A recent article in the New York Times claims midwives have become increasingly popular healthcare providers because they’re a status symbol. Apparently, upper middle class women are no longer too posh to push. Instead, they’re posh enough to take over the childbirth market with demands for personalized, family centered and wellness oriented prenatal, labor and delivery care. Hallelujah! If midwifery care has become the hottest trend, I say there’s hope for the American birth industry yet.
Here’s a newsflash though. Americans aren’t out in front on this trend. Midwives rule the market in lots of countries including those where maternal health outcomes are the best in the world (and way ahead of the US), like Norway, Ireland and Australia. In other parts of the world where obstetricians are scarce (including developing countries like rural Africa, India and South America) and there are very few midwives, it’s the midwives who are saving women’s lives.
Not just certified nurse midwives either, but also certified practical midwives and trained birth attendants (AKA lay midwives). They’re providing prenatal care and family health care, delivering babies and following up with postpartum and family planning care. In countries like Uganda, for instance, there are obstetricians, but not very many and most women can’t get to where they practice and they don’t provide most of the routine, normal, healthy-mother services. They focus on emergencies and complications. Midwives are more readily available, though there aren’t enough by any means.
The Times article quotes Christy Turlington Burns, model, film maker, CARE advocate, entrepreneur and founder of Every Mother Counts, (a non-profit advocacy and awareness organization working to improve global maternal health conditions). Turlington Burns says, “I knew I wanted a natural childbirth. When I met my midwife, her whole approach felt closer to home.”
That’s what a lot of women are looking for, partly in response to the backlash created by ever-increasing C-section rates and not-so-hot American maternal health statistics. They aren’t necessarily looking for home births (and neither was Turlington Burns. She delivered in a birth center located within a hospital), however, or even all-natural births. Instead, they’re looking for alternatives to the cookie-cutter, baby factory, high-intervention model of care that’s been prevalent for much of the last couple decades.
Rather than being viewed through the lens that many obstetricians use that evaluates women as potentially risky, midwives tend to see women as probably normal. Pregnancy and birth aren’t usually rife with complications. Most of the time, for most women they’re, well, normal. That’s what midwives do. They take care of normal women. Can you use a midwife if you want an epidural? Sure. Certified Nurse Midwives that work in hospitals have easy-access to epidurals and if you need one, you can get one and still continue as a midwife patient.
In many parts of the world (including areas with the very best maternal outcomes) labor and delivery units are staffed with certified professional Midwife (CPMs), not certified nurse midwives (CNMs). Here in the US, there’s a strong preference and bias towards CNMs.
What’s the difference? Certified professional midwives go through an intensive training program usually via a university program and take a test that certifies their education and skills meet all the same requirements as certified nurse midwives. The difference is, their course of study doesn’t include nursing school. Instead, they become the specialists in out-of-hospital birth settings like birth centers and home births. In a few states here in the US, CPMs also do hospital births).
There are some advantages to having a nursing background as CNMs do, but it isn’t always a mandatory element when it comes to choosing an excellent midwife. In fact, in many nurse midwifery programs, the nursing piece is covered by only a one-year boot camp nursing education that prepares them to function in a hospital setting. CNMs are generally considered the experts at providing hospital births though many also deliver in birth centers and at home. The biggest advantage of having that CNM versus CPM title is that CNMs are generally more accepted and respected by obstetricians and hospital administrators and they can practice legally in all 50 states.
Last year, I fundraised for an organization called Shanti Uganda, which was opening a birth center staffed by midwives in a rural area of Uganda. They’ve been providing high-quality care for over a year now and just celebrated the birth of their first twins last month. In addition to providing patient care, they also provide ongoing education to Ugandan women and children and healthcare providers who want to work with pregnant women. In fact, this fall they’re doing a ten-day intensive doula training workshop that’s open to anyone with a passion for pregnant women. If you or someone you know wants in on this, click the link and go for it. It could be the adventure of the lifetime and the beginning of a great career.
So back to that New York Times article - if what it takes to put normal childbirth in high demand is for it to become a status symbol, well then, so be it. Here are a couple other items on my wish list that I think could revolutionize the way we have babies here in the US, making it safer, more affordable and more available to all women, not just status-seekers:
· Open more birth centers focused on normal childbirth located in or near hospitals.
· Respect that midwives are really, really good at what they do and that includes CPMs, CNMs and even some non-certified midwives. They deserve the support and respect of the OB community.
· Provide more pain relief options to American women, including Nitrous oxide (AKA laughing gas which is available to women all over the world except here in the US), so we have more to choose from than just going all natural or going for an epidural.
· Add a safety net for women and midwives who want to try home birth by making it easier, friendlier and less adversarial to transfer to a hospital if an emergency arises.
· Make it easier for all women to get good quality prenatal care whether they live here in the US or somewhere else in the world.
Jeanne Faulkner, R.N., lives in Portland, Ore., with her husband and five children. Got a question for Jeanne? Email it to firstname.lastname@example.org and it may be answered in a future blog post.
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