Great Midwifery Article in the LA Times

Here’s a wonderful pro-midwifery article in the LA Times!

I also have the text here:

Midwives deliver

America needs better birth care, and midwives can deliver it.

By Jennifer Block
December 24, 2008
» Discuss Article (23 Comments)

Some healthcare trivia: In the United States, what is the No. 1 reason people are admitted to the hospital? Not diabetes, not heart attack, not stroke. The answer is something that isn’t even a disease: childbirth.

Not only is childbirth the most common reason for a hospital stay — more than 4 million American women give birth each year — it costs the country far more than any other health condition. Six of the 15 most frequent hospital procedures billed to private insurers and Medicaid are maternity-related. The nation’s maternity bill totaled $86 billion in 2006, nearly half of which was picked up by taxpayers.

But cost hasn’t translated into quality. We spend more than double per capita on childbirth than other industrialized countries, yet our rates of pre-term birth, newborn death and maternal death rank us dismally in comparison. Last month, the March of Dimes gave the country a “D” on its prematurity report card; California got a “C,” but 18 other states and the District of Columbia, where 15.9% of babies are born too early, failed entirely.

The U.S. ranks 41st among industrialized nations in maternal mortality. And there are unconscionable racial disparities: African American mothers are three times more likely to die in childbirth than white mothers.

In short, we are overspending and under-serving women and families. If the United States is serious about health reform, we need to begin, well, at the beginning.

The problem is not access to care; it is the care itself. As a new joint report by the Milbank Memorial Fund, the Reforming States Group and Childbirth Connection makes clear, American maternity wards are not following evidence-based best practices. They are inducing and speeding up far too many labors and reaching too quickly for the scalpel: Nearly one-third of births are now by caesarean section, more than twice what the World Health Organization has documented is a safe rate. In fact, the report found that the most common billable maternity procedures — continuous electronic fetal monitoring, for instance — have no clear benefit when used routinely.

The most cost-effective, health-promoting maternity care for normal, healthy women is midwife led and out of hospital. Hospitals charge from $7,000 to $16,000, depending on the type and complexity of the birth. The average birth-center fee is only $1,600 because high-tech medical intervention is rarely applied and stays are shorter. This model of care is not just cheaper; decades of medical research show that it’s better. Mother and baby are more likely to have a normal, vaginal birth; less likely to experience trauma, such as a bad vaginal tear or a surgical delivery; and more likely to breast feed. In other words, less is actually more.

The Obama administration could save the country billions by overhauling the American way of birth.

Consider Washington, where a state review of licensed midwives (just 100 in practice) found that they saved the state an estimated $2.7 million over two years. One reason for the savings is that midwives prevent costly caesarean surgeries: 11.9% of midwifery patients in Wash- ington ended up with C-sections, compared with 24% of low-risk women in traditional obstetric care.

Currently, just 1% of women nationwide get midwife-led care outside a hospital setting. Imagine the savings if that number jumped to 10% or even 30%. Imagine if hospitals started promoting best practices: giving women one-on-one, continuous support, promoting movement and water immersion for pain relief, and reducing the use of labor stimulants and labor induction. The C-section rate would plummet, as would related infections, hemorrhages, neonatal intensive care admissions and deaths. And the country could save some serious cash. The joint Milbank report conservatively estimates savings of $2.5 billion a year if the caesarean rate were brought down to 15%.

To be frank, the U.S. maternity care system needs to be turned upside down. Midwives should be caring for the majority of pregnant women, and physicians should continue to handle high-risk cases, complications and emergencies. This is the division of labor, so to speak, that you find in the countries that spend less but get more.

In those countries, a persistent public health concern is a midwife shortage. In the U.S., we don’t have similar regard for midwives or their model of care. Hospitals frequently shut down nurse-midwifery practices because they don’t bring in enough revenue. And although certified nurse midwives are eligible providers under federal Medicaid law and mandated for reimbursement, certified professional midwives — who are trained in out-of-hospital birth care — are not. In several state legislatures, they are fighting simply to be licensed, legal healthcare providers. (Californians are lucky — certified professional midwives are licensed, and Medi-Cal covers out-of-hospital birth.)

