Should you have a midwife deliver your baby?

The majority of American women will have their babies in the hospital with an obstetrician. But did you know that 80% of the world's babies are born at home with midwives?(1) In fact, the countries with the lowest infant mortality rates employ midwives as the sole attendants for at least 70% of births. (World Health Organization, Wagner, 1988). In America today, a minority of people elect an out-of-hospital birth either in a birth center or at home attended by a midwife.

"At home? Is that safe?" you might ask. Some people view planning an out-of-hospital birth as an unnecessary risk to mother and baby. However, there is an element of risk involved in all births. Hospital births present problems associated with unnecessary interventions and a higher rate of infection in the mother and newborn.(2) Dr. Alben Haverkamp of the University of Colorado and others, studies indicate that the use of technology such as the epidural anesthesia and the electronic fetal monitor correlate to a higher incidence of cesarean section.(3) Yet most people's fears are allayed knowing that at the hospital, the most advanced technology, pain relieving drugs and highly trained medical personnel are available. In homebirths, the risk is the lack of medical technology on hand in case of an unexpected outcome. Although most complications of pregnancy can be prevented by sound prenatal care by a doctor or midwife, certainly there are some factors which prohibit birth at home. Yet the research indicates that planned homebirth with good prenatal care and a competent attendant is a safe option for healthy women.(4)

A freestanding birth center (which is run by nurse-midwives and is not attached to the hospital) offers a middle ground halfway between the home and hospital for women having low-risk pregnancies. The birth center is a "home-like" environment, and birth there is family-centered. You can have your children present, labor in a hot tub, walk or squat, unrestricted by machines. Yet an electronic fetal monitor may be available for a difficult labor. An obstetrician will be "on call" in case such expertise is needed, but a nurse-midwife will deliver your baby.

How does the midwife receive her training? Generally, there are two roads to becoming a midwife. The Certified Nurse Midwife ("CNM") attends nursing school, receives a nursing degree and advanced training in obstetrics and gynecology. She is licensed by the state, regulated by medical boards, and must abide by standard medical protocol. Usually, an obstetrician oversees her practice. The "lay", "direct-entry" or "traditional" midwife entered the profession directly through either apprenticeship with a senior midwife or doctor, self-motivated study, or attendance at a Direct Entry Midwifery Training Program, or a combination of these avenues. In California, licensing is still pending before the state congress for direct-entry midwives. In 15 of the 17 western states, licensure is in effect.(5)

Despite the restraints, many direct-entry midwives continue to serve women who want to give birth in the privacy and comfort of their home. These women are willing to labor without drugs, prefer not being restricted by IVs and machines, and are determined to do whatever it takes to have a safe vaginal birth. Furthermore, direct-entry midwives, unrestrained by protocol, may be able to serve the client wanting a vaginal birth after a cesarean or a breech delivery at home. Both types of midwives do have doctor back-up in case a pregnancy turns high risk, or a patient needs to be admitted to the hospital during delivery.

Midwives offer services at a substantially lower cost than hospitals, although you will probably have to pay her out-of-pocket as she may not be able to bill your insurance. The midwife offers continuity of care and a wholistic approach including counseling on nutrition and emotional issues, and visits are generally an hour or two in length as opposed to the standard ten minute visit by the obstetrician. The pregnant woman and her midwife often develop an intimate bond during prenatal visits, and this support is given throughout labor, delivery and postpanum.

Choosing the place to have your baby and whether to have doctor or midwifery care is one of the most important decisions you'll ever make. Most people do more research when buying a car than when they're planning their baby's birth. The choice that is best for you will need to be carefully evaluated before making a decision. Parents have an obligation to educate themselves prenatally and to know what issues are to be considered. A childbirth educator who is not employed by a hospital can assist you in the decision making process. She can provide you with resources such as statistics, books, and birth videos to help you clarify your values and formulate a birth plan based on knowledge of your options. She can also make referrals to midwives, labor support professionals, and doctors in your community.

Regardless of the place you choose to give birth, you, the parents, are ultimately responsible. It is your right to choose a caregiver whom you trust will help you to have the safest and most fulfilling birth. After all, it is your body, your baby, and your money. With education and planning giving birth can be the most profoundly Influential experience of your life!

Footnotes:

(1.) Lani Rosenberger, "Myths About Midwives," The Wet Set Gazette, Oct. 1991. (2.) Burnett, et al. Journal of the American Medical Association, Dec. 19, 1980, pp.2741-2745. Lewis Mehl, MD, PhD, as presented before the American Public Health Assoc., Oct. 20, 1976 and printed in the Journal of Reproductive Medicine, Nov. 1977, pp.281-290. (3.) Ob/Gyn News, Vol. 22, No. 3, Dr. Benjamin Sach's report at the Symposium on High-Risk Obstetrics, Boston University School of Medicine. Ob/Gyn News, Vol. 22, No. 1, Dr. Timothy Johnson reporting before the Science Writers Conference sponsored by the American Medical Association and Johns Hopkins Medical Institution. (4.) Burnett, JAMA 1980. Mehl, JRM 1977. (5.) Rosenberger, Wet Set Gazette, 1991.

Cordelia S. Hanna is a mother of two and a Certified Childbirth Educator and Labor Companion accredited by IH/IBP. For more information, call (213) 6670884.