Posts tagged ‘midwives’

Midwives vs. Hospital Births

NOTE:  I realize that a lot of people that might be reading my blog will be completely un-interested in this (as it has nothing to do with makeup or video games), but this is the topic I had for my presentation in Medical Terminology tomorrow.  It ended up being very interesting, and very worth looking into on your own if you ever plan on having children.  If you do so, I recommend checking out ‘The Business of Being Born’, a very good documentary on Netflix and Youtube.

What is a midwife?

The term midwife is derived from the Middle English word ‘mid’ which means “with”, and the Old English word ‘wif’ which means ‘woman’.

A midwifery is a health care profession in which providers offer care to childbearing women during pregnancy, labor and birth, and during the postpartum period.  They also care for the newborn and assist the mother with breastfeeding.  They even provide primary care related to reproductive health, annual gynecological exams, family planning, and menopausal care.

Midwives are qualified health care providers that go through comprehensive training and examinations for certification.  Certification is offered by the American College of Nurse Midwives (ACNM) and the North American Registry of Midwives (NARM).  The practice and credentials related to midwifery differ throughout the United States.  Like in the EMT field, there are different levels and types of midwives:

  • Certified Nurse-Midwife (CNM): individual trained in both nursing and midwifery.  Nurse-midwives possess at least a bachelor’s degree  and are certified by the American College of Nurse Midwives.
  • Certified Professional Midwife (CPM): trained in midwifery that meets practice standards of the North American Registry of Midwives.
  • Direct-Entry Midwife (DEM):  independent individual trained in midwifery through a variety of possibilities that include: self-study, apprenticeship, a midwifery school, or college program.
  • Lay Midwife: an individual who is not certified or licensed as a midwife, but they are trained informally through self-study or apprenticeship.

The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes, and they seek a variety of options in order to eliminate or minimize unnecessary interventions.  They strive for a positive birth experience and a natural birth if possible.

HISTORY OF MIDWIVES:

History of midwives extends all the way back to ancient Egypt where it was a recognized female occupation.  This dates back to 1900 BCE.  Even back then and in Roman Empire, there was a range in the level expertise of midwives.  Some followed the stereotype of old women that used folk medical  traditions in villages, trained midwives who gathered information from a variety of sources like a DEM, and highly trained women who were considered female physicians, kind of like the nurse-physicians of today.

In the 18th century, a division between surgeons and midwives arose as medical men asserted that modern scientific processes were better for mothers and infants than midwives.  By the 19th century, a majority of babies born had a surgeon present.  With the changing conditions of urban life, new perceptions of women, and advancements in medical science, birth became increasingly viewed as a medical problem to be managed by physicians, rather than a natural process.    Birth evolved from a physiological event into a medical procedure.

An example of twilight sleep, a very scary thing.

In the early 1900s, there was a smear campaign against midwives in the US.  Midwives were portrayed as dirty, illiterate, and ignorant, whereas hospitals were portrayed as the cleaner, safer alternative.  Unfortunately back then, many doctors had not ever witnessed a live birth.

In 1900, 95% of births in the United States took place at home.

In 1938, 50% of all births took place at home.

By 1955, less than 1% of births took place at home.

Nurse-midwives were introduced in the United States in 1925 by Mary Breckinridge for use in the Frontier Nursing Service (FNS).  The combination of nurse and midwife was very successful.  The Metropolitan Life Insurance Company studied the first seven years of the service and reported a substantially lower maternal and infant mortality rate than the rest of the country.  With this success, the Frontier School of Midwifery and Family Nursing was founded in 1939 (the first nurse-midwifery education program in the U.S).

By the 1960’s, surgical medical interventions were common in most births and American hospitals, and most women are unaware of any other way to give birth (some unaware when they even gave birth…)  Infants were taken from mother at delivery and cared for in newborn nurseries, bottle feeding became the norm, babies born outside an operating room were labeled contaminated and kept separately.

In 2008, midwives attended over 70% of births in Europe and Japan, but in the United States they attended 317,626. which is about 7.5% of overall births.

The major misconception of midwives comes from the smear campaign I mentioned earlier from the 1900s.  Midwives were considered uneducated, dirty old women that clung to folk practices.

In actuality, nurse-midwives may work closely with obstetricians, who provide consultation and assistance to patients who develop complications.  They practice in hospitals, medical clinics, and private offices and may deliver babies in hospitals, birth centers, and at home.  They are also able to prescribe medications.  Most people think they can’t, and that is another common misconception.

Unfortunately, the ‘smear’ campaign extends today.  Nowadays, women are terrified of birth.   Society, culture, TV, and hospitals tell women that birth is a dangerous process from which few women escape unscathed.  Women expect it to be terrifying and traumatic, and that’s why they go to hospitals to get drugged up.

However, for normal childbirths (births that are low-risk and have no perceived complications), it is perfectly acceptable to use a nurse-midwife.  In high risk situations, it of course much safer to have the birth in a hospital setting where advanced interventions can take place.  However, this doesn’t mean the nurse-midwife should be eliminated from the scenario.  Low risk pregnancies make up about 60-80% of all births, which means 20-40% of births can have complications, with a much smaller percentage actually being high-risk.

