Wednesday, February 27, 2013

Why We Choose a Midwife

(Or Why I Loved My Doctor But Love My Midwife More)


Everyone's circumstances and needs are different so in no way do I think that everyone needs to make the same decisions that I do.  But I thought I'd share some of my reasons why after having a doctor for our first two births, we chose a midwife for the birth of our last two babes.  I've found that many women still don't know that a midwife is a real and valid option for them.  Many still don't even know what a midwife actually does!  So I present you with some of the reasons our family loves our midwife:

1.
Let's get this one out of the way first.  She is a medical expert.  People hear the word midwife and think Bohemian skirts, burning sage, and talk of auras.  They don't necessarily think of someone who has gone to school and been trained for years in the practice of birth and woman care.  A midwife knows what to do in an emergency and often knows more than one way to do it.  Often, she knows the optimum circumstances to get a baby born with the least amount of intervention and very often she knows things that doctors don't.  Midwives often work in hospitals or they have their own practice.  They are well educated and professional.  And some of them happen to wear skirts, burn sage, and talk of auras.

2.
Appointments with my midwife last at least an hour.  That is time spent with her, not her staff, her waiting room (she doesn't have one...there is no waiting), or some other midwife in the practice.  I'm there to see her and that is who I see.  There is time and freedom to ask questions, to chat about things totally unrelated to pregnancy and birth, to develop a friendship.

3.
She's a woman.  Oh, I know, sexist!  Strap on your controversy hat.

Men and women are different.  There I said it.

I had a male doctor attend the birth of my first two children.  He was wonderful and very supportive of natural birth and even attended home births.  Awesome.  I remember telling myself during exams that it shouldn't matter that this was a man doing it...he's a professional and this is a health matter.  It's not weird that there is a man all up in my business.  It's  a medical exam and that's the end of it.  Any feelings of being uncomfortable were my own issues.

It has only been in the last few years (and after having a woman provide care) that I've begun to think that it is incredibly weird to have men routinely attend births and perform well woman checkups.  It's also a very modern development in relation to the rest of history.  I now believe with all my heart that birth is not just something biological.  When a woman is giving birth it is one of the most intimate moments in her life.  It's emotional and spiritual and physical and social.  Writing that now it seems obvious.  It's not just some business transaction.  For that crazy intimate moment, I've learned I much prefer to be under the care of another woman.  A woman who gets it.  Besides, birth or not, we are body AND soul united...we can't just disconnect from the fact that there is another man, not my husband, in places that it's weird for another man to be.

With my last two babies I had two different female midwives.  There is a difference.  While my male doctor was awesome, my midwives were compassionate and open and understanding and empathetic in a way that no male could ever be.  You're not going to find a male doctor who truly KNOWS what it feels like to have a wrong-sized speculum placed in you or that understands why I may not want to be a chatty Cathy when there are fingers in places I would much rather there not be.  A man is not going to GET what labor feels like.  Ever.  A man can not know the absolute physical NEED for a woman to hold her baby right away.
A man will never ever ever understand what it is to be mother.

I could never go back to having a male unless (of course) it was in some emergency situation.  And that's okay because compared to all of the world's history THAT is what is normal.

I once had a conversation with someone about this and she had the exact opposite take.  When she had a female OB come in during a birth to check her, she hated it and felt like it was SO WEIRD that a woman would be looking in those places because it was such an intimate thing.  But a man who was not her husband was okay.  Strangest conversation ever.

(Again, this is just my experience and opinion, they don't have to be yours.)

4.
All that said, that doesn't mean I don't want a man to attend the birth.  I want my husband to be that man.  And my midwives have always been incredibly respectful of that relationship and the tremendous capacity for bonding that birth holds.  I've seen doctors push husbands out of the way when it's time for the baby to emerge.  My midwives were completely okay (and encouraged) Brian being right there to catch and give the baby to me (obviously as long as things were proceeding normally).  My doctor did do that as well, but that is sadly not the norm.  Brian was a part of the process and our midwife worked with us before the birth to discuss how involved we wanted him to be.

