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Choosing a Pregnancy Practitioner

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Midwives: The 'Girlfriend' Approach continued...

Once she began her prenatal visits, she liked the control and responsibility the midwives left to her. "I really liked the sense of women doing for themselves, of taking into our own hands this wonderful miracle that is natural to our bodies. It was the little things, like going to get your own chart and weighing yourself ... and the care was personal, like a good girlfriend sharing information with you," Sanders says.

"I felt much more relaxed asking questions because it wasn't as formal or clinical a setting as a normal doctor's office." After her daughter was born, Sanders and her husband dozed together with their daughter and woke up a few hours later to a pancake breakfast prepared by her best friend, brother, and sister-in-law. "It was a really wonderful way to have our first day with our baby."

Certified nurse-midwives are registered nurses who typically receive 18 months to two years of midwifery training and are then given credentials by the American College of Nurse-Midwives. They are licensed in the state where they practice and may provide care either in a hospital or birth center. Some nurse-midwives practice in partnerships with doctors, but they all have consulting relationships with an obstetrician in case a patient needs more specialized treatment. Lay midwives, on the other hand, may have the same training, coursework, and clinical experience as certified nurse-midwives, but they usually aren't nurses and deliver in the home or a birth center. Their experience, licensure, and legal standing varies significantly, both individually and from state to state.

Nurse-midwives generally rely on less invasive methods of pain relief and labor management than obstetricians. They use about 12% fewer interventions, such as episiotomies, epidurals, and electronic fetal monitoring, and their rate for cesarean sections was 8.8%, compared with 13.6% for obstetricians, according to a recent study. Midwives also encourage couples to make birthing plans, provide more hands-on care during labor, such as massage, and teach women "that birth can be gentle, quiet, and respectful," says Jan Kriebs, a certified nurse-midwife who practices with physicians at University of Maryland Medical System in Baltimore. "It's the woman's job to give birth and ours to support her."

Births by certified nurse-midwives also are considered safe for most women. A nurse-midwife's limitations vary depending on experience, place of practice, and arrangement with the consulting physician, but they generally won't accept women with significant health problems such as heart disease or insulin-dependent diabetes, and they don't normally handle multiple births beyond twins. They also cannot administer anesthesia or perform surgeries, but they do monitor patients carefully throughout pregnancy and childbirth, and will consult with or refer patients to a physician if they need an epidural, C-section, or other special medical care. A recent study of birth-certificate data showed that infant mortality and low birth weights were about one-third less common with nurse-midwives after adjusting for risk.

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