More Than A Scar

       Crisis [krahy-sis]

Noun

1.       A stage in a sequence of events at which the trend of all future events, especially for better or for worse, is determined; turning point.

2.       A condition of instability or danger, as in social, economic, political, or international affairs, leading to a decisive change.

3.       A dramatic emotional or circumstantial upheaval in a person’s life.

I was 37 weeks pregnant, sitting on the white, crunchy paper of a doctor’s office table, when my obstetrician informed me that I was very tiny and the fetus I was carrying was measuring large; “we should just schedule a c-section” he said. Something in me knew that was not the appropriate response and I declined, requesting I be allowed to try and birth my child naturally. Reluctantly, this man I entrusted with my care agreed as long as I “progressed fast enough.”

I was 40 weeks pregnant, sitting on the white, crunchy paper of a doctor’s office table, when my obstetrician reminded me that I was very tiny and the fetus I was carrying was measuring large. At this point, I scheduled my induction. Little did I know, ACOG does not support induction or routine cesarean section for a suspected big baby.

I was 40+3 weeks pregnant in a hospital bed, receiving Cervadil. A few hours later it was apparent that either my child was ready for his birthday or the Cervadil was all I was going to need. It was around 2am, Feb 6, 2007 and my labor had begun. I slept through most of early labor and a nurse came in at 7am because “it was time” for the Pitocin drip to begin. I didn’t want it, I was beginning labor on my own but “I had to” have it. It was started and then quickly stopped due to decels in fetal heart tones. I labored naturally on my own, frequently interrupted by “required” vaginal exams to ensure I was “progressing fast enough.”

It was Feb 6, 2007 at 2 o’clock in the afternoon, I was 7 centimeters dilated, my water had spontaneously ruptured about an hour ago, fetal heart tones were reading great, maternal blood pressure was spot on but twelve hours was long enough according to the obstetrician I had entrusted with my care. A cesarean section was ordered for “failure to progress” and approximately 1.5 hours later, my child was cut out of my body. I gave my child a kiss and we were separated, the rest of the operation details don’t matter much. He was 7lbs, 2oz, 20 in long and his head was 14 ¾ in diameter.  At my late ultrasounds, the doctor had estimated my baby to be around ten pounds but “Wow, what a big head. He wouldn’t have fit anyway,” was the explanation without apology from my obstetrician.

A mother seeking a TOLAC, (trial of labor after cesarean), in a rural town is very limited. At the hhosptal in my town an RCS, or routine cesarean section, is scheduled for mothers with prior cesareans. For my second birth I sought care from a group of midwives in the city and planned my birth place to be a hospital; not my first choice but one of the few options I had because of my prior cesarean. I was 37 weeks pregnant, moderately dissatisfied with my choice of care providers, sitting on the white, crunchy paper of a doctor’s office table. My midwife informed me my fetus was breech, I would “have to” have a cesarean. I found a new care provider. My crisis taught me that this is my body, my baby and my birth.

My crisis taught me that I shouldn’t trust another with my care; I had to be responsible for the decisions made. My crisis taught me to follow my heart. My crisis taught me that what one person says is not always correct. Little did I know how profound that statement was to become.

I was 41+6 weeks pregnant, it was a little after midnight and fear overwhelmed me; fear that if I didn’t “push fast enough” this opportunity, this right, and this birth, would be taken away from me. Three pushes later, my son was born, measuring in at 8lbs, 6oz, 19 in long with a head that was 14 ¾ in diameter. My prenatal challenges shaped who I was becoming as a mother but these numbers impacted the realization of my crisis on a deeply emotional level; realizing how much I had been lied to during my first pregnancy. The cut of my first birth may have been the actual event of a crisis but it was at this moment that it became such.  It was at this moment my life changed.

As the weeks unfolded I bonded with my VBAC baby like I have never done with my first child. It was during these moments I began to feel the emotional impact and realize my first birth experience was a crisis. It had always angered me, it had been a frustration during my second pregnancy but now, it hurt me. The cut of my cesarean cut more than just my body, it cut my soul.

