Written by Tracie Grimes
Long before a woman feels that first contraction there are decisions to be made. “What should I be eating?” “What theme should the nursery be?” “Do we want to know the sex of the baby?” From the moment all signs point to positive on the pregnancy test, the decision-making begins.
Fun decisions, like what color to paint the nursery walls and how many of those cute little onesies you’ll need to fill up the baby’s armoire don’t usually take a lot of time. But the really big decisions, like the who, what, where, and hows of your prenatal, labor, delivery, and post-natal care, should be given ample consideration.
“Most people probably spend more time looking into what kind of car or computer they are going to buy than they do on the birth of their child,” chuckles Wendy Gonzales, a Bakersfield mother of three who changed her whole approach to the way she would give birth after spending time on research.
When Gonzales gave birth to her oldest daughter Cadence in 2003, she did it the way most American women do it these days; in the hospital under a doctor’s care. But by the time her second daughter, Elliott, joined the Gonzales family, Gonzales and her husband Nick had decided to go a different route. An at-home delivery with a midwife attending was their birth plan of choice.
“I wanted a different experience,” she says. “I read a book by Ina May Gaskin [founder of the Farm Midwifery Center in Tennessee and past president of the Midwives’ Alliance of North America] that really opened my eyes to alternative methods of childbirth. The book really clarified a lot of what happens during the birthing process and why it happens, and I decided I really wanted to experience my child’s birth this time.”
And to Gonzales, experiencing her child’s birth meant no IV lines, no monitors, and no epidural. “With Cadence I was hooked up to a monitor, had an epidural, pitocin, and because the epidural affected my ability to push had to have a vacuum extraction. There was a lot of medical intervention with my first birth. With Elliott being born at home with a midwife, things went so much more smoothly and were definitely much more laid-back. And when I found out I was pregnant with my son Oliver (born in April), I knew I wanted a home birth again.”
“Comparing midwifery with conventional medical delivery is like comparing apples and oranges,” offers LaMonica Bryant, LM, the midwife who delivered Gonzales’ son, Oliver. “They’re both still fruit, but have different textures and taste.
“I think understanding that a woman’s body was made to give birth and giving women the time and space to do what their body was made to do is an important part of understanding midwifery,” continues Bryant, who’s helped in the delivery of over 300 babies (and counting). She’s also delivered seven of her own children (with number eight on the way) at home with the help of a midwife. “Ninety percent of giving birth is mental. Women have to understand and accept what’s going on with their bodies and give in to it.”
Understanding is the core of the midwife’s philosophy to birth. And their view of birth being a normal life event that can take place in a calm, natural way, is a system that’s been in place for centuries. Yet many people still aren’t quite sure what a midwife does.
Simply put, the term “midwife” comes from an Old English term that means “with woman.” The role of the midwife is to administer prenatal care, tend to the mom’s physical needs during labor and delivery (i.e. listen to the heartbeat, catch the baby, cut the cord, check the placenta, etc.), and deliver post-delivery care to the mother and baby. If medical interventions become necessary (such as surgery or the use of medication), mother and baby are transported to a hospital.
“I was taught that as midwives, we sit on our hands until we need them, then we use them to assist, not intervene,” Bryant adds. “The midwife model of care views the birth process as a normal experience, not a sickness. When you view the process as one that is normal, you allow things to happen the way they are supposed to because you are allowing mom and baby to do what comes naturally.”
And when it comes to letting the body do what comes naturally, it’s to each her own. “I had one mom leaning over the bed in the most uncomfortable-looking position I’ve seen, but it turned out that leaning over in this position helped to drop the baby,” Bryant recalls of one memorable delivery. “Her body told her what to do and she listened to her body so she could deliver that baby.”
That’s the whole point of the midwife model of care: giving in to what the body wants to do and was designed to do, Bryant emphasizes. “I want to give the woman the time she needs to allow the birthing process to happen naturally. It’s important that she accept and understand what’s happening to her body, and if she’s hooked up to monitors that make it necessary for her to stay in bed, that interferes with the process. If she’s uncomfortable, she needs to move around until she finds a comfortable position, just like we all do if we feel a pain in our knee or back; we move to a new position until it feels better.”
