WHERE TO GIVE BIRTH AND WITH WHOM

 
     Deciding where and with whom you would like to give birth  can be challenging.  Researching the numerous options in your area as you walk through your pregnancy opens the door for a wonderful, fulfilling and empowering transition into parenthood. Birth is a right-of-passage which rests in the hands of each one who ventures on this age-old journey.
     For many families the birth of a baby is a private, spiritual experience, a miracle, a celebration. For these people, the newborn baby is not a product to be weighed and measured and put under warming lights with electrodes attached to her chest so she doesn't get overheated.
     A baby is an aware human being, experiencing the direct physical sensations of light, sound, touch, and cold for the first time. The baby is capable of feeling secure or afraid. She recognizes the voices of her parents. Above all, she doesn't want to be taken away from her mother who is perfectly capable of keeping her warm. Among mammals, only humans can be persuaded to relinquish their newborns to the care of others.
     Any notion of natural childbirth involving the separation of mom and baby is a misnomer. Today, natural childbirth has come to mean anything short of surgical delivery. Women have been sold a bill of goods. They believe that if they take a childbirth class and utilize breathing techniques during labor, they are experiencing "natural childbirth". When questioned further, it is discovered that drugs were administered, a fetal heart monitor applied, an episiotomy performed, and baby removed to the newborn nursery.
     Nationwide, the cesarean-section rate is skyrocketing. Major abdominal surgery has risen from 24% in 1996 (which was a substantial increase from 5 years prior to that) to 32.2% now for  all babies born in U.S. hospitals.
     True, for the roughly 2 to 5 percent of women who need the operation, it is a lifesaver. Common sense, if nothing else, should reject the notion that such a high cesarean rate is either necessary or acceptable.
     In choosing who you would like to attend your birth and where, there are a number of considerations to ponder. Do you want an un-medicated, natural birth or would you like the option of medication and an epidural? Are you comfortable with your baby going to a hospital nursery or would you like your baby in your arms from the moment of birth?
     Read books. One good book to add to your list is A GOOD BIRTH ~ A SAFE BIRTH by Diana Korte and Roberta Scaer.  It guides you in asking for, and getting, the birth you want. How to find "Dr. Right" and make him or her your partner. Why and how to hospital shop. Who your helpers are before, during and after birth. The appropriate use of interventions. How to avoid becoming a victim of the cesarean epidemic. It delves extensively and completely into every hospital procedure. Read other books. Find out as much as possible about childbirth-related concerns and choices.. .
     Pregnant women have a variety of options for birthing their babies. Obstetricians attend the vast majority of births in the United States. As a group they have the highest cesarean rates and are most likely to intervene in labor. They are trained and expect to deal with pathology. Some family practice physicians attend birthing women as well. They tend to have lower cesarean 'rates than the obstetrician-specialists and are more likely to treat birth as a normal healthy process.
     An additional choice among medical doctors is between male and female practitioners. Many women assume that another woman will be more sympathetic. This may not be the case. Female practitioners have been trained by the same institutions as their male counterparts. They experience the same political and legal pressures. Another option among possible birth attendants is the Certified Nurse Midwife (CNM). CNM's are licensed nurses who have additional training in obstetrics. They provide prenatal care, and unlike the obstetricians, remain with a client throughout her labor and birth. Nurse midwives view birth as a normal process and interference with the course of labor is minimized. There is generally more support for non-separation of mom and baby after birth, too.
     Employing a nurse-midwife will significantly increase your chances of a normal, vaginal delivery, depending on the institution she is working in. (Sometimes her hands are tied by hospital regulations.) At one Michigan hospital, the nurse midwives have been holding steady at a 13 percent cesarean rate.
     In some states CNM's are allowed to attend homebirths, while in others licensing requires that they practice under direct medical supervision. In practical terms, this requirement precludes attending women at home because tremendous peer pressure is brought against doctors who associate themselves with homebirths. I spoke with one obstetrician in Roanoke, Virginia who said that he sees the trend in local hospitals pulling away from hiring nurse midwives and going more toward the doctor specialists.  Some CNM's operate free-standing birth centers. These centers offer low-intervention care in a friendly environment.
     Often CNM's work in a group practice, rotating prenatal care and on-call birth duties. Some women are disappointed to find that they do not really develop a relationship with their midwives and are unsettled by not knowing which one they will end up with at the time of birth. Each practice is different. Every person is different, so ask plenty of questions.
     Keep in mind that nurse-midwives are trained and work within the medical model. This means that problems arising during pregnancy, birth, and postpartum are typically dealt with in a regulated.  Watch out for the tendency to be "risked out" of their service. A doctor is quickly called in when the pregnancy, labor, or birth falls out of a narrowly-defined range of "normal." The ever-present hospital protocols will also be in effect.
     One option is a Certified Professional Midwife, (CPM).  A CPM is a midwife who rose up from the traditional or "lay" midwife and has been certified to prove her training.  Trained through apprenticeship and self-directed study, traditional midwives attend women at home. They may or may not be nurses. They do provide personalized prenatal care, typically spending one hour each visit with the expectant mother. Emphasis is placed on education and nutritional counseling to avoid complications of pregnancy and delivery.
     Most complications which do occur can be handled calmly at home utilizing standard emergency procedures, as well as herbs, homeopathies, and other natural remedies. When serious pathology manifests, CPM's are trained to identify for referral or transport those few women who require medical assistance. Cesarean rates of traditional midwives range between 2 and 7 percent nationwide, with no corresponding infant or maternal mortality rates.
     Unique to the homebirth setting is the level of control maintained by the parents. Only loved ones and invited guests can be present at a homebirth.
     The legal status of CPM's also varies from state to state. In some states they are illegal, unregulated and midwives practice underground. In others it is legal and unregulated, while in others they are required to be registered or licensed (regulated) to practice with self-regulation and training programs.
     You may find CPM's practicing alone, in groups, or in free-standing birth centers. Background, credentials, range of experience, and methods for handling complications vary widely among non-CPM, traditional midwives, so you'll have to ask plenty of questions to find someone you're comfortable with. In states where it is illegal or there are no regulations, the responsibility rests entirely in the hands of the expectant couple to choose someone with adequate experience because those wishing to practice midwifery can do so without adequate training. Although the medical institution carries many interventions and unacceptable treatment of natural birth, the non-CPM's practicing midwifery without adequate physiologic training will carry a higher rate of transport and problems due to lack of knowledge. .
     "Planned homebirth" is the key concept here. Opponents of homebirth ... generally the medical establishment, who are defending not only their sense of the public health but their own pocketbooks as well ... are fond of citing poor homebirth outcomes, lumping together unattended homebirths with midwife-attended homebirths. There is a vast difference between these two situations.
     Unattended homebirth often is the result of poverty, religious beliefs, personal choice due to lack of a suitable attendant, or accident.  Louis Mehl conducted a comprehensive study on home and hospital births in California. His study found that planned homebirth, attended by a skilled midwife, is at least as safe as hospital births for both moms and babies.
     Accept responsibility for your own health and that of your children. Acquaint yourself with the birthing options available in your community. Find out how complications are handled in various settings. Form an idea of what you want before you get pregnant, or as early in pregnancy as possible, and then set about to discover the attendant and place of birth most conducive to your requirements. It is your baby, your body, and your responsibility.

Written and Submitted by Susan Oshel, CPM
Excerpts from NATURAL CHILDBIRTH: A CONSUMERS GUIDE, by Patty Brennan.