Considering a midwife? Know your options.

A midwife is a sage who embodies loving kindness and listens with tender ears. She speaks with her eyes, feels from the heart and gently guides you with understanding. All with an embrace that feels like home; warm, safe and full of love.

I’ve seen midwives guide women through the births they have always wanted and support them through outcomes they work so hard to avoid.  They welcome new life with joy and witness experiences of sorrow and heartache. The midwives I’ve met are strong, intelligent, poised and excel under pressure. They are all amazing women.

Midwives are getting a lot of positive attention lately, both in articles and recent studies. You can catch your fair share of midwife-friendly documentaries like The Business of Being Born (BBB movie review from an MD), More Business of Being Born and Birth Story: Ina May Gaskin and The Farm Midwives.  I like to imagine that if Ina May were Batman, renowned doula, Penny Simkin, would be her Robin. A superhero, super-birth team.

The first home birth I attended as a doula.

The first home birth I attended, as a doula.

Perhaps you’ve heard of the legendary midwife Ina May Gaskin? A story about midwives is not complete without mention of her name. If you’ve come across the birth statistics from The Farm Midwifery Center, you understand how incredible they are. Take a look:

cesarean section rates

The Farm, 1970-2010 – 1.70%

compared to
The U.S. in 2010  –  32.8%
Wisconsin in 2010 –   26%
In 2011, national rates held close to the same. The most significant increase of 60% was between 1996-2009.

There is much to be said about these rates and with nearly 1 in 3 births ending in surgery, this is a topic of great concern. Birth advocates at Improving Birth and Childbirth Connection promote evidence-based medical practices and cesareanrates.com shows the differences in rates from state to state and even hospital to hospital. They are all striving to educate the public and keep people informed.

Now, having a midwife does not guarantee you will not have a c-section- there is no magic.

midwife, Jan Wolfenberg visiting with my daughter.

Midwife, Jan Wolfenberg visiting with my daughter. 2 of my 3 children were born at home with Jan and doula, Kara.

Even with the best care imaginable by an OB, MD, or midwife, a cesarean may still be medically necessary.

Understanding what increases your risks is important and knowing that having a midwife and/or doula lowers your risks is also worth investigating more. Here’s a list on tips to safely prevent a c-section, tips 1-3 will address how you can build your super-birth team.

What is a Midwife?

According to the Childbirth Connection: “Midwives are well-suited to care for healthy women who expect to have a normal birth. They provide prenatal care, care during labor and birth, and care after the birth. Many give priority to providing good information to women, involving women in decision-making, and providing flexible and responsive care. Many work to avoid unnecessary tests and treatments; and women under the care of midwives typically are less likely to have a cesarean, an episiotomy, and other interventions than women receiving care from doctors. Some midwives provide continuous support throughout labor and birth, which has many benefits for women, infants, and families and no known risks. midwives often encourage, are well-informed about, and provide much support for breastfeeding. Some midwives also have additional training and credentials for childbirth education, breastfeeding consultation, and/or doula care.”

How to find a Midwife in Milwaukee: Are there different types? Where do they practice?

Whether you are interested in a home birth, birth center birth or hospital birth; you have many great choices when it comes to midwives. The types of midwives you will find very from state to state, in Wisconsin we have two:

Certified Professional Midwife (CPM) and Certified Nurse Midwife (CNM)

  • CPMs practice in birth centers or attend births at private homes. We are so very fortunate to have two great options for birth centers in Milwaukee: Well-Rounded Maternity Center in Bay View and Authentic Birth Center in Wauwatosa. I highly suggest touring these beautiful spaces and utilizing their many services (many free):  from childbirth classes, prenatal yoga, breastfeeding support, baby wearing, cloth diapering to support/play groups and so much more.

We have an amazing resource in Milwaukee called the CARE Network; where you will find various providers, including midwives who are affiliated and practice in-home and birth center births.

  • CNMs are usually found to be affiliated with hospital/medical groups; like Aurora Sinai or the Women’s Pavillion, Froedtert Hospital and at Columbia St. Mary’s affiliated groups like the Sixteenth Street Community Health Centers.

The Midwife Alliance of North America (MANA) represents all midwives.  The organization does a great job explaining the differences between midwives here, in addition to the history of midwifery care as well as steps to on how to become one (if that’s your calling).

The North American Registry of Midwives (NARM) is an organization for CPMs as The American College of Nurse-Midwives (ACNM) is for CNMs.

Research articles that highlight midwifery care

“With obstetrician-led care, they write, often the doctor who has been caring for the woman during pregnancy is not the obstetrician present at birth.”  Midwife-led care linked to fewer premature births and greater continuity of care; read more about this August 2013 review here.  Find the source from which the previous article was written in The Cochrane Library here.

“In addition to normalizing and humanizing birth, the contribution of midwife-led care to the quality and safety of health care is substantial.” read more about this NIH Cochrane review here.

Wondering about the safety of a planned home birth? These recent studies from Canada, the Netherlands, and the United Kingdom are worth looking at.

Questions to Ask.

  • Why did you become a midwife? Can you tell me more about yourself, your family, experiences that have changed you or the way you practice?
  • Where are you practicing? Where do you deliver/catch babies?
  • What can I expect for prenatal care? Postpartum care? Can I continue care with you beyond this pregnancy?
  • Who do you work with? Do you have partners, an assistant or back-up?
  • Can I expect you at my birth or do you only attend births on specific days?
  • Are there doulas you work with or recommend? Do you suggest I have a doula?
  • Are there OBs you recommend me meeting with? Should I continue prenatal care with an MD or OB?
  • What is involved with my routine care? Where do I have my lab work drawn? What testing is recommended? Do you recommend ultrasounds? How many?
  • How many births have you attended? Where or with whom have you trained? How long have you been attending births as a midwife?
  • What is the cost?  Are services covered by insurance?  How do I handle billing?  If this is an out-of-pocket expense, is there a sliding fee or payment plan available?
  • In an emergency, what happens?  What is considered an emergency or outside of your scope of practice?
  • If I am birthing at the hospital, who should I expect to handle my care? Does an OB take over? Are you able to stay with me? Could you describe a scenario?
  • If I am not birthing at the hospital, how do you handle hospital transfers? What would be a cause for transfer? How often does that happen in your practice? Do you call for an ambulance or drive me? What hospital would I be transferred to? Do you stay with me? Could you describe a scenario?

For more questions to ask your midwife and inspiring birth stories, visit birth without fear.

As I said before, we are blessed with many great birth options in the Milwaukee area.  I have had the experience of working with many area midwives in my practice as a L&D acupuncturist and doula. However, we do have other excellent providers to choose from, including OBs and MDs. Some who practice just like midwives and others that use a model of care very similar to midwifery; keeping in line with evidenced-based maternity care practices to provide safe, effective and continuous quality care. For that, I am grateful. 

Knowledge is power and those who support you, empower you.

Do you have a provider you love? A story you’d like to share? Feel free to comment below.

Sources:

  1. Birth Matters, by Ina May Gaskin,Published 2011, Seven Stories Press Press, pp 235-236.
  2. CDC NCHS Births: Final Data for 2010 http://www.cdc.gov/nchs/fastats/delivery.htm
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