Differences Between Physician and Midwife - My Personal Reflections

I'm 30 weeks along in my pregnancy and doing well. This is my fifth baby, but it is a new experience for me because I am planning my first home birth and working with a midwife for the first time.

I had a prenatal checkup yesterday, and with each visit I am increasingly amazed at the difference in care I'm receiving from my midwife compared to what I've experienced with my obstetrician. At each prenatal visit, my midwife does the urinalysis, checks my blood pressure, weight, measurement, baby's heart rate, etc. She does all of the clinical things that my obstetrician (or his nurse) would do at a prenatal checkup. But she does much more than that.

Visits with my obstetrician generally lasted no longer than 10-15 minutes at the most. The majority of the visit was used for the clinical work I mentioned above, with a few minutes to talk with the doctor. My midwife reserves about an hour for each appointment. Very little of that is taken up by clinical procedures. The majority of the visit is spent talking. There is so much that a pregnant woman goes through. From my personal experience, I feel that the obstetric approach addresses mainly the physical changes in an expectant mother, and the midwifery approach looks at the woman as a whole and tries to address all concerns; including physical, emotional and mental.

My midwife asks questions that I don't remember my physician ever asking (in 4 previous pregnancies). She asks me about my diet, what I had for breakfast, lunch, and dinner the past day. She asks about my family, how my husband and kids are doing and how we are getting along. She gives me nutritional advice to help with my concerns about iron levels, getting enough good nutrition to help me feel better and have more energy. I feel that my midwife really cares about me personally, and that deep sense of care is reflected in the way she talks with me and conducts each prenatal visit.

I have a good obstetrician. He has always taken care of me, answered my questions and addressed all of my clinical needs. I've never had a complaint about him. The difference in care with my midwife is more emotionally fulfilling for me. I can talk with my midwife about anything, but when I go to a physician I tend to keep the questions on a purely clinical or medical level. I also have the comfort of knowing I can call my midwife at any time, with any concern, and she will answer the phone and answer all of my questions.

I'll put it in a nutshell: with my midwife I know that all of my clinical and medical needs are being taken care of as they would be with a physician, but I also have the added security of feeling emotionally and mentally supported as well.

My midwife only attends home births as a midwife. She has 15 years of experience as a direct entry midwife. She is also a doula and attends hospital births in that role, so she is familiar with all different birth settings. I am comfortable with her because I know that her views on childbirth match my own, and I feel completely supported in my plans for a home birth. Our prenatal visits are in her home, which is beautiful and comfortable.

Midwives differ according to their certification, training, office set-up and more. Certified Nurse Midwives only attend hospital births and most often work under the supervision of a physician in an office. In general, CNM's are more clinically focused and may not be able to schedule a long appointment for open discussion, depending on the office procedures and how busy they are. If you are looking for a prenatal care provider, please see my earlier post: Choosing a Prenatal Caregiver: Doctor or Midwife? Please also consider putting together a list of questions and concerns to use in interviewing caregivers and considering your options.

Excellent Breastfeeding Article

I've read so much about breastfeeding in my studies, including Dr. Jack Newman's Ultimate Breastfeeding Book of Answers. I've breastfed my own four babies each for at least a year, and I thought I was pretty well-informed about breastfeeding. That is, until I read this article:

The Backlash Against Breast is Best: Why Is Breastfeeding Under Attack?

Written by Jennifer Block and posted on the Business of Being Born website, this article is excellently written, in response to an article entitled "The Case Against Breastfeeding" written by Hannah Rosin for Atlantic Magazine.

The article addresses some political and cultural pressures, and why women today are feeling that they don't have the support they need to breastfeed their babies. It opened my eyes, and I hope you will take some time to read it.

For more information about breastfeeding, please read The Ultimate Breastfeeding Book of Answers by Dr. Jack Newman, or see La Leche League, The Baby-Friendly Initiative, Breastfeeding.com, or the Utah Breastfeeding Coalition. If you have any additional breastfeeding resources to share, please let me know!

"News Moms Need" Blog for Mothers

The March of Dimes website (that I mentioned earlier) has a blog set up specifically to give moms and moms-to-be information they can use. The blog is called "News Moms Need" and it provides a wide variety of topics for mothers to consider. Some of the latest topics they have covered are: turning off the TV and the computer, fighting exhaustion, help with grief, water births, and more.