-- Anonymous  

The cesarean rate in America is 32%. The World Health Organization recommends less than 15% to be appropriate.  With these numbers in mind, it's no surprise that so many mothers have suffered from birth trauma from a cesarean. If this is you, I encourage you to process your past birth experience(s). Find a local ICAN Chapter, take a birth after cesarean workshop, attend a group counseling session where you can share your experience(s), hopes and fears, and be showered with love, compassion and support. Some mothers may benefit from seeking a therapist trained in EMDR, (eye movement desensitization and reprocessing). All mothers will likely benefit from a doula.

Not all mothers feel traumatized by their cesarean but most view it as a crisis that challenges them to this day. Use this challenge to support those around you; use it to improve birth. Because when you know better, you do better. Find evidence based information; know and understand your options and make informed decisions, encouraging those around you to do the same. 

If a mother feels empowered in her birth experience, no matter the type of birth it is, she is less likely to suffer emotionally. Birth shapes the type of mothers we become, the relationships we have with our partners, our children and those around us.  A cesarean affects a mother emotionally, physically and medically for the rest of her life.

Final Rules for Midwifery Scope of Practice and Licensing

Just so that you're all aware: The Final Rules for Midwifery Scope of Practice and Licensing in Arizona. Effective July 2014. -via Arizona Department of Health Services, filed rules

Don't Hate, Let's Educate {Birth}

Stop the Mommy Wars is derived from the concept that the only choices we have control over are our own. What another mom chooses is her decision – who are we to judge that?  We are each free to make our own decisions and we should support another mother in her own decisions, creating a stronger community.  While I fully believe this is an excellent idea to stop the growing trend of pop culture pitting moms against each other, I also feel we have other battles placed in front of us that must be confronted. So should we fight one another, insisting that each person is in the right? No: Don't Hate, Let's Educate.

Birth

Your birth, your way. I firmly believe that and as a doula abide by that; I support whatever kind of birth my client chooses.  Here's the catch- I educate my clients. They are making informed choices.

The problem lies, once again, in our misinformed culture. Fear is rampant!  Less than half of all expectant mothers will have taken a childbirth preparation course by the time they give birth. A good majority of those who do take a course take one in a hospital setting. In a hospital course you learn how to be a good patient. You learn some basics about the stages of labor but not what you need to know; not evidence based birth. You'll learn what your [medical] pain management options are but most won't tell you all of the risks of an epidural or that a doula helps to relieve your pain naturally and is associated with a more positive birth experience. They'll tell you the process of admitting you to the hospital but not tips to keep your labor from stalling; they have pitocin for that. They don't work to undo the fear that has been bestowed upon us by our pop culture and the collective memory we've built from that culture.  It's easy and cost effective when birthing mothers can be put into the system, boxed up and released.

But we are each individual mothers with unique births, bodies and babies- we deserve to be treated as such. Don't Hate the system because it treated you unfairly, Let's Educate and spread the word that this is a human rights issue; autonomy of choice. This is what I'm talking about!

A cause that directly affects the health and well-being of millions of women around the world. That cause is human rights in childbirth.

You, mother who doesn't research and just does as your told in the birthing room, I judge you. I judge you and I apologize for that but if we are to take back birth then there is no room for mothers who don't care. We need all the support and advocacy we can get because birth matters.

So is this OB vs Midwife? Hospital vs home? Technology vs nature? No! We can all respect one another. I will respect your choice to birth in the hospital with an epidural if you respect my choice to birth at home without drugs. I respect yours because I've researched yours. Have you researched mine? I'm not asking if you believe it, I'm not asking you to achieve it. I'm simply asking you to be informed. Understand that home birth is a safe option for a healthy, low-risk mother. It's OK if it's not the choice for you, I don't judge you; I simply want you to know that pregnancy is not an illness. I want you to know the epidural is not free of risks. Do you know the benefits and joy of natural birth? Or are you overwhelmed by fear of the pain we have been programmed to expect in childbirth?

