospitals.
Homebirth with Direct-Entry Midwives
The Direct-Entry Midwife entered the profession directly-- as is customary in Europe---not through
becoming a nurse first. Rather, she learned her trade by self-directed study and experience,
attendance at a direct-entry midwifery school or apprenticeship with an experienced
midwife or doctor. California legalized Direct-Entry Midwifery in 1993; there are
approximately 14 states which have legalized Direct-Entry Midwifery.
However, just because a midwife does not have a license or certification does not necessarily
mean she is any less qualified than her colleagues who have obtained legal status. Often, these
midwives have the expertise that comes from many years experience.