Barack Obama could be, among so many other firsts, the first birth-friendly president. How about a Midwife Corps to recruit and train the thousands of new midwives we’ll need? How about federal funding to create hundreds of new birth centers? How about an ad campaign to educate women about optimal birth?

America needs better birth care, and midwives can deliver it.

Jennifer Block is the author of “Pushed: The Painful Truth About Childbirth and Modern Maternity Care.”

Lyric’s Birth Story

Here is the story of my second daughter’s birth.  I like to say that Haven made me a mother, which was about as earth shattering as you could get, but Lyric’s birth made me a doula and aspiring midwife.

Following a miscarriage in September of 07, my previous OB told me it was my fault because I was still breast-feeding.  I had already decided I wanted a water birth with the second and wanted to switch providers but this really sealed the deal.  I went looking for an affordable and more sympathetic (and less myth-based) approach.
Meeting the midwives at the Mountain Midwifery Birth Center I realized everything the midwifery model of care could offer.  They actually seemed like the LIKED their jobs and talking to moms about their pregnancy and whatever else was going on in their lives, unlike my OB.
My last pregnancy was good, but Lyric’s pregnancy was even better.  I felt fantastic, even right up until I went into labor.  Towards the end she was measuring a little small, so Cassie sent me for an ultrasound.  I was freaked out and the midwives were so great and supportive and listened to my fears (everything showed up fine).
I went into the office Wednesday, June 18 for my last prenatal appointment.  Tracy did my forty-week check and found me to be 2 cm and 70% effaced.  I was feeling totally overwhelmed and emotional and when I broke down and started bawling in the waiting room, Heather said, “I think you’ll have your baby really soon.”

Sure enough, that Wed I went into early labor, waking all throughout the night with contractions.  They got much more regular at 9 am, from 2-5 minutes apart for three hours.  At 12:30 we decided to head down to the Birthing Center since we live a bit far.  We dropped off our stuff and headed to a nearby park to walk around outside.  I think this turned out to be not the best idea since I couldn’t really get inside myself and settle into the Birth Center.
We returned at 4:30 where they checked me and found I was 2 cm, 70% effaced…exactly the same as yesterday!  I was so frustrated!  I didn’t mind a longer, slower, labor as long as it seemed to be doing something!  Cassie and Tracy were awesome at talking me through my frustration, Tracy saying her last birth took three days to get there!  Tiffany also helped me regain control by saying my baby might just need a little extra time to get used to the idea of being on the outside.  They almost sent me home to a bath and glass of wine, but I really didn’t want to spend an hour in the car (contractions in the car are awful!) and I wasn’t sure when to come back since contractions were pretty close together anyway.  They decided to give me two hours to see how I would progress.

I calmed myself down, refused to look at the clock, and went inside myself.  After two hours Cassie checked me and I was at 4 cm so they decided to let me stay!  I spent some time on the toilet where my water broke, a high tear that didn’t continually leak fluid.  Two of my good friends came, including my friend who was a doula and was amazing at helping me with my breathing and rubbing my back!  Contractions started getting really strong, along with bloody show and more of the mucous plug was lost.

I spent my time going through transition in the tub, which was great and made the contractions much more round.  I was always a little worried I wouldn’t have a break if I did it naturally since I had had an epidural with Haven and it really helped my long labor by giving me a rest.  Magically my body seemed to know this and contractions slowed down to 7-8 minutes after I had gone through transition.  I even started to fall asleep in the water between contractions!  My body was naturally preparing me to push.

