Midwifery Helping Homebirths Happen
Midwifery Helping Homebirths Happen
By Renee Rutz & Lisa Gottlieb-Clark
This is the fourth and final article in a series exploring the meaning and history of the alternative health care movement, the role it plays in our culture today, and how to become an informed health care consumer.
AGENDA has received a lot of positive feedback on these articles and will continue regular coverage of health issues in future months. In September, Rutz and Gottlieb-Clark begin a "Question and Answer" format health column. Send your health-related questions to: Health Editors, AGENDA, 220 S. Main, Ann Arbor, Ml 48104.
Midwives assist women with childbirth. Through extensive and postnatal visits the midwife helps the mother find awareness of her body and how it functions. Midwives believe that if a woman learns to trust her body and her feelings throughout her pregnancy, she will feel capable and self-confident during the birth of her baby. A midwife helps a woman prepare herself for the birth experience by providing nutritional counseling, education, and discussion about what might happen at the birth. Emphasis is placed on preventing complications from occuring through a well-balanced diet and diagnosing problems at their earliest symptoms.
Midwives believe it is essential for the mother and child to stay together after the birth. This is when the baby is most vulnerable and needs the warmth and comfort of its mother to begin the bonding process. For several weeks after the birth the midwife checks on the mother's and baby's health, lends moral support, and answers questions about breas tfeeding and other concerns. These home visits are especially important for new mothers, as those first few weeks can be stressful.
Midwives have a basic trust in a woman's innate ability to birth her baby, especially if the mother is in an environment that feels safe and comfortable to her. Of course some women feel safe in the hospital. Naturally that is where they should have their baby.
Midwives believe that the natural physiology of the mother should not be altered by the use of drugs, episiotomies, high-tech equipment, or mandatory specific positions while pushing. They think drugs cloud the mother's ability to focus on her body. Episiotomies are unnecessary because midwives give hands-on perineal support (using hot compresses and oil to gently stretch the vaginal opening instead of cutting the skin to get the baby out more quickly.)
High-tech equipment, such as fetal heart monitors are considered invasive and limit the mother's movement which is very important during labor. Use of a fetal monitor generally requires a woman to lie on her back. These strict limitations on her choice of position can undermine her sense of being in control of her own body.
Homebirth is not to be confused with "unplanned" or "unattended" birth. "Unattended homebirth often is the result of poverty, religious beliefs prohibiting medical care, or accident," says Patty Brennan, a local midwife. The midwife, however, is present for the entire labor and delivery. The people in attendance at a homebirth are chosen ahead of time which creates a trusting environment which is very important in the birth experience.
Advocates of homebirth feel that the home is the safest place to have a baby. Louis Mehl compared the relative safety of 1,146 planned home and hospital births in California (Journal of Reproductive Medicine, 1977). In this unique population-matched study, each homebirth mother was paired with a hospital-bound mother according to age, number of previous pregnancies, risk factors and other measures.
Data from the hospital population revealed 20 times more frequent use of forceps, greater overall use of drugs, six times more infant distress in labor, four times more infections among newborns, and three times more babies with respiratory difficulties in the first three days of life.
The hospital sample had 30 cases of birth injuries, including skull fractures, facial nerve paralysis, brachial nerve injuries, and severe cephalohematomas. Such injuries among the homebirth population were non-existent. Finally, there was no significant difference in infant death rates and no maternal deaths.
"Childbirth is not pathological," says Brennan. "It is more often than not a normal, healthy life experience. Since birthing came out of the home and into the hospital it has been hidden and there is a lot of fear about the unknown. Homebirth is a radical idea for most people in this country because going to the hospital has become acceptable."
Traditional or lay midwives are usually self-taught and have apprenticed with other lay midwives. The legal status of traditional midwives varies from state to state. In Michigan, lay midwives have legal status, and are not licensed or regulated by any governmental body. Complications during birth are handled with natural remedies such as herbs and homeopathic remedies. Lay midwives have had thorough hands-on training and have learned a variety of techniques to assist the mother at birth. If a serious pathology occurs during a birth, midwives are trained to be able to identify and solve the problem. If the midwife feels her treatment is not working, she knows when it is necesssary to transport the mother for medical assistance.
Homebirth is relatively inexpensive. A midwife in the Ann Arbor area charges anywhere between $800 to $1500 for prenatal care, attendance and support at the birth, and postnatal care. A hospital birth typically costs $5,000 or more.
Hospitals, in the last decade, have tried to make a more suppportive environment for the mother and family. In the last decade hospitals have started providing more comfortable rooms for birthing and have been allowing family members to be present for the birth. Many hospitals have hired nurse midwives to give mothers more attention and to support natural vaginal deliveries. (Nurse midwives have been trained as nurses and then have taken extra training in birthing.) They still are tied, however, to the medical model. Medical personnel have been trained to deal with pathology and emergency and thus respond to the needs of a birthing mother in a similiar manner.
Many of the medical procedures performed during hospital births are driven by the malpractice crisis. Obstetric physicians pay the highest malpractice insurance rates of all doctors, which puts them in a position to practice defensive medicine. Many parents today have the idea that scientific approaches to medicine ensure health and they thus expect their baby and the birth to be flawless. Given this patten, parents have a tendency to blame physicians if they don't get what they expect. This sets up a cycle that encourages doctors to use more and greater technology. The defensive position of the physicians and hospitals has driven the cesarean-section delivery rate to roughly 24% of all births in U.S. hospitals.
Midwives are notonly helping women to birth their babies, they are also helping to recover the notion that childbirth is a natural phenomenon which works best when it is allowed to happen with minimal intervention. Ann Arbor Area Midwives Patricia Kramer: 996-2347 Patty Brennan: 688-0016 Ute Beek: 483-1027 Mickey Sperlich and Janet Christman: 994-0971 Rahima Baldwin and Valerie El Halta: 582-5764.
Recornmended Reading
Elizabeth Davis, Heart and Hands: A Midwive's Guide to Pregnancy and Birth
Rahima Baldwin, Special Delivery.
Mehl, Lewis E., et al. "Outcomes of Elective Homebirths: A Series of 1,146 Cases," The Journal of Reproductive Medicine Vol. 19, No. 5 (November, 1977): 281-290.
Barbara Katz Rothman, Giving Birth: Altenatives in Childbirth.