As cesarean and induction rates in hospital climb to astronomical levels many women are turning to homebirth. When interventions become excessively high, the risk/benefit ratio of being in a hospital swings more dramatically into the “riskier” zone, and even physicians and nurses begin choosing homebirth. Just removing your birth from a hospital setting doesn’t guarantee that it will proceed in a natural, flowing manner. Too many women learn the hard way that a midwife can bring a hospital mentality and interventions right into the home and negatively affect the course of the birth. How can you assess the type of midwifery practice that you are purchasing? Here are some tips to help you assess the care that will be provided by midwives:
1. Ask to see a video of some births your midwife has attended. This is the modern age. Many people videotape their births and an experienced midwife will have been given many copies of videos with permission to share them with other families. Videos tell you a lot more than photo albums. Be wary of the midwife who won’t give or show you videos. Watch the videos for things like: Is the father playing an active role in the birth? Are the attendants quiet when things are normal and healthy? Is the cord left to pulse until the placenta is born? Does the baby breathe spontaneously without routine suctioning? Are the baby and mother locked in eye contact with no disturbance? Is a water tub part of the birth?
Watch the time clock on the video to see whether the birth of the placenta occurs in a leisurely way or whether the midwife wants it out in under 30 minutes.
2. Tell your midwife that you don’t wish to have any pelvic exams during your pregnancy. This avoids introducing bacteria and also avoids some routine interventions like membrane stripping (painful and ineffective). Making assessments of the readiness of the cervix to give birth at the end of pregnancy is inaccurate and largely discouraging to the mother. Remember that you were made to give birth—you’ve had menstrual periods, you conceived and you grew a baby; therefore you can have faith that your cervix will perform just fine. PAP smears can be done after the baby’s birth, if you so desire.
3. Always make the first day of your last menstrual period one week later than it really was. We live in a time of wholesale induction of healthy birth. When induction of any kind (yes, herbal, too) is done, the risk of cesarean section goes up. Smart women avoid the whole hassle of being pressured to induce their baby by giving their midwives a designed date that allows them a week of grace. One of the simplest things a woman can do for her baby is say “no” to induction and get her due date as far out in the future as possible.
4. Refuse the use of a Doppler during prenatal clinics. Dopplers are invasive and they can affect your baby’s brain. A good midwife will be interested in protecting your baby prenatally from unnecessary exposure to non-ionizing radiation. She’ll inquire about your diet and exercise at every visit because she’ll know that these two things are the best way to insure that your baby will have a smooth birth and a bright future. If she insists on using a Doppler, you know that she cares more about her convenience than she does about your baby.
5. Let your midwife know that you want a Lotus Birth. A Lotus Birth means that the cord is never cut and falls off naturally on day 4 or 5, still attached to the placenta. If you ask for a Lotus Birth, it means that you’ll be in charge of when the cord gets cut. There will be no rushing in the immediate post-birth period. You might decide after three hours that you really want to cut the cord and get the placenta bowl out of your bed. The timing of the cord-cutting is best done at the direction of the parents, not the midwives. More and more medical evidence is coming out that shows that leaving the cord to completely finish pulsing is an important health benefit for all newborns.
6. If your midwife cautions you about anything to do with your health or your baby’s health, ask her for references. A good midwife can back up anything she says with literature and is happy to have curious clients who ask for the evidence. Once you have research papers on any subject (e.g., erythromycin eye ointment, vitamin K, infant vaccines, Dopplers, ultrasound, triple screen, gestational diabetes testing, strep B testing, membrane stripping, etc.), you can go to the computer and type in the subject with the addition of “comma, dangers” or “comma, precautions.” That is, type into Google: erythromycin eye ointment, precautions.
This will take you into all the alternative views about these subjects and you can make a more fully informed choice about what you want to do. In the case of erythromycin eye ointment, for instance, you’ll find that Australian and British midwives don’t give this antibiotic treatment routinely, but it’s routinely given in North America to millions of babies in order to prevent gonorrhea eye infections. If you don’t have gonorrhea and you’re in a monogamous relationship, you’ll probably feel comfortable declining the treatment.
7. Ask your midwife at your first visit with her who makes the rules that she works under and what the punishment is if she disobeys those rules. This will give you an idea of what sort of pressures the midwife is under right from the beginning. It will guide you as to what you can and can’t tell her or ask of her. Don’t assume that the midwife is loyal to you first. Like all human beings, her survival is important to her. If you know how to help her survive, you will be a savvier consumer of her services.
The best births are those in which the clients come away happy and so does the midwife. Win-win situations. Midwifery is changing, as legislators, insurance companies, medical boards and professional bodies react and respond to this profession that used to be private and secretive but now is having a spotlight shone upon it. Unfortunately, this has put pressures on midwifery to become more and more like the medical model to which it was originally opposed. In many states and provinces, midwifery is even more “butt-covering” than medicine because of all the controlling entities that now rule the licensed home birth midwife. When a consumer uses the term “midwife,” her picture of what she is getting may not match the reality of the birth worker who’s trying to survive in a strictly legislated profession.
Take off your rose-colored glasses and really find out what your midwife does at a birth and what your rights are when it comes to refusing interventions and interferences with a life experience that you will remember forever. It’s important for parents to remember that the midwife will go to many more births but this is the ONLY birth of this child that you will ever have. Keep your eyes, ears and senses wide open. Have a joyous home birth.
This article is published in the Winter 2008 No. 88 issue of “Midwifery Today Magazine”