The purpose of this blog is to inform you about options for women's healthcare in our community. I am a graduate student in a nurse-midwifery program conducting market research about women's healthcare needs in our community. Please click here when done reading this blog to take the brief survey. Thank you for your time!
Monday, August 27, 2012
Who is a midwife?
A midwife is a licensed healthcare provider who cares for women’s primary and preventive health needs across the lifespan from the onset of puberty through menopause. There is an emphasis on comprehensive maternity care including pregnancy, childbirth, postpartum and newborn care for the first 28 days of life. Midwives utilize non-pharmacologic and pharmacologic modalities for intervention when appropriate and are able to prescribe medications in New York.
Women may choose to see a midwife for services including:
Midwives work in collaboration with obstetricians/gynecologists to provide care for women who need more specialized care during pregnancy.
Further information about midwives in New York may be found through the state’s Office of the Professions.
References
Women may choose to see a midwife for services including:
- Well-woman and adolescent gynecological care
- Annual examinations and screening for primary care, health screening and counseling
- Evaluation and treatment of common health problems
- Family planning and prescriptions for birth control
- Perimenopausal and postmenopausal counseling and care
Midwives work in collaboration with obstetricians/gynecologists to provide care for women who need more specialized care during pregnancy.
Further information about midwives in New York may be found through the state’s Office of the Professions.
References
American
College of Nurse-Midwives. (2012). Core
competencies for basic midwifery practice.
Retrieved from: http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADF ILENAME/000000000050/Core%20Competencies%20June%202012.pdf
New York State Education Department. (2012). Midwifery - Questions and Answers. Retrieved from: http://www.op.nysed.gov/prof/midwife/midwifeqa.htm#services
Choice of birthplace: Which type of birth setting is best for you?
Women who are considering pregnancy or are currently pregnant have three potential birth settings to choose from: birth center, hospital, or home. It is important to ask questions of the facility where you plan to give birth to gather information about whether the approach to care fits your wants and needs.
The majority of women in the U.S. give birth in a hospital. Midwives and physicians often work with women who give birth in a hospital. A hospital is the safest place for birth if complications or desire for epidural are anticipated. In the hospital:
Birth at home is also an option for women in NYC. Planned home births should always be under the supervision on a skilled birth attendant, who is usually a midwife. Women who give birth at home may expect:
The Coalition for Improvement of Maternity Services has an educational pamphlet available here to help guide you through the process of asking questions at your intended birthplace.
A free-standing birth center is a facility often run by midwives that provides full-scope care for healthy women during their pregnancy and childbirth. The Brooklyn Birthing Center and Morris Heights Health Center are two existing options for women in NYC. Birthing centers:
- Are a home-like environment that caters to low-risk pregnant women and their families
- Are just as safe as delivering in a hospital for low-risk women
- Offer non-pharmacologic pain relief and comfort measures in addition to limited pharmacologic pain relief options
- Are licensed, regulated and accredited just like hospitals. They go through a rigorious quality assurance process and must meet certain standards to be in operation.
- Are covered by Medicaid and many insurance companies if they meet accreditation and licensing standards in their state.
- Are part of a collaborative healthcare system. Agreements exist between midwives, physicians, and emergency services to quickly transfer your care to a hospital if a need for an elevated level of care arises during pregnancy or childbirth
- The option of having multiple and chosen support persons present during the birth
- A midwife with whom she has developed a relationship present during the birth
- The opportunity to change positions and utilize tools such as birthing stools, tubs, and balls during labor.
