Why I Had Children With a Midwife Instead of a Doctor
“Do you have an ultrasound scan?” the midwife asked on my first visit. I thought that there was a misunderstanding: no one told me if I would have it. “Well, it’s up to you,” she said. She could explain the pros and cons, but the decision was mine. Welcome to the obstetric care model.
Midwives are an alternative to midwives for women with uncomplicated pregnancies. They have training in pregnancy and childbirth, often with a nursing diploma, but they are not doctors. You can see a midwife for help during pregnancy and she can be present for your birth if you do not have serious complications or risk factors. Childbirth with a midwife tends to be more low-tech than a doctor in a hospital.
A midwife is not (just) an alternative delivery option for muesli lovers. They strive to provide you with science-based care and put you in the driver’s seat. They work with you to carefully consider all options, not just “we’ve always done this.” * There are other benefits of obstetric care, but this was a decisive argument for me.
I went to a group practice midwife for all three of my pregnancies, and was a midwife for every birth: once in the hospital, twice in the maternity ward . I know that with a midwife I have a better chance of giving birth naturally without surgery or medication, and that if I really need some kind of intervention, it is really necessary. I also have the option of giving birth in a maternity ward instead of a hospital, which has a ton of benefits that we’ll talk about later.
A midwife is not for everyone, and this is not an advertisement: you may prefer a hospital birth or a doctor’s birth. Midwives cannot perform surgery and will refuse “high risk” pregnancies, although this definition varies. (For example, my midwives will reject you if you have twins or gestational diabetes that is severe enough to require insulin.) And that’s perfectly normal. But that’s why I made this decision.
Midwives will put you in the driver’s seat
The American College of Nursing Midwives sets out its philosophy here . Some of the highlights:
- Self-determination and active participation in health decision-making
- Complete and accurate information for informed healthcare decisions
- [I] personalized therapies and treatments based on the best available evidence.
- Watchful waiting and non-interference with normal processes
- Appropriate use of interventions and technologies to address current or potential health problems
The first two explain why the midwife asked me, but did not say whether I’ll pass ultrasound, genetic screening in the first trimester or the test for streptococcus group B. They asked if I quietly took a shot of oxytocin immediately after birth there, and I want to my child had a standard eye ointment and a vitamin K injection.
I made a choice for each based on their risks and benefits, and in the case of tests, how effective they are: what would I do differently if the test came back positive? In some cases, I have deviated from the recommendations for reasons related to me and my medical history.
Most of the other elements of the obstetric care model can be summarized as follows: Midwives are expected to respect you as a person. They ask about what’s bothering you and give you time to talk, and they ask permission before sticking their hand in hurray (the medical version of the “yes, then yes” rule ).
Of course, there are doctors who work this way, and I applaud them. If I ever have a high-risk pregnancy, you can bet I’ll start a search party to find her. I chose a midwife because I know that their entire profession is dedicated to this philosophy, and because from the very beginning they have a different point of view than doctors. Midwifery education focuses on what can go wrong during labor and how to fix it. Midwives are the other way around: they watch for potential problems, but they know all the options for the normal and are experts in managing pregnancy and childbirth with minimal intervention.
There are different types of midwives and their licensing varies by state. In my state, for example, only certified nurse midwives are licensed: they are nurses who have additional education in midwifery. They don’t need to work with a doctor and can prescribe medication. CNM is licensed in all 50 states . Other types of midwives differ in their training and legal status from state to state: here is a table that compares three different midwife certifications.
No need to give birth in the hospital
Midwives practice in homes, hospitals, and intermediate locations called maternity hospitals. Maternity hospitals are equipped with everything necessary to treat normal childbirth and its minor complications.
My maternity room looked like a comfortable bedroom with a large bed (under the sheet, of course, there was a mattress topper), a bassinet and a rocking chair, and a bathtub with a jacuzzi. One wall was covered with wardrobes that opened to reveal a baby scale and examination table, as well as all the supplies needed for childbirth. When my baby had mucus in the airways and the midwife was worried about her breathing, an oxygen machine appeared out of nowhere.
I admit it: when I had contractions and the contractions got really painful – so intense that even video games didn’t help – I kind of wished I had the opportunity to get an epidural to relieve the pain. Epidural anesthesia is a hospital business and you need an anesthesiologist to administer it. If you are in the hospital and decide to have an epidural, you will usually also need to monitor your fetal heart rate and contractions to make sure your baby is okay and so you know – because you don’t necessarily feel – when you are having a contraction. Epidural anesthesia also has its own risks , including a greater likelihood of a caesarean section and possibly impairing the baby’s ability to breastfeed during this critical first hour after birth . I chose the birthing center in part because I didn’t want any of this.