"So many North American women have experienced the pain of labor, and then had an epidural, that our collective memory about birth is now full of hurt but is missing the feelings of ecstasy and success that natural birth provides." -Cynthia Gabriel

Our culture has been programmed to fear birth. When birth moved out of the home and into the hospital it became a mystery. Little girls no longer see birth as a normal part of life but as an illness that needs medical care. Everywhere you turn you see complications and pain and no mother wants to be the only woman in the birth circle talking about her blissful or ecstatic birth. Are you getting your information from the media? Are your friends, coworkers and complete strangers bombarding you with horror stories? What would happen if you surrounded yourself with positive birth stories? Have you considered finding a birth circle? Do you have a doula or other caring support persons?



Midwives may provide an excellent source or childbirth education but if you're getting your information from an obstetrician, you must understand that they are trained surgeons; they are trained to manage complications in birth! Don't be ignorant when choosing your care provider. Do you know your care providers birth philosophy? This should be one of the first questions you ask when in search for a care provider. You shouldn't have to settle or compromise. [<--Trigger warning]

Why is it that we get pregnant and call the surgeon! 

The United States spends $98 billion annually on hospitalization for pregnancy and childbirth, but the US maternal mortality rate has doubled in the past 25 years. The U.S. ranks 50th in the world for maternal mortality, meaning 49 countries were better at keeping new mothers alive.

So what's different here than in those other countries? Do they have better technology than us? No. What's missing here, in the United States, is the midwifery model of care. Only 8% of mothers are seeking a midwife for their prenatal care and birth. When are we going to catch on? When are we going to realize that birth is a normal life event. Not only does birth matter, mothers matter! It's not enough to merely say "the baby's healthy, that's all that matters."

There's not near enough of a concern for the rising cesarean rate. Can a cesarean save lives? Yes. Are all  these cesareans we're having necessary- not even close. The WHO recommends a cesarean rate below 15%; anything above that and our outcomes are not improving alongside of the rise in this major abdominal surgery. We are at a national average of 32%.
 
Take charge of your birth. Know what interventions increase your likelihood of a cesarean.
It is NOT ok that we are using pitocin to elictively induce labor.

Daily Med Plus

Don't Hate, Let's Educate. Surely, a mother who knew the risks of induction to her baby and to herself would not choose this. But as a culture, we have made pitocin far too permissible in birth and ignored the dangers of it. Roberto Caldreyo-Barcia, MD said,

Pitocin is the most abused drug in the world today.

We are disregarding the importance of mother nature and creating detrimental affects.

Infographic courtesy of Plumtree Baby

Beyond all of this, it's more than just this moment, this birth; pitocin impacts so much more. Michele Odent, MD first began exploring the desensitization of oxytocin receptors.

Oxytocin is the hormone of love and bonding and human connection. If the oxytocin system is damaged, or a child’s oxytocin receptors become desensitized, the ramifications are huge. Click here to read more about how pitocin impacts can be life-long. 

A recent ACOG survey found that in 43% of malpractice suits involving neurologically impaired babies, Pitocin was to blame. Is this really a risk you want to take because you're uncomfortable towards the end of your pregnancy? Of course not! But mothers are not being told of the risks and so we are overly seeking convenience. This "convenience" is affecting us as a society. This is what I am so angered by. I don't know your circumstances, I don't judge you; what I judge is ignorance. What I am enraged by is the lack of knowledge and respect for choices made surrounding birth. Why is this risk such an easy option to obtain but to VBAC you have to fight? You'll be told the risks of that and you'll be told in a way that makes you fearful, regardless that a vaginal birth may be a safer choice.

Fear mongering is not ok! Ever!

In conclusion: we must respect each women in the choices she makes for her birth and understand that she made the choice she felt best with the knowledge and support she was given. Don't Hate, Let's Educate. We need to stop bashing one another for the choices the other has already made and start reshaping the way our culture views birth. If we can influence the way we think about birth- trusting mother nature, understanding this normal life process- we can begin rethinking our choices and positively influencing future generations. But with so much negative influence from pop culture and a lack of prevalence in the midwifery model of care, where is a simple consumer to begin improving birth? [<---The answer here.]

Previously in Don't Hate, Let's Educate: Vaccinations and Baby Feeding

For more in evidence based birth to help you make informed choices, follow the Journey of Life.

What's important for your birth ?