I was checked and found to be sort of stuck at 9.5 cm with a little “lip” of cervix left.  After sixteen hours at the Birthing Center, I really wanted to be done, so Tracy said I could try and push past it if I wanted to.  I tried but it was hard, like pushing into a hammock where the baby kept bouncing back.  Cassie ended up helping break the bag of water around her head which felt AMAZING, like her head was suddenly half as big.  Then she helped hold the lip of cervix back while I pushed.
At first I couldn’t tell what was a productive push and what wasn’t and I was losing all my energy out my voice.  Tracy gave me a great pep talk to help me learn the right way, then I became much more productive.  Twenty minutes of pushing and she was out!  My daughter Haven watched as I brought her out of the water and then she and Kyle joined me in the birth tub.  As soon as she came out of the water Haven said, “It’s a baby sister!”  Even to this day she likes to tell the story.  She says “Uterus squeeeeze the baby out and the baby came out Mommy’s yoni in the water and nurse and get all dry dry.  That was hard work for Mommy, Mommy did a good job, good job Mommy!”  Haven was totally thrilled with her new baby sister and held her even before Daddy!  We got out of the bed and spent time cuddling as a family on the bed.
After a long time, Kyle and the nurses did all the weighing and checking while I took a luxurious, relaxing herbal bath.  It felt wonderful!  We stayed for a while, then packed up to go home…at 4 am!  It was nice to be in our own bed after such a long night.  The nurses and midwives needed a break too because with the full moon and Summer Solstice brought six new babies…IN 24 HOURS!
The recovery went really really well, much better than after Haven’s birth.  I think I was able to be aware of what my body was doing so much more without the epidural and not rush my body into a place it wasn’t ready to go.  As a result I had only one tiny tear that felt fine after a day or so.
Haven’s birth was good, but Lyric’s birth was phenomenal.  I never thought I could be so nurtured and supported in the process.  The midwives and nurses were all fabulous and Kyle and I both enjoyed the intimate atmosphere.  We loved having Haven there to watch the birth.  I can think of no greater responsibility than teaching our children (especially our daughters) that birth is a normal, natural part of life and nothing to be feared.  It was all I could have hoped for and more.

birth-145Lyric Hana Brynn
Lyric:  because she loves being sung to
Hana:  meaning “flower” in Korean, her placenta is buried under a flowering linden tree
Brynn:  meaning “little drop of water” for my little water birth baby

June 20, 2008
12:23 am
7 lb 3 oz
20 in

View Haven’s Birth

In the tub

In the tub


She's born!

She's born!


Proud Daddy

Proud Daddy

7 lb, 3 oz

7 lb, 3 oz

So happy

So happy

Our family with my good doula friend Rebekkah

Our family with my good doula friend Rebekkah

Fabulous Sibling Prep Book!

I just got the best sibling prep book for any sibling and/or parent who is interested in attending a birth.  My Brother Jimi Jazz follows the story of Trinity as she prepares for the birth of her new baby brother.   It’s frank and honest, but still very beautiful.  It has the laboring mom in all these great, active positions like hands and knees and squatting.  It talks about making birth noises, the crowning, umbilical cord, how the placenta looks like a tree, everything!  The book has great illustrations that are both realistic and beautiful.  I think this book is essential to anyone planing to have a child attend a birth!  Of course, it is a part of my lending library.  You can view the author/illustrator/mama/doula’s website here.  You can purchase it from Attachments Catalog and it’s a little cheaper.  She also has a new book on breastfeeding that I’m interested in buying.

Interviewing Your Midwife

Know your Midwife

It is so important to know what you’re getting into before you’re in labor!  Interview any OBs, midwives, hospitals, and birth centers you are considering and make the best decision for you.  Also, a great new website, The Birth Survey, provides consumer reporting for doctors, midwives, and hospitals (at this point you can take the survey, but the results are said to be formulated by Fall 2008).

Here are some questions to ask your Midwife to make sure you find one who is on the same page with your birthing beliefs.  These are taken from Gentle Birth Choices, written by Barbara Harper, 2005, p. 249 (a great book, also in my library).

