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!

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2 Comments (+add yours?)

  1. Alisa
    Jan 16, 2011 @ 20:12:42

    Very well stated! You go, girl!

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  2. Grandma
    Jan 23, 2011 @ 16:44:09

    One important comment from my personal experience. Usually when giving birth flat on one’s back is referenced, it’s in a negative way. Please be aware, girls, for some bodies, this is the way. Wranglermama was born this way. It just didn’t work otherwise, and nothing felt better than lying back (at the insistence of an experienced labor nurse, despite my protests) putting my tired legs in those awesome holders (Ahhh!) and finally have her make her way out. She emerged sunny-side-up, I assumed that was why I needed to lie down flat. Until her brother was born 4 years later, and I knew right away, I had to do it that way again. Maybe my bones align weirdly, who knows, but it got the job done!

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