How did mamas ever deliver babies before there were hospitals? Why has a hospital birth for even normal, healthy pregnancies become the standard? Personally, up until about 32 weeks along with my daughter I never gave a hospital birth a second thought. Although midwifery care is slowly growing in popularity, statistically speaking only about 1% of mamas have home births with a midwife. It wasn’t until I started envisioning my ideal birth that I realized hospital routines could easily stand in my way of birthing my child exactly how I wanted. That fear, coupled with my OB avoiding many of my questions, pushed me to look into alternative options.
I think it’s human nature to fear what we don’t understand, and midwifery practices are just not common knowledge, so I felt interviewing a local midwife to get the scoop on midwifery care for mamas was a natural next step in my series How I Survived Pregnancy. Many news and journal article headlines often pose the question, “How safe are out-of-hospital births?” But why aren’t we also asking “How safe are hospital births?” Interestingly, there are several nurses and doctors who have worked in the trenches of labor and delivery who actually prefer to have a midwife assisted home birth over a hospital birth with an OB given the kinds of borderline unethical circumstances they have personally witnessed. Picking the right provider who then strongly influences the unfolding of your birth really does set the tone for motherhood. Do OBGYN’s play an important role in the birth world? Of course they do! Going to an OB gives most mamas a lot of peace of mind. But can a midwife also offer exceptional care and sometimes even better care than an OB? Yes, 100% yes! But, it’s important to know midwives have limitations and can only work with normal and healthy pregnancies. Overall, there are too many myths out there about what midwifery and/or home births look like, and rarely is it accurate. So I went right to the source to make sure my beloved readers and followers have all the details!
The following excerpt was information gathered during my interview with a local midwife, Jennifer Green, CPM, who resides here in the heart of Colorado Springs, Colorado. Jennifer received her B.S. in Family and Human Services from John Brown University in Siloam Springs, AR, where she initially focused on client care from the social work lens. Shortly after becoming a mother herself, she quickly became passionate about birth and has been practicing midwifery since 2011. I have written this excerpt in Q&A style to more efficiently debunk centuries of myths about midwives and help mamas better understand this as a possible option for their own birth. You REALLY DO have the choice to birth your way! [Note: All answered responses have been paraphrased and approved by Jennifer.] For more information about Jennifer, please visit her website at http://organichomebirth.com/midwifery-care/meet-jennifer/.
[Note: Photo above is one of Jennifer Green, CPM at one of her homebirths. Photo credit to Jackie Parr at All Things Baby Photography]
What made you decide to become a midwife?
Jennifer: I knew after becoming a mother I wanted to change directions and thought to myself, “What would I do if I could do anything?” I just knew I should be doing something different. So I prayed about it. I always knew I wanted to do birth work and had previously done some work as a doula and other supportive roles. I received a lot of encouragement from others who believed in my talent for the profession. At the time I was considering making a career change, I was at home with a newborn, so I did the only thing in my power given my limited circumstances— reading and researching anything and everything on the topic. I was so eager to learn. When I was ready, I optimistically reached out to a local midwife to inquire about an apprenticeship. I was absolutely determined to jumpstart this new career path however I could. Being a midwife was absolutely the perfect fit.
What are the different certifications you can obtain as a midwife? What kind of training do you go through to get to where you are today?
Jennifer: I am a CPM; Certified Professional Midwife. There are two different tracks to become a CPM. The first track, the one I chose, requires about 3-5 years of training under a senior midwife. I had to complete an apprenticeship, internship, and a licensing exam. The second path a prospective CPM can choose requires a 4-year degree program, which also involves apprenticeship and an exam. There is also another type of midwife certification you can obtain to become a CNM; Certified Nurse Midwife. Most of these midwives obtain a bachelors degree in Nursing and then attend midwifery school. A CNM is essentially a Nurse Practitioner in the practice of midwifery, so they are uniquely able to prescribe medications. All in all, most midwives have a smilier approach and view, but the training is where we differ.
How is a midwife different from an OBGYN?
Jennifer: A midwife specializes in the physiological aspects of a normal pregnancy and birth, with an opportunity to provide personalized, continuous care to mamas from early pregnancy through the postpartum phase. Additionally, a midwife aides in supporting mamas who desire to have a natural birth and offers expertise, suggestions, and referrals in alternative medicine. A midwife’s focus is on the whole body and whole person. Conversely, an OB is a surgeon which most mamas don’t understand. An OB’s training and view of birth is significantly different than that of a midwife. OB’s typically treat the symptoms as they were trained through the lens of the medical model. OB’s also routinely use interventions and pain medications during labor. An OB views pregnancy as a medical condition that needs treatment and constant monitoring and assistance at a hospital. A midwife views pregnancy as a naturally occurring process that the mothers body is able to handle with minimal to no interventions.
