Sheesh! You all know that I don't like to stress out and I choose not to. But I was almost at the point of stressing out about writing this series. "Where do I begin? When do I find time to write? What if the topics are all out of order? How do I maintain a readable length for each entry? Do I need to cite everything?!"
Then...
I decided to take a deep breath...
With that, I'd like to welcome you to the first segment of our discussion on perinatal* choices! I'd like to keep things casual...but I am also a little anal about being systematic. So I'm going to keep a consistent format of going over these headings:
- Popular practice: What is an average American doing? What's common practice? What's the history behind these practices?
- The evidence: According to research, what should be put in practice? How do we compare to other countries? Where are we in achieving the goals for health outcomes that we have set? What's stopping us from getting there? How do we get there on the level of personal decision-making, telling others about the evidence, and integrating this into the broader healthcare systems? (Okay, this is where I might go off because I seriously love what I do: bridging the gap between research and patient care delivery. But I hope that I don't spend too much time in this section as I think the next section is very important.)
- Our experience: This is where I tell our story. The best part, I think. :)
- Acknowledgments & resources: Obviously I needed help putting this all together! This is where I cite some of the key people and resources that helped me present this information.
 |
| That Ryan Gosling, he really knows! |
Popular practice
What are our options? ObGyns or midwives. Obstetricians are trained medical physicians with an "MD" after their names. They have gone to school for many, many years and have learned to provide care for a wide range of pregnancies and birth situations including Cesarean sections. Midwives come in a variety of different forms, but essentially they differ from ObGyns in that they typically care for uncomplicated pregnancies and assist vaginal births.
The difference between the two models of care are outlined below:
| Midwifery Model of Care Focus on health, wellness, prevention Labor/birth as normal physiological processes Lower rates of using interventions Mother gives birth Care is individualized | Medical Model of Care Focus on managing problems and complications Labor/birth as dependent on technology Higher rates of using interventions Doctor delivers baby Care is routinized |
(from The Childbirth Connection)
Okay, okay, even though they claim to not be biased, I think the table above is pretty pro-midwifery. Reading it with a grain of salt, please realize that there are plenty of OBs who are low-intervention and I have come across quite a few "medwives" out there, too.
Historically, midwives have attended births for thousands of years. Birth used to be an all-woman event where a laboring woman would be surrounded by female family members and at least one person who knows what the heck she's doing. Then, somewhere along the way (I'm too lazy to look up exact dates), medical interventions such as Cesarean sections and forceps were introduced to help out complicated cases of labor. And then there was the introduction of hardcore pain management such as morphine and chloroform in labor. At the same time, general practitioners who wanted to gain a larger client base thought, "Hey, if I deliver this lady's baby, their whole family will come to me from now on for all their healthcare needs." Around that point is where more and more women turn to the medical model for the management of their pregnancy and birth.
In the 60's and 70's in the U.S., there was then a counter movement against the medicalization of birth. A few people said, "Eff this!" and started traveling around in buses, women didn't shave their armpits, and drugs were used in all settings except for birth. They were considered "really weird." But they did bring back a deep appreciation for the art of midwifery.
In the Pacific Northwest these days, evidence-based hippies as we are, there are still more women who choose to give birth in a hospital setting with obstetricians than those who choose any variety of midwives.
The evidence
Have you heard of the Cochrane Collaboration or the Cochrane Library? It is a collaboration that started out in the UK with the aim to find good, quality research on health and healthcare practices that can be brought back to the bedside. In 1979, Dr. Archie Cochrane published an essay to draw attention to this need for randomized controlled trials in which he designated the field of obstetrics as the least scientific medical specialty. Ouch!
Just looking at our own backyard, birthing in the U.S., compared with other industrialized countries:
- We are the most technology-oriented,
- Spend the most $ per capita,
- Largest % of birth attended by MDs,
- Smallest % of birth attended by midwives,
- Highest infant mortality rate (are you seeing this?!), and
- Maternity mortality and morbidity rates are similar, too.
