What is midwifery?
Midwifery is the care of women and their families throughout the various stages of reproduction with the belief that pregnancy and birth are normal life events. As adapted from the Midwives Model of Care™, midwives are responsible for: “monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle; providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support; minimizing technological interventions and; identifying and referring women who require obstetrical attention. When following this model of care, it has been proven to reduce the incidence of birth injury, trauma, and cesarean section.”
Currently in the United States about 1% of the population is choosing home births for their labor & delivery. In the year 2000, the North American Registry of Midwives, provided a large, well-designed prospective cohort student of 5,418 women who had planned homebirths. The study found, when compared to low-risk women delivering in hospitals, the cohort had markedly low rates of medical interventions (such as epidural, cesarean, or assisted delivery), no maternal deaths, and a comparable neonatal death rate – namely, 1.7 deaths per 1000 low-risk intended homebirths after planned breeches and twins were excluded. (http://narm.org/professional-development/research/)
Why choose midwifery care?
Many families decide to use midwifery care because of the individualized and personal care they receive throughout their pregnancy. Initial consultations with a caretaker include a medical history review, physical exams, and diet, lifestyle & nutritional supplementation plans for the pregnancy. Additionally, there is time spent discussing the creation of a birth plan, which is a very important component to an enjoyable and safe birthing experience. Follow-up visits typically involve a screening of the mother’s pregnancy, including an assessment of the fetal heart rate, mother’s vitals, and emotional and physical changes that typically surface during pregnancy. The purpose of each visit is to build a trusting relationship between the caretaker and patient, and to also assess maternal (baby) health status. Conventional screenings like routine blood work, vaginal cultures, and genetic screenings are discussed and offered at each appropriate prenatal visit.
Another common reason women choose midwifery care, in particular at home, is to reduce unnecessary interventions such as mandatory intravenous placement, continuous electronic fetal monitoring, and epidurals, which are typically employed during hospital delivery.
The primary issue with unnecessary interventions is that once in use, the patient has an increased likelihood to require additional interventions as a result of complications from the first. A classic example of this is found with an epidural placement, which can potentially slow the progression of labor for women. In an effort to counteract the slower labor, the drug Pitocin may be administered to speed up contractions. The drug may cause uterine hyper-stimulation and fetal distress, which may lead to an unnecessary “assisted” vaginal delivery (vacuum extraction) or cesarean section. We must remember that even though we have access to technology that can alter the course of labor and delivery, this is not always in the best interest of our women and their babies. Interventions do not come without risk, and so it is important to be able to discuss the benefits and risks with your care provider.
What medical professionals can manage midwifery care?
In the State of Arizona, there are three different types of midwives: Certified Professional Midwives (C.P.M.), Certified Nurse Midwives (C.N.M.), and Licensed Midwives (L.M.). These medical professionals attend low risk pregnancies and births in the home setting, a birthing center or hospital. Midwifery training varies but typically combines academic and clinical based learning that is specific for the practice setting of the midwife. While credentialing is different, we stand united in the Midwives Model of CareTM.
Naturopathic Doctor’s (N.D. or N.M.D.) are another care provider that incorporates midwifery philosophy into practice. Naturopaths are licensed in the state of Arizona as primary care physicians, and receive medical school training through an accredited naturopathic medical school. Similar to a conventional medical doctor, their education allows for them to diagnose disease, order lab-work and imaging, and prescribe medications. Many naturopaths practice with alternative therapies such as botanical medicine, acupuncture, homeopathy, and nutritional medicines as their primary method of treatment. However, they are able to use conventional methods, for those cases that do not respond to natural therapies or when patient’s desire conventional care. A few Naturopathic doctors choose to specialize in pregnancy care and birth; these physicians must complete post-graduate training and certification in midwifery, most often as C.P.M.’s.
When selecting a care provider for your pregnancy, it is important to first interview them in person. Bring any questions you have about homebirths, and inquire about their principles of practice, training and licensing. Above all, make sure you trust their ability to provide a safe and pleasant experience for you during this important period in your life.
Krystal Tellier, N.D., C.P.M. is a Naturopathic Doctor and Certified Professional Midwife. Dr. Tellier has a family practice in North Phoenix at 40th Street and Bell Road. She specializes in women’s health, prenatal care, home births, and pediatric medicine. Her practice is Health for Life Naturopathic Medicine. Visit www.DrKrystalTellier.com to learn more or contact her office at 602-368-9211 or email her at info@DrKrystalTellier.com. To learn more about midwifery practice in the state of Arizona visit, http://www.azdhs.gov/als/midwife/. To find more articles about home births and safety, please visit http://narm.org/professional-development/research/.