Category Archives: midwife

Exploring Your Options Series – Part 5

Deciding on a place of birth is simple for most women. Most women choose to give birth in a hospital. Women generally feel safe in a hospital. Are there any other safe options? Is it safe to give birth out of the hospital? YES! Studies show that out of hospital options, such as a birth center or at home, are safe for low risk women.

I would encourage you to consider and research the different options and their safety before coming to a conclusion about where to have your baby. The location of your birth will determine what other options are available to you. Some links to help with your research Science and Sensibility “Is Home Birth Reasonable Option?”Science and Sensibility “Birth Outcomes by Birth Location”Science and Sensibility “Flaws In Recent Home Birth Research”, Science and Sensibility – “Obstetricians Claim Homebirth is Unsafe…Again. Where’s The Evidence?”

Part of the decision making process should include weighing the pros and cons of each birth place. Previous decisions (ie: deciding on a care provider) will also have an influence on where you give birth. If you want a physician to attend your birth, having a home birth may not be an option. Not many physicians attend home births, but there are some. I am not sure there are any in Utah, though.

Below are some pros and cons I came up with. Because everyone is different and there is no one right answer for anyone, these things may not apply to your situation. Feel free to make your own pros and cons list to figure out what is the best option for you. Where you feel the most comfortable and safest will be the best place for you to give birth.

Most women in this area plan to have a hospital birth and never consider a birth center or home birth. I would encourage you to consider and research the different options and their safety before coming to a conclusion about where to have your baby. The location of your birth will determine what other options are available to you.

  • Hospital
    • Pros –
      • Specialized care for high-risk pregnancies and births.
      • Pain medication readily available
      • A nurse to take care of you and baby, meals brought to you
    • Cons –
      • Birth is seen as a medical crisis.
      • Mother and baby are often separated
      • Difficulties are often resolved with medications and high-tech procedures
      • Standardized care rather than individualized.
      • Often noisy, lack of privacy, strangers (the nurses are likely people you will not have met prior to your birth. Your particular doctor or midwife may not be the one to attend the birth)
      • Institutional feel.
      • Understaffed.
      • Higher risk of infection.
      • Have to pack and travel to birth place
  • Birth Center
    • Pros –
      • Less infection risk than hospital.
      • Midwifery Care Model
      • More home like than hospital
      • Most problems that arise can be dealt with on location.
      • Baby is never separated from the mother
      • Continuous support
    • Cons –
      • Have to pack and travel to birth place
      • Higher transfer rate than home birth.
      • Fewer pain medication options available
  • Home
    • Pros –
      • Your own space/Familiarity
      • Midwifery Care Model
      • Low-risk treatments used to resolve issues that may arise.
      • One-on-one care with your chosen birth attendant (although this isn’t always the case now. There are some homebirth midwives in the area that have a “practice” much like doctors)
      • Individualized care.
      • Continuous support
    • Cons –
      • Arrange for someone to take care of mom’s needs, the home, and other children.
      • No pain medications available
      • May need to transfer if difficulties arise.

Part 1 | Part 2 | Part 3 | Part 4

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Exploring Your Options Series – Part 4

questions to ask a potential care provider

After you’ve setup interviews with doctors and/or midwives, you’re going to need some questions to ask them. For this post I want to talk about how to conduct an interview.

Hence Goer, author of Thinking Woman’s Guide to a Better Birthsuggest asking questions in a way that does not give away your opinion. If they know what your opinion is, they may tailor their response to your opinion instead of what their actual answer is. It is important to ask open-ended questions. Begin a question with “When do you usually recommend….?” Using the vision of your birth experience as a guide, ask questions about key elements of your birth vision. If you want to push in different positions than the traditional-hospital-position of laying on your back with legs in stirrups, ask your potential care provider about this. You could ask “What is your opinion of pushing in upright positions?” or “What is your approach to the pushing stage of labor?”

When the care provider answers the question vaguely, such as “I only do that when it is necessary”, follow up with more questions. If the answer they give is “I only do that when it is necessary”, ask “In what situation would it be necessary?” or “How often do you find it necessary?” If it is important to you not to have an episiotomy (when the care provider cuts your perineum), and the care provider says they find it necessary in every first time mom and about 80% of the rest of moms, then this is probably not the best care provider for the birth experience you want.

Is the care provider answering with feelings instead of facts? These types of answers can be very misleading. At first it seems like they care about your experience, when really they are trying to appeal to your emotion rather than using evidence based practices. If they answer with a feeling based answer, follow up with questions to get them to state specifics. In the situation of episiotomies, would you rather hear “Would you rather have a clean cut than a jagged tear?” or “I do them very rarely. It’s been about 3 years since the last time I did one. They are routinely done as part of a forceps delivery”.

