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.
“The Caregiver’s Motto”
She has a very good reason for:
Believing this way
Behaving this way
For feeling this way
I may be the target, but I am not the reason for her behavior.
~Penny Simkin, PT, Author, Doula, Childbirth Educator
This past weekend I had the great privilege to learn from and train with 2 extraordinary childbirth professionals. Penny Simkin is a physical therapist who helped developed the modern day doula profession and co-founded Doulas of North America (DONA) now DONA International. Jennie Joseph is a Certified Professional Midwife (CPM) a Licensed Midwife (LM) and the Executive Director of The Birth Place-CommonSense Childbirth in Florida. These two “birth giants” shared their wisdom, their expertise and their vision for the future of childbearing. Comparatively speaking, I am green as grass, so I soaked up their words of wisdom like a sponge, and the message that I have carried home with me is, “Any way a mama feels is the right way for her to feel and it is my job to support her right where she is as she (prepares for and) gives birth”.
Is this what you hear when you go to your OB visits? It wasn’t what I heard. In this country, we have morphed pregnancy and child birth into this high tech, monitored and micro-managed phenomenon, and we Mamas on Bedrest are probably the ones with the most invasive experiences. Now I want to make one thing clear: I AM NOT advocating disregarding the medical advice of your obstetrician or midwife. You’ve been put on bed rest for a reason and most of you have needed the medical attention that you are receiving. But what I am saying, and what gave my heart leaps of joy when I heard it this weekend is,
“At no time is it EVER okay to disregard the human being in our presence, the one whom WE SERVE, in favor of our medical expertise!”
Perhaps it was because I was sitting in a room full of doulas, midwives, childbirth educators and lactation consultants that such phrases were embraced and acknowledged. But for the first time in a very long time, I felt at home discussing my concerns for birthing women and got a rousing dose of support and suggestions for how to make things better for the women that I serve.
When Penny Simkin presented The Caregiver’s Motto, she was in fact speaking about the care of survivors of child sexual assault who were pregnant and/or laboring/giving birth. However, as we continued our discussion, we all realized that this motto was valid across the spectrum of childbearing. How many of you have felt frightened, confused and anxious and lashed out or perhaps fallen apart, or maybe simply questioned the recommendation of your health care provider during an office visit? At that moment, did your health care provider become defensive and “write you off as difficult” ? Would it serve the greater good if he/she could at least try to relate to what you are feeling and going through? Applying this motto to Mamas on Bedrest, it’s easy for me to see how a mama who may be crying or yelilng or even swearing may be feeling. She is scared. She’s worried that her baby may not make it (and she may have similiar concerns for herself!). Isn’t that more than a little bit of a reason for her to be “less than courteous” in the moment? Sure, we should all endeavor to be courteous to our fellow (wo)men, but if that person just told you, “Your baby is in danger and you must go home/to the hospital right away and stay in bed and we’ll hope for the best”, can’t you see how that may cause her to react in a less than conscientious manner?
But I think Jennie Joseph summed it up best when she said,
“It’s not midwifery care that impacts birth outcomes (Jennie’s Birthing Center has a very low preterm birth rate, only 1-2 per year!). It’s the love that we give our women. When we treat her with respect and the expectation that she is a mom and that she will deliver a healthy baby, she rises to the challenge.”
Jennie made no mention of being upset if a mama yelled at her, if she missed an appointment or if she did not follow her instructions to the letter. She understands that many women face huge obstacles-both while pregnant and when not pregnant-and she simply meets them where they are. However, as the women learn that Jennie and her staff will never “fire them” or “chastize them for not doing right”, the women become more “compliant”, doing what they need to do to take care of themselves and their babies. And Jennie and her staff work with her mamas, many of whom are in extreme circumstances, to get the best prenatal care possible.
So I just want to take a moment to say, however you are feeling is exactly the right way for you to feel. Bedrest sucks and if you’re questioning whether or not its really the best thing for you right now, I’m not going to tell you, “You want a healthy baby, don’t you?” Nor will I say, “Do you want your baby to die?” These “scare tactics” are just that. They serve no real purpose but to invoke fear and cause distance between health care providers and the women they serve. My experience is that often mama’s strongest feelings are when she first learns about her situation, and as time goes on, she does much better. I have also learned that the more she is informed and educated about her situation and what she can expect, the better the pregnancy goes. It’s not rocket science folks, just common courtesy and respect.
