Why Choose Midwifery Care?
National and Global Birth Trends
Throughout the industrialized world countries recognize midwifery care as a superior way of birthing. In fact, the countries with the lowest infant mortality rates are those where over 70% of the births are attended by midwives, the majority of these at home or in free-standing birth centers.
In 2007 British Health Secretary Patricia Hewitt called on the British government to “challenge the assumption that the safest place to give birth is in a hospital and that homebirth can be dangerous”. She advocates for a shift back to birth as a normal, non-medical event in the life of a woman.
The World Health Organization and the American Public health Association both endorse out of hospital birth with a trained midwife as a reasonable alternative to the high tech/high cost medicalized birth found in U.S. hospitals.
The U.S. spends more on healthcare than any other nation in the world yet we rank 41st in newborn mortality. In 40 other countries babies have a greater likelihood of surviving their first year of life. These countries include Cuba, Portugal, Malaysia and the U.K.
In 2005 the British Medical Journal published the MANA 2000 study, the first ever large-scale prospective study of the safety of homebirth in North America. This study illustrates that homebirth with a Certified Professional Midwife (CPM) is as safe as a low-risk hospital birth. The cesarean section rate for attended homebirths in 2000 was 3.7% vs 19.1% for intended hospital births. Additionally, the rates of interventions were consistently half that of hospitals. Most importantly there were no fewer babies dying or injured in hospital than at home. The satisfaction of homebirth women vs hospital birth women was significantly higher with 97% of women reporting satisfaction with their homebirths.
In the Jan/Feb issue of the Journal of Midwifery and Women's Health an article titled "Outcomes of Care for 16,924 Planned Home Births in the US : The Midwives Alliance of North America Statistics Project, 2004-2009 by Cheyney et. al. this study again showed comparable rates of neonatal morbidity and mortality to low risk hospital birth, with fewer c-sections and greater overall satisfaction.
Currently the U.S. c-section rate is 32.8%. Despite the rising number of babies born by c-section, we have not lowered our neonatal mortality rate. Perhaps even more alarming, is the fact that despite spending $98 billion dollars on hospitalization of women for childbearing, the U.S. has doubled it's maternal mortality rate in the past 25 years. Currently the U.S. ranks 50th in maternal mortality. In 49 other countries women have a greater likelihood of surviving childbirth. The World Health Organization (WHO) recommends a 10 -15% c-section rate as necessary. In the U.S. CPMs report a 4- 10 % c-section rate.
The Midwifery Difference
At home, birth is allowed to unfold as nature intended. Because a woman feels safe in her home and is not disturbed by unfamiliar hospital staff and procedures, the hormones of labor are fully capable of moving her labor along. When a woman is exposed to bright lights, unnecessary activity and strangers performing intimate exams, the release of both oxytocin and endorphins are inhibited by the overproduction of stress hormones. This slows the progress of labor and intensifies the feelings of pain. It is not uncommon for a woman's contractions to slow upon arrival at the hospital. This may lead to augmentation with pitocin, a synthetic form of the hormone oxytocin which causes contractions. Pitocin has been associated with poor fetal heart rates possibly due to the strength and frequency of the contractions it causes. This apparent stress on the baby often leads to a c-section. Furthermore, the intensity of pitocin-induced contractions leaves the majority of women seeking an epidural. Epidurals are associated with maternal fever, and poor fetal heart rates which again leads to many more c-sections.
In choosing a midwife attended homebirth you are avoiding any unnecessary interventions and the complications they often lead to. While at times it becomes prudent to transport to the hospital from home, and even benefit from some of the above named interventions, this occurs in 10-15% of all planned homebirths. Most importantly, the decision to intervene is made in conjunction with the laboring woman and her partner. Full explanation of the benefits and risks of any intervention are given, allowing women to be active participants in their birth care. Nothing is done to you or your baby without your consent. When birthing at home women take full responsibility for their own excellent health care, hiring a midwife to guide and support the process while ensuring the safety of both mom and baby. When time-sensitive emergent action is needed, the solid relationship and trust that exist between mother and midwife allow for swift, decisive care.
Midwife means “with woman”. Midwives are dedicated to spending time with women, providing the space women need to explore their strengths and fears, answer their questions, and build strong relationships. Midwives are patient, allowing labor and birth to proceed naturally. There are no strict timelines on your labor. Likewise midwives are more comfortable with pregnancies that endure past their due dates. Inductions for being late are very rare.
Bonding, Babies and Breastfeeding
The practice of homebirth is very supportive of the mother/infant bond, indeed midwives strive to protect this most intimate time allowing for the creation and strengthening of the mother-baby dyad and unification of the entire family. Babies remain in constant contact with mom from the moment of birth onward. If any assistance is given to aid baby's breathing it is done on the bed next to mom, where she may touch and speak to her baby. This way baby senses the love and safety of the mother as he has known for nine months prior.
A growing body of evidence shows that immediately cutting the umbilical cord denies the new baby vital life blood. The blood remaining in the cord is the baby's and this contains necessary oxygen for easing the transition to breathing on his own. In addition it has been shown that the amount of iron contained in this blood is necessary for building an adequate store to prevent anemia in the first six months of life. Current hospital practice includes cutting the cord immediately upon delivery. At home, the cord is left intact sometimes as long as several hours. Most typically it is cut shortly after the placenta delivers. Never is the cord cut without parents' consent. This illustrates a midwife's respect for and trust in the physiologic process of birth and the wisdom inherent in this. Besides, not cutting the cord ensures that baby stays with mom!
Midwives believe in every woman and baby's right to breastfeed. Midwives provide a great deal of support as the breastfeeding relationship develops. By allowing mom and baby to remain in constant contact in the hours after birth, midwives are encouraging babies to find the breast and initiate nursing all by themselves, something they are innately driven to accomplish and that sets the stage for a successful breastfeeding relationship in the weeks to follow. Because midwives remain in attendance for several hours after birth and return several times in the first week, there is ample opportunity for breastfeeding support as needed.
Midwives are available 24 hours a day, seven days a week. In most cases there is no answering service or other barrier to access. This ensures that women are able to get their needs met in a timely fashion, often without having to leave the comfort of their own homes.
If you are curious about the additional benefits of midwifery care and homebirth and are wondering if it is the right choice for you, I encourage you to talk to a midwife today. It could be the difference you are looking for.