An Ancient Art–midwifery

It’s 2006 and you can have your baby any way you want—in a hospital, at home or in a birthing center. With a doctor, midwife, doula or combination of the three. And if you have that baby at home there are even more choices. “One of the beauties of being at home is you can do what you jolly well want,” quips Roberta Gehrke, Certified Nurse Midwife (CNM).

Some women want to lay down and not move a muscle, others want to run around. Some don’t want to be touched or even looked at, while others embark on touch therapy during labor. Gehrke remembers one soon-to-be mother who “wanted me to hold onto her belly and pull down during the contractions.”

“I try to give as many choices as possible during the birthing process,” says CNM Mikelann Caywood Baerg. That might include a water birth, reflexology, acupuncture, homeopathic remedies, singing, dancing or silence. Or none of the above. It might mean changing your mind and heading to the hospital or forgoing the planned natural birth for some pain killing drugs. It’s the mother’s choice.

Baerg’s own delivery was difficult and it was what spurred her to become a midwife. She gave birth three months early to a two-pound infant after being airlifted to a hospital in Salt Lake City. Her own midwife couldn’t go with her, but she was assigned one at the hospital and for her, it made all the difference. “She couldn’t change my problem, but she was there to support me. Mothering while you’re becoming a mother is so important,” she says.

Not everyone thinks it’s safe to give birth at home. Recently a Bozeman woman delivered her child at the hospital. “Everything went fine for me, but if there was a problem, I definitely wanted to be in the hospital, with a doctor. I was less concerned with emotional support than with getting this kid out healthy.”

“I can guarantee safety, knowledge, support, and I will be the one who’s there,” says Baerg. In fact, CNMs do many of the same things as doctors, including prenatal care, writing prescriptions, and follow-up check-ups.

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Midwifery is an old art, practiced in ancient Greece and mentioned in the Bible. It was one of the only medical practices dominated by women, and up until the 18th century midwives cared for mothers prenatal, during delivery and postpartum.

By the mid-18th century a division grew between midwives and surgeons as the modern scientific/medical process was viewed as a more valid method for bringing a new baby into the world. Eventually midwives were persecuted—even burned at the stake as witches. Doctors and hospitals replaced midwives as the appropriate care for birthing.

Mary Breckinridge, a pioneering nurse who founded the Frontier Nursing Service (FNS), fueled the resurgence of midwifery in the United States. In 1929, she brought British nurse-midwives to FNS as the first nurse-midwives in America. Then, in the 1930s two school of midwifery opened; one—Frontier Graduate School of Midwifery—is still in existence.

The popularity and acceptance of midwifery increased dramatically in the 1970s and 1980s. According to the American College of Nurse Midwifery, the number of CNMs in practice jumped from 275 in 1963 to 1,723 in 1976, to 2,550 in 1982, to over 4,000 in 1995 and 7,000 today. (See sidebar for explanation of the types midwives and required training).

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“The environment for midwives was a little more hostile in the past,” recalls Baerg, “Today (the medical community) is really wonderful and it’s because we’ve worked really hard.” Because of that perceived hostility, Baerg said midwives would wait until the last minute to get doctors involved in a troubled birth. Now, midwives call ahead at the first sign of a problem to give the hospital staff time to prepare.

Midwives are specific about who they’ll work with; it must be a healthy, low-risk pregnancy. That means parents cannot be smokers, expecting twins or multiples, have a breech birth or any health problems that might endanger the baby.

Even though midwives have lower rates of cesarean sections and episiotomies, some women are more comfortable in a hospital setting with a doctor. Many midwives attend births in a hospital, as do doulas.

“A doula’s job is to make the mother’s experience a positive experience,” says Certified Birth Doula, Marianne Donch. To that end, doulas provide the couple with emotional support, knowledge about the process, referrals to useful resources and aid in communicating with the birth team.

“One big piece that is missing (in the medical model of birth) is the continuity of one person being there, getting to know the couple and their wishes and dreams. A doula can help get that realized as much as possible,” explains Donch.

Donch had what she describes as a “long, difficult first birth” in which she feels she could have used the support of a doula. “I didn’t have a lot of help and could have used that one on one support.” She had a doula during her second pregnancy and discovered “there can be great joy in the experience.”

Melissa Summerfield, a client of Donch, chose to use a doula partly because her mother died when she was fourteen years old. “I felt I needed someone to give me the support that my mother might have given me,” she says. After doing her own research and finding studies that show women who work with a doula have better success and a lower rate of Caesarian sections, Summerfield was convinced.

Summerfield and her husband appreciate Donch’s approach. “She empowers the parents and gives us the information we need to make informed decisions, I’m not as frightened about giving birth and feel so much stronger.”

Both midwives and doulas agree that less intervention in births and more one on one support can make a big difference for both the mother and the infant. And ultimately, what alternative birthing methods can provide is more choices, good care and healthy babies.

Sidebar
From the American College of Nurse Midewifery (http://www.mymidwife.org/)

Certified Nurse-Midwife
Certified nurse-midwives (CNMs) are licensed healthcare practitioners educated in the two disciplines of nursing and midwifery. They provide primary healthcare to women of childbearing age including: prenatal care, labor and delivery care, care after birth, gynecological exams, newborn care, assistance with family planning decisions, preconception care, menopausal management and counseling in health maintenance and disease prevention.

Certified Midwife
A certified midwife (CM) is an individual educated in the discipline of midwifery, who also possesses evidence of certification according to the requirements of the American College of Nurse-Midwives (ACNM). Like CNMs, the CM provides primary healthcare to women of childbearing age including: prenatal care, labor and delivery care, care after birth, gynecological exams, newborn care, assistance with family planning decisions, preconception care, menopausal management and counseling in health maintenance and disease prevention.

Doula
The doula’s role is to provide physical and emotional support to women and their partners during labor and birth. A doula offers information, assistance and advice on topics such as breathing, relaxation, movement and positioning. Perhaps the most crucial role of the doula is to provide continuous emotional reassurance and comfort. Doulas do not perform clinical tasks, such as vaginal exams or fetal heart rate monitoring. Doulas do not diagnose medical conditions or give medical advice.

Balance
September 12, 2006

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