How is the care of a midwife different than an obstetrician?

Obstetricians are doctors who are extensively trained in pathology and surgery. The focus of their care is to control and treat illness. The service they provide can be very helpful for pregnant women who are struggling with health concerns which put them at risk for a complicated pregnancy and/or birth. However, for the vast majority of women who give birth, pregnancy is a normal event.

Midwives are primary healthcare providers also trained to identify illness and complications during pregnancy and birth. Their fundamental focus and approach is based in the belief that pregnancy and birth is a normal physiological process rather than a medical event.

Is midwifery care safe?

Yes! Midwives provide the primary care for approximately 70% of all births in other developed countries such as the Netherlands,Sweden, New Zealand and the UK.

In fact, low-risk women in the UK are encouraged to have their babies at home or in birth centers with midwives because obstetricians are recognized as specialists in high-risk pregnancies.

Currently, In the United States only 8-10% of all births are attended by midwives. Despite our technological and medical advancements, we rank surprisingly low in maternal and neonatal morbidity and mortality compared with developed countries that utilize the care of midwives.

In 1990, The World Health Organization declared that birth was safest when utilizing the care of midwives for pregnancy and childbirth.

If I see a midwife should I see a doctor too?

Midwives, obstetricians, and family physicians are all considered primary caregivers. You could have either a midwife or a doctor for your pregnancy, birth and newborn care. However, having two primary healthcare providers would be considered a duplication of care.

What are the reasons women choose to have their baby’s at home with a midwife?

Frequently, women who choose homebirth often express the same priorities and reasons for their decision. These are a few of the most common:

• Having a relaxed, peaceful and private atmosphere for labor and birth

• Feeling the security and comfort of a familiar environment

• Ability to move, dance, make noise and give birth in any position they choose.

• A desire to avoid interventions that are often done routinely in hospitals ranging from artificial rupture of membranes, induction or augmentation of labor and episiotomies to the escalating over use of cesarean surgery

• A desire to explore ways of coping with labor and giving birth without drugs

• Enjoying a relationship of equality with those caring for them so that decisions are made together instead of being imposed

• Being cared for after the birth in a way that is personal and intimate

• Maintaining close contact with baby, even for newborn exam

• Keeping the family together, having the other children there or close by

Is homebirth safe?

Several studies around the world have researched the safety of homebirth. Consistently studies have shown that planned homebirth for women with low risk healthy pregnancies, which are attended by a qualified birth attendant, is as safe as low risk birth in a hospital setting.

Recently, an important study was published in the British Medical Journal (June18, 2005) regarding the safety of birth with Certified Professional Midwives (CPM) in the U.S. and Canada. They found that, in comparison, planned home birth for low risk women in the United States was as safe as low-risk hospital births, and accomplished with much less medical intervention.

According to the British Medical Journal press release:

• Planned home births "had a low mortality rate during labor and delivery, similar to rates found in most studies of low-risk hospital births in North America"

• "Rates of medical intervention, such as epidural, forceps and cesarean section were lower for planned home births than for low risk hospital births”

• “Over 87% of mothers and babies did not require transfer to hospital care”

• “A high degree of safety and maternal satisfaction were reported”

What if an emergency occurs during labor?

Midwives, who are specially trained in out-of -hospital birth, have obtained skills required to stabilize most emergency situations.

Licensed homebirth midwives also carry oxygen, anti-hemorrhagic drugs, neonatal resuscitation equipment, suctioning devices, IV equipment, suturing supplies and maintain current certification in neonatal resuscitation and adult CPR.

Healthy, low-risk women, who plan a homebirth with a midwife skilled in appropriate screening and consistent monitoring of mother and baby during labor,significantly minimize potential complications.

In fact, it is rare for a transport to be a true emergency situation. Most transports are non-emergent in nature and mom and baby usually ride to the hospital in a non-emergent vehicle.

The most common reasons for transport are:

• Maternal exhaustion and/or request for compassionate use of pain relief (more common with very long labors)

• The cervix is not dilating properly (usually due to the baby’s head being malpositioned)

• The baby’s heartbeat is indicating that the baby is stressed for some reason

You and your midwife will make a personalized back-up plan to be followed in the unlikely event that medical transport is required. Your back-up plan will be based on your unique circumstances taking into consideration the closest hospital, insurance coverage, finances and medical services required.

How do I know if I am a good candidate for homebirth?

You are a good candidate for homebirth if:

• You are in good physical and mental health and have no serious chronic health conditions such as cardiac disease, pulmonary disease, essential hypertension, active cancer, severe renal or liver disease, uncontrolled thyroid disease or diabetes

• You prefer having a relaxed, peaceful, private atmosphere for labor and birth in a familiar environment

• You prefer freedom to move, dance, make noise and give birth in any position you choose

• You have adequate social support before, during and after the birth

• You have a home with electricity, running water, a working telephone and a clean birthing space to welcome baby

• You are motivated to explore ways of giving birth without drugs or unnecessary interventions that often occur routinely in hospitals

• You enjoy having a relationship of equality with those caring for you so that decisions are made together instead of being imposed

Meeting with our midwife to discuss questions you may have about care during your pregnancy and the birth of your baby is a great first step to determining if homebirth is for you.

Columbia Gorge Midwifery
(541)490-3140
Mamascompanion@earthlink.net