Wednesday, September 7, 2011

The Midwife Post

I know I've been promising it for a while and here it is!  The answer to the question everyone asks:
"Leigh Anne, why oh why did you choose to see a midwife instead of a real doctor??"

First of all, let me answer a more basic question, "What exactly is a midwife?"  I think many people picture midwives either as Hebrew women refusing to throw babies into the Nile or untrained/minimally trained women who deliver babies primarily in the home.  While the both images are correct historically, neither are true of midwives today.  In the interest of specificity (booyah, big words!) I should clarify that I'm seeing a Nurse-Midwife, which is the nationally board-certified variety of midwife.  Some facts about Nurse-Midwives:

*Certified nurse-midwives are registered nurses who have completed graduate-level training in midwifery and who have passed a national certification exam.
*Nurse-midwifery practice is legal in all 50 states and the District of Columbia.
*Nurse-midwives can prescribe medication in 50 states and the District of Columbia.
*Nurse-midwives practice in homes, birth centers, clinics, and hospitals.
(http://www.mymidwife.org/Midwifery-101)

Question? Comments? Concerns?  Ok then...moving on.

Why did I choose to see a midwife instead of an OB/GYN?
1. I am comfortable with the care that a midwife provides.  I am a nurse and some of my professors were midwives so I've seen how rigorous their training is and know their philosophy of care.  I've also been to a nurse practitioner for "normal" care and a nurse midwife is nothing but a NP for pregnant ladies.  So, I had no qualms about trusting a midwife to take care of me.

2. Midwives practice under the auspices of OB/GYNs.  So if I need more involved care, it's readily available.

3. Pregnancy is not an unhealthy state of being.  Doctors of all varieties (family medicine, cardiology, surgeons, ob/gyn, etc.) are trained in dealing with sick people.  They're taught how to spot problems and fix them.  NPs and CNMs (Certified Nurse Midwives) are taught to spot problems and refer to a doctor when needed.  That's why these nurses are so popular for "well-care".  As nurses, we are trained to care for people, not illnesses.  When you're ill, you need someone to fix your problem!  If you aren't ill, well...ya just need someone watching your back.  I'm pregnant, not sick.  My CNM will screen me for gestational diabetes, preeclampsia, and all of those pregnancy-related issues that can crop up.  If I develop any problems, they'll either treat me or refer me to one of their ob doctors.

4. CNMs have a record of fewer interventions in labor and delivery.  Yes, folks, I'm one of those "crazy ladies" who wants to do this with as few interventions (induction, epidural, etc.) as possible.*  Midwives are generally speaking more accepting and prepared for this approach than an OB doctor.  OB/GYNs are trained surgeons.  They do c-sections almost daily.  I don't want someone who is so used to having patients with epidurals and sedation that they don't know what to do with me.  I want someone to deliver me who is willing to let me move around with only intermittent monitoring, isn't afraid of a little moaning and groaning, and who will support my desires by not offering me medicine.  (UNLESS, of course, it's needed.  I'm totally aware of the fact that many many many things can hinder a plan like this and if, say, the baby is breach, I'm fully prepared for the possibility of a c-section.  I just...would like to avoid those types of things if I can.)  Midwives are trained with a focus on normal labor and delivery.  They can manage most interventions (i.e. epidural) but are more likely than an OB to try natural pain management techniques first.

So, to sum up: "Midwives approach birth, puberty, and menopause as normal life events rather than potential medical emergencies. These are times when women need special education or support, but nobody needs to cure or fix them. Midwives believe that if women are given the correct information, they can make safe and satisfying choices.  Midwives are trained to recognize complications early and refer you for appropriate care. In a midwife you’ll find the best of health care and human support in one savvy professional." (http://www.mymidwife.org/Midwifery-101)


*A note on natural childbirth: Again, my reasons for going this route revolve around #3 above.  Pregnancy is not a "sick" state.  It's a totally normal phase in a woman's life and my body was designed to carry and deliver a baby.  Women have been giving birth forever!  Labor is not a "problem" that needs to be "fixed" with medicine.  Also, part of the labor and delivery process is a series of hormones that are released.  Right after birth is the biggest endorphin (happy hormone) rush that you'll ever get.  This helps you bond w/ baby.  Pain meds and such interrupt that natural cycle so you don't get that hormone rush.  I want to feel the rush, man!

Ok, I think those are the biggest reasons for my choice.  I welcome your comments, questions, and suggestions!  I know this can be a touchy topic and the last thing I want is to offend anyone.  Thoughts, folks?

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