- Greater freedom to eat and drink as tolerated throughout the labor
- A short recovery period at the birth center after the birth with early discharge to home
The majority of women in the U.S. give birth in a hospital. Midwives and physicians often work with women who give birth in a hospital. A hospital is the safest place for birth if complications or desire for epidural are anticipated. In the hospital:
- There is immediate access to emergency care for high-risk pregnancies
- The option of a broad spectrum of pain relief options during childbirth including epidural analgesia
- Women often have continuous electronic fetal monitoring and less freedom to assume comfortable positions throughout labor and birth
- There are often policies discourage oral intake of food and fluids after admission
- There are often limited visitors allowed during labor and birth
Birth at home is also an option for women in NYC. Planned home births should always be under the supervision on a skilled birth attendant, who is usually a midwife. Women who give birth at home may expect:
- A lot of flexibility for laboring in different positions
- Alternative pain control and a commitment to medication-free birth
- The midwife to discuss plans for transfer to a hospital that can accommodate you in the event of an emergency
- The comfort of their own home, familiar surroundings and the presence of whomever they wish during the birth
The Coalition for Improvement of Maternity Services has an educational pamphlet available here to help guide you through the process of asking questions at your intended birthplace.
Are Independent Birth Centers Safe?
Many medical studies have confirmed the safety of birth for low-risk women in independent birth centers as an alternative to hospital birth.
The National Birth Center Study, published in 1989, looked at the pregnancy outcomes of 11,814 women at 84 independent birth centers.
Birth centers utilize thorough risk screening assessments and have early referral systems to nearby hospitals in the event of need to elevate care.
The National Birth Center Study, published in 1989, looked at the pregnancy outcomes of 11,814 women at 84 independent birth centers.
- Over 98% of women were satisfied with their birth experience
- 15.8% were transferred, mainly for slow progress or requiring anesthesia
- The overall C-section rate was 4.4%
- 2.4% required emergency transfer. There were no maternal deaths.
- The overall intrapartum and neonatal mortality rate was 1.3 per 1000 births.
Birth centers utilize thorough risk screening assessments and have early referral systems to nearby hospitals in the event of need to elevate care.
Other studies have shown that women utilizing birth centers are less likely to have medical intervention. A study published in the American Journal of Public Health in 2003 examined outcomes for 2,957 low-risk, low-income women: 1,808 receiving collaborative care in birth center setting and 1,149 receiving traditional care in hospital setting.
Women at the birth center had lesser rates of:
- Labor induction (8% vs 15%)
- Caesarean section (11% vs 19%)
- Episiotomy (13% vs 38%)
Their conclusion? The birth center setting resulted in a lowered level of technological intervention while maintaining a level of maternal and infant safety comparable to the hospital setting for low-risk women.
References
Jackson,
D. et al., “Outcomes, Safety, and Resource Utilization in a Collaborative Care
Birth Center Program Compared with Traditional Physician-Based Perinatal Care”, American Journal of Public Health, 93(6):999-1006, (June), 2003.
Rooks,
J., et al., “Outcomes of Care in Birth Centers: The National Birth Center Study
”, New England Journal of Medicine, 321 :1804-1811, (December 28), 1989
Choice of care provider: Which model of care?
Midwives and physicians approach care during pregnancy and childbirth in different ways. It is most important that you feel comfortable and safe with your provider of care. He or she should be someone whom you trust to have your best interest in mind and that you can talk to about any concerns you have. If you have several options for care, then it is okay to set up an appointment to talk to them about what you can expect for your care.
Midwives are specifically trained to deal with pregnancy and childbirth as normal physiological processes and to identify deviations from normal for referral to a higher level of care when necessary. For most women, pregnancy is a healthy life event without complications. The model of care emphasizes non-intervention unless clearly indicated.
Midwifery care is acknowledges the importance of continuity of care, informed choice, shared decision-making and choice of birthplace. This model of care views pregnancy as a normal, physiological event and not as a pathology that always requires intervention.
This short video explains more about midwifery:
Physicians are trained to diagnose pathology in complicated pregnancy and to perform medical interventions including operative vaginal birth and caesarean sections. Obstetrician/gynecologists or family physicians with additional training may provide care for pregnant and laboring women. A medical model of care may approach pregnancy as a pathological process with the possibility for complications until proven otherwise.