PROS OF MIDWIFE-ASSISTED BIRTH:

  • Midwives give a more personal level of care: it is directed at the woman and her individual reproductive needs.
  • Lower maternity care cost.  Physicians get paid around $280 for a delivery. This does not include costs for hospitalization, pre- or post-natal care, or any additional costs that may arise out of inducement of labour, cesareans, spinal blocks, or other services. The cost for an average hospital bed per night is $450. With the average stay for a birth being three to seven days, the cost to the mother is very high. Midwives, on the other hand, charge between $400 and $1000 for a package that includes pre-natal care, labour and delivery, and post-natal care.
  • Lower intervention rates in normal births.  An epsiotomy (cutting of the perineum) is done in 80% of hospital births, and midwives use it less than 1% of the time.  Labour is induced 40% of the time in hospitals; whereas midwives generally never induce births.    Etc.  Some doctors argue that these rates are skewed because hospitals deal with mainly high-risk scenarios.  However, according to Dr. Malcolm Brown, a health care economist at the University of Calgary, the high rate of cesareans done in hospitals is because doctors find it convenient and they make money on them.  Physicians collect extra fees for inducing labor and for giving spinal blocks.  This leads one to question whether these procedures were truly done in only high-risk scenarios as originally intended.
  • Mid-wife assisted births can offer mothers more control over the delivery, the ability to form and stick to your own birthing plan, and if you wish to have a natural child birth, you are much more likely able to be able to go through with it as most doctors would rather not wait as long as natural births tend to take.
  • In the cases of normal births, studies have shown that births assisted by midwives generally fare better.  A study done by Dr. Lewis Mehl in 1985 studied  421 women attended by physicians with 421 women attended by midwifes at home. The midwife sample fared far better with significantly less fetal distress, birth injuries, and infants needing resuscitation.  The former head of the International Confederation of Gynecology & Obstetrics, Dr. Caldero Barcia, goes as far to state that ‘iatrogenia’ (doctor-caused illness), is the main cause of fetal distress.   This happens when doctors use routines that protect high-risk mothers and babies on low-risk mothers as preventative measures.
  • Better development of baby – some studies show that the birthing experience can enhance the mother/child relationship and consequently, the child’s development.
  • Emotional benefit.  Most women that have a natural birth that is a non-traumatic experience generally get a huge confidence boost and see the experience as an uplifting experience.  Those who have hospital births tend to either not remember most of it, block parts of it out of their memory, or regard it as a traumatic experience.

CONS OF HOSPITAL BIRTH:

  • Most doctors have never, or have rarely seen a natural birth.  Surgeons should be doing surgery, not dealing with normal births.   Normal birth is not a surgery.  When surgeons treat something that is not a surgery like a surgery, it is more likely that complications will develop that will lead to surgery.  In other highly developed countries, OBGYNs do not even deal with normal births.  Those countries also have lower death rates in normal births.
  • Hospitals are businesses.  It’s about filling beds, and then emptying them in a timely manner.  Decisions are made for monetary and legal reasons, not because they are good for the mother and the baby.   Therefore if births take too long, doctors start implementing un-needed interventions in order to speed up the process.

(13:00)

There is no medically justified reason for doing this in a normal birth, except to get the woman out of the hospital faster so they can get their next customer in.

  • Birthing position – in hospitals they generally have you lay flat on your back with your feet in the stirrups so the doctor has easier access.  This is a very dysfunctional position, as it literally makes the pelvis smaller (by 10%), and makes it harder to use stomach muscles to push.  However, when standing vertically and moving throughout labour, it makes it much easier for the baby to slide out.  When laying in the flat position, it is easier for the baby to get stuck, for the umbilical cord to get wrapped around the neck, and makes it much more likely that the doctor will have to suck the baby out with a vacuum.  It’s gravity, pure and simple.
  • Cost is much higher.

FINAL THOUGHTS:

I honestly think that it’s all about compromise.  Midwives should be there to take care of normal births, and surgeons should be there and ready for the small percentage of when things go wrong as births can appear completely normal, only to go wrong at the last minute.  It’s a system used throughout the world, yet the US is the only country that does not follow this.  I think the problem is that when birth went into the hospital, midwives did not go with it.

However, contrary to popular belief, most midwife assisted births happen in hospitals.  (9 in 10) I believe that his should be the norm rather than the exception.  Unfortunately, this is a extremely touchy subject as people are  violently for or against midwives.  There is a tension between doctors and midwives that is leading, in my opinion, to an increase in mortality rates.  I believe that if all hospitals would work together with midwives, and in turn, if midwives and birthing centers would be more open to hospitals and emergency care, we wouldn’t have the second worst mortality rate in mothers and infants of developed countries.

I think the issue is a lack of trust – midwives do not trust that the doctors have the patient’s best interest in mind, therefore some are less willing to work with doctors which is bad.  Doctors on the other hand, would rather  not deal with the hassle of a normal birth and make things needlessly complicated, which is also bad.  I think an important fact for doctors to consider is if such and such technology is really making something better, or if it’s just complicating the birthing process to make the doctor’s job easier?

I personally think a good compromise would be to have the birthing section of the hospital run by midwives with surgeons and OBGYNS on standby in case anything wrong happened or for advice.

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