Midwives speak on birthing

Between midterms and picking the perfect Halloween costume, choosing a birth delivery method is probably the last thing on most Yale women’s minds. But according to four midwives who spoke at the Yale Women’s Center Monday night, it is never too early to start planning.

As part of Women’s Health Week, the Center hosted four specialists in midwifery for a panel discussion on the merits of alternative birth methods, which panelists said can empower women by offering more natural, lower-cost deliveries and a more personalized experience than clinical obstetricians currently offer. The four featured midwives — Christina Fleming C.M., Elise Resch C.M., Rebekah Wheeler and Christy Wilson R.N. — spoke to a gathering of 15 students, including two men, and reflected on their reasons for entering the profession.

Midwives at the Women’s Center discussion Monday night urged students to consider natural birthing methods.
Eva Galvan
Midwives at the Women’s Center discussion Monday night urged students to consider natural birthing methods.

“When I actually shadowed an obstetrician, it was clear that she approached a woman in labor as a woman who was sick and in an emergency,” Wheeler said. “These women aren’t sick; they might have complications, but certified midwives are trained to handle almost all of these problems. Every other developed country has midwives delivering babies, and obstetricians are essentially only surgeons.”

Fleming said she entered the profession because she views midwifery as a statement on a woman’s values. Obstetricians view birth as a high-risk situation, she said, and strive to avoid all potential harm to mother and child.

On the other hand, Fleming explained, midwives emphasize birth as a natural process of life. Under midwifery, she pointed out, mothers are not thought of as patients, but rather as autonomous women taking ownership over their own lives and the lives of their children.

Midwifery presents mothers with a range of birthing choices. Fleming said a few mothers prefer an “unassisted home birth,” where the only people present at the birth of the child are the mother and father. Most others seek some degree of experienced help, ranging from unschooled but practiced community midwives to certified professional or nurse midwives.

All four panelists emphasized that thinking about issues of women’s health and autonomy before getting pregnant is the best way for women to approach birth. In the moment, they said, obstetricians essentially dictate the terms of a woman’s birth — using the mother’s concern for the child’s health to justify any action that guarantees an expedited and painless birth.

“ ‘For the safety of your baby’ are the only words needed to convince parents to undergo unnecessary procedures,” Resch said.

Even mothers who witness their daughters giving birth can influence the birth process, Wilson explained, by insisting on medications for their daughter during the painful process of childbirth.

“Way before childbirth, women must consider the politics of women’s health care,” Resch added.

But Resch said midwifery faces challenges, the biggest of which is the malpractice suit; a huge portion of a midwife’s salary pays for malpractice insurance, she said. And states all have different regulations governing the profession, Fleming added.

Another problem is reimbursement. Resch said despite the fact that a midwife delivery leads to an average of four fewer hospital days and a less costly delivery overall, insurance companies are less willing to reimburse seemingly non-medical services.

Comments

  • Hieronymus

    Sad that centuries-old midwifery and "natural" birthing is relegated to "alternative methods."

    Ppl no longer consider C-section alternative (indeed, a "scheduled C" is de rigeur among educated wives). Sticking a big fat needle in one's spine is no longer not "alternative," it is often the first request.

    Hospitals are for sick folk; for the healthy, the family bed can make a mighty fine birthplace.

  • Anonymous

    And if something goes wrong, that family bed becomes a mighty fine deathbed.

    Thanks, but I'll stick with hospitals and modern medicine.

  • Anonymous

    I'm sorry, Anonymous, but that remark is based on prejudice and ignorance, not truth. I (SY '04) began to research birthing options when I first learned that I was expecting my first son. My husband and I opted for a natural homebirth assisted by a certified nurse-midwife. We also took courses in the Bradley Method of natural childbirth.

    While research data will tell you that most births will proceed without major complications, and indeed modern, western nations who base their birthing systems on the midwife model (such as in Scandinavia) have lower maternal and infant mortality and morbidity than the U.S., with all it's "hospitals and modern medicine."

    So here's the rub: something did go wrong. We were transferred to a hospital to continue to labor there, but knew that in our situation a Cesarean was likely. My son, now a beautiful and healthy 8-month old, was delivered via Cesarean Section and I consider him a successful homebirth. Why, you ask? Simple - part of the homebirth model is knowing when to take advantage of the strengths of the hospital model. (Namely, surgical assistance.) I would advise that you do the research when your time comes, rather than accepting the status quo.

  • Anonymous

    The vast majority of Certified Nurse Midwives attend births in hospitals. It's not an either/or. Plus, some new studies are showing that midwives might actually be safer and have better medical outcomes than OB/GYNs (Cochrane review).

  • Hieronymus

    Have to agree with the above: home birth is not for everyone; however, it is likely a fine (and, in many cases, relatively "better") experience for many--if only they could get beyond the fear instilled in them by, e.g., Hollywood drama (is there EVER a birth on TV now w/o screaming and lots of spatter?).