I was impressed by their post about water birth, which is something I am very interested in. I am planning a water birth at home for my baby that's due in the next few months, so I am reading everything I can about home birth and water birth.

I encourage everyone to check out this blog and see if there is a topic that catches your interest.

Birth Experience Essay Contest

Rachel, the author of The Beginning of Motherhood blog, has announced a birth essay contest. Here is her description:

"I am wanting to compile some essays on birth and the meaning behind birth, so I am offering a contest. The winner will receive a $100 gift certificate to The Kura Door, a holistic Japanese Spa in Salt Lake City, Utah. Submit an essay, any length, with these ideas in mind:

1. How has birth changed your perspective on life in a positive way?
   
2. How has overcoming the difficulties and trials in birth helped you to grow in a positive way?
   
3. How has birth provided meaning to your life as a woman and a mother?

Send all submissions to rachel.leavitt@gmail.com with birth essay in the title. All submissions become my property and will be used in conjunction with my blog at www.thebeginningofmotherhood.blogspot.com.

The deadline is Aug. 15, 2009. Also, just as a heads up, I will probably be doing this periodically if different areas also (ie media, photography etc.)"

The Birth of Baby Stephen - A Mother's Story

At our midwife appointment on April 14th, the day before my "guess date", my blood pressure was still high, so our midwife was concerned that pre-eclampsia was on the horizon. She didn't want to send us to the hospital for the 4th non-stress test in 2 weeks, so she suggested that we go to the hospital that night to start Cervadil to get my cervix to dilate since I was still at a 0, and then plan to start Pitocin the next morning to get things moving.

We went to the hospital at 7pm and by 7:30 they put in the Cervadil---it's like a suppository, but they have to put it behind the cervix to dilate it---NOT fun when your cervix is completely closed and high. Anyway, then Josh and I just played games and hung out til we got tired and went to sleep. As I'm sure most of you know, hospital beds are like ROCKS. I couldn't hardly sleep, so I listened to my "Come OUT Baby" Hypnobabies CD (our instructor suggested it as a way to avoid induction----it's like anything else used to induce---it won't work unless your body is ready for it). Well, I guess it was, because at 3am I woke Josh up because I was having pressure waves. I have no idea what stage I was in,

because the pressure waves were coming so close together I'd have like 5 in a row and Josh thought I was only having one. He was SO great supporting me and using Hypnotic suggestions and techniques to get me to relax. It was fabulous.

We really realized how important it is that birth partners get involved and how vital it is to practice together diligently. I didn't want to listen to any CDs (I thought the I-pod headphones would irritate me, so we put the relaxation music on on Josh's laptop), so Josh had to use scripts that he made up from what he could remember and what instinctively seemed to work from my body cues to get me to focus and relax. IT WORKED GREAT!

He called our doula, Cherylyn, and she came over, totally surprised to see me so relaxed and having so many pressure waves...it was nuts. The nurse came in and checked me and I was at a 2 and totally effaced. By 7:30am when they came to take out the cervadil and start the pitocin, I was at a 5, so they decided to just forget the pitocin because I was obviously progressing quickly on my own. By 8:30 am when the midwife came, I was at a 9, and by 9:57am Stephen was born. So total time was 7 hours. It was crazy and happened SO FAST. Josh was totally my hero, and Cherylyn was totally amazing.

Everyone kept saying that I was just glowing and so happy and were surprised that I could smile between pushes---the nurses were fabulous help too, and very encouraging. They never once offered me an epidural. Near the end I did get some Fetanol just so I could breathe in between a few contractions and they gave me oxygen to make sure that the baby and I were both getting enough. At one point they also had me stop pushing so I could let the last lip of my cervix finish dilating, which was SO hard, but when my midwife got there, she held back the cervix edge and let me push---it's amazing how your body just does it---it doesn't take any effort from you at all...you just have to go with it.

They also had to put an internal monitor on him shortly before he crowned because the pressure waves were so intense and close together that his heart rate was dropping and not going back up after each wave (he was also pinching off the cord- it was once around his neck, and one of his arms was tangled in it too), but he did just great and had a beautiful cry when he came out. I can't describe how I felt when his body came out---which is a totally amazing feeling too---I cried and laughed and was just...WOW....jeesh, I'm starting to cry now just thinking about it. :)

He weighed 7 lbs. 6 oz. at birth and was 20 inches long, so a perfect size. We love his fluffy brown hair and love looking into his eyes. He's so alert and just loves taking in everything he can hear and see. It's so amazing to have this new little life in our family.

