Interview Ques 4, 5 and 6
4 & 5
Pros (What are the advantages to this method/technique? What are its best features? Who is it best suited to? What are the limitations of this method/technique? Who is this method/technique not suited for? and
Cons: What kinds of problems might one encounter with this method/technique? In what cases are additional help or intervention needed? Etc.)
Hospital: Hospital care by an obstetrician is the best (usually only) choice for childbearing women who have serious medical problems or complications of pregnancy. This includes multiple gestations, fetal abnormalities, premature labor, abnormal bleeding, etc. However, having a planned hospital labor doesn’t mean that you can’t benefit from the supportive services of a midwife during the pregnancy and professional labor support by either a midwife or a ‘doula’.
Con: The down side of elective obstetrical care in a hospital is the greatly increased rate of medical interventions. According to the “Listening to Mothers” survey by the Maternity Center Association of NYC in 2002 (Google on title to read), every women laboring in a hospital was subjected to an average of 7 medical or surgical interventions. This would include induction of labor or speeding up of labor with synthetic hormones, being required to stay in bed due to IV tubes, electronic fetal monitoring leads, etc., and surgical interventions such as use of forceps, vacuum extraction or Cesarean section.
Hospital-based Midwifery: In areas where midwifery care in hospitals or hospital birth centers is available, it is a good option for women who do not feel comfortable with home-based or independent birth centers. Certified nurse midwives (CNMs) provide care in conjunction with an obstetrician and should the mother need or want more medical intervention, the obstetrician can authorize the CNM to provide labor stimulating drugs, pain medication or order an epidural.
Con: Hospital-based nurse midwives are still providing care in a medical system, so they are not usually able to provide the same hands-off, laid back time frame as community-based midwives.
The only reliable circumstance that permits a woman to have her labor managed physiologically is home-based care with a professional midwife. The outcome statistics for both mother and baby are excellent (the rate of interventions is far less than hospital-based obstetrics with perinatal mortality rate is equal or better (see citation below). There is privacy, no time pressure, women can walk around their house, yard, even neighborhood, eat and drink and use a non-drug variety of strategies to manage the pain of labor. That’s the good news.
Con: The bad news is that laboring at home does not allow for the use of pain meds or epidural anesthesia. However, it is OK to change one’s mind and transfer to hospital care anytime a mother decides that she doesn’t want to continue with an unmedicated labor. The other aspect of home-based birth services is that if the labor doesn’t progress on its own or there is any kind of emergency, you will have to transfer to the hospital either by your own care or in an emergency, an ambulance. This is very rare but none the less real limitation associated with community-based midwifery care.
BMJ 2005;330:1416 (18 June), doi:10.1136/bmj.330.7505.1416 “Outcomes of planned home births with certified professional midwives: large prospective study in North America Kenneth C Johnson, senior epidemiologist1, Betty-Anne Daviss, project manager)
6) What exactly is a Birthing Center? What is different about this process if one birth’s in a BIRTHING CENTER rather than at home?
The words “birth center” can be used to describe very different circumstances. Many hospitals now call their labor and delivery unit a “Birthing Center”. However, except for very rare exceptions, the policies will still be obstetrical, which is to say, medical interventions will be used very liberally. Don’t be fooled.
The kind of birth center that permit the midwives and physicians to use physiological management are known as “free-standing” or independent birth centers. The type of care is very similar to home-based midwifery except for whatever protocols are required by either their malpractice carriers or the state. For example, some state laws will not allow a patient to stay in an “outpatient” facility (the legal category) for longer than 23 hours and 59 minutes. That may mean getting discharged and driving around for an hour and then coming back to be admitted for a different 24 hours period.
Pro: The up side is that birth centers usually are specially designed for the purpose and have comfortable rooms with great big deep water tubs. The care is excellent and a lot of women find that their relative are “OK” with the idea of a birth center birth but would freak out if they were planning home-based care. In many instances, the midwives who own or run the birth center provide care in both places and so the care is very similar.