So go ahead mamas, feel what you feel. Let it all hang out! Here, it’s okay to feel what you feel and to express those feelings. Share your feelings in the comments section below. If you have other questions or concerns, don’t hesitate to send them to me at firstname.lastname@example.org.
A mama with gestational diabetes posed this question to the mama community on a pregnancy website:
Q: Hey all, do any of you have any tips for how I can make my labor and delivery more natural? I have always wanted a water home birth, but with each of my pregnancies (this is my third) I developed gestational diabetes. My first two labors and deliveries were very cold and sterile and highly mechanical. My doctor has already told me that I have to deliver in the hospital, have internal fetal monitoring and if the baby gets too big, that I’ll have to be induced. I called several midwives around town, but because I am on insulin (my blood sugars would soar in the early morning so I take a shot at bedtime).
I really want to avoid as much intervention as possible. I have hired a doula. What else can I do to make my delivery more natural and comforting?
The mamas on this particular website came up with some awesome ideas and I am going to share them here.
You Call the Shots! I was really heartened to hear the mamas in this community encouraging and empowering this mama to stand her ground for as natural a birth as possible. Many suggested that she find a midwife, but when “mama” shared her complicated course and her need for insulin, the mamas agreed that she should deliver in the hospital. However, they gave her sage advice to be very clear on her desires for her birth and to make sure that everyone knows what she wants and is on board to provide that care. One must always remember that the health care staff works for YOU! And while in our current paradigm health care providers often act as if they know what is best for us, in the end, we have the final say as to what treatments we receive.
Make sure that you understand each and every medication, treatment and procedure that is proposed. If you have questions, make sure they are answered to your satisfaction BEFORE you sign any consent form. (Truly make informed consent!)
Have an advocate. This mama was on this, she had already hired a doula. Having someone who knows what you want and who can express your desires if/when you cannot express them yourself is critical. Also, having someone there who is “all for you” is a tremendous emotional boost. This person has to be strong, knowledgeable, able to speak up to hospital personnel and yet someone who will first and foremost have your best health interest in mind, someone who may be able to help translate difficult information so you can make informed health care decisions if necessary. A doula is an excellent option if you don’t have a family member or friend who can take this stand for you, or if you prefer someone without the emotional ties and has some training in this area.
You Can Refuse to be Induced. Now this is a bit sticky. In Gestational Diabetes, there is always the risk of having a larger baby. However, if neither you nor the baby is in distress, there are no complications and you are not post dates, there really is no medically necessary reason to induce. You have the right to a trial of labor. Discuss this you situation with your OB and get the exact, specific reason he/she wants to induce your labor. If you have questions, you have the right to consult with another OB for a second opinion. Just be sure that an induction is truly indicated as it carries with it increased discomfort, the increased likelihood of an epidural, the increased likelihood of you having a c-section and an increased risk of your baby needing intensive care in the neonatal ICU (NICU).
You don’t have to have an epidural. You don’t have to have an epidural. Again, if every thing is progressing without complications or distress, and you feel comfortable and competent to manage your pain, you are well within your right to refuse an epidural.
You don’t have to have an episiotomy. An episiotomy, a surgical cut in the perineum is not necessary. Many OB’s perform this to “prevent tearing”. However, there are methods of perineal massage that allow for natural stretching of the tissue in this area. Most Midwives know these techniques and most OB’s do not. Ask a midwife or doula if they can share methods of perineum softening/stretching to ease delivery.
Make Friends with the L & D staff. If you can, visit the Labor and Delivery floor at the hospital at which you intend to deliver. Chat with the staff. If you can, get a feel for how the nurses care for the patients. The more you know up front, in terms of how the floor is laid out, how the nurses work with the patients and the nurses themselves, the better will be your experience.
Bring things from home to make your surrounds more comfortable and “homey”. Most of the mamas advised that mama bring her own gowns, robes and slippers, candles, music, pillows-anything that she finds soothing and that will make her surroundings feel more like home and less like a hospital room.