Midwives: A Satisfying Alternative
Having a baby can be both rewarding and confusing for women and their families as they negotiate the health care system in this country. Women are faced with many decisions along the way: What kind of birth experience do I want? Where do I want to give birth? Who do I want to attend my birth? How do I keep my birth normal?
Women deserve care that honors their intelligence and intuition, and respects their desire for active participation. As women, we need connection with our families, partners, children, and even health care providers. We want to know that we will be heard, and that our fears, dreams, opinions, and desires will be accepted, addressed, and honored. Unfortunately, many women feel they are not given the time or information to fully participate in shaping their childbirth experience according to their individual needs and desires.
Midwives offer an option to women who are looking for a different approach to their pregnancy and birth. The word "midwife" literally means "with woman," and the practice of midwifery is characterized by hands-on, time-intensive care that respects the unique needs and wishes of each woman. Midwives are "experts in normal," believing that since pregnancy and birth are part of our biological design, it makes sense to treat childbearing as a normal part of life. The midwife's role is to monitor the well being of the mother throughout her childbearing cycle, providing her with care and assistance to maintain her health and the health of her baby. Midwives are trained to continuously assess women for risk factors, which may interfere with a normal outcome, referring them to obstetrical care as needed.
In 2005, midwives attended approximately 11% of births in the US. There are several types of midwives, typically categorized by their educational background and by the setting where they attend births. Midwives may receive their training through graduate programs, direct-entry educational programs, or as apprentices. Midwives may provide services in hospitals, birth centers, or in the home. Some midwives own their practice, while others work for hospitals or OB-GYN groups. Many midwives offer full-scope midwifery, which offers health care to women throughout their life, including family planning, annual pap smears, care during pregnancy, birth, and postpartum, and menopausal care. Others offer services in one area or another, such as prenatal care but not labor support and birthing services, or gynecological but not pregnancy care. For women who are seeking a specific birth experience, it is necessary to consider all these variables when choosing a care provider.
There is a lot of fear surrounding childbirth in our society. Some women do not believe their bodies are able to birth naturally, and others desperately hope for a natural birth but have been told that they are "high risk" for one reason or another. Midwives operate on the assumption that women's bodies are amazingly strong and capable, and that with the right support, most women will successfully experience an uncomplicated birth. Risk factors may impact the options that are available to a woman, but midwifery care insists on keeping central the idea that childbirth is a normal part of life, and should be handled with respect and reverence.
Women are strong and well-equipped for the task at hand, capable of not only surviving, but of being triumphant. While labor and birth are physically and emotionally demanding, women are able to rise to the challenge, especially when they have a supportive caregiver who understands the natural process and has developed the necessary skills to help women achieve the experience they desire. Midwives understand that to keep childbirth normal, women need to feel safe, and must be free to listen to their bodies. Movement and making noise can be powerful tools to cope with the extreme sensations of birthing; the ability to use these tools is often affected by the environment in which a woman is laboring. As advocates for women, midwives excel at creating a safe space for women to labor in whatever manner they find helpful.
Many studies have shown that midwifery care is both safe and cost-effective because it minimizes interventions and procedures, while optimizing outcomes. Midwives view epidurals, pitocin, cesarean sections, and other interventions as tools to use when necessary, but often find that by supporting the woman's natural instincts and rhythms, these tools are not needed. Women who seek care with a midwife have access to all the technological advances of our health care system, but rarely need to use them because of the emphasis on natural, hands-on methods such as massage, a supportive encouraging presence, the use of water for comfort, and the ability to change positions as needed.
In 1996, the Midwifery Task Force developed the Midwives Model of Care, identifying the following key components to midwifery care:
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Monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle
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Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
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Minimizing technological interventions
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Identifying and referring women who require obstetrical attention
As a midwife and a woman, I am continuously amazed by the capability we inherently possess to bear children in our own way, even when that means pursuing an alternative to the standard experience in our culture. Midwifery care was once the rule rather than the exception, and today many women are again finding that it is a relevant model of care that meets the needs of women in a powerful and satisfying way.