Con: The down side is that it isn’t your home, you can’t control your space and your activities like you would be able to at home. You may also find your self being transferred into the hospital simply because your time ran out.
7) Are there any common or occasional “criticisms” of this method/ technique/ practice that you have heard other types of practitioners make that you would like to respond to directly here? If so, please list the criticism first – then your response.
8) Are there any other pieces of information, concerns, thoughts to consider, and/or criticisms that you have about any other specific birth method (or type of practitioner) that you feel women must know about and/or research further to be fully informed?
The Baby Catcher by nurse midwife Peggy Vincent, CNM;
Expecting Trouble by obstetrician Dr. Thomas Strong, MD;
The Thinking Woman’s Guide to a Better Birth by birth educator and medical researcher Henci Goer, ASPO;
Birthing from Within by nurse midwife Carolyn England, CNM;
Misconceptions by Naomi Wolfe; Perfect Madness – Motherhood in the Age of Anxiety by Judith Warner;
The Oxytocin Factor by Swedish mother and researcher Dr. Kerstin Uvnas Moberg
Helpful web sites ~ www.ScienceBasedBirth.com, and www.collegeofmidwives.org // subdirectory “Safety Issues”
What pregnant women want to know:
Hot Topics and Downloads:
- How do I choose my caregiver?
- How do I choose my birth setting?
- How will I cope with labor pain?
- How do I get the labor support I need?
- What should I know about cesarean section?
- How can I prevent pelvic floor problems when giving birth?
- Should I choose VBAC or repeat c-section?
Routine Episiotomy Harms Mothers
- Cesarean booklet — a new booklet to help prepare every pregnant woman to make informed decisions about this important matter.
- Continuous labor support — a systematic review finding important benefits and no known downsides is available here.
- Listening to Mothers — for the first time ever, hear what women nationwide are saying about their childbearing experiences.
- Maternity Topics — not sure whether to choose an ob-gyn, family physician, or midwife? Hospital, birth center, or home birth? Confused about VBAC vs. repeat c-section? See Maternity Topics for help with these and other maternity decisions.
- Trauma and Loss after 9/11 — a report on lessons learned from experiences of pregnant women, new mothers and maternity caregivers is available here.
Cesarean Section Booklet
- Episiotomy poses harms: Maternity Center Association responds to JAMA 5/2005 study on how episiotomy poses harms and offers no benefits to mothers
- Episiotomy Advice: Advice to mothers on how to avoid routine episiotomies
Maternity Center Association's cesarean section booklet measures the risks of cesarean birth vs vaginal birth. The accompanying chart "Cesarean Birth and Vaginal Birth: How do the risks compare?" complimentary with purchase. Click here to access the booklet.
Concerns About Early Epidurals:
Maternity Center Association responds to NEJM study on the effect of labor pain medication timing on c-section:
Order from the Maternity Center Association Bookstore:
- NEJM 2/2005 Epidural Study: Get help understanding New England Journal of Medicine study (February 2005) on pain medications and cesarean section
- Labor Pain Relief Advice: Read Maternity Center Association's pain relief advice for pregnant women.
- Cesarean booklet — an absolute essential read for every woman looking for the best research about childbirth options and seeking to avoid unnecessary risk during labor.
- A Guide to Effective Care in Pregnancy and Childbirth — want good information about common discomforts of pregnancy, understanding electronic fetal monitoring, or getting breastfeeding off to a good start? The full text of this acclaimed book is available here, in short easy-to-use chapters.
- Birth Atlas Easel Book - Life-size, high-quality, classic photographic reproductions of three dimensional views of a baby's growth from fertilization through labor and birth.
- Growing Uterus Charts - This full color set of poster-sized charts beautifully illustrates the stages of pregnancy.
- Journey to Parenthood: Your Guide Through Pregnancy, Birth & Beyond - Provides families with the information they need to make informed choices about pregnancy and childbirth.
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