CHILDBIRTH WITH MIDWIVES: AN IDEA WHOSE TIME HAS COME--AGAIN!
by Cordelia S. Hanna, B.A., C.C.E., C.B.A.

Most American women will have their babies delivered in the hospital by an obstetrician. But did you know that 80% of the world's babies are born with midwives? Those countries which use midwives in the majority of births have lower cesarean rates and lower infant mortality rates than the United States. The United States has a 22% cesarean rate and ranks 23rd in infant mortality--higher than many other industrialized nations. The World Health Organization states that there is no justification for having a cesarean rate higher than 15%.

Ask your grandmother about her experiences with childbirth. She was probably born at home or gave birth at home herself. Only since the 1940s have the majority of American women given birth in hospitals. During the "Back to Nature Movement" of the 1970s, there was a renaissance of interest in birthing at home. But childbirth at home is not an outmoded fad of the flower-children. In the 1990s, people are choosing midwives to help them at home, in freestanding birth centers and hospitals. In 1975, only 1% of births were attended by midwives. In 1994, midwives attended 5.5% of all live births, an increase from 4.8% in 1993. 62% of out-of-hospital births were at home and 29% were in Freestanding Birth Centers.

Still, midwives are an under-utilized resource which could improve maternal and child health status. According to a recent LA Times article, only 78.9% of pregnant women received prenatal care in 1993. By de-medicalizing childbirth, integrating midwifery care into our health care system and providing support for breast feeding, "from $13 to 20 billion a year could be saved in health care costs," according to Dr. Frank Oski, M.D., of Johns Hopkins University School of Medicine. Midwives are associated with lower cesarean rates, lower rates of prematurity and higher rates of successful breast feeding. Clients who hire midwives use less medication and undergo fewer medical procedures. Midwives take a holsitic approach, focusing on the woman's physical, emotional, psychological and spiritual process during the childbearing year. Midwives also provide gynecological services, contraception, pregnancy screening, prenatal care, childbirth education, counseling on health needs, family relations and postpartum concerns.

Hospital Birth

Hospital birth ensures immediate access to potentially life-saving technology, allaying many parents' fears. But one procedure often leads to another, disrupting the normal course of labor and birth, necessitating medication or more medical interventions. Studies indicate that epidural anesthesia and the Electronic Fetal Monitor correlate to a higher incidence of cesarean section. Hospital births involve giving the mother synthetic hormones to speed up labors slowed by anesthesia, cutting the mother's perineum as the baby's head emerges, pulling babies out of the birth canal by forceps or vacuum extraction. Hospital births also frequently involve newborns requiring assistance in getting started breathing and separation of mothers from their babies. However, all of these interventions can be reduced by the presence of a "Doula," a professional labor companion or midwife.

The Freestanding Birth Center

A 'Freestanding Birth Center' is not attached to or inside of a hospital. A woman laboring there is not encumbered or disturbed. Many women find they do not need medication because they are able to relax in a tub of warm water. It is possible for a baby to be born in water. But, unlike hospitals, birth centers do not have the personnel to handle many women in labor at once, so a woman must do her early labor at home, which could bring her many hours into labor. Many women choose to hire a professional labor companion. A study conducted by The National Birth Center reported that about 15% of women who began labor in a Freestanding Birth Center required transport to an acute care facility, while only 2% required emergency transfer. The others were mainly for slow progress of labor or because the woman requested anesthesia. The overall cesarean rate was 4.4%. Over 98% of women were satisfied with their birthing experience in a birth center.

Birth at Home

For a healthy woman having a normal pregnancy, planned childbirth at home with a skilled midwife is a safe option. Most complications can be prevented prenatally, but there are some maternal or fetal conditions that make birth in the hospital safer. The midwife is skilled in emergency measures, but, like a lifeguard, intervenes only when safety warrants it. Her birth supplies include some equipment available in the hospital or birth center, such as oxygen, IVs, medications to control bleeding, suturing materials for repairing tears, fetal heart rate monitoring devices and newborn resuscitation equipment. An obstetrician and hospital is available if transfer of care is required during the prenatal period, or transport is necessary during the birth. In urban areas, expeditious transport to emergency medical services is available in case of a rare emergency.

TYPES OF MIDWIVES

The midwife offers a wholistic approach including counseling on nutrition and psycho-social issues. The pregnant woman, her family and the midwife often develop an intimate bond during prenatal visits, and this support is given throughout the labor, delivery and the postpartum period (and sometimes into parenthood). The midwife is often part of the family's support network after the birth and becomes a trusted family friend.

Certified Nurse Midwife

The Certified Nurse Midwife (C.N.M.) has earned a Bachelor of Science in Nursing and is a licensed nurse. Many Nurse-Midwives have a Masters degree in Midwifery. They work in consultation with an obstetrician and refer patients if necessary. CNMs offer home birth or birth center deliveries, but most work in hospitals. Midwife-attended birth in the hospital is a good option for women who desire minimal intervention into the natural course of labor, while having the security that hospitals provide.

Direct-Entry Midwife / Licensed Midwife

The Direct-Entry Midwife (D.E.M.) enters the profession directly (rather than training as a nurse first). Her training includes academic study and clinical experience, apprenticeship with a senior midwife or doctor and/or attendance at a Direct Entry Midwifery Training Program. In California, birth at home is a legal option for parents- to-be. Direct-Entry Midwifery was legalized here in 1993 and midwives are currently obtaining licenses. Like the CNM, the DEM/LM has an obstetrician with whom she can consult and refer patients if necessary. Still other Direct-Entry Midwives are "conscientious objectors" to licensure. These traditional, community-based midwives have the expertise which comes from years of experience, and most are as qualified as their colleagues who chose to become licensed. National certification exists, for which verification of birth attendance and clinical evaluation and academic testing are required. Midwives who are nationally certified use the title "Certified Professional Midwife" (C.P.M.).

Most people do more research when they are buying a car then when they are preparing to have a baby. While pregnant, take time to learn about the differences between obstetricial and midwifery approaches to birth and figure out which is best for you. When parents educate themselves about all of their options, work through their fears about birth and find caregivers and birth places which support their choices, their baby's birth can be a very positive experience. Choosing whether to have a midwife attend your birth may be one of the most important decisions you'll ever make.

For a referral to a midwife, birth center or Professional Labor Companion in your area call 626-358-2318.
e-mail:shehina@earthlink.net.
Or, visit my webspace at: http://home.earthlink.net/~shehina/.

For information on childbirth at home, wholistic midwifery, pathways into the midwifery profession, or for a referral to a midwife in the Southern California Area, please go to:http://www.socalbirth.org/,
or call for booklets:
"Resources for Natural Birthing In Southern California" ($15 per copy),
and "Pathways Into Midwifery" ($10 per copy).

Cordelia S. Hanna, BA, CCE, CBA , Midwife's Assistant, Certified Childbirth Educator, Labor Companion is accredited by The Association of Labor Assistants and Childbirth Educators (ALACE).
She teaches wholistic birth preparation classes which focus on the cultural, emotional, physical, psychological, and spiritual aspects of pregnancy and birth.
She also offers Birth Options Consultations and Professional Labor Support.