The March of Dimes Supports Mothers and Babies

When I was growing up and going to elementary school, I collected donations for the March of Dimes and walked to help earn funds for the group. I never really knew what the March of Dimes was, except that it was supposed to help kids, and we were encouraged to support it.

The March of Dimes is a non-profit organization that funds research to prevent premature birth, birth defects and infant death.

Their website has a wealth of information for expectant parents about pregnancy and childbirth. I would recommend reading the information they provide and deciding if you feel it's a worthy effort to support.

If you are interested in supporting this group by walking, donating, or in any other way, please go to their website. There is a March for Babies coming up soon, and you can register for it here. You can use their interactive tool to find an event near you.

Home births 'as safe as hospital'

The BBC News has reported:

"The largest study of its kind has found that for low-risk women, giving birth at home is as safe as doing so in hospital with a midwife."

"...a comparison of "low-risk" women who planned to give birth at home with those who planned to give birth in hospital with a midwife found no difference in death or serious illness among either baby or mother.

"We found that for low-risk mothers at the start of their labour it is just as safe to deliver at home with a midwife as it is in hospital with a midwife," said Professor Simone Buitendijk of the TNO Institute for Applied Scientific Research."

Almost one-third of the women in the study who chose home birth were transferred to the hospital for complications, including abnormal fetal heart rate and the desire for epidural anesthesia, "But even when she needed to be transferred to the care of a doctor in a hospital, the risk to her or her baby was no higher than if she had started out her labour under the care of a midwife in hospital."

Please read the whole article here.

Amazing Birth Experience

I recently attended a birth, and the experience was incredible. The first-time parents had taken a Hypnobabies course and prepared themselves as much as they possibly could for the birth of their baby. Even though the the labor did not go exactly as planned, the mother still went through with her plan for a birth with no epidural and kept her focus. The baby came very fast, and it was intense, but everyone came together to help and support the mother and her baby, and we all had a wonderful experience.

I was very impressed by the father, who stayed at his wife's side the entire time and put his whole focus on her. He was able to tune in to her feelings, and when she started to show even the smallest amount of hesitation he was able to capture her focus and help her to be calm almost immediately. The mother was amazlingly strong, and followed her husband's cues excellently. She listened to our instructions and did a fabulous job. I feel in awe and truly privileged to have been a witness of such a miraculous event. My love for women and their roles as mothers is increasing with everything I learn about birth and every experience I have with it. I've asked the mother to write her birth experience and allow me to share it with you all here on my blog. I hope that will be forthcoming in the near future.

Beautiful Birth Art

I have been following the Beginning of Motherhood blog for a few months now, and I didn't even realize that Rachel, the blog's author also has a separate blog specifically set up for birth art. I visited it for the first time today and was blown away by the beauty and emotion of the artwork. There are drawn pictures and paintings as well as inspiring photography, along with some personal comments from the artists themselves. Please take a few moments to look through this inspiring compilation of art: The Journey of Giving Birth

Key Questions About Your Care

Key Questions About Your Care

by Penny Simkin, PT, CD (DONA)

Answers to the following questions will help you participate in your care responsibly and help you know what to expect.

When A Test is Suggested:

1. What is the reason for it? What problem are we looking for?
2. What will it tell us? How accurate or reliable are the results?
3. If the test detects a problem, what will happen next?
4. If the test does not detect a problem, what will happen next?
   

When A Treatment of Intervention is Suggested:

1. What is the problem? Why is it a problem? How serious is it? How urgent is it that we begin treatment?
2. Describe the treatment. How is it done? How likely is it to detect or solve the problem?
3. If it does not succeed, what are the next steps?
4. Are there risks or side-effects to the treatment?
5. Are there any alternatives (including waiting or doing nothing?)
6. Ask questions 2, 3, and 4 about any alternatives.

In an emergency it may be impossible to fully explore these questions. Your caregiver should tell you how serious and urgent a situation is.

It's All About Fear...

