In 2014, the Centers for Disease Control and Prevention (CDC) showed that the rate of cesarean births was 32.2 percent in the U.S. The World Health Organization (WHO) has a target rate between 10 and 15 percent to be considered medically necessary cesarean births. When we stop to remember that a cesarean is also major surgery, it begs the question, why? Why are women in the U.S. having this surgery more than double the amount of the rest of the world? It turns out, there is a growing number of women who are looking for alternatives to the hospital birth and these statistics are part of the reason.
Like in many other areas of our lives, women are starting to go back to “old” methods of childbirth, and midwifery is one of those options. But, do not be confused — modern midwives are nothing like the tales of an elderly woman, ready with towels and boiling water. Midwives today are medically trained experts in their field, and they will be the first ones to tell you if you need to go to a hospital during labor or if the midwifery route is even a viable option for you.
There are many misconceptions about midwives, and many people do not realize it is a very safe option. When most people think of having a baby, they think of a hospital, nurses and a doctor surrounding the mom-to-be, the dad or partner by her side, encouraging her to push and maybe the pregnant woman yelling not-so-nice things because she is in pain and trying to get that baby out. It has been the common picture for decades — it is what we see on television, in advertisements and hear about from our friends and families.
There are simply more options, and you have to decide for yourself which best suits your needs — both medically and for what you hope your birthing experience to be like.
There is no question, hospitals exist for a good reason, but births have been happening for centuries, long before hospitals existed. It might even be ideal for a woman to have her baby in her own home or at a birthing center where she can choose her style and method of delivery. More importantly, she should have her baby where she can feel comfortable and relaxed, without essentially total strangers checking not-so-public areas throughout the process.
There are many factors to consider when creating your birth plan. Most importantly, one must remember that it may not happen exactly how you imagined. If you are someone who is looking for the natural route or really interested in being in the comfort of your own home when you give birth, then it might make sense to have a midwife for your primary care instead of the OB/GYN.
Terri Mitchell is Frisco’s (and Dallas/Fort Worth’s) only dual-certified midwife and lactation consultant. She has a string of letters after her name that she jokingly refers to as “alphabet soup.” The first designation is “RN,” or registered nurse, for which she has a bachelor’s and a master’s degree. Mrs. Mitchell went on to earn her doctorate in nursing, or “DNP” from Baylor University. From there, it was on to becoming a “CNM,” or certified nurse midwife, by the American Midwifery Certification Board. As if all that was not enough, “IBCLC” stands for international board certified lactation consultant. As far as practical experience, as of this interview, Mrs. Mitchell has participated in about 1,000 births, including her hospital nursing career, and has been a part of about 150 births as a midwife.
Mrs. Mitchell explains the mystery surrounding her profession, saying, “We have three different kinds of midwives in the U.S., which can contribute to some of the confusion. There is a national board certification and then a state certification. We are similar to your nurse practitioner in that we can also provide women’s primary care.”
Some of the questions she encounters when educating women about her services include, “Do I have to go see my doctor first?” She says, “No, I have my own assessment to determine if I am right for her care.” Mrs. Mitchell will be the first to tell a woman if she is too high risk for her services. If you are delivering twins, delivering a baby who is breached or if the mom has a blood clotting disorder are a few of the examples Mrs. Mitchell cited. There might be situations where Mrs. Mitchell would work in partnership with a doctor (she has a collaborative physician she works with often), but again, each case is different and depends on the health history of the mom-to-be. Ultimately, midwives have the same goal in mind as hospitals and doctors: to have a safe and healthy delivery for both the mom and the baby. It is, however, a different experience.
You might be wondering what a midwife birth experience typically looks like. Mrs. Mitchell likes to call it “professionally intimate.” She adds, “I am your provider, you are my client, but we get to know each other well. By the end of your pregnancy, I know your dogs’ names, I know about your relationship with your in-laws, we just really get to know each other.” She says it is because her appointments are longer, and they are in clients’ homes. She says, “It actually contributes to the safety because I am with my clients for every single visit. When I come to her on a different day and she looks ‘off,’ there is just another sense of intuition because I know her or I have that gut instinct to ask if she is OK.”
