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NOTEWORTHY WEDNESDAY!

Midwife or Doctor?

Many pregnant women ask this question and the answer is not an easy one.

Let’s face it, we have all heard the ‘horror story’ labor and delivery tales. They are very frightening to the first time mom-to-be. It is a wonder any woman who has heard one of these stories chooses to get pregnant.

As a former labor and delivery nurse I surely have played a role in someone’s birth story…I hope it was one of the nice ones.

If you are planning to have a baby or are currently pregnant you may be considering going to a midwife for your prenatal care. There are a few things you need to consider;

  • Medical health: how is your general medical health and would you be considered high-risk due some underlying medical condition?
  • Approach: what type of approach do you prefer…are you looking for a practitioner that is more holistic in his/her approach?
  • Personal needs:you will need to know your own individual needs and find a practitioner who is respectful of them.
  • Setting:what kind of setting are you hoping for your labor and delivery…would you consider a birthing center or are you more inclined to want a natural delivery with options, such as epidural anesthesia, that are only available in a hospital?
  • Cost factor: what does your insurance cover … does it cover a birthing center delivery with a nurse mid-wife or a trained mid-wife home delivery.

Practitioner qualifications are sometimes confusing as well:

Obstetricians are generally board certified in obstetrics and gynecology…they are trained to deal with pregnancy, labor and delivery and any complications and emergencies that might occur. Physicians are many times waiting for a disaster to occur which is why they are quick to intervene in many cases. It is simply their focus as physicians and surgeons.

CNMs, (Certified Nurse Midwives) many times work alongside physicians…they tend to take more time with their patients; they are more apt to try measures in labor that will help to avoid use of pain medications and other interventions unless absolutely necessary. That is not to say you cannot find a physician that will do these things also.

Direct-entry midwives..they are not nurses but they are licensed and trained to deliver babies. They do home deliveries as do some CNMs.

Life is full of choices. When you are pregnant choosing the right person to take care of you during your pregnancy is extremely important…you need to feel comfortable, confident and secure in their approach and their qualifications to assist you through a healthy pregnancy and a safe delivery.

 How to find a midwife

  • American College of Nurse-Midwives operates a toll-free hotline (888/MIDWIFE) that lists CNMs in your area. For general information, call 202/728-9860; write to 818 Connecticut Ave. NW, Suite 900, Washington, DC 20006; or check out the group’s website at www.midwife.org.
  • Maternity Center Association publishes a booklet, Journey to Parenthood($6), with information on choosing a maternity-care provider. Call 212/777-5000 or Write to 281 Park Ave. South, 5th Floor, New York, NY 10010. Visit the MCA website at www.maternity.org.
  • Midwives Alliance of North America can refer you to direct-entry midwives and CNMs in your area. Call 888/923-6262 or Visit their website atwww.mana.org.
  • National Association of Childbearing Centers can provide a list of birth centers in your area, as well as information on how to select a birth center. Send a $1 donation to 3123 Gottschall Rd., Perkiomenville, PA 18074.

Should You Use a Midwife? – Parenting.com.

Doctor or midwife: Which is right for you? | BabyCenter.

http://www.acog.org/About_ACOG/News_Room/News_Releases/2011/The_American_College_of_Obstetricians_and_Gynecologists_Issues_Opinion_on_Planned_Home_Births

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Natural Birth and Hospital...can you ever have these words in the same sentence??? Can a natural birth be accomplished in a hospital setting?

In some cases, yes…but the key to accomplishing this feat is to “do your homework“. It is up to you to enable a ‘natural birth’ for yourself and your baby.

Whether or not you will be successful will be partly due to your preparation and partly due to your particular labor and your body’s and your fetus’ response to it.

It is my belief as a former Labor and Delivery nurse that every woman’s labor is unique as is their response to it. If you remember this, it will make sense for you to do your birth ‘homework’ because no one knows you like you.

You can use other mom’s experiences to help you plan what you would like your own birth experience to be. Always keep in mind that you are unique and things will happen that may throw your plan off kilter.

Homework Hints for Natural Hospital Birth:

  • Choose your obstetrical care very carefully… remember you should be aware of how your caregivers feel about ‘natural birth’. You will also need to know how their partners feel about it also. Remember to ask about what their hospital offers for women in labor. It will not help if your doctor is okay with tubs and showers during labor if they are not available at the hospital where you will be delivering. Put together a  great team…such as doctor, midwife, doula, coach/support person.
  • Take classes to learn all you can about labor and delivery … a one day class is, in my opinion, not enough…you are on overload by the time it is over. If it is the only option then by all means do it. Try to find classes to accommodate your needs…sometimes there are nurses who will do this privately if that is helpful to you. Remember, you have nine months to get ready use your time wisely and try not to procrastinate.
  • Get a good pregnancy book and use it…read it, dog ear it, discuss it with your partner. Stay away from multiple sources of information that will make you confused. Ask questions of your doctor, midwife and doula…trust them and yourself.

