Wednesday, April 14, 2010

modern midwifery

In the United States, less than 1% of births take place at home. It is difficult for the other 99% of Americans to make the transition from believing that technology is the benchmark for establishing worldwide leadership to the understanding that, in reality, the human body is designed to give birth. Our bodies are generous and amazing in their abilities to give birth naturally.

The rates of surgical birth and birth intervention in the US have soared beyond those of other developed countries around the world. The rate of maternal and infant mortality is not only significantly higher in the US than that of other developed nations, but also has not improved in nearly thirty years. Despite a significant improvement in the US maternal mortality ratio since the early 1900s, it still represents a substantial and frustrating burden, particularly given the fact that essentially no progress has been made in most of the US since 1982. Additionally, the Centers for Disease Control and Prevention has stated that most cases of maternal mortality are probably preventable. Among the causal deaths that could be prevented were those that involve both underlying health issues such as poor nutrition and high blood pressure as well as those that are physician-caused, including infection and hemorrhage.

There are many preventable risks of placing birth in a hospital environment. To begin with, bacteria can be introduced, first by the mother arriving in an environment where diseases are being treated, as well as from
infiltrating the natural barriers we have against infection through vaginal exams and, of course, surgical delivery. Additionally, there are higher incidences of hemorrhage from forced delivery of the placenta (when a care provider intentionally pulls on an umbilical cord). Furthermore, injuries and deaths related to the physician’s care range from the off-label use of medicine for the induction of labor as well as the sanctified use of surgical delivery, which is one of the leading causes of maternal mortality and a risk directly associated with cesareans and hospital births.

It is important to remember that pregnancy is a normal, low-risk, significant time in a woman's life. With knowledge of her body, a woman can interpret her body’s signals and maintain her own health. She can educate herself about care options and make good choices based on impartial and complete information because she knows her own body. Modern midwifery care is based on many concepts which are proven to reduce maternal and infant mortality rates and increase a mother’s joy in her birth experience.

Pregnancy effects and is effected by all aspects of a woman’s life: social, economic, professional, familial. A woman who knows about her body and how she gives birth is less likely to need medical interventions. An experienced midwife spends time with her clients. She gets to know them, teaches them and helps them think through their options to make reasoned decisions. She spends time with the client’s partner, observing the dynamics and providing holistic support. She helps identify how best to prepare the chosen space for labor and birth. Under a midwife's care, a typical prenatal visit lasts 30-60 minutes, labor accompaniment is consistent through the active labor and birth, and postnatal care includes several follow-up visits. It is estimated that midwives spend 10-15 times as many hours with a client as doctors spend--at about half the price! Midwives still do 70% of the births in the world and are experts not only at “normal” birth but at keeping infants normal around the birthing process. Midwifery care makes sense for normal pregnancies because midwives are skilled at keeping the pregnancy normal.

Women deserve knowledge to care for themselves before conceiving and during pregnancy and birth. Women gain the best birth knowledge from other women who have chosen natural childbirth with supportive birth care. Women are naturally intuitive and need not accept the negative images of labor that the media portrays. Women, their partners and their advocates can differentiate between normal birth and situations that may require medical guidance. Women want to choose important aspects of their birth experience based on credible information, not fear of litigation. The most favorable physical, mental and emotional birth outcomes for mothers and their babies are best supported by midwifery care.

Women have the right to choose a care provider and with whom and where to give birth. Every woman, and her family, must be recognized as being an individual with her own unique expectations for hers and her baby’s birth. It is a myth that women who seek a homebirth are willfully putting themselves at risk. Women are fully capable of considering their options and choosing how to care for themselves.  It is not rational to say homebirth is never safe; saying so is the product of hysteria. All birth information providers must create a more personable environment for the woman to learn about birth, her body and her birth options.  Protecting choice, not limiting choice, is good, no, GREAT health care.

Artwork: Music by Katie M. Berggren

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