Thursday, October 28, 2010
The Bad Midwife- Natural Birth's Dirty Little Secret
A few days ago I published a post about the curse of men entering the realm of childbirth. I maintain that the addition of men has greatly changed birth from a natural function to a pathology.
That being said, I think it is important to point out though I prefer and have always chosen midwifery care, choosing a midwife in and of itself does not guarantee you a perfect intervention free birth, or an attendant who is skilled or natural friendly.
I want to be very clear though first: Midwives tend to be much more open to natural birth and less likely to jump to unnecessary interventions than MOST Ob's. They tend to view birth as a natural process rather than an accident waiting to happen. I personally consider a medical doctor as somebody I would only see if I was high risk for some reason, whatever their gender.
But, because birth has for so long been within the realm of MEDICAL training, we see midwives who are also heavily influenced by this thinking, or who are so far the other direction that they may not be what you want.
The Dirty Secret-
Despite all of that, choosing a midwife is not any kind of guarantee.
There are midwives who are very medical, sometimes jokingly referred to as "med"wives.
There are midwives who lack basic skills necessary for resuscitation or other life saving needs.
There are midwives who are dishonest or unprofessional or disrespectful of women or the birthing process.
There are also great midwives who just might not be the best midwife for YOU.
Finding the Good One-
How do you make sure that your midwife is what a midwife should be?
There are a few ways to find out if somebody is what you are looking for.
~Get some good references from people who birthed how you would love to birth. Ask people about their birth stories. Then, listen to them. How did the midwife handle any problems? How was the mother treated? What interventions were used? Are you comfortable with them?
~Talk to the midwife. Find out what she is comfortable with. Some midwives LOVE to do VBAC's. Some don't feel comfortable with them. Don't try to change her. I wouldn't want a midwife who wasn't comfortable with me because that sets up a transfer or drop of care. I tend to have my babies later, so it is important to me to find out how long they are comfortable with me being pregnant. Some midwives MUST transfer care at 42 weeks. Some start suggesting induction at 40 or 41 weeks. Find out what they do. Just like you can't change hospital policy, you can't and shouldn't change what she is comfortable with, but you should know the score.
~Find out about laws in your state. Some states require an ultrasound at 42 weeks. Some require certain tests. Find out what your midwife is obligated to do in your state.
~Find out who she is accredited through or certified through. Some states allow lay midwives to practice. This can mean that somebody can really attend a few births and then call themselves a midwife. There is not necessarily anything wrong with that (and there is a whole debate on licensing midwives) but if that is fine with you, you might want to know what makes her an expert in her field. I have found midwives who are not certified to do neonatal resuscitation. Are you OK with the midwife at your birth not being able to do infant CPR?
~How experienced is she? How many births has she attended? In how many was she the primary midwife? There is nothing wrong with a newer or less experienced midwife, everybody needs to start somewhere. But that might be info you would like to know.
~Who does she work with? What are her back-up's qualifications? Almost all midwives work in pairs, one as the main, and one as support or back up. Sometimes a newer midwife will work with somebody who is her mentor and is much more experienced. They will both be at your birth though so you should like and know both of them.
~Where does she transfer and what does she transfer for? Does she have physician back up? I am in California where the law is written in such a way that home birth midwives don't have physician back up. I am fine with that. But you might have some questions regarding that and if you feel comfortable with her transfer doctor. And, should you transfer, does she stay with you for the birth? In some places where midwifery is illegal they don't stay with mom.
~Will she respect your birth wishes? Do you want her to be very hands on massaging and doula-ing you? Or would you rather have somebody who sits in the corner and only steps in if they are needed? Find out if her style meshes with yours.
~Listen to your instincts. When it comes down to it I have chosen midwives that I simply felt right about. One of these was a midwife I hear terrible things about. I felt so comfortable with her though, and I had a a great birth with few interventions. I choose another midwife that I wasn't sure about at first, but I had such a peaceful feeling about her attending my birth that I knew she was the right midwife for me. It was fabulous.
This might sound like a lot of work. It is. So is having a baby and being a parent. It is worth it to take the time to find the right person for you. You are only going to give birth to this baby once.
Good luck and joyful birthing!