    To #2 in particular: do you think midwives are idiots? You think they have not, as noted by #3, come across (the rare, believe it or not) circumstance where a woman that they have screened and worked with has a complication requiring intervention?

    Naive at best, but more like insulting (to you, not to me).

    At the most basic of Google searches, I find "In August (2005) Reuters reported that 1.2 million Cesareans were performed, making it the number one hospital procedure in 2003, at a cost of $14.6 billion."

    C-section, I will point out, is major invasive surgery, fraught with far greater potential downstream complications than planned home birth.

    #2 talks about a "deathbed"; I would love to see the results of #2's research on death during planned homebirth versus death during c-section (or even hospital birth). I bet the results would surprise (at least surprise #2, that is).

    C-section--and most in-hospital birth procedures--are not for the benefit of the baby, but to do CYA for the hospital. IN MOST (but not ALL) cases, planned homebirth--or even midwife-assisted birth center or even hospital birth--allows for a more holistic consideration of mother AND child (versus, say, the C-docs golf schedule…).

    Just planting the seed here; food for thought. Do your own research (and, really, #2, assuming you are a member of the Yale community, your knee-jerk, ear-covering "LA LA LA I'M NOT LISTENING" reaction is a bit…disappointing.)

  • Susan

    Most people do not realize that overuse of medical interventions, and even just common practices in hospital births, interfere with the process of labor and actually cause harm and complications for mothers and babies for the 80% or so of mothers who were perfectly healthy when they entered the hospital.

    For those of you who want to see the research, the Milbank Memorial Fund has just published "Evidence-Based Maternity Care: What It Is and What It Can Achieve" (available from the Milbank Foundation or you can download a free pdf file from Childbirth Connection). This document, complete with thorough citations from the scientific literature, spells out the harm caused by overuse of unnecessary medical interventions and underuse of evidence-based practices that are effective and do not cause harm. The result is the US spends tons more money on healthcare with much worse results for mothers and babies than other industrialized countries.

    If you read the research, you will likely feel outraged, and it will be obvious why some women want to give birth outside the hospital in a planned home birth with a trained midwife --CNM, CM or CPM.

    I have been involved in birth reform for more than 20 years. I have yet to hear a single government official (state or federal) ask the question: do we have better outcomes for mothers and babies with 30% cesareans, 50% inductions and 90% epidurals? (The answer is: we don't!) Until there is transparency and accountability in the "system", women have a big and continuing problem.

  • Alumna + Two

    This is mostly for Anonymous #2.

    With my first child, I assumed I would have a scheduled caesarian (just like my mother), due to narrow hips, small stature. I went to all the classes at the hospital, but something just wasn't right.

    The more the nurse-teachers talked about all the machines and procedures and gizmos, the more nervous I got. I had some questions about episiotomy (I didn't want one), and the nurse made me wait after class.

    She answered what, to me, was a simple question with a deeply revealing--and scary--response. She advised that, if I didn't want an episiotomy, she would show me all sorts of positions and exercises that would be useful to preclude necessity.

    More importantly, she advised telling the nurse on duty as the birth time neared, and that the nurse would work to keep the doctor out of the room for as long as possible.

    Instantly, I understood: birth (and nursing) is about WOMEN and Nature (and, trust me, I am NOT a tree hugger by any stretch), and the nurses would COLLUDE with me to fulfill my wishes by LYING and DECEIVING the approved medical practitioner.

    The nurse not only revealed that hospital birth is (or can be) over-mechanized and technologized, but that nurses (mostly women) KNOW that there is a better way.

    I went, late in my term, from assuming a "routine" scheduled c-section to a midwife assisted home birth--where *I* was in control: the 4-midwife team was there to ASSIST and to ATTEND, the birthing was up to ME.

    Both of my children were born at home (the second helped my husband cut the cord of the second arrival). During the birth, I had water and ice when needed (and a full breakfast in the morning.) The whole time I was in MY home in MY bed with MY baby in MY arms.

    Yes, there are instances when hospital birth may be warranted: but the instances are FAR FEWER than you would think (and my midwife, who had delivered at that time more than 300 babies, only had to "transport" once--and mother and baby were fine).

    You are a Yalie--research for yourself, decide for yourself what is best. Do not let others (even me, via this rant) DICTATE what is "best" for YOU and YOUR situation.

    BTW: if you believe in "conservation" (of whatever sort): homebirth was 1/3 the cost of hospital birth (and covered by insurance)--leaving needed hospital services available for someone in actual medical need.

    While few of my friends have gone for home birth (and more power to them), most have chosen midwife assisted birth centers--and been glad of it.

  • Sophia Nelson

    I gave birth to 3 wonderful children, all came in less than 15 minutes, and I experienced no pain at all.

    As a matter of fact it was quite joyful!

    I also gained very little weight during my pregnancies.

    I created the Zero Pain Child Birth Blueprint. You can read about it here:

    http://www.scottchopchop.com/zpb

    or here

    http://sites.google.com/site/zeropainchildbirth/

    Sophia Nelson