Midwifery: Your Baby, Your Way
by Adrian E. Feldhusen, CPM, NHCM

The practice of midwifery is the world's oldest profession. Since the beginning of time, a woman has given birth to her baby in the presence of other women. These women were knowledgeable about childbirth from experience, apprenticeship, and intuition. Although midwifery is somewhat different in background than it used to be, it is still - for the most part - the same profession. So why do women choose midwives in this day and age?

The things I hear most from my clients about why they chose midwifery care are continuity of care, individuality, personability, compassion, gentleness, and the amount of time spent with them. This list is just the tip of the iceberg, though, as there are so many reasons why midwifery care is different than standard obstetric care.

First and foremost, midwifery is safe. It is proven without a doubt that midwifery care for the normal, healthy mother and baby is as safe, and even safer, than hospital obstetric care. The outcomes for midwifery attended births worldwide are far better than hospital births. In all actuality, the United States is number 28 in the world for its mother and baby outcomes. This is in relation to morbidity and mortality. If you think about this, there are 27 other countries that fare better than we do. The countries that have the best outcomes, the fewest deaths and birth related problems, are countries who use midwives (and quite often home births) for the vast majority of their birthing mothers. We are led to believe that hospital birth is safer than out of hospital birth, and that going to a doctor will yield you a happy, healthy baby because of the extensive education and equipment that they have to offer. Think again.

Continuity of care and individuality- now there are two statements that should go hand in hand with having a baby. When a client contacts me for their care, it is me who answers the phone. I see them for every visit, my apprentice and I greet them together, and on time, for every prenatal appointment, and it is us who show up for their labor and birth. We spend a minimum of an hour with the family for each visit we have with them. It is us who palpate their beautiful bellies when they lay on the antique bed in my office. We know what the woman likes to eat, how things are with her family, and what her birthing desires are. We understand what her past has been, that fears can be eliminated if dealt with appropriately before birth, and we know what she desires for herself and her baby for this experience ahead of her. When she calls in the middle of the night to ask a "silly" question, she knows that truly it is not silly, and we honestly don’t mind at all. We are glad to hear from her. I did not choose this profession for the wonderful "office hours" as most of my work is done before the sun comes up.

What can a woman expect when she comes for her visits? Well, to start with, she is greeted at my door by many children, a friendly dog, and warm smiles from us. We do not go to an "office", but rather to my living room that is set for this special purpose. She is offered something to drink and possibly a nibble, a nice comfortable wing chair to sit in, and an informal atmosphere so that she is not inhibited by us. We do not make her lie on a hard examining table, but rather a lovely cherry antique bed with a quilt. We start with what her past month has been like- has she slept well? Eaten well? How about things with her family and friends? How are the plans for the birth coming? We then move to the check-up. We palpate her belly, listen for the heart beat of the baby, take her blood pressure and vitals, and assess her general well-being. When she leaves here that day, she is armed with an entire page of information all about herself - what position her baby was in, what her blood pressure was that day, how much her belly has grown, what the heart beat was, and the things that she could work on for the next visit. I find all too often a woman does not know what is going on with her body or her baby. And not because she doesn’t care; but rather because she is not given the option of knowing. After all, it is not me who is the prenatal caretaker for this baby - it is her.

Diet is so vital to the outcome of the birth. By that I do not mean how much weight a woman has gained. Truly that is not nearly so important as what she is putting into her body. We spend quite a bit of time discussing what is being eaten, how that food affects her health and how she feels, and what could be done to improve any complaints that she may have. We always try to combat discomforts with the altering of food, or herbs, before we even consider allopathic modalities. We try and find things she likes to eat to supplement her already wonderful diet, and help her to implement these into her daily life. It is a learning experience for all of us involved. And we always encourage her to enjoy her pregnancy - to eat a few of the "good" things she craves - even if she is not supposed to. Babies like dessert, too. We like our mothers to make time each day for relaxation, a nap, and some quality time with their unborn baby. And exercise - well, it seems most of us don’t get nearly enough. But gentle walking, yoga, swimming, and the like will greatly improve her comfort during pregnancy and birth. I have many mothers who ride their horses, ski the snowy slopes, hike mountains, and run several miles a day up until the day they have their baby. Women are truly amazing.

One thing we impress on the families we serve is that birth is a normal process, not a pathological and medical event. We do not use fear tactics to get results, we use encouragement and love. If a decision needs to be made in any capacity, it is impressed upon the family that it is THEIR decision, not ours. We can give them information- from all angles- but we will not make the decisions for them; and we will not judge them for the decisions they make. We show them wonderful movies of home births, water births, hypnobirths, and the like, reinforcing that birth is natural. They come to understand that deep within themselves is an incredible power and energy to bring forth this baby on their own- to birth, and not be delivered of.

The day of the birth arrives. We get the phone call, and it is time. We do not wait until the contractions are 5 minutes apart- we allow the family to tell us when to come. After all, each woman needs us in different capacities and at different times. We are happy to go whenever she would like us. She has been well prepared, has been nourished and rested, and is ready for the labor ahead of her. Her house has not been transformed into a medical establishment, but left as it is with the addition of a few boxes of supplies in her closet. A woman is most comfortable in her own home; and when a woman is comfortable, she is able to birth her baby with less discomfort (and quite often none) and in considerably less time. When we arrive, we do not take over this quiet and serene atmosphere, but rather blend into the background with our few things necessary for the birth. We make the family something to eat if necessary, a fresh pot of chicken or miso soup for after the birth, and quietly wait by her side.

What about pain relief? Well, quite honestly, my mothers don’t even ask. I don’t know why, actually. Quite possibly it is because they understand that they can do it without drugs, without the epidural, and that love and support is just as grand. Or better yet, that birth is just not as painful as the media would lead us to believe. Massage, hydrotherapy, relaxation, self-hypnosis, and accupressure work wonders. And then there is just plain old compassion. These are the best medicines of all. She is free to move around as she wishes, to eat lightly to keep her strength up, to take a bath and relax, or to love her mate in privacy. She can choose where she wants to labor, and birth, and whom she wishes to attend for the event. I have attended births with just the family and myself, and births with 19 people in attendance.

When the baby is born, we allow them quality time to bond as a new family, delaying anything unnecessary until later. We clean up, take some pictures if they wish, and tuck them all into bed together. Nursing is established, the mother and baby are stable, and the phone calls to family and friends have been made. After hanging a "Do Not Disturb" sign on the door and resetting the answering machine, we head off for a few hours and let them rest as a family. We will come back within 24 hours, at 3-4 days, at 2 weeks, and see them again at 6 weeks. And, of course, are available unlimited for postpartum and nursing questions and support.

I cannot impress upon one enough the importance of the birthing experience. It shapes the way a woman feels about herself, as a woman and a mother. Ask any woman what she ate yesterday, and chances are she may not remember. But ask any elderly woman what her birth experiences were like, and I am sure she will remember every detail. If a woman is empowered to birth her own baby, she will be empowered in all aspects of her life. It is a transforming experience, one that will impact her forever.