Does the potential care provider seem comfortable with you asking them questions? If they seems irritated or impatient with your questions, they may not be the best care provider for you. If they are not comfortable with your interview questions, how would they react if you had a “dumb” question to ask. Think to yourself, “would I feel comfortable asking them a ‘dumb’ question?” There are times during pregnancy or birth that something doesn’t feel right or you unsure about what is going on with your body and you should feel comfortable talking to your care provider about these things without feeling stupid about it.

Here are specific questions to ask a potential care provider:

  • Are you board certified (physicians only)?
  •  Under what circumstances would you transfer my care to an obstetrician (midwives and family physicians only)?
  • Do the midwives attend births? (if you are interviewing at a practice that has both midwives and OBs)
  • What is the likelihood that you will attend my birth?
  • What are your dietary recommendations? How much weight should I gain?
  • What is your policy on ultrasounds?
  • Under what circumstances do you recommend inducing labor?
  • How do you handle slowly progressing labors?
  • What are your policies regarding monitoring the baby’s heart rate in labor, IVs, drinking or eating in labor, breaking the bag of waters (amniotomy), epidurals, episiotomies?
  • What are your reasons to do a cesarean? How often do you find it necessary? How do you try to avoid the need for cesarean?

The Thinking Woman’s Guide to a Better Birth, Henci Goer, p. 195-196

 

Henci Goers book has a lot of information about evidence based practices and I would recommend getting your hands on a copy. It may help you define your birth vision. In the particular section referenced about she also has “Red Flag Responses”. Great read!

Here are some links to help with questions to ask a potential care provider: http://www.askdrsears.com/topics/pregnancy-childbirth/first-month/interviewing-midwife 
http://pregnancy.about.com/od/prenatalcare/a/10q4doc.htm 
http://www.ahaparenting.com/ages-stages/pregnancy/Choosing-doctor-or-midwife

Read the previous posts in this series here: PART 1 | PART 2 | PART 3 | Part 5

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Exploring Your Options Series – Part 3

In my last post I talked about choosing a care provider being an important decision in your childbirth experience. In that article I mentioned interviewing several care providers. Today I would like to talk more about interviewing a care provider.care providers

The first step to choosing a care provider is to become clear about what type of birth you want. Think about the experience you want to have. What does the end result look like? How do you want to feel about your experience? Become really clear about what is important to you and your partner as you begin this life changing event. If you decide you want a medicated birth in a hospital, you can eliminate home birth midwives from your list of care providers to interview.

The next step to choosing a care provider is to find some care providers to research and interview. This can be accomplished in several ways; receive recommendations from friends and acquaintances, ask for recommendations on social media, ask your current care provider for referrals and recommendations, you can search the internet. When asking friends and acquaintances for recommendations on a care provider make sure to ask them about their childbirth experience. You will know their care provider would make a good match for you, if their childbirth experience is similar to the one you hope for. If they had a wonderful medicated birth in the hospital and you would like to have an unmedicated birth without medical interventions, their care provider may not be the right one for you. Ask them how their care provider made them feel. I have heard several women talk about their care providers who say they were really nice, but they didn’t feel like their questions were important or the care provider didn’t spend much time with them. These points are important to know when receiving recommendations from friends and acquaintances. Searching online for a care provider can be very helpful. Several sites online have a rating and feedback system. You can read about other’s experiences with a particular care provider and see their overall rating. This can help you narrow down your list of care providers to interview. Keep in mind when hearing or reading feedback about care providers that birth is an emotionally charged event which creates strong feelings (positive and negative) toward those involved. Many times when things do not go how the birthing family had planned the care provider is seen as responsible and the negative emotion is directed solely toward the care provider. It also happens in reverse, when a birthing family has a positive experience, the positive emotion can become directed at the care provider. This is why many women have strong positive emotions toward their care provider and you may hear many say “I LOVE my OB” or “I LOVE my midwife”. Make sure to ask them why! What did they do to earn such a strong emotion?

The next step to choosing a care provider is to compile a list of care providers to interview. After you have become clear on the childbirth experience you want to have and have asked for recommendations, you are ready to compile a list, narrow it down and setup interviews. Take the recommendations you have received and use the information you gathered to determine which care providers can help you accomplish the type of childbirth experience you want to have. Make a list of these care providers. I suggest having at least 3 different care providers (as well as different types) and not more than 5. If a natural birth in a hospital is part of your ideal childbirth experience, I would suggest speaking with at least one licensed home birth midwife. You may find you can have the best of both worlds with a greater chance of having the childbirth experience you want. Make sure to ask questions about the safety of home birth and what she does in the case of certain emergencies (get specific!).