  1. What is your education and training as a midwife?
    It is good to discern if you are hiring a certified nurse-midwife (CNM), a certified professional midwife (CPM), or a direct-entry midwife.  Find out what their training or midwifery school was like.  The three groups represent vast differences in educational experience but not necessarily in the way they practice.
  2. What kind of testing or licensing procedure did you go through to become a midwife?
  3. How many years have you been practicing?
    Do you want to trust a midwife who is just starting out in independent practice or do you continue your search for a more experienced midwife?  Find this out right away.
  4. What is your general philosophy about pregnancy and birth?
    Midwives in general hold the philosophy that normal birth is not a medical event and needs to be respected for the creative process that it is.  I would be surprised if you found a midwife who viewed birth as a potential emergency to be prepared for.
  5. Are you a mother yourself?  How old are your children now?
    If you are choosing a midwife with young children, how will she be able to attend your birth if there are family needs?  Are you open to her bringing her young children and perhaps nursing child with her to your birth?  Ask her to share her birth stories with you.  Many women become midwives after a not-so-wonderful birth experience.  Find out about your midwife’s births.  Some argue that midwives who have never given birth cannot be as good as those who have had children.  I don’t agree with this assumption; I know some wonderful, talented, caring midwives who have not had the opportunity to give birth.
  6. Do you work alone or with a partner or assistant?  If you work with someone, what is his or her experience?
    It is important to meet all the people who will have any responsibility concerning your prenatal care, labor, or birth.  Some midwives take on apprentices or students.  Find this out in the beginning.
  7. How many births have you attended as the primary caregiver?
    How long has your midwife been in independent practice?  Has she always worked with an experienced partner?  You may ask for references from former clients.  Some midwives provide a chance for past clients and future clients to meet each other at informal classes or support groups.
  8. Do you attend births in a birth center or hospital?
    Perhaps this midwife has hospital privileges or attends births at home or in a birth center.
  9. How many births do you typically attend each month?
    For a home-birth practice, the most births that one midwife with one assistant can possibly attend is six to eight per month.  If she tries to attend more, there could be two women in labor at the same time, leaving one with no coverage.  Midwives in birth centers can handle many more births per month because they can attend more than one laboring woman at a time.
  10. Who takes over for you if you go on vacation or get sick?
    A very important consideration is who will take over the midwife’s practice if she is unable to continue or needs to leave for a certain period of time.  Make these plans with your midwife early on in your pregnancy.  Know that if you will be covered if anything happens to your midwife.
  11. Do you have guidelines or restrictions about who can give birth at home?
  12. Are these your policies or those that the state licensing requires?
    A midwife should have the same screening criteria as a doctor screening for risk factors.  Depending on licensing status, some midwives must refer to a physician for cases of breech or twins or even VBAC.  Other states have less restrictive or no guidelines.  This must be discussed.
  13. Do you require that I see a physician during my pregnancy even if everything is all right?
    A visit to a backup physician is usually in order just so you can meet and he or she can establish a chart on you.  If your midwife does not have an active relationship with a backup physician, it may be your responsibility to obtain a doctor and see him or her.
  14. What are your fees and what do they include?
    Just as with a doctor, most midwives’ fees cover all prenatal care, birth, newborn assessment, home care, and follow-up for six weeks.  Any lab tests, diagnostic tests, or extra doctor’s visits are not included.  Also not included are the costs of a hospital transfer, including ambulance, hospital, and doctor’s fees.
  15. Can you submit your charges to my insurance company?
    Many CPM and CNM services are covered by health insurance plans or state-funded Medicaid programs.
  16. What payment arrangements do you make?
    Most midwives will make an affordable arrangement to take payments throughout pregnancy.  Many even have payment forms and billing systems on their computers.  Payment of services in full is usually required before the birth.  Be considerate about the midwife’s bill and make clear and early arrangements for payment.
  17. How often will I see you?
    Visits are scheduled once a month until the seventh month, every two weeks until thirty-six weeks, and once a week after that.  Extra appointments can be scheduled at any time between regular visits.
  18. What are your guidelines concerning weight gain, nutrition, and exercise?
    Nutritional status will be monitored throughout pregnancy.  Most midwives focus on the importance of a healthy balanced diet and work with women to get the most out of what they eat.  Many midwives have special education in the use of herbs, food supplements, and homeopathy for pregnancy.
  19. Do you require that I take a childbirth education class?  Do you teach a childbirth preparation class?
    Midwives will often teach their own preparation classes.  Some midwives feel that they give so much individualized attention that couples do not need extra classes to prepare for birth.
  20. If I am planning a home birth, do you visit my home before I go into labor?
    Midwives generally make at least one home visit before they come to the house for labor.  They assure that the home is adequate and clean, and they help plan any necessary details with the couples, such as where the birth pool should go.
  21. When should I call you after my labor begins?