5.
She knows what normal birth looks like.
Would you believe that most OB medical students and doctors HAVE NEVER SEEN AN INTERVENTION FREE BIRTH?  It's true.  That's like a GI doctor never having seen someone eat a normal meal or an orthopedist who has never seen a healthy person run.  If I'm hoping for a normal natural birth, I want someone there who knows what that looks like.  There are very few doctors that have seen a woman birth a baby from start to finish without the aid of professionals or medical help, the way she's done for centuries.  Doctors by nature are there to treat anomalies and that's a good thing. But many doctors are trained to see birth itself as an anomaly and an emergency, and the only training they know is to jump in to "treat" the birth, even when it is going just fine on its own.

Midwives believe differently.  In the midwifery model of care birth is normal unless proven otherwise.  She knows what's abnormal but just as important, she knows what's normal.

6.
She welcomed my other children at appointments and didn't mind that they asked questions, wandered around her office, and didn't make everything efficient.  Every appointment David would want to be right next to me while we were listening for the heartbeat and she would pull the chair on over and help him climb up.  John Paul would help hold the Doppler.  She knows all their names and would chat with them about their latest interests and ask what was new with them at every appointment.

7.
The use of a midwife dramatically lowers your chance of a Cesarean (9.9% vs. 32%!) and LOWERS intrapartum and neonatal mortality rates.  (Read herehere, and here.)

8.
That oxytocin thing.  When a woman is in labor and gives birth naturally her body is flooded with oxytocin.  One of the primary functions of this hormone is to emotionally bond a woman to whoever she is with.  It's released during orgasm, labor and birth, and during breastfeeding.  This flood of oxytocin is one of the reasons that some women don't like the practices of their doctor but have a hard time 'breaking up' with him or her.  Maybe you'll think I'm a weirdo but I think as a married woman I feel more okay with being bonded with my female midwife who knows me, remembers me and who I consider a friend rather than a male doctor who has to check his file in order to remember my name.   I know.  Weirdo.

9.
I feel completely comfortable calling her by her first name.  It makes me feel like we are making decisions together and that we are on the same footing.  Oh, she definitely knows more than I do by far and she is the expert in the room, but I feel like she values the role of mother more so than if I had to use a title of respect (implying authority) before her name.

10.
We knew that she would be the one attending the birth.  Not another partner in the practice or whoever was on call from the group.  It would be her.  It's sad that women interview doctors and find someone they are comfortable with even discussing birth plans at length only to then have no control over who shows up at the birth.  Sometimes someone they have never even met.  It doesn't make sense.  When you're working with a doctor it should be that doctor that attends the birth but unfortunately, that isn't the case.  By hiring our midwife we knew that it would be HER at the birth.
(Midwives do have a back up but that is reserved for emergency circumstances.)

11.
She can also provide care outside of pregnancy and birth.  So if I need to see someone for other women's issues, I can go to her.  This also applies to someone who uses an obstetrician for their births...you can still go to a midwife for other care.

12.
I don't need a birth plan.  I'm an advocate for birth plans in many cases.  But when your care provider knows you well and their standard of care is based on a natural mindset, then there's not usually a need to type up and print out a birth plan.  We talk through our desires and plans and then she remembers.  It's pretty sweet.

13.
She helped me diagnose a B12 deficiency that had gone undiagnosed with every other pregnancy.  I told her some of my complaints all of which I had been told were "just pregnancy."  She opened up a few books during our appointment and figured out that it could likely be a B12 deficiency.  I began taking high doses of B12 and my pregnant life was changed (no dizziness, lightheadedness, crazy breathlessness?  yes please.).

14.
Continuity of care.  A midwife is fully qualified in newborn care.  This means that my midwife performed the first few checks of our babies to make sure everything was normal.  Not only does it just make things easier but it means that the person providing the care is intimately acquainted with the circumstances of his or her birth.  Which is actually really important.  (Note:  This isn't usually an option in most hospitals because of their (silly) protocols segregating maternity and newborn care.)

15.
Home visits.  After the baby is born.  Because have you ever tried bringing three little children and a newborn to a doctor's appointment??

16.
She's just plain kind and treats me with dignity and love.  I've had experiences in doctor's offices of being talked down to and laughed at.  I've had to wait over an hour for an appointment whereupon I was seen for ten minutes by a doctor who never once looked me in the eye.  She is extremely gentle with exams and always lets you know what she is doing.  Being around kind people always beats out the alternative.  Especially at such an important and special time in a woman's life.  

