Archive--Midwives

Features

03/05/01

Midwives becoming more common, more accepted

By Brook Cox

When Debbie Berg, an expectant USU mother who has chosen to use a midwife for her prenatal care and delivery of her baby, due in July, told her in-laws and others that she and her husband had chosen to use a midwife for the birth of their first baby, they were all a little leery.

"They pictured some lady boiling water while I was giving birth in the bathroom. Once I explained what the benefits of having a midwife were they weren't so worried," Berg said.

Many women would never consider using a midwife at the delivery of their baby, saying that it's crazy, while other mothers see midwifery as a wonderful option, Deb Flansburg, a certified nurse midwife in Cache Valley said.

People ask, "What if something goes wrong?" Those are the people that don't understand what a midwife does, Flansburg said.

A midwife provides care to women who are of childbearing age, according to the American College of Nurse Midwifes.

This care includes prenatal care, care during labor and delivery, care after birth, and other basic gynecological care.

The philosophy of midwifery "is focused on the needs of the individual and family for physical care, emotional and social support and active involvement of significant others according to cultural values and personal preferences," according to the ACNM.

In his article entitled, "Allies, not Enemies," Robert Engvall, PhD, said that instead of focusing on the argument of whether doctors are better than midwives or vice versa, people should consider the value of nurse-midwives as an alternative or help to a doctor and as professional medical colleagues. The prenatal care and delivery of a baby doesn't need to be made out to be a competition between doctors and midwife. Instead it should be a collaboration of differing experts, Engvall said.

Certified midwives undergo extensive training and must pass a national certification exam. There are 47 accredited nurse-midwifery programs in the United States and most of these programs offer a master's degree, according to ACNM.

To become a certified nurse-midwife a person first must obtain an undergraduate degree in nursing, then goes on to a master's program in midwifery, which usually takes three years, Flansburg said. Flansburg received her certification and midwifery master's degree through the University of Utah.

It doesn't make sense when people say that midwives are unsafe, Berg said, because a doctor goes to medical school for around four years to learn about the whole body, and midwives go to medical school for three years and focus on prenatal care, labor, and childbirth. They are like a very specialized doctor, she said.

Not only do midwives deal directly with the physical needs of pregnancy, they also deal extensively with the emotional needs of pregnancy and how a woman feels about her pregnancy.

Pregnant women are in a fragile emotional state, Elizabeth Austin wrote in "Electing an Alternative Approach." They shouldn't have to deal with an over-scheduled doctor and they should be able to be comforted and have all their questions answered,

"It's not just, 'How are we going to get this baby out of your uterus?' but 'How are we going to make this transition into being a mother," Laura Meckler said in a story for ABC News.

The value of a midwife is making sure that the patient is well educated and has adequate support and care. For this reason midwives stay with the mother during the entire labor and delivery. Flansburg said she has spent 24 consecutive hours with a mother. Women need to understand what is happening and have all their questions answered, Flansburg said.

Unlike doctors who have a tendency to treat pregnancy as a medical crisis, Flansburg said, midwives treat pregnancy as normal. Women who choose midwives often feel the same way and want to have a more natural childbirth.

Berg said the first time she and her husband sat down with their midwife, the midwife asked them what they pictured for the birth of their baby. The Bergs wanted a natural birth and their midwife told them about different birthing positions and massages that work with the body, instead of against it. Although the Bergs don't plan on the use of an epidural (a pain reliever) or having an episiotomy (an incision made to enlarge the vaginal opening), most midwives are able and willing to give pain medication or perform episiotomies.

Many women are receiving episiotomies unnecessarily, Charnicia E. Huggins writes in a recent article in Obstetrics and Gynecology, and in a comparison between private physicians and midwives, it was found that physicians were four times more likely to perform an episiotomy.

Berg's midwife, D'Anne Moon, said that she has an epidural rate of about 50 percent, and the hospital's rate is around 80 percent. Nationwide the average nurse-midwife's epidural rate is 14.6 percent and the episiotomy rate among midwives is 30.1 percent, according to ACNM.

Like the Bergs' delivery, most CNM-attended births occur in a hospital delivery room. According to the National Center for Health Statistics, in 1997 96 percent of CNM's deliveries were in hospitals, 2.4 percent were in freestanding birth centers, and 1 percent of all CNM's births were in the home of the mother.

Midwives like Moon and Flansburg work in doctors' offices, and work jointly with a doctor throughout the entire pregnancy. Then, because they have their deliveries done in the hospital, if something goes wrong there is always a physician to collaborate with, which gives the patient more attention and care, Flansburg said.

Since 1982 CNMs in Utah have also been given prescription writing authority, according to ACNM.

"Our midwife works for a doctor who is on call the whole time you are in labor, so you are not really having a midwife instead of doctor; you get both," Berg said.

With all the extra attention and care, some may wonder if having a midwife costs more or less. Cost depends on place, Flansburg said. Flansburg's time is billed through the doctor's office. She said that most insurance plans readily accept charges from midwives and, according to ACNM, certified nurse-midwives in Utah receive third party reimbursement from most insurance companies.

When looking for a midwife, what qualities should you look for? Look carefully at education; their philosophy of care; their relationship with the doctor

and their experience, Deanne Williams said during a webcast at onhealth.com. Also look for a midwife who has a style that you like; someone who is willing do to what you would like to do, Flansburg said.

Since 1975 the number of certified nurse-midwife-assisted births has increased. In 1998, nine percent of all vaginal births in the United States were done by certified nurse-midwives. In 1997, 6.2 percent of all births in Utah were performed by CNMs, according to ACNM.

There are 89 certified nurse-midwives in Utah and 31 nurse-midwifery practice sites, according to ACNM.