Can you provide more details as to how you view birth differently than other providers in the birth industry?
Jennifer: I believe birth is a natural process that is set to work even when nobody is there to assist. I encourage mamas to trust in their body’s ability to handle birth. Midwives typically don’t use many interventions to start or force labor to go faster. Every intervention has a cost and it’s best not to interfere with the body’s beautiful plan. Furthermore, I give informed consent to every client along the way and offer patience and emotional support from start to finish. This way, my clients understand their options and can make the best informed decision for their birth.
How are your services different from those of an OBGYN or NP?
Jennifer: Midwives typically provide many of the same services as other birth providers, however, their approach is what makes the experience with a midwife much different. Midwives provide services such as routine prenatal visits, lab work, ultrasounds (undiagnostic), and labor and postpartum care. However, midwives typically spend an average of an hour with each client at each appointment, which is significantly more quality time with their provider on a more frequent basis. Unlike many OB’s, I do more than look for complications and catch a baby. My client appointments are tailored to the client. I also provide in home postpartum care and newborn care up to 6 weeks old.
Why might it be advantageous for some mamas to have a midwife over an OBGYN?
Jennifer: The biggest advantage of choosing a midwife over an OB if you have a normal pregnancy is the benefit of true informed consent. Specifically, it is having access to the full range of risks and benefits, and being empowered to make your own decisions as you start or grow your families. Additionally, midwife care increases your chances of successfully having a natural birth if you so chose. There is more flexibility in allowing you the space and time to have the birth you want without timeline pressures or interventions. Statistics tell us that having a midwife decreases your risk of interventions significantly. For example, the Cesarean rate in the United States under the care of an OB is near 30%, whereas the Cesarean rate under the care of a midwife is just over 5%. Additionally, 93.6% of clients with a midwife successfully have their desired vaginal, planned home birth. Furthermore, 87% of mamas with a midwife successfully have a VBAC. Given the personalized, caring nature of midwife care, it also facilitates a higher rate of successful breastfeeding at 6 weeks postpartum. (Statistics gathered from https://mana.org/research/mana-stats).
What does your prenatal care look like?
Jennifer: I assess everything from small complaints to big concerns at each appointment. I try to get to know each client on a personal level and answer any questions they might have with each milestone she reaches. Of course I have routine procedures I complete at each appointment such as blood tests, urine checks, ultrasounds (undiagnostic) and I am always assessing for high risk factors that may put my client out of my scope. A lot of my prenatal care is providing education around pregnancy, fetal development, and the birth and labor process overall. I am also on-call for my clients all the time and I give them permission to reach me by phone and/or email if anything comes up at any time. Additionally, and maybe most importantly, I am regularly attending to the emotional wellbeing of my clients.
What are some reasons a mama might be out of scope for midwifery care?
Jennifer: Here are a few common examples, but of course it is not an all inclusive list…
*Negative blood type
*History of blood clots
*Previous uncontrolled postpartum hemorrhage
Contrary to popular belief, age and weight are NOT high risk factors for midwifery care.
What kind of settings do you deliver in?
Jennifer: I only deliver at my clients’ homes. However, Certified Nurse Midwives (explained above) are able to deliver at hospitals as well as birth centers.
Tell me why birth is often not actually a medical issue.
Jennifer: Birth is often not a medical issue because nobody is sick. Hence why I refer to my clients as a “client” and not a “patient.” Birth is part of life’s process. As a midwife, I don’t deliver babies. Mamas deliver babies. Midwives just catch them.
Why do you think so many mamas are afraid of home births?
Jennifer: I think a lot of people who are not educated on midwifery are scared their baby is going to die. They are so nervous not being close to an institution equipped with doctors, specialists, surgery, and readily available medicine. It has become so embedded in our society that going to a hospital to give birth is the “right” thing to do. Many mamas get a false sense of security in the belief that if they are in a hospital nothing bad can happen, and that whatever happens everything will be okay. Don’t get me wrong, there are several circumstances that do need hospital care and regular monitoring. However, for most normal pregnancies that is just not the case. I also think a lot of mamas feel an increased sense of responsibility planning a home birth versus the peace of mind they feel choosing a hospital because if anything takes a turn for the worse, they don’t have to feel it is their fault.
Why do you think so many medical professionals minimize and shame the practice of midwifery?
