delivery

Mamas on Bedrest: Who will attend your baby’s birth?

February 3rd, 2014

002_02Good Morning Mamas!

Have you considered having a midwife attend the birth of your baby? As a Mama on Bedrest, you most likely have been told that you are high risk and that you must have a your baby delivered in a hospital with a obstetrician. For many of us, this may be the case. But for women who go to term and in whom preterm labor, premature rupture of membranes, cervical insufficiency or other complications that become somewhat moot at term, having a midwife attend your birth is a viable option.

Why consider a midwife? If you are looking to minimize the amount of intervention you receive during your birth, then having a midwife attend your birth is the way to go! Certified Professional Midwives (CPM) and Certified Nurse Midwives (CNM) are highly trained and highly skilled health care professionals who have studied women’s health and the childbearing process in depth and have proficiency in providing care to the childbearing woman and her newborn baby. However, a midwife differs from an obstetrician in that she provides minimal intervention and is much more of an attendant to the process. A midwife is not a surgeon and does not bring surgical skills to the birth. However, CPM’s and CNM’s are trained in emergency procedures and are capable of managing a wide variety of birth complicatA midwife will allow a woman to birth her way; A woman may birth in bed, standing, squatting, on her hands and knees or in water (if she is an appropriate candidate for such a birth!). For women who are appropriate candidates and who choose to do so, some midwives will attend their births in their homes, in a comfortable environment, in the company of family and friends.

So who is not an appropriate candidate for having a midwife attend the birth of their baby? Any woman who has an unstable medical condition such as pregnancy induced hypertension, pre-eclampsia, Uncontrolled Gestational Diabetes, placenta previa or instability of the infant. These are major medical conditions and need to be addressed by medical doctors. Any condition that necessitates a cesarean section (specifically placenta previa and potentially pre-eclampsia with uncontrolled high blood pressure) these women should be attended by obstetricians. And a caveat for Mamas on Bedrest is that because of our histories, I do not recommend attempting home births. Even if a  Mama on Bedrest is attended by a midwife, I highly suggest that she be attended in a birthing center closely associated with a hospital or in a hospital where emergent medical care can be administered quickly if needed.

Why do I bring this discussion up? Because I want Mamas on Bedrest to explore all their options for their perinatal care. Unfortunately, many Mamas on Bedrest are told how they will birth their babies, told how their birth is going to go and are simply expected to show up and let the process happen to them. Having a baby is a very active process and it is my hope that all of you are as active participants as possible! This often doesn’t happen in the traditional hospital setting. There is little room for personalization, to have family members present, to be able to stand or walk during labor, to be able to deliver in a squatting position. But in a mama, these are all viable options and options that can make her labor and delivery easier, more comfortable and more memorable. As Mamas on Bedrest we have already lost so much of our pregnancy experiences because of bed rest. And while most of you would gladly do bed rest again if it means the safety and well being of your baby, whenever possible, my hope is that Mamas on Bedrest will be able to make informed health care decisions that will not only make for healthy and safe labors and deliveries for mamas and babies, but also make for memorable moments in the life of Mamas and babies.

If you have been considering having a midwife attend your birth, see what is available in your area. You may be able to deliver in a freestanding birth center or in a birth center attached or adjacent to a hospital. You may be able to have a combination of an OB and a midwife. There are as many possibilities as we can think of, but the first step is to have the desire and then to ask and see what is possible.

Who attend your baby’s birth? Share your story in the comments section below.

Mamas on Bedrest: Where Will You Give Birth?

September 27th, 2013

I was sent this infographic from the Institute of Medicine. I found it very interesting and worthy of sharing. So Mamas, where will YOU give birth? What influenced your choice? Are you giving birth in the setting most comfortable for you? If not, can you change your venue to better suit your comfort? Share your insights on this infographic and your experiences in the comments section below.birthsettingsgraphic

Mamas on Bedrest: Midwifery Care is Safe for Mamas on Bedrest

September 20th, 2013

IMG_3750 1x13One of my greatest disappointments being a high risk mama was that I was unable to have my births attended by a midwife. In Austin at the time when I was having my children, midwives had been banished from the hospitals and the only women who could have a midwife assisted birth were women who gave birth at home or at Birthing Centers. Thankfully that trend is reversing and many (but not all) women in Austin, TX have access to and the ability to choose midwifery care.

However, a recent study out of Australia reports that midwifery care is safe and cost effective for all women regardless of the level of complication of their pregnancies. Published in The Lancet and reported in MedScape OB/GYN Women’s HealthSally K. Tracy, DMid, a professor in the Midwifery and Women’s Health Research Unit at the University of Sydney, Royal Hospital for Women in Randwick, New South Wales, Australia, and colleagues sought to see of the benefits and positive birth outcomes seen in low risk pregnant women who are receive prenatal and intra-partum care from midwives could also occur for high risk pregnant women who received care from midwives. This was an unusual undertaking, the first of its kind, as midwives are usually removed from a woman’s case once she is labeled “high risk”, and her care is assumed by obstetricians and Maternal Fetal Medicine Specialist.

“We undertook a randomised controlled trial to assess maternal and perinatal clinical outcomes and cost of care for caseload midwifery compared with standard maternity care for women of all risk,” the authors write.

The researchers randomly assigned 871 pregnant women to caseload care consisting of antenatal, intrapartum, and postpartum care from a “caseload” (study prescribed) midwife and 877 women to standard care provided separate wards or clinics.

As for outcomes, the outcomes were fairly similar. There were similar number of cesarean sections for each group, however the number of elective cesarean sections for the standard care group was significantly higher as were the number of labor inductions. Instrumentation, use of epidurals and numbers of spontaneous vaginal births was similar for both groups. Women in the study group were significantly more likely to experience spontaneous labor onset, less likely to have labor induction, and more likely to have labor augmentation (walking, massage, manual manipulations, etc…) than women in the standard care group. Those in the study group were significantly more likely to have birth-related blood loss of less than 500 mL, but the risk for severe blood loss (>1000 mL) was similar between the groups. There were no maternal deaths during the trial. Additionally, more mothers from the study group were breastfeeding their babies than the standard group at 6 weeks post partum. There was no significant different difference in the infants at birth as assessed by Apgar scores, NICU admissions or birthweight.

A very significant difference was cost. The cost of midwifery care for prenatal and peri-partum care versus the standard hospital care was on average $566.74 (in Australian dollars) less.

While this is the first study of its kind to delve into providing midwifery care to high risk pregnant women, I feel its a landmark study. Midwifery has been the standard of care for childbirth since the beginning of time. Midwives and other women in the community would come and attend a birthing mother, caring for not only the mother but also for her family. With the advance of modern day obstetrics and hospital care, much of the intimate woman to woman care and community care of the family has been lost. It is my hope that with studies like this one and others all women will be able to experience pregnancy and childbirth and a safe and loving environment. Yes, sometimes things happen and interventions are necessary. However, there is always time and space for “humanizing” of the experience and that is what midwifery brings.