Your Birth People

Pregnant? Now what?

Whether you know it or not, your birth can be dramatically different depending on the caregiver you choose and place you decide to birth. Will you pick an OB or Certified Nurse Midwife and have you baby at the hospital? Or perhaps you would like to have your baby at home with a direct-entry midwife and a doula by your side.

I hope this post will help you understand the differences and debunk any myths you have about "unsafe" birth choices.

OBSTETRICIANS
OB's or OB/GYN's have completed medical school and four years of obstetric and gynecology residency. They have received specific instruction in gynecological surgery, women's health care, prenatal care, treatment for complicated pregnancies, vaginal delivery, and cesarean sections. The focus of an OB is to ensure you and your baby have come out healthy after the birth. They are not necessarily helping you to have a "birth experience". Many women choose an OB because of their high level of education and their ability to handle complications* should they arise.

*Please note that serious complications can occur due to procedures such as a medical induction, medications given during birth, and cesarean section, just to name a few.

FAMILY DOCTORS
Family doctors have also completed medical school where they learn to provide care for children, adults, and how to deliver babies. FD usually work with uncomplicated pregnancies and will consult and OB should a complication arise. Unless you live in a rural area or smaller town, you would most likely have access to an OB, but if not, a Family Doctor may be your only choice within a reasonable traveling distance.

CERTIFIED NURSE-MIDWIVES
CNM's are advanced-practice nurses who have two to three years of education in a nursing program. They have training in prenatal care, women's reproductive health, and childbirth. They care for women with uncomplicated pregnancies and will collaborate with an OB should a problem arise. Many CNM's are interested in helping women have a "birth experience" they desire. They work in hospitals or birthing centers.

CERTIFIED MIDWIVES
CM's have must pass the same national certifying exams as CNM's, but they are not nurses. They may have other medical training or a degree in a health-related field. They are for uncomplicated pregnancies and attend mostly hospital births. Only a few states recognize CM's. For more information about CM's in your state, contact your state health department.

DIRECT-ENTRY MIDWIVES
DEM's have midwifery training, but are not nurses. Their education varies and many of these midwives train with other established midwives who attend home births or work from a free standing birth center. They are familiar with the unique process of out-of-hospital births and are skilled to care for you and your baby during birth.

There are three kinds of Direct Entry Midwives:

• Licensed Midwife: attended a direct entry midwifery school and passed a state exam. Many licensed midwives will take payment from your health insurance provider. They care for uncomplicated pregnancies and attend out-of-hospital births. Many of them have a recognized relationship with a physician should a complication develop prenatally or during labor.
  
• Lay Midwife: trained by apprenticing with an experienced midwife. She attends home births and may or may not have a back up physician. She is not regulated or certified by the state, so you must do your own research into her skills and background.
• Certified Professional Midwife: is a licensed midwife and recognized nationally for her certification. She undergoes a lengthy process of establishing her experience and demonstrating her skills. She must keep her certification current by completing continuing education every three years.
  

REGISTERED NURSES
When you choose to birth at the hospital, you will be assigned a nurse for your labor. She may have one to three patients that she is monitoring at once depending on the staffing and number of patients that day. Nurses vary in their interests and experience. Some may be very supportive of natural birth and others may be more comfortable with medicating and high-tech monitoring.

DOULAS
A doula, or professional labor assistant, is trained to emotionally and physically support a laboring woman and her partner. Doulas know a variety of comfort measures such as massage, positioning for comfort, visualizations, and relaxation techniques. A doula can help you to have the "birth experience" you desire. She can also help you in understanding what may come during birth and give you the information you need to make informed choices about your birth.

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Of course, there are many other types of people that I recommend to have the ultimate pregnancy and birth you want such as: yoga instructors, childbirth educators, nutritionists, fitness instructors, chiropractors, lactation consultant, and acupuncturists.

Hoping you have a wonderful pregnancy, birth, and beyond!

Homebirth: Not Just for the Crunchy, Country Folks

Recently, I have had many women comment about their "normal" friends birthing at home. Many people are under the misconception that only "weird" people have babies at home. I can tell you that growing up I may have been guilty to think that only certain types of people had babies at home. I now know differently.

