Why I Used a Midwife and Birth Center

I want to provide some information about the care model I followed because some people are curious, some are misinformed, and I want to provide feedback to anyone else considering a similar option.  This is a long post, so proceed at your own interest.

After a lot of research and education both on my own and during my formal university education, I decided before I was ever married or pregnant that a birth center model would provide me the type of care I wanted through pregnancy and delivery as long as I remained healthy, normal, and low-risk.  I feel blessed that I happened to move somewhere that allowed this choice.

My daughter was born at Mountain Midwifery Center (MMC), an out-of-hospital birth center, attended by certified nurse midwife (CNM) and registered nurse (RN).  CNMs are specialists who are medically trained first as RNs, then complete several additional years of graduate or post-grad schooling and clinical training in gynecology, midwifery, and newborn care.  In hospital settings they often attend births individually or in tandem with an OB.  They are distinguished from direct-entry midwives who are not required to receive prior nursing or doctor training and learn through self-study, apprenticeship, or a private midwifery school.

I wanted to use a CNM for primary prenatal care because for normal, low-risk pregnancies, midwifery care is associated with lower intervention rates, lower mortality and morbidity associated with interventions, fewer recovery complications, and increased positive outcomes when compared with other models of care (such as OB, family doctor, etc).  Using a nurse midwife was important to me because I still wanted someone with general medical training.  Birth centers are associated with the similar positive outcomes.

Since I was healthy and low-risk, it seemed like a no-brainer to me to go the CNM care route.  I figured if my pregnancy wasn't risky, why use the people who specialize in risky?  Its like if I have healthy teeth and gums, why have a periodontist clean my teeth when a hygienist will do just fine (and for cheaper too)?

CNMs perform all the same tests and screenings a doctor would.  They can identify abnormality that will put you outside their scope of care and they have a high interest in doing so. MMC only accepts patients with normal, healthy pregnancies.  Any number of circumstances can result in "risking out", or being referred to hospital care.  They want everyone to be properly cared for, even it means patients must be sent elsewhere.

As their website says, MMC is "an education-intensive program of care".  In addition to qualifying physically, MMC requires all mothers AND their partners to complete classes covering breastfeeding, newborn care, natural childbirth, and expectations for labor and delivery at  MMC.  If you don't do the classes, you have to go elsewhere.  We spent nearly 20 hours in medically-based, researched-backed classes taught by RNs, CNMs, board certified lactation consultants and educators, certified childcare educators, and a research director with a PhD of molecular biology. (All of the teachers held two or more of those titles).  The classes were invaluable for helping us feel prepared for labor, delivery, and postpartum.

Midwives can attend births in a hospital, but I wanted to use MMC because of its flexibility with supporting labor and delivery.  You can labor and birth standing up, kneeing down, squatting, using a yoga ball, hanging onto a sling, sitting on a stool, lying on your side, sitting in a tub of water... basically any position is encouraged if it feels good and helps you progress except reclining on your back with your feet up. Labor tends to be shorter and more effective when the mother feels safe and comfortable in her environment, and when she is able to maneuver in ways that open the pelvis.

One other way MMC helps women feel safe and comfortable is making sure all patients have at least one prenatal appointment with every midwife and clinic nurse.  You don't know who will be on call when you go into labor, and they don't want you to have any strangers at the birth.  And if more than one woman is in labor and may deliver close together, they call in the next on call midwife and nurse so every woman has at least two attending personnel taking care of them.  There is never any "Stop pushing! Wait for the [whoever is supposed to be helping]!"

Nurses use external monitors for tracking mother and baby's vitals which allows mothers freedom of movement.  And thank goodness!  I couldn't take a contraction sitting or lying down.  I could only handle it if I was on my feet and bent over the bed into a pile of pillows moaning.  In retrospect, even if I'd expected to have an epidural in a hospital, my labor was so fast and strong that I never could have stayed in the position required to insert a catheter!  Good thing I'd mentally prepared to do without it in advance.  I think it makes a difference in perceived and actual tolerance.

And do without anesthesia I did.  Not because I was particularly brave, or crazy, masochistic, or virtuous, but because the birth center doesn't employ an anesthesiologist.  Of course they have emergency medication and equipment, oxygen, etc., but as far as medication for comfort you have to go to the hospital for that. I was OK with going the natural route because I'm not comfortable with the risks and side effects of epidurals on the mother or the baby (yes, it does affect the baby), and the other interventions it necessarily precipitates.  For me, the option seemed better reserved for an emergent complication.

If in the course of labor and delivery a mother needs to be transferred to a hospital because of an unforseen complication, or the mother simply decided she wanted anesthesia after all, the supporting hospital Swedish Medical Center is literally around the corner.  MMC has a fantastic relationship with the labor and delivery staff, and all MMC patients have to preregister with Swedish to streamline admission in the event of an unplanned transfer.

MMC's statistics speak for themselves.  Their rate of transfer to the hospital for any reason (both emergent [i.e. placental retention, excessive hemorrhage] and non-emergent [mainly for anesthesia]) is around 12%, and their overall c-section rate is around 6%.  For comparison, Colorado's hospital c-section rate is 30%-40%. The statistics can't be directly compared since it pits normal, low-risk pregnancies against all risk categories, but the chance of ending up with a c-section is still much lower for a low risk pregnancy when delivering at the birth center than at a hospital due to the lower rate of intervention.

Like I said in my last post, delivering a child was the hardest thing I've ever done.  But even though it hurt and I did not enjoy it like some people reportedly do, I don't regret choosing this route.  I felt safe, healthy, educated, and well cared for throughout my entire pregnancy, labor, and delivery.  We were released to go home 5 hours postpartum to rest and recover in the comfort and privacy of our home, fully trained to monitor and care for our child and recognize signs of abnormality requiring immediate medical attention.  Six weeks later, I'm fit as a fiddle and my daughter is a model of infant growth and development.

Heaven knows how many people implied or outright told me I was crazy, or uninformed, or weird, or irrational for using a midwife and/or a birth center.  I'd never had a baby before.  I don't know what I'll want when it comes down to it.  I will for sure be crying for anesthesia, blah, blah, blah.... spare me.  I trusted myself and my capabilities so I was not assuaged by discouragement though I was hurt sometimes when people I respected tried to undermine or dismiss my plan.  I kept in mind that all advice is autobiographical, and someone else's experience did not have to be predictive of my experience.

God bless the women who did the opposite of the people above-- who told me I was strong and could do it.  They didn't sugarcoat the guts it would take, but they also reinforced my confidence.  It meant a lot to me to feel understood and empowered.  It also helped to talk to or read about women who had the same plan as me but ended up with induction or c-section because of special need.  Their stories helped diffuse my anxiety and helped me feel OK if things didn't turn out the way I wanted.

Yes, birthing carries risk, but not everyone carries the same risks.  I was fortunate to be low risk and have the low-intervention birth experience I wanted.  If that is a possibility for you too, consider it!  And if you want it, you can do it!  Be strong and informed and don't fear.  The default is success, not failure.  If it wasn't so, Homo sapiens would not still be around.

Whatever your situation, plan for the birth you want and need, then surround yourself with people who support it.  Pregnancy is full of enough anxiety that you don't need to add to it by fraternizing with downers.

Now, a treat for those of you who made it through the whole post:

Gassy smiles

First trip to the park!