Midwifery - Going Through a Rebirth

by Sharon Cullars

What do Erykah Badu and Cindy Crawford have in common? Well, when it came time for both women to give birth to their first child, they opted for a home birth attended by a midwife over the impersonal and sterile environment of a hospital.

Having a midwife is an option that many mothers-to-be are considering. And for those healthy enough to forego a clinical birth, midwifery is a way to keep the childbirth experience as natural as possible. The intimacy of a home birth with family and friends around helps to decrease the stress of childbirth and can provide a relaxing, peaceful atmosphere for both mother and child.

Although midwifery is starting to gain more acceptance than in past years, only six percent of American women used midwives in 1995 according to the Centers for Disease Control and Prevention. Still, midwifery has come a long way and is going through a rebirth of sorts.

Who should consider using a midwife? Only those with a strong commitment to home birthing, those willing to do the research, and those willing to find the right practictioner. As for the practictioner, there are three basic types of midwives:

1. The certified nurse midwife (CNM) is a registered nurse disclipined in nursing and midwifery and is certified by the ACNM. She may work through a hospital, a birthing center or have an independent practice.

2. The certified professional midwife (CPM) is certified through the North American Registry of Midwives and may have received training through a school or through an apprenticeship. Many of them work in birthing centers or in homes.

3. The lay midwife may have apprenticed with other midwives and may have received training through supplemental classes. She is not certified and, although she may be affiliated with a physician, she usually is not under a physician’s directive.

   In choosing a midwife, certain factors should be considered: the training of the midwife and whether or not she is licensed; whether she belongs to a midwifery organization; how many births she has attended; whether or not she has handled high-risk situations such as breech; what kind of prenatal care she provides, including nutritional information, exercise recommendation, in-home care, and recommendations for parent education; whether she is accessible 24 hours and can be reached by beeper; what medical facility she is affiliated with; and what kind of postpartum care she provides.

   Prenatal visits are very important in the home birthing process. Whether the birth will take place in a birthing center or the family's home, prenatal visits allow the family to become familiar with the midwife and allow the midwife to get to know those who will be involved in the birthing experience, including other family members including children, grandparents, as well as family friends.

   The midwife should establish a bond with the family in the early stages of the pregnancy so that the family will feel comfortable asking her questions and to allow her an opportunity to fully explain what they should expect in the birthing process.

   Although many couples may have reservations about not being in a hospital surrounded by the latest technology, homebirths can be safe for those mothers who are not high risk. High risk mothers are women with diabetes, blood diseases or high blood pressure. Usually, home births are not recommended in these cases.

   In anticipation of an emergency requiring medical intervention, some midwives require mothers-to-be to register at the nearest hospital. Even given this precautionary measure, ceasarean birth rates are lower in home births than they are in hospitals. This may be due to the fact that most midwives have helped to provide the mother with good prenatal care and have the leisure of an unhurried birth. There is less trauma and stress, which lends itself to a complication-free birth.

   The parents should plan for the birthing environment – whether they want the privacy of their own home or the intimate setting of a birthing center. Certain comforts like music, candles, religious rituals can help create a relaxing atmosphere. The midwife should have established a level of trust by the time labor begins, and should provide a calming force to deter any tension that arises from stress or fear, both of which can slow the labor process.

   After labor, the midwife should be available during the postpartum period to answer the new mother’s questions or in case problems arise. This period can last from six months or longer, especially if the midwife and family have formed a friendship.

   As for costs, a home birth under the care of a midwife costs less than a maternity stay at a hospital. In Los Angeles, for example, services for midwives range from $2,500 to $3,500 and covers prenatal care as well as postpartum visits. The costs can also include equipment used such as oxygen tanks, gynecological equipment as well as tubs for women who want to give birth underwater. In comparison, the average cost for a vaginal birth at a hospital is $4,030, according to the Office of Statewide Health Planning and Development.

   The decision to use a midwife is one not to take lightly. In the end, it depends on how comfortable with and committed to the whole process the mother-to-be will be. Some women will only feel comfortable in a fully staffed hospital, with an epidural and other high-tech conveniences. However, with good nutrition and good prenatal care, a carefully monitored homebirth can provide the mother with the support and intimacy she will need to make the childbirth experience one that is loving and wonderful.

   
   

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