I fully realize that there are wonderful doctors and there are not so wonderful midwives.  There are midwives in name only who basically work as a doctor's assistant.   And there may be doctors who do some or all of these things I've discussed.  That is awesome.  But it's fair to say that in many areas, those doctors are few and far between (if they exist at all) and that midwives as a whole offer this kind of care much more routinely.  (Again, this is just my experience.)  I believe that every woman should have the information available to make the choice with which they are most comfortable.  And every woman should know the options available and if one of them is an awesome midwife, then she has a right to know that.  If you haven't been happy with the care from your current provider, perhaps you may want to consider a midwife.

May we all choose the provider that will treat both us and our precious little ones with the care and dignity we deserve.

For other moms out there:
If you used a midwife, what did you appreciate most?
 What led you to choose the provider you did?
 Do you have any regrets over the provider you chose?  Feel free to share!

21 comments:

  1. For my 5 labors, I've had 3 midwives (used one twice) and one doctor. They were all females. My first midwife was okay, young and inexperienced and not a mother herself. My second midwife was sort of mean. The doctor was very very smart and I would love her if it was an emergency situation or difficult labor, but she had zero bedside manner and came in when it was time to push. The (awesome) nurses did all the work. The midwive I've used most recently is AWESOME!! She is so calming and yet tells me what to do when I need it. She doesn't believe in medication during birth, is a huge support with breastfeeding and NFP use, and just a saint.

    I really think experienced and wonderful midwives are way better than doctors in a normal and healthy pregnancy. I have 2 siblings that are doctors, and they can't stand the idea that I use a midwife because they have seen horrible situations where due to one minute of medical action needed, the baby has suffered. Because of this, I always give birth in a hospital and with an OB on duty. Doctors are trained for medical emergencies and I really respect their knowledge in this area, but for a natural birth, midwives are best.

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    1. Sounds like you found a keeper! Don't let her get away :)

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  2. I went to a freestanding birth center that is run by midwives for the births of both of my children. The level of care and compassion was wonderful. I lost my last two children to miscarriage, and the level of care I received from my midwives was above and beyond what I expected of them. That being said, if CPMs were able to get licensed in my home state, I would have a home birth with a midwife in a heartbeat, but unless that changes I am perfectly happy having birth center births.

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    1. I'm so very sorry about your losses and thank God you were treated with love and compassion during those times. It's so important during such a heart wrenching time. So glad you have midwives who were able to give you the care you deserved.

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  3. Your defnition of midwife seems different to ours around her - we have OB doctors, Nurse Midwifes (like the LDR version of a Nurse Practioner) and Doulas, but I don't think we have a stand along "midwife" unless it's another class of Doulas. What do you think?

    We plan on using a nurse midwife and possibly a doula next time around. I liked my doctor (who's now retired) but she was a top OB doc and our low risk pregnancy wasn't very high on her priorities and she ended up going home a 6 pm on our delivery day and handing us over to another doctor and set of residents. Big dislike. Our hospital now has a great nurse midwife program set up that allows for a lot more 1:1 time as well as group programs and we're looking forward to that.

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    1. Midwives can be Certified Nurse Midwives or Certified Professional Midwives. Most practice as part of a group or they have their own practice. But some are hired by a hospital to be on staff (is that what you're familiar with?). My midwife works completely on her own as a private practice. So she's not beholden to any doctor, though she does have to have "hospital privileges" to work at a specific hospital, as any doctor would.

      There are Certified Nurse Midwives and Certified Professional Midwives and they're definitely different than a doula. CNMs have a normal nursing degree then go on to become specialized in midwifery. CPMs are trained through apprenticeship and education as midwives without the nursing degree. Each state has different laws regarding how each can practice. As far as I know, CNMs are allowed to practice on their own almost anywhere (as long as they can afford it!). I hope that makes sense!

      Oh, and I'm biased, but I say get a doula :)

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    2. I'm not sure if CPM's are legal in our state, but I think we're both talking about CNM's - our Nurse midwifes are nurses who've specialized and that's what we're doing. I have no great goal of going 100% natural on my next birth (though it'd be great if I did, right now a VBAC with or without assistance is my main goal), but I really want to make sure as much of my "team" is with me through out the whole delivery.

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  4. Love my midwives and homebirths for all the reasons you mentioned. I have had three babies, all homebirths and one did involve a transfer to the hospital for a post partum problem that began about 30 minutes after delivery. In my opinion midwives really shine in emergency situations. My issue wasn't a full on emergency but it was a crisis for sure. The midwives were excellent as was the OB at the hospital. The funny thing is is that in the end the midwive could have treated me at home with the exact same procedure that the OB ended up doing. But the midwives err on the side of caution and made the decision to transfer. I trusted their decision and all was well in the end.