Well, if you are pregnant and you'd like to be well-informed about your care, this is a critical junction where you need to decide on a provider whose beliefs and practices align well with yours. It's fine to go with an obstetrician for your pregnancy and birth (complicated or not). But if you haven't considered midwives as an option, it might benefit you to know that a recent review of 21 legit studies showed that births that are attended by midwives:
- have comparable outcomes as those attended by OBs,
- result in less interventions (e.g., episiotomy, labor induction, epidural analgesics),
- have fewer incidence of perineal tearing, and
- resulted in higher rates of breastfeeding.
I feel that I can talk until I am blue in the face about evidence...but it doesn't impact the lives of people until it is relevant. I am hoping that by telling our story and perspective, you could see the benefits of a less medicalized birthing experience. So, read on!
Our experience
We went with a group of midwives from Neighborcare Health starting when I was pregnant with Penelope in the Spring of 2009. I chose to go with midwives for a number of reasons:
- I found them more personable,
- the approach of these nurse midwives are both scientific and intimate,
- I always felt that they were informing me of everything along the way,
- and I have not met many OBs that I have felt very comfortable with.
 |
| Sam, the UW midwifery student who caught Camille (with Chin's help, of course ;P) |
A typical office visit with my midwife would start out with her asking, "How are you?" I never felt rushed or brushed off. When we found out that Penelope had many health complications, my midwife called me right away and checked in on how we were doing. She asked, "Do you have people around who can cook and take care of household things for you during this time?" I could not imagine any of the OBs I know to think of asking that!
With the Penelope's poor prognosis, the midwives suggested that we transferred our care to a group of perinatologists at a larger local hospital. We tried them out. Here is a quotable moment from the visit with that perinatologist:
Perinatologist [talking to Chin and ignoring me]: I think you should have a D&C. I'm telling you right now that there is 0% chance your baby can live. And there are many health complications that could affect your wife. If the baby dies in-utero, there are risks of infection. She could have DIC. She could have mirror syndrome. Your wife could swell up like the Michelin Man!"There were several other things from that visit that made us question this doctor's level of competence. At the end of the day, we called up our midwives and asked to be returned to their care.
Me: I don't believe that mirror syndrome is very likely going to occur (I saw a case on House, MD - how prevalent could this disorder be if it was on House?!). Sure, there are risks of complications but these are risks we are willing to take. Please, just for the sake of our conversations going forward, assume that we do not want a D&C.
Perinatologist: Wow, you sound really smart. Are you in the medical field?
Me: I'm just well-informed and I know what I want.
Perinatologist: Because, most patients I work with would choose to terminate. There is NO chance of survival.
Me: Please, doctor. I don't want to discuss this anymore.
Perinatologist: Is it a religious thing?
Chin & me: [Utterly speechless. Does it effin' matter, you moron?!]
Both Penelope and Camille were born under their care and we were very happy. After moving to the Eastside and finding out that we were pregnant with Marcus (Chestnut) we considered other local options. But after searching for a couple of months, Chin insisted that we go back to the Neighborcare midwives. Even if this meant that I had to commute to South Seattle for prenatal checkups and we'd have to drive across the toll bridge to get to the hospital for birth. (Yes, my husband is prepared to pay the toll. That's how much we love and trust these midwives!)
There is a lot more of our story to come. It'll just unfold as we delve further into this subject. I hope you will read on because there is much more I'd like to share with you!
Acknowledgements & Resources
- A great article on birth options, written by a smart mom
- Different types of midwives
- Read more about your options in choosing a provider
- History of obstetrics & midwifery
- Studies on safety & effectiveness of midwife-attended births
- Some documentaries that might be of interest are:
- The Business of Being Born - with Ricki Lake (there is a 2nd one out that I haven't seen yet)
- Orgasmic Birth - this was a good one
- Pregnant in America - I didn't like this one so much, it was a little pushy
- Gentle Birth Choices - this is probably my favorite out of these...probably because of the 80's hair
- Some fantastic books on midwifery & making smart perinatal choices:
- Ina May's Guide to Childbirth
- Spiritual Midwifery - a classic by Ina May, one that I actually read!
- The Thinking Woman's Guide to a Better Birth
- Birthing from Within
- The pictures are from here, here, and here.
No comments:
Post a Comment