Frequently UN-Asked Questions {A Birth Circle Topic}

Write down the questions you have for your pediatrician, midwife or obstetrician        
Trust your gut; ask about the things that worry you on a day to day basis
You feel comfortable and cared for

Excellent! So you think you're ready to get the most out of your provider? But wait! There must be more.  That was for the month of May at the Yavapai County Birth Circle- those frequently un-asked questions. Keep reading to get the scoop..

Fact or Fiction: Midwives

Fact or Fiction: Midwives » ProProfs


'Who Will Attend Your Birth' on the Journey of Life?








Get the scoop without the quiz:

Birth of our Society

The quality and outcome of childbirth in our society is in need of reform.  This is a life changing event for a family and should be recognized as such. Throughout time our statistics in health outcomes have declined along with the quality of care a woman receives.  Options have been stripped, the compassion and art of birth is being lost in the rush of our culture. Today it is common to find birth rushed and controlled and being born of those demands we continue to live those demands. [This is no way to live!] We need to recognize this as a problem and begin remember the midwifery model of care and give birth back to the mother.

The birth of her baby will impact a woman for the rest of her life; this occasion will affect what kind of mother she will be, the kind of lover she is and ultimately determine how she perceives herself.  If her birth experience left her feeling strong and able she will be empowered and confident; birth matters.    Ask any woman her birth story and you’ll see the flood of emotions come back to her.  ACOG defines delivery as the extraction of a fetus.

The state of maternity care in the United States renders us third highest of developed nations for maternal mortality rate.  In a nation where we flaunt our technology this statistic is shameful.  Our cesarean rate is 32% when the World Health Organization recommends no higher than 15%. Hospitals emphasize standardized care across the board for this personal life event.  Putting a woman in a hospital, treating her as if she has an illness, completely undervaluing her power and ability to birth her own baby is not the appropriate approach to birth.  Maternity care should protect mothers from complications rather than creating them.  Far too often care providers are managing birthing women in the most time efficient, convenient manner; cost being a huge influence of how they provide care and further influence coming from insurance companies and new technology that is released before its full impact can be determined. Indeed, we are seeing today the effects of the epidural and still seeing more negative outcomes than positives as a result of standardized continuous fetal monitoring. These fetal monitors interfere with the ability to labor comfortably; whatever happened to women being attended individually and monitored by their personal birth attendant?  This can’t be done in a hospital when the demand is for more patients, nurses stop by for scheduled readings and care providers step in to “deliver” the baby or if the machines determine a problem.  In other developed nations such as Holland, home is the place of choice for birth, yet here the first thing we do is call a trained surgeon and pick a hospital.  At home we can’t control labor and birth like we can in a hospital but that’s just the thing—like Mother Nature, birth is not meant to be controlled.  In a hospital, a woman must be firm in her request for staff to ‘sit and wait’ because it’s so common for them to speed things along, manage her pain “the easy way” and turn the bed for the next patient. Those who are aware of their options have to exert great effort for what they want, negotiate to prevent what they don’t want and constantly repeat their desires.  If health care providers were to protect the mother’s space, being there when needed to assist as she birthed, patiently sitting on their hands when not needed, birth could become the sacred, peaceful event it was meant to be.

Today, the media has instilled into women fear surrounding birth. From the introduction of hospitals, came a veil, separating fathers for a time, and stripping birth from its normal role within the family when girls once saw birth many times prior to their own experience. In this harsh environment complications were born where we sought to make things easier.  Doulas are said to create a buffer for this harsh environment as well as provide continuous emotional and physical support for the mother and even for the father allowing him to participate at a level that he feels comfortable.  Prepared childbirth aims to give women understanding of the physiological process of birth, understanding the hormones, emotions, variations of 'normal' and their options. There are various methods of prepared childbirth that equip women with means of coping and accepting their labor in a positive, relaxing way.  The goal of prepared childbirth is to take away fear and instill confidence; doulas facilitate this preparation. Unfortunately only 36% of women will take a childbirth education course and only 3% will use a doula.  Fear of birth results in negative outcomes, while acceptance is attributed to positive birth outcomes. 