Mrs. Mitchell follows the WHO guidelines for her checkups, so clients are still getting all the medical attention necessary for pregnancy, but her patients are more “in charge” of their care. Mrs. Mitchell says, “I provide them with evidence-based research, with best practice recommendations and they have the opportunity to take that information, gather more themselves and then decide what is best for their own family.” She uses what is called the “shared decision making model,” which is being encouraged more throughout the health care industry, not just pregnancy or midwifery. She says it is replacing informed consent, where they tell you what they are about to do and you agree to let them do it. She adds, “Informed decision making says this is what is recommended. Take some time to think about it and talk with others. If it is right for you, we will talk about it.” No one knows what is best for a person more than that person.
Who might seek out a midwife as a potential option for pregnancy and birth care? Mrs. Mitchell says she has seen women fall mostly into one of three categories. “One is someone who believes in what we do and in the natural process. Two is someone who is afraid and that is powerful. They can be afraid of hospitals for various reasons or have heard horror stories, or worse, had horror stories of their own. These women want something different. The third type of clients are the ones who are looking for the more cost-effective route. Maybe they do not have insurance or they have a very high deductible policy. They are willing to commit to a natural birth to control costs.”
Now, for the birth experience (do not worry, it is a family-friendly version). At the end of of several months of great prenatal care, a woman tells Mrs. Mitchell when she is in active labor. “I bring medical equipment, so all of the emergency equipment, basically everything but an epidural and an operating room.” She enters the woman’s home quietly, often in the night, and usually finds her client in her bedroom or somewhere comfortable with her husband by her side. She sets up all the equipment and then does an evaluation of the mom-to-be, checks vital signs, the baby’s heartrate and more. When everything is set up and the mom has adjusted to Mrs. Mitchell’s arrival, she provides whatever support or encouragement is needed (even if that is for someone other than the mom).
As long as things are progressing, they just wait until the mom feels the natural urge to push. She adds, “A lot of dads participate in helping to catch the baby, and then the baby is placed directly on the mom’s chest for immediate skin-to-skin contact. The baby remains connected to the umbilical cord until it stops pulsing. One third of the baby’s blood volume is in the placenta, so while the baby is learning to breath and getting used to the air, the baby is still getting oxygen from the cord, so that helps with the transition.” She says her babies tend to be a lot pinker, plumper and less likely to cry, due to some of the approaches they use that a hospital might not.
Moms get time to bond, the baby has time to naturally find its way to nurse and the midwife observes everything to make sure it is going as it should. After a couple of hours, the mom will need to go to the restroom, and that is when Mrs. Mitchell typically weighs the baby and gives it a full pediatric exam. Another added benefit is that because of this pediatric care, the mom does not have to rush her newborn to the pediatrician’s office for checkups, if they so desire. A midwife is qualified to handle all the baby’s routine care for the first few weeks of life. “If I find anything out of the norm, then I tell them I want them to go to the pediatrician right away,” she adds.
Mrs. Mitchell stays with her patients anywhere from two to four hours postpartum to check vitals, make sure the mom is strong enough, make sure everyone is comfortable and reassure everyone they are ready to handle it on their own. She remains available to her patients all day, every day. “I call and check on them one day postpartum. I do a home visit for the baby around two or three days postpartum. There, we do a number of state mandated tests. Then, I see them again two to three weeks postpartum. We do more tests and we discuss postpartum depression, which is really important. We touch base and review her birth and how she feels about her birth.”
It is a growing movement, for many reasons. Mrs. Mitchell recommends watching two documentaries to get more information. The first is “The Business of Being Born,” which is available on Netflix. The second is “Why Not Home?” which is a more recent release.
Having a baby is life-changing in every way. Going through pregnancy and preparing to give birth is also life-changing. We have this idea in our heads of what it might look like, but it is worth the time and effort to find out what that picture should look like to you. It is different for everyone, and it is important to know all your options.