Want a Natural Birth? Choosing a Midwife or Obstetrician

Why is it so important? Why not just go with the flow and do what everyone else does, namely, use an obstetrician? Are midwives really safe? What about homebirth?

In the interest of honesty, there are a few obstetricians who treat birth as a midwife would. The operative word there is "a few". And if you find one of them, you've got a rare treasure! But on the whole, unfortunately, obstetricians are trained to treat every birth as an impending medical disaster, and to "manage" it closely. Viewing birth as a "problem" to be "solved" often leads to interventions which themselves lead to problems, including all the way down the cascade to a c-section. Induction medications (like Pitocin) can make labor much more difficult for a mother and baby to handle than normal labor, and that in turn can cause concern for the baby's well-being, which can eventually lead to an emergency c-section. What people don't seem to realize is that often, labor and delivery problems are iatrogenic-caused by the medical care (or rather, intervention) itself-and could have been avoided in most cases. Instead, they praise the doctors for "saving the baby's life", when in reality, the baby's life was never in danger, or wouldn't have been if not for medical meddling. That is not to say that there is never a call for surgical birth. But many c-sections are completely unnecessary, and it's a shame that women will suffer the side effects of major surgery when they didn't actually have to.

If you are a healthy woman, a midwife may very well be your best and safest route to a happy, empowering, non-traumatic birth. Yes, even if you're petite. Yes, even if you have big babies. Yes, even if your baby is breech. Yes, even if you've had horrible labors before. And, yes, even if you've had previous c-sections.

There are, within the realm of midwifery practice, many options for a woman to choose. If you'd feel safer at a hospital, many CRNM (Certified Registered Nurse Midwife) practices will gladly attend you there. Most also work in conjunction with obstetricians ("back up doctors") in case of a real emergency. If there happens to be some cause for concern during your pregnancy, your midwife would almost certainly have you seen by a specialist and determine between the three of you what type of birth would be the best for your situation. Many large cities now have free-standing birth centers, which would be a good option for those who don't like hospitals but aren't confident birthing at home. Most birth centers are just minutes from a hospital, and are equipped to handle normal birth. Most are also designed for your comfort, rather than your caregivers' convenience, and are more home-like than even hospital birth centers. You could also opt for a midwife-attended home-birth, which an increasing number of women now do. The midwife would provide care and birth support (bringing along all necessary supplies) in the comfort of your own home. Many women and midwives feel that homebirth is the safest option, as it avoids unnecessary interference by medical personnel, and if a problem arises, the one-on-one focus of midwife to client may very well result in a much quicker diagnosis of the problem. Additionally, with a midwife you will not be told to "wait for the doctor!" when you feel the urge to push, and never (heaven forbid!) have your legs held together if the doctor is slow to arrive. With a midwife, you will have someone trained to view birth as a natural event, and sympathetic to your desire to avoid drugs and surgical procedures.

My own experience clearly shows the difference between traditional medically managed birth, and birth attended by a midwife. With my first son, I went with an OB/GYN practice. All the doctors were professional and gentle, but several of them seemed uptight and made me uncomfortable. They weren't terribly respectful of my beliefs and desires, and when I objected to some procedure, they made every effort to guilt me into accepting it. When I delivered at the hospital, I actually did have an "easy" birth by most standards-6 hours of labor with 40 minutes of pushing. However, it left me feeling anything but satisfied. I had a drug that did nothing for pain but made me feel loopy and confused. I hated all the medical personnel standing around me yelling at me when to push. I knew when my body needed to push, for goodness sake! I hated the wires and tubes and shiny metal, and the doctor who rolled his eyes at me when I crowed triumphantly once the baby was out. If I looked sleepy, they wouldn't let me hold the baby ("You might crush him!"). The lactation consultant wasn't much help, but she did say "Well, you've certainly got all the equipment!" in an admiring voice. I was never more ready to leave any place than I was to leave that hospital.

When I was pregnant with my second son, we had moved to Pittsburgh and found that there was a wonderful midwife practice there. I was happy to find that our insurance covered them, and made the first appointment. Even walking in the front door was different from my previous experience. I left the world of cold, sterile floors, walls and equipment, and walked into a cozy office complex with exposed brick, carpeted floors, and then found that even the exam rooms were different-couches to sit in, privacy screens for changing into the homemade and comfortably modest exam gowns, pictures and figurines over old fireplaces, and even little covers for stirrup feet (which were used very rarely). The midwives were warm and friendly, concerned about what I wanted for the birth, interested in my life and my past, and utterly respectful of my religious beliefs. For most exams, I was permitted to wear my regular clothing, and if there was anything I objected to, they did not insist on it. Because of my objection to induction, they had no problem letting me get to over 42 weeks without it, although they warned me that past 42 weeks, they couldn't let me deliver at their birth center. So, even though I had to deliver at a hospital again, I was attended only by a midwife, and found the experience so much better than the first one. They gave me a birthing ball to sit on during contractions, and that was just bliss! When I was ready to push, nobody told me not to, or counted for me. They got me situated on the bed, on hands and knees, and let me go ahead and do my thing. That baby was out in 15 minutes! And he was just short of 10 pounds! Now, I know had I been under the care of regular doctors, I would have been induced willy-nilly after 41 weeks. And if not, I certainly wouldn't have been given a birthing ball, or allowed to push on my hands and knees, and given his size, I probably would have ended up with a c-section.

So, while it's completely true that at times the services of an Obstetrical Surgeon is necessary and very helpful, all women should know that there are other-and possibly much better-options for the healthy delivery of their babies. So much is made of education in this country-let's educate ourselves about pregnancy and birth, too, and not just assume that our cultural norms are best.