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    1. So glad you had a good experience! It was really comforting to me when my midwife brought over all the supplies she would have at our home for the birth and explained them to me. They are definitely well prepared. I admit I do fear a hospital transfer (if we have another baby) because of the way I've heard others have been treated but your story makes me feel better!

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  5. See Foze! This is what I am talking about! I would never (never say never, but never) use a midwife and for sure now won't...but I LOVE your perspective on it and understanding why, for you this rocks. This was great.
    As a sidenote, I am also a bit weird about female only doctors. :) I always feel bad because I know male doctors are phenomenal, and am aware of awesomely solid Catholic doctors in my area and beyond, but yeah, having a man all up in my biznass, just doesn't sit right with me.
    And one more thing, my doctor is part of a practice in case she cannot be at the hospital. Because Joey came a bit sooner than expected and with a csection, we had to use the doctor who happened to be at the hospital to deliver him. And, for us, she ROCKED. We got so lucky there. But my doctor is very intentional about who she chooses to work with. All like minded, all female. seriously, the woman rocked. She came in wearing a 'sprite' tshirt and scrubs and instantly we connected!!!

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    1. Okay, I'm really glad I'm not alone with being really uncomfortable with a male! I know people whose husbands are OBs so it's a weird situation, right??

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  6. I love this! I've only delivered with midwives, so I guess I don't have a basis for comparison, but you've listed reasons I love midwifery care that I hadn't even consciously thought about! Sadly #10 no longer applies to me, though - I moved and my new midwifery practice has something like 15 midwives, so I get who I get when I deliver in May. Boooo. Luckily I've met very few midwives who I don't adore, so I'm sure I'll be fine with any of them when the time comes. But I still think it's a ridiculous system.

    Can I add a No. 17 that might only apply to me? I've found that my midwives, more than any MDs I've seen, use physical touch in a way that is very comforting and loving. Rubbing my back during labor, patting my knee when I'm worried, touching my arm to emphasize a point - I'm a pretty tactile person myself, and it just makes me feel so much more connected and cared for than the colder, clinical approach most doctors have. This probably goes along with No. 3 - I definitely wouldn't want a male doctor rubbing my knee!

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    1. Oh my goodness, I totally almost had another one in there about how my midwife gave me a back rub during an appointment (I was in a lot of pain...) but I couldn't word it in a way that wouldn't possibly weird people out so I deleted it!! Thank you for adding this! And yes, a male doing that would have been more than awkward :)

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  7. AMEN to everything you said!! I had a midwife during the whole 9-months with my son, but when he didn't (and wouldn't) drop by the end of 42 weeks, she deferred to an OB. I ended up having a c-section without ever having gone into labor. I was sooooooo upset because we had planned a natural birth. But everything turned out perfectly. The OB I ended up meeting an hour before the c-section was WONDERFUL! He even let me hold my son between the surgery suite to my hospital room. My son never left my sight until we left the hospital four days later.

    I so agree with you on every level. I just happened to one of those cases that needed an OB in the end. Hopefully, (God willing and soon) we'll be pregnant again and I can use my midwife through to the very end.

    The OB I ended up with would never be my first choice, because I would use a midwife again, for sure. But he was so humble and caring. He happened to come into my room to check on me one day while I was working at breast-feeding. He excused himself, said he'd come back later and took my empty lunch tray out of the room...wow!

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    1. This is a great story...not that you were transferred and for the C-section, I'm sorry things didn't go as you were hoping. But I do think it's great that you were a case of a valid need for more intervention, that you got the care you and baby needed AND you were treated with respect and dignity. Praying that you are blessed again soon!

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  8. I've had that same doctor you speak of for an MD attended homebirth, as well as a strange doctor at a hospital from a group practice, and then a CPM attended homebirth. After my experience in the hospital I swore NEVER AGAIN but with this fourth I am contemplating another hospital birth. I love the midwifery style of care and was extremely happy with my midwife (the only female of the three.) I feel the personality matters so much more than the gender. With both my homebirths I had a good relationship with my attendant and felt extremely comfortable. With my hospital birth, not at all, but I must say I was NOT happy with my nurses at the hospital and they were all women. It annoyed me the way they kept spreading fear and barking orders at me "Push harder! Push now!" They were strangers, and that's what I hated most.

