When researching birth options nowadays women have plenty of choices, and one of them is having a baby under midwives’ care. Independent midwives provide an alternative to a hospital delivery offering more personal birth center or home birth experience.
After speaking with several moms and moms-to-be about their childbirth decisions, it became apparent that women have two main concerns when considering independent midwifery care: “What if I’m not healthy enough?” and “What if something goes wrong and they don’t have the technology at hand to deal with a problem?” I interviewed midwives from two estimable Eastside birth centers and a doula to address those questions.
Heike Doyle, midwife with 25 years of experience and co-founder of the Puget Sound Birth Center in Kirkland, suggests to come for a free initial consultation offered at the center to determine whether or not you qualify to be under their care. There are legal health restrictions that apply to prospective clients but statistically 80% of women are considered healthy. Although, PSBC cannot assist women with a prior C-section*, high blood pressure or a breech presentation*, most women are healthy enough to be under their care.
Heike mentioned that some women opt for a natural childbirth at a hospital with their first pregnancy “just to be on a safer side” and in the hopes of coming to a birth center for future deliveries. However, this scenario rarely works out as planned. Hospital birth for the first pregnancy increases your chances of having an unnecessary C-section, which, in return, lowers the chances of giving birth at a birth center during a subsequent pregnancy. Unfortunately, the US rate for C-sections is unjustifiably high compared to other developed nations: 32.8% percent versus 15.9% in Belgium, 17% in UK, and 12.9% in Holland. The WHO recommendation is 10-15% based on their recent studies, whereas Evergreen hospital in Kirkland performs 39% of C-sections on healthy women.
As for the safety concerns, Heike assured me that midwives are highly skilled and thoroughly trained professionals who undergo rigorous training, consisting of a minimum of five years of study and passing National and State licensure examinations in order to practice. PSBC midwives have all the necessary training, experience, and equipment (such as anti-bleeding drugs, oxytocin, high blood pressure medication etc.) to deal with emergencies. However, under their care only 0.03% of women are transferred to a hospital in an ambulance, and 10-12% are transferred to a hospital for non-emergency reasons such as prolonged labor. Midwives closely monitor Mom and baby for the signs of any complications, and if needed, will transfer them to a hospital before an emergency arises.
Andrea Hawkins-Henderson, a midwife and lactation consultant at the Eastside Birth Center in Bellevue (now at Northshore Midwives & Lactation Consulting) has shared her opinion both as a patient, who had experienced home birth and hospital birth, and a practitioner.
Since she had seen both sides, she is able to compare the quality of care firsthand. Among the downsides of hospital care Andrea notes short visits, multiple people (5-6) involved in the care, not all of whom you get a chance to meet prior to delivery, the hospital setting itself, and, finally, not knowing which team of the doctors will be there for you at the time of birth. Andrea said it was an eye opening experience for her, since she had her first daughter at home under midwives’ care.
At the birth center, 30-45 minute long appointments are the norm, every patient gets to meet and spend equal time with each of the midwives in the practice. At the delivery midwives treat women and babies kindly and with respect. For example, they allow Mom and baby up to two hours of personal time & bonding before doing a newborn exam.
Whereas, at the hospital everything seems to be rushed: babies are taken away from mothers shortly after birth for measurements and other routine procedures. From Andrea’s perspective, a midwife’s approach is more humane and allows each Mom to get individual attention. In a hospital, however wonderful providers may be, the system itself does not allow them to spend more time with each patient.
EBC welcomes women who are considering midwifery care to schedule an initial phone interview to determine whether or not they qualify before coming to the center. EBC generally accepts low-risk healthy women, however, certain health issues, such as diabetes or thyroid dysfunction would not prevent one from being able to give birth with the midwives.
Regarding safety concerns, Andrea assured me that they watch for “pink” flags and, if needed, transfer their patients to a hospital before an emergency situation may arise. They are practicing safely, are accepted and covered by most health insurance companies in the State, and always have a plan and equipment to deal with difficult situations: oxygen tank, three various anti-bleeding drugs and other emergency medications are at hand. Less than 1% of EBC clients need emergency transfers to the Overlake hospital.
Studies have proven that midwives are as safe as OB/GYN, but the outcome is better.
Usually about 10% of EBC patients, mostly first-time Moms who endure long, non-progressing labor and need rest, are transferred to a hospital. The other 90% of Moms have successful birth at home or at the birth center with no complications or interventions.
Chrissy Valuzzi, a doula and the owner of sacredlifedoula.com, attends both hospital and midwives’ assisted births. She had observed major differences in the relationships those providers form with their patients. She finds that doctor’s main concern is physical health, and there is no time or room to address emotional aspect of pregnancy and birth. Midwives, on the contrary, are able to form safe and trusting relationships with their clients, which helps achieve a greater comfort level for a patient and contributes to a smooth labor and birth free of unnecessary interventions.
Since doctors are trained to deal with emergencies and are always prepared for the worst, quite often they intervene too soon. For example, labor induction may be scheduled at 40.5 weeks for “overdue” babies despite the fact that healthy babies are born between 38 and 42 weeks of gestation. Unfortunately, such interventions always carry health risks and may obstruct normal labor. Midwives, on the contrary, are very familiar with the natural flow of labor, they trust women’s bodies, and have a wide range of holistic treatment options available to support progress of birth naturally but without compromising safety.
Moreover, the relationship between midwife and woman goes beyond birth experience as midwives make postpartum home visits and are there to help with breastfeeding, contraception, diapering and other postpartum concerns.
I, personally, had two hospital births,one water birth at a freestanding birth center and one midwives’ and a doula assisted home water birth. For me those experiences were incomparable in quality of care during pregnancy and birth, as well as in the atmosphere at the delivery and postpartum. Our first two children were born in Russia, where independent midwives were non-existent at the time.Water birth that I had intuitively wished for was unavailable. In my memory the sterile, impersonal hospital setting embodied images of illness and emergencies.
PSBC midwives provided our family with professional yet personal approach, unrushed thorough care and safe welcoming environment, which resulted in the smooth deliveries both times. I never felt so confident and empowered as during my pregnancies with them: all health concerns (hypothyroiditis and placenta issues), insecurities (my both babies were born at 42 weeks) were addressed knowledgeably, with attention and encouragement. I always felt supported instead of helpless as I oftentimes did while under a doctor’s care during my previous pregnancies.
In a hospital it seems like the doctors want to take control over you and your baby hooking up devices, suggesting convenient for them positioning, and regularly performing exams without a regard to Mom's wishes. Whereas a midwife acts more like a guardian, who is there to support and gently guide you through the birthing process but only when asked or needed, therefore allowing for an intimate and sacred experience of welcoming new life into the parents arms and the world.
*For those considering breech delivery or VBAC, following resources are available in the Seattle area : Suzanne Thomson at New Life Midwifery Care: (206) 365-5156, http://www.midwifeseattle.com/vbac.php , http://w ww.seaobgyn.com/foltz.html.