Agreeing that midwives view their role in the birthing process as someone who supports the mother while letting nature takes its course, Justine Backhaus, LM, CPM, IBCLC, goes on to say that birth is a unique, miraculous event and a woman’s body does a beautiful job on its own. “My whole philosophy as a midwife is that women have been beautifully designed for giving birth and breastfeeding, and that design can’t be perfected. I’m really just here to check the boxes and make sure all the numbers are right. Most of the time I don’t have to do a bloody thing!”
And it’s this perfect design that allows many women the opportunity to give birth to their babies in a low-key way that’s controlled by them, notes Linda Cowley, LM, CPM, who’s been delivering Kern’s newest citizens (including three of her own grandchildren) at home for the past 17 years. She also gave birth to five of her seven children at home with a midwife.
“Having a baby at home where you are in private, familiar surroundings for labor and delivery not only promotes the family bonding process, it’s very empowering,” Cowley continues. “You can bring your baby into the world on your own terms. It’s a very positive, natural, and peaceful experience if you’re prepared for what’s going to happen during birth beforehand. Before all births, I provide prenatal care to my moms and instill in them through counseling the confidence they need to give birth at home. And as I’m educating moms about their bodies and the birthing process, I’m also establishing a rapport with them so I can give them the emotional support they need before, during, and after birth.”
Though the midwifery model of care is focused on birth as a natural process, Bryant, Backhaus, and Cowley agree that there are times when medical intervention is needed. Complications can arise suddenly at any point during pregnancy, labor, and delivery.
“There is definitely a time and place for medical intervention by physicians. In my own practice I’ve had to transport about two or three patients a year to the hospital and I really feel that we [midwives] have a very appropriate, cohesive system in place. Our goal is to give babies the best start possible by facilitating a natural, undisturbed greeting for them, but it’s important to have a backup system in place,” Backhaus emphasizes.
The best way to ensure a successful home delivery is to make sure moms considering home births are the right candidates. All three women agree that moms who are considering at home births with midwives should have smooth, uncomplicated pregnancies (meaning they don’t have obstetric complications like hypertension or diabetes).
“I look at each candidate on a case-by-case basis, but the best candidates are women with no pre-existing obstetrical problems or conditions,” Bryant says.
Parents also need to do their due diligence when it comes to finding the right midwife to assist in the delivery. Hiring a skilled, licensed midwife (LM), certified nurse midwife (CNM), or certified midwife (CM) who has a relationship with a physician and a hospital is recommended.
“Parents who’ve decided on an at-home, midwife birth need to take the time to talk with several midwives and ask questions like, ‘are you licensed?’ (licensed midwives can accept insurance and have been through midwifery school and an apprenticeship with a senior midwife or doctor); ‘how many births have you assisted with?’; ‘what types of problems have you dealt with?’; ‘how many transports and losses have you had?’; ‘what areas of the county to you cover?’; ‘how many moms have a due date around the time of my due date?’; ‘what is your back-up plan if complications arise?’ ” Cowley suggests.
And although most births are uneventful, midwives should not only have a plan in place for a safe, quick transport to a nearby hospital, the midwife needs to be prepared to spring into action when needed.
“Every midwife should be carrying oxygen, know how to monitor mom and baby throughout the birthing process and be trained in neonatal CPR,” Cowley emphasizes. “We’re also trained to look for any signs of trouble ahead of time [during pre-natal visits] and if we see anything that doesn’t look normal, we go to our back-up plan for medical intervention.”
“I really don’t think midwives are out to prove that anybody can have an at-home birth,” Gonzales says, emphasizing that the two midwives (Backhaus and Bryant) she’s had experience with wouldn’t have hesitated to send her for medical intervention the moment a problem arose. “Their [midwives] whole purpose is to look out for the best interest of mom and baby.
“I’m so glad I had the opportunity to experience what it’s like to let nature just take its course. It’s such an amazing experience and I encourage everyone I know who’s pregnant to at least consider a home birth.”
Article appeared in our 28-5 Issue - December 2011