Or the absence of it. When it comes down to it, childbirth is all about fear. If you are afraid then you are tense and feel more pain. If you are calm, relaxed and free of fear, you can avoid pain. There is such thing as pain-free childbirth, and I believe it's achieved through childbirth that is free of fear.

Dr. Grantly Dick-Read wrote a book in the 1930's entitled Childbirth Without Fear, in which he wrote about his discovery of the Fear-Tension-Pain Syndrome. In his obstetric practice spanning over 20 years, he observed countless births that were calm, peaceful and free of pain or fear. Dr. Dick-Read successfully educated and prepared expectant mothers and helped them achieve a beautiful natural birth experience. In his experience, Dr. Dick-Read found that 95% of women were able to achieve this. His work has inspired many of our modern childbirth methods including, but not limited to, Hypnobirthing and Hypnobabies, both of which offer the education to prepare oneself for and experience a positive, peaceful birthing experience with little or no medical intervention. I have links on the right side of this page to each of these childbirth methods if you want to learn more about them.

The Beginning of Motherhood blog has two recent posts that address the role of fear in the birth process. One of the posts lists the steps to dispel fear, and I want to list them here because I think it's important:

1. Be aware of your body
2. Be in the present moment
3. Embrace silence through meditation
4. Relinquish the need for external approval
5. Get rid of negative emotions
6. Have total knowledge of yourself
7. Don't judge yourself and others
8. Remove toxins from your body and your environments

The blog author promises to post more about these steps later, and I look forward to seeing what she has to say on the matter.

Preeclampsia, Toximia, HELLP Syndrome & Pregnancy-Induced Hypertension

Pregnancy-Induced Hypertension or PIH is a diagnosis which includes the complications of: toximia, preeclampsia, eclampsia (which indicates that a seizure has occured) and the HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, which indicates blood and liver complications. The term PIH can be used to refer to any or all of the above complications.

Sustained high blood pressure or Hypertension can increase an expectant woman's risk of reduced placental blood flow to the baby, placental abruption, and possible internal organ damage to the mother. Blood pressure can vary according to activity level, emotional state and body position. If you are at rest and free of emotional stress, your blood pressure is more likely to be low, whereas if you are active and/or stressed your blood pressure is more likely to be elevated. Blood pressure readings can vary depending on the instrumentation used and the skill of the person taking the reading, so it's a good idea to request that the same person with the same equipment take your blood pressure reading each time you have it checked.

PIH can be prevented and/or reversed through a healthy diet. 80 to 100 milligrams of protein daily can reverse the symptoms of PIH. Good sources of protein include:

• Meat, poultry and fish
• Eggs
  
• Dried beans and peas
• Cheese (cottage cheese is especially high in protein)
  
• Milk
• Whole grains
• Peanut butter
• Nuts

For more information about a health pregnancy diet, please see my post about Staying Healthy and Low-Risk

Mild PIH consists of the following symptoms:

• Blood pressure over 140/90
  
• Edema (fluid retention and swelling)
• Protein in the urine

Mild PIH is generally treated with bed rest (the best position to rest is on your side), regular blood pressure checks, and close medical supervision to watch for signs of a more serious problem.

Severe PIH is characterized by any or all of the following symptoms:

• Blood pressure over 160/110
• Headaches
• Blurred vision
• Spots before the eyes
• Pain in the upper abdomen
• Decreased urine output
• Increased knee and ankle reflexes
• Changes in blood chemistry that indicate problems with the liver, kidney and blood platelet levels
• In the most severe cases, seizures or coma or death of the mother and baby can occur, which is why PIH is treated very aggressively

Severe PIH may be treated with hospitalization and medication such as magnesium sulfate to decrease the risk of seizures.

If signs of severe PIH persist after treatment, an induction of labor or cesarean section may be planned. Blood pressure generally normalizes within days or weeks after birth, and with early diagnosis and treatment, complications from PIH are usually minimal and a healthy outcome is achieved.

The causes of PIH are unknown, but it has been found to be more common in first time mothers, those pregnant with twins, teenagers, women over the age of 35, obese women, those with poor diets, and women in high stressful living conditions. Expectant mothers with a personal or family history of chronic hypertension, kidney or liver disease, diabetes mellitus, or a past pregnancy with PIH are also more likely to develop PIH.

Information paraphrased from Pregnancy, Childbirth and the Newborn by Simkin, Whalley & Keppler.