Each week here at cord, we'll feature local Colorado midwives answering questions we received from you, our readers! If you have a question you'd like answered or if you're a midwife who wants to participate, send me an email (email@example.com).
What are some of the more effective pain management techniques you see women use?
Women laboring and birthing at home have an arsenal of comfort techniques to choose from. Water is probably the most sought-out comfort measure, from showers and warm compresses to a birth tub. Though not everyone wants to deliver in the water, it does offer relief for many people at some point during labor. Good support is an essential labor tool as well. Partners, grandmothers, doulas, and midwives are all reliable sources of labor support. Mobility is the hallmark of midwifery care. As Gail Tully says, "When you move the mother, you move the baby." Position changes not only help the progress of labor along, but also provide relief. Finally, being in a comfortable environment--your own home--goes a long way to making labor feel more manageable. Most mothers I've worked with who have had both hospital and home births report that labor is more comfortable at home--not painless or easy, but more comfortable.
What Needs to Change in Maternal Care in America?
Americans spend more money on health care, including maternity care, than any other country in the world, with middle-of-the-road results. We seem to think that throwing money at a problem solves it, but it is time to acknowledge the flaw in that viewpoint. Most European countries have excellent outcomes and rely on midwifery care. It is true that most of that care is provided in hospitals or tertiary birthing centers, but the acknowledgement of the wisdom in the Midwives Model of Care is obvious. Here in the US, midwife-attended births are a small minority. We are making strides to change that, but some things need to change.
Midwives and doctors need to have mechanisms in place to improve communication and collaboration. Doctors should be providers to high-risk women and consultants to midwives instead of the baseline care providers. That being said, insurance companies need to reimburse fairly for midwifery care, while acknowledging that many midwives do not have client loads sufficient to offset poor reimbursement rates, when reimbursement is even possible. But since midwifery clients utilize far fewer medical interventions, a cost savings is still easily realized.
Direct-entry midwives are important care providers, but have very little recognition in the US. Nursing and midwifery are separate fields, and it is not beneficial to make legitimized midwifery a masters level nursing specialty. However, direct-entry midwifery rules and educational requirements are not consistent from state to state, and if we are to grow into a recognized profession, that should be addressed. There is work being done on that front now--including my own Capstone Project for my Masters of Public Health degree.
Change is slow. Our maternal health system will not change overnight. But I would like to see midwives recognized as valuable members of women's health care teams--if not become the primary provider of maternity care for US women.
What Makes a Mom a Good Candidate for Homebirth?
There are many types of people who are good candidates for home birth, but as a general rule they share similar characteristics:
Home birth moms are healthy. This includes not only being low-risk in pregnancy, but also having minimal health challenges in general. It also means being attentive to eating a healthy diet and getting enough of exercise. Both of these things not only give moms energy and stamina that they'll need to grow a healthy baby and go through a natural labor, but they also help ward off some of the conditions that make someone a poor candidate for home birth. And healthiness extends to emotional, spiritual, and social health as well--it takes a lot of resources to give birth at home.
Home birth moms are not only willing to take responsibility for their choices, but they insist on it. Though the risks of home birth are low, and in fact many outcomes are improved with home birth, there are still risks involved (as there are with carrying any pregnancy). A family who chooses home birth needs to accept responsibility for their decision to have a home birth as well as many other decisions that need to be made for themselves and their baby, throughout the entire course of care. Because midwives believe in informed choice, consent, and refusal, that means home birth moms must be willing to become educated about every issue and make her own decisions about them.
Home birth moms are smart and flexible. They are smart enough to weigh risks and benefits, smart enough to believe that the age-old process of giving birth works most of the time, but also flexible enough to know that sometimes plans change. Home birth moms are okay with changes in the plan--sometimes the most desired water birth ends up on dry land, sometimes the girl promised by the ultrasound is a boy, and sometimes a planned home birth doesn't happen at home at all. Hiring a home birth midwife is about seeking out midwifery care more than it is about the place of delivery. It's about knowing that the Midwives Model of Care is the best plan for most low-risk women and their babies. It's about arming yourself with knowledge, and then surrendering to the process.
Gina Gerboth, RM, CPM, IBCLC is a Certified Professional Midwife (registered in the state of Colorado) and International Board Certified Lactation Consultant, living in Denver. She is married to her high school sweetheart, and is the mother of three sons, two of whom were born at home. She can be contacted by phone at 303-482-5829 or email at firstname.lastname@example.org.