I grew up in a rural community in Kansas. If you were to ask me as a teen what I thought about homebirth?" I would probably have told you that I am sure that the local Mennonite community was maybe the only group that would birth at home. My mother had five natural, unmedicated, hospital births, but I don't think I even knew there were any other options.

When my sister and her husband got pregnant with their first child in 2005, they decided to have a home birth. They live in Northwest Arkansas where they have access to midwives that would come to their home for prenatal visits and then for the birth. They don't have birthing
centers in their immediate area.

I recently sat down with my sister to ask her specific questions about her homebirth experience and the choices they made surrounding their pregnancy and birth. "I don't like drugs or pressure," she told me when asked why they decided to have their children at home. After interviewing local midwives, they made their choice based on the openness of the midwives, their loving spirit, and their passion for birth. (*Pictured is my sister with her daughter who was born at home in August 2008.)

She went on to say she had a positive, interested reaction from friends and family. No one ever made them feel bad or guilty for having a home birth. They got asked many questions that they could easily answer because of their comfort level with birthing at home. Her only concern with homebirth was "the worst case scenario" option which, in their mind, they were believing that they weren't going to have. And, they never did with either birth.

They loved both of their experiences with having babies at home. The intimate, safe, calm, peaceful atmosphere is what they desired for the baby and themselves and it was perfect for them. She believes the safest place to have a baby is where a mother and her support feel most comfortable. She read that during her first pregnancy and tells that to anyone asking advice.

"It is awesome," is her response to having a homebirth, "the love and care you get at home and the approach to labor and newborn care is refreshing and reassuring." She would tell anyone on the fence to keep doing research. If one of the parents is not in agreement with the other, continue to get educated. Read books, watch documentaries on birth, talk to friends who have had a homebirth experience, and talk to midwives, natural childbirth educators, and doulas. Make a final decision based on education, not fear.

Homebirth is safe. Midwives come fully prepared for anything that could happen during and after birth. I wouldn't say that homebirth is for every couple, but certainly I believe that it is a glorious option for every low-risk, healthy mother and baby.

A Home Birth Story

Yesterday morning at about 2:00am I got the call. It was the call I had been waiting for for about two weeks. She said "Hannah, my water just broke and I am having really strong contractions." I said, "ok, I will be right over. She was having a home birth and lives about 25 minutes away. Surprisingly, I was not nervous or anxious despite the fact that this was only my second "natural birth" and the other one I had attended was not truly "natural" (that story is for another time). I had been praying a lot that I would have the instincts to know what to do for her when the time came. I had also been praying very specifically that I would be able to attend all of her birth and that the baby would not come at a time that I could not get to her immediately due to other obligations.

I arrived at their home at about 2:4oam. She was still in first stage labor and dealing very well with her contractions. We tried several different positions for her to be comfortable. I did some massaging on her back to ease her contractions as well. Ultimately she found the bathtub filled with warm water to be most comforting. She had prepared for this birth which The Bradley Method (taught by my friend Donna) and with hypnobirthing techniques. While in the tub, she became very peaceful and allowed her body to work for her not against her. So much so, that none of the midwives, nor I, could really tell when she was having contractions. Although extremely tired, she was very relaxed and trusted her body at that point. As she got close to second stage (pushing) she wanted to be out of the bathtub. As it was being drained for her to safely get out, she began to have the strong urge to push. It seemed as though she wasn't going to be getting out of the tub and that the birth was going to take place right there. With her husband and I at her head coaching her along, she had one midwife at her bottom and one midwife at her side. With several pushes a baby girl was born at 5:22am. Mother and baby bonded right away. After immediately nursing, mother and baby enjoyed an herbal bath together. Dad did an awesome job in his support roll for her. It isn't always easy to fully understand the needs of a laboring woman and, in my opinion, we worked together well to achieve the mothers needs. I stayed for about two hours postpartum to ensure mother, family and baby were doing well. The midwives were going to stay for a few hours as well. I will be visiting her at least one postpartum depending on her needs.

I feel very honored to have been a part of the birth. It is such an intimate experience for the family and to be asked to attend is such a wonderful feeling. I enjoy working along side women who desire to have an amazing and memorable birth experience. I know that having support and comfort during that time means a lot to moms..... and dads too!

And, I highly recommend the midwives at The Cleburne Birthing Center in Cleburne, TX. They were amazing!