This article is discussing my prenatal care with both an OB and an independent midwife while I was pregnant with our first child, Max. I also included a section describing what my birth experience was like because I just LOOOOVE sharing it with the world.
My OB experience…
My plan was to birth Max intervention-free. For about the first 32 weeks of pregnancy I saw a Sarasota area OB who has two certified nurse midwives (CNM) on staff. Around this time I began to acknowledge that, although my OB is a highly regarded practitioner and a very nice man, I was less than relaxed during each visit.
I was shuffled from the waiting room, to the bathroom, to an examining room for a short encounter with a nurse who took my vitals and asked a few routine questions. After the nurse left, I waited some more. Then, my OB– who was always in a hurry to get to his next patient– came in and asked a few more routine questions. Hardly looking up, he’d check me over, give me a few orders, and then disappear out of the room. Unless I was armed with a list of questions it was impossible to convey anything meaningful about my pregnancy.
Essentially, my prenatal care providers were not able to spend quality time with me. They had too many other patients to attend and had the difficult task of balancing out the needs of all of them. Furthermore, it always felt like I was taking up too much of their time when I did have that list of questions ready to rattle off. I felt uncertain about the normalcy of my pregnancy and nervous to speak up about anything. Despite the kindness of everyone I encountered, the experience of being shuffled from one place to the next, the impersonal interactions with the staff and OB, and the lack of intimate conversation made it feel like my pregnancy was being treated the same as a routine check-up at a walk-in clinic.
Who can provide the professional and compassionate quality care I’m looking for?
Giving birth for the first time was the most emotional and life altering event I was ever going to confront. It seemed below standard that my OB and the CNM working under him didn’t have time to talk about what I was really going through or what my body was experiencing. I began to re-evaluate the term “quality care.” Did I need to hire a psychologist as well as an OB in order to address the non-physical changes I was undergoing? Was it possible to receive quality medical care with emotional/intellectual support as part of that care? Am I the only one who feels that being pregnant is not just about my body changing and the baby growing inside of me, but also about what I’m thinking and feeling because of these events? How will this emotional disconnect from the OB affect my labor and delivery? I contemplated these questions as I carefully researched midwifery care in the state of Florida and across the world. It soon became apparent that the kind of care I was looking for could only be found with an independent licensed midwife.
My midwife experience…
When I tell people that I had a homebirth with my son, their first response is usually, “Wow, you are brave!” I smile and tell them that I don’t consider having a homebirth to be an act of bravery, but it was the most empowering experience of my life thus far. Trusting that your body knows how to birth a baby has more to do with education and knowledge than bravery. My reasoning to give birth at home– and certainly this is true for many women who choose midwifery care in our country– was based on a desire to have an honest opportunity at a natural childbirth without any interventions to start or augment labor. Equally as important was to have my needs and Max’s treated together and not as separate units, because they are symbiotic needs. With an experienced and licensed midwife all of my standards of care were met… and then some.
Our first visit together was a two hour appointment in which we talked for about one hour 45minutes and did the exam within 15minutes. Each additional visit was roughly 45mins of conversation time and 15 mins of exam. Although I began my care with her at 33 weeks pregnant, by the time I gave birth I felt close to her, confident about what my body was going through, and had a clear sense of what labor and birth would entail. I also stopped having nightmares about going into labor. Rather than feeling isolated and fearful, I started having dreams about feeling safe, loved, and protected as I went into labor.
Is homebirth really safe?
Yes! Florida actually sets a notably high standard for midwifery education so as to make the option of homebirth as safe as an intervention-free hospital birth. Midwifery has been legal here since 1931, and The Midwifery Practice Act was last updated in 1992. The revisions are based on World Health Organization standards and successful European direct-entry midwifery programs. To become a licensed midwife in the state of Florida, an applicant completes a three-year program of academic and clinical education and must pass the North American Registry of Midwives national certification examination.
With the midwifery model of care, birth has an astoundingly low rate of interventions. Scientific medical academia consistently shows that the less interventions a laboring mother has, the less likely she will end up having a cesarean birth. In 2002, a study titled, “Outcomes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America,” was organized by, Kenneth C Johnson and Betty-Anne Daviss and published in the British Medical Journal. This study included 5,418 women in the U.S. and Canada who intended to give birth at home as of the start of labor. Throughout their pregnancies all the women were attended by Certified Licensed Midwives. Although many people have a knee-jerk reaction to assume homebirth is dangerous, the results of this study clearly prove otherwise.
The study concluded “…home birth is safe for low risk women and involves far fewer interventions than similar births in hospitals.”
Results of the 2002 survey, “Outcomes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America”
- 12.1% transferred to a hospital either during or after delivery and only
- 3.4% of these transfers where considered urgent. Most transfers occurred for failure to progress, needed pain relief or exhaustion.
- 9.6% electronic fetal monitoring
- 2.1% episiotomies
- 0.6% vacuum extractions
- 3.7% cesarean section (as opposed to in 2004, Sarasota Memorial Hospital delivered 3,461 babies with a c-section rate of 36.95%, and Manatee Memorial Hospital delivered 2,164 babies with a 31.10% c-section rate).
- 1.7% of the mothers said they would choose a different type of caregiver for a future pregnancy.
What Giving Birth at Home Was Like For Me…
I have never in my life felt so at one with spirit and body as I did while in active labor. I could have been laboring a million and one years ago and it wouldn’t have felt any different. The connection to my primitive spirit was beautiful, powerful, wild, foreign, and uninhibited. As labor progressed, I began to move on instinct alone. I was able to walk around, drink juice or water, and eat whenever I wished to do so. I vocalized the pain and moved my body as needed. By my side at all times were my midwife, my husband, and four of my closest friends. Labor was intense and painful but manageable, especially while resting in warm water. Of course, I had moments of doubt that I’d make it through. But, instead of someone asking me if I was ready for drugs, I heard a soft voice of encouragement telling me I was beautiful, doing great, and that everything was progressing normally. The lights were dim and I felt safe, like my midwife was a guardian watching over Max and me. She checked Max’s heartbeat often as well as my blood pressure – all was perfect. I moaned, moved, cried, and eventually became what I was doing. I found my way to that sacred place within that only I could travel and where my greatest inner strength was revealed. Pain at this point ceased to bring fear with it and became a welcoming means to an end– Max in my arms.
Ultimately, regardless of who is surrounding us or how many machines are available, we all give birth alone. It is the birthing woman who is left with the most powerful memories, good or bad, of the birth experience. My friends and husband played important roles in my labor memories; however, it was my midwife that had the power to “make or break” my confidence. She was the one I entrusted to make decisions about our safety. This power that we give to someone is a gift. Whether we give this gift to an OB or a midwife it is vital to choose our birth attendant(s) wisely. It is our birth attendant(s) and their philosophies about childbirth that have an enormous influence on how our labor progresses and how we feel about the birth experience overall. Maxamilian was born into my husband’s arms in a tub of warm water after 12 hours of intense, meaningful work… without any complications.
Ina May’s Guide to Childbirth by Ina May Gaskin: I recommend this book over all others! Ina not only provides great information about natural childbirth, it also has a very comprehensive and honest section dedicated to interventions.
The Thinking Woman’s Guide to a Better Birth by Henci Goer, Rhonda Wheeler
Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation by Pam England, Rob Horowitz
http://www.motherfriendly.org – The Coalition for Improving Maternity Services (CIMS). Here is a great place to learn how to find a provider that has built a practice around mother centric values.
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