I just finished reading  “Natural Hospital Birth: The Best of Both Worlds” and I loved it! It’s written by medical anthropologist and doula, Cynthia Gabriel and it’s solidly helpful for women hoping for this kind of birth.

Home birth is not for everyone for a whole host of reasons, but some women feel they’d like to have something close to it in a hospital setting. And for those women there are strategies. This book is dedicated to that concept.

via 7 Tips for Having a Natural Hospital Birth | Being Pregnant. by Ceridwen

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Noteworthy Wednesday!

I follow many parenting blogs and commentaries. Over the past few weeks there has been much chatter about “home births”

“No surprises here. ACOG looked over the scientific evidence once again and found that it still shows that homebirth increases the risk of neonatal death.

The ACOG practice bulletin, Committee Opinion No. 476: Planned Home Birth appears in the February issue of Obstetrics and Gynecology. The Committee notes that many of the existing scientific papers are of poor quality, and almost all are observational:”

via The Skeptical OB: New ACOG opinion on planned homebirth.

As a masters prepared mother baby nurse and a licensed clinical social worker, I have shared in many of these discussions over the years and I have definite opinions.

It was my fortune to work with very competent obstetricians during my work in Labor and Delivery. They were willing to teach me what they knew and helped to make me a skilled practitioner. I relied on them for their expertise and they relied on me for mine. Of course many times our experience overlapped and that was expected and respected. I was not a physician and they were not nurses.

My early practice was mainly in New York City in the 70’s and La Maze was a popular childbirth preparation…it was even taught by Elizabeth Bing herself. She was the guru of “natural childbirth” in those days. Elizabeth was a physical therapist by practice and she was extremely enthusiastic about her practice and adamant that women should be able to be in control of their labor and delivery. I took classes with her become a La Maze instructor. There were no prerequisites to becoming an instructor except desire. What I noticed was most of the women in the class had delivered successfully with the La Maze method. It was a very skewed population who were learning to be instructors…these were women whose only experience with childbirth was their own. For me, this was not a good thing. Every childbirth that I have attended has been different and I have attended many. My feeling was that when I stopped seeing each birth as an individual unique event that was the time for me to retire from what I was doing.

At the time home births were somewhat popular in NYC but there was a birthing center available…”Maternity Center Association” where women could deliver in a more homey atmosphere. Maternity Center had a hospital connection and guidelines for the patients that delivered there. No high risk were accepted. I had no relationship with this birthing center and do not pretend to know any statistics of their outcomes.

Maternity Center Association

1975

Established The Childbearing Center, a project in New York City to demonstrate out-of-hospital, family-centered maternity care, which was approved by the New York State Department of Health and operated from September 1975 through June 1996.

“1979

Developed innovative classes to prepare children for the birth of a sibling.

1983

Established the National Association of Childbearing Centers, a professional association for out-of-hospital birth centers.

1985

Established the Commission for the Accreditation of Freestanding Birth Centers to ensure high standards of operation for out-of-hospital birth centers across the United States.

1988

Opened the Childbearing Center of Morris Heights, a neighborhood-based birth center in the South Bronx serving low-income families.

1989

Results of the 84-site National Birth Center Study of outcomes of care in out-of-hospital birth centers were published in the New England Journal of Medicine, with funding secured by Maternity Center Association; the study concluded that care in birth centers was safe, satisfying, and cost effective.”

Childbirth remains a “natural” occurrence but when complications set in they can occur very rapidly. These complications can have disasterous results. I am only one practitioner and have seen a maternal death and other extremely serious complications for mother and baby. I can surely say without reservation if these particular patients were not in a hospital they would not have survived. They needed expert care, and immediate intervention not available in the home.

Nurses and physicians are educated and trained extensively. Their goal is a healthy outcome for mother and baby. We are not in opposition to each other we are each others colleagues. If home birth is to continue and be as safe as it can be there must continue to be extensive training for the nurse-midwives and there must be a collegial partnership with the medical community.

Any one who is considering a home birth should discuss their wishes with a Board Certified Obstetrician and weigh the pros and cons of carefully. This is a decision that could seriously impact you and your family for the rest of your life. Your obstetrician should not be considered your enemy he/she is your advocate…if you do not feel this way find one that is.

http://blogs.babble.com/being-pregnant/2010/12/21/pregnancy-related-deaths-rising/?utm_source=Babble&utm_cam

http://parenting.blogs.nytimes.com/2011/01/04/debating-home-birth/?scp=10&sq=motherlode&st=cse

http://parenting.blogs.nytimes.com/2008/11/20/guest-blogger-a-birthing-story/

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