Choosing a Pregnancy Practitioner
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.