Midwife FAQ #3: “If you are in the tub, what do you wear?”

Honestly, this is not an FAQ.  But it was funny, and I doubt my dear friend would mind me using her question on my blog.  She’s the only person who has asked me this, but I’m sure that if she thought of it, other people must have wondered it too.  Also, I am in the mood for a short post today after my long-winded ramblings from the last couple posts.

I did not wear anything when I got in the birth tub.  Other mothers sometimes wear a bathing suit top or a sports bra.  Some may even wear shorts until it’s time to push and then take them off.   My friend who asked me this was kind of horrified at the thought of being naked in front of “all those people,” saying that she at least had a gown to cover up when she had her baby.  Now, I admit, I was also naked when I gave birth to my first child in the hospital.  I just kept getting really hot and I decided I didn’t care.  By the time my daughter was born, there were at least 7 adults in my hospital room besides me: my husband, my doula, my OB, a nurse for me, a nurse for the baby, a nursing student, and a pediatrician (the only man besides my husband, and he just ducked in at the last possible second and was gone before I knew it).  There may have been more–I didn’t have my glasses on, so I couldn’t really see, and I wasn’t paying attention to anything else besides trying to push the baby out.

At the birth center, there were 3 people present for the birth: my husband, my midwife, and my midwife’s apprentice.  So even when I was laboring and floating around in the tub, I was perfectly comfortable being in the tub in my birthday suit.  The room was warm and lit pretty dimly too, so it was a fairly relaxing environment — something I believe is very important for allowing labor to progress easily!

Midwife FAQ #2: “So they can do a c-section at the birth center if they need to, right?”

No, “they” can’t.  “They” is my midwife.  She is a licensed midwife, authorized to give prenatal care and deliver babies.  She is NOT a trained surgeon.  Obstetricians are trained surgeons.  Chances are, I will not need a surgeon to deliver this baby, so I choose not to hire one.  Approximately 5% of my midwife’s clients end up transferring to the hospital for a c-section.  Another 5% transfer to the hospital but do not need c-sections (many of those are not medically necessary, but because the mom ends up wanting pain medication, which my midwife cannot administer).

So, how can my midwife have only about 5% of her clients need a c-section when the national cesarean rate is at an all time high of 32.9%?  I think it should be obvious that it is not necessary for 1 out of 3 women to have a cesarean to deliver their babies.  The World Health Organization (WHO) recommends that a nation’s c-section rate should remain between 10-15%.  This recommendation has been in place since 1985 and it is still valid! We are headed in the wrong direction from meeting that goal, that is for sure.

Back to my question about why my midwife (and many others like her) are able to safely achieve such a low cesarean rate.  Part of it is certainly that licensed midwives are not able to take on high-risk patients.  There are some conditions that absolutely require a c-section.  Therefore, midwives do have an immediate edge in having a lower rate of clients who end up with a c-section.  That only explains part of the picture, though.  The most important piece of the puzzle, I believe, is that the midwifery model of care is to allow birth to happen naturally and with as LITTLE INTERFERENCE AS POSSIBLE unless something happens that indicates an intervention is necessary.  This is contrary to the medical model of care, which often uses routine interventions such as amniotomy (breaking the water artificially), IV fluids, restricting the mother to bed so she can stay on a monitor, withholding food and drink from the laboring mother, routine use of epidurals, inductions for no medically indicated reason, requiring the mother to deliver while flat on her back, etc.  I truly believe that within the medical model of care, doctors and nurses greatest asset (being able to help in an emergency) is also their greatest weakness — they want to help, so they do all these things because they feel they have to do something.  Now these interventions are routine and part of hospital policies, but I believe that the desire to “do something” is how they came to be standard practice.

Nothing drove this point home for me more than witnessing a veterinarian help a horse have her foal.  I was in college, and my riding instructor’s horse was in labor.  She was away at a horse show, so she asked the local vet to come for the birth in case anything went wrong.  (Had she been there, she would have only called the vet if something wasn’t right.)  Two other students and I were watching the mare walk around with the feet hanging out for awhile.  She seemed to be doing fine.  The vet arrived and watched for a little bit with us.  Then he said, “Well, as long as I’m here, I might as well do something.”  He proceeded to help pull the foal out, even though it was properly positioned and there was absolutely nothing wrong.  I really think that it is that “Well, I am here, I am getting paid,  I really should probably DO SOMETHING and use my training,” mindset that gets so many doctors turning up the pitocin, telling mothers to hold their breath and push until they turn purple, cutting episiotomies, etc.  (Nevermind arbitrary time limits on labor, wanting to get home for dinner, needing to clear beds in the labor unit . . . you get the idea.)