In most cultures midwives provide the primary care for expectant mothers and obstetricians are there in case of complications.  This is not to say that all ob’s are medicalized but that is their training—in managing complications prenatally and in labor & delivery.  In the 1920’s when birth moved into the hospital, doctors slandered midwives to gain more patients and attract attention to their “nice, shiny facilities”; there became a rift between these two birth professionals.  Across the United States midwives face animosity from obstetricians and hospitals when in fact, their goals should be the same—a healthy mother & baby and a satisfying birth experience.  The birth experience will influence bonding between mother and baby as well as overall maternal health, therefore, this aspect cannot be ignored.  The problem remains in the great divide between obstetricians in midwives.  It is immensely important that we bridge that divide as well as heed to the “do no harm” creed in obstetrics care. It would be prudent of us to follow suit of those cultures where birth is attended by a midwife and medical interventions and ob’s come in play as necessary.  Birth is a natural life event, an important part of the Journey of Life, and should be treated as such; it’s not a money-making endeavor. 

Where is a pregnant woman to go?

Home A home birth is an excellent choice for a low-risk pregnancy.  Midives attend home births. They tend to have a hands-off approach and trust birth. Licensed midwives take only a certain number of births per month and you can expect individualized care.  You will want to interview midwives to find one whom you share a common view of birth with.  Midwives are trained to attend natural labors and have many years of knowledge passed down to them.  At a home birth routine interventions are avoided and the body’s physiology is relied upon as opposed to technology. Your midwife will bring what is needed to your birth.

Hospital Hospitals provide a medical model of care relying on technology to monitor patients. If you have a high-risk pregnancy you may need to seek out a physician (OB) and birth at a hospital.  CNM’s also attend births at hospitals.  Interview your care provider to determine what their philosophy is on birth. Technology will be used to monitor your labor and you will be mostly attended by on-staff nurses.  Hospitals provide standardized care for women.  When finding a hospital to birth at, be sure to find out what policies, procedures and interventions are common for them as well as from you care provider.

Birth Center Not comfortable with birthing at home but don’t want to go to the hospital?  A birth center may be just the choice for you.  Birth Centers show a reduced incidence in c-sections and provide the midwifery model of care.  Commonly they are located near a hospital in case of emergency.  Hospital Birth Center Choose carefully to determine whether standardized or individual care will be offered and what policies and procedures are typical.  These may offer a home-like feel within the same building of the technology.

Frequently, women face controversy from well meaning friends and family when choosing where to birth.  This is a tough predicament for women to be in as most want to maintain their relationships with your family; who wouldn't?- They can be an intricate part of your birth/support team but that's the key, they have to support you. In order to do so you can take the initiative to provide them with evidence and knowledge and reasons to understand your choice but in the end it's your choice and their job, once given the knowledge, is to either support you or hold their peace.

In the 1920's birth in the United States was moved into the hospital.  This move was pushed forward by new and exciting options for pain management during labor, such as "the blessed ether" and "twilight sleep" but like many of today's hospital interventions those were not fully tested when made available to the public.  Today, we are still learning the ramifications of the epidural and having more negative than positive affects from the standardized electronic fetal monitors.  So are all hospitals evil??  No!! Medical interventions such as cesareans, iv's, pitocin and more have a time and place- when complications arise.  When there's a need these medical interventions can be life saving measures for both moms and babies and we are blessed to have access to them; the problem arises when the need for intervention is created by interventions. Hospitals offer technology that may be imperative to high-risk pregnancies; in low-risk pregnancies a hospital might be a good choice for a woman who wants to be nearest to the technology or who is desiring to birth with medication or who simply wants the immediate access to help in the case of an emergency like cord prolapse.

Pregnancy is not an illness!  Michel Odent, renowned French Physician said, "One cannot help and involuntary process. The point is not to disturb it."{Do No Harm} For this very reason many women choose not to birth in a hospital. The Cascade of Interventions is becoming a commonly known phrase, and not just in the birthing community, for a reason. Women who wish to avoid this cascade so as not to create problems in a low-risk pregnancy and birth will hire or doula or choose to birth outside of a hospital or both. A guest blogger on Banned From Baby Showers says,

Looking back, having a baby at home was the best experience possible. We didn't have to worry about the drive to the hospital. We didn't have to deal with any cranky hospital personnel poking and prodding all hours of the day and night. We didn't have to deal with hospital regulations, the nursery, and the list goes on. And I never had to deal with any bloody mess whatsoever!