    The only reason I am considering the hospital this time around is because of Group B Strep. Still, every time I imagine what it's going to be like to have a bunch of strangers dead set on ridiculous protocols that only apply to sick women, I get tense. Still haven't made up my mind what I'm going to do...

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    1. It's so so strange to have strangers there at that moment, isn't it??

      FYI, I was Strep positive with my first at home and Dr. E. just had me take oral antibiotics as soon as I knew I was in labor. I know a lot of home midwives have their own treatment plans as well. There's several ideas online as well on things you can do yourself to lower the chance of passing Strep the day of birth. Not sure if you were already aware of that or not but just thought I'd share! Prayers that you discern the best plan for you!

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  9. Great post Mary! Definitely agree with all your points, because the attitude of importance towards birth makes such a difference to a mother! Midwives approach baby, mom, birth in such a whole, connected way. Not compartmentalized and clinically. I think I've liked having a midwife the most because I would be a complete crazy person if I had to labor and deliver surrounded by strangers! I just would go nuts! So far I've had four natural births go wonderfully with the same midwife, I'm so happy and grateful to have had her for all my pregnancies, and soon for another birth!

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    1. I love that you've had the same midwife every time! What a special bond she must have with your family! Congrats on the new little one! May you be blessed with another beautiful healthy birth.

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  10. Good Questions! All 5 of my kids have been born at hospitals, the last three with a pro-life doctor who I adore. He's my general practicioner too so I get to see him even when I'm not pregnant. I think my dr. is great, however, he has not actually "delivered" any of my kids (although he was present). The hospital I go to is a "teaching" hospital, so more often than not, I feel like I'm being experimented on and I've had a newbie dr. catch our baby almost every time (one almost was dropped and on our third the new dr. was impatient for the afterbirth to be deliverd and pulled on the cord, which then detached and they had to do an emergency manual extract of the placenta, very glad to have had an epidural on that one)! I've given birth twice drug free, the last time was interesting because interns and nurses kept coming in and out (one told me that it was so rare to see a drug free birth and that was why they were hanging out in my room). Even my husband commented that he feels that after so many births we deserve to actually have an experienced doctor deliver at least one of our babies.

    I've had both women and men doctors, all things the same I prefer to have a women but personality counts more than anything (the one who detached the placenta was a woman who had a terrible bedside manner). I've had the same doula for 3 births and she's a gem, it really helps when going to the above hospital that there is someone there just for me that can explain things and run interference. When reading all the above you might think that I've had horrible birth experiences, but I look back really fondly on all my births and I think she and my wonderfully supportive husband are the two main reasons behind that.

    I live in a state that basically outlaws homebirths and birth centers. It is not illegal to give birth at home but it is illegal for midwives to attend them, every time one does she is opening herself up to criminal charges if something goes wrong. God bless them, there are still dedicated ones who do them and I've known a few women who still give birth at home somewhat "under the radar". There are doulas who will attend them too even though it's also dangerous for them. The medical malpractice situation in our state makes it impossible for doctors to be able to afford the insurance to be able to attend homebirths, and so they don't. If you want a midwife you have to find a hospital with one, and then they have to follow hospital procedure. Our local hospital just did away with their doula program and the midwife program is probably next.

    I came across a doula in our area who does do homebirths (my other one has retired). If we are blessed with another baby we might consider going the homebirth route because of all the reasons you listed. I like that you put it all in a positive light rather than in a negative tone. I don't want to choose homebirth because I'm afraid of what would happen in a hospital. I want to choose homebirth because that's the experice I want, choosing the positve instead of trying to avoid the negative (if that makes sense).

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    1. Thank you! I didn't really realize I was doing that but you're right. Having positive reasons for choosing something is often preferable to not doing something out of fear (if that made sense!). Sort of like choosing homeschooling for the positives not necessarily because you just don't like school (though those reasons may be very valid and may be more than enough reason to choose or not choose something!).

      It's worth considering whether or not you just tell your doctor you don't consent to being treated by any of the students. We have a teaching hospital here as well and I've heard so many stories about groups of students being hustled in to watch a birth without any consent from the mother. So disrespectful!
      And so sad about your state. That's so messed up and ridiculous.

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