I know just that title alone had people’s hackles raised, so let me start off with a few points.
First, I understand that some pregnancies are high risk and require a hospital or comparable facility. Some women and/or pregnancies just shouldn’t be out of a hospital for birth. Hospitals, ob-gyn’s, and c-sections are there for just that reason.
Second, I understand some women feel better in a hospital. I think almost every woman can benefit from a midwife, but I understand some women probably will still prefer an in-hospital midwife.
Okay? I’m not a home birth Nazi. I want that straight.
I do strongly believe, however, that the birth industry as it exists in America is not ideal for women or babies, and statistics support me on that.
Unfortunately, when many people think of midwives, they have an idea of someone who has rather primitive knowledge and capabilities for birth; God forbid the mother hemorrhage or have any other complication, because she or the baby might die.
The reality is different. While I’m sure there are sub-par midwives (just like there are sub-par doctors), the training midwives are required to receive is impressive. A thorough college education and the attending and assisting of a minimum number of births (I believe 100) is required in Washington. It’s common for midwives to have other medical background as well. For instance, mine worked as a nurse in labor and delivery before practicing midwifery.
To the surprise of the average woman, the U.S. has one of the worst maternal and infant mortality rates among first world countries. And, surprise surprise, the countries that have better rates have about 70% of births attended by midwives.
There are a few reasons for this. At a hospital, births are often rushed. Considering how long a normal birth can take, particularly the first, getting impatient at twelve hours is ridiculous. It seems intuitive enough that in a natural, healthy, normal process, human interference can cause problems. In birth, that’s often exactly what’s done. A woman goes a while, and before she knows it the hospital staff are urging her to start pitocin. Since epidurals can slow labor, this is more likely in a hospital birth involving drugs.
The biggest problem with pitocin is that the contractions are longer and harder than normal. This causes greater pain, requiring more drugs, which slows labor again, so more pitocin is given. In the meantime, the baby is enduring these longer, harder contractions, making fetal distress more probable. And then oh, we’re off for a c-section and wasn’t it good we were here to save your baby? Never mind that the mother probably would not have needed the surgery had she not had so many interventions in the first place.
In fact, c-section rates with midwives tend to be significantly lower, along the lines of 3% versus 30%, yet mortality rates are no higher and often lower.
Many women don’t really think of a c-section as major surgery, but it is. A woman is opened up, her intestines are moved around, the uterus gets cut open. She faces all the regular risks of major surgery. And if she is sewn up badly, her life could be at risk if she has a subsequent pregnancy too soon. Even if all goes well, subsequent births are riskier and more likely to require another surgery, increasing risks even further. Since only maybe a tenth of c-sections in hospital births are actually medically necessary (and not precipitated by hospital interventions), this seems like unacceptable risk.
If that weren’t enough, drugs and surgery interfere with the normal bonding of mother and newborn. A cascade of hormones, such as oxytocin, respond to the first contact of mother and child in the moments after birth. It is a bonding, an emotional high, like nothing else in life. It is nature’s way of guaranteeing that a mother will love and nurture her child. When this bonding is interfered with in the animal world, it is so devastating that often the mother will abandon the baby. Yet when we put drugs and surgery into the mix for birth when not necessary, interfering with this experience is exactly what we’re doing. Obviously humans don’t usually abandon babies even after a c-section, but mothers who have experienced both a birth with drugs and/or surgery and a birth with out almost always will attest to the major difference in bonding.
Natural birth with a midwife has many other benefits. Midwives are trained and able to handle emergencies, either completely on their own or until emergency services take over. (Hint: if a midwife does not have such capabilities, don’t use her.) A midwife will have oxygen, IV, and many other items for emergencies, in additional to the more normal fetal monitors, stethoscope, blood pressure cuff, and other things to monitor the well being of mom and baby. A midwife is capable of handling virtually all prenatal care, including blood tests and pap smears.
Midwives are not the reason for higher death rates before modern medicine. Lack of antibiotics and other modern medicine to handle emergencies (including the lack of ability to perform a c-section without killing the mother) were the cause. Combining modern medicine with the natural process and personal care of a midwife is far different from primitive birthing conditions.
A birth with a midwife is often more personal, relaxed, and comfortable, especially out of hospital. The mother can move; she doesn’t have to be in bed. This can help her use gravity and movement to bring the baby into place. The mother can give birth in a better position than the typical feet-in-stirrups in a hospital. The father can be more involved in helping ease contractions or bracing his wife during pushing, instead of just holding her hand. The mother is likely to tear less, if at all (many midwives try to avoid doing an episiotomy, for many good reasons).
The environment and personal level of care received is often superior out of a hospital. Whether in a birth center or at home, the environment is more homey and comfortable. The midwife is there for much of the labor, instead of arriving for the last part only. For the most part, there is a confidence and trust in a woman’s body, one that is rightly placed in most normal, low-risk births. As long as all is going well, the woman can labor how she needs and birth in the best way for her.
Midwives have lower mortality and c-section rates than hospital births with ob-gyn’s. Ob-gyn’s are wonderful for emergencies, but they’re really meant — and trained — for emergencies. Midwives can handle emergencies, but they are meant for the beautiful, empowering process of a natural birth, in or out of a hospital.
I would highly recommend the documentary “The Business of Being Born”, available on Netflix, for anyone who wants to know more.