Jennifer: It seems like many medical professionals think midwives are ignorant and uneducated. I also think they believe midwives take too much risk in trusting the birth process to unfold naturally. Medical doctors are trained how to intervene and midwives are trained to sit back. So it really comes back to very different viewpoints of birth. OB’s don’t see birth as a partnership with an opportunity to stand alongside mamas. Instead, they themselves as the expert on a woman’s body and their baby every step of the way. Additionally, OB’s typically see birth as a medical condition that needs constant monitoring. So I think given how different OB’s and midwives approach the birth process, it’s only natural they resist our way of practice.
Do doulas play a critical role in the work you do?
Jennifer: Yes! Doulas are crucial in my work. They provide one-on-one continuous care to our client every step of the way. Doulas offer so many benefits such as education and vast knowledge of community resources, emotional and physical support, coaching and encouragement during every stage of labor, companionship and relief for you and your partner. They really help fill in the gaps wherever needed so I can focus on the clinical care side.
Do most of your mamas who plan for a natural birth, carry through with that plan successfully?
Jennifer: Yes, most that plan for a home birth, successfully have a home birth.
What does a typical home birth look like?
Jennifer: Once a mama goes into labor, I make myself available by phone during early labor for any questions or concerns. I will also check in periodically to see how things are progressing throughout the labor process. When a mama is in active labor (usually 5-6 cm) I will arrive at their home and stay well past birth. My primary focuses during labor are regular monitoring of baby’s heart rate, monitoring mama’s vital signs, and setting up for the birth. If a mama desires a water birth, I also make sure the birth pool is warm and ready. Between my assistants, the partner, and the doula we are all there helping mama stay as comfortable as possible. Once I catch the baby, mama and baby have skin-to-skin with the cord in tact immediately, and I wait for signs that the placenta is ready to be delivered. Once mama and baby are stable and happy, I give them a some alone time for bonding while I clean up. Prior to leaving, I complete the routine newborn exam, check that the breastfeeding latch was smooth, and make sure mama has eaten. I am typically with mama and baby for about 2-3 hours after birth.
What does your team usually consist of?
Jennifer: Myself (or the midwife on call for me if I am out of town), 1-2 assistants, a doula and/or a birth photographer (if the mama so choses) will all be present at the birth.
What equipment do you bring with you to each birth?
Jennifer: I bring a variety of supplies that prepare me for almost any circumstance. For example, I bring oxygen, neonatal resuscitation equipment, pitocin, vitamin K, suture supplies, newborn screen materials, warming blankets, etc. As a midwife, a lot of mamas are also comforted knowing we are CPR and neonatal resuscitation certified.
What are some red flags you look for during labor?
Jennifer: I usually look for a fever in mama, any abnormal bleeding, maternal exhaustion, or any indications that baby’s heart rate doesn’t sound good. If any red flags arise, it’s typically a progression rather than an emergency situation, and I try to resolve it at home before considering a hospital transfer.
Do you see many infant or maternal complications?
Jennifer: No I have not seen many complications during birth. However, I have seen some complications during pregnancy and postpartum, but I would still consider most of those within the realm of “normal.” Infant and maternal death are extremely rare.
Do you have many emergency situations during labor?
Jennifer: No, emergencies during labor are very rare given we don’t use many, if any, interventions. If a complication arises it’s typically something we have warning signs of well in advance.
How common is it for a mama to need a hospital transfer?
Jennifer: Across the board, among midwives in the United States, about 10% of mamas need a hospital transfer. A transfer is rarely for a clinical emergency, and is more commonly due to a long labor or for pain relief/management. First time mamas have a higher rate of hospital transfers, usually due to the intolerance of labor pain. Even among those who transfer to a hospital from home, research tells us these mamas feel happier with the end result than those who begin in a hospital. This is primarily due to the fact that they feel more a part of the decision making process.
What kind of postpartum and newborn care do you provide?
Jennifer: I feel it’s important that mama can stay in the comfort of her own home the first few visits after birth, so I typically do a couple of home visits during the first week postpartum. I look for any unusual postpartum bleeding, assess for any signs of postpartum depression, and check in about any issues with breastfeeding, etc. For newborn care, I offer to see the newborn for up to 6 week postpartum. However, I always inform mamas they always have the option to go directly to their chosen pediatrician. I usually do a few routine newborn checks as well as take weights, check stools, assess for any rashes, complete a newborn screen, assess for jaundice, etc.
For more information on alternative birth options, I strongly suggest the following two documentaries:
The Business of Being Born
Why Not Home?