The U.S holds the one of the highest maternal mortality rates in the developed world. Hospitals did not reduce that number but increased it. Compare us to Holland, where birth is common at home and it becomes shockingly apparent that hospitals are not the safest place to birth. Hospitals have a higher rate of infection, high nurse to patient ratio and many protocols that treat women like cattle rather than individuals. That may sound harsh but they are required to follow standardized care for all women regardless of individualism and that creates added risk in an uncomplicated birth. The nurses in a hospital rely on machines, that were introduces before fully understood, to monitor labor. In America our cesarean rate is 32% while the WHO recommends below 15%. You can research hospitals in your area to see their individual rates but the numbers hash out to 25-30% of women who give birth in a hospital setting end in a cesarean compared with 6% of those who choose a birth center to give birth in.

Birth Centers are licensed and/or accredited by ACOG as safe places for giving birth. The care provided is individualized; laboring mothers are closely watched and the midwives who watch over them are trained in knowing if a complication is beginning to arise. Instead of being monitored by machines, women in birth centers are watched over by their care providers. Birth centers have a transfer rate of 2%, the majority of which are non emergency transfers and can commonly be for prolonged labors that end in vaginal births. The risk for infection at a birth center is higher than of that at home but significantly lower than that of a hospital. Accredited birth centers have emergency medical equipment on hand and sometimes even a house physician. Accredited centers also have agreements with hospitals in case the need for a transfer arises and it is possible that your midwife will have privileges at the hospital of transfer resulting in no interruption of care.

Even more important than where you give birth is who you choose to attend your birth. Midwives are trained in birth, OB's are trained in medicine. That doesn't go without mentioning some midwives are extremely medicalized and some OB's are great at sitting on their hands; what's important is to find a care provider with a birth philosophy similar to yours who will be there to support the choices you make.  This alone is evidence to the safety of home births.  Home births are attended by midwives who have earned their degrees and/or license by their training, knowledge and experience.  This title wasn't handed over to them lightly, they worked for it and birth is their passion.  A good home birth midwife isn't out to manage your labor and deliver your baby but to walk beside you and support you in your pregnancy, labor, birth and postpartum period.

You birth your baby- where you choose to do this is your prerogative.  If you're most comfortable in your home, in your bed, with your comforts and surroundings, then in a low-risk pregnancy this could be the best choice for you.  Birthing at home doesn't mean you have to go with out all medical equipment; midwives carry oxygen, pitocin and other supplies should the need arise.  As said before, they are trained to know if a transfer is necessary and like birth centers, most transfers from home birth are not full scale emergencies.  Questions about how your care provider handles a transfer are something you'll want to discuss prior to making your decision to birth at home just like questions about cesarean rates and induction percentages should be asked prior to choosing to birth in a hospital.

After you've provided your family and friends with information, you can kindly ask them if they aren't going to be supportive to refrain from input. Pregnancy and birth are sacred and should be treated as such; to influence a woman negatively is not only disrespectful to her, it can also be harmful.

Today's evidence for birth centers is amazing! Congratulations on your decisions and pregnancy! Best of luck on your journey.

For a much more detailed analysis and what you need to know about choosing a place of birth:  http://childbirthconnection.com/article.asp?ClickedLink=252&ck=10145&area=27

Where will you begin your baby's Journey of Life?

Who Will Attend Your Birth

Did you realize this the birth of your baby?? The people there should be those chosen by you!  You hire your doctor/midwife, you hire your doula, you invite whoever else you please and restrict anyone you like.  I've already mentioned the benefits of a doula here and be sure to read up on what the American Pregnancy Association has to say about having a doula. 

If you're wondering whether or not to have your mother or mother-in-law present, have a chat with her.  Let her know what kind of support you will find beneficial at your birth and decide from there.  Do you have a sister who offers too much unsolicited advice?  A best friend who loves updating her facebook every contraction?  You may want to kindly ask them to wait in another room and invite them to visit your new little bundle whenever you're ready.

An OB or a Midwife- which is right for you? 

