prenatal – The Well Midwifery

I was recently lunching with a friend that had given birth to an adorable baby boy a few months ago. It was the first time we had met up since she became a mother and she finally had a chance to tell me the full story of his birth. It was very difficult and a constant refrain was “I wish I had chosen a midwife” “If I ever get pregnant again, I’m definitely choosing a midwife” “We NEED more midwives!” I was sad she had experienced such a difficult pregnancy, labor AND postpartum. I am frequently faced with pregnant women who are trying to make choices for their pregnancy and birth. I always suggest they look into midwives and it seems like very few, if any, take my advice.

I asked my friend, “I’m glad you feel so strongly about the benefits of having a midwife. Why do you think women don’t choose midwives?”

Through her response and our discussion, I realized there are a few common myths or misconceptions about midwives. If only women knew the facts! I’m sure more women would chose midwives and have a happier and healthier birth experience. So here’s the truth, and nothing but the truth:

1. MYTH: Midwives aren’t medically trained to deliver babies.

FACT: Certified Midwives (both Certified Professional Midwives and Certified Nurse Midwives) are well experienced, well trained, professionals! Certified Nurse Midwives (CNM) have gone to school to become RN (Registered Nurses) and then went back to college to get an additional degree specializing in midwifery. They then take a nationally recognized certification exam.

FACT: Certified Professional Midwives (CPM) have two routes: complete a 2+yr academic program in addition to getting 2+years clinical experience (at home births and/or in a birth clinic), or complete 3+ years of intense clinical experience. Both routes require the midwife to take the same nationally recognized certification exam as CNMs and get licensed in their state.

FACT: Both CNMs and CPMs provide all of your prenatal care and are the only ones needed at your birth to deliver your baby. Midwives are qualified to provide care for you and your newborn for at least 2 months after birth.

2. MYTH: Midwives aren’t as good as OB/GYNs.

FACT: Historically, midwives have been around longer than OB/GYNs and have passed their generations of information onto one another. Midwives trained some of the first OB’s.

FACT: Midwives are trained to trust, encourage, and guide normal labor. Roughly 85-90% of births are “normal” and do not require emergency surgery. OB/GYNs are trained to combat complicated births and therefore tend to treat birth as an illness or problem. Midwives have seen more natural, safe, healthy births than OB/GYNs with decades more of experience (many OB/GYNs have never seen a natural birth!). Midwives have numerous techniques they can use to help aid a difficult labor before resulting to interventions such as induction, forceps, episiotomy, or cesarian. While midwives rely on natural methods first, they are NOT against medicine, and they are thankful for the benefits hospitals can offer for births that truly need medical intervention.

3. MYTH: OB/GYNs give you better prenatal care.

FACT: Midwives care about all of you; mind, body and spirit. They acknowledge the effect your mental, emotional and spiritual health has on your physical health. The average prenatal visit with a midwife is +1hr, while the average OB/GYN visit is 15 minutes.

4. MYTH: Midwives aren’t as safe as OB/GYNs.

FACT: Midwives have better maternal and infant outcomes than OB/GYNs. The average cesarian rate for a midwife is 10%, while for an OB/GYN it is around 32% or more (resource ACNM)! To give credit where it is due – midwives have lower rates partially because midwives only take on low risk, healthy mothers while many OB/GYNs have to take on more complicated pregnancies. But there is also the factor that midwives treat the whole woman, anticipate health problems and treat them before they become serious and trust natural birth.

FACT: Midwives give better personal and more thorough prenatal, labor and postpartum care. As stated above, they spend more time with you, get to know you better and see signs of potential health risks earlier than an OB/GYN would. They know your personal health and help you combat pregnancy complications (such as high blood pressure or gestational diabetes) before they become serious health issues and risk you out of their care. They use natural, healthy ways (such as diet, exercise, and herbal medicine) to help you stay healthy throughout your pregnancy.

5. MYTH: Midwives cost too much.

FACT: Midwives are cheaper than OB/GYN. The average midwife costs roughly $4,000 for all of your prenatal care AND birth (this varies by the midwife, their practice, their experience and location). The average OB/GYN prenatal care costs $1,500. Then the birth can cost over $40,000 (I’ve heard over $100,000 as well)!

