"Cynthya was our doula for the birth of our third child in April 2016. As this was my third birth, and I had been attended to by a doula at the first two, I knew that finding the right doula was crucial to a successful and satisfying birth." - Winter Wheeler-Young
Maternity Care in America: Midwifery Model of Care
Although not everyone needs the skills of a surgeon at their births; every woman can benefit from the presence of a midwife. Read more thoughts by Nuria Nelkin, certified nurse-midwife at North Fulton Regional Hospital in Roswell, GA.
How does society view pregnancy and birth? How do YOU view pregnancy? How do YOU view birth? Is it automatically an illness/problem? Are pregnant women ill, weak? Is it a natural state of the body? Can things go wrong? When are interventions appropriate?
The belief and attitude towards pregnancy and birth as a normal part of life versus an illness waiting to happen is the basis between the medical versus midwifery models of obstetric care. The short answer is, NO. Most pregnancies are not a medical problem. Because there is always a possibility of complication during the amazing transformation of a woman growing a person, it is sensible to monitor pregnancies closely to be able to recognize potential or actual problems, and refer to appropriate providers (that can manage a higher risk/problem) as needed.
“Although not everyone needs the skills of a surgeon at their births; every woman can benefit from the presence of a midwife.”
Approximately 90% of births in the U.S. are attended by physicians (National Vital Statistics Reports, 2014). All women do not need a surgeon to directly manage their pregnancy, labor, and birth. Physicians/surgeons are taught how to analyze situations by identifying a medical problem and solving it. Labor and birth don’t always need that type of analysis or intervention. The midwifery model approaches pregnancy and birth as a normal process until proven otherwise.
Midwives are taught to educate women about the process of labor, birth, and motherhood and help a woman manage labor and birth, while also having the skills to identify complications. They are taught to handle small complications and identify which ones they need to send on to a physician. Sometimes that means using their amazing, life-saving surgical skills; sometimes it does not. Although not everyone needs the skills of a surgeon at their births; every woman can benefit from the presence of a midwife.
Midwives and obstetricians working as a team is the perfect answer. Having hands-on care treating pregnancy as normal unless it presents otherwise, and involving the obstetrician/physician in the care if concern arises, gives women high-touch, low-intervention care unless otherwise necessary.
About the author Nuria Nelkin, CNM:
After working as a nurse for several years and experiencing the pregnancy and birth of her second child, she knew that to pursue a career in midwifery was her calling and dream, and completed her MSN in Nurse-Midwifery at Frontier Nursing University. Nuria is also a wife and mother of two young, active boys. She enjoys spending time with her family and friends, reading, and exercising.
References:
Liljestrand, Jerker. Midwives are Essential to Global Health. Time Magazine. May 5, 2016.
National Vital Statistics Reports, Volume, 64, Number 12. Births: Final Data for 2014. December 23, 2015. Obstetric Care Consensus. Levels of Maternity Care. Number 2. February 2015.
Related articles:
5 Labor Tools for Partners
The Most Common Complications of Childbirth
AROM: To Break or Not To Break
Labor Comfort Measures
Is Waterbirth Safe? What are the benefits and risks for mothers and babies?
Our team has seen the beneficial effect of hydrotherapy use for labor and when clients give birth in the tub. The warmth of the water, the added buoyancy, with the addition of pouring water down the back or tummy, always adds a measure of comfort throughout labor and birth.
How To Have An Easy and Relaxed Labor
As labor doulas, we have seen the beneficial effect of hydrotherapy use during labor and while giving birth in a tub. We often suggest to clients that they take a long, warm bath in early labor to slow down contractions and relax the uterus enough so that sleep becomes possible. Once a strong pattern of contractions has been established, typically, a bath will not slow labor but allow for complete relaxation of the muscles between contractions.
The warmth and buoyancy of the water provides a measure of comfort throughout labor and birth. Slowly pouring water down the back or tummy is also helpful. Hydrotherapy and underwater birth is safe and reduces the need for pain medications while lowering your risk of a c-section due to the ability to move into and maintain open-pelvic positions for easier rotation and descent of the baby.
“A 2012 Cochrane review found no harm to the baby in 12 randomized controlled trials of water labor or birth involving 3,243 women, and less use of epidural anesthesia.”
The evidence shows that babies born in the water have similar health outcomes compared to babies born on land. The bottom line is that waterbirth is a reasonable option for low-risk birthing people.
An excerpt by Dr. Rebecca Dekker of Evidence Based Birth from her article titled Water Immersion During Labor for Pain Relief:
"The bottom line is that researchers have found that water immersion during labor poses no extra risks to the baby. They’ve overwhelmingly found that it lowers the need for pain medications and it makes people feel more satisfied with their pain relief. Hydrotherapy’s effectiveness on pain appears to be less effective than an epidural or spinal, but more effective than using IV opioid drugs. The good thing about water immersion during labor is that there doesn’t seem to be any side effects. Also, evidence shows that water immersion during labor increases people’s satisfaction with their childbirth and their sense of privacy and comfort. Mothers who labor and give birth in water tend to remember their experiences as being more positive and less painful." Read full article here.
We encourage you to explore for yourself all that underwater birth can offer you. Seek out medical facilities and care providers offering inflatable tubs or birth pools for labor and delivery (not just water "labor" or immersion). For further reading on water birth, checkout NPR's Shots article from March 2014.