 

An obstetrician/gynocologist is a phsycian who provides medical and surgical care for women, with specialize training of the female reproductive system and pregnancy.

This OB/GYN link specifies their training requirements and more.  An OB is a great choice if you are high-risk because they are trained to find complications and manage them. OB's attend hospital births which typically cost $16,000-$21,000 for an uncomplicated vaginal birth.

When deciding on an obstetrician get an idea for their view of childbirth with these questions:

1. What is your philosophy about childbirth? What do you feel your role is?

2. What is your cesarean rate?  (The WHO recommends no higher than 15%)

3. How do you feel about parent written birth plans?

4. How do you feel about unassisted childbirth? (This isn't to say your planning on one, it's just to get a feel for how much this particular care provider trusts birth.)

5. What is your episiotomy rate?

6. What do you do to reduce the chance of tearing or the need for an episiotomy?

7. How do you feel about doulas?

8. (If they are female) Do you have children? Tell me about your birth experiences.

9. What happens if my water breaks before labor begins? What kind of time-frame am I restricted to?

10.  Do you practice active management of labor? Do you routinely intervene or allow labor to progress normally?

11. What hospital(s) do you practice in?

12. What happens if I go past 40 weeks? 41 weeks? 42 weeks?

13. What is your induction rate? Under what conditions to you advice an induction?

14.  What natural induction techniques do you recommend?

15. What percentage of your "patients" are high-risk / low-risk?

16. What conditions do you consider high-risk?

17. How do you handle fetal monitoring?

18. Will I have freedom of movement during labor?

19. Can I try alternate birth positions?

20. Do you have any plans or interferences around the time my baby is due?

21. What prenatal procedures do you typically do?

 

A midwife is a person trained to assist women in childbirth. 

There are different types of certification and training for midwives, the most common of which I'll cover. 

There are direct-entry midwives, who do not require prior education as a nurse.  These are CPM's, or a certified professional midwife who has met the standards for certification set by the  North American Registry of Midwives or licensed midwives, LM, who practice in a specific state.  These midwives work in out of hospital settings. A typical home birth varies in cost by location.  After midwife fees, supplies and labs you can probably expect to pay $4000-$5000.

Some questions to ask a potential midwife:

1. What is your philosophy about childbirth?

2. What is your training and experience?

3. Do you routinely perform vaginal exams or only by request?

4. What other methods do you use to assess dilation?

5. What happens if I go past 42 weeks?

6. What do you do if the baby is breech?

7. Regardless of whether you will attend a vaginal breech birth, how do you feel about them?

8. What do you consider high risk?

9. When in labor do you come to my home?

10. How often do you check baby's heart rate and what do you use?

11. What is your episiotomy rate?

12. What do you do to help prevent a tear? 

13. What kind of equipment and medication do you have at a birth?

14. How does a transfer work? What is your transfer rate?

15. What are your fees? What is included/not included?

16. Do you offer placental encapsulation?

17. What happens if my water breaks before labor begins?

18. What is your experience with shoulder dystocia? Cord prolapse? Postpartum hemorrhage?

19. Do you work with doulas? Birth photographers?

20. Do you recommend or work with a doctor in case of emergency?

21. Who will attend my birth if you are sick or unavailable?

22. Do you offer or recommend a particular childbirth education class?

23. Can I have a water birth? Do you supply the tub?

24. Can I eat while in labor?

25. What do you normally do during labor?

26. Can my partner catch the baby?

27. Under what circumstances would you artificially rupture the membranes?

28. What newborn procedures do you typically do?

A CNM, or certified nurse midwife, is an advanced practice nurse who attends your birth in a hospital or home.  They work with a doctor who backs them up should complications arise.  I like to think of CNM's as the in-between- you don't want a doctor but you still want to birth at the hospital. Or possibly you'll choose a CNM because they are covered by your insurance provider.  No matter who you choose, remember you have hired them! You can change care providers at anytime if you determine they are not the right fit for you!

Getting ready for your baby's Journey of Life can involve making a lot of decisions; it's important to have people beside you who will support you in positive ways and empower you in your childbirth experience.  

What questions do you ask potential care providers and doulas?  Share your experiences here!