I love birth. I love supporting all types of birth. I have seen natural home water births, epidural births that were so much fun and very empowering for the mom, beautiful planned cesareans and everything in between. My goal is NOT helping everyone have a certain type of birth. My goal is always helping families to be empowered and educated so they can have a birth that will be positive for them.
I have noticed however that many families will say they want a low intervention birth, but then they choose to hire a provider who doesn't routinely do that type of birth. Thank goodness for OBs and their surgical skills when birth goes awry. But, as trained surgeons, OB's skills are not being best utilized by patients having normal births. Just the other day my doula partner and I interviewed with a couple who are interviewing providers for their late summer arrival. They met with an OB and after telling her the type of birth they want, she told them to go see a midwife. How amazing and what a gift that this OB has given this family!
Medical Model of Care: Focuses on preventing, diagnosing, and treating the complications that can occur during pregnancy, labor, and birth. Prevention strategies tend to emphasize the use of testing, coupled with the use of medical or surgical interventions to avert a poor outcome. In short: birth is a disaster waiting to happen that may require lots of medical tests, treatments and interventions by a trained surgeon in order to happen safely.
Midwifery Model of Care: Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle. Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support. In short: birth is a family and mother-centered event that is natural and normal the majority of the time.
Side note: Not all OBs see birth as a medical emergency waiting to happen. Not all midwives truly believe that birth is usually a natural, normal process that needs watchful yet patient waiting in many cases. We have a number of amazing OBs and Family Practice physicians in the Twin Cities who practice the Midwifery Model and some midwives who do not. But, because most providers practice in groups and you get who is on-call when your baby decides to come, it's important that the vast majority of the providers in your practice routinely "do" the type of birth YOU want.
I'd like to share five surprising reasons why YOU may want to hire a midwife (i.e. a group of providers who practices the midwifery model) for your low intervention hospital birth.
#1: Obstetricians typically spend a very short amount of time at your birth. If they are on the floor they may stop in and say hi for a couple minutes once or twice during the hours you are at the hospital working to birth your baby. Or they may be home getting updates from the nurse until you are very close to giving birth. It is the nurses who are monitoring your vital signs and the baby's heart rate to make sure all is looking normal. Your nurse will also be in charge of managing your pushing stage until the baby is very close to being born. With an average pushing stage lasting 1-3 hours, families are often surprised that their OB isn't there for most of it. Only for the last 5-10 minutes of a typical OB birth will the OB come into the room to catch the baby. Then after the birth they try to quickly get the placenta out, stitch up any tears and leave pretty quickly. Midwives are generally more present. Hospital midwives in the Twin Cities may be helping multiple families at once so they can't be in the room 100% of the time, but they are in for much more of the birth process. With midwives you still have a nurse who is caring for you as well.
#2: The provider who catches your baby is not in charge of your baby's care once he or she is born. In a hospital birth, when the baby is about to be born, the birthing person's nurse calls in the doctor or midwife and a second nurse comes in. This second nurse is the person in charge of caring for the baby if he is not transitioning well after the birth. A nurse practitioner may come in if the baby needs more specialized care, and babies who need extra help will go to a special care nursery or NICU to be treated by a full pediatric team of doctors and nurses. So, whether you have a midwife or doctor catch your baby, he or she will receive the same excellent care after the birth by the pediatric team. It's a false belief to choose an OB "just in case something goes wrong." Which also leads us to surprising reason #3.....
#3: Of course people sometimes worry about something going wrong for the birthing person or baby during birth. Complications are rare but can happen. But does having an OB lower your risks? In fact the research shows that a midwife-attended birth lowers many risks without increasing poor outcomes in any way.. I pulled this information from this Cochrane Review study. Seeing a midwife reduces your risk of preterm birth, losing a baby before 24 weeks, episiotomy, epidural, and forceps or vacuum assisted birth. Having a midwife increases your chances of a spontaneous vaginal birth and families who use midwives report higher levels of satisfaction. And all of these benefits come without an increase in neonatal/fetal death or any other adverse outcomes. When a family chooses to birth in the hospital with a midwife, they benefit from the midwifery model of care for as long as their birth continues to be normal and low risk. And, in those cases where an OB's special training is needed, midwives simply make a call and consult with the OB who supports their practice and the client receives a seamless transfer of care as needed.
#4: Hospital midwives support all your choices! They are skilled in helping clients avoid interventions they don't want, but also will support what you do want. You CAN still get an epidural with a midwife in a hospital if you want. Are you surprised by that? Maybe you are dreaming of a natural birth but aren't sure how it will go? Midwives offer the best of all options. Hospital midwife practices offer tons of natural support techniques like water immersion (and many offer water birth), birth balls, support with different positions, and can help many birthing people avoid pain medication if they want. But, if a person changes their mind or knows they want an epidural to begin with, that is fine too! It's YOUR choice and when it comes to birth, it's always beneficial to have as many options as possible.
#5: Other things you may have heard are beneficial come standard with midwives. Families these days know that things like intermittent fetal monitoring, mother-directed pushing in positions the birthing person chooses, and delayed cord clamping are safe, beneficial and evidence-based practices. But, interestingly, it takes about 15 years before routine practices catch up with the evidence. Unfortunately, even today, we see many OBs telling patients they can have these things, but then not actually doing them when push comes to... well... pushing a baby out! If you want these things, choose a provider who actually does these things every day, not who you will have to closely monitor to make sure they are following your wishes. Parents are vulnerable during birth and it is nearly impossible to know if your provider is doing what is really needed or just what they prefer to do. If your birth plan needs to say "I don't want this and I don't want that" then your provider may not be aligned with the type of birth you want!
Of course as a doula and childbirth educator, I strongly believe all families benefit from excellent preparation and education before birth, and the support of a doula during the process. But, nothing matters more to how your birth will really go then the provider you choose to invite to your birth experience. Choose wisely!