Everything in medicine is associated with benefits and risks, including some of the things that are common with hospital births. Not being in the hospital is like taking away cookies from home or putting your credit card in the freezer: you reduce temptation, but also make it harder to access your credit card or epidural when you really need it.
I had a moment of regret every time I was born, and yet, afterwards, I always felt that I did the right thing by signing up for the maternity center instead of planning the birth in the hospital. After all, my first child was given an epidural, so I had both experiences.
If you are somewhere outside the hospital when you have contractions, you should consider the possibility that you could end up in the hospital anyway. This is what happened to my first child: there was meconium (fetal feces) in the amniotic fluid , which was the reason for the trip to the hospital: this is a red flag for possible other problems, and if the child inhales meconium, it can affect his breathing. … As this was not an emergency, an ambulance was not called. I, my partner and the midwife drove ten minutes to the hospital in our cars. (This is where I got the epidural. It was great.)
There are other types of emergencies that can be fatal to a mom or baby if they occur outside the hospital and sometimes inside the hospital. If the umbilical cord extends beyond the baby ‘s head, the head can press on the umbilical cord, cutting off the baby’s blood supply. If the placenta separates from the uterus before the baby is born , this is another catastrophic situation.
Both of these risks are 1 in 10,000. On the other hand, hospital intervention can lead to complications that are usually less serious but much more common.
A Cochrane review of hospital birth versus home birth for low-risk pregnancies found that neither one nor the other could be recommended as a clear winner. Another Cochrane review found no difference between obstetric care and standard care for serious outcomes such as neonatal deaths or hospitalizations. Women under the supervision of a midwife had fewer interventions (such as episiotomy or amniotomy ) and were generally more satisfied with their care.
So, when it comes to choosing between a hospital and a maternity hospital or a doctor and a midwife, you cannot choose a situation without risk; you can only choose which type of risk is more convenient for you.
Midwives (and maternity hospitals) do things differently
During my last delivery, I checked into the maternity hospital in the early evening and the nurse asked if I had dinner. Since they encourage walking during childbirth, my husband and I called the nearest spaghetti warehouse (which is why the center has a takeaway menu) and walked four blocks to pick up our lasagne. We ate, knowing we were both going to have a long night.
In most hospitals, women in labor are not allowed to eat or drink anything. Standard fare is ice chips (suck). But midwives have been saying for years what recent research has confirmed : the no-eat rule is outdated and unnecessary.
(Of course, I vomited when the contractions got really excruciating, but it was great as long as it lasted.)
Midwives also tend to approve of walking and changing positions during labor , which can help advance labor and can either ease the pain or distract you from it (heck, you canwhip during labor if you’re coordinated enough).
Doctors are beginning to adapt to some methods that have been standard for midwives for some time, such as delayed clamping of the umbilical cord after childbirth. It is difficult to generalize for all midwives compared to all physicians, so these are not universal statements. If you are trying to decide between a doctor and a midwife, call them and ask them what their rules are.
How to find a midwife
Midwives attend a small proportion of births in the United States, but that number is growing : midwives were the leading provider with 9% of births in 2013, up from 3% in 1989. Depending on where you live, a midwife can be difficult to find, and a birth center can be even more difficult.
According to the American Association of Maternity Hospitals , there are only 295 maternity hospitals in the United States, and 13 states do not. You can find the birth center near you here .
In addition to maternity centers, some midwives practice in hospitals, while others provide home births. You can find a Certified Nurse Midwife or Certified Midwife here . If your state has certified professional midwives, you can find them on this site .
Since you are an active participant in your care, your first step in choosing a midwife (or doctor) should be to read about pregnancy, childbirth and childbirth and decide which factors are important to you. Then ask vendors about these things. Don’t be afraid to ask, for example, what percentage of their patients receive a C-section.
Since midwives cannot cope with serious complications, you should ask the midwife what conditions they can cope with. For example, if you have twins, or if you have gestational diabetes, or if you have had a cesarean section before but this time you want to have a vaginal birth, some midwives will refer you to a doctor and others may be able to include you in my practice. Here is a list of ten good questions to ask your midwife or midwife . If you want to be careful, then this list of 47 questions will become more detailed. You probably won’t ask them all, but it covers many things that you might not otherwise think of.
Cost is also worth considering: a hospital birth is more expensive than a home birth, or usually a maternity hospital. Insurance may cover some types of midwives but not others, or they may cover an obstetric birth in a hospital but not a maternity ward. You will want to check your coverage for the midwife and the institution where they practice.
A midwife is not for everyone, but if you are at low risk and enjoy making your own decisions, this option is worth considering. I’m really glad I did.
Illustration by Tara Jacoby.
Vitals is a new blog from Lifehacker dedicated to health and fitness. Follow us on Twitter here .