    Each midwife sets her own protocols about when and the reasons why to call after labor begins.  Generally midwives want to know as soon as contractions begin so they can plan their day (or night).  Some midwives will have apprentices who come right away, others arrive when they are needed.  Most encourage women to enjoy the early stages of labor and to get plenty of rest and eat if they are hungry.
  22. How do you handle emergencies?
    Ask very carefully just what kind of emergencies she is prepared to deal with and has dealt with in different situations.  A very experienced midwife may have different answers from someone just graduating from midwifery school, but their protocols should be very similar.
  23. In what situations would I need to go to the hospital?
    Find out exactly why you might be transported.  Transports can sometimes be an emergency, but more than likely they are for women who have been laboring for more than a day and become exhausted.  Find out what your midwife’s transport rate is and evaluate it.  Most home birth midwives and birth centers have a rate of less than fifteen percent.
  24. Would you stay with me in the hospital?
    Most midwives can accompany their clients into the hospital and stay with them, but in some states where midwifery is still illegal, the midwife cannot come into the hospital and admit that she has been attending a home birth.  Find out if your midwife has a good working relationship with a local hospital.
  25. What is your experience with water for labor and birth?
    Midwives traditionally have used water for pain relief during labor.  Many are now advocating its use by all of their clients.   It is difficult to find a midwife today who doesn’t use water in labor or for birth.
  26. Can I give birth in water?
    Ask if your midwife has access to a birth pool for her clients or if she knows where you can rent or purchase one.  Find out if she truly supports the option of waterbirth.  I have talked with many women who have said that their midwives talked about waterbirth prenatally and even encouraged water labor, but then asked the mother to get out of the birth pool at the last minute.
  27. How ‘hands off’ are you during a birth?
    Is your midwife is willing to “allow” the family to conduct the birth under her supervision?  Ask if she is willing to give you complete control.  Will she encourage or instruct you and your partner when and how to catch the baby?  Will she leave you alone in another room if that is what you want?  How involved can your children be in the labor and birth?
  28. What is your experience with breech births?  How many have you attended?
    Breech may be beyond the scope of practice for some licensed midwives.  Others handle it just like any other birth and specialize in breeches, especially in water.
  29. What in your experience with twins?  How many have you attended?
    Twins may also be beyond the scope of practice.  Find this out before you make further plans. (It is also illegal to have twins anywhere but in a hospital in Colorado)
  30. Do you cut episiotomies and suture perineal tears?
    Home-birth can birth-center midwives usually have an episiotomy rate of close to zero, but tears do sometimes happen during birth.  Unless your midwife sutures well, you may need to travel to a hospital if you need stitches.  This might influence your choice of practitioners.
  31. What is your experience with a VBAC?
  32. Will you attended a VBAC at home? in the hospital?
    Many midwives cannot legally attend a first-time VBAC at home because of licensing restrictions.  Some are willing to look the other way in order to give the woman a chance.  This is a very serious consideration that requires much discussion with your midwife.
  33. Have you ever had to resuscitate a baby?
    Assess the resuscitation skills of the midwife.  Midwifery organizations and nursing schools teach courses in neonatal resuscitations, and your midwife should have a current certificate.  As to see it.  Ask if her resuscitation course focused on the latest information about the consciousness of newborns.
  34. What kind of equipment do you bring to a birth?
    Find out what kind of drugs, oxygen, resuscitation equipment, intravenous (IV) equipment, and other emergency equipment your midwife keep sin her bags.
  35. Do you examine the baby after birth?
    Midwives perform a normal newborn exam on the baby usually an hour or two after the baby has been born and breast-fed.  Assess from the midwife what her routines are for newborn exams and what she uses for eye drops and vitamin K.  She may use alternatives such as oral vitamin K.
  36. Will you help me with breast-feeding?
    Midwives should be on call twenty-four hours a day, seven days a week, for all problems after birth, especially breast-feeding.  Many even have special classes or private sessions to evaluate breastfeeding readiness and answer any questions.  Some have great relationships with lactation conselors or consultants for more difficult problems.  Babies born without medications usually have an easier time breast-feeding, but that doesn’t mean every mother automatically has an easy time.
  37. How often do you come to see me after I give birth?
    Home-birth midwives generally come back for follow-up visits after twenty-four hours, two days, five days, and ten days.
  38. Do you provide or know of anyone who will help new mothers after birth?
    Some home-birth services provide a postpartum doula or can recommend one for help after the baby’s birth.  There is generally an extra charge that is well worth every penny.
  39. Do you have a pediatrician you work with or recommend?
    Some naturopathic doctors who attend home births automatically become the pediatrician.  Midwives often have collaborative relationships with pediatricians who support home birth and possibly delayed immunizations or not immunizing at all.  Interview pediatricians the same way you would your provider.
  40. How do you feel about circumcision?
    I don’t know of very many midwives who will present both viewpoints about circumcision unless their clients are Jewish or Muslim.  If there is a religious consideration, the thoughtful midwife will support her clients’ decision.

