Midwives, doulas, and doctors, oh my!

A lot of the medical knowledge I've acquired through my nursing training I have taken for granted and assumed everyone had the same pot of knowledge. It wasn't until I got pregnant and the questions came flowing in that I realized there is a lack of knowledge and resources for young women, pregnant women and new moms. Knowing that people don't have the full spectrum of information related to women's health and obstetrics is really frustrating. I've found many women didn't even realize they had options when it came to their pregnancy or labor. 

This is a long post, but very educational, so stay with me!

Let's start with doulas. Many people don't know what doulas are, or how they differ from midwives, and many people think both do some sort of witch craft in your back yard back in 1802 anyways. The word doula literally means "woman's servant", a type of birth support that started way back. A doula is not medically trained, so that's the biggest difference between doula and midwife. Many doulas have become licensed massage therapists so they can perform various acupressure during labor. Doulas are almost essential in natural childbirth when there are no pain medications used because in their training they know how to provide acupressure, massage therapy, and utilize breathing techniques to get women through natural childbirth. The use of doulas has been shown to reduce labor complications, decrease labor time and reduce cesarean rates. Post-partum they also help with breast feeding and usually make at least one post-partum visit to the mom to assess for post-partum depression or any breast feeding issues. For more information http://www.dona.org/. Although many doulas are utilized during natural childbirth, a woman who is getting an epidural or other types of pain relief can also benefit from a doula during labor. In the case of emergency cesarean's, doulas still provide essential support to both mom and dad.

As far as midwives, I could talk about them all day long. They are amazing, underutilized professionals that sprinkle my pregnant life with fairy dust. Since the beginning of time, women helped women deliver babies. There was little training for both midwives and physicians during this time, and all countries/states utilized them differently. Some countries required some form of licensing (I'm talking back in the 1500s). Around the 1900s, medicine had grown popular and more regulated requiring specific education and licensing from physicians. Midwifery was popular in Europe but was less known and used in the US until around 1929 when Mary Breckinridge brought midwifery to America. Breckinridge was the founder and driver of the Frontier Nursing Service in Kentucky, which was a huge start to the midwifery movement. Ina May Gaskin is also a well known midwife, however definitely a flower-child hippie from the 70s, has written books and made documentaries about birth in America.

Midwives today are masters and sometimes doctorate-prepared nurses, same as nurse practitioners, just with a focus on mom/baby. Many midwives gain years of experience in labor and delivery as registered nurses and go on through rigorous education and clinical hours to become a certified nurse midwife. Midwives are licensed professionals, meaning they can prescribe and diagnose, same as a physician. They can perform well women visits (pap smears, ect.), prescribe birth control, family planning counseling, STD counseling and prevention, and also deliver babies! One difference between physicians and midwives is that midwives do not take high risk pregnancies, including pregnant women with uncontrolled hypertension, diabetes, morbid obesity or other chronic conditions. They see the average, healthy uncomplicated pregnancy. They also usually work in a team with other midwives and partner with physicians. In the case of an emergency, they have physician backup and partnership, some midwives are licensed as first assists in surgery, so if you go for an emergency cesarean and have been seen for 9+ months by your midwife, he/she is still in the operating room during the cesarean assisting the OBGYN physician.

A large misconception still in effect today is that midwives only deliver at your home in your backyard with wolves, or in a cave while they sacrifice a lamb or some crap. Although there are midwives (and physicians!) that do home births, when they do, they bring all the supplies the hospital would have for a normal delivery (IV fluids, IVs, medications, fetal monitoring equipment, ect.). However, a vast majority of midwives practice and deliver in large medical centers or birthing centers affiliated with hospitals and physicians.

Why a midwife you ask? Certified nurse midwifes (CNM) come with a vast variety of benefits that many women are unaware of. Midwives have shown to decrease rates of cesarean (C-sections), lower maternity care costs, reduced morbidity/mortality of mother and baby, lower intervention rates and lower complication rates.

In the US we are heading in an unfortunate direction with labor and delivery. The term "too Posh to push" sets my skin on fire. The average rate of c-sections in the US has risen to about 33% from about 20% in 1996. What people fail to understand or recognize is that c-sections are surgical procedures and should only be used for medical emergencies, not because a woman wants to schedule her delivery for convenience. We are utilizing trained surgeons to deliver babies, and we wonder why our cesarean rate is increasing. Should healthy normal pregnancies be delivered by OBGYN, trained surgeons? Or is this utilization a poor use of resources and proving poorer outcomes? OBGYN's are phenomenal for emergencies and interventions when labor has taken a turn from natural uncomplicated vaginal delivery.

There is a hospital in Chicago that I can guarantee almost any pregnant woman I meet is delivering there. When I ask why, the response is usually because the labor and delivery suite is so pretty, with views of the lake! However, what many women fail to ask their provider is what is their cesarean rate- this particular hospital has one of the highest cesarean rates in the state if IL. I don't want to make it seem like everyone should run to a midwife and that OBGYNs are not fit for normal delivery, however, as women we should be asking providers more questions and have a better role in our pregnancy and delivery, because up until there's an emergency, we have options! In a following post, I will put together a list of questions to ask your provider, or list of questions you should think about when researching a provider or hospital.

As a society we are heading in the wrong direction of where our birth statistics are. More cesarean rates, more complications and interventions and unfortunately higher mortality rates than many other developed countries. Scheduled inductions and scheduled cesareans for no medical reasons should be looked at carefully and in my opinion, should be illegal for physicians to perform. Talk to your provider and be part of your care; pregnancy and birth are a time of celebration. Our bodies were made to do this!

I put the prep in your granola.

http://www.midwife.org/index.asp
http://www.huffingtonpost.com/2013/03/06/c-section-rate-variation-hospitals_n_2819024.html
http://www.childbirthconnection.org/article.asp?ck=10456
http://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html?_r=0