Now I know there are doctors out there that don’t always fall prey to that way of thinking.  I had one when I delivered my first baby.  But they are hard to find.  And there are midwives who are quick to break the bag of waters or send their clients off to the hospital.  But I think something that helps them in general is that they CAN’T perform many interventions.  Their training focuses on patience and helping the mother labor along at her body’s pace.  That patience, as well as allowing a mother to seek comfort in whatever position she desires and eat and drink to provide her body with much needed energy, give laboring women the TIME and ability that they need to give birth.  I don’t know how many birth stories I ready where the mother said, “I was so tired I could barely walk so  I agreed to the epidural at that point so I could rest” after laboring for 12 hours with nothing to eat.  (I think eating during labor should be another post.)

I didn’t think this would end up being such a long post.  Sorry!  I hope it made sense!

Midwife FAQ #1: “So are you having a homebirth?”

No, I’m not.  I live a little too far for my midwife to do a home birth for me, but I like her birth center just fine!  It was basically like having a homebirth, only it was at someone else’s home.  (She doesn’t actually live there though.)   In fact, I REALLY liked her birth center.  And I loved having a waterbirth (details on that will be in another FAQ post).  Honestly, I feel a lot more comfortable with the idea of me telling my husband that it’s time to take me to the birth center instead of trying to explain to him how to set up the birth tub while we wait for the midwife to arrive.  Nevermind that the birthing suites at the center are 10xs nicer than any room in my house.  🙂

Also, we live on a mountain.  There are only a couple roads to get down, and sometimes they get closed due to accidents, extreme weather, or the results of extreme weather.  I’d rather just plan to go to the birth center once I’m sure I’m in active labor.  Then if an emergency arises, there is a hospital nearby.  My midwife even does orientation for the local EMTs so they are familiar with the birth center should an emergency arise.  If I were at home and needed to get to the hospital quickly, it would take 25 minutes in the best of circumstances.  So I feel safer at the birth center.

While this last tidbit is not a deciding factor, I have to say that if I were in labor at my house, I would feel… watched.  We have FABULOUS neighbors.  I am sure that the Blue Dragon and Lion Cub will stay at one of the neighbors when I go to have this baby.  I am also sure that because my neighbors are so fabulous, they would absolutely NOT be knocking on the door wanting to know how things are going.  But I know that they would be wondering, and when I am in labor I like to retreat into a secret cave.  I wouldn’t want to hear the neighbors getting into their cars or coming home and wonder if they knew I was in labor and if they were staring at my house.  Crazy paranoid, right?   The birth center is so nice for privacy, especially compared to a hospital!  I had the whole place to myself and did not feel self-conscious about making noises or anything like that.

That’s about it for question #1!

How this Wrangler Mama does Pregnancy

Yes, friends, it’s that time again — time for me to have another baby!  I am 14 weeks today.

No, I have not been to “the doctor” yet.  Hopefully, I will not need to see a doctor for this pregnancy.  I will be seeing my midwife who delivered my second baby.

Yeah, that’s the one — my little Lion Cub a few days old.

When I tell people I go to a midwife for prenatal care and to have my baby, they often have a lot of questions.  I am going to use my blog to answer some of those questions.  Now, there are plenty of other blogs and websites out there that address in detail the reasons why standard maternity care in the US is not so fabulous right now.  One of my favorites is the Birth Sense blog.  I don’t need to create another website like that.  What I intend to do is share my pregnancy and birth journey with you so you can see how things can be different (yet still safe!) than the experience most pregnant women have in the US.

One of the biggest reasons I prefer the midwifery model of care is that it is not based on fear.  While I had a good OB with my first baby, when it came down to it, there were tests, more tests, and many others I declined.  With this type of care, there was this cloud of “just in case” hanging over  me.  I don’t like that.  Yes, birth can be dangerous.  Yes, babies can be born with all sorts of problems.  I will talk more about that later.  The babies I have now want to go to bed.  So to bed it is, and hopefully tomorrow I will start on my “you go to a midwife?” FAQs.  Feel free to ask some of your own questions too!

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