Interviewing Your Place of Birth

It is so important to know what you’re getting into before you’re in labor!  Interview any OBs, midwives, hospitals, and birth centers you are considering and make the best decision for you.  Also, a great new website, The Birth Survey, provides consumer reporting for doctors, midwives, and hospitals (at this point you can take the survey, but the results are said to be formulated by Fall 2008).

Here are some questions to ask your hospital or birth center to make sure you find a place that is on the same page with your birthing beliefs.  These are taken from Gentle Birth Choices, written by Barbara Harper, 2005, p. 246 (a great book, also in my library).

  1. Does the hospital [/birth center] encourage women to follow written birth plans?
    This is a question for a hospital [/birth center] but it may also be asked of the physician.
  2. Could you tell me how a routine vaginal birth is handled here?
  3. When do I need to check into the hospital [/birth center]?
    The longer you stay at home in early labor, the less possibility there will be for interventions.
  4. Can I labor, give birth, and stay with my baby in the same room?
    The concept of labor, delivery, recovery, and postpartum (LDRP) in the same room has been promoted for the last ten years.  If your prospective hospital is one that still transfers women into a delivery room, request that they make an exception in your case.  (There is nothing worse than being moved right before pushing!) Also be aware of the “cosmetic cover-up” discussed in chapter 8.  Not all LDRP rooms are alike, and not all allow women to do what they want.
  5. Do you routinely require an IV?
  6. Do you routinely require electronic fetal monitoring during labor?
  7. How often does someone do a vaginal exam to assess progress?
  8. What mechanism is in place so that I can refuse routine interventions like vaginal exams?
  9. How soon after my labor begins will you (or the doctor on call) come to see me?
  10. Whill you stay with me during labor?
  11. Can my partner stay with me the entire time?
  12. Can the rest of my family members, including my children or my mother and father, be present during labor and birth?
  13. Does the hospital have showers or baths in each room?
  14. Can I eat and drink during my labor?
  15. Do you encourage women to walk, squat, or be on their hands and knees during labor?
    Understanding the philosophy behind why you need to remain active during labor encourages women to move.  Lying still on a bed during labor is probably the hardest thing for women to cope with.
  16. Can I birth the baby in the position of my choice?
    Hospital beds often break apart at the foot to “allow” a woman to semi-squat.  What some women have found easier is to simply put the mattress on the floor or be supported by their partners while they squat on the floor.  Assess early on if those alternatives are acceptable to your doctor and the hospital.
  17. Can I use a warm bath for pain relief during my labor, even if my water has broken?
    There is absolutely no reason to restrict the bath even with ruptured membranes.  One woman at Santa Monica Hospital was promised that she would be able to use the brand-new baths that had been installed for labor.  What her doctor did not tell her was his list of restrictions:  A woman could not take a bath if her water had not broken and the head had not engaged into the pelvis (for fear of a cord prolapse), and she could not enter the water after her water had broken (for fear of infection).  She never once used the new baths and ended up with an epidural and her baby experienced the application of low-forceps.
  18. Can I stay in the water to birth my baby?
    Find out right away what position your doctor takes on waterbirth.  It might be your opportunity to educate him or her.
  19. What kind of pain medication do you routinely use?
  20. What kinds of nonpharmacological pain management techniques do you recommend?
  21. If I want an epidural, what are your guidelines?
    Some doctors offer a “walking epidural” which is a different kind of epidural.  Question your doctor carefully about the kids of medication used and the guidelines with which they are administered.
  22. Do you do episiotomies?  Why?  In what percentage of births?
    Does your doctor think that episiotomies are necessary?  Is he or she willing to allow you to try other techniques?  If a doctor cuts more than 10 percent of birthing clients, look for a new doctor.
  23. Do you ever use vacuum extractor?  In what percentage of births?
    Vacuum extractors were developed to take the place of low forceps.  A large suction cup (usually made of hard plastic and sometimes silicone) is placed on the baby’s scalp.  The cup is attached to a tube that is attached to a vacuum.  When a suction on te baby’s head has been achieved, constant suction will quite literally pull the baby out within ten to twenty minutes.  There are some risks with extraction, such as perineal lacerations, hematomas on the baby’s scalp, and pain for both mother and baby.  It requires a fully dilated cervix, a baby with at least some part of the scalp visible in the birth canal, and the cooperation of the mother.  Vacuum extraction is preferred over the use of forceps.