The next step to choosing a care provider is to setup and conduct interviews. Some women wonder why in the world you would interview a care provider. For most it doesn’t make sense, because it is rarely done. We usually just go to whomever is covered by insurance or whoever our mom or best friend go to. However, the care provider that attends your birth is a very important element to the type of experience you will have. If you want to have a natural birth with few medical interventions in a hospital and the OBGYN you choose is not supportive of natural birth your likelihood of having the experience you want is very low. If you want to reduce the risks of having a cesarean section and your OBGYN has a high c-section rate, your risk of cesarean is increased just by the care provider you chose. Choose carefully! Take your time! And if the one you choose isn’t supportive of the experience you want to have, fire them! Go to a new care provider who is supportive. I have known women you have fired their care provider during labor. They work for you!

The final step is to conduct interviews. Call the care provider’s office and setup a “consult” appointment. Tell the receptionist you would like to discuss different birth options with the care provider. This will help them know how much time to give you for the appointment. On my next post I will discuss how to interview a care provider.

Read the previous posts in this series here: PART 1  PART 2

Image courtesy of photostock / FreeDigitalPhotos.net

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Exploring Your Options Series – Part 2

I first thing I want to talk about are 2 very important choices. These two choices will determine what other choices you have surrounding your birth. This week we will talk about the first important choice:

Care ProvidersMidwife, Suzanne Smith

When choosing a care provider, it is important not to make assumptions about the type of care or philosophy based on the sex or type of care provider. You cannot assume that a female care provider will be more caring, flexible and less likely to introduce interventions, than a male. You cannot assume that all midwives practice from the midwifery care model and that OBs or Family Doctors will not. There are some OBs that act as excellent “midwives” and some midwives that offer a more medicalized approach to pregnancy and birth. The pros and cons I will present are generalized. What may be a con to you, may be a pro for someone else and vice versa. It is important to interview several different care providers before choosing one. Ask lots of questions!

  • Obstetrician/Gynecologist or OB/GYN
    • Pros –
      • Skills and experience to diagnose and treat serious complications during pregnancy and birth
      • Rarely would require transfer of care
    • Cons –
      • Trained surgical specialist in the pathology of women’s reproductive organs. More medicalized care. Less naturally minded.
      • Low-risk women often seen as high-risk
      • Limited repertoire; no experience in other lower risk options
      • As someone put it “If you don’t want to get cut, don’t go to a surgeon.”
      • Limited to hospital
  • Family Doctor
    • Pros –
      • Tend to introduce fewer interventions than an OB.
      • All members of the family can see one doctor.
        • This creates better doctor/patient relationships and convenience.
    • Cons –
      • Pregnancy or birth complications may mean a transfer of care.
      • Still have a “high-risk” mentality of pregnancy and birth and introduce interventions more than a midwife.
      • Limited to hospital
  • Midwife

Most midwives practice under the Midwives Model of Care. This model of care is based on the fact that pregnancy and birth are normal life processes.

The Midwives Model of Care includes:

  • Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
  • Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
  • Minimizing technological interventions
  • Identifying and referring women who require obstetrical attention

The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.

  • Pros –
    • Offer flexible, individualized, supportive care rather than introducing medical interventions routinely.
    • More attentive to emotional issues during pregnancy and childbirth.
    • Offer many low-risk strategies for correcting problems that may arise during pregnancy and childbirth.
    • Midwife practices, procedures and tests come closer to the recommended guidelines of official physicians’ organizations, than those of a typical OB.
    • Many midwives offer well-woman care. This allows women to continue their care postpartum with the same care provider.
    • Midwives aren’t just limited to hospital care. They attend birth at freestanding birth centers and home births.
    • Cons –
      • Pregnancy and birth complications may mean a transfer of care to an OB.
    • Different Types of Midwives
        • There are three different types of midwives that can legally practice in Utah:
          • LDEM- Licensed Direct Entry Midwife. This is someone who went straight into midwifery and is licensed by the state. He or She is a CPM (Certified Professional Midwife), having met the requirements with NARM (North American Registry of Midwives). LDEMs are licensed with the State of Utah and can carry oxygen, lidocaine (for stitching up your perineum in the case of tears), Rhogam for Rh- mothers, pitocin for a hemorrhage, vitamin K for baby, eye ointment for baby, and with a physicians approval, IV’s if needed, more medications for hemorrhage, and certain antibiotics for labor. They are not under the supervision of a doctor but practice independently.
          • CPM or DEM- Certified Professional Midwife or Direct Entry Midwife. In Utah no certification or licensure is required to call oneself a midwife. Therefore it is up to you the consumer to determine the skill level and capability of anyone calling them self a midwife. Therefore this midwife may or may not have the CPM credential. Many midwives in this category are very skilled, but once again it is up to the consumer to determine the knowledge and skill level of this midwife. This midwife can carry oxygen, but cannot carry any other medications.
          • CNM- Certified Nurse Midwife. This midwife has gone through formal nurse’s training and certification as well as midwifery training. Most CNM’s work in the hospital, they can carry medications, and write prescriptions. They are under the supervision of a doctor.

 

The next important choice we will talk about next week is where you will give birth.

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