Midwives and physicians are independent care providers that work together collaboratively to achieve the best possible outcomes for women and their pregnancies.
Resources for choosing a provider:
Questions to ask your care provider: - A comprehensive list of questions. Read through the list and don’t get overwhelmed! Focus on the questions that you feel to be most important to you.
Who Should Deliver My Baby?: This is a website with a quiz for you to take that will help you decide which type of care provider is a good match for you. There are also links to questions to ask your care provider.
Midwives are specifically trained to deal with pregnancy and childbirth as normal physiological processes and to identify deviations from normal for referral to a higher level of care when necessary. For most women, pregnancy is a healthy life event without complications. The model of care emphasizes non-intervention unless clearly indicated.
Midwifery care is acknowledges the importance of continuity of care, informed choice, shared decision-making and choice of birthplace. This model of care views pregnancy as a normal, physiological event and not as a pathology that always requires intervention.
This short video explains more about midwifery:
Physicians are trained to diagnose pathology in complicated pregnancy and to perform medical interventions including operative vaginal birth and caesarean sections. Obstetrician/gynecologists or family physicians with additional training may provide care for pregnant and laboring women. A medical model of care may approach pregnancy as a pathological process with the possibility for complications until proven otherwise.
Midwives and physicians are independent care providers that work together collaboratively to achieve the best possible outcomes for women and their pregnancies.
Resources for choosing a provider:
Questions to ask your care provider: - A comprehensive list of questions. Read through the list and don’t get overwhelmed! Focus on the questions that you feel to be most important to you.
Who Should Deliver My Baby?: This is a website with a quiz for you to take that will help you decide which type of care provider is a good match for you. There are also links to questions to ask your care provider.
Choice of midwives: Are they all the same?
There are two different credentials for midwives in New York: Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs). Both CMs and CNMs are held to the same standard of education, knowledge and skill to obtain licensure to practice in New York.
CMs and CNMs have completed an appropriate graduate-level educational program to prepare them for practice. CNMs are nurses prior to pursing graduate education in midwifery. CMs have a variety of educational backgrounds, often in a health-related field, prior to pursing graduate education in midwifery. CMs and CNMs both take qualifying board examinations through the American College of Nurse-Midwives (ACNM).
Certified Professional Midwives (CPMs) are certified by the North American Registry of Midwives (NARM) and usually attend birth in out-of-hospital settings. They usually have a year of foundational education prior to completing an apprenticeship with another CPM.
The term lay midwife is sometimes used to refer to women who attend births and may have learned by apprenticeship but do not have formal education, licensure or certification.
You can easily find a licensed midwife via NYC Midwives, an affiliate organization of the ACNM.
CMs and CNMs have completed an appropriate graduate-level educational program to prepare them for practice. CNMs are nurses prior to pursing graduate education in midwifery. CMs have a variety of educational backgrounds, often in a health-related field, prior to pursing graduate education in midwifery. CMs and CNMs both take qualifying board examinations through the American College of Nurse-Midwives (ACNM).
Certified Professional Midwives (CPMs) are certified by the North American Registry of Midwives (NARM) and usually attend birth in out-of-hospital settings. They usually have a year of foundational education prior to completing an apprenticeship with another CPM.
The term lay midwife is sometimes used to refer to women who attend births and may have learned by apprenticeship but do not have formal education, licensure or certification.
You can easily find a licensed midwife via NYC Midwives, an affiliate organization of the ACNM.
Further Information
http://givingbirthwithconfidence.org/: Web site of Lamaze International. A blog with multiple contributors that covers a variety of topics including birth, breastfeeding, PTSD, education, and new research
www.evidencebasedbirth.com: Web site recommended for anyone wanting to know more about birth. It is frequently updated and offers a lot of information about evidence-based childbirth practices.
www.midwife.org: The home page of the American College of Nurse Midwives
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