  24. Do you ever use forceps?  In what percentage of births?
  25. What is your policy concerning stripping or rupturing membranes?
    Rupturing membranes is often the first intervention that doctors do to “get labor going.”  Ask your doctor if a labor can progress normally and slowly without rupturing the membranes.  Will you be informed of his or her desire to break your water?  Do you have the right to refuse this intervention?  Assess your doctor’s guidelines for ruptured membranes.  How long will he or she allow you to go without starting labor?  What lab tests are required? Some doctors take white blood counts every twenty-four hours and body temperatures every hour and leave a woman alone.  Others want her hospitalized immediately and induce labor with Pitocin.  Studies have shown that women who walk and remain active have fewer cesareans and generally give birth before those who receive Pitocin.
  26. How long will you allow me to labor before starting interventions?
    Does your doctor go by the book in judging length of labor?  What are his or her considerations:  maternal exhaustion, nutritional needs, movement?
  27. How long will you wait to cut the cord and deliver the placenta?
    (Cutting the cord after it stops pulsing allows the baby’s organs to perfuse with much-needed blood, replenishes iron stores, and creates a smoother transition from oxygen from placenta to oxygen from baby’s lungs)
  28. Can my partner cut the cord?
    Is cord cutting viewed as a medical procedure or simply part of the process of birth that the couple has shared?  Are fathers included in this process?
  29. Is it necessary to put antibiotics in the baby’s eyes right away or can we delay that for 24 hours?
    State laws mandate that an antibacterial agent be put into the baby’s eyes to reduce the incidence of blindness from venereal disease that has been passed from the mother to the baby.  The use of silver nitrate has been abandoned by most hospitals.  More common antibiotic agents are now used.  Find out from your doctor what he or she recommends, and ask if you can choose not to use anything at all, especially if your baby is not at risk.
  30. Do you routinely give vitamin K shots to newborns?
    Vitamin K is routinely given to prevent hemorrhagic disease in newborns.  The incidence of intracranial hemmorhage is extremely low.  The administration of vitamin K has also been given to counteract the possibilities of bleeding after circumcision.  There has been an unusually high incidence of childhood ancer linked to vitamin K shots.  Oral vitamin K has not shown any relationship to cancer in children.  Ask your doctor if oral vitamin K may be substituted and if he or she has access to the latest research.
  31. Can I breast-feed immediately after birth?
  32. Can I delay weighing and measuring the baby for at least an hour?
  33. Can the baby stay with me in my room (rooming-in)?
  34. Do you routinely recommend circumcision?
    If your doctor is still suggesting circumcision and does not stress the normalcy of the intact penis, take the opportunity to educate him or her before you find another doctor.
  35. How soon after the birth can we leave the hospital?
    Most doctors recommend a short stay in the hospital.  Some are even willing to discharge after twenty-four hours.  Find out if your doctor is open to discharge after six to twelve hours, especially if you have given birth vaginally and you have adequate help at home.

Midwives Model of Care

The Midwives Model of Care reflect the idea that pregnancy, birth, and postpartum are a natural, normal phase in a woman’s life and should not be treated like a catastrophe waiting to happen.  They protect the birthing space from elements that might make a mother self-conscious or alarmed.  They also discourage medical management of labor and instead let the process work while lovingly guiding the laboring woman emotionally, physically, and spiritually.

Elements of the Midwives Model of Care

The following statement of purpose was developed by the Midwives Association of North America (MANA), the North American Registry of Midwives (NARM), the Midwivery Education Accredidation Council (MEAC), and the Citizens for Midwifery (CFM).

The Midwives Model of Care includes:

  • Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
  • Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
  • Minimizing technological interventions
  • Identifying and referring women who require obstetrical attention

The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.

You can download a brochure of this information here