Health Care Delivery
I hope that you have had a chance to listen to our podcast interview with Ms. Carol Sakala, Director of Chilbirth Connection Programs for the National Partnership for Women and Families. In this podcast, Ms. Sakala shares with us the latest comprehensive report put out by Childbirth Connection entitled Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care. This report outlines the hormonal physiology of pregnancy and childbirth and shows how many of the common interventions used during labor and delivery in the United States are not only detrimental to this delicate hormonal balance between mamas and babies, but potentially harmful to them both. They offer practice recommendations for clinicians as well as tips and tools for patients.
There are many documents that both patients and clinicians can download and print for free. These documents are available on the Childbirth Connection website. Below is a very informative infographic which shows the hormonal systems of pregnancy and how many of the common interventions used here in the United States are impairing those systems. It too is available for download and free for clinicians and patients to share. There is also an infographic with more detailed information for clinicians.
A few weeks ago (March 21st to be exact) I introduced you to the Global Prenatal Initiative. Well, things have been heating up since that post and I want to give you an update-mainly because I have jumped in with both feet and am involved with organizing the US Prenatal Education Association!
No one is more acutely aware of the shortcomings in US prenatal care than Mamas on Bedrest. While it is safe to say the we receive prenatal care, in many instances one would be loathe to say that it is patient centered, baby friendly or offering a compassionate start to our little ones. And while many of the interventions that Mamas on Bedrest endure are necessary, how they are administered and how Mamas on Bedrest are cared for are often lacking in the compassion and nurturing department.
The foundation principle of the Global Prenatal Initiative is,
“The time spent in the womb is the foundation for long-term health, emotional security, intelligence, creativity and much more for every human being. It is vital that the link between these early stages of human development, their long-term impact and the current global challenges be known.”
~ Julie Gerland, GPI Co-Founder and Director
Dr. Gerland and other members of the United Nations have been collaborating to improve maternity outcomes and have come to the very reasonable conclusion that to make any sort of appreciable impact on our cultural deficiencies and disparities, it is imperative that we focus on human development-namely improving birth outcomes and in turn, life expectancy and quality of life. Their major focuses are:
- Confronting family poverty
- Ensuring work-family balance
- Advancing social integration
- Inter-generational solidarity
This is all well and good, but what does this mean for Mamas on Bedrest exactly???
- It means empowering mamas about what they can do to feel safe, secure and healthy during pregnancy.
- It means empowering mamas to provide safe, secure environments for their babies to develop and grow-both in utero and externally. We have to remember, whatever mama is experiencing during her pregnancy, her baby is also experiencing. As much as possible, we want those experiences to be peaceful and to have positive impacts on baby’s growth and development.
- It means working with both parents in the pre-conception and prenatal periods to foster healthy relationships, ones in which as much as possible both parents stay connected (not necessarily married) and involved in the lifelong growth and development of the baby.
Mamas, We already know so much of this! We know what it’s like for our families to face financial challenges because we go on bed rest and are not paid while we are not working. We know what it’s like to lose a job because we go on bed rest! We know what it is like to have to choose to nurture our children on bed rest in lieu of pursuing a career. We know what it is like to try to navigate bed rest without the support of family. We could (wo)man these panels ourselves and give birds eye views of what life is like when we don’t have the resources necessary for a peaceful pregnancies. And while all of you are welcome to step up in support of the Global Prenatal Initiative, I am stepping in and stepping up on behalf of high risk pregnant women, the Mamas on Bedrest. Stepping into this community of global prenatal health workers, it is my intention to not only represent Mamas on Bedrest but to also be your eyes, your ears and most importantly-YOUR VOICE! This is the chance for our voices to be heard, for our stories to be told and for the management of high risk pregnancies to be evaluated and changed as necessary to suit the needs of Mamas on Bedrest. I am counting on you all to speak up! I am counting on you all to tell me exactly what you needed when you were on bed rest; what would have made bed rest bearable and more successful. In return, I will relay your thoughts and request to my colleagues in the association, as well as to the pertinent United Nations sub-committees on human growth, development and overall well being.
The time has come, Mamas! We have the chance to change the course of prenatal care and birth outcomes for generations to come! Most importantly, we have the chance to make much needed changes in the care of high risk pregnancy!
I was just surfing around and came across a most disturbing webpage. Under the guise of wanting to “protect babies” this webpage’s content focused soley on disparaging midwives, lay midwives and Certified Professional Midwives in particular.
Now I am going to out myself right here and now and say that I have immense respect for midwives and the work that they do. I know both Certified Nurse Midwives-midwives who studied and trained at major universities here in the United States, as well as Midwives who were trained in other countries and chose to simply sit for the midwife exam rather than repeat their entire education (and pay the hefty educational costs) here in the US. I also know a few “lay midwives”, women who had such a passion for midwifery and childbearing that they have spent countless hours appreticining beside a midwife. All of these women are extremely dedicated to their clients and provide excellent care. Like all professionals, I do believe that they have all had some “untoward events”, i.e. births that have gone poorly. And like all professions, I believe that there are some really good midwives and some that aren’t so good.