FACT: Even if your insurance covers the cost of an OB/GYN but doesn’t cover a midwife, you can end up paying MORE out of pocket for an OB/GYN, depending on how the birth goes. Be sure you know your policy and what “emergencies”, “complications” and additional fees they do NOT cover. You may find yourself paying more for mediocre prenatal care and a disappointing birth experience.

What facts and myths affect your decision on a healthcare provider?

Vintage “Prenatal Care” book photo from Etsy.com (advice below is not from this book)

As a doula I have worked with and know a lot of new moms. Their questions usually centralize around a few topics; health care provider, birth location and preparation. If I had a 5 minute window to give the best advice I know to newly pregnant or attempting pregnancy women it would be these things:

Get healthy and stay healthy. There are so many statistics about how dramatically your health affects you pregnancy, your labor and your baby. Good diet and exercise through pregnancy decreases complications, length of labor, complications, and improves the health of the baby throughout the first moments and years of its life, as well as improves mother’s recovery time and decreases risk of postpartum mood disorders (depression). If you don’t exercise and eat well right now, it’s never too late to start! Women who have been diagnosed with serious conditions like gestational diabetes can minimize their risk and sometimes even eliminate the disease by simply exercising and eating right. And if you don’t know how to get into these good habits now, it’s not gonna get any easier with a baby! You wanna know now how to do these things right so you can keep up with these habits with a baby, set a good example and keep your baby healthy.
Choose a health care provider (HCP) that cares about your preferences and agrees with your priorities. Do not choose a HCP based solely on insurance!!!! Can I say that again? Don’t do it! It is not worth the money to have a terrible pregnancy and labor and possibly risk your health, your child’s health and your happiness. Invest in your future and find someone who believes in what you believe in. Someone you can trust to help you make good decisions for your life and your child’s life. PLEASE consider midwives as well as doctors. OBs are trained in the medical, surgical, complicated side of birth. Midwives are trained in the healthy, support and encourage mind and body side of birth. There are midwives that work in hospitals if you still want a hospital birth. Midwives will NOT take on clients that have any complications in pregnancy that would make it risky for an out of hospital birth.
Where do you feel the safest? Do you view hospitals as a place to go when you are sick or ill or when something is wrong? Have you had bad experiences at a hospital? Do hospitals make you nervous, anxious, stressed or fearful? Then consider a birth center or an at home birth! Your comfort and frame of mind SIGNIFICANTLY affect the labor process. If you don’t feel safe or comfortable labor will be more difficult. However, if hospitals feel like a safe place that you go to feel better, get help, and relief, than a hospital could be a much better place for you to give birth than at home. If you are having a normal, uncomplicated pregnancy, the risk of complications arising during labor that require a transport to the hospital are low.
Prepare but don’t obsess. Moms tend to be on one side of the spectrum or the other when it comes to preparation. There are the borderline obsessed, need all of the information, contemplate everything, plan everything, need to have control kind of moms, and then there are the I don’t care, I don’t have any preferences, I don’t do any research, I don’t mind not knowing what to do and I’m just gonna wing it kind of moms. Both moms are putting themselves at risk. You can’t control everything or know everything. The more stressed you are, the less healthy it is for your baby and the labor process. There are going to be things that happen during labor that go outside your birth plan. Don’t freak out! For my Christian clients I advise them to focus on the peace that God gives despite your circumstances. God grants us peace in the midst of chaos and turmoil. Being comfortable or getting what you want or expect is not always the best thing and does not guarantee peace. Trusting God’s plan for your birth, not matter how it looks, will bring you peace no mater the circumstances. On the other side, not preparing or not having preferences does not mean you will be without stress or disappointment. The biggest regret I hear from parents after the birth of their child is “I wish I had known more or had been better prepared”. You are right Ms. Unprepared, things never go as planned. But when things go wrong and you are forced to make a life or death decision for your baby, are you going to wish you had done a little more research? And there’s nothing wrong with having preferences. In fact, preferences are what make the birth unique, memorable and make you and your partner feel more like you are apart of this amazing experience. Don’t know where to start? Try taking a childbirth class or reading some books like “Pregnancy Childbirth and the Newborn”, “The Birth Partner” or “Ina May’s Guide to Childbirth”.
Finally, have a doula. Read my previous post on the “Why everyone needs a Doula”.

Any other good advice out there?

The Well Midwifery

Tag: prenatal

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