Email: "All-Natural Delilvery: Childbirth With a Midwife"
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When a women discovers she is pregnant, one of the first things she does is choose an obstetrician. She will probably tour the hospital in which she plans to give birth. Toward the end of her pregnancy, she may take a childbirth class and receive the information on the hospital policies. Her doctor will discuss the upcoming birth: will she be induced; is she interested in a Caesarean section; when does she want the epidural to be administered?

This is the modern way to give birth. To many, the idea of birth without medical interventions sounds barbaric. Why deal with pain when a simple I.V. can make it all disappear? In the United States, 99 percent of women give birth in a hospital. Over half of all laboring women have their labors induced or medicinally augmented. A full 30 percent have C-sections, half of which are scheduled and avoid all sensations of labor.

These rates are the highest they have ever been in America. In her 2007 book “Pushed: The Painful Truth About Childbirth and Modern Maternity Care,” Jennifer Block says a “pushed” birth is “one that is induced, sped up, and/or heavily medicated for no good reason, and all too often concludes with surgery, invasive instruments, an episiotomy or a bad vaginal tear. These practices are not leading to better outcomes for American women and their babies — far from it.

According to  Block, the United States ranks 32nd in infant mortality and 30th in maternal mortality, of 33 industrialized nations. Despite the nearly limitless stream of medical options available, women in the United States are 70 percent more likely to die in childbirth than women in Europe.

What Is the Alternative?            
Where do the other 1 percent of American moms give birth? And are their births difficult and dangerous?

These women may give birth in birthing centers or at home, but are typically attended by a midwife instead of an obstetrician. Midwives also work in hospital settings. The practice of consistently using a medical doctor to deliver babies is a practice unheard of in most of the rest of the world.

And it’s not just women in remote villages who are giving birth without anesthesia. In most of Europe, OBs only attend high-risk pregnancies.

This affects the outcomes positively. In the Netherlands, 20 percent to 30 percent of births take place at home. In that country, the C-section rate remains at 14 percent to 18 percent.

What Is a Midwife?
Midwives have attended births for eons. Today, most achieve certification to practice in one of two categories. Certified Nurse-Midwives are registered nurses with additional training, are licensed in all  states and recognized by the American College of Obstetrics and Gynecology to assist hospital births. They are familiar with hospital protocol and are permitted to give I.V.s, suture tears and write prescriptions.

Certified Professional Midwives are licensed to practice in only 22 states. They work autonomously, attending mostly home births. They are educated according to the standards of the Midwives Alliance of North America.

Births attended by midwives are less medical because the mothers are educated and encouraged to work with the natural rhythms of their bodies. Nancy Niemczyk, clinical director of The Midwife Center in Pittsburgh, reports that the free-standing birth center has a C-section rate of 16.5 percent, about half that of hospital births. Eighty-two percent of the births were spontaneous vaginal deliveries — without induction or surgery.

She attributes these rates to the education of expecting mothers prior to labor. Women planning to give birth at The Midwife Center are given expert advice on exercise, nutrition, breastfeeding, labor and pain relief techniques that do not involve medication. They are also prepared in advance for caring for an infant.

Births at a site such as The Midwife Center have the flexibility to be very different from births in a hospital. Niemczyk explains that women are encouraged to eat and drink as they desire, move around and wear their own clothes. The facility has a full kitchen as well as a whirlpool tub in every room for a more comfortable labor. Women are given the option of music, candles and visitors. They will accommodate religious and cultural traditions the couple wishes to observe, which are often ignored in a hospital setting.

Midwives do not consider a woman over 35 to be high-risk simply because of her age. They are also more likely to encourage a women to have a vaginal birth after a Caesarean (called a VBAC).

Midwives perform fewer inductions, episiotomies, epidurals and births with forceps or vacuums. Instead, they teach women to use — and support them in the use of — non-medicinal methods of pain relief such as massage, water, visualization, a birthing ball and relaxation.           

When a laboring woman enters a hospital delivery room, medication is nearly standard. Epidural use is prevelant and expected; but, in conjunction with being immobilized in a hospital bed, can lengthen labor and increases the risk for a C-section.

How Do I Decide?
Some women, such as those with high-risk pregnancies, health complications or multiple fetuses, should choose an OB. CNMs are trained and prepared, however, to deal with emergencies that may occur during labor and birth. They have the same equipment and medications to help a baby start breathing or a to deal with a woman who is hemorrhaging at the hospital.

Each expectant mother should determine what type of delivery she wants. Midwives are an alternative for those who don’t want to be “pushed” and are looking for a more natural birth experience. If an expectant mother decides she wants an epideral or other medicated pain relief, however, a midwife will respect her wishes.

Niemczyk encourages mothers-to-be to interview potential doctors, midwives and delivery sites to understand their policies and procedures. (See questions, in fact box). Also, make a birth plan so everyone in the delivery room understands your preferences. A fill-in-the-blank birth plan template can be found at www.babycenter.com

Regardless of what type of birth you choose, participate in a good childbirth education class. Find the one that fits with your birth philosophy. You do not have to be delivering with a certain practitioner to attend most classes.

Niemczyk also recommends laboring at home for awhile. And she says women should consider hiring a doula. Even in hospital settings, the presence of a doula, someone in addition to a spouse who provides physical and emotional support, decreases the risk for C-sections and the use of forceps.

Choosing how your baby will enter the world is a big decision, but there are many options available. The best advice is to research and prepare. For those who want to avoid the cascade of medical interventions during delivery, midwives offer an alternative. 

-- Martins Ferry resident Stacey Sacco lives in Martins Ferry with her husband and 2 1/2-year-old son.

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