The same can be said of physicians. We all know really excellent physicians and we also know physicians we wouldn’t let care for the neighborhood Alley cat! We must all remember that in every medical school, there are those students who graduate at the top of their class and those students who are amongst the bottom tier. Yet, We cannot (well, we should not) judge an entire profession based on the performance and habits of a few.
I was really disheartened to see this webpage really bashing midwives. There were a lot of sensational articles and posts, but little to no data to back up the claims. The moderator made very disparaging comments stating that laymidwives and Certified Professional Midwives had little more than highschool diplomas. It was shocking because most of the midwives that I know have sat for and passed national certifying examinations. I am all for having an opinion for or against something, but if you are going to make claims-and especially if those claims are disparaging or potentially impactful to those who may not be aware of all the facts-you must be able to back up what you are saying with hard evidence.
So that being said, Mamas on Bedrest, how did you decide with whom to deliver and where? If you are wondering how to figure this out, I’ll share with you how I made my decision.
1. Determine what type of practice and birth you want. I knew I wanted a midwife. I love the midwife model of care and I love that woman to woman interaction. I chose a practice that was all women. This is not to say that a practice that has men can’t be good or can’t be sympathetic. In my current area, the practices that are predominantly male were not as open to the less invasive, expectantly wait “midwifery” model. But I do want to say, before I got married I had a wonderful OB/GYN that was a man, and only switched because I moved out of state.
2. Interview the practices. Now I have had many people gawk when I say this. But let’s be real. You interview contractors before you have work done on your house. You interview daycare providers before leaving your children. Heck, I interviewed vets before I ever took my beloved cats even near the door! Don’t you deserve at least as much? And when I say interview practices, I mean OB/GYN practices as well as Midwife practices. Your personalities have to mesh! Ask about call schedules, ask about meeting the other providers, ask about classes and how questions are answered and how soon phone calls are returned and how lab results are delivered. Make sure that you are able to have the level of communication and attention that suits you! Every practice is different and you must feel comfortable, heard and free to ask questions and get a reasonable response. If you feel put off, if things are more automated than you like, If you just don’t feel comfortable, try another practice.
3. Know your As/gynecologic history. I had a history of uterine fibroids and was over 35 conceiving, so I knew that I was at increased risk of having complications. While I wanted the back up of obstetricians, I also wanted a practice that would be as minimally invasive as possible. Be reasonable. If you have a history that is complicated, you may not be a candidate for a midwife. Don’t be mad and don’t berate her skills. If she tells you that she isn’t comfortable handling your case, you should thank her. She is putting your health and well-being first! Likewise, if you have a complicated history like I did and a midwife tells you, “No problem, you can totally deliver out of hospital!” Be wary. She may be operating beyond her scope of practice and potentially putting you and your baby at risk.
4. I wanted as much midwife interaction as possible. Almost immediately, my first pregnancy went high risk and my hopes of a midwife delivery went out the window. However, my OB worked closely with a midwife and so I was able to see the midwife for many of my OB visits. Additionally, after I gave birth to my daughter, I was able to have my follow up visits with the midwives. Go for what you want as much as possible. I was not a candidate for a midwife attended birth in a birthing center birth, but I was able to have a lot of education and interaction with midwives. For me, I got the best of both worlds.
5. Speak to friends, Get references. One of the best indicators of a practice is references and testimonials. There are a lot of websites where patients rate their experiences with doctors or doctor’s offices. This is a good place to start. Likewise, Midwives are also rated and referenced. But far and away the best information comes from other mamas. Try to connect with other mamas in your community to see what their experiences were like. Remember, every pregnancy and every birth will be different, and not all personalities mesh. But if you have a practice that everyone loves, you can be pretty sure that it’s a good practice. Likewise, if there is a provider that consistently gets poor reviews-be it OB or midwife-you may want to steer clear (or at the very least, do a thorough evaluation to see if this is the provider for you!). Also, the American Medical Association (AMA), the American Congress of Obstetricians and Gynecologists (ACOG), the American College of Nurse Midwives (ACNM), and Midwives Alliance of North America (MANA) all have ways to find out about those in their profession, evaluate their performances, etc…
It all comes down to being a savvy consumer. Don’t be swayed by positive or negative advertising. Do your homework and get enough information so that you are making a wise and informed decision about who will provide health care to you.
And this is important even if you are in a small town or have limited options. I frequently get e-mail from mamas saying, “I can only go to this one practice because its the only one covered by my insurance.” Or “I have to go to this practice because its the only one in my town that serves high risk pregnancies.” No matter. You still need to do your homework. Get to know the providers and the staff. Get to know how the office works and who you need to contact if you need information. Establish as much open communication as possible so that you can voice your concerns and make your preferences heard.
Mamas, how did you choose with whom and where you will deliver your baby? Please share your experiences and any tips for other mamas in the comments section below.